Proactive, Analytical and Motivated Business Analyst with over 6 years of experience in Healthcare. Efficient, committed and detailed individual who has a multitude of experience in designing, developing and implementing innovative business process and system solutions within the healthcare domain. Experienced self-starter who works as a independent contributor or cross-functional team member in fast-paced, deadline-driven environments. Seeking a Business Analyst position as a Healthcare Analyst from a reputable and innovative firm.
Critical Thinking * Problem Solving * Data Analysis * GAP Analysis
Regulatory Compliance Programs * Government Sponsored Programs (Medicare, Medicaid.) * Care Management & Transition
Requirements Gathering * Business Writing * Process Modeling
Workflow Analysis * Sequence Diagrams * Test Cases /Use Cases * Cube Processing * OLAP and OLTP Databases
GAP Analysis * Data Analysis Methods * Data Warehousing Structures
SDLC * Agile * Healthcare Systems (ITS, QNXT) * EDI transactions 837, 834, 835, 270/271
ICD9/ICD10 * UAT (User Acceptance Testing)
HIPPA 4010 * HIPPA 5010 * EDI X12 * HL7 * MAC * UML
MS Office * MS Access * MS Visio * Rational Clear Case * Rational Rose
SQL Server Object Explorer Version 11 * HP Quality Center * JIRA * Ralley * Oracle
Microsoft Visual Studio 2012 * Balsamic
Company NameNovember 2014 to CurrentBusiness Analyst
BCBSM HIPPA EDI Project focused on the HIPPA 4010 to 5010 conversion.
Enhanced existing EDI transactions in accordance with HIPPA Transitions; project also involved the ICD 9 to ICD transition using Agile Methodology.
Partook in the initial impact analysis for all critical EDI functions, including, memberships, enrollments and claims.
Conducted JAD Sessions while identifying functional requirements and business rules when working on the HIPPA 4010 to 5010 transitions.
Coordinated with Business Owners, Applications Vendors, Business Project Teams and Clearinghouses to execute processes and mitigate impact to current revenue flow under 5010 compliance requirements.
Created Test Cases in order to provide GAP Analysis for the HIPPA 4010 to 5010 transitions.
Managed software system development and integration projects through all phases of project life cycle - analysis, design, development, testing, implementation, and post-production support.
Involved profoundly in the GAP Analysis of the transition from HIPAA 4010 to 5010 focusing on how As Is system was going to be effected by the 5010 compliance Developed a crosswalk for understanding major changes from ICD-9 to ICD-10.
Drafted the major changes that would be essential for the development of the new system Diligently worked on ETL mappings, as well as Analysis and documentation of OLAP reports.
November 2012 to November 2014Aetna
Company NameJanuary 2010 to September 2012Business Analyst
Aetna is one of the nation's leading diversified health care benefits companies.
Aetna is providing Medicaid & Children's Health Insurance Program (CHIP) services to eligible populations in the Tarrant and Bexar Service Areas.
Medicaid and CHIP's free and low-cost programs allow families to access immunizations, prenatal visits, checkups, emergency care and more, without worrying about how to pay for them.
This application was built for processing claim with complete benefit administration, claim rules setup and some features relating to reporting.
This is a web-based application that offers health-benefits, and claims information for providers, members, and employers.
The application is integrated according to the rules and regulation of HIPAA.
Converted Business Requirements into Functional Specifications and Technical Specifications using Rational RequisistePro.
Conducted JAD Sessions to develop an architectural solution that the application meets the business requirements, resolve open issues, and change requests Gathered and documented the requirements that were critical to the business and used those requirements to design Use cases in Rational Rose.
Worked with IT teams regarding EDI transaction such as X12 835/837, X12 270, X12 271, X12 275 codes and many more for claims processing.
Gathered health plan and dependent business requirements so that members can access personal information, claim histories and enroll for coverage in QNXT.
Developed Project Status metrics for weekly evaluation of Project Status and impact of the Change Request on the Time line.
Conducted technical/non-technical presentations to the management and training workshops for the clients.
BACHELOR OF SCIENCEFINANCE AND MANAGEMENT:
Rutgers University-Rutgers Business School * New Brunswick-Newark, NJ
Agile, automate, benefits, Business Writing, conversion, Critical Thinking, clients, Data Analysis, Databases, Data Warehousing, documentation, EDI, emergency care, ETL, features, FINANCE, Functional, Government, HP, ICD10, ICD-10, ICD-9, IDs, immunizations, Insurance, Explorer, Regulatory Compliance, logic, MAC, marketing, access, MS Access, MS Office, OLAP, Oracle, presentations, Problem Solving, processes, Process Modeling, Quality, Rational Rose, reporting, Requirement, Requirements Gathering, RUP, SDLC, scripts, software system development, SQL Server, UML, upgrading, Visio, Microsoft Visual Studio, Workflow Analysis, workflow, workshops
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