Analyst Data

Natasha Raza

407-***-**** adlsto@r.postjobfree.com

Seeking: Dallas, TX or Remote opportunities

www.linkedin.com/in/natasha-raza-0456ab16b/

IT BUSINESS SYSTEM ANALYST

SUMMARY

IT professional with 8 years of experience in the areas of IT Healthcare Industry in Business Analysis, Business System Analysis and Project management.

Strong understanding and working knowledge of MMIS subsystems like Claims, Pre-Admission Screening, EDI, TPI.

Extensively use JIRA, Rally, TDP user for Agile Boards, product backlog user stories, bug tracking, team velocity, and deadlines.

Strong understanding of HIPAA Transactions & Code Sets Standards like (820- Premium Payment for enrolled health plan members, 837, 834- Enrolment /Disenrollment to a health plan, 835).

Experienced with Federal contracts, X12 transactions, health care act, EDI transactions 270, 271, 834, 835, 837.

Hands on experience with JIRA for issue tracking & User stories / requirements

Expertise in X12, XML, EDIFACT and VDA. Deep knowledge of PPACA rules surrounding the Enrolment and Eligibility piece. Excellent understandings about ANSI X12 EDI standard and HIPPA compliancy mandates for ANSI X12 EDI.

Developing and maintaining project plans for all business analysis efforts and selected software deployments.

Managing direct reports and other matrix staff. This includes participating in interviewing, hiring and performance reviews. Schedules work of staff based on operation priorities, reviews work and mentors’ staff.

Working with other development staff in a matrix assignment environment.

Analysing and assigning Change and Help Tickets related to new development requests and implementations.

Reporting, tracking, and communicating status and issues, based on departmental defined reporting templates. Working with end users to determine business needs/requirements for new/enhanced systems or applications.

Participating in the development of long-range plans and goals.

Coordinating and providing impact analysis on new projects.

Developing and documenting as-is/to-be business processes, configuration scripts, and other associated technical specifications from end user requirements.

Analysing information needs and functional requirements. Evaluating information gathered, reconciles conflicts, decomposes high-level information into details, abstracts up from low-level information to a general understanding, distinguishing user requests from underlying true needs.

Preparing analysis templates based on standard UML methodologies for analysis. (Reqs, Use cases and OO diagrams)

Documenting projects scope and prepares submittals for the IT governance board.

Identifying software decommissioning opportunities.

Providing guidance to stakeholders on devising effective and efficient approaches to achieve the project objectives using manual processes or software tools.

Facilitating cross-functional team meetings to develop and implement business solutions and optimize operations, conducts impact analysis of new products, systems, upgrades, and changes for department/functional areas, and evaluates systems and business processes for feasibility.

Developing requirements specifications according to standard templates, using natural language. Assists with the development of the organizations requirements engineering policies, procedures, and tools.

Reviewing and approving requirements developed by staff and outside team members.

Establishing and implementing effective requirements practices, including use and continuous improvement of a requirements process.

Preparing a standard process for eliciting requirements and developing use cases based on best practices. This may involve using interviews, document analysis, focus groups, surveys, site visits, business process descriptions, and workflow analysis. Documents the tools and procedures that will be used in these processes

Experienced in FACETS claims management system.

Experienced with Affordable Card Act (ACA) complete implementation.

Strong background of creating HL7 mapping and translation documents

Background of documenting HL7 and X12 interface specifications.

Worked on multiple projects as a project team member, and occasionally as a project team leader.

Mentored other team members on the development & support of HL7 interfaces for clinical applications.

Significant Epic EMR work experience, tasked with building, implementing and supporting the Epic application from both the end user (clinical) and technical perspectives.

Extensive experience in gathering requirements and estimate effort for HL7 interfaces.

Experience with Business Objects to test Reports. EDUCATION

Bachelor of Commerce Karachi University

WORK EXPERIENCE

Senior Business Systems Analyst WellMed / UnitedHealth Group, San Antonio, TX Oct 2018 - Present Role was sophisticated requirement gathering to create and define high-value problem statements. Baselining and documenting the metrics that will define success on project. Worked on the process for getting payer automated.

Hands on experience to build SQL queries in order to extract the date.

Work with business side to keep track on claims such as voided, rejected, spliter, and misdirected claims.

Formulate and finalize test cases with test teams. Created test cases for UAT, IVT and ERT. Most of the testing was done around healthcare insurance, dashboards, and XML reporting.

Created XML into X12.

Work on projects to improve the claims processing performance and efficiency. I have independently improved 35% on success rate and reduced cost by 12%.

