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healthcare business analyst resume example with 11+ years of experience

Jessica
Claire
resumesample@example.com
(555) 432-1000,
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Summary

Experienced Business Analyst with 5+ years in Finance/Healthcare domains and an in-depth understanding of the business process models underlying these domains. Certified Scrum Master - Feb 2020.

  • Hands on experience in gathering Business Requirements, Data Modeling, Evaluating Data Sources, Translating Requirements into Specifications and Application Design.
  • Extensive knowledge on commercial loans, cards, mortgage loan life-cycle, lending origination, under writing, loan delivery, and loan servicing.
  • Strong knowledge in Business Analysis, Software Development Life Cycle, System Analysis, Design, Development, Testing, and Implementation on Business Systems.
  • Extremely proficient in using Agile and RUP methodologies following sprint sessions and used Rally software extensively to write User Stories and assign tasks to individual team members.
  • Worked on various sectors - Full life-cycle implementation, Design, Development, Documentation, Initiation, Transition, Configuration, Testing (Manual and Automation test), Support, Data Migration, Merging Project, Acquisition project, Divesture project, Marketing Mix Modeling, Conjoint Analysis, Data Analysis using SPSS, etc.
  • Experience in performing Gap analysis (GAP), Feasibility and SWOT Analysis by identifying existing technologies and documenting the enhancements to meet the end-state requirements.
  • Strong experience in creating design documents like data flow diagrams, process flow charts, use case diagrams, activity flows and sequential diagrams using MS Visio and UML.
  • Strong communication, business understanding, critical thinking, and analytical skills. Highly motivated, organized, and target oriented team player who enjoys working with multi-functional team towards a common goal.
Skills & Tools
  • Forecasting and planning
  • Requirements gathering
  • Budgeting
  • Team Management
  • Project Planning
  • Scheduling
  • MS Office
  • JIRA
  • Rally
  • Confluence
  • Microsoft Project
  • BitBucket
  • Service Now
  • MS Visio
  • UML
  • Lotus Notes
  • HPQC
  • Rational Rose
  • Toad
  • Cognos
  • Crystal Reports
Education and Training
Guru Jambheshwar University of Science & Technolog India, Expected in 10/2010 MBA : Human Resource Management - GPA :
Delhi University India, Expected in 08/2008 Bachelor of Commerce : - GPA :
Certifications

Certified Scrum Master - Feb 2020

Experience
Cgi Group Inc. - Healthcare Business Analyst
Livonia, MI, 11/2018 - Current

Project: The Medi Pharma online service was designed to deliver refill medication to follow-up on disabled and elderly patients at their homes without the necessity to visit the physician.

  • Involved in implementing HIPAA EDI transactions (837 P/I/D, 835) in the application.
  • Also involved in modules: pre-pricing claims, claims adjudication, claims payment, coordination of benefits (COB), and adjustments

Responsibilities:

  • Conducted Joint Application Development (JAD) process with Stakeholders to analyze deliverables and system constraints.
  • Utilized corporation and developed Agile SDLC methodology.
  • Used Scrum Work Pro and Microsoft Office Software to perform required job functions.
  • Worked on transaction-835 claims payments and remittance advice which deals with the payment from payer to provider.
  • Interacted with Claims, Payments, and Enrollment hence analyzing and documenting related business processes.
  • Collaborated with CMS program and technical staff to review proposed program definition/ruling and provided recommendations to program design and high-level risks and/or impacts.
  • Involved in the overall program management of the Health Care Financing Administration (HCFA/CMS).
  • Analyzing Medicaid claim data and financial data as well as reviewing applications for completeness to process applicants for Federal Medicaid Program.
  • Defined the test criteria, project schedules, and base lined the Test Plan with the help of project meetings and walkthroughs.
  • Performed extensive Regression testing on Claims supported simulated system.
  • Analyzed the existing claims process and specific business rule logic to be applied in the requirement model.
  • Conducted UAT to confirm that all derivative products can be successfully processed through stages of the trade life cycle.
  • 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.
  • Prepared Test cases (using test data available from CMS test document) during Design phase with presence of QA team and implemented plan for integration and functional testing.
  • Assisted with user testing of systems and maintained quality procedures and ensured appropriate documentation is in place.
  • Integrated Requisite Pro with Rational Rose to provide all teams visibility and maintain tractability among requirements, use cases, and change requests.

Environment: SQL Server, Windows 7, Rational Rose, Rational Requisite Pro, Clear Case, Clear Quest, UML, Rational Suite, MS Visio, MS Project, MS Office (MS Word, MS Excel, MS PowerPoint), MS Access, and XML.

Avalon Healthcare Solutions - Business Analyst
Tampa, FL, 06/2016 - 11/2018
  • The project aimed at fixing the Medicaid/Medicare membership to synchronize with State and Vendor.
  • It also included adding some error prompts to adjudication system and automating reports.
  • Also, another project undertaken for the same client was the implementation of HIPAA 5010 and migration of ICD 9 to ICD 10.

Responsibilities:.

