Summary

• Over 7 years of experience as a Business Analyst and Systems Analyst in Healthcare Industry.
• Excellent working knowledge of HIPAA Compliance Life Cycle.
• Experience in creating Business Requirement Documents BRD , Use Cases, Business Systems Designs BSD and Project Plans.
• Maintaining the Requirements Traceability Matrix RTM across the Deliverables of a project.
• Excellent understanding of various insurance purviews including Medicare and Medicaid. Profound understanding of insurance policies such as HMO and PPO as well as proven experience with HIPAA X12 transaction codes for EDI such as 270/271 inquire/response health care benefits , 276/277 claim status , 834 benefit enrollment , 835 payment/remittance advice , and 837 health care claim .
• Strong understanding of underwriting and claims business processes in health insurance. Processing of new business, renewal, cancellation, reinstatement, and billing.
• Extensive experience in strategic development of data warehouses as well as performing statistical data analysis and data mapping from an operational data store to an enterprise data warehouse
• Extensive qualifications in all facets of information systems methodology from conceptual design through analysis of business specifications, documentation, implementation, user training, and quality review. Expertise in utilizing Business Process Modeling Notation BPMN as well as translating user requirement into functional use cases for analysis of business needs.
• Performed Data Analysis and Data validation by writing SQL queries using Oracle.
• Conducted GAP Analysis, SWOT analysis, Cost benefit analysis and preparing Training manuals and Knowledge Transfer manuals.
• Adept at creating and transforming business requirements into functional requirements and designing business models using UML diagrams Use Case, Sequence, Activity diagrams in MS Visio .
• In-depth knowledge of complete software development life cycle SDLC and various Software Methodologies such as Rapid Application Development RAD , Agile and Waterfall Methodology.
• Created test plans, test cases and worked with development team to analyze bugs and fix defects.
• Strong knowledge of business intelligence BI , data warehousing business architecture
• Strong aptitude for analyzing, excellent communication, good project documentation skills, adaptability to time bound projects, managing multiple projects simultaneously, a good team player and quick learner.
• Expert level skills in MS Office products like MS Word, MS Excel, MS PowerPoint, and MS Visio.

Areas of Expertise

Professional Experience

Confidential

Sr. Business Analyst

The project implemented Electronic Data Interchange EDI , improved First-pass claim adjudication and payment X12 transaction codes of 276, 277, 835, and 837 by creating a database of preexisting claims and cross referencing new claims with the database. I gained a thorough understanding of front and back end operations for claims processing through this project. The FACETS client/server based system was used as a platform for system development.

Responsibilities:

• Planned and documented procedures for data processing and prepared data flow diagrams for Electronic Data Interchange EDI , Enterprise Document Automation EDA .
• Followed a systematic approach to eliciting, organizing, and documenting requirements of the system.
• Conducted and facilitated workshops targeting structured walkthrough's, JAD Sessions, Gate Review, and Risk Analysis for requirements management activities.
• Implemented analytical application for retrieval, grouping and display information from enterprise data warehouse.
• Assessed data from various sources and generated conceptual and logical database designs using ERwin data modeling tool.
• Interacted with client and the technical team for requirements gathering and translation of business requirement to technical specifications.
• Defined and documented the Functional Requirements Document FRD , Business Requirements Document BRD , System Requirements Specification SRS , Requirements Traceability Matrix RTM and Use Case Specification.
• Performed feasibility, adaptability study and risk analysis to identify the business critical areas from the user perspective.
• Analysed and translated business requirements into system specifications utilizing BPMN and UML.
• Utilized data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data within an Oracle database.
• Prepared and documented workflows.
• Utilized corporation developed Agile SDLC methodology. Used Greenhopper Atlassian suite and Microsoft Office software to perform required job functions.
• Extracted, transformed, and loaded ETL data into a data warehouse/data mart and Business Intelligence BI tools. Developed graphs and pie charts utilizing Business Objects for presentation of project results.
• Interacted with claims, payments, and enrolment users to analyze and document related business processes.
• Performed unit testing and UAT and documented test results and defects.
• Designed and developed project document templates based on the scope and plan for the project.

Environment: HL7 v2.X, EDI, FACETS, SQL Server, MS Access, Rational Requisite Pro, MS Project, Agile methodology, Lotus Notes 7.0.2, Windows 2000/XP, MS Office.

Confidential

Sr. Business Analyst

The project improvised the EDI system on company's mainframe network. The primary focus was the interchange of claims data following ANSI X12 format including 270 Eligibility/Benefit Inquiry, 271 Eligibility/Benefit Information, 276 Claim Status Request, 277 Claim Status Response, 810 Invoice, 820 Payment Order/Remittance Advice, 834 Benefit Enrollment, 835 Remittance Advice and 837 Claims and Encounter, to meet and exceed HIPAA requirements set forth by the federal government. The project included testing all the loops, segments and elements within each hierarchal loops for 837 I and 837 P transactions.