Strong experience and understanding with the process flow of 837 claim encounters correction and submission on weekly basis.

Experience with workflow configuration, design, and implementation.

Gather new features which were then developed and implemented.

Experience with Provider Electronic Solution (PES) Application: Claims Processing, Recipient Eligibility, Medical Plan, Provider, Utilization Management.

Analyze and work with X12 HIPAA specific EDI transactions for claims, member enrollment, billing transactions.

Work specifically with 837, 835, 834, 270/271, 276/277

Involved in TruCare authorization validations by monitoring performance and authorization.

Document, create and update process flows, documentation, and diagrams

Gather Business/Functional user requirements, created Use Cases as per user requirements, developing/designing diagrams such as Activity, Class, and or Sequence diagrams, and in addition to creating Business Requirements Document (BRD)

Facilitate meetings with stake holders, Business owners, developers, system analyst and testers to collaborate resource allocation and project completion using MS Project.

Write SQL scripts to extract data from the SQL Server for data clean-up.

Prepare custom reports and performed SQL query, data analysis and verification on MS Access.

Design mock-ups of various reports and the UI to communicate visual data flow to the Business Users via Presentations.

Track progress and notified management of issues that require escalation, and resolved the resolution of system and process issues

Perform feasibility & gap analysis, adaptability & risk analysis; document to identify business critical & high-risk areas.

Coordinate various projects and conducted daily Scrum meetings, Planning Sessions and Retrospective Sessions with offshore and on-site teams present in multiple locations.

Coordinate with QA Team for testing activities across multiple systems and managed Conversion test execution.

Work with the business Team to review UAT validation scenarios and execute the UAT test cases.

Resubmit the rejected claims to manually fix the errors and placed them to the FTP location for business to pick for adjudication process.

Create and execute a detailed UAT Test Plan aimed at capturing the client's core requests.

Develop and maintain strong relationships with both internal/externals customers at the senior management and executive level in order to influence project teams and gain consensus on selection of the most viable solutions

Translate business requirements into functional requirements and approaches for developers.

Provide management support to the off-shore End to End integration/ Regression Test Team.

Workflow documentation and comprehensive training to the healthcare clients.

Provide support for the Successful Releases of Multiple Projects.

Document various workflow diagrams like AS-IS and TO-BE processes.

Hands on experience managing the workflow sessions with external customers

Create standard changes in ServiceNow for bulk adjustment of data. Environment: MS Access, ORACLE, MS Word, Excel, and PowerPoint, SQL Management, ServiceNow, Optum, Ika Claims System, TortoiseSVN

Business Analyst/EDI Analyst Emblem Health, New York, NY Sept 2017 - Sept 2018 Worked with the Enterprise Project Management Office (EPMO) as a Business Analyst. My project involved Medicare Plan Changes based on the CMS approved changes. Other projects involved Automated Letter Generation for Members and Providers and UAT assessments for the organization.

Worked on Facets Data Tables like (MEES, MEME, BLEI, MESU, BLDF etc;) and created audit reports using queries.

Tested the changes for the front-end screens in FACETS related to Membership, Benefit and Plan modules.

Established workflows and customized JIRA for managing project-related issues and processes.

Involved in Project tracking through JIRA.

Manually loaded data in FACETS and have good knowledge of Facets Business rules.

Conducted business validations, covering the following deliverables: FACETS Providers, Facets Claims and Facets Membership and Operational reports.

Wrote Test Plan and Test Cases and aggressively involved in Regression Testing and Performance Testing using automation tools like WinRunner, LoadRunner, TestDirector, Quick Test Pro, Silk Test and Oracle table manipulation using SQL

Provided administrative direction for all FACET initiatives and programs, including input into strategic planning of the organization and external relations.

Gathered Business Requirements from the Subject Matter Experts (SMEs) and documented the requirements in the BRD. Utilized data flow diagrams, user story/ use case diagrams and process flow diagrams to represent information provided by the Business Owners.

Extensively involved in cross-functional testing efforts with internal systems - QCARE, Data Warehouse, Web & Esaws

Involved in Reconciling Part D payment cost estimates and supporting documentation.

Involved in documenting changes to the Benefits Administration, Enrollment Processing and Claims Processing Systems based on the Medicare Plan Changes initiative.

Organized meetings and led JAD sessions to ensure legal and compliance deadlines of CMS (Centers for Medicare and Medicaid Services) are met.

