Senior Business Analyst Resume Profile

PROFESSIONAL PROFILE

Certified Business Analyst from IIL International Institute of Learning
Senior Business Analyst/Systems Analyst with 8 years of industry experience in identifying business needs, and determining solutions to business problems for complex software projects including system development component, business process improvement, strategic planning and policy development in Healthcare sector
Excellent knowledge of Health Insurance Portability Accountability Act HIPAA standards, Electronic Data Interchange EDI , and Implementation and knowledge of HIPAA code sets, ICD-9, ICD-10 coding, and HL7.
Extensive experience with Business Process Management BPM system.
276/277 Claim Status Request / Response
277/275 - Claim Request for additional Information and Response
270/271 - Eligibility Benefit Inquiry and Response
835 - Claim Payment/Advice
834 Benefit Enrollment and Maintenance
837 Claims and Encounters
Proficient in Rational Suite including Rational Rose, Requisite Pro, MS Visio, MS Project and MS Access.
Experienced in writing Functional Requirements Document FRD , Non Functional Requirements Documents NFRD , AS-IS and TO-BE workflows.
Also worked using various methodologies such as Waterfall methodology, Agile Software Development, Joint Application Design JAD , and Prototyping.
Strong knowledge of Object Oriented Analysis and Design OOAD using Unified Modeling Language UML , Rational Unified Process RUP , Capability Maturity model CMM , Six Sigma DMAIC .
Documenting and creating Test Plans, Test Objectives and Test Cases. Also involved in maintaining Test Matrix and Traceability Matrix.
Good knowledge and understanding of Medical Management Information System MMIS
Extensive experience in Medicare Part D/PBM and Medicaid.
Widespread knowledge of EHR/EMRs Electronic Medical Records , HL7 and its Patient Protection and Affordable Care Act PPACA .
Experience with full Software Development Life Cycle SDLC and project life cycle including Feasibility Analysis, Requirements planning and Management, Application Design and Development, Testing, Production with Implementation and Post-Implementation Validation, and Solution Assessment.
Experience in creating and organizing deliverables in a secure retrievable area: such as BRD Business Requirement Document , FRD Functional Requirement Document , PDD Project/ Product Definition Document , SRS System Requirement Specification BSR Business support request and Change Management Documents.
Lead Business Analyst highly skilled in various techniques to elicit requirements, including intellectual JAD sessions, facilitating requirements workshops, Whiteboard sessions, KT sessions, interview and prototyping, focus groups, brainstorming including others
Working experience with SQL/PL SQL, .NET, HTML, and MS Access
Widespread knowledge and experience in QA Roles Quality Assurance White Box, Black Box, Unit, Functional, Integration, Regression, End to End and Back End System Level Testing
Working knowledge and experience with SQL/PL SQL, .NET, HTML, and MS Access

Brief Profile	Highly motivated and energetic team player known for abstract reasoning, system thinking, excellent collaboration, effective communication, great presentation and interpersonal skills, expert in Eliciting requirements information, always willing to work in challenging and cross-platform environments and ready to volunteer for tasks above and beyond the scope of my normal duties with abilities to experiment confidently and intelligently. Recognized for big picture vision, dynamic direction, negotiating and prioritizing skills and tenacity to make high-stake decisions if required using experience backed judgment and intuition, strong work ethic, and irreproachable integrity. Able to take a large conceptual problem or project, break it into components, establish plans and a critical path, achieve incremental goals and deliver project on time and at or below budget. Excellent analytical and problem solving skills in designing, developing, and implementing innovative business processes using new approaches and technology.
Total Experience	8.5 Years
Certifications	Business Analysis Certification from IIL International Institute of Learning
Systems and Tools	Crystal Reports, Rational Unified Process RUP , UML, MS Office Visio, Word, Excel, PowerPoint, Project, Outlook, Access , SharePoint, MS SQL Server, Rational Rose, Rational Requisite Pro, EPIC, Mirth, HL7 messaging, Visual Studio, E-Commerce, Rational Clear Quest, HP Quality Center, Business Objects, MS BizTalk 2009, Toad for Oracle
Languages	SQL, UML, .NET, C , Java
Methodologies	Waterfall, Agile, RUP
Domains	Payer/Provider, MMIS, Healthcare IT, EMR/EHR, HIPAA, HL7, EDI Claims, ICD-9/10 conversions, Clinical Data Management

