- Over 7 years of extensive experience inBusiness Analysis with hands on experience in integrating business needs into IT solutions with core activities like: Requirement Gathering Analysis, GAP Analysis, Designing, Software Development, Implementing,Software Validation/Testing,Project Cycle Management PCM in industries like Healthcare, Insurance and Pharmaceuticals and extensively worked on Insurance Claims, Medicare/Medicaid Claims.
- Extensive experience in gathering requirements by conduction of JAD sessions Joint Application Development ,Interviews, Workshops and Requirement Elicitation sessions with end-users, clients, stakeholders and development team and converting them in to BRDs Business Requirement Documents and FRDs Functional Requirement Documents or NRFD Non-Functional Requirement Document .
- Thorough Understanding of SDLC Software Development Life Cycle involved in all phases from Planning to the Implementation stage. In depth knowledge and experience in Classic Waterfall, Rational Unified Process RUP , Agile, Scrum, RAD Rapid Application Development methodology.
- Expertise in defining Scope of projects based on gathered Business Requirements including Documentation of Constraints, Assumptions, Business Impacts, Project Risks Scope Exclusions.
- Expert in working with SME's Subject Matter Experts across each group during entire SDLC with strong experience in conducting GAP Analysis, Cost Benefit Analysis, SWOT Analysis and Return of Interest ROI Analysis.
- Proficient in developingData Flow Diagrams DFD , Use Case Diagrams, Flowchart Behavior Diagrams Sequence diagrams and Activity diagrams based on UML methodology using Rational Rose and MS Visio.
- Very Strong PL/SQL skills writing queries and verifying data with solid understanding of Databases, Data Warehouse, OLTP, OLAP, Data Modeling,Business process design, application systems analysis, object oriented analysis, Business Intelligence tools like Business Objects involved in gathering data mart requirements from business users
- Experience in Change Management Process Identify, Analyze, Evaluate, Plan, Implement, Review and Close
- Experienced with HIX Health insurance Exchange , PPACA Patient Protection and Affordable Care Act ,Plan Management, Eligibility and Enrolment process, SHOP Small Business Health Options Program as well as Financial Management.
- In depth understanding of the HIPAA 4010 and 5010 compliance standards,CPT/ HCPCS, HIPAA insurance regulations and claims processing,ICD-9, ICD-10 coding and HL7.
- Excellent knowledge of Medicare Part A, Part B, Part C and Part D.
- Experience with conducting assessments and impact/gap analysis concerning State Medical Management Information System MMIS .
- Thorough Understanding Experience in EDI Electronic Data Interchange transactionsand Codes like:ANSI X12 837 Health care claims , 820, 835,270/271 Inquire/response health care benefits , 276/277 Claim-status , 278 Health Care Services Review Information , 834 Benefit-enrollment , 835 Payment/remittance advice , 999 Implementation Acknowledgement document transactions and ICD-10 Code sets, andCMS.
- Experienced in Conversion of HIPAA X12 4010 codes to X12 5010 codes.
- Experienced in-depth knowledge in Conversion of, ICD 9-CM Clinical modification to ICD-10-CM/PCS Clinical modification/procedure coding system and CPT codes for mental and medical health.
- Adjudicated Medical Professional and Institutional and Pharmacy Claims in Claims adjudication and procedures, pay professionals and members, select Individual claims for payments, change the claims status of an individual payment to hold or release, create, print, or display EOB explanation of benefits for a member or EOP explanation of payments for a provider.
- Experience in Conversion of HIPAA X12 4010 transactions to X12 5010 transactions.
- Hands on experience in Claims Adjudication System and Complete Revenue Life Cycle
- Worked with Claims NASCO , provider, enrollment, finance, benefits and Vendor Management Business Areas.
- Experience in White Box, Black Box, Unit, Functional, Integration, User Acceptance Testing UAT , Back End and System Level Load and Stress Testing for many types of applications including web and client-server applications.
- Assisted QA Quality Assurance team in writing test plans, defining test cases, test scenario and data sets.
- Expertise in designing and building Work Flows using MSSharePoint 2007/10/13.
- Possess strong business technical writing skills required for documenting Business Process Documents.
