PROFESSIONAL SUMMARY:

• Business Analystwith around 9 years of proven skills in requirement gathering, interacting with developers, documenting various business processes, coordinating various projects within healthcare
• Experienced in interfacing with stakeholders and senior management with excellent communication and interpersonal skills
• Excellent organizational, multi - tasking, problem solving, risk and time management skills
• Extensive experience with analyzing business processes and documenting them using MS Visio, MS PowerPoint, MS Excel, and MS Project
• Experience in understanding database structures and in writing SQL queries
• Strong experience in developing Use Case Diagram, Use Case document (UC), FRD (Functional requirement document), BRD (business requirement document) requirement Traceability Matrix.
• Proficient in creating UML diagrams such as Use Case, Activity, Sequence, Workflow, Process flow, Data flow using tools such as Draw.io, MS Visio.
• Coordinated meetings with customers, and developers to identify customer needs, gather requirements and authored BRD, FRD across multiple projects.
• Experience reviewing Test plans, Test cases and Test case execution, writing test cases using Quality Center.
• Strong expertise in building Templates, Graphical analysis charts and Statistical reports using MS Excel, MS Word, MS PowerPoint, MS Project.
• Strong knowledge of managed claims management process, Knowledge of Medicaid and Medicare Services. CMS, Health Assessment Systems, Hl7 Standards, HIPAA, PPACA(Patient Protection and Affordable Care Act), Compliance issues, LO INC and SNOMED Mapping, HL7 Message Validation, ICD 9, Electronic Health Records, Electronic Medical Records
• Strong experience in documenting existing process, analyzing business requirements, re-engineering business processes.
• Expertise in managing multiple projects and teams with an excellent track record.
• Experience with claims process and adjudication in the Medicare, Medicaid and Private Insurance Sectors.
• Experience in business requirements gathering and writing EDI. Well versed on HIPAA regulations and requirements. Experienced in HIPAA Transactions 270/271, 837, 835 within ICD10 HIPAA 5010 companion guide.
• Experienced working in Medicare and Medicaid projects.
• Proficient in creating mapping spreadsheets, Source to Target mapping documents including transformation rules.
• Ability to plan and coordinate all testing phases including making test plans, conducting User Acceptance Testing (UAT) and creating & executing Test Scripts/Test Cases and highly involved with Regression, system testing and integration testing.
• Generated Traceability Matrix to ensure that all the requirements are covered by the test cases.
• Developed and documented business requirements which include wire frames, Mockup Screens, Prototyping and Business workflows.
• Ability to develop high quality documents and presentations for multiple audiences including business and detailed requirements specifications.
• Worked with the development team to provide an environment ready for testers and end-users.
• Facilitated test plan/test case walk-throughs for the business and development teams to obtain feedback and/or approval sign-off.
• Excellent organizational, interpersonal, communications, teamwork with proven skill to interact across multiple levels of organization.

PROFESSIONAL EXPERIENCE:

Confidential, Oakland, CA

Business Analyst

Responsibilities:

