| Candidate Information | | Title | Business Analyst Project Management | | Target Location | US-PA-Mechanicsburg |
| | 20,000+ Fresh Resumes Monthly | |
|
|
| |
Click here or scroll down to respond to this candidateExperienced Business Analyst with advanced knowledge of Healthcare systems with exceptional organizational, project management and leadership skills, Business process mapping and end-user testing expertise and focus on delivering quality system on timely manner.SUMMARY:Over 15 years of experience working as Business Analyst, Business System Analyst in the field of IT systems development, Client/Server, Web-based Internet, Extranet, Intranet and Stand-Alone Applicationsin Healthcare domain.Extensive experience of Software Development Life Cycle (SDLC) and SDLC methodologies Waterfall and AgileExperience in conducting Business Requirements gathering meetings and workshops with clients, SMES and project stakeholders.Extensively worked on creating Business Requirement Documents, documenting Functional and Technical specifications, Data Mapping Document, Creating Use Cases and User stories.Experience in conducting Joint Application Design (JAD) sessions to resolve issues.Expert in Requirement Analysis, Data Analysis, Gap Analysis and System Configuration and implementation.Experience in creating application process flow, data flow diagram, Activity Diagram and Sequence Diagrams.Worked on Healthcare Insurance Enrollment Membership, Claims, Billing, Benefit Eligibility, Providers, Medicare and Medicaid areas.Extensively worked on data migration and system integration projects by using relational databases.Experience in working with HIPAA EDI X12 transactions 834, 837, 835, 270/271, 276/277.Wrote advance level SQL queries to extract data from relation databases and data warehouses.Experience in creating test scenarios, Test cases as per requirement functionality.Experience in performing User Acceptance Testing on behalf of end users.Worked on various healthcare claims processing systems like Mainframe and Facets.TECHNICAL SKILLS:Methodologies: Waterfall, Agile ScrumDatabases: Oracle, SQL ServerPlatform: Windows, MainframeChange Request Tools: Rational Clear Quest, Rational Quality ManagerRequirement/Defect Management Tools: HP Quality Center, ALM, Test Director, Jira, Confluence, Azure, RTCMicrosoft Tools: MS Office, MS VisioPROFESSIONAL EXPERIENCE:HIGHMARK HEALTH SOLUTIONS, Camp Hill, PA Sep 2021 PresentSenior Consultant/Business AnalystAt Highmark, working for Claims departments for frontend and backend.Job Responsibilities:Currently working as a Consultant with claims team. Responsible for collaborating with the solution leads and determining impacts of the client proposals to the claims domain.Driving key collaboration discussions with the Clients regarding their demand forecast & marketing strategies.Created functional specification and detailed test scripts for UAT providing business approval.Acted as the liaison between business and the IT department managing requirements and resolving defects.Troubleshot, identified, and resolved complex problems in the new system and created temporary solutions when needed.Created training manuals and maintained system documentations.Created daily and weekly status reports.Created test scripts and developed test cases.Implemented strategies to enhance testingWorking on Use cases, vision document and presenting use case/vision walkthroughs to the delivery team leads and customers.Coordinated with offshore development and testing teams.Completed peer reviews for Vision and Supplementary specifications with Business Lead.Conducting Joint Application Development (JAD) sessions with the business users to gather requirements.Efficiently managing multiple projects with competing deadlines.Department of Environmental Protection Sep 2020 to Aug 2021State of PABusiness AnalystWorked for DEP as a Business Analyst/QA to support all below applicationsOil and GasBureau of Waste ManagementBureau of Air QualityStorage TanksClean WaterJob Responsibilities:Analyzing the structure of a business to determine how it operates and determine its objectivesPrepared mock-ups to provide visual aids for requirements gathering.Analyzed, elicited, and documented requirements according to the SDLC using Waterfall methodology.Gathered business requirements with various investment stakeholders across various business lines to understand and document the business needs for complex data modifications.Provided production support to the customers.Identifying any problems with the current business model.Provided assistance with system testing.Researched files, records and other documents to obtain business information and key data in order to respond to development requests.Worked closely with