Project Customer Service

EHjj

WORK SUMMARY:

Over *+ years of work experience in IT as Business System Analyst in healthcare domain (Payer and Provider)

SPECIFIC EXPERTISE:

Goal oriented professional with superior analytical, communication and presentation skills.

Extensive knowledge of all phases of Software Development Life Cycle methodologies like Agile, Iterative Software Development, Waterfall and Rational Unified Process.

Experienced in conducting Joint Application Development (JAD) sessions for Requirement Analysis, Risk analysis, Adaptability and Feasibility Studies with various stakeholders to identify business critical and high-risk areas of the application.

Experience in writing requirements and specification like Business Requirements Document (BRD), Use Case Realization Document, Functional Requirements Specifications (FRS), Systems Design Specification (SDS), Systems Requirements Specification (SRS), Data Dictionary, Requirements Traceability Matrix (RTM), Defect Traceability Matrix (DTM), User Guides, Release Notes.

Conducted communication between the client and IT department, involved in gathering, analyzing, and documenting Requirements. Understands the Business Rules and can effectively implement them in Business Process Flow.

Thorough knowledge of object oriented analysis and design using UML diagrams such as Use Cases, Class Diagrams, State Diagrams, Activity diagram and Flow Chart Diagrams.

Experienced in interviewing Business Group, asking detailed questions and recording the requirements in Vision Documents and Software Requirement Specifications (SRS) that can be understood by both business people and technical people.

Experience in verifying EDI raw data of 837 transactions as per HIPAA based transactional 5010 formats.

Extensive experience in Gap analysis of 4010 to 5010 conversion using the implementation guide and companion guide of 837 EDI transactions.

Good knowledge of ICD 9- CM, ICD 10-CM structures and differences.

Sound experience in conducting Impact Analysis caused due to migration to ICD 10 on the key business process and key application system like claim processing, payments, reporting in health insurance companies.

Strong Experience in preparing Project Plans, Test Plan, test script, Traceability Matrix, Work Scopes, Flowcharts, Systems Requirements Specification. Proficient with Microsoft Project to manage schedules, deadlines and resources, collaborate with different teams and analyze project information.

Communicated and applied project standards and consistently delivers high-quality services to clients.

Understands the components of running a fiscally successful project.

Expertise in White Boxtesting and BlackBox testing which include GUI testing, functional, System, Integration Point, Negative, System Integration, Security, Browser Compatibility,

Possess excellent organizational, interpersonal, communication and documentation skills with good process management skills to bring out a quality product.

Strong experience with MMIS, MEDITECH, Quality Center, QTP, Rational requisite pro, Rational rose, IBM Caliber etc.

SKILLS:

LANGUAGES:

DotNet, C#, Java

TESTING TOOLS:

HP Quality Center,SOAP UI Pro, Notepad++, Excel Comparison, XML comparison tools, JIRA, CA Rally

RDBMS:

Oracle, MS SQL Server, DB2, MS Access

WEB & CLIENT-SERVER

J2EE (JSP-Servlet/Struts, Spring MVC), EJB, JavaScript, TIBCO, JMS

TOOLS/PRODUCTS:

MS SharePoint, MS Office Suite, MEDITECH, Cerner, HL7, Websphere, Rhapsody, MMIS, Rational ReqPro, rational Rose, IBM Caliber, EHR.

MAJOR ASSIGNMENTS:

Aug 2015 – Present

Client

Grave's Gilbert Clinic, Morgantown, Kentucky

Environment and Tools:

OHI, EDI, MS Office Suite (Word, Excel, Access, Visio, Powerpoint and Outlook), Agile/Scrum, Sharepoint, JIRA, HP Quality Center, EHR

Role:

Business System Analyst

Project Description: It was an Adjudication Project involved working on 4010/5010 HIPAA compliance with EHR and creating Business Rules for our EHR system for Medicare Annual Wellness visits. The project’s goal was to create EHR of patients from data existing sources and new data source and provide access of EHR to patient and other needed party on the basis of access level. The application will also assist in checking eligibility status of the Patients, scheduling appointment, and check in patient and checkout patient which involved billing module as well.

Project Accomplishments:

Performed gap analysis for HIPPA EDI transactions such as 837 I, 837 P, 837 Crossover and 835.

Developed the Business requirements for all the major claims transactions such as 837I/P and 835.

Define flow and documented requirement for collecting medical records of patients from hospitals and putting them in electronic health records of patients.

Validated Use cases to ensure that all requirements for Medicare Annual wellness visits are met and charts are incompliance with Medicare regulations and schedule patients

Worked closely with the development team regarding the technical and design aspects of the HIPAA 5010 project.

