SUMMARY

• More than 8+ years of proactive IT experience working as Business Analyst in Healthcare industry wif expertise in Healthcare Systems ITS, Health insurance plans Indemnity plans, Managed Care plans HMO, PPO POS, Government Sponsored Programs Medicare, Medigap, MMIS, FEP SHBP Consumer Driven Health plans CDHP. Medicare Part A, B, C, D and Medicaid systems
• Experienced and in - depth knowledge of all phases of System Development Life Cycle (SDLC) methodologies such as Waterfall, Agile-Scrum, and Waterfall-Scrum Hybrid.
• Skilled in creating operational workflows, data diagrams, and other industry standard documents to represent client's business processes and other needs.
• Extensive experience in Unified Modelling Language diagrams (like Use Case, Activity, Sequence, data flow) and charts (like velocity, burn down charts) respectively using Rational Rose, TFS, JIRA and MS Visio.
• Widespread knowledge of EHR/EMRs Electronic Medical Records, HL7 and its Patient Protection and Affordable Care Act PPACA.
• Familiar wif HIPAA EDI transactions such as 835, 837 (P, D, me) 276, 277, 278 etc.
• Good knowledge and extensively used RDBM, SQL, along wif MS SQL administration, SQL Enterprise Manager, Data analysis and reporting.
• Proficient in all phases of Requirement Management; including gathering, analyzing, detailing and tracking requirements using RTM or JIRA/TFS. Experienced in creating Business Requirements Document (BRD), Functional Requirements Document (FRD) or user stories wif acceptance criteria.
• Working knowledge of MMIS (Medicaid Management Information System), HIX (Health Insurance Exchange), EMR (Electronic Medical Record), EHR (Electronic Health Record) and healthcare reforms like the Patient Protection and Affordable Care Act (PPACA), Emergency Medical Treatment and Active Labour Act (EMTALA).
• Adequate knowledge in Health Administration - Claims processing (auto adjudication), COB, EOB/ Drafts, Claims pricing and testing, HIPAA, enrolment, EDI, HER, HIX, Medicare, Medicaid, CDHP (consumer driven health plans).
• Familiarity wif current technology and industry standards such as APIs, FHIR, JSON etc.
• Facilitated scrum meetings (all phases including the release planning, grooming, sprint planning, retrospectives, daily stand-ups, etc.)
• Extensive Experience in Functional, Integration, Regression, User Acceptance UAT, System.
• Experience in Database design and development using Oracle 10g, and Oracle PL/SQL. Experience in Database Performance tuning and SQL query optimization.
• Experienced wif HIX Health insurance Exchange, PPACA Patient Protection and Affordable Care Act, Plan Management, Eligibility and Enrolment process, SHOP Small Business Health Options Program as well as Financial Management.
• Working knowledge of Health Insurance Programs (Medicaid, Medicare Part A, Part B, Part C, Part D) and Managed Care Programs (HMO, PPO, POS), wif expertise in paper claim forms (CMS 1500, UB 04).
• Proficient in using UML forBusinessProcess Modeling, Use Cases, Activity Diagrams, Sequence Diagrams, Data Flow Diagrams, Collaboration Diagrams, Class Diagrams, Wireframe, Prototypes and documenting them using Microsoft Visio.
• Experience in creating Test Plans, Test Scenarios and Test cases and documenting project processes and procedures.
• Experience in EDI automated first-pass claim adjudication, requiring thorough understanding of claim processing, both front and backend operations
• Excellent ability and capability to interact wif customers. Self-motivated wif TEMPeffective communication skills and strong background in multiple tasking. Ensure that value is delivered by deriving the need of the client.

