Skills

Please use this table to list the skills noted in the Required/Desired section of the requirement. In addition, please respond with the years of experience for each skill and the last time each skill was used. Add or delete rows as necessary.

Years Used

Last Used

Tracking and prioritizing issues from discovery through resolution

7 years

2012

Assignment and tracking of action items, issues, and risks

7 years

2012

Status reporting to stakeholders

7 years

2012

Conduct stakeholder meetings, including meeting agenda, minutes, and action items

7 years

2012

Meeting facilitation and proactive follow up with individual providers

7 years

2012

Excellent organization and communication skills

7 years

2012

Direct provider outreach

6 years

2012

Newsletter/website communication with provider community

6 years

2012

Creating, updating, and coordinating communication plans; all aspects of functional testing, schedules, and success criteria

7 years

2012

Creating, updating and coordinating communication plans; including acceptance procedures, validation trend analysis, error resolution, etc

7 years

2012

Creating RACI charts, process flow charts, swim lane diagrams, memorandums, etc.

3 years

2012

Knowledge and experience with HL7 messaging

1year

2012

Government experience in the healthcare arena

-

-

Statistical analysis of issues to identify hotspots, weaknesses, issues, and risks

7 years

2012

Confidential,
OKC, OK March 2011 – Present
Senior Business Analyst
Electronic Medical Record Management System:
A Physician Support System was built to capture the out-patient clinical data using an Electronic Health Record System. The purpose of this system was to have a Paperless Medical Record and instant retrieval of data and laboratory records by the doctors, especially for Behavioral and Mental Health Record Systems. Besides information such as physical examination and information specific to the medical discipline, the system could also capture information about the patient’s appointments with the doctors; the patient’s medical summary and track the flow of patients through the clinic.

Responsibilities:

• Served as Communication Bridge between non-technical users and technical solution developers.
• Collaborating with project stakeholders throughout all SDLC phases to ensure timely delivery of specified business solutions.
• Implemented the Rational Unified Process (RUP) methodology of iterative software development with and developed user stories and dashboard for the system.
• Participated in the development of project plans, assessing business processes, working with business users and IT to develop system solutions and implementing the same.
• Recognize scope limitations and raise potential scope issues while designing the best system approach.
• Analysis for making system compliant with HIPAA. Involved in making the Medicare patient profiles being compliant with the HIPAA regulations. Management of patient profile transfer (PPT) reports created by data team by verifying the associated data.
• Collected Business Requirements and converted them to Functional Requirements in the Facets Platform.
• Worked with fellow business analysts in methodology for defining ICD-10mapping processes and documenting business requirements. Developed additional processes specifically designed to handle Benefits Administration.
• Extensively created test cases for the claims administration and customer service modules like subscriber/member enrollment, adding premium rates, claims, billing and recoveries. Third Party liabilities, benefits. Service authorizations, entity relations.
• Wrote Use Cases and used Use Case diagrams during analysis to capture the requirements diagrams and Sequence diagrams so that the development team and other stake holders can understand the business process.
• Assessed Electronic Medical Record Management System and performed GAP analysis using ‘Tracer’ tool between current Paper Medical Record and to-be Paperless Medical Record.
• Generated weekly reports based on results and used Sharepoint 2010 to store all Project Artifacts.
• Executed Change Management considering Requirements Traceability Matrix to determine areas impacted by HIPAA 5010 and ICD-10 related data.
• Constructed RACI Charts.

Environment: MS Office, RUP, UML, Power designer, SQL, SWOT analysis, Sharepoint 2010, Tracer.
.

Confidential,
NY September 2009 – March 2011
Business/QA Analyst

The project was focused on implementation of HIPAA 5010. As a Business/Quality Analyst, I was involved in requirement gathering, creating test data for HIPAA 5010 transactions, test data creation, Test execution and compliance checking. Transaction involved was 837I/P, 834, 835, 270/271.The business process chosen was Agile/Scrum methodology.

Responsibilities:

• Identify the client/organizational needs and provide suitable agile system based solutions.
• Involved in interview sessions with end-users to gather information about business processes.
• Actively worked on Business requirement gathering, analysis and Data Analysis.
• Conducted JAD sessions and developed various strategies to distribute the work in team.
• Reviewed documents (policies, manuals, business processes, systems documents, banners, bulletins) from various divisions. Analyzed and performed Impact Analysis to determine areas impacted by HIPAA 5010 and ICD-10 related data
• Executed Change Management considering Requirements Traceability Matrix.
• Analyzed URS and Functional Requirements Specifications to understand business rules of application.
• Created “As-IsBusiness Models” to understand the existing claim settlement process flow through interacting with SMEs, underwriters and Finance department.
• Worked extensively on GAP analysis of 4010 and 5010 using ‘Tracer’ tool and used Sharepoint 2010 to store Project Artifacts.
• Responsible for getting the sign-offs for BRDs, FRDs.
• Responsible for the reviews for Functional Specs to development team and QA team.
• Transactions involved were Enrollment (834), 835, 837I/P for HIPAA 5010.
• Created BRCs of EDI inbound and outbound transactions and mapped the provided data.
• Mapped ICD codes and prepared final result summary documents with reports.
• Designed and developed use cases, activity diagrams and sequence diagrams.
• Worked intensively with Medicare & Medicaid claims for 5010 X12 transactions.
• Performed Regression Testing to ensure the product integrity.
• Reviewed Test specifications, Test cases and performed Manual Testing.
• Executed queries in test databases using SQL, PL/SQL queries.
• Validated data at the Backend to ensure that all the Claims related data has been loaded to the corresponding Data Sets in the Backend and the pricing for these Claims is done as per the Standards.
• Analyzed the results, generated reports and tracked the defects using Quality Center.
• Well versed with Claim processing from point.
• Used IBM Mainframes- Incremental Scripts foradding, updating and modifying Datasets and fields in back-end to be populated in front-end.
• Used SQL statements for Back-end testing.
• Performed User Acceptance testing, developed Test logs and opened/closed as and when the issue is fixed and Quality checked with the assumed company data with all the possible Test Scenarios.
• Proficient in working with HL7 messaging standards.

