- Over7 years of experience in HealthCare, Insurance Medicaid and Medicare Claims and Pharmaceutical based Industries as a Business Analyst.
- Strong experience in documenting the Business Requirements Document BRD , developing the UAT Plan, maintaining the Traceability Matrix and assisting in Post implementation activities.
- Extensive experience in working in SDLC for Various methodologies included RUP, Agile, and other internal methodologies
- Expert in translating business requirements user expectations into detailed Functional Requirements Specifications FRS by employing Unified Modeling Language UML
- Expertise in creating Use Cases, Use Case Diagrams, Class Diagrams, Sequence Flows using MS Visio and UML concepts.
- Highly experienced in performing Feasibility Studies, Impact analysis, GAP analysis and Risk Analysis.
- A great deal of experience with insurance administration systems included Actuarial, Policy Application, Eligibility, Enrollment, Underwriting, Claims, Billing, and Payments.
- Knowledge on Electronic data interchange EDI transaction, Electronic Health Record EHR and Health Information Technology HIT
- Strong testing experience in HIPAA X-12 EDI Insurance/Health Series INS such as 270/271, 274, 276/277, 278, 820, 834, 835, 837, and Version 5010 of this transactions.
- Hands on experience with SQL server reporting services and other Business Intelligence tools such as Cognos and Informatica
- Web Portal Development worked in the development of a web portal used by providers and members to view referral information
- Extensive experience in working with Claims, Provider, Enrollment, finance, benefits and Vendor Management Business Areas.
- Good understanding in analysis of healthcare claims, use of ICD 9 diagnosis codes, CPT and NDC coding withunderstanding of HIPAA 5010,ICD -10 initiatives
- Sound knowledge of the Medicare Fee for Parts A, B, D claims processing system.
- Knowledge of claims, enrollment, and authorizations in a Medicaid environment
- Defect Management / BugFixing Fully involved in the process of defect identification and resolution using tools like Test Director, Clear Quest and Quality Center.
- Good experience in conducting User Acceptance Testing UAT and documentation of Test Cases.
- Organized professional with excellent oral and written communication skills, excellent presentation, interpersonal skills, problem solving skills, fast learner and also adept quickly new technology with ability to take new roles in minimum time and little training
HIPAA, CMMI, Six Sigma, MMIS, SDLC, RUP, Agile Methodology, CPT and ICD-9 Coding, ANSI X12, Rational Rose, Requisite Pro, Microsoft Visio, Mumps, SAS, SAS/SQL NET, Cobol, Microsoft Project, Microsoft Office, Erwin, Clinical Data Management Systems ARGUS, Crystal Report, MS SQL Server-2005/2008, MS-Access, MS Windows 7/98/XP.
Business System Analyst
- Gathered requirements and document the proposed processes to the existing system.
- Modules included: Medicaid Claims Processing Files and HIPAA Guidelines adherence across the company.
- Enhanced applications associated with Claim Numbers so that duplicate Claim Numbers could be eliminated in the system. Updated the Electronic Claims, Patient Screen and Sales Administration processes.
- Mapped process flow assess as-is processes through user interviews, data collection and analysis, design and evaluation of to-be process solutions
- Claim Transactions and Billing Transactions Created flows for adequate matching of Claims. Matched Billing File and EDI Claim File records upon receipt.
- Duplicated Claim Number Project Enhanced three different applications EDI Feeds and Patient Screen App to remove duplicate claim numbers.
- Worked in a project involving Miami Systems to create Drug Cards.
- Defined Functional Test Cases, documented, Executed test script in Facets system.
- Validated the following: 837 Health Care Claims or Encounters , 835 Health Care Claims payment/ Remittance , 270/271 Eligibility request/Response , 834 Enrollment/Dis-enrollment to a health plan
- Created Test File to be sent to the Drug Card Vendors for approval. Worked on a Paid without prejudice project for various States.
- Conducted JRP sessions and JAD sessions with the management, users and other stakeholders for open and pending issues to develop specifications
- Assisted the Project Manager in setting realistic project expectations, in evaluating the impact of changes on the organization and plans accordingly, and conducted project related presentations
- Worked with PL/PL/SQL queries using MS Access for data manipulations
- Assisted QA manager to develop test plan and test case
- User Acceptance Testing UAT Performed UAT tests using the MORAE Usability Testing Tool using the Observer and the Manager Mode.
- Testing - Developed Test Scripts using Test Director/Quality Center and coordinated with developers to quickly resolve the defects associated with them.
- Participated in system testing and user acceptance testing worked with System Test Review team and developers to resolve system test issues and re-test.
- Facilitated Change Control Board and Governance Board meetings and acted as a liaison between parties impacted by the change requests
- Helped create the 'Business Glossary' to facilitate efficient understanding of the business process amongst the other teams.
MS Visio, Word, Excel, PowerPoint, MMIS, MITA, CMMI, Rational Rose, Requisite Pro, Clear Case, Clear Quest, SQL, Oracle, J2EE technology, Java, Perl.
- Conducted detailed and comprehensive Business Analysis by working with end users and other stake holders to identify the system, operational requirements, and proposed enhancements.
- Data Hub testing scope includes testing the Data Hub requirements, documenting and testing source system records, change requests and assist SMEs with validation of daily error files
- Responsible for architecting integrated HIPAA, Medicare solutions, Facets.
- Facilitated Joint Application Development JAD sessions with all IT group members for communicating managing expectations and to discuss various means for integrations with current system using an adoption through execution strategy
- Conducted Gap Analysis on the AS-IS and TO-BE business processes and technology and identified potential pitfalls, risks, and issues. Mitigated risks and developed contingency plans for risk management
- Identified all necessary Business and System Use Cases from requirements, created UML diagrams including Use Case Diagrams, Activity Diagrams, and Sequence diagrams using Microsoft Visio.
