- 7 years of experience as a Business Systems Analyst. Working in the Healthcare and Retail industries.
- Strong understanding of various SDLC methodologies such as RUP, Waterfall and Agile with hands on experience in all of them.
- Proficient in Requirement Management, including gathering, analyzing, detailing and tracking requirements.
- Experienced in documenting requirement using Unified Modeling Language Use Case and Activity Diagrams also building business Process Flow, Context Diagrams, Sequence Diagram using tools such as Visio and Rose to make users and developers understand the system.
- Good knowledge in healthcare insurance domain including Medicare and Medicaid. Profound understanding of insurance policies like HMO and PPO and proven experience with HIPPA X12 EDI transaction codes such as 270/271 inquire/response health care benefits , 276/277 Claim status , 834 Benefit enrollment , 835 Payment/remittance advice , 837 Health care claim .
- Experience and strong understanding of HIPPA 4010-5010, ICD- 9 ICD-10, Claims Processing, Dual Processing of claims, Medical management information system MMIS , Claim Adjudication, Memberships and other standards.
- Hands-on experience in creating UML Diagrams including Use case Diagrams, Context Diagrams, Activity Diagrams, Software Requirements Specifications Documentation, and Scope Documents.
- Experience in writing requirements and specification like Business Requirements Document BRD , USE Case Realization Document, Functional Requirements Specifications, Systems Design Specification SDS , Systems Requirements Specification SRS , Data Dictionary, Business Continuity Plan BCP , Requirements Traceability Matrix RTM Defect Traceability Matrix DTM , throwaway prototypes, Knowledge Transfer manuals, User Guides, Release Notes, Training Material.
- Expertise in performing GAP Analysis, Impact Analysis and Risk Assessment in several projects.
- Strong experience in the creation of Test Plan and Test Cases from the Requirements document. Documentation of the Test Plans, Test Cases, Test Scripts, Test Procedures based on the Design Document and User Requirement Document for the Unit, Integration, Regression, Functional, Performance, and User Acceptance Testing UAT using HP ALM, Rational Test Manager and Mercury's Test Director.
- Experience in Defect management.
- Excellent communication skills and adept at facilitating walkthrough and training sessions.
Sr. Business Systems Analyst
- Analysis on the Business requirement document BRD structure as well as focusing on the completeness and clarity of the requirements.
- BRD analysis was classified into three categories- not applicable for enterprise testing, ready for scenario development and additional information needed to complete the development of testing scenarios.
- Review and analysis of BRD involved in a number of artifacts which will continue to be a working document to record the progress and traceability of test preparation, testability analysis report and detailed business requirement analysis checklist.
- Involved in Functional Area Analysis to report the overall status of projects. It reports the key summary data as well as the current status of open question and missing information for each project. It enabled QA to review status of projects based on a number of criteria such as Impacted Area, Open Questions, Information required and Functional area.
- Perform a baseline assessment and related interfaces, the existing service level agreements and/or policies and operational business procedures for readiness to comply with HIPAA as well as ICD-10 requirements.
- Have strong experience in requirements gathering by conducting interviews with end users.
- Actively worked on Data analysis and Report analysis with respect to ICD-10 impact.
- Identified risks, problems, requirements and concerns to comply with ICD-10 changes.
- Highly involved in understanding of department workflows and process flows with respect to applications
- Collected the information related to ongoing application upgrade and their impact on ICD-10 implementation and created awareness within the departments regarding the need, impact, benefits and risks of ICD-10 code application.
- Re-Organized the collected data and prepared documentation for implementation.
- Performed impact analysis on applications for deadliness of ICD-10 conversion.
- Worked on Medicare Advantage A, B, C , Medicare Part D MA-PD , Medicaid Options Under 65 and Over 65 and Managed Care Care, Disease and Case Management and also in Insurance regulations and Claims Processing and claim scrubbing in HMO, PPO, Medicare and Medicaid.
- Key finding concerning the business requirements and supporting artifacts analysis were categorized into the following areas: QA status, Testing complexity and Area of impact.
- Used Rational Clear Quest for defect tracking and change management request and reported them. Responsible for writing UAT test plan, scripting the test cases and performing UAT.
- Key impacts documented in the analysis focused on the financial integrity, benefit neutrality and operational stability.
- Coordinated and conducted system requirements sessions JADs with business Owner/stakeholders/SMEs as well as design/development teams. Worked with business area SMEs/analysts to develop and finalize test plans/scripts/use cases. Analysis of key business requirements and assisted in the development of Business Requirement BRS , Functional Requirement FRS and System Requirement Specification SRS .