  • Gathered requirements by coordinating with external vendor and internal team.
  • Analyzed Gap Analysis of the HIPAA 4010 and HIPAA 5010 processes to identify and validate requirements.
  • Coordinated JAD sessions with all the stakeholders to understand the impact of HIPAA 5010 on the existing system.
  • Gathered requirements for "Front End" and for "Core Adjudication System" by conducting meetings and brainstorming sessions with end users and Subject Matter Experts (SMEs) and documented them using Requirement Traceability Matrix and later exporting them to HP Quality Center.
  • 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.
  • Gathered requirements for ICD 10 transition.
  • Organized requirements into High level Use Cases and Low level Use Case Specifications and modeled them into UC, Activity, and Sequence Diagrams using MS Visio.
  • Assisted the QA personnel in the creation of Test Cases using HP Quality Center.
  • Defined and analyzed test cases, test scripts, bugs, interacted with QA/ development teams in fixing errors and conducted User Acceptance Test (UAT).
  • Coordinated and prioritized outstanding defects and enhancement/system requests based on business requirements, allowing sufficient time frame to ensure accuracy and consider deadlines.
  • Streamlined Claims (837 EDI X12) Migration project by gathering functional specifications in Edifecs.
  • Tracked the change requests.
  • Maintained and tracked the project plan using MS Project.
  • Daily and weekly status reporting to senior management.
Amerisourcebergen Corporation - Corporate - Healthcare Business System Analyst
Edison, NJ, 02/2015 - 05/2016

The project I worked on was for the large group sales setup that deals with the enrollment for groups containing 51+ (Large Group - LG) employees.

  • Analyzing various health care reforms and changes had a major effect on the project, which was a part of my responsibility.
  • Formatting and creating various Standard operating procedures and Data flows (Using MS Visio) adaptable to the changes that came along Heath Care reforms.
  • Responsibilities:.
  • Developed HIPAA EDI Transmissions.
  • Work included completing business cycle management and hands-on production as well.
  • Create EDI Testing process, documentation, and performance matrices.
  • Involved extensively in TriZetto Facets System implementation, Claims and Benefits configuration set-up testing, Inbound/Outbound Interfaces and Extensions, Load and extraction programs involving HIPAA 837 and proprietary format files, and Reports development.
  • Analyzed medical and claim data from various EMR/EHR, PDS (Practical Data Solutions) and PMS (practice management software) systems.
  • Worked to configure following EDI transaction 277, 837I, P &D, 834.
  • Designed and documented new EMR functionality and associated work/data flows.
  • Worked with HIPAA EDI transaction sets 837, 835, 834, 820, 270, 271, 276, 277, 278, EMR and HER.
  • Adjudicated medical claims for correct pricing to administer payment to medical providers.
  • Identified gaps between standard FACETS functions and client specific requirements to write requirements for FACETS extensions.
  • Implemented Healthcare system including enterprise Electronic Medical Records (EMR) software.
  • Worked in Facets online modules such as Billing, Provider, Claims, and Membership modules.
  • Ensured all the staff and the EMR are compliant to HIPAA regulatory and compliance requirements.
  • Validated various applications with Memberships of Enrollment, Cancellation, Termination, Reinstatement etc.
  • For commercial, Medical and Billing in Facets.
  • Performed Gap Analysis and created test plans for clients for conversion from data collection to EMR solution.
  • Set up appropriate network servers, tablets, printers, EDI, and PC's which are used to run and support selected EMR.
  • Validated the HIPAA/EDI transactions, tested the claims processing and Adjudication (EDI 837 & EDI 835).
  • Gathered requirements by conducting meetings and brainstorming sessions with end users and SME and documented them using Requisite Pro - the documentation tool offered by Rational.
  • Used MS Access, MS Excel (Pivot tables), and SQL for data analysis and data validation.
  • Undertook back-end testing using SQL and wrote queries.
Cenveo Publisher Services - Associate Project Manager
City, STATE, 01/2011 - 02/2014
  • Assessed projects to determine project specification compliance, as well as conformance to company's high-quality standards.
  • Interacted with business executives to identify requirements and created project plan to help meet objectives.
  • Served as a liaison between stakeholders and coordinated activities with support departments.
  • Developed and monitored project schedule and tracked the progress to ensure that timelines are met.
  • Maintained regular production status reports and communication with the stakeholders.
  • Utilized talents in project management, organization, and time management to successfully manage simultaneous tasks and stakeholders.
  • Resolved conflicts between stakeholders.
  • Developed team communications and information for daily status meetings.
  • Worked with customers to understand requirements and provide exceptional service.
  • Escalated identified risk issues, challenges, and trends to senior management.
    Worked closely with team members to deliver project requirements, develop solutions, and meet deadlines.

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Resume Overview

School Attended

  • Guru Jambheshwar University of Science & Technolog
  • Delhi University

Job Titles Held:

  • Healthcare Business Analyst
  • Business Analyst
  • Healthcare Business System Analyst
  • Associate Project Manager

Degrees

  • MBA
  • Bachelor of Commerce

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