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Business Analyst Resume Profile

NY

Summary

  • Overall Seven years experience as a Health Care Business Analyst.
  • Extensive experience in Clinical Data Management, data analysis and generated CRT tables, reports, graphs for FDA submission according to protocol.
  • Experienced in payer rules, requirements, governmental regulations and HIPAA compliance. Interacted with claims payment and enrollment to review, analyze and document business processes.
  • Experience with healthcare system, Medicaid and with prime focus on claims adjudication, provider, eligibility and prior authorization.
  • Expertise in developing Software Test Plans, Test Case Design, Test Scripts based on User Requirements Specification URS ,System Requirements documents SRS , Functional Requirement Specification Documents FRS
  • Exposed to SOX, HIPAA / EDI transaction code include 270, 271, 276, 277, 278, 834, 835 and 837
  • Adequate knowledge in Health Administration Claims processing auto adjudication , COB, EOB/Drafts, Claims pricing and testing, HIPAA, enrollment, EDI, Medicare, Medicaid, CDHP consumer driven health plans
  • Experience using MS Visio, Rational Unified Process RUP , Rational Rose, Requisite Pro, Advanced MS Excel.
  • Experienced in SQL Server Reporting Service SSRS , Executing Queries and Running Store Procedures.
  • Experience in using the guidelines and artifacts of the Rational Unified Process RUP to strategize the implementation of RUP effort in different phases of the project.
  • Experience with System Life Cycle SLC and Medidata RAVE application.
  • Exceptional Documentation skills for writing use cases, business requirement documents and functional requirement documents as well as for creating Use Case diagrams based on UML Methodology and business process flow diagrams using EA, Requisite Pro and MS Visio
  • Excellent analytical, problem-solving and interpersonal skills and Effective verbal and written communication skills
  • Solid team player with initiative, adept at building relationships with colleagues and customers.

Technical Skills:

EDI transactions: 270,271,276,278,810,820,835 and 837 P, I D

Healthcare Management: HIPAA, HL7, ISO 9000, Six Sigma and TQM.

Healthcare Claims Systems: NASCO

Operating Systems: Windows XP, Windows 2000

Languages: UML, SQL, PL/SQL and Client/Server architecture. .

Database Analysis: Oracle 8, MS Access, SPSS and

Process/Model tools: Rational Suite and MS Visio

Testing Tools : Win Runner and Test Director.

Office Tools : MS Office MS Word, MS Excel, MS PowerPoint, MS Project

Work Summary

Confidential

Business Analyst

Responsibilities:

  • Responsible for defining the scope and implementing business rules of the project, gathering business requirements and documentation.
  • Responsible for writing Functional Requirement Specifications FRS and User Requirement Specification URS .
  • Analyzed Business Requirements and segregated them into high level and low level Use Cases, Activity Diagrams / State Chart Diagrams using Rational Rose according to UML methodology thus defining the Data Process Models.
  • Developed straightforward DBMS queries, knowledge of HL7 and xml interface messaging.
  • Assisted in monitoring ancillary data transactions and addressed problems with HL7 messages.
  • Responsible for architecting integrated HIPAA, Medicare solutions, Facets.
  • Identify Member, Provider, Coverage, Medicare, and Medicaid.
  • Assisted the database development team in data modeling, data structure and data table layouts required for consolidation of incongruent databases,
  • Involved in Service Oriented Architecture SOA of the claims processing system
  • Understand the As Is system and develop the To Be system concept and also prepare the System Process Maps.
  • Performed extensive requirement analysis including Data analysis and Gap analysis.
  • Defined Functional Test Cases, documented, Executed test script in Facets system.
  • Analyzed and translated business requirements into system specifications utilizing UML and RUP methodology
  • Established a RUP Rational Unified Process centric business analysis methodology.
  • Successfully conducted JAD sessions, which helped synchronize the different stakeholders on their objectives and helped the developers to have a clear-cut picture of the project.
  • Conducted presentations of the QA test results with analysis to the stakeholders and users and documented modifications and requirements.
  • Coordinating and Developing QA activities.
  • Developed test plans with QA team and helped test every scenario using Mercury Test Director Tool for system testing
  • Assigned tasks among development team, monitored and tracked progress of project following Agile methodology.
  • Created Process Flow diagrams, Use Case Diagrams, Class Diagrams and Interaction Diagrams using Microsoft Visio and Rational Rose.
  • Wrote Test Cases and performed User Acceptance Testing, documented the in detail defects using the Defect Tracking report.
  • Used Test Case distribution and development reports to track the progress of test case planning, implementation and execution results.
  • Wrote PL/SQL statement and stored procedures in Oracle for extracting as well as writing data.
  • Created Use cases, activity report, logical components and deployment views to extract business process flows and workflows involved in the project. Carried out defect tracking using Clear Quest
  • Maintained proper communication with the developers ensuring that the modifications and requirements were addressed and also monitored these revisions.
  • Involved in compatibility testing with other software programs, hardware, Operating systems and network environments.

