OBJECTIVE

• Business Analyst with over 7+ years of experience working in fast paced and dynamic healthcare industry/environment. Comprehensive knowledge of all the aspects of Software Development Life Cycle (SDLC). Known for the ability to grasp diverse business needs and translate them into clear, concise and detailed requirements, functional specifications and test plan, as well as ensure delivery of product.

SUMMARY

• Specific expertise in Business Analysis, GAP Analysis, Data Analysis, Business Rules, developing and creating business process documents (BRD), Use Case and Functional Specifications.
• 4 Years of Experience working in Agile scrum methodology.
• Detailed knowledge of the Software Development Life Cycle (SDLC) phases, with in depth understanding and hands on experience working with SDLC methodologies like Waterfall, RUP and Agile.
• Good knowledge of important and frequently used UML diagrams such as Use Case, Activity Diagrams Sequence and State Chart Diagrams.
• Experience in using Joint Requirement Planning (JRP) and Joint Application Deployment (JAD) sessions for gathering requirements and brainstorm ideas.
• An excellent knowledge of ICD - 9 and ICD-10 structures and formats.
• Well versed and experienced with the complex tasks of ICD 9 to ICD 10 conversion and mapping.
• Strong understanding of EDI Claims, Member Enrollment, Eligibility, HIPAA standards, Medicare and Medicaid.
• Knowledge of different modules within Healthcare Claims Adjudication Process (Membership process, billing process and enrollment & Claims process).
• Experience providing analysis for business processes running on EDI (Electronic Data Interchange) standard.
• Working Knowledge of HIPAA 4010/5010 versions and X12 standards development processes
• Experience in HIPAA, ANSI, X12, 4010, 5010 formats including 270,271, 276, 277, 273, 278, 835, 837, 997, NPI, ICD 9,ICD 10, NDC, DRG, CPT
• Documented enhancements to the EDI Claims processes (EDI 834, 820, 837, 835, 276, and 277) to ensure accurate enrollment and processing of Members claims.
• Knowledge and experience working with FACETS 4.8 claims processing.
• Experience in defect management using HP Quality Center.
• Strong skills in performing and leading Regression, Integration, Performance, Load, Functionality, Smoke, Sanity, System, Stress and Usability Testing for web and Client/Server application.
• Performed User Acceptance Testing (UAT) methodologies to validate the product before implementation
• Excellent capability and hands on experience working as a Technical Writer and handling UAT
• Strong understanding of Service Oriented Architecture (SOA), Object Oriented Analysis (OOA), Object Oriented Design (OOD) techniques,
• Hands on experience in writing SQL queries for data gathering.
• Excellent working knowledge of requirement management tools like Microsoft SharePoint.

TECHNICAL SKILLS

Test Reporting Tools: Quality Center, Rational Clear Quest, JIRQ

Databases: Oracle, SQL Server, MS Access and DB2, MS SQL Server, MySQL, TOAD

Requirement Tools: MS Word, MS Power Point, MS Excel, MS-Visio, SharePoint 2010, HP Quality Center, IBM DOORS, TFS

Operating System: Windows 2008 Server, Windows 7/8/XP, Linux, UNIX, Mac OS

Web Technologies: HTTP/HTML, MS FrontPage, Adobe Photoshop and XML

PROFESSIONAL EXPERIENCE

Confidential, Lyndhurst, NJ

Business System Analyst

Responsibilities:

• Conducted meetings with business process owners, SME (subject matter experts) and Trading Partners for requirement gathering during the definition stage.
• Analyzed data/workflows, defined the scope, and performed GAP analysis.
• Employed a variety of approaches to collecting and documenting business, functional and user requirements such as leading workshops, writing use cases, creating context diagrams, performing stakeholder analysis,
• Defined cross-walks to integrate data from different types including clinical, registration and billing. As well as different sources including EMR's, HL7's, 837's, and Practice Management Systems
• Analyzed the data movement between systems in order to validate the Business Requirements.
• Worked on data mapping to bring data from one system and reside in another system.
• Ensured that EDI files were in compliance with new ICD-10 standards
• Carried out forward/ backward mapping when necessary.
• Created Use Cases and maintained the traceability matrix.
• Worked on FACETS claims processing, payment adjustments, claims inquiry, benefits,
• Conducted JAD sessions to understand the detailed requirements.
• Actively participated in status report meetings and interacted with developers to discuss the technical issues.
• Helped developers with the following list of HIPAA-EDI Transaction Code Sets: (837, 835, 270/271, and 276/277)
• Conducted walkthroughs and defect meetings periodically to assess the status of the testing process.
• Followed workgroup for EDI standards for testing that need to comply with the HIPAA guidelines.
• Performed overall Requirements Management and built the Requirements Traceability Matrix
• Responsible for understanding the “As Is” business process and defining the “To Be” business process.
• Frequently communicated with developers and senior QA team members to assist in the clarification of technical issues

