Business Analyst

SUMMARY

• Over eight years of Business Analysis experience with in-depth knowledge of business processes in health care and financial industries.
• Experience in business requirement gathering, analyzing, detailing, tracking and documenting in Requirement Specification Document for the health care projects like the APCD, EDI transactions, 4010 to 5010 migration, ICD9 to ICD10 conversion, COB, leading to well versed on HIPAA regulations and requirements
• Good knowledge in healthcare insurance domain including APCD, Medicare, Claim Domain including Claim Adjudication Process and great exposure of EMR/EHR
• Proven experience with HIPPA X12 EDI transaction codes such as 835 I/P Remittance and 837 I/P Health care claim .
• Expertise in performing GAP analysis and Impact analysis in several projects.
• Strong understanding of various SDLC methodologies such as Waterfall, Agile, RUP
• Experience in writing requirement and specification like Business Requirements Document BRD , Use Case Document, Functional Requirements Specifications, Systems Design Specification SDS , Systems Requirements Specification SRS , Business Continuity Plan BCP , Requirements Traceability Matrix RTM , and Process Mapping.
• Experienced in documenting requirement using Unified Modeling Language Use Case and Activity Diagrams and building Business Process Flow, Sequence Diagram using tools such as Visio and Rose.
• Experienced using various IBM Tools for requirement management used Requisite Pro, for defects tracking used HP Quality Center, for sign offs used Clear Quest and also used Clear Case, SharePoint for uploading
• Experienced in running SQL queries, Stored Procedures ETL to extract and load data from multiple source on to data mart.
• Worked with various functional areas within IT projects with exposure in overall project life cycle
• Excellent communication skill, interpersonal skill, interacting with team members, leadership qualities, mentoring, ability to work independently.
• Quick learner, self-starter, can adapt to new atmospheres and technologies with confidence and ease.

KEY TECHNOLOGIES TOOL EXPERIENCE

Confidential

Business System Analyst

• I worked as a resource for Data Exchange Team and worked as Business System Analyst for two projects RHI re-platform project and APCD project.
• RHI re-platform project: This project was related to migrate the platform of this specialty business from SQL server to Netezza. My responsibility was to gather the requirements for the products delivered by this business in the new platform.
• APCD project: This project was to provide data to the states following the All Payers Claim Data mandate. After receiving the DSG from each state, I was responsible to write the requirements in order to handover to the development team to build the code and assist in testing.

Responsibilities:

• Research and document detailed requirements in response to a system problem statement.
• Understand healthcare industry and anticipate needs of the business.
• Create Business and Technical Requirement Document following Lean SDLC to be SOX compliant
• Document detailed business requirements and technical requirements
• Conduct Joint Application Development sessions to review the requirements with the teams of business and development
• Upload requirements in SharePoint, RequisitePro, trace them and run Requirement Traceability Matrix.
• Data Profiling
• Create Variance Request, Carrier Defined Tables and Mapping Tracker
• Reference Data Manager tables creation and updating existing tables
• Schedule User Acceptance Test/System Integration Test calls
• Communication data availability for User Acceptance Test testing
• Acquire User Acceptance Test approvals
• Use tools SharePoint, Shared Drive, RequisitePro, Green Plum, FileNet, Teradata, Informatica Data Explorer, Reference Data Manager, Rational Quality Manager, ClearQuest
• Use strong interpersonal skills and drive to results.
• Use oral and written communication, analytical, and planning skills required.

Confidential

Business Analyst

I worked with the IT Department as a Business Analyst in this project with the different business areas. I worked with the Claims, Enrollment, Provider Admin, Finance and Group Admin Business Areas. This project was the analysis of ICD 9 ICD 10 Code Set Conversion. I was involved in the analysis and documentation of ICD 9 10 Crosswalk using GEM General Equivalence Mapping .

