Summary

• More than 8 years of proactive IT experience working as Business Analyst in Healthcare industry with expertise in Healthcare Systems ITS, QNXT , Health insurance plans Indemnity plans, Managed Care plans HMO, PPO POS , Government Sponsored Programs Medicare, Medigap, MMIS, FEP SHBP Consumer Driven Health plans CDHP . Medicare Part A, B, C, D and Medicaid systems.
• Strong experience handling HCPCS, HIPAA ANSI X12 4010, 5010 formats including 834, 835, 837 , ICD9/10, NDC, DRG, LOINC/SNOMED codes.
• Extensive experience in working with healthcare claims, HIX,HBE, EHR, EMR use of ICD 9 diagnosis codes, CPT, Claims, Provider, Enrollment, finance, benefits and Vendor Management Business Areas.
• Strong knowledge in Patient Protection Affordable Care Act PPACA legislation, EMTALA, and HEDIS.
• Strong experience with Care Management and Care Transition Programs designed to target high cost, complex patients for improved care transitions and care coordination using the embedded nurse care manager and medical home model
• Extensive experience of working with Care Management teams responsible for coordinating primary and specialty care, Applying for government assistance benefits and Enrolling in medical day programs
• Excellent experience with Care Management workflows such as Complex Case Management, Monitored Case Management and Lifestyle Management

Professional Experience

Confidential

Sr. Business Analyst/Data Analyst

Responsibilities

• Led AccelRX Commercial Claims, Financial Integration, and EHD, IHD, SEHD projects
• Review, analyze, and evaluate business system, process, and needs in order to build liaison between the business, development and testing teams.
• Interact with business partners in order to gather business and functional requirements that supported the overall strategy, goals, and objective of current projects
• Identify source and the target data
• Create mapping documents to illustrate and match source and target data
• Participate in daily team meetings to review progress on current projects and discuss upcoming projects
• Create Functional Requirements Matrix FRM in order to capture all functional requirements for ETL jobs of the current project
• Create Task Decomposition Document TDD for overall view of the project and SI ETL team responsibilities
• Develop Activity Diagrams for exact illustration of the process flow
• Create Swim Lane Diagrams in order separate and better illustrate the different data flow
• Support development team during ETL coding process
• Identify issues that occur during the coding as value differences between target and source data or unclear functional requirements
• Support Quality Assurance QA team during the internal testing to identify solutions for any kind of data discrepancies
• Identify source of the issues that occur during development and internal and integration testing and provide solutions to them
• Develop templates of ETL mapping and Functional Requirements Matrix for the SI ETL team
• Update Share Point with current ETL mappings, Functional Requirements Matrix, Issue log, Change Control spread sheets
• Attend weekly SI ETL work session meetings to go through overall processes of current projects
• Organize internal and external meetings for review of finalized ETL documents for current projects.

Environment:

MS Visio, Word, Excel, PowerPoint, SQL, SharePoint,Agile and Rally

Confidential

Sr. Business AnalystJune 2012 December 2013

Responsibilities:

• Participated in the initial Impact Analysis ICD-10 for all the critical functions, i.e., Membership and Enrollment, Claims Processing, Utilization Management, Medical Policy, Reporting, Vendor Management, etc.
• Worked with internal team to build out of Documented impact analysis on 5010 upgrades and ICD-10 conversions.
• Participated in ICD 9 to ICD 10 codes conversion requirement gathering sessions and created high level business requirements documents BRD's .
• Prepared product backlog working with product owner and other SME Subject Matter Experts .
• As Scrum Master prioritized Backlog Items after story point estimation and assigned them to different sprints.
• As Scrum Master facilitated daily stand ups and managed task board with user stories and board.
• Prepared 5010 GAP documents involved with 835 and 837 transactions in collaboration with other team members.
• Evaluated HL7 messages to identify usage of ICD-9 codes and replicate the processing for ICD-10
• Used Business intelligence techniques manage company's data to improve quality of care, increase financial efficiency and operational effectiveness, conduct innovative research and satisfy regulatory requirements.
• Managed health plans as Medicare and Medicaid in order to use HCPCS codes as a method for formulating fee schedules for durable medical equipment
• Rejected HL7 messages received with no reference to the ICD coding system
• Defined ICD-9 to ICD-10 mapping process using GEM General Equivalency Mapping crosswalk file.
• Led the Change Control Process for changes submitted for the BRD once the document was submitted to IT department.
• Documented the UAT Plan for the project and worked with the UAT Team to ensure every acceptance criteria for the requirements has been included in the UAT task plan.
• Used PMBOK, the standard industry methodology of PMO in order to standardizing and following project management policies, processes and methods
• Extensively worked on the ETL mappings, analysis and documentation of OLAP reports requirement
• Developed data modules on Erwin and created databases on SQL
• Performed back end testing using SQL queries

Environment:

Agile, Java,Rally,HL7, MS Visio, Word, Excel, PowerPoint, UML, SQL, SharePoint 2010, MS Project

Confidential

Business System Analyst

Responsibilities:

• Facilitated JAD sessions to define business and functional requirements and developed a Functional Requirements Documentation FRD that supported the overall strategy, goals, and objective of the HIPAA 5010 mandate.
• Developed To-Be Business Process Models BPMs in MS Visio by conducting interviews and workshops with different project stakeholders, and by analyzing existing State and Federal BPMs.
• Performed GAP analysis of 4010 and 5010 EDI transaction using implementation guide to identify the changes in the segments and data elements.
• Worked on analysis of FACETS claims processing system and to gathered requirements to comply with HIPAA 5010 requirements
• Documented the Business Requirements Document BRD and the Functional Specification Document FSD .
• Identified Actors, Activities, Artifacts and Workflows and developed use case diagrams using Rational Rose.
• Created use cases specifications, use case diagrams, swim lane diagrams, component diagram and context diagrams to define the workflow and segregate high-level and low-level requirements using MS Visio.

Environment:

Rational Requisite Pro, Rational Rose, UML, FACETS, SQL, UNIX, Java, File-Aid, Clear Case, Clear Quest, MS Visio, MS Access, Rational Test Manager.

Confidential

Sr. Business System Analyst

Responsibilities

• Created use-case scenarios and storyboards in MS Word and MS PowerPoint for better visualization of the application and managed them using Rational Requisite Pro.
• Identified project stakeholders and their roles andstudied the need to develop and implement this project.
• Gather high level business requirements related to the Care Management workflows for OB-GYN like Labor and Delivery documentations, Peri- Anesthesia documentations, Peri-Operative documentations and Respiratory Therapy documentations
• Involved in requirement gathering of the operational components of large-scale STORK implementation with the use of JAD sessions with emphasis on the technical aspects of informational planning, process executions, resource identification and deployment.
• Actively participate in steering committee that would accept or decline milestones necessary for departmental and facility endurance structure within the Epic system for STORK.
• Involved in extensive Subject Matter Expert interviews, needs assessments, work flow mapping and conceptual integration of facility to software for full STORK curriculum content creation.
• Used Business Intelligence techniques in order to convert and transfer data to Epic Stork with high quality
• Documented specifications for multiple LOBS Lines of Business in migrating additional interface systems to the EPIC electronic medical records system. L D Devices, OBIX fetal monitoring system, etc.
• Worked within compliance of DMHO, HIPAA, SOSA, JCAHO, EMTALA and various other regulatory agencies and mandates in order to meet the standards.
• Used MS Visio for Process modeling and Business Process flow diagrams.
• Created UML notations for Object Oriented Design and Documentation for Care Management workflows.
• Measured project performance on time and budget as per the project plan
• Managed changes to project scope using a change management procedure in coordination with Change Control Board CCB

Environment

Rational Unified Process RUP , Java, MS Office, MS Visio, MS Project, SQL, Rational Requisite Pro, Rational Test Manager, Rational Clear Quest.

