SUMMARY

• Over 8+ years of Experience as Business Analyst in Healthcare include understanding of Business Requirement Gathering, Business Analysis, Joint Application Development JAD sessions with clients and referring to accessible documentation and procedure.
• Expertise in Analysis and Review of Software and Business Requirement Documents.
• Experience in performing Business Process Reengineering/Gap Analysis to check the compatibility of the existing system infrastructure with the new business requirements.
• Experienced in Medicare and Medicaid domains of the healthcare systems and industry for inpatients, outpatients, Reimbursement Methodology and Medicaid Management Information System (MMIS).
• Experience in all phases of the Software Development Life Cycle (SDLC), Rational unified process (RUP), agile methodology.
• Preparing Business Process Models that include modeling of all the activities of the business from the conceptual to procedural level. Followed top down, leveled technique for building Business Process Models.
• Extensively participated in verification of EDI file formats against Standards.
• Proficient in developing UAT plans, UAT cases, UAT scripts and executing UAT.
• Extensive knowledge of Healthcare Insurance including Medicaid. Medicaid Information Technology (MITA), Medicare (Part A, B, C, D), Procedural and Diagnostic codes, Claims Process and Medicaid Management Information Systems (MMIS).
• Solid understanding of Business Requirements gathering, Business Process flow, Business Process Modeling and Analysis, design documentation.
• Possess excellent business, analytical, and interpersonal skills with the ability to communicate with Developers, Architects, Subject Matter Experts (SMEs), Business Stakeholders, Testing team and Senior Executives.
• Excellent knowledge of Health Insurance Portability and Accountability Act (HIPAA) transaction and code set rules such as EDI 837,270,271,276,277,834,835.
• Experience working in Medicare and Medicaid projects.
• Proficient in writing queries/ SQL/ MS Access to assist in UAT, data validations and data analysis.
• Experience using Rational Rose, and MS Visio for business process modeling and designing data flow diagrams.
• Exceptional Documentation Skills for writing Use Cases and Functional Requirement Documents.
• Expertise in creating Use Case diagrams, Activity diagrams, Data Flow Diagrams (DFD), Sequence diagrams, State diagrams based on UML Methodology and business process flow diagrams using MS Visio/Enterprise Architect/Rational Rose.
• Experience in implementation of HIPAA changes in the claim processing integrated systems.
• Extensive experience in claims processing and billing, Medicare/Medicaid billing and claims management.
• EDI healthcare experience working with implementation guides, TR3s.
• Strong knowledge of HL7, HIX (Health Insurance Exchange), EMR/EHR, Health Care Reform and Patient Protection and Affordable Care Act (PPACA) and Facets.
• Experience in conducting JAD Sessions to develop an architectural solution that the application meets the business requirements, resolve open issues, and change requests.
• Experience in Rational Unified Process (RUP), Rational Requisite Pro, Rational ClearQuest, and Microsoft Project.
• Performed AS - IS and TO-BE business process flow for clear translation of Functional to system requirement specification.

PROFESSIONAL EXPERIENCE

Confidential, Yonkers, New York

Business Analyst

Responsibilities:

• Involved in documentation of Functional Requirement Documents (FRD/SRS) and the Non-Functional Requirements and used SharePoint for document and file management.
• Applied Agile (SCRUM) methodology to develop the application and worked closely with Data Architects and ETL Leads and was responsible to perform detailed data requirements analysis.
• Involved in GUI Design sessions with Usability Team while system compatibility and usability were tested manually.
• Also worked on implementing Intelligent Character Recognition (ICR) which is an advanced OCR to detect various kind of handwriting on the patient records in the system. This was done to retrieve the information from the patient ID or patient records in the client portal.
• Provided the Data mapping document and assisted the team to create the mappings.
• Facilitating priority meetings with stakeholders to help business understand the impact of the JIRA in prioritizing them.
• Created and assessed current and future process models for the purposes of creating common understanding and uncovering process issues.
• Identified business logic and prepared Business Process Modeling diagrams, Use Case Scenarios, Use Case Stories and describe the requirements with relevant UML Diagrams and facilitate data validation.
• Responsible for gathering and preparing requirement documents, working with the development team on the delivery of functionality, to confirm that the end result meets the specified requirements.
• Involved in HIPAA assessment and HIPAA X12 EDI transaction (820, 834) mapping and identified changes that needed to be done to comply with HIPAA regulations and HL7 compliant.
• Instrumental in instituting a process workflow to improve EDI transactions and improve claims processing. Assisted in this process flow.
• Assisted in using AJAX for batch processing to make sure that our widgets have real time updates from the server without user having to reload the page and clients could see automated progress after performing each step of capturing the patient ID.
• Created various Use Cases and workflow diagrams using MS Visio.
• Maintained Traceability Matrix in Excel and improved data collection quality using Six Sigma.
• Worked on Amazon Web Services (AWS) for cloud products and services.
• Conducted brainstorming and prototyping to form a baseline structure associated to the proposed recognition and reading system properties and focus on error handling and error management.
• Generated Charts like Line-Chart, Bar-Chart, Scatter Chart, Pie-Chart, Multi-Dimensional Chart for analyzing situations. Analyzed the data using Data Analysis in excel.
• Used Service Oriented Architecture (SOA) using JSP In the presentation layer, worked on the fixed source capture device like desktop scanners and high-speed sorters to capture the code from the patient ID.
• In the middle tier, worked on linking the XML tags to create, modify and change the existing provider details and also mapped the APIs to the HMO, PPO, and POS.
• Involved in analyzing defects that have been reported in the JIRA and sending them over to the developers for a fix.

