SUMMARY:

• Dedicated, results oriented Business/Systems Analyst professional with over eight years of Healthcare experience in Healthcare Insurance, Medical billing, Accounts Receivable, U.S. Health Insurance Portability, Accountability Act, EDI Transactions (834, 835, 837), HIPAA, MMIS, Medicare and Medicaid. Successfully bridged the knowledge and communication gap between Business and Technology channel groups in various situations. Able to work independently and as a team member. Experienced in auditing, analysis, research and resolution of contracted insurance and claim reimbursement issues in a timely manner.
• Expert of all the phases of SDLC, Scrum/Agile, Kanban Methodology throughout the project life cycle.
• Expert in Business Analysis, Project initiation, Scoping, Prioritization, Estimation, Planning, Executing, Tracking and Monitoring. Project timelines and Project milestones.
• Managed on - shore and off-shore teams of varying sizes to deliver high quality project deliverables.
• Experienced in conducting Daily Scrum meeting, Planning Sessions, Backlog updates, User Stories updates.
• Used Microsoft SharePoint as a Web-based Content Management System as well as a Document/ Project Management tool.
• Skilled in designing and preparing monthly status reports, assisting in corporate projects in health care, health economics model, and evaluating all clinical trial data.
• Experience in ensuring employers and workers comply with safety legislation and that safety policies and practices are adopted and adhered to.
• Experienced in healthcare revenue cycle, billing and claim process cycle (ICD-10 and CPT code), staffing/volume forecasting, ad-hoc business analysis, combine and utilize data from different sources (SQL database, MS Access, etc.), writing VBA scripts to aid accounting pro-forma reporting, create dashboards for operational, financial, marketing, human resource purposes.
• Expertise in gathering/eliciting business requirements, detailing, converting business requirements to technical requirements using different tools and techniques.
• Experienced in interacting with business users to identify their needs, gathering requirements and authoring Business Requirement Documents (BRD), General system Design (GSD), Functional Requirement Document (FRD) and Software Requirement Specification (SRS) across the deliverables of a project.
• Highly analytical in developing the methods and measures to meet requirements, handling Change Request, prevent scope creep and solve any issues that arise during the project.
• Ability to develop business rules, context data flow diagram, entity relationship diagram, workflow diagramming, prototyping and document current state, gaps and future state processes.
• Skilled in managing Feasibility Studies, Scope Documents, Requests for Proposal and end-user support documentation.
• Experience in utilizing SAS Procedures, Macros, and other SAS applications for data extraction, data cleansing, data loading and reporting.
• Logs the bugs in JIRA and assists the developers in the resolution of bugs.
• Experience creating Traceability matrix to better manage the requirement gathering process and keeping track of the milestones.
• Experience in visualizing the design of the system using UML diagrams, Activity diagrams, and Web page mock-ups.
• Executed SQL queries and documented them as part of validating the Business Object reports and for testing purposes.
• Experienced in working and supporting Project Management (PMO), Mentoring & Coaching the team and Problem solving.
• Detail-oriented Senior Financial Analyst with background leveraging extensive clinical experience with financial management and negotiation skills in clinical trial budgeting, leadership, accounting, analysis, and reporting.
• Experience with web application development, and SAS based clinical trials applications.
• Knowledge of HIPAA standards, EDI (Electronic data interchange) Transaction syntax such as ANSI X12.
• Extensive knowledge Qualified Health Plans (QHP), Health Insurance Exchange (HIX) and Affordable care Act (ACA).
• Worked with multiple Relational databases like MySQL, Oracle, Sql server and in depth knowledge in ETL tools (Pentaho, SSIS).
• Participated in Joint Application Development (JAD), brainstorming sessions, reviews, walkthroughs, and customer interviews to gather customer requirements.
• High degree of computer literacy in MS Office: Word, PowerPoint, advanced Excel skills (formulas, pivot tables, vlookup functionality), Visio, project, Access, and SharePoint for document sharing/collaboration.
• Proficient in developing & automating reports, iteratively build & prototype BI dashboards using Tableau to provide insights at scale, solving for analytical needs of business team.
• Managed reports, analysis and decision-making for change requests.
• Prepared status reports, SLA reports, performance metrics and scorecards.
• Experienced in conducting GAP analysis, User Acceptance Testing (UAT), SWOT analysis, Risk Analysis and mitigation plan, Cost benefit analysis and ROI analysis.
• Proficient in offering care, medical management, coordination, supervision and facilitating daily operations of medical offices & with the ability to excel in fast-pacetime-sensitive environments
• Strong analytical, problem solving and interpersonal skills; acquired credentials of medical profession having zeal to treat patients with empathy and compassion
• Outstanding communication skills, self-motivated and goal-oriented with a high degree of flexibility, creativity, commitment and optimism

