SUMMARY:

• Over 6+ years of Business Analysis experience with in - depth knowledge of business processes in health care field and IBM Curam environment (health care programs, pharmaceutical, Medical Device) with several years of experience and expertise in HIPAA regulations, EDI and ICD.
• Worked closely with various project stakeholders, SMEs, and Expertise in preparing Business Requirement Document (BRD), Functional Requirement Document (FRD) and Non-functional Requirement Document and also maintained a Requirement Traceability Matrix
• Proficient in facilitating and conducting Joint Application Design (JAD) sessions, focus group and brainstorming sessions, reviews and walk through and customer interviews for various business processes
• Strong business analysis skills through an in depth understanding of Software Development Life Cycle (SDLC) and understanding different methodologies at all stages of Rational Unified Process(RUP), Agile, Waterfall and Business Process Re-engineering
• Provide Business Analysis, SQL Programming for data collection and data extraction of client medical claims, pharmacy claims, and eligibility data.
• Experience in various phases of Software Development life cycle (Analysis, Requirements gathering, Designing) with expertise in documenting various requirement specifications, functional specifications, Test Plans, Source to Target mappings, SQL Joins.
• Experience in IBM Curam environment with experience in both Medicaid and Medicare
• Requirements development execution, including the elicitation, analysis, specification, and validation.
• Documented and analyzed agency business processes and recommended improvements.
• Documented and analyzed data requirements and relationships. Provided requirements interpretation and guidance to technical and test teams.
• Pro actively identified risks, issues, and action items leading to possible solutions. Interacted with internal and external organizations.
• Participated in stand up of business operations supporting the Eligibility and Enrollment Member Management Project.
• Planning for, conducting, and reporting on testing and other quality assurance activities.
• Worked with Clemson Information Technology teams to coordinate effort on the Member Management project.
• Researched and documented business rules for assigned process areas.
• Great experience in using the IBM Curam Application tool to set up test cases with the given test scenarios and arriving at the expected results and uploading them using Content Management tools such as Share point and Documentum.
• Assist with implementation efforts of the Agile SDLC methods used for IBM Curam ACCESS software system.
• Experience in Data warehousing, Data Extraction, Transformation and loading (ETL) data from various sources like Oracle, SQL Server, Microsoft Access, Microsoft Excel and Flat files into Data Warehouse and Data Marts using Informatica Power Center.
• Extensive experience in Strategic development of a Data Warehouse and in Performing Data Analysis and Data Mapping from a Operational Data Store to a Enterprise Data Warehouse
• Experience in real-time EDI transactions such as Benefit Inquiry and Response and Claim status Request and Response
• Involved in Forward Mapping from ICD-9 to ICD-10 and Backward Mapping from ICD-10 to ICD-9 using General Equivalence Mapping (GEM)
• Experience in Managed Care Plans (HMP, PPO and POS) and Government Sponsored Programs (Medicare, Medicaid, Medigap) with understanding of compliance and regulation of CMS and other State/Federal regulations
• Involved in the HIPAA 4010 to 5010 conversion analysis including the documentation of HIPAA 5010 changes to EDI 837, 834, 835, 276, 277 transactions, strong HIPAA EDI 4010 and 5010 with ICD-9 and ICD-10
• Knowledge of SQL Queries and identifying various test scenarios. Extensive experience working in AGILE and SCRUM development
• Involv ed in AS IS and TO BE process analysis.
• Facilitated scrum ceremonies (release planning, grooming, sprint planning, re trospectives, daily stand-ups, etc.)
• Proficient in all phases of Requirement Management; including gathering, analyzing, detailing and tracking requirements using RTM, create Business Requirements Document(BRD) and Functional Requirements Document(FRD)
• Expertise in Healthcare Industry including, Care Management, Primary care services, HMO
• Utilized corporation developed Agile SDLC methodology. Used ScrumWork Pro and Microsoft Office software to perform required job functions.
• Strong HIPAA EDI 4010 and 5010 with ICD-9 and ICD-10, analysis & compliance experience from, payers, providers and exchanges perspective, with primary focus on Coordination of benefits
• Expertise in State Medicaid Management Information System (MMIS) projects implementation (Provider enrollment & Contact Management)
• Oversaw claim processing and EDI transactions - 837, 834, 835, 270/271

TECHNICAL SKILLS:

Languages: C, C++, SQL, PL/SQL, XML, JAVA, .NetTools: DOORS, Clarity, JIRA, Clear case, Clear Quest, Rational Rose, UML, Requisite Pro, MSP, Bugzilla, Quality Center, Informatica, CVS, Winscp, BPEL, Apix, Filezilla, winmerge, CA Clarity, IQN, TeamTrack, 7edit(HL7), Apix, Putty, Toad, Rally, Erwin

Project Methodologies: Agile, Rational Unified Process (RUP), System Development Life Cycle (SDLC), Waterfall, SWOT, Cost/Benefit

Microsoft Tools: MS Word, MS Excel, MS PowerPoint, MS SharePoint, MS Project, MS Visio

