Skills

Please use this table to list the skills noted in the Required/Desired section of the Peoplefluent requirement. In addition, please respond with the years of experience for each skill and the last time each skill was used. Add or delete rows as necessary.

Employment History

Confidential

Senior Business System Analyst

Responsibilities:

• Served as Communication Bridge between non-technical users and technical solution developers..
• Extensive experience on Web Based solutions using .NET and Java technology stacks. Extensive experience in migrating legacy Microsoft Applications to .NET platform.
• Working on Medicare related processing knowledge and expertise with Regulatory background and/or Medicare enrollment and billing. Working with Production support. Documented support processes to deliver best results training to end use. Optimized training plans and training efficiency when applying the special conditions.
• Analyzed client requirements in development of membership services relational data base application used by several different clients, providing new business offering.
• Medicare part A and Medicaid billing and coding working deny claims follow up on claims for status of payment. Experience with TriZetto's Integrated NetworX product. Reviewed and analyzed Medicare and Medicaid specific programs and assists in developing end product design in TriZetto's Facets product. Reviews and analyzes complex provider reimbursement and assists in developing end agreement designs
• Looked up ICD-9 codes to verify if a code has been changed and entered deposited and updated patients' demographics using the Medisoft system and ePACES online system to verify a their Medicaid status.
• Managed and leads configuration analysts to support product and agreement configuration within Facets.
• In a team environment led analysis and development of enhancements for a mission critical Java/JSP/J2EE application performing requirements gathering, analysis, design and implementation of enhancements including XML application integration.
• Defining, deploying and implementing processes aligned to ITIL framework Develop Policies and Procedures Manuals, Desk Level Procedures, and Custom Workflows for the teams.
• Created patient folders for new patients using unique identification numbers according to established protocols.
• Retrieved patient charts and refilled charts in proper sequence completed out guides for pulled charts.
• Copied physician-dictated reports and complied with requests for copies of patient records from patients and other persons such as physicians, attorneys, and insurance companies following departmental policies to safeguard patient confidentiality.
• Defining and Develop plan for Change, Problem Incident management Process based on ITIL. Used HIPAA 4010 transactions to support the analysis of current business processes and work with management to improve and implement enterprise solutions to ensure compliance and got involved in designing future state processes for HIPAA 5010 transaction processing EDI's 837,835, 270, and 271.
• Analyzed HIPAA 5010 related to 837,835, 270, and 271. Transactions and performed gap analysis between the 4010 and 5010.
• Expert in Windows Communication Foundation WCF and Duplex model and Good Knowledge of COM and COM and DCOM.
• Also, worked on XSLT, XML, TFS, MSMQ, SQL Server 2008/R2 , WCF, IIS 7.5, 6.0 , InfoPath and Web Services.
• Serve as a SME for PBM functional questions for client's clients as well as internal team members.
• Determine user/business/functional requirements and produced work flow processes and diagrams using Microsoft Visio and other Microsoft Suite Applications.
• Performed analysis, process flow and use case development for integration of mainframe data between two existing companies. Reviewed and updated Business Flow Processes to insure applications were meeting the objectives of the business. Changes and revisions were illustrated using Microsoft Visio and other Microsoft Office applications.
• Lead the efforts of the client architecture team in defining the Business Intelligence / Data Warehouse end-to-end architecture.
• Understand the overall business model of Medicare Part D products and the PBM claim adjudication system and translate concepts into practice.
• Review and analyze formulary data to determine the appropriate process for building and maintaining formularies in the Formulary Management application.
• Involved in HIM Health Insurance Management , to manage the administrative, financial and clinical aspects of a hospital and also encompasses paper-based information processing as well as data processing machines.
• Maintain internal system tables such as provider ID and chart locator for the HIM department to ensure efficient use of the system and accurate information.
• Extensively worked on Informatica Designer Components Source Analyzer, Warehouse Designer, Transformation Developer, Mapplet and Mapping Designer.
• Implemented the Rational Unified Process RUP methodology of iterative software development with and developed user stories and dashboard for the system.
• Met with business units and project stakeholders to gather and develop business requirements for operations related restructuring programs for Facets 4.31v upgrade.
• Collected Business Requirements and converted them to Functional Requirements in the Facets Platform.
• Mentored business analysts in methodology for defining ICD-10 mapping processes and documenting business requirements. Developed additional processes specifically designed to handle Benefits Administration.
• Involved in Web Development and Content Management system like Planning and execution of digital projects developing schedules defining and owning feature requirements for website development managing website content, establishing and enforcing content governance, creating business requirements documents, and offering input on content migration plans, workflows, testing plans, and quality assurance
• Extensively created test cases for the claims administration and customer service modules like subscriber/member enrollment, adding premium rates, claims, billing and recoveries. Third Party liabilities, benefits. Service authorizations, entity relations.
• Used Use Case diagrams during analysis to capture the requirements diagrams and Sequence diagrams so that the development team and other stake holders can understand the business process.

