Sr. Business Analyst

• Facilitator between Business Systems and Information Technology with over 6 years of experience in the field of Business Analysis and Project Management.
• Dedicated Business Analyst with experience in assisting in Healthcare related functions
• Willingness and ability to assist with special projects in support of business goals

SKILLS ABILITIES

SUMMARY

• Functional experience in Health Care Industry with in depth knowledge on Medicaid and Medicare Part A, B, C D, PPO, POS, and HMO health insurance plans, EMTALA, CMS.
• Experience in working on Systems Development Life Cycle SDLC such as Agile, Rational Unified Process RUP , Waterfall and knowledgeable of Spiral as well as Rapid Application Development RAD .
• Experience in conducting SWOT Analysis, Gap Analysis, Cost Benefit Analysis and ROI Analysis, Risk Analysis, Impact Analysis, User Acceptance Testing UAT .
• Documentation Skills for developing Use Cases, Project Plan, Risk Mitigation Plan, Vision and Scope documents, Requirement Traceability Matrix and Business Requirement document BRD .
• Experience in eliciting, documenting and reviewing Functional Requirements, System Requirement Specifications SRS , and Non-Functional Requirements NFR/SLR .
• Active role in eliciting requirements from stakeholders and users by utilizing methods like Interviews, Brainstorming Requirement Gathering Workshops, Joint Application Development JAD .
• Expertise in creating Use Case diagrams, Activity diagrams, Sequence diagrams, State diagrams based on UML Methodology and Data Flow Diagrams, Business Process Flow diagrams.
• Worked with Rational Requisite Pro, MS Project and Rational Clear Quest.
• Excellent knowledge of Health Insurance Portability and Accountability Act HIPAA , 4010 to 5010 transaction conversions, code set rules such as EDI 837, 834, 835, 270, 271, 276, 277 and ICD9-ICD10.
• Knowledge of Health Care Reform and Patient Protection and Affordable Care Act PPACA .
• Knowledge of Medical Management Information Systems MMIS , HL7, HIX Health Insurance Exchange .
• Knowledge of Electronic Medical Record EMR and Electronic Health Record EHR .
• Efficient in MS Office Tools.
• Worked on Trizetto Facets.
• Knowledge of CMM and Sig Sigma quality standards.
• Working knowledge of SQL.

PROFESSIONAL EXPERIENCE

Confidential

Business Analyst

Confidential, offer an open, integrated portfolio of healthcare information technology solutions including Ambulatory Care Solutions, Electronic Health Records and Ambulatory Services for hospitals, physician practices, and post-acute organizations.

Responsibilities

• Worked in a cross-functional team environment to identify and translate business requirements and use cases for Patient Access Services Enterprise Patient Registration and Enterprise Patient Appointment Scheduling from Product Management into efficient and effective user interactions.
• Effective Agile team member, through the project's conceptual and functional design phases of the Patient Access Management system eliciting Business requirements, Project Objectives, Functional and Non-functional Requirements from internal and external stakeholders via Discussions, Brainstorming, Interviews, and user-centered design activities.
• Facilitated in Current State and Gap Analysis for the proposed application.
• Worked jointly with Management team and technical resources to document and review functional analysis, business rules, system processes and recommendations to meet business needs.
• Documented Vision, Scope, Use Cases, Business Requirement Document, Requirement Traceability Document.
• Involved in developing requirement procedures for making the Application Portal HIPAA 5010 compliant with EDI standards for Online Bill Payments.
• Aided in specifying designs, including system logic and data, workflow diagrams, and other details needed to convey functional or user intent for QA, Development, and Support.
• Used UML to produce Use Case models, Activity and Sequence diagrams, as part of the detailed design of interfaces.
• Completed assigned project tasks according to project schedules.
• Proactively identified issues related to the quality, timeliness or budget of the project and communicated solutions to Business Unit Owner and Project Manager.
• Worked with developers to analyze and resolve application configuration issues and software defects.
• Co-ordinated with QA team in creation of Test Plans, Test Scenarios, Test Cases for system and integration testing, User Acceptance Testing UAT .

Environment: Agile Methodology, Rational Requisite Pro, Visio, MS Project, MS Office.

Confidential

Business Analyst

Confidential offers a broad and diverse range of health care coverage options to individuals and employer groups. The plan provides members innovative tools and resources dedicated to promote healthy lifestyles while managing health care costs.

Responsibilities

• Facilitated sessions with senior agency staff to identify the business flows and determined whether any current or proposed systems are impacted by the EDI X12 Transaction Code Sets and Identifier aspects of HIPAA.
• Produced reports through Impact Analysis on system, data, technology, providers and clearing houses, enabling recommendations and best practices for becoming HIPAA compliant.
• Involved in developing Project Plan, detailing the tasks and effort required to achieve HIPAA compliance.
• Elicited, documented and managed Business and System requirements for HIPAA 5010 version 837, 834, 835, 270, 271, 276, 277 transactions through requirements gathering sessions with stakeholders.
• Performed Gap Analysis between HIPAA 4010 and 5010 and involved in evaluating benefits of new system with the Management team to strategize solutions to the process of HIPAA compliance.
• Created Vision, Scope, and Use Case documents, Business Process Models, System Models depicting software architecture and interaction of system components.
• Involved in developing Business Requirement Document, System Requirement Specification document for application development.
• Maintained Requirement Traceability Matrix, Change Requests.
• Coordinated work plans between project manager and stakeholders using MS Project.
• Utilized Waterfall methodology to configure and develop process, standards, and procedures.
• Coordinated Joint Application Development JAD , Interview sessions with stakeholders throughout SDLC to resolve open issues.
• Worked with QA team to get technical designs developed by application and database developers validated against functional specifications.
• Worked with QA managers, developers to get sign offs after internal, external and system testing.
• Reviewed Privacy regulations of HIPAA and documented changes for developing PHI privacy policies for member, group employer and agents.

