Project Data

SOWMYA REDDY

Business Systems Analyst

*******.******@*****.*** Ph: 682-***-****

PROFESSIONAL SUMMARY

7+ years of experience acting as a liaison between clients and development teams providing business/functional requirements.

Strong understanding of project life cycle and SDLC methodologies including RUP, RAD, Waterfall and Agile.

Experienced in translating business requirements and user expectations into detailed specifications using Agile methodology.

Efficient in conducting many workshops and JAD/JAR sessions involving company employees and end users.

Experience in developing Use Cases, creating Screen Mockups, conducting Gap Analysis.

Excellent work experience in creating Project Plans, Business Requirement Documents, Functional Requirement Documents, Use Cases, Activity Diagram, Sequence Diagram, Requirement Traceability Matrix and Test Plans.

Experience in conducting User Acceptance Testing, SWOT Analysis, Cost Benefit and ROI analysis

Experience in Healthcare Industry with strong operational knowledge of Health Insurance Portability and Accountability Act (HIPAA).

In depth knowledge of health care basics including Medicare/Medicaid, HIPAA 4010-5010, ICD9 and ICD10, and EDI Transactions.

Experience in HIPAA 4010 and 5010 EDI healthcare transactions like 837, 835, 834, 820, 270, 271, 276, 277, and 278 along with ICD-9/10.

Extensive knowledge on the various types of health insurance programs such as: Medicaid, Medicare (Part A, B, C and D), PPO, HMO, Dental claim and POS, Health Insurance Portability & Accountability Act (HIPAA) standards, Electronic Data Interchange (EDI), HL7.

In depth knowledge of Medicaid and Medicare claims processing along with extensive knowledge on CMS, MITA, MMIS.

Cultivated expert knowledge and understanding of business rules in order to provide quality data analysis

Experience of writing SQL queries such as Select, Insert, Left Join, Right Join etc.

Experienced in executing test plans, test cases, test results analysis with the testing team and reporting defect management and test status matrices.

TECHNICAL SKILLS

Business Planning & Work Flow Tools

UML, MS Visio, Rational Rose, MS Project, Rational Requisite Pro, MS Office, Word Perfect

Processes

RUP, RAD, Agile, Spiral JAD, Waterfall SDLC models

Databases

MS Access, MS SQL Server, ORACLE, DB2

Testing/Defect Tools

Rational Test Manager, Quality Center, Clear Quest, QTP

Operating Systems

Windows, Unix, Linux

Management Tools

Microsoft Project, MS Office, MS Outlook

PROFESSIONAL EXPERIENCE

Blue Cross & Blue Shield, Richardson, TX Jan 2016- Till date

Business Systems Analyst

Blue distinction total care (total care) is a national program that recognizes doctors that spend more time on prevention, holistic (total) care and personalized care planning for their patients. Total care encourages a focus on health care instead of sick care. The program is designed to encourage strong relationships between doctors and their patients that can lead to better health. The requirement of the project is to develop individual blue prints for each division taking into consideration the current state and aiming for the target (future) state.

RESPONSIBILITIES:

Working on master documents of Business and Technical Architecture for end to end enrollment.

Developing capabilities for current state of End to End Enrollment per stakeholders requirements.

Participating in capability modeling for product and pricing within the scope of End to End Enrollment.

Work with Data Ware House Architect to design the Logical Data Model based on the approved DSD

Conducting requirement gathering sessions to define the project and to reduce the time frame required to complete deliverables.

Responsible for business analysis, requirement specifications, risk analysis, project planning and identifying the resources and implementation of the project.

Participating in the identification of the gaps and the pain points in the current state perspective and aiming for the target (future) state.

Record meeting minutes at time of conference call or meetings and keep track of all meeting notes.

Involved in EDI transactions Analysis, Design, Implementation and Documentation.

Conducted Functional meetings with the Project Manager to align and analyze resource capacity for planning the demands of the project.

Preparing the Test Scenarios for Health Care Claim Payment/Advice.

