SUMMARY:

• A result - oriented individual with over 7 years of diversified experience in Healthcare and Finance IT industry.
• Expertise in Project Planning, Project Design, creating functional specifications and data flow diagrams.
• Extensive experience as Business Analyst in the Healthcare Industry with expertise in EDI Transactions (834, 835, 837), HIPAA, MMIS, Medicare and Medicaid.
• Experienced in business process flows, business process modeling, case tools, business analysis, gap analysis and organizational change management.
• Experienced in conducting sessions and worked with executives, developers, and end-users to define the exact requirements.
• Solid understanding of Membership, Claims Processing, Billing, Benefit/ Eligibility, Authorization/ Referrals, COB, and have experience in HIPAA standards and corresponding EDI transactions (837, 834 and 835).
• Knowledge of health care services regulatory environment in compliance with HIPAA, ICD, MITA, MMIS.
• Knowledge on Medicare, Medicaid, MMIS, HIPAA EDI transactions 278, 820, 834, 835, 837, ICD-9, ICD-10, HL7, HMO, PPO, ANSI X12 Procedural and Diagnosis codes.
• Used Microsoft SharePoint as a Web-based Content Management System as well as a Document/ Project Management tool.
• Excellent knowledge of HIPAA (Health Insurance Portability and Accountability Act) transaction codes such as 270/271 (inquire/response health care benefits), 276/277 (claim status), 470 (benefit codes), 835 (payment or remittance advice), 837 (health care claim) and 834 (benefit enrolment).
• Adequate knowledge in Health Administration - Claims processing (auto adjudication), COB, EOB/ Drafts, Claims pricing and testing, HIPAA, enrolment, EDI, HER, HIX, Medicare, Medicaid, CDHP (consumer driven health plans).
• Ability to develop business rules, context data flow diagram, entity relationship diagram, workflow diagramming, prototyping and document current state, gaps and future state processes.
• Experience in multi-tasking such as managing numerous simultaneous projects with great attention to detail.
• Experience in solution assessment, validation and applying critical thinking for problem solving approach.
• Experience in Requirements elicitation techniques like conducting user interviews, document analysis, JAD sessions and managing the requirements.
• Comprehensive knowledge of Software Development methodologies (SDLC) such as Waterfall, Agile, Spiral and Scrum.
• Create various documents like the Software Requirement Specifications (SRS), Business requirements document (BRD), Use Case Specifications, Functional Specifications (FSD), Systems Design Specification (SDS).
• Good Knowledge of software and applications designing tools for the preview of the project at the very beginning.
• Analysed different types of Risks such as Credit Risk, Market Risk etc and developed the test scripts with all these parameters to analyse the securities.
• Worked closely with project Stakeholders, SMEs, PM, to understand, analyze, document, validate, and review the requirements and specifications for new applications along with enhancements to the existing applications.
• Efficient in writing Business Requirement Document (BRD), Functional Specification Document (FSD), Use Cases, User Interface Specifications (UIS), System Requirement Specification (SRS) and Report Specifications Documents.
• Skilled in translating business requirements and user expectations into detailed specifications and building business process flow charts using MS Visio and Enterprise Architect to communicate project functionality to the development team employing designing techniques like Unified Modeling Language (UML).
• Sound proficiency in analyzing and creating, Use Case Diagrams, Sequence Diagram, Activity Diagram, Data Flow Diagrams, Business Flow Diagrams, Wire Frames and Mock-ups using MS Visio and Rational Rose to communicate business and functional requirements to clients and developers.
• Performed AS-IS and TO-BE business process flow for clear translation of Functional to system requirement specification.
• Support the Test Team and the rest of the Development Team in compliance related issues while working with them in the development phases of the projects.
• Business Analyst with solid understanding of Business Requirements Gathering, Business Process Flow and Business Process Modelling and Data Mapping.
• Extensive working experience on Medicaid, Medicare and MMIS projects.
• Capable of managing multiple projects simultaneously

PROFESSIONAL EXPERIENCE:

Confidential, Tampa, FL

Healthcare Business Analyst

Responsibilities:

• Played an active and lead role in gathering, analyzing, and writing business requirements.
• Project was implemented in phases, enabling system to deliver as many business requirements as early as possible.
• Involved in Requirement Scoping and analysis of high priority requirements for implementation.
• Worked on Transaction-835 claims payments and remittance advice, which deals the payment from payer to provider.
• Involved in HIPAA EDI transactions such as 270, 271, 837 (P, D, I), 276, 277, 834, 820, 278, 999/TA1, and 277 CA.
• Evaluated Medicare requirements and benefits in Medicare Health Plans for member enrollment and management.
• Coordinated, implemented and provided on-going support of the Quality Performer as outlined in the Specifications Manual for Well Care Inpatient Quality Measures Centers for Medicare & Medicaid Services (CMS).
• Used HP Quality Center for writing Test plans and Test Cases.
• Worked on documenting business rules to be defined in the business rules management engine (IBM ODM).
• Participated in requirements meetings, writing requirements in CaliberRM, converting requirements from Caliber RM to HP Quality Center.
• Working knowledge of implementing software development projects using methodologies such as Waterfall, RUP, and Agile Scrum.
• Used HIPAA guidelines and regulations to keep track of Healthcare transactions like Eligibility Request/ Response, Request and Response for Claims Status, Prior Authorization, Claims Vision and Claims Payment.
• Worked closely with business team, and identified, analyzed the core requirements and key features of the ongoing project. Extracted, discussed, and refined business requirements and developed comprehensive business requirement document (BRD).
• Developed Software Requirement Specification (SRS) document using Visio and MS Office.
• Loaded the defects on to HP Quality Center and maintained a track record of the updates on the defects from the development team.
• Executed Test Cases Manually, once the application is stable and documented the successful or unsuccessful completion of each test case in HP Quality Center (QC) for End-to-End Scenario based testing.
• Worked on Agile SDLC during the project phase, performed the role of Product Owner and Team member in Scrum Meetings.
• Participated in agile process - planned iterations, created tasks, assigned tasks to quality assurance team based on the priorities and estimated capabilities of quality assurance team for every iteration.
• Involved in Testing Out-Bound Transactions (835 Health care claims Payment, 277 Claim Status Response).
• Consulted with healthcare third-party administrator company to develop conversion specifications for member, enrollment, and authorizations.
• Involved in Scrum development process and prepared Sprint burn down chart, product catalog and sprint backlog contain Business Requirements and supporting documents that contain the essential business elements and definitions as well as the tasks to be completed.
• Responded to billing inquiries from patients and payers.
• Analyzed and studied the technical, structural and data content changes for EDI transaction sets 834 (Enrollment and Maintenance), 837 (Professional, Institutional and Dental Claims) and 835 (Claim Payment/ Advice).