Confidential, Lees Summit, MO

Business Analyst

Responsibilities:

• Worked with project team and developers in implementing Trizetto Facets Claim System and configuring benefit plans in QNXT
• Acted as co work stream lead on Reporting creation and remediation efforts.
• Mapped business processes across organization into Flowcharts and re-engineered them for business process excellence initiative.
• Worked as Sr Business Analyst for a Health Plan for federal employees.
• Responsibilities include IT and Business remediation due to federal regulations, business process mapping, getting applications rewritten in .Net and Analysis for designing data warehouse and reporting requirements.
• Vendor communication and management and partnering with business and IT to gather requirements, build, configure, test, train and deploy solutions.
• Worked on defining the project schedule and creating the project plan during the initial stages of the ICD 10 project
• Worked on Facets configuration across Claims, Repricing, Subrogation and Risk management.
• Worked on subsystems of QNXT for configuring Medical Policies, Contracts of Hospital, facilities, DME, ambulatory services
• Created Business Requirements document for conversion of EDI .
• Involved in testing for various EDI transaction sets including 837I, 837P, 837D, 278, 835
• Assisted Care Management department and Claims intake department. Implemented new CMS 1500 and UB04 Claim Forms in Sungard's FormWorks software.
• Created Flowcharts, Business and Technical requirements for ICD-10 project
• Worked along BI developer using tools like Informatica, SSRS, Report2Web and Cognos 10
• Analyzed Reports and stored procedures across all business units for diagnosis and procedure codes and remediated them for changes in byte length for ICD 10 conversion.
• Consolidated and analyzed Interfaces, extracts, portals, reports and custom codes for all inbound and outbound files between vendors and the health payer, and remediated them for ICD 10 project.
• Designed surveys to collect information and coordinated Testing efforts across vendor spectrum for Facets implementation and ICD-10 conversion.
• Assisted Portfolio manager for Cost and Effort estimation for ICD 10 project.
• Worked on multiple work streams for Facets implementation and ICD 10 conversion.
• Analyzed Facets and hpXr data models and created requirements for new Reports requested by Business.
• Worked on provider Match and Member match for Facets implementation.
• Involved in forward mapping of ICD 9 to ICD 10 and backward mapping of ICD 10 to ICD 9 using General Equivalence Mappings (GEM).
• Helped formulate strategy and decide among various cut over options after Oct 1 2014 as per CMS guidelines on ICD 10.
• Worked along Trizetto and Optum personnel for both Facets and ICD 10 project
• Mentored junior team members on Business rules and requirements writing and maintained artifacts in Sharepoint.

Confidential, Richardson, TX

Business Systems Analyst

Responsibilities:

• Conducted surveys, interviews and JAD sessions and GAP Analysis for preparing a Business Requirement Document (BRD), Functional Requirement Document (FRD) and then translating it to functional specifications and test plans.
• Facilitated various brainstorming, requirement gathering sessions, and provided training on HIPAA Compliance, HIPAA Standard transactions and current version of X12 HIPAA 4010A1.
• Performed Data mapping on the extracted data, created class diagrams, ER diagrams and used SQL queries to filter data.
• Involved in the HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Health Insurance Claims. Worked on HIPAA Standard/EDI standard transactions: 270, 271, 276, 277, 278, 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.
• Designed and developed Use Cases and scenarios, Activity Diagrams, High Level and Low Level Process Flow Diagrams.
• Interacted with DBA for the process of data extraction, data transformation, data load, data integration and conversion processes using business intelligence tools on the Benefit Plan functionality.
• Worked with PM to prepare Project charter, Project plans, daily, weekly and monthly team deliverables for each phase, using MS Project. Served as a Peer review member to verify, validate and modify necessary changes made considering technical and business aspects.
• Also performed UAT testing.

Confidential, Baton Rouge, LA

Jr. Business Analyst/ Internee

Responsibilities:

• Involved in gathering user requirements and preparing Functional requirement Specification (FRS), System Requirement Specification (SRS), Business Requirement document (BRD), General System Design (GSD) and Product Configuration Specifications.
• Involved in preparing the high level Business Requirements by working closely with business owner and external stake holders.
• Logged defects in JIRA, re-tested defects, analyzed defects with Users and Developers.
• Loaded (HIPAA 837) Professional claims within the system to verify edits and cleared testing phase.
• Performed data validation and data integrity on production data.
• Involved in testing 837 Professional Claims which involved validating file elements.
• Analyzed data & business work flow process to enhance decision making & in corporate the changes in the member eligibility database.
• Involved in support for Application Maintenance, Change Management and Server patches.
• Applied Rapid Application development techniques to enhance process development within Claims Screens.