Have profound experience of over 5 years as a Business Analyst in Healthcare domain.
Knowledge in Software Development Life Cycle (SDLC) methodologies like Agile, RUP and Waterfall.
Expert in Business Process Management, Business Process Reengineering, Business Process Modeling, Business Analysis, System Analysis, Feasibility Studies, Scope Documents and Requests outstanding for proposal.
Extensive experience in requirements gathering, surveys, questionnaire, business requirement documents (BRD), functional requirement documents (FRD).
Strong experience in GAP analysis to identify system restrictions, potentials, process maps and creating AS-IS and TO-BE documents.
Expert in developing Use Case Diagrams, Behavior Diagrams (Sequence Diagrams and Activity Diagrams) based on the UML Methodology.
Strong Experience in conducting Joint Application Development (JAD) session with onsite and offsite team.
Skilled in working with teams in Agile environment and perform as Business analyst Facilitator.
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.
Good understanding of health care industry, Claims Management process.
Solid understanding of Claims Processing and have experience in HIPAA standards and corresponding EDI transactions.
Extensive experience in Healthcare/Claims adjudication with knowledge of industry compliance standards like HIPAA and EDI X12 transactions (837, 276/277).
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
Proven ability to support multiple complex projects under tight deadlines, often with competing priorities
Experience in Change Management and Conflict Resolution at various stages of the project life cycle
Strong Experience in developing test plans, building Test Conditions and Test Cases, creating test data, analyzing bugs, and interacting with development team members to fix errors.
Strong SQL background, including data validation and system testing using SQL.
Highly motivated and organized leader with excellent client relationship, communication, and delivery skills.
Microsoft Technologies: MS Project, Visio, Excel, Word, Outlook, PowerPoint
Requirements Management Tools: Rational Requisite Pro, Rational Rose, MS Visio, HP ALM
Operating Systems: Windows 2000/7/XP, DOS
Languages/Standards: SQL, UML, XML, HTML, ORACLE
Defect management Tools: Jira, HP Quality Center
Testing skills: Manual and Automated testing
UNITED HEALTH GROUP OPTUM JUNE2017-PRESENT
The United health group provides quality health insurance and administers the Medicaid and Medicare programs. Objective of the project was to develop Medicaid Management Information System for United health group following HIPAA standards. The web-based Health Care Management System is developed using HIPAA guidelines and regulations which keeps track of Healthcare transactions like Request and Response for Claims Status, Prior Authorization and Claims Payment. This application also provides data to other State agencies as required.
Facilitated collection of functional requirements from system users, and prepared business and technical requirement specification documents.
Interacted with the Subject Matter Experts (SMEs), gathering business requirements to get a better understanding of client’s business processes.
The Agile-scrum SDLC was used and worked on writing user stories to track requirements and used SharePoint to share and maintain the document versions.
Conducted the meetings as the Business Analyst and helped maintain the product backlog and sprint backlog. Co-ordinated with scrum team for efficient delivery within designated sprint cycle.
Created Use Case Diagrams, and Use Case Specification document (USD). Validated the following: 837 (Health Care Claims or Encounters), 835 (Health Care Claims Payment/ Remittance).
Prioritized project efforts, developed project plans, process flows and SRS using scrum. Researched the existing client processes and guided the team in aligning with the HIPAA rules and regulations for the systems for all the EDI transaction sets.
Conducted JAD sessions with management, SME, users and other stakeholders for open and pending issues.
Used Unified Modeling Language (UML) for process modeling and use cases.
Generated daily, weekly, and monthly reports using MS Office Tools and submitted to the Team Leads and Manager for reporting, status reporting and analyzing purpose.
Developed gap analysis document, logical and physical design and remediation plan.
