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Sr. Business Analyst Resume

Dublin, OH

SUMMARY

  • Qualified professional with 7+ years of extensive experience as Business Analyst in Healthcare include understanding of Business Requirement Gathering, Business Analysis, Joint Application Development JAD sessions with clients and referring to accessible documentation and procedure.
  • Experience and understanding of Healthcare and Health Insurance business models and operations including Enrollment, Membership Management, Claims Processing, and Client Management.
  • Involvement in all phases of Software development life cycle including System Analysis, Design, Modeling, Implementation and Support.
  • Experienced in working with executives, subject matter experts and client in all the revenue cycle management departments and front office departments to ensure a positive patient experience.
  • Familiar with HIPAA EDI transactions such as 835, 837 (P, D, I) 276, 277, 278 etc.
  • Experience in writing complex SQL queries involving multiple table’s inner and outer joins, stored procedures.
  • Experienced in working on FACETS batches like XPF and MMS to upload bulkdatainto the FACETS system.
  • Extensively used rational tools for UML, tracking and reporting and applied the Rational Unified Process in all areas of a software development life cycle.
  • Broad and in - depth knowledge and practical experience with System Development Life Cycle (SDLC) & Computer System Validation (CSV).
  • HIPAA Transactions mapping experience and in-depth knowledge of HIPAA framework. Strong experience transacting with Healthcare EDI standards - ANSI X12v 5010/, 835/837, 270/271, 276/277 BPML and HR-XML formats.
  • In-depth knowledge of conducting User Acceptance Test (UAT), data quality checks using SQL, gap analysis and Requirement Traceability.
  • Determination of error corrections in those cases where the business units are not able to provide the information (example, the Claims department does not provide corrections for denied claims so the EPRA analysts will have to do it). Medical, Medicaid, and Medicare.
  • Extensive experience in healthcare insurance payer systems, Security, Compliance, Healthcare Reform implementation, reporting, integration, equivalent consulting experience.
  • Experience in SQL query skills (Oracle and TSQL) in analyzing and validating SSIS ETL database data warehouse processes.
  • Provided cost benefit analysis on recouping financial transactions towards month end close, and recommended cost saving changes to the products to achieve positive ROI on projects.
  • Experience in modeling UI wireframes, mockups and documenting the end-user AS-IS workflow and TO-BE business processes.
  • In-depth knowledge of creating use cases, functional design specifications, activity diagrams, logical, component and deployment views to extract business process flow.
  • Experience in Agile environment, participating in daily stand-ups and planning meetings. Worked directly with client SMEs in gathering and defining business requirements. Presented recommendations to client and wrote functional requirements document.
  • Experience in Creating test documents like QA Status Report, QA Summary Reports, QA Test Logs, Test sign-off, Maintain issue and defect databases.
  • Performed UAT and exposure to User Certification Testing (UCT) and Operational Readiness Testing (ORT).

PROFESSIONAL EXPERIENCE

Confidential - Dublin, OH

Sr. Business Analyst

Responsibilities:

  • Worked on HIPAA EDI transactions such as 835(medical claim payments), 837(medical claims), 276(claim status), 277(claim status response), 278(Healthcareservice review information), 270(eligibility inquiry), 271 (eligibility response).
  • Performed Data mapping, logical data modeling, created class diagrams and ERP diagrams and used SQL queries to filter data.
  • Active member for the policy review to implement the blueprint requirements for Medicaid/MMIS,Medicare, CHIP and Tax Credits benefits per CMS guidelines.
  • Analyzed and Design Health plan Enrollment and Maintenance ANSI X12 834 and Premium Payment ANSI X12 820 file specifications under HIPAA framework for ACA Affordable Care Act.
  • Worked on Software Development Life Cycle (SDLC) including requirements gathering, analysis, design, implementation, testing and deployment.
  • Interfaced with business users to prepare and update Business Process Requirements for the new release ofHealthcaretools and prioritized outstanding defects and systems problems, ensuring accuracy and deadlines were met.
  • Worked with SQL queries using MS Access for data manipulations and involved in writing scripts for patient online registrations using the VB Script.
  • Wrote PL/SQL statement and stored procedures in Oracle for extracting as well as writing data.
  • Elicited business and functional requirements using in interviews, document analysis, business process descriptions, use cases, business analysis and workflow analysis with the use of Waterfall and Agile methodologies
  • Provide a full range of healthcare services to business clients, enrolling and assisting with applications and regulations for the Affordable Care Act.
  • Worked on conducting a CSV audit and prepared a position paper for ensuring compliance for all SOX and GxP servers and applications being migrated to one of three central locations as part of a data center consolidation, and presented findings to all levels of management.
  • Responsible for validating inbound and outbound data files (XML, CSV, IDOCs) to and from the contracting system to regional (MDM, SAP).
  • Worked along with Project manager and recommended changes for system design, methods, procedures, policies and workflows affecting Medicare/Medicaid claims processing in compliance with government compliant processes like HIPAA / EDI formats and accredited standards like ANSI.
  • Collaborate withRevenueRecycle team handling metrics and KPI authorization reporting.
  • Worked on solving the errors of EDI 834 load to Facets through MMS. Created keyword files to have memberdatabulk loaded into the FACETS system through the MMS batch
  • Completed the Risk Analysis and Gap (CSV) Analysis for the system, and formulated a remediation plan.
  • Created and maintained user stories in JIRA for better understanding of the requirements for the development team also use JIRA for bug tracking.
  • Responsible for attaining HIPAA EDI validation from Medicare, Medicaid and other payers of government carriers.
  • Followed up on rejected/denied Medicare and Medicaid claims via Epremis, FISS, Epic and HP Web-Portal
  • Reviewed the data model and reporting requirements with the Data warehouse/ETL and Reporting team.
  • Performed web service Testing Send X12 834/820 Messages, Send/Receive 999 / TA1.
  • Actively participated in gathering requirements from various SMEs, Financial Analysts, Risk Analysts and Portfolio Management via JAD/JAR sessions.
  • Prepared Business Process Models that includes modeling of all the activities of the business from the conceptual to procedural level.
  • Worked on the BRD document and derived the FRS in to system use case diagrams.
  • Kept track of Agile (scrum/ Kanban),Safemetricstracking variables to gain transparency on product and sprint backlogs.
  • Created Test Case and Test Scenario based on X12 834/820 B2B Integration Functional Testing.
  • Assisted QA department to write and execute Test plans and Test Cases and work on UAT testing.

