SUMMARY:

• Qualified professional with 7+ years of extensive experience in the field of Business Analysis, working with the technical staff to implement management and staff's business requirements into the software application in Healthcare Industry.
• Highly motivated team player with excellent communication, presentation and interpersonal skills, always willing to work in challenging and cross - platform environment.
• Experienced as a Business Systems Analyst in using the iterative software development life cycle principles of Rational Unified Process to manage, develop and test distributed client/server, internet and intranet applications on heterogeneous environments.
• Highly proficient in working with users to gather requirements, analyze them and subsequently use the Rational project and design tools to model the requirements.
• In-depth knowledge of creating use cases, functional design specifications, activity diagrams, logical, component and deployment views to extract business process flow.
• Good Knowledge of HIPAA Compliance Lifecycle, HIPAA Insurance Regulations and Claims Processing.
• Used Query Analyzer, Execution Plan to optimize SQL Queries.
• Experience with SOX, Regulatory Compliance and Controls.
• Strong understanding of project life cycle and SDLC methodologies including RUP, RAD, Waterfall and Agile.
• Interviewed SMEs and Stakeholders to get a better understanding of client business processes and gather business requirements.
• Conducted JAD sessions, created Use Cases, work flows, screen shots and Power Point presentations for the Web Applications
• Gathered and documented Non-functional requirements.
• Knowledge of healthcare standard Health Level Seven (HL7).
• Experienced in preparing Business Process Re-engineering Models
• Expertise in the EPIC Medical software application (EMR, HER) as it relates to hospital workflows and setting up the infrastructure for a software implementation in a clinic environment.
• In depth knowledge of SDLC and implementation of the Rational Unified Process (RUP) in all four phases of a project: Inception, Elaboration, Construction and Transition.
• Utilized a fusion of industry knowledge and technical programming to provide executive management the development and implementation of interactive busines1s tools, and strategic analysis, vital for use in mission-critical decision-making
• Conducting requirement gathering sessions, feasibility studies and Impact Analysis and organizing the software requirements in a structured way using Rational RequisitePro to track development.
• Interacting regularly with the development team, creative services, database designer, system administrator and the higher management to meet the deadlines of Project milestones.
• Worked in close co-ordination with the testing team in developing test plan and test cases from functional and business requirements.
• Performed UAT and exposure to User Certification Testing (UCT) and Operational Readiness Testing (ORT)

TECHNICAL SKILLS:

Programming Languages: C, C++, HTML, XML, SQL.

Data Base: MS Access, Oracle (SQL Series), DB2

Reporting Tools: Crystal Reports 8.0

Operating Systems: MS-DOS, Windows95/98/NT/2000/XP, Apple McIntosh, Linux

Software: MS Office Suite(Word, Excel, Access, PowerPoint & Outlook), MS Visio, Rational Rose, Rational Requisite Pro, Adobe Acrobat, MS Office FrontPage, Lotus Notes

Performance Testing Tools: Virtual User Generator, Load Runner

Processes/Technologies: Rational Unified Process (RUP), Waterfall, UML & Microsoft Office SharePoint 2007

Automation Tools: Requisite Pro, Win runner, QTP, Test Director, Quality Center

PROFESSIONAL EXPERIENCE:

Confidential, Atlanta, GA

Business System Analyst

Responsibilities:

• Utilized Rational Unified Process (RUP) to configure and develop process, standards and procedures.
• Prepared the Business Requirement Document (BRD) and System Requirement Document (SRD).
• Facilitated Joint Application Development (JAD) Sessions for communicating and managing expectations.
• Manage the Requirements (Business as well as System requirements), performed requirements analysis along with the creation of Use Case Scenarios. Modeling of the business and application using Rational Unified Processing (RUP) and Unified Modeling Language (UML).
• Performed Gap analysis and assessed risks of the project.
• Gathered Requirements through interviews and JAD sessions with business owners.
• Involved in mentoring specific projects in application of the new SDLC based on the Agile Unified Process, especially from the project management, requirements and architecture perspectives
• Facilitated Provider Enrollment, Setting up Provider profile & Trading Partner Agreement.
• Set up Provider's Access to the System. (Security Setup).
• Coordinate changes with customers, vendors and users for EDI.
• Track tickets related to EDI and provide periodic updates
• Troubleshoot issues with EDI partners and transaction processes.
• Analyzed EDI X12 - 837I/P, 835 and 834 transactions consistency related to providers, payers, subscribers and other related entities
• Full knowledge of the Diagnosis and Procedural Code changes for Healthcare Entities like Payers, Employer Groups, and Providers. Worked on ICD 9 codes and gathered future requirements based on ICD 10 codes. Managed creation of sample mappings for the conversion of EDI X12 transactions code sets version and translation of ICD 9 codes into ICD 10 codes.
• Prepared and maintained EDI maps for different EDI transactions
• Helped creating Provider Reports i.e. Financial, Claims processing.
• Prepared the Business requirement Document for the enhancement of the existing services.
• Wrote FRDs for the defects and enhancements and got approval from business for the developers.
• Worked on Technical Design Documentation (TDD) of the claims processing system.
• Used Microsoft Word, Excel, Access, Project and Visio as working tools.
• Performed task estimations and documentation of procedures.
• Designed, prepared and implemented test cases for system testing as well as for User Acceptance testing.
• Involved in the testing of web portal of New MMIS system.
• Used Facets 4.71 to receive, store and send HIPAA-standard transactions (835, 837, 270, 271, 276, 277) and to administer HIPAA privacy rights.
• Gathered requirements and prepared functional documents for Facets 4.71 upgrade for the Trizetto's Client.
• Performed frontend configurations for Facets profiles in room type profile configuration build.
• Conducted integration testing and regression testing with developers in development and QA, also 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.
• Did impact analysis for changing requirements and coordinated with business users for prioritizing the testing/release of the changes.
• Maintained a very close interaction between business users and developers to avoid any gaps in understanding or implementation of requirements.
• Performed SQL Backup and Restore tasks on Various SQL Servers.
• Ensured different internal & external systems exchanged data according to the specification to transform data from enterprise data warehouse to SQL Server & load data to fact tables.
• Deployed Reports for Internal, Departmental & Executive Reporting based on the requirements using SQL Server Reporting Services.