Environment: Agile-scrum, MS Project, MS Office Suite, SQL, UML, MS Visio, Requisite Pro, Clear Case, Rational Clear Quest, Jira
Nationwide advise the members, offering comprehensive solutions like home, auto, life, business insurance, as well as retirement savings tools . The applications programs to determine the impact of the HIPAA final rule on EDI Transaction Set and Code List implementation and defined the changes to bring the affected systems into HIPAA compliance. Analyzed legacy system documentation, file and record formats, system flow charts and other information to develop a comprehensive depiction of the existing environment as it relates to HIPAA rulings. Involved in claim processing and developed the Business Crosswalks for 837 (P, I, D), 835 and 276/277 according to HIPAA implementation rules.
Gather requirements and document the proposed processes to the existing system. Modules included: Claims Processing Files and HIPAA Guidelines adherence across the company.
Experience in configuration of claims processing applications, claim adjudication process, claims management process, real time claims adjudication, Electronic Medical Records / Electronic Health Records (EMR/EHR) and Medicaid Management information System (MMIS), and Medicaid Information Technology System (MITS).
Worked on claims, Claim adjudication.
Enhanced applications associated with Claim Numbers so that duplicate Claim Numbers could be allowed in the system. Updated the Electronic Claims processes.
Claim Transactions - Created flows for adequate matching of Claims.
Responsible for system integration testing of 837 claim files and 277 interface files to ensure required interactions are met during the SDLC process.
Involved in creating and executing test cases, test plans and test scripts for EDI 837 Claims (I & P) Transactions.
Worked on Facets Claim processing (online and batch adjudication) claim adjudication, Accumulators.
The process included importing claims into Facets that had been adjudicated and setting them in a "PAY" status so that a payment cycle could be run to create checks on Facets.
Performed Data mapping to validate and customize Claims daily load into the system for processing the transactions.
Validated Inbound and outbound 837 transactions, including but not limited to the loading and correcting any errors with the process of EDI inbound and outbound files
Created Test File to be sent to the Vendors for approval. Worked on a Paid without prejudice project for various States.
Testing - Developed Test Scripts using Quality Center and coordinated with developers to quickly resolve the defects associated with them.
Conducted JAD sessions with the management, users and other stakeholders for open and pending issues to develop specifications.
Planned the entire Data Warehousing initiative from requirements gathering, analysis, design, identifying and analyzing the source systems, to data quality, to ETL, and to the end user data access.
Provided release management strategy checklists and change management techniques.
Presented and assisted end users for education and training about the new system.
Generated reports using SQL and MS Excel spreadsheets.
Involved in Source Data Analysis, analysis and design mappings for data extraction.
Environment: Windows, Oracle, MS Office (MS Word, MS Excel, MS PowerPoint, MS Visio), MS Access, Agile, SQL, ETL, UML, Quality Centre, and SharePoint, Jira
ZENSAR, INDIA MAY2012-APRIL2015
Project description: Zensar delivers innovative industry focused solutions with measurables business outcomes.
The project scope was to analyze and gather requirements for Zensar front end and back end system for an enhance automation to reduce manual solutions.
Assisted Lead Business Analysts in capturing requirements by driving user-group meetings and working with various global, cross-functional and virtual teams
Helped Prepare project deliverables through business workflow analysis, process analysis, user requirement documents (Use Cases & Use case diagrams) and managed the requirements
Documenting artifacts including, but not limited to, Functional Specifications, and the Use Case Specifications
Responsible for handling data manipulation, mapping, and basic database tasks
Experience in developing Data Mapping, Performance Tuning and Identifying issues of sources, mappings, targets and sessions.
Designed and developed Use Cases, Use stories, Activity Diagrams, Sequence Diagrams, UML and Business Process Modeling
Used HP QC and Load Runner for test management, functional, performance, load testing
Worked along with the development team to solve browser compatibility issues.
Generated daily, weekly and monthly reports using MS Office tools and submitted to the team leads and manager for reporting, status reporting and analyzing purpose.
Developed Gap analysis document, logical and physical design.
Environment: Agile, SQL, MS Excel, MS Word, SharePoint, HP-Quality Center, MS Office, MS Visio, Jira