SUMMARY

• 6+ years of Experience in Healthcare Payer and Provider Operations, re - engineering claims, benefits, enrollment and eligibility processes.
• Complete knowledge of registration, scheduling and billing processes for Revenue Cycle and Patient flow.
• Excellent knowledge of E-Commerce, healthcare IT along with HIPAA regulations, EDI transaction Code Sets, and CMS regulations.
• Firm ability to research, analyze and translate complex business and technical information to stakeholders, SMEs, and developers at all levels of the organization. Also, in Defining, Gathering, Documenting, and Managing requirements to identify the real business need of the client company.
• Excellent communication, interpersonal consulting and facilitation skills.
• Working expertise in Software Development Life cycle (SDLC), Project Life cycle, Business Process Modeling (BPM), Software Development Methodologies including Rational Unified Process (RUP), Waterfall, Spiral, and Agile with SCRUM process
• Organized in Joint Application Development (JAD) and Rapid Application Development (RAD) sessions with business/end users, expert team and technical team.
• Developed use case diagrams, sequence diagrams, state diagrams and activity diagrams, business requirements and user expectations into detailed specifications employing Unified Modeling Language (UML).
• Experience in producing documents like Business Requirements Documents (BRD), Functional Requirement Documents (FRD), Software Requirement Specifications (SRS), Creating Request for Proposals (RFP), creating Requirements Traceability Matrix (RTM)
• Experience in creating Prototypes and Wire frames and documenting them using MS Visio and Enterprise Architect
• Involved in all phases of Testing life cycles including integration testing, User Acceptance testing (UAT) Functional testing/Black Box Testing, Regression testing, GUI testing, and performance testing.
• Hands on experience with Object Oriented Analysis and Design (OOAD); work side by side with technical managers; senior design engineers/ analysts; used UML extensively with emphasis on Use Case diagrams, state diagrams, sequence diagrams, activity diagrams and collaboration diagrams using Rational Rose and MS-Visio; solid hand-on experience working with MS Excel, writing very complex Excel macros to pull data in Data Mining and Data Warehousing environment; help in designing the ETL processes.
• Creative and aggressive self-starter and a versatile team player with excellent analytical, problem-solving capability for collecting clear and detailed Business Requirements and Functional Specifications.
• Team player, hardworking, highly self-motivated, fast-learner and goal-oriented individual committed in pursuing a long-term career in Information and Communication Technology.

TECHNICAL SKILLS

Project Methodologies: Agile/SCRUM, Waterfall

Business Modeling Tools: Rational Rose, MS Visio

Bug Reporting Tools: Jira, Quality Center

Languages: SQL, HTML, XML, JSON

Requirement Management Tools: Rational RequisitePro

Defect Tracking Tools: Rational ClearQuest, HP QC/ALM

Operating Systems: Windows, UNIX

Business Applications: MS Project, Microsoft Office Suite, MS Outlook

Environment: SQL Server 2008

PROFESSIONAL EXPERIENCE

Confidential - Denver, CO

Senior Business Analyst

Responsibilities:

• Interactions with the end users in order to generate the report required and to understand the business requirements relating to Medicaid program and Pharma.
• Obtained Data requirements, identified data sources, determined the content of data fields and created Data Mapping Documents and performed Data Extraction and Data Compilation using SQL queries.
• Built and managed successful client relationships with representative, director, and deputy chief level contacts within the Centers for Medicare & Medicaid Services (CMS).
• Facets support systems were used to enable inbound/outbound HIPAA EDI transaction in support of HIPAA 834, 835 /271 transactions.
• Expertise in Claims, Subscriber/Member, Plan/Product, Claims, Provider, Commissions and Billing Modules of Facets.
• Worked on Customer Support module on FACETS. Reviewed various customer transactions using theFACETSapplication.
• Interacted with Informatica developers for designing and developing complex web intelligence, Business intelligence, Client and ad hoc reports for corporate data.
• Successfully designed and implemented statistical reporting processes for regular data collection and clinical data analysis. Analyzed safety and efficacy data from Phase II and III clinical trials.
• Met with physicians, nurses, billing and administrative personnel. Documented the clinical, financial and administrative business practices, procedures and workflows.
• Applied guidelines, standards and regulations such as HL7 CDA, CDISC, MedDRA, Code of Federal Regulations (CRFs) to clinical data modeling.
• Designed, authored, reviewed and revised Clinical Data Management Plans and Drug Safety Technical Reports are FDA 21 CFR Part 11 compliant
• Documented technical services with desktop and other technologies and worked on analyze business and process flows.
• Worked with SME’s in Finance, Investment, Commercial and Personal banking to collect the Business process requirements, documented them in Business Requirement Document (BRD) and performed Business Process Re-engineering.
• Obtained Data requirements, identified data sources, determined the content of data fields and created Data Mapping Documents and performed Data Extraction and Data Compilation using SQL queries.
• Analyzed data flow requirements and developed a scalable architecture for staging and loading data and translated business rules and functionality requirements into ETL procedures.
• Knowledge on HIPAA Compliance EDI Transaction Sets 834, 837 and Good understanding of the EDI transaction sets 834, 837.
• Experienced in software development life cycle such as Waterfall, Agile-SCRUM methodologies, BusinessAnalysis and Modelling.
• Instructed and modeled core Agile principles of collaboration, prioritization, team accountability and visibility, ensured consistent application of SCRUM methodologies across the enterprise
• Used Facets support systems to enable inbound/outbound HIPAA EDI transaction in support of HIPAA 834, 835 /271 transactions.
• Ability to analyse engineering product support issues described within a bug-tracking system (JIRA) and provide guidance to other Client Services members in an advisory capacity, focusing on the quick resolution of the production issue and using this as a training opportunity for other team members
• Proficiency with Microsoft Office applications (Word, Excel, PowerPoint, and Visio and Project Management Software), and Atlassian (JIRA, and Confluence).
• Maintain knowledge on working of all HIPPA EDI protocols and map all data for various ERP systems and applications and perform audit on all EDI processes to maintain accuracy
• Analyzed business requirements and implemented technical solutions and assisted with local WAN, LAN, Server, desktop and other technologies.
• Developed test plans, test scenarios, test cases, test data to be used in testing based on business and user requirements, technical specifications.
• Interpreted logical and physical data models with data modelers to determine common data definitions and establishing the referential integrity system.

Confidential, Chicago, IL

Sr. Business/Systems Analyst

Responsibilities:

• Gathered, analyzed, documented business and technical requirements from both formal and informal sessions and validate the needs of the business stakeholders.
• Performed Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data
• Presented detail walk through of Functional Specifications, Detail Design and VISIO work flow process diagrams to Business, EDI, MQSI, HIPAA project managers and HIPAA project regulators.
• Supported the implementation and ongoing development and testing of electronic transactions, including claims processing through electronic data interchange (EDI) with HIPAA standards.
• Created use case scenarios and documented work flow and business process using Rational Rose
• Maintained pricing configuration in Facets System for Medicaid, Medicare and Dual Eligible Products; creating new and updating existing provider contracts
• Validated member eligibility and eligibility inquiry in the facets application to the legacy application in order to confirm the migration successful or not.
• Involved in eliciting requirements via SME interviews, document analysis, requirements workshops, surveys, business process descriptions, use scenarios, and workflow analysis.
• Have proven business insight and the technical know-how to implement large-scale EMR and EHR engagements.
• Tracked the day-to-day activities, responsible for new requirements and enhancements associated with EMR EPIC system.
• Wrote SQL Stored procedures for numerous different KPI Metrics from different modules like Average Length of Stay (Epic Care Inpatient), Patients that left the ED without being seen (ASAP), First Case Late Starts (OpTime), Study Turnaround Time (Cardiant), Barcoding Compliance (Willow Inpatient), Average Daily Revenue (Hospital Billing) etc.
• Expertise in the EPIC Medical software application (EMR, EHR) as it relates to hospital workflows and setting up the infrastructure for a software implementation in a clinic environment.
• Expertise in creating Business Domain Model, interviewing SME (Subject Matter Experts) and requirement elicitation.
• Extensively used SAS for data analysis in Clinical Trials and worked closely on Clinical Operations to provide specialized programming support.
• Maintained Gitlab repositories, JIRA bug tracking system. Created custom JIRA workflows. Install, configure and maintain JIRA bug tracking system
• Capture Feature/Function information at varying levels of granularity and document them in a requirements management tool (e.g. Microsoft TFS, JIRA, etc.)
• Involved in all SDLC stages under Agile process requirement analysis, implementation, testing (functional and use acceptance) and deployment.
• Involved extensively in writing Agile User Stories and get them reviewed with Business lead and project manager for Sign Off.
• Worked on AGILE Environment with daily scrum meetings, grooming sessions, planning and sprint cycles.
• Documented requirements associated change requests with requirements and connected requirements with Use cases.
• Incorporated Rational Unified Process (RUP) to create Requirement Document Specifications using Visible Analyst.
• Responsible for creating test scenarios, scripting test cases using testing tool and defect management for Policy Management Systems, Payables/Receivables and Claims processing.
• Involved with all the phases of Software Development Life Cycle (SDLC) methodologies throughout the project life cycle.
• Served as conduit for managing system requirements between the business and the software development team.

