SUMMARY

• Business Systems Analyst with 7+ years of extensive experience, specializing within Health Care.
• Aggressively productive and creative individual with excellent management, administrative, communicative, analytical, and integrative skills; with capabilities to maintain progressive and prosperous working environment.
• Exceptional abilities to build and maintain relationships with Business Users, Stakeholders and Subject Matter Experts (SME), alongside Project Manager / Scrum Master, Business Analyst Team, Development Team, Quality Assurance Team, and Deployment Team.
• Excellent knowledge of the Software Development Life Cycle (SDLC), such as Rational Unified Process (RUP), Waterfall, and Agile (Scrum) methodologies.
• Experienced of working on both Java and .Net projects.
• Have good experience of working with Webservices.
• Adept in requirements gathering, documenting, analyzing, detailing, and reporting.
• Expertise in the functional processes of Business Analysis and Data Analysis, such as Business Requirements Documents (BRD), Functional Requirements Specifications (FRS), System Requirements Specifications (SRS), Use Cases (UC), and Requirements Traceability Matrix (RTM).
• Proficient in constructing detailed GAP Analysis, Analysis Models, Activity / Process Models, and Data Flow Diagrams in the forms of Swim Lane Diagrams, Sequence Diagrams, and Wireframes.
• Skillful in preparing User Guides, and performing System Integration Testing (SIT) and User Acceptance Testing (UAT).
• Developed a 3 - tier application using Java Messaging System containing Student Registration & enrollment, Course creation & scheduling, assigning Instructors to courses
• Skillful when utilizing Microsoft SQL for complex queries and in-depth data analysis.
• Highly knowledgeable in utilizing Health Care Integration systems and their respective applications, such as TriZetto Facets, NASCO, HIPAA Gateway, and Informatica HIPAA Validator.
• Experience in web services testing using standards like XML, WSDL, SOAP and Java Message Service.
• Expertise with compliance standards, such as Affordable Care Act (ACA), Health Insurance Portability and Accountability Act (HIPAA), Centers for Medicare and Medicaid Services (CMS), American National Standards Institution X12 (ANSI X12), Electronic Data Interchange (EDI), International Classification of Diseases (ICD).
• Exceptional understanding of HIPAA Compliance 4010, HIPAA Compliance 5010, EDI Transactions (834, 835, 270, 271, 276, 277, 278, 837, 999), ICD-9 Codes, and ICD-10 Codes.

TECHNICAL SKILLS

Methodologies: Rational Unified Process (RUP), Waterfall, Agile (Scrum)

Microsoft Applications / Tools: Microsoft Office Suite, Microsoft Project,, Microsoft FrontPage, Microsoft SharePoint, Microsoft SQL Server

Reporting Applications / Tools: Oracle PeopleSoft Suite,, SAP Business Objects, SAP Crystal Reports

UML Application / Tools: Microsoft Visio, IBM Cognos, IBM Rational Suite

Testing Applications / Tools: Oracle TOAD, HP Application Lifecycle Management (ALM), HP QuickTest Professional (QTP)

Integration Applications / Tools: TriZetto Facets, NASCO, Informatica HIPAA Validator

Languages: UNIX, HTTP, HTML, UML, XML, SQL

PROFESSIONAL EXPERIENCE

Confidential, Parsippany, NJ

Sr. Business Analyst

Responsibilities:

