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Business Analyst Resume

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Pittsburg, PA

SUMMARY

  • Over 9 years of professional experience as a Business Analyst including process modeling, process re - engineering, requirement elicitation/documentation/management, test planning/scripting/executions, and systems specifications in Health Care, Insurance, Logistics and Finance domains.
  • Extensive knowledge working through the Software Development Life Cycle (SDLC) including Enterprise Analysis, Requirements Planning and Management, Requirements Elicitation, Requirements Analysis and Communication, Solution Assessment and Validation of Projects. Excellent analytical and problem-solving skills in designing, developing and implementing innovative business processes using new approaches and technology.
  • Excellent knowledge of health care industry and claims management.
  • Experience with the working of Medicare and Medicaid Health Insurance Policies, Personal Injury Protection (PIP) insurance, billing experience with life and disability in health plans with thorough understanding of CPT Coding, UCR, FS, HCFA-1500 and CMS-1500 claim forms and reimbursement forms.
  • Extensive knowledge of Medical Management Information Systems (MMIS),GDPR, CCPA and National Provider Identification (NPI)
  • Sound understanding of comprehensive health reform, the Patient Protection and Affordable Care Act (ACA) and medical claim policies and requirements including benefits, membership, enrollment and implementation and Data Analyst
  • Experienced in HIPAA compliance, Electronic Data Interchange (EDI) and implementation of HIPAA code sets, ICD-9, ICD-10.
  • Extensive knowledge in insurance products like HMO, PPO, POS and Managed Care.
  • Expertise in ICD-9 to ICD-10 Conversion & creating a crosswalk between ICD-9 to ICD-10
  • Thorough understanding and hands-on working experience with standards of EDI/X12- 270/271 & 276/277, 834, 835, 837.
  • Knowledge on QNXT and Facets, Inbound & Outbound interfaces, EDI configuration, and data mapping using ANSI X12
  • Experience in conducting Joint Application Development (JAD) sessions and White Board Sessions with end-users, Subject Matter Expert (SMEs) team, Architects and design group development and QA team for project meetings, walkthroughs and customer interviews commensurate with excellent communication skills.
  • Hands on experience with UML modeling, Use Case Documents, Use Case Diagrams, class diagrams, interaction diagrams, activity diagrams, state chart diagrams and documentation of each and every method and attribute
  • Prepared multiple Statement of Works (SOW) as formal document that captured and defined the work activities, deliverables, and timeline a vendor must execute in performance of specified work for a client.
  • Expert in Tracking, Managing and verification the requirements using Requirements Verification Traceability Matrix (RTM) that links and controls numerous artifacts produced by several teams across the deliverables of the project.
  • Elicit, Analyze, Create and Review of Business Requirement Documents (BRDs), Functional Specification Documents (FSDs), Use Case Documents, and Business Rules Spreadsheets (BRS), Standard Operating Procedures (SOPs)
  • Good with MS Project, MS Visio, Jira, Azure board, Agile and waterfall methodologies.
  • Expertise in understanding business needs and defining creative and useful software solutions.
  • Skilled at working as a liaison between the business owner and IT personnel for communication requirements between the two communities.

TECHNICAL SKILLS

Operating Systems: Windows XP, 10, 8

Methodologies: Software Development Life Cycle (SDLC), Waterfall, Agile Methodologies

Languages: C, C++, SQL/PL-SQL, HTML, XML

Management Tools: Sharepoint, AZURE DevOps, JIRA

Modelling Tools: Smartdraw, MS Visio

PROFESSIONAL EXPERIENCE

Confidential, Pittsburg, PA

Business Analyst

Responsibilities:

  • Performed as a high-visibility business relationship management liaison, working with internal and external business owners and stake holders.
  • Analysis of complex Health Information Technology, Medicaid Management Information System databases, reports and system processes.
  • Supported and responded to complex issues impacting the Design Development Implementation (DDI) Team, in the layout, design, and reporting provided by the Medicaid Management Information System (MMIS) and Vendor Subsystems.
  • Drafted recommendations to respond to the client and provider issues including identification of Medicaid Fraud.
  • Researched and analyzed the CMS Policies and drafted recommendations like Data Analysis, CCPA And GDPR.
  • Managed and maintained project deliverables and responsibilities to ensure that business and contractual requirements are met.
  • Proactively addressed potential issues that may affect the system and worked with developers to resolve the matter.
  • Utilized Agile Methodology approach to successfully manage projects.
  • Developed As-Is and To-Be process flow and solution documents.
  • Designed the primary templates of the flow of the new system with HIPAA rules using MS-Office and Visio.
  • Enforced change management process and captured all changes as new revisions of system documentation.
  • Conducted GAP analysis in comparison to the proposed system to enhance the functionality of the system, which had to fulfill the 3 formats.
  • Developed plan for data feeds and data mappings for integration between various systems, including XML, to follow ICD 10 Code set and ANSI X12 formats.
  • Performed System testing of the Claims processing systems (Pricing Rules, Duplicate/Limits validation, Member Eligibility, Provider Enrollment).
  • Prepared graphical depictions of Use Cases, Use Case Diagrams, State Diagrams, Activity Diagrams, Sequence Diagrams, Component Based Diagrams, and Collateral Diagrams and creation of technical design (UI screen) using Microsoft Visio.
  • Developed documents to design the data to be accepted in HIPAA Compliant 837, National Standard Format (NSF) other proprietary formats and to be converted into the required format by the provider/clearing houses/Insurance agencies.

