Profile

7 years of IT experience as a Business Analyst within the healthcare industry, with knowledge of SDLC methodologies, such as, RUP, AGILE-SCRUM, Waterfall and expert in conducting Joint Application Development JAD sessions, interviews, workshops and requirement gathering sessions with business users, stakeholders and development team.

Professional Summary:

• HIPAA Health Insurance Portability and Accountability Act transaction codes such as 270/271 Eligibility Benefit Inquiry/Response , 276/277 Claim Status , 835 Payment or remittance Advice , and 837 Health Care Claim .
• Medicaid, Medicare Part A, B, C, D , Procedural and Diagnostic codes and Claims Process.
• EDI HIPAA 4010 - 5010 Project to convert EDI X12 Healthcare 4010 transactions into 5010 Complaint transactions.
• HL7 Standards, HIX, EHR - Electronic Health Records, EMR - Electronic Medical Records, CMS regulations, Health Care Reform, EMTALA, PPO, POS and HMO.
• CD 9/ICD 10 conversions
• Medical Management Information Systems MMIS
• Data Migration, Data Integrity, Data Quality, Business Flow Diagrams and Business Requirement Documents.
• Development, implementation and integration strategies in a team oriented environment by utilizing quantitative and qualitative analytical skills
• Developing detailed functional specs through JAD sessions, interviews, on site meetings with business users development team.
• Provider Life cycle, Members Enrollment process, Claim processing and other data models.
• Identifying the Data Sources, ETL methods, Data Conversion process, OLAP designing and Reports generation required for reporting purpose.
• Comfortable in working with different requirement gathering techniques. For example, Brainstorming, JAD sessions, Document Analysis, Interview, Prototyping and Observation.
• Design and review of various documents including, Software Requirement Specifications SRS , Business requirements document BRD , Functional Requirements document FRD , Requirement Traceability Matrix RTM , Testing documents..
• Creating Use Cases, Sequence Diagrams, Activity Diagrams, Class Diagrams etc.
• Data Modeling, Data Analysis, Requirement Analysis, Business Modeling, Data Migration, Data profiling, Dimensional Modeling.
• Proficient in UAT user acceptance testing , Functionality Testing, Unit testing, System Testing, Integration Testing and Regression Testing.
• Extensive experience with Data Warehousing, Extraction, Transformation and Loading ETL and Business Intelligence BI tools.

Technical Skills:

• Operating Systems : Windows 95/98/NT/2000/XP, Linux
• Languages : SQL/PLSQL
• Databases : MS-Access03/07/10, SQL Server, Oracle, Sybase, DB2,
• Tools : MS Suite, MS Visio, Rally, GEM
• Rational Tools : Rose, Clear Case, RequisitePro
• Defect Tracking Tools: Mercury Test Director, Rational Clear Quest
• Testing Tools : Test Director, Quality Center

Professional Experience:

Confidential

Role: Sr. Business Analyst

The goal of the project was to enhance existing Web-services for Claim Transaction such as EDI 270-271 for Claims Eligibility Inquiry, EDI 276-277 for Claims Status Check, EDI 837 for Claim Submission to comply with the HIPAA 5010 standards, to integrate all HIPAA 5010 rules with ICD10 for the TRICARE dental program. As well as, modifications and enhancement of various web services like Eligibility, Claim, Plan, Billing to support the TRICARE Dental Program. The project followed RUP methodology

Responsibilities:

Inception:

• Developed vision document involving general vision of the core project's requirements, key features, and main constraints.
• Documented an initial project glossary and an initial business case, which included business context, success criteria revenue projection, market recognition, and so on , financial forecast and an initial risk assessment.
• Analyzed TRICARE Dental Program Coverage for modification and enhancement of various services for Eligibility, Claim, and Billing etc.

Elaboration:

• Initiated discussions with Clients Business/IT team for Functional query resolution.
• Analyzed and documented differences between the AS-IS and TO-BE processes.
• Developed mapping documents for ICD 9 to ICD 10 application.
• Analyzed all ICD10 codes and validated the outcomes.
• Analyzed Business requirement document, developed functional requirement document FRD and got it approved by the client.
• Created help documentation in accordance to the client's documentation guidelines.
• Efficiently interacted with designers and software developers to understand application functionality and navigational flow and keep them updated about business user's specifications.

