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PHONE NUMBER AVAILABLE : EMAIL AVAILABLE : Ashburn, Virginia, Street Address : USC______________________________________________________________________________________________________Sr. Business Analyst
SUMMARY: 8 years of Business Analysis experience with in-depth knowledge of business processes in health care & Pharma domain. Experience in business process analysis, modeling and Business requirement gathering. Experience in gathering Business/Functional user requirements, expertise in creating Use Cases, Use Case Diagrams, Class Diagrams, Sequence diagrams and Activity diagrams using MS Visio and UML concepts. Excellent industry knowledge on Membership, Claims processing, Provider, Prescription Benefits Management, Clinical Data, LAB data Value Based Care, User Acceptance UAT, Medical Management and Medicare, HEDIS, HL7, EDI, CMS Compliances/Regulation and Standard Medical code set (CPT, ICD9/ICD10, LAB etc). Strong understanding of project life cycle and SDLC methodologies including RUP, RAD, Waterfall, Scrum and Agile. Experience on Membership, Billing, Claims Payment Processing in relation to HIPAA, EDI 4010, 5010 X12, ICD-9 ICD-10, codes 834, 837,835, and 270, 271,HL-7and FHIR. Functional Knowledge of Medicaid Management Information System MMIS. Experience working with HL7 (traditional version) and (xml-based version) and FHIR. Experience in working closely with project Stakeholders, SMEs, PM, to understand, analyze, document, validate, and review the requirements and specifications for new applications along with enhancements to the existing applications. Extensive healthcare experience in Medical Imaging, EHR/EMR, Medicare-Medicaid, HIPPA, HIX on EPIC software applications Skill in implementing Clinical Trial Management System (CTMS) and Electronic Data Capture (EDC) in the clinical research environment. Vast experience in Payer Claims Adjudication, HIPAA (EDI), Cash disbursement. Experience with healthcare system, Medicaid and with prime focus on claims adjudication, provider, eligibility and prior authorization. Experience in all the sprints of the project in SCRUM. Excellent knowledge in Health Insurance, Health Insurance Exchange (HIX), Asset Management, PBM and Human Health Services (HHS) environment. Experience with Member, Enrolment, Claims, Product setup within FACETS. Experience in participating JAD sessions for project definition, analyzing requirements. Experience in developing reporting application using ETL (Informatica) and Cognos Business Intelligence Suite with multiple data sources like Oracle, MS SQL and DB2 database. Extensive knowledge on EPIC (EMR - Electronic medical record software) modules like Ambulatory, Inpatient, Hospital billing, professional billing, ADT (admit, discharge and transfer). ADT: stands for Admission, Discharge and Transfer. Experience with Stake holders/users to understand and document business, functional and technical requirements using Azure DevOps. Experience in creating/writing the user stories in JIRA and Confluence tools.
Experience working in back end tester by writing SQL Queries and PL/SQL scripts on large enterprise data warehouse systems. Extensive experience on Excel, Word, PowerPoint, MS Project, MS Visio, Rational Suite and SQL. Strong knowledge in the ETL (Extract, Transform and Load) of data into a data warehouse/date mart and Business Intelligence (BI) tools like Business Objects Modules (Reporter, Supervisor, Designer, and Web Intelligence). In depth knowledge of healthcare industry, clinical data recording & research, clinical operations for drug and medical device industry & Outcome Research preparedness. Expertise on Testing REST API using Robot Framework and SOAP UI. Experience with Iterative SDLC Process as per Rational Unified Process (RUP), involved in inception, elaboration, construction & transition phases using rational tools like RequisitePro, ClearCase, ClearQuest during various phases of RUP.
Experience in designing and reviewing of various documents including the Software Requirement Specifications (SRS), Business requirements document (BRD), Use Case Specifications, Functional Specifications (FSD), Systems Design Specification (SDS), Requirement Traceability Matrix (RTM) and testing documents. Excellent presentation skills, and interpersonal; expert at managing multiple projects simultaneously.
Excellent oral and written communication skills with ability to communicate with all levels of management and team members.
Highly motivated team player with excellent problem solving, team building, judgment and decision making skills.WORK EXPERIENCERole: Sr. Business Analyst
Client: TennCare - Nashville, TN(Remote) Sep 2022 to PresentProject 1: Health Information Exchange (HIE): The project was based on developing a patient-centered Medicaid Health Information Exchange (HIE) to aid healthcare providers in accessing real-time patient data. The aim was to offer actionable clinical information to the Care Coordination Tool (CCT) to enhance provider decision-making and payment objectives, ultimately leading to improved patient outcomes. This involved the integration of Electronic Health Records (EHR), Health Information Exchange (HIE), and Health Exchange (HEX) systems.Project 2: Receiving Real-Time HL7 ADT messages helps stable data-sharing with both the hospital and provider communities. The ultimate goal is to transition all patient information collected through the interoperability process, to a shared care-coordination tool (Altruista) and enable healthcare providers the ease (single sign-on), speed and agility of receiving verified patient information in one place for review and assessment.Responsibilities: Prepared Business Requirements Document (BRD), Functional Requirements Document (FRD), Process Flows and Requirement Traceability Matrix (RTM). Analyzed and translated business requirements into system specifications utilizing UML and RUP methodology. Performed Gap Analysis to identify AS-IS processes of claims transactions of 4010/4010A standard and TO-BE processes of 5010 standard. Troubleshooting utilizing CPT4, ICD9 & ICD10 codes. Interacted with the Subject Matter Experts (SME's) to gather information about the health care enrolment, eligibility, billing and health care claims processing.
