- Over 7 years of experience working as a Business Analyst in Healthcare sector, with excellent communication and interpersonal skills to gather information required, documenting various business processes, interacting with developers, stakeholders and other team members and coordinating the projects Ability to use oral and written communication skills to express ideas effectively and persuasively with all organizational stakeholders.
- Excellent knowledge of HIPAA Health Insurance Portability and Accountability Act transaction codes such as 270/271 inquire/response health care benefits , 276/277 claim status , 470 benefit codes , 835 payment or remittance advice , 837 health care claim and 834 benefit enrollment .
- FACETS experience, knowledge of medical coding and billing, ICD-10-CM, ICD-10-PCS, HL-7, HIPAA 4010/5010 initiatives and regulatory compliance framework.
- Solid understanding of all phases of Software Development Life Cycle SDLC methodology such as requirement, analysis, design, data modeling, business process modeling, implementation and deployment
- Knowledge of EMR/EHR, Patient Protection and Affordable Care Act PPACA .
- Experience working in Medicare and Medicaid projects.
- Experience in conducting SWOT Analysis, GAP analysis, Cost Benefit and ROI Analysis.
- Broad knowledge of Test plans, Test Cases and Test Scripts from the Requirements Document.
- In-depth knowledge of Rational Unified Process RUP risk engineering, data modeling and mapping, and design using UML Unified Modeling Language , Rational Rose and Visio.
- Excellent Client Interfacing Skills. Ability to interface with business owners in other to understand current processes, business issues and data challenges of client's organization.
- Extensive experience in conducting Joint Application Development JAD sessions for project definition involving analyzing requirements, creating prototypes, user interface, database schema and system design.
- Experience reviewing existing Organizational Process Assets.
- Familiar with test automation tools such as HP QuickTest Professional and HP Quality Center QC .
- Experience in writing Use cases and Functional Requirement Document.
- Knowledge of Sarbanes Oxley Act, Six Sigma, Capability Maturity Model Integration CMMI standard and Project Management Body of Knowledge PMBOK .
- Created Requirements Traceability Matrix to keep the stakeholders informed of the progress of the project.
- Strong expertise in Health Insurance Claim process, social services, Medicaid and banking.
- Good knowledge of Oracle, SQL, Business Objects, Report Scripting and Data Modeling/Warehousing.
- Participated in project planning activities including defining detailed project tasks.
- Conducted project administrative tasks, such as work plan administration, time and expense tracking, and project schedule maintenance
- Ability to make effective management decisions that exhibit high ethical standards ethics within the working environment.
- Ability to manage the effective use of technology in an organization to achieve superior performance and operational effectiveness.
- Exceptional problem solving and sound decision making capabilities.
- Experience in writing queries/scripts for data analysis ad QA report testing.
- Conducted successful projects with the help of teams to achieve deadlines timely and proficiently.
- Experience in User Acceptance Testing, Smoke Testing, Regression Testing Performance Testing and Functional Testing.
- In-depth experience in financial analysis, financial modeling, Research, Accounting, and good knowledge of Assets, Liabilities, Equities, Fixed Income and Taxation.
- Extensive experience in gathering Business/Functional user requirements, creating Use Cases as per user requirements, developing/designing diagrams such as Activity, Class, and or Sequence diagrams, and in addition to creating Business Requirements Document BRD .
MS-DOS, OS/2, Windows 3.x Windows
MS Office Suite Microsoft Visio, Microsoft Project, Microsoft Outlook, Microsoft Access, Microsoft Excel and Microsoft PowerPoint
Aldon Affiniti and IBM Rational ClearCase
Business Modeling Tools
MS Visio, Rational Rose MS Project.
HP QuickTest Professional, Quality Center
MS SQL, MS Access, Oracle
SQL, Visual Basic
SDLC, RUP, UML, CMM
- Used the Rational Unified Process RUP to build the different phases of Software Development Life Cycle SDLC .
- Prepared the Functional Specification Document FSD and Software Requirement Specifications SRS as per SEI-CMM standards.
- Conducted the JAD Sessions with stakeholders and developers to have a clear picture of a project.
- Conducted interviews with key stakeholders to analyze existing data and gather requirements.
- Used UML to create use case diagrams, sequence diagrams and activity diagrams.
- Worked on improvement of Claims Reimbursement User Interface for a better experience and incorporate changes as per HIPAA 4010/5010 guidelines using the gap analysis.
- Developed flowchart and process diagram using MS Visio.
- Wrote SQL scripts for creating performance evaluation reports
- Clarified QA team issues and reviewed test plans and test scripts developed by development team and QA team to make sure all requirements have been covered in scripts and tested properly.
- Performed Backend testing by using PL/SQL queries to test the integrity of the application Was in regular contact with Business partners on the status of issues, action plans and timeframe for resolution throughout the development cycle.
- Identified bugs during the test phase and reported them using HP Quality Center.
- Maintained Traceability Matrix throughout the project.
- Developed Test Cases and Test Plans on the basis of requirements and also did manual testing of the functionality of the application to ensure that the application is able to handle a lot of data
Environment: Rational Unified Process RUP , SQL, MS Visio, MS Project, MS Office, UML, Windows XP, Rational TestManager.