Management Tools: Rational Requisite Pro, ClearCase, ClearQuest, Quality Center Modeling Tools Rational Rose, UML, Axure, Erwin, Balsamiq Mockups

Database: MS Access, MS SQL Server, Oracle 9i/10g, Sybase

Testing Tools: WinRunner, Quicktest Pro, Loadrunner, Testdirector, HP Quality Center, Rational Suite

Operating System: Windows98/XP/ NT/ 2000, DOS, UNIX

Data Modeling UML, E: R Diagrams, Data Flow Diagrams, Data Dictionary, Data mapping, Visual Basic Reporting Tools Cognos, Report Net, Microsoft Reporting Services, and Crystal Reports Healthcare Knowledge HIE, EMR/EHR, PPACA, ICD9, ICD10, HIPAA4010, HIPAA5010

WORK EXPERIENCE:

Confidential, Herndon, VA

Curam Business Analyst

Responsibilities:

• Used IBM Curam Health care software for its ongoing Eligibility and Enrollment Framework (EEF).
• Prepared Project Requirement Documents (PRDs) and distributed for review and approval according to Requirements and Solution Analysis (RSA) process
• Provided report analysis that differentiates both existing Medigap plans as well as the newly modernized Medigap plans.
• Conducted interviews, to understand client needs and gather and analyze the requirements as well as JAD sessions with stakeholders throughout SDLC to resolve open issues.
• Handled HIPAA ANSI X12 4010, 5010 formats and primary analysis for business processes using EDIs (270, 271, 276, 277, 835, 834, 837, 997). Familiarity with HL7 and Migration Environments for HIPAA 4010 to 5010 and ICD 9 to ICD 10 Conversions.
• Excellence usage in IBM Curam (HCR and CGIS).
• Coordinated and executed Request for Proposals (RFPs) for Small Employer Groups to assist in finding the appropriate Pharmacy Benefit Management (PBM) organization for their needs.
• Identified scope systems that will be modified by the ICD-10 project to accommodate ICD-10 code and/or downstream impacts steaming from ICD-10 codes.
• Created meaningful reports for analysis and integrated the Performance Testing in the SDLC.
• Responsible for Big Data strategy, road map and modeling.
• Extensive knowledge of the IBM/Curam health care product, a web-based application used to improve the efficiency of managing eligibility for entitlement services.
• Worked on analysis of common APIs for IBM Curam Agenda Player and dynamically load agenda pages based on administration configuration.
• Performed gap analysis of current operations with IBM Curam Health Care Reform (HCR) software.
• Working with Curam Business Application Suite, Coordinating and working with IBM Curam team on Curam requirements and then verifying the test cases/scenarios for the same.
• Used GEM (general equivalence mapping) in forward mapping and backward mapping of ICD9 and ICD10 code sets
• Drove data migration strategy and process to enable quality data delivery without delays.
• Advised and assisted in data extraction, data cleansing, data mapping, data harmonization, data enrichment, data consolidation, data loading and data reconciliation.
• Involved in designing and developing ETL processes using Informatica ETL tool to read the data from XML source system and stage at SQL server database to perform transformation activity and load into Oracle database.
• Received and acknowledged Exchange HIX membership Enrollment /Termination / maintenance file from EDI Gateway (EDI 834/999).
• Conducted and moderated JAD sessions with business users to gather requirements
• Worked with the Functional Specialists and SMEs to document high level work flows for the Claims processing, EDI, and Reporting
• Experience in gathering reporting requirements from the business users for business intelligence, data-warehouse application.
• Prepared ICD-10 GAP documents and involved with 837, 835, and 278 transactions in collaboration with other team members
• Assured HIPAA 4010 and 5010 with ICD-10 analysis & compliance
• Prepared Project Requirement Documents (PRDs) and distributed for review and approval according to Requirements and Solution Analysis (RSA) process
• Experience in Managed Care Plans (HMP, PPO and POS) and Government Sponsored Programs (Medicare, Medicaid, Medigap) with understanding of compliance and regulation of CMS and other State/Federal regulations
• Designed and developed Use Cases and UML diagrams (class diagrams, activity diagrams, sequence diagrams) using MS Visio
• Assisted in writing test strategies, test plans, test cases, test scenarios, and performing UAT (User Accepted Testing)
• Established System Analysts taskforce to facilitate testing and supervised development of test cases based on requirements for ICD 10 compliance.