• Gathered requirements from stakeholders for provider management and member management.
• Interacted with the ICD-10 transition team and participated in JAD sessions.
• Modelled the ‘as-is’ and the ‘to-be’ process flow and analyzed the gap and developed the action steps to fill the gaps.
• Worked with legacy team in developing BRD and FRD for system change requests and participated in system testing.
• Worked within project team to identify and interpret state Medicaid policies as applicable to customer defined algorithm research as well as assist with internal development of new healthcare analytics.
• Involved in preparing project plans and identifying major milestones for each stage as per the SDLC model
• Prepared behavioral UML diagrams such as Use Cases, Activity and sequence diagrams.
• Developed Test plan, Test cases and generated templates for Test cases, Test scripts, Test Defect Log, Test Case Checklist, etc.
• Reported project status, software issues/concerns, and weekly team status reports to the QA Manager.
• Provided QA oversight to the developers and facilitated the development and implementation to meet the requirements.
• Worked with Data Warehouse in the development and execution of data conversion, data cleaning and standardization strategies and plans as several small tables are combined into one single data repository system MDM (Master Data Management).
• Analyzed different systems such as Provider Systems, applications, and websites to understand the existing Business Process.
• Developed and followed agile project management plan (Agile Ceremonies). Facilitated, built requirements log (product backlog) with cost estimates and priority.
• Extensively involved in Data Mapping Exercise to develop FHIR based REST API's and to migrate clinical data from Non-FHIR database to FHIR database
• Involved in creating requirements that comply with HIPAA, HL7, and ANSI X12 format regulations to protect the privacy of the employee insured under any policy.
• Conducted Scrum Daily standup, Product backlog, Sprint Planning, Sprint Review and Sprint Retrospective meetings.
• Determined the team capacity (velocity) from historical data. Created Work Break down structure (user stories) and corresponding activities (tasks).
• Experience with HIPAA 4010 EDI gateway healthcare transactions like 270, 271, 276, 277, 837, 835, 834, 820, and 278.Strong Knowledge on ICD- 10, HL7, Companion Guide business rules 5010.
• Monitored the project progress and radiated the information to stake holders. Identified and mitigated team risks and impediments (Blocking Issues, Critical Defects) on daily basis.
• Profound understanding of insurance policies like HMO, and POS with proven experience in EDI transaction codes such as 270/271(inquire/response health care benefits), 276/277(Claim status).
• Assisted in upgrading HMO Medicare EDI and reporting.
• Assisted in managing and billing Medicare, Commercial HMO/PPO claims on a daily basis.
• Gathered managed care specific business requirements from several different managed care programs.
• Used HP ALM for writing/analyzing project vision, goals, specifications and requirements.
• Involved in the testing of web portal of new provider enrolment process in health system.
• Performed gap analysis by matching the requirements.
• Assisted with documenting processes, used agile methodology to write the System Requirements documents and designed Functional specifications.
• Developed UAT test cases associated with the functional requirements.

Confidential - Norfolk, VA

Business Analyst

Responsibilities:

• Analyzed the existing claims process and specific business rule logic to be applied.
• Gathered requirement through workshops and JAD sessions.
• Developed documents like BRD, FRD, Data specification document, technical specification documents, file transfer document, Data mapping document etc.
• Developed Use case diagrams, activity diagram and system design diagrams.
• Created Data mapping document for change request
• Organize and facilitate Agile and Scrum meetings, which include Sprint Planning, Stand-ups, (SUM), Sprint Check-In, Sprint Review and Retrospective and Sprint report generation.
• Preferred knowledge of Medicaid Management Information Systems (MMIS), National Provider Identification (NPI), Electronic Data Interchange (EDI), Health Level -7 (HL7), HIX (Health Information Exchange), EMR/EHR, Health Care Reform and Patient Protection and Affordable Care Act (PPACA).
• Worked on HIPAA Transaction Sets 837P and 837I Standards according to the test scenarios.
• Created Test Conditions from business requirement document and functional requirement document.
• Processed Medicaid claims and worked on X12 format of EDI 837 for Medicaid claims.
• Accessed Diagnosis Master File and Crosswalk Mapping file to use ICD Diagnosis and Surgical Procedure Codes.
• Performed GAP Analysis to make sure that all requirements were covered by test cases.
• Analyzed the System Impact including MMIS Tables, Windows, Reports and Interfaces on external entities.
• Worked on EDI 834 to validate new enrolment and dismiss the enrolment.
• Facilitate all agile ceremonies including daily stand-ups, weekly grooming, retrospective, and review and planning session.
• Accepted and validated messages in EDI 999 form like accepted, rejected, and accepted with error.
• Ensured the functionality meets business requirements as defined in test results logged in HP ALM
• Created Test Cases to test the functionality of the system based on the test conditions.
• Used Facets to receive 834 inbound files and processing of the files across different modules in the application
• Worked with Systems team for HIPAA Claims validation and verification process (Pre-Adjudication).
• Conducted claim validation and end/denied claims analysis for the health plans Medicaid programs.
• Maintained the EDI Inquiry Problem database including the evaluation of problems or issues through to resolution.
• Performed CR tracing by matching the use cases related to the CR’ s, Test Plan, Test Case ids to the location on the
• Analyzed several defects related to Edits & Audits functional area with the help of a SME.
• Conducted KT sessions for Member, Provider and Service Authorization.