Confidential, Schenectady, NY

Business Analyst

Responsibilities:

  • Obtained business requirements from business users and stakeholders using interview sessions, brain storming sessions, and personal interviews to get better understanding of the enrolment requirement changes from the Health Insurance Exchange.
  • Provider inquiry about the status of Remittance Vouchers (RVs). This involved checking the MMIS provider subsystem and checked the setup of their Remit Media.
  • Facilitated discussions on the shortcoming/limitation/extendibility of the system to provide clear understanding of system capabilities to theclinicalbusiness users.
  • Reported to practice manager and CEO to evaluate value-based strategy and provider-side revenue cycle management.
  • Met with client groups to determine requirements and goals. Utilized Rational Unified Process (RUP) to configure and develop process, standards, and procedures and create a Business requirement Document.
  • Joint Application Development (JAD) sessions with stakeholders throughout SDLC to resolve open issues.
  • Worked closely with office of healthcare reform on current issue from CMS on 834 files. Raised tickets with CMS and triage the issues on basis of severity.
  • Worked on conducting a CSV audit to determine what documentation was required, and prepared a remediation plan for developing same.
  • Actively participated inClinicalCareManagementweb application system enhancement by conducting thorough analysis on the app usability.
  • Enforce compliance withHealthInsurancePortability and Accountability Act (HIPAA) throughout all levels of the program.
  • Worked with HIPAA Transactions/mapping and Code Sets including ASC X12 837, 270/271, 276/277, and 835.
  • Worked on Data cleansing and loading application using ETL, Tableau and SQL Server.
  • Extensively worked on development of Reporting Data Warehousing System.
  • Troubleshoot any problems found within FACETS and when testing the SQLdatadatabase while validating the business rule.
  • Worked on creating Data Stage jobs to extract, transform and load data into data warehouses from various sources like relational databases, application systems, temporary tables, flat files etc.
  • Improved the newrevenuecyclemanagementand Electronic Medical Record (EMR) for PARTNERS.
  • Worked on Creating Jira User Guide and performed training sessions to introduce Jira to the team.
  • Medicaid Claims experience in Process Documentation, Analysis and Implementations in 835/837, 270, 276/277processes or Medicaid Claims from the Provider/Payerside.
  • Working with clients to better understand their needs and present solutions using structured SDLC approach.
  • Involved in creating databases for various departments forad-hocreporting.
  • Assisted in writing BRD for the Regulatory Reporting Unit under the system streamlining, followed the Agile Methodology for the entire SDLC.
  • Involved in mapping data from different EDI files onto database using different routing transformations.
  • Translated stakeholder requirements into different tangible deliverables such as functional specifications, user cases, user stories, workflow/process diagrams, data flow/data model diagrams.
  • Extensively involved in designing the SSIS packages to export data from various sources like Oracle, SQL Server, and MS Access etc. to SQL Server database.
  • Maintained key records for purposes of Compliance review, QA/QC, and/or regulatory inquiry. Performed Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data.
  • Participate in conducting review sessions on regular basis with QA and development teams for preparing status, delivery report and client reporting.
  • Identified and clearly defined functional issues and support IT development staff throughout the design, development, unit testing, and implementation phases of the software development life cycle (SDLC).
  • Analyzed and translated business requirements into system specifications.
  • Acted as User Acceptance Testing (UAT) coordinator, monitored business testing, and interred with the development team regarding defect status and fixes on a daily basis.