Wrote and utilized assorted Business Objects reports, both scheduled and on-demand.

Maintaining Requirement Traceability Matrix (RTM).

Participating in Enrollment and Eligibility Blueprinting Deliverables.

Use Case development using modeling tool MS Visio.

Involved in creating Reports and Documents like Requirements Documents, and Management Plan, Issue/Alternatives documents, Project Summary and Plans with formats like PDF, HTML, Excel and Word.

Monitoring and optimizing the performance of the database.

Used SQL knowledge to retrieve and understand data from relational database warehouse to make recommendations to product team.

Produced for transaction sets 835 and 837 (I/P) a full gap analysis 4010 vs. 5010 against the documented application 5010 enhancements ensuring the upgraded application included the required changes and additions for 5010 compliancy.

Involved in up-gradation of 4010 transaction to 5010 by conducting Impact Analysis and Risk Assessment and worked on the mitigation plan to avoid the risks.

Enhance format template for outcomes of interviews conducted with stakeholders and maintaining communication deck for the same.

ENVIRONMENT: MS Outlook 2007&2010, MS Office 2010, SharePoint 2007&2010, MS Project, SQL, Microsoft Visio, Windows 2000/XP, DB2, Agile-scrum.

Sanford (Merit Care), Fargo, ND Feb 2014- Oct 2015

Business Analyst/ Data Analyst

Sanford is a healthcare provider with a mission of dedication to health and healing. The requirement of the project was to develop an application to manage health claims for the patients electronically. A web based electronic claim processing solution was needed which could provide real time patient insurance information. The application had to be designed to be able to connect the organization with the largest nationwide commercial and government health plan network to provide real time patient benefit information. HIPAA compliance and privacy of transaction had to be maintained.

RESPONSIBILITIES:

Analyzed the current software used to manage health claims.

Worked hand in hand with the Project Manager to ensure project timelines & deliverables using MS Project.

Defined and refined Data mapping files for Data migration and Data Integration. Worked on Data rubbing process. Lead preparation of data warehouse requirements document.

Gathered needs of the end users through meetings, informal workshops and JAD/JAR sessions. Helped to bridge the gap between the IT department and the end users.

Responsible for business analysis, requirement specifications, risk analysis, project planning and identifying the resources and implementation of the project.

Performed Gap analysis pertaining to HIPAA 4010 – 5010 conversion to accommodate the ICD-10-CM and ICD-10-PCS code sets.

Gathered and prioritized requirements, developed business scenarios to check how the system would work with the roles and processes of the departments, and developed acceptance criteria.

Developed Use cases, use case models, Activity models, sequence diagrams and other UMLs to better understand the functioning and desirability of the application.

Involved in designing and developing Data Models and Data Marts that support the Business Intelligence Data Warehouse.

Configured, mapped, validated, and tested data based on business requirements.

Optimized accessibility to data through advanced Excel functions and utilization of VBA and macros.

Assisted with building the EDI 837, 835, 270/271, 276/277, 278, 820 and 834 transactions processing flow from the Trading Partners to the translator.

Facilitated review of Enrollment, Claims, Commissions, and membership port designs with architects and developers to ensure that the goals of the portal requirements were satisfied.

Communicated with business, technology leadership for overall project/program office milestones.

Analyzed requirements and formulated a Test Plan for testing the functionality, navigation testing of the application.

Worked with Data Extraction, Transformation and Loading Metadata architecture was also provided, for the purposes of query enhancement and clarification of data relationships. Also built the foundation for process implementation in MS-SQL.

Experienced with Data Warehousing, Extraction, Transformation and Loading (ETL) and Business Intelligence (BI) tools.

Understand rules and regulations of HIPAA as imposed during Electronic Data Interchange (EDI).

Prepared documents to conduct professional meetings for the client and team members.

Participated in enhancement meetings to make the product more effective in real time. Worked with developers and QA Analyst to clarify the SRS.

ENVIRONMENT: MS Project, MS SQL,, Rational Requisite Pro, Rational Rose, Microsoft Visio, Windows 2000/XP, Business Objects, Waterfall Methodology.

