Summary:-

• Over 7 years of experience in HealthCare and Pharmaceutical based Industries as a Business Analyst.
• Strong experience in documenting the Business Requirements Document BRD , developing the UAT Plan, maintaining the Traceability Matrix and assisting in Post implementation activities.
• Extensive experience in working in SDLC for Various methodologies included RUP, Agile, and other internal methodologies
• Expert in translating business requirements user expectations into detailed Functional Requirements Specifications FRS by employing Unified Modeling Language UML
• Expertise in creating Use Cases, Use Case Diagrams, Class Diagrams, Sequence Flows using MS Visio and UML concepts.
• Proven success as a business analyst through the years, providing a well-balanced understanding of business relationships, business requirements, and technical solutions.
• Good working knowledge of Claims processing, HIPAA Regulations and 270, 837P, 837I, 837D EDI Transactions for health care industries.
• Highly experienced in performing Feasibility Studies, Impact analysis, GAP analysis and Risk Analysis.
• A great deal of experience with insurance administration systems included Actuarial, Policy Application, Eligibility, Enrollment, Underwriting, Claims, Billing, and Payments.
• Knowledge on Electronic data interchange EDI transaction, Electronic Health Record EHR and Health Information Technology HIT
• Strong testing experience in HIPAA X-12 EDI Insurance/Health Series INS such as 270/271, 274, 276/277, 278, 820, 834, 835, 837, and Version 5010 of this transactions.
• Hands on experience with SQL server reporting services and other Business Intelligence tools such as Cognos and Informatica
• Web Portal Development worked in the development of a web portal used by providers and members to view referral information
• Extensive experience in working with Claims, Provider, Enrollment, finance, benefits and Vendor Management Business Areas.
• Good understanding in analysis of healthcare claims, use of ICD 9 diagnosis codes, CPT and NDC coding with understanding of HIPAA 5010,ICD -10 initiatives
• Good experience in conducting User Acceptance Testing UAT and documentation of Test Cases.
• Organized professional with excellent oral and written communication skills, excellent presentation, interpersonal skills, problem solving skills, fast learner and also adept quickly new technology with ability to take new roles in minimum time and little training
• Served as a liaison among multiple teams, organized team meetings and work sessions to produce quality documentation.
• Excellent Analytical Skills in understanding the business process and translating business requirements into system functionality requirements in technical terms.
• Developed functional specifications for business process refinement and automation, data modeling, system architecture, conducted feasibility studies, analyzed scope and vision of the project.
• In depth knowledge in writing SQL queries ETL , creating tables, testing procedures using SQL server.
• Extensive experience in documenting Training Materials and conducted training classes to the end users
• Excellent Interpersonal Skills, Communication Collaborative Skills, Critical Thinking, established strong and effective relationships at all levels.
• Solid understanding of Business Process definition, Risk Analysis and SDLC methodologies.
• Excellent in Developing and evaluating business process Models.
• Excellent Analytical, methodical, and resourceful approach to problem solving, identifying and documenting root causes and corrective actions to meet short and long term business and system requirements.
• Effective in executing multiple tasks and assignments ahead of schedule. Created and maintained effective budgets.
• Excellent in Business proposal Risk Assessment. Highly effective management and organizational skills with ability to prioritize.
• Exposure to Client/Server, Web Application developmental tools and Software development and design.
• Demonstrated ability to identify root causes of problems, consider both the long and short-term impact of proposed solutions and develop workable solutions. Ability to manage Multiple project tasks with changing priorities and tight deadlines. Ability to work well in a team. Open to Team related tasks, team meetings, team interaction and conference calls.

Technical Summary:-

Professional Experience:-

Confidential

Business Analyst:-

Responsibilities:-

• Gathered requirements and document the proposed processes to the existing system.
• Mapped process flow assess as-is processes through user interviews, data collection and analysis, design and evaluation of to-be process solutions
• Defined Functional Test Cases, documented, Executed test script in Facets system.
• Validated the following: 837 Health Care Claims or Encounters , 835 Health Care Claims payment/ Remittance , 270/271 Eligibility request/Response , 834 Enrollment/Dis-enrollment to a health plan
• Created Test File to be sent to the Drug Card Vendors for approval. Worked on a Paid without prejudice project for various States.
• Conducted JRP sessions and JAD sessions with the management, users and other stakeholders for open and pending issues to develop specifications
• Assisted the Project Manager in setting realistic project expectations, in evaluating the impact of changes on the organization and plans accordingly, and conducted project related presentations
• Worked with PL/PL/SQL queries using MS Access for data manipulations
• Assisted QA manager to develop test plan and test case
• User Acceptance Testing UAT Performed UAT tests using the MORAE Usability Testing Tool using the Observer and the Manager Mode.
• Testing - Developed Test Scripts using Test Director/Quality Center and coordinated with developers to quickly resolve the defects associated with them.
• Participated in system testing and user acceptance testing worked with System Test Review team and developers to resolve system test issues and re-test.
• Facilitated Change Control Board and Governance Board meetings and acted as a liaison between parties impacted by the change requests
• Helped create the 'Business Glossary' to facilitate efficient understanding of the business process amongst the other teams.

Environment, Tools and Technology Used:-

SQL Server 2012, Black Baud CRM, Oracle database, MORAE, Web Services, Share Point, MS Suite, HP ALM 11.5, Windows 7.

