SUMMARY

• Over 7+ years’ experience in Information Technology with focus on Senior Business/Systems Analysis and Software Validation of applications for various businesses.
• Experienced cross functional professional across technology areas, and operations focusing primarily on business requirements gathering and analysis, technical writing, functional requirements gathering, and analysis.
• Experience in Healthcare Industry, with good operational knowledge of Health Insurance Portability and Accountability Act (HIPAA).
• Skillful in preparing User Guides, Performing System Integration Testing (SIT) and User Acceptance Testing (UAT).
• Experience in Healthcare/Claims adjudication with knowledge of industry compliance standards like EDI X12 transactions (834, 837, 835, 270/271, and 276/277).
• In - depth knowledge of EDI transactions between the implementation partners in Healthcare Industry.
• Experience in develop and maintain the artifacts such as test plan document, test case document, updated the RTM (requirement traceability matrix), test Summary report, bug report, user stories, backlogs.
• Experience in creating UML diagrams, Data Flow Diagrams (DFD), Use Cases, Class Diagram, Activity Diagrams, Sequence Diagram, and UML Modeling.
• Extensive experience in Writing SQL Queries for Data validation, Data Analysis and Data Profiling in RDBMS.
• Facilitated User Acceptance Testing and test strategies with developers and testers and participated in manual front-end testing to check all functionalities of different modules.
• Highly motivated team player, possessing an excellent communication and presentation skills with detail oriented analytical abilities and a willingness to work in a cross-platform environment.

TECHNICAL SKILLS

Microsoft Technologies: Project, Visio, Excel, Word, Outlook, PowerPoint

Requirements Management Tools: Rational Requisite Pro, Rational Rose, MS Visio, Share Point

Business Skills: Business Process Analysis & Design, Process Improvement and Implementation assessment, Requirement Gathering, Use Case Modeling, JAD/JRP Sessions, Gap Analysis, CA Clarity (version 12 and 13), Impact Analysis.

Languages/Standards: SQL, XML, HTTP, HIPPA, ANSIX12

Methodologies: Rational Unified Process (RUP), Agile, Waterfall, Rapid Application Development (RAD)

Product Evaluation: Revenue Cycle Management (RCM), Provider Portal, Member Portal, KPHealthConnect

PROFESSIONAL EXPERIENCE

Confidential, MN

Sr Business System Analyst

Responsibilities:

• Identified the scope, business objective and documented the functional requirements for each release.
• Directly involved in process improvement Plans and implementing business change.
• Write SQL queries, analyze the data, and perform data migration processes.
• Data mapping, logical data modeling, used SQL queries to filter data within the Oracle and Sybase.
• Produced clear user manuals & guides for User Acceptance Testing (UAT) and deployment for end-clients with step-by-step instructions and appropriate GUI screenshots.
• Involved in Validation of HIPAA/EDI for 270/271, 276/277, 837, 837i and 835 claims used for professional, Institutional and Dental billings by Writing Test cases, Test Plans.
• Create and maintain documentation as it relates to system configuration, mapping, processes, and service records.
• Working on exporting reports in multiple formats including MS Word, Excel, and PDF template mapping.
• Designed the total revenue cycle management solution, such as professional billing and claims, remittances, and charge routers.
• Interacted with the development team on regular basis to ensure and balance practicalities with innovative and efficient business systems solutions.
• Successfully used Agile/Scrum Method for gathering requirements and facilitated user stories workshop.
• Facilitated JAD sessions for requirements gathering with the business and IT to create business required documents.
• Prepared high-level logical data models and Business Required Document (BRD) and supporting document containing essential business elements, detailed definition, and description of the relationship between the actors.
• Created 837 claims and maintained data mapping documents about HIPAA transactions primarily 837, 834, 835, 820, 270, and 271.
• Used JIRA to create and maintain User Stories and created UAT test scripts.
• Extensively worked with Member/Subscriber and HIPAA Privacy Facets application groups.
• Involved in creating documents and diagrams for Enrollment according to the HIPAA 834 Compliance Standards for Enrollment.
• Developed and executed SQL queries against data warehouses to support data mapping and ad-hoc analysis.
• Executed test cases for the existing market’s various lines of business. (The test cases covered: Authorization of claims, Accumulator, Benefits, Claim Payment, and Pricing, as well as a member and provider data updates).
• Conducted and Participated JAD sessions to gain consensus on various issues related to the project. Acted as a facilitator on different occasions.
• Held regular meetings with the Business users and SME’S to priorities the business Requirements.
• Used Rational Requisite Pro for overall Requirements Management and to build the Requirements Traceability Matrix.