Construct:

• Created and maintained Issues Log and ensured timely resolution of all items.
• Supported User Acceptance testing UAT and collaborated with the QA team to develop test plans, test scenarios, test cases and test data to be used in testing, based on business requirements and application knowledge.
• Reviewed Integration Test Plan for integration between modules.
• Interacted with the developers to report and correct bugs.
• Assisted Project team in test case preparation for testing MetDental Provider Application functionalities by sharing functional knowledge on dental insurance and making them understand different business scenarios that need to be tested.
• Managed all the requirements effectively and made them available to all team members and presented the testing defects and resolution in the project review meetings.

Transition:

Involved in training of users and maintainers and executed roll-out of the product to the marketing, distribution, and sales teams

Tools Technologies:

Windows XP, Business Objects, Rational Unified Process RUP , MS Excel, Word, Visio, Java/J2EE, UML, power point, SQL, Oracle, DB2, Rational DOORS, Rational Rose, Erwin.

Confidential

Role: Business Analyst

The goal of the project was to implement the regulatory changes from HIPAA 4010- 5010 which involved enhancements to the EDI transactions and ICD 9-10 conversion using the AGILE-SCRUM methodology.

Responsibilities:

• Performed GAP analysis and analyzed EDI 837 Health Care Claim transaction from 4010 to 5010.
• Developed crosswalk between ICD-10 and ICD-9 to assist with transitioning to ICD-10 and identify the differences between the two versions.
• Conducted JAD sessions involving SME's, business users, data administrators, system architects, managers and development team in order to create a good business process model.
• Identified the project scope, business objective, feasibilities and risks based on Scope/Vision documents.
• As Scrum Master facilitated all aspects of the scrum framework, including sprint planning sessions, backlog grooming sessions, daily scrums, product demos, sprint reviews and sprint retrospectives.
• Support and consult product owner in developing, maintaining and grooming product backlog.
• As Scrum Master maintained the capacity plan, iteration board, sprint backlog, velocity charts and burn down charts.
• Identified and removed impediments to the success of the sprint by working with every single team member.
• Created Data Flow Diagrams and process diagram using MS Visio
• Developed Business flow diagrams, use cases and activity diagram assisted developers in creating sequence diagrams and collaboration diagrams.
• Generated Functional Requirement specifications FRS and User Requirements Specifications URS that helped to guide the design of the application.
• Maintained Requirement Traceability matrix throughout the project.
• Reviewed test plans and test scripts developed by development team and QA team to make sure all requirements have been covered in scripts and tested properly.
• Functional testing of the application was performed as per the ICD10 changes.
• Helped in conducting User Acceptance Testing UAT , Unit and System Integration testing SIT .

Tools Technologies:

Windows 2000/XP, Toad, Agile, Rally, MS Access, MS Visio, SQL Server, HP Quality Center, Crystal Reports, UML, MS Office, HL7, ECMAP.

Confidential

Role: Business Analyst

The goal of the project was to implement I Know Med EHR to achieve the functionalities for scheduling, check-in, charts, SOAP notes, labs, ePrescribe, referrals, billing and patient workflow. This EHR system is specific to the needs of oncologists and hematologists to create a system that improves the overall quality of cancer care delivery. The project followed RUP methodology.

Responsibilities:

Inception

• Met with users and stakeholders to understand the problem domain, gathered customer requirements through interviews group and one-on-one along with JAD sessions.
• Performed requirements gathering process in iterative approach using RUP methodology.
• Worked effectively with physicians, nurses, and engineers to solve problems related to EMR, EPM, and ICS to make software more user-friendly to staff and doctors.
• Work with Compliance and Regulatory operations to follow and monitor different IT process bound by CMS Regulations.

