Professional Summary:

• 7 years of experience in Business Modeling, Document Processing, EDI transactions, Mapping, HIPAA regulatory changes and Application Integration in healthcare domain.
• Experience with Business Analysis, Project Management, SDLC Methodologies and Modeling Techniques, Software Validation and Process Re-engineering.
• In depth understanding of Software Development Life Cycle SDLC starting with requirement gathering, analysis and documenting the requirements as various deliverables and validating output of each phase from the SME's and Project Manager.
• Knowledgeable in User Acceptance Testing with experience in performing UAT with business users.
• Clear understanding of testing concepts and hands on experience writing test cases, test plans and planning test strategy.
• Proficient in creating UML Diagrams, including Use Case Diagrams, Activity Diagrams, Class Diagrams, Sequence Diagrams using various tools such as MS Visio, Rational Rose.
• Adept at gathering Functional requirements and specifications through interviews, facilitated sessions, brainstorming, questionnaires and organizing JAD to accomplish user-client objectives and results .
• Excellent communication and analytical skills with strong problem solving capabilities to interface with end users, business representatives and development teams.
• Strong experience with the Health Care Reform HCR mandate and its provisions.
• Understanding of ICD 9 and ICD-10 structures and formats.
• Experienced in GAP Analysis of HIPAA 4010 to 5010 with particular attention to qualifier, length and required field and situational rules.
• Strong Analytical skills in determining and conducting Feasibility Analysis, Cost/Benefit Analysis, GAP Analysis, Risk Analysis and Mitigation and Change Configuration Management for complex process and systems.
• Strong Project Management skills including planning, scheduling, monitoring and budgeting with proficiency in MS Project for planning reporting and assisted Project Managers in the development of weekly and monthly status reports.
• Proficient in writing SQL Queries for Backend Testing to check and analyze data integrity and validation.

Professional Experience:

Confidential

Healthcare Business Information Analyst

Confidential is a not-for-profit organization that provides long-term care for eligible seniors living in San Francisco, Fremont, Newark, Union City or Santa Clara. The program offers full medical care and support services with the goal of helping seniors live at home and in the community for as long as possible.

Responsibilities:

• Worked on migration of reports from old ICCIS system to the new NextGen system.
• Provided End-User training for new deliverables.
• Facilitated meetings and worked closely with upper management to understand the business needs and created several reports specifically for upper management.
• Conducted interviews with the end user and managers to create user specific deliverables.
• Facilitated technical work sessions and gathered requirements for upgrading the system from KBM 7.9 to KBM 8.1.
• Involved in all phases of testing like Functional, User Acceptance, and System testing, on various reports.
• Responsible for submitting annual ALIRTS report to state.
• Worked as a team to develop new database to provide effective solution to ON Lok's numerous Ad Hoc report requests.
• Created Dashboard Reports for better customization of reports.
• Prepared Process Task List to prioritize different tasks and activities.

Confidential

Regulatory Business Analyst

Nebraska DHHS administers the Medicaid Program which provides health care services to eligible elderly and disabled individuals and eligible low-income pregnant women, children and parents. The Health Care Projects involved making changes within Medicaid Long Term Care to be in compliant with Federal Legislation.

Responsibilities:

• Worked on Health Care projects such as Administrative Simplification, Pay Medicare rate to Primary Care Physicians, Provider Enrollment and Screening and Non Payment for Provider Preventable Conditions.
• Read and analyzed Federal Regulations to develop high level business requirements.
• Developed As Is and To Be Business Process flow diagrams using BPMN and MITA 3.0
• Business Process Mapping of impacts of various health care reforms on Medicaid Long Term Care.
• Prepared Process Task List to prioritize different tasks and activities.
• Performed Gap Analysis for As Is and To Be Business Processes.
• Documented meeting minutes and key issues of various JAD sessions.
• Prepared State Plan Amendment Requirements for Provider Screening and Enrollment to be presented to Center of Medicare and Medicaid Services.
• Responsible for preparing Business Planning Document for various projects.
• Serving as a liaison by working closely with the Business and IS T team for achieving milestones.

