Bela Patel

q6o8pv@r.postjobfree.com

513-***-****

Professional Summary

• 7 years experiences as Business Analyst with extensive experience in healthcare, pharmaceutical and health insurance industries

• Sound knowledge of Health Insurance and Portability and Accountability Act (HIPAA)

• Well versed with FDA guidelines, rules and regulations

• Strong knowledge and experience in Healthcare industry. Functional knowledge of Medicaid Management Information System (MMIS).

• Worked with HL7, EDI ANSI 4010 and 5010 Standards. Involved in a 4010 to 5010 migration process and respective GAP Analysis.

• Expertise in EDI HIPAA 4010 - 5010 Project to convert EDI X12 Healthcare 4010 transactions into 5010 Complaint transactions.

• Worked on 837 (I, P, D), 834, 835, 820, 270, 271, 276, 277, 278 transactions and BRCs of the transactions.

• Exposed to using ICD 9/ICD 10/ANSI/HL7 coding standards in Medicare and Medicaid domains of the healthcare systems and industry for both inpatients, outpatients, Reimbursement methodology.

• Implemented various HIPAA codes (270 and 276) used for Billing and Eligibility purposes of patient records.

• Have develop and design interfaces between Argus and other drug safety systems.

• Have Process documentation creation experience and ability to facilitate requirement sessions and proof of concept sessions

• Have strong experience in requirements gathering by conducting interviews with end users

• Comprehensive knowledge of Software Development Life Cycle (SDLC), having thorough understanding of various phases like Requirements, Analysis/Design, Development and Testing

• Exposure in Forward Mapping and Backward Mapping analysis of ICD 9 – ICD 10 Conversion for CM (Diagnosis Codes) and PCS (Procedure Codes).

• Have exposure to EDI, Web Portal, DSS and System documentation

• Experience in conducting UAT (User Acceptance Testing) and documentation of test cases, ability to communicate both on a business and technical level and experience in coordination with business and technical resource

• Good control on MS Office suite, MS Visio and MS Project.

• Adept at creating and transforming business requirements into functional requirements and designing business models using UML diagrams – Context, Use Case, Sequence, Activity diagrams in MS Visio and Rational Rose

• Organized many Joint Application Developments (JAD) sessions, scrum meetings and Joint Requirement Planning sessions (JRP), walkthrough, Interviews, Workshops and Rapid Application Development (RAD) sessions with end-user/clients/stake holders and the IT group

• Excellent presentation skills with MS Power Point, which was extensively used in different JAD sessions and to track progress. Communication ability with prospective vendors

• Writing Complex SQL queries and optimizing SQL Queries. Familiar with COBOL technologies and DB2. Good understanding of Mainframe environment.

• Assisted the project manager with activities like development of business processes, effort estimation, resource management, issue/risk analysis, milestone tracking and associated documentation

• Comprehensive knowledge of RUP, Agile, Scrum, FDD, Waterfall Methodologies

• Extensive experience in gathering, managing and documenting business requirements and functional requirements, communicating effectively with upper management, senior BAs, developers and QA engineers

• Excellent track record for meeting deadlines and submitting deliverables on time

• Excellent documentation, communication and interpersonal skills

Education

Master of Business Administration (Healthcare Management)

Bachelors in Pharmacy

Technical Skill-Set and Computer Efficiency

Operating System Window 2000 / XP / Vista / Unix / Dos

Languages SQL, HMTL, SAS

Application Management Tools Rational Rose, Rational Requisite Pro, Clear quest, Clear case,

Databases MS Access, DB2, Oracle 8i, MS SQL Server

Microsoft Applications Word, Excel, PowerPoint, SharePoint

Workflow Tools MS Visio, MS Project

Professional Experience

Blue Cross Blue Shield of Massachusetts, Quincy, MA (Aug 2011- Present)

Sr. Business Analyst

Blue Cross Blue Shield of Massachusetts (BCBS MA) need to comply with the U.S. Department of Health and Human Services (HHS) published implementation date of the 10th revision for the International Classification of Diseases (ICD-10).The move to ICD-10 version requires significant changes across the operations of the enterprise including departments like Pre-Authorization, Claims Adjudication and Provider Reimbursement. The conversion of ICD-9 codes to ICD-10 will require a rigorous and complex testing execution plan to be completed prior to the compliance date to ensure the BCBS MA can operate in a “business as usual” status post October 1, 2013.