SKILLS:

Use Cases, User stories, Requirement Gathering, Analysis, Gap Analysis, Test Cases, Test Plans, Unified Modeling Language (UML), Business Requirement Document (BRD), Software Requirement Specification (SRS) document, Functional specifications, SWIM Lanes, Data Warehousing, Business Intelligence, Data flow Diagrams (DFS’s), Waterfall environments, Agile, Scrum, Kanban, SWOT analysis, Acceptance testing (UAT), Reporting, Prototypes and Wireframes, MS Office - Word, Excel, PowerPoint, Outlook, Access, Project, Visio, Rational Unified Process (RUP), Water Fall Method, Testing Process Design and Implementation and OOAD, ERWIN, XML, HTML, Adobe Acrobat, Microsoft SharePoint, Trial Feasibility Assessment, Jira, Edifecs, ETL,Claims Auditing and Research, Payment Analysis, data modeling, data mining, Claims Reimbursement for Primary and COB payments, Overpayment/Underpayment Auditing, Medicare Secondary Payer and End Stage Renal Disease Reimbursement, Medicare/CMS Applications experience, Service Now, Claim Payment Methodologies experience, Medicare Secondary Payer and End Stage Renal Disease Reimbursement, Transplant Claims Reimbursement, HP Quality Centre, Win Runner, TOAD, Ultra Edit

TECHNICAL SKILLS & E XPERTISE:

Process Methodologies: RUP - Rational Unified Process, UML - Unified Modeling LanguageWaterfall, SAFe, Agile, Scrum, Six Sigma, CMMI, BPM

Object-Oriented: Rational Rose

Data-Oriented: Erwin

Universal: VISIO, Irise Studio

Quality Management: JIRA, Mercury Quality Center, Track Wise, VersionOne, RTC

Reporting: SSRS, Cognos, MSAccess, Irise Manager

Project Management: MS Project, Excel Spreadsheets

Change Management: Bugzilla, Clear Quest, SharePoint

Configuration Management: PVCS, CVS, Clear Case, SharePoint

Testing: SIT, UAT, Unit test, Rational Robot, Rational Test Director, Win Runner, Load Runner and Manual Testing

Requirements Tools: Rational Requisite Pro, Irise Manager

Languages: PowerBuilder, C, C++, Visual Basic, PL/SQL, HTML, Java, J2EE

Databases: Oracle (9i), MS SQL Server, MS Access, ETL, TOAD

Office Tools: MS Word, Excel, PowerPoint, Project, Outlook, Lotus

Business Intelligence Tools: Tableau, Cognos

Healthcare Expertise: Provider Domain, 834, 837, EDI, HIE, Claims, Credentialing, HIPAA

Healthcare Applications: EPIC, IDX, Meditech, MBE- Market Prominence, Centricity

Healthcare Tools: IDX, CARE, Centrix, APTA Connect, HealthQuest, Macess, Edifecs, CCMS, Claim Check, Wizard, and APEX, Allscripts, Peoplesoft, Centricity

IT SM/AM Tools: Service Now, HP Service Manager, HP Asset Manager

PROFESSIONAL EXPERIENCE:

Confidential, Moorestown, NJ

Business Analyst

Responsibilities:

• Enhancement related to pl/sql and sql for Oracle Clinicals (oracle product used by client for clinical trials)
• Business / Functional Analysis of the Clinical Data Management Applications (EDM, RDC (TAO-Trial Access Online), SMT, I-Review, PRS, IBISecg, DLS, PC Imaging, EmBARC) . The tools help to support the IT part of the Life Sciences (like Clinical Trail and Discovery)
• Involved in Order Management and Inventory Modules.
• Production support on OM, Advance Pricing, Inventory.
• Testing the New functionality related to OM, Purchasing, Advance Pricing, Inventory.
• Worked on Price Lists, Qualifiers, Modifiers, Pricing Attributes in Advanced Pricing.
• Responsible for requirement gathering, business process flow, business process modeling and business analysis.
• Facilitated JAD sessions with management, users and other stakeholders to define the project and to reduce the time frame required to complete deliverables.
• Conducted project kickoff meetings with team members to explain and assign roles / responsibilities, relationships with other groups, deliverable, timelines, assignments and status reporting.
• Created minutes of meetings and published to all stakeholders highlighting discussion points and pending action points.
• Performed as-is analysis, to-be analysis, data Analysis, Gap analysis, competitive analysis, comparative analysis, process flows and business flows.
• Used Jira for writing Epic, user stories with acceptance criteria or user stories with use cases, used Confluence for upload documents.
• Prepared BRD (Business Requirements Document), FRD (Functional Requirements Document) and N-FRD (Non-Functional Requirements Document).
• Reviewed the business requirements document with the business and development team to understand the architecture and functionality of the application.
• Understand user requirements and translate them to functional requirements/specification and assist end user with Epic request submissions obtaining team approval.
• Coordinated with system architects and developers to convert business requirements into system requirements.
• Worked on backlog grooming items and presented what items can be picked up in next sprint to the squad/scrum master.
• Participated in sprint planning with PM/Dev/QA to conclude the User Story points and the effort estimates.
• Used Definition of Done (DoD) as a checklist to verify whether all necessary value-added activities were completed, after a feature or sprint is done.
• Facilitate business requirements gathering sessions with the client, and manage the creation of Use Cases/activity Diagrams and Functional Specifications using Microsoft Visio.
• Conducts coverage analysis of clinical research trial procedures to delineate standard of care and research procedures; reaches out to research site to assist in determining charge direction.
• Assists in feasibility review process by gathering information from Recruitment Core, Pharmacy and Finance Core for budgeting purposes .
• During the Service Now implementation, I was involved in developing processes that support or interact with the Change Management process, Configuration and Asset management, Service catalog, incident and problem management.
• Exported and extracted HEDIS measures from NCQA certified SQL-based software into user-friend MS Excel formats.
• Implemented multiple ITSM modules:Incident, Change, Service Request, Asset, configuration, knowledge, problem, release, capacity, availability, and service level management.
• Created reading material for better analysis and explanation of system flows.
• Accurately forecast clinical trial timelines using advanced modeling and simulation techniques .
• Develops process for participation in the reporting and improvement of QCDR measures to fulfill PQRS reporting requirements.
• Reviewed statistical data on HEDIS measures and manages special projects that are related to disease prevention, and quality improvement.
• Collaborate with Clinical and IT staff to support HEDIS business requirements and maintain consistency and integrity of data collection and storage.
• Gathering user requirements and conducting in depth analysis of the same
• Used SQL query to analyze the Pfizer source systems and existing data warehouse data. Prepared data mapping documents to build the new data mart and Tableau reporting.
• Resolving the complex requirements into simpler fragments and conveying it to the technical team for faster and efficient development.
• Coordinated with Data Analyst, ETL and UI interface Developers and did tasks in construct phase.
• Generated and designed reports for HEDIS specifications to analyze complex data through internal databases.
• Reviewed Stored Procedures for reports and wrote test queries against the source system (SQL Server) to match the results with the actual report against the Data mart (Oracle).
• Conducts coverage analysis of clinical research trial procedures to delineate standard of care and research procedures; reaches out to research site to assist in determining charge direction.
• Educating external and internal users on the product and its usability.
• Preparation of process flow diagrams for reviews with clients.
• Participating in testing process and coordinating with QA team in each test cycle.
• Create and run analytical reports as needed using tools such as Reporting Workbench, Epic Cubes, BI Portal and other reporting tools.
• Assist in the co-ordination and management of various activities associated with clinical trial planning and initiation including clinical trial budget and agreement review, third-party vendors identification, and site/study feasibility assessment; among other responsibilities.
• Involved in Project co-ordination, Onshore/Offshore Co-ordination, optimal service delivery and Knowledge management.
• Submits ticket /issues in accordance with DFCI issue management processes. Escalates issues and ask questions to bring issue to closure, when necessary.
• Performed UAT and participated in writing test plans, and developed different testing strategies like black box testing and load testing.
• Staff Augmentation and mentor new team members.

