SUMMARY:

• Highly successful and multi - skilled Business/System Analyst, with more than six years of international, multicultural experience, within world-class health care environment.
• Well networked and proactive leader, possessing a number of considerable achievements.
• Flexible and willing to go the extra mile to achieve individual and collective objectives.
• Experience in all phases of software development life cycle (SDLC), including requirement gathering and documentation, analysis and design, quality assurance, testing and end user support.
• Highly skilled at converting business requirements and user stories to software requirements.
• Demonstrated ability to leverage resources through effective communications and building strong relationships with peers and customers.
• Strong experience in Waterfall, Agile, and Prototyping methodologies.
• Analysis and data analysis using SQL and Excel involving the product attributes of Broker Dealer products
• Be the liaison between the business units, technology teams, and support teams.
• Elicit requirements using interviews, document analysis, requirements workshops, surveys, use cases, scenarios, business analysis, tasks and workflow analysis
• Extensively used RDBMS, Oracle, SQL, VBA, and PL/SQL along with MS SQL administration, SQL Enterprise Manager, MS Access, Data analysis and reporting.
• Solid Experience in modeling Relational Databases and Data Warehouses using tools like Erwin and Oracle.
• Critically evaluate information gathered from multiple sources, reconcile conflicts, decompose high- level information into details, abstract up from low-level information to a general understanding, and distinguish user requests from the underlying true needs.
• Adhered to HIPAA for the Affordable Care Act (ACA), health insurance & Medicare claims.
• Worked on EDI transactions: 270, 271, 834, 820, 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.
• Experience in Healthcare/Claims adjudication with knowledge of industry compliance standards like HIPAA and EDI X12 transactions (834, 837, 835, 270/271 and 276/277).
• Tested EDI transaction like 270, 271, 837, 835 and 834.
• Documented the process flow & Business Use Case and Desk level procedures for the EDI 835 transaction.
• Dealt with Revenue Cycle Management (RCM) in processing of office claim's, payment and revenue generation, tracking claims.
• Hands on experience in Claims Adjudication System and Complete Revenue Life Cycle.
• Extensive experience in documenting business and user requirements.
• Result oriented Joint Application Development (JAD) facilitator and meetings coordinator.
• Exposed to Medicare and Medicaid domains of the healthcare systems.
• Hands on experience in Medicare and Medicaid Claim Process

TECHNICAL SKILLS:

Methodologies: Agile, Waterfall, RUB, Prototyping

Office Tools: MS Project, MS Word, Excel, PowerPoint

Programing Language: Java, J2me

Operating Systems: Unix/Linux, Windows, Mac

Business Modeling Tools: Microsoft Visio, PowerPoint

Language Skills: English Fluent, Arabic Native, French Beginner, German Beginner

Volunteer: Marine Corps Marathon, Fairfax Memorial Day Parade, Asian Chamber of Commerce Former professional squash player.

PROFESSIONAL EXPERIENCE:

Confidential,Boston, MA

Business Analyst

Responsibilities:

• Translated business requirements into functional and non-functional requirements.
• Involved in all the phases of the System Development Life Cycle (SDLC) to ensure that business objectives were met.
• Interfaced with the project manager, developers, QAs and business owner.
• Created Medicare, Medicaid, Coordination of Benefits (COB) claims during the testing effort.
• Experienced in employing Revenue Cycle Management (RCM) to enrich healthcare delivery.
• Developed custom system logic/build to suit end user's specifications as it relates to the Revenue Life Cycle.
• Involved in the loading of beneficiaries claims files (CCLF) into the database.
• Analyzed plan requirements and then contributed further defining the plan requirements with their Project Manager. Observed the compliance of the requirements with federal and state government regulations Medicaid, Medicare, and accreditation body requirements.
• Working within a growing knowledge of HIPAA 837 I, P, D, 835, 834, 820, 270, 271, 276, 277, and 278, EDI, Privacy, Security, and Medicaid.
• Communicated with members and providers and explained the medical benefit structures, claims adjudication process and discuss regarding different payment methods.
• Designed and implemented HIPAA 835 Payment Advice Transaction, 837 Health Care Claim Transaction.
• Executed and validated test cases and test scripts through MS Access, SQL
• Extensively used SQL to retrieve, and manipulate data in the database
• Created SQL Queries using Oracle, SQL Server and DB2 in validating data into Data Warehouse/ETL applications.
• Researched, investigated and adjusted complex claim issues identified from customer service calls and correspondence submitted by providers. post adjudicated medical claims for various clients, for correct payments, medical coding and adherence to payment policies of various carriers.
• Developed the Test Claims and adjudicated them to determine the members' payment in the Facets
• Use SQL to select the accounts with certain characteristics and to track the volumes with each processed file for a time period to create volume and functionality graphs.
• Support Documentation updates for CMS file transfers.
• Requested report claims, analyzed data, researched CMS policies to determine accuracy of claims processing.
• Analyzing data and querying SQL tables, views, and reports for updates, changes, and functional support.
• Conducted meetings to allow different stakeholders to communicate their perspectives with each other.
• Developed the detail business requirements based on the high level requirements and information gathered from the customer and multiple business partners
• Gathered business and user requirements through open ended discussions and brainstorming sessions.
• Communicated and maintained strong working relationship with various business groups.
• Designed flow chart, use case and activity diagrams using UML/Visio.

