SUMMARY

• Business Analyst in Healthcare domain with 5+ years of experience in business process analysis/modelling, business requirements gathering, database design and development of Web Based, and Client/Server applications, with hands on experience in Healthcare Sectors.
• Expertise in Business Process Reengineering in Health Care Sector with prime focus on claims adjudication, provider, member, eligibility and prior authorization for Medicaid and Medicare programs.
• Experience with healthcare system, Medicaid and with prime focus on claims adjudication, provider, eligibility, and prior authorization.
• Adequate knowledge in Health Administration - Claims processing (auto adjudication), COB, EOB/Drafts, Claims pricing and testing, HIPAA, enrolment, EDI, Medicare, Medicaid, CDHP (consumer driven health plans)
• Having good experience in design experience, IVR application, requirements collection, and design documentation
• Experienced in SDLC methodology for Agile Scrum and traditional Waterfall. Well versed with agile ceremonies and agile tools (JIRA, RTC). Worked with clients and business SMEs to create business (BRD) and functional (FRD) requirements including work break structure (WBS). Analyzed the business processes and mapped to SAP functionality.
• Comprehensive knowledge of business Analysis methodologies like Iterative Software Development Life Cycle (SDLC) including Waterfall, Rational Unified Process, Agile, SCRUM, Safe.
• Excellent knowledge of HIPAA standards, EDI (Electronic Data Interchange) Transaction syntax like ANSI X12, Implementation and Knowledge of HIPAA code. Expert in Performance Tuning of complex T-SQL Stored Procedure, SSIS Packages, Power BI/SSRS Reports.
• Well knowledgeable in Requirement Gathering, Analysis, Design, Development and Implementation of Enterprise solutions and JAD sessions for requirements gathering, creating data mapping documents and queries.
• Strong knowledge of the Software Development Life Cycle methodologies (phases and gates) like Agile and Waterfall models.
• Experience in facilitating Joint Application Development (JAD) sessions, Rapid application development (RAD) sessions, conducting user interviews and acting as a liaison between the customers, development team and testing team.

TECHNICAL SKILLS

Business Skills: Business Process Analysis & Design, Requirement Gathering, Use Case Modelling, JAD/JRP Sessions, Gap Analysis and Impact Analysis.

Project Methodologies: Agile-SCRUM, Waterfall, Kanban.

Business Modeling Tools: MS Visio, Figma, CyberArk Celestial Domain.

Document Management Tools: JIRA, Confluence, Azure DevOps, Salesforce.

Project Management Tools: MS Project, SharePoint.

Operating System: Windows, Mac, UNIX.

RDBMS: Oracle, SQL Server, MS Access.

Programming Skills: SQL, HTML, XML.

Business Applications: Microsoft Office Suite - MS Word, Excel, PowerPoint, Outlook, MS Teams.

PROFESSIONAL EXPERIENCE

Confidential, MN

Business System Analyst

Responsibilities:

• Identified the scope, business objective and documented the functional requirements for each release.
• Directly involved in process improvement Plans and implementing business change.
• Write SQL queries, analyze the data, and perform data migration processes.
• Data mapping, logical data modeling, used SQL queries to filter data within the Oracle and Sybase.
• Produced clear user manuals & training guides for User Acceptance Testing (UAT) and deployment for end-clients with step-by-step instructions and appropriate GUI screenshots.
• Involved in Validation of HIPAA/EDI for 270/271, 276/277, 837, 837i and 835 claims used for professional, Institutional and Dental billings by Writing Test cases, Test Plans.
• Create and maintain documentation as it relates to system configuration, mapping, processes, and service records.
• Working on exporting reports in multiple formats including MS Word, Excel, and PDF template mapping.
• Designed the total revenue cycle management solution, such as professional billing and claims, remittances, and charge routers.
• Interacted with the development team on regular basis to ensure and balance practicalities with innovative and efficient business systems solutions.
• Successfully used Agile/Scrum Method for gathering requirements and facilitated user stories workshop.
• Facilitated JAD sessions for requirements gathering with the business and IT to create business required documents.
• Prepared high-level logical data models and Business Required Document (BRD) and supporting document containing essential business elements, detailed definition, and description of the relationship between the actors.
• Created 837 claims and maintained data mapping documents about HIPAA transactions primarily 837, 834, 835, 820, 270, and 271.
• Used JIRA to create and maintain User Stories and created UAT test scripts.
• Involved in creating documents and diagrams for Membership Enrollment according to the HIPAA 834 Compliance Standards for Membership Enrollment.
• Developed and executed SQL queries against data warehouses to support data mapping and ad-hoc analysis.
• Executed test cases for the existing market’s various lines of business. (The test cases covered: Authorization of claims, Accumulator, Benefits, Claim Payment, and Pricing, as well as a member and provider data updates).
• Conducted and Participated JAD sessions to gain consensus on various issues related to the project. Acted as a facilitator on different occasions.
• Held regular meetings with the Business users and SME’S to priorities the business Requirements.
• Used Rational Requisite Pro for overall Requirements Management and to build the Requirements Traceability Matrix.

