Business Analyst Process
Resume:
Nagajyothy musugu
Business Analyst
*********@*****.*** # +1-512-***-****
Professional Summary:
Dynamic professional with over 7+ years diverse Business and Quality Analysis experience dealing with varied business processes in Healthcare Insurance, Pharmaceutical, and Hospital domains
Mentored the development teams to understand and practice the core Scrum principles, roles, rules, and values
Solid understanding of Business Requirement Gathering, Requirement Analysis, Business Process Flow, Business Process Modeling, Data Analysis, and Data Mapping
Experience in conducting JAD sessions / Facilitated sessions for project definition involving analyzing requirements, creating prototypes and user interface documents
Experience in preparing various documentations including Business Requirement Document (BRD), Functional Requirement Document (FRD), Data Mapping Document (DMD), Report Specification Document (RSD), Requirement Traceability Matrix (RTM), and other client specific documents
Experience in Eligibility and Benefit systems, ICD-9 to ICD-10 Conversions, HCPCS, CPT, HIPAA 4010 and 5010, Claims Adjudication, Affordable Care Act (ACA), and Healthcare Reform (HCR)
Experience in implementing HIPAA Gateway EDI X12 Transactions. Experienced in HIPAA transactions EDI 837 (Dental/Institutional/Professional), 835 (Payment Remittance Advice), 270 (Eligibility Request) / 271 (Eligibility Response), 276 (Claims Status Inquiry Request) / 277 (Claims Status Inquiry Response), 834 (Benefit Enrollment and Maintenance Transaction), 997/999 (Transaction Acknowledgement)
Knowledge of EDI X12 standards in healthcare insurance
Knowledge of revenue cycle management (RCM)
Knowledge of MITA, MMIS, EPIC, and NPI business areas
Knowledge of Medicare, Parts A, B, C and D / Medicaid Claims processes from Admin/Provider/Payer side which were later part of the training program to vendors
Experienced in writing SQL queries / joins using MS SQL Server and Oracle databases.
Experience in defining test cases, creating test scripts, analyzing bugs, interacting with QA / developer teams in fixing errors and performing User Acceptance Testing (UAT)
Experience maintaining SharePoint
Google Workspace Tools: Drive, Docs, Sheets, Meet, Admin Console, AppSheet, Apps Script
Excellent team player with interpersonal dexterity and proven ability to converse, liaise, negotiate, and relate with a wide range of personalities from diverse backgrounds
Have excellent analytical, problem solving, communication, presentation, and interpersonal skills
Ability to interact with individuals at all levels- can work as a part of a team as well as independently
Demonstrated leadership abilities and teamwork skills as well as the ability to accomplish tasks under minimal direction and supervision
Strong analytical skills with detail follow-through and skills in business process mapping and analysis
Good technical abilities and skills developed by a strong work ethic and self-learning
Technical Skills:
Requirement Management
JIRA, Confluence
Defect Tracking
HP Quality Center, ALM
Query and Programming
SQL, HTML
Databases
SQL Serve, Oracle, and MS Access
Document Management
SharePoint
Methodologies
Waterfall and Agile
Other Tools
SQL Management Studio, MS Visio, EPIC
Professional Experience:
Access healthcare, Dallas, TX Apr 2024 - Present
Business Analyst
Responsibilities:
Performed the role of Business Analyst, interacted with various business user groups for requirement definition and elicitation for HIPAA 5010 X12 EDI clients.
Gathered high-level and detailed-level functional and non-functional requirements via daily JAD sessions to define business requirements.
Worked closely with business SMEs and project stakeholders to define and clarify requirements and identify key project constraints, risks, and assumptions.
Created and maintained BRDs and FRDs for modules developed in .NET, mapping healthcare KPIs and compliance regulations.
Facilitated requirements gathering for integrating third-party clinical decision support tools into Epic via SMART on FHIR.
Spearheaded ServiceNow ITSM implementation, cutting incident resolution time by 25% via automated workflows.
Analyzed and mapped clinical data elements between EHRs and HIEs to support CCD/CDA exchange.
Responded to customer requirements with timely and effective solutions.
Served as a lead analyst for enhancement of enrollment (EDI 834) application.
Gathered requirements and facilitated meetings for development of API/Web Services including SOAP and REST API for request and response of data in json and .xml formats
Conducted gap analysis between EHR-native data formats and USCDI-defined formats for compliance with ONC interoperability mandates.
