Skills

Employment History:

Confidential

EDI Business Analyst/Business Process Analyst/Engineer

Responsibilities:

• Scope of this project was to incorporate changes/enhancements to adjudicate claims processing through Web portal MITS in real-time, and EDI eligibility assignments for different aid categories that were assigned to different waver plans and contracts for different facilities and specialties like LTCF, Medicare Advantage plans and audit criteria's, HLTCF etc.
• Responsible to define audit criteria's for members eligible and not eligible for Medicare coverage that goes through the DTRR process
• Defined the pricing objectives with the business on identifying the proper Medicare coverage type that is on file that comes through the claims paid by Medicare.
• Expertise at analyzing, designing and Business Process reengineering system applications and business Technical processes.
• Responsible for defining requirement for MITS that accepted multiple, unique data feeds from different agencies and applies that data according to ODJFS-specific business rules that will affect EDI Transactions
• Elicited Business Requirements analyzed them and tested them.
• Used Business Process Re-engineering BPR in IT Project, Business process optimization and process mapping
• Performed GAP analysis of business rules, business and system process flows for EDI 834 and 837, user administration and requirements to document the Current As-Is processes and the Future To-Be processes
• Developed/maintained general understanding of business functions and processes across the one or more Taxonomy Groups / Process Flows as needed to support BPR sessions, as well as and enterprise-wide view required to integrate processes
• Experienced in SDLC life cycle, understands and developing process workflow diagrams, and documenting As Is and To Be processes.
• Interacted with the ETL team, developer s , management, and account holders to get the requirements, document them, design templates, and write specifications.
• Designed Functional Specification Documents for the reports.
• Created the process flow diagrams for end-to-end flow of information and report creation process.
• Conducted JAD sessions for the report users, requestors, and the developers.
• Reviewed Requirements deliverables for delivery timeline.
• Methodical testing of new application enhancements and production defects.
• Identified risks, problems, concerns and suggested improvement to the business users.
• Trained and coached new hires regarding CRIS-E and MITS interface.
• Prepared Data Flow Diagrams and Use case models using MS-Visio where required.
• Created a Test Plan and executed them in Quality Center.
• Conducted user interviews, attended JAD Joint Application Development sessions, and documented analysis.
• Represented the client in various process improvement discussions.
• Involved in conducting Functionality testing, Integration testing, Regression testing and User Acceptance testing UAT .
• Facilitated the UAT/Testing team during test script preparation to clarify application functionality.

Confidential

Lead Business Analyst/Business Process Analyst

Responsibilities:

• Working as a Business Analyst on various strategic process improvements, and quality management of the Information Technology solutions for Medicare, Medicaid, and MAPD clients.
• Worked closely on the 4010-5010 new HIPAA guidelines for EDI 837 and 834 to identify if the fields were mapped accurately.
• Proficient in the analysis, design, and Business Process re-engineering of system applications using established system analysis, business and system process design, Implementation of methodologies.
• Develop strategic solutions using technologies that support quality management, process improvements, productivity, and metrics to drive continuous improvement.
• Used Business Process Re-engineering BPR in IT Project, Business process optimization and process mapping
• Develop a baseline set of metrics and dashboards measuring progress for client implementations, applications, and core adjudication system upgrades.
• Supported Business Transformation Project Manager/Senior BPR Lead Analyst with Business Process Reengineering BPR workshops: planning, preparing materials, guiding workshop execution, analyzing and capturing results, and preparing input for follow-up BPR review and related work sessions
• Manage budgets, interviews, and administrative issues related to various Business and Operational areas.
• Involved in creating, modeling and developing process workflow diagrams, and documenting AS IS and TO BE business process flows.
• Performed GAP analysis of business rules, business and system process flows for EDI 834 and 837, user administration and requirements to document the Current As-Is processes and the Future To-Be processes.
• Developed Use Case Diagrams using Microsoft Visio and developed web sites, portals, intranets, content management systems and search engines for Cigna Healthcare using Microsoft SharePoint.
• Conducted JAD sessions with business stakeholders to reach a decision on changing strategies regarding the way business will be conducted on the new platform

Confidential

Business Process Analyst

Responsibilities:

• Hands-on experience and good understanding of the hospital system including Registration, Scheduling, Radiology, Laboratory, Pharmacy, Patient Accounting, HIM, Claim Processing functions.
• Identified risks, problems, requirements and concerns of the Hospital in order to comply with PHI regulations.
• Used Business Process Re-engineering BPR in IT Project, Business process optimization and process mapping
• Performed baseline assessment of Hospital-Provider systems and related interfaces. The existing service level agreements and/or policies and operational business procedures for readiness to comply with HIPAA
• Gathered requirements by conducting interviews with end users.
• Expertise at analyzing, designing and Business Process reengineering system applications and business Technical processes.
• Prepared use cases, functional system requirement specifications so that developers can understand the business process and rules according to their perspective.
• Identified potential business problems and UAT implementation problems.
• Highly involved in documenting department workflows and process flows with respect to applications. Analyzed System flows of various department of the hospital.
• Involved in providing education about the 5010 standards, its requirements, complexity and accuracy to Physicians and Nurses of the hospital.
• Re-Organized the collected data and prepared documentation for implementation.
• Figured out the requirement of training in various departments of the hospital based on their daily work.
• Performed impact analysis on applications for deadliness of conversions.
• Experienced in SDLC life cycle, understands and developing process workflow diagrams, and documenting As Is and To Be processes.
• Additionally, was also responsible to meet the information demands of our business users by delivering timely, accurate, meaningful and standardized data and reporting
• Mapped the collected data with the existing data provided by the hospital departments.
• Also, used Word, Excel and Visio as a working tool and SQL scripts/queries for data verification and validation.