Skills

Please use this table to list the skills noted in the Required/Desired section of the requirement. In addition, please respond with the years of experience for each skill and the last time each skill was used. Add or delete rows as necessary.

Employment History

Confidential

Senior Business Analyst

Responsibilities:

• Served as Communication Bridge between non-technical users and technical solution developers.
• Collaborating with project stakeholders throughout all SDLC phases to ensure timely delivery of specified business solutions.
• Implemented the Rational Unified Process RUP methodology of iterative software development with and developed user stories and dashboard for the system.
• Participated in the development of project plans, assessing business processes, working with business users and IT to develop system solutions and implementing the same.
• Recognize scope limitations and raise potential scope issues while designing the best system approach.
• 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.
• Collected Business Requirements and converted them to Functional Requirements in the Facets Platform.
• Worked with fellow business analysts in methodology for defining ICD-10mapping processes and documenting business requirements. Developed additional processes specifically designed to handle Benefits Administration.
• Extensively created test cases for the claims administration and customer service modules like subscriber/member enrollment, adding premium rates, claims, billing and recoveries. Third Party liabilities, benefits. Service authorizations, entity relations.
• Wrote Use Cases and used Use Case diagrams during analysis to capture the requirements diagrams and Sequence diagrams so that the development team and other stake holders can understand the business process.
• Assessed Electronic Medical Record Management System and performed GAP analysis using 'Tracer' tool between current Paper Medical Record and to-be Paperless Medical Record.
• Generated weekly reports based on results and used Sharepoint 2010 to store all Project Artifacts.
• Executed Change Management considering Requirements Traceability Matrix to determine areas impacted by HIPAA 5010 and ICD-10 related data.
• Constructed RACI Charts.

Environment: MS Office, RUP, UML, Power designer, SQL, SWOT analysis, Sharepoint 2010, Tracer.

.Confidential

Business/QA Analyst

Responsibilities:

• Identify the client/organizational needs and provide suitable agile system based solutions.
• Conducted JAD sessions and developed various strategies to distribute the work in team.
• Actively worked on Business requirement gathering, analysis and Data Analysis.
• Involved in interview sessions with end-users to gather information about business processes.
• Reviewed documents policies, manuals, business processes, systems documents, banners, bulletins from various divisions. Analyzed and performed Impact Analysis to determine areas impacted by HIPAA 5010 and ICD-10 related data
• Executed Change Management considering Requirements Traceability Matrix.
• Analyzed URS and Functional Requirements Specifications to understand business rules of application.
• Responsible for getting the sign-offs for BRDs, FRDs.
• Worked extensively on GAP analysis of 4010 and 5010 using 'Tracer' tool and used Sharepoint 2010 to store Project Artifacts.
• Created As-IsBusiness Models to understand the existing claim settlement process flow through interacting with SMEs, underwriters and Finance department.
• Responsible for the reviews for Functional Specs to development team and QA team.
• Transactions involved were Enrollment 834 , 835, 837I/P for HIPAA 5010.
• Created BRCs of EDI inbound and outbound transactions and mapped the provided data.
• Mapped ICD codes and prepared final result summary documents with reports.
• Designed and developed use cases, activity diagrams and sequence diagrams.
• Worked intensively with Medicare Medicaid claims for 5010 X12 transactions.
• Performed Regression Testing to ensure the product integrity.
• Reviewed Test specifications, Test cases and performed Manual Testing.
• Executed queries in test databases using SQL, PL/SQL queries.
• Validated data at the Backend to ensure that all the Claims related data has been loaded to the corresponding Data Sets in the Backend and the pricing for these Claims is done as per the Standards.
• Analyzed the results, generated reports and tracked the defects using Quality Center.
• Well versed with Claim processing from point.
• Used IBM Mainframes- Incremental Scripts foradding, updating and modifying Datasets and fields in back-end to be populated in front-end.
• Used SQL statements for Back-end testing.
• Performed User Acceptance testing, developed Test logs and opened/closed as and when the issue is fixed and Quality checked with the assumed company data with all the possible Test Scenarios.
• Proficient in working with HL7 messaging standards.

Environment: UML, Agile/SCRUM, HTML, XML, Toad, SQL Server 2008, UNIX, Subversion, Use cases,Quality Center 9.5, HIPAA 4010/5010, CVS, MS office tools and Visio, Tracer, Sharepoint, HL7

Confidential

Business Analyst

Responsibilities:

• Designed Use Cases, Use Case diagrams, Activity diagrams, Sequence diagrams in UML methodology using MS Visio.
• Conducted Joint Requirements Planning JRP sessions with management, SME's Subject Matter Expertise users and other key members for open and pending issues to develop specifications.
• Developed a set of best practices with regard to Part 11 remediation and have implemented innovative and cost effective strategies for achieving compliance.
• Provided all standard and ad hoc quarterly reports including data analysis and graphs.
• Prepared and maintained data for Core Measure reporting.
• Attended daily SCRUM and guided QA and Developer regarding the defects, Technical Specification Documents and Mapping Documents.
• Used Process log browser to view different types of log history files to figure out issues with 834 transactions.
• Builds and Runs Test Claims from subscriber information on NPS, working on those claims to ensure that they process through the system, and obtaining the results from the claim processes.
• Understood Functional/Technical Data Model flow of 4010 HIPAA Transactions and identify the new segments/element changes required with minimum changes to system.
• Worked on multiple 837 and multiple Eligibility 270/271 and healthcare claim status 276/277 .
• Developed an automated approach for capturing all 837 data received from GHI that supports claim utilization and reporting.
• Dealt with the EDI transaction -835 claims payments and remittance advice, which deals the payment from payer to provider.
• Dealt with 834 import member lookup processes and resolving issues with member attributes, enabling multiple rules associated with member lookup process.
• Worked with ICD 9 encoding to verify the validity of incoming claims documented ICD 9 codes presently used by the system.
• Participated in / facilitated data requirements definition e.g. extracts, sourcing, reporting and design sessions.
• Was responsible for the research and analysis of data requirements and issue resolution as they related to the design.
• Considered HIPAA rules while data validation and testing.
• Worked toward Healthcare Rewards, Incentive and wellness exposure.
• Determine which claim system to interact with to display data on the UI.
• Worked toward claim processing such as Claim Adjudication and Claim Reimbursement.
• Tracked Business requirement traceability matrix RTM and handled scope creeps.
• Compiled Vision and Scope documents to better define the rationale for the project. Gather requirements from business to determine the functionality that should be provided to the users.
• Constructed RACI Charts.

Environment: Mainframe, DB2, SQL Server 2005, MS Visio, Facets, Business Intelligence, MS Project, MS Office, SharePoint, UML.