Responsibilities:

• Gathered Business Requirements from the Subject Matter Experts SMEs and documented the requirements in the BRD. Utilized data flow diagrams, use case diagrams and process flow diagrams to represent information provided by the Business Owners.
• Worked in Agile/Scrum environment by assisting in breaking the requirements out into user stories and sprints.
• Involved in scoping and scheduling meeting with Project manager, business sponsors and delivery manager.
• Helped PO in breaking product backlog items into coherent user stories in advance of iteration.
• Performed Analysis of ICD 9 Codes in accordance with ICD 10 CM and ICD 10 PCS Conversion Compliances.
• Organized meetings and led JAD sessions to ensure legal and compliance deadlines of CMS Centers for Medicare and Medicaid Services are met.
• Got a great exposure to Electronic Medical and Health Records EMR EHR /Automated Health Care Systems.
• Worked with the UAT and QA teams to conduct an assessment and determine how effective UAT and QA guidelines can help the company achieve timely completion of projects.
• Effectively elaborated the Current process and gave a clear picture of the proposed process for the projects in the organization. Worked aggressively towards timely completion of High Priority Tasks.
• Participation in a HP Quality Center for System Integration Testing support and help finalizing defects.
• Led the Change Control Process for changes submitted for the BRD once the document was submitted to IT department.
• Worked with IT to resolve issues and clarify Business Requirements from the Business Owners.
• Wrote test cases, test script and test plan for testing.
• Documented the UAT Test Plan for the project and worked with the UAT team to ensure every acceptance criteria for the requirements that has been included in the UAT task plan.
• Maintained the Traceability Matrix table to uniquely trace the identified business requirements from general design to testing as proof that requirements requested have been developed into a solution and that it has been tested and tracked.

Confidential

Position: Business Analyst

The project was contributed to the early phase into conversion of ICD-9 to ICD-10 compliant with HIPAA 5010. HIPAA requires that all health insurance payers in the United States comply with the EDI standards for health care as established by the Secretary of Health and Human Services. The Addenda version of the ANSI ASC X12 837/835 transaction set was selected as the HIPAA-mandated format for electronic enrollment and disenrollment in a Health Plan. Also of another project aimed in managing claims processing for the entire enterprise of EDI X12 837/835 I/P .

Responsibilities:

• Assisted in identifying project scope, to conform to the regulatory compliance related to X12 837 I/P and 835.
• Responsible for soliciting and eliciting requirements for 4010-5010 conversion.
• Worked using Agile methodology that was set up for the project
• Carried out Risk Assessment, GAP analysis and Impact Analysis for the 4010-5010 conversion project.
• Involved in one-to-one interview sessions and JAD sessions with stakeholders, SME's and business owners to discuss the scope of the conversion.
• Produced, for transaction sets 835 and 837 I/P , a full gap analysis 4010 vs. 5010 against the documented application 5010 enhancements ensuring the upgraded application included the required changes and additions for 5010 compliancy.
• Involved in up-gradation of 4010 transaction to 5010 by conducting Impact Analysis and Risk Assessment and worked on the mitigation plan to avoid the risks.
• Worked as a liaison among stakeholders both business and IT side in order to elicit, analyze, communicate and validate requirements for changes to business processes.
• Involved in creating Reports and Documents like Requirements Documents, and Management Plan, Issue/Alternatives documents, Project Summary and Plans with formats like PDF, HTML, Excel and Word.
• Prepared UML diagrams Activity diagrams, Sequence Diagrams, Use case diagrams for Extensions.
• Involved with reviewing defects reported from UAT efforts and analyzed for root cause and took actions based on the findings.
• Used extensively of HP Quality Center for Test scripts, Test plans and defects management.
• Identified the master file changes and builds needed to enable the 5010 format to be utilized.
• Conducted Business Process As Is/To Be sessions with various department directors and staff to ensure the Testing Plan and Test Approach would meet the identified Business Requirements, and the Training Program covered all identified new and changed processes.
• Raising the bar for the client on code quality via education in best practices for coding, unit testing, integration testing, and acceptance testing, teaching Agile techniques and development practices such as Test-Driven Development, and pair-programming, continuous integration.
• Gathered requirements for impacted system and business areas for ICD-10 and their needs to embrace the changes.

Confidential

Position: Business System Analyst

• Confidential is the nation's leading provider of comprehensive home health services. Gentiva serves patients through more than 350 direct service delivery units within approximately 250 locations in 35 states, and through CareCentrix , which manages home healthcare services for many major managed care organizations throughout the United States and delivers them in all 50 states. Gentiva Health Plan is a community-accountable health plan that serves nearly 800,000 residents through four free or low-cost health insurance programs: Medi-Cal, Healthy Families, Gentiva's Healthy Kids.
• Coordination of Benefits COB is a Health Care Financing Administration HCFA Program undertaken by Gentiva. Medicare Coordination of Benefits is the process for ensuring that payment of Medicare beneficiaries' claims is properly shared among insurers when the beneficiary is covered by private insurance in addition to Medicare. By coordinating benefits, the COBC assists Medicare in paying claims more accurately the first time, which saves costly follow up and mistaken payments.

