SUMMARY

• Overall 8+ years of extensive 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.
• Experience and understanding of Healthcare and Health Insurance business models and operations including Enrollment, Membership Management, Claims Processing, and Client Management
• In - depth understanding of provider networks, managed care contracts, Accountable care organizations ACO, patient benefit plans, and administrative procedures that support new and existing contractual agreements within hospitals and Centers of Excellence.
• Expertise in Healthcare Systems ITS, Health insurance plans Indemnity plans, Managed Care plans HMO, PPO POS, Government Sponsored Programs Medicare, Medigap, MMIS, FEP SHBP Consumer Driven Health plans CDHP. Medicare Part A, B, C, D and Medicaid systems.
• Involvement in all phases of Software development life cycle including System Analysis, Design, Modeling, Implementation and Support.
• Experienced in software development life cycle such as Waterfall, Agile/SCRUM and SAFE methodology, Business Analysis and Modeling.
• Experienced in working with executives, subject matter experts and client in all the revenue cycle management departments and front office departments to ensure a positive patient experience
• Experience in creating Power BI reports and data Visualization dashboards.
• Experience in Medicaid Management Information System (MMIS). Expertise in various subsystems of MMIS- Claims, Provider, Recipient, Procedure Drug and Diagnosis (PDD), Explanation of Benefits (EOB).
• Experience in documenting the methodologies for integrating data from different applications to EDW.
• Solid experience in using Microsoft BI studio products like SSIS, SSRS, Power BI, Power Pivot, Tableau, SSAS, Python.
• Experience in writing complex SQL queries involving multiple table’s inner and outer joins, stored procedures.
• Good knowledge ofETLreporting tools Power BI, Tableau, QlikView and Excel to develop dashboards and data
• Extensively used rational tools for UML, tracking and reporting and applied the Rational Unified Process in all areas of a software development life cycle.
• Having extensive domain knowledge in MMIS, EPIC, EDI X12, HIPAA, System, Medicare and Medicaid, CMS Compliances/Regulations.
• Extensive experience in usingTableaufor analyzing data sources from Excel/MySQL, Oracle, SQL server
• In-depth knowledge of conducting User Acceptance Test (UAT), data quality checks using SQL, gap analysis and Requirement Traceability.
• Expertise in generating reports using SQL server reporting Services, Crystal Reports, Power Pivot and Power BI.
• Determination of error corrections in those cases where the business units are not able to provide the information (example, the Claims department does not provide corrections for denied claims so the EPRA analysts will have to do it). Medical, Medicaid, and Medicare
• Extensive experience in healthcare insurance payer systems, Security, Compliance, Healthcare Reform implementation, reporting, integration, equivalent consulting experience
• Experience in SQL query skills (Oracle and TSQL) in analyzing and validating SSIS ETL database data warehouse processes.
• Provided cost benefit analysis on recouping financial transactions towards month end close, and Recommended cost saving changes to the products to achieve positive ROI on projects
• Experience in modeling UI wireframes, mockups and documenting the end-user AS-IS workflow and TO-BE business processes
• In-depth knowledge of creating use cases, functional design specifications, activity diagrams, logical, component and deployment views to extract business process flow.
• Experience in Agile environment, participating in daily stand-ups and planning meetings. Worked directly with client SMEs in gathering and defining business requirements. Presented recommendations to client and wrote functional requirements document
• Experience in Creating test documents like QA Status Report, QA Summary Reports, QA Test Logs, Test sign-off, Maintain issue and defect databases.
• Performed UAT and exposure to User Certification Testing (UCT) and Operational Readiness Testing (ORT)

PROFESSIONAL EXPERIENCE

Confidential - Edison, NJ

Sr. Business System Analyst

Responsibilities:

• Worked on Software Development Life Cycle (SDLC) including requirements gathering, analysis, design, implementation, testing and deployment.
• Created EDW source-to-target mapping and report requirements documents.
• Worked on HIPAA EDI transactions such as 835(medical claim payments), 837(medical claims), 276(claim status), 277(claim status response), 278(Healthcareservice review information), 270(eligibility inquiry), 271 (eligibility response).
• Elicited business and functional requirements using in interviews, document analysis, business process descriptions, use cases, business analysis and workflow analysis with the use of Waterfall and Agile methodologies
• Established interoperable data requirements for tracking IPA, ACO Capitation fee and Managed Care - Bundled Payments for Care Improvement (BPCI) involving SNF, LTAC operations.
• Used various customer data to create dynamic BI presentations inTableau& PowerPoint
• Created and maintained user stories in JIRA for better understanding of the requirements for the development team also use JIRA for bug tracking.
• Conducted end-to-end source to target validation of a sample of claims, encounters, eligibility, and provider by year.
• Assisted QA department to write and execute Test plans and Test Cases and work on UAT testing.
• Kept track of Agile (scrum/ Kanban),Safemetricstracking variables to gain transparency on product and sprint backlogs
• Responsible for attaining HIPAA EDI validation from Medicare, Medicaid and other payers of government carriers.
• Followed up on rejected/denied Medicare and Medicaid claims via Epremis, FISS, Epic and HP Web-Portal
• Reviewed the data model and reporting requirements with the Data warehouse/ETL and Reporting team.
• Actively participated in gathering requirements from various SMEs, Financial Analysts, Risk Analysts and Portfolio Management via JAD/JAR sessions.
• Prepared Business Process Models that include modeling of all the activities of the business from the conceptual to procedural level.
• Worked on the BRD document and derived the FRS in to system use case diagrams.
• Created Source to target mapping Documents, business rules, and workflows.
• Created different types reports like graphs, pie charts etc. based on user requirement by using SSRS
• Monitored the compliance mapping of transactions to the EDI transactions standards ANSI -X12.
• Reviewed Stored Procedures for reports and wrote test queries against the source system SQL Server to match the results with the actual report against the Data mart Oracle.
• Facilitated Product Incremental meeting in SAFe Framework with Release Train Engineers, other teams and identified dependencies/ Risk for Project success goals.
• Involved in Microsoft Dynamics 365 data capture, integration, auditing, data mapping, importing data and Creation of interfaces.
• Developed SQL queries and tables which replicated the ETL, and compared the SQL results with the Informatica tables.
• Worked on Informatica Power Center client tools - Mapping designer, Workflow manager, Workflow monitor, Repository manager.
• Interfaced with business users to prepare and update Business Process Requirements for the new release ofhealthcaretools and prioritized outstanding defects and systems problems, ensuring accuracy and deadlines were met.
• Created various data quality mappings in Informatica Data Quality (IDQ) tool and imported them into Informatica PowerCenter as mappings, mapplets.
• Worked in developing Power BI Reports and Dashboards from multiple data sources using Data Blending, Data Model and also resolve the data integration and mapping source to target issues arising out of data transfer to and from distributed sources.
• Performed Data mapping, logical data modeling, created class diagrams and ERP diagrams and used SQL queries to filter data.
• Worked with SQL queries using MS Access for data manipulations and involved in writing scripts for patient online registrations using the VB Script.
• Worked with application team to in corporate application changes into EDW. Involved in training others in EDW design and usage.
• Identified the elements the needs to be mapped for the business requirements and analyze the data and ensure the data was mapped correctly.
• Analyzed data contained by the databases using Structured Query Language (SQL and PL/SQL) and Tableau to confirm data accuracy and integrity of various reports.
• Involved in Implementing metadata standards, data governance and stewardship, master data management, ETL, ODS, data warehouse, data marts, reporting, dashboard, analytics, segmentation, and predictive modelling.
• Involved in upgrading from CRM 2011 to Dynamics 365 Online and Involved in requirements gathering, analysis and project planning.
• Wrote PL/SQL statement and stored procedures in Oracle for extracting as well as writing data.

