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Senior Business Systems Analyst Resume

SUMMARY

  • Project Management Professional (PMP).
  • 13 years of experience in multifaceted roles requiring project management, scrum master, product owner, business analysis, systems analysis, solutions consultant and developer.
  • Prepared and maintained project plans and track activities against the plan, providing regular and accurate reports to customers and line management as appropriate.
  • Adept in managing various modules and delivering the knowledge solutions for business problems processes, carrying out analysis, finding gaps in processes, and devising a road map for enhancing applications.
  • 11 years of Healthcare industry experience.
  • Experience in Medicaid and Medicare Claims Processing, Eligibility and Enrollment.
  • Knowledge of Medicare, Medicaid, Worker’s Compensation, CHIP, HMO, PPO, POS, Managed Care products.
  • Knowledge of Electronic data interchange (EDI), HIPPA, 5010, 837,835,834,270,271, 276, 277, Claims, Billing, Payers, Providers, Remits, Medicaid, Medicare, FFS, Capitation, DIAMOND, FACETS, EPIC
  • Hands on experience in requirement analysis, system study, UI prototyping, handholding the technical team, testing, documentation and implementation.
  • Expertise in all phases of software development life cycle (SDLC).
  • Expertise in architecting, designing and development of healthcare electronic data interchange (EDI), enrollment, premium and claims applications.
  • Experience working with multi - disciplinary project teams (Developers, Architects, DBAs, QA, BSAs, and Sales).
  • Extensively worked on MS Visio, MS Excel, MS Word, PowerPoint, SQL, JIRA and MS Project.

TECHNICAL SKILLS

IT Compliance: SDLC, Agile methodology, Negotiations, Scope definition, Estimation, Planning, Configuration management, Task management, Risk Management, Escalation procedures

Technical Acumen: Java, SQL, Cloud Technology, MS Share point, MS Excel, MS Word, MS PowerPoint, MS Project, JIRA, MS Visio, RPA, OCR, AI, Work Front, Air Table, Dundas BI, SSRS BI

Systems Analysis: Data collection, BRD, PRD, Proposing solutions, Metrics collection & analysis

PROFESSIONAL EXPERIENCE

Confidential

Senior Business Systems Analyst

Responsibilities:

  • Led delivery of Data migration, API Integration, Single sign-On (SSO), MFA, BI, Robotic Process Automation (RPA) and Artificial Intelligence (AI) offerings.
  • Led JAD sessions with stakeholder’s and gathered business requirements.
  • Analyzed gathered data and developed solutions/alternative methods of proceeding.
  • Presented and provided clarifications on proposals, reports, or findings to stakeholders.
  • Consulted and negotiated with clients to prepare project specifications.
  • Managed the coordination and overall integration of SDLC activities in architecture or Engineering projects.

Confidential

Senior Business Systems Analyst

Responsibilities:

  • Led Mainframe Decommission Project for the Ratings team.
  • Responsible for Analysis of various product and rating systems in as-is state.
  • Documented findings of study and prepared recommendations for implementation of new systems, procedures, or organizational changes.
  • Managed agile SDLC practices and events, including sprint planning, retrospective, backlog refinement and estimation, and release planning. Identifies action items and tracks them to completion.
  • Ensured issues are identified, tracked, reported on and resolved in a timely manner using JIRA software.
  • Participated in reviewing test results and business sign off.

Confidential

Senior Business Systems Analyst

Responsibilities:

  • Led the support and administrator for ePREMIS and Claims Manager revenue cycle applications. These applications applies payer specific edits to claims from various HIS Billing systems to ensure compliant claims are being submitted to payers.
  • Led successful application upgrade of 8 versions of ePREMIS and 2 versions of Claims Manager.
  • Introduced methodologies and best practices that enhanced product definition, release processes and customization of applications to user needs.
  • Managed requirements, performed gap analysis, defect and issue resolution including documentation of test cases, test results, defects, modifications, and system issues/concerns.
  • Wrote Status Reports, Presentations, Emails and coordinated extensive communication network with the Business application Owners, Revenue cycle executives, Billers, PFS, System Integration team and vendors.
  • Performed SOX compliant activities for the applications.
  • Led regional revenue cycle meetings.
  • Managed new payer enrollment activities with the Clearinghouse.
  • Worked with the business partners to ensure high clean claims rate.
  • RCA (Root cause analysis) of denials and RTD’s (Resubmission Turnaround Doc).
  • Acted as a single point of contact for any communication to Clearinghouse.
  • Analyzed claims data in 837 files coming out of Epic system and in ePREMIS application to fix the issues.
  • Involved in ICD-10 project, including the analysis of changes to ePREMIS application and payer’s readiness.
  • Analyzed and updated ePREMIS interfaces for HIPAA 4010 to HIPAA 5010 changes.
  • Facilitated application training to over 200 end users.

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