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Sr. Mmis Business Analyst Resume

Nebraska, NE

SUMMARY

  • Over Seven years of experience as a Sr. Business System Analyst.
  • Solid understanding of Business Requirement gathering, Business Process flow, Business Process Modeling and Analysis, design documentation.
  • Experience in all phases of the Software Development Life Cycle (SDLC) including Requirement gathering, Design, Development, Testing and Deployment.
  • Organized Joint Application Development (JAD), workshops and interview sessions.
  • Expertise in Documentation and Review of Software and Business/Technical Requirement Documents.
  • Managed complex business initiatives to balance requirements for functionality, efficiency and quality.
  • Excellent knowledge of Health Insurance Portability and Accountability Act (HIPAA) transaction, code set rules such as EDI 837,270,271,276,277,834,835, NCPDP and ICD9 - ICD10.
  • Experienced with Rational tools like ReqPro, Clearquest, ClearCase, Rational soda, Rational Rose.
  • Experienced working in Medicare and Medicaid projects.
  • Exceptional Documentation Skills for writing Use Cases and Functional Requirement Documents.
  • 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.
  • Strong experience with MS Visio for creating visual representation of Software/Data Architecture, Use Case diagrams (specially in an Agile environment), Sequence diagrams, Class diagrams, Business Process Flows and basic flowcharts.
  • Extensive experience in configuring data mapping of files using Edifacs Specbuilder.
  • Through knowledge of various phases of Edifacs Specbuilder- Analyzer and Mapper.
  • Conducted JAD Sessions to develop an architectural solution that the application meets the business requirements, resolve open issues, and change requests.
  • Good Knowledge of Test Plan, Test Scripts and Test Cases for Functional, System, Integration, UAT, and Regression Testing based on the Design Document for the Functional, Security, and Performance Testing.
  • Excellent written and verbal communication.
  • Consistently demonstrated ability to achieve tight deadlines.

AREAS OF EXPERTISEO

perating Systems: Win 98/XP/Vista/Windows 7, UNIX, LINUX, Mac.

Languages: C, C++, Java, SQL, HTML, XML, C#, VB, ASP, .Net

Databases: Oracle, MS SQL server, MS Access

Tools: MS Office Word, Excel, Access, Power point, Project, Visio, Front Office, Rational Rose, SoDA, Software Modeler, Team Test, Doors, PROLOG, Clearcase, Clearquest, WinRunner, LoadRunner, WebSphere, Business Modeler, HP Quality Centre, Ultra Edit, TOAD and Test Director, MMIS.

Industry Standards: HIPAA 5010, ICD 10, PPACA (Patient Protection and Affordable Care Act)

PROFESSIONAL PROFILE

Confidential, State of Nebraska, NE

Sr. MMIS Business Analyst

Roles and Responsibilities

  • Gathered requirement using Interviews and JAD sessions.
  • Worked with client to gather Business/Technical Requirements, Approval of CR (Change request), Design and Implementations.
  • Gained extensive experience in designing/modifying the CICS screens for various areas such as Enrollment, Billing, Provider Record and Reimbursement Status.
  • Wrote clear, concise detailed System Requirements Specification(SRS) documents and user documentation in accordance to guidelines and standards of a level where developers can interpret, design and develop the application with minimum guidance
  • Developed business cases and provided Use Case and Activity Diagrams in MS Visio.
  • Worked on Rational Requisite Pro application to manage business and technical requirements.
  • Thorough knowledge about HIPAA EDI 835 and EDI 837 ANSI X12 transaction code sets.
  • Worked on the Business Requirements and Technical requirements for the major enhancements.
  • Prepared test data for all the Change Requests and tested the modifications.
  • Participated in ICD9 - ICD 10 Implementation.
  • Worked on the major RFP for the transactional changes required for future modifications.
  • Provided online support to users for various internal systems such as SURS, RAIS and claim submission applications.
  • Created Test cases and Test Scenario’s for Unit, Functional and Regression testing.

Environment: HP Quality Center 10.0, Caliber RM, SAP, MS Office, Windows XP, Windows Vista, MS Visio, HP SharePoint, MS Project, MS Visio, SQL, SOA Infra, XML

Confidential, State of Minnesota, MN

Sr. Business Analyst

Roles and Responsibilities

  • Responsible for designing future state processes for ICD 9-10 Crosswalk Table and drafted High Level Business Requirements for ICD 9-10 conversion mapping.
  • Worked extensively on the Procedure and Diagnosis Pricing and worked on the Reimbursement processing.
  • Gained extensive experience in designing/modifying the CICS screens for various areas such as Enrollment, Billing, Provider Record and Reimbursement Status.
  • Analyzed HIPAA 5010 related to 837 (I/P), 835, 270,271 transactions and performed gap analysis between HIPAA 4010 and 5010.
  • Wrote clear, concise detailed System Requirements Specification(SRS) documents and user documentation in accordance to guidelines and standards of a level where developers can interpret, design and develop the application with minimum guidance
  • Experience in implementation of ICD-9-CM codes and ICD-10-CM codes changes in the current claim processing system.
  • Worked on HP Quality Center 10.0 which include Defects Management, Test Plan and Dashboard.
  • Talking to the client based on requirements of that particular defect, uploading document required, checking history, status notes, setting up resources to handle and fix it.

