Soumya

916-***-****

Summary

●*.* years of professional experience as a Business Analyst in Healthcare Domain with solid understanding of Business Analysis, Business and Functional Requirements Gathering, Translating Requirements into Specifications, Project management, Application Design, data mapping/modeling, and Testing.

●Possess good understanding of the HIPAA (Health Insurance Portability and Accountability Act) 4010 and 5010 regulations, transactions, identified the major differences between HIPAA 4010 and HIPAA 5010 through GAP analysis and experience with the standard claim forms.

●Understanding and implementation of ICD- 9 and ICD-10 in accordance to HIPAA compliance.

●Expertise in verifying and understanding EDI raw data, both in 4010 and 5010 format and extensively worked on analysis & compliance of ICD 9 to ICD 10 and Electronic Data Interchange (EDI) transactions ex. 837, 835, 276, 277, 270,271, etc.

●Extensive knowledge of various standards including American national standard institute's (ANSI), accredited standard committee (ASC) and X12 Standards.

●Expert in working with Medicare and Medicaid benefits in accordance with Federal Regulations.

●Extensive knowledge about the various types of health insurance programs such as: Medicaid, Medicare (Part A, B, C and D), PPO (Preferred provider organization), HMO (Health maintenance organization), Medical Management Information Systems MMIS

●Excellent Knowledge in Electronic Medical Record (EMR) / Electronic Health Records (EHR) modules and process flow

●Sound knowledge of Patient Protection and Affordable Care Act (PPACA) and Obama Care implementation.

●Expertise in using Rational tools (Rational Tools used during various phases of RUP such as Inception, Elaboration, Construction and Transition) for creating Use Cases, Version Control, defect Tracking, monitoring and extensively used the Agile Scrum, Rational Unified Process (RUP) methodologies in all areas of the software development life cycle (SDLC).

●Experience working as Joint Application Development (JAD) facilitator and meetings coordinator with excellent interpersonal and communication skills.

●Performed Requirement Analysis by gathering both functional and non-functional requirements based on interactions with the process owners & stakeholders, document analysis and represented them in Requirements Traceability Matrix (RTM).

●Experience in using business modeling tools like MS Visio and Unified Modeling Language (UML) for creating Use Case Diagrams, Business Process Models, Process Flow Diagrams, Class Diagrams, Activity Diagrams, Sequence Diagrams, and workflow diagrams.

●Expertise in reviewing Test Procedures, creating Test plans, defining System & Integration Test Cases, executing Test Cases, Test Data reviewing and maintaining and executing detailed Test scripts for User Acceptance Testing (UAT), analyzing bugs, interacting with team members in fixing.

●Experience in Gap analysis to compare as-is with to-be business processes and worked with technical resources to draft one or more solutions so that pros and cons can be presented to the business.

●Experience in SQL ad-hoc queries to extract data from various database for data analysis and generating reports per the format specified Subjects Matter Experts (SME’s).

●Excellent written and oral communication skills with ability to articulate requirements, process flows and relationships.

●A dynamic team member with proven abilities to be a part of a team during various project phases.

●Possess excellent analytical, programming, troubleshooting and interpersonal skills. A result oriented enthusiast, with highly developed, planning and management, analytical, technical communication, decision-making and leadership skills, driven with the ability to multitask and deliver effectively, in a fast paced environment.

Computer Skills

Methodologies: Waterfall, RUP, Agile SCRUM.

Tools: MS Office (Word, Excel, Project, Visio, etc.), Outlook, SharePoint, Rational Rose, Requisite-Pro, Clear case, BLUEPRINT, JIRA, RALLY.

Testing tools: HP Quality Center, Quick test pro

Languages: SQL, UML, HTML

Operating system: Windows XP, UNIX

Databases: MS-SQL Server, MS Access

Industry Standards: HIPAA 5010, ICD 10, PPACA (Patient Protection and Affordable Care Act)

Projects

Independent Health, Buffalo, New York Sept 2016 to Present

Healthcare IT Business Analyst - Senior

Project 1: Working as an IT Business Analyst on the project Fitworks for Medicare which is a program designed for Medicare members to reward store valued gift cards for doing wellness activities. The program goals are to promote provider and member engagement along with increase in Enhanced Annual Visits (EAV’s) and other wellness activities and also to retain membership in 2017. Some of the activities included for gaining points were preventive services, annual well visits, direct debit enrollments and e-fulfillments. Any member reaching 100 points are rewarded $50 TOPS store valued card.