• Acted as a primary contact in all the phases of Software Development Life Cycle SDLC, including Quality Assurance Testing, Performance & User Acceptance testing.
• Recommended changes for system design, methods, procedures, policies and workflows affecting Medicare/ Medicaid claims processing.
• Worked with the data architecture and data analyst team in designing the model and in creation of the data mapping documents
• Elicited requirements for Agile projects by documenting User stories, Product Backlogs and Acceptance Criteria.
• Followed Agile methodology as software development methodology.
• Analyzed the impacts of HIPPA 5010 project on inbound 837 claims
• Extensively worked with FACETS Implementation, FACETS Billing, Claim Processing and Subscriber/Member module.
• Used Data warehousing for Data Profiling to examine the data available (Data Analysis) in an existing database
• Involved in gathering requirements, configuration, and data conversion of the Facets application modules like Enrollment, Membership and Claim.
• Performed GAP analysis for ICD-9 and ICD-10 and EDI Message Structure with the 4010 Structure. Developed End-to-End Business Process Flows for HIPAA 5010 EDI transactions including 834 (Benefit Enrollment and Maintenance), 835 (ERN-Electronic Remittance Notification) and 837 (Claims Submission) Transactions.
• Worked in the analysis of the ICD 9 - ICD 10 codes conversion Project using GEM (general Equivalence mapping) processes and concepts. Worked in a project involving Miami Systems to create Drug Cards and created Test files to be sent to drug card vendors for approval.
• Worked extensively with TriZetto Facets and Informatica HIPAA Validator on HIPAA 5010standards for Electronic Data Interchange (EDI) Transactions 834 (Membership Enrollment), 835 (Enrollment of Benefits), 270 (Benefits Inquiry), 271 (Benefits Responses), 837 (Claims Processing).
• Maintaining knowledge of Medicare and Medicaid rules and regulations pertaining to the Facets configuration and evaluating the impact of proposed changes in rules and regulations
• Contributed in the build and design of organizational Wiki that provided comprehensive knowledge of workflows, policies and procedures, patient care objectives, regulatory requirements, and industry best practices for membership management.
• Worked on a Paid without prejudice project for various States. Performed UAT tests using the (MORAE) Usability Testing Tool using the Observer and the Manager Mode.
• Worked closely with the Enterprise Data Warehouse team and Business Intelligence
• Experience in writingSQLqueries, Stored Procedures and Triggers.
• Worked extensively with Tableau and MS Excel for the generating of reports.
• Responsible for architecting integrated HIPAA, Medicare solutions, and Facets EDI 834.
• Worked with FACETS, eBilling and EDI HIPAA Claims(837/835/834) processing .
• Analyzed results and EDI ANSI X12 file mapping and reported on standard analysis spreadsheet. Reviewed EDI companion guides for all payers to ensure compliance, edit integrity and maintain up-to-date list of payer contacts. Acted as a liaison between client and payer/intermediary.
• Developed test Scripts using Quality Center and coordinated with developers to quickly resolve the defects associated with them.
• Experienced in data warehouses and data marts for business intelligence reporting and data mining along with developing and documenting process flows for business processes.
• Worked with SSIS for data transformation and defining To-Be processes.
• Experience in Data Validation, Data Modeling, Data Flows, Data Profiling, Data Mining, Data Quality, Data Integration, Data Verification, and Data loading
• Developed several detail and summary reports including line and pie charts, trend analysis reports and sub-reports according to business requirements using SQL Server Reporting Services (SSRS).
• Created source table definitions in the Data Stage Repository by studying the data sources.
• Developed Database packages, procedures, functions, triggers using SQL.
• Worked on Data mapping, logical data modeling used SQL queries to filter data within the Oracle database tables.
• Conducted JAD sessions with the management, users and other stakeholders for open and pending issues to develop specifications. Analyzed and evaluated User Interface Designs, Technical Design Documents and Quality Assurance Test Conditions to test the performance of the application from various dimensions.
• Helped create the 'Business Glossary' to facilitate efficient understanding of the business process amongst the other teams. Assisted in creation of the Functional Design Document from the Business Requirements Document which was used as the reference by the development team while preparing the design and held the responsibility of the required data setup for unit testing.
• Strong communication skills with the ability to communicate appropriately in business and technical situations at all levels. Effectively presented projects using MS PowerPoint.
• Validate transaction records using SQL queries.
• Extracted data from Teradata and Oracle and created pivot tables in Excel
• Worked extensively on Business Requirements, Functional Specification, Data-Integration, Data Mapping, and Data Warehouse access using SQL and Crystal Reports, ETL process, use cases modelling (UML) using MS Office (Word, Excel, Access, Visio) and dashboards
• Developed new reports using Business Objects/Crystal Enterprises on SQL Server, Oracle and Teradata databases utilizing T-SQL and DTS, focusing on data verification and query performance.
• Interpret and analyze data to determine appropriate configuration changes
• Worked extensively in the executing of SQL queries on the database to verify data integrity.