Confidential - Grand Rapids, MI

Business Analyst

Responsibilities:

• Work as a Business Analyst while building US Health Care Public Exchange (HIX) & WEM as well as for respective implementation (MA, KY & CO) carved out of Federal Exchange product.
• Enterprise-wide effort to implement the Health Insurance Exchange (HIX)/ Health Care Reform and Patient Protection and Affordable Care Act (PPACA).
• Committed to establishing FFM/FFE (Federal facilitate Exchange) under HIX (Health Insurance Exchange) that meet the functional requirements of Patient Protection and Affordable Care Act (PPACA).
• Gathered requirements, organized team meetings requirements from business users such as insurance policy managers, generated business process models, & use-case models, and created business requirements document (BRD) & functional requirements document (FRD).
• Configured facets modules such as Claims, Membership, Billing, Benefit, and plan.
• Responsible for ensuring HIPAA EDI Trading Partner transactions meet established standards and can be transmitted and processed.
• Prepared test data from user stories, write and execute test cases in JIRA.
• Translated business requirements into User stories and functional requirements. Used Rally and Jira for tracking and monitoring.
• Worked closely with Business end-users and developers for detailed understanding of the opportunities for improvements of systems in order to gather requirements and prepared a comprehensive set of documents to define the specifications and business value of the system.
• Prepared and maintain Business Rules Spreadsheets (BRS) identifying Rules, Triggers, and corresponding data fields from Legacy to target CRM application.
• Worked as a liaison between the developers and the QA team in creating the Test Plan and Test Cases using Rational Test.
• Have conducted knowledge transfer sessions to Jr business analyst on using Team foundation server.
• Developed Use-Cases, Business rules, functional and non-functional requirements after understanding the business processes.
• Created the use case diagrams, and Process flow diagrams using MS Visio.
• Conduct JAD/JRD with Business and SMEs to come up with BRDs.
• Involved in Writing use case based on HIPAA standards.
• Responsible for creation of Collaboration Diagrams, Activity Diagram, Project Flow Diagram in MS Visio.
• Implemented and managed the formal SDLC implementation using the RUP/Agile Methodologies (depending on the client and project).
• Conducted workshops to understand requirements for Data Warehouse design. Conducted client-side validation to study ETL Extract Transform and Load operations on database.
• Integrated the Picture Archiving and Communicating system PACSs with heterogeneous information systems like hospital information system HIS and radiologic information system RIS.
• Utilized Informatica to ETL data for business intelligence and reporting.
• Strong knowledge of creating conceptual data models, ER diagrams, data mapping, data profiling, data verification, data integrity, ETL process, data normalization, data dictionary, SQL queries for data analysis and data validation.
• Demonstrated experience in Data analysis, data cleansing, and data migration.
• Performed Data mapping in XML, XQuery and performed data analysis with SQL Queries
• Created Process Flow diagrams, use case diagrams UML using MS-Vision.
• Prepared and documented System Requirements and workflows for the Content Management Application tool.
• Create technical design documentation for the data models, data flow control process, metadata management.
• Created reports and presentation of key components and milestones to Top Management
• Helped in development and functioning in workflow analysis and process design.
• Provided data modeling support to each logical data model according to specifications of EDM.
• Worked with developers, testers, and business users, stakeholders at various levels at different stages of the SDLC.

