Business Data Analyst resume example

• CNA Insurance with more than 40 years of experience in the healthcare industry, CNA is a trusted leader and one of the top five underwriters of healthcare insurance products and services for a wide spectrum of organizations. We offer extensive industry knowledge; valuable insight and core coverage’s tailored to meet the unique needs of healthcare providers. Involved in Claims Processing System, this project consisted of providing various reports to the management to track how many claims are we processing and what are the efforts being done to contain claims cost.

Responsibilities

• Propose strategies to implement HIPAA 4010 in the new MMIS system & eventually move to HIPAA 5010.
• Documented business requirements, and communicated these requirements with the development team for design and implementation of business solutions.
• Worked with Business Analysis team to prepare a detailed Business Requirement Document.
• Analyzed Business Requirements to develop Functional and detail Design Specifications of the application.
• Conducted Requirement Gathering Sessions with the stakeholders.
• Interacted with the project team to help define the Business and System Objectives, confirmation of scope, identify constraints and the measures of success for the system to be developed.
• Conducted the JAD sessions, daily meetings, brainstorming sessions to solve the problems and enhance the workflow.
• Documented, organized and tracked the requirements using Rational RequisitePro.
• Documented the detailed business as well as technical requirements to upgrade the current system to 5010 transactions.
• Involved in designing future state processes for HIPAA 5010 transaction processing EDI’s 837,835, 270, and 271.
• Perform Gap Analysis of the processes to identify and validate requirements.
• Performed GAP analysis to identify AS-IS a process EDI transaction set 834,837 and 835 of 4010A and TO-BE processes of 5010 standards and based on that developed Business Requirement Documents.
• Used the DataStage Designer to develop processes for extracting, cleansing, transforms, integrating and loading data into data warehouse database.
• Involved in the claims adjudication process of Facets.
• Worked on Facets extensions mapping attributes.
• Responsible for architecting integrated HIPAA, Medicare solutions, Facets.
• Responsible for integrating with Facets.
• Designing test scripts for testing of Claims in Development, Integration and production environment.
• Worked with Source System Subject Matter Experts (SMEs) to ensure that the extracts are properly mapped.
• Used SQL for data mapping and querying.
• Tracked and maintained Stakeholder requested enhancements and changes using Requirement Traceability Matrix (RTM).
• Incorporated Rational Unified Process (RUP) and analyzed User Business Requirement Document (BRD), Technical Requirement Specification and Functional Requirement Specification (FRS) using Requisite Pro, Rational Rose and MS Visio.
• Completed a review of existing documentation for orders, referrals and reports and compared it to the clinical details needed for HIPPA 5010.
• Worked with technical experts to prepare test case scenarios for unit testing, integration testing, user acceptance testing and compliance testing.
• Streamlined the Restatement Financial Data Warehouse access review Process.
• Assisted in building a Business analysis process model using Rational Rose and Visio.
• Did Technical documentation for the project using tools like Visio, Word, etc.
• Used MS Project for managing schedules, resources and collaboration.

Technical Environment: Microsoft Office ( MS Word, MS Excel, MS PowerPoint, MS Visio, MS Access),RUP, MS Project, Visio, Oracle, Rational Rose, UML, MS Project, FileHandler Enterprise

• Molina Healthcare has grown into one of the leaders in providing quality healthcare for financially vulnerable individuals and families. Currently, Molina Healthcare arranges for the delivery of healthcare services or offers health information management solutions for nearly 4.3 million individuals and families who receive their care through Medicaid, Medicare and other government funded programs in 16 states. The focus of the project was the replacement of 22-year-old Medicaid Management Information System (MMIS).