Responsibilities:

• Gathered requirements and prepared business requirement document BRD .
• Responsible for translating BRD into functional specifications and test plans. Closely coordinated with both business users and developers for arriving at a mutually acceptable solution.
• Conducted JAD sessions to define the project and to reduce the time frame required to complete deliverables and got acquaintance and experience working in the Agile environment as the methodology used to carry out the project was Agile
• Prepared Data Modeling diagram to depict the relationship of various parties responsible for billing and payment, i.e. Coordination of Benefit.
• Created and maintained data mapping document s in reference to the claim process transactions.
• Used Rational Rose/MS Office Suite for creating use cases, workflows and sequence diagrams according to define the Data Process Models.
• Involved in EDI transactions Analysis, Design, Implementation and Documentation.
• Reviewed in preparing the Test Scenarios for Health Care Claim Payment/Advice.
• Maintained Requirement Traceability Matrix RTM .
• Use Case development using modeling tool MS Visio.
• Developed queries using SQL to automate the weekly and monthly Meds Update Reports .
• Maintained documents for change request and implemented procedures for testing changes.

Confidential

Position: Business Analyst

Responsibilities:

• Gathered Business Requirements, analyzed data workflows, and defined the scope, and Cost/Benefit analysis.
• Facilitated collection of Functional Requirements from system users, and prepared Business Requirement documents using Rational Requisite Pro.
• Involved in development of Business and Technical Requirements in preparation of Design and Functional Specifications for Business Needs and Processes.
• Followed a structured approach to organize requirements into logical groupings of essential business processes, business rules, and information needs, and ensured that critical requirements are not missed.
• Provided data and work-flow analysis, workflow evaluation data attribute identification for post-trade processing of information related to Fixed Income business and involves Risk management, Profit and Loss P L , Compliance, Reporting trade execution.
• Defects tracking using HP Quality Center.
• Constructed Corporate Action documentation, highlighting the Business Judgment Rule, In-Scope and Out-Scope details, Stock Split and Dividend based on Acquisition and Merger contract and distributed among Program-level managers for approval.
• Created and segregated SQL views and stored procedures for obtaining meaningful set of data.
• Prepared Logical Process and Data Models that contained set of diagrams and supporting documents containing the essential business elements, detailed definitions, and descriptions of the relationships between the data elements to analyze and document Business Data Requirements.
• Established Incident Reporting and Change Control procedures using defect-tracking mechanism of Test Director.

Confidential

Position: Business Analysis, Functional Analyst

Worked in Confidential's Cash Management services division. This division has various services under its umbrella like Information Reporting, Deposits and Collections, Disbursements and Cash management services. Each division has its own applications and the team was responsible for the testing of these applications in the cash management services division.

The project primarily comprised of my participation as a Functional Analyst in the Enterprise Architecture-Utilities team for specific assignments of priority. iFast and iStream were the applications whose functional analysis, use case preparation and coordination were under my purview, handling chief responsibilities as follows:

Responsibilities:

• Reviewed and analyzed Business requirements and interacted with the business users to resolve conflicts.
• Constructed data lineage information on usability and conceptualized data applications in a program-level scenario, high-lighting the happy or base flow and probable exceptions.
• Utilized Rational Unified Process RUP to configure and develop process, standards, and procedures.
• Constructed, developed and deployed ACH Money Transfer documentation for Overseas Business Unit, created functional and technical specifications mid-level , highlighting chief actors, process flows and exception errors.
• Responsible for working with various Overseas Funds Transfer Applications.
• Interacted with development team, incorporating the analysis and requirements in the final detailed design documentation.
• Reviewed and provided critical document feedback to team members, communicated document analysis to team lead and stake holders.
• Data Mapping from source file to target file.
• Used MS Project to develop project schedules and tasks.
• Worked with QA team to design test plan and test cases for User Acceptance Testing UAT .
• Participated in developing Use Cases and UML, activity and sequence diagrams to define the functionality scope of the applications during walkthroughs and JAD sessions.