SUMMARY

• Results - driven, versatile consultant with over 7+ years’ experience as a Business Analyst.
• Specialized in Healthcare, Insurance, Risk and Compliance, Document management.
• Good knowledge of Business Analysis methodologies, Iterative and Incremental Software Development Life Cycle (SDLC) using Rational Unified Process (RUP).
• Experience in Facets Configuration and Implementation for Healthcare and Dental projects.
• Proficient in gathering business and technical requirements from both formal and informal sessions through interviews, NetMeeting, questionnaire, video conferencing, JAD sessions and conference calls.
• Strong knowledge of Use Cases, Sequence Diagrams, Collaboration Diagrams, Activity Diagrams, and Class Diagrams.
• Experience in developing Test Plan and Test Cases as per the business process requirements to match the functionality requirements and UML diagrams.
• Possess very good organizational skills, with the ability to multi-task and deal with shifting priorities.
• Experience in Claims Processing and Claims Scrubbing in HMO,PPO,Medicaid and Medicare.
• Experience in EDI(270,271,835,834,837) transactions.
• Sound analytical and problem solving abilities.
• Worked on healthcare standards such as HIPPA 4010, 5010, DICOMM, CPT, ICD-9 and SOAP.
• Expertise in ICD-9 to ICD-10 Conversion.
• Working knowledge of healthcare Technology standards such as HL7, ANSI ASC X12, IHE XDS/XDM, HITSP, CCR(continuity of Care Record), CCD(Continuity of Care Document),NCPDP Script 8.1, ELINCS, and CDA.
• Knowledge on dealing with Standard Operating Procedures (SOPs), Test plan, Laboratory information management system (LIMS).
• Worked on various Professional billing and Hospital billing products.
• Experience in working with HHS, CMS or Medicaid Programs, RHIOs, IHDNs.
• Knowledge on medical necessities, software validation and healthcare compliance auditing.

TECHNICAL SKILLS

Methodologies: RUP, Agile, CMMI, CMM, Six Sigma, OOAD, UML, Business Modelling, Process Modelling and Data Modelling.

OfficeTools: MS Word, MS Excel, MS PowerPoint, MS Access, MS Project, MS Outlook, Lotus Notes.

Process/ModellingMS Visio, Rational Rose, Rational Requisite Pro, Smart Draw, ClearCase, Clear Quest.:

Testing ToolsTest Director, Quality Centre, Win Runner and Selenium:

Operating SystemsWindows Vista, NT/2000/2003/ XP/98:

Quality Management: HIPAA, CMMI, CMM, Six Sigma, TQM.

Languages: C/C++, Java, SQL, PL/SQL, HTML, XML.

Database: MS Access, SQL Server 2000, Oracle 9i & 10g, Teradata.

OtherTools: Macromedia Dream Weaver, Macromedia Flash, Labware LIMS, WATSON,LIMS and Adobe Photoshop.

PROFESSIONAL EXPERIENCE

Confidential - New Jersey, NJ

Business Analyst

Responsibilities:

• Understand the Business, Model and Products of Confidential .
• Created a Feasibility study report which was already conducted using the supporting notes provided.
• Created Vision and Scope document with all details of the project clearly mentioned.
• Worked on Member Management, Eligibility, Claims, and Provider modules within Facets.
• Worked onFacetsData tables and created audit reports using queries. Manually loaded data inFacetsand have good knowledge onFacetsbusiness rules.
• Tested the changes for the front end screens inFacetsrelated to following modules, test theFacetsbatches.
• We were the first team in the company to implement Requirements management plan and charter in the Project Planning Schedule.
• Analysed Impact of the project on the existing systems, other projects and documented it.
• Coordinated and conducted JAD sessions and one-on-one sessions as part of Requirements gathering process with Business Stakeholders and SME’s.
• Created overall high level process diagram and broke it down to individual process diagrams and flowcharts for use along with BRD’s and FRD’s using MS Visio, MS Project and MS Word etc.
• All Business and Functional requirements were uploaded in ALM tool for the testing and developing team to be able to view the same document, work or comment at the same time as a BA can.
• Coordinated with developing team located in Ireland over the phone in performing a gap analysis of the existing Billing system WISDOM and ICE and highlighted the functionalities required to be updated in ICE as in WISDOM or add more as the Business requires.
• Huge Integrations of the third-party systems for Billing presentment portal, Commissions Portal and Dynamics AR maintenance were incorporated into the process diagrams and flow charts.