- Understood the Business Logic, User Requirements and test-objectives to develop Test plans, Test cases, Use Case Scenarios.
- Involved in comprehensive testing of the system to check it satisfies functional specifications.
- Responsible for checking the benefit set and adjudication of claims.
- Created High Level Test Scenarios, Test Cases and Test Scripts for Data Hub requirements as described in RSD Requirement Specification Documents and DSD Design Specification Documents as well as HIPAA
- Gathered Data Hub requirements and responsible for creating test cases and test scripts under Quality Center Test Plan and Test Lab modules.
- Created Test File to be sent to the Drug Card Vendors for approval.
- Developed Test Scripts using Test Director and coordinated with developers to quickly resolve the defects associated with them.
- Analyzed and evaluated User Interface Designs, Technical Design Documents and Quality Assurance Test Conditions the performance of the application from various dimensions.
- Documented the UAT Plan for the project and worked with the UAT Team to ensure every acceptance criteria for the requirements has been included in the UAT task plan
- Verified and validated all the build or release related issues and resolve then through discussion with business analysts with the users approval
MS SQL, Windows XP, Rational Rose, Rational Requisite Pro, Test Director, Clear Case, UML, Rational Suite, MS Visio, MS Project, MS Excel
- Understanding business requirements for Medicare Part C and D file required for CMS.
- Defined Business Process aligns with Company goals and existing HIPAA regulation to communicate with CMS Programmatically from Amisys system.
- Defined Use cases for Group, Claims and Enrollment process, required for suspect management.
- Defined Test Cases, documented in QTP, Executed test script in both manual and auto mode in Amisys and Facets system.
- Documented results in QTP and send to SME and BA for verification.
- Analyzed with business to define integrated test cases scenario with step-by-step documentation.
- Defined, developed specs for federal reporting specific to Medicare Advantage Identify select technologies for federal reporting, integration and data warehouse
- Determination of the timeline, equipment, training, resources, etc needed to implement future processes.
- Designed High level design, for new process, integrating with Facets and CMS Evaluation/determination of the tools/methods for evaluating the effectiveness of business process change.
- Develop change management strategies for implementation of new business processes to remove barriers to the change.
- Develop a communication plan and incorporate it into the overall Amisys and Medicare implementation plan.
- Involved in documenting Change Management for New Process. Worked closely with BPR team for user training.
- Manage implementation, if required, of selected processes, including development of project plans, coordination of vendor activities, securing of additional resources and interface with end users.
- Identify, document and resolve outstanding issues.
FACETS 4.31, Citrix, UNIX, Crystal report, MS Visio, Erwin
- Understanding the current business process, defining scope of the project along with vision statement.
- Work with Project Managers, Development Managers, and other Business Intelligence Analysts to develop and implement DataMart solutions for the Enterprise using Microstrategy tools.
- Applied Unified Modeling Language UML methodologies to design Use Case Diagrams, Activity Diagrams and Sequence Diagrams in Rational Rose.
- HIPAA EDI transactions such as 835, 837 P, D, I 276, 277, 278.
- Established RUP Rational Unified Process methodology and provided assistance in developing Use cases and project plans.
- Designed the business requirement collection approach based on the project scope and SDLC methodology.
- Created use-case scenarios and storyboards in MS Word and MS PowerPoint for better visualization of the application and managed them using Rational Requisite Pro.
- Resolved issues and improve the process to ensure a stable and accurate solution.
- Used MS Visio for Process modeling and Business Process flow diagrams.
- Used UML notations for Object Oriented Design and Documentation.
- Developed Use Case diagrams, business flow diagrams, Activity/State diagrams and Sequence diagrams so that developers and other stakeholders can understand the business process.
- Validated business rules and all artifacts with users, approval and sign off.
- Analyzed data, logical data modeling, created class diagrams and ER diagrams in Rose for designing databases.
- Created test plans and scripts, facilitated user acceptance testing and tested strategies with developers and testing team.
- Helped in Deployment of Portal a venue for the on-line trading application a Collaboration Bundle Solution.
- Designed and created Excel sheets to provide market analysis charts.
Visio, Word, Excel, PowerPoint, SQL, Rational Rose, Requisite Pro, Clear Case, Clear Quest
Associate Business Analyst
- Involved in writing the Business Requirements for different functionalities of the web based application, including creation of an account online.
- Diligent in writing the Data Dictionary for different processes and their file layouts
- Mentored the effort to develop artifacts with an emphasis on the Rational Suite including: Vision, User requirements specifications, Functional specification quality assurance plan, product Acceptance plan, and test plan, test case.
- Wrote high-level use case and generated UML use case diagrams using Rational Rose.
- Designed prototypes for development and maintenance processes to explore the feasibility of ideas.
- Participated in JAD workshops, refined prototypes and use cases.
- Wrote requirements management plan document using Rational Requisite Pro.
- Extensively used RUP methodology in all phases of the project.
- Used Clear Case and Clear Quest for data management and defect tracking.
- Assisted in system testing and user acceptance testing worked with System Test Review team and developers to resolve system test issues and re-test.
- Developed timelines for project delivery, and managed projects and resources to successful completion.
- Assisted in development of training materials for new technology and process improvement.
Requisite Pro, Clear Case, Clear Quest, SQL, Oracle, J2EE technology, Java, Perl MS Excel, MS Project,Windows 2003, Clear Case, Rational Rose