Environment: HP Quality Center 10.0, Caliber RM, SAP, MS Office, Windows XP, Windows Vista, MS Visio, HP SharePoint, MS Project, MS Visio, SQL, SOA Infra, XML

Confidential, Rochester, NY

Requirements Analyst/ Business Systems Analyst

Roles and Responsibilities:

  • Read and analyzed the federal legislation to update the products as per the mandated provisions of HCR.
  • Interacted with senior business teams and legal firms to gather and analyze requirements.
  • Participated in various JAD sessions involving various business and technical teams.
  • Documented various Use Case scenarios, Process Flows and other diagrammatic representations in MS Visio pertaining to various provisions of HCR.
  • Performed Gap analysis for various existing product lines and operations with respect to HCR.
  • Worked extensively on all the mandated first phase of provisions of Health Care Reform.
  • Responsible for gathering and documenting Legislative, Business, Functional requirements for all the provisions and their impact on the existing products and systems.
  • Gathered and documented functional requirements pertaining to Facets and other legacy systems such as LRSP, TOPPS and MABIL.
  • Extensively used Requisite Pro and other Rational tools for Requirements Management and their traceability.
  • Gained extensive experience related to various product lines and impact on the respective products due to HCR.
  • Worked on the modification of Pricing Modeler of the various systems.
  • Gained extensive experience with medical codes and the change of benefits regarding various products.
  • Gained extensive experience regarding all phases of Requirements Management and Change Control for various projects.
  • Ensured legal compliance of the corporation in regards to the mandates of the Federal and State regulations.
  • Worked with Customer Care department to document the User Guides and Corporate Communications regarding policies and products.
  • Attended training sessions for the latest versions of existing Rational tools such as Rational Requisite Pro 7.1.1, Rational Quality Manager and Rational ClearQuest 7.1.1.
  • Analyzed the structural and operational impact of ICD-10 on the current systems.
  • Worked for Provider & Quote to Bill team for requirements gathering and documentation phase.
  • Interacted with various departments and application admin regarding the impact of ICD 10 into the system.

Environment: MS Office, Rational ReqPro, Rational Quality Manager, DB2, Rational rose, Unix, J2ee, Java, XML, Mainframes and Rational ClearQuest, ClearCase, Windows XP

Confidential, Bellevue, WA

Sr. Business Analyst

Roles and Responsibilities:

  • Aided Valuable Information’s in the collection of User Requirements and Business Requirements to create the Business Requirement Documentation (BRDs), using MS Word and MS Visio that provided appropriate scope of work for technical team to develop prototype and overall system.
  • Conducted AS-IS and TO-BE analysis and assisted in developed process models and systems integration structure.
  • Conducted and facilitated Joint Application Development (JAD) sessions to reduce time spent in moving information between stakeholders and team members.
  • Wrote test cases and test plans for the related and assigned scripts according to the test strategies defined in the project and testing team guidelines in Rational Quality Manager.
  • Identified critical areas of business risk and modified business processes to reduce risk by using the Risk-Management Process.
  • Knowledge of the complete EDI format used in electronic documentation which was part of the knowledge transfer program to the vendors as per the requirements.
  • Worked with Source system Subject Matter Expert (SME) to ensure that the extracts are properly mapped. Used SQL for data mapping and querying.
  • As part of the data mapping procedures, assisted in writing requirement document for ETL - Data Extraction, Data Analysis and Loading process of collected data.
  • Involved in various types of Audits and the Financials involved through different stages.
  • Gained Compliance audit experience due to exposure to the legal/audit consulting groups.

Environment: MS Office, Rational Quality Manager, SQL Server, MS Project, Server, MS Visio, Unix, J2ee, Java, XML, Mainframes and Rational ClearQuest, ClearCase, Windows XP

Confidential, San Francisco, CA

Business/Requirements Analyst

Roles and Responsibilities:

  • Worked with a cross functional and diverse team of business users and developers to enable accurate communication of requirements and ensure consensus.
  • Attended the training sessions provided by Confidential to make sure that I have an understanding of all the modules in QNXT for example: Members, Providers, Claims, Utilization Management, Finance, Underwriting etc.
  • Had meetings with business users and managers to understand the process what is required/to understand the AS IS process and providing them with the best solutions
  • Conducted JAD sessions with management, SMEs, developers and users for open and pending issues.
  • Worked on )
  • Was involved in the documenting the BRDs for letters to be sent out to members. Had meetings with developers and managers to make sure that letters are coming out of QNXT using SSRS. Users were able to generate letters from reporting services or letters were sent directly to folders using subscription.
  • Was involved in QA the reports/letters before user testing and was communicating with developers if correction needed.

Environment: MS word, MS excel, MS Visio, HP ALM, Waterfall, MS Access, Clarity, MS SharePoint.

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