SUMMARY:

• 7+ years of experience as Business Analyst with solid understanding Business Requirement Gathering, Data analysis and Business Process Modeling.
• Experience working in all stages of SDLC (system development Life cycle), facilitating and conducting Joint Application Development (JAD) sessions with stake holders and technical management, creating project plans and schedules and managing changes.
• Have proposed from the outcome of JAD session and proposed alternative tasks and prepared them into Business Requirement Document(BRD).
• Excellent communication and presentation skills. Experience working with business users as Confidential as senior management.
• Experience in working in Microsoft Project, Agile, Balsamic Wire, MS Visio, Gantt chart and designing Data flow diagrams.
• Experience in GAP analysis, User Acceptance Testing, SWOT (Strength, weakness, opportunities and threats) analysis, and RTM (Requirement Traceability Matrix).
• Very confident in writing Requirements, Test Plans and Test Cases.
• Understanding of insurance policies like HMO and PPO and proven knowledge of HIPAA (Health Insurance Protection and Accountability Act), and EDI (Electronic Data Interchange) 837(health Confidential claim), 270/271 (inquire/response health Confidential benefit), 276/277 (claim status), 834 (benefit enrollment),835 (payment or remittance advice). Experience with HIPPA 4010 and 5010.
• Exposed to using ICD - 9-CM and ICD-10-CM coding standards in Medicare and Medicaid domains of the healthcare systems and industry for inpatients, outpatients, and Reimbursement methodology.
• Strong knowledge and experience in Healthcare industry with knowledge of Medicaid Management Information System (MMIS), HIX (Health Insurance Exchange), EMR (Electronic Medical Record), EHR (Electronic Health Record) and healthcare reforms like the Patient Protection and Affordable Confidential Act(PPACA).
• Experience work in SQL.
• Experience with AGILE Tool and methodology
• Confidential versed with HIPAA, Facets, claim adjustments, claim processing. From point of entry to finalizing, claim review, identifying claims processing problems.
• Expert in using use case diagram with Rational Rose.
• Excellent organized, interpersonal, communications, teamwork and leadership skills with proven skill to interact across multiple levels of organization.
• Flexibility in adaption to a wide range of work environments.

WORK EXPERIENCE:

Confidential, Dublin, OH

Business Data Analyst

Responsibilities:

• Gathered Business Requirements from all the stakeholders and interacting with the providers, managers, developers to develop the business Processes.
• Conducted Risk Analysis and Impact Analysis whenever there is any change in the business requirement and proposed solutions while continually updating the business requirement document.
• Conduction JAD sessions and ultimately reducing the time spent in moving all the information from stakeholders and other team members.
• Created and updated data mapping documents with reference to the source for 270/271 (Eligibility & Benefit Inquiry & Response), 276/277 (Claims Status Inquiry & Response) and 837(Health Confidential Claim).
• Assisted in the meetings with the technical team as Confidential as the clients regularly to assess the current process and how it could be changed in making a better proposed process.
• Performed six-sigma process during the project to eliminate any defects in the process.
• Helped in developing test cases such as test plans and test scenarios.
• Utilize Rational Unified Process (RUP) and build different phases of software developmental cycle.
• Actively involved in designing EDI transactions using the new HIPAA 5010 version and ICD-10 codes and analyzing HIPAA compliance and EDI transaction.
• Recommending actions against the action plans during the ongoing progress of the project to the project manager.
• Knowledge of the software system and the programs.
• Creation of project management plans to manage timely delivery using MS project.
• Performed Requirements Traceability Matrix (RTM) too track and maintain stakeholders requested requirements and changes.

Environment:: MS Project, Required Traceability Matrix(RTM), Rational Rose Test, JAD, MS Visio, Windows OS, MS Office, SharePoint, SQL Server.

Confidential, Rochester, NY

Role: Business Analyst

Responsibilities:

• Testing EDIX 12 837 files to meet HIPAA implementation guides standards and different compliance levels.
• Experience on submitting claims through direct data and uploading batch (EDI) using MITS (Medicaid Information Technology System) which is a provider online portal.
• Good understanding on processing claims, Prior authorizations and referrals using MITS.
• Experience on working with claims module involving claims search, claim adjustments, data corrections, claims reprocessing.
• Good understanding pricing methods, provider billing rules, benefit plan, administration rules for pricing claims.
• Thorough knowledge on claims edits criteria, resolutions and dispositions.
• Good knowledge on various types of insurance such as Medicaid, Medicare, long-term Confidential and other forms of health insurance like HMO, PPO.
• Understanding of procedure and diagnosis compatibility.
• Experience in gathering and documenting requirements, writing test cases and test plans of projects.
• Responsible for attending team meeting, JAD sessions and walkthrough with developers.
• Also experience with working on other EDI transactions such as 270/271 and 276/277.
• Good knowledge on various compliance levels of X12 transactions.

Environment:: Windows, MS Word, MS Excel, MS Project, SQL server, JAD, MITS.

Confidential, Watertown, MA

Role: Business Analyst

Responsibilities:

• Facilitated sessions with senior agency staff to identify the business flows and determined whether any current or proposed systems are impacted by the EDI X 12 Transaction Code Sets and Identifier aspects of HIPAA.
• Produced reports through Impact Analysis on system, data, technology, providers and clearing houses, enabling recommendations and best practices for becoming HIPAA compliant.
• Involved in developing work plan, detailing the tasks and effort required to achieve HIPAA compliance.
• Elicited, documented and managed Business and System Requirements for HIPAA 5010 version, 837, 834, 835, 270,271, 276 transactions through requirements gathering sessions with stakeholders.
• Involved in developing Business Requirement Document, System Requirement Specification document for application development.
• Coordinated work plans between project manager and stakeholders sung MS Project.

Environment:: Windows, MS Office, Share Point, SQL server, MS Project, Facets and Agile Methodology.

Confidential, LA

Business Analyst

Responsibilities:

• Specializing in healthcare business process modeling, business analysis, Business requirement gathering in all phases of various full software development life cycle methodologies with Confidential -balanced understanding of business relationship.
• Has comprehensive knowledge of SDLC methodology variant such as Waterfall and Spiral as Confidential as Agile, Rapid Application Development(RAD).
• Designed the implemented HIPAA 835 Payment Advice Transaction, 837 Healthcare Claim Transactions, ICD-9, EDI X12 transaction set 835, 837, 270, 271, 276 and 277 responsible for claims processing, coordination of benefits and pricing process.
• Experience in creating Use Cases, Class diagram, Activity diagrams, Sequence diagrams using MS Visio.
• Facilitated Joint Application Development (JAD) sessions.
• Wrote detailed User Acceptance Test(UAT) plans, Business requirement documents.

Environment:: MS Project, MS Visio, Windows, Rational Rose.