- Highly skilled and professional Sr. Business Analyst with 7+ years of specific experience in the fieldof Healthcare.Extensively used Rational tools and HP Quality Centre for Business Requirement Management, Defect tracking, Test Planning, Reporting, Change and Release Management. Extensively worked on writing complex SQL queries using DDL and DML commands and has used sub - queries and joins to generate complex reports. I was involved from the initiation to the final phase of SDLC. In-depth knowledge of UML diagrams to create Use cases, Activity, and Use Case diagrams to extract business process flow.
- Goal oriented professional with superior analytical, communication and presentation skills.
- Extensive knowledge of all phases of Software Development Life Cycle methodologies like Agile, Iterative Software Development and Rational Unified Process.
- Experienced in conducting Joint Application Development (JAD) sessions for Requirement Analysis, Risk analysis, Adaptability and Feasibility Studies with various stakeholders to identify business critical and high-risk areas of the application.
- Conducted communication between the client and IT department, involved in gathering, analyzing, and documentingR equirements. Understands the Business Rules and can effectively implement them in Business Process Flow.
- Thorough knowledge of object oriented analysis and design using UML diagrams such as Use Cases, Class Diagrams, State Diagrams and Flow Chart Diagrams.
- Experienced in interviewing Business Group, asking detailed questions and recording the requirements in Vision Documents and Software Requirement Specifications (SRS) that can be understood by both business people and technical people.
- Experience in verifying EDI raw data of 837 transactions as per HIPAA based transactional 5010 formats.
- Extensive experience in Gap analysis of HIPAA 4010 to HIPAA 5010 conversion using the implementation guide and companion guide of EDI transactions(EDI 837, EDI 835, EDI 834, EDI 820).
- Good knowledge of ICD 9- CM, ICD 10-CM structures and differences.
- Sound experience in conducting I mpact Analysis caused due to migration to ICD 10 on the key business process and key application system like claim processing, payments, reporting in health insurance companies.
- Strong Experience in preparing Project Plans, Work Scopes, Flowcharts, Systems Requirements Specification. Proficient with Microsoft Project to manage schedules, deadlines and resources, collaborate with different teams and analyze project information.
- Communicated and applied project standards and consistently delivers high-quality services to clients.
- Understands the components of running a fiscally successful project.
Rational Tools: Administration, Requisite Pro, Robot, Rose, Test Manager, Clear Case and Clear Quest
Mercury Tools: WinRunner, Load Runner, QTP
Web Tools: HTML, XML, MS FrontPage, Macromedia Dreamweaver
Programming Languages: SQL, Test Script Language, SQA Basic
Applications: MS Office MS Word, MS Excel, MS PowerPoint
Databases: MS SQL Server, MS Access
Operating System: Windows 98/2000/XP, Unix
Confidential, San Diego, CA
Sr. Business System Analyst
Roles and Responsibilities
- Gathered requirements by conducting meetings with key stakeholders, end users and Subject Matter Experts (SMEs).
- Extensively interacted with the stakeholders and the IT Department in finalizing the requirements according to the Center for Medicare and Medicaid Services (CMS) Compliances/Regulations and HIPAA Regulations.
- Facilitated JAD sessions involving the management, development and user teams for clarifying requirements and facilitating better communication.
- Working within a growing knowledge of ANSI 834 (Benefit Enrollment), 820 (Premium Payment), EDI, Privacy, and Security.
- Worked on rebate table accumulators and discount accumulators for Plans.
- Interacted with the business users in knowing the business rules and gathered the reporting requirements to design the business objects reports.
- Performed Gap Analysis of the processes to identify and validate requirements.
- Involved in business requirements (BRD/High Level Document (HLD) / Low Level Document (LLD)), Functional Requirement Document (FRD), Project Specifications Document (PSD).
- Prepared Unified Modeling Language (UML) diagrams, Business Process and Data Process Model using MS Visio.
- Organized requirements into high level Use Cases and low level Use Case Specifications.
- Created wireframes and developed a prototype of the GUI using Axure and demonstrated it to the stakeholders and business users and noted feedback from them.
- Coordinated with project stakeholders to track the progress of the project, updated status and lead the review meeting to ensure that schedules and deliverables are met.
- Assisted product owner on working with USER stories to create Product Backlog.
- Facilitated daily scrum meetings to review the status of sprint backlogs and sprint review meetings to discuss the accomplishments and issues that the Scrum Development team faced.
- Facilitated the process by resolving theconflicts in the team and avoiding the impediments.
- During requirements churn, did impact analysis and application feasibility study.
- Tracked defects in HP ALM and worked with QA team to resolve defects.
- Assisted in the UAT and in the preparation of the Test Plan, Test cases with the testing team as well as ensuring testability, reliability, usability, maintainability and performance of the application.
- Worked on JIRA for continuous update with project schedules, quality, issues/defects and managing resources.
