SUMMARY

• 6 years of experience in Business Analysis and Project Management in healthcare industry.
• Experience in working with SDLC methodology and project life cycle. Worked with software methodologies such as Waterfall, Agile, RAD and RUP.
• Excellent knowledge of standards like six sigma and CMM. Conducted many workshops and JAD sessions involving company employees and end users.
• Adequate knowledge of Medicare/Medicaid Claims processes. Proficiency in medical terminology, ICD-9, CPT and EDI codes. Adequate knowledge of HIPAA standards.
• Excellent work experience in creating project plan, use cases, activity diagram, sequence diagram, requirement traceability matrix and test plans.
• Created the Business Requirements Document BRD and Functional Requirement Document FRD .
• Involved in project implementation, training and maintenance. Extensive experience working with and managing a wide variety of business and technology groups such as developers, QA analysts, data architects, project managers.
• Experienced in ensuring quality, budget and timeliness of the project.
• Expertise at requirement analysis, requirement prioritizing and developing the Business requirement documents.
• Experience in project planning, management and project plan development in Microsoft project.
• Worked extensively on each phase of Software Development Life Cycle SDLC and managed the requirement traceability matrix at all the stages of SDLC.
• Knowledge of various software methodologies like waterfall, agile, RAD and RUP
• Effectively conducted Joint Application Development JAD sessions with users, stakeholders and system analysts.
• Experience in modeling Use Case Diagram, Sequence Diagrams and Activity Diagrams using UML.
• Analytical, methodical, and resourceful approach to problem solving, identifying root causes and corrective actions to meet short and long-term business, financial, and system requirements.
• Involved in executing test plans, test cases, test results analysis with the testing team and reporting defect management and test status matrices. .
• Experience in web designing using HTML and PHP.
• Extensive documentation skills Experience in conducting User Acceptance Testing, SWOT Analysis, Cost Benefit and ROI analysis.
• Used MS Excel spread sheet, Access, PowerPoint, MS Visio and MS Projects.
• Functional experience in Health Care Industry with in depth knowledge on Medicare and Medicaid.
• Performed Gap analysis pertaining to 4010 5010 conversion to accommodate the ICD-10-CM and ICD-10-PCS code sets.
• Understand rules and regulations of HIPAA as imposed during Electronic Data Interchange EDI .
• 837 - Claims and Encounters
• 834 - Benefit Enrollment and Maintenance
• 835 - Claim Payment/Advice
• 270/271 - Eligibility Benefit Inquiry and Response
• 277/275 - Claim Request for additional Information and Response
• 276/277 - Claim Status Request / Response
• Extensive Documentation Skills for use in Standardization of Testing and Programming Procedures and Guidelines.
• Excellent communication and presentation skills. Experience working with business users as well as senior management.

SKILLS

EXPERIENCES

Business Analyst

Confidential

• Managed the project efficiently to produce ICD-9 CM codes files into their corresponding ICD-10 CM and PCS codes mapped files EDIFECS mapping tool was used to map these files. Key challenge was the coordination with MMIS claims team to identify/extract the exact claim file layout and the data for business rules that are built in the MMIS system for an exact map with the ICD-10. This process was necessary to make sure that loading of the mapped ICD-10 files into the MMIS system is successful.
• Modified and used Project Templates to gather the requirements.
• Facilitated the requirement gathering work sessions with stakeholders, SME's and Business owners to understand and incorporate the potential requirements in the BRD.
• Coordinated the project team for JAD and BRD Sessions.
• Performed QA Analysis and coordinated System testing, Regression testing and UAT for several claim types and test scenarios.
• Compared and validated 5010 system test results with 4010 results for the same test scenarios.
• Followed a structured approach to organize requirements into logical groupings of essential business processes, business rules, information needs and ensured that critical requirements are not missed.
• Involved in doing ICD9 to ICD 10 Remediation.
• Coordinated activities between business units and technical staff, developed new methods, policies, and procedures to meet the business needs.
• Responsible for creating test scenarios, scripting test cases using testing tool and defect management for Policy Management Systems, Payables/Receivables and Claims processing.
• Studied the existing CDW with a view to Map the data from CDW to ODS EHDW with ICD 10 fields.
• Created the Mapping specification for loading the EHDW.
• Mapped the source and target databases by studying the specifications and analyzing the required transforms.
• Analyzed and translated business requirements into system specifications using UML and RUP methodology.
• Analyzed and translated business requirements into system specifications using UML and RUP methodology.
• Prepared Functional Design Specifications FRS employing Use case scenarios, sequence diagrams, DFDs and class diagrams.
• Identified and clearly defined functional issues and supported IT development staff throughout the design, development, unit testing, and implementation phases of the software development life cycle.
• Documented the Requirement Traceability Matrix for tracing the Test Cases and requirements.
• Documented and assisted the QA Team with the Test Plan.

