SUMMARY:

• Qualified Business Analyst with 15+ years in the healthcare arena
• 10+ years in the Medicare and Medicaid Industry
• Experience in requirement analysis, participating in Business reviews and working sessions to understand the requirement and system design .
• Strong knowledge of software development lifecycle methodologies like Agile and Waterfall.
• Experience in Agile Methodology and updating user stories in Rally
• Involved in sprint planning and daily scrum standup meeting, as well as sprint retrospect meetings
• Proven ability to identify problems, analyze requirements and develop solutions
• Effective communication skills, written and oral with the ability to communicate appropriately in business and technical situations at all levels.
• Knowledge of Healthcare Systems and Applications, Systems Analysis and Project Management Tools and Techniques
• Experience with databases like Toad for Data Analysis, Hadoop, Looker.
• Experience using MMIS for Transactions Codes, 834, 835, 837/P, 276/277,270/271
• Assisted and maintained Sarbanes - Oxley (SOX) Quarterly Audits
• EDI Daily reconciliation for paper and electronic claims for daily and quarterly review
• Knowledge of Member Enrollment, Provider Information Management, Claims Processing, and Call Center
• Comprehensive knowledge and experience of ANSI 837v 5010, 4010A1Claims and 837 v 5010, 4010A1
• Ability to manage Stakeholder meetings to help Stakeholders define and articulate business requirements
• Provides leadership to contribute significantly as a team player as well as work independently.

TECHNICAL SKILLS:

Project Methodologies: Waterfall, Agile

Business analysis techniques: BRD,, Use case, Change request analysis, System Test Planning, System Testing, UAT/SIT, Proposal Writing, Development/QA/Production Implementation, Claims, Member, Enrollment,Provider,HIPAA,ICD-10,EDI,AVRS,SOX,Rally

Software: NexGen (Pega), AMISYS,Facets,Faciledi,Macess,ICD-10 Discovery tool, SharePoint, IBM Rational modeler/Rational Clearquest, MS Visio, MS-Office, MS Excel, MS Power Point, software tools, MS Project, Balsamic wire framing tool, MMIS Web Portal, Compass, Tableau, OneGuide, Medical Management, Service Now

Technologies: Tidal, Jira, Toad, SQL, IT Testing, MMIS Web Portal (SIT/UAT),Looker, Hadoop, AR

PROFESSIONAL EXPERIENCE:

Confidential

Business Systems Analyst

Responsibilities:

• Document and manage support structure-apply broad knowledge and work independently to code, test, debug, document, implement, and maintain OneGuide and CHE Operational Dashboards.
• Provide production Support for One Guide and Operational Dashboards
• Responsible for interaction with business stakeholders, gathering requirements and managing the delivery.
• Obtains approvals of projects by reviewing documents and Demo of system changes with Business Stakeholders and project managers.
• Perform IT Testing, defect tracking and defect resolution management and communicate defect issues to the development/QA team within One Guide and CHE Operational Dashboards.
• Ability to work with technical resources (Development) to support technical software implementation of requirements while involved with user acceptance testing (UAT).
• Developed system test plan specifying an overview of testing approach, testing strategy, roles, responsibilities and its scope within OneGuide and CHE operational Dashboards.
• Analyzed Business and user requirements attended meetings for changes in the application requirements and documents within OneGuide and CHE Operational Dashboards.
• Perform IT Testing, defect tracking and defect resolution within creation of dashboard reports within Looker (ARC)
• Creation of One Guide Training Document with use of PowerPoint
• Creation of OneGuide POC Metric Definitions guide with use of Excel
• Performed production testing, which ensures the new system will perform correctly in production environment and interface correctly with other production systems.