Environment: Requisite Pro, Rational Rose, Agile, HL7Interfaces, UNIX, PL/SQL, HTML, MS Office, MS Visio, EDI, UML.

Confidential

Business Analyst

Responsibilities:

  • Worked on EDI transactions processing: 270, 271, 834, 835, and 837 P.I.D to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
  • 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
  • Conducted user interviews, gathered requirements, and analyzed the requirements using Rational Rose Requisite Pro RUP in Clinical Phases I, II, III
  • Developed modules for extracting encounter data from multiple systems, converted to common format, and loaded into a regional Health Information Exchange for regional patient care management and clinical decision support.
  • Facilitated and managed meeting sessions with Business Users to review business requirement capture. Have set-up weekly status meeting and JAD Sessions with the Stakeholders, Business Users and Technical leaders from various departments Clinical trial, Drug Discovery and Pharmaceutical Development .
  • Performed In-Death analysis of systems and business processes of Medicare Part D as per CMS rules and procedures.
  • Involved in testing the Pharmacy Claims adjudication and Billing processing is done through PBM Health Trans and Claims Accumulation and Adjudication is done through Diamond.
  • Researched the existing client processes and guided the team in aligning with the HIPAA rules and regulations for the systems for all the EDI transaction sets.
  • Consulted with healthcare insurance company to develop conversion specifications for other insurance Coordination of Benefits including Medicare .
  • Working within a growing knowledge of X12 4010 HIPAA 837 I, P, D, 835, 834, 820, 270, 271, 276, 277, 278, EDI, Privacy, Security, and Medicaid.
  • Facilitated reviews of Business and System Requirements documents as provided by Software Development Engineering. Representatives from all Functional teams in attendance
  • Troubleshooted file transmission problems and assisted customers in a call center environment with EDI and Medicaid Insurance claim related inquiries explained and enforced guidelines in the X12 Implementation guides 837P, 837I, 837D, 270/271 .
  • Design and review of various documents including the Software Requirement Specifications SRS , Business requirements document BRD , Use Case Specifications, Functional Specifications FSD , Systems Design Specification SDS , Requirement Traceability Matrix RTM and testing documents
  • Assisted JAD sessions to identify the business flows and determine whether any current or proposed systems are impacted by the EDI Transaction, Code set and Identifier aspects of HIPAA.
  • Used Test Director and Mercury Quality Center for updating the status of all the Test Cases Test Scripts that are executed during testing process.
  • Used MS Visio for Process modeling, Process mapping and Business Process flow diagrams.
  • Performed UAT and exposure to User Certification Testing UCT and Operational Readiness Testing ORT
  • Develop and maintain sales reporting using in MS Excel queries, SQL in Teradata, and MS Access. Produce performance reports and implement changes for improved reporting.
  • Used Rational Tools for creating use cases, version control and defect tracking, monitoring. Use Rational Unified Process RUP methodology in all areas of the software development life cycle SDLC .
  • Facilitated Deign/Development technical design review's and ensured that business and system requirements are met.
  • Performed source data profiling to verify that data meets the business requirements.
  • Played major role in writing lower level and upper level Use case.

Environment: Technical Analyst, Share Point, C , Java, NET, SQL, PL/SQL, UML, MS Office Suite Word, Excel, Access, PowerPoint, and Outlook, MS-Project, Visio , Requisite Pro.

Confidential

Business Analyst

Responsibilities:

  • Worked according to the activities/roles laid down in each phase of software development life cycle created using Rational Unified Process.
  • Working within a growing knowledge of X10 4010 HIPAA 837 I, P, D, 835, 834, 820, 270, 271, 276, 277, 278, EDI, Privacy, Security, and Medicaid.
  • Responsible for developing Front end edits for claims adjudication
  • Develop MITA Maturity Model MMM Business Capability Matrix BCM to identify the maturity level of SD Medicaid Enterprise.
  • Involved in performance testing of Medicaid client server claims processing system, Medicaid MCC / MCO and Medicaid Management Information System MMIS
  • Worked on EDI transaction 835 to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
  • Authored test plans, test cases for various test scenarios and helped testing team to better understand the test scripts.
  • Applied RUP methodology with its various workflows, artifacts and activities to manage life cycle from Inception to Transition phase.
  • Extracted the Business Requirements from the end users keeping in mind their need for the application and prepared Business Requirement Documents BRD using Rational RequisitePro.
  • Prepared a Project Charter and a detailed Business Requirements Documents BRD .
  • Defined, developed specs for federal reporting specific to Medicare Advantage
  • Develop and maintain sales reporting using in MS Excel queries, SQL in Teradata, and MS Access. Produce performance reports and implement changes for improved reporting.
  • Developed Use Cases in Microsoft Visio along with Activity Diagram to present the workflow in a visual form.
  • Performed task decomposition, delegated tasks and monitored project milestones using MS Project.
  • Facilitated sessions with SME's in understanding the requirements pertaining to billing Origination to billing Processing.
  • Prepared UAT Materials, including the UAT Process, UAT Test document which would include step-by step process for UAT as well as all the tests that would cover all requirements.
  • Develop implementation guidelines and principles for practice-based clinical applications, including various practice management and EMR systems
  • Utilized corporation developed Agile SDLC methodology. Used Scrum Work Pro and Microsoft Office software to perform required job functions.
  • Extensively involved in every phase of the RUP process starting from Inception to Transition
  • Assisted and written System Requirements Documents SRD and Business Requirements Documents BRS including Functional and Non-Functional requirements.
  • Implemented the entire Rational Unified Process RUP methodology of application development with its various workflows, artifacts, and activities.
  • 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.
  • Produced UML Activity diagrams with defined swim lanes using MS Visio as part of claims process analysis
  • Responsible for building a Business Analysis Process Model using Rational Rose and Visio.
  • Created DTS Packages for migration of data between MS SQL Server database and other databases like MS Access, MS Excel and Flat Files.
  • Worked with heterogeneous sources from various channels like Oracle DBMS, SQL Server, flat files, and web logs.
  • Helped the business to articulate and prioritize their ideas, and created UML-based feasibility studies and Use Case Models to communicate those ideas to the developers.

Environment: Rational Requisite Pro, Share Point, SQL, UML, MS Visio, Win Runner, Test Director, MS Access, Windows 2000, Java, J2EE, Oracle

Confidential

Business Analyst

Responsibilities:

  • Conducted one to one interviews with Portfolio Manager to gather Business Requirements and was involved in the documentation of Business Requirement Documents.
  • Developed detail class diagrams and sequence diagrams using Rational Rose XDE implementing J2EE patterns in UML design.
  • Involved in construction of data flow diagrams and documented the process.
  • Assisted the Project Manager in setting realistic Project expectations and in evaluating the impact of changes on the organization and plans accordingly and conducted Project related presentations.
  • Identified internal and external system Requirements, design and configuration set-up.
  • Developed strategic partnerships with the Business units to develop a solid knowledge base of the Business line, including the Business Plan, Products, and Process.
  • Worked with SMEs to understand various assets and security classes, exchange traded derivatives such as futures, options on futures, equity options and index options , OTC derivatives such as interest rate swaps, swaptions, credit default swaps and total return swaps and portfolio allocation and management.
  • Worked with FAs and RAs to conduct Credit Risk Measurements like calculation of RWA Risk Weighted Asset .
  • Translated the Business needs into system Requirements, communicating with the Business on a broader scale and with an in-depth view.
  • Designed and developed all Use Cases and UML models using Rational and Visio
  • Participated in UAT and worked with Mercury Quality Center for bug and defect tracking.
  • Involved actively in determining the quality and quantity of data to be provided for UAT.
  • Conducted JAD sessions for communicating with Stakeholders and Project directors.
  • Designed and developed Project document templates based on SDLC methodology.
  • Developed Business Requirement Document as well as High-Level Project Plan.
  • Functioned as the primary liaison between the Business line, operations, and the technical areas throughout the Project Cycle.
  • Participated in the Logical and Physical Design sessions and developed Design Documents.
  • Worked with developers to make sure that they understood the Use Cases.
  • Designed and implemented basic SQL queries for QA Testing and Report / Data Validation.
  • Partnered with the Technical Areas in the research and resolution of System and User Acceptance Testing.
  • Worked with Quality Control Teams to develop Test Plan and Test Cases.
  • Develop User Manuals, and Training Manuals as per Project Specifications and timelines.

Environment: Microsoft Office Suite,MS Word,MS PowerPoint, MS Visio, Windows XP, Dreamweaver, SQL, PLSQL, XML, VB, ASP, UNIX,VBA, Crystal Reports, Adobe Photoshop, Mercury Test Director, Win Runner, Load Runner

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