Roles and Responsibilities:

●Acted as a liaison between Business and IT throughout all phases of SDLC.

●Facilitated JAD sessions with all the important stakeholders for gathering requirements.

●Gathered requirements through one on one meetings with business owners.

●Documented all the requirements in blueprint.

●Created documents like Requirements Specifications Document, Correspondence Requirements Document, Data mapping document etc.

●Peer Review of the documents with the fellow business analysts before handing off to the Solution Architects or the developers.

●Sign Off from the business for the documented BRD’s and CRD’s.

●Uploading the documents to the project SharePoint site for maintaining records, for future changes and for easy traceability for the team members.

Environment: Agile, Blueprint, Outlook, MS Word, MS PowerPoint, MS Excel, MS Visio, HealthRules,

SharePoint, Notepad, OneNote, Kalido Crosswalks.

Project 2: Working for the Enterprise Content Management (ECM) Team as a Business Analyst for gathering requirements for various Correspondences. Worked on creating new Correspondence Requirements Document (CRD) like the Physician Enrollment Roster which should be available to the physician on the 1st and 15th of every month and also worked on changes for the existing correspondence requirements documents like the Correspondence Death Letters that go to the subscriber or to the estate of the subscriber on the death of either the subscriber or the member.

Roles and Responsibilities:

●Acted as a liaison between Business and IT throughout all phases of SDLC.

●Facilitated JAD sessions with all the important stakeholders for gathering requirements.

●Gathered requirements through one on one meetings with business owners.

●Documented all the requirements in blueprint.

●Created Correspondence Requirements Document (CRD), Correspondence Mock ups, Fulfillment Data mapping documents etc. required for the correspondence.

●Peer Review of the documents with the fellow business analysts before handing off to the Solution Architects for Arch review.

●Sign Off from the business for the documented CRD’s.

●Uploading the documents to the ECM SharePoint site for maintaining records, for future changes and for easy traceability for the team members.

Environment: Agile, Blueprint, Outlook, MS Word, MS PowerPoint, MS Excel, MS Visio, HealthRules, SharePoint, Notepad, OneNote.

Project 3: Updating the Billing Data Mart Dictionary. Billing Data Mart is used for financial billing and reporting purposes because the financial capabilities are not available in HealthRules at Independent Health. Each term had business terminology and technical source and logic for which i served as a liaison between the business and technical team for updating the dictionary. The dictionary contained various tables like the Billing Rates, Financial Receivables etc.

Environment: MS Excel, SQL.

State of Georgia- Department of Health May 2014 to Sep 2016

Sr. Business Systems Analyst

As a Business Analyst in the State Department, I was involved with HIPAA 5010 compliance for the new MMIS system. The project also involved performing gap analysis and identifying the changes in HIPAA 5010 to upgrade second web portal to comply with the new standards approved by the Health Insurance Portability and Accountability Act (HIPAA).

Roles and Responsibilities

●Acted as a liaison between Business Area Subject Matter Experts (SMEs) & development team throughout all phases of SDLC.

●Gathered requirements through workshops and JAD sessions.

●Developed documents like BRD, FRD, Data specification document, technical specification documents, file transfer document, Data mapping document etc.

●Provide various strategies to implement HIPAA 4010 in the new MMIS system and ultimately move to HIPAA 5010

●Maintained Requirement Traceability Matrix (RTM) to make sure that all the requirements are covered in test cases

●Developed Use case diagrams, activity diagrams and system design diagrams.

●Hands on experience with various sub-systems of MMIS – Provider subsystem, claims subsystem, reference subsystem and also recipient subsystem.

●Expertise in claims processing subsystem - Enrollment and Eligibility verification for recipients and providers, claims processing, Claims Pricing, Claims Adjudication and payment scheduling and claims reporting.

