We provide IT Staff Augmentation Services!

Edi Business Analyst Resume Profile

PROFESSIONAL SUMMARY

  • Facilitator between Business Systems and Information Technology with over 6 years of extensive Business Analyst skills - Understanding of Software Development Life Cycle SDLC , Rational Unified Process RUP ,Agile/Scrum methodology, Unified Modeling Language UML , Object Oriented Analysis and Design Concepts OOAD , Business Process Re-engineering BPR , Test Lifecycle, Data Modeling.
  • Experience in writing Business Requirements Documents BRD ,System Requirement Document SRD , Use Case Specifications, Functional Specifications, and Technical Specifications across the Deliverables of a project.
  • Good experience in Relationship Database Management System RDBM .
  • On hand experience in implementing changes in FACETS 4.X-5.X NASCO extensions for HIPAA 4010 to 5010 conversions on SOA Service Oriented Architecture .
  • Experience in handling Change Management and Release Management.
  • Extensive Experience in UML and Process modeling using Use Case Diagrams, Activity Diagrams and Sequence Diagrams.
  • Good experience in conducting Joint Application Development JAD sessions through interviews and workshops with subject matter experts and business users.
  • Good experience with Rational Rose, Rational Requite Pro, Rational Clear Quest, Rational Clear Case, MS Project, MS Visio, Crystal Reports.
  • Well versed with Medicaid Management Information Systems MMIS , National Provider Identification NPI and familiar with Patient Protection and Affordable Care Act PPACA .
  • Experienced in conducting GAP analysis, User Acceptance Testing UAT , Risk Analysis and mitigation plan, Cost benefit analysis and ROI analysis.
  • Experienced in various MS Windows platforms, OS, Office Suite, etc.
  • Excellent knowledge of Health Insurance Portability and Accountability Act HIPAA transaction, code set rules such as EDI 837, 835, 834, 270, 271, 276, 277 and ICD9-ICD10.
  • Extensive knowledge of Medical Management Information Systems MMIS , Medicaid, Medicare, Procedural and Diagnostic codes and Claims Process
  • Strong knowledge of Health Insurance Portability Accountability Act HIPAA standards, Electronic Data Interchange EDI , Implementation and knowledge of HIPAA code sets, ICD-9, ICD-10 coding,,HL7, HMO, PPO.
  • Presented several documents and Use Cases for multiple transactions and worked with ANSI X12 5010 and ANSI X12 4010 including the standards for medical transactions like 837I, 837P, 835, 276, 277, 270, 271 both inbound and outbound transactions for ongoing industry projects.
  • Good knowledge of Health Insurance Plans Medicare Part A, B, C and D , managed care concepts Medicaid and Medicare and experienced in determining the membership eligibility, billing experience within life and disability in health plans. Excellent knowledge of HIPAA standards, EDI Electronic data interchange , transaction syntax like ANSI X12, Implementation and Knowledge of HIPAA code sets, ICD-9, ICD-10 coding and HL7.
  • Experience with Business Process Management.
  • A motivated, committed, quick learning, detail-oriented team player with good communication, analytical, leadership, interpersonal and problem solving skills.
  • Understanding of pharmacy benefit management.

AREAS OF EXPERTISE

Operating Systems

Windows, UNIX, LINUX, Mac

Languages

SQL, C, C , Java, XML, C , VB, ASP, .Net, Assembly, VHDL

Databases

Oracle, MS SQL server, MS Access, IBM DB2

Tools

MS Office: Word, Excel, Access, Power point, Project, Visio, Front Office, Rational Rose, SoDA, Software Modeler, Team Test, Doors, PROLOG, Clearcase, Clear Quest, , Web Sphere, Business Modeler, HP Quality Centre, Ultra Edit, TOAD.

