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Sr. Business Analyst Resume Profile

TECHNICAL SUMMARY:

  • 9 years of experience as a Business/EDI Analyst with strong analytical and problem solving skills, maintain excellent interpersonal communication while working on long, complex and tedious assignments.
  • Extensive knowledge of Software Development Life Cycle SDLC including Enterprise Analysis, Requirements Planning, Elicitation, Analysis, Communication, Solution Assessment and Validation of Projects.
  • Worked on various methodologies such as Agile Software Development, Rapid Application Development RAD , Joint Application Design JAD and Prototyping.
  • Create, Review and Analysis of Business Requirement Documents BRDs , Functional Specification Documents FSDs , Use Case Documents, Business Rules Spreadsheets BRS and Standard Operating Procedures SOPs .
  • Extensive knowledge of Medical Management Information Systems MMIS , Medicare, Medicaid and National Provider Identification NPI .
  • Excellent knowledge of Health Insurance Portability Accountability Act HIPAA standards, Electronic Data Interchange EDI , Implementation of HIPAA code sets, ICD-9, ICD-10 coding and HL7.
  • Worked on ANSI X12 5010 and ANSI X12 4010 including the standards for medical transactions like 837 medical claims , 835 medical claim payments , 270 eligibility inquiry , 271 eligibility response , 276 claim status , 277 claim status response , 820 enrollment , and 834 premium payments .
  • Excellent knowledge of Medicare Part A, B, C and D and Medicaid Health Insurance Policies, Personal Injury Protection PIP insurance, billing experience with life and disability in health plans with thorough understanding of CPT coding, UCR, FS, HCFA-1500 and CMS-1500 claim forms and reimbursement forms.
  • Hands on experience with UI, White Box, Black Box, Unit, Functional, Integration, Back End and System Level Load and Stress Testing for applications including web and client server applications.
  • Understand and Functional Analysis of HIPAA EDI X12 837, 835, 834, 820, 999 and TA1 Transactions.
  • Perform X12 837, 835, 834, 820, 999 and TA1 Review and Functional Testing
  • Web service Testing Send X12 837, 835 and 820 Messages, Receive 999 / TA1
  • Document Interchange Control Document ICD and Exchange Companion Guide for 834, 837 and 820
  • Document process flows of EDI transactions using Visio and Power point
  • Create 834 and 820 specification documents for Coding and Development
  • Create Master Mapping Document mapping of 834 and 820 data fields with CMS, CG, Siebal and OneGate application fields.

TECHNICAL SKILLS:

  • Methodology: SDLC, RUP, Agile, Agile PLM, OOAD and Waterfall.
  • Languages: Oracle, PL/SQL, HTML and XML, .NET, JAVA, C
  • Management Tools: CaliberRM, Rational Rose, Requisite Pro, Clear Quest, Clear Case, Serena Team Track and MS Visio.
  • Testing Tools: HP Quality Center, Mantis, Win Runner, Load Runner, TOAD and SOAPUI/WSDL
  • Data Modeling Tools: ERwin, Informatica 7.1.1/8/9, Hyperion.
  • Database: Oracle 8i/9i/10g, DB2, MS SQL Server.
  • Operating Systems: UNIX/Linux, Windows 95/2000/NT/XP and MS-DOS.
  • Microsoft tools: MS Office 2003, 2007, 2010 Word, Excel, Power Point, Outlook , MS SharePoint, MS Visio, MS Project and MS FrontPage.

PROFESSIONAL EXPERIENCE

Sr. Business/EDI Analyst

Confidential

Confidential in helping people live healthier lives and helping to make the health system work better for everyone. Recently Massachusetts has hired UnitedHealth Group Inc.'s Optum unit and an insurance executive to fix its problem-plagued health exchange, which is still not working properly, more than four months after it launched. I am working as Business/EDI Analyst, dedicated to handle enrollment 834 and payment 820 files across different systems.

