Healthcare Business Analyst :SQL,Jira,Uat,Visio, Hpalm, Erwin.Hedis

Professional summary:

Business Analyst with *+ years of diverse experience in Health Care domain with exposure to innovative business processes and creating data mapping and data modelling documents.

In-depth knowledge and experience in System Development Life Cycle (SDLC) with RUP, Agile and Waterfall methodologies.

Expertise in creating prototypes and mock-ups for user interface designs with the use of Axure and MS Visio.

Provides managed care coordination services to meet medical, behavioural health and social needs of member of Independent care Health Plan.

Responsible to migrate developed Dashboards and reports between Cognos Environments.

Complete initials and annual assessments of member's medical, behavioural, and social needs in effort of establishing a care plan for the individual's needs.

Ability to work on multiple project requests simultaneously while meeting tight deadlines.

Developed Dashboards, reports and book of business using cube source data.

Clear understanding of ICD-9-CM and ICD-10-CM/PCS and well versed with ANSI X12, HIPAA standards and strong understanding of EDI in 4010, 5010.

Used Tableau for the data / business predictive analysis, for trending, for finding the pattern of data over the period of time.

Used HEDIS for researching data, data integration for quality improvement.

Provided project management and analytical support to the Quality Improvement Department for the HEDIS Program.

Extensively used Power Designer to create data Models for relational and dimensional modelling.

Good understanding of Normalization forms and database design methodology Expertise in using data modelling tools like MS Visio and Erwin for logical and physical design of databases.

Well versed with Data Mapping, data modelling from Facets to outbound eligibility extracts.

Assisted System analysts in Claims Data migration and other ETL concepts.

Deployed naming standard to the data Model and followed company standard for Project Documentation.

Worked at conceptual/logical/physical data model level using Erwin according to requirements.

Coordinated with technical team in preparing dashboards using calculated fields, parameters, calculations, groups, sets and hierarchies in Tableau.

Conducted analysis on key performance indicators (KPI’s) across all our operations to support monitoring of performance against all plans.

Taking complex data and distilling it into relevant information, documents and/or presentations for use by various business units.

Aligned BI requirements to overall company strategy.

Excellent knowledge of MS SQL Server and Oracle and with Data modelling techniques.

Experience in designing the data conversion strategy, development of data mappings and the design of Extraction, Transformation and Load (ETL) routines for migrating data from non-relational or source relational to target relational.

Excellent command in writing complex routines for Data Validations, Data Extraction, transformation and loading to target decision support systems using MS Excel on various environments.

Efficient in using MS Project/MS Excel for planning/status reporting/writing test scenarios.

Experienced in writing SQL queries / joins using MS SQL Server and Oracle databases.

Involved in analysing and documenting various reports such as ad-hoc reports, drill-down, drill-through and parameterized reports.

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

Technical skills:

Project Methodologies

Rational Unified Process (RUP), Waterfall, Agile (Scrum), BPMN

Business process modelling Tools

Business Process Analysis & Design, Process Improvement, Requirement Gathering, Use Case Modelling, JAD Sessions

Tools and MS office tools

Microsoft Office Suite, Microsoft Project, Microsoft Front Page, Microsoft SharePoint, Microsoft SQL Server, Tableau

Project Tracking Tool

JIRA, HP QC ALM, Rational ClearQuest, Rally

Content Management Tools

Content Management, Adobe Experience Manager, SharePoint, Decision Support System

Testing Application/Tools

Oracle TOAD, HP Application Lifecycle Management (ALM), HP Quick Test Professional (QTP), ERWIN

Integration Application/Tools

NASCO, HIPAA, Validator

Languages/Standards

SQL, UNIX, XML, HTML, UML

Professional experience:

Tek Systems Jan 2017 to till date

Business Systems Analyst

Chicago- IL

Responsibilities:

Gathered information and documents from stakeholders and SMEs through meetings, JAD, sessions, emails as well as reviewing the information.

