SUMMARY

• IT professional wif 7 years of experience in teh areas of IT Healthcare Industry in Business Analysis, Business System Analysis and Project management.
• Facilitating cross - functional team meetings to develop and implement business solutions and optimize operations, conducts impact analysis of new products, systems, upgrades and changes for department/functional areas, and evaluates systems and business processes for feasibility.
• Experienced inclaims management system.
• Strong understanding and working knowledge of MMIS subsystems like Claims, Pre-Admission Screening, EDI, TPI.
• Familiar wif X12 Financial series code set for 820 (Payment order / Remittance advice) and 821 (financial information reporting).
• Worked on multiple projects as a project team member
• Mentored other team members on teh development & support of HL7 interfaces for clinical applications.
• Significant Epic EMR work experience, tasked wif building, implementing and supporting teh Epic application from both teh end user (clinical) and technical perspectives.
• Extensive experience in gathering requirements and estimate effort for HL7 interfaces.
• Experienced wif Federal contracts, X12 transactions, health care act, and EDI transactions 270, 271, 834, 835, 837.
• Good understanding of X12, XML, EDIFACT and VDA. Deep knowledge of PPACA rules surrounding teh Enrolment and Eligibility piece. Knowledge about ANSI X12EDIstandard and HIPAA compliancy mandates for ANSI X12EDI.
• Developing and documenting as-is/to-be business processes, configuration scripts, and other associated technical specifications from end user requirements.
• Analyzing information needs and functional requirements. Evaluating information gatheird, reconciles conflicts, decomposes high-level information into details, abstracts up from low-level information to a general understanding, distinguishing user requests from underlying true needs.
• Preparing analysis templates based on standard UML methodologies for analysis. (Requirements, Use cases)
• Providing guidance to stakeholders on devising TEMPeffective and efficient approaches to achieve teh project objectives using manual processes or software tools.
• Experienced wif Affordable Card Act (ACA) complete implementation.
• Developing and maintaining project plans for all business analysis efforts and selected software deployments.
• Managing direct reports and other matrix staff. This includes participating in interviewing, hiring and performance reviews. Schedules work of staff based on operation priorities, reviews work and mentors’ staff.
• Knowledgeable inETL(Extract, Transform and Load) process to load teh data into a data warehouse or a data mart using Informatica and designing Physical and Logical Data Models using Power Designer.
• Analyzing and assigning Change and Help Tickets related to new development requests and implementations.
• Reporting, tracking and communicating status and issues, based on departmental defined reporting templates.
• Working wif end users to determine business needs/requirements for new/enhanced systems or applications.

TECHNICAL SKILLS

Methodologies: Waterfall, Agile - Scrum, Waterfall Scrum Hybrid, RUP

Project Management: Rally, JIRA, Cognos, HP ALM, MS Project, MS SharePoint

Languages: HTML, SQL, XML, JSON

Database/ETL: TOAD, Oracle DB, DB2, MS Access, SQL Server, Java

Data Warehousing: Data Modeling, Data Marts, Data Mapping, OLTP, OLAP, ETL

Business Modeling Tools: MS Visio, Balsamiq, Lucid Chart, Mockup Screens

Reporting/BI: Tableau, IBM Cognos, Microsoft Power BI, Informatica power center, Swagger tools.

Defect Tracking/Testing Tools: HP QC, JIRA, HPALM, Test Manager, Bugzilla, Postman, Rational Requisite Pro, Rational Rose, TFS.

Operating Systems: Windows, Mac OS

Web Development: Java, CSS, JS, HTML, SPL, XML, REST, SOAP

Miscellaneous: MS Excel, MS Word, GoToMeeting, Google+

PROFESSIONAL EXPERIENCE

Confidential, Indianapolis, IN

Business Analyst

Responsibilities:

• Participated in teh analysis and documentation of current and future needs as well as workflows through interviews, gathering data regarding regulatory requirements, operation procedures and hospital/departmental policies.
• Formulated Business Requirements usingAgile / Scrummethodologies to decompose requirements into Epics and User Stories iteratively.
• Functioned as a liaison to teh system users and stakeholders to translate business requirements into technical requirements, data flows and process flows.
• Provided feedback to physicians and others regarding performance profiles and data trends.
• Involved in developing training manuals for users to help them understand teh business process.
• Prepared a comprehensive set of wireframes to ensure teh consensus onUIwif teh help of SME and by continually interacting wif teh network Physicians for feedback.
• PerformedGAP analysisassessed as-Is processes through user interviews, data collection and analysis, design and evaluation of To-Be process solutions.
• Used Queries to generate monthlyHEDISreport using 12 month rolling measurement period from Clinical data repository.
• Gatheird requirements from wide variety of stakeholders using various elicitation techniques and documented them.
• Assisted in interfacingEMRsystem wif decision support analytics dat summarize patient profiles.
• Directed and participated wif others in teh planning, development, implementation, maintenance, and evaluation of clinical or business application systems as assigned.
• Create and update training documentation and provide user training on ITSM tool.
• Used data mining tools performed in aSQL databaseto analyzeEHRdata.
• AnalyzedCMScomparison documentation highlighting changes of5010 formatandICD10diagnosis and procedure codes.
• Prepared written documentation for application changes or replacements, coordinates staff, and managed project plans for their implementation.
• Participated and developed documents and validated comprehensive test plans complying wif current standards, design to produce successful and failed outcomes.
• Responsible for leading and coordinating User Acceptance TestingUAT, System Integration testingSIT, and Regression TestingRTby working along wif teh QA team.
• Educated analysts and programmers on business requirements, objectives and operational needs and teh relevant system applications.
• Designed and created Excel sheets and used decision tree to provide market analysis charts.

Environment: MS Visio, MS Project, MS Office (MS Word, MS Excel, MS PowerPoint), MS Access, XML, Microsoft Office Suite, SQL, UAT, SQL Server, RUP, SharePoint, UAT.

Confidential, Houston, TX

Business Analyst

Responsibilities:

• Acted as a liaison between Business Area Subject Matter Experts (SMEs) & development team throughout all phases of SDLC; starting from Inception to Transition phase of Rational Unified Process (RUP) methodology.
• Participated on meetings related to HIX impact on systems and teh subsidies.
• Generated numerous Business Requirement Documents & Functional requirements specification documents, Use cases, system flow and work flow diagrams.
• Worked wif teh Managed Care Subject Matter Expert (SME) and Users to ensure dat all teh requirements for system change are covered.
• Worked on various modules of MMIS.
• Worked onEDI transactions: 270, 271, 834, 835, and 837 (P.I.D)to identify key data set elements for designated record set. Interacted wif Claims, Payments and Enrollment hence analysing and documenting related business processes.
• Extracted and refined user requirements by conducting JAD sessions, facilitating meetings & interview wif Business Units and Technical Supports & Development team, identifying teh business flows and process flows, conducting detailed and comprehensive business, functional & system analysis to determine High Level and Low-Level artifacts & deliverables.
• Developed business and detailed functional requirements related to changes to be made to teh claim entry screens, including Practitioner, Crossover Practitioner, Dental and Hospital Claim Entry Screens.
• Assisted in performing User Acceptance Testing for teh ANSI X12 Version 5010/EDI transactions(HIPAA) for Claims Status and Eligibility (270, 271, 276, 277, 834, 837P, 837I, 837D, 835 remittances and NCPDP claims), for teh Facets upgraded system wif emphasis on ensuring dat teh HIPAA regulation are met across all teh modules.
• Involved in remediation of teh legacy MMIS to meet teh minimal functionality necessary to electronically send, receive and process teh HIPAA compliant standard transactions, and fully implement all components of NPI Compliance.
• Incorporated and updated all MMIS screens for NPI Implementation wifin teh MPS1 subpart used for paying claims.
• Created new screen layouts and identified locations for new fields being added and existing fields which are being moved.
• Used teh ETL Tool; Informatica Power Center for Data Mapping and performing transformations. Well versed wif various Data Warehousing Concepts, Schemas, Data Marts, Data Structures, and ER Diagrams.
• Developed business and functional requirements for teh National Provider Identifier (NPI) Crosswalk and Crossover Claims Crosswalk solution.
• Developed Test Plans and Test Execution Procedure Document based on teh Business & Functional Requirement.
• Document and numerous Test Cases and Test Scenarios to cover overall aspect of quality assurance.
• Used SQL Server for writing SQL Queries to perform Data Retrieval, Manipulation, Analysis and Validation.
• Successfully tested all teh test conditions, documented teh defects and discussed wif technical analysts teh discrepancies between expected and actual results for teh test conditions.
• Conducted knowledge transfer sessions which were used to make teh users and other teams aware of all teh changes being made in teh system as part of various projects.
• Assisted End User in performing User Acceptance testing and performed testing of teh end result files created by teh development team to verifying whether all teh User Requirements were catered to by teh development effort.
• Worked wif Team Leads, Technical staff and key users to identify track and manage project issues as they arise.
• Developed workflows dat demonstrate current and proposed business requirements.
• Provided weekly status updates to project stakeholders on teh progress of project development activities.