Environment: HIPAA versions, XML, Sybase, HTM, Oracle, XML Notepad, Medicare, Medicaid, EDI transactions and code sets, SQL, Momentum, Pearl Script, XML, SQL, Java, J2me, Flat file, MS Access, MS Visio

Confidential,Bloomfield,CT

Business System Analyst

Responsibilities:

• Derive Functional Requirement Specifications based on User Requirements.
• Understand and articulate business requirements from user interviews and then convert requirements into technical specifications.
• Generated periodic reports based on the statistical analysis of the data using SAS/SQL queries and MS Access and Excel.
• Troubleshoot any problems found within FACETS and when testing the SQL data database while validating the business rule.
• Medicare and Medicare encounter reporting considering the complete data field which is required to submit for the reimbursement.
• Worked on EDI transactions: 270, 271, 834, 820, 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.
• Validating all the Subscribers and members are enrollment successfully and using Oracle SQL and DB2 to verify in back end.
• Involved in Data mapping to/from legacy to Facets that will be used to populate the database.
• Extensively worked on Patient Encounter in order to validate Claims and membership data in Facets.
• Created detailed logic for each scenario given on CMS for processing these claims.
• Updated value sets to make changes per CMS.
• Worked on Claims (Dental, Medical, and Rx), Customer services, Members, Enrolment interfaces and extensions for FACETS as a part of FACETS implementation team.
• Validating the EDI 837 claim billing (professional, institutional and dental claims) & 835 (remittance advice or payment) claims adjudications.
• Tracking and addressing the problems on timely manner encountered on Acknowledgement 997, Claim Status Inquiry/Response 276/277, Remittance Advice 835, Eligibility Inquiry/Response 270/271, Prior Authorization 278 claims.
• Participated in all phases of the revenue life cycle from requirements definition through product delivery and support including configuring, testing, and implementing technical and business process solutions.
• Employed Revenue Cycle Management (RCM) to imply in healthcare delivery.
• Prioritize business requirements and segregate them into high, Medium, Low level.
• Experience in creating requirement documents use cases, user stories, data flow diagrams.
• Offered data support and checking using SQL/Query and developed complex spreadsheets using SQL.
• Responsible for documenting business, functional requirements, and technical specs for converting their reports from Crystal to SQL; application enhancements, optimization, and upgrades.
• Wrote complex SQL queries to perform the backend testing of the Oracle database using SQL developer and UNIX commands
• Functioned as the primary liaison between the business line and the technical areas.
• Provided gap analysis of the current system. Provided data mapping, as-is and to-be, source to target, and data migration from the legacy system.
• Coordinator for user acceptance testing (UAT) and resolution of issues to include change management, root cause analysis, and appropriate escalation as needed. Created test cases and performed QA testing.
• Assisted UAT testing team on HIPAA 4010 EDI 837 and 835.
• Ensure that requirements remain within scope and schedule.

Environment: Facets, Facets interfaces, Agile, Requisite Pro, SQL Share point, Java, MS Access, MS Visio, MS office, MS word, MS excel Clear Case Clear Quest, Quality Center, Oracle, Data Warehousing

Confidential, Bloomfield,CT

Business Analyst

Responsibilities:

• Supported the assigned project manager by creating detailed project plans and assisting in developing, scheduling and tracking project timelines.
• Created use case scenarios and documented work flow and business process.
• Arrange sprint meetings (Retrospect & Review) on team’s velocity, improvements and what needs to be done differently in the next sprint.
• Involved in writing SQL Queries for back end testing oracle database.
• Worked with 834 (enrollment), 835 (medical claims payments), 837 (medical claims), 270 (eligibility inquiry), 271 (eligibility response), 276 (claim status), and 277 (claim status response).
• Worked on EDI transactions: 270, 271, 835, and 837 to identify key data set elements for designated record set.
• Conducted eligibility analysis of EDI (X12) 837, 834, 820, 835, 999 protocols in Medicaid and Medicare Services
• Designed, developed, and maintained various Business unit reports by using Teradata, SQL, and MS Excel.
• Participated in database design and worked with SQL / Oracle queries for change control and compliance audit reports/applications.
• Providing status update, reporting on major milestones, timelines, and assignments within expected dates.
• Worked with specific business users to gather requirements and analyze open issues; translating user requirements into functional specifications.
• Gather Business Requirements from the Subject Matter Experts (SMEs) and document the requirements in the BRD.
• Acted as User Acceptance Testing coordinator and monitored business testing and interfaced with the development team regarding defect status and fixes on a daily basis.
• Developed technical specifications and templates for documentation

Environment: MMIS, UAT, ORACLE, MS SQL Server, SAS, MS office, MS Visio, Quality Center, EDI X12