- Over 5+ years of Industry experience as a Business Analyst with understanding of Business Requirements Gathering, Translating Requirements into specifications and provide solutions to critical business needs.
- Experience in Software Development Life Cycle (SDLC) with business process models like Agile (Scrum) methodologies
- Good Working Knowledge of HIPAA Regulations.
- Strong experience in Requirements elicitation techniques, document analysis, JAD sessions and managing the requirements.
- Comprehensive experience in writing Test Plans, Test Cases and Test Scripts using manual and automated testing tools.
- Actively involved in developing, executing and managing User Acceptance Testing (UAT).
- Assisted Quality Assurance (QA) team in writing test plans, defining test cases, test scenario and data sets.
- Strong communication with clients, vendors and stakeholders for business needs and demonstrated commitment to delivery.
- Proficient in understanding business, strong critical thinking and analytical skills.
- Developed new and enhanced existing work flow for many processes in MMIS. Well versed with Medicaid management Information Systems (MMIS).
- Highly motivated, organized and target oriented team player who enjoys working with multi - functional team towards a common goal.
- Proficient in Technical and Business Writing, Business Process Flow, Business Process Modeling, Business Analysis and Testing various methodologies.
- Conducted JAD sessions for project definition involving analyzing requirements, creating prototypes, user interface.
- Extensive exposure to Rational Unified Process (RUP), Agile Scrum and Waterfall methodologies with UML diagrams like sequence diagrams, collaboration diagrams, state diagrams and activity diagrams.
SDLC Methodologies: Waterfall, RUP, Agile, Scrum
Requirement Tracking Tools: JIRA, Team Foundation Server (TFS), ALM.
Microsoft Tools: SQL Developer, MS Visio, MS SharePoint, MS Project, MS Access, Word, PowerPoint, Excel
Databases: Oracle 11g/12c
Business Skills: Business Definition Requirements, Business Process Analysis, Gap Analysis, Use Case Modeling & Analysis, Data Analysis, credit risk analysis
Sr. Business Analyst Consultant
Confidential, Frankfort, KY
- Maintained an understanding of current business issues, objectives and strategies within Prior Authorizations, Claims Adjudication, Financial and Business Analysis domains of Medicaid and recognized issues and opportunities to optimally apply technology to enhance existing and to build new business capabilities.
- Worked directly with the business user to formulate and define project scope and objectives that encapsulated end-user business needs.
- Worked on full SDLC to plan, manage, and execute the integration of new interfaces,file transfers into existing network infrastructure, systems and software throughout the application.
- Extensive experience in the areas of Waiver Program Management as related to Medicaid activities.
- Participated in the elicitation, documentation, analysis, validation of business processes, systems and business requirements.
- Developed As-is and To-be business process models.
- Worked with other Business Analysts to ensure that business design is cohesive across all business areas impacted.
- Conducted the walk-through session to validate the final Functional Specification Documents with stakeholders.
- Performed manual as well automated testing to validate the functional specification in addition to User Acceptance Testing (UAT) and drove Go/No-Go Sessions upon successful testing in lower and Production environments. •
- Involved in Claims reporting process.
- Experience with integrations between multiple systems via web services and batch approaches.
- Involved in applying edits on various payment methods to ensure the consistency and accurate payment of paid claims.
- Involved in identifying the aging schedule for unpaid claims over 45 days outstanding and responsible for payment reconciliation.
- Involved in HIPAA EDI transactions such as 835, 837 (P, D, I) 276, 277, 278.
- Owned the entire reporting process. Interacted with the ETL team, developer(s), management, and account holders to get the requirements, document them, design templates, and write specifications.
- Identify Member, Provider, Coverage, Medicare, and Medicaid.
- Designed Functional Specification Documents for the reports.
- Map forms such as Claims according to X12 EDI 837I, 837P & 837D standard so that edits and audits can ensure claims and claim details abide by current policy criteria to validate Encounter/Claim data and store it in the database.
- Involved in the process of Prior Authorization mechanism to review, assess, and approve or deny the services which are identified by Department of Medicaid services prior to claims adjudication.
- Supported technical teams to ensure that business requirements are appropriately and comprehensively translated into solid technical designs.
- Created and maintained requirement documents for Facets for the different modules like Billing, Member enrollment and Claim adjudication.
