Business Analyst
Resume:
Shivani Prajapati
****@**********.***
SUMMARY:
Result-driven Information Technology professional with 7+ years of experience as a Business Analyst, Business Consultant, Scrum Master in the Healthcare Industries.
Extensive knowledge of Software Development Life Cycle SDLC methodology worked on Agile, Waterfall and RUP, and Scrum Framework.
Experience in networking with individuals at various levels and facilitating elicitation sessions for Surveys, Interviews, Interface Analysis including Focus Groups and Brainstorming. Successfully gathered SMART pre-requisites from various stakeholders and users and converted the needs of business users and stakeholders into Functional Requirements Specifications.
Experience in conducting As-Is and To-Be Analysis and possess strong knowledge in carrying out processes for Risk Analysis, SWOT analysis, Change Management and perform Feasibility Study.
Participated in Scrum Ceremonies such as Daily Scrum, Scrum Retrospective, Sprint Planning, Sprint Review. Facilitate requirements grooming session to redefine the User stories.
Proficient in creating Request for Proposal (RFP), Business Requirement Document (BRD), Functional Requirement Document (FRD), System Requirement Specification (SRS), Requirement Traceability Matrix (RTM).
Proficient in creating UML diagrams like Class Diagrams, Activity Diagrams, use case Diagrams and Sequence Diagrams in addition to creating Mockups and Wireframes using tools such as MS Visio, Mockup Screens to communicate requirements to Development and UI teams.
Maintained Sprint Burn-down chart, Product Release Chart, White Board in JIRA to keep track of the team’s progress and the team’s velocity for better estimation of the sprint’s deliverables. Proficient in writing User Stories and Acceptance Criteria and handling Requirement Churn.
Participated in Root Cause Analysis (RCA) and Continuous Improvement activities.
Assisted Product Owner in slicing Features/Epics into User Stories.
Knowledgeable working with ETL process Extract, Transform and Load of data into a data warehouse.
Executed SQL queries for testing and report/data validation.
Good experience in the EDI transactions and knowledge on EDI transaction process flows.
Strong experience and understanding of health care industry, claims management process, Knowledge of Medicaid and Medicare Services.
Knowledge and expertise in working with Claims, Provider, Enrollment, Finance, Benefits, and Vendor Management Business Areas.
Experienced in EDI and HIPAA Testing Privacy with multiple transactions exposure such as Inbound 834Membership Enrollment, 837Institutional, 837Professional, 837 Dental, 835 Claim Payment/Remittance Advise, 270/271 Eligibility Benefit Inquiry/Response, 276/277 Claim Status Inquiry/Response Transactions and testing in Client Server systems and Mainframe Applications.
TECHNICAL SKILLS:
Project Methodologies: SDLC, RUP, UML, Agile, Waterfall, Business Modeling
Tools: Microsoft Visio, Rational Rose Platforms, Windows
Testing Tools: Mercury Quality Center,
Change Management Tools: Rational Clear Quest
Office Tools: MS Project, MS Office, MS Visio
Version Control Systems: Rational Clear Case
Database: MS SQL Server, MS Access, and Oracle
Reporting Tools: Crystal report XI, Tableau
EDUCATION:
Bachelor of Business Administration from GLS University.
Masters of Business Administration from University of Potomac.
PROJECT EXPERIENCE
Care Centrix, Hartford, CT, April 2018 - Present
Business Analyst
Worked on Member Management, Eligibility, Claims, and Provider modules within FACETS
Conducted extensive analysis on migration and conversion of Provider and Member data, Group configurations, premium billing, from Legacy system to Claims Engine.
Developed End-to-End Business Process Flows for HIPAA 5010 EDI transactions including 834 (Benefit Enrollment and Maintenance).
Worked on solving the errors of EDI 834 load to Facets through MMIS.
Used Agile Methodology for the Software Development Life Cycle.
Proficient in using JIRA to log user stories, epics and acceptance criteria.
Prioritized the spring and product backlogs directly working with the product owner and scrum master.
Gathered high level requirements from the product owner and coordinated with the scrum master to conduct sprint meetings.
Involved in documenting the business process by identifying the requirements and involved in finding the system requirements.
Actively involved in process flow analysis EDI 834for content management system.
Reviewed and gathered requirements from the Subject Matter Experts (SME) and Business Partners using various elicitation techniques and create Scope Management Documents,
Worked in creating interfaces for various external vendors.
Facilitated Joint Application Development (JAD) sessions with all IT group members for communicating & managing expectations and to discuss various means for integrations with current system using an adoption through execution strategy.
Wrote multiple Test-Cases for transactions include 837, 835.
Conducted JAD/RAD sessions and elicited customer requirements by organizing interviews with internal/external stakeholders and subject matter experts (SMEs).
Facilitated data mapping activities and helped with the expansion of membership and provider data model
Created workflow diagrams, process flow and data flow diagrams
Assisted team with Data Mapping and Data Extracting Strategies for data migration.
Checked the data flow through the front end to backend and used SQL queries, to extract the data from the database.
Involved in Database testing by writing SQL queries.
Clarified QA team issues and reviewed test plans and test scripts developed by development team and QA team to make sure all requirements have been covered in scripts and tested properly.
Tools Technologies: Quality Center, HIPAA, QTP, Windows 2000, SQL Server, SQL, PL/SQL.
Welltok Inc. Burlington, MA Feb 2017 – Mar 2018
Business Analyst
Involved throughout the Software Development Life Cycle, (SCRUM) including sprint planning meetings, review meetings and backlog refinement meetings.
Managed roles offshore and served as a liaison between development team and business team.