- Met the deadlines and scheduled day to day meeting sessions.
Environment: Java, J2EE, MS Word, Excel, PowerPoint, SharePoint, Visio, HP ALM, UAT, ETL, SQL, UML.
Sr. Business Systems Analyst
- Analyze and document NE Medicaid impacted areas for ICD 10 codes sets.
- Analyze impacted HIPAA Transactions for process changes with ICD 10 implementation.
- Identify and document changes in coding definition, conventions and guidelines between ICD 9 and ICD 10
- Analyze 4010 Companion Guides and define NE Medicaid HIPAA 5010 Companion Guide Approach and Design.
- Responsible for documenting As-Is and To Be systems.
- Analyze and document HIPAA Trading Partner Application changes for HIPAA 5010 Implementation.
- Gather Business Requirements for HIPAA Trading Partner Application.
- Responsible for attaining HIPAA EDI validation from Medicare, Medicaid and other payers of government carriers. Developed Requirements Traceability Matrix RTM using Rational Rose to trace each software requirement to test case.
- Designed the business requirement collection approach based on the project scope and SDLC Methodology.
- Conducted requirement gathering sessions for MMIS Mainframe Claim processing screens.
- Followed the Business Rules, and ensured that HIPAA compliant Rules are followed to display minimum benefit information that the Provider is required to pass on the EDI transactions.
- Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims.
- Worked on EDI transactions: 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.
- Gathered requirements for 277CA Claims Acknowledgement which is new for 5010
- Worked on requirements gathering for 997 and 999 acknowledgements.
- Responsible for scripting HIPAA 5010 Implementation changes.
- Interacted with Business analysts and developers for the requirement clarification.
- Worked as an Interface between the users and the different teams involved in the application development for the better understanding of the business and IT processes
- Managed the privacy and security environments of healthcare data that was governed by HIPAA and other government mandates.
- Responsible for developing and Executing Test Scripts for HIPAA Trading Partner Application.
- Conduct User Training for 5010 changes for Trading Partner Application.
- Responsible for Performing External Trading Partner Testing.
Environment: Data stage, Microsoft Windows Server system, Quality Center, Visual studio, ASP. Net, Web services MS-Project, MS-Visio, and Windows 7, Power Builder 12, UltaEdit-32 Professional, IBM Mainframe, SQL, Oracle 9i, File Viewer, MS Office 2007, MS Visio.
Business System Analyst
- Actively involved in building training material and planning material for 4010 - 5010. Defined communication plans and build a project budget for the transition.
- Gained a clear understanding of the claims adjudication and reimbursement systems based on HIPAA X12 5010 standards.
- Worked with Facets Team for HIPAA Claims Validation and Verification Process Pre-Adjudication and assisted in version upgrade and impact analysis on data warehouse tables.
- Assisted in EDI transactions of medical claims 837 /underwriting for support and point of reference for the providers in business issues.
- Extensive use of FACETS backend tables and front end application system for data validation purposes.
- Produced transaction sets 835 and 837, complete gap analysis 4010 - 5010 against the document application 5010 enhancements ensuring the upgraded application included the required changes and additions for 5010 compliance.
- Involved in the upgrading process of 4010 transactions to 5010 by conducting impact analysis and risk assessment and worked on the mitigation plan to avoid the risks.
- Gathered analyzed, documented business and technical requirements and prepared both the non-functional and functional requirement documents and validated the needs of the business stakeholders.
- Performed extensive Gap Analysis in order to understand and to identify AS-IS processes of claims transactions of 4010/4010A standard and TO-BE processes of 5010 standard.
- Worked closely with the product owner and SMEs and developed the product backlog and prioritized the user stories and assigned them to different sprints.
- Managed task board with user stories. Facilitated daily stand-ups meeting for timely delivery of the projects and generated burn down and velocity charts.
- Designed and defined User Interface Requirements and visual patterns and incorporated the UML methodologies to design and develop system requirement into Wireframes with Visio and Mockup Screens.
- Developed business flow diagrams, activity diagrams, and interaction diagrams so that the development team and other stakeholders could understand the business process clearly.
- Conducted Claims and HIPAA Compliance Training in order to run the test cases.
- Helped requirement documentation for Data Extraction, Data Transformation, and Loading processes as a part of data mapping procedures.
- Interacted with the QA team to performed Unit and Integration Testing for multiple transactions and implemented Alpha Test in order to confirm the functionality of recent conversion.