Environment: MS Project, Microsoft Visio, Facets, Rational Rose, HP ALM and SQL

Confidential, MD

Senior Business Analyst

Responsibilities:

• Assist with creation and maintenance all necessary documentation and training materials for Epic Ambulatory application
• Performed analysis, design, development and maintenance of the Epic Ambulatory applications and other clinical information systems
• Experience with EPIC user and provider record provisioning, including the development of role-based access, security classes, and user profiles
• Experience in Epic Resolute product implementation and deployment
• Hands on experience with Epic Hospital Billing and Ambulatory
• Experience with Epic Healthcare Information Systems
• Conducted user interviews, gathered requirements, and analysed the requirements.
• Worked with the business team to collect the business requirements, security and service level requirements and documented them.
• Analysed set behaviour and contribution to business performance, critical business metrics & tracking underlying business trends using Business Objects.
• Working with different IT & Business groups to understand and determine the Impacts to the Data Warehouse and/or Data Marts for different projects
• Participated in the logical and physical design sessions and developed design documents.
• Designed new process flows for the existing system as well as for the enhanced system.
• Conducted and lead status report meetings with the business and the IT team on a weekly basis.
• Manage Scope and change throughout the life cycle of the product.
• Development and optimization of LIMS reports.
• Mapping and implementing Business Process change in the LIMS.
• Assisted in documenting and authorizing qualification protocols for installation of Labware LIMS
• Assisted in IQ, OQ and PQ testing protocols for Labware LIMS
• Assisted in developing Validation Strategy and documented in Validation Plan.
• Prepared Operational Qualification and User Acceptance Test Plans.
• Conducted Gap Analysis to demonstrate that LIMS System remains in a validated state in its life cycle.
• Supported integrating EDI batch processing and real-time EDI
• Recommend tactic to implement HIPAA 4010 (EDI X12 837,834,278,270) in the new System
• Responsible for conducting gap analysis as is to be for ICD9 and ICD10. Prepared Data Flow Models for code sets validating in Facets and Claim Process Engine.
• Worked with Facets edits and EDI HIPAA Claims (837/835/834) processing
• Worked on Electronic Confidential record system as a CRM web based application.
• Working Experience in Electronic Submissions in standard format E2B.
• Knowledge of regulatory issues including State, Federal, AABB, CAP, CLIA, and JCAHO

Environment: MS Project, Microsoft Visio, SQL, Labware LIMS, EPIC and Business Objects

Confidential, Hershey, PA

Business Analyst

Responsibilities:

• Analysis for making system compliant with HIPAA. Involved in making the Medicare patient profiles being compliant with the HIPAA regulations. Management of patient profile transfer (PPT) reports created by data team by verifying the associated data.
• Involved in analysis, design, and implementation of the following systems:
• Control Management Reporting and Security Systems: generation of daily, weekly, and monthly reports of hospital patients' activity. Medical Billing and Collection Systems: generation of daily billing activity based on patient records and establishment of collection protocols. Accounting Systems: Financial Statement generation and analysis according to government standards and protocols.
• Coordinated and conducted system requirements walkthroughs/sessions (JRDs/JADs) with business Owner/stakeholders/SMEs as well as design/development teams. Worked with business area SMEs/analysts to develop and finalize test plans/scripts/use cases. Analysis of key business requirements and assisted in the development of Business Requirement (BRS), Functional Requirement (FRS), and System Requirement Specification (SRS).
• Working knowledge of Epic Rx /Epic Lab/Epic Care Inpatient/ Confidential Information Management and Chart Tracking
• Experience with the use of clinical laboratory information systems within a medium to large clinical laboratory
• Experience with Epic Resolute Professional and Hospital Billing system experience
• Experience in a highly regulated environment (healthcare, financial, SOX, HIPPA etc.)
• Hands on experience on Mercury Quality Centre
• Member of the patient information reporting project team for analysing and designing responsible for analysing and designing a system that would improve reporting of patient data especially with relation to Medicare population.

Environment: EDI ANSI X12/HIPAA, UML, SQL, MS Access, MS Office, MS Visio and Rational Suite.

Confidential, MA

Business Analyst

Responsibilities:

• Analysing the existing policies and procedures and providing the inputs to Executive Management Team to fit into the compass project goals.
• Conducting JAD sessions with different Business Users to develop new policies and procedures for the Service Catalogue, Charge Capture and Service Work list /Charge Router, Hospital billing, coding, special coding requirements for BCBS and Claim processing.
• Performing GAP analysis between Meditech and Soarian application for the Data Migration and Conversion.
• Identifying the impacts and training the users on new policies /procedures changes.
• Developed Use cases, Test Cases for the Business users and QA team.
• Performing Impact analysis for readiness of ICD-10 conversion.
• Identifying the Security Risks in the application that being built and address them in the requirement document to avoid the security breaches.
• Improved the new revenue cycle management and Electronic Medical Record (EMR) for PARTNERS.
• Developed an implementation guide for Partners for EDI X12 transactions such as 834, 835,837,270 and 271.
• Worked with Facets Team for HIPAA Claims Validation and Verification Process (Pre-Adjudication)
• Designed the flexible solution for patient treatment plan and patient care plan.
• Designed the tight user authentication and application security.
• Modified Existing policies and procedures for patient access such as Enterprise Scheduling, Patient Check-in/Out and Encounter automation.
• Supporting the Business Users after go live.