Environment: MM portal, EDIFECS, HIPAA, Oracle, SQL, QTP 10.0, MS Office, MS-Visio

Business Systems Analyst

Confidential

• The project was to provide web based revenue cycle automation and management solution to its clients on demand basis. The main objective of the application will be to maintain patient related information and account receivable to increase collection from insurance companies. HIPAA compliance was needed in all processes from tracking medical claims, sending it to the insurance company and follow up and closing of the claims.
• Responsible for developing and reviewing business requirements, functional specifications, project schedules, documentation and test plans.
• Closely interacted with designers and software developers to understand application functionality, navigational flow and updated them about end-user sentiments.
• Collecting information from various insurance companies to be able to develop an application for checking the outstanding balance
• Bridging gap between the Business needs and the Technical solutions
• Used RUP methodology to satisfy business needs
• Defining the Business Process Model and Data Process Model
• Follow HIPAA compliance to safe guard patient information
• Coordinated with Project Managers to resolve risk issues and ensure compliance of Security System-Related to the HIPAA.
• Performed Gap analysis pertaining to 4010 5010 conversion to accommodate the ICD-10-CM and ICD-10-PCS code sets.
• Gathered AS-IS and TO-BE information about work processes and information flows Claims process, Membership, Enrollment and conceptualized using activity diagrams
• Managed and developed EDI specifications, gap analysis, and applications structures for data feeds and mappings for integration between various systems, including XML, to follow ICD 10 Code set, ANSI X12 4010 formats including 270 Eligibility/Benefit Inquiry , 271 Eligibility/Benefit Information, 276 Claim Status Request, 277 Claim Status Response, 700 Attachment Request, 701 Attachment Response, 810 Invoice, 820 Payment Order/Remittance Advice, 834 Benefit Enrollment, 835 Remittance Advice, 837 Claims and Encounter, and 997 File Transmission Acknowledgement, to meet and exceed HIPAA requirements set forth by the federal government.
• Developed use cases, and traceability matrices to better assist software development.
• Developed training material for understanding the newly developed application.
• Wrote technical documentation for root cause analysis on customer support issues.
• Part of the team assisting in documentation such as proposal writing, evaluation criteria, proposal approval, design document, project plan, project scheduling and project report.
• Prepared and presented monthly collection reports.
• Involved in training and quality of the overall workflow process.
• Creating and analyzing numerous clients' reports for various financial requirements
• Led both internal peer review and external reviews of use case specifications and in the process clarifying the critical requirements.
• Met with business teams as well as test teams to review the requirements as outlined in the use cases.
• Involved in developing test plans, test conditions and test cases to be used in testing based on business requirements using Quality center.
• Created and maintained the Requirement Traceability Matrix between the requirements and other products such as design documents and test plans.
• Familiar with User acceptance testing UAT , System testing, Integration testing and Regression Testing.

Environment - MS Word, MS Power Point, MS Access, MS Excel, MS Visio, MS Projects, HTML, MS SQL Server 2000, Windows 2000/XP, RUP.