Environment: UML, Agile/SCRUM, HTML, XML, Toad, SQL Server 2008, UNIX, Subversion, Use cases,Quality Center 9.5, HIPAA 4010/5010, CVS, MS office tools and Visio, Tracer, Sharepoint, HL7

Confidential,
CT February 2008 – August 2009
Business Analyst

United Health Group is a managed health care and health insurance company and serving more than 75 million people worldwide.

Responsibilities:

• Compiled Vision and Scope documents to better define the rationale for the project. Gather requirements from business to determine the functionality that should be provided to the users.
• Tracked Business requirement traceability matrix (RTM) and handled scope creeps.
• Worked toward claim processing such as Claim Adjudication and Claim Reimbursement.
• Determine which claim system to interact with to display data on the UI.
• Worked toward Healthcare Rewards, Incentive and wellness exposure.
• Considered HIPAA rules while data validation and testing.
• Was responsible for the research and analysis of data requirements and issue resolution as they related to the design.
• Participated in / facilitated data requirements definition (e.g. extracts, sourcing, reporting) and design sessions.
• Worked with ICD 9 encoding to verify the validity of incoming claims documented ICD 9 codes presently used by the system.
• Dealt with 834 import member lookup processes and resolving issues with member attributes, enabling multiple rules associated with member lookup process.
• Dealt with the EDI transaction -835 claims payments and remittance advice, which deals the payment from payer to provider.
• Developed an automated approach for capturing all 837 data received from GHI that supports claim utilization and reporting.
• Worked on multiple 837 and multiple Eligibility (270/271) and healthcare claim status (276/277).
• Understood Functional/Technical (Data Model) flow of 4010 HIPAA Transactions and identify the new segments/element changes required with minimum changes to system.
• Builds and Runs Test Claims from subscriber information on NPS, working on those claims to ensure that they process through the system, and obtaining the results from the claim processes.
• Used Process log browser to view different types of log history files to figure out issues with 834 transactions.
• Attended daily SCRUM and guided QA and Developer regarding the defects, Technical Specification Documents and Mapping Documents.
• Prepared and maintained data for Core Measure reporting.
• Provided all standard and ad hoc quarterly reports including data analysis and graphs.
• Developed a set of best practices with regard to Part 11 remediation and have implemented innovative and cost effective strategies for achieving compliance.
• Conducted Joint Requirements Planning (JRP) sessions with management, SME’s (Subject Matter Expertise) users and other key members for open and pending issues to develop specifications.
• Designed Use Cases, Use Case diagrams, Activity diagrams, Sequence diagrams in UML methodology using MS Visio.
• Constructed RACI Charts.

Environment: Mainframe, DB2, SQL Server 2005, MS Visio, Facets, Business Intelligence, MS Project, MS Office, SharePoint, UML.

Confidential,
WI June 2006 – February 2008
Business Analyst

‘SonoSmart’ is GE Medical Health care Claims processing, insurance pricing and claim adjudication process portal build for automated reporting in health care facilities. In the formal SDLC (Software Development Life Cycle) environment and object oriented platform, automated reporting with secure data archiving of patient history and tracking and laboratory records. Information Management system has direct interface with the hospital management in additions. The claims and insurance details were processed at the health care facility for preferred insurance company and providing them in EHS – Environmental health and safety system.Project was implemented in accordance with the HIPAA guidelines in Facets platform.

