SUMMARY

• Business Analyst with 6 years of diverse experience in Health Care domain with exposure to innovative business processes and creating data mapping and data modeling documents.
• In - depth knowledge and experience in System Development Life Cycle (SDLC) with RUP, Agile and Waterfall methodologies.
• Expertise in creating prototypes and mock-ups for user interface designs with the use of Axure and MS Visio.
• Provides managed care coordination services to meet medical, behavioral health and social needs of member of Independent care Health Plan.
• Complete initials and annual assessments of member's medical, behavioral, and social needs in effort of establishing a careplan for the individual's needs.
• Ability to work on multiple project requests simultaneously while meeting tight deadlines.
• Developed Dashboards, reports and book of business using cube source data.
• Clear understanding of ICD-9-CM and ICD-10-CM/PCS and well versed with ANSI X12, HIPAA standards and strong understanding of EDI in 4010, 5010.
• Used Tableaufor the data / business predictive analysis, for trending, for finding the pattern of data over the period of time.
• Used HEDIS for researching data, data integration for quality improvement.
• Provided project management and analytical support to the Quality Improvement Department for the HEDISProgram.
• Extensively used Power Designer to create dataModels for relational and dimensional modeling.
• Good understanding of Normalization forms and database design methodology Expertise in using datamodeling tools like MS Visio and Erwin for logical and physical design of databases.
• Well versed with Data Mapping, data modeling from Facets to outbound eligibility extracts.
• Assisted System analysts in Claims Data migration and other ETL concepts.
• Deployed naming standard to the dataModel and followed company standard for Project Documentation.
• Worked at conceptual/logical/physical datamodel level using Erwin according to requirements.
• Coordinated with technical team in preparing dashboards using calculated fields, parameters, calculations, groups, sets and hierarchies in Tableau.
• Conducted analysis on key performance indicators (KPI’s) across all our operations to support monitoring of performance against all plans.
• Taking complex data and distilling it into relevant information, documents and/or presentations for use by various businessunits.
• Aligned BI requirements to overall company strategy.
• Excellent knowledge of MS SQL Server and Oracle and with Data modelling techniques.
• Experience in designing the data conversion strategy, development of data mappings and the design of Extraction, Transformation and Load (ETL) routines for migrating data from non-relational or source relational to target relational.
• Excellent command in writing complex routines for Data Validations, Data Extraction, transformation and loading to target decision support systems using MS Excel on various environments.
• Efficient in using MS Project/MS Excel for planning/status reporting/writing test scenarios.
• Experienced in writing SQL queries / joins using MS SQL Server and Oracle databases.
• Involved in analyzing and documenting various reports such as ad-hoc reports, drill-down, drill-through and parameterized reports.
• Experienced in creating test plans, test cases, test results analysis with the testing team and reporting defect management and test status matrices.

TECHNICAL SKILLS

Project Methodologies: Rational Unified Process (RUP), Waterfall, Agile (Scrum), BPMN

Business process modeling Tools: Business Process Analysis & Design, Process Improvement, Requirement Gathering, Use Case Modeling, JAD Sessions

Tools: and MS office tools: Microsoft Office Suite, Microsoft Project, Microsoft Front Page, Microsoft SharePoint, Microsoft SQL Server, Tableau

Project Tracking Tool: JIRA, HP QC ALM, Rational Clear Quest, Rally

Content Management Tools: Content Management, Adobe Experience Manager, SharePoint, Decision Support System

Testing Application/Tools: Oracle TOAD, HP Application Lifecycle Management (ALM), HP Quick Test Professional (QTP), ERWIN

PROFESSIONAL EXPERIENCE

Confidential, Norfolk, VA

Business Analyst

Responsibilities:

• Involved in creating functional requirements specification (FRS) for the design, development and implementation of the project.
• Designed future state processes for HIPAA 5010 transaction processing EDI's 837 and 835.
• Analyzed HIPAA 5010 related to 837,835, 834 transactions and performed GAP analysis between HIPAA 4010 and 5010.
• Performedseveral levels of testing of the conversion from which included syntax verification, balancing of the segments, situational cases and verification of the loops as per the guidelines of the implementation guides and companion guides.
• Conducted meetings and JAD sessions withbusinessusers and other stakeholders.
• Assessed flaws in existing "As-Is" system and made clear recommendations ofBusinessProcess Improvements and incorporated them in "To-Be" future system.
• Worked with the end client for user acceptance testing and obtained final system acceptance sign-off.
• Created the templates for test plan, test cases and process flow diagrams.
• Analyzed, defined, documented and communicatedbusinessrequirements to technical architects, developers by interacting with the end customers to meetbusinesspartner's needs.
• Developing Attributes, Facts, Metrics, Filters, Prompts and Hierarchies as per Specifications for developing reports.
• Preparing Report Mapping Documents as per Specifications.
• Actively involved in gathering requirements from end users, involved in modifying various technical & functional specifications.
• Validating the generation of EDI 834 files and validate the entries, loops and segments are in correct format.
• Developing detailed cutover task plan for EDI implementation. Coordinated functional integration testing with EDI subsystem team through best practices, standards within EDI capabilities.