PROFESSIONAL EXPERIENCE

Sr. Business System Analyst

Confidential, Greenville, North Carolina

Responsibilities:

• Functioned as the liaison between the line of business and the technical teams throughout the project life cycle.
• Conducted Joint Requirements Planning (JRP) sessions wif the Subject Matter Experts (SME) and the key stakeholders to understand business requirements and the functionalities in detail.
• Demonstrated understanding of best practices for the architecture, processing, analyzing, modeling, and managing of healthcare data, using Infrastructure as a Service (IaaS) for cloud migration
• Assisted wif the implementation and ongoing support of the Health Insurance Exchange HIX environments.
• Extensively involved in working wif HL7 messages like ADT, ORM and ORU during while integrating iHelix wif the existing applications.
• Disigned Test Plans and Test Cases for User Acceptance testing (UAT) wif the help of QA teams.
• Conducted Requirements review through rally and system walkthrough wif the architect, developers and testing team.
• Involved in writing Medicaid and Medicare requirements as per the Centres for Medicare and Medicaid services (CMS) guidelines.
• Involved in determining membership eligibility, billing experience wifin life and disability in health plans wif through understanding of CPD coding, CMS -1500 claim forms and reimbursement forms.
• Utilized Agile Software Methodology using Scrum framework. Actively participated in creating the user stories and prioritizing user stories along wif tracking of burn up, burn down charts to estimate sprint delivery.
• Developed User Accepting Testing (UAT) plans and test cases based on the business requirements.
• Analyzed trading partner specifications and created EDI mapping guidelines.
• Facilitated project management using JIRA Task Manager Platform for all sprint related stories and epics wif bi- weekly sprint planning and backlog grooming.
• Conducted GAP analysis for identifying improvement areas from on premise data center to the Amazon Redshift.
• Worked on the screenshot and prototype development for the various online screens meant for the EHR project.
• Provided functional support for HR, Payroll, MSS applications and their interface.
• Involved in developing and executing SQL queries on claim records to validate reporting.
• Analyzed the risks involved by conducting SWOT and Cost-Benefit Analysis in Microsoft Office Environment.
• Used Agile and Rational methodology in the project development for Rational Test Suite for various phases of RUP.
• Involved in maintaining source-to-target Data Mapping and Data conversion spread sheet.
• Worked closely on 834 transaction code for Benefit Enrollment and was involved in Validation of HIPAA for 837, 270/271, 276/277, 835, 834 EDI transactions.
• Maintained Gitlab repositories, JIRA bug tracking system. Created custom JIRA workflows.
• Involved in creating Unified Modeling Language (UML) diagrams including Activity Diagrams, Entity relationship diagrams and Use Case Diagrams.
• Messaging, FHIR, middleware principals concepts, APIs, REST, SOAP, Web Services etc.
• Collaborated wif Systems Architect in constructing the Architecture Diagram depicting the data migration from On-premise servers to Amazon Redshift data warehouse.
• Implemented Transformation rules for migration, facilitated creating ETL jobs using AWS Glue
• Ensured Data Quality and Data Integrity is maintained throughout the Project Lifecycle
• Well versed wif EPIC, EMR systems, EPIC bridges, EHRs, Mirth and Production support processing problems by being one of the chief sources and providing alternative solutions using best practice models and principals.
• Knowledge of Cost Accounting software and Oracle based databases
• Being able to adapt and work efficiently in an agile environment where the cumulative Standard Operative Procedure (CSOP) and Policy directives and decision Matrix documents were in process and unstable during the initial phase of the project.
• Maintained Kanban boards in JIRA, involved in creating Static Prototypes using HTML for an overview of the Graphical User Interface.
• Worked wif Product Owner and development team to prioritize user stories in the product backlog; as well as, mitigate any issues that impeded the completion of Sprint objectives.
• Main role was to gather requirements Health Insurance Exchange HIX and add those changes to the present system.
• Helped in Developing implementation guidelines and principals for practice-based clinical applications, including various practice management and EMR systems.
• Analyze, modify, and write SQL queries utilizing multiple data sources.
• Tested the requests and responses provided by the Restful Web Services using Postman plugin for google chrome and standardized them to the format required by the application.
• Maintained Continuous communication wif the team to track requirements on rally and discuss to fix defects wif JIRA tools, and corrected lesson learnt from each sprint.
• Collaborated wif the Quality Assurance team to ensure adequate testing of software both before and after completion, maintained quality procedures, and ensured that appropriate documentation is in place.