Confidential, Atlanta, GA

Healthcare Business Analyst

Responsibilities:

• Extensively involved in implementation of effective requirements practices, including gathering User Requirements, and analyzing User Requirement Document (URD), and functional specification document (FSD), use and continuous improvement of a requirement gathering processes.
• Applied RUP methodology with its various workflows, artifacts and activities to manage life cycle from inspection to transition phase.
• Acted as liaison between external clients and SMEs to generate and standardize product requirements specification documents such as URS/FRS/Use Cases.
• Employed UML methodology in creating UML Diagrams such as Use Cases, Sequence Diagrams, State Diagrams, Activity Diagrams and business process and workflows.
• Involved in implementing Six Sigma practices to systematically improve processes and standards and by eliminating defects
• Assisted JAD sessions to identify the business flows and determine whether any current or proposed systems are impacted by the EDI X12 Transaction, Code set and Identifier aspects of HIPAA.
• Involved in GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims. Worked on EDI transactions: 270, 271, 835, and 837 to identify key data set elements for designated record set.
• Involved in designing & determined 3-tier architecture for the claim processing system. Assisted team lead in developing Requirements Traceability Matrix (RTM) to trace the relationship between business and functional requirements to test cases.
• Prepared and executed different Test Cases and Test Scripts.
• Involved in conducting Functionality testing, Integration testing, Regression testing and User Acceptance testing (UAT). Provided analysis and insight to QA Team in defects and bugs tracking.

Confidential, Addison TX

Business Analyst

Responsibilities:

• Gathered business, system and functional requirements by conducting detailed interviews with Business users, Stakeholders and Subject Matter Experts (SME)
• Performed Gap Analysis to check the compatibility of the existing system architecture with new business requirements
• Worked extensively through Agile development methodology by dividing the application into iterations
• Supported the product owner in maintaining the Product Backlog, Sprint Backlog and scheduling next release
• Participated and contributed in Daily Scrum, Sprint Planning, Sprint Review and Sprint Retrospective meetings.
• Created User Stories with good acceptance criteria
• Worked closely with PO in refinement of user stories
• Addressed change management and other related activities
• Created weekly progress summary reports using Tableau to provide insights to the management
• Worked closely with QA in writing test cases and clarifying user stories
• Conducted User Acceptance Testing (UAT) and demonstrated new features to customer post demo release
• Generated reports such as burnout chart, velocity chart and defect reports using Rally

Confidential, Boston MA

Business Analyst

Responsibilities:

• Followed all the phases in the project management life cycle.
• Acted as a liaison between the business users and technical teams to build applications based on the business requirements - provided a single point of contact for user communication (managed issue tracking, prioritization and resolution).
• Hands on experience with JIRA for issue tracking & User stories / requirements
• Created complex reports utilizing SQL Server Reporting Services (SSRS)
• Developed and Deployed of SQL Server Integration Services (SSIS) Packages
• Organized meetings and worked together with PM across OWM Departments to discuss Project Requirements.
• Single-point contact for issues encountered by the client which were managed & co-ordinated via JIRA system.
• Gathered Requirement for Data Mart integrating data from UDB/DB2, Oracle, SQL Server, text, Excel, and Access.
• Assisted in designing and populate OLAP cube & Data Mart.
• Implemented CMS (Content Management System) in automating various aspects of Web and Publication Content Creation, Document Management and Delivery.
• Worked with OWM Team to write up Requirement Documents (define user and system interfaces - actors with the help of use case diagrams).
• Prepared Mock-up reports for the Cognos development team.
• Reporting the weekly and quarterly reports to the C-level executives.
• Refined the requirements (use-cases) and Business Process Models to detailed level appropriate for technical analysis and system design.
• Participated in sessions to define the solution approaches, and identifying assumptions, constraints, risk and issues. Analysis and specification of system changes.
• Revealed unidentified requirements, evaluated changes to requirements, and assessed impact of changes.
• Recommended process or system changes intended to eliminate identified risks or gaps.
• Worked with Finance and IT department to operate across functions and worked with resources external to the Project Team
• Developed functional requirements and specifications.
• Provided regular verbal and written status reports to IT management and business community; published meeting minutes and maintained project plans.
• Coordinated with the project team and testing team to revise project artifacts (such as use-case specifications, test scripts, and so on) to reflect requirement changes.
• Worked independently with minimum supervision as part of a dynamic IT team.