- Excellent communication, business understanding, critical thinking and analytical skills with the ability to communicate appropriately in business and technical situations at all levels.
- Highly motivated,organized and target oriented team player who enjoys working with multi-functional team towards a common goal.
SQL, Oracle, MS Access, SQL Server 2000,DB2, Teradata, Sybase
MS Project, MS Visio, Microsoft Office 2003/07/10/13 Excel, Word, PowerPoint, Access, Outlook Microsoft Project, MS SharePoint.
SQL, C,C , PL/SQL, JAVA, HTML,DHTML,XML, VB,.NET,JSP
Business Objects Designer, Webi, Dashboard , Cognos, Informatica, OBIE
Requirements/ Management Tools
Rational Requisite Pro, Rational Rose, MS Visio, Balsamiq, Mockup Screen
Quality Center, QTP Quick Test Pro , SoapUI Pro,Siebel, RMT, HP ALM
Windows 98/2000/VISTA/XP/7/8/8.1, DOS, Unix, Linux, MacOS/OS XSun Solaris.
Business Documentation Skills:
Documented Business Requirement, Use Case Specifications, Functional and Non-functional Specification, System Requirement Specification, UML Diagrams Use case, Class and Sequence , Traceability Matrix, Project Estimate, Change- Training and User Manuals, Master Test Plan Review Integration, System and Acceptance .
HIPAA 4010/5010, ICD9/10, ANSI X12, CPT, CMS form., Six Sigma,CMMI,PMBOK
OOAD, Joint Application Development JAD , Rapid Action Development RAD , Rational Unified Process RUP , Unified Modeling Language UML , System Development Life Cycle SDLC , Crystal Reports, Visual Source Safe,Waterfall Model, Agile Model, SCRUM, Rational Unified Process RUP .
ANSI X12, HL7, HIPAA, HIX, PPACA, EDI, HL7, Enrolment/Claims, Medicare,Medicaid, CHIP,DHR,Facets.
Sr. Business Analyst
- Conducted Interviews and facilitated JAD sessions with SME's,Management, development team, users and other stakeholders to understand the business requirements refine functional requirements.
- Gathered and created BRD Business Requirement Document , performed cost-benefit analysis with Project Manager.
- Used Requisite Pro for the Requirement Document Preparation and Prepared Business Process Models BPM that includes modeling of all the activities of the business from the conceptual to procedural level.
- Performed detailed analysis for the functional areas that will be impacted by implementation of ICD-10 codes
- Identified gaps and performed GAP analysis, cost analysis with respect to CMS requirements and conducted Impact Analysis and prepared an Implementation and Recommendations Report communicated to the stakeholders.
- Created FRD Functional Requirement Document based on the signed-off business requirements.
- Created Use case models, analysis models, implementation models, authored use cases, use case diagram, behavior diagrams sequence diagrams, activity diagrams based on UML methodology using Rational Software Modeler and MS Visio.
- Created and maintained a RTM Requirement Traceability Matrix to see if all the requirements are being captured and are being worked on, throughout the project lifecycle.
- Worked on HIPAA EDI transactions such as 835, 837, 276, 277, 278, 270, 271, 834, 820.
- Assisted SME forauthoringCompanion Guide to support all the information needed to process HIPAA transactions.
- Managed all the Change Requests Document that came in through after signoff and maintained all the artifacts on SharePoint.
- Arranged meetings with the IT team to configure Data Mapping Document facilitating the conversion from ICD-9-CM codes to ICD-10-CM/PCS codes to ensure that both the application and Health Record comply with new regulations.
- Analyzed the impact of ICD-10-CM/PCS coding system and identified General Equivalence Mappings to facilitate the conversion from ICD-9-CM codes to ICD-10-CM/PCS codes validating that both the application and Health Record comply with new regulations.
- Involved in designing and developing Data Models and Data Marts that support the Business Intelligence Data Warehouse and Streamlined the Restatement Financial Data Warehouse access review Process.
- Interacted with various HMO, PPO, Medicaid/Medicare Representatives discussing benefits of contracts on behalf of facilities or appeals from denials and compliance issues.
- Extreme involvement in production and development phase to report out to the stakeholders about the current status of the project.