Confidential, Oklahoma City, OK

Business Analyst

Responsibilities:

• Analyzed, documented, and managed all project requirements and change to requirements throughout the software development lifecycle using Requisite Pro.
• Involved in various Facets Data models like Gateway, Claims, Membership, Provider, Billing, Capitation, Invoice Benefits, Product and Plan.
• Gathered Business Requirements and wrote Business Requirements Document (BRD) by working with the client IT staff, project managers.
• Worked according to the activities/roles laid down in each phase of software development life cycle created using agile methodology.
• Liaison and coordinated in resolving HIPAA/EDI mapping issues arising from the third-party systems.
• Responsible for writing Functional Requirement Specifications FRS and User Requirement Specification URS.
• Analyzed and documented the system specifications, Business requirements and detail design of the software for full understanding of the business and used Requisite Pro for the requirement tracking and analyzing.
• Worked with various IT functional areas as well as regularly interacted with hospital personnel such as Clinical Informatics, hospital IT management, clinicians, physicians, and senior management.
• Performed requirements analysis and design using Rational Rose and Requisite Pro.
• Conducted JAD sessions for communicating with all the project directors and stakeholders. Created process workflows, functional specifications, and project initiation artifacts.
• Created Use-Cases, Sequence and Collaboration Diagrams to demonstrate software architecture and interaction of system components before prototyping. Used Rational Rose, Requisite-Pro for requirement traceability.
• Responsible for data management, data modeling, data mapping from xml to facets.
• Responsible for SDLC Technical Writing/Requirements Gathering.
• Analyzed Impact analysis when there is any change in the requirements and updated the Business Requirements Document (BRD) and Systems Requirements Specification (SRS).
• Involved in GAP analysis around the identification of business rules, business and system process flows, user administration, requirements, and assumptions.
• Worked on theEDI 834-fileload toFacetsthrough MMS (Membership maintenance sub-system).
• Worked onHIPAA Transactionsand Code Sets Standards according to the test scenarios such as270/271, 276/277,837/835transactions.
• Held Weekly Status meetings to track changes and respond to any project variables.
• Involved in developing and implementing change control policies and procedures for EMR template change requests.
• Worked closely with QA and Developers to clarify/understand functionality, resolve issues and provided feedback to nail down the bugs.
• Involved in developing test cases and scripts based on business requirements for the GUI, functional, User Acceptance & System Back-end testing.
• Utilized SQL Server and Oracle databases to query the claims processing system.
• Involved in White Box Testing of the Java Code with developer in Unit Testing phase.
• Performed Backend testing by using PL/SQL queries to test the integrity of the application.
• Interacted with developers & various members of my team to discuss and resolve defects and their priorities.
• Reviewed and evaluated all the modules of the software before delivery to users to confirm its meeting the standard criteria.

Confidential -Raleigh, NC

Business Analyst

Responsibilities:

• Built an Information Security Risk Assessment (ISRA) for the secure exchange of health insurance data as part of the Affordable Care Act (ACA).
• Responsible for implementing payers onto the Health Care Exchange (HIX) for the Affordable Care Act.
• Strong working knowledge of the 834, 837 & 835 EDI Healthcare files and Transactions.
• Compiles validate and report system-wide metrics to attest meaningful use of EHR to the Centers for Medicare and Medicaid Services.
• Involved in creating, altering, and implementing T-SQL Stored Procedures for the use of processing consumer data and developing new web delivered tools.
• Responsible for UAT User acceptance testing (UAT) is the last phase of the software testing process. During UAT, actual software users test the software to make sure it can handle required tasks in real-world scenarios, according to specifications. project planning like creating testing scenario, test plans, and test scripts.
• Assisted JAD sessions to identify the business flows and determine whether any current or proposed systems are impacted by the EDI X12 Transaction, Code set and Identifier aspects of HIPAA.
• Gathered the Requirements for Medicare Systems as part of Patient Protection Affordable Care Act (ACA) eve loped Schemas of EDI X12 Claims (837) and Eligibility forms in XML.
• Perform responsibilities of conducting research on IT requirements and business requirements in UAT areas.
• Responsible for support and enhancement requests for a SQL data warehouse and transactional database.
• Performed Regression, UAT, Integration, User Interface, GUI, and Usability Testing and wrote test cases and test scripts, execute test scripts, and analyzed outcomes.
• Wrote user acceptance testing (UAT) scripts and led testing/ quality assurance for both HL7 ADT interface and the application.
• Generated and maintained SQL Scripts to perform back-end testing on the oracle database.
• Produced customer functions, complicate SQL commands in Business Object Enterprise XIR2 and Oracle 11g, Crystal Reports XI environments.
• Assist clients in resolving billing issues for Medicare, Medicaid, and private insurance.
• Involved in creating sample mappings for the conversion of EDI X12 transactions code sets.
• Coordinated with QA teams in the execution of User Acceptance Testing (UAT)
• Acted as an SME on various subject areas including state reporting, death benefits, Medicare, Bill review and RX eligibility.
• Troubleshooting utilizing CPT4 codes and Managed HL7 interfaces for PM/EHR software and Lab computers and performed requirements gathering, business process mapping and re-engineering as a part of health exchange readiness efforts for leading public health plan entering state HIX market.
• Involved in designing a state-customized Financial Management solution for Health Insurance Exchange (HIX).
• Involved in HIPAA/EDI Medical claims analysis, design, implementation, and documentation.
• Developed various test cases for testing HIPAA 8371/P/D 834/835 and 276/277.
• Ensured that the pre-UAT activity is performed accurately and efficiently.
• Developed UAT test process and monitored SIT execution phases.
• Troubleshoot EDI, and XML document errors and troubleshoot translation and mapping errors.
• Involved in developing EDI specifications and applications structures for data feeds and mappings for integration between various systems, including XML In computing,

