SUMMARY

• Over 7 years of Experience as Business Analyst in Healthcare include understanding of Business Requirement Gathering, Business Analysis, Joint Application Development JAD sessions wif clients and referring to accessible documentation and procedure.
• Functional Knowledge of Medicaid Management Information System MMIS .
• Exposed to Medicare and Medicaid domains of teh healthcare systems and industry for inpatients, outpatients, Reimbursement Methodology.
• Extensively Knowledge in teh Member Enrollment 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 wif 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
• Demonstrates broad knowledge of GxP ( Medical Device Healthcare and Life Sciences).
• Extensive Experience in Functional, Integration, Regression, User Acceptance UAT, System.
• Knowledgeable working wif 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 teh software meets teh 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 teh enhancements to meet teh 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 wif teh halp 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

Confidential - Dublin OH

Healthcare Business Analyst

Responsibilities:

• Prepared Business Requirements Documents, Functional Requirement Documents.
• Worked extensively wif developing business rules engine enabling teh business rules such as referral, prior authorization, eligibility, claims processing and billing essential.
• Utilized Agile Software Methodology using Scrum framework. Actively participated in creating teh user stories and prioritizing user stories along wif tracking of burn up, burn down charts to estimate sprint delivery
• Performed GAP analysis by performing teh system analysis between teh scheduling systems and documented teh 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 teh completion of teh sprints including resources, costs and systems.
• Reviewed validation / compliance requirements for SOX and GxP servers wif site managers
• Created data mappings to transform teh 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 teh wireframe and prepared a data dictionary for teh same
• Managed testing for various functionalities using Quality Center tools.
• Worked closely wif QA and Developers to clarify/understand functionality, resolve issues and provided feedback to nail down teh bugs.
• Maintained a close and strong working relationship wif teammates and management staff to achieve an expected QA result for teh project team.
• Conducted project related Presentations periodically to teh management and end users during various phases of Software Development Life Cycle SDLC .
• Messaging, FHIR, middleware principles concepts, APIs, REST, SOAP, Web Services etc.
• FHIR messaging, structure and expertise in building complex event based real time interface.

Confidential - Columbus (OH)

Healthcare Business Analyst

Responsibilities:

• Conducted weekly meetings for deciding teh Policies and Procedures to be followed while constructing new sites.
• Gatheird high-level requirement for all teh external projects in a release.
• Performed teh requirement analysis, impact analysis and documented teh requirements.
• Involved in teh 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 teh 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 teh full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims.
• Used different ad-hoc analysis, teh 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 wif DRGs.shift through CMS files.
• Documented ICD9 to ICD 10 mappings one to one/one to Many according to teh GEM files from CMS wif teh functional and structural changes related to teh conversion
• Involved in Able to understand and implement Processing ICD-10
• Worked on EDI transactions: X12,835, and 837 P.I to identify key data set elements for designated record set. Interacted wif Claims, Payments and Enrollment hence analyzing and documenting related business processes
• Executed teh test cases and test scenarios using HP Quality center QC .
• As Scrum Master maintained teh capacity plan, iteration board, sprint backlog, velocity charts and burn down charts.
• As Scrum Master facilitated all aspects of teh 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 teh 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 teh impacting projects and updated teh documents based on recommendations if any .
• Created various reports such as billing payment reports, Billing Grouping Payment and discount reports
• Allscripts, EHR-EMR, Pharmacy, Drs, Hospitals across continuum of care.
• Use HP Quality Center to house all test documentation and report/track all issues and defects Defect Management .

Confidential - Columbus (OH)

Business Analyst

Responsibilities:

• Facilitated interview, one on one and brainstorming sessions wif SME's User's in understanding teh requirements pertaining to billing Origination to billing Processing.
• Assisted and written System Requirements Documents SRD, including Functional and Non-Functional requirements.
• Gatheird business requirements through interviews, surveys, prototyping and observing from account managers, finance manager, and independent advisors and got an accurate understanding of their needs
• Experience wif HIPAA EDI Transactions 837, 835, 820, 276, 277, 278 code sets testing in Health Insurance.
• Developed Use cases and activity diagrams and analyzed business requirements.
• Created UML-based feasibility studies and Use Case Models to communicate those ideas to teh developers.
• Followed teh UML based methods using Microsoft Visio to create: Use Cases Diagrams, Activity Diagrams, and Sequence Diagrams.
• Worked wif SME's and business users to gain in-depth understanding of teh business' mission, objectives, purpose and processes.
• Responsible for sales and marketing specializing in practice management, managed care systems, thin-client technology, Electronic Media Records EMR/EHR/PHE/PMR, ASP technology, and full integration tools.
• Enhanced teh business to articulate and prioritize their ideas, and assisted in development of training materials for new technology and process improvements.
• Collaborated wif teh QA testing team to develop teh test plan, test conditions and test cases to be used in testing based on business requirements, technical specifications and/or product knowledge.
• Conduct project related Presentations periodically to teh management and end users during various phases of Software Development Life Cycle SDLC .
• Involved in teh User Acceptance testing UAT to check teh reliability for end users.

Confidential

Business Analyst

Responsibilities:

• Prepared teh Functional Specification Document FSD and Software Requirement Specifications SRS as per SEI-CMM standards.
• Conducted teh JAD Sessions wif stakeholders and developers to has a clear picture of a project.
• Conducted interviews wif key stakeholders to analyze existing data and gather requirements.
• Used UML to create use case diagrams, sequence diagrams and activity diagrams
• Worked on improvement of Claims Reimbursement User Interface for a better experience and in corporate changes as per HIPAA guidelines using teh gap analysis.
• Developed flowchart and process diagram using MS Visio.
• Wrote SQL scripts for creating performance evaluation reports
• Interpreted legal and financial payor-provider contracts between healthcare practices and health insurance providers surrounding teh methodology and rates of insurance reimbursement.
• Clarified QA team issues and reviewed test plans and test scripts developed by development team and QA team to make sure all requirements has been covered in scripts and tested properly.
• Performed Backend testing by using PL/SQL queries to test teh integrity of teh application was in regular contact wif Business partners on teh status of issues, action plans and timeframe for resolution throughout teh development cycle.
• Identified bugs during teh test phase and reported them using HP Quality Center.
• Maintained Traceability Matrix throughout teh project.
• Developed Test Cases and Test Plans on teh basis of requirements and also did manual testing of teh functionality of teh application to ensure that teh application is able to handle a lot of data
• Conduct Presentations periodically to teh management and end users during various phases of Software Development Life Cycle SDLC .
• Conducted UAT, documented and reported user feedbacks to management team, and developed training materials for different end users and assisted in users training for teh new system.