Brief Project Experience Summary:	Role	Period
Confidential Project was a full transition from their own CVS proprietary EMR system to Epics EMR system, requiring over 100 interfaces to be integrated seamlessly while sorting out the dependencies linking various interfaces with Epic. This was a significant pathway to achieve long-term strategic goals to deliver the highest quality of healthcare and for CVS to be the leading innovators in the Pharmaceutical healthcare industry	Senior Business Analyst/Quality Assurance Analyst
Confidential developed, leverages the department to manage the whole Medicaid Management System effectively, by adding the Medicaid Incentive program. Along with updating the different functional areas Provider Enrollment, Claims Status and Prior Authorization EDI transactions following HIPAA Regulations and Implementation Guidelines	Senior Business Analyst
Confidential The scope of the project was to Implement an ESB web based claims processing and management application to manage health insurance claims electronically	Business Analyst
Confidential project was an initiative associated with conversion of group health insurance policies from the legacy system to a newer policy management solution entering the patient's data	Business Analyst/Systems Analyst
Confidential This project comprised of providing a software solution with various functionalities such as patient admission, lab investigation and diagnosis, patient billing, patient discharge, summary and doctor consultation billing	Business Analyst/Systems Analyst
ConfidentialThe project objective was to upgrade the Mortgage Loan Origination Process beginning with the customer initiation to title transfer	Business Analyst
ConfidentialI was mainly involved in gathering business requirements and extensively testing of the CIM Customer Implementation Management delivery for the Comcast Customer	Business Analyst

Confidential

Tools Used Database	MS Visio, HP Quality Center, MS SQL, Visual Studio. Mirth, HL7, EPIC Bridges, Rational Requisite Pro, MS Office, SharePoint, UML, Java, Unified Process Oracle
Domain Knowledge	Healthcare Business Analytics, Standard Workflows of EMR systems, HIPAA, GAAP SOP98-1
Business Method	Agile Methodology
Role	Senior Business Analyst
Team Size	35

Confidential is an implementation of an integrated electronic health record platform that provides clinician access to patient data, documents, medical assessment and treatment and improves output and workflow while maintaining high quality and safe health care. Partnering with Epic also allowed for the greater opportunity for affiliate patient record sharing. 51 of the nation's patient records are stored on Epic customers EMRs. Epics Care Everywhere application lets CVS MinuteClinic NP's easily access patient health records from affiliates and vice versa. The CVS MinuteClinic Epic Project was a full transition from their own CVS proprietary EMR system to Epics EMR system, requiring over 100 interfaces to be integrated seamlessly while sorting out the dependencies linking various interfaces with Epic. This was a significant pathway to achieve long-term strategic goals to deliver the highest quality of healthcare and for CVS to be the leading innovators in the Pharmaceutical healthcare industry.

Roles and responsibilities:

Elicited requirements from stakeholders through alternative and creative methods
Documented high level business requirements along with non-functional requirements.
Wrote complete Design documents for the interfaces translating the Business Requirements to Technical specifications.
Performed SWOT and Gap analysis for the functional requirements
Led and facilitated countless JAD sessions, Whiteboard sessions, KT sessions
Conducted a comprehensive GAP analysis and Impact analysis of CCDs while mapping each data point to the correct table
Recognized and documented the dependencies between the business processes and the various interfaces.
Documented Use Cases, Activity Sequence diagrams and Logical views using MS Visio, MS Office and Rational Rose for a clear understanding of the requirements for the development and QA team.
Converted CSV flat files into HL7 messages
Modified and translated segments of HL7 messages to properly send to EPIC
Prepared quarterly statements from the project budget with PM
Dealt with the budget forecast with management team
Fully adhere to GAAP SOP98-1 guidelines
Strong accounting knowledge with exposure to corporate clients
Data modeling using UML. Extensively involved in mapping data from various sources to the target database tables for several complex interfaces.
Worked with developers to understand data warehousing schemas, data models and the correct data workflows to ensure and verify that the IT work is properly supported by us and the QA team.
Well versed with EPIC, EMR systems, EPIC bridges, EHRs, Mirth and Production support processing problems by being one of the chief sources and providing alternative solutions using best practice models and principles.
Worked in strong coordination with the PM in preparing the Project Charter and identifying major milestones for each stage as per the SDLC model RUP Methodology .
Gave visual walkthroughs and dozens of Knowledge Transfer sessions to the users/QA/managers pertaining to the new-implemented EPIC System once the project was nearing completion.
Managed and completed end to end-testing for several interfaces including Credit Card testing and EPIC performance testing while being aggressive in reaching the deadline
Transitioned to BA/QA for last 2 months of project to conclude full functional testing and regression testing
Wrote detailed test scripts in HP Quality Center for numerous interfaces

Confidential

Tools Used Database	Rational Requisite Pro MS Office, UML, Asp.net/VB.netRational Unified Process Oracle
Domain Knowledge	Healthcare Business Analytics, Standard Workflows of EDI, ICD-9/10, HIPAA
Business Method	Agile Methodology
Role	Senior Business Analyst
Team Size	20

Confidential is responsible for the Medicaid Incentive Program. The System developed, leverages the department to manage the whole Medicaid Management System effectively, by adding the Medicaid Incentive program. Along with updating the different functional areas Provider Enrollment, Claims Status and Prior Authorization EDI transactions following HIPAA Regulations and Implementation Guidelines. The Present System EMC Legacy Mainframe System was enhanced with MS BizTalk 2012 as the advanced processing system.

Roles and responsibilities:

Executed Gap analysis for the functional system requirements
Worked with HIPAA rules and regulations to draft business rules and claim processes.
Interacted with the client and the Technical Team for requirement gathering and translation of Business Requirements to Technical specifications.
Conducted JAD sessions.
Wrote detailed Business Requirement Documents for different ICD 9/10 Codes
Conducted detailed GAP analysis and Impact analysis. Analyzed the current state and future state
Identified and documented the dependencies between the business processes.
Responsible for checking 834 queries and approval of claim payment.
Data modeling using UML. Significantly involved in mapping data from assorted sources to the target database tables.
Involved with updating the EDI 837 I, D, P , 835, 277-U, 270/271, 276/277, 278,

820 and 834 transactions

Worked with business representatives to comprehend data marts requirements, data models, data flows, Facets on-line, priorities and ensure that IT work is appropriately aligned.
Well versed with HIPAA, claim adjustments, claim processing from point of entry to finalizing, claims review, identifying claims processing problems, their source and providing alternative solutions using best practice models and principles.
Gave visual walkthroughs to the users pertaining to the new implemented tool.
Coordinated end to end-testing efforts of the HIPAA Compliance and EDI Transactions.