Responsibilities

• The review process will also identify improvements in current documentation practice that will assist in establishing the Testing Center

• Analysis on the BRD structure, addressing this area as well as focusing on the completeness and clarity of the requirements.

• BRD analysis was classified projects into 3 categories - not applicable (N/A) for enterprise testing, ready for scenario development and needing additional information to complete the development of testing scenarios. Used MS Visio for Process modeling, Process mapping and Business Process flow diagrams.

• Involve in the review and analysis of the BRDs employed a number of artifacts which will continue to be working documents to record the progress and traceability of test preparation, testability analysis report, a detailed business requirements analysis checklist for each project, communication log with comments, questions and responses and functional area analysis summary with status of all submitted projects.

• Involve in functional area analysis report is used to report the overall status of projects. It reports the key summary data, as well as the current status of open questions and missing information for each project. It enables QA to review status of projects based on a number of criteria such as Impact area, open questions, information required and functional area.

• Key findings were concern with the business requirements and supporting artifact analysis are categorized into the following areas; key decisions required QA status, testing complexity, and area of impact.

• Key impacts documented in the analysis focused on the financial integrity, benefit neutrality and operational stability objectives of the remediation effort.

• Working tools used were MS Office, Visio.

Rex Healthcare Hospital, Raleigh, NC (April 2010 July 2011)

Business Analyst

The Rex Healthcare Hospital has to comply with CMS mandated ICD-10 requirements within very tight deadlines. The scope of the project is to collect the detailed information from various areas of the hospital and gather the requirement regarding all the applications, which are currently in use in hospital. The purpose of the project is to define the roadmap for implementation and analyze the collected data in order to fulfill the change from ICD-9 to ICD-10.

Responsibilities

• Perform a baseline assessment of Hospital-Provider systems and related interfaces, the existing service level agreements and/or policies and operational business procedures for readiness to comply with HIPAA as well as ICD-10 requirements

• Have strong experience in requirements gathering by conducting interviews with end users

• Actively worked on Data analysis and Report analysis with respect to ICD-10 impact

• Analyzed System flows of various department of the hospital

• Identified risks, problems, requirements and concerns of the Hospital in order to comply with ICD-10 changes. Assisted JAD sessions to identify the business flows and determine whether any current or proposed systems are impacted by the EDI X12 Transaction, Code set and Identifier aspects of HIPAA.

• Highly involved in understanding of department workflows and process flows with respect to applications. Developed business process models in RUP to document existing and future business processes. Improved process for payment of Medicare Secondary Payer claims through revised workflows.

• Collected the information related to ongoing application upgrade and their impact on ICD-10 implementation and created awareness within the departments regarding the need, impact, benefits and risks of ICD-10 code application

• Re-Organized the collected data and prepared documentation for implementation.

• Involved in providing education about the ICD-10 codes and 5010 standards, its requirements, complexity and accuracy to Physicians and Nurses of the hospital. Figured out the requirement of training in various departments of the hospital based on their daily work

• Performed impact analysis on applications for deadliness of ICD-10 conversion.

• Responsible to meet the information demands of our business users by delivering timely, accurate, meaningful and standardized data and reporting

• Mapped the collected data with the existing data provided by the hospital departments

• Used Word, Excel and Visio as a working tool

• Hands-on experience and good understanding of the hospital working system including Registration, Scheduling, Radiology, Laboratory, Pharmacy, Patient Accounting, HIM, Claim Processing etc.

• Also involved in implementation of ARGUS drug safety system.

• Met the deadlines and scheduled day to day meeting sessions.

State Division of Medicaid, Alabama (Sept 2009 – March 2010)

Business Analyst

Alabama Division of Medicaid’s Medicaid Management Information System (MMIS) has to comply with Health Insurance Portability and Accountability Act (HIPAA) and ICD 10 requirements. Purpose of the project is to analyze GAP between current HIPAA 4010 / ICD 9 and compliance HIPAA 5010 / ICD 10 for state Medicaid Management Information System.

Responsibilities

• Involved in requirements gathering sessions with Business Analysts and Architects to understand requirements in terms of business change.

• Actively worked on Business requirement analysis and Data analysis.

• Analyzed System Impact including MMIS Tables, Windows, Reports and Interfaces to external entities.