●Processed Medicaid claims and worked on X12 format of EDI 837 for Medicaid claims.

●Working knowledge on different 837’s (institutional, professional and dental).

●Created Test Conditions from business requirement document and functional requirement document.

●Analyze and monitor encounter data and provide MCOs and subcontractors with technical assistance to ensure compliant with federal/state laws, rules and agency policies.

●Validated Professional and Institutional Claims, Processed and Adjudicated the Claims according to test scenarios.

●Developed Test Cases to test the functionality of the system based on the test conditions

●Extensively used Rational Quality Manager to monitor the progress of assignment of testing activities and Reported executed results.

●Logged the defects in Clearquest tool, assigned the right severity level and managed the defects through it.

●Using financial dashboards for ensuring shared financial comprehension and engagement among board members.

●Ensured the functionality meets business requirements as defined in test results logged in RQM.

●Performed traceability to make sure that all requirements were covered by test cases.

●Prepared and submitted weekly test status reports to QA Lead.

●Creation of project management plans to manage timely delivery using MS project

●Experienced working diverse queries using Teradata SQL.

●Actively involved in designing EDI transactions using the new HIPAA 5010 version and ICD -10 codes and analyzing HIPAA compliance and EDI transactions.

●Communicated with Development team and Business Analysts to ensure testing issues are resolved.

●Generated test execution reports and uploaded validation documents in sharepoint for review.

Environment: Agile, MS Office, MS SQL Server, MS Project, MS Visio, MS Word, MS Excel, MS Access, UNIX, XML, Windows XP, Main frame/CICS/DB2 (Client Server Applications), Rational Clearquest, Rational Quality Manager, Share Point.

Kaiser Permanente, Pleasanton, CA Nov 2011 to Apr 2014

Business Analyst

The project was involved in the application development supporting the EMR (Electronic Medical Records) and EHR (Electronic Health Records), maintaining medical records and managing medical history and billing. The project also involved the usage of ICD 10 and HIPAA 5010 release versions for EDI (X12) to make third party payments, institutional insurance claims with respect to CMS Regulations

Roles and Responsibilities:

●Gathered business requirements by driving user-group meetings and working with various global, cross-functional and virtual teams.

●Experience in improving marketing applications using Teradata.

●Successfully conducted JAD sessions, which helped synchronize the different stakeholders on their objectives and helped the developers to have a clear-cut picture of the project.

●Used HIPAA 4010 transactions to support the analysis of current business processes and work with management to improve and implement enterprise solutions to ensure compliance and got involved in designing future state processes for HIPAA 5010 transaction processing EDI’s 837,835, 270, and 271.

●Responsible for GAP analysis of ICD9-ICD10.

●Involved in Mapping Disease codes from ICD system to EHR.

●Validated all health data in EHR as per HIPAA 5010.

●Involved in testing Diseases codes and health information in EHR.

●Helped in improving EHR as per customer service perspective and developed user guide for our customer support team.

●Using financial dashboards for ensuring shared financial comprehension and engagement among board members.

●Used Teradata in increasing competitive advantage with greater speed and agility.

●Involved with ICD-10 implementation testing.

●Consulted with healthcare insurance company to develop conversion specifications for other insurance Coordination of Benefits (including Medicare).

●Performed Unit Testing and User Acceptance Testing and documented detailed defects.

●Developed Test Cases to validate the requirements and documented the Traceability Matrix for Test Cases and Requirements

●Conducted presentations of the Q/A test results with analysis to the stakeholders and users and documented modifications and requirements.

●Create tuning reports that include a detailed analysis of areas in an IVR application needing improvement and include recommended enhancements.

●Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams using UML and Business Process Modeling.

●Developed business process models in RUP to document existing and future business processes.

●Created Business Requirement Document (BRD), Functional Requirement Specification (FRS) document, User Requirement Specification (URS) and Change Request (CR) document for system application development.

●Experienced working diverse queries using Teradata SQL.

●Provided management support to the off-shore End to End Integration / Regression Test Team.

●Sophisticated workload management using Teradata.

●Using a combination of reporting applications, track & report on IVR retention and success levels.