Followed AGILE methodology throughout the project.

Created numerous FRS, use cases and data mapping documents based on the user stories.

Conducted meetings and JAD sessions with business users and other stakeholders.

Planned and defined system requirements to Use Case, Use Case Scenario, and Use Case Narrative using the UML (Unified Modelling Language) methodologies. Assisted in writing Test cases and developed strategies with Quality Assurance group to implement them.

Conducted project kick off meetings with team members to explain roles/responsibilities, relationships with other groups, deliverables, timelines, assignments and status reporting.

Experienced in GAP Analysis of HIPAA 4010 to 5010 with particular attention to qualifier, length and required field and situational rules.

Exposed to using ICD 9/ ICD 10 coding standards in Medicare and Medicaid domains of the healthcare systems and industry for inpatients, outpatients, reimbursement methodology.

Provided support for different systems for mapping ICD 9 to ICD 10.

Excellent knowledge on EDI transactions such as 270,271,274,275,276,277,834,835,837,997, 999 and vast knowledge on data elements, loops and segments I EDI structure.

Extensively used relational and dimensional data modelling for creating Logical and Physical Design of Database and ER Diagrams using data modelling tools like ERWIN.

Experience with logical and physical data modelling and database design using Erwin. Created Sessions and Workflows of the source to Target loading.

Created action filters, parameters and calculated sets for preparing dashboards and worksheets in Tableau.

Effectively used data blending feature in tableau.

Analyzed business operations and recommended methods and processes to improve productivity and quality.

Conducted gap analysis for re-engineering and upgraded the current system where ever necessary.

Acted as Liaison for project managers, managers and stakeholders.

Created sprint backlogs, user stories and participated in creating test scenarios.

Worked on SQL and Erwin Data modelling tool .

Excellent experience using Service now, clear quest and visio.

Documented schedule, requirements; and generated functional documents for technical team to execute.

Created business process flow charts, swim lane diagrams and data base (ERD, logical and Physical) models using MS Visio.

Provided constant support to implementation team on need basis and acted as a point of contact.

Worked closely with key functional stake holders, such as planning, production, inventory management, finance and logistics to ensure consistent and effective design.

Conducted stand up and weekly review meetings.

Worked closely with developers, testing team and project managers.

Prioritizing the issues and follow up with various teams.

Created training documentations with the help of implementation team, which was used during UAT.

Excellent experience in using service now and clear quest for ticket tracking.

Environment: Windows, MS Office (MS Word, MS Excel, MS PowerPoint, MS Visio, MS Access, MS SharePoint), Service Now, Clear Quest, Excel, Visio, JIra. ERWIN, SQL,Quality Centre and HPALM,

Blue Cross Blue Shield May 2015 to Dec 2016

Detroit, Michigan

Sr. Business Analyst

BCBS is promoting the health and well-being of the residence of Detroit. I worked as a BA on Medicare claim accuracy project for provider reimbursement and various modules like multiple surgeries, late payment interest and coordination of benefits. I worked with EDI HIPAA transactions.

Responsibilities:

Planned and allocated resources for completion of tasks in various sprints/iterations and maintained engineering backlogs and project backlogs for different projects.

Gathered information and documents from stakeholders and SMEs through meetings, JAD, sessions, emails as well as reviewing the information.

Followed AGILE methodology throughout the project.

Planned and defined system requirements to Use Case, Use Case Scenario, and Use Case Narrative using the UML (Unified Modelling Language) methodologies. Assisted in writing Test cases and developed strategies with Quality Assurance group to implement them.

Conducted project kick off meetings with team members to explain roles/responsibilities, relationships with other groups, deliverables, timelines, assignments and status reporting.

Experienced in GAP Analysis of HIPAA 4010 to 5010 with particular attention to qualifier, length and required field and situational rules.

Analysed performance using HEDIS and generated reports for improving the services.

