Business Analyst Resume Example Sofi - Northridge, California

BUSINESS ANALYST

Summary

Qualified professional with over 6 years of extensive experience as a Business Analyst and System Analyst in the Healthcare Industry.

Strong understanding of project life cycle and SDLC methodologies including Waterfall and Agile.

EDI files successfully verified and processed into respective Database.

In-depth knowledge about HIPAA compliance, Medical plans such as HMO, PPO, POS, EPO, Medicare/Medicaid.

Successfully produced Business Requirement Document (BRD) and its approvals.

Knowledge of Sitecore use in web content management.

Strong skills in conducting JAD sessions UAT Test plans, scripts creation, co-ordination and execution.

Experience in Change Management Process (Identify, Analyze, Evaluate, Plan, Implement, Review and Close).

Experienced in preparing Business Process Re-Engineering Models.

Single point of contract to communicate Business and Technical requirements.

Tools and Methodologies

Tools: MS SQL Server, Rational Rose, MS-Excel, MS-PowerPoint, MS-Visio, Jira, MS-Office, Rational RequisitePro, Rational ClearQuest.

Methodologies: Agile-Scrum, Hybrid (Agile + Waterfall), RAD, Waterfall. Requisite Pro, Rational Rose, Agile, PL/SQL, HTML, MS Office, MS Visio, EDI, UML.

Experience

01/2015 to Current

Business AnalystSofi

LA Care Health plan is in the process of upgrading & enhancing the existing user interface and organization's web portal and internal claim & billing systems to improve performance, user interface and user experience.
Responsibilities:.
Conducted weekly meetings for deciding the Policies and Procedures to be followed while upgrading systems.
Performed the requirement analysis, impact analysis and documented the requirements.
Documented the requirements for billing system, cash management module and enhanced the encrypting standards that are required for the application.
Documented the current business flows for Utilization Management (UM), Case Management (CM) and Disease Management (DM).
Created and managed Business Requirement Document, Use Cases for the upgraded functionality.
Worked in mainframe environment and used SQL to query various reporting databases.
Analyzed system performance and initiated process improvement measures for mainframe and Web-based applications.
Followed a systematic approach to eliciting, organizing, and documenting requirements of the system.
Reviewed the Joint Requirement Documents (JRD) with the cross functional team to analyze the High Level Requirements.
Been a part of Architecture and modeling team and have used SOA (Service Oriented Architecture).
Interacted with client and the Technical Team for requirement gathering and translation of Business Requirement to Technical specifications.
Planned and documented procedures for data processing and prepared data flow diagrams for the application.
Analyzed and translated business requirements into system specifications utilizing UML methodology.
Interacted with line of business managers and coordinated the transition into the security database to ensure business compliance with HIPPA.
Collaborated with testing teams for running detailed UAT tests before roll out.
Documented the Traceability Matrix for tracing the Test Cases and requirements related to them.
Developed UML Use Cases using Rational Rose and developed a detailed project plan with emphasis on deliverables.
Designed and developed project document templates based on SDLC methodology.
Performed Unit Testing and User Acceptance testing and documented detailed results.
Provided input (scope, goals, risks, constraints, timelines and interfaces) to PM for project planning and control.
Environment: Windows 2000/XP, Microsoft Office SharePoint 2007, Rational Requisite Pro, MS Office, SQL Server, Agile, MS Project, MS FrontPage 2003, MS Access, EDI, Documentum 2.0, UML.

09/2014 to 12/2014

Business AnalystSofi － CA

Prime Healthcare Services is a holding company that owns and operates 43 hospitals in the United States.
The project was to develop an application for the hospitals to use as a central repository for storing reports from different departments of the hospital.
Major modules included Enrolment/Registration, Billing and Reports.
This System was being developed using HIPAA guidelines and regulations which keeps track of Healthcare transactions like Eligibility Request/Response, Request and Response for Claims Status, Prior Authorization, and Claim/Encounter.
Responsibilities:.
Gathered business, system, and functional requirements by conducting detailed interviews with business users, stakeholders, and Subject Matter Experts (SME's).
Conducted group (JAD) sessions with business units and stakeholders to define project scope and deliverables.
Validate the Business-to-Business data exchanges between data exchange partners; validate the internal processing of the MMIS, or other transaction processing system.
Provide technical support for the Minimum Data Set (MDS) and the Outcome and Assessment Information Set (OASIS) Systems to enable the electronic transmission for patient data for the purpose of payment and quality of care analyses for the Medicare and Medicaid Programs.
Responsible for creating use cases, system architecture document, supplemental requirements document, architecture diagrams; verifying technical production infrastructure; designing and executing performance tests; and documentation.
Worked on Medicare Advantage (A, B, C), Medicare Part D (MA-PD), Medicaid Options (Under 65 and Over 65) and Managed Care (Care, Disease and Case Management and also in Insurance regulations and Claims Processing and claim scrubbing in HMO, PPO, Medicare and Medicaid.
Assisted in loading managed care contract rates into managed care contracting information systems.
Also, worked with other departments to provide managed care information and identify improvement opportunities.
Also performed complete reconciliation of the Explanation of Payments (EOP) and check remittances as they received from Managed Care Contracts.
Entered Minimum Data Set (MDS) into computer database and transmitted them to the Medicare website.
Designed and maintained managed care contract databases to streamline collection, analysis, and dissemination of contract information.
Performed the requirement analysis, impact analysis and documented the requirements using Rational Requisite Pro.
Prepared client process maps for the consumer, broker, employer and provider transactions for the Facets process.
Developed and wrote test script walkthroughs with developers and Quality Analyst.
Set and continually managed project expectations with team members and stakeholders.
Analyzed and Documented Business Requirement Document (BRD), Functional Specification Documentation, and System Requirement Documentation, using UML methodologies.
Conducted meetings to understand the workflow, their processes and assisted in gap analysis to derive requirements for existing systems enhancements.
Environment: Windows 2000/XP, Microsoft Office SharePoint 2007, Rational Requisite Pro, MS Office, SQL Server, Agile, MS Project, MS FrontPage 2003, MS Access, EDI, 2.0, UML.

