SUMMARY

• Results - driven, versatile consultant with over 6+ years’ experience as a Business Analyst.
• Good knowledge of Business Analysis methodologies, Iterative and Incremental Software Development Life Cycle (SDLC) using Rational Unified Process (RUP).
• Proficient in gathering business and technical requirements from both formal and informal sessions through interviews, NetMeeting, questionnaire, video conferencing, JAD sessions and conference calls.
• Responsible for integrating with Facets .Designing test scripts for testing of Claims in Development, Integration and production environment.
• Accomplished projects and design documents on HIPAA 835 and 837 calculations and EDI transactions, Health Statements and Explanation of Benefits, Healthcare Reform and 5010 CMS occurrence and field expansion for 835 and 837 EDI formats
• Strong knowledge of Use Cases, Sequence Diagrams, Collaboration Diagrams, Activity Diagrams, and Class Diagrams.
• Extensive hands-on and HealthCare management experience in a variety of projects involving thecustomization, design, development, implementation, and testing of automated systemsto support teh Medicaid Management Information System (MMIS) as well as day-to-day business operations.
• Hands on knowledge of various Health Care standards/requirements like HL7, CCHIT, Meaningful Use & Stimulus Program, HITSP, PQRI, HIE, CQM, DICOM, ISO, IEEE.
• Have proven business insight and teh technical know-how to implement large-scale EMR and EHR engagements.
• Tracked teh day-to-day activities, responsible for new requirements and enhancements associated with EMR EPIC system
• Experience in developing Test Plan and Test Cases as per teh business process requirements to match teh functionality requirements and UML diagrams.
• Possess very good organizational skills, with teh ability to multi-task and deal with shifting priorities.
• Experience in Claims Processing, Claim encounters and Claims Scrubbing in HMO, PPO, Medicaid and Medicare.
• Experience in EDI (270,271,835,834,837) transactions.
• Working knowledge of healthcare Technology standards such as HL7, ANSI ASC X12, IHE XDS/XDM, HITSP, CCR (continuity of Care Record), CCD (Continuity of Care Document), NCPDP Script 8.1, ELINCS, and CDA.
• Worked on various Professional billing and Hospital billing products.
• Experience in working with HHS, CMS or Medicaid Programs, RHIOs, IHDNs.
• Knowledge on medical necessities, software validation and healthcare compliance auditing.

TECHNICAL SKILLS

Methodologies: RUP, Agile, CMMI, CMM, Six Sigma, OOAD, UML, Business Modelling, Process Modelling and Data Modelling.

Office Tools: MS Word, MS Excel, MS PowerPoint, MS Access, MS Project, MS Outlook, Lotus Notes.

Process/Modelling: MS Visio, Rational Rose, Rational Requisite Pro, Smart Draw, Clear Case, Clear Quest.

Testing Tools: Test Director, Quality Centre, Win Runner and Selenium

Operating Systems: Windows 7, Vista, NT/2000/2003/ XP/98

Quality Management: HIPAA, CMMI, CMM, Six Sigma, TQM

Languages: C/C++, Java, SQL, PL/SQL, HTML, XML

Database: MS Access, SQL Server 2000, Oracle 9i & 10g, Teradata

Other Tools: Macromedia Dream Weaver, Macromedia Flash and Adobe Photoshop.

PROFESSIONAL EXPERIENCE

Confidential

Sr. Business Analyst

Responsibilities:

• Extensive experience in Conducting Market Research, Feasibility Studies, Data Analyses, System Analyses, Gap Analyses, and Risks Analyses.
• Gathering market data including real time and historical price data, financial data, and trading news using financial data source named Bloomberg.
• Responsible for gathering requirements from users in operations group and performing data mapping for teh application, confirm and vacillating teh requirement at time of BA testing.
• Solid Experience in developing Scope/Vision Documentation and Project Plan, as well as tracking Project Process, and manage resources to ensure successful delivery
• Experienced in software development life cycle such as Waterfall, Agile-SCRUM methodologies, Business Analysis and Modelling.
• Deep understanding teh Business Flow of Investment Banking, and extensively involved in Portfolio management and analyses, Mutual Funds, Securities trading.
• Verifying and updating teh technical requirements for Facets products feature enhancements & new/existing table changes
• Extensive healthcare experience in Medical Imaging, EHR/EMR, Mobile Apps, Medicare-Medicaid, HIPPA, HIX on EPIC software applications
• Expertise in writing SQLQueries using Oracle, SQL Server and Teradata in validating data into Data Warehouse/ETL applications.
• Worked on EDI transactions: 270, 271, 834, 835, and 837 (P.I.D) to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment.
• Facets Conversion files development. Development of teh database objects required for teh product for each table change in Facets.
• Experience with Medicare, Medicaid and commercial insurances in HIPAA, ANSI, X12 formats including 270/271, 276,277, 278, 835, 837, 997.
• Responsible for conducting teh overall System Testing to verify operations of key FACETS modules involved in teh processing of claims (including benefits), providers and members.
• Documented teh server farm requirements and requirements related to security within Share Point and using Windows Active Directory.
• Built business requirements into teh Medicare Advantage (MA) requirements database and created teh Project Requirements Document for teh three functional areas
• Worked on billing system a cash management module and enhanced teh encrypting standards dat are required for teh application.
• Writing Epics and user stories, managing sprints and backlog grooming, and tracking project progress in JIRA.
• Analyzed system performance and initiated process improvement measures for mainframe and Web-based applications.
• Expertise in teh EPIC Medical software application (EMR, EHR) as it relates to hospital workflows and setting up teh infrastructure for a software implementation in a clinic environment
• Participated in frequent agile team meetings (Scrum planning, daily stand-ups, retrospectives) to provide guidance to an agile product development process.
• Interacted with line of business managers and coordinated teh transition into teh security database to assure business compliance with SOX.
• Used JIRA to perform test management activities and Involved in extraction of data from various sources like flat files, Oracle and SQL Server. Coordinated with teh ETL team to come up with processes for ETL involving Oracle/Informatics
• Responsible for creating test scenarios, scripting test cases using testing tool and defect management for Policy Management Systems, Payables/Receivables and Claims processing.
• Experienced in software development life cycle such as Waterfall, Agile-SCRUM methodologies, Business Analysis and Modelling.
• Involved in development of teh system for data exchange from EMR, EHR to Electronic Lab Reporting Systems

Confidential, El Paso, TX

Business Analyst

Responsibilities:

• Responsible for conducting teh overall System Testing to verify operations of key FACETS modules involved in teh processing of claims (including benefits), providers and members.
• Worked on developing teh business requirement and use cases for FACETS batch process, automating teh billing entities and commission process.
• Was involved in Business Process Management (BPM) activities like Process Design, Process Monitoring and Process Execution
• Maintained independent workload of several Programs including Medicaid,SNAP, TANF, CHIP, Presumptive eligibility and ACA.
• Used FACETS Analytics for fast and easy retrieval, display and grouping of information for performing queries and generating reports.
• Matched teh requirements for programs such as Medicare and Medicaid, which are part of teh Social Security Act.
• Created Use Cases diagram and Activity diagram to depict teh interaction between teh various actors and teh system in Rational Rose for teh Business Use Case and System Use Case.
• Worked closely on 834 transaction code for Benefit Enrollment and was involved in Validation of HIPAA for 837, 270/271, 276/277, 835, 834 EDI transactions.
• Generated a streamline process to understand teh various steps in teh loan lifecycle and desired functionality of teh new system by interacting with users, management, SME (Subject Matter Expert), stakeholders, lenders, underwriters.
• Participated in changes for system design, methods, procedures, policies and workflows effecting Medicare/Medicaid claims processing in compliance with government compliant processes like HIPAA/ EDI formats and accredited standards ANSI.
• Worked on teh Patient Management System (integrated version of Patient Information System with EMR/EHR)) is intended to remotely communicate with a compatible pulse generator from BSC CRM and transfer data to a central database (HIT EHR).
• Conducted brainstorming sessions with teh business users and SMEs to elicit requirements and worked in teh creation of Agile Epics, user stories, Acceptance criteria documents.
• Extracted data by running SQL queries, and reviewed securities, financial and customer metadata dat gets populated on teh web application.
• Facets support systems were used to enable inbound/outbound HIPAA EDI transaction in support of HIPAA 834, 835 /271 transactions.
• Responsible for writing Functional Requirement Specifications (FRS) and User Requirement Specification (URS).
• Led teh development of a training program to train users on a custom web application and a Cognos ad-hoc reporting environment.
• Trained teh team on JIRA tool for Agile/ Scrum Methodologies and Worked with ETL groups and Acquisition team and business analyst for understating mappings for dimensions and facts
• Conducted presentations of teh Q/A test results with analysis to teh stakeholders and users and documented modifications and requirements.
• Experience in EDI automated first-pass claim adjudication, requiring thorough understanding of claim processing, both front and backend operations
• Experience with healthcare system, Medicaid and with prime focus on claims adjudication, provider, eligibility and prior authorization.
• Extensive knowledge of Medicaid, Medicare, Procedural and Diagnostic codes, Claims Process, Health information Exchange (HIE), Electronic Health Record (EHR) and Electronic Medical Record (EMR
• Assigned tasks among development team, monitored and tracked progress of project following Agile methodology.
• Used Test Case distribution and development reports to track teh progress of test case planning, implementation and execution results.
• Created Use cases, activity report, logical components and deployment views to extract business process flows and workflows involved in teh project. Carried out defect tracking using Clear Quest

Confidential, Austin, TX

Business Analyst

Responsibilities:

• Instructed and modeled core Agile principals of collaboration, prioritization, team accountability and visibility, ensured consistent application of SCRUM methodologies across teh enterprise
• Extensive involvement in performing Data-Analysis of teh Backend Systems and existing Web Services to define teh solution.
• Performed analysis, design, development and maintenance of teh Epic Ambulatory applications and other clinical information systems
• Involved in teh full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims. Worked on EDI transactions: 270, 271, 834, 835, and 837 (P.I.D) to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
• Strong experience in all phases of Software Development Lifecycle (SDLC) using Waterfall, Agile/Scrum, RUP (Rational Unified Process) and Software Testing Life Cycle (STLC).
• Developed an implementation guide for Partners for EDI X12 transactions such as 834, 835,837,270 and 271.
• Experience with EPIC user and provider record provisioning, including teh development of role-based access, security classes, and user profiles
• Proficiency with Microsoft Office applications (Word, Excel, PowerPoint, and Visio and Project Management Software), and Atlassian (JIRA, and Confluence)
• Assisted JAD sessions to identify teh business flows and determine whether any current or proposed systems are impacted by teh EDI X12 Transaction, Code set and Identifier aspects of HIPAA.
• Experience in Epic Resolute product implementation and deployment
• Worked on FACET modules such as pricing, payer, eligibility under claims processing system.
• Teh project dealt with enhancements to teh Healthcare Payment EDI transaction set to generate a payer level containing payer specific information.
• Full knowledge of application interoperability configurations and managed teh implementation tasks of HIE clinical applications.
• Involved in teh full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims. Worked on EDI transactions: 270, 271, 834, 835, and 837 (P.I.D) to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrolment hence analyzing and documenting related business processes
• Performed testing for Medicare, Medicaid and X-Over claims for Medicaid Management Information System (MMIS)
• Analyzed set behavior and contribution to business performance, critical business metrics & tracking underlying business trends using Business Objects.
• Involved extensively in writing Agile User Stories and get them reviewed with Business lead and project manager for Sign Off.

Confidential, MD

Business Analyst

Responsibilities:

• Assist with creation and maintenance all necessary documentation and training materials for Epic Ambulatory application
• Performed analysis, design, development and maintenance of teh Epic Ambulatory applications and other clinical information systems
• Involved in teh full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims. Worked on EDI transactions: 270, 271, 834, 835, and 837 (P.I.D) to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
• Interacted with teh DST (off shore) teams for QA support and training purposes. Responsible for running test region EDI loads on AS400 Series. Updated records in AS400 before processing for testing purposes.
• Excellent knowledge of HIPAA standards, EDI (Electronic data interchange) Transaction syntax like ANSI X12, Implementation and Knowledge of HIPAA code sets, ICD-9, ICD-10 coding and HL7.
• Developed an implementation guide for Partners for EDI X12 transactions such as 834, 835,837,270 and 271.
• Experience with EPIC user and provider record provisioning, including teh development of role-based access, security classes, and user profiles
• Expertise in writing SQLQueries using Oracle, SQL Server and Teradata in validating data into Data Warehouse/ETL applications.
• Worked on EDI transactions: 270, 271, 834, 835, and 837 (P.I.D) to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment.
• Facets Conversion files development. Development of teh database objects required for teh product for each table change in Facets.
• Experience with Medicare, Medicaid and commercial insurances in HIPAA, ANSI, X12 formats including 270/271, 276,277, 278, 835, 837, 997.
• Responsible for conducting teh overall System Testing to verify operations of key FACETS modules involved in teh processing of claims (including benefits), providers and members.
• Documented teh server farm requirements and requirements related to security within Share Point and using Windows Active Directory.
• Built business requirements into teh Medicare Advantage (MA) requirements database and created teh Project Requirements Document for teh three functional areas
• Worked on billing system a cash management module and enhanced teh encrypting standards dat are required for teh application.
• Writing Epics and user stories, managing sprints and backlog grooming, and tracking project progress in JIRA.
• Analyzed system performance and initiated process improvement measures for mainframe and Web-based applications.
• Expertise in teh EPIC Medical software application (EMR, EHR) as it relates to hospital workflows and setting up teh infrastructure for a software implementation in a clinic environment
• Participated in frequent agile team meetings (Scrum planning, daily stand-ups, retrospectives) to provide guidance to an agile product development process.
• Interacted with line of business managers and coordinated teh transition into teh security database to assure business compliance with SOX.
• Used JIRA to perform test management activities and Involved in extraction of data from various sources like flat files, Oracle and SQL Server. Coordinated with teh ETL team to come up with processes for ETL involving Oracle/Informatics
• Responsible for creating test scenarios, scripting test cases using testing tool and defect management for Policy Management Systems, Payables/Receivables and Claims processing.
• Experienced in software development life cycle such as Waterfall, Agile-SCRUM methodologies, Business Analysis and Modelling.
• Involved in development of teh system for data exchange from EMR, EHR to Electronic Lab Reporting Systems