SUMMARY

• Healthcare Business Analyst with Over 8+ years of diversified experience in areas like Business Analysis and Testing.
• Experience in working with Microsoft Office suite (word, excel, Access, Visio, Power Point and Outlook) for documentation, analysis and presentation.
• Extensive healthcare experience in Medical Imaging, EHR/EMR, Mobile Apps, Medicare - Medicaid, HIPPA, HIX on EPIC software applications
• Expertise in Software Development Life Cycle (SDLC), Use Cases, Business Process Modeling Notation (BPMN), Object-oriented Analysis and Design, Rational Unified Process (RUP) and Rational tools used during all four phases of RUP: Inception, Elaboration, Construction, and Transition.
• Hands on experience working on Eligibility determination of Medicaid, SNAP, TANF and Food Stamps.
• Strong knowledge of Families First/TANF, SNAP/FS, Child Care, Medicaid and Standard policies.
• Facets is a product which handles enrollment, claims processing and other allied services pertaining to the Managed Care.
• Processing claims through EDI 837 files to FACETS system and also worked on scenarios for complete claims lifecycle
• Performed Defect Tracking and Project Tracking using Jira - Change Notification Request (CNR).
• Have in-depth knowledge of Software Development Life Cycle (SDLC) methodologies, assisting and working as Scrum Master on several projects, vast experience working in Agile, Waterfall, RUP methodologies. Primarily in Agile methodology. Handling Scrum team offshore and onsite.
• Extensive knowledge of Medical Management Information Systems (MMIS), and National Provider Identification (NPI).
• Proficiency with Microsoft Office applications (Word, Excel, PowerPoint, and Visio and Project Management Software), and Atlassian (JIRA, and Confluence).
• Expertise in EDI and HIPAA Testing Privacy with multiple transactions exposure such as 837 for submitting claims, 835 for payments, 834 for benefit enrollment, and 820 for premium payments to insurance products, 270, 271 for healthcare benefits and eligibility, 276, 277 for claims status and 278 for transmitting health care service information.
• Worked with FACETS Team for HIPAA Claims Validation and Verification Process (Pre-Adjudication)

PROFESSIONAL EXPERIENCE

Confidential

Healthcare Business Analyst

Responsibilities:

• Used Queries to generate monthly HEDIS report using 12 month rolling measurement period from Clinical data repository
• Gathered requirements from wide variety of stakeholders using various elicitation techniques and documented them.
• Assisted in interfacing EMR system with decision support analytics that summarize patient profiles
• Directed and participated with others in the planning, development, implementation, maintenance, and evaluation of clinical or business application systems as assigned.
• Participated in the analysis and documentation of current and future needs as well as workflows through interviews, gathering data regarding regulatory requirements, operation procedures and hospital/departmental policies
• Formulated Business Requirements using Agile / Scrum methodologies to decompose requirements into Epics and User Stories iteratively
• Functioned as a liaison to the system users and stakeholders to translate business requirements into technical requirements, data flows and process flows.
• Provided feedback to physicians and others regarding performance profiles and data trends
• Performed GAP analysis assessed as-Is processes through user interviews, data collection and analysis, design and evaluation of To-Be process solutions.
• Create and update training documentation and provide user training on ITSM tool.
• Responsible for leading and coordinating User Acceptance Testing UAT, System Integration testing SIT, and Regression Testing RT by working along with the QA team.
• Analyzed CMS comparison documentation highlighting changes of 5010 format and ICD10 diagnosis and procedure codes.
• Prepared written documentation for application changes or replacements, coordinates staff, and managed project plans for their implementation.
• Participated and developed documents and validated comprehensive test plans complying with current standards, design to produce successful and failed outcomes
• Involved in developing training manuals for users to help them understand the business process
• Prepared a comprehensive set of wireframes to ensure the consensus on UI with the help of SME and by continually interacting with the network Physicians for feedback.
• Educated analysts and programmers on business requirements, objectives and operational needs and the relevant system applications.
• Designed and created Excel sheets and used decision tree to provide market analysis charts.
• Used data mining tools performed in a SQL database to analyze EHR data

Confidential, Newark, NJ

Healthcare Business Analyst

Responsibilities:

• Performed felid-by-field mapping of interface between parent EMR system and downstream system.
• Worked on the Patient Management System (integrated version of Patient Information System with EMR/EHR)) is intended to remotely communicate with a compatible pulse generator from BSC CRM and transfer data to a central database (HIT EHR).
• Worked closely with the development team and offshore testing team to coordinate the testing
• Prepared ETL standards, Naming conventions and wrote ETL flow documentation for Stage, ODS and Mart, used Change Data Capture (CDC) to simplify ETL in data warehouse applications.
• Expertise in Facets extension development, Facets Testing, Facets Interfacing
• Has exposure in the Design, development and maintenance of commercial projects using Waterfall Model and Agile Model.
• Agile and Waterfall methodologies were present and identified deficiencies, created a defined business cases, and upon approval, implemented strategies for the department and adjacent teams.
• Worked on HL7 inbound and outbound interfaces. Define data specifications and map out data crosswalks. Understanding of interface messages and triggers such as A01, A02, A03, A05, A08 and A17, Merge messages, appointments, and other types of HL7 messages; ORM, ORU, DFT, MDM and MFN.
• Configured, analyzed, and tested Epic Resolute Hospital, Home Health, and Hospice Billing applications based on end user workflows, state and federal regulations, and patient needs.
• Performed Data Analysis, writing SQL Queries for Testing and Troubleshooting against Data Warehouse.
• Performed Defect Tracking and Project Tracking using Jira - Change Notification Request (CNR).
• Ability to analyze engineering product support issues described within a bug-tracking system (JIRA) and provide guidance to other Client Services members in an advisory capacity, focusing on the quick resolution of the production issue and using this as a training opportunity for other team members
• Proficiency with Microsoft Office applications (Word, Excel, PowerPoint, and Visio and Project Management Software), and Atlassian (JIRA, and Confluence)
• I assisted the Epic Resolute Hospital Billing and Epic Security team with successfully completing Phase I and Phase II of their system Go-Live.
• Extensive healthcare experience in Medical Imaging, EHR/EMR, Mobile Apps, Medicare-Medicaid, HIPPA, HIX on EPIC software applications
• Generated reports using SQL server Reporting Services (SSRS), and created user-friendly templates, indexes, using XML and worked on project life cycle and SDLC methodologies including RUP, RAD, Waterfall and Agile.
• Worked with the business to identify rules for the automatic generation of letters and correspondence for the Lead cases.
• Accomplished projects and design documents on HIPAA 835 and 837 calculations and EDI transactions, Health Statements and Explanation of Benefits, Healthcare Reform and 5010 CMS occurrence and field expansion for 835 and 837 EDI formats
• Identified gaps in the existing Lead survey and assessment, developed in Phase I, and documented them in the TRD and the survey specification document.
• Extensive healthcare experience in Medical Imaging, EHR/EMR, Mobile Apps, Medicare-Medicaid, HIPPA, HIX on EPIC software applications