Created relevant documentation: Business and Functional Requirement Document (BFRD), Functional Specification Document (FSD), Requirement Traceability Matrix (RTM), UML diagrams - Use Cases, Sequence Diagrams, Process Flow Charts, and Prototypes including Wireframes.
Prepared documents for business requirements document (BRD), systems requirements specification (SRS), high level design documents (HLDD), and traceability mapping / matrix with the assistance from the business group, and the IT team members.
Designed and automated workflows using Google Apps Script, cutting manual data entry by 50% for finance and HR teams.
Created Use Cases, Process Designs, Data Mappings, Project Plans and Requirement documentation
Performed gap analysis to bridge differences and merge similarities between present and future state
Worked with stakeholders from different departments to gain in depth knowledge of their issue portfolio
Create various profiles and configured the permissions based on the organizational hierarchy requirements.
Integrated ServiceNow with SAP and Workday, reducing manual data entry by 40%.
Facilitated provider onboarding for data exchange through HIEs using C-CDA as the standard format for clinical summaries.
Collaborated with IT to enforce security policies (2FA, DLP) in Google Workspace, reducing phishing incidents by 40%.
Led interoperability initiatives involving HL7 and FHIR APIs across multiple provider systems to support seamless EHR integration.
Created workflows using MS Visio to demonstrate claim flows from client and system perspectives
Developed various Custom Reports and deployed them for different business user levels.
Worked in cross functional team environments, served as a liaison between SMEs, Project Manager, and stakeholders to ensure accuracy in business requirement and SDLC implementation.
Worked extensively with the QA team for designing Test Plan and Test Cases for the User Acceptance testing (UAT).
Moda Health, Portland, OR Jan 2022 – Mar 2024
Business Analyst
Responsibilities:
Coordinated with multiple stakeholders to elicit requirements and analyze solutions to automate internal claims and enrollment enhancement
Worked on claims processing and adjudication.
Designed future state processes for HIPAA 5010 transaction processing of EDIs 835 and 837
Supported applications development (third party provider/ payer) in EDI transactions to CMS: inbound {837 (P/I/D) used for submitting the health care claims; outbound transactions as 835 (electronic remittance)
Prepared Business Requirement Documents (BRDs) after the collection of Functional Requirements from System Users that provided appropriate scope of work for technical team to develop prototype and overall system.
ServiceNow Modules: ITSM, ITBM, CSM, HRSD, GRC
Collaborated with clinical stakeholders and developers to ensure accurate representation of USCDI data classes including Allergies, Medications, Immunizations, and Clinical Notes.
Involved in the usage of ICD-10 and 5010 release versions for EDI (X12) containing the transactions of HIPAA standards, to make third party payments, insurance, Medicare Part D (Prescription Drug Coverage), Medicaid Management supportive system with respect to CMS regulations (Center for Medicare and Medicaid Services) for tracking submission, retrieval, queries, and acknowledgement of claims
Worked with interface engineers and vendors to define message specifications and ensure HL7 compliance.
Worked on inbound transactions 270/271 for claims eligibility and the outbound transactions 276/277 for claims inquiry and response
Gathered customer information through various techniques including JAD sessions, one on one meetings, group discussions, and emails
Automated approval workflows for procurement using googleAppSheet, reducing processing time by 35%.
Followed AGILE methodology throughout the project
Used .NET classes extensively. Also used datasets for binding data to UI controls.
Created epics with success criteria and user stories with acceptance criteria in JIRA
Facilitated walk throughs for various teams including business, stakeholders, development, and testing
Analyzed business operations and recommended methods and processes to improve productivity and quality
Worked closely with developers and testing team to prepare mock data and perform testing
Documented project schedule, assisted with project planning, and generated functional documents for technical team to execute
Facilitated UAT sessions for new HL7 v2 interfaces and documented validation scenarios for patient demographics, orders, and results.
Created sprint backlogs and participated in creating test scenarios
Contributed to the project plan and defined the schedule of the project
Negotiated with external and internal teams to ensure schedule adherence to the project deliverable timeline and that delivery dates were met
Mentored the development teams to understand and practice the core scrum principles, roles, rules, and values
Worked in accordance with government regulations and HIPAA implementation in the system application development
Interacted and arranged meetings with business end users to gather business requirements for changes triggered by government regulations and HIPAA, business needs, and process improvement
Translated user needs to business requirements using Unified Modeling Language (UML)
Worked with the software architects/developers to ensure that the applications conform to customer requirements
Performed gap analysis for business and proposed changes to bring the affected systems into HIPAA compliance
Followed a structured approach to organize requirements into logical groupings of essential business processes, business rules, and information needs to ensure that critical requirements are not missed
Performed defect tracking and change control procedures
Provided status report on a weekly basis to the senior management on the project status
Conducted project status meetings to track the progress of the project
Reviewed UAT test cases with business owners to test the application functionality and also provided necessary training material.