Business System Analyst

Confidential -Phoenix, AZ

Responsibilities:

• Responsible for proactively identifying opportunities for improvement throughout the business which could include working wif department management to create a business case detailing the cost/benefit of the improvement.
• Assisted JAD sessions to identify the business flows and determine whether any current or proposed systems are impacted by the EDI X12 Transaction, Code set and Identifier aspects of HIPAA.
• Strong understanding of the business functionalities like Medicare, Medicaid, Tricare, Workers Comp, Commercial Claims, Bulk Billing, Denial Analysis and Insurance specific trends.
• Worked on Claims, Claims Intake Process, Claims Adjudication Process and Claims scrubbing in HMO, PPO, POS, Medicaid and Medicare
• Involved in creating role-based matrix, decision tables when required as per the requirements through the project.
• Worked on HCM setup for company information, location, department, salary grades, job codes, benefit programs, plan types, pay groups and other payroll related issues.
• Facilitated all Aspects of scrum framework, including product backlog, release backlog, sprint planning session, daily scrum meeting, sprint reviews and sprint retrospectives.
• Worked on developing Procedures, Functions, packages and triggers in PL/SQL
• Proficiantly worked on HIPAA (Health Insurance Portability and Accountability Act) transaction sets such as 270/271 (inquire/response health care benefits), 276/277 (claim status), 835 (payment or remittance advice).
• Prepared UAT Test plan and coordinated UAT wif stakeholders and business users.
• Captured all the user stories in Rally the agile based tool.
• Used Jira Agile management tool to maintain team metrics and make visible to team (including burn down charts) and Work as a Jira admin assign new user to project, delete user and Create Project.
• Gained extensive experience wif HL7 for various interfaces.
• All MITA business processes were reviewed and a feasibility study was conducted to integrate the EHR Provider Program business process into standard MITA business process.
• Identify and Review the HIX Work track 12 reports and compare wif the Contract Reporting section.
• Successfully interpreted data to draw conclusions for managerial action and strategy.
• Optimized data collection procedures and generated reports on a weekly, monthly, and quarterly basis.
• Experienced wif various database objects to write SQL queries on multiple databases like MS SQL Server, MS Access and Oracle databases.
• Strong understanding of various SDLC methodologies such as RUP, Waterfall and Agile wif hands on experience in all of them.
• Developed and implementing change control policies and procedures for EMR template change requests.
• Worked on Health Insurance exchanges HIX and analyzed the data and worked wif EDI NCPDP considerations and implemented HIPAA regulations.
• Wrote PL/SQL statement and stored procedures in Oracle for extracting as well as writing data.
• FHIR messaging, structure and expertise in building complex event based real time interface.
• Analyzed massive and highly complex data sets, performing ad-hoc analysis and data manipulation.
• Collaborate wif both technical and business stakeholders to understand reporting and data requirements based on customer and internal needs.
• Using Rally tool to capture all the Business and Technical User stories
• Involved in daily scrums and all scrum activities-Sprint Planning, Sprint Reviews and Sprint Retrospectives and works as agile coach throughout the project.
• Conducted Walkthroughs and Meetings involving leads from Development, QA, Database and Technical Support teams to validate the Budget planning for Amazon services.
• Responsible for identification and analysis of errors/inconsistencies in the data and provides timely resolutions.
• Proficiency wif Microsoft Office applications (Word, Excel, PowerPoint, and Visio and Project Management Software), and Atlassian (JIRA, and Confluence).
• Reviewed MMIS documents to understand the customer requirement
• Worked on payer plan sponsor and the EDI transactions like 837
• Provide ad-hoc and structured reporting document to partners and stakeholders.
• Was involved in maintaining dashboards, reports, visualizations, and alerts that concerned business decisions.
• Involved in creating documents like Root-Cause, Cost-Benefit, SWOT and ROI wif excellent track record as a JAD facilitator and knowledge of all the best practices for requirements gathering.
• Prepared data analysis, writing data mapping documents, data transformation rules and maintained data dictionary for business intelligence and data warehouse applications.
• Used industry standards like ISO, Six Sigma and HIPAA wifin the project
• Single point of contact between business users, development teams and QA teams for sign-offs and finalization of requirements.
• Developed strategies wif Quality Assurance group to implement Test scripts in HP/Mercury Test Director for stress testing and UAT (User Acceptance Testing)
• Acted as an SME on different subject areas including state reporting, death benefits, Medicare, Bill review and RX eligibility.
• Used knowledge of Health Care Information Systems EMR model to develop proposed workflow in MS Visio.
• Tested the HIPPA EDI, 834, 270/271, 276/277, 837/835 transactions according to test scenarios and verify the data wif Facets on different modules.
• Skilled in using change control and bug tracking tool JIRA for identifying, analyzing, assigning and documenting defects including version and change control.
• Involved in creating sample mappings for the conversion of EDI x12 transactions code sets.
• Assisted clients in resolving billing issues for Medicare, Medicaid, and private insurance.
• Used complex SQL queries to analyze the data pattern to accommodate the various business scenarios.