Industry Standards

HIPAA, SOX, ISO, Six Sigma, CMM

PROFESSIONAL PROFILE

Confidential

EDI Business Analyst

Responsibilities:

  • Identified and validatedbusiness rules and data elements.
  • Created 837 P, I, D claims, and maintained data mapping documents in reference to HIPAA transactions primarily 837 P, I, D , 834, 835, and 270/271.
  • Worked within project team to identify and interpret state Medicaid and Medicare policies as applicable to customer defined algorithm research as well as assist with internal development of new healthcare analytics.
  • Worked with Trizetto based software called QNXT to obtain members information.
  • Worked with Medicare and Medicaid Encounter Pro to obtain Encounter from the main server to be submitted to Medicare and Florida Medicaid.
  • Utilize SQL server to run basic queries and obtain necessary data for Medicaid and Medicare Encounters.
  • Using SQL query to produce data for 270 EDI X12file, and create 270 files and submit to MEVSNET to check dual snip member for Medicaid benefits.
  • Review vendor files for any errors, missing segments, and for missing data on X12 file. Ensure file has complete data before claim can be submitted to Medicare and Florida Medicaid.
  • AnalyzedImpact 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.
  • Analyzed Audit and Change Files of 834, 835, 820, 837 PDI, 997, 999, 270 271HIPAA EDI Transactions using MS Word, MS Excel, MS Access and Facets PROD PPMO
  • Streamlined Claims 837 EDI X12 Migration project by gathering functional specifications in Edifecs
  • Tracked the change requests.
  • Have utilized RequisiteProto import word and excel documents in different extension formats. i.eexv, csv comma delimited file, tab delimited file.
  • Have utilized ClearQuest to repair and detect errors in a program.
  • Maintained and tracked the project plans using MS Project.
  • Daily and weekly status reporting to senior management.

Confidential

Business Systems Analyst

Responsibilities:

  • AnalyzedGap Analysis of the HIPAA 4010 and HIPAA 5010 processes to identify and validate requirements.
  • Coordinated JAD sessions with all the stakeholders to understand the impact of HIPAA 5010 on the existing system.
  • Gathered requirements for Front End and for Core Adjudication System by conducting meetings and brainstorming sessions with end users and Subject Matter Experts SMEs and documented them using Requirement Traceability Matrix and later exporting them to HP Quality Center.
  • Prepared Business Requirement Documents BRDs after the collection of FunctionalRequirements from System Users that provided appropriate scope of work for technical team to develop prototype and overall system.
  • Extensive knowledge of Patient Protection and Affordable Care Act PPACA .
  • Gathered requirements for ICD 10 transition.
  • Organized requirements into High Level Use Cases and Low Level Use Case Specifications and modeled them into UC, Activity and SequenceDiagrams using MS Visio.
  • Assisted the QA personnel in the creation of Test Cases using HP Quality Center.
  • Defined and analyzed test cases, test scripts, bugs, interacted with QA/ development teams in fixing errors and conducted User Acceptance Test UAT .
  • Coordinated and prioritized outstanding defects and enhancement/system requests based on business requirements, allowing sufficient time frame to ensure accuracy and consider deadlines
  • Streamlined Claims 837 EDI X12 Migration project by gathering functional specifications in Edifecs
  • Tracked the change requests.
  • Have utilized RequisiteProto import word and excel documents in different extension formats. i.eexv, csv comma delimited file, tab delimited file.
  • Have utilized ClearQuest to repair and detect errors in a program.
  • Maintained and tracked the project plans using MS Project.
  • Daily and weekly status reporting to senior management.

Environment:UML, MS Visio, MS Project 365, Ms Office 2003 to 365,C , Java, SQL, RDBMS, XML, Windows, Re

Confidential

Business Analyst

Responsibilities:

  • Gathered requirements from stakeholders for provider management and member management.
  • CoordinatedJAD sessions for Requirement Validation with Dept. of Cleveland clinic to gather requirements for the new MMIS.
  • Identified and validatedbusiness rules and data elements.
  • Created 837 P, I, D claims, and maintained data mapping documents in reference to HIPAA transactions primarily 837 P, I, D , 835, 270/271, 276/277 and 278.
  • 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.
  • Worked within project team to identify and interpret state Medicaid policies as applicable to customer defined algorithm research as well as assist with internal development of new healthcare analytics.
  • AnalyzedImpact 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.
  • Analyzed Audit and Change Files of 834, 835, 820, 837 PDI, 270 271HIPAA EDI Transactions using MS Word, MS Excel, MS Access and Facets PROD PPMO
  • Created functional requirement specification documents such as UML diagram, use case diagram, scenarios, activity diagrams and mapping.
  • Have utilized RequisiteProto import word and excel documents in different extension formats. i.eexv, csv comma delimited file, tab delimited file.
  • Have utilized ClearQuest to repair and detect errors in a program.
  • Developed the User Interface UI prototypes to capture and validate requirements and spike solutions to the current problem.
  • Analyzed requirements for developing a crosswalk for understanding major changes from ICD-9 to ICD-10 with the help of SME's.
  • Participated in developing test plan, test scripts, and test scenarios and designed user documentation.
  • Examine the system design deliverables validating it against the SLA.
  • Maintained and tracked the project plans using MS Project.

