SUMMARY:

• Seeking role as a Business System Analyst to work with the IT project team to gather, analyze and implement business requirements for the software development process and managing UAT, which can add value to the entire lifecycle of the project.
• Healthcare Business Analyst with 8+ years of experience in the HealthCare, Insurance Industry.
• Knowledge and expertise in working with Claims, Provider Relations, Enrollment, Benefits Administration, and Vendor Relations' Business Areas.
• Vendor Management - Worked as a facilitator for Testing Efforts and New Requirements between the Healthcare Company and its various Vendors.
• Worked in projects involving Benefit Base Plan changes and Configuration changes to ensure the accurate processing of claims. Determined dependencies between enrollment and benefits processes and ensured each Business Areas delivered their tasks on the projected target dates.
• Good understanding of Health Care Industry claims management process, Medicaid and Medicare Services and insurance sector.
• Extensively worked on MS SQL Server Databases, as well as Microsoft Access
• Experienced in EDI and HIPAA Testing Privacy with multiple transactions exposure such as Inbound Claims 834 - Membership Enrollment, 837-Institutional, 837-Professional, 835-Claim Payment/Remittance Advise, 270/271-Eligibility Benefit Inquiry/Response, 276/277-Claim Status Inquiry/Response Transactions and testing in Client Server systems and Mainframe Applications.
• Experience in developing ETL for Data extraction, Data transformation and loading.
• Involved in the gathering requirement and testing of web portal of New MMIS System.
• Extensive experience in conducting Joint Application Development (JAD), Rapid Application Development (RAD), Surveys, questionnaire and User Stories in requirement gathering.
• Implemented various HIPAA codes (270 and 271) used for Billing and Eligibility purposes of patient records.
• Expertise in all the phases of the Software Development Life Cycle (SDLC), Agile Development and RUP methodology.
• Experience in writing SQL Queries for Data Validation, Data Integration and testing.
• Expert in creating Use Cases, Use Case Diagrams, Class Diagrams, Sequence Flows using MS Visio and Rational Rose using UML concepts.
• Expertise in documenting the Business Requirements Document (BRD), generating the UAT Plan, maintaining the Traceability Matrix and assisting in Post Implementation activities.
• Expert in building test plans and test cases working with UAT and QA teams.
• Defect Management - Fully involved in the process of defect identification and resolution using Quality Center.

TECHNICAL SKILLS:

Project Methodologies: Rational Unified Process (RUP), UML, Agile, SDLC

Business Modeling Tools: Rational Rose, MS Visio

Requirement Management Tools: Rational Requisite Pro, Word/Share Point

Defect Tracking Tools: Quality Center, Test Director, Quick Test Pro

Operating Systems: Windows/ NT/ XP/ 2000

RDBMS: MS Access, Oracle, SQL Server, SQL Star Plus

Quality Assurance Tools: Mercury Quality Center, QTP

Design Tool: Microsoft Visio, MS Excel

PROFESSIONAL EXPERIENCE:

Confidential

Sr. System Analyst

Responsibilities:

• Worked with QA to create Test Plans and Test Cases based on the business requirements.
• Executed test cases and documented defects that arose in the process in HP-ALM
• Liasoned with Technical Functional Area Lead (TFAL) and system engineers to find fixes for the defects
• Maintained the Detailed system design (DSD) and Final System Document (FSD) through iTrace
• Proficient in Technical Writing & documentation such as user and training manuals.
• Managing requirement gathering process from all the engineers, scoopers, fielders, project coordinators, project managers, program managers.
• Worked extensively on Business Requirements, Functional Specification, Data-Integration, Data Mapping, and Data Warehouse access using SQL and Crystal Reports, ETL process, use cases modeling (UML) using MS Office (Word, Excel, Access, Visio) and dashboards
• Developed test plans and templates to be used by the project team and tested the data on reports using SQL queries and toad.
• Done claims processing, benefits, provider reimbursement, provider set, billing and accounts receivable.
• Utilized Agile/Scrum Methodology to configure and develop process, standards and procedures.
• Created ETL packages with different data sources (SQL Server, Flat Files, Excel source files, XML files etc.) and then loaded the data into destination tables.
• Closely work with all BAs and stake holders for reviewing User Stories.
• Worked with other Business analyst to create the fund code cross walk
• Worked with the claims team in testing the claims engine through the submission of inpatient, outpatient, pharmacy and dental claims using TTG, web-portal and Interchange (MMIS)
• Created SQL reports, data extraction and data loading scripts for different databases and Schemas.
• Interacted with client and the management teams to further understand the requirements and to report the status of the testing efforts on their applications.
• Convert high-level requirements into Epics and high-level User Stories and derive lowest level of clear and concise User stories
• Involved and participated in introspective sprint review meetings with other agile team members.
• Validated system modifications and performed UAT on test scenarios.

