SUMMARY

• Qualified professional wif 7years of extensive experience in theHealthcare, Hospital and Pharmaceutical field of Sr. Business Analysis.
• Expertise working wifthe technical staff, Project Manager, VP, Stakeholder, Clientsto implementandmanageproject from scratch to end wifprioritizinggoals andresponsibilitieswif Budget.
• Worked as Healthcare Data Analysts work in medical billing organizations or in healthcare units where they gather, analyze and compile medical data.
• Expert in HIPAA Transactions and in - depth noledge of HIPAA framework (Health Insurance Portability Accountability Act) riles for ANSI X12 messages 837P/me, 834, 835, 277, 271 etc.
• Strong experience inData Analysis, Data Migration, Data Cleansing, Transformation, Integration, Data Import, andData Exportthrough the use of multiple ETL tools such as Ab Initio and Informatica Power Center.
• Experience in testing and writingSQL and PL/SQLstatements - Stored Procedures, Functions, Triggers and packages.
• Proficient Understanding of ACA, FACETS, MMIS, HL7, ICD 9-10, HIPAA, X12 transactions .
• Expertise noledge in FACETS Providers, claims, Membership and Operational reports.
• Highly motivated team player wif excellent communication, presentation and interpersonal skills, always willing to work in challenging and cross-platform environment.
• Experince working on Hospital Revence Cycle Management wif profound noledge in testing Enrollment, Patient, Deniel, Payment, Billing and Claims processing.
• Knowledge on HIPAA Compliance EDITransaction Sets 834, 837 and Good understanding of the EDItransaction sets 834, 837.
• Extensive experience wif CMS Centers for Medicare & Medicaid Services and Medicaid Incentive Program Transactions Experience (MIPS).
• Extensive experience wif Medicare (Part A, Part B, Part C and Part D) and Medicaid benefits, NASCO, TriZettos QNXT, FACETS as well as ICD 9 and 10.
• Up to date noledge of Industrial, Compliance and Regulatory Bodies like HIPAA, CGMP, GAMP, Six Sigma, FDA, HIM, CMS, 21 CFR chapters 210, 211, 820, 110, 606, CMM and PCMM.
• Interacted closely wif End users from Underwriting & Claims teams and SMEs to understand and gather the business needs and requirements.
• Experienced as aBusiness Analystin using the iterativeSDLCprincipals ofRUPto manage, develop and test distributed client/server, Internet and intranet applications on heterogeneous environments.
• Expertise experience working on the Centricity Business modules BAR, EWS, TES, ICW, and VM.
• Worked closely on 834 transaction code for Benefit Enrollment and was involved in Validation of HIPAA.
• Expertise inEDIfiles transferred to Trading Partners in HIPAA 5010 standards.
• Experienced in troubleshooting and resolving errors in 834 and 820 transactions for health insurance exchanges and performing root cause analysis.
• Experience working on Upgradation, Migration, Integrationfrom legacy system to Newer system .
• Expert in commercial Property and Casualty and Personal Lines Insurance experience wif national carriers.
• Strong noledge and experience in Healthcare Medicaid Management Information System (MMIS),Medicare/Medicaid Claims processes.
• Highly proficient in working wif users to gather requirements, analyze them and subsequently use the Rational project and design tools to model the requirements.
• In-depth noledge of creating use cases, functional design specifications, activity diagrams, logical, component and deployment views to extract businessprocess flow.
• Used Query Analyzer, Execution Plan to optimize SQL Queries.
• Strong understanding of project life cycle and SDLC methodologies Waterfall and Agile.
• Worked in close co-ordination wif the testing team in developing test plan and test cases from functional andbusinessrequirements.
• Expertise in understanding and supporting the client wif Project Planning, Project Definition, Requirements Definition, Analysis, Design, Testing, System documentation and user training.
• Expertise in Gathering requirements, creating As Is and To Be Process flow and preparing FIT - GAP Analysis documents.
• Well versed in writing queries/Scripts for Data Analysis and QA reporting and testing.
• Good noledge of Workflows and Content Management Tools.

TECHNICAL SKILLS

Healthcare Industries: - ACA, HL7, HIX, HIPAA, MMIS, ICD 9-10, Facets, X12, Billing,RCM cycle.

Documentation Tools: - UML, MS Office (Word, Excel, Power Point, Project), MS Visio

Methodologies: - SDLC, Waterfall, Iterative, Rational Unified Process (RUP), Spiral, Agile

Modeling Tools: - UML, MS Visio,Swim lean.

Reporting Tools: - Cognos, MS Office Suite

QA Tools: -HP Quality Center, JIRA, UAT, Testing.

Databases: -MS SQL Server 2005/2008, Oracle 9i/10g/11g, DB2,Dataware house.