• Created Business Rule Comparison (BRC) documents and Side-By-Side (SBS) comparison documents using 4010 / 5010 implementation guides for X12 transactions in Excel spreadsheet.

• Got hands on experience on analysis of GAP analysis between current HIPAA 4010 and HIPAA 5010 requirements.

• Analyzed HIPAA 4010 and 5010 standards for 837P EDI X12 transactions, related to providers, payers, subscribers and other related entities.

• Got exposure of IBM mainframe environment for Medicaid Management Information System impact assessment. Dealt with the EDI transaction-835 claims payments and remittance advice, which deals the payment from payer to provider.

• Analyzed HIPAA 5010 impact on external Data Warehouse and data warehouse extract process and mapping of MMIS database and data warehouse.

• Got exposure of EDI, Web Portal, DSS and System documentation.

• Analyzed MMIS system impact for Windows and Interfaces.

• Gathered all the needed data (table names, column names, field names, notes) from the Windows and Interfaces documents

• Analyzed RRI/Viking Subsystem (an external system off the state, dealing with conversion of paper claims to electronic claims) and recommended changes for HIPAA 5010.

• Responsible to meet the information demands of business users by delivering timely, accurate, meaningful and standardized data and reporting.

• Documented analysis, observations and recommendations.

• Attended daily meetings and dealt with day-to-day deadlines.

• Experience in Forward Mapping and Backward mapping analysis of ICD 9 – ICD 10 Conversion for CM (Diagnosis Codes) and PCS (Procedure Codes).

Aetna, Phoenix, AZ (July 2008 – August 2009)

Business Analyst

The project Claims-Funds involved creating a new UI for better user experience in claim reimbursement process. UI was used to view and modify claim fallouts that occur during claim adjudication process. Claim fallouts appear as a work item in Claim Processors Inbox, from where various action such as claim adjudication, claim denial, claim reversal etc. could be performed.

Responsibilities

• Conducted user interviews at both in-house and client locations, gathering and analyzing requirements using Requisite Pro and Requisite Web

• Extensively used Agile Methodology in the process of the project management based on SDLC.

• Designed and developed Process Flow Diagram, Use Cases, Activity Diagrams, Sequence Diagrams, and Object Oriented Design (OOD) using UML and extensively used MS Visio.

• Gathered and documented Business Requirements, created Functional specifications and translated them into Software Requirement Specifications.

• Used gap analysis framework to identify AS-IS processes of claims transactions of HIPAA X12 4010/4010A standard and TO-BE processes (ICD-10-CM and ICD-10-PCS compliance requirements) of 5010 standard. Experience in EDI automated first-pass claim adjudication, requiring thorough understanding of claim processing, both front and backend operations.

• Performed Gap analysis by identifying existing technologies, documenting the enhancements to meet the end state requirements

• Developed test cases and test scripts and assisted Quality Assurance activities, with system integration testing and user acceptance testing (UAT), developing and maintaining quality procedures and ensuring that appropriate documentation is in place

• Responsible for identifying and documenting business rules and creating detailed Use Cases

• Participated in the process of internal and external auditing activities and developed timelines for project delivery, and managed projects and resources to successful completion

• Involved in data dictionary management, extraction, transformation and loading (ETL) of data from various sources. Participated in ETL requirements process during data transition from source systems to target systems

• Involved in Data Analysis & Mapping to track all data elements used in the application from the user interface through different interfaces to the target databases in which they are stored.

• Developed tables, Views, Stored Procedures and Triggers using SQL Scripting

• Established Inner Join, Outer Join and created Indexes whenever necessary

• Writing Complex SQL queries and optimizing SQL Queries

• Responsible to meet the information demands of our business users by delivering timely, accurate, meaningful and standardized data and reporting

• Participated in creating logical and physical data models, their enhancement. Based on the data models, worked with business architect, to create the software solution models.

• Helped in creating of Data-Mapping best practices document including visual processes and trained team members on Data Mapping process and tools

O.U Medical Center, OKC, OK (May 2007 – June 2008) Business Analyst

Project scope: Electronic Medical Record Management System

A Physician Support System was built to capture out patients clinical data using an Electronic Medical Record Management System. The purpose of this system was to have a Paperless Medical Record and instant retrieval of data by doctors. The patient’s medical record contains information such as physical examination and information specific to the medical discipline. The system also captures information about the patient’s appointments, medical summary and flow of medical activities of his/her throughout the clinic visits.

