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Click here or scroll down to respond to this candidateCandidate's Name , CSMEMAIL AVAILABLEPHONE NUMBER AVAILABLESUMMARY: 7+ years of experience as Sr. Business Analyst/Business Systems Analyst within business requirements modeling and development of Web Based, and Client/Server applications extensively in Healthcare and Pharmaceutical domain. Experience using Agile (SCRUM & KANBAN) and Waterfall SDLC methodologies. Proficient in gathering and converting User Requirements into Business Requirements and Functional Requirement Specifications (FRS) and using Modeling tools like Microsoft Visio and Lucidchart for requirements modeling and process flows. Strong experience in using MS Azure Dev Ops (ADO) for creating user stories, keeping track of project backlog and project sprints. Sound knowledge of API integration, API functionally and API build. Hands-on experience in Salesforce, using Salesforce as data HUB, manipulating Salesforce to match client business, generating reports and process different implementations. Strong expertise in the field of project management, IT Strategic development, planning and execution, Business Process Management & re-engineering, business analysis, delivery expertise, high-performance team building, product development and performance/quality assurance. Excellent Business writing skills in writing BRD, FRDs USE Case Specifications, Functional Specifications Design (FSD), Systems Requirements Specification (SRS). Extensively used JIRA to gather and document Integration requirements and maintained backlogs. Thorough knowledge in writing User stories, creating UML Modeling, Use Cases, State Chart Diagram, Deployment Diagram, Class Diagram, and Component Diagram. Hands on experience in creating software mock on Figma platform for client walk through. Strong expertise in writing technical logic, technical requirements, understanding and being able to read code and HTSQL queries. Sound understanding of Gap Analysis, requirement management, risk analysis and project plans. Adept at creating Use Case Diagrams, Activity Diagrams, Business Process Models, Workflow Diagrams, Data Flow Diagrams, Flow Diagrams (Business and Navigation), Sequence Diagrams, Process Flows (Business and System) using Unified Modelling Language (UML) and UML modeling tools such as TIBCO, Rational Rose, Lucidchart and MS Visio. Experienced in performing User Acceptance Testing (UAT) to ensure that the product meets client expectation.TECHNICAL SKILLS:Business Skills Business Process Analysis & Design, Requirement Gathering, Use Case Modeling, JAD Sessions, Gap Analysis and Impact Analysis. Methodology Agile, Scrum Agile and Waterfall.ManagementToolsSalesforce, ADO, JIRA, MS Visio, MS Project, Figma Database Dev Ops, Oracle, DB2, Python, SQL, MS SQL Server, HTSQL, Google Spyglass Candidate's Name , CSMEMAIL AVAILABLEPHONE NUMBER AVAILABLEBI/ETL Tools Salesforce, Tableau, Crystal Reports, Cognos, ETL Office tools MS Office (Word, Excel, Power Point, Outlook, Note), MS Visio, MS Project, MS Teams, Adobe AcrobatPROFESSIONAL EXPERIENCE:AssistRx, FLOct 2022- PresentSr. Business System AnalystAssistRx is an organization known for providing technological solutions and online platforms to provide pharmaceutical help for different participants, such as, patients, prescribers, pharmacies and pharmaceutical manufacturers.Responsibilities: Working as a client faced Business Analyst to understand the client's ask and business and transform them into business requirements. Successfully downstreamed the business scope to the technical team with continued assistance and guidelines to build working products that meets clients expectations. Using Salesforce as a platform to process enrollment, benefit investigation, triage to pharmacy, generate reports. Manipulate Salesforce to match and meet the different expectations of each client. Using Figma tool to create mockups and prototypes for the clients to help them understand what the working product will look and function like. Creating data mapping document, data migration document and data matrix document to assist the developer to create working logic. Also working with a Data Analyst to prepare a data transfer agreement to provide it to the client. Preparing and presenting intricate workflow diagrams, process diagrams, system diagrams for clients to understand the process of deliverables. Providing assistance to the Project Manager and Project Coordinator in resource allocation, effort estimation and deadline projection. Run daily stand ups in absence of Scrum Master. Creating an Implementation guide to provide the client to have firm requirements in place and get the client's sign off. Conducting research on new change requests and creating impact analysis document to maintain a smooth operational change/ implementation change/ logic change. Creating, maintaining and keeping track of user stories and developments using Jira. Managing communication with internal and external stakeholders (kick off meetings, regular status meetings, emails, progress reports, brainstorming sessions, etc.). Candidate's Name , CSMEMAIL AVAILABLEPHONE NUMBER AVAILABLEIQVIA, NCAug 2021- Aug 2022Business System AnalystIQVIA is a well known organization for providing technological solutions and data innovation ideas to its clients in the healthcare domain. I had the opportunity to be involved in three different projects as a lead Business System Analyst where the clients were NFL (National Football League), NBA (National Basketball Association) and ABNS (American Board of Neurological Surgery). For NFL and NBA, IQVIA created their COVID platform to run different COVID operations smoothly. For ABNS, IQVIA built their POST platform for the neurosurgeons to have a one stop shop to get their certification. Responsibilities: Closely worked with the Client, SMEs and stakeholders to determine what would be in-scope and what would remain as out of scope for the project