Confidential, Carmel, IN

Business Analyst

Responsibilities:

  • Worked with the EDI crosswalk team to identify incoming ANSI X12 fields where NPI information would come in and maps it to our internal Physician ID.
  • Understand the As Is system, develop the To Be system concept, and prepare the System Process Maps.
  • Working within a growing knowledge of X12 HIPAA 837 I, P, D, 835, 834, 820, 270, 271, 276, 277, 278, EDI, Privacy, Security, and Medicaid.
  • Responsible for integrating with Facets. Designed High level design for new process, integrating with legacy & Facets.
  • Worked on HIPAA EDI transactions such as 835, 837 (P, D, I) 276, 277, 278 etc.
  • Involved in presentations of the Q/A test results with analysis to the stakeholders and users and documented modifications and requirements.
  • Coordinated with Business Owners, Application Vendor, Payers and Clearinghouses to bring all processes to a level of execution to mitigate any impact to current revenue flow under the compliancy requirements.
  • Involved in defining the scope and implementing business rules of the project, gathering business requirements and documentation.
  • Consulted with healthcare insurance company to develop conversion specifications for other insurance Coordination of Benefits (including Medicare).
  • Involved inFacetsbilling module mainly in Back - End system process for membership's enrollment info to downstream system and involved in Front - End system process for the information feed toFacets-Facetsfile transfer.
  • Worked on converting CSV flat files into HL7 messages.
  • Involved in Designing and Built the Dimensions, cubes with star schema using SQL Server Analysis Services (SSAS).
  • Involved in all phases of Software Development Life Cycle (SDLC) and implemented multiple product development initiatives.
  • Created Process Flow diagrams, Use Case Diagrams, Class Diagrams and Interaction Diagrams using Microsoft Visio and Rational Rose.
  • Identify risks and inform SeniorQASpecialists andQAManagers and participated in development of Test Data Strategy.
  • Responsible for attaining HIPAA EDI validation from Medicare, Medicaid and other payers of government carriers.
  • Used JIRA for User Story requirements management throughout the Agile Sprints and development life cycle.
  • Documented elicited requirements into Business requirement document (BRD), Functional Requirement Document (FRD) and Software Requirement Specification (SRS).
  • Involved in compatibility testing with other software programs, hardware, Operating systems and network environments.
  • Created Use cases, activity report, logical components and deployment views to extract business process flows and workflows involved in the project. Carried out defect tracking using Clear Quest.

Confidential, Virginia Beach, VA

Business Analyst

Responsibilities:

  • Gathered requirements and modeled the data warehouse and the underlying transactional database.
  • Using SQL server reporting services (SSRS) delivering enterprise, Web-enabled reporting so creates reports that draw content from a variety of data sources.
  • Using SQL server reporting services (SSRS) delivering enterprise, Web-enabled reporting so creates reports that draw content from a variety of data sources.
  • Involved in creating context and workflow models, information and business rule models, Use Case and Object Models during the analysis using rational tools.
  • Extensively involved in maintaining requirements traceability and communicating any changes to these requirements to different business groups and programmers.
  • Responsible for writing detailed descriptions of user needs, program functions, and steps required for developing or modifying software programs using Rational Rose (UML).
  • Created context and workflow models, information and business rule models, Use Case and Object Models during the analysis using rational tools.
  • Followed agile methodology, being Business Analyst as Product Owner for better Collaboration among Scrum Master, Scrum Team and Business Stakeholders.
  • Wrote PL/SQL statement and stored procedures in Oracle for extracting as well as writing data.
  • Used JIRA for User Story requirements management throughout the Agile Sprints and development life cycle.
  • Involved in reviewing and writing BRD, URS and Functional Requirements for MDMBusinessand Data Quality Requirements for Health Insurance Exchange (HIX) and Health information exchange (HIE) system.
  • Conducted JAD sessions with management, SME, vendors, users and other stakeholders for open and pending issues.
  • Actively participated in review sessions on regular basis with QA and development teams for preparing status, delivery report and client reporting.
  • Collaborated with the QA team to ensure adequate testing of software both before and after completion, maintained quality procedures, and ensured that appropriate documentation is in place.
  • Involved Functional Specification Documentation (FSD) and communicated these to the stakeholders.
  • Conducted user interviews, gathered requirements and analyzed the requirements by using Rational Rose, Visio and Requisite pro - RUP.
  • Actively interacted with different business groups to perform Gap analysis to identify the deficiencies in the system by comparing the actual objectives with the system objectives desired.

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