Facilitated modifications to Qcare contract linkages

Worked with Business Owners of Market Prominence, the Enrollment Processing System, to ensure that the enrollment process for the new members is updated with changes.

Involved in Identifying patterns in public health data, as it relates to Medicare Part C and D.

Worked with the UAT and QA teams to conduct an assessment and determine how effective UAT and QA guidelines can help the company achieve timely completion of projects.

Worked with Business Owners of Quality Care, the Claims Adjudication Process, and documented updates and enhancements.

Professional working knowledge of X12 5010 HIPAA 837 I, P, D, 835, 834, 820, 270, 271, 276, 277, 278, EDI, Privacy, Security, and Medicaid.

Effectively elaborated the current process and gave a clear picture of the proposed process for the projects in the organization. Worked aggressively towards timely completion of High Priority Tasks.

Vendors and Delegates: Worked with Business Owners and Relationship Managers for Vendors and Delegates, e.g. Davis Vision, Montefiore, HCP, to ensure that Eligibility and Membership File exchanged on daily and weekly basis is updated with the Medicare changes.

Change Control Process: Led the Change Control Process for changes submitted for the BRD once the document was submitted to IT department.

Worked with Development Team to resolve issues and clarify Business Requirements from the Business Owners.

Documented the UAT Plan for the project and worked with the UAT Team to ensure every acceptance criteria for the requirements has been included in the UAT task plan.

Maintained the Traceability Matrix table to track the Business Requirements to the design to the testing keeping track of all requirements in the BRD.

Environment: QCARE, MS Access, ORACLE, MS Word, Excel, and PowerPoint. IT Business Analyst State Street Bank, Boston, MA Sept 16 – Aug 17 The project scope included enhancement of web banking application and workflow management.

Gathered business, system and functional requirements by conducting detailed interviews with Business users, Stakeholders and Subject Matter Experts (SME)

Performed Gap Analysis to check the compatibility of the existing system architecture with new business requirements

Worked extensively through Agile development methodology by dividing the application into iterations

Supported the product owner in maintaining the Product Backlog, Sprint Backlog and scheduling next release

Participated and contributed in Daily Scrum, Sprint Planning, Sprint Review and Sprint Retrospective meetings.

Created User Stories with good acceptance criteria

Worked closely with PO in refinement of user stories

Addressed change management and other related activities

Created weekly progress summary reports using Tableau to provide insights to the management

Worked closely with QA in writing test cases and clarifying user stories

Conducted User Acceptance Testing (UAT) and demonstrated new features to customer post demo release

Generated reports such as burnout chart, velocity chart and defect reports using Rally EDI Business Analyst Beacon Health Options, Boston, MA March 15 - Aug 16

Gathered detailed business and technical requirements and participated in the definitions of business rules and data standards.

Single-point contact for issues encountered by the client which were managed & coordinated via JIRA system.

Involved in the reconfiguration of FACETS in functional areas, including Membership, Claims, Provider, Enrollment, and Service Modules.

Defect Tracking and Bug Reporting were performed using Quality Center and Jira

Oversaw all data collection, analysis and utilization of information for all FACET initiatives.

Analyzed a wide range of Trizetto FACETS configuration change requests for the purposes of determining the technical scope of the change, its impact on existing systems configuration.

Extensively worked on Data mapping of EDI Segments from 834 FFM (Federally Facilitated Marketplace) to Facets database and vice-versa.

Analyzed the operational procedures/methods and recommended changes for improvement with an emphasis on automation and efficiency.

Worked on EDI transactions: 270, 271, 834, 835, and 837 (P.I.D) to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrolment hence analysing and documenting related business processes.

Performed gap analysis of claims and enrolment business process for changes from SSN identifier to USI (Unique Subscriber Identifier) affecting for HIPAA EDI X12 transactions 837, 834, U277, 276/277, 270/271, 278,835 and 820.

Created specifications for EDI HL7 (A28, A31, ADT) and X12 (837/835) transactions that were transmitted between Claims Editor and Legacy Billing application and external Payers.

Worked with data migration and file mapping for various EDI transactions. Enhanced the Provider/Patient verification criteria using additional parameters based on the information retrieved from the EDI 837 I/P transaction files.

Translated the EDI X12 data into XML format for initial transformation/migration.

Facilitated functional requirement gathering from system users and prepared business requirement documents

(BRD).

Created Business Process Mapping Diagrams and Documentation for the process improvement recommendations.

Used MS-Visio for flow-charting, Use- Case process model and architectural design of the application.