Confidential

Languages	SQL,PL/SQL
Tools Used Database	MS Project, MS Visio, SQL, Rational Unified Process RUP , Rational Requisite Pro, Rational Rose, Clear Quest, Microsoft Visio, Windows 2000/XP, HP Quality Center Oracle
Domain Knowledge	HIPAA,EDI, ICD9/ICD10
Business Method	Agile Methodology
Role	Business Analyst
Team Size	15
Project Description: The scope of the project is to Implement a web based Confidential application to manage health insurance claims electronically. The ESB software is a web-based electronic claims processing solution providing real-time patient insurance information. The application connects the organization to the largest all-payer network of commercial and government health plans nationwide to provide a wealth of real-time patient benefit information. Clinical Workflow Data is automatically translated to meet HIPAA compliance standards and the privacy of transactions is protected with the highest level of security. Roles and responsibilities: Analyzed the Business Requirements and their impacted systems within the organization. Responsible for starting RUP and UML Processes for creation of documentation to use by IT Team. Created Requirement Specification Documents based on interviews with End Users, JAD Sessions, Whiteboard sessions and a comprehensive analysis of their existent systems. Tracked EMR patient data for full visits Evaluated Data from EMR for Clinical Workflow Data Organized and Produced Flowcharts in MS Visio for Clinical Workflow Data Identified patients through EMR who were due for screenings and provided data extracts to better treat and assess them. Created Use Cases, Use Case Models, Work Flows, and System Specification Document Using RUP Methodology. Analyzed end-user requirements, their strategies, and their objectives to create Requirements Specification Documents and Use Cases. Involved in creating requirements that comply with HIPAA, HL7, and ANSI X12 format regulations to protect the privacy of the employee insured under any policy. Analyzed requirements and formulated a Test Plan for functionality testing, navigation, and integration testing of the application. through Version 4010 A1 and newer, conversion needs and understanding of legacy EDI formats, such as UB92 Versions 4, 5, 6 and NSF. transaction sets requirements, EDI development and Design, X12 protocols and others. Resource for UB92 and HCFA1500 billing format, transactions such as: HIPAA 270/271, 276/277, 835, 837- I, P, D , 835 Remittances Created transaction sets requirements, usually with Microsoft Excel, for and other related processes, including communication, security, and privacy. Scheduled meetings with technical personnel to determine technical parameters for EDI Maintained Traceability matrix throughout the project. Work responsibilities primarily involved understanding the business logic, requirements, communicating them to the developers, generating documentation, designing use cases, creating various diagrams like Business process flows, Activity Diagrams, Sequence Diagrams as part of project. to the Mainframe and back to the Trading Partner. Transactions processing flow from the Trading Partners to the translator Assisted with the building EDI 837 I, D, P , 835, 277-U, 270/271, 276/277, 835 Used Component business modeling for improving strategic planning and efficiency. Understand rules and regulations of HIPAA as imposed during Electronic Data Interchange EDI . Confidential Languages .NET,SQL Database Oracle Tools Used Asp.Net/VB.net, SQL Server 2008, MS Access, Sharepoint, MS Visio Domain Knowledge HIPAA, EDI, ICD9, Claims Processing Business Method Waterfall Methodology Role Business Analyst/Systems Analyst Team Size 11 Confidential advantage is they focus exclusively on providing managed care services through government-sponsored programs, such as Medicaid and Medicare. They offer a variety of health plans for families and children, as well as prescription drug plans for the approximate 3.3 million members they have. The project was an initiative associated with the conversion of group health insurance policies from the legacy system to a newer policy management solution. It also involved day-to-day data management based on client requested data additions/modifications/ deletions using the HIPAA regulated EDI files. Roles and responsibilities: Requirement gathering, product development, defect analysis, testing and production support activities. Created Screen Mockups in Axure for project workflow/ design discussions with functional and design teams. Facilitated JAD sessions and worked with business users through interviews, workshops, and brainstorming sessions. Was responsible for defining the scope of the session, eliciting requirements, scheduling design sessions, reviewing the project scope, objectives, definition document, meeting minutes Designing of activity diagrams, business process models such as data flow diagrams, Entity Relationship diagrams ER-Diagrams for value-addition of existing project. Processed and modified requirements, usually with Microsoft Excel, for transactions such as: HIPAA 270/271, 276/277, 835, 837- I, P, D Worked with EDI file formats like X12, EDIFACT, SWIFT messages for data conversion and compliance Confidential Languages UML, SQL Database Oracle Tools Used