Jesny M

Business Analyst

Con: 703-***-**** Email: ade5rs@r.postjobfree.com

C2C, C2H only Citizen

SUMMARY:

7+ years of Industry experience as a Business System Analyst with solid understanding of Business Requirements Gathering, Experience in elicitation, documentation and presentation of high level and detailed requirements, Experience in creation of test plans, test cases and analyzing test results. Hands on experience on the entire SDLC methodology from Ideation to Implementation of a Project.

Worked closely with project managers, SMEs, and staff to understand and brief the requirements and specifications for new applications along with re-engineering the existing applications.

Strong understanding of various SDLC methodologies such as Waterfall and Agile with hands on experience in all of them.

Strong knowledge of EDI Claims, member enrollment, Eligibility as well as ICD9 and ICD10 conversion.

Experienced in writing and preparing business design documents (BSD), requirements analysis document (RAD), requirement design document (RDD), functional specifications, defining project plan and change request.

Conducted JAD sessions, Gap analysis, and prioritized requirements using interviews, document analysis, and requirements workshops.

Have developed standards for data definitions, data element naming conventions, and logical/physical database design for applications and data warehouse development.

Good knowledge of Business Intelligence, Data Warehousing and Business Architecture.

Experienced in documenting requirement using Unified Modeling Language (Use Case and Activity Diagrams) and building business Process Flow Charts.

Expert in organizing and managing all phases of the application testing process using Quality Center.

Strong experience and understanding of health care industry, enrolment, eligibility, and claims management process, Knowledge of Medicaid and Medicare Services.

Strong understanding of test plans, test cases, test scripts and defects tracking/reporting.

Extensive knowledge of SQL queries and back end system integration testing.

Conducted User Acceptance Testing (UAT) and verification of performance, reliability and fault tolerance issues for web based and client/server applications.

Strong understanding of Functional, Integration, System, and Regression testing.

Experienced in various Healthcare areas like Enrollment, Benefits, Claims, Medicare, and implementation of HIPAA key EDI (ANSI X12) transactions.

Involved in HIPAA gateway transactions 997/999 and converting HIPAA 4010 messages into HIPAA 5010.

Well versed experience in all EDI transactions like 834, 837 P, 835, 27x and conversion of 4010 to 5010.

Dealt with the complexity of migrating from the ICD9 set of diagnostic codes to ICD10.

Excellent communication and writing skills and adept at facilitating walkthrough and training sessions.

TECHNICAL SKILLS:

Methodologies: Agile, Waterfall

Requirement management tools: Rational Requisite Pro, Enterprise Architect

Project management tools: MS Project, ALM

Business Modeling: Rational Rose, MS Visio, Ultra Edit

Defect tracking: MQC, Test Director, Rational Clear Quest/Clear Case

Front-End tools: Microsoft Excel, Access, MS PowerPoint, Front Page, Flash

SharePoint, Notepad ++

Database: SQL Server Management Studio 2012, Oracle,

SQL *Loader, Toad 7.6

Operation system/platform: MS Windows 2003/XP/2000/NT, UNIX,

PROFESSIONAL EXPERIENCE:

WellCare, Tampa, FL May 2018-Present

Business System Analyst

Responsibilities:

Worked with a cross functional and diverse team of business users and developers to enable accurate communication of requirements and ensure consensus for BRD and FRD and business docs.

Analyzed data and created reports using SQL queries for all issued Action Items. Performed the Gap Analysis to find the existing gap between the HIPAA 4010 and HIPAA 5010 EDI transactions.

Involved in the testing of web portal of New MMIS system

Acted as a liaison and conducted meetings, JAD sessions and presentations with the teams

Involved in preparing several Use Cases, Business Process Flows, and Activity Diagrams using Microsoft Visio.

Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Eligibility. Worked on HIPAA Standard/EDI standard transactions: 270, 271, 276, 277, 278, 834, 835, and 837 (P.I.D), 997 and 999 to identify key data set elements for designated record set. Interacted with Eligibility, Payments and Enrollment hence analyzing and documenting related business processes.