Responsibilities

• Gathered Business Requirements and managed them using Requisite Pro.

• Interacted with the Users, Designers and Developers, SMEs, Project Manager to get a better understanding of the Business Processes.

• Designed the project development plan based on Agile methodology of SDLC.

• Helped Project Manager in Project Management Documentation and got MS Project experience.

• Used Excel to create the Data Mapping documents which is used by the Development & Testing team. Worked very closely with the latter in order to make sure the correct Data Element is being passed from one system to another

• Responsible for creating UML modeling plans, Use cases, process flows, and business requirements documentation using MS Visio, RequisitePro and ClearCase tools.

• Analyzed and modeled the system using Data flow Diagrams, Functional Hierarchy Diagram, Process Development Diagram, CRUD (Create, Read, Update and Delete) Matrix

• Performed underwriting tasks and analyzed and optimized the online application for the insurance agents

• Experience with documenting Claims processing lifecycle and got good exposure of X12 837 transactions for HIPAA 4010.

• Used Query Analyzer to optimize SQL Queries.

• Maintaining SQL Script for creation of Database Objects.

• Responsible to meet the information demands of our business users by delivering timely, accurate, meaningful and standardized data and reporting.

• Developed tables, Views, Stored Procedures and Triggers using SQL Scripting.

• Established Inner Join, Outer Join and created Indexes whenever necessary.

• Used RUP iterative process to conduct Data Analysis on the client profile data to find missing data fields in the database and customize them

• Created Supplemental Specifications in RequisitePro and updated the RequisitePro Global Glossary.

• Systems Documentation included Business Requirements Document (BRD), Systems Requirement Specification (SRS) and test plans using RequisitePro. Worked as Liaison between users and technical team for BRD and SRS.

• Created AS-IS and TO-BE business process flow diagrams, integrated process flow diagrams to show one end-to-end business model and process mapping including swim lanes.

• Performed Data cleansing to detect and correct corrupt data. Responsible for creating and maintaining end-to-end Data Mapping and Data conversion spreadsheet

• Helped in creating of Data-Mapping best practices document including visual processes and trained team members on Data Mapping process and tools and got good exposure of RDBMS of different databases of the organization.

• Used Rational Clear Quest to maintain and track the requested enhancements and changes.

• Used Rational Clear Case to maintain different builds of the application with description about all changes and versions.

• Created Project management plans for managing on time delivery using MS Project along with writing test cases, test scripts and systems integration test and user acceptance test plans.

Hindustan Lever, India Aug ‘2004-Oct‘2006

Business Analyst

This project was aimed at creating a Hand Held (PDA) based sales automation process for the client. As a Business Analyst, my responsibilities included conducting user meetings, assisting the tech lead to develop the functional specification document, document the requirements gathered, help the users in UAT testing, provide user training.

Responsibilities

• Managed the Change requests for the client

• Communicated with the client to understand requirements and propose solutions for the concerns raised by client

• Prepared functional specifications

• Update of the project documents and ensure they are up to date.

• Was instrumental in successful integration of the customer’s complex pricing mechanism with the SFA solution

• Prepared the functional test cases and update the user manuals

• Performed User Acceptance Testing (UAT) for the customer releases

Merchandising Audit Solution:

• Identify the challenges faced by the Companies in execution of Trade Promotion plans

• Identify the GAPs in the current processes and conceptualized the Handheld based solution for the merchandising reps

• Prepared the business case and identified the Industry best practices.

• Solution was conceptualized to provide managers visibility into Promotions, Pricing and Location of the products.

• Prepared the Functional Specification for the development team

• Write Functional Test Cases and conduct User Acceptance Testing

• Prepared solution documents and presentations for the Demos and sales pitching

Handheld Based Stock Management Solution for Retail Stores:

• Identify the challenges faced by the Retail stores in stock management

• Understand and Document the As-Is processes followed in the stores using paper based system for stock management. Identify the gaps in the As-Is process

• Documented the To-Be process which results due to introduction of Handheld Solution

• Prepared the business case

• Prepared the Functional Specification for the development team

• Write Functional Test Cases and conduct User Acceptance Testing

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