Environment: Agile/Scrum, Guidewire Policy Center, Claim Center, SQL Server, Microsoft Visio, HP Service Manager, Oracle EBS 11.5.10 (Oracle Inventory, Oracle Supply Chain, Advance Pricing), CRM, DML,MS Office, HTML, CSS, Informatica Power Center 9.1/8.6, Rational RequisitePro, Java, .NET, Business Objects, ServiceNow .

Confidential, PA

Business Analyst

Responsibilities:

• Utilized Agile methodology and gathered high level requirements from the business, created user stories, and prioritized the backlog with Scrum Master.
• Conducted one-on-one meetings with the project SMEs to gather the requirements. Facilitated sessions with users and documented their changes in requests.
• Applied RUP methodology with its various workflows, artifacts and activities to manage life cycle from Inception to Transition phase.
• Facilitated business requirements gathering sessions with the business and overlooked the creation of Use Cases/Activity Diagrams and Functional Specifications using MS Visio.
• Created Use Cases and Business Requirement Document after accessing the status and scope of the project and understanding by service-oriented architecture.
• Worked in a team environment to finalize Use Cases to develop functional and detailed design specifications of the application and Enterprise resource planning in order to organize the process.
• Performed feasibility study and risk analysis to identify the critical requirements from the user's perspective.
• Performed Requirement Traceability Matrix to map the requirements with the Test Cases and performed Gap Analysis and Relational database design system.
• Understood and articulated business requirements from user interviews and then converted requirements into system requirements.
• Designed and developed Business Flow Diagrams, Activity Diagrams, Sequence Diagrams, and Object-Oriented Models using MS Visio.
• Identified problems, risks, requirements and concerns in order to comply with ICD-10 changes by conducting interviews with various stake holders involved in Health care Industry.
• Extensively worked on claims processing and with HIPAA in different EDI healthcare transactions 837, 835,834, 820, 270, 271, 276, 277 and 278, file transfer success/failure.
• Analyze EDI -X12 data elements captured by the existing system to validate it against the data elements required for new system.
• Involved in the GAP analysis of 270/271,837,835 and 834 transactions from EDI X12 4010 to EDI X12 5010.
• Prepared and submitted 837 I/P files processed in Edifecs to state reporting agencies.
• Worked in Edifecs to process X12 files as per requirements in Edifecs X-engine.
• Conducted JAD sessions with end-user community ensuring that the software addressed all business needs.
• Worked with Human resources protocols and policies to ascertain functional requirements.
• Extensively worked on EDI 834 on FACETS to customize and configure membership benefit enrollment data files according to the need of the proposed system.
• Developed test plans for Business requirements recording test scripts that would be applied as regression as later date.
• Involved in Feasibility, GAP and Risk Analysis to identify the business critical and high-risk areas of the application.
• Fostered software initiatives through the full product lifecycle from the initial concept through design, development, QA, release and support.
• Facilitated in the design process to plan intuitive workflows, created detailed GUI wireframes and mockups and designed process models, specifications, diagrams, and charts to provide direction to developers.
• Extensively worked on Dimensional modeling, Data cleansing and Data Staging of operational sources using ETL processes.