Worked on requirements of the 835 HIPAA projects, 276/277, 278, 837, and HIPAA EDI Transactions across enterprise.

Initiated with a comparison report of migration of 4010 to 5010. 270 Eligibility, Coverage or Benefit Inquiry (V4010X092A1) vs. 270 Eligibility, Coverage or Benefit Inquiry (V5010X279), 278 Prior Authorizations.

Tested the ANSI X12 Version 4010 / EDI transactions (HIPAA) like 270, 271, 276, 277, 278 837P, 837I, 837D, 835 remittances)

Performed Gap Analysis for HIPAA 4010 837P and 835 transactions and HIPAA 5010 837P and 835 transactions.

Involved in impact analysis of HIPAA 5010 835 and 837P transaction sets on different systems.

Assisted in Regression Test, System Test, and UAT.

Environment: Microsoft SharePoint, MS Visio, MS Office, HP Quality Center 10.0, Toad for Oracle, Team Track, AGILE methodology, COGNOS.

Cognosante, Mclean, VA

Business System Analyst / Requirement Analyst July 2016-Mar 2018

Responsibilities

Gathered analyzed, documented business and technical requirements from both formal and informal sessions and validate the needs of the business stakeholders.

Performed Data mapping on the extracted data, logical data modeling, created class diagrams and ER diagrams.

Designed and developed Use Cases and Use Case scenarios, Activity Diagrams, Sequence Diagrams, High Level and Low-Level Process Flow Diagrams using UML and Business Process Modeling.

Responsible for creating test case scenarios, creating test data plan and writing test scripts for the UAT using testing tool and defect management for Policy Management Systems, Payables/Receivables and Claims processing.

Conducted surveys, interviews, and WPR work progress review, stand up meeting, and JAD sessions and translated them into system Requirements. Suggested measures and recommendations to improve the current application performance of the system.

Assisted the team members to develop Service Oriented Architecture (SOA), and data warehouse system (EDW) to utilize data mining for data analysis.

Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data within the Oracle database.

Involved in defining and documenting the vision and scope of the warehousing project.

Responsible for preparing Business Requirement Document (BRD), Functional Requirement Document (FRD) and then translating into functional specifications and test plans. Closely coordinated with both business users and developers for arriving at a mutually acceptable solution.

Performed Gap Analysis in every phase and stages to check the compatibility of the existing system infrastructure with the new business requirements.

Interacted with DBA and SE for the process of data extraction, data transformation, data load, data integration and conversion processes using business intelligence tools on the Benefit Plan functionality.

Worked with PM to prepare Project charter, Project plans, daily, weekly and monthly team deliverables for each phase, drafting WBS and RBS systematically using MS Project.

Lead requirements analysis and inspection, ensuring that requirement statements and business rules are complete, consistent, concise, comprehensible, traceable, feasible, unambiguous, and verifiable, and that they conform to standards.

Facilitated various brainstorming, requirement gathering sessions, and provided training on HIPAA Compliance, HIPAA Standard transactions and current version of X12 HIPAA 4010A1.

Environment: PWB, Citrix, WIN7, HPQC/ALM, MS Excel, MS Word, MS Access, MS Project, MS Visio, SharePoint.

TMG Health Inc., King of Prussia, PA June 2015-May 2016

Technical Business Analyst/Requirement Analyst

Responsibilities

Conducted interviews and JAD sessions with TMG to document high level needs and features.

Worked on designing & documenting the current process flow and the futuristic BCBS TX operating process flow.

Responsible for documenting all business, technical/non-technical functionality needed for smooth migration of Coordination of Benefits, Medicare and Utilization Management data to TMG.

Involved in regular meetings with the TMG team to identify the gaps in migrated claims processing.

Conducted GAP Analysis to identify GAP between in house STAR system and TMG FACETS system.

