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Sr. Core System Business Analyst Resume

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SUMMARY

  • Over 15 years of IT Experience with an emphasis on Business & System Analysis, Software Testing End to end, and Maintenance including 7 years of Operational experience in EDI application support.
  • Expertise on Legacy systems, Client - Server and Web Applications.
  • Extensive Experience in Commercial & MEDICAID Health care arena in following areas Fiscal Intermediary Shared Systems (FISS) Claims Processing, Common Edit Module (CEM) Front end edit processing including all HIPAA Transactions.
  • Requirement's gathering with extensive analysis for both mid-scale to large scale system development projects.(Including but not limited to Gateway Reengineering).
  • Proficient skills and noledge related to testing (System & Integration Testing, Regression Testing, UAT, Functional Testing and Volume Testing, Creation and execution of test matrix for both internal and external users).
  • Extensive experience in EDIFECS/Specbuilder, Cognos, Informatica, Infosys CMS, FTP SFTP, Mercator, Amisys, Pro32, Quality Center (QC), SQL query Management Practice Systems (MPS), GP.Net, TSOG (IBM Mainframe applications).
  • Proficient experience in handling On-Call support production support.
  • Extensive noledge of HIPAA Standards and Security.
  • Extensive noledge of 5010, ICD-10, Centers for Medicare Medicaid Health Benefit Exchange.
  • Proficient experience with interacting with trading partners and creating standard specifications for various inbound and outbound transactions using ANSI X12 4010 and 5010 standards.
  • Extensive experience in EDI transactions 837I/P, 835, 834, 820, 278, 270/271, 276/277, 999A/E, 277CA & TA 1.
  • Experienced in Data Analysis Techniques & Data Management Tools (MS Excel, SQL & Relational Databases)
  • Excellent root cause analysis, advised options, risks, cost benefit analysis and impact on other business processes and system priorities to clarify interdependencies, to ensure systems traceability of projects are accurate.
  • Experience with CAQH certification
  • Strong analysis, coding and design skills.
  • Excellent documentation and PowerPoint presentation skills
  • Highly advanced written and oral interpersonal communication skills, PC skills and problem-solving skills.
  • Proficient experience as Client management liaison for Provider Services, Provider Contracting and Reimbursement, Project management functions, managing multiple projects simultaneously and working with Developers / Testers via onsite and or offshore business models.
  • Over 15 years of consistent, excellent Customer Service/ Advocate Skills

PROFESSIONAL EXPERIENCE

Confidential

Sr. Core System Business Analyst

Responsibilities:

  • Troubleshooting cose system (IDX) errors for Business Units (Claims, Benefits, Medical Management, Pharmacy)
  • Testing specs for the systems that interface with IDX
  • Modification, Updating, Adding Creating Rules for Rule Banks
  • Modification, Updating, Adding Creating various Dictionaries
  • Facilitating meetings with both internal/external customers
  • Review current productions processes, and ensure documentation exist and is current with updates and versions.
  • Review current manual process to automate by replacing manual touch points with job scripting and scheduling.
  • Support business critical projects through the system development life cycle
  • Modify and maintain rulebanks for IDX (GE Centricity)
  • Maintain Dictionaries (Provider. Employer)
  • Implementation of New Document Generation Solution (Napersoft)

Confidential

Sr. EDI & SharePoint Programmer Analyst

Responsibilities:

  • Troubleshooting test and production issues for EDI and proprietary transactions
  • Point of contact for Centers of Medicare/Medicaid (CMS) regarding the Edge Server
  • Attend weekly CMS Edge server calls and work groups, communicating to upper management any issues that may require action
  • Responsible for all Preferred Provider Group (PPG) onboarding and testing
  • Requirements gathering for both internal and external customers relating to service requests
  • Managed communications between application users and vendors reporting to provider representative as needed
  • Review current productions processes, and ensure documentation exist and is current with updates and versions.
  • Review current manual process to automate by replacing manual touch points with job scripting and scheduling.
  • Support business critical projects through the system development life cycle
  • Remediate EDI processes to send and receive X12 file formats which contain ICD10 codes by the compliance date 10/1/15. Complete testing with inbound and outbound trading partners. Support the enterprise ICD10 project

Confidential 

Sr. Enrollment Accounting EMPO Business Analyst 

Responsibilities:

  • Create Business Requirement Documents (BRD's)specific to Medcaid/Medicare 834 (Enrollment)
  • Create and update Test Case Scenarios specific to Market Place Exchange for several states including but not limited to OH, FL,MI,
  • Gather and document Business requirements specific Subject matter Expert for Enrollment projects
  • Facilitated project review walkthroughs
  • Identified interfaces that need to be standardized and consolidated with timeline (immediate, future).
  • Participated in weekly conference calls with corporate Business Intelligence team to improve reporting functions
  • Gathered all impacted HL7 field information of each applications in to Impact Analysis document.
  • Tested the Business test case scenarios specific to 834 transactions.
  • Prepared GAP analysis, impact analysis, migration documents of the assigned application.
  • Collected purchase orders from applications to halp remediate all project related activities and submitted it to the legal team for approval.
  • Managed communications between application users and vendor and contacted application vendor as needed.
  • Raised change request and participated in Change Management as required (To perform testing on the production).

Confidential

Senior EDI HIPAA 5010 CEM FISS Business Analyst

Responsibilities:

  • Interpretation of CMS guidelines, mandates and quarterly updates for front end edits
  • Subject Matter Expert for Common Edit Module (CEM)
  • Analyze Medicare/ Medicaid requirements to effectively create ANSI 5010 transaction.
  • Gathering business requirements, per CMS change requests for 837 me/P, 276/ CA
  • Create test case scenarios that meet CMS guidelines as swell as creating fixes for code when issues arise.
  • Troubleshooting CEM edit issues to resolution.
  • Review and monitoring of test cases with in Quality Center.
  • Review CMS requirements on a daily basis, including but no limited to monitoring ECHIMP for updates, changes, modifications to CR's (Change Requests).
  • Participate in EIC or 3 and 5 day sessions, system related walkthroughs inquiring, documenting questions providing comments as needed.
  • Determine appropriate level of testing needed for each CR.
  • Perform CR analysis necessary to develop accurate, testable test scenarios.
  • Develop and maintain High quality Test Scenarios within Quality Center.
  • Work closely with seasoned testers for developing the detailed Test Procedures and Test Case Specifications.
  • Develop and maintain test documentation including Test Scenario Specification, Test Plan, and Test Case Specification.
  • Conduct BA/Tester meetings with Testers to present the test scenarios and answer questions.
  • Support defect management life cycle resulting no unresolved issues before implementation.
  • Attend (facilitate within STCCEM) POC review twice weekly including analysis and research of and distribution of POC drafts among delegated team members.
  • Contribute towards internal Software Quality Assurance Processes.

Environment: FISS production and beta testing, Soap UI, Quality Center, Sharepoint, .

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