We provide IT Staff Augmentation Services!

Systems Analyst Resume Profile

Professional Summary

PMP certified IT professional with experience helping clients plan for and implement enterprise-wide solutions to improve efficiency on medium and large-scale projects. Experience in conducting discovery sessions to identify, elicit and gather requirements from client stakeholders and translating them into system requirements to meet clients' needs as well as suggesting business process improvement opportunities. Along with Excellent collaboration and organizational skills along with strong work ethic and interpersonal skills, possess a thorough understanding of the software development life cycle and has extensive experience in creating business and technical artifacts, data and system analysis, issue resolution and functional requirement gathering

Expertise Summary

Healthcare Industry Expertise

Payer-provider relations and communication

Healthcare claims processing life cycle

Electronic Data Interchange EDI standards and X12 EDI transaction sets

Medicaid Information Technology Architecture MITA

Medicaid Management Information System MMIS

IT Systems Lifecycle Experience

Requirements gathering

Systems integration implementations

Custom software implementations

Change management

Data and system analysis

Software testing defect management

Work Experience

Confidential

Lead Business Systems Analyst

  • working for the State of Michigan's Department of Community Health MDCH on the ICD-10 initiative. The scope of the project is to ensure that the State's Medicaid System is compliant with the ICD-10 coding standards. Lead a team of three business analysts and four developers during requirements gathering, system development, UAT and strategy development sessions.
  • Part of the ICD-10 Assessment Team responsible for ICD-10 impact assessment. Accountable for the Care Management, Program Management and Program Integrity Management MITA business processes and deliverables
  • Working with the PMO to define the strategy, project methodologies and approach for ICD-10 assessment, requirements and testing activities
  • Drive process improvement with the PMO and play a key role in making sure that different business units are achieving quality goals every month
  • Acting as the business lead for industry wide collaboration activities on ICD-10 remediation with Healthcare Information and Management Systems Society HIMSS and Workgroup for Electronic Data Interchange WEDI
  • Worked with the Assessment Training team to develop the ICD-10 training plans for different support groups and with the ICD-10 end-to-end testing team to come up with the ICD-10 test plan and ICD-10 end-to-end testing strategy
  • Performed data analysis on ICD-9 and ICD-10 code maps and data sets. Worked with the medical administration and medical policy teams to identify risks and clinical scenarios based on the analysis
  • Developed strategy for comparative testing with the provider community working in collaboration with the medical administration and medical policy teams

Confidential

Senior Business Analyst

  • worked on the eBilling and National Provider Identifier NPI Team within the VHA Chief Business Office CBO . The team was responsible for reporting, tracking and resolving payer and provider issues related to NPI for over 900 facilities and 80,000 practitioners at the largest integrated Healthcare System in the country VHA .
  • Analyzed large amounts of healthcare claims data, track and report on those trends maintain data integrity across disparate information systems
  • Managed issues communicated regularly with VHA leadership. Provided detailed and high level reports on issues, risks, impacts, alternatives and resolutions
  • Guided VHA NPI data cleanup activities and instituted policies and procedures to keep clean data up to date. Maintained databases and assisted with extracts containing updated NPI information
  • Provided data management strategy on collection, maintenance, security, and dissemination of Personally Identifiable Information PII of healthcare providers
  • Facilitates resolution of NPI payer issues including legacy number cross-walking strategies and taxonomy code maps for both professional and institutional claims
  • Assists in development and implementation of agency-wide strategy around standardizing, obtaining and updating VHA facility NPIs, Tax IDs and Legal Business Names
  • Applied knowledge of HIPAA EDI Privacy Rules and Transaction Code Sets to resolve questions and issues from the field served as liaison between VHA facilities and their third-party payers troubleshoots with and educates VHA billing and payer relations staff
  • Provided VistA billing assistance specific to NPI for facilities throughout the country
  • Guided data management strategy on collection, maintenance, security, and dissemination of Personally Identifiable Information of healthcare providers

Confidential

Business System Analyst

  • worked on the HIPAA 5010 and ICD-10 projects. The project scope was to ensure that FEPOC became HIPAA compliant for the ASC X12N Version 5010 and to implement the ICD-10 changes across all sub-systems. Also worked as a business analyst for a strategic initiative to re-architect the claims processing system to support and enable component based, service driven architecture and enable the retirement of the existing mainframes based legacy system.
  • Coordinated and partnered with the project management for business deliverables including project status reports, change requests summary reports and prioritizing project outcomes
  • Organized and coordinated the Plan Summit where 20 different Plans across the country came to discuss the project status and implementation of HIPAA 5010 and ICD-10
  • Authored the Functional Requirements for FEP Express Messaging Services FEMS and conducted walk-through and validation sessions with SMEs, business owners, developers and the testing team
  • Created FAQ documents for HIPAA 5010 and ICD-10 to help create understanding about both projects across different groups in the organization
  • Conducted JAD sessions to resolve conflicts arising due to ambiguous requirements
  • Conducted validation sessions/walkthroughs with technical and business SMEs to identify and resolve open issues in the existing design document for technical logic additions/changes based on the dynamics of desired business flow and system interactivity.
  • Created the business rules and claim error documents to documenting he business rules for FEP Thin and defined/managed the change control process to handle revisions to the same
  • Responsible for defect analysis tracking after the code was moved to production

Confidential

Business analyst

  • worked on the project to revamp the existing portal implement a new knowledge management portal for the university intranet. Led a team of eight students and was responsible for resource allocation and assigning tasks.
  • Worked with user groups in various schools engineering, law, medicine, cinema, business to gather requirements categorized them into functional and non-functional requirements
  • Gathered requirements and created the use cases for authentication, online payments equipment management business processes along with creating the process flow diagrams traceability matrix
  • Involved in creating test plans, tests scripts conducted User Acceptance Testing
  • Analyzed and documented the compatibility issues of the existing system with the new knowledge portal
  • Worked with the User Interface team to create wireframes page mockups for the homepage, transactional page and the landing page
  • Created As is and To be documents to show the current and proposed functionalities of the system thereby assisting in the GAP Analysis
  • Documented and managed all the change requests from different user groups

Skills and competencies

  • Software applications: MS Office Suite, MS Project, MS Visio, Rational Rose, Rational Requisite Pro, Rational DOOR, Rational ClearQuest, Rational ClearCase, JIRA, HP Quality Center, MS SQL, Toad for Oracle, Altova XML Spy, TeamTrack
  • Project management and business analysis concepts methodologies: PMO support, project planning and control, request for proposal RFP , change control and management, statement of work SOW , cross-team communications, business development strategy, data analysis, system analysis, risk identification and mitigation, SDLC, UML Modeling, use cases, functional specifications documentation, data mapping and modeling, page mockups, wireframes, UAT, AGILE SCRUM

Hire Now