Responsibilities:

• Web based application designing with connectivity to access data base.
• Worked on Data Analysis, Database Development, Data Cleansing, Metadata, Data Marts, Business Analysis, Database Design, and Reporting for Capital Market, Financial and Mortgage projects.
• Processed EDI test files and verified system is able to validate certified and non certified trading partners. Worked with cross functional business teams to design sharepoint applications that best meet their content and document management requirements.
• Participated in HIPPA 4010 to 5010 upgrade JAD sessions and documented the outcomes on FACETS Platforms..
• Participated in 1CD 9 to ICD 10codes mapping sessions as well as status meetings and provided comments and suggestions on challenges. Gathered requirements on Trading Partner Registration and certification. Verified Trading Partner configuration and the profiles.
• Created an enterprise workflow application based on CRUD rules for Customer Data that would allow for future integration of data infrastructure across various business areas into a single UI.
• Conducted interviews with key business users to elicit, collect and manage requirements and prepared business process flowcharts. Created RFPs and evaluated vendor proposals.
• Developed business requirement and specification documents as well as high-level project plan and translated business requirements into data and process models
• Created detailed level test scenarios on HIPAA compliance testing. Gathered business requirements from business users such as Insurance Policy Managers, credit card Managers and drafted business requirement specification (BRS).
• Developed process decomposition diagrams, data models, data flowcharts, entity relationship diagrams, screen mockups and state diagrams.
• Defined and documented operational control and security procedures, including those required for backup and recovery.
• Used MMIS – Medicaid Management Information System for Insurance Claims Filing and patient information using MITA - Medicaid Information Technology Architecture as a platform
• Set up work flowcharts using FLOWer, and worked in close conjunction with Business Process Modeling tools for users for the procedures in claims with the help of SMEs.
• Developed scripts, scenarios and performed comprehensive testing – User Acceptance – UAT, Alpha and Beta testing of applications
• Performed relational database design and modeling and conducted multiple SQL querying
• Participated in meetings with Developers, Project Managers and Quality Analysts to discuss business requirements, test planning, resource utilization and defect tracking.
• Used Rational Clear Questfor defect tracking and prioritizing defects and for enhancements after base lining the requirements.

Environment: RUP, UML, SQL, MS Office, MS-Project, Test Director
Confidential,
CT April 2005 – May 2006
Business Analyst

Aetna Inc, an American Healthcare company provides consumers directed healthcare products, including medical, pharmacy, dental, behavioral health , group life, long-term care and disability plans, and medical management capabilities. Aetna is a member of Fortune 100.
The project AIM (Aetna Individual Markets) was to design an automated underwriting business function, Consumer Portal-Interface for online enrolment, eHealth, eVendors-Broker sites that route business to Aetna through their websites, Billing and enrollment-for Approval/Declines of applications.

Responsibilities:

• Understood and articulated business requirements from user interviews and then convert requirements into user interface design technical specifications.
• Part of team to elicit, organize, and document required functionality and constraints by engaging in iterative requirements gathering sessions with the various business users in the projects, including company employees, brokers, and analysts.
• Facilitated requirements meeting, group discussions with business users and subject matter experts (SME) to elicit requirements
• Functioned as the primary liaison between the business line, operations, and the technical areas especially with the stakeholder’s team, which provided the web-based underwriting solution
• Worked with different business users and analysts by conducting interviews to collect requirements and business process information
• Designed and implemented HIPAA 835 Payment Advice Transaction, 837 Health Care Claim Transaction. Populated ICD-9, NDC Disease code sets as per the standards. Experience with transaction sets 835, 837, 270, 271, 276, 277 and 5010.
• Gathered Business requirements. Interacted with the End users, Designers and Developers, Project Manager to get a better understanding of the Business Processes
• Involved in Project Management by preparing Working Break down Structure (WBS) in Gannt Chart. Used Rational Portfolio for project plans, process templates and work products. Assisted project managers with the development of project schedules, Cross-Functional Meetings, JAD Sessions, Project Presentations and manage scope using MS Project and Excel.
• Experience in working with application developers, DBAs, QA Testers and User Acceptance Testers.
• Responsible for creating UML modeling plans, Use cases, process flows, Wire Frames and business requirements documentation using Define IT, Visio.
• Analyzed and modeled the system using Data flow Diagrams, Functional Diagram and Process Diagram.
• Proposed an object change management system to support object-oriented system design
• Analyzed business requirements from user interviews and then convert requirements into Technical specifications using Rational Requisite Pro.
• Analyzed XML to identify input and output data in Web Services.
• Systems Documentation included Business Process Document (BPD), Functional Requirements Document (FRD) and test plans using MS Visio.
• Bridged the gap between AS-IS and TO-BE business process flows, Integration of process flow diagrams to show one end-to-end business model and process mapping exercise including swim lanes.
• Responsible for application functionality improvement and coordinate process through the Program Management Office (PMO).
• Conducted technical review sessions and facilitated cross functional project meetings as required.
• Documented Database/Stored procedures specifications and defined the database constraints.
• Consulted with management and designed and developed several SOA processes and data management tasks related to the project, whilst developing all phases of the application.
• Documented Maintained all the Project Changes Request (PCR) and Work Product Review (WPR) documents and updated them accordingly.
• Participated in all the phases of testing, documented the “User Acceptance Test” scripts and participated in Regression testing sessions, verified the Business Scenarios on new builds to allow extended testing by the QA team once the system was in testing environment.
• Assisted in development of training materials for new technology and process improvements.

Environment: Mainframe, HIPAA, DB2, FACETS, PMO, MS Office Suite (Word, Excel, Access and PowerPoint), MS-Project, MS Visio, Windows XP, Lotus Notes, Clear Case, and MS-Excel.