SUMMARY:

• Business Systems Analyst with 8 years of experience in Healthcare Industry involving in-depth understanding of Business Process Flows.
• Have a degree in Bachelor of Engineering from Dayananda Sagar Institution, Bangalore, India.
• Have a Scrum Master Accredited Certification from International Scrum Institution and a member of International Institute of Business Analysis IIBA .
• Experience in Software Development Lifecycle SDLC from association with end-users for requirements determination, defining the system scope, system analysis, Business Case Development to Rollout, Production, testing, maintenance and documentation.
• Thorough knowledge of Unified Modeling Language UML , Rational Unified Process RUP , Agile-SCRUM, Waterfall, Rapid Application Development RAD methodology and rational tools.
• Proficiency in transforming business requirements into functional specifications focusing on workflow analysis and design, user interface design, and process flow modeling.
• Lead and organized Requirements gathering sessions and JAD sessions before groups of Subject Matter Experts as needed in order to document decisions regarding future state of business processes.
• Experienced in Healthcare Pricing/Reimbursement, EHR Electronic Health Records and EMR Electronic Medical Records .
• Good knowledge of Health Insurance Plans Medicare Part A, B, C and D , managed care concepts Medicaid and Medicare .
• Proficient in medical terminology and coding outpatient and inpatients diagnosis and procedures using ICD-9, ICD-10 codes.
• Experience in a MMIS Medicaid Management Information System environment, HIPAA, HL-7, EDI Transactions 270,271,276,277,834, 835, and 837 .
• Have good knowledge of health insurance claims like Ub04 and CMS1500.
• Extensive experience with process modeling using UML, activity diagrams swim lane charts and Use Cases, flow charts and sequence diagrams.
• Business writing skills in writing Business requirements document, Use-Case Specifications, Systems Requirements Specification SRS .
• Experienced in Systems Testing, Integration Testing, and Software Quality Standards, Documentation and implementation in a business environment.
• Experience in Business Requirements Elicitation, Process Modeling, Gap analysis, Risk analysis, and conducting SWOT analysis.
• Have experience in selection of PK, SK and CK, understanding the entities and communicating the same to ER diagrams and dimensional modeling with designing of data marts. Experience in ETL tools like Informatica.
• Experience in writing Test Cases and Test Scripts from the system requirements.
• Ability to rapidly learn new concepts and good experience in handling global projects.
• Can work individually and in a team, posse's excellent communication and interpersonal skills.

Confidential

TECHNICAL SKILLS

PROFESSIONAL EXPERIENCE:

Confidential

Sr Business Systems Analyst

Confidential is a global health service company that works to develop innovative programs to assist individuals and families to improve their health at a lower cost. The scope of the project was to implement an application that allowed patients to review plan information and find in network providers, for patients, providers and clearing houses to review submitted X12 835 claim statuses, expansion of network providers globally and handling of international insurance claims in compliance with HIPAA standards.

Responsibilities:

• Involved in Requirement Scoping, RFP documenting and analyzing high priority requirement for implementation Created BRD, functional Requirement documentation and use case documents using Agile-Scrum methodology.
• Used rational Requisite Pro to manage the requirement and keep the Traceability Matrix.
• Prepared logical data model in the form of Business Context diagram to include various entities and attributes in order to facilitate the design of Data model in the form of Use case Diagrams.
• Conducted Joint Application Development JAD and Rapid Application Development RAD sessions for communicating and managing expectations.
• Involved in HIPPA assessment and HIPAA X12 EDI transaction 835, 837, 270/271 mapping and identified changes that needed to be done to comply with HIPAA regulations.
• Involved in gap and feasibility analysis for the design and architecture of the new application.
• Worked with HIPPA compliant ANSI X12 837 formats for all the types of claims.
• Executed SQL queries to test the database for records that detect and submit functional acknowledgement and remittance advice in the claims application.
• Prepared test cases, test script and coordinated with the QA team for testing and Interacted with the developers to report and track bugs using Test Manager.
• Managed the change request and analyzed the impact of the change request on the application in regards to Project Plan, Scope, and Schedule.
• Involved in GUI Design sessions with Usability Team Browser compatibility and navigation were tested manually.
• Tested the final application for usability testing to verify whether all user requirements were catered to, by the application.
• Responsible for testing the HIPAA Transactions and Code Sets 837 transactions.

