SUMMARY

• Ten years of overall business analysis and project management experience in the healthcare industry.
• Extensive experience in business analysis, data profiling, data warehousing, data mining, standard and ad hoc reporting, project management, operations management, SDLC, change and problem management.
• Experience in coordinating sessions with stakeholders for documenting requirements, pain points, solutions and communicating with developers and business users for implementation, acceptance testing and sign off.
• Extensive experience in writing requirement documents for product development, functional specs, use cases, UI design, gap analysis, process flow diagrams and UAT for system / application updates or implementations.
• Complete life cycle experience of implementing new data feeds and software applications as well as maintenance, augmentation, conversion and migration of data into data warehouse.
• Extensive experience in processing and analyzing medical claims for Medicare, Medicaid and commercial lines of business, writing / executing test plans for application development, reports, investigation, escalation and documentation of issues and resolutions.
• Experience in managing process flow, ETL, testing, queries, studies and analyses of clinical and financial outcomes.
• Comprehensive understanding of claims processing, adjudication, medical reporting, provider files, databases and financial concepts.
• Experience in EDI mappings and conversion of files in X12 formats including 270/271, 276/277, 835/837 transactions
• Practical knowledge of Client/Server architecture, data models, star schema, relational databases (Oracle, Access, Db2) and complete application development lifecycle with Waterfall and Agile methodologies.
• Detail oriented with excellent written and oral communication skills with experience in fast paced technical team environment.
• Masters degree in Business Administration.
• Extensive use of Microsoft office applications throughout the career for preparing assignments, projects and presentations.

TECHNICAL SKILLS

Programming Languages: Visual Basic 6, PowerBuilder 6, Standard SQL

Databases & Software Tools: Oracle, MS Access, Advanced Excel, Crystal Reports, PowerPoint, Lotus Notes, SAS Enterprise Guide, MS Visio, MS Project, IBM Rational Suite, MetaVance, CaliberR

EXPERIENCE

Business Analyst

Confidential, Bloomfield, CT

Responsibilities:

• Client facing Business Analyst role for Claims - Integration Team for Eagle Phase II Project
• Requirements Gathering for through JAD sessions
• Facilitate sessions to gather detailed business, functional, non-functional requirements, assumptions and dependencies.
• Current and future state diagrams and all documentation related to the assigned interfaces

Lead Business Analyst

Confidential, Bloomfield, CT

Responsibilities:

• Business Requirements Document (BRD) for External Data Intake Redesign project
• Facilitate daily scrum and Joint Application Development/Design (JAD) sessions with SMEs, systems architects, development and operations team for gathering business, functional and user requirements
• Create current and future state process flow diagrams with Visio
• Develop functional specs for metrics and reports from ETL and downstream processes
• Create use cases, stories, user interface layout and screen sequence
• Develop data models for pre and post reformatting stages
• Review EDI mappings for external files and conversion to XML format
• Review QA process and reports from current state process for loading external data in warehouse and repositories
• Data mining, user acceptance testing (UAT) and production support for data integration projects

Business Systems Analyst

Confidential, Shelton, CT

Responsibilities:

• Project manager and Liaison between clients, development teams and SMEs for enhancements in application and creating new or ad hoc reports.
• Requirements gathering to successfully implement new data feeds for case management, application changes, outcomes analyses, studies and queries.
• Functional specs, use cases and UAT of application updates
• Maintain all current and prospective clients through controlling the flow of complete, accurate and timely data intake, identification, resolution, escalation, follow-up and documentation of issues and quality concerns. Major clients include large insurance companies like Emblem and HealthSpring.
• Managed the ETL process for provider, eligibility and claims data for Medicare and commercial LOBs from several sources, validation through control totals and frequencies on key data elements, cleansing, de-duplication and augmentation, reformatting through EDI mappings, integration into SQL server databases and electronic health records.
• Run proprietary algorithms, HCC calculation and data mining on client data to identify high cost and high risk patients for care and utilization management programs
• Control / improve processes, workflows, operational costs, QA, resource allocation
• Maintain complete and updated data models, data dictionaries, service requests, implementation and test plans, mappings and reformatting programs, lookups and rollups.
• Prepare multimedia presentations and executive summaries on outcomes, studies, patient profiles, population segments, provider control groups and performance analyses for clients and upper management

IS - Business Analyst

Confidential, Rocky Hill, CT

Responsibilities:

• Working as a Senior Business Analyst for maintaining data warehouses for employee benefits data of large employers like IBM, BP, AmEx etc.
• Implementing new clients and software applications while using SDLC methodology.
• Reviewing reports and frequencies on member eligibility, provider, medical, drug, behavioral health, capitation, dental, vision, health risk assessment and lab results data feeds from vendors for periodic updates to the data warehouse.
• Reviewing inpatient and grouped data based on episode treatment, episode risk and evidence based medicine.
• Managing data feeds, layouts, functional specs, gap analysis for new implementations and migration, de-bugging, investigation, escalation and resolution of issues, data mining, documentation, profiling and trend analysis.
• Writing functional specs for system modifications, update forms, special reporting requests, data validation and acceptance based on business rules for resubmissions and reprocessing.
• Documentation of data issues, maintenance of update grids and research of issues, data models, data dictionaries, definitions of terminology, lookup tables and reference files.
• Presenting status of on-going projects, investigations, analyses and solutions through power point and Visio diagrams internally and to the clients
• Coordinate the workflow between clients, vendors, developers and teams of BAs

Business Analyst

Confidential, New Britain, CT

Responsibilities:

• Writing and executing test plans for testing COBOL based mainframe application for processing and reimbursement of Medicaid claims and maintain eligibility and provider files for the department of social services of the state of Connecticut.
• Comprehensive understanding of claim submission and payment processes, standard medical management reporting concepts, data models, database management and financial concepts. Completed projects include implementing 270/271, 276/277, 835/837 transactions, web based claim status and client eligibility verification.
• Requirement gathering, documentation, update and presentation of test analyses of various on-going projects
• Balancing the bi-weekly claims processing cycle and the daily POS claims worksheets.
• Submitting and monitoring test claims through various windows, client/server and DOS based electronic environments.

Programmer & System Installer

Confidential, Orange, CT

Responsibilities:

• Working on the project of installing long distance learning stations on General Motors dealerships in the states of New York, Connecticut and New Jersey.
• Designing the layout of satellite receivers, wiring, viewing and log-in terminals.
• Programming the satellite receivers and the site controller.
• Resolving issues with equipment, cabling and software through communication with the hub.
• Providing technical support to the installed sites.