Coordinated testing efforts with QA team members and provided support to Project Manager for tracking time in JIRA
Worked with the end client for user acceptance testing, supported customer training sessions, and obtained final system acceptance sign-off
Stanford Healthcare, Newark, CA Oct 2019 – Dec 2021
Business Analyst
Responsibilities:
Interacted with Senior Executives and Stakeholders to understand needs and identify key challenges, constraints, and risks; thereby defining scope
Gathered high-level and detailed-level functional and non-functional requirements via daily JAD sessions to define the business requirements and also created Requirement Traceability Matrix (RTM)
Created high level epics and user stories
Created use case documents, UML Diagrams using MS Visio for all functional requirements to help architects, developers and testing team
Involved in converting the business rules into Functional Requirements Document (FRD), Business Requirement Documents (BRD) and also created business process models from the requirement specifications.
Coordinated with the development team to facilitate understanding of requirements
Coordinated the upgrade of Transaction Sets 837 to HIPAA compliance
Performed gap analysis for HIPAA 4010 EDI 837 and HIPAA 5010 EDI 837
Involved in impact analysis of HIPAA 5010 837 transaction sets in different systems
Conducted walkthroughs and participated in defect triage meetings
Utilized SQL Server (within .NET apps) to run complex queries and data validations supporting reporting requirements for clinical and billing departments.
Identifying the requirements for accommodating HIPAA 4010 and 5010 standards for EDI X12 transactions
Collaborated with testing teams in reviewing test strategy, test plans and test scripts
Performed UAT Testing with QA and business team
Performed data validation using SQL queries
Managed and controlled the project documentation using SharePoint
Ensured the timely delivery of Business Analyst team artifacts
Facilitated status, business requirement elicitation, and solution meetings
Assisted Business User during deployment in formulating User Acceptance Testing (UAT) for customized application and getting confirmation for product Release.
Dignity Health, Phoenix, Los Angeles, CA Jul 2017 – Sep 2019
Business Analyst
Responsibilities:
Leveraged in-depth knowledge of healthcare principals, analysis concepts, and data to support critical business needs for a variety of healthcare clients
Elicited and documented business user requirements from key stakeholders drive agile development of reporting and analytic solutions to support Post-Acute Care facilities improve treatment outcomes, and prevent medication and hospital related errors for patients in Long Term Care Hospitals, Inpatient Rehabilitation Facilities, Skilled Nursing Facilities, and Hospices
Documented business functionality requirements in Business Requirement Document (BRD).
Wrote epic features, user stories, and use cases for management and staff to review ensuring that they are correct, complete, clear, consistent, testable, traceable, feasible, and agreed upon between with other contractors, stakeholders, and clients.
Analyzed findings and provided actionable insights and recommendations based on analysis
Developed innovative ideas and created partnerships with internal customers to drive the adoption of data-driven decision-making
Maintained Traceability Matrix to ensure all the features for the project has been captured and mapped back to the requirements in the BRD.
Served as a mentor to highly collaborative cross-functional teams
Facilitated JAD sessions to collect requirements from system users and prepared business requirement that provided appropriate scope of work for technical team to develop prototype and overall system
Created test plans and test cases based on the business requirements
Researched and analyzed NQF (National Quality Forum), CMS, and HEDIS measure data to ensure quality improvement and pay-for-reporting programs for specific healthcare providers and created a blueprint measures matrix document
Wrote and updated existing Provider Threshold Reports, Patient Level Reports, and SOPs
Created Source-to-Target (S2T) Mapping spreadsheets used to communicate to the ETL development team the operating rules for transformation of data from the source system to a target database for data receipt
Performed peer reviews and created logs to ensure the client’s business requirements were satisfied and were in adherence with CMS regulations
Created requirements for the Oncology Care Medical Registry, a payment model designed to test the effect of better care coordination and appropriate clinical care on health outcomes for Medicare fee-for-service beneficiaries with cancer and used JIRA for requirement management and defect tracking/logging
Worked with teams to plan, implement, track, report, and provide required registry data
Created test cases with steps and expected results, scenarios, and test plans in DEV and drove VAL testing
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