Environment: MS Office, SQL Server, MS Project, MS Visio, UNIX, J2ee, Informatica, Java, XML, Windows.

Confidential, Minnetonka, MN

Healthcare Business Analyst

Responsibilities:

• Gatheird and validated inventory of applications, interfaces, and reports dat will need to be modified to comply wif ICD-10 requirements.
• Organized impacted systems into high, medium and low impact to help business analyze teh level of effort for remediation activities and ease resource allocation work.
• Prepared and maintained Requirements Traceability Matrix (RTM) throughout teh project lifecycle.
• Participated in monthly calls on ICD-10 impacts for home and host plans.
• Created a comprehensive Test Plan to test existing and new features in teh IVR system.
• Assisted in determining teh right approach to carry out ICD-10 operations by assessing their business and IT operations.
• Conducted brainstorming sessions to analyze provider contracts, provider reimbursement, benefit rules, medical policies and medical management rules to see teh impact of ICD-10 diagnosis codes.
• Worked wif teh compliance and audit team to made sure we were following correct HIPAA guidelines/protocols throughout teh project lifecycle.
• Included in selection committee for teh selection of a code-mapping tool.
• Conducted working sessions to gather and document high level business requirements and detailed level business requirements for different business units impacted by ICD-10 such as EDI Claims Intake, FACETS, Claims Adjudication, Medical Management, Utilization Management, Case Management Provider Reimbursement and Provider Payment.
• Worked wif querying FACETS data via SQL.
• Managed list of vendors and trading partners dat were impacted by ICD-10 and required remediation work to be compliant.

Environment: MS Office Tools, Windows, MS Project, SDLC, Agile, Requisite Pro, Rational Rose, Clear Case, MS PowerPoint, MS-SharePoint, MS-Word, MS-Excel, Business Objects, XML, XSLT, Oracle, SQL Server

Confidential - Nashville, TN

Healthcare Business Analyst

Responsibilities:

• Interacted wif business users and performed Gap and Analysis of Client requirements.
• Worked under Agile methodology attending daily standup calls wif 2- week sprint timeline which were tracked.
• Involved in gathering requirements for developing custom features and components wifin MetaVance.
• Completed teh documentation of Claims Scenario's for teh source system. Analyzed teh existing claims and authorization process and specific business rule logic.
• Designed, developed, tested and maintained Tableau functional reports based on user requirements.
• Utilized Tableau server to publish and share statistic reports wif teh business users.
• Implemented Agile Scrum methodology guidelines to build artifacts in different sprints and phases of teh application development process.
• Identified and eliminated redundancies wifin teh business workflow processes.
• Identified system/application data sources, data integration and data flow processes.
• Provided data integrity strategies and solutions to eliminate any disruption of business and to move changes into a production environment.
• Prioritization of customer value streams based on scaled agile principals of shared software services, continuous integration, and continuous delivery.
• Educated and reinforced Scrum methodology and Agile framework to team members and key stakeholders when needed.
• Coached and developed a distributed team of business managers and technical professionals regarding Agile roles, routines and responsibilities.
• Provided access to end-users for Acceptance Testing and sent defect reports to developers.
• Performed UAT User Acceptance Testing, ATDD (Acceptance test driven development).
• Conducted several levels of testing including functional, regression, user acceptance, integration and performance testing to verify dat teh client’s requirements are met.
• Designed a manual of Inpatient Quality Measures for Medicare & Medicaid Services (CMS).

Environment: Web-based, Healthcare, VersionOne, Axure, Kanban board, Waterfall, Scrum, Agile, MS Visio, MS Excel, MS Word, MS PowerPoint, SharePoint