Confidential

Sr. Business Analyst

Responsibilities

• Supported in developing the Data Conversion from legacy system Quadramed to EPIC implementation program/ projects.
• Developed, execute, lead and manage Radiology Data Conversion from Quadramed to EPIC electronic medical record EMR .
• Actively perform Elicitation, Gap Analysis for Business Requirement Document BRD , and Functional Requirement Document FRD creation in EPIC Data Conversion.
• Actively participated in preparing the scope of the program/project.
• Supported in preparing resource, budget and effort estimate.
• Elicited by Interviewing SMEs Radiologist, Physicians, Nurses and technologists and Lab Managers
• Own the BRD process - ensure that the business is providing high quality business requirements and ensure traceability through development and test phases.
• Determined utilization of ICD codes in HL7 message types as ORU and OUL

Environment: HL7, TOAD, DB2, HP Quality Center, Mainframe, Windows XP, MS Office, MS Visio

Confidential

Sr. Business Analyst

Responsibilities

• Analyzed Business Requirements document and Functional Design document.
• Worked projects on Agile and Waterfall methodologies.
• Conducted sessions between business owners and IT if requirement clarifications are needed.
• Conducted requirements reviews to ensure that business needs are met.
• Completed requirements, obtained sign off.
• Documented flow diagrams to define processes.
• Agile/Scrum specialty - Document user stories, Story points, Business Value, Velocity, Sprint review, Sprint retrospective, Burn down charts, Product Backlog, Release Backlog, Sprint Backlog etc.
• Verified test case completion through Traceability matrix.
• Used HP Quality Center for documenting requirements, view, modify requirements and converting requirements to tests.
• Involve in User Acceptance testing UAT to validate the application, to check that the application properly reflects business functions and requirements

Environment: MS Visio 2007, MS Office 2007, SharePoint, Rational Unified Process RUP , Rational RequisitePro, 2003 MS SQL Server 7/2000.

Confidential

Business Analyst

Responsibilities

• Involved in business analysis, coordinating between the team members and creating test plans according to the business requirements.
• Facilitated JAD sessions to collect requirements from system users and prepared business requirement that provided appropriate scope of work for technical team to develop prototype and overall system.
• Involved in gathering, documenting and verifying business requirements.
• Worked with the project manager for planning and organizing the project activities, and in communicating with other business mangers and stakeholders of the project.
• Utilized Rational Unified Process RUP to configure and develop process, standards and procedures.
• Involved with the business partners to define requirements, determine solution alternatives, and develop high-level designs and estimates.
• Defined and documented the vision and scope of the project.
• Conducted JAD sessions with business owners, SMEs Subject Matter Experts and marketing team, for requirements gathering in definition Stage.
• Created the Business Requirements Document with its key components including Use Cases, Functional Requirements Document, and Gap Analysis.

Environment: MS Office Suite, MS Visio, SQL, Rational Unified Process RUP , Rational Suite, Windows XP, SharePoint, Axure.

Technical Skills

• Operating Systems: Win 98/XP/Vista/Windows 7, UNIX, LINUX, Mac.
• Languages: SQL, C, C , COBOL, Java, HTML, XML, C , VB, ASP, .Net
• Databases:MS SQL server, Oracle, MS Access, IBM DB2
• Tools: MS Office: Word, Excel, Access, Power point, Project, Visio, Rational RequisitePro, Rational Rose, SoDA, Software Modeler, Team Test, Doors, PROLOG, Clearcase, Clearquest, WinRunner, LoadRunner, WebSphere, Business Modeler, HP Quality Centre, HP, Quick Test, Trackwise, AERS, ARISG, Professional, Ultra Edit, Erwin, TOAD and Test Director, MMIS, COTS products and different types of antivirus software
• Industry Standards: HIPAA, SOX, ISO, CMM.