Conducted a detailed research on how the claims migrate on the system through each step in the process flow.

Authored business requirements repositories and report requirements specifications.

Created test cases and test scripts for standard reports (Claims, procedure file reports and diagnosis file reports).

Worked with the business/functional unit to assist in the development, documentation, and analysis of functional and technical requirements within FACETS.

Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data within the Oracle database.

Active role in defect management for the entire project as a Business System Analyst Defect Coordinator.

Assisted specific track BSA's (Business Systems Analyst) in cross matching test plans and test cases with actual requirements.

Worked closely with the Enterprise Data Warehouse team and Business Intelligence Architecture team to understand repository objects that support the business requirement and process.

Conducted Root Cause Analysis for hundreds of State issued Errors due to missed requirements.

Authored claims data mapping documents and file transfer specifications.

Responsible for tracing requirements using Requisite Pro for development and enterprise requirements team.

Involved in implementation of Business Intelligence Applications using Cognos and Business Objects, building Data Marts and enterprise wide Data Warehousing.

Worked on claims which involve specific logic for Medicare and Medicaid Claims.

Worked as a team in understanding & documenting the system logics needed to operate the claims on the new operating system.

Perform root cause analysis, document action plans and provide organizational feedback

Elicit requirements from various sources to create business and functional requirements documentation.

Conduct system integration and user acceptance testing to ensure accuracy is met.

Work with IT team to troubleshoot defects identified during testing cycles. Provide ad-hoc reporting for Managers and Clients.

Deliver detail-oriented work under tight timelines while juggling priorities.

Environment: Facets, WIN7, MS Excel, MS Word, MS Access, MS Project, MS Visio, HP ALM QC, RRM, TM

Affinity Health Plan, Bronx, NY Mar 2013-May 2015

Business Analyst

Responsibilities:

Assisted the project manager in the creation of the project charter BRD, FRD & vision document during the inception phase of the project

Performed GAP analysis as pertains to membership management and claims processing to evaluate the adaptability of the new application with the existing process

Understood EMEVS, the NY state's electronic Medicaid eligibility verification system & the Medicaid & Medicare intermediary along with their roles in claim processing

Produced Activity diagrams with defined swim lanes as part of claims process analysis

Involved in gathering and prioritizing requirements using 1 to 1 interview, job shadowing, brainstorming & developing questionnaires

Coordinated with the developers and IT architects to design the interface of the new system according to the X12 (270, 276, 278, 834, 837 (I,P,D) and 820) standards

Designed Claims Inquiry screen within the MMIS and executed Testing Scenarios, Cases & Conditions involving User Acceptance testing, Regression, Integration and System testing.

Contributed in the build and design of organizational Wiki that provided comprehensive knowledge of workflows, policies and procedures, patient care objectives, regulatory requirements, and industry best practices for membership management

Owner of the business rules document which documented the business rules across different systems.

Participated in all phases of the Facets Extended Enterprise administrative system implementation to include the planning, designing, building, validation, testing, and Go-live support phases

Involved with various aspects of the project's needs such as the logging, tracking, and resolution of issues, current state workflow assessments, assist with integration and script testing, downtime activities/testing

Created detailed use cases, use case diagrams, and activity diagrams using MS Visio

Conducted requirement feasibility analysis with the developers to ensure the project was in scope with the timeline defined in the project plan

Created test plan, test data and conducted manual testing to validate functionality and performed regression testing

Clarified to claims personnel the new Affinity payments and Explanation for payments (EOPs) for same claim processing cycle

Designed and implemented complex SQL queries for QA testing and data validation.

Conducted user training pertaining to old and new Affinity Provider ID appearing on documents providers receive from Affinity (mainly occur with EOPs, capitation rosters, PCP membership rosters, provider directory listings and some system generated letters)

Environment: Oracle, MS Project, MS Office suite, SQL, SQL Server, Rational Suite, Citrix, MS SharePoint.

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