Over 7+ years experience as a Business Analyst in Health Care and Facets Application.
Experience in Healthcare Application Facets in different modules like Claims, Membership, Provider and Billing.
Experience in Finance industry and Customer Support.
Extensive experience and knowledge on all stages of the Software Development Life Cycle (SDLC) and Object Oriented Analysis and Design (OOAD) utilizing project life cycles such as Agile, Rational Unified Process (RUP), and Rapid Application Development (RAD).
Well versed in writing SQL queries, together with inner and outer Join commands for data analysis and retrieval.
Knowledge and experienced on Health Insurance Portability & Accountability Act (HIPAA 4010 and HIPAA 5010), Affordable Care Act (ACA), International Statistical Classification of Diseases and Related Health Problems, 9th Revision and 10th Revision (ICD-9 and ICD-10), Current Procedural Terminology (CPT).
Proficient in Medicaid, Medicare (Part A, B, C, and D), Procedural and Diagnostic codes, and Claims Process.
Experienced working with Claim Transactions such as 837 P/I/D - Medical claims, 835 - Health Care Claim Payment/Advice, 270 - Eligibility, Coverage or Benefit inquiry, 271 - Eligibility, Coverage or Benefit response, 276 - Claim status request, 277 - Claim status response, 820 - Payment Order/Remittance Advice, and 834 - Benefit Enrollment and Maintenance.
Good Knowledge of Health Care reform - Risk Adjustment, Reinsurance and Risk Corridors.
Strong understanding on Electronic Data Interchange (EDI), both in 4010 and 5010 formats.
Extensive experience in organizing and facilitating joint application development (JAD) sessions, interviews and workshops with user(s), subject matter experts (SME’s), and business stakeholders.
Proficient in producing Business Requirement Documents (BRD), Functional Requirement Document (FRD) and Software Requirement Specification (SRS) across the deliverables of a project.
Excellent analytical skills with extensive experience on performing GAP analysis, User Acceptance Testing (UAT), Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis, Impact Analysis, Risk Analysis and Mitigation plan, Cost benefit analysis and Return on Investment (ROI) analysis.
Proficient in handling functional and non-functional requirements with exceptional understanding and skill set in writing Test Scenarios, Test Conditions, Test Cases, and Test Scripts.
Possess understanding and experience in using Rational Requisite Pro to trace and update business requirements throughout the lifecycle of a project and keep stakeholders informed about the progress of the project utilizing Requirement Traceability Matrix (RTM).
Energetic and creative. Dynamic team player with integrative thinking skills.
Excellent problem solving, conflict managing, decision making and leadership skills.
Excellent analytical, written, communication, presentation and interpersonal skills.
RUP, SDLC, Agile Methodology
Rational Rose, MS Visio, MS Project
Requirement Management Tools:
Test Director(Quality Center), Rational Requisite Pro, Clear Quest, SoapUI
C++, SQL, PL/SQL, UML, HTML, VB Script
Defect Tracking Tools:
Rational Clear Quest and Mercury Test Director
MS SQL, MS Access, Oracle
Windows 2000/XP/ME/VISTA, LINUX, UNIX
Project Management Tools:
MS Office Suite, MS Project, MS SharePoint
Spectrum Health System, Grand Rapids, MI March 2015 to till date
Business and Systems Analyst
Project Description: Michigan-Based Priority Health offers a nationally recognized HMO and other group and individual health insurance plan options. Priority Health is serving more than 600,000 members and more than 12,000 employer groups. The project was specifically related to Implement the new State-issued Healthy Michigan Plan (formerly known as “Medicaid Expansion”).
Responsible for writing and reviewing the BRD/FRD documents, 'As-Is' / 'To-Be' Process flows with the Core team, Business owners, SMEs and all required signatories.
Worked on Enrollment, Claims and provider departments to analyze impacts.
Analyze and remediate as needed Reports.
Involved in the requirement gathering and Analysis for developing the Ad-hoc reports that are extracted from the consumer portal back end data.
Preparing business use cases; map Business Requirement / Software Requirements Specifications (SRS) document (As-Is & To-Be Analysis) and GAP Analysis and translating them into functional specifications, detailed test plans and coordinating for Go-Live.
Performing knowledge transfer to the technical/development and QA team by creating quality test cases and providing accurate test data.
Developed, executed and maintained Test Scripts, Reviewed and documented system and implementation Test Strategy Documents for Parallel Testing, and system integration testing.
Documenting requirements and creating functional design documents, process flow and design flow diagrams. Defined Functional Test Cases, documented, Executed test script in Facets system.