Environment: MS Office, RUP, UML, Power designer, SQL, SWOT analysis

Confidential

Business Analyst

Responsibilities:

• Attended and Facilitated JAD Sessions, Personal interviews with the Stake holders, SME's and Quality analysts for information gathering regarding the software's and hardware's Server, Network. involved in the project
• Analyzed the risks involved in the project as well as analyzed and documented the time required to recover the application RTO and RPO
• Created Application Disaster recovery plan, Standard Operating Procedures and Work Instructions as a part of the Disaster Recovery Plan
• Used Microsoft Share Point as the version tracking tool for managing the requirements documentation, and Microsoft Project for Project planning and management
• Implemented the concepts of data warehousing by creating relational/multidimensional databases that was designed for query and analysis.
• Supported design efforts by lead architects by defining data models and Use Case analysis models
• Collaborated with the business and application team in the creation of Business Continuity plan Business Work Around as a part of the Disaster Recovery Documentation
• Responsible for translating BRDs into use-cases, and context diagrams and used UML 2.0 to visually model the system
• Gathered requirements to confirm the functional and data validation for the various Service Center modules and Created Process models for the DR processes using Microsoft Visio
• Used Data modeling to understand various elements of data that could be stored, the size of these elements and the kind of information each element can contain
• Coordinated with the application team and Quality Analysts in the creation of test plans, User Acceptance Test scripts and Regression test cases for upgrade

Environment: MS Office, Microsoft Visio, RUP, Microsoft Project, Microsoft Share Point

Confidential

Senior Business Analyst

Responsibilities:

• Key player in Managing project and was involved in resource management.
• Analyzed existing Business units, Business process, System/ Application and there Interfaces with their capability through open-ended discussions, brainstorming sessions, and prototyping, prioritizing them and converting them as system requirements that must be included while developing the software.
• Responsible for a wide variety of technical activities related to requirements gathering, solution synthesis, planning, implementation, testing, documentation, upgrade and support of Agile PLM and other engineering related business systems.
• Assisted with documenting processes, used agile methodology to write the Business Requirements documents and designed Functional specifications.
• Responsible for task assignment among development team and tracked progress of project following Scrum methodology.
• Existing and proposed business processes were diagramed using Microsoft Visio.
• Involved in HIM Health Insurance Management , to manage the administrative, financial and clinical aspects of a hospital and also encompasses paper-based information processing as well as data processing machines
• Participated in design review meetings and translated the requirements to the developers and guided the team when issues related to business requirements arose.
• Well versed with HIPAA, claim adjustments, claim processing from point of entry to finalizing, claim review, identifying claims processing problems, their source and providing alternative solutions using best practice model and principles.
• Conducted JAD sessions between the business users, Developers, testers Subject Matter Experts to resolve bottlenecks.
• Used HL7 guidelines and dictionary for defining business rules associated with pre-defined workflows according to business requirements.
• Played important role into creation of CRUD Create, Read, Update and Delete Metric to make analysis and better understand data flows between different systems.
• Conducted Risk Analysis to identify the risks associated with developing the patches, and formulated a Mitigation Plan to eliminate or reduce risks of high severity and any major effects.
• Played an active role in the UAT.
• Responsible for creating maintaining Requirement Traceability Matrix in order to track the development and QA process.
• Interacted closely with QA to finalize the Test strategies and maintained quality assurance using HP Quality Center.

Environment: UNIX, SQL Advantage, MS Visio, MS Word, Agile, SSMS, HP Quality Center

Confidential

Business Systems Analyst

Responsibilities:

• Processed EDI test files and verified system is able to validate certified and non-certified trading partners. Worked with cross functional business teams to design SharePoint applications that best meet their content and document management requirements.
• Participated in HIPPA 4010 to 5010 upgrade JAD sessions and documented the outcomes on FACETS Platform.
• Participated in 1CD 9 to ICD 10codes mapping sessions as well as status meetings and provided comments and suggestions on challenges. Gathered requirements on Trading Partner Registration and certification. Verified Trading Partner configuration and the profiles.
• Created an enterprise workflow application based on CRUD rules for Customer Data that would allow for future integration of data infrastructure across various business areas into a single User Interface.
• Conducted interviews with key business users to elicit, collect and manage requirements and prepared business process flowcharts. Created RFPs and evaluated vendor proposals.
• Developed scripts, scenarios and performed comprehensive testing User Acceptance UAT, Alpha and Beta testing of applications.
• Performed relational database design and modeling and conducted multiple SQL querying
• Participated in meetings with Developers, Project Managers and Quality Analysts to discuss business requirements, test planning, resource utilization and defect tracking
• Used Rational Clear Quest for defect tracking and prioritizing defects and for enhancements after base lining the requirements

Environment: RUP, UML, SQL, MS Office, MS-Project, Quick Test Pro

Confidential

Business Analyst

Responsibilities:

• Played a key role in the planning, testing, and implementing system enhancements and conversions.
• Aided documentation of Computer system validation lifecycle per FDA regulations.
• Worked on functions such as system audit, Change Control and Request, CAPA and managed complaints to ensure customer satisfaction.
• Experience of managing multiple stakeholders across the organization, and in QA integration of systems.
• Involved in detailing project mission, data process flow diagrams, and timelines.
• Worked with SQL queries for data manipulations.
• Assisted in building a business analysis process model using Rational Rose, Requisite Pro and Visio.
• Aided documentation of Computer system validation lifecycle per FDA regulations.
• Designed and developed Use Cases, Activity Diagrams and Sequence Diagrams.
• Assisted in process modeling conducted and participated in JAD sessions with system users helped with design walkthroughs with stakeholders for base lining architecture.

Environment: Rational Rose, Requisite Pro, QTP, cGMP, CICS, CFR, MS Visio, RUP, MS Project, SQL, MS Access, MS Excel and MS Word