Confidential, Toledo, OH

Business Analyst

Responsibilities:

• Implemented an integrated RUP solution with complete line of traceability for all the artifacts of web development projects.
• Created and updated tasks in the MS Project and Project Management Directory for the senior management reviews.
• Performed GAP analysis and documented business and system level use cases to derive the requirements illustrating the functional behavior.
• Collaboration and reviews with different application owners and SME’s to ensure the GAP Analysis was performed accurately.
• Business Process Modeling: Business process improvement and optimization, Document and model business processes, automated workflows and Manage business rules.
• Involved in documenting Business Requirements Documents by conducting interviews with the project stakeholders, SME’s and Business users.
• Maintained JIRA team Confluence System Engineering pages that included: Process Flow Management, Team Requirements, Roles and Responsibilities, and COP User Metrics.
• Assist in creating and updating tickets in JIRA, along with implementing improvements in Jira to track and produce metrics for all phases of Intake and Development processes.
• Created reports and dashboards in JIRA to track hours and project status to report to finance team.
• Documented Traceability to ensure all the features for the project has been captured and mapped back to the requirements in the BRD.
• Performed application functionality user acceptance testing (i.e. front-end application testing) in a controlled testing environment that replicates the end user usability of the application.
• Tested different functionality of the application like Medicaid eligibility data, state available funds program, Medicaid claim processing etc.
• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims. Worked on EDI transactions: 270, 271, 834, 835, and 837 (P.I.D) to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
• Ensured UAT test scripts review sessions with business owners to test the application functionality, providing necessary training material.
• Clear quest and HP quality center to log defects and assign to the right team to ensure the defects are addressed on a timely manner.

Confidential, Washington DC

Business Analyst/Data Analyst

Responsibilities:

• 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.
• Interacted with various cross-functional teams on building business use cases, and understanding expenses and revenue stream.
• Gathered requirements for the inputs in the Competitive Intelligence System from the stakeholder’s including methods like personal interviews, questionnaires, surveys, JAD sessions and joint team meetings. Identified systems requirements that would help create the CI System by meeting up with the technology team and then having a JAD session to include SME’s from the business side.
• Developed the systems implementation project management plan with milestones and steps from procurement of vendors to project implementation and maintenance.
• Followed a structured approach to organize requirements into logical groupings of essential business processes, business rules, and information needs. Ensured that critical requirements are not missed.
• Aided management in standardizing web applications by preparing GUI standards and recommending alternatives for in corporation in a phased, iterative manner.
• Interacted with client and the Technical Team for requirement gathering and translation of Business Requirement to Technical specifications.
• Serve as a point of contact for the client’s stakeholders and provided customer support in addition to team building with on and off shore agile teams.
• Involved in mentoring specific projects in application of the new SDLC based on the Agile Unified Process, especially from the project management, requirements and architecture perspectives
• Worked as a part of scrum team, in an agile methodology with sprint cycles, daily stand ups and story implementation, large cross functional project and support teams.
• Designed new database tables to meet business information needs. Designed Mapping document, which is a guideline to ETL Coding.
• Responsible for developing, support and maintenance for the ETL (Extract, Transform and Load) processes using Oracle and Informatica PowerCenter.
• Worked as functional Analyst in the software development team for outsourcing Electronic medical records (EMR) and paperless office system implementation to the medical facilities.
• Responsible for EMR interface development and implementation. Specialized in Nephrology EMR, Internal medicine EMR, Psychiatry EMR, Oncology EMR, Anaesthesia EMR etc.
• Lead abstraction of core measure data from EHR and submission of these data to CMS. Data converted to knowledge and wisdom contributed to the establishment of objective measurement, performance transparency, best practice sharing, and standardization.
• Effectively manage EHR staff by hiring, developing, training, and overseeing personnel to meet the needs of the practice.
• Supported the physician applications and ordering module during the initial EMR go-live and provided support to end users during maintenance and optimization activities
• Observed and analyzed corrections-specific workflows to adapt the EMR and optimize provider efficiency and success.
• Owned the entire reporting process. Interacted with the ETL team, developer(s), management, and account holders to get the requirements, document them, design templates, and write specifications.
• Analysis of the new requests specified by the end users for the future releases and discussion with the functional and technical teams.
• 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.