SUMMARY

• 6 years’ experience as a Business Analyst in the HealthCare industry working with companies like Confidential, Govt. of Nebraska, Confidential and HealthNet.
• Specific expertise in Business Analysis, GAP Analysis, Data Analysis, Business Rules and developing and creating business process documents.
• In depth knowledge and hands on experience working with SDLC methodologies like Waterfall, RUP and Agile.
• Expertise and experience in preparing Business Requirement Documents, Use Case Specifications and Functional Specifications.
• Good knowledge of important and frequently used UML diagrams such as Use Case Diagram/Template, Activity Diagrams and Sequence Diagrams.
• Experience in using Joint Requirement Planning (JRP) and Joint Application Deployment (JAD) sessions for gathering requirements and brainstorm ideas.
• Well experienced with the complex tasks of ICD 9 to ICD 10 conversion and mapping.
• Strong understanding of EDI Claims, Member Enrollment, Eligibility, and HIPAA 5010 standards
• Knowledge of different modules within Healthcare Claims Adjudication Process (Membership process, billing process and enrollment & Claims process).
• Excellent experience in 837 - Claims processing and Encounters, 834 - Benefit Enrollment and Maintenance, 835 - Claim Payment/Advice
• Experience providing analysis for business processes running on EDI (Electronic Data Interchange) standard.
• Knowledge and experience working with FACETS 4.71 & 5.0 claims processing.
• Experience in defect management using Quality Center.
• Hands on experience in writing SQL queries for data extraction and mapping.
• Excellent project management skills and hands on experience working with software like Microsoft Project.
• Excellent working knowledge of requirement management tools like Microsoft SharePoint.
• Experience with handling UAT.

TECHNICAL SKILLS

Methodologies: Waterfall, Scrum, Agile XP/Kanban, UML

Testing Tools: Requirement Management Tools:

Quality Center, QTP: JIRA, Requisite Pro, SharePoint

Languages: C++, SQL, XML, VB Script

Office Tools: Word, Excel PowerPoint, Access, Project

Wire framing Tools: Balsamiq, Visio, Rational Rose

PROFESSIONAL EXPERIENCE

Confidential, Norfolk, VA

Business Systems Analyst

Responsibilities:

• Involved in forward mapping of ICD-9 to ICD-10 and backward mapping of ICD-10 to ICD-9 using General Equivalence Mappings (GEM).
• Created and maintained data mapping document(s) in reference to the HIPAA mandated transactions 837I, 837P, and 835.
• Gathered business requirements, analyzed data sources, workflows by conducting interviews and meetings.
• Created business process models, flow diagrams, activity diagrams, use cases and wrote Business Requirement Documents (BRDs) and Functional Requirement Documents (FRDs) using tools and applications such as MS Word, MS Excel, and MS Visio.
• Performed responsibilities of integrating network in IVR systems as required
• Analyzed and confirmed the source and target data in the database using Oracle SQL Developer.
• Created wireframes using Balsamiq.
• Implemented the suggested changes and finalized the design to be presented to the developers.
• Wrote SQL queries to gather data required for supporting the application development.
• Held meetings and constantly updated the BRD and FRD as per the changes requested by the stakeholders and approved by the Change Control Board (CCB).
• Actively conducted and participated in status report meetings and interacted with developers to discuss the technical issues.
• Extensively involved in demos and walkthroughs whenever required at various stages of Agile Scrum.
• Coordinated the testing process while working with the QA team by helping them setup the test environment and users.
• Actively participated throughout the User Acceptance Testing (UAT) process and helped coordinate the application deployment process.
• Attended daily standup meetings and sprint planning meetings, did product estimation and validations, determined velocity and scope of sprints, worked closely with Scrum Master to determine Definition of Done (DoD)
• Worked on production issues raised by the business pre- and post UAT
• Worked with off shore QA team to create test plan, test cases and to give sign off on requirements traceability matrix

Environment: Agile Scrum, UAT, SharePoint, MS Office, MS Visio, ICD-10 and ICD-9, Quality Center, XML, SQL Server

Confidential

Business System Analyst

Responsibilities:

• Analyzed the impacts of HIPPA 5010 project on enrollment, Claims and Benefit.
• Gathered, defined and documented highly complex business requirements forNPI crosswalk implementation.
• PerformedGap Analysisfor HIPAA 5010 enhancement using the TR3 implementation guides, Washington Publications and side-by-sideHIPAA guides provided by CMS (Center for Medicare & MedicaidServices).
• Review and understand theclaims processand complex requirements for the enhancement of the current system created under theRequirement Specification Documentsafter conducting interviewswith End Users, JAD Sessions and analyzed their current systems.
• Documented complexBusiness requirementsand madeprocess flowdiagram for the837, 820, 834, 278REQ transactions as per the implementation for the Medicaid claim processing system enhancement.
• Worked onData Mappingdocuments explaining flow of data from one-to-another table for the system enhancement purpose required by HIPAA 5010 implementation.
• Worked with technical staff and business users to problem-solve and identify workable solutions.
• Worked as an Interface between the users and the different teams involved in the application development for the better understanding of the business and IT processes.
• Maintained Requirements Traceability Matrix (RTM) throughout the project.
• Performed manual testing bybuilding 837 claims, converting them into EDI file, uploading them intomainframe regionand doing error resolution & testing for 5010 requirements & NPI crosswalk.
• EDI file testingfor checking the HIPAA 5010 (X12) compliance of the inbound 837 claims.
• Testing of outbound 820, 834, 278RESP EDI files.
• Working on As-Is To-Be analysis ofICD-9 to ICD-10conversion for the new qualifiers used in the 837 claims for the Diagnosis and Surgical Procedure codes.
• Working on Impact Analysis of ICD-09 to ICD-10 on the current Legacy Systems.
• Working on the GAP Analysis of PHASE I and PHASE II rules of AS-ECS (As Simplification Electronic Claims Status).
• Conducted User Acceptance Testing and User Training for the HIPAA 5010 Project.

Environment: Agile methodology, MS Project, TFS,FACETS, Quality Center, MS SQL Server 2005, MS Share Point, MS Office 2007 (Word, Excel, MS Access, PowerPoint), MS Visio

Confidential, Dublin, OH

Business Analyst

Responsibilities:

• Conducted meetings with business process owners, SME (subject matter experts) and Trading Partners for requirement gathering during the definition stage.
• Analyzed the data movement between systems in order to validate the Business Requirements.
• Worked on data mapping to bring data from one system and reside in another system.
• Carried out forward/ backward mapping when necessary.
• Participated in daily scrum meetings, product estimation and grooming sessions, determined acceptance criteria for user stories.
• Created Use Cases and maintained the traceability matrix.
• Worked on FACETS claims processing, payment adjustments, claims inquiry, benefits,
• Conducted JAD sessions to understand the detailed requirements.
• Actively participated in status report meetings and interacted with developers to discuss the technical issues.
• Helped developers with the following list of HIPAA-EDI Transaction Code Sets: (837, 835, 270/271, and 276/277)
• Conducted walkthroughs and defect meetings periodically to assess the status of the testing process.
• Followed workgroup for EDI standards for testing that need to comply with the HIPAA guidelines.

Environment: Facets 4.71, Windows, MS office, Oracle, MS-Visio, Microsoft Project, HP Quality Center.

Confidential, Woodland Hills, CA

Junior Business Analyst

Responsibilities:

• Interacted with the stakeholders and end users in order to define the purpose and scope of application and gather User Requirements.
• Developed Process/workflow analysis by understanding the process modeling.
• Validated business requirements by facilitating JAD sessions.
• Designed and documented Business Requirements (BRD) by using ASCI ASX X12 EDI guides, reviewed and interviewed business process owners and companion guides.
• Prepared business requirement documents and functional requirements using Rational Requisite Pro.
• Facilitated meetings with users for requirement collection, design changes and feedbacks.
• Escalated issues and reported them as appropriate to Project manager and management for support and guidance.
• Identified issues and worked with application and data team to resolve.
• Prepared Project Plan and Production deployment schedule using MS office tools (Word & Excel).
• Followed UML based methods using MS Visio to develop use cases and activity diagrams; assisted developers in creating sequence diagrams and collaboration diagrams
• Prepared user instructions and use cases to conduct User acceptance testing (UAT).
• Facilitated the requirement changes and fixes along with the release management team.

Environment: Waterfall, MS Office, SQL Server 5.0, QTP, Quality Center