SUMMARY:

• Over 8 years of Experience as Business Analyst in Healthcare include understanding of Business Requirement Gathering, Business Analysis, Joint Application Development JAD sessions with clients and referring to accessible documentation and procedure.
• Functional Knowledge of Medicaid Management Information System MMIS .
• Exposed to Medicare and Medicaid domains of the healthcare systems and industry for inpatients, outpatients, Reimbursement Methodology.
• Extensively Knowledge in the Member Enrollment and Billing information.
• Knowledge and Experience on Membership, Billing, Claims Payment Processing in relation to HIPAA, EDI 4010, 5010 X12, ICD-9 ICD-10, codes 834, 837,835, and 270, 271.
• Strong knowledge of ICD-9/ICD-10 business analyst with healthcare.
• Able to understand and implement Processing ICD-9 ICD-10
• In dept. knowledge of Software Development Life Cycle SDLC methodology such as Agile, Waterfall and RUP .
• Efficient in writing Business Requirements Document, Use Case Specifications, Functional Specifications and Workflows.
• Strong knowledge of Use Cases, and Activity Diagram.
• Involved in Facet Implementation and conversion of 4.21
• Extensive Experience in Functional, Integration, Regression, User Acceptance UAT , System.
• Knowledgeable working with ETL process Extract, Transform and Load of data into a data warehouse.
• Designed and implemented basic SQL queries for testing and report/data validation
• Experienced in client interaction, deep understanding of business systems functionality and technicality.
• Proficient in Developing and executing Test Plans, Test Case, Test Scenarios, also performing functional, usability testing and ensuring that the software meets the system Requirement.
• Knowledgeable about preparing RTM documents
• Experience in developing project plan and estimating project timeline.
• Excellent working knowledge in Project Life Cycle and clear understanding of Project Management.
• Experienced in performing Gap analysis by identifying existing technologies, documenting the enhancements to meet the end-state requirements.
• Excellent business communication and presentation skills. Adapt at creating, editing, and coordinating extensive communication networks, to keep executive staff and team members apprised of goals, project status, and resolving issues and conflicts.
• Conducted successful projects with the help of teams to achieve deadlines timely and proficiently.
• Organized, goal-oriented, self-starter, and ability to master new technologies manage multiple tasks while following through from start to completion.
• Experienced in analyzing business requirement at all stages of Software development of life cycle SDLC .

TECHNICAL SKILLS

PROJECT EXPERIENCE:

Confidential

Role: Sr. Healthcare Business Analyst/Scrum Master

The project was to make enhancement to care radius which is a Point of care application which supports to organizations to manage all clinical documentation, including comprehensive assessments, physician orders, visit notes, medication profiles, labs and X-ray reports, pictures and maintaining the EHR. Agile Scrum methodology was used throughout the project.

Responsibilities:

• Prepared Business Requirements Documents, Functional Requirement Documents.
• Worked extensively with developing business rules engine enabling the business rules such as referral, prior authorization, eligibility, claims processing and billing essential.
• Utilized Agile Software Methodology using Scrum framework. Actively participated in creating the user stories and prioritizing user stories along with tracking of burn up, burn down charts to estimate sprint delivery
• Performed GAP analysis by performing the system analysis between the scheduling systems and documented the gap items.
• Conducted JAD sessions, meetings, workshops to gather requirements from various stakeholders and SMEs.
• Facilitated all Aspects of scrum framework, including product backlog, release backlog, sprint planning session, daily scrum meeting, sprint reviews and sprint retrospectives.
• As scrum master communicated dependencies and potential risk to the completion of the sprints including resources, costs and systems.
• Created data mappings to transform the data according to business rules.
• Developed Test Cases for unit testing, prepared spreadsheet for testing criteria, including regression, positive and negative testing, process flow testing and screenshot for test results to complete expected and actual results.
• Prepared various diagrams by using MS Visio.
• Prepared documents for the wireframe and prepared a data dictionary for the same
• Managed testing for various functionalities using Quality Center tools.
• Worked closely with QA and Developers to clarify/understand functionality, resolve issues and provided feedback to nail down the bugs.
• Maintained a close and strong working relationship with teammates and management staff to achieve an expected QA result for the project team.
• Conducted project related Presentations periodically to the management and end users during various phases of Software Development Life Cycle SDLC .

