SUMMARY

• Over 6+ years of Experience as Business Analyst in IT Healthcare include understanding of Business Requirement Gathering, Business Analysis and Joint Application Development (JAD) sessions with clients and referring to accessible documentation and procedure.
• Especially worked with Utilization Management work stream to help Development, and Quality Assurance team to produce business efficient product by providing Product design and business understanding.
• Strong functional expertise in the Healthcare Payer Area - Membership Claims, Benefits, Eligibility, HIPAA, and CMS HCPCS, Care Management Case Management, Utilization Management and Disease Management.
• Hands on Experience with JIRA Tools.
• Exposed to Medicare and Medicaid domains of the healthcare systems and industry for Inpatients, Outpatients, and Reimbursement Methodology.
• Extensive Knowledge in the Member Enrollment and Billing.
• Knowledge and Experience on Membership, Billing, Claims Payment Processing in relation to HIPAA, EDI X12, codes 834, 837,835, and 270, 271.
• Knowledge of healthcare standard Health Level Seven (HL7).
• Extensive use of Claim Management System (CMS).
• Extensive experience in healthcare insurance payer systems, Security, Compliance, Healthcare Reform implementation, Reporting, Integration, equivalent consulting experience.
• Designed and implemented basic SQL queries for testing and report/data validation
• Experienced in client interaction, deep understanding of business systems functionality and technicality.
• MaintainJIRAprojects, workflows, permissions, and users while working in aJIRA
• ImproveJIRAsecurity. Set access permissions forJIRAprojects and Confluence spaces.
• Work withJIRAfilters, reporting, dashboards, workflows, fields, andJIRAadministration
• Excellent working knowledge in Project Life Cycle and clear understanding of Project Management.
• Used tools like JIRA and RALLY to create and maintain Product Burn-down chart, Sprint Burn-down/ Burn-up chart.
• In depth knowledge of Software Development Life Cycle (SDLC) methodology such as Agile, Waterfall and RUP.
• Efficient in writing Business Requirements Document (BRD), Non-Functional Requirement Documents (NFRD), Functional Requirement Document (FRD), Use Case Specifications, Functional Specifications and Workflows.
• Strong knowledge of Use Cases and Activity Diagram.
• Extensive Experience in Functional, Integration, Regression, User Acceptance (UAT), System.
• Excellent business communication and presentation skills. Adaptive to creating, editing, and coordinating extensive communication networks, to keep executive staff and team members apprised of goals, project status, and resolving issues and conflicts.
• Organized, goal-oriented, self-starter, and ability to master new technologies manage multiple tasks while following through from start to completion.
• Conduct research relating to the development of the modernization systems

TECHNICAL SKILLS

Business / Modelling Tools: MS Project, MS Visio, MS Excel, MS Word, MS PowerPoint, Rational Rose, SharePoint

Requirements Management Tools: Rational Requisite Pro

Databases: SQL Server, Sybase, MS Access, Oracle

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

Operating Systems: Windows 95/98/2k/NT/XP/Vista/Window 7

PROFESSIONAL EXPERIENCE

Business Analyst

Confidential - Richardson, Tx

Responsibilities:

• Created updating documentation needed to support knowledge transfer and training to data and solution consumers (so not system documentation but more geared toward our actuaries and underwriters). By documentation this may be true office type documents, videos showing the steps/process, pre-recorded training course.
• Helped with a SharePoint site setup to deliver this information.
• Created FAQ’s on SharePoint.
• Created Classification/Glossary on SharePoint.
• Worked on PowerPoint to create the documents.
• Conducted weekly and monthly meetings to review SharePoint documents, and update the team on project progress.
• Collaborate with teams using MS Teams and Sharepoint services.

Business Analyst

Confidential - Menlo Park, CA

Responsibilities:

• Conducted, Coordinated and Facilitated Joint Application Development (JAD) Sessions for communicating and managing expectations and to discuss the different ways and means for the integration ofFacet with the current system using an "adoption through execution" strategy.
• Wrote User acceptance for user stories via Jira.
• Analyze and resolve claims payment, utilization management aka Health Services, enrollment, and/ or provider production issues when configuration team unable to resolve.
• Interacted with the Subject Matter Experts (SME) and stakeholders to get a better understanding of client business processes and gather business requirements.
• Participated in providing implementation assessment forFacetusing Unified Modeling Language (UML).
• Responsible for successfully setting, managing and communicating the schedule, scope and budget of the projects using project management software like JIRA and Microsoft project management.
• Initiated a new workflow process ensuring compatibility of Jira to a client's change management process.
• Analyzed and worked with X12 HIPAA specific EDI transactions for claims, member enrollment, billing transactions. Worked specifically with 837, 835, 834, 270/271, 276/277
• Converted the XML files into X12 and X12 to XML files on GIS for sending and receiving theEDI files.
• Developed an implementation guide for Partners for EDI X12 transactions such as 834, 820.
• Worked as the primary liaison between the business user and the developers throughout the project cycle.
• Performed Gap Analysis to identify the deficiencies of the current system and to identify the requirements for the change in the proposed system.
• Documented and maintained Requirement Traceability Matrix
• Created Use Case diagrams using UML and Business Process Models using MS-Visio. Developed Use Cases, Sequence Diagrams, Collaboration diagrams, Activity Diagrams and Class Diagrams.
• Responsible for preparing the Software Requirement Specifications (SRS) document, Standard Operating Procedures (SOPs), Functional Specification Document (FSD).
• Understanding Health Insurance Claim Process.
• Scheduled meetings with developers, system analyst's (SA) and testers to identify resource allocation and project completion using MS Project.

Environment: Business Analysis, Waterfall Methodology, Technical Project Management, MS Visio, MS Office Suite, MS Excel, JIRA.