• Did data analysis, created data mapping and data interface documents and kept the documents updated with changes in requirements and functional specifications.
• Performed Risk Analysis based on defect severity and priority.
• Tested User Interface inconsistency and application functionality.
• Developed Reports and Graphs to present the Stress Test results to the management.
• Created BPR charts for AS IS and TO BE processes of different business functionalities.

Environment: Windows XP, SQL, MS Visio, MS project, MS Word, MS Excel, Rational Rose, Requisite Pro, Clear Quest, UML, Axure, Java, Agile.

Confidential, New Jersey

Sr. System Analyst

Responsibilities:

• Developed High Level Project Requirements (HLR) for a very large project.
• Responsible for updating the impact analysis document and requested for attestation from external vendors.
• Worked on collecting requirements for procedure codes (CPT/ HCPCS), MEDICAID member benefits and provider contracts.
• Coordinated the project team for JAD and requirements elicitation Sessions.
• Analyzed and translated high-level requirements into detailed system requirements.
• Responsible for documentation of different Medicare Benefit terms and Programs Configuration library.
• Dealt resolving issues with member attributes, enabling multiple rules associated with member lookup process in QNXT.
• Resolved issues like member duplicated in file, dealing with dependent transaction if subscriber is not found, failures in submissions in QNXT.
• Responsible for working with the State to review and modify process flows to increase productivity and effectively utilize QNXT features not provided by the legacy systems.
• Manually tested the claims and performed data reconciliation in QNXT.
• Manually tested the Claims and adjudicated them to determine the member’s payment in the QNXT.
• Created process flows and use case diagrams to provide user a comprehensive summary of the whole system in a single illustration.
• Familiar with HIPAA EDI transactions such as 835, 837 (P, D, I) 276, 277, 278 etc.
• Coordinate changes with customers, vendors and users for EDI..
• Track tickets related to EDI and provide periodic updates
• Troubleshoot issues with EDI partners and transaction processes.
• Identify possible solutions to EDI issues
• Performed Gap Analysis for 5010 enhancement using the TR3 implementation guides and side-by-side HIPAA guides provided by CMS (Centre for Medicare & Medicaid Services)
• Validated EDI X12 files for Connecture (CNX) and Center for Medicare System (CMS) using Ingenix Claredi and manually edited and fixed the errors to make it error free and ready for processing.
• Proficiency with Microsoft Office applications (Word, Excel, PowerPoint, and Visio and Project Management Software), and Atlassian (JIRA, and Confluence)
• Ability to analyze engineering product support issues described within a bug-tracking system (JIRA) and provide guidance to other Client Services members in an advisory capacity, focusing on the quick resolution of the production issue and using this as a training opportunity for other team members
• Maintained Gitlab repositories, JIRA bug tracking system. Created custom JIRA workflows
• Install, configure and maintain JIRA bug tracking system
• Supported IS Business Analyst in creating Functional Design Specifications (FRS) employing Use case scenarios, sequence diagrams and class diagrams.
• Documented the Requirement Traceability Matrix (RTM) for tracing the Test Cases and requirements in Blueprint.
• Assisted Project Manager to complete the project approval process.