- Used the mapping tools to map 4010 and 5010 transactions along with ICD 9 and ICD 10 codes
- Performed Unit Testing and User Acceptance testing and documented detailed results creating test plans and scripts, tested strategies with developers and testing team for ValidationandProvided input scope, goals, risks, constraints, timelines and interfaces to PM for project planning and control.
- Implemented SDLC, which included requirements specifications, design, analysis and testing. Followed RUP methodology with Agile/SCRUM.
- Organized daily scrum calls to keep the team on track and the stakeholders updated.
- Worked with the software development team for testing codes and used PL/SQL to query various reporting databases.
- Reproduced, verified and validated issues documented in a defect tracking system and writing tractability matrices based on use cases and business requirements BRDs performed the requirement analysis and documented the requirements using Rational Requisite Pro.
- Involved with the compliance and audit team to make sure we were following correct HIPAA.guidelines/protocols throughout the project lifecycle.
- Involved inSWOT analysis of project plan.
Environment: Rational Rose, Rational Requisite Pro, MS Project, Quality Center 220.127.116.11,MS Visio,Siebel, Clear Case, Rational Clear Quest, XML, JAVA, HTML, Microsoft SQL Server, Agile, Oracle, MS SharePoint,Mainframe, HP ALM/Quality Centre.
HIX Business Consultant/Sr. Business Analyst
- Worked as a liaison between the Business and Technology Department.
- Worked with the managers, management and reportrequestors to gather requirements.
- Validated the following Transaction Processing: 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
- Gathered requirements, analyzed them and created formal Business Requirement Document BRD Functional Requirement Document FRD
- Constantly researching best practices for health insurance issuer accreditation, reinsurance, and risk adjustment.
- Creating of Business Process Workflow Diagrams with Stakeholders throughout the Business System Development Life Cycle SDLC , to create the provider portal which allows providers to access patient information to increase convenience.
- Involved in requirements gathering sessions with Business Analysts and Architects to understand requirements in terms of business change.
- Created and maintained the Requirements Traceability Matrix RTM
- Owned the entire reporting process and interacted with the ETL team, developer s , management, and account holders to get the requirements, document them, design templates, and write specifications.
- Designed Functional Specification Documents for the reports and worked in RUP environment using Rational Requisite Pro
- Analyzed trading partner specificationsand EDI mapping guidelines.
- Conducted JADsessions for the report users, requestors, developers and prepared Need Analysis Documents of the requirements gathered through JAD sessions. .
- Created presentations explaining the entire report development process, while drawing a comparison between the legacy the new report.
- Developed and conducted statewide HIPAA 5010 and ICD-10awareness program for all IDS staff in Assurant.
- Coordinated with the developer, on day-to-day basis, during the development process.
- Helped with Data Mapping between the data mart and the Source Systems.
- Participated in workshops and update meetings with Insurance carriers
- ConductedClaim/Encounter Management, claim data collection, claim quality check, and filtered claims for Risk Adjustment.
- ConductedStakeholder Analysis.
- Facilitated Health Insurance Form Filing requirement sessions.
- Developed Preliminary Business Object Model for Health Insurance Form Filing, Requirement Document for Health Insurance Form Filing.
- Wrote and maintainedproject requirements, facilitated meetings, built business and system flows, managed defects and wrote test scripts and use cases.
- Successfully usedScrum Analysis Model Agile for gathering requirements by facilitating Use Case Workshops and sessions.
- Involved with thesubject matter expertise for the implementation of Health Exchange Business Process with a special focus on Medicaid Integrated Eligibility, Plan Management, SHOP/SHOPPING, and Financial Management Business domains.
- Followed the Agile Scrum SDLC System Development Lifecycle methodology,
- ValidatedSystem requirements for the Certifications, Accreditations and Attestations of Insurance Carriers
- Involved in communicating with the software development team for the online application.
- Wrote PL/SQL statement and stored procedures in Oracle for extracting as well as writing data
- Migrated Data from MS Excel to SQL Server Reporting ServiceUsing DTS and SQL loader utilities.
- Modified System flow diagrams using Visio.
- Created Wireframes, UI Mockups using Mockup screen and maintainedRequirement traceability Matrix RTM by using MS Visio based on UML.