Environment: Scrum, UML, HP Quality Centre, ANSI X12, Edifecs(transaction Management), Win Runner, ERP, Rational Clear Quest, SharePoint, Windows, MS Office, XML, TOAD, Ultra Edit, Rational Rose, Rally, TFS, JIRA, Java.

Confidential

Business Analyst

Responsibilities:

• Collaborated with Business Stakeholders to gather correct requirements to enhance Salesplace functionality.
• Responsible for resolution of various issues from Business Stakeholders as a liaison between Business and IT department.
• Establishes a single objective site to provide feedback on transaction compliance.
• Responsible for architecting integrated HIPAA, Medicare Solutions, and Facets.
• Facilitated the organization and reviewed deliverables process related to the HIX/IES project by EOHHS staff to PMO resulting in decrease of the turnaround time of documents by 5 days each review cycle.
• Managed sub-projects of the HIX/IES project in relation to supporting EOHHS efforts on the project.
• Responsible for verifying the plan's pricing and illegibility of policy holders in regards to ACA (Affordable Care Act).
• Led JAD sessions to identify the business flows and determined whether any current or proposed systems were impacted by the EDI X12 Transaction, Code set and Identifier aspects of HIPAA.
• Assisted project teams in preparing Functional Specification Documents (FSD), Business Specification Documents (BSD), RFP, User Interface Design Documents (UI) and Supplementary Specification Documents (SS).
• Conducted various Joint Application and Design Sessions with participants (including Business, Deployment and Support personnel) from across the globe.
• Validated the following Transaction Processing: 837 (Health Care Claims or Encounters), 834, 835 (Health Care Claims Payment/Remittance), 270/271 (Eligibility Request/Response), 834 (Enrollment/Dis-enrollment to a health plan.)
• Attend GDAHC meetings to develop the use of HIPAA required ANSI X12 standards between trading partners.
• Ensured deliverables met SSA's general policy/standard such as Security Standard, 508 Compliance Standard, etc.
• Collaborated with the development team and system design personnel to interpret functional systems with ERP.
• Used Informatics to extract and transform data from various DB2 database to the data warehouse analysis by relational database system integration design.
• Used Test Director and Mercury Quality Center for updating the status of all the Test Cases, Test Plan & Test Scripts that were executed during testing process and used edifecs for specs development.

Environment: MS Project, MS Excel, ANSI X12, Edifecs, MS Access, MS Visio, ERP, SharePoint, UAT, SDLC, SQL, XML, Clarity, Visual Basic, TOAD, Java

Confidential, Cherryhill, NJ

Business Analyst

Responsibilities:

• Facilitated JAD sessions to collect requirements from system users and prepared business requirement that provided appropriate scope of work for technical team to develop prototype and overall system.
• Identified processes for developing and documenting detailed business requirements. Data was collected from end-users, and analysts.
• Implemented systematic approach (BPR) to redesign of business processes.
• Through Business Process Re-engineering designed the cost effective and competitive business processes possible.
• Worked on EDI 834, 837, 835 and 278 files and validated the functionality according to HIPAA regulation.
• Created mapping documentation from fields to proprietary Tandem Front End (TFE) fields for 837 Institutional, 837 Professional and 837 Dental .
• Worked on the EDI 834 inbound and 834 outbound data movement with our trading partners.
• Conducted process mapping to identify current As-Is business processes and To-Be road map for reengineering the products using visio.
• Used the mapping tools to map 4010 and 5010 transactions along with ICD 9 and ICD 10 codes, and validated the HIPAA Syntax.
• Created Use-Cases and Requirements documents to document business needs.
• Requirements were gathered through interactions and meetings and periodic walkthroughs with loan analysts, credit analysts and other potential users of the application.
• Created and maintained the Requirements Traceability Matrix (RTM).
• Worked with the Project Manager on -various Project Management activities like keeping track of Project Status, Deadlines, Environment Request, and Compliance Issues.
• Refined the requirements (use-cases) and Business Process Models to detailed level appropriate for technical analysis and system design.
• Worked on EDI transactions: 270, 271, 834, 835, and 837 (P.I.D) to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
• Validated and processed healthcare transactions across all channels in multiple formats using edifecs.
• Create and maintain encounter file companion guides.
• Identified and analyzed the data requirements for the various site teams and made sure that the required data is available in the testing environment.
• Assisted in the data conversion and data mapping of the legacy data to new database.
• Followed the RUP methodology for the entire SDLC.
• Was involved in Functional System Testing, Integration Testing, Regression Testing, and User Acceptance Test using the test cases given by the client before releasing the application.