Blue Cross & Blue Shield, Chicago, IL June 2010 – Dec 2013

Business Analyst

BCBS is the health insurance and health care provider company. The project was to provide web based revenue cycle automation and management solution to its clients on demand basis. The main objective of the application will be to maintain patient related information and account receivable to increase collection from insurance companies. HIPAA compliance was needed in all processes from tracking medical claims, sending it to the insurance company and follow up and closing of the claims.

RESPONSIBILITIES:

Responsible for developing and reviewing business requirements, functional specifications, project schedules, documentation and test plans.

Coordinated with Project Managers to resolve risk issues and ensure compliance of Security System-Related to the HIPAA.

Closely interacted with designers and software developers to understand application functionality, navigational flow and updated them about end-user sentiments.

Gathered needs of the end users through meetings, informal workshops and JAD/JAR sessions.

Collecting information from various insurance companies to be able to develop an application for checking the outstanding balance.

Bridging gap between the Business needs and the Technical solutions.

Defining the Business Process Model and Data Process Model.

Follow HIPAA compliance to safe guard patient information.

Coordinated with Project Managers to resolve risk issues and ensure compliance with HIPAA standards.

Performed GAP analysis and feasibility studies.

Managed and developed EDI specification, gap analysis and applications structures for data feeds and mappings for integration between various systems to follow ANSI X12 4010 formats including:

o270/271: Eligibility/Benefit Inquiry and Information.

o276/277: Claim Status Request and Response.

834: Benefit Enrollments.

835: Remittance Advice.

837: Claims and Encounter.

997: File Transmission Acknowledgement to meet and exceed HIPAA requirements set forth by the federal government.

Developed use cases, and traceability matrices to better assist software development.

Developed training material for understanding the newly developed application.

Wrote technical documentation for root cause analysis on customer support issues.

Part of the team assisting in documentation such as proposal writing, evaluation criteria, proposal approval, design document, project plan, project scheduling and project report.

Prepared and presented monthly collection reports.

Involved in training and quality of the overall workflow process.

Creating and analyzing numerous clients’ reports for various financial requirements

Led both internal peer review and external reviews of use case specifications and in the process clarifying the critical requirements.

Met with business teams as well as test teams to review the requirements as outlined in the use cases.

Experienced in developing test plans, test conditions and test cases to be used in testing based on business requirements using Quality center.

Created and maintained the Requirement Traceability Matrix between the requirements and other products such as design documents and test plans.

Familiar with User acceptance testing (UAT), System testing, Integration testing and Regression Testing.

ENVIRONMENT: MS Word, MS Power Point, MS Access, MS Excel, MS Visio, MS Projects, HTML, MS SQL Server 2000, Windows 2000/XP, RUP, SDLC.

Google, Mountain View, CA (Off-Shore) Feb 2008 -April 2010

Business Analyst/ Content Engineer

Google Maps is a web mapping service developed by Google. The main objective was to ensure all data reflected on Google Maps is accurate, user friendly and in accordance with Google’s policy.

RESPONSIBILITIES:

Maintain data accuracy and identify patterns in data for Google Maps.

Making outbound calls in needed language to verify and correct information on Google database.

Compare between multiple sources of information with strong attention to detail in order to ensure all data reflected on Google Maps is accurate, user friendly and in accordance with Google’s policy.

Experience in Software Development Life Cycle (SDLC) methodologies

Led requirement gathering sessions (RGS) and joint application development (JAD) sessions.

Assisted in deriving functional requirement specifications (FRS) based on user requirement specifications (URS).

Knowledge in documenting Unified Modeling Language (UML) diagrams like Use Case Diagrams, Activity Diagrams, Sequence Diagrams, Data Flow diagram, Business process modeling and Business Flow Diagrams using MS Visio.

EDUCATION

Masters in Computer Science, Chicago State University (2012)

Bachelor's in Civil Engineering, JNTUH (2009)

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