SUMMARY:

• Over 7 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.
• Functional Knowledge of Medicaid Management Information System MMIS .
• Experience in all phases of the Software Development Life Cycle (SDLC) including
• Exposed to Medicare and Medicaid domains of the healthcare systems and industry for inpatients, outpatients, Reimbursement Methodology.
• Extensively Knowledge in the Member Enrollment and Billing information.
• Knowledge and Experience on, Billing, Claims Payment Processing in relation to HIPAA, EDI 4010, ICD - 9 ICD-10, codes 834, 837,835, and 270, 271.
• Strong knowledge of ICD-9/ICD-10 business analyst with healthcare.
• Able to understand and implement Processing ICD-9 ICD-10
• Excellent knowledge in Software Development Life Cycle (SDLC) / Rational Unified Process (RUP) methodologies, Agile Methodology.
• In dept. knowledge of Software Development Life Cycle SDLC methodology such as Agile, Waterfall and RUP .
• Expert in tuning the performance of SQL queries and ETL process.
• Developed customs reports using SQL
• Knowledge on HIPAA Compliance EDI Transaction Sets 834, 837 and Good understanding of the EDI transaction sets 834, 837
• Expertise in EDI files transferred to Trading Partners in HIPAA 5010 standards
• Efficient in writing Business Requirements Document, Use Case Specifications, Functional Specifications and Workflows.
• Strong knowledge of Use Cases, and Activity Diagram.
• Involved in Facet Implementation and conversion of 4.21
• Extensive Experience in Functional, Integration, Regression, User Acceptance UAT, System.
• Knowledgeable working with ETL process Extract, Transform and Load of data into a data warehouse.
• Designed and implemented basic SQL queries for testing and report/data validation
• Excellent working knowledge in Project Life Cycle and clear understanding of Project Management
• Experienced in client interaction, deep understanding of business systems functionality and technicality.
• Evaluate current QNXT 4.7 system configuration for Medicare Advantage and Medicaid plans and recommend configuration improvements to increase auto adjudication of claims.
• Proficient in Developing and executing Test Plans, Test Case, Test Scenarios, also performing functional, usability testing and ensuring that the software meets the system Requirement.
• Knowledgeable about preparing RTM documents
• Assist IS team with QNXT infrastructure schema questions and solutions.
• Experience in developing project plan and estimating project timeline.
• Develop program and material for new hires and existing configuration team members to increase QNXT knowledge base and facilitate cross within configuration department.
• Excellent working knowledge in Project Life Cycle and clear understanding of Project Management.
• Experienced in performing Gap analysis by identifying existing technologies, documenting the enhancements to meet the end-state requirements.
• Excellent business communication and presentation skills. Adapt at creating, editing, and coordinating extensive communication networks, to keep executive staff and team members apprised of goals, project status, and resolving issues and conflicts.
• Conducted successful projects with the help of teams to achieve deadlines timely and proficiently.
• Organized, goal-oriented, self-starter, and ability to master new technologies manage multiple tasks while following through from start to completion.
• Experienced in analyzing business requirement at all stages of Software development of life cycle SDLC.

PROFESSIONAL EXPERIENCE:

Business Analyst

Confidential,Washington, DC

Responsibilities:

• Work closely with business to identify the requirements and provide support in the development of technical proposals and provide input on the technical content and level of effort of the proposed scope of work.
• Created User stories, business requirements documents and technical design deliverables, process flows and Mockups for all the business applications.
• Assisted in industry standard requirements elicitation such as Joint Application Development (JAD), interviews, prototyping, and user observation.
• Acted as team member in the requirements traceability such as tracing across the software development lifecycle to ensure that each succinct requirement is met at each step of the life cycle.
• Implemented knowledge of healthcare terminology and industry changes such as ICD-10, healthcare, and SDLC processing.
• Developed Gap Assessment and Impact Analysis Roadmap, Implementation Advanced Planning Document (IAPD) and developed the action steps to fill the gaps for the HIPAA compliance.
• Assist internal infrastructure team with QNXT schema questions/solutions.
• Meet with client SMEs to develop new or update current business practice.
• Developed new letter generation process utilizing current QNXT configuration for utilization management team.
• Analyze and resolve production claims issues for Medicaid product when client's claim team is unable to resolve issues.
• Assist with the implementation and integration of EAM system into QNXT 4.7.
• Lead on project to clean up corrupt provider records within QNXT affecting claims payment.
• Analyze and resolve all payment manager issues within QNXT.
• Publishing test cases to HP-QC, providing test data to QA test team, manage defect and bi-directional traceability.
• Developing GAP matrix for test case coverage from End to End Test Scenario.