Confidential - Deerfield, IL

Business Analyst

Responsibilities:

• Met with client groups to determine requirements and goals. Utilized Rational Unified Process (RUP) to configure and develop process, standards, and procedures and create a Business requirement Document.
• Joint Application Development (JAD) sessions with stakeholders throughout SDLC to resolve open issues.
• Worked closely with office of healthcare reform on current issue from CMS on 834 files. Raised tickets with CMS and triage the issues on basis of severity
• Obtainedbusinessrequirements frombusinessusers and stakeholders using interview sessions, brain storming sessions, and personal interviews to get better understanding of the enrollment requirement changes from the Health Insurance Exchange.
• Created frequency distributions of provider type, claims, aid category, by year, and analyze patterns.
• Worked on SQL queries and PL/SQL stored procedures for QA testing and data validation of Metric Reports.
• Facilitated discussions on the shortcoming/limitation/extendibility of the system to provide clear understanding of system capabilities to theclinicalbusiness users.
• Documented all data mapping and transformation processes in the Functional Design documents based on the business requirements.
• Worked in accordance with the Safe Agile/Scrum methodology for various phases of the business and created business vision, business architecture documents and mock reports.
• Analyzing Business Object report and analyzing data in Source EDW systems.
• Involved in designing and developing programs to transform Claims and Membership of most of the regional and operations systems into Enterprise Data Warehouse (EDW).
• Involved in defining the source to target data mappings, business rules and data definitions.
• Played the role ofRequirement Analystin critical business functionalities forShared Saving Program (MSSP) and Pioneer Program of Confidential ACO project for Confidential.
• Created Business requirement documents and plans for creating dashboards by designing and developing Tableau visualization solutions.
• Worked on HIPAA EDI transactions such as 835, 837 (P, D, I) 276, 277, 278 etc.
• Performed ETL Testing/Validation (Designed and documented test strategy, test plan, test cases, test results, etc.) using Cognos reports to ensure data quality.
• Actively participated inClinicalCareManagementweb application system enhancement by conducting thorough analysis on the app usability
• Enforce compliance withHealthInsurancePortability and Accountability Act (HIPAA) throughout all levels of the program
• Worked with System Matter Expert (SME) and Point of Contact (POC) for Chart of Accounts and GL Balancing of Claims and Membership for EDW
• Visually reviewed, systematically tested, and verified all customer enrollment data when putting customer EDI group data into test or production systems, based on customers' EDI status.
• Worked on Updating EDI Feed data as needed once re-provided by customer for re-initialization. Once successful, assisted in project management finality tasks to mark group as live.
• Troubleshoot any problems found within FACETS and when testing the SQLdatadatabase while validating the business rule.
• Served as a liaison between the internal and external business community (Claims, Billing, Membership, Capitation, Customer service, membership management, provider management, advanced Healthcare management, provider agreement management) and the project team.
• Drove and managed the integration of Power BI and SSRS visualization tools, effectively replacing excel and other outdated processes department-wide
• Worked on automate reporting processes utilizing SSIS, Power BI and SQL Server scheduled Jobs.
• Working with clients to better understand their needs and present solutions using structured SDLC approach.
• Involved in creating databases for various departments forad-hocreporting
• Assisted in writing BRD for the Regulatory Reporting Unit under the system streamlining, followed the Agile Methodology for the entire SDLC.
• Involved in Building, publishing customized interactive reports and dashboards, report scheduling usingTableau server.
• Responsible for integrating with Facets. Designed High level design for new process, integrating with legacy & Facets.
• Involved in mapping data from different EDI files onto database using different routing transformations.
• Translated stakeholder requirements into different tangible deliverables such as functional specifications, user cases, user stories, workflow/process diagrams, data flow/data model diagrams.
• Extensively involved in designing the SSIS packages to export data from various sources like Oracle, SQL Server, and MS Access etc. to SQL Server database.
• Reviewed the data model and reporting requirements for Cognos Reports with the Data warehouse/ETL and Reporting team.
• Maintained key records for purposes of Compliance review, QA/QC, and/or regulatory inquiry. Performed Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data
• Participate in conducting review sessions on regular basis with QA and development teams for preparing status, delivery report and client reporting.
• Involved in Iteration or Sprint Planning meeting (SAFE Agile) with the team members to plan and agree on the stories and backlog items.
• Created reports to evaluate provider performance relative to patient care and associated HEDIS measures.
• Acted as User Acceptance Testing (UAT) coordinator, monitored business testing, and interred with the development team regarding defect status and fixes on a daily basis.
• Identified and clearly defined functional issues and support IT development staff throughout the design, development, unit testing, and implementation phases of the software development life cycle (SDLC)
• Analyzed and translated business requirements into system specifications.

