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Sr. Business Analyst Resume

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Boston, MA

SUMMARY

  • 7+ years of experience as a Business/EDI Analyst with strong analytical and problem solving skills, maintain excellent interpersonal communication while working on long, complex and tedious assignments.
  • Extensive knowledge of Software Development Life Cycle (SDLC) including Enterprise Analysis, Requirements Planning, Elicitation, Analysis, Communication, Solution Assessment and Validation of Projects.
  • Worked on various methodologies such as Agile Software Development, Rapid Application Development (RAD), Joint Application Design (JAD) and Prototyping.
  • Create, Review and Analysis of Business Requirement Documents (BRDs), Functional Specification Documents (FSDs), Use Case Documents, Business Rules Spreadsheets (BRS) and Standard Operating Procedures (SOPs).
  • Extensive knowledge of Medical Management Information Systems (MMIS), Medicare, Medicaid and National Provider Identification (NPI).
  • Excellent knowledge of Health Insurance Portability & Accountability Act (HIPAA) standards, Electronic Data Interchange (EDI), Implementation of HIPAA code sets, ICD - 9, ICD-10 coding and HL7.
  • HIPAA Transactions mapping experience and in-depth knowledge of HIPAA framework. Strong experience transacting with Healthcare EDI standards - ANSI X12 v 5010/4010 for 834, 835/837, 270/271, 276/ /214 BPML and HR-XML formats
  • Excellent knowledge of Medicare (Part A, B, C and D) and Medicaid Health Insurance Policies like CHIP, Personal Injury Protection (PIP) insurance, billing experience in life and disability in health plans etc.
  • Hands on experience with UI, White Box, Black Box, Unit, Functional, Integration, Back End and System Level Load and Stress Testing for web-based client server applications.
  • Architecture and design work for specific EDI Mapping Projects, Mapping and implementing message translations for connecting trading partners to each other and to the applications
  • Document Interchange Control Document (ICD) and Exchange Companion Guide for 837/835, 834 and 820.
  • Create Master Mapping Document for Sterling B2B Integrator (mapping of 834 and 820 data fields with CMS, CG, Siebal and OneGate application fields).
  • Worked with prospective trading partners to determine data processing and EDI operation requirements, from this, authored technical specifications to support findings
  • Web service testing for ANSI X12 837/835, 834 and 820 Messages, Send/Receive 999 / TA1
  • Create 834 and 820 specification documents for Coding and Development
  • Handled EAM profile to create data process request, monitor and maintain inventory.
  • Schedule, Process and Monitor EDI data(batch and real-time processing)

TECHNICAL SKILLS

Methodology: SDLC, RUP, Agile, Agile PLM, OOAD and Waterfall.

Languages: Oracle, PL/SQL, HTML BPML, XML, .NET, JAVA, C++

Management Tools: CaliberRM, Rational Rose, Requisite Pro, Clear Quest, Clear Case, Serena Team Track and MS Visio.

Testing Tools: HP Quality Center, Mantis, Win Runner, Load Runner, TOAD and SOAPUI/WSDL

Data Modeling Tools: ERwin, Informatica 7.1.1/8/9, Hyperion.

Database: Oracle 8i/9i/10g, DB2, MS SQL Server.

Operating Systems: UNIX/Linux, Windows 95/2000/NT/XP and MS-DOS.

Microsoft tools: MS Office 2003, 2007, 2010(Word, Excel, Power Point, Outlook), MS SharePoint, MS Visio, MS Project and MS FrontPage.

PROFESSIONAL EXPERIENCE

Confidential, Boston, MA

Sr. Business Analyst

Responsibilities:

  • Analyzed and Design Health plan Enrollment and Maintenance (ANSI X12 834) and Premium Payment (ANSI X12 820) file specifications under HIPAA framework for ACA (Affordable Care Act).
  • Prepared implementation plan and negotiated agreement on EDI file specifications with Trading Partners and vendors in accordance with HIPAA guidelines.
  • Interfaced with technical staff, trading partners, Clearinghouses and internal staff including programmers on all HIPAA related information and changes.
  • Created Test Case and Test Scenario based on X12 834/820 B2B Integration Functional Testing.
  • Work on Production Environment Revert to Draft (R2D) process and used SOAPUI tool for Web-service Testing (Send X12 834/820 Messages, Send/Receive 999 / TA1's) along with maintenance of the file using Oracle Spec builder 6.6.1 powered by Edifecs.
  • Design process flow chart of EDI Transactions (Portal --> HIX --> Carriers) using MS Visio 2010.
  • Identified/anticipated issues with HR-XML/ANSI File feed and business rules. Documented the event, articulate and demonstrate the problems to facilitate resolution.
  • Worked with trading partners to implement and troubleshoot connectivity to EDI systemsthat included Secure FTP, FTP with PGP encryption for batch transactions and Web services for real time transactions.
  • Reviewed errors and EDI transaction reports and analyzed information for trends.
  • Created Process Flow Charts, Business Requirements Documents, and Functional Specification Documents for Revert to Draft (R2D) process.
  • Developed Test Plan and Test cases based on the Use cases and Functional specifications and also performed User Acceptance Testing (UAT) of the functionality of the application by inserting varying data on different test runs.