Technical Skills Used: Requirements Gathering, OneGuide, CHE, SharePoint, Service Now, IT Testing (Development/QA), Documentation, Presentation skills, Communication skills, Deadline Oriented, Looker, Toad for Data Analysts, Hadoop(Hue), Tableau, Agile, PowerPoint, Excel

Confidential

IT Business Analyst

Responsibilities:

• Document and manage support structure debug
• Document, implement and maintain software applications
• Provide production Support of all user Medicaid/Medicare issues and concerns within NexGen (Pega)
• Collaborate with Management, Project Leads and Project Managers on Requirement gathering and reporting
• Obtains approvals of projects by reviewing documents and Demo of system changes with key providers and project managers.
• Perform IT Testing, defect tracking and defect resolution management and communicate defect issues to the development/QA team within NexGen
• Ability to work with technical resources to support technical software implementation of requirements.
• Developed system test plan and performed testing of software upgrades within NexGen
• Analyzed Business needs, evaluated software releases and new products within NexGen

Technical Skills Used: Requirements Gathering, NexGen, Facets, SharePoint, Jira, IT Testing (Development/QA), Documentation, Presentation skills, Communication skills, Deadline Oriented, Medicare, and Medicaid, Compass

Confidential, Virginia

Technical Business Analyst

Responsibilities:

• Develop process diagrams
• Develop data flow diagrams
• Document functional business processes
• Document and manage support structure-apply broad knowledge and work independently to code, test, debug, document, implement, and maintain software application
• Perform data extraction using SQL/ETL tools
• Implementation of projects with National Vendors

Technical Skills Used: FACETS, EDI (Healthcare related; 834 form), EMC Document Sciences xPression-Document Management/Letter Generation Software, JIRA, TOAD, Ultra-Edit, Requirements Gathering, Tidal, SharePoint, Confluence, Medicare, Medicaid

Confidential, Mississippi

Business Analyst Proposal Writer

Responsibilities:

• Determines proposal concept by identifying and clarifying opportunities and needs, studying request for Proposal, and attending strategy meetings.
• Develops Proposal by assembling information including project nature, objectives, writing and editing drafts.
• Maintains Quality results by using templates, following proposal writing- standards including readability, consistency and tone.
• Meets proposal deadline by establishing priorities and target dates for information gathering, writing, review, and approval; entering and monitoring tracking data; coordinating requirements with contributors; contributing proposal status information to review meetings; transmitting proposals.
• Gathers proposal information by identifying sources of information; coordinating submissions and collections; identifying and communicating risks associated with proposals.
• Obtains approvals by reviewing proposal with key providers and project managers.
• Improves proposal-writing results by evaluating and re-designing processes, approach, coordination, and boilerplate; implementing changes.
• Accomplishes organization goals by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments.

Technical Skills Used: Written Communication, Problem Solving, Market Knowledge, Deadline-Oriented, Presentation Skills, Technical Documentation, Strategic Planning

Confidential

Business Analyst

Responsibilities:

• Participate in Quality Assurance efforts during each phase of the software development life cycle and ensure their effective implementation
• Responsible for implementation of QA testing processes on assigned projects following ITD methodologies and standards
• Create QA project documentation and deliverables including test design specifications, test cases and automated test scripts
• Develop and execute functional regression and system test cases
• Test integration points between internal and external systems
• Execute test cases manually or with test automation tools
• Collaborate with QA Analyst, Project Leads and Project Managers on metric gathering and reporting
• Perform defect tracking and defect resolution management and communicate defect issues to the development team
• Ability to work with technical resources to support technical software implementation of requirements.
• Plan coordinate and supervise testing team’s excellent verbal, writing and interpersonal skills.