Worked on the various systems such as HEATS (HIPAA EDI Activation Testing System) and SURGE. Also developed requirements and specifications for the same due to the HIPAA 5010 and D.0 Enhancement.

Validated eligibility and claims for Medicare Part A and Part D.

Modified designed state processes for HIPAA 5010 transaction processing EDI’s 837 and 835.

Performed in-depth GAP analysis between HIPAA 4010 and 5010, in compliance with the new firm transaction processing system.

Extensively used MS Project for project scheduling and budgeting activities.

Strategized implementation of EDI 837 (I, D, P), 835, 277-U, 270/271 and 834 transactions for the HIPAA 5010 in compliance with the firm’s policies and evaluated the modified data manual

Involved in Manual Testing as well as the business side of the project

Tested new EDI gateway application for HIPAA 5010 compliance. Worked on testing HIPAA 4010A to 5010 and ongoing ICD-9

Worked on Medicare claims to process them.

Analyzed use-case document and functional requirement specification document. Effectively implemented QA methodologies, strategies and plans in all stages of SDLC.

Created test cases and test data from the functional requirement specifications

Created different document and matrices like test log, test incident report, test coverage matrix, requirements traceability matrix

Experienced in Defect Management, Defect Triaging using HP Quality Center

Responsible for signing off tested patches and updating the Change Management System for periodical release of patches for UAT and PROD

Analyzed response time of business transactions and generated reports and graphs using Load Runner Analyzer

Worked on analyzing defects for Medicare claim.

Generated test reports and logged errors using HP Quality Center

Involved in detailed functional and GUI testing and User acceptance testing (UAT)

Involved in writing SQL queries for Backend Testing. Used SQL Navigator to test the backend

March 2013 – July 2015

Client

State Medicaid Minnesota. St Paul, MN

Environment and Tools:

Rational Rose, Quality Center, QTP, Cerner, HL7, Microsoft Excel, Rhapsody, InternetExplorer, MMIS, SharePoint, Rally.

Role:

Sr. Business System Analyst

Project Description

The project HIPAA 5010 Enhancement and ICD 10 conversions involved making all the changes within MMIS as per the mandate to be in compliance with HIPAA and CMS.

Project Accomplishments:

Responsible for Gathering High and low level requirement for ICD and HIPAA upgrade in MMIS using JAD sessions.

Responsible for analyzing business, functional and IT requirement documents and prepare complete Test Plans including system test plan, integration test plan, QA project plans and resource planning and allocation.

Created High and low level Use case diagram for HIPPA and ICD changes in MMIS.

Translated requirements into system performance solutions and developed Implementation plan, Test Metrics and defined Metrics Tracking Strategy to be followed after each successive load test.

Performed and documented GAP analysis for HIPAA 4010-5010 and ICD9-ICD10.

Responsible for designing future state processes for ICD 9-10 Crosswalk Table and drafted High Level Business Requirements for ICD 9-10 conversion mapping.

Worked extensively on the Procedure and Diagnosis Pricing and worked on the Reimbursement processing.

Worked on CRM software to analyze customer data and make recommendations on sales, marketing and customer service initiatives to our Business team.

Conducted Gap Analysis by brainstorming with Project managers, IT lead and Business users to get the low level “To Be”/ proposed environment

Gained extensive experience in designing/modifying the CICS screens for various areas such as Enrollment, Billing, Provider Record and Reimbursement Status.

Wrote test script for HIPAA 5010 and ICD 10functionality in MMIS.

Documented business rules/functional requirements to support system enhancements with the minimal guidance of a senior associate

Tested new ICD 10 procedure and Diagnosis code in EDI 837 and 835 X12 file format.

Validated all the Medicaid claims for new HIPAA 5010 standard.

Tested the implementation of ICD 10 and HIPAA 5010 on MMIS system.

Wrote test script, test plans for EDI 835, 837, 270, 271.

Recommended a new SharePoint site collection. Design concepts, site planning, meetings, Q&A sessions, developed project plan

Jan 2012– February-2013

Client

St Joseph Health System, Anaheim, CA

Environment and Tools:

MEDITECH 5.66, Ensemble Integration Engine, HL7 v2.3, Interface explorer, WebSphere, Microsoft Office, SharePoint, Engine Migration-Sybase, IBM Caliber, Quality center, MS Word, MS Visio.