Environment: Agile - Scrum, SQL Server 2012, MS Office (Word, PowerPoint, Excel), MS Visio, SharePoint, Spotfire, HP ALM/QC, Axure, JIRA
Confidential, Sacramento, CA
Sr. Business/Quality Analyst
Roles and Responsibilities
- Worked with client to gather Business/Technical Requirementsfor HIPAA 5010 and ICD 10 projects.
- Worked on gathering requirement for testing EDI 834 with business and technical team.
- Validated and tested the entire new enrollment through EDI 834.
- 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.
- Tested ICD 10 codes integrated with HIPAA 5010( EDI 835 and EDI 837)
- Gained extensive experience in designing/modifying the CICS screens for various areas such as Enrollment, Billing, Provider Record and Reimbursement Status.
- Tested various screens for ICD 10 such as RSF-890, RSF 891 and numerous other Formulary screens.
- Tested number of reports affected by the ICD 10 Procedure and Diagnosis code changes. Also tested for ICD indicator on various reports and Mainframe screens.
- Maintained EDMS (Electronic Data Management Systems) for CARR reports for both Daily and Weekly batch cycles.
- Worked extensively on reports such as CP-O-012 and CP-O-014.
- Experience in implementation of ICD-9-CM codes and ICD-10-CM codes changes in the current claim processing system.
- Worked on Rational Quality Manager which includesTest Cases, Scripts and Scenarios for EDI 834 and 837.
- Responsible for the full HIPAA compliance lifecycle from gap analysis, mapping, implementation and testing for Medicaid Claims.
- Responsible for Medicaid Claims Resolution/Reimbursement for health plan using MMIS.
- 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.
- Worked on Rational Requisite Pro application to handle various requirementsincluding Functional requirements, High-level requirements, Non-functional requirements, Scope statement and User requirements.
- Provided online support to users for various applications such as IPCS (Internet Professional Claims Submission using EDI 837).
- Filed Bugs in Quality center for EDI 837 and EDI 834 and analyzed them to resolve the issue.
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, Franklin Lakes, NJ
Sr. BA/EDI Analyst
- ConductedJAD sessions, which focused on the definition of Business Requirements, security access groups and third party insurance companies associated with claims business process (EDI 837 and EDI 835).
- Studied the existing business process and created AS-IS workflow to illustrate the existing system.
- Documented Technical specifications and business documents for EDI 837, 820 and 835.
- Worked with IT teams regarding EDI transaction such as X12 837/835 codes for claims processing.
- Conducted Gap Analysis to analyze the client’s applications programs to determine the impact of the HIPAA final rule on EDI Transaction Set and Code List implementation and defined the changes to bring the affected systems into HIPAA compliance.
- Recorded requirements in the Requirement Traceability Matrix (RTM).
- Assisting the project manager in creating the business case and project plan.
- Involved working with HIPPA-EDI 837 and 835 ANSI X12 Transaction Code sets.
- Served as a liaison between the internal and external business community (Claims, Billing, Membership, Capitation, Customer service, membership management, provider management, advanced Healthcare management, provider agreement management) and the project team.
- Actively analyzed current business processes (Claims, Recipient eligibility and enrollment etc.) and worked with management to improve and implement enterprise solutions to ensure compliance.
- Work with business representatives to understand data marts requirements and priorities and ensure that IT works is appropriately aligned.
- Responsible for creating business work flows and processes and creating management reports based on the analysis.
- Followed the UML based methods using Rational rose to create use cases, activity diagram, sequence diagram, collaboration diagram that include functional and non-functional specifications to hand off to development teams.
- Actively involved in updating internal processes (submit claims, check eligibility), updating data collection and data reporting.
- Wrote multiple Test-Cases (unit, compliance, integration) for multiple transactions including 837, 835, 276, 277, 270 271 transactions.
- Defects and bug testing by using Rational Clear-Quest, Configuration management and Version control with Clear-Case.
Environment: HTML, Windows 2000, Rational Requisite Pro, RUP, MS Visio, MS Excel, MS Word, MS Office, UML, SQL, HIPAA, MS Access.
Confidential, Albany, NY
- Gathered requirements from stakeholders through personal interviews, questionnaires and surveys.
- Interviewed Subject Matter Experts (SME), asking detailed questions and carefully recording the requirements in a format that can be reviewed and understood by both business people and technical people.
- Prepared Business Requirement Documents (BRD) based on the gathered requirements.
- Assisted QA in Test Cases and Test plans for the department director that was used to review and evaluate results of a testing cycle.
- Performed GAP analysis to identify holes in the requirements.
- Documenting the entire test plan, including test strategies and test cases.
- Used Rational Rose to prepare Use Case views for a clear understanding of the vision document and stakeholders’ requests.
- Implemented the Rational Unified Process (RUP) methodology of application development with its various workflows, artifacts and activities.
- Performed the UAT with the clients and documented to clarifications.
Environment: - MS Word, Visio, UML, RUP, SQL, Java