Elaboration

• Formulated logical statements of business requirements researched and evaluated alternative solutions and recommend the most efficient solution for system design.
• Review requirements and understand technical recommendations and constraints, and develop comprehensive and accurate functional specifications Data Mapping, and process flows.
• Prepared test Data sets using Prototyping and performed data testing using the PL/SQL scripts.
• Used Rational Rose for creating the Use Cases Diagrams, Activity Diagrams, Class Diagrams, and Sequence Diagrams etc.
• Created Mapping Documents, Report Mockups and modified existing report mockups and finalized for development
• Involved in preparing flow diagrams for various scenarios of scheduling, check-in, charts, SOAP notes, labs, ePrescribe, referrals, billing and patient workflow

Construction

• Involved in Testing by using SQL and work with QA together to develop test Scenarios and test cases.
• Involved in defect tracking and maintaining Requirement Traceability Matrix

Transition

• Facilitated UAT and documented User manuals for the user community
• Conducted training sessions to ensure user acceptance.

Tools Technologies:

Windows XP, Business Objects, Rational Unified Process RUP , MS Excel, Word, Visio, Java/J2EE, UML, power point, SQL, Oracle, DB2, Rational DOORS, Rational Rose, Erwin.

Confidential

Business Analyst

The goal of the project was to develop a system to interact with the health insurance providers, get information from the patient information systems, and record claims with insurance providers for the same patients. Also, implemented a software application to check the insurance eligibility of patients,as well as, developing an application to expedite the claims process.

Responsibilities:

• Held regular meetings with the system architects, developers, database developers,quality testers during the entire project to assure that the critical as well as the minute details of the project were discussed and issues were resolved beforehand.

• Participated in meetings with Developers, Project Managers and Quality Analysts to discuss business requirements, test planning, resource utilization, and defect tracking.
• Designed and developed all use cases and UML models using Microsoft Visio and implemented SQL queries for QA testing
• Implemented the entire Rational Unified Process RUP methodology of application development with its various workflows, artifacts and activities
• Maintained and kept track of stakeholders requests for enhancements and changes using Rational Clear Quest
• Assisted the PM in setting realistic project expectations and in evaluating the impact of changes on the project, and conducted project related presentations
• Played a key role in the planning and testing the system enhancements and conversions.
• Identified test execution method: Manual/Automated. Read and Understood Test Cases and identified the frequent functions.
• Worked closely with the UI team to model the screens, which met user, defined requirements and also company standards.
• Created Use cases, activity report, logical components to extract business process flows and workflows involved in the project using Rational Rose, UML and Microsoft Visio.
• Developed user manuals, presentations and training manuals as per project specifications and timelines.

Tools Technologies:

NET, SQL Server, Windows NT, Rational Rose, Rational Requisite Pro, MS Office, Load Runner.

Confidential

Role: Business Analyst

The goal of the project was to develop a web-based service application developed for streamlining office workflow processes involved in Electronic Data Interchange EDI transactions and benefits in claims management cycle based on HIPAA Guidelines. As well as, reporting the policy premium which involved generating seven reports in the portal. The project was based on Agile Scrum methodology.

Responsibilities:

• Led and conducted JAD sessions for requirements gathering, analysis and design of the system.
• Provided hands on agile project management approach planning, apply strategy and scrum framework in various projects/phases, set team's objectives and goals.
• As Scrum Master facilitated all aspects of the scrum framework, including sprint planning sessions, backlog grooming sessions, daily scrums, product demos, sprint reviews and sprint retrospectives.
• Support and consult product owner in developing, maintaining and grooming product backlog.
• As Scrum Master maintained the capacity plan, iteration board, sprint backlog, velocity charts and burn down charts.
• Identified and removed impediments to the success of the sprint by working with every single team member.
• Helped in defining Change Management Process for Release Management Team.
• Mapped process flows assessed as-is processes through user interviews, data collection and analysis, design and evaluation of to-be process solutions.
• Prepared Business Object / Business Process Models that included modeling of all the activities of business from conceptual to procedural level.
• Consulted with healthcare insurance company to develop conversion specifications for other insurance Coordination of Benefits including Medicare .
• Validated the following: 837 Health Care Claims or Encounters , 835 Health Care Claims payment/ Remittance , 270/271 Eligibility request/Response , 834 Enrollment/Dis-enrollment to a health plan
• Responsible for creating Customized Transaction set using ECMAP tool
• Identified gaps in the business process.
• Worked in HL7 transactional environment
• Analyze business requirements and segregated them into Use Case Diagrams, Activity Diagrams, Sequence Diagrams, and OOD using Borland Together according to UML methodology thus defining the Data Process Models.
• Responsible for writing and reviewing Functional Specs Use cases and user stories
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, OOD using UML
• Documented Requirements for Management Reporting with Crystal Reports.
• Performed Functional and GUI Testing to ensure that the user acceptance criteria are met.
• Co-coordinated the UAT with the SME's to make sure that all the Business Requirements are addressed in the application.
• Used SQL for data mapping and querying.
• Extensively worked on the ETL mappings, analysis and documentation of OLAP reports requirements
• Interacted with database developers for formulating the ER diagrams and data
• flowdiagrams