Tools Technologies:

Agile Scrum, MS Office, MS Visio, MS Project, JIRA, SharePoint, Rally, UML, SQL

Confidential

Role: Healthcare Business Analyst

The goal of the project was the development of a state of the art web-based technology re-engineered from a legacy database technology, including the business Functions. The project involved re-engineering of the existing billing System along with achieving HIPAA compliance. The deliverables in the project included core billing functionality and standard reports.

Responsibilities:

• Conducted weekly meetings for deciding the Policies and Procedures to be followed while constructing new sites.
• Gathered high-level requirement for all the external projects in a release.
• Performed the requirement analysis, impact analysis and documented the requirements.
• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims.
• Developing a single application to process data from multiple integration points, convert the data for reporting purposes and feed data into mainframe system to be compliant to reporting requirements.
• Performed Analysis on Data mapping between different data models.
• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims.
• Used different ad-hoc analysis, the Reports assist in defining strategy for each customer category. Informatics was used for ETL process and Business Objects.
• Created ICD-9-CM/ICD-10-PCS comparison document and dealt with DRGs.shift through CMS files.
• Documented ICD9 to ICD 10 mappings one to one/one to Many according to the GEM files from CMS with the functional and structural changes related to the conversion
• Involved in Able to understand and implement Processing ICD-9 ICD-10
• Worked on EDI transactions: X12,835, and 837 P.I to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes
• Executed the test cases and test scenarios using HP Quality center QC .
• As Scrum Master maintained the capacity plan, iteration board, sprint backlog, velocity charts and burn down charts.
• As Scrum Master facilitated all aspects of the scrum framework, including sprint-planning sessions, backlog-grooming session, daily scrums product demos, sprint reviews and sprint retrospectives.
• Prepared Business Requirement Documents BRD's after the collection of Functional Requirements from System Users that provided appropriate scope of work for technical team to develop prototype and overall system.
• Facilitated and led JAD sessions aimed at functional requirement walkthroughs for all the impacting projects and updated the documents based on recommendations if any .
• Created various reports such as billing payment reports, Billing Grouping Payment and discount reports
• Use HP Quality Center to house all test documentation and report/track all issues and defects Defect Management .

Tools Technologies:

Rally, MS Visio, HP QC, UML, MS Office, Agile Scrum, SSRS

Confidential

Role: Healthcare Business Analyst

The goal of the project was to replace old Medicaid Management Information System MMIS . It included technical and professional services related to analysis and assessment of the current MMIS and EDI claims, documentation of business and technical requirements, preparation of cost analysis and implementation of new MMIS automation system. The project involved RUP Methodology.

Responsibilities:

Inception

• Propose strategies to implement HIPAA 4010 in the new MMIS system and eventually move to HIPAA 5010
• Created BRD Documents
• Coordinate with stakeholders and project manager to gather functional and non-functional requirements during JAD sessions.
• Performed a High-level analysis of the requirements from a business perspective to determine the feasibility of constructing the new application.
• Responsible for gap analysis in changing old MMIS to new MMIS.

Elaboration

• Served as a Relationship between internal and external business community Claims, Billing, Membership, Customer service, Healthcare Management and the project team.
• Assisting the project manager in creating the business case and project plan.
• Followed the UML based methods using Rational rose to create Use Cases, Activity Diagram, that include Functional and Non-Functional specification to hand off to development teams.

Construction

• Recorded requirements in the Requirement Traceability Matrix RTM defining each technical requirement in detail.
• Analyzed business processes and worked with management and improved and implemented the solution to ensure compliances.

Transition:

• Assisted in Conducting UAT User Acceptance Testing to make sure that all the user requirements are catered by the application.
• Involved in preparing a simple and detailed User Manual for the application, for an intended novice user.

Tools Technologies:

RUP, SQL, MS Office, MMIS, MS Visio, SharePoint, Lotus Notes, Rally. Rational Tools

Confidential

Role: Healthcare Business Analyst

The existing information system was outdated and the hospital staffs were facing issues in capturing the patient flow from the outpatient visit to discharge hence lots of waiting time and cost were involved while an individual patient care is done. The project was to analyze various clinical transformation systems available in the market and present a report for them to choose the best-suited clinical suite for united health care group. Based on the studies the vendors were called for final presentation and we chose its best-suited vendor for its patient care implementation is done.