Strong business and Data Analysis skills with emphasis on researching data, data integration, data validation and collecting business requirements for the Quality Improvement HEDIS program.

Prepared High Level Logical data Models using Erwin, and later translated the model into physical model using the Forward Engineering technique.

Designed future state processes for HIPAA 5010 transaction processing EDI's 837 and 835.

Analysed HIPAA 5010 related to 837,835, 834 transactions.

Experience with logical and physical data modelling and database design using Erwin. Created Sessions and Workflows of the source to Target loading.

Expertise in dealing with Relational Database Management Systems Including normalization, stored procedures, constraints, querying, joins, keys, indexes, data import/export, triggers and cursors.

Involved in logical and physical data models using Erwin.

Created dashboard reports for the management to give multidimensional view of the business using Cognos.

Responsible to migrate developed Dashboards and reports between Cognos Environments.

Developed ETL mappings and workflows to facilitate dimension and fact data loads in the data warehouse.

Assisted testing team to write test cases based requirements and followed up with them when performing smoke, regression and integration testing.

Managed and assigned defects to the development team in Microsoft Team Foundation Server.

Environment: Windows, MS Office (MS Word, MS Excel, MS PowerPoint, MS Visio, MS Access, MS SharePoint), SQL, and Quality Centre, HPALM, ERWIN.

Cigna September 2013 to April 2015

New Brunswick, NJ

Business Data Analyst

Cigna insurance offers behavioural health benefits, work/life support programs, medical management and leading health & wellness services. Cigna Web application provides Quality level of Health services for customers. The web site and supporting system was developed to provide online insurance services to their customers & Agents. The project was to implement health management solution for providing real-time claims adjudication capability for faster payment to physicians.

Responsibilities:

Prepared high level logical data models, business requirement document (BRD) and functional requirement specification (FRS).

Conducted JAD sessions with stakeholders throughout SDLC to resolve open issues.

Performed GAP analysis and created "as-is" and "to-be" claim adjudication process flows.

Prioritized backlog of requirements assigned to development teams based on business value.

Coordinated with technical team in generating reports in the form of tabular, matrix and chart forms using tableau.

Exposed to using ICD 9/ ICD 10 coding standards in Medicare and Medicaid domains of the healthcare systems and industry for inpatients, outpatients, reimbursement methodology.

Provided support for different systems for mapping ICD 9 to ICD 10.

Extensively used relational and dimensional data modelling for creating Logical and Physical Design of Database and ER Diagrams using data modelling tools like ERWIN.

Followed the UML based methods using Rational Rose to create: Use Cases, Activity Diagrams, Sequence Diagrams, and Collaboration Diagrams; created the AS-IS and TO-BE process flows.

Partitioned the fact tables and materialized views to enhance the performance and used calculated fields when required.

Extensively used bulk collection in PL/SQL objects for improving the performance.

Expertise in dealing with Relational Database Management Systems Including normalization, stored procedures, constraints, querying, joins, keys, indexes, data import/export, triggers and cursors.

Worked extensively on multiple data connections using blending, worked on Data Extracts and managing queries.

Assisted in writing test cases and developed strategies with team members group to implement them.

Performed Functional and Regression testing using automation tool QTP.

Performed black box testing including smoke, regression, integration and functional testing.

Performed GUI testing manually.

Administered and coordinated user acceptance testing (UAT).

Environment: Agile, JAD, MS Office Suite (Word, PowerPoint, Excel, Outlook), EDI X12, HIPAA, UML, JIRA, SQL server, Tableau.

Universal Health Care February 2012 to August 2013

Saint Petersburg, FL

Business Data Analyst

Universal Health Care is a Medicare/Medicaid health insurance provider. It provides managed care services for government sponsored health care programs, focusing on Medicare and Medicaid. The project is implementing HIPAA 4010 and HIPAA 5010 changes in the existing claim processing integrated system. It also allowed providers to automate tasks like patient management with monitoring and audit support of Medicare Part D claims.