Tools Technologies:

Windows 2000/XP, Toad, Agile, Rally, MS Access, MS Visio, SQL Server, HP Quality Center, Crystal Reports, UML, MS Office, HL7, ECMAP.

Confidential

Role: Business Analyst

The goal of the project included the addition of a new Medicare Advantage Health Plan Medicare Part D to the standard e-Portal usability platform for Eligibility and Benefits application for the Providers, Members, and Customer Service and Provider web transactions and to choose the details about the medical service types, deductible and benefit limitations. This new Health Plan provides the benefits of Original Medicare Part A and Part B and Prescription Drug Coverage Part D .

Responsibilities:

• Work with business to define document business needs for the RFP package.
• Lead multiple project teams of technical professionals through all phases of the SDLC using technologies including Oracle, Erwin, Data Stage, Data Warehousing, WebSphere and Cognos.
• Responsible for architecting integrated HIPAA, Medicare solutions, Facets.
• Directed the clinical trial data capture and worldwide data collection systems for various therapeutic areas.
• Created Process Flow diagrams, Use Case Diagrams, Class Diagrams and Interaction Diagrams using Microsoft Visio and Rational Rose.
• Managed the planning / test process for Medicare Part D Pharmacy Claims PBM NCPDP code sets
• Facilitated and managed meeting sessions with Business Users to review business requirement capture. Have set-up weekly status meeting and JAD Sessions with the Stakeholders, Business Users and Technical leaders from various departments Clinical trial, Drug Discovery and Pharmaceutical Development .
• Gathered requirements and modeled the data warehouse and the underlying transactional database.
• Experience in configuration of claims adjudication systems, i.e., Amisys, FACETS.
• Analyzed and tested various Common Eligibility Outbound Interface Process and other Inbound/Outbound Facets interfaces.
• Worked on following applications Business Objects, Enterprise Architect, Toad, Plan View project management , Microsoft Suite Word, Excel, PowerPoint, Visio, Access, Project
• Developed process design such as vision models, process hierarchy, workflows, object models applying OOAD standards and using industry best practices such as BPMN, OO, and UML etc.
• Created RUP activity diagrams and sequence diagrams to analyze the requirements and recommend solutions.
• Developed HL7 messaging for bi-directional case and disease report exchange, in text and XML formats, in accordance with
• HL7 specifications
• Healthcare system implementation including enterprise Electronic Medical Records EMR software.
• Gathered requirements from business users and by going through COBOL programs, legacy use cases, and program specs.
• Represented the business requirements in various alternative views such as analysis models, process flow diagrams and user stories.
• Analyzed the change detection process on Facets database tables to capture the daily changes done by Users through Online Facets Application.
• Served as a resource for analytical services utilizing SQL Server, and TOAD/Oracle.
• Create and maintain data model/architecture standards, including master data management MDM
• Involved in creating reports for the end users using Crystal reports from the gathered requirements.
• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims. 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.
• Defined Functional Test Cases, documented, executed test script in Facets system.
• Responsible for architecting integrated HIPAA, Medicare solutions, Facets.
• Identify Member, Provider, Coverage, Medicare, and Medicaid.

Tools Technologies:

Windows 2000/XP, SQL Server, Agile, MS Project, Enterprise Architect, MS Access, Business Process, Rational Clear Quest, Rational Clear Case, Rational Requisite Pro, Cobol, Crystal Reports, Rational Rose, UML, RUP, Informatica, MS Office, MS Visio.