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Business Analyst Resume

St Louis, MO

PROFESSIONAL SUMMARY:

  • About 8+ years of experience as a Quality Specialist, Validation Analyst and Healthcare, Pharmaceutical and medical device
  • Experience in Process Development conducting Proof of Concept Studies, Design of Experiments (DOEs), Statistical studies and experience in Quality Assurance, CAPA, GAP analysis.
  • Extensive experience in Salesforce CRM, Good Exposure to Sales cloud and Service cloud.
  • Have performed testing in Salesforce Classic as well Lightning.
  • Expertise in working with various salesforce standard objects like Accounts, Contacts, Opportunities, Cases, Leads.
  • Experience in using of custom Tabs, custom Objects, custom Fields, Page Layouts, Workflow Actions and Approvals, custom reports, Dashboards, Visual Force Pages, Apex Classes, Controllers & Triggers and various components as per the client and application requirement.
  • Knowledge and Experience on Membership, Billing, Claims Payment Processing in relation to HIPAA, EDI 4010, 834, 837,835, and 270, 271.
  • In dept. knowledge of Software Development Life Cycle SDLC methodology such as Agile and Waterfall
  • Experienced in providing Medicare Operations support, with a focus on leading configuration activities for Medicare Part D operations as well as in Requirements Traceability Matrix (RTM) and test plan.
  • Efficient in writing Business Requirements Document, user cases, HIPAA, Use Case Specifications, Functional Specifications and Workflows.
  • Implemented basic SQL queries for testing and report/data validation
  • Experienced in client interaction, deep understanding of business systems functionality and technicality.
  • Strong Knowledge and experience of EDI transactions, HIPAA, ASC2 Transaction sets: 834 (Benefit Enrolment and Maintenance), 835 (Claim Payment/Advice, 837 (Claims and Encounters), 820 (Payroll Deducted and Other Group Premium Payment for Insurance Products) 270/271 (Explanation of Benefits (EOB) /Response to EOB), 276/277 (Claim Status/Claim Status Response).
  • Proficient in Developing and executing Test Plans, Test Case, FRD, TriZetto Facets 4.x and Medical Billing, Test Scenarios, also performing functional, usability testing and ensuring that the software meets the system Requirement.
  • Experience in developing project plan and estimating project timeline.
  • Excellent working knowledge in Project Life Cycle and clear understanding of Project Management.
  • Experienced in performing Gap analysis by identifying existing technologies, documenting the enhancements to meet the end - state requirements.
  • Conducted “As-Is” and “To-Be” business analysis, Cost benefit analysis, GAP analysis, Impact, SWOT, Root cause, Interface Analysis, ROI Analysis and Risk Analysis.
  • Organized, goal-oriented, self-starter, and ability to master new technologies manage multiple tasks while following through from start to completion.
  • Experienced in analyzing business requirement at all stages of Software development of life cycle SDLC.

TECHNICAL SKILLS:

Business Skills: Business Process Improvement, Business Process Analysis, Use Case Modeling, BPMN, Risk Analysis, Requirements Workshops, JAD Sessions, GAP Analysis, SWOT Analysis, Document Analysis, Impact Analysis.

SDLC Methodologies: Waterfall, Agile Scrum,SAFe, Kanban

Documentation Tool: Microsoft Word, Microsoft Excel

Collaboration Tool: Microsoft SharePoint, Confluence

MS Visio, Azure, Mock: up screens

Requirement Management: JIRA, HP ALM

Testing Tools: HP QC, HP ALM, Selenium

CRM Tools: Salesforce (SFDC)

Project Management tools: MS Project, Jira, HP Agile Manager

Databases: MySQL, Oracle, MS Access

Operating Systems: Windows, Mac OS, Linux

PROFESSIONAL EXPERIENCE:

Confidential, St. louis, MO

Business Analyst

Roles and Responsibilities:

  • Facilitated requirement gathering and brainstorming sessions with SME's User's in understanding the requirements pertaining to billing Origination to billing Processing.
  • Performed PEGA PRPC validations (Decision Tables, rules, roles)
  • Review test cases, prepare test plans and run defect triage calls
  • Responsible for providing Medicare Operations support, with a focus on leading configuration activities for Medicare Part D operations.
  • Participated in the designing of the Validation Master Plan(VMP) and Testing Criteria
  • Extensive knowledge of Medical Management Information Systems (MMIS) and HL7.
  • Preparation of test data based on access roles and rules
  • Actively involved in analyzing the business requirements to develop quality assurance test plans, test cases and test scripts.
  • Profound knowledge of EDI X12 standards in healthcare insurance
  • Verified accuracy of billing information and codes before processing Medicare and Medicaid forms, as well as other third-party insurances.
  • Worked with SME's and business users to gain in-depth understanding of the business' mission, objectives, purpose and processes.
  • Collaborated with the BA testing team to develop the test plan, test conditions and test cases to be used in testing based on business requirements, technical specifications and/or product knowledge.
  • Conduct project related Presentations periodically to the management and end users during various phases of Software Development Life Cycle SDLC.
  • Involved in the User Acceptance testing (UAT) to check the reliability for end users.