Environment: MS Project, MS Visio, RUP, Rational Suite (RequisitePro, Clear Quest, Clear case), Facets, Blueprint, SQL, ETS and EDI ANSI X12/HIPAA. Meditech, Soarian.

Confidential, Bluebell, PA

Business Analyst

Responsibilities:

• Conducted detailed and comprehensive Business Analysis by working with end users and other stake holders to identify the system, operational requirements, and proposed enhancements.
• Facilitated Joint Application Development (JAD) sessions with all IT group members for communicating & managing expectations and to discuss various means for integrations with current system using an adoption through execution strategy
• Gathered business requirements from business users such as Insurance Policy Managers, credit card Managers and drafted business requirement specification (BRS).
• Co-authored Business Requirements Specification (BRS), Use Case Specifications, Systems Requirement Specification (SRS) and Change Request along with the Business Group and the IT project group members.
• Identified all necessary Business and System Use Cases from requirements, created UML diagrams including Use Case Diagrams, Activity Diagrams, and Sequence Diagrams using Microsoft Visio.
• Understood the Business Logic, User Requirements and test-objectives to develop Test plans, Test cases, Use Case Scenarios.
• Assisted in developing test scenarios, test scripts and test data to support unit and system integration testing.
• Involved in comprehensive testing of the system to check it satisfies functional specifications.

Environment: MS Visio, Rational Requisite Pro, RUP, UML, SQL, PL/SQL,MS Office, MS-Project, Windows 2000, Test Director

Confidential, IL

Business Systems Analyst

Responsibilities:

• Designed Test Plans and Test Cases for User Acceptance testing (UAT) with the help of QA teams.
• Utilized RUP to configure and develop process, standards and procedures.
• Interfaced with business users to prepare and update Business Process Requirements for the new release of Healthcare tools.
• Prioritized outstanding defects and systems problems, ensuring accuracy and deadlines were met.
• Worked with the management for improving and giving new ideas for designing future processes of the HIPPA transactions dealing out with EDI’S 271, 276 and 270, 470, 835, 837, 834, HIPAA 4010, claim adjustments, claim processing from point of entry to finalizing, claim review, identifying claims processing problems, their source and providing alternative solutions using best practice model and principles and also well versed with ICD10, Facets.
• In depth knowledge of Medicare/Medicaid Claims processes from Admin/Provider/Payer side which were later part of the training program to vendors.
• Performed GAP analysis of business rules, business and system flows, user administration and requirements.
• Tracked and maintained Stakeholder requested enhancements and changes using Requirement Traceability Matrix (RTM).
• Used the Rational Unified Process (RUP) to develop the different phases of Software Development Life Cycle (SDLC).
• Prepared Business process models; used Visio to create use case diagrams.
• Designed mock-up and wireframes to communicate visual data flow to the end users.
• Developed use cases, activity diagrams and sequence diagrams for a clear understanding of the vision document.
• Recommended corrective actions, if necessary, along with the progress against Development/Action Plan routinely to the Project Manager.
• Administered and coordinated User Acceptance Testing and obtain final system acceptance sign-off with the help of Program Manager.
• Conducted Risk Engineering to derive and execute action plans on time.
• Conducted Joint Application Development (JAD) sessions with stakeholders throughout SDLC to resolve open issues.
• Wrote SQL Queries in MS Access to sort data and analyse the large set of data during project life cycle.
• Used Rational Clear Quest for defects and bug testing.

Environment: User Acceptance Testing (UAT), Rational Unified Process (RUP), Rational Clear Quest, Joint Application Development (JAD), SQL, MS Access, Windows, Rational Test Manager, MS Office, Requirement Traceability Matrix (RTM).

Confidential

Business Analyst

Responsibilities:

• Gathered Business Requirements and wrote Business Requirements Document (BRD) by working with the IT staff and project managers
• Clarified Business requirements, business needs and project objectives, via feedback sessions and face to face meetings, in collaboration with all service heads.
• Translated Business requirements to functional and technical language with the help of Use cases and UML diagrams for developers.
• Documented various workflow diagrams like AS-IS and TO-BE processes.
• Interacted with the developers on resolving the reported bugs and various technical issues.
• Assigned Q.A. team members to develop test cases, browser requirements, functional analyses of online products, and worked with internal and external departments, content producers and service heads to conduct interim project reviews and final project weeks prior to launch.
• Developed test plans and test cases.
• Supported the Program Manager in balancing project goals and business needs
• Assisted the Account Management people in reviewing the Customer accounts.

Environment: Project Plan, project scope, use cases, sequence diagrams, production plan, SQL, Business Requirements Document, UML.