Responsibilities

• Coordinated with the stakeholders and project key personnel to gather functional and non-functional requirements during JAD sessions.
• Studied the existing business process and created AS-IS workflow to illustrate the existing system.
• Recorded requirements in the Requirement Traceability Matrix (RTM) defining each technical requirement in detail from areas like: main hardware, application software, networks, servers, internet and desktop configuration.
• Experience with AGILE Tool and methodology.
• Responsible for the full HIPAA compliance lifecycle from gap analysis, mapping, implementation and testing for Medicaid Claims.
• Responsible for gap analysis in changing old MMIS and Involved in testing new MMIS.
• Also, accountable for Medicaid Claims Resolution/Reimbursement for peach state health plan using MMIS.
• Involved in HIPAA EDI transactions such as 270, 271,837 (P, D, I), 276, 277, 834, 820, 278,999/TA1, and 277 CA.
• Involved with System Tester for Facets Billing and Finance.
• Defined Functional Test Cases, documented, Executed test script in Facets system.
• Drafted the Physical Data Mapping document for the data flow from Facets to the data warehouse.
• Performed extensive data modelling to differentiate between the OLTP and Data Warehouse data models.
• Identify opportunities for the creation of algorithms and data models to detect incorrect or fraudulent Medicaid billings.
• Manage EDI for business partners world-wide and was Responsible for new trading partner implementation including mapping and testing of various EDI transactions in ASCI-X12 and EDIFACT standards, to/from various internal processes and platforms.
• Facilitate the process for requirements validation that follows the MITA process/sub F process business model.
• Analyzed HIPAA 4010 and 5010 standards for 837P EDI X12 transactions, related to providers, payers, subscribers and other related entities.
• Worked on 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.
• Worked closely with business team, and identified, analyzed the core requirements and key features of the ongoing project.
• Extracted, discussed, and refined business requirements and developed comprehensive business requirement document (BRD).
• Developed Software Requirement Specification (SRS) document using Visio and MS Office.
• Worked into Healthcare claims process, EDI transactions, EMR (Electronic Medical Records), DSM (Direct Source Messaging) HIPAA (Health Insurance Portability Accountability Act), EOB, ANSI 837 UB92, 5010, HIX.
• Responsible for creating business work flows and processes and creating management reports based on the analysis.
• Experience in Rational Rose & HPALM/Quality Centre.
• Followed the UML based methods using Rational rose to create Use Cases, Activity Diagram, Sequence Diagram, Collaboration Diagram that include Functional and Non-Functional specifications to hand off to development teams.
• Actively involved in updating internal processes (submit claims, check eligibility), updating data collection and data reporting.
• Defects and bug testing by using Rational Clear-Quest, Configuration management and Version control with Clear-Case.

Technical Environment: Microsoft Office (MS Word, MS Excel, MS PowerPoint, MS Visio, MS Access), MS Project, NSI X12- EDI UML, Rational Requisite Pro, MS Word, Visio, SQL, MS Excel.

• Universal Health Care is a Medicare/Medicaid health insurance provider based in St. Petersburg, Florida. It provides managed care services for government sponsored health care programs, focusing on Medicare and Medicaid. It offers a variety of health insurance products to our Members, including Medicare Advantage plans in 13 States, Medicaid in the State of Florida, and a Long-Term Community Diversion program in Florida (designed to enable seniors to live a healthy and comfortable life in their homes).

Responsibilities

• Implemented an integrated RUP solution with complete line of traceability for all the artifacts of web development projects.
• Responsible for designing future state processes for HIPAA 5010 transaction processing EDI’s 837 and 835.
• Analyzed HIPAA 5010 related to 837,835, 834.
• Transactions and performed gap analysis between HIPAA 4010 and 5010.
• KnowledgeofICD-9-CM and ICD -10-CM coding and claims processing.
• Involved in the creation and maintenance of the Workflow plans and artifacts.
• Prepared Business Process Models that includes modeling of all the activities of the business from the conceptual to procedural level.
• Followed top down, leveled technique for building Business Process Models.
• Experience with AGILE Tool and methodology.
• Serve as subject matter expert with respect to the annual benefit changes and rules associated with the Medicare Part D program.
• Documented Requirement Traceability Matrix(RTM) for requirement elicitation and linkup to deliverables.
• Worked with the individual sub-project managers to translate these into PRDs (Product Requirement Documents) for the development teams.
• Examined, analyzed and model Test plans, Use Case Model cases & Test procedures based on RUP methodology.
• Used Rational Rose to visually determine the proper structure, key elements and optimal design for Database and to aid efficient creation of tables, stored procedures.
• Evaluated the information gathered from multiple sources during requirement gathering and analysis and responsible for tracking, tracing and managing requirements using Rational Requisite.
• Used MS Project for various planning and budgeting activities.
• Wrote clear, concise detailed System Requirements Specification(SRS)documents and user documentation in accordance to guidelines and standards of a level where developers can interpret, design and develop the application with minimum guidance.

Technical Environment: Microsoft Office (MS Word, MS Excel, MS PowerPoint, MS Visio, MS Access),Rational Requisite, RUP, Oracle, SQL