UML, SQL, Windows Server 2003, .NET, Facets, Excel, MS Visio, MS Project, Power Point, Share Point Server, Test Director, SQL Server 2005 Domain Knowledge HIPAA, Medicare/Medicaid, EDI, ICD9 Business Method Waterfall Methodology Role Business Analyst/Systems Analyst Team Size 9 Confidential is a managed healthcare company, which provides highly comprehensive solution to the medical and health care consumers. This project comprised of providing a software solution with various functionalities such as patient admission, lab investigation and diagnosis, patient billing, patient discharge, summary and doctor consultation billing. Using this software, a provider can enter a patient information, time spent, case type, fee, and some other related information. This information is authenticated by Case Reviewers for claims benefits processing and billing. Roles and responsibilities: Successfully defined the scope and business rules of the project, elicited and gathered business requirements and documented them textually or using models. Facilitated JAD sessions and worked with business users through interviews, workshops, and brainstorming sessions. Researched and understood the claims adjudication and reimbursement systems based on HIPAA X12 4010 standards. Exposed to using ICD 9/ANSI/HL7 coding standards in Medicare and Medicaid domains of the healthcare systems and industry for both Inpatients and out patients. Documented Functional Requirements specifications and User Requirements specifications. Ensured that ICD-9-CM procedure codes used for inpatient services and CPT codes for outpatient and physician services were not outdated. Created transaction sets requirements for transactions such as HIPAA 270/271, 276/277, 835 Also worked on claim processing for HIPAA transaction set 837 I,P,D medical claims . Accommodated requirement changes into project timeline and managed project tasks using MS Project. Conducted daily build validations and report status to Production and QA team. Interacted with developers to report software bugs and retested the fixed issues. 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. Confidential Tools Used SQL, Windows Server 2003, .NET, Facets, Excel, MS Visio, MS Project, Power Point, Share Point Server, Test Director, SQL Server 2005 Domain Knowledge Business Analytics, Standard Workflows of Consumer Finance Business Knowledge Waterfall Methodology Role Business Analyst Team Size 5 Confidential is a diversified financial services company in the United States with consumer finance subsidiaries doing business in Canada and Puerto Rico. The project objective was to upgrade the Mortgage Loan Origination Process beginning with the customer initiation Roles and responsibilities: Performed financial research and analysis as necessary and respond to data requests and additional projects and responsibilities as assigned. and the quality of the output files. Suggested measures and fine-tune queries to improve the performance of each Interface from current systems and recommended solutions to overcome these limitations. Identified the limitations users currently experience in the operational reports obtained reporting requirements and system information. Served as liaison between IT and business users including Accounting and Claims on out of scope aspects of the process. Prepared Business Requirement Design Specification and determined in scope and submitted by the production support/QA team during UA testing. Prepared Statement of Work documents based on defects or change request documents source system to Target Pre-staging. Assisted in documenting all existing Files and Data elements to be converted from Crystal Reports was used to generate reports from different databases of different asset classes like equities, bonds, derivatives, and commodities, for all business needs. Confidential Tools Used MS Project, HP Service Desk, MS Visio, MS Word, MS Excel Domain Knowledge Communication Business Analytics, Standard Workflows CIM Business Knowledge Waterfall Methodology Role Business Analyst Team Size 5 Confidential is the leading provider of billing software products to many wireless communication companies across the world and to the broadband and cable companies. I was mainly involved in eliciting and gathering business requirements and extensively testing of CIM Customer Implementation Management delivery for the Comcast Customer. Roles and responsibilities: Writing the detailed user needs, gathered requirements during inception phase, documented And delivered functional specification documents, and assisted architecture analysis and design Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, Identified, researched, investigated, analyzed, defined and documented business process Developed the test plan, test conditions and test cases to be used in testing based Assisted in conducting Functionality testing, and User Acceptance testing UAT . Functioned as the primary liaison between the business line, operations, and the technical areas throughout the project cycle. Analyzed research on operational procedures and methods and recommended changes for improvement with an emphasis on automation and efficiency. Used Mercury Test Director with QA team for testing.

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