Senior Business Analyst
Resume:
MIKOLA T OBISIKE
***********@*****.*********:***********@*****.***
•An accomplished IT Professional with Eight (8) years of experience as a Business Analyst in all phases of Software Development Life Cycle with solid understanding of Business Requirement Gathering, Business Process Workflow and Business Process Modeling.
•Experienced working on HIPAA implementation guides relate to Claim Testing and Medical Billing
•Good understanding of health care industry, Claims Management process, Medicaid and Medicare Services.
•Proficient in all phases of Requirement Management, including gathering, analyzing, detailing, and tracking requirements.
•Involved in Test Planning, Test Preparation, Test Execution, Issue Resolution and Report Generation to assure that all aspects of a Project are in Compliance with the Business Requirements.
•Familiar with HIPAA Standards and Compliance issues, HIPAA Privacy policy, requirements gathering .
•Proven ability to analyze complex problems, identify risks and develop effective solutions to improve productivity, reduce cost and track progress through all phases of SDLC
•Strong experience in all phases of Software Development Lifecycle (SDLC) using Waterfall, Agile/Scrum, RUP (Rational Unified Process) and Software Testing Life Cycle (STLC).
•Involved in GEM (General Equivalence Mapping) tools for forward mapping of ICD 9 – ICD 10 codes as required by the project.
•Expert in analyzing, elicitation and management of requirements. Highly experienced in creating Business Requirement Document (BRD) and Functional Requirement Specifications (FRS) document.
•Facilitated one on one interviews, Joint Requirement Planning (JRP) and Joint Application development (JAD) sessions
•Experienced in methodologies like Agile, Waterfall Model and Data Modeling; Creating Process mapping, Use Cases, Sequence diagrams, Activity diagrams
•Solid understanding of Membership, Claims Processing, Billing, Benefit/Eligibility, Authorization/Referrals, COB, and have experience in HIPAA standards and corresponding EDI transactions.
•Exceptional ability to maintain and build client relationships with business owners to identify, prioritize and document business requirements.
•Extensive experience in Healthcare/Claims adjudication with knowledge of industry compliance standards like HIPAA and EDI X12 transactions (834, 837, 835, 270/271, 276/277).
•Used SQL on TOAD to upload catalog updates
•Experience working with EDI transactions - 834, 835, 837 & 820 for Enrollment, Claims (Inbound & Outbound) and Premium Payments.
•Executed advanced level SQL queries to verify data integrity of the databases.
•Excellent knowledge and hands on experience with SSRS reporting systems.
•Scheduled meetings and reinforced business analysis with developers, system analysts and testers to collaborate rescore allocation and project completion using MS Project.
•Have worked with SAS (Statistical Analysis System) Integrated system, particularly in the modules w.r.t. Data Analysis, Performance and Risk Management.
Senior Business Analyst
Sundance Healthcare- Arlington, TX ( March 2014-Present)
Work with and interview various appeals related departments such as hearings,
adjudication, intake, large employer.
Use business tool called Jama contour for managing requirements, test cases, creating defects
Use tool called EACMS for testing environment and managing health care appeals.
Work as lead for user acceptance testing to find defects.
Design test cases used in the UAT.
Identify the business functions and processes, and prepared system scope and objectives based on user needs and industry regulations.
Responsible for preparing and maintaining high level of business requirements and also deal with detailed requirements specifications, designing data flow process
Coordinated with the stakeholders, and other key personnel from the wellness department, laboratory facilities, medical professionals to gather functional and non-functional requirements
Worked with project team representatives to ensure logical and physical data models were developed in line with corporate standards and guidelines
Documented important documents such as BRD, FRD and all other supported documents that clarify and supported business needs
Designed workflow diagrams, UML diagrams, activity diagrams, use cases in order to demonstrate design in the portal
Performed data mining and querying in mainframe and also web administrative systems using SQL skills.
Designed and implemented data integration modules for Extract/Transform/Load (ETL) functions
Produced test plans documents and test case and ensuring scenarios that reflect user needs
Involved in integration testing part of the project and coordinated with QA regarding UAT testing approach
Extensively involved in performance testing, load testing, stress testing .