Responsibilities:

• Facilitated interview, one on one and brainstorming sessions with SME's User's in understanding the requirements pertaining to billing Origination to billing Processing.
• Assisted and written System Requirements Documents SRD , including Functional and Non-Functional requirements.
• Gathered business requirements through interviews, surveys, prototyping and observing from account managers, finance manager, and independent advisors and got an accurate understanding of their needs.
• Developed Use cases and activity diagrams and analyzed business requirements.
• Created UML-based feasibility studies and Use Case Models to communicate those ideas to the developers.
• Followed the UML based methods using Microsoft Visio to create: Use Cases Diagrams, Activity Diagrams, and Sequence Diagrams.
• Worked with SME's and business users to gain in-depth understanding of the business' mission, objectives, purpose and processes.
• Responsible for sales and marketing specializing in practice management, managed care systems, thin-client technology, Electronic Media Records EMR/EHR/PHE/PMR , ASP technology, and full integration tools.
• Enhanced the business to articulate and prioritize their ideas, and assisted in development of training materials for new technology and process improvements.
• Collaborated with the QA testing team to develop the test plan, test conditions and test cases to be used in testing based on business requirements, technical specifications and/or product knowledge.
• Conduct project related Presentations periodically to the management and end users during various phases of Software Development Life Cycle SDLC .
• Involved in the User Acceptance testing UAT to check the reliability for end users.

Tools Technologies:

Rational Requisite Pro, SharePoint, UML, MS Visio, Win Runner, MS Access

Confidential

Role: Healthcare Business Analyst

The project was to improve the claims reimbursement user interface of Coventry One for a better user experience and incorporate changes as per guidelines. The main objective of the system was to secure the health information entered by the user at the time of submitting the claim, and to also ensure the veracity and privacy of the user information.

Responsibilities:

• Prepared the Functional Specification Document FSD and Software Requirement Specifications SRS as per SEI-CMM standards.
• Conducted the JAD Sessions with stakeholders and developers to have a clear picture of a project.
• Conducted interviews with key stakeholders to analyze existing data and gather requirements.
• Used UML to create use case diagrams, sequence diagrams and activity diagrams
• Worked on improvement of Claims Reimbursement User Interface for a better experience and incorporate changes as per HIPAA 4010 /5010 guidelines using the gap analysis.
• Developed flowchart and process diagram using MS Visio.
• Wrote SQL scripts for creating performance evaluation reports
• Clarified QA team issues and reviewed test plans and test scripts developed by development team and QA team to make sure all requirements have been covered in scripts and tested properly.
• Performed Backend testing by using PL/SQL queries to test the integrity of the application was in regular contact with Business partners on the status of issues, action plans and timeframe for resolution throughout the development cycle.
• Identified bugs during the test phase and reported them using HP Quality Center.
• Maintained Traceability Matrix throughout the project.
• Developed Test Cases and Test Plans on the basis of requirements and also did manual testing of the functionality of the application to ensure that the application is able to handle a lot of data
• Conduct Presentations periodically to the management and end users during various phases of Software Development Life Cycle SDLC .
• Conducted UAT, documented and reported user feedbacks to management team, and developed training materials for different end users and assisted in users training for the new system.

Tools Technologies:

HIPAA, MS office suit, Rational Requisite Pro, SQL, HTML, XML, Windows XP/2000,MS Project, Windows XP,UAT

Confidential

Role: Business Analyst

The goal of the project was to integrate patient Management system with billing system. The project also involved creating Reports such as Denial, Self-Pay, Administrative Adjustment, Missing charges.

Responsibilities

• Gathering requirements for a data collection and reporting system
• Researching various topics, scheduling meetings and documenting meeting minutes.
• Analyze patient accounts and clarify any information needed to correctly answer patient's questions regarding their account.
• Performing application support monitoring system interfaces, generating reports, researching data issues, documenting support requests
• Performing business process support reviewing user questions, making data updates, providing one-on-one user training, identifying process improvements
• Managed multiple Patients Accounts across various platforms.
• Provided good customer service to the patients by proving answers to their question in a timely and courteous manner.

Tools Technologies:

MS Office, Windows, UML, MS Visio. MS Project, Java