Environment: Rational Unified Process (RUP), Agile (Scrum), Java, Web Services, HIPAA (5010), EDI X12 (834, 835, 270, 271, 837), Microsoft Office Suite, Microsoft Project, IBM Rational Suite (DOORS, MS Visio, Word, Excel, PowerPoint, Rose, Clear Case, Requisite Pro), IBM, Cognos, UML, XML, Java, Microsoft Visio, HP Application Lifecycle Management (HP ALM), TriZetto Facets.

Confidential, Tampa, FL

Sr. Business Analyst

Responsibilities:

• Performed GAP analysis as pertains to membership management and claims processing to evaluate the adaptability of the new application with the existing process
• Responsible for Documentation in each phase of RUP Methodology, Risk Assessment, and Validation & Verification process.
• Followed Agile (Scrum) SDLC methodology software development
• Developed Test Plans and Test Cases to test the GUI and workflow for Quality Assurance.
• Used Quality Center to plan tests, manages test assets, create and run manual and external scripts to check GUI and functional features of the AUT
• Involved with requirement gathering and analysis for the data marts focusing on data analysis, data quality, data mapping between ODS, staging tables and data warehouses/data
• Experienced in data warehouses and data marts for business intelligence reporting and data mining along with developing and documenting process flows for business processes.
• Involved in developing and maintaining Test Matrix and Traceability Matrix, and performing Gap Analysis.
• Maintaining knowledge of Medicare and Medicaid rules and regulations and evaluating the impact of proposed changes in rules and regulations.
• Created Process Work Flows and responsible for preparing Functional Requirement Specifications Involved in gathering and prioritizing requirements using 1 to 1 interviews, job shadowing, brainstorming & developing questionnaires
• Efficiently worked alongside Project Manager and Lead Business Analyst to determine the Scope and utilized Rational Unified Process (RUP) and Agile (Scrum) System Development Life Cycle (SDLC) methodologies to coordinate and strategize concise solutions within a constricted timeframe involving multiple interfaces.
• Prepared test Data sets and performed data testing using the PL/SQL scripts. Also used MS excel for data mining, data cleansing, data mapping, data dictionary and data analysis.
• Developed, designed & implemented department plan to configure new Facets integrated processing system, to include but not limited to, workflow, management oversight and performance analysis.
• Translated business requirements into functional specifications and documented the work processes and information flows of the organization
• Configured Process Models and Data Flow Diagrams by means of Swim Lane Diagrams, Sequence Diagrams, and Wireframes compliant to HIPAA 5010 standards for Electronic Data Interchange (EDI) Transactions 834 (Membership Enrollment), 835 (Enrollment of Benefits),270 (Benefits Inquiry), 271 (Benefits Responses), 276 (Claims Status Requests), 277 (Claims Status Notification), and 837 (Claims Processing) via Microsoft Visio.
• Used HIPAA Gateway to comply with HIPAA standards (270/271, 276/277 & 837) for EDI transactions
• Coordinated with the developers and IT architects to design the interface of the new system according to the X12 (270, 276, 278, 834, 837 (I, P, D) and 820) standards
• Responsible for configuration/ compatibility and BA testing with the help of Facets, SharePoint and Tidal scheduler
• Contributed in the build and design of organizational Wiki that provided comprehensive knowledge of workflows, policies and procedures, patient care objectives, regulatory requirements, and industry best practices for membership management
• Involved in Up-gradation of HIPAA X12 4010 transactions to HIPAA X12 5010 and ICD-9-CM to ICD-10.
• Full knowledge of the Diagnosis and Procedural Code changes for Healthcare Entities like Payers, Employer Groups, and Providers. Worked on ICD 9 codes and gathered future requirements based on ICD 10 codes. Managed creation of sample mappings for the conversion of EDI X12 transactions code sets version and translation of ICD 9 codes into ICD 10 codes.
• Participated in changes for system design, methods, procedures, policies and workflows affecting Medicare/Medicaid claims processing in compliance with government compliant processes like HIPAA/ EDI formats and accredited standards ANSI.
• Analyzed EDI X12 - 837I/P, 835 and 834 transactions consistency related to providers, payers, subscribers and other related entities
• Analyzed the data in the Facets source system to map into the correct field and attribute in the target storage
• Owner of the business rules document, which documented the business rules across different systems.
• Participated in all phases of the Facets Extended Enterprise administrative system implementation to include the planning, designing, building, validation, testing, and Go-live support phases
• Led and managed the User Acceptance Testing (UAT) for the implementation of Facets Extended Enterprise administrative system with emphasis on ensuring that the HIPAA regulation are met across all the modules
• Conducted requirement feasibility analysis with the developers to ensure the project was in scope with the timeline defined in the project plan.
• Worked with Source system Subject Matter Experts (SMEs) to ensure that the extracts are properly mapped. Used SQL for data mapping and querying
• Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data within the Oracle database.
• Executed advanced level SQL queries to verify data integrity of the databases.
• Used Microsoft Word, Excel, Access and Visio as working tools.
• Involved in the development of Test Plans, Test Cases and Expected Results, and coordinated the tests with the QA team to verify implementation of new features and enhancements.
• Performed numerous data extraction requests using SQL scripts to prepare ad hoc reports.
• Performed Data Analysis, Data profiling and Data validation by writing SQL queries using TOAD
• Involved in designing and developing Data Models and Data Marts that support the Business Intelligence Data Warehouse.
• Resolveddataissues and updates for multiple applications usingSQLqueries/scripts
• Responsible for unit testing and working with System/Integration testing team in debugging/resolving any issues raised during testing.
• CreatedDataFlow Diagramsand Process flow diagrams for various load components like FTP Load, SQL Loader Load, ETL process and various other processes that required transformation.
• Conducted user training pertaining to old and new Affinity Provider ID appearing on documents providers receive from Affinity (mainly occur with EOPs, capitation rosters, PCP membership rosters, provider directory listings and some system generated letters)