Healthcare Business Analyst

Responsibilities:

• Involved in gathering and documenting the requirements that were critical to the business process and using those requirements to design application software using a Use Case approach.
• Involved in Pre -Project Analysis and in pre-implementation tasks coordinating with project coordinators for contractual work, change management, quality and impact analysis.
• Identified/documented data sources and transformation rules required to populate and maintain data warehouse content.
• Lead multiple project teams of technical professionals through all phases of the SDLC using technologies including Oracle, Erwin, DataStage, Data Warehousing, Websphere and Cognos.
• Handled multiple projects including ICD-9, ICD-10 and claim processing in test environment
• Identifying ETL specification based on Business Requirements/Mapping Document. Formulating and documenting ETL process design. Participated and lead research and development efforts (proof of concept, prototypes), as subject matter experts, with new technologies.
• Analyzed the ICD conversion information provided by the CMS (Centers for Medicare & Medicaid Services) to gain understanding of the ICD-9 versus the ICD-10 code sets
• Executed data migration in coordination with management and technical services professionals
• Managed the released backlog and sprint backlog during the entire SDLC.
• Managed entire project lifecycle and performed GAP analysis to differentiate between the "as is" and "to be" systems. Involved in business process re-engineering (BPR).
• Reviewed the data model and reporting requirements for Cognos Reports with the Data warehouse/ETL and Reporting team.
• Worked on IBM mainframe environment for Medicaid Management Information System impact assessment.
• Involved in Medicaid and Medicare claims processing along with CMS, MITA, MMIS, Electronic Medical Health Record (EMR/EHR) and Pharmacy Benefit Management (PBM).
• Have knowledge of Managed Care, Medicaid, Medicare Services, EDI, XML, American national standard institutes (ANSI), Accredited Standard Committee (ASC), HL7 and X12 Standards
• Conducted Functional Requirement reviews and walk throughs with the designers, developers and stakeholders
• Interviewed business users to gather business wants and needs around project ideas and translate them into business and technical requirements
• Create and update BRD and Data Mapping documents for new reports, data sources, and data migrations.
• Preparation of Migration strategy and architecture document
• Interacted with clients and end users in order to understand the process and gather User Requirements
• Involved farm capacity and planning and migrations from one environment to other environment
• Worked With HIPAA compliant ANSI X12 837 formats for both professional claims and institutional claims
• Helped developers with the following list of HIPAA-EDI Transaction Code sets: 837,834,835,270/271,277/275 & 276/277
• Understanding of HIPAA compliant ANSI X12 837 formats for both professional claims and institutional claims.
• Analyzed forms and successfully crosswalk details to corresponding ANSI X12 formats

Business Analyst

Responsibilities:

• Gathered Business Requirements by close interaction with business teams.
• Involved in the Analysis & Design workflow for various processes by following the Rational Unified Process (RUP) and Business Use Cases.
• Conducted one on one interviews with Business Leads.
• Created Business Process Diagrams, Use Case Diagrams and Activity Diagram for business problem and solution requirements.
• Dealing with international data requests, extracting data from different database using SQL, Cubes to fulfill data demands from international markets
• Elevated to high customer satisfaction levels through assessment, analysis and continual improvement initiatives.
• Tracked record of involvement in successful on-time, on-budget delivery of projects.
• Assisted project team leads in tracking budget and status of multiple medium and large scale projects, and also maintained all process documentations using MS Visio.
• Assist with long range strategy by participating in the planning, design, development, implementation, maintenance, and evaluation of information systems and services in a Technology delivery environment.
• Developed standard upgrade guides, procedures and presentations for major version upgrades.
• Held walk throughs with the developers and QA teams in order to create a better understanding of the system requirements.
• Automate data migrations, deployments and administration activities via use of administration tools
• Accountable for deployments and data migrations across farms
• Make data reports for business needs, working with developers tracking data for projects and takes, evaluating features performance through data results.
• Used Rational Clear Case version control system to keep track of different versions of artifacts generated within the life cycle.
• Performed Lean Analysis for various business processes by following the Rational Unified Process (RUP) to document Business Use Cases and create Process scenarios.
• Setting up document hierarchy and standers to define different level of requirement using Requisite Pro.
• Conducted walkthrough with the development team and stake holders.
• Identified critical areas of business risk and modified the business process to reduce the same.

Business Analyst

Responsibilities:

• Responsible for ensuring the business requirements are captured, documented, maintained and met throughout the life of the program.
• Created user stories from epics and made sure that it is scheduled in product backlog for the respective sprint.
• Tracked status of multiple projects from Initiation through Completion. Developed various status tracking reports, ad hoc report requests, and develop and maintain management and resourcing procedures.
• Created business cases for enhancement requirements, which may be as a result of either brainstorming sessions between the stakeholders, users and BA's, through client feedback, or both.
• Provided business and analytical contribution to the development and technology delivery team, enhancement and implementation of a workflow based service components, in line with the overall business strategy.
• Held JAD sessions to facilitate resolving of conflicts and to on various issues discuss the release notes for every build during the course of projects.
• Interacted and effectively communicated with project managers, customers and management team.
• Used SQL to query Oracle Database and resolve data issues, also compiled business intelligence reports based on results.
• Support operational data needs on a wide range of customer data, including identification of trends.
• Presented data in charts, graphs, and tables that include levels, trends and comparisons of the data in a form that best meets the customer's needs.
• Assisted the QA team in designing test scripts, test scenarios and test plan for integration and user acceptance testing (UAT).
• Quality Center was used to perform bug tracking and reporting, also followed up with development team to verify bug fixes, and update bug status.
• Coordinated the defect management process using Quality center. Implemented processes, procedures, guidelines and policies for the Development and Quality Assurance Teams.