Role:

Sr. Business System Analyst

Project Description: St. Joseph Health System is standardizing MEDITECH v5.66 all over there 11 facilities across California and Texas as a part of their EMR system implementation. One of the vital aspects of this project is to integrate MEDITECH with multiple downstream applications. My goal was to implement integrations of MEDITECH with other applications in their facilities

Project Accomplishments:

Worked with client to gather Business/Technical Requirements for MEDITECH and other applications integration.

As a BA analyst, studied the application thoroughly to understand its functionality and trained new team member as they joined along the process/journey.

Responsible for designing future state processes for integration of different applications (EHR) with MEDITECHand drafted High Level Business Requirements.

Involved in creating BRDs and GAP Analysis, Design, Development andTesting of the Interfaces.

Created Data mapping documents for integration of every application with MEDITECH including EHR.

Developed Use cases, Use case diagram, flow charts, BRD, FRD, File transfer file, Data integration document etc.

Performed configuration and troubleshooting of EHR.

Responsible for mapping and configuring existing ITA business processes within the selected CRM solution.

Mapped EHR data with other applications.

Worked on Rational Requisite Pro application to handle various requirements including Functional requirements, High-level requirements, Non-functional requirements, Scope statement and User requirements.

Extensively worked on backend testing and has very good knowledge of writing SQL queries to verify the test data, create test data and manipulate test data.

Defects were tracked, reviewed, analyzed compared using HP Quality Center.

Extensive experience in Regression testing, creating regression test suite and selecting test cases for automation.

Helped business team using CRMto understand the right market to sell product sale.

Performed End to End and User Acceptance Testing, once product was ready to release.

Validated various in-house developed configurations relating to business rules, client specific requirements, release notes, etc.

Generated weekly Status Reports for the team and participated in weekly status meeting, project review meetings, daily stand-up and Sprint planning meetings.

Responsible for development of MEDITECH-Third party applications like PYXIS, All-scripts, Amalga, Phys Connect, GE-CPN, GE Centricity, PICIS etc. interfaces

Responsible for performing User Acceptance Testing (UAT) for each downstream apps with App Owner.

Manually created system based test scripts and tested using Interface Explorer

Validating HL7 messages, transforming Business Requirements into System Requirements.

Processing various HL7 v2.3 interfaces through Ensemble Integration Engine as a part of Integration

Worked with cross-functional teams (MEDITECH vendor, SJH build team and third party application owners) to provide needed assistance to Integration and/or third party applications team.

Expert in validating billing charges and running the revenue cycle for BAR Module in MEDITECHC/S 5.66.

Timely escalation of issues related to build or MEDITECH functionality

Implemented system integration testing using MEDITECH module HL7 messages and sending them through Interface explorer to validate them in Ensemble Integration Engine

May 2009- Dec 2011

Client

Key Stone Mercy, Philadelphia, PA

Environment and Tools:

FACETS, Quick Test Pro, Test Director, Windows XP, C#, PL/SQL, Oracle, UNIX, Manual Testing

Role:

Business Analyst

Project Description: Keystone Mercy Health Plan is Pennsylvania’s largest Medical Assistance (Medicaid) managed care health plan serving more than 250,000 Medical Assistance recipients in Southeastern Pennsylvania including Bucks, Chester, Delaware, Montgomery, and Philadelphia counties. Key Stone is implementing Facets to manage their healthcare needs.

Project Accomplishments:

Involved in the Review of Requirements Specification with functional manager and technical specialists of the application

Conducted JAD sessions, which focused on the definition of Business Requirements, security access groups.

Created use cases that defined the role of customers, medical practitioners, clearing house Administrators and healthcare plans such as: Medicaid.

Studied the existing business process and created AS-IS workflow to illustrate the existing system.

Responsible for the full HIPAA compliance lifecycle from gap analysis, mapping, implementation and testing for Medicaid Claims.

Responsible for gap analysis in changing old MMIS and Involved in testing new MMIS.

Recorded requirements in the Requirement Traceability Matrix (RTM).

Assisting the project manager in creating the business case and project plan.

Actively analyzed current business processes (Claims, Recipient eligibility and enrollment etc.) and worked with management to improve and implement enterprise solutions to ensure compliance.

Work with business representatives to understand data marts requirements and priorities and ensure that IT works is appropriately aligned.

Followed the UML based methods using Rational rose to create use cases, activity diagram, sequence diagram, collaboration diagram that include functional and non-functional specifications to hand off to development teams.

Actively involved in updating internal processes (submit claims, check eligibility), updating data collection and data reporting.

Defects and bug testing by using Rational Clear-Quest, Configuration management and Version control with Clear-Case.

Conducted System, Integrated and Regression testing to the application

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