Business System Analyst

Confidential -Santa Fe, NM

Responsibilities:

• Collected the EDI files from testers and sent it to the suppliers after a high-level validation of the 850 and 844 EDI files.
• Involved in designing and developing Data Models and Data Marts that support the Business Intelligence Data Warehouse.
• Gathered high-level requirement for all the external projects in a release.
• Performed the requirement analysis, impact analysis and documented the requirements.
• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims.
• Involved in generating reports such as burnout chart, velocity chart and defect reports using Rally.
• Implemented data access, storage and validation routines on the database server using Procedural Language/Structured Query Language (PL/SQL).
• Worked on FHIR conversion to be able to provide a 360-patent view from Hospital Discharge to Long-term Care, Home Health or Senior Living.
• Provided business and mapping expertise during a transition of the EDI applications from the GXS Application Integrator (AI) to GIS.
• Prioritized the sprint backlog and came up wif techniques/tools to efficiently manage Sprint backlog.
• Involved in developing, executing and managing User Acceptance Testing (UAT), Quality Assurance (QA) in reviewing Test Procedures and Test cases, reviewing and maintaining Test script both manually and Automated.
• Did GAP analysis by comparing the past HIX reports wif present Contractual Reports to create the Future Reports.
• Helped lead the transition of Requirements Management in the Business Analyst Team to the agile methodology by creating and managing user stories and Requirements Traceability Matrices in the JIRA toolset.
• Developing a single application to process data from multiple integration points, convert the data for reporting purposes and feed data into mainframe system to be compliant to reporting requirements.
• Performed Analysis on Data mapping between different data models.
• Provide ad-hoc and structured reporting document to partners and stakeholders.
• Responsible for gap analysis in changing old MMIS and Involved in testing new MMIS.
• Was involved in maintaining dashboards, reports, visualizations, and alerts that concerned business decisions.
• Followed Agile (Scrum) SDLC methodology software development.
• Directly interacting wif the stakeholders to elicit the requirements and translate them into technical user stories, user stories and acceptance criteria for teams and documenting them in tools like Wiki and Jira.
• Performed Backend testing by using PL/SQL queries to test the integrity of the application.
• Created data mappings to transform the data according to business rules.
• Developed Test Cases for unit testing, prepared spreadsheet for testing criteria, including regression, positive and negative testing, process flow testing and screenshot for test results to complete expected and actual results.
• Participate in decision around data warehouse architecture and more specifically data models and database design and code complex programs, database scripts, and ETL packages that meet data flow.
• Prepared various diagrams by using MS Visio.
• Facilitated Sprint planning, daily Scrum meeting, Backlog Grooming, Sprint retro & Sprint review.
• Improved TFS (Team Foundation Server) functionality by designing efficient hub of documents related to processing, SQL scripts, SSIS packages, UAT planning, test cases etc.
• Prepared Business Requirement Documents BRD's after the collection of Functional Requirements from System Users that provided appropriate scope of work for technical team to develop prototype and overall system.
• Worked on Healthcare system implementation including enterprise Electronic Medical Records EMR and Electronic Health Records EHR software.
• Facilitated and led JAD sessions aimed at functional requirement walkthroughs for all the impacting projects and updated the documents based on recommendations if any.
• Prepared documents for the wireframe and prepared a data dictionary for the same
• Managed testing for various functionalities using Quality Center tools.
• Worked closely wif QA and Developers to clarify/understand functionality, resolve issues and provided feedback to nail down the bugs.
• Modified and translated segments of HL7 messages to properly send to EPIC.
• Analyzed and documented MMIS Claims business rules, edit rules, audit rules, to create and process unit and string test cases to verify and validate updated programs.
• Maintained a close and strong working relationship wif teammates and management staff to achieve an expected QA result for the project team.