Business Analyst

Confidential

• Confidential The project involved an interactive health care communication system which automated the manual work flow process followed by physicians and medical staff to suffice patient needs. It offered patients with online access to their practice using interactive web pages. Patients could schedule appointments, request prescriptions, manage account statements, maintain personal records, and receive email notifications. The system also facilitated the health care providers to place claims request which is processed with the aid of the Claims Processing System.
• Assisted in designing policies and procedures to protect the privacy of Electronic Protected Health Information to ensure data integrity as per HIPAA guidelines.
• Involved in creating the business case and project plan.
• Extensive HIPAA EDI 4010 transactions knowledge - 835,837,277,278,270,271 and the new 5010 formats.
• Played an active and lead role in gathering, analyzing, and writing business requirements.
• Created use cases using UML and managed the entire functional requirements life cycle using Rational Unified Process, Requisite Pro.
• Created and managed project templates, use case project templates, requirement types and traceability relationships in Requisite Pro.
• Reviewed detailed test cases with in-depth description of each test scenario of the system according to HIPAA guidelines.
• Conducted GAP analysis and assessed the status of the organization to determine the scope of the application.
• Assisted in building a business analysis process model using Visio.
• Designed and developed Use case diagrams narrative, Activity diagrams, and Sequence diagrams using UML.
• Documented the Functional Specifications Document.
• Developed Test Cases, test plans and strategies with Quality Assurance group to implement them.
• Facilitated JAD sessions with stake holders, developers, systems analyst and testers to collaborate resource allocation and project completion using MS Project.
• Identified and involved all key stakeholders, contributors, business, operations and technical resources that must participate in a project and ensured that contributors are motivated to complete assigned tasks within the parameters of the project plan.
• Conducted interviews with client to ensure developed functionality complied with user requirements.
• Collected and documented business processes as well as business rules.
• Experience with User Acceptance Testing UAT , System testing.
• Used Test-Director for testing requirements, test cases, reporting bugs, work completion status.
• Analyzed, organized, and updated database using SQL.

Environment: Rational Requisite Pro, Microsoft Office Suite Word, Excel, Power Point, Visio, Project , Windows XP, XML, SQL, Test Director.

Business Analyst

Confidential

• The project involved generating reports on various service providing systems such as Financial Eligibility, Claims Budget System, Claims Processing System, Automated Authorization System, Insurance and Third Party System, Correspondence, Liquidation and Encumbrance. The system primarily aimed at handling Medicare / Medicaid insurance claims and process exceptions.
• Involved in designing Healthcare Claims Administration Processing 837/835 and HIPAA Claims Validation and Verification Process.
• Addressed the changes made to the Medicare Medicaid program and created requirements mapping for the system requirements.
• Mentored several of the team members on best practices of HIPAA documentation requirements with Process Flow diagrams and Uses Cases.
• Participated in the identification, understanding of Business Requirements and authored the Business Requirement Document BRD and also documented business processes and business rules.
• Generating Use Case Diagrams, Sequence Diagrams, Business Objects, Domain Object Model using MS Visio, to depict process flows and Power Point Presentation.
• Developed Test plans and Test cases to be used in testing based on business requirements and technical specifications.
• Followed a structured approach to organize requirements into logical groupings of essential business processes, business rules, and information needs, and ensures that critical requirements are not missed.
• Used the artifacts of the RUP to strategize the implementation of RUP effort in different iterations and phases of the SDLC.
• Maintained Requirement Traceability Matrix RTM and utilized Clear Quest for change requests and defect tracking.
• Conducted and Managed JAD sessions with Subject Matter Experts SMEs and Business departments, for planning and Requirements Gathering.
• Functioned as the primary liaison between the business line, operations, and the technical areas throughout the project cycle.
• Developed Business process flows and documented the GAP analysis.
• Organized one-on-one meetings to identify business and System Requirements, and documented using Use Case Modeling, Process Flow diagrams and documentation.
• Worked closely with Developers, User Representatives and participated in the product design process including specifications and other document reviews.
• Involved in back end testing to verify data integrity using SQL.
• Created Full Life Cycle documentation from Project Requirements in the developmental stage to Functional Specifications for the completed modules of application components.

Environment: MS Office Suite, MS Visio, Windows XP/NT, SQL, Rational Rose, Requisite pro, Test Director.