Version Control: -SharePoint

Microsoft tools: - MS Office Suite (Word, Excel, Power Point, Outlook), MS SharePoint and MS Project

Languages: -HTML/CSS, SQL, C#, Java

Operating Systems: -Linux, Windows XP/ 7, Mac.

Software Skills: -Adobe FrameMaker,Adobe Photoshop, RoboHelp, SnagIt, Microsoft Visio, Microsoft Office,Microsoft Word, Screen Hunter, GIMP, Accurev, SVN, JIRA, Notepad ++, Adobe Acrobat, MS Project.

PROFESSIONAL EXPERIENCE

Sr. EDI Business Analyst

Confidential - Arlington,TX

Responsibilities:

• Conducted weekly meetings for deciding the Policies and Procedures to be followed working on 1095 issue cases.
• Prepared SOP's for Monthly Premium, Policy Start/ End date, Monthly APTC, Covered Individual, BUUon SharePoint for various Businessto approvals.
• Worked wif SME for defining the processes for the reprints, Missing 1095A, Missing Info, and mailing address updates.
• Created Decision Matrix for the reprints, Missing 1095A, Missing Info, and mailing address updates to benefit the entire 1095A Project.
• Data Extraction by identifying source for the solution to be offered to consumer. Extensive use of MIDAS, EDBO and Pre audit data bases to pull the consumer's data to resolve data issues.
• Training sessions and process walkthroughs provided to the entire 1095A Project teams and provided instructions on how to resolve the consumer dispute.
• Assisted in preparing the consolidated SOP containing all the process of processing 1095A.
• Conducted JAD Sessions to gather the project Requirements and gain more understanding of the various 1095A processing - Reprints, Serco Letters, BUU Updates, BUU Rejects and HICS Updates.
• Developed high level design of new processes and graphically presented them to the project teams.
• As is and To be scenarios created for the Reprints- 1095A.
• Knowledgeable for gap analysis in changing old MMIS and Involved in testing new MMIS.
• Supported all phases of the design, development and implementation of the Enrollment Resolution and Reconciliation process for health insurance exchanges for Consumer Individual Market.
• Gathering requirements as a closeout team on BUU (Batch Utility Update) wif SME's. And creating As Is and To Be Process flow and preparing GAP Analysis documents.
• Worked wif direct client is the Center for Consumer Information & Insurance Oversight (CCIIO) (an office wifin HHS's Centers for Medicare & Medicaid Services, CMS).
• Worked closely wif insurance trading partners, Firms selling insurance coverage through FFM, State-Based Marketplaces.
• Reconcile an Advanced Premium Tax Credit (APTC), a government subsidy to reduce monthly health insurance cost, to what the insurance actually cost for the year.
• Worked closely on 834 transaction code for Benefit Enrollment and was involved in Validation of HIPAA.
• Participate in design sessions, report on project progress and identify potential risks and issues.
• Responsible for troubleshooting and resolving errors in 834 and 820 transactions for health insurance exchanges and performing root cause analysis.
• ValidatedandBuild dictionaries, fee schedules, and payor contractFull file andDaily file on 834 Transaction.
• Performed Unit Testing and User Acceptance testing and documented detailed results.
• Supporting all phases of the design, development and implementation of an Enrollment Resolution and Reconciliation process for health insurance exchanges.
• Responsible for analysis of discrepancies in the eligibility reconciliation process for multiple stakeholders and continuous process improvement of the reconciliation process.
• Provide content to and for collaboration wif training staff on training stakeholders on the transactions and the reconciliation process.
• Analyzed trading partner specifications and created EDImapping guidelines for 834 and 820 transactions.

Business Systems Analyst

Confidential -Detroit, MI

Responsibilities:

• Gathered Business Requirements. Interacted wif the P & L s, Designers and Developers, Project Manager to get a better understanding of theBusinessProcesses.
• Involved in Creating Test Plans based on the URD ( User Requirement Documents) and Design Specifications .
• Experiences workingon Edifacets forANSI x12 837, 834,835 EDITransaction.
• Analysed the Facets Requirements by Conducting Gap Analysis.
• ConductingBusinessvalidations, covering the following deliverables: FACETS Providers, Facets claims and Facets Membership and Operational reports
• Involved in testing HIPAA EDITransactions and mainly focused on Eligibility system 270/271 transaction
• Experience working wif HIPAA 4010A and HIPAA 5010.
• Responsible for creating UML modelling plans, Use cases, process flows, Wire Frames andBusiness requirements documentation using Visio & Requisite Pro
• Analysed and modelled the system using Data flow Diagrams, Functional Hierarchy Diagram and Process Development Diagram
• Worked on the Upgradation from ICD 9 to ICD 10 .
• Systems Documentation included Requirements Document (BRD),Systems Requirement Specification (SRS) and test plans using Requisite Pro
• Analysed the current process and documented the Technical Requirements required for implementing the new HIPAA 5010 standards.
• Acted as a liaison between the IT teams and theBusinessUsers.
• Facilitated meetings wifin the IT platform which includes the Development and theBusinessteams.
• Involved in coordinating wif theBusinessusers to ensure common understanding wif the IT teams.
• Created EDIX - 12 files and compares the results to the expected results.
• Exported scenarios from Excel spreadsheet into Quality Centre 9.2 by using Microsoft Excel
• Created HLE (High level Estimate) for the project, provide training on the transactions and on the reconciliation processes.
• Participation in all phases of testing, Performed testing and thoroughly document issues.
• Queried database using SQL for backend testing.
• Review documented training material for accuracy and assist in end user training and support
• Knowledge of X12 standards development processes
• Responsible in writing and executing Oracle SQL queries against the database designed
• Used Clear Quest to maintain and track the requested enhancements and changes
• Created Project management plans for managing on time delivery using MS Project along wif writing Test Cases, Unit and Systems Integration Test plans in Quality Centre
• Managed defect using HP Quality Centre and Defect Resolution.

Business Analyst

Confidential - Baltimore, MD

Responsibilities:

• Writing requirement specifications and functional specifications, participation in requirement session wif clients and are discussed wif users and gathered so dat they can provide an understanding of the problem or opportunity before trying to propose a solution.
• Worked on the Health Authority Claims management project, a health insurance claim tracker, which tracks hospitals credit business and assist them in noing their outstanding wif the payer and to collect receivables from payers
• Direct interaction wif business users and various stakeholders to gather specific information related to projects.
• Worked on the Documentation of Revenue Cycle Management system for the claim, Proactive Billing, collections etc.
• Interviews, surveys, analysis of historical data, organize brainstorming, facts - finding and structured walkthrough sessions. Identify source of requirements and develop priority matrix. Provide the required domain and functional noledge.
• Using MS Office Suite for creating use cases, workflows and sequence diagrams
• Analyze Operational Procedures & Processes to identify areas for automation or improved workflow.
• Finding out gaps in existing process, arranging training plans for new process development and implementation.
• Provide assistance to the entire team to have an understanding of the project- respond to questions, obtain and provide clarification for designs.
• Serve as a conduit for effective communication between team members in India and team members in North America, Triage Defects.
• Preparation of functional test scenarios including end to end scenarios before demoing to potential clients
• Follow Scrum
• Conducting User Acceptance Testing (UAT) and verifying performance, reliability and fault tolerance issues. Performing GAP analysis and SWOT analysis.
• Responsible to conduct DAILY SCRUM MEETING and lead the meeting as a SCRUM MASTER.

Business Analyst

Confidential -Pittsburgh, PA

Responsibilities:

• Asa business analyst, assisted the Project Manager in defining the detailed scope, objectives, architectural vision of the project, and worked wif the design team during the Conceptual design phase.
• Conduct workflow, process diagram and GAP analysis to derive requirements for existing systems enhancements
• Gathered business requirements by interviewing the Subject matter experts (SMEs), conducting JAD sessions wif stakeholders and documented them in a format dat could be reviewed and understood by both business and technical teams.
• Performed as a business and technical analyst by translating user requirements into practical/integrated process based solution
• Developed and Documented timelines for Project Delivery, and managed Projects and Resources to successfulcompletion.
• havingexperience of entire Software Development life Cycle (1 Project completed)
• Worked along wif the Project Manager and other BA's to develop various project plans to track down the time and progress of various projects using MS Project.
• carriedout extensive analysis of the business requirements and subsequently developed high level Use Cases.
• Prepared Use Case diagrams using MS Visio.
• Prepared basic design diagrams including flow charts, data flow diagrams using MS Visio following the UML conventions.
• Converted functional specifications to technical specifications (design of mapping documents)
• Designed UI (User Interface) models, prototypes for the returns integration workflow.
• Wrote Functional specifications for each of the ETL processes, working in close co - ordination wif business users and development leads.
• Involved in preparing "BRD" Businessrequirement Documents for 4010.
• Followed the AGILE methodology for the entire "SDLC".
• Reportedthe overall progress periodically to the Project Management and business stakeholders.
• Maintained Requirements, Traceability Matrices and Attribute matrices using Rational Requisite Pro.
• Worked on Documentum for Version Controlling, to maintain up to date changes in the Documents.
• workedextensively wif the QA team for designing Test Plan and Test Cases for the User Acceptance Testing
• Conducted User Acceptance Testing (UAT), gathered and documented User Manuals and business Rules.