Environment: MS Access, MS Excel, MS Visio, Test Manager, MS Project, Rational requirements composer 4.0.5, HTML, My SQL.

Confidential Business Systems Analyst

The scope of the project was to gather the requirements and perform gap analysis and facilitate ICD-9 to ICD-10 mapping according to HIPAA guidelines. It included forward and backward mappings using GEM as basis.

Responsibilities:

• Compiled the Vision Document and composed detailed Use Case Specification Documents in Rational Requirements composer.
• Used UML to perform Use-Case analysis to capture the dynamic aspect of the application.
• Interacted with stakeholders and gathered requirements as per the business needs using Agile Scrum methodology.
• Identified AS-IS processes of claims transactions of 4010/4010A standard and TO-BE processes ICD-10-CM and ICD-10-PCS compliance requirements of 5010 standard using the gap analysis for ANSI X12 837 form and encounter form processing and submission to CMS and state facilities.
• Use of standard vocabularies like SNOMED and RxNorm to optimize target code description database. Used a late binding data model approach to data warehouse design. Ensured the accuracy and consistency of the data during the data loading process.
• While working with various members at the management level to understand the business process and decision models, was also involved in compiling the vision document and composing detailed use case specification documents in Rational RequisitePro.
• Was involved in managing the daily standup meetings and also ensured that quality standards were enforced as per the build-release schedule. Conducted GAP analysis by understanding the AS-IS system and the TO-BE system requirements by having discussions with the SME's.
• Developed Test Plan and Test cases based on the Use cases and Functional specifications and also performed manual testing of the functionality of the application by inserting varying data on different test runs. Developed Flowchart and process diagram using Microsoft Visio

Environment: Windows 2000/XP, HL7, Microsoft Office SharePoint 2007, Agile-Scrum, Rational Requirements Composer 4.0.5, MS Office, My SQL Server, MS Project, Informatica, Cognos.

Confidential

Business Systems Analyst

Quest Diagnostics offers convenient access to testing and services to patients, for physicians and hospitals throughout the US. The scope of the project was to design and update an operating of the diagnostic portal and registry for an effective EHR system.

Responsibilities:

• Worked with business representatives to understand requirements and priorities and ensure that software development work is appropriately aligned.
• Involved in the meeting with Business Process Owners, Subject Matter Experts SME and Health Center users for Requirement gathering in Definition Stage using Rational Requisite Pro.
• Used RUP with Waterfall methodology to satisfy business needs.
• Facilitated Requirements Sessions for portal framework and content management system with emphasis on support for Electronic Health Record management.
• Worked closely with Data Architects and ETL Leads/Managers and was responsible to perform detailed data requirements analysis and create design specifications and operational documentation.
• Provided the ETL team with the Data mapping document and assisted them to create the mappings.
• Worked closely with the architects, database administrators and technical team during Data Mapping and Data Integration.
• Involved in data modeling and building fact and dimension tables. Used an adaptive approach towards data warehouse design.
• Executed complex SQL queries to test the database for records that detect and submit functional acknowledgement and remittance advice in the claims application.
• Worked closely to relate all lab reports with Medicaid Management Information Systems in compliance with HIPAA 5010 regulations.
• Participated in user meetings to understand requirements for integration with vendor EHR solutions compliant with HIPAA regulations and Meaningful Use guidelines.
• Involved in GUI Design sessions with Usability Team Browser compatibility and navigation were tested manually.
• Created various Use Cases and workflow diagrams, using MS Visio.
• Maintained Traceability Matrix in Excel.
• Created Report Mockups and Sample Mapping documents for the Error Reporting.