Environment: MS Office 2007 to 365, Windows, .NET, Agile, MS Visio, MS SharePoint, TFS, MS Project, MS Access 2007, Web Services, MS Visio, SQL, Oracle, SOA, HTML.

Confidential

Business Analyst

Responsibilities:

  • Gathering requirements from various insurance companies to develop a system to check for the outstanding balance from various accounts using highly efficient RUP process of software development.
  • Liaison between the Business needs business users and sponsor and the Technical solutions development and testing staff , ensuring technical solutions satisfied business requirements.
  • Web Page Mock-Ups using MS Visio and thus defining the Business Process Model and Data Process Model.
  • Experienced in RUP software development cycle methodology with four consecutive phases - Inception, Elaboration, Construction and Transition.
  • Experienced with MS SharePoint and Team Foundation Services TFS . TFS is utilized to effectively manage software developments projects throughout the IT lifecycle.
  • Ensured that the claims processing is strictly under the HIPAA compliance regulatory document to safe guard patient information.
  • Authored Business and Functional requirements with supporting diagram, use cases, traceability matrices, and training manuals for Provider Portal web-based application.
  • Developed training material and trained the users on newly developed application.
  • Analyzed and wrote technical documentation for risk analysis on customer support issues.
  • Part of the team assisting in documentation involved in this project such as RFP, proposal, evaluation criteria, proposal approval, design document, project plan, project scheduling, project report, release document.
  • Prepared and presented monthly collection reports.
  • Involved in training and quality of the overall workflow process.
  • Documenting workflow and results of analysis for the aging accounts.

Environment: RUP, Rational Requisite Pro, UML Use Cases, VB.NET, SQL Server, Rational Rose, XML, Use Case Documentation, Web services, MS. Access 2010, MS Office 365, MS Share point 2007, 2010, MS Visio

Confidential

Business Analyst

Responsibilities:

  • Participated in structuring, underwriting and documentation of credit facilities.
  • Facilitated in compiling and structuring data using SQL.
  • Authored Business Requirement Document BRD for development of software to support Black Scholes Model, CAPM, and Sharpe Ratio for investment decisions, in keeping with risk regulations that were in place.
  • Documented financial and industry analyses to support portfolio decisions.
  • Monitored bank's credit risk exposure to its new and existing clients.
  • Periodically reassessed and updated internally assigned risk ratings.
  • Conducted ROI analysis for competing portfolio candidates.
  • Evaluated risk-return ratio to facilitate most efficient allocation of capital.
  • Introduced newer areas of clients that could be nurtured for long term deposit flows.
  • Introduced newer ways of competing with existing big banking institutions.
  • Developed models to determine the effects of possible mergers with other banks.
  • Conducted JAD sessions with merger and acquisition M A SMEs, the management of charter one, and research and management teams of other banks.
  • Prepared documents and conducted interviews and JAD sessions to facilitate a smooth transition during merger.
  • Documented changes that needed to be done before, during and after possible mergers.
  • Documented website availability and availability of dashboard reporting and other resources before, during and after merger.
  • Introduced banking procedures to business analysts and other members of merged entity.
  • Performed data analysis and gap analysis to keep projects on track.
  • Helped in user acceptance tests UAT and other tests.
  • Authored user manuals for customers of merged entity.
  • Was instrumental in a smooth transition of entity, and in a much broader client base.

Environment: MS SQL Server, Informatica Power center, Mercury Quality Center, MS Word, MS Excel, Clear Quest, Clear Case.

Hire Now