Confidential

Business Analyst:-

Responsibilities:-

• Coordinated with Business Owners, Application Vendor, Payers and Clearinghouses to bring all processes to a level of execution to mitigate any impact to current revenue flow under the 5010-compliancy requirements
• Helped with building ICD 9 to ICD 10 crosswalk map by grouping thousands of codes and ranges in Clinical, Benefits, Financial, Medical policy waves
• Conducted working sessions to gather and document high level business requirements and detailed level business requirements for different business units impacted by ICD 10 such as EDI Claims Intake, Claims Adjudication, Medical Management- Utilization Management, Case management and Provider Reimbursement- Provider Payment
• Coordinated with the project team on MS SharePoint to reduce redundancy across two systems.
• Worked on Financial Analysis of DRG shifts from ICD 9 to ICD 10 to avoid any over or under payments to the providers
• Organized impacted systems into high, medium and low impact to help business analyze the level of effort for remediation activities and ease resource allocation work
• Prepared use cases and data flow diagrams to analyze the impact of ICD 10 diagnosis codes, CPT and HCPCS codes embedded in different systems and applications
• Documentation of existing reports and reports usage analysis.
• Gathered and validated inventory of applications, interfaces, and reports that will need to be modified to comply with ICD-10 requirements
• Designed and developed Business Rules Document about the Claim Component and HIPPA
• Created business workflows on the claims module for the client to get a better understanding of the software and prepared a detailed BRD including all functional and non-functional requirements
• Used UML for Specifications, Documentation and Construction of systems
• Worked closely on 834 transaction code for Benefit Enrollment and was involved in Validation of HIPAA for 837, 270/271, 276/277,835, 834 EDI transactions
• Created Source to target Mapping Matrix for the ETL developers in loading the data to Dimensions and Fact Tables.
• Performed the Gap analysis of the earlier systems, generated a detailed Requirements document describing new system architecture through Use Cases and Activity diagrams
• Designed robust 5010 testing and 4010 regression SIT and UAT Testing Scripts for the 5010 Project
• Analyzed the testing results to ensure that the results were in accordance with the Gap Analysis and expected results for 5010 compliance
• Documented workflows and executed comprehensive testing and training plans to ensure the new acknowledgement results demonstrated in the 999 and 277CA were properly interpreted and managed to ensure Payer acceptance of the 837 files.
• Took action in the process flow to prevent rejected claims from falling into limbo .
• Mitigated claim denial increase through a complete analysis of the application Claims Scrubber to ensure 277CA accepted claims would not result in an increase in Denials at the payer adjudication level
• Identified all risks associated with the project and proposed suggestion for mitigating the identified risk related to the business

Environment, Tools and Technologies used:

MS Access, MS Visio, MS Project, MS Office, HTML, SQL 2000/2005/2008, SQL Loader, SQL Navigator, TOAD, Control M, Test Director, Load Runner, MS Access, Windows XP, and Quality Center.

Confidential

Business Analyst

Responsibilities:-

• Documented the server farm requirements and requirements related to security within Share Point and using Windows Active Directory.
• The HIPAA component efforts included mapping and gap analysis of legacy claims formats, CMS 1500 and UB92 to 837P and 837 I.
• Load and extraction programs involving HIPPA 837 and proprietary format files and Reports development
• Helped with Data Mapping between the data mart and the Source Systems
• Heavily involved in gathering requirements using Storyboard techniques, Joint Application Development JAD sessions and Requirement Elicitation Sessions.
• Heavily involved in defining scope of the project, objectives, and deliverables as part of each cycle.
• Extensively involved in analyzing data by creating and running SQL Queries TOAD , gathered and evaluate data via numbers, trends and came to conclusions based on findings.
• Heavily involved in creating User Requirement Document URD , Functional Requirement Document FRD , Workflow diagrams, Test Cases, Test Plan and Test Strategy.
• Worked closely with Project Manager to determine the requirement feasibility, time and effort involved in coding for the requirements, prioritizing requirements.
• Worked closely with QA Team and developed Internal
• Understanding the current business process, defining scope of the project along with vision statement.
• Applied Unified Modeling Language UML methodologies to design Use Case Diagrams, Activity Diagrams and Sequence Diagrams in Rational Rose.
• Established RUP Rational Unified Process methodology and provided assistance in developing Use cases and project plans.
• Designed the business requirement collection approach based on the project scope and SDLC methodology.
• Resolved issues and improve the process to ensure a stable and accurate solution.
• Used MS Visio for Process modeling and Business Process flow diagrams.
• Used UML notations for Object Oriented Design and Documentation.
• Developed Use Case diagrams, business flow diagrams, Activity/State diagrams and Sequence diagrams so that developers and other stakeholders can understand the business process.
• Validated business rules and all artifacts with users, approval and sign off.
• Conducted Joint Application Development JAD sessions and Requirement Elicitation Sessions to extract the Business Requirements to understand their need to upgrade to the new system
• As the only Business Analyst, heavily involved in all phases of the project starting from gathering Requirements gathering and ending at Business Testingand End User Training
• Extensively involved gathering requirements and developed Project Plan, Requirement Traceability Matrix and documented Commercial Requirements, Detailed Requirements as per the business requirements
• Resolved open and pending issues by conducting JAD and Review Sessions with Subject Matter Experts, System Architects, Technical team and other stake holders on a regular basis
• Created Use Case document and Flow Diagrams using EA Enterprise Architect and MS VISIO as per the business and detailed requirements and understanding the business processes from End User perspective
• Involved in performing Proof of Concept for the Claims Processing through the current existing system Payer Path, Vision All Scripts for the new service line as per the HIPAA 5010 regulations
• Creating artifacts for Rational Unified Process RUP - system architecture document, supplemental requirements document, desk procedure manual, architecture diagrams verifying technical production infrastructure designing and executing performance tests.
• Created data flow diagrams, system Use cases and UML models to depict required functionality.
• Managed the change request in Clear Quest and analyzed the impact of the change request on the application in regards to Project Plan, Project Scope and Project Schedule