Environment: MS Office, MS Visio, MS Word, MS Excel, Java, ETL, MS Power Point, Oracle, SQL, Rational RequisitePro, Quality Center, UML, JIRA, Agile.

Confidential

Business System Analyst

Responsibilities:

• Responsible for checking member eligibility, provider enrollment, member enrollment for Medicaid and Medicare claims.
• Performed Gap Analysis by analyzing “AS IS” and “TO BE” scenarios.
• Created Business Requirement Documents (BRD) for the replacement of the current X12 to XML translator to a newer translator
• Re-engineered the HTS synchronous process using MS Visio.
• Closely worked with ETL team to understand Data extraction and Data conversion from application front-end with SQL databases and data warehouse.
• Gathered high-level requirements from business, created user stories, and prioritized backlog with project manager.
• Worked in Software development life cycle (SDLC) using Agile Scrum methodology.
• Participated in JAD sessions to finalize the requirements for Plan Selection and Fixed Enrollment(PSFE)
• Performed Data mapping, logical data modeling and used SQL queries to filter data within the Oracle database
• Conducted regression testing with developers in development and conducted user acceptance testing with UAT team.
• Served as a liaison between the business and the client.
• Maintained documentation related to difficulties, complexities and anomalies that may arise during the ETL process.
• Actively participated in Scrum Planning meetings, helped clarify user requirements to the team, and assisted the product owner in prioritizing user stories.
• Worked with QA to create Test Plans and Test Cases based on the business requirements.
• Document and tested the AVR/IVR System
• Identified limitations in software and communicated findings to vendor for future releases during testing.
• Worked with Project Manager in planning and organizing the project activities, and in communicating with other business managers and stakeholders of the project.
• Worked with different agencies (DYS, DTA, DMH, PAC, HSN) to resolve delicate member Medicaid ID issues

Environment: UML, MS Word, Rational Requisite Pro, MS Excel, ETL, MS Visio, MS Power Point, Rational Clear Quest, Quality Center, SQL, RUP, JIRA, Agile

Confidential

Business System Analyst

Responsibilities:

• Created Use Cases that defined the role of users who receive claims, users who process claims and users who adjudicate claims. Used MS Visio to develop UML diagrams to Validate EDI Claim Process according to HIPAA compliance.
• Performed SWOT and Gap analysis for the new functionality requirements Worked with HIPPA rules and regulations to draft business rules and claim processes.
• Removed data anomalies and supported data model development using SQL in Oracle and ER Studio. Established and enforced documentation formatting standards and guidelines.
• Edited major deliverables for consistency, clarity, and compliance with established guidelines and client directives.
• Edited design use cases for grammar and language usage, as well as clarity and consistency of tone, terminology, and formatting.
• Liaisons with business partners to develop User Stories and ensure functionality is working as expected
• Wrote Test Use Cases for two of the development areas.
• Identified the key Stakeholders and the business users of the application.
• Assisted data modelers and BDA’s to create models by providing definitions and explaining business rules for standardization and avoid nomenclature issues.
• Interacted with the client and the Technical Team for requirement gathering and translation of Business Requirements to Technical specifications.
• Involved in all phases of Software development life cycle (SDLC) using Agile Scrum methodology.
• Responsible for validating claim processing transaction of MMIS.
• Responsible for checking member eligibility, provider enrollment, member enrollment for Medicaid and Medicare claims.
• Involved in Data Migration, Data Conversions and Data Extraction/Transformation/ Loading (ETL).
• Write, edit and publish a series of specifications for deploying a virtual network within customer-supplied networks
• Wrote and edited R&D, engineering, and quality documentation; standardizing formatting and writing styles.
• Utilized Word/Visio to produce document and workflow diagrams for requirements throughout the departments.
• Facilitated daily stand ups and managed task board with user stories and board.
• Use HIPAA transactions to interface with Third-Party Administrators (TPA) also various proprietary file interfaces for TPAs not supporting HIPAA transactions.
• Develop health and welfare fund and/or TPA to administer all member benefits and payment
• Determined eligibility benefits for customers with EDI Health Care Eligibility/Benefit Inquiry (270).
• Setting up Enterprise Data Warehouse (EDW) and associated ETL service to generate business reports.
• Tested EDI X12 transactions 837 (Claim for Institutional, Professional and Dental Claims), 835 (Claim Payment) (Claim status), 834 (Enrollment), 270/271 (Member eligibility).
• Analyzes Eligibility for State Children’s Health Insurance Program (S-CHIP), Food Stamps (SNAP), Child Welfare and Temporary Assistance to Needy Families (TANF) (CHIP, SNAP, TANF)
• Experience in writing SQL queries for testing and data validation.
• Understood the state's electronic Medicaid eligibility verification system & the Medicaid & Medicare welfare system intermediary along with their roles in claim processing.
• Identified and documented the dependencies between the business processes.
• Responsible for Medicaid Claims Resolution/Reimbursement for state healthcare plan using MMIS.
• Responsible for checking NPI and approval of claim payment.
• Conducted JAD sessions and Data modeling using UML.
• Worked with Medicare operational management to monitor, trend, and report on operational metrics such as timeliness, workload, and staff trending, customer satisfaction, and other key measures to facilitate performance excellence.
• Responsible in testing and analyzing data consolidation, organization, and presentation in MMIS.
• Create and maintain Use Cases, visual models including activity diagrams, logical Business process models, and sequence diagrams using UML.