Confidential, Burlington, VT

Sr. Business Analyst

Responsibilities:

  • Teamed up with Senior Managers in managing System (EDI and data processing) requirements, System design and Architecture, develop and test EDI Portal Redesign applications and transactions.
  • Worked on EDI Portal from its inception to completion and then support it.
  • Interfaced with technical staff, trading partners and internal staff including programmers on all Eligibility/enrollment related information and changes.
  • Developed and implemented testing scenarios in conjunction with Business Requirements.
  • Involved in developing Business Functions/rules and regression test cases.
  • Performed EDI technical and operational customer support to trading partners and customers related to their operational and business needs, requirements and issues
  • Monitored EDI systems to ensure smooth processing of inbound and outbound transactions and provided technical support when needed.
  • Teamed up with various e-Business areas in their overall efforts to make EDI infrastructure X12 5010 compliant and got involved in Gap/Risk Analysis.
  • Worked on design and Analysis of HIPAA EDI X12 834, 820, 999 and TA1 Transactions, Performed web service Testing (Send X12 834/820 Messages, Send/Receive 999 / TA1).
  • Documented Interchange Control Document (ICD) and Exchange Companion Guide for 834/820 along with process flow of EDI transactions using Visio and Power point.
  • Create Master Mapping Document (mapping of 834 and 820 data fields with CMS, CG, Siebel and One Gate application fields) along with Technical Specification Document (TSD) for Coding and Development.
  • Develop EDI X12 transactions (Oracle XSD, ECS and XML files) using ORACLE Spec Builder and SOA B2B Integrator.
  • Handled EAM profile to process EDI data, Batch and Real-time process of 834/820 EDI files
  • Worked on Configuring SOA Server, Enabled security features to create secure tunnel to communicate with different trading partners.
  • Very good understanding of ORACLE Health Care Adapters (HIPAA EDI X12 0).
  • Developed Test Plan and Test cases based on the Use cases and Functional specifications and also performed User Acceptance Testing (UAT) of the functionality of the application by inserting varying data on different test runs.

Confidential, Chicago, IL

Business Analyst

Responsibilities:

  • Analyzed current business process flow by understanding preset business rules and conditions.
  • Conducted formal interviews, Live Meetings and JAD sessions with business users Subject Matter Experts (SME’s)
  • Designed and developed Use Cases, Activity Diagrams and Sequence Diagrams using UML.
  • Involved in Backend Testing to verify data integrity by using SQL.
  • Documented, organized and tracked the requirements using Rational RequisitePro.
  • Created Data Flow Diagrams (DFDs), ER diagrams for data modeling and Web-page mock-ups using MS Visio for acceptance from end users.
  • Defined project milestones, schedules, and monitored progress using MS-Project and updated plans as required.
  • Analyzed and tested Data Interface needs with external systems.
  • Analyzed, manipulated and updated Database using SQL.
  • Wrote multiple Test-Cases (unit, compliance, integration) for multiple transactions include 837, 835, 276, 277 (both inbound and outbound) transactions.
  • Gap Analysis: Analyzed the client’s applications programs to determine the impact of the HIPAA final rule on EDI Transaction Set and Code List implementation and defined the changes to bring the affected systems into HIPAA compliance.
  • Worked with FACETS Team for HIPAA Claims Validation and Verification Process (Pre-Adjudication).
  • Assisted with user testing of systems and maintained quality procedures and ensured appropriate documentation is in place.
  • Maintained Requirement Traceability Matrix (RTM) and Utilized ClearQuest for change requests and defect tracking.
  • Claim validation and Pend/Denied Claims Analysis for the Health plans Medicaid programs.
  • Worked closely with the technical team to look up for the best possible solution on requirements by keeping business needs and technical constraints in mind.
  • Updating, transferring and sharing Files using FTP between Windows and UNIX machines.