Responsibilities:

Proficient in gathering and converting User Requirements into Business Requirements and Functional Requirement Specifications (FRS) and use Modelling tools like Rational Rose and Microsoft Visio for requirements modelling.

Strong experience with different project methodologies including Agile, Scrum Methodology, SDLC, RUP.

Developed crosswalk between ICD 10 and ICD 9 to assist with transitioning to ICD 10 and identify the differences between the two versions.

Created worksheets and dashboards by using custom queries and multiple tables.

Created action filters, parameters and calculated sets for preparing dashboards and worksheets in Tableau.

Effectively used data blending feature in tableau.

Administered user, user groups, and scheduled instances for reports in Tableau.

Responsible for the mainframes that receive the HL-7 message in pre-approved format from the middleware as disclosed in the documentation.

Conducted Gap analysis (HL7 specifications), map, interpret HL7 messages, monitor, and troubleshoot/test using analyst skill sets-SDLC for correct implementation.

Designed future state processes for HIPAA 5010 transaction processing EDI's 837 and 835.

Analysed HIPAA 5010 related to 837,835, 834transactions and performed gap analysis between HIPAA 4010 and 5010.

Worked with various streams for the patient engagement platform including data integration of HL7 and EDI formats.

Build and maintain SQL scripts, indexes, and complex queries for data analysis and extraction.

Created reports by extracting data from cube.

Involved in the creation and maintenance of the workflow plans and artefacts.

Prepared business process models that includemodelling of all the activities of the business from the conceptual to procedural level.

Conducted SWOT Analysis for better market understanding and fool proof project implementation.

Experience in rational rose & HP quality centre.

Documented requirement traceability matrix (RTM) for requirement elicitation and linkup to deliverables.

Environment: Microsoft Office (MS Word, MS Excel, MS PowerPoint, MS Visio, MS Access) Rational Requisite, RUP, UML, SQL, Test Director.

Emdeon July 2010 to February 2012

Nashville, TN

Business Analyst

Change Healthcare (formerly Emdeon Inc.) is a provider of revenue and payment cycle management and clinical information exchange solutions in the U.S. Healthcare system. This project is about implementing the automated adjudication system, which deals with different phases of claim process such as Intake Phase, adjudication phase and reporting phase. Implementation of ACAS (Automated Claim Adjudication System) to comply with HIPAA Rules and Regulation.

Responsibilities:

Involved in creating functional requirements specification (FRS) for the design, development and implementation of the project.

Designed future state processes for HIPAA 5010 transaction processing EDI's 837 and 835.

Analyzed HIPAA 5010 related to 837,835, 834 transactions and performed GAP analysis between HIPAA 4010 and 5010.

Performed several levels of testing of the conversion from 4010 to 5010 which included syntax verification, balancing of the segments, situational cases and verification of the loops as per the guidelines of the implementation guides and companion guides.

Conducted meetings and JAD sessions with business users and other stakeholders.

Assessed flaws in existing "As-Is" system and made clear recommendations of Business Process Improvements and incorporated them in "To-Be" future system.

Worked with the end client for user acceptance testing and obtained final system acceptance

sign-off.

Created the templates for test plan, test cases and process flow diagrams.

Analyzed, defined, documented and communicated business requirements to technical architects, developers by interacting with the end customers to meet business partner's needs.

Developing Attributes, Facts, Metrics, Filters, Prompts and Hierarchies as per Specifications for developing reports.

Preparing Report Mapping Documents as per Specifications.

Actively involved in gathering requirements from end users, involved in modifying various technical & functional specifications.

Validating the generation of EDI 834 files and validate the entries, loops and segments are in correct format.

Developing detailed cutover task plan for EDI implementation. Coordinated functional integration testing with EDI subsystem team through best practices, standards within EDI capabilities.

Environment: Waterfall methodology, MS Project, MS Visio, UML, Rational Rose, MS Office Suite (Word, PowerPoint, Excel), Oracle.

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