Environment: Rational Unified Process (RUP), Agile (Scrum), HIPAA (5010), EDI X12 (834, 835, 270, 271, 276, 277, 837), ICD-10, Microsoft Project, Java, IBM Cognos, IBM Rational Suite, MS Visio, Word, Excel, PowerPoint, UML, XML, Microsoft Visio, Atlassian JIRA, Microsoft SQL, Microsoft Access, Facets.

Confidential, Virginia Beach, VA

Business Analyst

Responsibilities:

• Reviewed CMS regulations of EGWP and PDP programs and translates regulations into business requirements.
• Conducted numerous JAD sessions with business users, developer and SMEs.
• Attended regular project team meetings and scrum meetings every day.
• Discussed and applied Rational Unified Process (RUP) and Agile (Scrum) methodologies, indicative to System Development Life Cycle (SDLC) with Project Manager and Senior Business Analyst.
• Worked closely with the Enterprise Data Warehouse team and Business Intelligence Architecture team to understand repository objects that support the business requirement and process.
• Used Data warehousing for Data Profiling to examine the data available in an existing database.
• Design, development, implementation and roll-out of Microstrategy Business Intelligence applications
• Prepared several use cases, designed use case diagram and process flow diagram.
• Created and executed test plans that improved data warehouse report quality using Word, Excel and Access.
• Extensively worked on Facets, the claim processing tool used in the project.
• Analyzed the member/eligibility information on claim to that in Facets.
• Utilized TriZetto Facets for mapping coordination of EDI Transactions 834 (Membership Enrollment), 835 (Enrollment of Benefits), 270 (Benefits Inquiry), 271 (Benefits Responses), 276 (Claim Status Requests), 277 (Claims Status Notification), 278 (Healthcare Services Review Information), and 837 (Claims Processing).
• Performed Data analysis from the data warehouse along with business intelligence solutions delivery team.
• Reviewed existing functional practices and recommends modification to processes or new strategies in meet business requirements.
• Involved in testing and reporting of errors of subsequent builds during the process of development and production.
• Worked with different IT & Business groups to understand and determine the Impacts to the Data Warehouse and/or Data Marts for different projects.
• Created detailed mapping documents and technical specification documents mapping the fields between multiple databases and the reporting data warehouse.
• Align with the BOs for defining test scenarios; workflow (or business process flows) and training processes.
• Reported and updated any issues to SharePoint repository, as necessary.
• Extensively involved in testing Trizetto's Facets and mainly involved in Enrollment and Eligibility modules.
• Analyzed the mainframe reports for member/eligibility/claims and mapped the fields withFACETSbatch jobs and reports.
• Worked on preparing sprint backlog and user stories in agile scrum methodology with business users, developers, and stakeholders.
• Involved in data mapping for new databases created to support PDP/ EGWP project.
• Helped database architects define the various fields necessary and create database structure.
• Provided QA support in writing test cases.
• Involved in the PDE design session, provided support to development team in PDE creation as well as PDE reject handling process.
• Wrote SQL queries to produce various day- to-day report and for testing purpose.
• Actively participated in CMS audit.
• Created detailed use cases, use case diagrams, and activity diagrams using MS Visio.

