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Business Analyst Resume Profile

Professional Summary:

  • A dedicated, result driven, dynamic and goal oriented Business Analyst with over 7 years of experience in HealthCare, Insurance and Pharmaceutical based Industries.
  • A great deal of experience with insurance administration systems included 270, 271, 275, 276, 277, 834, 835 837.
  • Good understanding in analysis of healthcare claims, Benefit Management, use of ICD 9 diagnosis coding with understanding of HIPAA 4010-5010 and ICD -10 initiatives
  • Experience in Electronic data interchange EDI transaction, Facets, Electronic Health Record EHR and Health Information Technology HIT
  • Sound knowledge of the Medicare Fee for Parts A, B, D claims processing system.
  • Expertise in claims, enrollment, and authorizations in a Medicaid environment
  • Strong experience in Preparing the Business requirements Document BRD and Functional requirements documents FRD , developing the UAT Plan, maintaining the Traceability Matrix and assisting in Post implementation activities and Training
  • Extensive experience in working SDLC for Various methodologies included waterfall, RUP, Agile, XP and Scrum methodologies
  • Expert in translating business requirements user expectations into detailed Functional Requirements Specifications FRS by employing Unified Modeling Language UML
  • Highly experienced in performing Feasibility Studies, Impact analysis, GAP analysis, SWOT analysis and Risk Analysis.
  • Expertise in creating Use Cases, Use Case Diagrams, Class Diagrams, Sequence diagrams and Activity diagrams using MS Visio and UML concepts.
  • Defect Management / Bug Fixing 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.
  • Good understanding of Clinical Trials and various phases of the process
  • Expertise in product Training and Development
  • Organized professional with excellent oral and written communication skills, excellent presentation skills, interpersonal skills, problem solving skills, hardworking, fast learner and also adept quickly to new technology with ability to take new roles in minimum time and little training.

Education Certification:

Master of Health Services Administration

Business/Technical Skills:

HIPAA ANSI X12 4010-5010, Six-Sigma, SWOT analysis, Scrum, MMIS, SDLC, RUP, Agile Methodology, CPT and ICD-9 Coding, FACETS, AMISYS, Rational Rose, Requisite Pro, Microsoft Visio, SAS, MS SQL Server-2005/2008, Java, .NET, XML, HTML, Cobol, SPSS, Microsoft Project, Microsoft Office Word, Excel, Access, PowerPoint, Outlook , Erwin, Clinical Trials, Clinical Data Management Systems, Clinical Decision Support Systems, CMMI, Crystal Reporting, MS Windows 7/98/XP/Vista, and Share Point.

Project Summary:

Confidential

Sr. Business Analyst

Sandata Technologies is an industry leader which provides information technology strategies to the companies in a way that increases the quality and efficiency of their patient care and business operations. The project was to update comprehensive Electronic Health Record EHR system which allows healthcare organizations to manage all clinical documentation, including comprehensive assessments, physician orders, visit notes, medication profiles, labs and X-ray reports, pictures, images and other data. Additionally, paper documents can be scanned and stored electronically in the EHR.

Responsibilities:

  • Conducted detailed and comprehensive Business Analysis by working with end users and other stake holders to identify the system, operational requirements, and proposed enhancements.
  • 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.
  • Designed load scripts to load test high traffic end user processes for performance and reliability. Work with PL/SQL Procedures, functions, triggers.
  • Conducted Gap Analysis on the AS-IS and TO-BE business processes and technology and identified potential pitfalls, risks, and issues.
  • Conducted database testing using SQL queries. Extensively worked on SQL, PL/SQL, Procedures, functions, triggers.
  • 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.
  • Assisted in Integrating LIMS with EHR with very good understanding of the LIMS and ELN
  • 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.
  • Assisted in data mapping and data warehousing
  • Gathered Data Hub requirements and responsible for creating test cases and test scripts under Quality Center Test Plan and Test Lab modules.
  • 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 to check 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.
  • Documenting and testing source system records, change requests and assist SMEs with validation of daily error files.
  • Verified and validated all the build or release related issues and resolve then through discussion with business analysts with the users approval.