Environment: UML, MS Word, Rational RequisitePro, Rational ClearQuest, Quality Center, SQL, FTP

Confidential, Hartford, CT

Business Analyst

Responsibilities:

  • Worked with the EDI crosswalk team to identify incoming ANSI X12 fields where NPI information would come in and maps it to our internal Physician ID.
  • Identified the impacts areas in the EDI process and proposed workaround
  • Worked with Business rules engine (BRE), a software system that executed IBC business rules in an EDI runtime production environment.
  • Worked on BRE error Management, EDI portal processing resulted in various BRE errors to the customers/vendors.
  • Identified top 10 BRE errors that resulted in 90% of all EDI errors.
  • Designed a Business process that isolated those top 10 errors and then defined and classified them for the customers and provided error resolution methods in a step-by-step procedures
  • Worked with HIPAA Transactions/mapping and Code Sets including ASC X12 837, 270/271, 276/277, and 835.
  • Played a leading role in the testing of various HIPPA transactions with Claredi and in getting it certified
  • As a Sr. EDI Specialist, served as the primary implementations interface for national and regional accounts
  • Served as a technical resource for all Data Feeds as well as technical resource for Network and ANSI X12 transaction troubleshooting
  • Focused experience in the area of systems integration, business workflow solution design, planning and implementation consisting of a variety of technology platforms, systems, and encompassing business problems of all types.
  • Performed testing and quality control checks on mapping projects.
  • Consulted with customers to obtain EDI requirements, mapping specifications, and project objectives.
  • Developed and maintained applicable documentation for the entire EDI Process and Keeping abreast of all technical and procedural changes, various additions and enhancements to the data exchange products and associated communications infrastructure affecting EDI.
  • Received and sent transactions/data to the Application and verified the output with Input using the Data Requirements, Data map and EDI Standards.
  • Hands on experience on HP Quality Center 10.0, including Defects Management, Requirements, Test Plan and Dashboard.
  • Worked on Defect management, including Opening New Defect, Defect Assignment, Setting up priority, Current status, Description, setting up different environments (DEV, SYT, SIT, PROD and PVS) and many more activity related to Defects.

Environment: HP Quality Center 10.0, Caliber RM, SAP, MS Office, Windows, MS Visio, HP SharePoint, MS Project, MS Visio, SQL, SOA Infra, BPML, XML, SOAPUI and WSDL.

Confidential, Nashville, TN

System Analyst

Responsibilities:

  • Gathered requirements from stakeholders for provider management and member management.
  • Identified and validated business rules and data elements.
  • Developed the stakeholder list and created stakeholder assessment matrix to prioritize them.
  • Developed and Maintained Requirements work plan and assessed the performance metrics of the team members.
  • Created and Analyzed Business Requirement (BR) and Functional Requirement, Directed development team to developed Member login Web Portal (Intranet).
  • Worked on Document Management, used Workflows to route documents from person to person so they can complete their document management tasks, such as Reviewing documents, approving their publication and managing their disposition.
  • Modeled the ‘as-is’ process flow and the ‘to-be’ process flow and analyzed the gap and developed the action steps to fill the gaps.
  • Proposed strategies to implement HIPAA 5010 in the new MMIS system and worked on planning and documentation.
  • Worked extensively with ETL process, migrated data from old system to new one, make sure that data format match new system requirement.
  • Facilitated JAD sessions for Requirement Validation with Client Dept. of Health & Human Services (DHHS).
  • Worked on Electronic Data Interchange (EDI), and Implementation knowledge of HIPAA code sets, ICD-9, ICD-10(Migration, Mapping, Verification of ICD).
  • Developed UAT test cases associated with the functional requirements.
  • Analyzed Health plan claim processing (ANSI X12 837/835) file and Premium Payment (ANSI X12 820) file specifications under HIPAA framework.
  • Prepared implementation plan and negotiated agreement on EDI file specifications with Trading Partners and vendors in accordance with HIPAA guidelines.
  • Interfaced with technical staff, trading partners, Clearinghouses and internal staff including programmers on all HIPAA related information and changes.
  • Teamed up with Senior Management, Legal to formulate EDI Trading Partner Agreements in accordance with HIPAA compliancy rules.
  • Wrote companion guides for several EDI formats evaluating system requirements and business rules.
  • Analyzed different Data cross-walks, complicated logic & look ups required by different fields for the source to target transformations.
  • Broke down the services from the Confidential MMIS Logical Design into multiple layers of normalized functionality that correspond to utility services, general business services and Medicaid specific services.
  • Participated in developing Team Foundation Server (TFS) test plan, test scripts, and test scenarios and designed user documentation.
  • Worked with legacy team in developing BRD for multiple system change requests and participated in System Testing.

Environment: MS Office, Windows, .NET, MS Visio, MS SharePoint, TFS, MS Project, MS Visio, SQL, Oracle, SOA, HTML

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