Business Analyst

Confidential -Middleton, WI

Responsibilities:

• Performed extensive GAP analysis by identifying AS-IS and TO-BE process models and process flows.
• Identified the business users who will use the new application. Summarized the primary job responsibility for each user. Also identified client business needs, problems, and desired outcomes and established a common understanding of the business problems and possible solutions.
• Involved in conducting Functionality testing, Integration testing, Regression testing and User Acceptance testing (UAT). Provided analysis and insight to QA Team in defects and bugs tracking
• Responsible for eliciting, analyzing, document, business requirements, functional and non-functional specifications based on DCO sessions wif business unit stakeholders and technical team members, SMEs.
• Worked wif System Architects, and other project members collaboratively and iteratively to create the content in the artifacts like Application Profile, Application Specifications, Application Requirements.
• Used Agile Workbench to directly capture user stories and used JIRA for issue tracking and generated reports to analyze the performance of the project/team.
• Involved in creating requirements that comply wif HIPAA, HL7, and ANSI X12 format regulations to protect the privacy of the employee insured under any policy.
• Assisted Product Owner in define Acceptance Criteria for User Stories, DOD, DOR.
• Involved in creation of Mock-Ups and Wireframes of user interface using Pega's UI Designer for client verification.
• Performing business analysis, software validation and testing for client/server, multi-tier and web-based applications for EMR and commercial business for managed healthcare plans and Industries.
• Configured payroll schema, wage types and remuneration statements.
• Involved in designing, documenting and determined n-tier architecture for the claim processing system.
• Worked on HIPAA Standard/EDI standard transactions: 270, 271, 276, 277, 278, 834, 835, and 837 (P.me.D), 997 and 999 to identify key data objects.
• Basic understanding of Healthcare Jargons such as Health Insurance Exchange HIX.
• Used Connect SQL rules to run SQL statements like joins to verify the autanticity of the data.
• Involved in designing an Objected Oriented Security model for different Access Groups and assigned different roles to the Users.
• Defined the Correspondence and Notification needs of the system and identified the triggers for the correspondence.
• Assisted QA team wif Test Planning, Writing the test cased and Test Scenarios, Defect Tracking and Test Results.
• Involved in developing, executing and managing User Acceptance Testing (UAT).

Business Analyst

Confidential -Madison, WI

Responsibilities:

• Attend all weekly and biweekly Responsive PDP Page Redesign business as well as IT meetings wif the different stakeholders.
• Provide status update reports on requirement gathering process related to Responsive PDP Page Redesign.
• To understand, gather, detail and documented business as well as functional requirements related to Responsive PDP Page Redesign.
• Involved in preparing Design Documents.
• Involved in the process of integration and installation of new releases.
• Provided database support by coding utilities.
• Worked on ATG Health Care B2B System scenarios to develop the Workflows.
• Involved in Preparation of Data Sets for the ATG Health Care System Development.
• Involved in Conducting the Validation and Verification of the Oracle ATG Data Sets during the User Acceptance Testing for the ATG Health Care System.
• Prepared SLA (Service Level Agreement) and Solution Requirements Document for the CVS Web Service portal.
• Identified and gathered test data needed to support the testing effort.
• Held daily scrum meeting wif the Project team and change management team to discuss the requirement updates, change requests, tasks and assign/re-assign ma hours on a daily basis.
• Assisted in payroll preparation by providing relevant data (absences, bonus, leaves, etc.)
• Involved in maintaining application security by monitoring compliance to standards.
• To prepare BRD (Business Requirements Document), FRD (Functional Requirements Document), WSRD (Web Service requirements document), and RTM (Requirements Traceability Matrix) for the Responsive PDP Page Redesign.
• Defined User roles, Authorization, and Tasks for the newly build Share Point Database management system.
• Prepared Use cases and process flows for the newly build Share point system.