Responsibilities

  • Analysis and Design of HIPAA X12 834 and 820 EDI Transactions for Health Insurance Exchange HIX .
  • Create Test Case and Test Scenario based on X12 834 E2E Functional Testing.
  • Work on Production Environment Revert to Draft R2D document and Test Plan.
  • Use SOAPUI tool for Web-service Testing Send X12 834 and 820 Messages, Receive 999 / TA1's .
  • Design process flows of EDI Transactions Portal --> HIX --> Carriers using MS Visio 2010.
  • Create 834, 820, Transport Layer Specification and Master Mapping Document MMD stating loops and segments.
  • Generate, Edit and Analyze EDI X12 transactions using Oracle Spec builder 6.6.1 powered by edifecs.
  • Very good understanding of ORACLE B2B Health Care Adapters HIPAA EDI X12 834 / 820
  • Working on SOA Web Service testing, watching HBE Enroll Web Service and Carriers Enroll Web Service interaction, using SOAPUI to test web service request and response between to ends.
  • Created Process Flow Charts, Business Requirements Documents, and Functional Specification Documents for Revert to Draft R2D process.
  • Initiated all business and functional requirements around R2D to make sure ON HOLD EDI files are being processed as requested by business stake holders.
  • Developed Test Plan and Test cases based on the Use cases and Functional specifications and also performed User Acceptance Testing UAT of the functionality of the application by inserting varying data on different test runs.

Confidential

Confidential

Sr. Business/EDI Analyst

  • CGI is Partner with 175 global P C, life and commercial health insurers plus agencies and brokers, provides end-to-end IT and business process management services along with industry-leading software solutions.
  • Vermont has contracted with global IT firm CGI to build the infrastructure for Vermont Health Connect, the state's health insurance exchange.

Responsibilities:

  • Interacting with Vermont Health Connect State employees, talking on best possible way to customize of Liferay.
  • Gathering requirements related to Liferay customization like Member section, Claims section, Insurance products etc.
  • Understand and Functional Analysis of HIPAA EDI X12 834, 820, 999 and TA1 Transactions.
  • Perform X12 834, 820, 999 and TA1 Review and Functional Testing
  • Web service Testing Send X12 834 and 820 Messages, Receive 999 / TA1
  • Document Interchange Control Document ICD and Exchange Companion Guide for 834 and 820
  • Document process flows of EDI transactions using Visio and Power point
  • Create 834 and 820 specification documents for Coding and Development
  • Create Master Mapping Document mapping of 834 and 820 data fields with CMS, CG, Siebal and One Gate application fields
  • Develop EDI X12 transactions Oracle XSD, ECS and XML files using ORACLE SOA B2B.
  • Very good understanding of ORACLE Health Care Adapters HIPAA EDI X12 834 / 820
  • Working on SOA Web Service testing, watching HBE Enroll Web Service and Carriers Enroll Web Service interaction, using SOAPUI to test web service request and response between to ends.
  • Created Process Flow Charts, Business Requirements Documents, Functional Specification Documents.
  • Developed Test Plan and Test cases based on the Use cases and Functional specifications and also performed User Acceptance Testing UAT of the functionality of the application by inserting varying data on different test runs.

Confidential

Sr. Business Analyst

  • Since 1990, Benecard has provided carve-out prescription benefit programs founded on the philosophy of integrity, Innovation and a clients first approach. Benecard is a full service, in-house prescription benefit administrator that includes mail and specialty drug dispensing. They are specializing in delivering progressive benefit programs to private and public sector organizations with a 100 to 5,000 membership.
  • I am working on the project call Medicare Part - D Prescription Drugs Plan which includes Members and their enrollment eligibility group and individual , Coordination of Benefit COB , Billing and Payment assignments.

Responsibilities:

  • Serve as an active member of PDP team, interacting with developers, business users and subject matter experts SME to analyze and configure PBM Web-Portal functionality based on Business Requirement.
  • Gather and analyze requirements for Member eligibility Group and Individual , Coordination of Benefit COB , Billing and Payment to develop PBM Prescription Benefit Management .
  • Worked on Configuration and integration of Member Enrollment, CMS, Drugs, Plans, Pharmacy, Claims, Clinical and AR/AP member activity Management sections.
  • Create and Analysis of Data Transaction Reply Report DTRR , Schedule meetings with Business team and Developers on project status. Try to make sure that all three releases A, B and C follows deadline.
  • Conduct JAD sessions with Business Team and Developers to discuss the Code implementation and configuration of Web Portals.
  • Perform Regression testing on both internets PBF and Intranet PBM Web-portals to check compatibility between two code releases.
  • Create and Maintain Requirements, Test Cases and Test Plans, Perform Agile development methodology on development process we are going through.
  • Coordinate with BSA to analyze User requirements, Current operational procedures, functional specifications and User data processing.
  • Run Batch eligibility query BEQ files check Transaction Code TC and Transaction Reply Code TRC to make sure Member enrollment has been completed.
  • Perform object-oriented analysis, discuss finding with Developers to make sure both teams are on same page during this development process.
  • Attend walk through meetings for Requirements Review, Analysis and Approval of them.
  • Worked on System and Integration testing and used Mantis Bug tracking tool to report and monitor issues in code, Perform Manual Testing to make sure issues have been fixed.
  • Deal with CMS Member Pending Enrollment on daily basis like Low income Part LIP -D, Late enrollment penalty LEP etc.
  • PBM incorporate complete Member Enrollment and Eligibility check, Drugs Prescription, Plan design, Claim adjudication and Verification, Call chain, Rx enquiry, Clinical requests handling etc.
  • Worked on all the phases of Medicare Part-D claims, for example Deductibles, initial coverage, gap and catastrophic etc.
  • Developed Traceability Matrix including BRD and FRD to track down different defects related to Member enrollment eligibility, Claims adjudication, Clinical request from members.

Environment: MS Office MS Word, MS Excel, MS PowerPoint, MS Visio Lotus Notes, Mantis, Rational Requisite Pro, Sql, Java scripts, JSP

Confidential

Business/EDI Analyst

Confidential to support the implementation of HIPAA 5010 system enhancements. The delivery of the 5010 transactions executed in multiple integrated releases throughout 2011

Roles and Responsibility

  • Worked with Client and Customer to gather Business Requirements, proposed Workflow Design, Approval of CR Change request and Implementations.
  • Organized JAD sessions between CIGNA and Developers so that everyone stay on same page during development process, Intention was to bring accuracy in whole implementation and integration process of BPM.
  • Worked as Lead BA for Dental scenarios on 837 and 835 Claim Processing, shared responsibility on other two types of claims Professional and Institutional .
  • Understand and Functional Analysis of HIPAA EDI X12 837, 835, 999 and TA1 Transactions.
  • Perform X12 837, 835, 999 and TA1 Review and Functional Testing
  • Web service Testing Send X12 837 and 835 Messages, Receive 999 / TA1
  • Document Interchange Control Document ICD and Exchange Companion Guide for 837 and 835
  • Document process flows of EDI transactions using Visio and Power point
  • Create 837 and 835 specification documents for Coding and Development
  • Create Master Mapping Document mapping of 834 and 820 data fields with CMS, CG, Siebal and OneGate application fields
  • Hands on experience on HP Quality Center 10.0, including Defects Management, Requirements, Test Plan and Dashboard.
  • Worked on Defect management, including Opening New Defect, Defect Assignment, Setting up priority, Current status, Description, setting up different environments DEV, SYT, SIT, PROD and PVS and many more activity related to Defects
  • Talked to the Client based on Requirements of that particular Defect, uploading required documents, checking history, status notes, setting up resources to analyze and fix it.
  • Worked on CaliberRM, tool to handle various requirements like Functional, Non-functional, High-level, Scope statement and Use Case. Also Added new requirements to the CaliberRM, Updated existing ones, removed them if not needed.
  • Performed task like checking existing version, Owner of the requirements, updating each and every Tab Name, Responsibility, Traceability, Validation, History, Details, Manage Attributes, Notes if required.
  • Worked on UAT and various phases of Unit, System and Integration Testing PVS and PROD Env , Task includes Watching server activity, Generating Reports, Monitoring BAM dashboard, Checking Enterprise Manager for flow of claims and Verifying messages.
  • Worked on SharePoint 2010, supporting New features like Support for Analytical Services formatting, Business Intelligence Center, Enhanced navigation, including filtering and sorting top/bottom 10, switchable measures

Environment: HP Quality Center 10.0, Caliber RM, SAP, MS Office, Windows 2000, Windows Vista, MS Visio, HP SharePoint, MS Project, MS Visio, SQL, SOA Infra, XML, SOAPUI and WSDL.

Confidential

System Analyst

As a Business Analyst, I am involved with drafting the migration plan for the Claims Processing data which needed to be migrated from the Mainframe to the SQL Server environment and also involved in Property/Causality Insurance automobile, dwelling property, homeowners property and liability combined , personal Liability including personal umbrella along with HIPAA 5010 compliance for the new MMIS Medicaid Management Information System system.