●Very strong Excel skills.

●Prepared UAT Materials UAT Test Cases to include various steps involved for UAT and to have proper coverage of requirements

Environment: Windows XP Professional, MS Excel, RUP, UML, SQL, Rational Rose, Rational RequisitePro, Rational Clear Quest, MS Office, XML, MS Visio, HP Quality center.

Molina HealthCare, San Antonio, TX Aug 2010 – Oct 2011

Business Systems Analyst

Molina HealthCare has initiated the Patient Services System. Patient Services System is a comprehensive web-based application software solution that manages the practice of medicine. This ultimate doctor driven system consist of patient medical records, administrative, billing and business functions. Patient Services System (PS System) was mainly designed to allow the patient to communicate with the doctor's office.

Roles and Responsibilities

●Involved in Scrum type of agile methodology.

●Gathered, analyzed and documented the technical requirements that were critical to the business mission and used those requirements to design application software using a Use case.

●Facilitated JAD sessions for open and pending issues.

●Created detailed designs for business domain application features, worked closely with software developers to ensure that business classes are developed properly.

●Used MS Visio to carry out the business modeling and object modeling effort to develop the information business architecture and workflow diagrams for the application for rapid and controlled Web Application development.

●Participated in the analysis of user interface design efforts; participated in design sessions, documented and validated recommendations.

●Analyzed Requirements and created Use Cases, Use Case Diagrams, Activity Diagrams using Visio.

●Tested the final application for Usability testing to verify whether all the User Requirements were catered to by the application.

●Trained clients in the use of product definition tools and serve as a resource throughout the project implementation process.

●Involved in documenting Quality Assurance procedures and policies complying with rules.

●Developed test cases with different scenarios and aligned them to the Functional Requirements.

●Conducted Functional testing, Regression testing, Integration testing and System testing.

●Schedule meetings with the development team to estimate time required for the new changes.

●Participated in daily SCRUM meeting with the team members for day to day updates, counter daily problems and fixing the bugs.

●Performed feasibility and risk analysis to identify the business critical areas from User perspective.

●Documented project plans, process flow, timelines and other technical requirements.

Environment: Agile, MS Office, MS SharePoint, MS Project, HP Quality Center, MS Visio, Jira, SQL Server

Magellan Health Services Inc., Lemoyne, PA Jun 2009 – Jul 2010

Business Analyst

Magellan Health Services, Inc. provides managed behavioral healthcare, radiology benefits management, specialty pharmaceutical management, and Medicaid administration products and services in the United States. The company provides services to health plans, insurance companies, employers, labor unions, and various governmental agencies The company’s radiology benefits management services consist of managing the delivery of diagnostic imaging services, which are provided under the contracts with managed care companies, health insurers and other health plans, Medicaid, and Medicare members. I was involved in updating an existing coding and enrolling program based on the business requirements and also integrated eligibility check application so application can check before offering plans like Medicare.

Roles and Responsibilities:

●Gathered Business Requirements, analyzed data/workflows, and defined thescope

●Met with client groups to determine User Requirements and goals, thus converting User Requirements into Business and Functional Requirements.

●Responsible for the compilation of the Business Requirement documents and the Functional Requirement documents.

●Responsible for claim adjudication like Medicare claims, professional claims, institutional claims.

●Applied the RUP model throughout the development and testing process.

●Involved in development of Business and Technical Requirements in preparation of Design and Functional Specifications for Business Needs and Processes.

●Worked closely with Business users to determine the workflow of the product.

●Performed walkthroughs of the prototype with end users to better understand user needs.

●Followed a structured approach to organize requirements into logical groupings of essential business processes, business rules, and information needs, and ensured that critical requirements are not missed.

●Followed the UML based methods using MS Visio to create Use Case Diagrams, State Chart Diagrams and Sequence Diagrams

●Prepared Logical Process and Data Models that contained set of diagrams and supporting documents containing the essential business elements, detailed definitions, and descriptions of the relationships between the data elements to analyze and document Business Data Requirements.

Environment: RUP, Microsoft Office, Windows XP, SQL, MS Visio, HTML, XML

Education

Bachelors in Dental Surgery

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