Prepared detailed requirements as User Stories and Use Cases to provide details of each business and functional.
Requirement, development and implementation plan of these requirements, timelines, owners, etc.
Excellent knowledge of Health Insurance Portability and Accountability Act (HIPAA) transaction, code set rules such as EDI 837, 835, 834, 270, 271,and ICD9-ICD10.
Successfully used Agile/Scrum Method for gathering requirements and facilitated user stories workshop.
Validated 837 (Health Care Claims or Encounters), 835 (Health Care Claims payment/Remittance), 270/271 (Eligibility request/Response), 834 (Enrollment/Dis- enrollment to a health plan).
Extensive knowledge of Medical Management Information Systems (MMIS), Medicaid, Medicare, Procedural and Diagnostic codes and Claims Process.
Good knowledge of Health Insurance Plans (Medicare Part A, B and D), managed care Plans (Medicaid and Medicare) and experienced in determining the membership eligibility, billing experience within life and disability in health plans.
Interacted with the development team on regular basis to ensure and balance practicalities with innovative and efficient business systems solutions.
Work closely with the QA lead and assisted with the development of test plan and walk through meetings in absence.
Captured all HIPAA-related EDI data in the repository using FACETS, supported integrated EDI batch processing and real-time EDI using FACETS.
Tools Technologies: Rally, MS Visio, HP QC, UML, MS Office, Agile Scrum, SSRS, Facets and ticket upholding
McKesson, Atlanta, GA Dec 2015 – Jan 2017
Business Analyst
Responsible for requirements analysis, design and developing technical requirements.
Performs in-depth investigation, analysis, and evaluation to determine project feasibility.
Conduced Joint Application Development (JAD) sessions and walk in interview with the business users to gather requirements.
Matched the requirements for programs such as Medicare and Medicaid, which are part of the Social Security Act.
Created Use Cases diagram and Activity diagram to depict the interaction between the various actors and the system in Rational Rose for the Business Use Case and System Use Case.
Organized regular status meetings with vendor to identify accomplishments and any issues that need to be addressed.
Analyzed forms and successfully crosswalk details to corresponding ANSI X12 formats.
Worked with HIPAA compliant ANSI X12 837 formats for both professional claims and institutional claims.
Assisted Business User during deployment in formulating User Acceptance Testing (UAT) for customized application and getting confirmation for product Release.
Involved in preparing UML diagrams, Business Process Flows, and Activity Diagrams using Microsoft Visio.
Worked with the business/functional unit to assist in the development, documentation, and analysis of functional and technical requirements within FACETS.
Assisted in Regression Test, System Test, and UAT
Performed Migration and Validation per SDLC standards. Interacted with the Test Team and reviewed test Cases.
Worked with all Facets Provider of software development from requirements gathering to testing, configuration and international deployment.
Worked in Facets Application Groups Claims Processing, Guided Benefit Configuration, Medical Plan, Provider, Subscriber/Member, Utilization Management, automated claim processing, Provider management.
Tools Technologies: RUP, SQL, MS Office, MMIS, MS Visio, SharePoint, Lotus Notes, Rally. Rational Tools
Nirmal Hospital, Gujarat, India Jan 2014 – Oct 2015
Business Analyst
Facilitated interview, one on one and brainstorming sessions with SME's User's in understanding the requirements pertaining to billing Origination to billing Processing.
Assisted and written System Requirements Documents SRD, including Functional and Non-Functional requirements.
Gathered business requirements through interviews, surveys, prototyping and observing from account managers, finance manager, and independent advisors and got an accurate understanding of their needs.
Developed Use cases and activity diagrams and analyzed business requirements.
Followed the UML based methods using Microsoft Visio to create: Use Cases Diagrams, Activity Diagrams, and Sequence Diagrams.
Worked with SME's and business users to gain in-depth understanding of the business' mission, objectives, purpose and processes.
Responsible for sales and marketing specializing in practice management, managed care systems, thin-client technology, Electronic Media Records EMR/EHR/PHE/PMR, ASP technology, and full integration tools.
Enhanced the business to articulate and prioritize their ideas, and assisted in development of training materials for new technology and process improvements.
Collaborated with the QA testing team to develop the test plan, test conditions and test cases to be used in testing based on business requirements, technical specifications and/or product knowledge.
Tools Technologies: Rational Requisite Pro, SharePoint, UML, MS Visio, Win Runner, MS Access
Silicus Technologies India Pvt Ltd. India Jun 2013 - Dec 2013
Intern Business Analyst
Prepared the Functional Specification Document FSD and Software Requirement Specifications SRS .
Conducted the JAD Sessions with stakeholders and developers to have a clear picture of a project.
Conducted interviews with key stakeholders to analyze existing data and gather requirements.
Developed flowchart and process diagram using MS Visio.
Wrote SQL scripts for creating performance evaluation reports
Clarified QA team issues and reviewed test plans and test scripts developed by development team and QA team to make sure all requirements have been covered in scripts and tested properly.
Identified bugs during the test phase and reported them using HP Quality Center.
Maintained Traceability Matrix throughout the project.
Developed Test Cases and Test Plans on the basis of requirements and also did manual testing of the functionality of the application to ensure that the application is able to handle a lot of data
Conduct Presentations periodically to the management and end users during various phases of Software Development Life Cycle SDLC.
Facilitated and documented UAT, Reported user feedback to management team, and developed training materials for different end users and assisted in users training for the new system.
Tools Technologies: HIPAA, MS office suit, Rational Requisite Pro, SQL, HTML, XML, Windows XP/2000, MS Project, Windows XP, UAT
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