Roles and Responsibilities:

  • Gathered requirements from stakeholders for provider management and member management.
  • Identified and validated business rules and data elements.
  • Developed the stakeholder list and created stakeholder assessment matrix to prioritize them.
  • Developed and Maintained Requirements work plan and assessed the performance metrics of the team members.
  • Worked on Property and causality insurance, maintaining database, handling client and stakeholders at the same time.
  • Created and Analyzed Business Requirement BR and Functional Requirement, Directed development team to developed Member login Web Portal Intranet .
  • Worked on Personal Injury Protection PIP , Analyzing Individuals Policies and Updating Web portal for their personal information and Data.
  • Worked on HL7 including complete lifecycle of interoperability specification Deployment, Adoption, utilization, Adherence etc , clinical decision support, exchange of clinical documents,
  • HL7 testing included connectivity to the Database, validate inbound and outbound messages, validate ack and nack, generate values and test message from specification, repeat test plan and test scenarios and generate reports.
  • Worked on Document Management, used Workflows to route documents from person to person so they can complete their document management tasks, such as Reviewing documents, approving their publication and managing their disposition.
  • Worked as a Lead BA with HCA Dedicated Team for Property and causality Insurance, Created Documents like Business Requirement Document BRD and Estimate for Development Team.
  • Modeled the 'as-is' process flow and the 'to-be' process flow and analyzed the gap and developed the action steps to fill the gaps.
  • Conducted Risk analysis and developed mitigation plans.
  • Conducted Impact analysis when there is any change in the requirements and updated the Business Requirements Document BRD and Systems Requirements Specification SRS .
  • Facilitated meetings with the technical team and client team to analyze the current process and gather requirements for the proposed process.
  • Proposed strategies to implement HIPAA 5010 in the new MMIS system and worked on planning and documentation.
  • Worked extensively with ETL process, migrated data from old system to new one, make sure that data format match new system requirement.
  • Designing Functional Specifications for the target physical database.
  • Facilitated JAD sessions for Requirement Validation with Client Dept. of Health Human Services DHHS
  • Worked on Electronic Data Interchange EDI , and Implementation knowledge of HIPAA code sets, ICD-9, ICD-10 Migration, Mapping, Verification of ICD .
  • Developed UAT test cases associated with the functional requirements.
  • Analyzed different Data cross-walks, complicated logic look ups required by different fields for the source to target transformations.
  • Analyzed EDI X12 data elements captured by the existing system to validate it against the data elements required for new system.
  • Broke down the services from the HCA MMIS Logical Design into multiple layers of normalized functionality that correspond to utility services, general business services and Medicaid specific services.
  • Participated in developing test plan, test scripts, and test scenarios and designed user documentation
  • Worked with legacy team in developing BRD for multiple system change requests and participated in System Testing.
  • Worked on SharePoint 2007, Browser based customizations, Business connectivity Services, Human Work Flows and Access are some composites I have been working on.

Environment: MS Office, Windows 2000, .NET, MS Visio, MS SharePoint, TFS, MS Project, MS Visio, SQL, Oracle, SOA, HTML, FMS/3

Business Analyst

A leader in healthcare for more than 75 years, Baxter assists healthcare professionals and their patients with treatment of complex medical conditions. It also deals with global medical products, services, expertise in medical devices, pharmaceuticals and biotechnology. I worked with an application that was taking care of Online Account Services that included Billing Application, Checking the bill history, Changing customer profile, Ordering auto insurance ID cards and Modifying the load provider details.

Roles and Responsibilities:

  • Interacted with stakeholders and gathered requirements as per the business needs.
  • Implemented RUP methodology for iterative and incremental development of the system.
  • Involved in the planning of the RUP iterations and documenting of the artifacts throughout the various phases of the development process.
  • Conducted GAP analysis by understanding the AS-IS system and the TO-BE system requirements by having discussions with the SME's.
  • Worked on Healthcare domain including Electronic Data Interchange EDI , and Implementation and knowledge of HIPAA code sets, ICD-9, coding and HL7 standards.
  • Created test cases and test scenarios based on HL7 interoperability specifications like workflow, performance, Load and networking.
  • Worked on Facets including Claim processing online and batch adjudication , Case management, Customer service, Member/subscriber administration, Provider network management and reporting.
  • Maintained Quality Center 10.0 and CaliberRM for quality management issues in SOA Server where we handled Defects and Requirements management for better system development.
  • Compiled the Vision Document and composed detailed Use Case Specification Documents in Rational Requisite Pro.
  • Used UML to perform Use-Case analysis to capture the dynamic aspect of the application.
  • Ensured the accuracy and consistency of the data during the data loading process.
  • Developed State Diagrams, Activity diagrams and Class Diagrams in MS Visio using UML for various modules of the project.
  • Created Process Flow Charts, Business Requirements Documents, Functional Specification Documents.
  • Worked on Required Traceability Matrix RTM in Rational Requisite Pro for traceability of requirements through test cases.
  • Involved in managing the Daily Standup meetings and also ensured that quality standards were enforced as per the build-release schedule.
  • Developed Test Plan and Test cases based on the Use cases and Functional specifications and also performed User Acceptance Testing UAT of the functionality of the application by inserting varying data on different test runs.
  • Developed Flowchart and process diagram using Microsoft Visio.
  • I was in regular contact with Business partners on the status of issues, action plans and timeframe for resolution throughout the development cycle.
  • Worked on Privacy Impact Assessment PIA and HIPPA including Consent and Limiting use after Security Breach
  • Contributed in reviewing and editing of the test scripts.

Environment: Windows, MS Office MS Word, MS Excel, MS PowerPoint, MS Visio , MS Access, MS Project, Rational Rose, Community Manager, BPML, SQL, Clear Case, Agile, Informatica 7/8, Load runner

Confidential

Business Analyst

Interim HealthCare is the nation oldest proprietary national organization providing health care personnel at all skill levels in all settings. There are more than 300 independently owned franchise locations nationwide. I worked on System Requirement Analysis and CRM chain of the company it also dealt with Data handling of company at server level computation.

Roles and Responsibilities:

  • Identified System Integration Requirements, and coordinated the collection and verification of business needs.
  • Collected and documented business processes as well as business rules.
  • Participated in the identification, understanding, and documentation of business requirements, including the applications capable of supporting those requirements.
  • Translated the business needs into system requirements, communicating with the business on a non-technical level, and with the System Analyst on a more technical level.
  • Have been using these HL7 standards for integral for system integrations, inter-operability and compliance. I used them to support clinical practice and the management, delivery, and evaluation of health services.
  • Worked on Healthcare Effectiveness Data and Information Set HEDIS to interpret its result to track year-to-year performance, Collecting HEDIS data for Medicare and Medicaid Services CMS requirements.
  • Generated Report based on HEDIS data also interpreting its data to match requirement from client.
  • Documented and delivered Functional Specification Document so that development team can be directed to develop Member Web Portal.
  • Created and analyzed business requirement BR and Functional Requirement to the project Team.
  • Responsible for multiple roles such as requirements gathering and solution development across the full insurance life cycle from CRM marketing, sales, service to underwriting quoting, policy administration, commissions broker management, claims, financial reporting and analytics for Property and Casualty division.
  • Worked on Personal Injury Protection PIP , Analyzing Individuals Policies and Updating Web portal for their personal information and Data.
  • Participated in the logical and physical design sessions, developed design documents.
  • Worked extensively with Oracle, SQL Server and ETL process.
  • Worked FMS/3, Analyzing result and based on that created report to help making decisions
  • Designed and developed the database for various projects.
  • Helped the business units understand how Data warehousing and Data mining techniques can help them do their decision making in a more organized and easy manner.
  • Helped the developer team understand the needs of the business environment using the programming terminology.
  • Collaborated with development architect and the business to develop both high-level and detailed application architecture to meet the business needs.
  • Conducted User Acceptance Testing UAT with the help of Test Director.
  • Assist the PM in setting realistic project expectations and in evaluating the impact of changes on the organization and plans accordingly.
  • Developed Test scenarios and implemented Test plan, providing key input in working with users in defining project and system requirements.
  • Conducted Project related Presentations.

Environment: Windows, MS Office, MS Visio, Lombardi, Oracle, SQL, Test Director, UML, MS Project, Rational Requisite Pro, Rational Clear Quest, FMS/3.

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