Environment: Windows 2000/XP, HL7, Microsoft Office SharePoint 2007,RUP, Rational Requisite Pro, MS Office, Microsoft SQL Server, Microsoft visual studio, MS Project, HTML, Informatica

Confidential

Business Systems Analyst

The project involved launching a Web Application using XML Web Services designed to simplify Core Business Functionality. It is leader in the e-prescribing movement. Physicians can use the electronic prescribing tools to access Electronic Health Records EHR of the patients and write prescriptions for all of their patients, regardless of the patient's prescription benefit coverage.

Responsibilities:

• Gathered requirements through a series of interview sessions and group meetings with the identified users and developers. Involved in documenting Business process Model and process Overview.
• Conducted Joint Application Development JAD sessions with stakeholders throughout SDLC to resolve various issues raised by the Network Physicians in adapting eScribe.
• Prepared a comprehensive set of wireframes to ensure the consensus on UI with the help of SME and by continually interacting with the network physicians for feedback.
• Gathered requirements to customize the Electronic Health Records for Smartphone UI, provided wireframes and mockups for user satisfaction.
• Interfaced with business users to prepare and update Business Process Requirements BPR and Software Specifications Requirements.
• Developed workflow, screen mock-ups, and conversion requirements.
• Produced Visuals for the application using Rational Rose and created Use Cases, State diagrams, Sequence Diagrams and Activity Diagrams.
• Extensively used SQL scripts/queries for data verification at the backend. Worked to regulate flexibility of the application's features during development to help in customization of the product onsite at the client organization.
• Prepared User Manual detailing the functioning of the Software Application.

Environment: MS Access, MS Excel, MS Word, Requisite Pro, MS Project, MS Visio, Outlook

Confidential

Business System Analyst/Data Analyst

At Semler Research Center, new formulation drugs testing reports were being stored and submitted manually. The Project was for creating and maintaining applications that would automatically keep testing records of drugs and submit electronically the gathered reporting requirements of the testing results in specified formats.

Responsibilities:

• Analyzed and optimized the existing business processes using the conceptual modeling methods and documented the business process. Conducted requirement workshops with key business users to make them understand the project scope and deliverables and to check the feasibility of the project.
• Documented user and technical interface design documents to specify data files, control files, trigger files, receiving and sending systems.
• Analyzed and translated business requirements into system specifications utilizing UML diagrams.
• Conducted walkthrough session with business end users, stakeholders, SME, project manager etc. to discuss and resolve various issues.
• Extensively worked on Data Analysis of different tests for tablets such as Disintegration, Hardness, Friability and Dimensional analysis etc.
• Importing, cleaning, transforming and validating data with the purpose of understanding or making decisions.
• Assisted architect in selection of PK, CK and SK for developing of star schema. Involved in development of fact tables and establishing relationships using dimension modeling as basis for designing data warehouse.
• Created Use case diagrams and activity diagrams using UML for designer and developer to describe whole scenarios using MS-Visio.
• Data validation, analysis and generating accurate reports for different testing of pharmaceutical drugs.
• Trained business end for new functionality of application.

Environment: MS Access, MS Excel, MS Word, Requisite Pro, MS Project, MS Visio, Outlook, Microsoft SQL Server, Microsoft Visual studio, SSIS.

Confidential

Business Analyst

confidential in the area of healthcare gastrointestinal, cardiovascular, cancer, respiratory and infection. Project involved the implementation of a EMR Solution.

Responsibility:

• Assisted in transforming user requirements into functional solutions.
• Facilitated meetings JAD Sessions and interviews with stake holders to gather the Business Requirements
• Define and establish end user requirement for configuration and implementation of EMR.
• Provide healthcare specific operational knowledge to support system design including workflows charts, diagrams
• Prepare business process flow diagrams and perform use case analysis.
• Provide insurance specific knowledge of back office applications including under-writing, billing, claims submittal and processing
• Develop and maintain models and documentation of all business and system requirements configuring the system accordingly

Environment: EMR, GE Centricity, MySQL, Windows XP, MS Office, MS Visio.