Confidential -Salt Lake City, UT

Business Analyst

Responsibilities:

• Extensively involved in maintaining requirements traceability and communicating any changes to these requirements to different business groups and programmers.
• Created context and workflow models, information and business rule models, Use Case and Object Models during the analysis using rational tools.
• Gathered requirements and modeled the data warehouse and the underlying transactional database
• Using SQL server reporting services (SSRS) delivering enterprise, Web-enabled reporting so creates reports that draw content from a variety of data sources.
• Analyzed Audit and Change Files of 834, 835, 820, 837 PDI, 997, 999 HIPAA EDI Transactions using MS Word, MS Excel, MS Access and Facets PROD PPMO.
• Responsible for writing detailed descriptions of user needs, program functions, and steps required for developing or modifying software programs using Rational Rose (UML).
• Followed Agile methodology, being Business Analyst as Product Owner for better Collaboration among Scrum Master, Scrum Team and Business Stakeholders
• Involved in writing PL/SQL statement and stored procedures in Oracle for extracting as well as writing data.
• Used JIRA for User Story requirements management throughout the Agile Sprints and development life cycle.
• Involved in reviewing and writing BRD, URS and Functional Requirements for MDMBusinessand Data Quality Requirements for Health Insurance Exchange (HIX) and Health information exchange (HIE) system.
• Worked on Health Insurance Exchanges (HIX) working on eligibility, enrollment, premium reconciliations, Medicaid/Medicare provisions of the Affordable Care Act (ACA) direct-to-consumer requirements, etc.
• Conducted JAD sessions with management, SME, vendors, users and other stakeholders for open and pending issues.
• Actively participated in review sessions on regular basis with QA and development teams for preparing status, delivery report and client reporting.
• Collaborated with the QA team to ensure adequate testing of software both before and after completion, maintained quality procedures, and ensured that appropriate documentation is in place.
• Involved Functional Specification Documentation (FSD) and communicated these to the stakeholders.
• Conducted user interviews, gathered requirements, analyzed the requirements by using Rational Rose, Visio and Requisite pro - RUP
• Actively interacted with different business groups to perform Gap analysis to identify the deficiencies in the system by comparing the actual objectives with the system objectives desired.

Confidential -Houston, TX

Business Analyst

Responsibilities:

• Involved in defining the scope and implementing business rules of the project, gathering business requirements and documentation.
• Understand the As Is system, develop the To Be system concept, and prepare the System Process Maps.
• Converted SSRS reports into Power BI reports through implementing Power BI Desktop tool.
• Involved in presentations of the Q/A test results with analysis to the stakeholders and users and documented modifications and requirements.
• Facilitated and conducted JAD sessions with SMEs of all sources and warehouses to help them understand the EDW requirements, identify the GAPs between warehouses and EDW, and identify the alternatives.
• Involved in Designing and Built the Dimensions, cubes with star schema using SQL Server Analysis Services (SSAS).
• Involved in all phases of Software Development Life Cycle (SDLC) and implemented multiple product development initiatives.
• Coordinated with the Scrum masters, Product owners and Project Managers to work in Scaled Agile Framework (SAFe).
• Used various customer data to create dynamic BI presentations inTableau& PowerPoint
• Involved in creating Dashboards as needed usingTableauDesktop andTableauServer
• Created Process Flow diagrams, Use Case Diagrams, Class Diagrams and Interaction Diagrams using Microsoft Visio and Rational Rose.
• Collected business requirements to govern proper data transfer from data source to data target during the data mapping process.
• Identify risks and inform SeniorQASpecialists andQAManagers and participated in development of Test Data Strategy.
• Responsible for attaining HIPAA EDI validation from Medicare, Medicaid and other payers of government carriers.
• Used JIRA for User Story requirements management throughout the Agile Sprints and development life cycle.
• Created Use cases, activity report, logical components and deployment views to extract business process flows and workflows involved in the project. Carried out defect tracking using Clear Quest.
• Involved in using IBM Rational JAZZ Team Concert products and tools to support the application of the Scrum and SAFE Agile Methodologies in developing and managing the application development process.
• Documented elicited requirements into Business requirement document (BRD), Functional Requirement Document (FRD) and Software Requirement Specification (SRS)
• Involved in compatibility testing with other software programs, hardware, Operating systems and network environments.