Confidential

Sr. Business Systems Analyst

• Worked extensively with Test Case and Scenario development and active participation during Test Execution.
• Responsible for creating and reviewing business requirements, functional specifications, project schedules, documentation and test plans.
• Developed Use Cases, Activity Diagrams and Class Diagrams for various modules of the project.
• Developed high level business and technical requirements for various EDI transactional changes.
• Prepared Companion Guides for various payers in accordance with CORE compliance.
• Participated in the CORE Committee on Operating Rules for Information Exchange compliance process of the company.
• Prepared structural difference report for transactions in regard to the affected elements of the transactions.
• Performed testing of various EDI transactions related to HIPAA 5011 for future implementation.
• Created test scenarios for various EDI transactions such as 270/271, 276/277 and 278 for future implementations in HIPAA 5010.
• Performed gap analysis 'Effect on CMS-1500 by 837P HIPAA 5010' and recommended the user interface changes.
• Performed Gap Analysis for EDI transactions such as 276 claim status , 277 claims status response , 278 and coordinated various meetings with Technical teams to finalize the 'bridging the gap from HIPAA 4010 and 5010' process.

Responsibilities:

• In one of the projects at Minnesota Department of Health which involved modification Healthcare EDI X12 transactions and the entire system to be in compliance with HIPAA 5010 standards from the current HIPAA 4010. The project involved analysis the 4010-5010 business and functional gap and therefore development of business and technical requirements.
• Responsible for requirement and design documentation review, test plans, identifying and reporting software anomalies and test results.
• Developed test scenarios and implemented test plan. Providing key input in working with users in defining project and system requirements.

Confidential

Requirements Analyst/ Business Systems Analyst

Excellus BCBS is the leading healthcare insurer in upstate Confidential. The project Health Care Reform involved making all the changes within the corporation as per the legislation to be in compliance with HCR.

Responsibilities:

• Read and analyzed the federal legislation to update the products as per the mandated provisions of HCR.
• Interacted with senior business teams and legal firms to gather and analyze requirements.
• Participated in various JAD sessions involving various business and technical teams.
• Documented various Use Case scenarios, Process Flows and other diagrammatic representations in MS Visio pertaining to various provisions of HCR.
• Performed Gap analysis for various existing product lines and operations with respect to HCR.
• Worked extensively on all the mandated first phase of provisions of Health Care Reform.
• Responsible for gathering and documenting Legislative, Business, Functional requirements for all the provisions and their impact on the existing products and systems.
• Worked on various HCR Health Care Reform mandates such as Grandfather Rule, Preventive Care, Early Retirees Insurance Program, Rescissions among other major provisions.
• Developed Test Cases, Scenarios and actively participated in the Test Execution activities.
• Conducted Defect Management meetings with the Quality Assurance team.
• Extensively used Requisite Pro and other Rational tools for Requirements Management and their traceability.
• Gained extensive experience related to various product lines and impact on the respective products due to HCR.
• Gained extensive experience with medical codes and the change of benefits regarding various products.
• Gained extensive experience regarding all phases of Requirements Management and Change Control for various projects.
• Ensured legal compliance of the corporation in regards to the mandates of the Federal and State regulations.
• Worked with Customer Care department to document the User Guides and Corporate Communications regarding policies and products.

Confidential

Jr. Business/Test Analyst

The project involved development of a Medicaid Statistical Information System MSIS that would help the users to perform an in-depth analysis of the Medicare and Medicaid claims data. This will enable Freedom Health to determine trends, how money is spent, the public impact of certain diagnoses and drugs, and much more. The application was built under Informatica Power Center enterprise data integration platform.

Responsibilities

• Worked as a liaison between technology and the business clients to improve business processes and support critical business strategies.
• Utilized industry knowledge to provide executive management, the development and implementation of interactive business tools, and strategic analysis, vital for use in mission-critical decision-making
• Gathered requirements by using interviews, observation, JAD, brainstorming sessions, and documents analysis
• Performed Gap analysis for both private and government plans, designed business rules and requirements for privacy issues, and managed development of technical specifications for data interfaces conforming to HIPAA requirements and data transaction sets
• Involved in creating Business Flow Diagrams, Dataflow diagrams, UML Activity diagrams and USE cases diagrams using MS VISIO
• Designed use-cases and use-case models to further refine the requirements and understand the business processes. Worked extensively in Rational Requisite Pro to organize and catalog requirements, documents, and use-case documents
• Conducted need analysis and resource allocation to determine the most effective use of the Design, Architecture, and Review
• Reviewed development plans, quality assurance test plans, and user documentation to ensure correct interpretation of original specifications
• Facilitated JAD sessions for defining business requirements and follow-up for Project Plan updates, gained consensus for User Acceptance Testing requirements