Implemented the Rational Unified Process (RUP) methodology guidelines with its various workflows and artifacts in Requirements Management and Development.

Gathered and documented functional requirements and use cases for automation of operational and administrative business processes.

Provided overall project management to multiple projects successfully completing them on-schedule and on- budget.

Documented the "AS-IS" Business Workflows adhering to UML standards. Conducted JAD sessions to define requirements and finalize the Functional Requirement Document (FRD).

Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, OOD (Object oriented Design) using UML and Visio.

Interfaced with team leaders, identify and analyze the given information, procedures and decision flows, evaluated existing procedures, methods and technical documentation. Communicated with executives, managers, and other stakeholders regarding project scope.

Responsible for business process analysis that includes requirements facilitation, definition & analysis, alternatives, software selection, prototyping, business process design and mapping.

Maintained a Traceability Matrix to ensure that all functional requirements are addressed at the use case level as well as the test case level.

Environment: Microsoft Office:, Excel, Outlook, Project; Rational Rose, Rational Requisite Pro, RUP, UML, Quality Center Business Systems Analyst Mercy Health Plans - Janesville, WI Oct 13 - Feb 15 Performed a pivotal role in multiple projects & handling three releases at the same time. Release 1 & 2 was web-based service application developed for streamlining office workflow processes involved in Electronic Data Interchange (EDI) transactions and benefits in claims management cycle based on HIPAA Guidelines. Release three was based on reporting the policy premium. There were seven reports, which were generated in Brio portal.

Interacted with business heads to finalize the Business Requirements for the application.

Performed the requirement analysis and documented the requirements using Rational Requisite Pro.

Used Jira to log defects also retested and verified and closed defects.

Strategically created marketing items for all outlets of FACET as well as attends and represents the organization.

Strategized configuration of Facet modules such as Claims, Membership, Billing, Benefits and Plan.

Comprehensive experience in writing Test Plans, Test Cases and Test Scripts using manual and automated testing tools from Rational and Mercury Interactive such as test Director, WinRunner.

Used the requirement attributes (priority, effort, and risk) as the basis for negotiating the inclusion of the requirement, to manage the scope of the system efficiently.

Developed UML Use Cases using Rational Rose and developed a detailed project plan with emphasis on deliverables.

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 SDLC (System Development Life Cycle) methodologies like the RUP and the waterfall.

Understand the As Is system and develop the To Be system concept and prepare the System Process Maps.

Managed changing requirements which included establishing a baseline, keeping track of the history, determining dependencies that are important to trace, tracing relationship between related requirements and maintaining version control.

Prepared and documented System Requirements and workflows for the Content Management Application tool.

Responsible for integrating with Facets. Designing test scripts for testing of Claims in Development, Integration and Production environment.

Checked Business Readiness and determined activities of flow.

Developed and executed several Optimized queries in SQL on this data.

Performed Unit Testing and UAT and documented detailed defects.

Wrote Procedure Manuals and was responsible for continuity preparedness.

Managed various tests, stored test information, reviewed and analyzed test results.

Conducted presentations of the QA test results with analysis to the stakeholders and users and documented modifications and requirements.

Helped in writing Training manuals and helped business with the Training on a one to one session.

Employed Rational Clear Quest for effective Change Management (Requirements Creep) and bug tracking during the testing life cycle.

Environment: Requisite Pro, Rational Rose, Agile, PL/SQL, HTML, Microsoft Office, MS Visio, EDI, UML. Wake Med, Raleigh, NC Business Analyst August 2012 to September 2013 Domain: HealthCare Management

Worked along with the project manager to define the product scope and deliverables adhering to the HIPPA rules.

Identified the key stake holders and users of the system.

Conducted JAD sessions with medical personnel, SME's and technical leads to elicit requirements and do feasibility study.

Documented the product requirements through multiple UseCases. Also presented key requirements through UML diagrams like UseCase and Activity diagrams that provided detailed explanation of system process flow and results.

Maintained the UML models in MS Visio.

Presented wireframes in coordination with UI design engineers to the Medical personnel and End Users for better understanding of the product being developed.

Created all the documents like Business Requirement Documents, Functional Requirement Documents in Ms Word and Excel.

Coordinated with the technical team and conducted walkthroughs involving Medical personnel's, developers, end users and stakeholders for sound development of the product. Certifications

ServiceNow reporting (Wellmed university)

Service Request Process Overview (Wellmed University)

IT Service Management (ITIL) - (Wellmed University)

Change Management Process Overview - (Wellmed University)

Incident Management Process Overview - (Wellmed University)

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