SUMMARY:

A goal driven, compassionate and experienced Business Analyst with 5 years of experience in Healthcare, Pharma and Information Technology Industry. Has extensive experience in Health Insurance and Managed Care Information Systems. Proficient in MS Office, Clinical Search Engines, Pharmacovigilance, Electronic Medical Records EMR Systems with more than three years' of eClinical Works.

WORK EXPERIENCE:

Confidential

Business Analyst

• Ahealth care management start-up, we worked with independent physician models so providers can access, support, and manage delegated risk models and stay independent while payers can diversify and strengthen their network.
• Worked with clients to deliver a truly unique, state-of-the-art solution for Payers, Providers / ACOs, and partnering organizations and facilities.
• Lead the effort to define and document internal operational processes associated with servicing clients.
• Analyzed and documented best practices and internal processes for workflows associated with servicing clients.
• Gatheredrequirements and specifications for applying workflows to internal systems i.e. system changes and configurations in support of working with new clients and their business needs.
• Communicate and interact effectively and professionally with co-workers, management and customers
• Worked with various teams across the organization to analyze requirements and manage projects across multiple departments.
• Used MS Office Visio to document workflows and worked with the project team to create other documentation and training aids.
• Worked with care management system- MEDecision , clinical guidelines and provider contract implementations.
• Worked efficiently andeffectivelyto communicate with senior executives, stakeholders and other business partners.
• Conducted gap analysis on the as-is and to-be states which required working very closely with the data analytics team and other teams which were located in other locations across the nation.
• Helped the data warehouse teams in analyzing all the various data elements across all the different jobs, tables and applications.
• Worked closely with provider and business teams across all locations to capture upgrade changes.

Confidential

Business Analyst

• Provided ongoing support and expertise to insurance companies and medical professionals through comprehensive assessment, planning, implementation, and overall evaluation of individual patient needs.
• Worked extensively on HCSC system, which is a Blue Cross Blue Shield medical management system Similar to HEDIS Management System .
• Worked directly with Blue Cross Blue Shield members and Medicaid Members across the nation, namely BCBS state plans for Florida, Illinois, Texas, Oklahoma, Montana, New Mexico and California.
• Identification of data elements deemed to PHI Protected Health Information as HIPAA Regulation, Created Meta data for encryption engine.
• Data analysis to support UB92, HCFA, 4010 to 5010, NCPDP 5.1 to D.0 conversion.
• Trends break analysis and History data conversion to new layout.
• Data Analysis related to ICD9 to ICD 10 qualifiers.
• Reviewed existing system manuals, design documents and user guides and created As-Is Business Process flows.
• Facilitated JAD sessions to confirm understanding of the As-Is Business Process
• Interviewed business users, SMEs, end users and gathered requirements for To-Be Systems.
• Defined Project Scope and created Business Requirements Document BRD .
• Facilitated Requirements walkthrough with Business and IT stakeholders and prioritized requirements across releases.
• Assisted the Project Manager in building the product release roadmap.
• Created Detailed Functional Specifications based on the high level requirements.
• Used UML tools - Use Case Specifications and Activity Diagrams to describe functionality/features in Functional Specifications.
• Traced Business Requirements BRD to Functional Requirements using RequirementsTraceability Matrix.
• Coordinates the preparation of the annual medical record review project which includes MOCK refinement, test run and analysis.
• Collaborates with other staff in Missed Services Report production.
• Assists Manager in annual Roadmap preparation.
• Conducts data extraction, validation and analysis.
• Assists in the Medical Record collection process including making phone calls to providers if assigned by manager.
• Assists in the preparation of the annual HCSC Compliance audits.
• Works with the corporate HCSC team similar to healthcare systems like HEDIS . to monitor accuracy of data and methodologies when assigned.
• Participates in scheduled meetings with the corporate HCSC team and vendors, HCSC auditors.
• Gather requirements for enhancements that would assists as needed in support of accreditation activities such as NCQA reviews, CAHPS, state audits.
• Coordinated with the offshore development teams and acted as a primary point of contact for Requirements/Business Rule clarification.
• Assisted Quality Assurance Testers in preparing System Test Cases and clarified Requirements.
• Prepared User Acceptance Test Cases and ensured that all Business and Functional Requirements are adequately covered by the UAT Test Cases.
• Performed Business Requirements, Functional Specifications, UAT walkthroughs with the team members and incorporated modifications and obtained Sign-off
• Produced clear user manuals training guides for User Acceptance Testing UAT and deployment with step-by-step instructions and created appropriate GUI screenshots.
• Interacted with the Data Modelers and Data Warehouse teams to understand the designing of the new data warehouse
• Used SQL to query the existing data warehouse. Required data was exported to an excel sheet which was then provided to the Business Intelligence team for their analysis purposes.
• Created Data Mapping documents to support migration of data from Legacy to New systems.

• Used the Agile Scrum methodology to carry out every step of the business modeling process.
• Identified and documented business processes to define high level model.
• Lead brainstorming sessions to gather business requirements and discuss possible solutions, documenting them into a Business Requirements Document and translating into Functional Requirements Document as well as User Stories.
• Gathered Business Requirements from users, maintained Requirements Traceability Matrix RTM .
• The project was developed using the Agile Scrum framework in four week sprints.
• Analyzed, elicited, and documented requirements with user stories.
• Lead user requirements gathering sessions/meetings, working closely with project manager, SME's and business users to facilitate sessions.
• Collaborated with business owner of product and application to improve and integrate new business with current operations.
• Updated priority and complexity numbers based on input from product owner, development lead and quality analyst lead during product backlog meeting sessions.
• Created user stories, with user phrase, user narrative, and user acceptance criteria components and obtained sign-off.
• Participated and occasionally facilitated daily standup meetings for the team status.
• Provided demos to the product owner on completed functionality to gather input and other changes during the user story development.
• Highlighted and removed roadblocks for the Scrum Master.
• Managed requirements churn and scope creep during sprints.
• Involved heavily in QA life cycle, which includes designing, developing and execution of the entire QA Process and documentation of test plans, test cases, test procedures and test scripts.
• Participated in the sprint retrospectives and incorporated lessons learned into next sprint.
• Worked in the enhancement and implementation of EDI applications to process Health Care transactions as per the HIPAA standards.
• Involved in HIPAA Complaint 837, 835 Transaction testing.
• Written and executed multiple Test Cases Unit, System, and Integration for multiple transactions including 837,835,276,277,270,271 both inbound and outbound transactions.
• Tracked all the HIPAA errors in the NASCO T51 format for 837 Institutional Claims. Verified the mapping to X12 format.
• Conducted JAD sessions to elicit requirements.
• Performed the Analysis Design workflow by following the Agile Approach for the migration of the application.
• Used MS Visio to create Use Cases, Workflow diagrams, Wireframes, Use Case diagrams and Activity diagrams.
• Reviewed interfaces specifications and identified data elements required for interfaces.
• Reviewed Low level design documents and High level test case documents created by the development and testing teams.
• Facilitated development of test strategy and test plans for performing Integration and System testing.
• Involved in analysis of Test Plans and Test cases, detecting bugs in the system, prepared defect reports using Quality Center and interacted with developers for debugging the defects.
• Supported clients during the UAT User Acceptance Testing phase.
• Involved in writing Test Cases, procedures, reports and approval of software release during production implementation.