Technical Skills Used: Problem-Solving, Deadline-oriented, Quality Assurance, Testing (Manual and Automated), Defect Management, Traceability Matrix, EDI (820,834,835,837,270,271,276,277,278) and Automated Voice Response System (AVRS)

Confidential, Norfolk, VA

Business Applications System Analyst

Responsibilities:

• Created and coordinated workflows, implemented and planned project around application release
• Supported software applications, through maintenance of tables/files to support business operations
• Developed system test plan and performed testing of software upgrades
• Successfully met the 5010 2012 compliance date by assisting in transitioning all 837 files to 5010
• Responsible for testing IDX functionality to contribute to a successful GE Centricity Business upgrade from 4.3 to 5.0
• Responsible for technology and business process feasibility studies of replacement software or new acquisitions to include development of cost/benefit analysis
• Developed system test plans and performed testing of software upgrades and patches
• Analyzed customer needs, evaluated software releases and new products
• Identified required information fields and developed data dictionary
• Performed system tests in Bar Data Dictionary for transformation of ICD-9 to ICD-10 with use of ICD-10 Discovery tool

Technical Skills Used: HIPAA 5010, EDI 837, 270, 271, ICD-9/10

Confidential

Business Analyst/ 5010 Business Tester

Responsibilities:

• Evaluated and performed User Acceptance testing within the Facets ITS3 environment for PCS EDI, hospital and Medical claims
• Evaluated and performed User Acceptance testing for GTESS within PCS Simulation for EDI, Hospital and Medical claims and within Facets & Macess for Rejected QA Scenarios
• Performed claim Defect testing and Re-testing for EDI, Hospital and Medical claims within Facets and PCS Environments
• Gathered and defined the requirements with the Business and Subject Matter Expert
• Produced the Requirements Functional Document with use of Use Cases
• Detailed the Functional specifications across the respective requirements
• Performed System Integration Analysis of the production system for Metavance Billing and Banking for FM 140,141,142, 260 & 270
• Performed Gap and Risk Analysis for Cigna Systems IBOR, HBOR, XCCR, ACCR
• Produced the Requirements Traceability Matrix
• Gathered requirements across work streams through testing and use of Use Cases
• Created the Functional Specifications Document which detailed the functional specifications across the respective requirements with use of Use Cases
• Performed the configuration and systems analysis of the production system utilizing Visio for the implementation of EDI 5010 (835, 837)
• Performed the risk analysis of the HIPAA Security and Compliance Audit utilizing lifecycle principles and methodologies for the implementation of 5010

Technical Skills Used: Facets, Claims, EDI 835, 837, Use Cases, Metavance Billing, HIPAA 5010

Confidential, Virginia Beach, Virginia

EDI & Business Systems Coordination II (Medicaid/Medicare)

Responsibilities:

• Worked on Service Payment rules per market specifics (HIPAA Implementation)
• Worked on Facets-Amisys Claims/ with use of Data module in XML
• Worked on mapping of Contracts/ Product Variable Setup (x12 Transaction Readers)
• Provided technical support for providers submitting claims electronically with use of Faciledi and Macess
• Acted as lead liaison and advocate between the technical staff, trading partners, third party vendors and business users
• Maintained Macess EXP process work flow and EDI database from claim processing platform
• Reviewed reports and output files generated to ensure data integrity with use of Paper Free EDI Software (XML)
• Evaluated and performed testing for Transactions (834, 835, 837/p, 276/277) for moderate to complex modified programs, clinical applications and operating systems
• Familiar and experienced with mainframe development environments
• Incorporated EDI and Amisys logic for HCFA and UB procedure codes
• Performed Service Procedure and Service Revenue Code Mapping in Relation to Transaction codes 835/837p and ANSI 276/277
• Maintained pending claims and processing reports for Facets XC below 10% on daily basis
• Experienced with process flow diagrams, with use of WEB-based development environments
• HIPAA Security and Compliance Audits (SOX) for Daily and Quarterly Reconciliation

Technical Skills Used: Medicaid, Medicare, HIPAA, XML, X12, Faciledi, Macess, EDI 834, 835, 837, 276, 277, SQL, Mainframe, HCFA, UB, Facets, SOX

Confidential, Virginia Beach, Virginia

Claim Analyst I

Responsibilities:

• Processed inpatient and outpatient medical claims as well as electronic submissions within Amisys Processed correspondence and claim adjustments within Amisys
• Maintained statistical and financial quality scores in accordance with claims department and company guidelines

Technical Skills Used: Claims Analysis