Environment: Facets, Project Plan, ANSI X12, Edifecs, RUP and MS OFFICE (Word, Excel, MS Access, PowerPoint), MS Project, MS Visio, Java.

Confidential

Busienss Analyst

Responsibilities:

• Involved in Creating Business Integration Model (BIM) which depicts the Business Processes in form of high level Business Flows
• Responsible to standardize processes and system qualification.
• Involved in creating the Business Requirements, User Requirements Specifications and Functional Specifications.
• Expertise in writing the Baseline Configuration Specification documents for all the projects that I worked with in Confidential Labs.
• Involved in writing the Design Specifications.
• Used edifecs to quickly perform gap analysis and automate migration between guideline versions.
• 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.
• Experience in sprint planning, daily scrums, retrospectives, stakeholder meetings, and software demonstrations.
• Protect development team from outside distractions, impediments or team conflicts, and maintain focus on product backlog and project timeline.
• Developed requirements and updated visualizations in Spotfire for CORD and SIOP.
• Created reports using LIMS and BO Reports for QPR project.
• Developed and applied the taxonomy and metadata for the GCMA (Veeva vault) application, to be able to logically upload information from GCL into GCMA and also create any new entities and supporting information in GCMA.
• Involved in defining the Global Project Strategy.
• Write Project Plan and Risk Assessment documents.
• Experience in building Labware LIMS analysis and complex calculations.
• Ability to work alone and as a team.
• Input risk management plans and notify the project lead when plans and deliverables are out of tolerance and have a negative impact on the schedule.
• Involved in the validation of the Manufacturing Enterprise Solution.
• Track and manage product backlog, burn-down metrics, velocity, and task break-down.
• Prepare and present Use Cases, test cases, and data mapping analysis for MAPS data.
• Involved in writing Standard Operating Procedures (SOPs)
• Assessed and created Impact Assessment documents.
• Developed relationships with carriers to research, answer and handle all EDI related questions to determine accurate payment.
• Involved in creating the Business Requirements, User Requirements Specifications and Functional Specifications.
• Expertise in writing the Baseline Configuration Specification documents for all the projects that I worked with in Confidential Labs.
• Participated on the project team to implement the Ariba Contract Management module including user acceptance testing, finalizing document templates, and system administrator responsibilities.
• Supported the Ariba Buyer system through troubleshooting user issues, catalog management, and new supplier enablement projects.
• Tested new enhancements to the Ariba Buyer and SAP systems. Provide Business area with all necessary table dumps for UAT and Production installations.
• Perform functional software testing on site with customer and end users.
• Track and use document control methods for updating SOPs and policy directives.
• Responsible to lead the analysis phase of the MAPS (MRP II system)
• Developed a systematic approach to eliciting, organizing, and documenting the requirements of the to-be-system using the Iterative Requirements Engineering Methodology
• Work with Credit and Accounting on freight accruals and other journal entries impacting Logistics.
• Knowledge of Six Sigma techniques and tools.

Environment: Scrum, HTML, CSS, JavaScript, Edifecs, Informatica power center, .NET, Micro-strategy, MS Visio, MS Excel, MS (Power Point, Excel, Word, Project), JIRA, HPQC, IBM Cognos, JIRA, Tableau, SSRS