- Reviewed Stored Procedures for reports and wrote test queries against the source system SQL Server to match the results with the actual report against the Data mart Oracle .
Sr. Business Analyst/Quality Analyst
- Conducted user interviews, gathered requirements, and analyzed the requirements.
- Worked with the business team to collect the business requirements, security and service level requirements and documented those usingRequisite-Pro Visio.
- Analyzed set behavior and contribution to performance, critical business metrics tracking underlying business trends using Business Objects.
- Created and maintained a RTM Requirement Traceability Matrix .
- Worked with different IT Business groups to understand and determine the Impacts to the Data Warehouse and/or Data Marts for different projects
- Working experience in the Analytical CRM for health care customers and their custom data management.
- Worked on Clinical Trials using IVR Interactive voice response to conduct global clinical trials and manage the large volumes of data generated.
- Participated in the logical and physical design sessions and developed design documents.
- Designed new process flows for the existing system as well as for the enhanced system.
- Conducted and lead status report meetings with the business and the IT team on a weekly basis.
- Assist with creation and maintenance all necessary documentation and training materials for Epic Ambulatory application
- Performed analysis, design, development and maintenance of the Epic Ambulatory applications and other clinical information systems.
- Assisted in Clinical Data Management and Clinical Trials Management.
- Worked on on interface analysis of existing Clinical Trial Management System to answer questions/query requested by the business users.
- Helped with the collection, coding, assessment and reporting of adverse event data using ARISg.
- Involved with workfor the implementation of the EHR-Pharmacy Module.
- Used Safety Mart for Clinical Safety Data Management.
- Captured all HIPAA-related EDI data in the repository using FACETS.
- Supported integrated EDI batch processing and real-time EDI using FACETS.
- Worked on Electronic Health Record EHR system on a CRM web based application.
- Assisted for the work on Data design, Architecture design and Staging requirements for the Data warehouse environment.
- Exposure to HIPAA Compliance requirements and HL 7 standards.
- Assisted project managers with the development of project schedules. Developed requirements and preliminary design for client applications.
- Performed analysis and designed projects using a systems development methodology. Worked with all levels of client staff in solution definition.
- Performed Content Management using Documentum.
- Managed Scope and change throughout the life cycle of the product.
- Translated customer/client needs into new features and new services
- Developed UAT test cases associated with the functional requirements.
- Maintained a bi-weekly status report for validating the requirements with the team and incorporated the same to the PMO status reports.
- Participated in developing test plan, test scripts, and test scenarios and designed user documentation.
- Analyzed the As is and To be system documents to show the current and proposed functionalities of the system using MS Visio.
- Responsible for creating maintaining Requirement Traceability Matrix RTM in order to track the development and QA process.
- Conducted daily scrum meeting with the project team and change management team to discuss the requirement updates, change requests, tasks and assign/re-assign man hours on a daily basis.
- Interacted with Developers and Users in resolving risk factors and other issues.
- Documentedtest cases during requirements gathering, analysis and design phases.
Business Systems Analyst Ecommerce
- Gathered high level requirements and developed scope of the project for the implementation of the project.
- Conducted weekly meetings for deciding the Policies and Procedures to be followed while constructing new sites.
- Gathered requirements for the integration of POS Point of Sale system with the supply chain system and assisted with the BRD for the POS implementation project.
- Performed the requirement analysis, impact analysis documented the requirements using Rational Requisite Pro
- Validated technical design documents created by IT developers against functional specifications
- Coordinated participation and sign-off of various business partners and customers.
- Performed Gap Analysis to check the compatibility of the existing system infrastructure with the new business requirements.
- Designed and developed Activity Diagrams, Sequence Diagrams,Use Cases and other Process Flow Models using Visio and Rational Rose.
- Followed a systematic approach to eliciting, organizing, and documenting requirements of the system.
- Reviewed the Joint Requirement Documents JRD with the cross functional team to analyze the High Level Requirements.
- Assisted with the creation ofPhysical Inventory process for retail stores, consisted of data integration and inventory processes with third party vendor
- Interacted with client and the Technical Team for requirement gathering and translation of Business Requirement to Technical specifications.
- Created Data Stage jobs to extract, transform and load data into data warehouses from various sources like relational databases, application systems, temp tables, flat files etc.