Confidential - Philadelphia, PA

Business Analyst

Responsibilities:

• Responsible for implementing payers onto theHealthCareExchange (HIX) for the AffordableCareAct.
• Strong working knowledge of the 834, 837 & 835 EDI Healthcare files and Transactions.
• Built an Information Security Risk Assessment (ISRA) for the secure exchange ofhealthinsurance data as part of the AffordableCareAct (ACA).
• Compiles validate and report system-wide metrics to attest meaningful use of EHR to the Centers for Medicare and Medicaid Services.
• Responsible for UAT User acceptance testing (UAT) is the last phase of the software testing process. During UAT, actual software users test the software to make sure it can handle required tasks in real-world scenarios, according to specifications. project planning like creating testing scenario, test plans, and test scripts.
• Assisted JAD sessions to identify thebusinessflows and determine whether any current or proposed systems are impacted by the EDI X12 Transaction, Code set and Identifier aspects of HIPAA.
• Gathered the Requirements for Medicare Systems as part of Patient Protection AffordableCareAct (ACA)eve loped Schemas of EDI X12 Claims (837) and Eligibility forms in XML.
• Lead SCHIP, CMS request to be able to identify the Medicare eligible candidates.
• Perform responsibilities of conducting research on IT requirements andbusinessrequirements in UAT areas.
• Responsible for support and enhancement requests for a SQL data warehouse and transactional database.
• Performed Regression, UAT, Integration, User Interface, GUI, and Usability Testing and wrote test cases and test scripts, execute test scripts, and analyzed outcomes.
• Involved in scheduling, creating snapshots and subscriptions for the reports using SSRS.
• Involved in designing Parameterized Reports for generating Ad-Hoc reports as per the client requirements.
• Wrote user acceptance testing (UAT) scripts and led testing/ quality assurance for both HL7 ADT interface and the application.
• Generated and maintained SQL Scripts to perform back-end testing on the oracle database.
• Assist clients in resolving billing issues for Medicare, Medicaid, and private insurance.
• Involved in creating sample mappings for the conversion of EDI X12 transactions code sets.
• Coordinated with QA teams in the execution of User Acceptance Testing (UAT).
• Acted as an SME on various subject areas including state reporting, death benefits, Medicare, Bill review and RX eligibility.
• Lead projects to design a state-customized Financial Management solution forHealthInsurance Exchange (HIX).
• Involved in HIPAA/EDI Medical claims analysis, design, implementation, and documentation.
• Developed various test cases for testing HIPAA 8371/P/D 834/835 and 276/277.
• Ensured that the pre-UAT activity is performed accurately and efficiently.
• Set up the Agile Rapid Action Development Process for the Project Development and Implementation.
• Developed UAT test process and monitored SIT execution phases.
• Troubleshoot EDI, and XML document errors and troubleshoot translation and mapping errors.
• Involved in developing EDI specifications and applications structures for data feeds and mappings for integration between various systems, including XML In computing.