Tools and Technologies:-

HIPAA ANSI X12 , MMIS, SDLC, RUP, CPT and ICD-9 Coding, ELN, LIMS, Rational Rose, Requisite Pro, Microsoft Visio, SAS, .NET, MS Project, MS Excel, PL/SQL, MS Word, MS Outlook, Erwin, Crystal Report, MS SQL Server-2005/2008, MS-Access, Clinical Decision Support System, HIT, EDI.

Confidential

Business Analyst

American Family Insurance is an organization dedicated to the delivery of quality health care plans and products working together with its customers, consultants, brokers, providers and employers. Health care plans included Medicare and Dental Plans. The project was to build an online insurance handling application that would facilitate the users find the right insurance for their individual needs. The application required the user to login with a valid user id and password to authenticate the person. After authentication, they can learn about insurance, get a quote, retrieve a quote or buy an online insurance policy. They can also file a claim or pay their monthly payments online.

Responsibilities:

  • Gathered requirements and document the proposed processes to the existing system.
  • Conducted JAD sessions with the management, users and other stakeholders for open and pending issues to develop specifications
  • Modules included: Medical Claims Processing files and HIPPA 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.
  • Implemented the ETL process and business logic by using PL/SQL and built the data ware house using the Business Object Data Integrator.
  • 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
  • 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/SQL queries using MS Access for data manipulations
  • Assisted QA manager to develop test plan and test case
  • 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

Tools and Technologies:-

HIPAA ANSI X12 4010-5010, MMIS, SDLC, Agile Methodology - SCRUM, CPT and ICD-9 Coding, FACETS, Rational Rose, Requisite Pro, Microsoft Visio, SAS/SQL, Microsoft Project, Microsoft Office, MS Excel, Erwin, Clinical Data Management Systems, and Crystal Report.

Confidential

Business Analyst

Johnson and Johnson's offer a wide range of healthcare products through our Pharmaceuticals, Vaccines and Consumer Health Divisions. Johnson and Johnson automated its clinical drug trial procedures, which resulted in reduced development costs and time to market. The project was to develop a Clinical Trial Image Management System with international focus on cancer and with the Documentation team Regulatory Affairs for projects to meet with System Requirement Case Report Forms, Adverse Events, Annual Reviews, Protocol design etc .

Responsibilities:

  • Performed Gap analysis, requirements gathering and for enhancements to existing systems and processes.
  • Worked with Investigator Brochures, NDA periodic Reports, PSUR, and e-CTD.
  • Involved with Regulatory Report Authoring Publishing management Systems e.g. Dossier, Liquent Insight etc and Documentation.
  • Ensuring that the company complies with all of the regulations and laws pertaining to the 21 CFR Part 11 for R D
  • Extensively worked on LIMS data for sample management and integrate it with CTMS
  • Worked with the Documentation Query Language and Documentation wrapper.
  • Prepared use case models based on Business Requirement documentation gathered through interaction with users and the stakeholders.
  • Implemented RUP, which included requirements, specifications, design and analysis.
  • Created and maintained the Requirements Traceability Matrix RTM .
  • Worked with the Project Manager on various Project Management activities like keeping track of Project Status, Deadlines, Environment Request, and Compliance Issues.
  • Ensured Use-Cases were consistent and covered all aspects of the Requirements document.
  • Identified and analyzed the data requirements for the various site teams and made sure that the required data is available in the testing environment.
  • Worked directly with software engineers to ensure clear communications on requirements and defect reports.
  • Designed and developed scenarios based on business requirements.
  • Was involved in Functional System Testing, Integration Testing, Regression Testing, and User Acceptance Test before releasing the application.
  • Validated the scripts to make sure they have been executed correctly and meets the scenario description.
  • Involved in project status meetings, QA review meeting, and System Test meeting.

Tools and Technologies:-

CMMI, Six Sigma, MMIS, SDLC, RUP, Rational Rose, Requisite Pro, Microsoft Visio, SAS, Microsoft Project, Microsoft Office, Erwin, Clinical Trial Management Systems, LIMS, Crystal Report, MS SQL Server-2005/2008, MS-Access, MS Windows 7/98/XP.

