Objective:

7 years of experience in healthcare industry Provider, Payer and State Agency Business Analysis, Process improvementand participation in Project Management Solid understanding of all phases of SDLC methodology such as requirement planning, analysis, design, data modeling, business process modeling, implementation and deployment and experience in different methodologies like Agile, Waterfall. Quick adaptation,fast learning along with my communication and presentation skills brought me success and make me an effective contributor in the team. Moderating and attending meeting with the project owner,SMEs' and other stakeholders documenting meeting outcomes and translate and interpret to the other team been my key responsibilities.

Sound knowledge of MMIS, MITA Business process model MITA Business Areas Member and Provider Management , Interface/Prototyping/Mapping, MMIS replacement project, Microsoft Visio, FACETS, NetworXPricer, claim processing system GAP analysis RAID, IV V Independent Verification Validation Section 508, Migration to Office 365, Cloud Computing, RadiantCMS

Core competencies:

• Requirement Management Business Process Modeling/Reengineering Functional Specification
• IT Project leadership WCMS Technical Design
• Agile, Scrum Data Analysis and Reporting SQL Query

Key competencies:

• Business requirement, data analysis, process mapping, system mapping, analysis and presentation
• Competency and experience in ECM or WCMS - Web Content Management Systems
• Healthcare Claims, Member, Plan/Product, Provider, Commissions and Billing modules of Facets
• Gap Analysis for legacy to new or As Is to To Be through analysis, process flow, project requirement
• Well co-ordination with SME, PMO officials, stakeholders, IT vendors Facilitated JAD, bi-weekly PM-BA forum, workgroup meeting, webinar walkthrough, status update meeting UAT
• Excellent communication, presentation skills with data analysis and dashboard update using MS Excel, MS CRM, MS Powerpoint
• Assisted/participated in creating Project Charter, Project Plan, RACI, RAID update
• Competent in Agile, Waterfall, RUP, SDLC, BPM, UML, Rational Requisite Pro, Sprint, BABOK familiar

Professional Summary:

• 7 plus years of experience in healthcare domain in ACA, EDI and Medicaid, FACETS, MITA environment
• Experience with TriZettos Facets Application Groups: Claims Processing, Guided Benefit Configuration, Medical Plan, Provider, Subscriber/Member, Utilization Management NetworXPricer automated claim processing, Provider management
• Familiar with the end to end business process in Provider Management and Member Management in MMIS
• Responsible for -
• Facilitated meeting with SMEs' and stakeholders to produce, design, packaging, implementation and rating SMEs' feedback and performance
• Conducted work breakdown meeting to identify milestone, deliverables and anniversary date
• Created and shared calendar-timeline on the basis of committed dates for delivery from work effort owners
• Played as documents owner in the JAD session to answer on the questions on requirement, dependency, project current status, potential risk, assumptions, decision taken and so on
• Escalated issues to SMEs', Sr leaderships, managers, to ensure correct message is conveyed and communication is flawless
• Completed given tasks on time and followed up with other responsible parties and folks for smooth workstream
• Coordinated closely with other project BA's for updating Dashboard and present to the program level meeting and give update to the team of 50 including business leads, project sponsors, program director
• Worked closely with Program Manager, Project Manager in assigning or referring BA's to fill in position and support them in understanding project works
• Proficient understanding and demonstration knowledge of Medicaid, Medicare, EDI, ICD 10, HIPAA 5010
• Conducted PM-BA forum on bi-weekly basis for open discussion on project works and interependencies
• Worked alongside the Moveable Online Project Management team for defined projects, ensuring that project deliverables meet business requirements and specifications.
• Assisted Project Manager in the development of business cases, RFI's and RFP's.
• Built and maintained effective relationships with business and technology partners, subject matter experts to obtain consensus and support for required changes or enhancements.
• Translate customer business needs into requirements to support their online strategy.
• Provided analytical solution to the customers for Facets Production Issues.
• Worked on migration project from legacy to Cloud system - acted as liaison between business and IT to ensure all application and tool migration needs are met
• Provided operational support between the customer and internal team during the migration process managing RAID and regular update to the stakeholder with the work status
• Possess leadership in the projects at the both client and implementation partner stands point - present before the Sr. leadership on project outcome, dashboard updates organizing , scheduling and attending PM-BA forum to discuss on the ongoing projects, interdependencies, learning scope and to do's preparing webinar Inhouse to arrange group learning with knowledge sharing platform.
• Schedule and moderate the bi-weekly conference calls for the consultants with the implementation partner Sr. Leadership to report of project status working hours, new resource requirement opportunity follow up with new resources on project assignment from the Program Manager/Program Director's office
• Competent in creating workflows, Business Process Modeling BPM , process improvements and facilitating process engagements document business processes using visio and company in-house tools walk through the BPM in the meeting or conference calls to ensure everyone on the same page and do needful update from the feedback
• Initiated to archiving so far created business processes on worksite for interdependency project work and new resources education program
• Processes and understanding Six Sigma methods for maximum quality improvement
• Performed data analysis, and data and software conversions, and led multiple system implementations.
• Worked on Data migration, Facets version upgrades, Reports Implementation, letters, Inbound/outbound Interfaces and Facets Extensions. Implemented EDI transactions 835, 270/271, 276/277 and 834.
• Experience with EDI transactions such as EDI 834 Benefit Enrollment and Maintenance , 277/275 Health Care Claim Request for Additional Information and Response , 276/277 Health Care Claim Status Request and Response , 835 Health Care Claim Payment/Advice , 837P Health Care Claim: Professional , ICD9, CPT and NDC Codes.
• Excellent knowledge of Medicare Part A, B, C and D and Medicaid Health Insurance Policies and reimbursement forms.
• Experienced in various Healthcare areas like Enrollment, Benefits, Claims, Medicare, and implementation of HIPAA key EDI ANSI X12 transactions.
• Dealt with the complexity of migrating from the ICD-9 set of diagnostic codes to ICD-10.
• Experienced in complete AGILE, RUP, SDLC, Client /server architecture providing a well-balanced understanding of business relationships, business requirements, worked for financial and technical solutions and help the team at all levels until final product release.
• Experienced in writing and preparing business requirements documents BRDs , system requirements specifications SRS , system design specification SDS , functional specifications, defining project plan and change request.
• Extensive experience in Requirement analysis, Business Modeling, defining business processes, sequence diagram, activity diagram, and Use Case using UML methodology.
• Strong HIPAA EDI 4010 and 5010 with ICD-9 and ICD-10, analysis compliance experience from, payers, providers and exchanges perspective, with primary focus on Coordination of benefits
• Assist the Project Manager in the development of SDLC methodology and documentation strategy and act on behalf of the Project Manager during the PMs Absence.
• Facilitated UAT with stakeholders and business users
• Excellent analytical skills for understanding the business requirements, business rules, business process and detailed design of the application Knowledge of SQL and experience of writing SQL commands.

Skills/Tools

• Requirement Management RequisitePro, Doors
• UML Tools MS Visio,
• Other Tools Putty, TOAD, FTPZilla, Notepad , MS Office,
• Testing Tools WorkSite, Quality Center, ClearQuest, QTP
• Database Oracle, SQL
• Skills Analytical, problem solving, leadership, organized,
• Communication, documentation and reporting

Project Experience:

Confidential

Business System Analyst

Responsibilities:

• Participated in company's largest team responsible for ACA implementation under Govt. Mandates Program including ICD 10 migration and Chapter 224 -Payment reform
• Worked on migration claim processing system to NetworX Price system as per tech modernization project
• Created cost benefit analsis document for migration from legacy system to NetworX system
• Worked alongside the Moveable Online Project Management team for defined projects, ensuring that project deliverables meet business requirements and specifications.
• Assisted Project Manager in the development of business cases, RFI's and RFP's.
• Built and maintained effective relationships with business and technology partners, subject matter experts to obtain consensus and support for required changes or enhancements.
• Translate customer business needs into requirements to support their online strategy.
• Facilitated meeting with SMEs' and stakeholders to produce, design, packaging, implementation and rating SMEs' feedback and performance
• Worked in testing the professional, institutional claims processing and adjudication and validate data with facets.
• Worked with the business/functional unit to assist in the development, documentation, and analysis of functional and technical requirements within FACETS.
• Provided analytical solution to the customers for Facets Production Issues.
• Conducted work breakdown meeting to identify milestone, deliverables and anniversary date
• Created and shared calendar-timeline on the basis of committed dates for delivery from work effort owners
• Created functional design document for web based application FAD - Find A Doctor with details of each requirement i.e. priority, source, cost/benefit high level or narrative , possible implications and dependencies
• Wireframes or screen/webpage mock-ups
• Used MS Excel Pivot Tables for data analysis and reporting for status update and presentation
• Created Use Case, Prototypes for web application how it will be used routes through a business process that are also useful as a basis for test cases.
• Worked on and tested Interface/API functions Screen, Window, Webpage technical process flow - menu structuring and route from screen to screen
• Played as documents owner in the JAD session to answer on the questions on requirement, dependency, project current status, potential risk, assumptions, decision taken and so on
• Escalated issues to SMEs', Sr leaderships, managers, to ensure correct message is conveyed and communication is flawless
• Completed given tasks on time and followed up with other responsible parties and folks for smooth workstream
• Worked on migration project from legacy to Cloud system to Office 365 - acted as liaison between business and IT to ensure all application and tool migration needs are met provided operational support between the customer and internal team during the migration process managing RAID and regular update to the stakeholder with the work status
• Coordinated closely with other project BA's for updating Dashboard and present to the program level meeting and give update to the team of 50 including business leads, project sponsors, program director
• Worked closely with Program Manager, Project Manager in assigning or referring BA's to fill in position and support them in understanding project works
• Participate in assigning projects by using the performance log and skill matrix created by the PMO resource personnel - scheduling and moderate PM-BA forum
• Initiated and lead the work group in archiving the BPM - processes company created or currently being created for WIP project for resources to share and reference
• Competent in creating workflows, BPM, process improvements and facilitating process engagements document business processes using visco and company in-house tools walk through the BPM in the meeting or conference calls to ensure everyone on the same page and do needful update from the feedback
• Initiated to archiving so far created business processes on worksite for interdependency project work and new resources education program
• Worked with a cross functional and diverse team of business users and developers - onsite and offsite to enable accurate communication of requirements and ensure consensus through IM, group meeting conference calls, webinar and email using ppt deck.
• Assisted in Regression Test, System Test, and UAT testing and maintain log for the business team and update in the weekly status meeting or bi-weekly program team meeting
• Analyzed data and created reports using SQL queries for all issued Action Items. Performed the Gap Analysis to find the gap between AS IS and TO BE and suggest Project Manager and Senior Leadership on to do.
• Developed Data Mapping and Crosswalk documents.
• Performed Impact analysis for readiness of Go Live preparation and schedule meeting inviting key resources and dependencies.
• Prepared Business Requirement Document BRD for Multi-State Plan, Native American, MAss Banker's body-mind program, Wellness and Fitness benefit projects
• Tested claim process using the NPI and courtesy Taxonomy number using status non-Participating and Participating and also using the assigned Taxonomy number - to ensure system waive cost share when Native American members get services through Indian Health Service - IHS providers
• Participated and assisted ICD 10 conversion team on adhoc basis and also as focused group on surveying
• Performed Gap Analysis for HIPAA 4010 837P and 835 transactions and HIPAA 5010 837P and 835 transactions.
• Involved in impact analysis of HIPAA 5010 835 and 837P transaction sets on different systems.
• Re-engineering and capturing of EDI transactions with legacy systems Enrollment -834, Eligibility Transaction 270/271 , Claims 837 , Claim Status Request and Response 276/277 , Remittance 835 .
• Worked in testing the professional, institutional claims processing and adjudication and validate data with facets.
• Worked with the business/functional unit to assist in the development, documentation, and analysis of functional and technical requirements within FACETS.

Environment: WorkSite, MS Visio, MS Office, HP Quality Center, Toad for Oracle, Team Track, AGILE methodology, DB2, Facets, Java, AltovaMApForce, MS Excel PIVOT , Radiant

Confidential

Business System Analyst

Responsibilities:

• Perform various Operations for Different Health Plan needs within the Macess Application Established new Medicare groups in Facets Group Application GRGR and linked these Groups to its Subgroup SGSG , Class/Plan CSPI and Product PDDS .
• Develop, coordinate and support Information Technology Division on all operational requirements of FACETS claims processing system and production management.
• Worked on migration claim processing system to NetworX Price system as per tech modernization project
• Created cost benefit analsis document for migration from legacy system to NetworX system
• Involved in developing database objects using FACETS database in both SQL Server and Sybase environments.
• Worked alongside the Moveable Online Project Management team for defined projects, ensuring that project deliverables meet business requirements and specifications.
• Assisted Project Manager in the development of business cases, RFI's and RFP's.
• Built and maintained effective relationships with business and technology partners, subject matter experts to obtain consensus and support for required changes or enhancements.
• Translate customer business needs into requirements to support their online strategy.
• Provided operational support between the customer and internal team during the migration process managing RAID and regular update to the stakeholder with the work status
• Worked closely with business and IT folks along with SME's to amend, create, and updating process flow charts from AS IS to TO BE system.
• Used MS Excel Pivot Tables for data analysis and reporting for status update and presentation
• Worked with a cross functional and diverse team of business users and developers to enable accurate communication of requirements and ensure consensus.
• Updating and maintaining RAID - Risk, Assumptions, Issues and Decision log and assist Project Manager in overall project work efforts.
• Worked on migration project from legacy to Cloud system to Office 365 - acted as liaison between business and IT to ensure all application and tool migration needs are met
• Wireframes or screen/webpage mock-ups
• Created Use Case, Prototypes for web application how it will be used routes through a business process that are also useful as a basis for test cases.
• Worked on and tested Interface/API functions Screen, Window, Webpage technical process flow - menu structuring and route from screen to screen
• Create process flow and walk team through on the conference call/meeting and get signed off by the product owner
• Finding and documenting GAPs between legacy system vs new system and communicate with the business and IT
• Escalated issues to SMEs', Sr leaderships, managers, to ensure correct message is conveyed and communication is flawless
• Created UML, Business Process Modeling BPM , to interpret business processes for project work and also to present to the senior leadership while discussing on the project
• Worked on the initiative to the cloud migration project
• Analyzed data and created reports using SQL queries for all issued Action Items. Performed the Gap Analysis to find the existing gap between the HIPAA 4010 and HIPAA 5010 EDI transactions.
• Developed Data Mapping and Crosswalk documents.
• Involved in preparing several Use Cases, BPM, Business Process Flows, and Activity Diagrams using Microsoft Visio.
• Conducted PM-BA forum on bi-weekly basis for open discussion on project works and interdependencies
• Wrote Test scenarios and test cases for testing the migration of EDI 4010 to 5010 and the processing of member enrollment and benefits, batch jobs corresponding to the claims 837 and real time transactions like 270/271/276/277.
• Worked in testing the professional, institutional claims processing and adjudication and validate data with facets.
• Assisted in Regression Test, System Test, and UAT.

Environment: Microsoft SharePoint, MS Visio, MS Office, HP Quality Center, Toad for Oracle, Team Track, MMIS, CMS, AGILE methodology, DB2, Facets, Java, AltovaMApForce, MS Excel, MS Power Point, Radiant CMS

Confidential

Business Analyst

Responsibilities:

• Conducted JAD sessions with Subject Matter Experts SME's .
• Incorporated Rational Unified Process RUP and analyzed User Business Requirement Document BRD , Technical Requirement Specification and Functional Requirement Specification FRS using Requisite Pro, Rational Rose and MS Visio.
• Did Presentations making Stakeholders understand how the changes would affect different modules w.r.t. Medicare and Medicaid
• Revised HCFA-1500 and MCS-1500 forms with stakeholders.
• Designed and developed Use Cases, Activity Diagrams and Sequence Diagrams using UML.
• Documented, organized and tracked the requirements using Rational Requisite Pro.
• Worked with Source system Subject Matter Experts SMEs to ensure that the extracts are properly mapped. Used SQL for data mapping and querying.
• Tracked and maintained Stakeholder requested enhancements and changes using Requirement Traceability Matrix RTM .
• Integrated Requisite Pro with Rational Rose to provide all teams visibility and maintain tractability among requirements, use cases and change requests.
• Assisted in writing test case scenarios for unit testing, integration testing and compliance testing.
• Assisted with user testing of systems and maintained quality procedures and ensured appropriate documentation is in place.
• Assist end users and IT staff in the use of data to satisfy informational and reporting requirements and implementing and using SQL and DBMS.

Environment: Facets , Oracle, MS Project, MS Office suite, SQL, SQL Server, Rational Suite, Citrix, MS SharePoint.

Confidential

Business Analyst

Responsibilities:

• Conducted JAD sessions with Subject Matter Experts SME's .
• Incorporated Rational Unified Process RUP and analyzed User Business Requirement Document BRD , Technical Requirement Specification and Functional Requirement Specification FRS using Requisite Pro, Rational Rose and MS Visio.
• Did Presentations making Stakeholders understand how the changes would affect different modules w.r.t. Medicare and Medicaid
• Revised HCFA-1500 and MCS-1500 forms with stakeholders.
• Designed and developed Use Cases, Activity Diagrams and Sequence Diagrams using UML.
• Documented, organized and tracked the requirements using Rational Requisite Pro.
• Worked with Source system Subject Matter Experts SMEs to ensure that the extracts are properly mapped. Used SQL for data mapping and querying.
• Tracked and maintained Stakeholder requested enhancements and changes using Requirement Traceability Matrix RTM .
• Integrated Requisite Pro with Rational Rose to provide all teams visibility and maintain tractability among requirements, use cases and change requests.
• Assisted in writing test case scenarios for unit testing, integration testing and compliance testing.
• Assisted with user testing of systems and maintained quality procedures and ensured appropriate documentation is in place.
• Assist end users and IT staff in the use of data to satisfy informational and reporting requirements and implementing and using SQL and DBMS.