12/2010 to 09/2012

Business Systems AnalystHighmark Inc. － Claymont Ut

Uniprise Technologies is a part of Presbyterian Healthcare System, a Fortune 500 company and a leading player in the Health Insurance and services market.
UHCI specializes in Network based care co-ordination health care services for small groups, government and specialized groups and commercial employers.
The system streamlined patient registration, patient scheduling, medical insurance checking, claims processing, and reporting.
The purpose of this project involves population of the Enterprise Data Warehouse (EDW) which is used in critical reporting and analysis.
The data is pulled together from multiple, disparate systems.
I was also involved in certain modifications to the claims processing system.
Responsibilities:.
Gathered, analyzed, documented business and technical requirements from both formal and informal sessions and validated the needs of business stakeholders.
Conducted user interviews and documented business and functional requirements.
Performed Requirement Analysis and developed Use Cases, Activity Diagrams using Rational Rose.
Developed UML Use Cases using Rational Rose and developed a detailed project plan with emphasis on deliverables.
Defined, developed specs for federal reporting specific to Medicare Advantage.
Performed Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data.
Maintained on-going technical assistance and provided help desk support to customer's mainframe systems software that included problem determination and resolution.
Completed the documentation of Claims Scenario's for the source system.
Analyzed the existing claims process and specific business rule logic will be applied in the ACP model.
Documented Medicare claims processing.
Designed High level design, for New process, integrating with legacy and Facets.
Documented requirements, associated change requests with requirements and connected requirements with Use cases.
Environment: Windows XP Professional, Oracle9i, MS Access 2000, MS Excel, RUP, Oracle, UML, Rational Rose, Requisite Pro, Clear Case 2002, Rational Clear Quest 2002, MS Office suite, MS Visio 2003.

02/2007 to 10/2010

Business Analyst/Data AnalystAetna Health Services － Healdsburg , STATE

This project involved creating the medical claims processing system for Aetna.
It consisted of different modules like provider enrollment, member enrollment, programs and coverage.
This project also involved the maintenance of claims workstation that automatically handles the entire claims life cycle.
Responsibilities:.
Responsible for defining the scope and implementing business rules of the project, gathering business requirements and documentation.
Responsible for writing Functional Requirement Specifications (FRS) and User Requirement Specification (URS).
Analyzed Business Requirements and segregated them into high level and low level Use Cases, Activity Diagrams / State Chart Diagrams using Rational Rose according to UML methodology thus defining the Data Process Models.
Responsible for architecting integrated HIPAA, Medicare solutions, Facets.
Identify Member, Provider, Coverage, Medicare, and Medicaid.
Involved in gather requirement for claims processing system.
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.
Created Process Flow diagrams, Use Case Diagrams and Interaction Diagrams using Microsoft Visio and Rational Rose.
Wrote Test Cases and performed User Acceptance Testing, documented the in detail defects using the Defect Tracking report.
Used Test Case distribution and development reports to track the progress of test case planning, implementation and execution results.
Wrote PL/SQL statement and stored procedures in Oracle for extracting as well as writing data.
Created Use cases, activity report, logical components and deployment views to extract business process flows and workflows involved in the project.
Carried out defect tracking using Clear Quest.
Maintained proper communication with the developers ensuring that the modifications and requirements were addressed and also monitored these revisions.

Education

2011

MBA: Business Administration

2008

Business Administration

Skills

streamline, Agile, Analyst, approach, Billing, billing system, billing systems, business process, C, Case Management, cash management, Clear Case, Contracts, client, data processing, data modeling, Data Warehouse, databases, database, designing, Disease Management, Documentation, Documentum 2.0, EDI, MS FrontPage, Functional, government, help desk support, HTML, information systems, Insurance, logic, MA, mainframe, mainframe systems, market, meetings, MS Access, MS Access 2000, MS Excel, MS-Excel, exchange, Microsoft Office, MS Office, MS Office suite, MS-Office, MS-PowerPoint, MS Project, SharePoint, Microsoft Visio, Windows 2000, Windows XP, modeling, Enterprise, Network, Oracle9, Oracle, PL/SQL, organizing, Policies, Prime, processes, process improvement, progress, project planning, Quality, Quest, RAD, Rational Rose, reporting, Requirement, RUP, scheduling, Scrum, SDLC, script, Specification, MS SQL Server, SQL, SQL Server, system architecture, technical support, technical assistance, transaction processing, translation, transmission, UML, upgrading, user interface, Visio, web portal, website, workflow

Resume Overview

Job Titles Held:

Business Analyst
Business Systems Analyst
Business Analyst/Data Analyst

Degrees

MBA : Business Administration
Business Administration

Business Analyst Resume Example

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