Successfully downstreamed the business scope to the technical team with continued assistance and guidelines to build working products Gathered business rules and business requirements and transferred them into technical requirements Created mockup and prototype for the client to help them understand what the working product look and function like Created data mapping document, data migration document and data matrix document to assist the developer to create working logic Prepared and presented intricate workflow diagrams, process diagrams, system diagrams for clients to understand the process of deliverables Provided assistance to the Project Manager and Project Coordinator in resource allocation, effort estimation and deadline projection Helped the team not only in building a successful product but also updating and maintaining it according to the change request made by the clients Conducted research on new change request and created impact analysis document to maintain a smooth operational change/ implementation change/ logic change Created, maintained and kept track of user stories and developments using Jira. Managed communication with internal and external stakeholders (kick off meetings, regular status meetings, emails, progress reports, brainstorming sessions, etc.) Extensively used SQL, HTSQL scripts/queries for data verification and data quality check at the backend.Candidate's Name , CSMEMAIL AVAILABLEPHONE NUMBER AVAILABLEWellmark, IAFeb 2021- July 2021Business System AnalystWellmark wanted to leverage inherent Facets capabilities to uniquely identify products and benefits, create efficiencies in product/benefits configuration, reduce complexities in process and support better management of products. Outcomes include the ability to compare products over the years, the ability to pre-built and configure products, optimized member enrollment, benefit configuration and billing process, and administrative savings through reduced product and member maintenance and manual claims processing.Responsibilities: Closely worked with the Business team, SMEs and stakeholders to determine what would remain as out of scope for the project. Acquired strong knowledge on organizations DTA (Dual Track Agile) approach to manage projects which further projected in every step of the project. Facilitated meetings with the Data Governance team and Solution architect to provide future logic to improve Facets. Closely worked with the Business Vendors of Wellmark on the proposed solution and negotiations. Gathered and documented business requirements including business processes as well as business rules. Closely analyzed data flow, data mapping and S2Ts documents to understand the organization current data logic and to identify and outline future logic Created and assigned S2T tasks, Tech Specs tasks, Dev tasks for different team members and assigned them as well as kept track of the progress by monitoring sprint backlog and sprint planning. Managed on-shore and off-shore developer team by assigning tasks, maintaining communication, providing necessary documents to complete development tasks, allocating and distributing tasks for sprints. Managed communication with internal and external stakeholders (kick off meetings, regular status meetings, emails, progress reports, brainstorming sessions, etc.). Baseline project plans using MS Project and ADO; Monitor progress against plans and report to stakeholders for corrective action. Conducting business validations, coveting the following deliverables: Facets Providers, Facets Enrollment and Facets Membership and Operational reports. Prepared Business Workflow models and process diagrams depicting how business processes are accomplished. Created Activity Diagram, detailed Data Flow Diagrams, Use Cases, and business process flowcharts for the As-Is and To-Be process. Extensively used SQL scripts/queries for data verification at the backend. Developed test cases and test scripts and assisted Quality Assurance activities including executing and validating the test cases, with System Integration Testing and User Acceptance Testing (UAT), developing and maintaining quality procedures and ensuring that appropriate documentation is in place.Candidate's Name , CSMEMAIL AVAILABLEPHONE NUMBER AVAILABLEBlue Shield of California, CAMar 2019 Dec 2020Sr. Business System AnalystBlue Shield contracted with the Medicare Advantage Plan to provide quick, easy, and affordable access to the health care service and additional benefits like dental, vision and hearing care of their choice. Project involved integrating Market Prominence, Member enrollment, claims processing system, and Billing system with the data warehouse to support the reporting requirements. I was also extensively involved in another project for Interactive Care Reviewer where a web based application is developed to consume services for utilization management.Responsibilities: Gathered and documented business requirements including business processes as well as business rules. Baseline project plans using MS Project; Monitor progress against plans and report to stakeholders for corrective action. Maintain charge codes; validate appropriate charge code use by team members. Analyzed data to generate information about clients and their attributes and drafted a data requirements document. Analyzing the FACETS requirement and thus conducting gap analysis. Managing and Billing Medicare, Medicaid, claims on a daily basis. Conducting business validations, coveting the following deliverables: Facets Providers, Facets Claims adjudication and Facets Membership and Operational reports. Analyzed the mainframe Reports for Member/Eligibility/Claims/Billing and mapped the fields with Facets batch jobs and reports. Documented complex Business requirements and made process flow diagrams for the 834, 837, 270/271, 276/277 & 835 Remittance transactions as per the implementation for the Medicaid claim processing system enhancement. Business requirements for 834 Enrollment from