Confidential - Silver Spring, MD

BUSINESS ANALYST

Responsibilities:

• Conducted Interviews and JAD sessions with SME’s and stakeholders to understand the business requirements.
• Gathered and created Business Requirement Documents (BRD), performed cost-benefit analysis with Project Manager.
• Conducted GAP analysis and Impact Analysis and prepared an Implementation and Recommendations Report communicated to the stakeholders.
• Worked in Agile/Scrum for gathering requirements and facilitated user stories workshop.
• Worked with Development and DBA team as well as System Integration Testing team to collaborate results analysis on Conversion User Acceptance Testing (UAT) and related issues
• Detailed analysis and review current SAP Logistics applications, design and business process and system configuration.
• Proposed pricingconfigurationchanges in accordance with client and state reimbursement methodologies
• Gathered requirements and developed process flows and evaluated the impact of proposed changes.
• Worked on Data mapping, logical data modeling used SQL queries to filter data within the Oracle database tables.
• Assist and interact with allRevenue Cycle Management (RCM)teams to resolve database or client issues.
• Created Functional Requirement Documents (FRD) based on the signed-off business requirements.
• Created and maintained a Requirement Traceability Matrix (RTM) to see if all the requirements are being captured and are being worked on.
• Worked on different Enterprise Data sources like PDF Template mapping, Data Mapping, Flat Files, and Teradata
• Performed Requirements Gathering and Analysis, interviewed the SME (Subject Matter Experts), and ensured that contributors and all key stakeholders were motivated to complete assigned tasks.
• Imported data from SQL Server and Excel toSASdatasets.
• Performing system configuration based on the requirements
• Worked extensively with IT team on building the architecture and underlying logics of the system.
• Implemented manual test cases for each sprint task and executed them using Soap UI
• Executed UAT testing for appropriate modules
• Work closely with application design managers and directors to test the migration of a DB2 database to a SQL database.
• Development of source data profiling and analysis reviewed the data content and metadata would facilitate data mapping and validate assumptions that were made in the business requirements.
• Attended frequently scheduled meetings to identify any tasks or user stories that are “at risk” and provide necessary support.
• Extreme involvement in production and development phase to report out to the stakeholders about the status of the project.
• Created test plans and scripts, facilitated user acceptance testing and tested strategies with developers and testing team.
• Performed Backend testing on Membership Enrollment and various functionality

Confidential - Watertown, MA

Responsibilities:

• Responsible for developing in-house application comparing data from different sources i.e., EDI, XML.
• Performed requirements gathering and analysis; interview the subject matter experts, stakeholders, and executive sponsors.
• Interacted with the business analysts & business users for design & requirement clarification for external projects & change requests.
• Gathered requirements for different products and do the gap analysis for the products.
• Worked closely with business users, in-house technical team, and external vendor to conduct data mapping and migration, system configuration/customization for the ERP system with help of team, introduced and implemented ERP system in the company.
• Authored Data flow diagram, sequence diagrams and business process models that describe how the EDI Health Care Claim Transaction set (837) is used to submit health care billing information and encounter.
• Recorded requirements and translate them into User Stories and work with stakeholders to gain approval.
• Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data within the Oracle database.
• Developed test plans and test cases, based on the information provided in the Business Requirement Documents (BRD), to ensure applications are almost defect-free before moving to production stage.
• Extracteddatausing SQL queries and transferred it to Microsoft Excel further analysis.
• Conducted JAD sessions to define the project and to reduce the time frame required to complete deliverables.
• Constantly interact with the Product Director for enhancements and discussion on the changes.
• Worked extensively with the QA team for designing Test Plan and Test Cases for the User Acceptance Testing.
• Facilitateddatamigration between databases using import/export facility inSAS.
• Modified the 834 file and then checked if the eligibility enrollment is properly loaded.
• Documented all the changes for the enhancements and recommended changes.
• Analyzed the current state and recommended changes for the future state of the products.
• Prepared and Reporting test cases for requirements.
• Developed Business Process diagram to understand the whole workflow.
• Facilitated the requirement changes and fixes along with the release management team.