software development and testing team members to design and develop outbound solutions to meet client requirements for functionality, scalability and performance.Documented business processes and analyzed procedures to ensure alignment with changing business needs.MERCER Health and Benefits, Norwood, MA May2019-June 2020Senior Business AnalystMercer is a leader in the health and benefits marketplace, globally. Mercer deliver innovative solutions that address the health and wellness needs of our clients and their employees.Mercer Provides access to local market experts as well as national and international resources that advise on regulatory compliances and innovative benefit strategies. Worked for several clients to understand the current market dynamics, identify their goals and then develop a tailored strategy to meet their business needs.Job Responsibilities:Worked as a Consultant with Benefits team. Responsible for collaborating with the solution leads and determining impacts of the client proposals to the Benefit domain. Eventually designing use cases, visions, process flow Visio and presenting use case/vision walkthroughs to the delivery team leads.Analyzed Clients HRIS requirements and created demographic file mapping document to transform the data according to business requirements.Provide expert data analysis and consultation regarding complex data processes, business processes and interfaces to support the business platforms.Assist in development, planning, and updating of overall project schedule. Attend/direct regular job scheduling meetings.Worked with Triage team for payroll open enrollment and ongoing files and resolved the defects after go live.Responsible for Clients vs Mercer mapping documentation on products and benefits for client groups.Strong ability to compile and present the results of gathering requirements and subsequent solutions.Solid understanding of technology and the software development process.Should be able to work independently as well as a part of the team; working with minimal direction.Proven ability to deliver under pressure with a high degree of customer satisfactionWorked on HRIS file issues and submitted for ETL Process.Analyzed and align the data for HRIS inbound file and uploaded to the MMC 365 portal.Have been actively involved in rolling out the workflow tool to end customers through multiple training sessions/documentations/user manuals.Worked on employee benefit such as MEDICAL, VISION, HSA, FSA, STD, LTD and extracted the employee data population with SD team.Discussed and resolved all issues of HRIS and Payroll files with internal and offshore configuration teams.Ran and extracted HRIS/Payroll data from the backend database and compared with MMC portal.For Small Business Health Options Programs (SHOP) performed end to end and interface testing of following applications.Worked on employees enrollment and eligibility.Worked with clients on Payroll files.Experience in writing intermediate SQL queries/joins for Access/Oracle/SQL Server database.Strong analytical and technical writing skills with high credibility to communicate within all levels ofan organization.HIGHMARK HEALTH SOLUTIONS, Camp Hill, PA Feb 2010 - April 2019Business Technical Analyst/QA AnalystAt Highmark, worked for Membership and Claims departments.Membership Department (March 2016 - April 2019)Enrollment & OPISThe enrollment & OPIS Platform is a sub-department within strategic operations and is responsible for Business Analysis, gathering requirements and testing projects and corporate initiatives for member data. Worked for the enrollment team in membership and was part of the end to end processes for the following subsystems Membership Inbound system, Membership Outbound system, Membership Online, Member Profile.Job Responsibilities:Created Supplementary Specs and Use Cases and uploaded them to the SharePoint site and used Req Pro for the small enhancements.Analyzed, elicited, and documented requirements according to the SDLC using Waterfall methodology.Gathered business requirements with various investment stakeholders across various business lines to understand and document the business needs for complex data modifications.Development of written test cases worked as an embedded resource with the development teamEnsure the team is focusing on automation along with manual testing.Created workflow diagrams and Gantt charts to clearly demonstrate inbound /outbound processes and timelines.Mapped current outbound business processes and operational processes and offered recommendations for improvement for all clients.Researched files, records and other documents to obtain business information and key data in order to respond to development requests.Worked closely with software development and testing