Business Analyst Consultant
- Actively involved in requirement gathering and requirement management. Analyzed requirement, assigned attributes and segregated them into high level and low level use cases using Rational Requisite Pro
- Conducted JAD sessions with different stakeholders and development team as and when necessary to elicit use cases
- Developed requirement traceability matrix and attribute traceability matrix to manage changing requirements
- Created full life cycle documentation from product requirements in the developmental stage to functional specifications for the completed modules of application components
- Created Use-Cases, Wireframes and State Diagrams to demonstrate software architecture and interaction of system components before prototyping. Used Rational Rose, Requisite-Pro for requirement traceability
- Designed Wireframes which allowed development of variations of a layout to maintain design consistency throughout the E-Commerce site
- Carefully analyzed vision document and devised detailed interview plan and guidelines for the interview process
- Interviewed the domain experts and carefully recorded the requirements in the format that can be reviewed and understood by both business people and technical people
- Assisted in documenting various business related texts
- Helped in designing workflow diagrams with the help of UML
- Prepared documents to conduct professional meetings for the client and team members
- Participated in enhancement meetings to make the product more effective in real time. Worked with developers and QAs to clarify
- Extensively used brainstorming sessions to generate ideas
Environment: Agile, Wire-framing, Windows XP, UML, SQL, Rational Tools, MS Visio, MS Word, Excel, PowerPoint, Access.
- Interacted with stakeholders and gathered requirements as per the business needs.
- Implemented RUP methodology for iterative and incremental development of the system.
- I was involved in the planning of the RUP iterations and documenting of the artifacts throughout the various phases of the development process.
- Conducted GAP analysis by understanding the AS-IS system and the TO-BE system requirements by having discussions with the SME's.
- Compiled the Vision Document and composed detailed Use Case Specification Documents in Rational Requisite Pro.
- Used UML to perform Use-Case analysis to capture the dynamic aspect of the application.
- Ensured the accuracy and consistency of the data during the data loading process.
- Developed State Diagrams, Activity diagrams and Class Diagrams in MS Visio using UML for various modules of the project.
- Created ProcessFlow Charts, Business Requirements Documents, Functional Specification Documents.
- Worked on Required Traceability Matrix RTM in Rational Requisite Pro for traceability of requirements through test cases.
- Was involved in managing the Daily Standup meetings and also ensured that quality standards were enforced as per the build-release schedule.
- Developed Test Plan and Test cases based on the Use cases and Functional specifications and also performed manual testing of the functionality of the application by inserting varying data on different test runs.
- Developed Flowchart and process diagram using Microsoft Visio.
- Worked with Business partners on the status of issues, action plans and timeframe for resolution throughout the development cycle.
- Contributed in reviewing and editing of the test scripts.
Environment: Windows, MS Office MS Word, MS Excel, MS PowerPoint, MS Visio , MS Access, MS Project, RationalRose, Community Manager, BPML, SQL, ClearCase, RUP.
- Gathered Business Requirements, analyzed data/workflows performed GAP analysis.
- Facilitated JAD sessions for the collection of Functional Requirements from system users, and prepared Business and Technical Requirement Specification documents.
- Analyzed business and technical requirements, thus creating the Business Use Case BUC and Application Use Case AUC documents.
- Utilized RUP to configure and develop processes, standards, and procedures, and to perform System analysis.
- Assisted in Data File Definitions and Data mapping activities for the data gathered during the process of development and implementation.
- Documented approved change controls to add them into business design.
- Prepared Logical Process and Data Models that contained set of diagrams and supporting documents containing the essential business elements, detailed definitions, and descriptions of the relationships between the data elements to analyze and document Business Data Requirements..
- Developed Data Flow, Work Flow, Process Flow, and Entity Relationship Diagrams in MS Visio, and analyzed them to create AS IS and TO BE scenarios.
- Worked as an Interface between the users and the different teams involved in the application development for the better understanding of the business and IT processes.
- Maintained Project Glossary for the entire project team.
- Followed a structured approach to organize requirements into logical groupings of essential Business Processes, Business Rules, and Information Needs, thus ensuring that Critical Requirements are not missed.
- Followed the UML based methods using MS Visio to create Use Case, Activity/State Chart, Sequence, and Collaboration Diagrams.
- Participate in continuous process improvements that will result in greater efficiencies, improved customer service, increased revenue, and overall improved project performance.
- Worked with the Project Manager on various Project Management activities like Resource Planning, Resource Request, keeping track of Project Status, Deadlines, and Issues, Environment Request, and Compliance Issues.
Environment: Windows XP, UML, SQL, Rational Tools, MS Visio, MS Word, Excel, PowerPoint, Access.