- Was responsible for understanding the business logic and assisted other business analysts in generating Functional Requirement specifications FRS and User Requirements Specifications URS .
- Developed use cases, workflow, screen mock-ups and conversion requirements.
- Coordinated work plans between project manager and client using MS Project.
- Helped in reviewing and editing of the test scripts.
- Followed UML based methods using Rational Rose to develop use cases and activity diagrams assisted developers in creating sequence diagrams and collaboration diagrams.
- Reviewed business process, URS, and functional requirements.
- Assisted in process modeling conducted and participated in JAD sessions with system users helped with design walkthroughs with stakeholders for base lining architecture.
- Created and tested scripts for the premium calculations and claim limits and deductible.
- Involved in detailing project mission, data process flow diagrams, and timelines.
- Developed Test plans and Test cases according to business requirements with the help of Mercury Test Director.
- Used Rational ClearQuest for handling change requests.
- Participated in automated regression and Non-functional test plans.
- Provided assistance in building EDI's 270, 271, 276, 277, 470, 835, 837 and 834 transactions.
- Maintained Requirement Traceability matrix throughout the project.
Environment: Rational Requisite Pro, Rational ClearQuest, MS Office, Visio, MS Visio, MS Project, Windows XP, UML, SQL.
- Assessed the requirements, audience, and organizational process assets to determine the level of formality appropriate for business analysis communication
- Implemented the SDLC for the developing life cycle and followed the standards process in the application.
- Translated business requirements into functional requirements and approaches for developers.
- Provided management support to the off-shore End to End integration/ Regression Test Team.
- Workflow documentation and comprehensive training to the healthcare clients.
- Analyzed corporate healthcare business processes to develop customized solutions.
- Worked with Medicare operational management to monitor trends and report on operational metrics such as timeliness, workload, and staff trending, customer satisfaction, and other key measures to facilitate performance excellence.
- Interacted with healthcare clients to gather requirements, objectives, and input and output requirements.
- Developed test cases and scripts for front end testing.
- Performed execution of test cases manually to verify expected results.
- Ensured the accuracy and consistency of the data during the data loading process.
- Developed Use Case, Class and Deployment diagrams using Rational Rose.
- Responsible for architecting integrated HIPAA, Medicare solutions, Facets.
- Was involved in managing the Daily Standup meetings and also ensured that quality standards were enforced as per the build-release schedule.
- Developed a detailed test plan and test cases to cover all the requirements.
- Used rational Rose to create UML diagrams such as use case, activity, sequence, class and component diagrams.
- Developed Flowchart and process diagram using Microsoft Visio.
- Analyzed data architecture, documented and delivered data mapping, performed risk analysis.
- Frequently communicated with developers to resolve technical issues.
Environment: SQL, Test Director, MS Office, UML, Rational Rose, Windows XP. MS Visio, MS Project. Rational Test Manager, Requirement Traceability Matrix RTM .
Business Systems Analyst
- Developed Use Cases, Activity Diagrams and Sequence Diagrams for a clear understanding of the vision document.
- Designed Test Plans and Test Cases for User Acceptance testing UAT with the help of QA teams.
- Conducted Joint Application Development JAD sessions with stakeholders throughout SDLC to resolve open issues.
- Wrote SQL Queries in MS Access to sort data and analyze the large set of data during project life cycle.
- Prepared Business process models used Visio to create use case diagrams.
- Utilized RUP to configure and develop process, standards and procedures.
- Interfaced with business users to prepare and update Business Process Requirements for the new release of Healthcare tools.
- Prioritized outstanding defects and systems problems, ensuring accuracy and deadlines were met.
- Worked with the management for improving and giving new ideas for designing future processes of the HIPAA transactions dealing out with EDI'S 271, 276 and 270, 470, 835, 837, 834, HIPAA 4010 claim adjustments, claim processing from point of entry to finalizing, claim review, identifying claims processing problems, their source and providing alternative solutions using best practice model and principles and also well versed with ICD10, FACETS.
- In depth knowledge of Medicare/Medicaid Claims processes from Admin/Provider/Payer side which were later part of the training program to vendors.
- Performed GAP analysis of business rules, business and system flows, user administration and requirements.
- Tracked and maintained Stakeholder requested enhancements and changes using Requirement Traceability Matrix RTM .
- Used the Rational Unified Process RUP to develop the different phases of Software Development Life Cycle SDLC .
- Designed mockup and wireframes to communicate visual data flow to the end users.
- Conducted Risk Engineering to derive and execute action plans on time.
- Used Rational Clear Quest for defects and bug testing.
- Recommended corrective actions, if necessary, along with the progress against Development/Action Plan routinely to the Project Manager.
- Administered and coordinated User Acceptance Testing and obtain final system acceptance sign-off with the help of Program Manager.
Environment: MS Visio, MS Project, Ms Office, User Acceptance Testing UAT , Rational Unified Process RUP , Rational Clear Quest, Joint Application Development JAD , MS Access,