Confidential, Greensburg, PA

Business Analyst

Responsibilities:

• Assisted project managers with the development of project schedules.
• Successfully used Agile/Scrum Method for gathering requirements and facilitated user stories workshop. Documented User Stories and facilitated Story Point discussions to analyze the level of effort on project specifications.
• Working closely with the scrum teams and larger organization on how to get the most out of Agile/Scrum practices
• Performed scope analysis, impact analysis and GAP analysis
• Managing business requirements through Rational Unified Processes (RUP).
• Responsible for resolving issues related to financial module like AP, GL, FA and Sys Admin. Setups.
• Plan new workflows and clinical IT solutions towards health care.
• Performed risk analysis of the requirements to identify key business areas for the project.
• Propose new table data models, existing table changes to support project requirements.
• Developed the requirements document and a preliminary design for the HIX web portal.
• FacetsProduct Configuration of new products and components including research, testing and trouble shooting inFACETs.
• Skilled in using change control and bug tracking tool JIRA for identifying, analyzing, assigning and documenting defects including version and change control.
• Worked with the management for improving and giving new ideas for designing future processes of the HIPPA transactions dealing out with EDI'S 271, 276 and 270, 470, 835, 837, 834, HIPAA 4010, 5010, claim adjustments, claim processing from point of entry to finalizing, claim review, identifying claims processing problems, their source and providing alternative solutions using best practice model and principles and also well versed with ICD10,Facets.
• Firm understanding of HIPAA regulations and experienced working in all phases of healthcare insurance processing like defining Eligibility and Enrollment and various Medical Claims processing.
• Effective management of clinical data using Electronic Medical Records (EMR) and Electronic Health Records (EHR).
• Created source to target mapping documents from staging area to Data Warehouse/Data Mart.
• Experience in using Quick Test Professional (QTP) testing for Client /Server, Web and Database Applications.

Confidential, Franklin Lakes, NJ

Business Analyst

Responsibilities:

• Prepared Business Requirements Documents, Functional Requirement Documents.
• Worked extensively with developing business rules engine enabling the business rules such as referral, prior authorization, eligibility, claims processing and billing essential.
• Utilized Agile Software Methodology using Scrum framework. Actively participated in creating the user stories and prioritizing user stories along with tracking of burn up, burn down charts to estimate sprint delivery
• Performed GAP analysis by performing the system analysis between the scheduling systems and documented the gap items.
• Conducted JAD sessions, meetings, workshops to gather requirements from various stakeholders and SMEs.
• Facilitated all Aspects of scrum framework, including product backlog, release backlog, sprint planning session, daily scrum meeting, sprint reviews and sprint retrospectives.
• As scrum master communicated dependencies and potential risk to the completion of the sprints including resources, costs and systems.
• Created data mappings to transform the data according to business rules.
• Developed Test Cases for unit testing, prepared spreadsheet for testing criteria, including regression, positive and negative testing, process flow testing and screenshot for test results to complete expected and actual results.
• Prepared various diagrams by using MS Visio.
• Prepared documents for the wireframe and prepared a data dictionary for the same
• Managed testing for various functionalities using Quality Center tools.
• Worked closely with QA and Developers to clarify/understand functionality, resolve issues and provided feedback to nail down the bugs.
• Maintained a close and strong working relationship with teammates and management staff to achieve an expected QA result for the project team.
• Conducted project related Presentations periodically to the management and end users during various phases of Software Development Life Cycle SDLC .
• Conducted weekly meetings for deciding the Policies and Procedures to be followed while constructing new sites.
• Gathered high-level requirement for all the external projects in a release.
• Performed the requirement analysis, impact analysis and documented the requirements.
• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims.
• Developing a single application to process data from multiple integration points, convert the data for reporting purposes and feed data into mainframe system to be compliant to reporting requirements.
• Performed Analysis on Data mapping between different data models.
• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims.
• Used different ad-hoc analysis, the Reports assist in defining strategy for each customer category. Informatics was used for ETL process and Business Objects.
• Created ICD-9-CM/ICD-10-PCS comparison document and dealt with DRGs.shift through CMS files.
• Documented ICD9 to ICD 10 mappings one to one/one to Many according to the GEM files from CMS with the functional and structural changes related to the conversion
• Involved in Able to understand and implement Processing ICD-9 ICD-10
• Worked on EDI transactions: X12,835, and 837 P.I to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes

Confidential, Cypress, CA

Business System Analyst

Responsibilities:

• Involved in handling HIPAA/EDI Medical Claims, design and documentation.
• Monitored and Analyzed activity report and transaction monitoring.
• Created document and diagrams for enrollment according to HIPAA 834 compliance standard for enrollment.
• Worked on improvement of Claims Reimbursement User Interface for a better experience and in corporate changes as per HIPAA guidelines using the gap analysis.
• Conducted meeting with the development team to discuss any requirement changes.
• Checked inbound/outbound HIPPA regulated EDI transactions facets.
• Experience in Health Care Insurance Industry with exposure to Electronic Medical and Health Records (EMR & EHR)/Automated Health Care Systems.
• Extensive experience in Health Care and well versed with HIPAA compliance, HL7 standards, CMS HCPCS, ICD 9/ICD 10 coding multispecialty, e.g. Interventional Radiology, Respiratory Therapy, Nuclear Medicine, and Breast Center.
• Expert on US Health Care Industry, Electronic Data Interchange (EDI), Health Level 7(HL7) and Health Insurance Portability and Accountability Act (HIPAA).
• Conducted business validations, covering the following deliverables: FACETS Providers, Facets Claims and Facets and Operational reports
• Involved in GEM (General Equivalence Mapping) tools for forward mapping of ICD 9 - ICD 10 CM/PCS codes.
• Involved in Manual Testing and UAT testing.
• Performed felid-by-field mapping of interface between parent EMR system and downstream system.
• Prepared BRDs (Business Requirement Documents), Functional requirement documents, supporting documents containing the essential business elements, detailed definitions, and descriptions of the relationships between the actors to analyze data requirements fromData ware house.
• Performed GAP analysis of business rules, business and system process
• Designed Activity, Sequence and process flow diagrams using MS Visio to simplify and elaborate certain selection and filter condition.
• Documented requirement using Use Case analysis.
• Conducted JAD session, meetings, and information sessions to gather the requirements from the clients.

Confidential, Blue Bell, PA

Business System Analyst

Responsibilities:

• Led the initiative on process improvement by identifying and migrating jobs that were running on a specific server to distributed environment. This allowed to process jobs much faster, and ability to retire legacy servers.
• Defined process flow for Development team to automate manual executions
• Participated in the Scrum Cycle for requirement gathering and represented Data Operations in related Sprint stories.
• Worked with cross functional teams in order to establish comprehensive business and functional requirements and translate those requirements into software design specifications using various notations of UML.
• Worked with Facets System implementation, Claims and Benefits configuration set-up testing, Inbound/Outbound Interfaces and Extensions, Load and extraction programs involving HIPPA 834 and proprietary format files and Reports development.
• Developed test plans based on test strategy for Data Warehousing Application.
• Created and executed test cases based on test strategy and test plans based on ETL Mapping document.
• Conducted requirements analysis and performed GAP analysis.
• Preparation of technical specifications and Source to Target mappings.
• Extensively used SQL programming in backend and front-end functions, procedures, packages to implement business rules and security.
• Develop test deliverables (test plan, defect report, status report, etc.) and automate testing scenario design for various platforms.
• Created UAT test cases and scenarios based on Use Cases and made sure those UAT test cases meets the business requirements.
• Wrote Test Cases for ETL to compare Source and Target database systems.
• Interacted with senior peers or subject matter experts to learn more about the data.
• Identified duplicate records in the staging area before data gets processed and conducted data validation testing.
• Assisted in System Test and UAT testing scenarios as required.
• Actively involved in the requirements gathering sessions.
• Tested the source and target databases for conformance to specifications.
• Conditional testing of constraints based on the business rules.
• Developed automated test scripts from manual test cases for Regression testing based on the requirement documents using Quick Test Professional / ALM.
• Defects identified in testing environment where communicated to the developers using defect tracking tool Mercury Test Director.
• Involved in testing scripts as part of the ETL process, automate the process of loading, pulling the data.
• Worked with ETL group for understating mappings for dimensions and facts.
• Extracted data from various sources like Oracle, flat files and SQL Server.
• Extensively tested several Business Objects reports for data quality, fonts, headers & cosmetic.