Environment:

Facets , Oracle, MS Project, MS Office suite, SQL, SQL Server, Rational Suite, Citrix, MS SharePoint.

Confidential

Business Analyst/QA Tester

Responsibilities

• Gathered analyzed, documented business and technical requirements from both formal and informal sessions and validate the needs of the business stakeholders.
• Performed Data mapping on the extracted data, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data.
• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Health Insurance Claims. Worked on HIPAA Standard/EDI standard transactions: 270, 271, 276, 277, 278, 834, 835 to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.

• Involved in preparing Test Plan and Test Cases based on business requirements.
• Wrote Test Cases based on Technical Specifications, Functional Specifications and Business rules for online application system.
• Authored Test cases for HIPAA EDI Transactions 270/271, 276/277,837/835.
• Executed Test cases manually by composing 270, 276,837 EDI files and dropped inbound and check response 271,277,835 using interleaves and outbound
• Tested HIPAA Transactions and Code Sets Standards according to the test scenarios such as 270/271, 276/277,837/835 transactions.
• Designed and developed Use Cases and Use Case scenarios, Activity Diagrams, Sequence Diagrams, High Level and Low Level Process Flow Diagrams, OOAD using UML and Business Process Modeling.
• Responsible for creating test case scenarios, creating test data plan and writing test scripts for the UAT using testing tool and defect management for Policy Management Systems, Payables/Receivables and Claims processing.
• Conducted surveys, interviews, and JRP, JAR and JAD sessions and translated them into system Requirements. Suggested measures and recommendations to improve the current application performance of the system.
• Responsible for preparing Business Requirement Document BRD , Functional Requirement Document FRD and then translating into functional specifications and test plans. Closely coordinated with both business users and developers for arriving at a mutually acceptable solution.
• Performed Gap Analysis in every phase and stages to check the compatibility of the existing system infrastructure with the new business requirements.
• Provided highly complex analytical support through the analysis and interpretation of data in support of cross-functional business operations.
• Developed budget tools and templates, and prepared and analyzed highly complex financial and budget reports for management review.

Environment:

RUP, COBOL, CICS, Citrix, DB2, MS Excel, MS Word, MS Access, MS Project, MS Visio.

Confidential

Jr. Business Analyst

Responsibilities:

• Elicited requirements from the stakeholders using various requirement gathering techniques such as: end-user interviews, job shadowing, questionnaires, etc.
• Created As-Is and To-Be process maps and conducted a gap analysis.
• Created business requirement documents based on high level requirements, and producer manuals.
• Conducted JAD sessions to allow different stakeholders to communicate their perspectives with each other, resolve any issues and come to an agreement quickly and ascertain that requirements were feasible.
• Led business analysts and testers during the development and execution of test cases, verifying test results and documented defects.
• Developed test plans, test conditions, and test cases from business/functional/technical requirements.
• Developed Excel formulas for testing and verification of insurance premiums, forward/backward traceability of functional requirements to test scenarios/test cases.
• Trained testers to create test cases and manually calculated insurance premiums by using specifications and insurance rules.
• Used VISIO to draw the diagrams required in the development efforts.
• Participated in conference calls to figure out the scope and the needs of the business requirements.
• Created UI Documents as supporting documents for the Business Requirements Documents.
• Involved in Data Flow/Business Process Diagrams to illustrate the flow, input and output of data.
• Developed a Test Plan for testing the application after reviewing requirement specification document.
• Involved in Business Process Management BPM activities like Process Design, Process Monitoring and Process Execution
• Effectively and timely completed client project which met and exceeded client expectations
• Prepared workflow charts and diagrams to specify in detail operations to be performed by equipment and computer programs and operations to be preferred.

Environment:

JIRA, MS Excel/Word/FrontPage, Agile SCRUM , Lotus Notes, Cisco VPN client, Citrix ICA client, Microsoft SQL Server, Windows.