Environment: Rational Unified Process (RUP), Waterfall, HIPAA, EDI X12 (834, 835, 270, 271, 276, 277, 278, 837), Java, IBM Rational Suite (DOORS, Rose, Clear Case, Requisite Pro), UNIX, UML MS Visio, Word, Excel, PowerPoint,, Axure RP, Application Lifecycle Management (HP ALM), Microsoft SQL, Microsoft Access, TriZetto Facets.

Confidential, Bloomfield, CT

Business Analyst

Responsibilities:

• Coordinated the upgrade of Transaction Sets 837P, 835 and 834 to HIPAA compliance.
• Involved in the creation and maintenance of theWorkflow plans and artifacts. Used Agile Scrum methodology.
• Completed Data Mapping for Group and detail Product analysis and report writing
• Work closely with EDI to ensure accuracy in data transmissions and shared processes.
• Worked on Mapping documentation using the Implementation Guide for EDI HIPAA 834,835,837(D, P, I), 277/278 and other Health Care Transactions.
• Utilized SDLC Methodology to configure and develop process, standards and procedures.
• Experience with Trizetto Facets System especially with the Managed Care Credit policies.
• Responsible for managing the Data Warehouse and Business Intelligence functions
• Coordinated with various IT teams related to various Facets backend database for Test Data Setup.
• Designed Test Plans, Scripts after analyzing various scenarios/requirements & performed defect tracking using Test Director & Clear Quest.
• Worked closely on 834 transaction code for Benefit Enrollment and was involved in Validation of HIPAA for 837, 270/271, 276/277,835, 834 EDI transactions.
• Provided Production support and documented System Release/deployment issues.
• Coordinated the upgrade of Transaction Sets 837P, 835 and 834 to HIPAA compliance.
• Responsibilities include the - Analysis of inbound and outbound interfaces and extensions to FACETS claims processing system
• Completed Data Mapping for Group and detail Product analysis and report writing
• Work closely with EDI to ensure accuracy in data transmissions and shared processes
• Performed in depth analysis of data & prepared periodic reports using MS Excel and SQL.

Environment: Rational Unified Process (RUP), Waterfall, HIPAA, EDI X12 (835, 271, 276, 277, 278, 837, 999), Java, IBM Rational Suite (DOORS, Rose, Clear Case, Requisite Pro), MS Visio, Word, Excel, PowerPoint, UML, Axure RP, Microsoft SQL, Microsoft Access.

Confidential, Mineola, NY

Junior Business Analyst

Responsibilities:

• Worked alongside Lead Business Analyst and Senior Business Analyst to deliberate on plausible approaches and System Development Life Cycle (SDLC) methodologies.
• Conducted numerous interviews with Subject Matter Experts (SME), utilizing Meeting Minutes to obtain details of the requirements, as envisioned by Business Users.
• Assisted in building Business Requirements Documents (BRD), as proposed by Confidential (SSHC).
• Produced Functional Requirements Specifications (FRS) based upon requirements analysis via Oracle PeopleSoft Suite.
• Consistently interacted with Development Team and Quality Assurance Team to ensure requirements were delivered functionally.
• Identified Actors, Activities, Artifacts, and proper Workflows to develop substantial Use Cases (UC).
• Coordinated with various teams, located at multiple sites for Deployment.
• Performed functional testing of restful web services using both XML and JSON
• Subsequent to Transitioning phase, prepared User Guides, and performed User Acceptance Testing (UAT) alongside Business Users to determine latency or scalability irregularities.

Environment: Rational Unified Process (RUP), Waterfall, EDI X12 (834, 835, 837), Oracle PeopleSoft Suite, UNIX, UML, Java, Microsoft SQL, Microsoft Access, MS Visio, Word, Excel, PowerPoint, and TriZetto Facets.