Confidential - Dallas, TX

Business Analyst

Responsibilities:

• Responsible for understanding User needs and accurately representing them in a well-documented software functional specifications document.
• Gathered Business Requirements, interacted with the Users, Designers and Developers, Project Manager and QA Team to get a better understanding of the Business Processes.
• Interacted with the End-Users by interviewing them, by preparing appropriate questionnaire to better understand end-user needs and the business process.
• Followed a structured approach to organize requirements into logical groupings such as requirements for Customer, Client, Group, Member and Reporting so that critical requirements are not missed.
• Involved in creating Business Process Documentation, identified Use Cases from the requirements.
• Created UML Diagrams including Use Case Diagrams, Activity Diagrams, Sequence Diagrams, and using MS-Visio.
• Research Medicaid and Medicare requirements for system automation
• Utilized JIRA to develop and track agile epics, stories and tasks.
• For Project management purpose, worked on Microsoft Project, used Microsoft Share Point for maintaining the updated Documentation.
• Microsoft Office (Outlook, Word, Excel, Visio, Access) at various phases of development for documenting the requirements.
• Analyzed and optimized the process, Prepared Business Requirement Document and managed requirements using ALM.
• Facilitated JAD sessions with business and technical units to prioritize requirements and use cases.
• Involved in analysis of HIPAA compliance and EDI Transactions sets and took part in discussions for designing the EDI transactions
• Conducted Claims and HIPAA Compliance to run the test cases, worked with NPI
• Implemented and worked on Acceptance Test Driven Development (ATDD) agile methodologies completing releases ahead of schedule.
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams using UML.
• Managed RTM (Requirement Traceability Matrix) to track the project flow.
• Prepared BRD and Derived Functional Requirement Specifications (FRS) based on User Requirement specifications and delivered to the project team. Understand and articulate business requirements from user interviews and converted requirements into technical specifications

Confidential

Business Analyst

Responsibilities:

• Responsible for gathering User needs and accurately representing them in a well-documented software functional specifications document.
• Gathered Business Requirements, interacted with the Users, Designers and Developers, Project Manager and QA Team understand the Business Processes.
• Interacted with the End-Users by interviewing them, by preparing appropriate questionnaire to better understand end-user needs and the business process.
• Followed a structured approach to organize requirements into logical groupings such as requirements for Customer, Client, Group, Member and Reporting so that critical requirements are not missed.
• Involved in creating Business Process Documentation, identified Use Cases from the requirement, created UML Diagrams including Use Case Diagrams, Activity Diagrams, Sequence Diagrams, and Collaboration Diagrams using MS-Visio.
• Research Medicaid and Medicare requirements for system automation
• For Project management purpose worked on Microsoft Project, used Microsoft Share Point for maintaining the updated Documentation.
• Microsoft Office (Outlook, Word, Excel, Visio, Access) at various phases of development for documenting the requirements.
• Analyzed and optimized the process, Prepared Business Requirement Document and managed requirements using Rational RequisitePro.
• Facilitated JAD sessions with business and technical units to prioritize requirements and use cases.
• Involved in analysis of HIPAA compliance and EDI Transactions sets and took part in discussions for designing the EDI transactions
• Conducted Claims and HIPAA Compliance to run the test cases, and worked with NPI
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, OOD (Object oriented Design) using UML.
• Managed RTM (Requirement Traceability Matrix) to track the project flow.
• Prepared BRD and Derived Functional Requirement Specifications (FRS) based on User Requirement specifications and delivered to the project team. Understand and articulate business requirements from user interviews and converted requirements into technical specifications