Environment: : SME,Pega, PRPC, MMIS, HL7, EDI, EDI X, Test

Confidential, Bethesda,MD

Business Analyst

Roles &Responsibilities:

  • Gather Business Requirements from the Subject Matter Experts (SMEs) and document the requirements in the BRD. Utilized data flow diagrams, use case diagrams and process flow diagrams to represent information provided by the Business Owners.
  • Performed Analysis of ICD 9 Procedure and Diagnosis Codes in accordance with ICD 10 CM and ICD 10 PCS Conversion Compliances.
  • Organize meetings and led JAD sessions to ensure legal and compliance deadlines of CMS (Centers for Medicare and Medicaid Services) are met.
  • HIPAA Conversion Analysis Involved in the documentation of HIPAA 5010 changes to EDI 837, 834, 835, 276, 277 Transactions.
  • Formulate system design, methods, procedures, policies and workflows affecting Medicare/Medicaid claims processing in compliance with government compliant processes like HIPAA/ EDI formats and accredited standards like ANSI.
  • Configured the Claim Processing in FACETS 4.51. Good knowledge about the workflow and backend Tables in Claim Processing.
  • Worked in Claims processing system for Pharmacy Benefit Management along with review, design and reconfigure of the FACETS in functional areas like Membership, Claims, provider, Enrollment and Service.
  • Effectively elaborated the Current process and gave a clear picture of the proposed process for the projects in the organization. Work aggressively towards timely completion of High Priority Tasks.
  • Performed Salesforce.com configuration activities creating Users, Roles, Profiles, Organization Wide

    Defaults, Permission, Sets, Public Groups and Queues.

Environment: HIPPA, JAD Session, ICD9, ICD 10-cm and pcs, EDI. Facets, workflow

Confidential, Danville, PA

Business Analyst

Roles and Responsibilities:

  • Followed agile approach of development throughout the project
  • Facilitated JAD session meetings with stakeholders (Medical Director, Laboratory Manager and Wellness specialists) and developers to perform Requirement Gathering & Analysis by actively soliciting, analyzing user requirements and prepared the requirements specification document for the solution.
  • Worked closely with Business Directors, Project Managers in various business areas to gather, analyze and document the requirements and supported the project manager throughout the development lifecycle.
  • Interviewed the stakeholders from different departments to identify their current needs and understand their Current Workflows and Ideal Workflows, to created process diagrams documented As-Is and To-Bebusiness processes.
  • Performed impact analysis during the project to manage requirements churn by checking the feasibility in maintaining triple constraints and discussing them in Daily Scrum Stand-up Meeting.
  • Ensured the compliance with HIPPA for electronic healthcare transactions.
  • Developed activity diagrams and sequence diagrams to analyze the requirements and recommend solutions.
  • Performed data analysis on Amysis database for membership related requirements
  • Involved in creating User Stories with acceptance criteria and documented acceptance scenarios to facilitate test driven development.
  • Generated UML Diagrams mainly, Use Cases, Activity Diagrams, and Sequence Diagrams to define the interactions between the user and the system using Microsoft Visio
  • Documented specifications for calculating scorecards based on biometrics results for wellness programs.
  • Assisted the technical team in translating application functionality into application architecture.
  • Participate in the bug review meetings.
  • Developed Test Plan, documented and executed test cases and reported the bugs in Quality Center.

Environment: Agile, HIPPA, UML, Use Cases, Bug, Director, Laboratory Manager and Wellness specialist,s user stories, As-Is, workflow,Microsoft, JAD.

Confidential

Business Analyst

Roles and Responsibilities:

  • Organized and facilitated JAD sessions to elicit the requirements and document the client requirements for the customization of the EHR andEDRdevices and converted the requirements into Business Requirements Document (BRD) and Functional Requirements Documents (FRD) as per the client’s requirements.
  • Interviewed the stakeholders from different departments to identify their current needs and understand their Current Workflows and Ideal Workflows, to created process diagrams documented As-Is and To-Bebusiness processes.
  • Worked closely with the PMO to develop the Project Plan and helped the SME’s in analyzing the reports for Project Execution. Was involved in requirements gathering with the clinicians and other healthcare practitioners
  • HIPAA 5010 and ICD 10 compliance check were carried out by developing a checklist of compliances.
  • Worked with the system architects in understanding and designing the User Interface as per the stakeholders needs by preparing a systems design document. Helped in Developing Functional and Technical Design Specifications
  • Assisted the Project Manager and the development team in understanding the requirements for developing generic (History of Previous Illness) HPI templates used to document each of the Chief Complaints
  • Actively documented theHPI templateswhichwere used by the patients with the diagnoses of bronchitis, otitis media, sinusitis, pharyngitis, and upper respiratory tract infection
  • UsedJIRA for Issue Tracking, user story management and Requirements Traceability weekly progress reports relating to the progress of the process were submitted to the Project Manager

Environement: EHR, EDR, As-Is, workflow, PMO, HIPPA, ICD, HPI, JIRA

Confidential

Technical support

Roles and Responsibilities:

  • Worked on 24/7 Technical and Customer support
  • Worked on High Priority tickets and addressed them within the SLA
  • Awarded for quality resolutions
  • Performed timely resolutions of Hi Priority tickets exceeding customer satisfaction .
  • Outstanding customer service/focus skills
  • Awarded twice for Highest customer satisfaction
  • Troubleshooting and handling technical issues.
  • Developed SLA based reports
  • Created trending reports for customer volume using Salesforce CRM .
  • Analysis on various trending as well as customer centric service level agreements( SLA )
  • Issue resolution, tracking and radiation of Hi Priority issues.
  • Troubleshooting and handling technical issues.
  • Handled hardware and software issues related to internet.
  • Configuring Modems, Routers, Laptops.

Environment: Technical support, SLA,troubleshooting,CRM, hardware and software

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