Environment: Waterfall methodology, MS Project, MS Visio, UML, Rational Rose, MS Office Suite (Word, PowerPoint, Excel), Oracle

Confidential, Pasadena, CA

Healthcare business analyst

Responsibilities:

• Develop business process models for projects and demonstrations at the Centers for Medicare and Medicaid (CMS) using business process model notation and enterprise architecture.
• Worked extensively with developing business rules engine enabling the business rules such as referral, prior authorization, eligibility, claims processing and billing essential.
• Utilized Agile Software Methodology using Scrum framework. Actively participated in creating the user stories and prioritizing user stories along with tracking of burn up, burn down charts to estimate sprint delivery.
• Manage company's EDI catalog for prospective EDI customers.
• Experience in ICD9-ICD10 conversion and expertise in forward and backward mapping using GEM.
• Involved in HIPAA 5010 gap analysis of ANSI X12 4010 and ICD 10 initiatives.
• Gathered the Requirements for Medicare Systems as part of Patient Protection Affordable Care Act (ACA).
• Implement new services and programs via MMIS for the Medicaid program by directly interfacing with the customer and the system engineers on a regular basis .
• Wrote user acceptance testing (UAT) scripts and led testing/ quality assurance for both HL7 ADT interface and the application.
• Developed a work plan that ensured RFP would meet federal prior approval requirements including use of modular project development, compliance with MECT, MITA, HIPAA and other federal guidelines
• Creating documentation such as BRDs and FSDs (Business and Functional design specs) with elaborate UseCases and process flows
• Worked on FACET claim processing system and gathered and documented functional requirements in the Functional Requirements Document (FRD).
• Performed GAP analysis by performing the system analysis between the scheduling systems and documented the gap items.
• Analyze and document Medicaid EDI transactions issues related to implementation of HIPAA 5010 and ensure these issues are documented and addressed in the approach to the HIPAA 5010 version.
• Conducted JAD sessions, meetings, workshops to gather requirements from various stakeholders and SMEs.
• Prepared Business Requirements Documents, Functional Requirement Documents.
• Worked on analysis of FACETS claims processing system and gathered requirements to comply with HIPAA 5010 requirements.
• Facilitated all Aspects of scrum framework, including product backlog, release backlog, sprint planning session, daily scrum meeting, sprint reviews and sprint retrospectives.
• As scrum master communicated dependencies and potential risk to the completion of the sprints including resources, costs and systems.
• Created data mappings to transform the data according to business rules.
• Developed Test Cases for unit testing, prepared spreadsheet for testing criteria, including regression, positive and negative testing, process flow testing and screenshot for test results to complete expected and actual results.
• Prepared various diagrams by using MS Visio.
• Prepared documents for the wireframe and prepared a data dictionary for the same
• Managed testing for various functionalities using Quality Center tools.
• Worked closely with QA and Developers to clarify/understand functionality, resolve issues and provided feedback to nail down the bugs.
• Maintained a close and strong working relationship with teammates and management staff to achieve an expected QA result for the project team.
• Conducted project related Presentations periodically to the management and end users during various phases of Software Development Life Cycle SDLC .

Confidential

Sr. Data Analyst

Responsibilities:

• Responsible for envisioning and architecting the enterprise-level Identity and Access Management Infrastructure initiative, addressing the need for compliance with the HIPAA regulations pertaining to security and privacy of patient health information.
• Participated in Facets Table data modeling; planning, designing, implementation of the data warehouse and conducted testing by developing complex SQL queries.
• Document and communicate changes throughout the user organization, supporting Information System Change Management (ISCM) and compliance.
• Ensure that PQRI quality measures reporting are accurate in review of a claim or incident report in QualityNet.
• Reviewed EDI companion guides for all payers to ensure compliance, edit integrity and maintain up-to-date list of payer contacts.
• Responsible for executing User Interface Testing, System Testing, Data Quality Testing on the configuration design and prototypes.
• Conducted user interviews and documented business and functional requirements. Assisted quality assurance team to functional-test the new HL7 interfaces always keeping in mind HL7 and HIPAA guidelines, and coordinated user acceptance testing using derived test data.
• Tested the HL7 File formats received from different Vendors & validated the parsing and Data Loader (BizTalk, SSIS Process) functioning using SQL Statements in the backend.
• Developed and Enhanced Electronic claims processing screens and programs for Online editing and Claim entry in CICS.
• Use Adobe Captivate tool to create Web Based Training materials for Client’s App System.
• Involved in mapping data from different EDI files onto database using different routing transformations.
• Involved in testing QNXT Member, Provider, Claims Processing, and Utilization Management, Contracts, and Benefits modules.
• Analyzed the root cause analysis for batch job failures and online application failures and take the appropriate action to avoid the batch delays.
• Defined, developed specs for federal reporting specific to Medicare Advantage. Contributed to software process-reengineering efforts aimed at evolving previous software development practices to adopt Lean/Agile and Scrum practices.
• Assisted JAD sessions to identify the business flows and determine whether any current or proposed systems are impacted by the EDI X12 Transaction, Code set and Identifier aspects of HIPAA.
• Execute timely completion of quarterly reviews and annualSOXaudits by cooperating with external auditors
• Managing overall testing process and project to production change management life-cycle.
• Participated in preparation of root cause analysis (RCA) documents
• Selected as core team member tasked with developing and delivering Disaster and Incident Management Exercises at client sites, conferences and workshops.
• Preparing System Test Cases from functional and technical requirement and Use case documents and performing System Testing. Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data within the Oracle database.
• Consolidated the analysis of multiple business lines after the COTS evaluation.
• Prepared an ROI analysis report after evaluating the COTS product of the multiple business lines.
• Prepared Business Context Diagram, Use Case diagrams and corresponding Activity Diagrams using Rational Rose to depict the workflows to be incorporated into the development of page Business Process Management (BPM) tool.
• Created Source to target data mapping documents identifying key data elements and prepared Data Flow Diagrams
• Highly involved in data reporting, exchange, and archival, data conversion functionalities, validation programs, keyword resources, related products, services, and information
• Conducted User Interviews and Work Shops to gather accurate Business Requirements.

Environment: Rational Requisite Pro, AXURE, Adobe Captivate, Windows 7, .net, Oracle, PL/SQL, MS-Project, MS-Office Suite, MS Visio, UML, XML, QCARE, Quality Center.

Confidential

Business Data Analyst

Responsibilities:

• Regression Testing of Web applications and applications dealing with MEDICAID and MEDICARE Services
• Medicare Advantage plans work similarly to employer-sponsored health insurance plans, which may help you continue the same level of coverage you have now or be similar to ones you have had in the past.
• Conducted weekly meetings for deciding the Policies and Procedures to be followed while constructing new sites.
• Developed the strategy for developing and implementing new EDI (HL7 and X12) interfaces and converting historical clinical and data.
• Conduct complex documentation and user needs analysis. Interface with team and staff to develop HL7 integration
• Assisted JAD sessions to identify the business flows and determine whether any current or proposed systems are impacted by the EDI X12 Transaction, Code set and Identifier aspects of HIPAA.
• Prepared an analysis report based on the COTS evaluation.
• Conducted user interviews, gathering requirements, analyzing the requirements using Requisite pro
• Responsible for customer interface, requirements definition, general and detailed design, testing, maintenance and training programs and managed requirements using Rational Requisite Pro.
• Developed, implemented and executed test methodologies and plans to ensure software product quality as per the RUP methodology. Test some of the Extensions in Facets application manually.
• Medicare Part C plan also provides some of the extra coverage of a medical gap insurance policy.
• Conducted business-impact assessment and the results were compared with the new HIPAA 5010 standards to determine the current level of compliance and developed an action plan for approval by the project steering committee
• Developed plan for data feeds and data mappings for integration between various systems, including XML, to followICD 10Code set andANSI X12 5010formats.
• Test Data Generation for Quality Assurance using various testing tools like EDISIM or EDIFECS
• Create documentation and guides for set up, implementation, and testing of different Advanced Clinical Applications within MEDITECH.
• Defined Functional Test Cases, documented, Executed test script in Facets system.
• Utilized corporation developed Agile SDLC methodology. Used Scrum Work Pro and Microsoft Office software to perform required job functions.
• Wrote PL/SQL statement and stored procedures in Oracle for extracting as well as writing data.
• Involved in analyzing activities for a variety of major projects including Medicare Plan part D, Coordination of Benefits, New Client Implementations, Consumer driven and regularly scheduled system upgrades.
• Extensively interacted with the stakeholders and the IT Department in finalizing the requirements according to the CMS Compliances/Regulations and HIPAA Regulations.
• Assisted to develop the Test Plan, Test Cases and Test Scenarios to be used in testing based on Business Requirements, technical specifications and/or product knowledge.
• Prepared graphical depictions of Use Cases, Use Case Diagrams, State Diagrams, Activity Diagrams, Sequence Diagrams, Component Based Diagrams, and Collateral Diagrams and creation of technical design (UI screen) using Microsoft Visio.

Environment: Windows 7, HL7, Microsoft Office SharePoint 2007, Cognos, Data Connect, Agile, Rational Requisite Pro, MS Office, SQL Server 2008, Cobol, DB2, .net, MS Project, MS FrontPage.