Federal and State Exchanges. Prepared Business Workflow models and process diagrams depicting how business processes are accomplished. Worked on claim processing module which involved Receipt and Verification of Claim Forms (837) and Claims Adjudication, Health Claim Payment/Advice (835) as per HIPAA guidelines. Coordinated with EDI team, developers and production support team at various stages of the project. Worked with 834 (enrollment), 835 (medical claims payments), 837 (medical claims), 270(eligibility inquiry), 271 (eligibility response), 276 (claim status), and 277 (claim status response). Worked on EDI X12 transactions, HIPAA standard transaction codes including 837, 835, 270, 271, 276, 277 and performed analysis and testing of such transactions. Used SQL, Data Warehousing and Data Cleansing for the arrangement of customer data. Used Data mapping for collecting the data. Checked the data flow through the front end to backend and used SQL queries, to extract the data from the database.Candidate's Name , CSMEMAIL AVAILABLEPHONE NUMBER AVAILABLEAffinity Health Plan, NYFeb 2018- Jan 2019System AnalystAffinity Health Plan is an independent, non-profit managed care plan that serves the needs of over 210,000 residents of the New York Area and provides healthcare coverage through its family health plus Medicare & Medicaid programs.Responsibilities: Assisted the project manager in the creation of the project charter & vision document during the inception phase of the project. Led the technical writing effort and produced documentation including white papers, design specifications, system manuals and online help for technical, business and consumer audiences. Performed GAP analysis as pertains to membership management and claims processing to evaluate the adaptability of the new application with the existing process. Coordinated with the developers and IT architects to design the interface of the new system according to the X12 (270, 276, 278, 834, 837 (I, P, D) and 835) standards. Worked on the EDI 834-file load to Facets through MMS (Membership maintenance sub-system). Performed Requirement Gathering by interacting with Business users and documented the requirements. Created detailed use cases, use case diagrams, and activity diagrams using MS Visio. Created various database objects like views, tables, and procedures to extract data and support the end user reporting data warehouse requirements. Performed data mapping and tracing data from system to system in order to solve a given business or system problem. Tested web services by generating XML SOAPUI Requests and validated the corresponding XML SOAPUI Responses. Conducted requirement feasibility analysis with the developers to ensure the project was in scope with the timeline defined in the project plan. Clarified to claims personnel the new Affinity payments and Explanation for payments (EOPs) for the same claim processing cycle. Executed SQL queries to test the database for records that detect and submit functional acknowledgement and remittance advice in the claims application. Conducted user training pertaining to old and new Affinity Provider ID appearing on documents providers receive from Affinity (mainly occur with EOPs, capitation rosters, PCP membership rosters, provider directory listings and some system generated letters). Candidate's Name , CSMEMAIL AVAILABLEPHONE NUMBER AVAILABLEUnitedHealth Group, CTJune 2016 Dec 2017Business AnalystThe scope of the project was to implement FACETS, a claims processing and management application to manage health insurance claims electronically. Through integration with FACETS, the Workflow application enables seamless, real-time delivery of claims and customer service items, eliminating bottlenecks, automating work and reducing costs while improving speed and accuracy. Responsibilities Created Business Requirement Documents as a result of meetings with the Business Areas. Obtained business sign offs on the documents after reviewing the final documents with them. Gap Analysis of client requirements, generated workflow process, flow charts and relevant artifacts. Documented the User Stories to get a better understanding of client's business processes of both the projects using the Agile (Scrum) methodology. In charge of facilitating daily scrum meetings and weekly review meetings. Monitored application claim adjudication systems, business requirement development, user functionality testing, and performance activities to ensure optimal functionality. Worked on Facets Claims Software System, to convert data from their legacy system and add custom applications to satisfy in-house requirements. Proposed FACETS claims adjudication procedures, standards and editing guidelines. Analyzed and worked with HIPAA specific EDI transactions for claims, member enrolment, billing transactions. Worked on Facets claims processing, payment adjustments, claims inquiry, benefits. Worked on HIPAA Standard/EDI standard transactions: 270, 271, 276, 277, 278, 834, 835, and 837 (P.I.D), 997 and 999 to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes. Conducted JAD sessions to gather and document requirements that enhance a wide range of functionalities including claims processing, eligibility and enrollment, provider networks, and electronic data interchange for our Facets core application. Designed Use Cases using UML and managed the entire functional requirements life cycle using MS Visio Extensively used Informatica power center for extraction, transformation and loading process. Defect Tracking and Bug Reporting was performed using Quality Center. Participated in weekly status meetings to present status and incorporate any digressions from the original scope. Involved in cross-functional teams, developing new ways to boost efficiency and delivering results in a fast-changing environment to achieve company goals.Candidate's Name , CSMEMAIL AVAILABLEPHONE NUMBER AVAILABLEEDUCATION: Master in LawCERTIFICATIONS: Certified Scrum Master (CSM) |