Environment: SQL, MS-Office, MS-Visio, Azure Board, Jira and SharePoint.

Confidential, Hopkins, MN

Business Analyst / Quality Analyst

Responsibilities:

  • Conduct detailed and comprehensive business analysis by working with the client IT staff and end-users in order to identify system and operational requirements and improvements.
  • Analyze and document Business requirements and Business Process Models to create BRD for better understanding of the business process.
  • Requirements management, load, update and maintain in ALM and do coverage analysis to check traceability
  • Create data-diagrams, UML, screen design, wire-frames, and use case diagrams to specify operations performed by application.
  • Facilitated Vendor integration test planning, design and execution of test scripts
  • Coordinate design sessions for Vendor integration and performed gap analysis
  • Produce System Diagrams, Business Requirements, Functional Specification, Use Case Documents, Workflows and other documentation as required for Project Analysis, Planning and Design
  • Coordinate with the stakeholders, development teams, and QA team to verify the business requirements are covered in design, test plan, test procedures, test scenarios and use cases and maintain traceability Matrix
  • Test Management, test planning and devise test strategies, effort estimation, risk analysis and management.
  • Prepare UAT test cases, test data execute test cases and document test results
  • Perform smoke testing, System/Integration Testing, End-to- End Testing and Regression Testing
  • Conduct war room meetings, troubleshoot defects and track them to closure by working with developers and testers
  • Perform system analysis, root cause analysis for defects, change requests and enhancements
  • Created HTML and XML based templates to load GAN’s in the EGMS system, validation of XML input & output files GDPR, CCPA and.data Analyst
  • Perform backend testing using SQL queries to validate databases
  • Validate WSDL using SOAP UI tool and perform error message validation on vendor application
  • Support sprint releases and validation
  • Perform user acceptance testing (UAT), perform defect reviews
  • Facilitate Go/ No Go meetings for production release
  • Perform production shakedown and support production defects triage and retesting

Confidential

Business Analyst / System Analyst

Responsibilities:

  • Analyzed and implemented changes into the product as per current business requirement.
  • Played a key role in company initiatives for developing new products for future use.
  • Responsible for driving sales of End User Engagement/Customer Contact Services Solutions. Conducted Impact Analysis and created risk management document.
  • Assisted in designing prototypes for user interface components.
  • Assisted project manager in planning and scheduling product related activities.
  • Identified scope, functional and non-functional business requirements.
  • Created a standardized process document for the department to ensure successful integration of existence.
  • Acted as liaison between the business and the development team.
  • Review tasks and provide input in case needed. Conducted functional walkthroughs and supervised the development of User Manuals for customers.
  • Used the Office Suite extensively which included MS Word, MS Excel, MS Access, MS Project, MS Visio for various documentation and analysis reports.
  • Defined product milestones, schedules, monitored progress and updated plans using MS Project

Confidential

Business Analyst

Responsibilities:

  • Analyzed and implemented changes into the product as per current business requirement.
  • Played a key role in company initiatives for developing new products for future use.
  • Responsible for driving sales of End User Engagement/Customer Contact Services Solutions. Conducted Impact Analysis and created risk management document.
  • Assisted in designing prototypes for user interface components.
  • Assisted project manager in planning and scheduling product related activities.
  • Identified scope, functional and non-functional business requirements.
  • Created a standardized process document for the department to ensure successful integration of existence.
  • Acted as liaison between the business and the development team.
  • Review tasks and provide input in case needed. Conducted functional walkthroughs and supervised the development of User Manuals for customers.
  • Used the Office Suite extensively which included MS Word, MS Excel, MS Access, MS Project, MS Visio for various documentation and analysis reports.
  • Defined product milestones, schedules, monitored progress and updated plans using MS Project

Confidential

Business Analyst

Responsibilities:

  • Assisted the entire teaching faculty of Narayana IIT Olympiad School staff in using digital board smart classes.
  • Identifying training and developing needs within organization.
  • Helped in arranging the video conferences with other branches of schools from different districts
  • Assisted the school management in learner counseling guidance and promote extracurricular activities, debates and other competitions.
  • Maintain up-to-date training matrix for all the staff. Search for outdated training records on a monthly basis.
  • Used MS Excel to enter data from various sources into spreadsheets and also helped in maintaining records on Excel.
  • Ensured quality of service and efficient operations support for the assigned areas within the school.
  • Created positive environment in the classroom, motivated students and helped them to use their knowledge and experience as resources during lessons.
  • Shared and supported the school’s responsibility to provide and monitor opportunities for personal and academic growth.

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