SUMMARY

• Over 8 years of Experience as Business Analyst in Healthcare include understanding of Business Requirement Gathering, Business Analysis, and Joint Application Development JAD sessions with clients and referring to accessible documentation and procedure.
• Functional Knowledge of Medicaid Management Information System MMIS .
• Exposed to Medicare and Medicaid domains of the healthcare systems and industry for inpatients, outpatients, Reimbursement Methodology.
• Extensively Knowledge in the Member Enrolment and Billing information.
• Knowledge and Experience on Membership, 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
• In dept. knowledge of Software Development Life Cycle SDLC methodology such as Agile, Waterfall and RUP.
• 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
• Experienced in client interaction, deep understanding of business systems functionality and technicality.
• 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
• Experience in developing project plan and estimating project timeline.
• 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 analysing business requirement at all stages of Software development of life cycle SDLC.
• Experience working with diversified portfolios, due diligence scenarios, market interest rates and investment product risk factors.
• Experience in sales tax filing for several states AR, NY, CT
• Great understanding of e-Commerce, Commercial Lending, Real Estate, Retail and Insurance Industries
• Experience in creating “AS IS” and “To BE” business process.
• Extensive experience in analyzing and documenting business requirements and system functional specifications including Use Cases, Data and GAP Analysis.
• Good Knowledge and application of U.S. GAAP
• Experience in evaluating and documenting internal controls, preparing narratives, performing risk assessment and analysis. Experienced in Financial Budgeting, Analysis and Forecasting including expense report preparation.
• Experience in conducting Joint Application Development (JAD) and Rapid Application Development (RAD) sessions.
• Proficient in Microsoft suite of products including MS Word, MS Excel, MS PowerPoint and MS Visio.
• Expertise in the role of Scrum Master, facilitating/organizing daily scrum sessions, sprint planning meeting and sprint review meeting and preparing/analyzing burn down charts.
• Experience in conducting UI reviews of the prototype and the final end product.
• Effective in planning and executing business re-engineering solutions to take advantage of current market trends.

PROFESSIONAL EXPERIENCE

Confidential, San Diego, CA

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 .

Tools: Technologies: Agile Scrum, MS Office, MS Visio, MS Project, JIRA, SharePoint, Rally, UML, SQL

Confidential, Portland, Oregon

Business Analyst

Responsibilities:

• 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
• Executed the test cases and test scenarios using HP Quality center QC .
• As Scrum Master maintained the capacity plan, iteration board, sprint backlog, velocity charts and burn down charts.
• As Scrum Master facilitated all aspects of the scrum framework, including sprint-planning sessions, backlog-grooming session, daily scrums product demos, sprint reviews and sprint retrospectives.
• Prepared Business Requirement Documents BRD's after the collection of Functional Requirements from System Users that provided appropriate scope of work for technical team to develop prototype and overall system.
• Facilitated and led JAD sessions aimed at functional requirement walkthroughs for all the impacting projects and updated the documents based on recommendations if any .
• Created various reports such as billing payment reports, Billing Grouping Payment and discount reports
• Use HP Quality Center to house all test documentation and report/track all issues and defects Defect Management .

Tools: Technologies: Rally, MS Visio, HP QC, UML, MS Office, Agile Scrum, SSRS

Confidential, Southfield, Michigan

Business Analyst

Responsibilities:

• Translated the business needs into system requirements, communicating with the business on a non-technical level, and with the System Analyst on a more technical level.
• Used Visio to carry out the Business Use Case Modeling and Business Object Modeling effort to develop the business architecture for rapid and controlled application development.
• Reconciling book and bank balances on a monthly/ yearly basis in QuickBooks
• Passing beginning of the year, month end and year ending Adjusting Journal Entries and Year End Journal Entries QuickBooks
• Creating Invoices and make payments as well as working on accounts receivable ledger on receiving payments as well as making adjustments with bad debts in QuickBooks
• Creating and analyzing financial reports along with working with the financial advisors with the Revenue Recognition principles stated in US GAAP
• Running payroll, recording and paying payroll liabilities along with generating and filing quarterly and annual payroll forms and with generating employee W-2 in QuickBooks
• Maintaining a documented system of accounting policies and procedures along with maintaining a system of controls over accounting transactions in SSCS (Service Station Computer Systems)
• Assisting in the production of annual company budget and financial forecast
• Automated the sales tax filing system along with generating and submitting monthly sales tax report for each location including tax exempt sales
• Calculating variances from the budget and report significant issues to the top management
• Worked towards integrating CRM solution to automate the payroll for employees worldwide along with paying payroll liabilities, filing quarterly and annual form
• Coordinating the provision of information to the Financial Firm for tax reporting purpose
• Provided recommendations to senior management to dissolve the problems. Identified and escalated problems to senior management.

Confidential, Madison, NJ

Business Analyst

Responsibilities:

• Entered and reconciled bank statements and credit cards for 53 companies in a monthly/ yearly/ weekly basis into QB
• Responsible to analyze results and provide financial observations to upper management.
• Mentored new hires with any accounting related questions
• Passed year end Adjusting Journal Entries and Closing Journal entries.
• Made adjustments with Revenue Recognition principles according to US GAAP
• Created financial (P&L, Balance Sheet) reports at year end and compared reports with previous year. If any discrepancies found then contacted and interrogated client (s) to find out reason for discrepancy.
• Worked towards automation of scheduling payroll (both direct deposits & manual checks) for clients on weekly/ bi-weekly/ monthly basis on a web based interface for time management system.
• Also accounting for 401-K deductions. Kept records of payroll liabilities and paid online to IRS and State (Promp Tax: NYS-45, NJ-927, WR-30 etc) on a weekly, bi-weekly or monthly basis. Filed quarterly and annual payroll forms.
• Automated the filing of monthly and quarterly sales tax for multiple states
• This job also included going to the client’s site and doing bookkeeping for them such as creating invoice, keeping track of the vendors, making bill payments on time, running payroll, entering and reconciling bank statements every month.
• Attended phone calls, communicated directly with clients and solved their accounting related issues according to their demand.