Confidential, San Diego, CA

Business Systems Analyst

Responsibilities:

• Conducted Interviews and JAD sessions with SME’s and stakeholders to understand the business requirements.
• Gathered and created Business Requirement Documents (BRD), performed cost-benefit analysis with Project Manager.
• Conducted GAP analysis and Impact Analysis and prepared an Implementation and Recommendations Report communicated to the stakeholders.
• Worked in Agile/Scrum for gathering requirements and facilitated user stories workshop.
• Worked with Development and DBA team as well as System Integration Testing team to collaborate results analysis on Conversion User Acceptance Testing (UAT) and related issues
• Detailed analysis and review current SAP Logistics applications, design and business process and system configuration.
• Proposed pricingconfigurationchanges in accordance with client and state reimbursement methodologies
• Gathered requirements and developed process flows diagrams in accordance with care and Medicaid rules and regulations pertaining to the Facets configuration and evaluated the impact of proposed changes.
• Worked on Data mapping, logical data modeling used SQL queries to filter data within the Oracle database tables.
• Assist and interact with allRevenue Cycle Management (RCM)teams to resolve database or client issues.
• Created Functional Requirement Documents (FRD) based on the signed-off business requirements.
• Created and maintained a Requirement Traceability Matrix (RTM) to see if all the requirements are being captured and are being worked on.
• Worked on different Enterprise Data sources like PDF Template mapping, Data Mapping, Flat Files, and Teradata
• Performed Requirements Gathering and Analysis, interviewed the SME (Subject Matter Experts), and ensured that contributors and all key stakeholders were motivated to complete assigned tasks.
• Imported data from SQL Server and Excel toSASdatasets.
• Performing system configuration based on the requirements
• Worked extensively with IT team on building the architecture and underlying logics of the system.
• Implemented manual test cases for each sprint task and executed them using Soap UI
• Executed UAT testing for appropriate modules
• Work closely with application design managers and directors to test the migration of a DB2 database to a SQL database.
• Development of source data profiling and analysis reviewed the data content and metadata would facilitate data mapping and validate assumptions that were made in the business requirements.
• Attended frequently scheduled meetings to identify any tasks or user stories that are “at risk” and provide necessary support.
• Extreme involvement in production and development phase to report out to the stakeholders about the status of the project.
• Created test plans and scripts, facilitated user acceptance testing and tested strategies with developers and testing team.
• Performed Backend testing on Enrollment of Facets functionality

Confidential, Bronx, NY

Business Systems Analyst

Responsibilities:

• Responsible for developing in-house application comparing data from different sources i.e., EDI, XML and FACETS.
• Performed requirements gathering and analysis; interview the subject matter experts, stakeholders, and executive sponsors.
• Interacted with the business analysts & business users for design & requirement clarification for external projects & change requests.
• Gathered requirements for different products and do the gap analysis for the products.
• Worked closely with business users, in-house technical team and external vendor to conduct data mapping and migration, system configuration/customization for the ERP system with help of team, introduced and implemented ERP system in the company.
• Authored Data flow diagram, sequence diagrams and business process models that describe how the EDI Health Care Claim Transaction set (837) is used to submit health care billing information and encounter.
• Recorded requirements and translate them into User Stories and work with stakeholders to gain approval.
• Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data within the Oracle database.
• Developed test plans and test cases, based on the information provided in the Business Requirement Documents (BRD), to ensure applications are almost defect-free before moving to production stage.
• Extracteddatausing SQL queries and transferred it to Microsoft Excel and Python for further analysis.
• Conducted JAD sessions to define the project and to reduce the time frame required to complete deliverables.
• Constantly interact with the Product Director for enhancements and discussion on the changes.
• Worked extensively with the QA team for designing Test Plan and Test Cases for the User Acceptance Testing.
• Facilitateddatamigration between databases using import/export facility inSAS.
• Modified the 834 file and then checked if the eligibility enrollment is properly loaded onto Facets.
• Documented all the changes for the enhancements and recommended changes.
• Analyzed the current state and recommended changes for the future state of the products.
• Prepared and Reporting test cases for requirements.
• Developed Business Process diagram to understand the whole workflow.
• Facilitated the requirement changes and fixes along with the release management team.

Confidential, Blue Bell, PA

Business Analyst

Responsibilities:

• Performed felid-by-field mapping of interface between parent EMR system and downstream system.
• RepresentRCMdept. at business meetings and disseminate related communication, including but not limited to preparation and presentation ofRCMdata.
• Identified Claim Processors requirement and documented technical specifications for the claim Inquiry system
• Identified the USER types and roles to prepare a process modeling diagram and Information flow diagram.
• Developed entity diagrams, data interface mapping to map all the possible inputs and outputs.
• Used HIPAA Gateway to comply with HIPAA standards (270/271, 276/277 & 837) for EDI transactions
• Used SQL for organizing and abstracting data from MS access data bases, created reports, forms on MS Access.
• Designed the total revenue cycle management solution, such as professional billing and claims, remittances, and charge routers.
• Involved in the writing of different user stories for the front end and back end.
• Create Business Requirement Document (BRD), Functional Requirement Document (FRD), Technical specification Document (TSD).
• Assist and interact with allRevenue Cycle Management (RCM)teams to resolve database or client issues.
• Prepared scenarios, Use Cases & UML State Diagram for scenarios using Rational Rose.
• Performed analysis on data inputs, datasets, reporting for the impacts with interacting systems.
• Involved in discussions and meetings with implementation team to verify the proposed functionality.
• Traced requirements using traceability matrix to trace the requirements
• Prepared a document with the reporting specification and reporting requirement and trained decision makers on the report analysis.