Prioritize user stories and assigned to different sprints.
Facilitated daily stand ups and managed task board with user stories and board.
Prepared and tracked burn down charts and velocity charts for timely delivery of projects.
Utilized corporation developed Agile SDLC methodology used scrum work pro and Microsoft office software to perform required job functions.
Developed and reviewed functional specification/design documents and assisted in architecture analysis based on the mainframe.
Environment: MS Word, MS Excel, MS Power Point, MS Visio, SDLC, XML, Caliber RM, MS Project.
Accenture/WellPoint, Indianapolis, IN Nov 2013 to Feb 2015
Business Systems Analyst (Facets)
Project Description: Worked with Claim EDI Transactions such as 837 while building the custom components for Claims Life cycle.
Performed GAP and Impact analysis on Claims lifecycle.
Helped testing to organize the flow of testing and involved in analysis for Batch job.
Worked with Claim EDI Transactions such as 837 while building the custom components for Claims Life cycle.
Performed extensive GAP Analysis in order to understand the As-Is and To-Be conditions and determine the feasibility of the new project with the existing system.
Carried out User Acceptance Testing and extensively used SQL to perform Backend Testing in order to verify data integrity.
Interacted with the QA team to performed Unit and Integration .
Worked with Trizetto to resolve the issues identified at analysis state while building the Custom components for Claim life cycle.
Updated, analyzed, and manipulated the SQL database.
Collected, documented, organized, and tracked the business requirements using Rational RequisitePro.
Made business requirements document, change requests, and use cases available to all teams using Rational RequisitePro, Rational Rose, and MS Visio.
Developed business flow diagrams, activity diagrams, and interaction diagrams so that the development team and other stakeholders could understand the business process clearly.
Maintained project milestones, schedules, and project progress using MS Project.
Environment: UML, MS Word, Rational RequisitePro, Rational ClearQuest, Quality Center, SQL, FTP, TelNet, Facets, Microsoft SharePoint
Bank of America, Charlotte, NC Feb 2012 - Oct 2013
Project Description: Worked in Cash Management services division. This division had various services under its umbrella like Information Reporting, Deposits and Collections, Disbursements and Cash management services. Each division had its own applications and the team was responsible for the entering of these applications in the cash management services division.
Reviewed and analyzed business requirements and interacted with the business users to resolve conflicts.
Performed initial functional and business analysis to determine scope and document review for the technical team.
Constructed data lineage information on usability and conceptualized data applications in a program-level scenario, highlighting the happy or base flow and probable exceptions.
Constructed, developed, and deployed ACH Money Transfer documentation for Overseas Business Unit, created functional and technical specifications (mid-level), highlighting chief actors, process flows, and exception errors.
Used Wireframes for web-based customer account management system.
Worked with various Overseas Funds Transfer Applications.
Interacted with Offshore development team, and incorporated the analysis and requirements in the final detailed design documentation.
Reviewed and provided critical document feedback to team members, communicated document analyses to team lead and stake holders.
Chaired and participated in project conferences for coordinating group efforts leading to the development and testing phase.
Used MS Project to develop project schedules and tasks.
Participated in developing Use Cases, activity and sequence diagrams to define the functionality scope of the applications during walkthroughs and JAD sessions.
Environment: Rational RequisitePro, Rational Rose, RUP, UML, Load, MS-Project, MS Visio, MS Office, Windows XP.
Green Byte Technologies, India Mar 2010 - Jan 2012
Project Description: The purpose of the project was to deliver Phase 2 of the Enterprise Data Warehouse (EDW) program. This project is being undertaken as part of the larger Enterprise Data Warehouse (EDW) Program, a 12 to 18 month effort focused on acquiring data from SAP modules and enabling reporting and analysis functionality for those business areas and functions whose business processes are primarily captured in SAP.
Handled a team of 5 Recruiters and freelancers working for IT & Non IT process.
Has initiated the quality drive in all recruitment and training to match the ISO standards.
Handled Mass recruitment for team member level.
Structuring the SLA’s for the team and handling all motivation and commission structure
for the team.
Coordinated with Project Head and hiring managers related to recruitments activities of projects and HR activities.
Independently handled end to end recruitment for a vertical. Sourcing of candidates at various levels (Middle and Senior management) from various sources like Job portals, employee referrals, manpower consultancies, advertisements, job fairs etc.
Arranging for on site and off site Interviews, coordination with Line managers and the candidates.
Environment: MS PowerPoint, Test Director, Rational Requisite Pro, RUP, UML, Rational ClearCase
Bachelors in Business management from The Oxford College of Business, India