- Supported testing team to ensure that test plans and test cases comprehensively address business requirements.
- Effectively communicated project status, risks, issues, and constraints to project management.
- Track functional area deliverables and activities and provide weekly status reports and metrics.
- Attend/organize project and ad-hoc meetings as required.
- Developing and maintaining customer relationships.
- Work with other subject matter experts to gather technical and functional information required for the successful implementation of the Project.
- Collaborate with the Project Manager on project/roadmap planning, facilitated daily stand-up meetings, reviews, retrospectives, Scrum-related meetings.
- Managed Vendor and Stakeholder relationships with Business teams.
Confidential, Rockville, MD
- Gathering and documenting the requirements which are critical to the business mission and using those requirements to design application software.
- Extensively interacted with the stakeholders and the IT Department in finalizing the requirements according to the Compliances/Regulations.
- Interacted with the users by actively involving in JAD.
- Determined and documented the As-Is and the To-Be (future) business process flows using MS Visio and maintained the requirement traceability
- Analyzed and gathered requirements for Health Rules software which mainly included all configurations, benefit plans, lines of business, enrollment, billing.
- Worked with Reporting team to create and reports using reporting requirements.
- Performed Gap Analysis by identifying current technology, policies and procedures, documenting the enhancements for the requirement, and analyzing new HIPAA 5010 compliance and developed an action plan for the migration process.
- Attending Client Meetings, Project Steering Committee Meetings and Project Management Committee Meetings.
- Preparing BRD, Business Scenarios, Test Cases to the clients.
- Experience in Business Analysis, Use Case Development and developing test cases.
- Developed Test Cases for unit testing, prepared spreadsheet for testing criteria, including regression, positive and negative testing, process flow testing and screenshot for test results to complete expected and actual results.
- An accomplished liaison between business stakeholders, subject matter experts and technical team for gathering requirements and prioritizing them.
- Efficient in elicitation techniques like interviewing, questionnaires, brainstorming, focus groups etc.
- Strong Analytical skills to understand the Business process, functionality and requirements and to translate them in to system requirements.
- Strong Data Analysis qualifications and experience.
- Experience in developing Use Cases, creating Screen Mockups, performing 'AS IS' and 'TO BE' analysis, conducting Gap Analysis, SWOT analysis, Cost Benefit Analysis, and Risk Analysis.
- Ensure timely, accurate and complete financial data and balance on patient accounts
- Maintain and update patient demographics and financial information within data systems.
- Input billing information and patient classification into the systems
- Maintain HIPAA compliance and confidentiality of information received, pertaining to but not limited to patient, physicians.
- Provides financial and operating data and analysis to ensure accuracy of patient accounts in preparation for billing
- Experience in UAT (User Acceptance Testing) and QA team in creating the Test Plan and Test Cases. • Conducted walkthroughs with stakeholders and end-users.
- Experienced in writing user manuals/help documents.
- Impeccable work ethics and outstanding organization skills for Strategic Planning, Prioritization and Execution.
- Highly motivated, team player, willing for challenges and oriented towards achieving project quality goals
- Interaction with clients to determine requirements and goals. Utilized Rational Unified Process (RUP) to configure and develop process, standards, and procedures and create a Business requirement Document.
- Responsible for preparing Software Requirement Specification (SRS) and documenting them.
- Established questionnaires and resource leveling required for implementing.
- Created Process Work flows, Functional Specifications documents and documented system requirements.
- Provide implementation assessment and conducted ad-hoc and daily stand up meetings with the stakeholders and clients.
- Interacted with various cross-functional teams on building business use cases and understanding expenses and revenue stream.
- Working with clients to better understand their needs and present solutions using structured SDLC approach.
- Interaction with the developers to report and correct bugs.
- Developed the systems implementation project management plan with milestones and steps from procurement of vendors to project implementation and maintenance.
- Followed a structured approach to organize requirements into logical groupings of essential business processes, business rules, and information needs. Ensured that critical requirements are not missed.
- Analysis of the new requests specified by the end users for the future releases and discussion with the functional and technical teams.
- Identified and clearly defined functional issues and support IT development staff throughout the design, development, unit testing, and implementation phases of the software development life cycle.
- Analyzed and translated business requirements into system specifications.