- Used the DataStage Designerto develop processes for extracting, cleansing, transforms, integrating and loading data into data warehouse database.
- Developed, maintained and published project plan scheduled project deliverables using MS Project.
- Extensively involved in the modeling and development of Reporting Data Warehousing System.
- Was involved in the creation of new E-Commerce Products Arrival Notices and Customized Reporting
- Accumulated system requirements from various departments through surveys and interviews.
- Involved in prioritizing the defects and writing business requirements to resolve them.
- Conducted JAD sessions with management, SME, vendors, users other stakeholders for open end pending issues.
- Involved in mentoring specific projects in application of the new SDLC based on the Agile Unified Process, especially from the project management, requirements and architecture perspectives.
- Create technical design documentation for the data models, data flow control process, metadata management.
- Assisted in writing detailed specifications for various reports generated using Cognos.
- Analyzed the data collected and processed maps to determine the root causes and identify opportunities.
- Planned and defined system requirements to Wire Frame with Use Case, Use Case Scenario and Use Case Narrative using the UML Unified Modeling Language methodologies
- Interfaced between Business new product builders and System platform builders.
- Documented the Traceability Matrix for tracing the Test Cases and requirements related to them.
- Developed Data Conversion Strategy for converting data from the existing site to the new site.
- Designed workflows and allocated permissions within SharePoint.
- Performed Unit Testing and User Acceptance testing UAT and validated user acceptance test plans UAT and documented detailed results.
- Involved with all the phases of Software Development Life Cycle SDLC methodologies like RUP and the waterfall. throughout the project life cycle.
Environment: RUP, UAT, GAD Gap Analysis Document , Clarity, MS Visio, Rational Rose, Java, J2EE ,Agile, SQL Server, Windows 2000 Advanced Server, UNIX / Oracle Platform,EDI, Documentum 2.0.,UML, Web Form, Cognos.
Business Systems Analyst
- Actively interacted with the client and the salesteam to gather client requirements regarding the patient Electronic Medical Reports.
- Analyzed Business Requirements, developing, tracking and enhancing them into functional requirements.
- Collected and documented business processes as well as business rules.
- Developed the SRS SpecificationRequirements Document based on the vendor interaction and user requirements.
- Interacted with the third party vendors to collect details and quotes regarding the Vendor EMR.
- Coordinated closely with the diagnostic lab and sales team for approvals.
- Developed Use Cases for the main modules and describe the requirements to the developers.
- Conducted JAD sessions with the entire team.
- Worked closely with the development team to communicate client requirements
- Worked closely with the Project Manager in handling the scope creep and analyzing its effects
- Provided key input in working with users in defining project and system requirements.
- Communicated final adjustments required based on user feedback.
- Held regular status meetings on behalf of the Project Manager to keep track of the status.
- Created and maintained the Requirements Traceability Matrix to keep track of each requirement.
- Designed and developed Use Cases, Activity Diagrams, and Sequence Diagrams, using MS VISIO.
- Wrote test cases to validate functionality for end users
Environment: Microsoft Office Excel Word, PowerPoint, Project , Macros, Rational Requisite Pro, MS Visio, SQL.
- Interacted with client to assess needs, identify key challenges, and define project Scope and deliverables
- Analyzed software requirements specification SRS , prepared functional specification document FSD , and designed documents as per standards
- Conducted group JAD sessions with business units and stakeholders to define project scope and deliverables
- Extensively used the UML methodology to create various use case diagrams.
- Responsible for creating artifacts for Rational Unified Process RUP - use cases, system architecture document, supplemental requirements document, architecture diagrams verifying technical production infrastructure
- Review architectural templates, process flow diagrams, cross walk documentation for the current systems
- Assisted Quality Assurance QA team in writing test plans, defining test cases, test scenario and data sets
- Developed Process flow charts which helped in better understanding of the system
- Performed integration testing, product testing, User Acceptance Testing UAT and data driven testing
Environment: Rational Rose, Rational Requisite Pro, MS Project, MS Access, MS Excel, MS PowerPoint, Quality Center 8.2,DB/SQL, MS Project, MS Visio, Rational Clear Quest, XML, J2EE, Microsoft SQL Server.