Confidential

Business Analyst

TMG Health is the leading provider of Business Process Outsourcing BPO services to the government health programs market including support for Medicare Advantage, Part D, Medicaid Managed Care, SCHIP and group retirees. The project was to create a Data Hub for processing the Medicare claims and adjudicate them. In order to process Medicare claims correctly it needs information about individuals eligible to receive medical treatment from the state of PA, the Data Hub will be the conduit through which eligibility data is passed from the state eligibility source systems. The Data Hub delivery model included a structured iterative approach to design, development, testing and deployment where different parts of the solution are developed and delivered at different times and integrated as they are completed.

Responsibilities:

  • Conducted detailed and comprehensive Business Analysis by working with end users and other stake holders to identify the system, operational requirements, and proposed enhancements.
  • 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.
  • 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 BRD Business Requirements Document and FRD Functional Requirements Document 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.

Tools and Technologies:-

HIPAA ANSI X12 , MMIS, SDLC, RUP, CPT and ICD-9 Coding, FACETS, Rational Rose, Requisite Pro, Microsoft Visio, SAS, .NET, Microsoft Project, MS Office, MS PowerPoint, Erwin, Crystal Report, MS SQL Server-2005/2008, MS-Access.

Confidential

Business Analyst

Vention medical is a worldwide market leading manufacturer and distributor of high tech medical devices that enable or enhance diagnostic and therapeutic medical procedures for completed tomography, magnetic resonance and cardiovascular applications. The project was to support the Clinical Trials Office CTO and working on Clinical Trial Management System CTMS . The tasks also included gathering Business requirement, GAP analysis and writing use cases to design and develop internet based form submission application for Specialty Billing data from DB2. Used mainframe platform to retrieve data and utilized SAS/ETL to extract data from operating data system.

Responsibilities:

  • Conducted meetings with Data Architects, Data Modelers and MS SQL Reporters to determine the feasibility of the related data.
  • Extensively involved in requirement gathering and design meetings with Integrated Product Team IPT Business / Lead users to understand requirements for configuring / test System Workflows
  • Successfully conducted numerous Joint Application Development JAD Sessions with various stakeholders at different phases of the Software Development Life Cycle SDLC
  • Conducted feasibility study to identify if the business system can be created within the limited time, budget and resources.
  • Performed GAP Analysis to identify areas of improvement for the business process.
  • Developed, compiled and updated the Requirement Traceability Matrix RTM during all phases of the software lifecycle.
  • Worked with Technical Writer and Senior System Analyst to prepare User Manuals, System Administrator, Facility Administrator and BHQ Administrator Manuals.
  • Provided Training to Business Users, Test Team, and Product Specialists
  • Involved in Prototyping of the application and Gap Analysis
  • Worked with Senior Requirement Analyst to understand the User Requirements
  • Reviewed / revised Use Case Document
  • Prepared User Acceptance Testing UAT Protocol from Use Cases encompassing basic and alternate flows
  • Wrote Test Cases and Procedures for User Acceptance Testing
  • Tracked documents through all stages of lifecycle coordinate activities with authors, reviewers and approvers to promote document flow through the system.
  • Execute distribution workflow phase for new and revised documents.
  • Authored and reviewed technical documentation for multiple CFR Part regulated business units within company.

Tools and Technologies:-

Six Sigma, SDLC, RUP, Agile Methodology, Rational Rose, Requisite Pro, Microsoft Visio, MS Excel, MS Word, SAS/SQL, .NET, Microsoft Project, Microsoft Office, Erwin, Clinical trial Management Systems, Crystal Report, MS Windows 7/98/XP.

Confidential

Associate Business Analyst

Life Insurance Corporation of India LIC is a health insurance company that provides access to the Health Insurance Coverage Plans for numerous clients. The project delivers clients with health plans, which allows the users to access the health plan provided by their employer. Provide users the ability to make an assessment of their health risk, to receive directed information on specific life events and feedback on health plans offered. The application also facilitates the users to use email and chat with customer support.

Responsibilities:

  • Involved in Gathering and 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.

Tools and Technologies:-

SDLC, RUP, Rational Rose, Requisite Pro, Microsoft Visio, SAS, MS SQL Server-2005, .NET, JAVA, Microsoft Project, Microsoft Office, Erwin.

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