Environment: Waterfall Methodology, Rational Requisite Pro, Visio, MS Project, MS Office.

Confidential

Business Analyst

Confidential more than 240,000 individuals in Connecticut and Western Massachusetts. ConnectiCare offers health insurance products on both a fully-insured and self-funded basis including: HMO, PPO, HAS, HRA, Individual, Dental and Medicare Advantage health plans.

Responsibilities

• Performed gathering, analysis, review and signoff of business, system, technical and non-functional requirements and coordinated Interviews, JAD sessions, Brainstorming, etc.
• Documented requirements and communicated these to development team for design and implementation of business solutions.
• Participated in Gap analysis between stakeholders/user's needs currently available on the present website and proposed solutions.
• Developed documentation for SWOT Analysis, Risk Analysis, Risk Management Matrix, Issues and Budget.
• Worked with Project Manager and Project lead on detailing Business Requirement Document.
• Maintained Requirement Traceability Matrix.
• Maintained documents for Change Request.
• Applied change requests, versions, and addendums.
• Incorporated stakeholder feedback throughout project lifecycle to ensure project quality and stakeholder satisfaction.
• Created Use Case descriptions, Website Features Models, Workflows, Data Process Models, Use Cases, Activity and Sequence diagrams.
• Documenting application's capabilities and features
• Analyzed HIPAA administrative standards to incorporate in health plan products.
• Evaluated Medicare requirements and benefits in Medicare Health Plans for member enrollment and management.
• Worked according to the activities/roles laid down in each phase of software development life cycle created using Rational Unified Process RUP .
• Developed summaries of research findings including implications and recommendations for dissemination in support of strategic and business planning as well as policy development.
• Worked with QA team for creation of Test Plans, Test Scenarios and Test Cases for system, integration and User Acceptance testing.
• Documented User Manual for website navigation.

Environment: RUP, Rational Requisite Pro, Visio, MS Project, MS Office

Confidential

Business Analyst

Confidential offers health plan under the Rhode Island Medicaid managed care program and partnership with the Community Health Centers.

Responsibilities

• Functioned as a primary bridge between the business, operations, and the technical areas throughout the project cycle.
• Worked with Project Management Office for managing product planning and implementation activities.
• Participated in analyzing state and federal requirements to ensure programs and business processes meet necessary requirements.
• Gathered and interpreted data and trends on health care industry, managed care and Medicaid health care policy resulting in the identification of changes to state health care and Medicaid policy.
• Coordinated Requirement Gathering Sessions for gaining detailed Business and System requirements.
• Conducted Business Analysis and Requirements Analysis activities to incorporate HIPAA and Medicaid provisions for Design, Development and Implementation Project.
• Maintained Requirements Traceability Matrix.
• Documented and managed Business and System Requirements, to recommend business priorities along with options, Risks and Cost Benefit Analysis of solutions.
• Worked with Project Manager to develop Business Requirement Document BRD .
• Used Rational Unified Process of SDLC.
• Used UML to produce Use Case models, Activity and Sequence diagrams, as part of the detailed design of interfaces.
• Provide project manager with key deliverable status and changes within the cross-functional team including priority changes ensuring program success.
• Worked with QA team to design and execute Test Plans and Test Cases for User Acceptance Testing.
• Worked with policy reviewers for creating new Coverage Summary and Billing Guideline for providers.

Environment: RUP, Rational Requisite Pro, Visio, MS Project, MS Office

Confidential

Jr. Business Analyst

Confidential offers flexible, fully integrated software solutions and services that help streamline and centralize business information, enabling companies to operate more efficiently, maximize customer relationships and profitably.

Responsibilities

• Assisted in Requirements Gathering Sessions by working with management and project implementation teams in eliciting product requirements.
• Documented, tracked and maintained Systems Requirements and Non-Functional Requirements for developing core solutions.
• Coordinated in Trend and Market Analysis for similar applications of other companies.
• Analyzed requirements, data and workflows to generate Business Flow Diagrams, As-Is and To-Be process flows.
• Assisted with writing text and graphical Use Cases detailing business and system process flows / data flows as well as Sequence and Activity diagrams.
• Maintained Requirement Traceability Matrix and Change Request documents for tracking changes.
• Co-coordinated with Product Management team for providing strategic inputs to help develop functional roadmap of the product and ensure client offerings are in-line with evolving business needs.
• Worked with QA team to review Test Plans and Test Cases.
• Helped develop Product documentation and Training documentation User manuals, quick-reference guides, best-practices, etc. .

Environment: Agile, MS Visio, MS Project, MS Office