Environment: Rational tools (Rose/Requisite Pro/Clear Quest), RUP, MicroSoft.Net, JAVA, Oracle, MS Word/PowerPoint/Excel/Project/Visio/SharePoint, Windows XP, UNIX.
Business Analyst
Atlantic Health Care -Morristown New Jersey (Aug 2012-Feb 2014)
Responsibilities:
Interacted with stakeholders to get a better understanding of client business processes and gathered requirements.
Designed a claim processing system for the healthcare management client system. It allowed the user to inexpensively capture information regarding patient, summary of medical history, symptoms (ICD-9 codes), and treatment (CPT).
Responsible for gathering the functional requirements for the health benefit claims receiving and processing system.
Conducted requirement gathering sessions with the purpose of creating and defining the Business Requirement Document (BRD) and the Functional Requirement Document (FRD) using Rational Requisite Pro.
Involved in Requirement Scoping and analyzing high priority requirement. Conducted sign-off meetings with IT teams to lock down the requirements.
Created high-level Use Cases from Business Requirements and created UML diagrams like Use Case and Activity diagrams using MS-Visio.
Conducted JAD sessions to allow different stakeholders to communicate their perspectives with each other, resolve any issues and come to an agreement quickly.
Tracked stakeholder requested enhancements and changes using Requirement Traceability Matrix (RTM).
Involved with the following list of HIPPA-EDI Transaction Code sets: 837, 835, 270/271,277/275 and 276/277
Executed SQL queries to test the database for records that detect and submit functional acknowledgement and remittance advice in the claims application.
Involved with the Quality Assurance Team to develop and design test plan and test cases.
Executed test cases and test scripts for manual and automation testing. Defects are raised in the HP Quality Center/HP ALM for logging, tracking and reporting bugs in the application.
Conducted User Acceptance Testing (UAT) of the application with the QA team.
Performed testing of the health benefit claims receiving and processing system to ensure that the system adheres to project standards, performance criteria, and functional specifications.
Environment: MS Office Tools, Windows XP, MS Project, SharePoint 2007, MS-PowerPoint, SQL, Agile framework
Business Analyst
Magna care New York -New York, NY (Dec 2009 to July 2012)
The goal of the project was to implement an interactive wellness portal called as Well on Target for BCBS of Texas. The web-based project would allow members to access many wellness tools in order to optimize their health. This project followed Agile Scrum methodology.
Responsibilities:
Identified the business functions and processes, and prepared system scope and objectives based on user needs and industry regulations.
Defined terms, conducted stakeholder analysis, elicited business needs, conducted business process modeling, and facilitated JAD sessions. Elicited, documented requirements and use cases. Analyzed, validated & prioritized requirements; traced requirements to related project documentation (process models, designs, test scenarios & scripts).
Documented the Requirements and circulated them to Business & Technical teams for Signoffs.
Coordinated with the developer and testers for transition of EDI X12 4010 series to 5010 series. Maintained traceability through updates to the Requirement Traceability Matrix (RTM) using Requisite Pro.
Identified testing scenarios and defined Test Cases for detailed functional testing.
Facilitated claims processing while passing 837 claims for a compliance check and running through load processing.
Developed a Schedule and identified project milestones.
Analyzed business scenarios to track possible business outcomes for the functions which could be incorporated into more detailed test scripts.
Reported project progress to the team, senior management and all stakeholders periodically.
Identified risk and project impact and performed risk assessment and mitigation.
Benefit Advisor
Extend Health, Richardson, TX (June 2007-Dec 2009)
Responsibilities:
Attend to all the customer calls, setting up appointment for enrollment, Fulfill customers’ needs and enrolling the customers in various health plans and schemes pertaining to their health care needs.
Educating the customers about HRA with their benefit.
Making sure the customer understand difference between HRA and HSA.
Assisting them in their transition.
Providing customer service with clear and crisp communication and product knowledge.
Collections Agent
West Asset Management, Texarkana, TX (Mar 2005-May 2007)
Responsibilities:
Locate and notify customers of delinquent accounts.
confer with customers by telephone to determine reasons for overdue payments.
analyze financial situations.
customer persuasion/payment negotiation
arrangement for debt repayment
financial advice on necessary account actions and miscellaneous clerical duties.
mailto:***********@*****.***
Contact this candidate