Environment: SQL, MS Word, Excel, EDI, SQL, ACCESS, ETL, Java, Agile, Lotus Notes, File Viewer, Web Client, Quality Center, MS Visio, SharePoint

Confidential, Owings Mill, MD

Business System Analyst

• Responsibilities:
• Worked with Project Manager in planning and organizing the project activities, and in communicating with other business managers and stakeholders of the project.
• Maintained clear understanding of project goals among stakeholders by conducting Structured Walkthroughs and meetings involving various leads from BA, Development, QA and Technical Support teams.
• Created Business Requirement Documents (BRD) and Functional Specification Documents (FSD) as per user requirements.
• Created Business Workflow based on the requirements gathered from the client.
• Created Use Cases, Use Case Diagrams and Activity Diagrams.
• Prioritize the requirements and crested user stories from the gathered requirements.
• Followed Agile Methodology for the entire SDLC.
• Created a detailed document to outline data quality and validation process to outline certain rules which would be validated during ETL batch jobs.
• Performed Gap Analysis by analyzing “AS IS” and “TO BE” scenarios.
• Carried out data mapping. Created and maintained detailed Data Dictionary for all data elements while identifying the source and target information for each data element. Wrote complex SQL queries in Oracle and SQL Server as part of data analysis and data validation.
• Designed new Process Flows and documented business processes and various business scenarios.
• Conducted Joint Application Development (JAD) sessions with business stakeholders and technical units.
• Organized JAD Sessions to resolve issues and conflicts, and to arrive at quick agreements regarding the system architecture design.
• Worked with QA to create Test Plans and Test Cases based on the business requirements.
• Interacted with client and the management teams to further understand the requirements and to report the status of the testing efforts on their applications.
• Worked on EDI 834, 835,837, 276/277, 278, ICD 9 and ICD 10 as per HIPPA guidelines.
• Documented complex Business requirements and made Process Flow Diagram for EDI 837, 270/271, 276/277 & 835 transactions as per HIPAA implementation for the Medicaid claim processing system enhancement.
• Developed and conducted statewide HIPAA 5010 and ICD-10 awareness program for staff.
• Participated in various meetings and discussed enhancement and modification request issues.
• Actively worked with developers as needed to isolate the Root Cause Analysis of defects.
• Worked with clients on the final signing process in the User Acceptance stages.

Environment: MS-Visio, MS Word, Excel, PowerPoint, SQL, Java, Agile Methodology

Confidential - Bowie, MD

System Business Analyst

Responsibilities:

• Facilitated Provider Enrollment, Setting up Provider profile & Trading Partner Agreement.
• Set up Provider's Access to the System. (Security Setup).
• Conducted business meeting for requirements gathering.
• Gathered claims processing (837I, 837P) requirements from business users.
• Created requirement document for 835 EDI remittance transactions and worked on ROI reports.
• Participated in preliminary data analysis discussion with SMEs to gather requirements
• Performing business process and systems analysis with a focus on data, analysis models and diagrams in support of building out current state and future state views.
• Conducted JAD sessions with management, vendors and other stakeholders for open, pending and critical issues
• Gather detailed business and technical requirements and participate in the defining of business rules and data standards.
• Gathered high level requirements from the business, created user stories, and prioritized the backlog with project manager.
• Used Agile and Rational methodology in the project development for Rational Test Suite for various phases of RUP.
• Worked extensively with the QA team for designing Test Plan and Test Cases for User Acceptance Testing.
• Developed and updated Requirements Traceability Matrix using Excel.
• Helped creating Provider Reports i.e. Financial, Claims processing.
• Prepared the Business requirement Document for the enhancement of the existing services.
• Worked on Technical design documentation (TDD) of the claims processing system.
• Performed task estimations and documentation of procedures.
• Involved in the testing of web portal of New MMIS system.
• Conducted integration testing and regression testing with developers in development and conducted user acceptance testing with UAT team. Safety reporting on system-based projects, acted as a liaison, writing documentation and increased project coordination.
• Analyzed and documented system release/deployment issues according to version management, backward compatibility, load balancing of components in production environment.

Environment: s: Microsoft SharePoint, MS Visio, MS Office, Java, HP Quality Center, Toad for Oracle, AGILE methodology, DB2