Environment: MS Visio, MS Project Professional, QNXT 5.0, MS Project, WebEx, and Microsoft Office package, MS Share point, SQL

Confidential, Long Beach, CA

Business Analyst

Responsibilities:

• JAD sessions with Subject Matter Experts (SME's).
• Analyzed User Business Requirement Document (BRD), Technical Requirement Specification and Functional Requirement Specification (FRS) using Requisite Pro, Rational Rose and MS Visio.
• Proven experience with Agile (Scrum) and Waterfall Development Life Cycles (SDLC) methodologies.
• Did Presentations making Stakeholders understand how the changes would affect different modules w.r.t. Medicare and Medicaid.
• Strong knowledge of managed claims management process, Knowledge of Medicaid and Medicare Services. CMS, Health Assessment Systems, HL7 Standards, HIPAA, PPACA(Patient Protection and Affordable Care Act), Compliance issues, LO INC and SNOMED Mapping, HL7 Message Validation, ICD 9, Electronic Health Records(EHR), Electronic Medical Record (EMR), Invision to Epic, E-gate Monitoring, Orion Rahposdy.
• As Interface Architect designed and developed Admission, Scheduling Charge messages flow and transformations for 50 applications such as Dietary, Oncology, Radiology, Professional Billing, Operating Room, materials management, HIM Coding, Lab, External Partner EMRs additional Hospital Billing Systems, and HIEs
• Served as Healthcare Informatics Analyst for nation's largest touch screen and clipboard vendor with Apartnerships including various EMRs, GE PACs, GE Centricity, Imagecast Radiology, Meditech, Seimens
• Co-ordinating/Managing ETL Offshore team
• ETL Architect(Informatica and PL/SQL) /SME
• Converting the Business rules into Technical Specifications for ETL process
• Scheduled the ETL jobs daily. Weekly and monthly based on the business requirement
• Extensively worked in the performance tuning of programs, ETL procedures and processes.
• Tuned the Performance for ETL jobs by tuning the SQL used in Transformations and fine tuning the database.
• Scheduled the ETL jobs daily. Weekly and monthly based on the business requirement
• Revised HCFA-1500 and MCS-1500 forms with stakeholders.
• Designed and developed Use Cases, Activity Diagrams and Sequence Diagrams using UML.
• Documented, organized and tracked the requirements using Rational Requisite Pro.
• Conducted User Acceptance Testing (UAT) prior to and after implementation phase.
• Worked on conversion from ICD-9 to ICD-10 with respect to the claims related to Medicare (Part A, Part B, Part C, Part D).
• Worked with Source system Subject Matter Experts (SMEs) to ensure that the extracts are properly mapped. Used SQL for data mapping and querying.
• Tracked and maintained Stakeholder requested enhancements and changes using Requirement Traceability Matrix (RTM).
• Played a key role in planning UAT and implementation of system enhancements and data migration and conversions.
• Integrated Requisite Pro with Rational Rose to provide all teams visibility and maintain tractability among requirements, use cases and change requests.
• Part of the team for migration of HIPAA - EDI X12 4010 series to 5010 series for EDI Transaction code sets: 820, 834, 835, and 837 (I, P and D).
• Performed GAP analysis of 4010 and 5010 EDI transactions 270, 271, 276, 277 and 999 using implementation guide to identify the changes in the segments and data elements.
• Completed a review of existing documentation for orders, referrals and reports and compared it to the clinical details needed for ICD-10.
• Assisted in writing test case scenarios for unit testing, integration testing and compliance testing.
• Involved with ICD-10 implementation testing.
• Extensively worked on Facets, the claim processing tool used in the project.
• Involved in configuration of Facets Subscriber/Member Application group.
• Analyzed the member/eligibility information on claim to that in Facets.
• Worked on Facets to efficiently execute core administrative functions, including claims processing, premium billing and customer service.
• Worked with SME close to analyze the Claim Adjudication Process setup in Facets.
• Worked with Claims, enrollment, eligibility verification for members and providers, benefits setup, and backend payment cycle in Facets.
• Gathered requirements from the user and prepared functional specifications along with data flow diagrams for the Member/Group configuration, Enrolling subscribers and members, Configuring different sections of members like Eligibility, Address, Medicare and Claims data.
• Assisted with user testing of systems and maintained quality procedures and ensured appropriate documentation is in place.
• Proficient in Business Process Modeling for representing processes of an enterprise, so that the current process may be analyzed or improved.
• Created Business Process Modelling workflows for projects using Microsoft Visio.
• Assist end users and IT staff in the use of data to satisfy informational and reporting requirements and implementing and using SQL and DBMS(Data Base Management System).
• Facilitating Sprint planning, Daily Scrum, Sprint Review, Dev validation/ Story estimation, defect prioritization, retrospective as Scrum master for 5 Scrum teams.
• Work with stake holders / product owners to prioritize the User Stories for Sprint.
• Allow the User Stories into the Sprint based on team velocity and individual capacity.
• Coaches and mentors Agile team members coached 5 teams (total of fifty four team members).
• Motivated the team to come up with quality shippable product and meet the product goals.
• Working with Product owner On Artifacts Such as Product Backlog, Spring Backlog, Sprint burn up / Burn-down, and Release Burn up / Burn-down.
• Help the product owners to come up with set of stories for better understanding for estimate and development.
• Co-ordinate with release team to align the UserStories with release schedule.
• Review User Stories written by Junior Business Analysts and provide constructive feedback.
• Lead group of 6 Business Analysts for Profile team and define process around breaking down features into independent User Stories.
• Conduct User Story estimation meetings on epic level as well as story level.
• Creating a story board which will provide the User Stories on which a BA is working for the future projects.
• Assisted in monitoring ancillary data transactions and addressed problems with HL7 messages.
• Performed manual testing, including validation/smoke testing of HL7 interface messages on each new build before delivering to the quality assurance team.

Environment: MS-Project, Visio, Rational Rose, Requisite Pro, Clear Quest, QC, QTP, Oracle, Facets, Agile.

Confidential, Austin, TX

Business EDI Analyst

Responsibilities:

• Involved in Inception Phase and prepared vision statement and initial data models that contain Business Requirement Documents and supporting a document that contains the essential business elements and detailed definitions.
• Propose strategies to implement HIPAA 4010 in the new MMIS system & eventually move to HIPAA 5010.
• Working with clients to better understand their needs and present solutions using structured SDLC approach.
• Worked with DHS data and data systems including MMIS and MAXIS.
• Worked closely with the Enterprise Data Warehouse team and Business Intelligence Architecture team to understand repository objects that support the business requirement and process.
• Work with CMS business owners to define their target goals and propose alternative business solutions
• Provide technical, business, management expertise, and support the Department of Health and Human Services and Centers for Medicare and Medicaid Services \(CMS\) in building and maintaining a comprehensive enterprise architecture program
• Experience in CMS and MMA Guidelines.
• Strong knowledge of managed claims management process, Knowledge of Medicaid and Medicare Services. CMS, Health Assessment Systems, HL7 Standards, HIPAA, PPACA(Patient Protection and Affordable Care Act), Compliance issues, LO INC and SNOMED Mapping, HL7 Message Validation, ICD 9, Electronic Health Records(EHR), Electronic Medical Record (EMR), Invision to Epic, E-gate Monitoring, Orion Rahposdy.
• Familiarity with a requirements management tool like MS Team Foundation Server, JIRA or the like
• Helped lead the transition of Requirements Management in the Business Analyst Team to the agile methodology by creating and managing user stories and Requirements Traceability Matrices in the JIRA toolset.
• Report on project status to appropriate project management chain using Jira
• Participate in projects when assigned infrastructure tasks in Jira
• Document and track application failures and bugs using tools like Jira and Confluence.
• Expertise in the EPIC Medical software application (EMR, HER) as it relates to hospital workflows and setting up the infrastructure for a software implementation in a clinic environment.
• Currently leading, coordinating EMR/EHR (iHelix Suite) implementation to achieve meaningful use stage 1.
• Performing business analysis, software validation and testing for client/server, multi-tier and web-based applications for EMR and commercial business for managed healthcare plans and Industries
• Testing the accuracy of iHelix inpatient EMR for Stage 1 meaningful use clinical quality measure calculation by using Cypress tool.
• Created job schedules to automate the ETL process.
• Prepare the document for Claims Editing & Resubmission and verify the backend process to resubmit the claim by transferring correct X12 files
• Accurate processing of Medicare claims using the Diamond system
• Gathered user and business requirements through open-ended discussions, brainstorming sessions and role-playing.
• Responsible for integrating with Facets .Designing test scripts for testing of Claims in Development, Integration and production environment.
• Designed and development of test cases based on functional requirements for Institutional and Professional claims for EDI and HIPAA Transactions 837/835, 834, 276/277, 270/271 testing.
• Troubleshot the designed jobs using the DataStage Debugger.
• Tuned DataStage transformations and jobs to enhance their performance.
• Wrote PL/SQL statement and stored procedures in Oracle for extracting as well as writing data.
• Used the DataStage Director and its run-time engine to schedule running the solution, testing and debugging its components, and monitoring the resulting executable versions on an ad hoc or scheduled basis.
• Designed DataStage ETL jobs for extracting data from heterogeneous source systems, transform and finally load into the Data Marts.
• Worked with Cognos and micro strategy reporting systems to extract the data for analysis using filters based on the analysis.
• Prepared Demo on SharePoint for various Business to get new approvals like the Therapist and Nursing divisions.
• Designed workflows and allocated permissions within SharePoint.
• Wrote detailed specifications for various reports generated using Cognos
• Analyzed data and created class diagrams and ER diagrams for designing databases.
• Performed felid-by-field mapping of interface between parent EMR system and downstream system.
• Planned and defined Use Cases created Use Case diagrams, Scenarios and Use Case Narratives using the UML methodologies.
• Responsible for gap analysis in changing old MMIS and Involved in testing new MMIS. Also, accountable for Medicaid Claims Resolution/Reimbursement for peach state health plan using MMIS.
• Responsible for designing and developing universes for development of reports using business object designer
• Used Query Analyzer, Execution Plan to optimize SQL Queries.
• Query optimization using SQL Profiler and performance monitors to enhance the performance of database servers.
• Converted various SQL statements into stored procedures thereby reducing the Number of database accesses (since Stored Procedures passes the whole block at one time.)
• Created Activity Diagrams, Sequence Diagrams and ER Diagrams.
• Created Mock-up forms in MS word for better visualization and understanding of the software solution.
• Analyzed the test results from QA teams using Performance Studio Analysis to create various scenarios.
• Developed strategies with Quality Assurance group to implement Test Cases in Test manager for User Acceptance Testing.

Environment: Java, J2EE technology, Windows 2000 Advanced Server, Liberty,UNIX / Oracle Platform, MS Visio, RUP, UAT, Rational Rose 2002, Rational Clear Quest, Rational ClearCase, Rational requisite pro, rational test manager, Rational Robot.