team members to design and develop outbound solutions to meet client requirements for functionality, scalability and performance.Documented business processes and analyzed procedures to ensure alignment with changing business needs.Implemented business and technical client training on new systems and supervised software integration on client's website.Developed start-up and scaling cost estimates for business plans proposed to all partners.Developed analysis models to meet aggressive employee benefit plan roll-out dates and deliverables.Worked effectively with cross-functional design teams to create software solutions that elevated client-side experience and significantly improved overall functionality and performance.Worked for WIPRO/M360 and CMS.Collaborated on all stages of systems development lifecycle, from requirements gathering to production releases.Implemented user acceptance testing with a focus on documenting defects, identifying bottlenecks and executing test cases.Claims Department (Jan 2010 - March 2015)Worked as a Technical Business Analyst within the claims department to support the below subsystems.Adjustments, Finalization, PRE and POST Enrollment, History Update, Eligibility,Job Responsibilities:Created business requirements for the following HIPAA EDI transactions: 834, 837/835, 276/277.Validating the EDI 837 claim billing (professional, institutional and dental claims) & 835 (remittance advice or payment) claims adjudications.Applied medical billing/coding and claim processing/adjudicating knowledge during the business requirements gathering process.Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims.Analyzed and documented complex business processes in multiple forms such as Business Requirements Documentation (BRD), Functional Requirements Documentation (FRD), Technical Requirements Documentation (TRD), and Process Flowcharts using Visio.Completed peer reviews for Vision and Supplementary specifications with Business Lead.Conducted Joint Application Development (JAD) sessions with the business users to gather requirements.Efficiently managed multiple projects with competing deadlines.Worked on Health Information Exchange (HIX) project and tested all requirements using SOAP UI.Supported corporate and interim releases for backend and frontend systems.Environment: Windows, MS Office, SQL, Note pad. Adjustments, Finalization, PRE and POST Enrollment, History Update, Eligibility, ICD 10CareFirst BCBS, Owings Mills MD April 2009 - Sept 2009QA AnalystEnterprise Data Warehouse (EDW)FacetsJob Responsibilities:Created accurate and efficient test scripts to manage automated testing of certain products and features.Supported the company in maintaining a work environment focused on quality, communication, collaboration, integration and teamwork.Created test plans and test cases for backend testing from the business requirements to match the project's initiatives. Created and executed detailed test cases with step by step procedures and expected results.Created and Executed advanced SQL queries using relational database and Dimensional Model concepts on Oracle database using TOAD 8.5 and SQL developer to test the integrity of the data content, ETL processes and reports for CareFirst BlueCross BlueShield Products.Responsible for gathering requirements from the Subject Matter Expert. (SME).Performed defect tracking and reporting with strong emphasis on root-cause analysis to determine where and why defects were being introduced into the development process.Used HP Quality Center to manage the entire process and log in defects.Validation of member's data from Facets to EDW.Kaiser Permanente, Pleasanton, CA Feb 2008 - Dec 2008QA AnalystClaimsOutside claims processing system (OCPS)IFILEJob Responsibilities:Wrote and optimized test cases to maximize success of manual software testing with consistent, thorough approaches.Worked with Business Analyst and QA Lead in reviewing and analyzing the Business Requirements Documents and Functional Requirements Documents.Prepared Test Scenarios based on business requirements and business rules for mainframe applications.Prepared Test claims according to the scenarios and Test casesScanned Paper Claims in Cardiff and sent to the IFILE.Worked with the IFILE team to convert 837 in CFF (Common File Format) using DI (Data Interchange)Executed test cases in OCPS (Outside Control Processing System) according to our test scenarios and expected results.Tested HIPAA Transactions and Code Set Standards such as 270/271, 276/277,837/835 transactions according to test scenariosUsed HP Quality Center to manage the entire process and log defects.EDUCATION:Bachelor in Computer Science AIOU Islamabad, PakistanMasters in Computer Science University of Northern Virginia, VA |