Responsibilities:

• Implemented claim management system following the HIPAA guidelines of state and federal government ensuring HIPAA compliance in claim adjustments, claim processing from point of entry to finalizing, claim review, identifying claims processing problems, their source and providing alternative solutions.
• Prepared Test plans and assisted the QA team in Unit testing and Integration testing.
• Created Use Cases from the list of requirements and prepared use case diagrams using Rational Rose.
• Conducted JAD session with management, senior management executives, and other stakeholders for open and pending issues on the development of the project.
• Designed a high level spec document to show various paths that need to be taken into consideration for the transformation phase of 4010 to 5010.
• Involved in writing Test plans, Test cases and point person for executing the Test scripts.
• Collected weekly status reports to ensure that all deliverables are met on time and on schedule.
• Conducted web meetings with off-shore team members to ensure that everybody is on the same page.
• Worked extensively with inbound 837 I and P as well as outbound 835 claims processing systems
• Met with the Provider Communities and Trading Partners to ensure that HIPAA transactions pass the EDI gateway and interpret technical difficulties into simple language.
• Extracted the business requirements from the client and end users keeping in mind their need for the application internet, claims, provider, and recipient and documented it for the developers following the HIPAA Guidelines for an Individual functional area by conducting JAD sessions
• Facilitated collection of User Requirements and Business Requirements from Business User Group such as to document Business Requirement Documents BRD , User Requirement Documents URD ,Functional Requirement Specification FRS , Technical Requirement Specification using Rational Rose, that provided appropriate scope of work for technical team to develop prototype and overall system
• Reviewed the business process through SWOT analysis and existing documentation and conducted GAP Analysis between AS-IS and TO-BE scenario
• Worked with HIPAA rules and regulations to draft business rules
• Performed Data Analysis and Data validation by writing SQL queries using Oracle.

Environment:UML, ClearCase, WinRunner 6.0, Load Runner 6.0, Oracle 11i, HP Quality Center,QTP,PL/SQL, and UNIX.

Confidential

Sr. Business Analyst

• Confidential Cancer center has integrated programs in cancer treatment, clinical trials, education programs and cancer prevention. A web based application, Know Chart navigator was created to provide online access to the components of disease management programs and staging process. This system recommended a treatment based on patient's staging information and then matched the patient with appropriate clinical trial as recommended by practice guidelines.
• The goal of the project is to implement a clinical data repository a statistical computing environment. The repository will be used to store manage clinical data for Phase II III trials from the different data sources like Rave, Oracle Clinical, Watson LIMS, IVRS, etc. Business users of the project include statistical programmers, clinical scientists, and biostatisticians.

Responsibilities:

• Gathered requirements relating to the configuration of the EDC and CDM system - RAVE, ECRF Electronic Case Report Form design, clinical trial reports and output data extracts.
• Created high quality functional requirement specifications and supporting documents for business systems.
• Participated in statistical program validation and quality control activities, as assigned by interacting with other departments, such as Clinical Operations, Project Management, and Data Management to ensure a high level of client satisfaction through successful execution of projects.
• Successfully designed and implemented statistical reporting processes for regular data collection and clinical data analysis. Analyzed safety and efficacy data from Phase II and III clinical trials.
• Met with physicians, nurses, billing and administrative personnel. Documented the clinical, financial and administrative business practices, procedures and work-flows.
• Defined the current clinical and financial business processes and practices.
• Applied guidelines, standards and regulations such as HL7 CDA, CDISC, MedDRA, Code of Federal Regulations CRFs to clinical data modeling.
• Designed, authored, reviewed and revised Clinical Data Management Plans and Drug Safety Technical Reports are FDA 21 CFR Part 11 compliant
• Developed reports based on the Clinical Trial protocol
• Used Test Director, PL/SQL for testing the application
• Worked on complex business problems, analyzing and evaluating current business methods and procedures for improvements.
• Generated Statistical Analysis, Tables, Listings, Figures, Summary Reports and Graphs as per the Statistical Analysis Plan SAP and Table Shells in compliance with 21 Code of Federal Regulations 21 CFR Part 11 and GCP- ICH guidelines.
• Developed and maintained programs in SAS for UNIX in a user support environment.
• Analyzed and translated business requirements into system specifications utilizing UML and RUP methodology
• Involved in set up of testing methodologies and improvement of process model.
• Used Data Mapping for the creation of conversion programs into CDISC SDTM Standards from oracle clinical data.
• Created traceability matrix to ensure that the requirements are traced to the test cases.
• Ensured that extremely thorough, effective and organized test process is implemented and delivered the highest quality product.
• Worked closely with the project team in planning, coordinating and implemented QA methodology on various phases of the application.
• Analyzed results of Regression Testing as performed by Testers using QTP and held meetings with Developers and Testers.
• Interacted with the developers to report and track bugs using Test Director

Environment: Java, UML, Rational Rose, Requisite Pro, SAS, Zachman Framework, ClearCase, ClearQuest, WinRunner 6.0, Load Runner 6.0, Rational Clear Case, Perl and Oracle 8.5 on Windows NT, PL/SQL, and UNIX.

Confidential

Business Analyst

Responsibilities:

• Gathered user and business requirements through interviews, surveys, prototyping and observing from portfolio managers and UI User Interface .
• Facilitated Joint Application Development JAD with all relevant stakeholders.
• Analyzed and prioritized user and business requirements as system requirements that must be included while developing the software.
• Involved in Inception Phase and prepared Logical Data Models that contains set of diagrams and BRDs Business Requirement Documents supporting documents containing the essential business elements, detailed definitions, and descriptions of the relationships between the actors to analyze and document business data requirements.
• Planned and defined system requirements, Use Case Scenarioand Use Case diagrams for web-based application based on HIPPA compliancy.
• Narrative using the UML Unified Modeling Language methodologies.
• Created Use Case Diagrams, Activity Diagrams, Sequence Diagrams and ER Diagrams in MS Visio.
• Conducted Daily Scrum meetings with management, vendors, users and other stakeholders for open and pending issues.
• Scheduled meetings with developers, System Analysts SA and testers to collaborate resource allocation and project completion using MS Project.
• Created and managed project templates, use case project templates, requirement types and traceability relationships in RequisitePro
• Followed the UML based methods to create Use Cases, and Data Flow Diagrams.
• Involved in developing the test strategy and helped in developing QA Test plans with QA Team.
• Helped the testing team in tracing the requirements from RTM and involved in the UAT.