Worked on the HIX (Health Information Exchange) project to provide state specific Medicaid support.
Research, write, and present on HL7, FHIR standards and related topics. Worked on Medicaid Management Information Systems (MMIS) and HL7. Developed Use cases, activity diagrams and analysed business requirements and Working skills on Health Level 7 Interface (HL7). Worked with developers on HL7 and non-HL7 message integration depending on source and destination of the endpoint application. Tested various HL7 Interfaces like ADT, ORU and MDM. Tested and consumed RESTful Web services using Advanced Rest API.
Worked with vendors and internal customers to test new HL7 interfaces and support existing interfaces. Worked on defining and managing Electronic Health Record (EHR), Medicare, Medicare Advantage, Health Information Exchange (HIE), Health Exchange (HEX), Protected Healthcare Information (PHI) and Healthcare reform processes.
Worked with FACETS Team for HIPAA Claims Validation and Verification Process Pre-Adjudication. Documented complex Business requirements and made process flow diagram for the EDI transactions EDI 837, 835, 820, and 834 as per the 4010 to 5010 implementations for the Medicaid claim processing system enhancement. Reviewed state documents (policies, manuals, business processes, systems documents, banners, bulletins) from various divisions. Analyzed and performed quality assurance to determine areas impacted by HIPAA 5010 and ICD 10 related data. Worked on Timeline management of all HEDIS related data collection activities including HEDIS-related quality improvement projects. Analyzed weekly EMR checklist to stay aligned with the federal regulations (HIPAA), and ensuring patient health information, medical history, treatments and test records are integrated, accessible and secured in the course of care management. Worked on different projects using various methodologies such as Agile, Rapid Application Development (RAD), Joint Application Design (JAD) and Prototyping. Reviewed EDI companion guides for all payers to ensure compliance, edit integrity and maintain up-to-date list of payer contacts. Confluence to provide necessary online documentation to enhance the communication of the team and link the JIRA issues with online documentation. Involved in the implementation of Microsoft Dynamics CRM designed to help in acquiring and retaining customers and reduce the time spent on administrative tasks. Prepared Business Requirement document to detail how Azure DevOps items maps to project Plan items for the technical system. Worked closely with project stakeholders, SMEs, staff to understand the requirements and specifications for new applications along with re-engineering the existing application. Developed departmental performance reports to provide optimal analysis of utilization management and care management.
Coordinated the integration of clinical applications and electronic health record (EHR) systems to the HIE. Worked in data validation and manipulation in SQL Server databases using SQL queries for integration between various systems like mapping and converting of Provider data to FHIR format. Responsible to get data from FHIR servers and store it into a DB2 database. Collaborated on Data Cache (DAMA data load from FHIR API to Oracle DB) Project to map FHIR data into the Oracle DB. Involved in project cycle plan for the data warehouse, source data analysis, data extraction process, transformation and ETL loading strategy designing. Reviewed data flow diagram to illustrate where data originates and how data flows within the Enterprise Data warehouse (EDW). Worked with data modelers in creating conceptual and logical data models for the warehouse.
Worked in agile/scrum methodology for better and rapid delivery of the business enhancements. Designed complex integrations using SOAP and REST API - Both Web Service Callouts and Publishing custom web Services.
Configured, tested and secured customized web service API's using FHIR Interconnect REST and SOAP services. Lead BI Solution lifecycle from requirement gathering through testing and deployment. Facilitated JAD sessions for Requirement Validation and requirement gathering for the new MMIS. Delivered business requirement documents, functional documents, Use Cases, test plans, and requirement traceability matrices.
Performed UAT for web services using SoapUI. Coordinated with the application team and Quality Analysts to create test plans, test scripts and test cases for functional, system integration testing (SIT), end to end testing user acceptance test (UAT) and Regression testing. Followed the UML based methods using Microsoft Visio to create: Use Cases Diagrams, Activity Diagrams, and Sequence Diagrams. Collaborated with the QA testing team to develop the test plan, test conditions and test cases to be used in testing based on business requirements, technical specifications and/or product knowledge. Involved in all stages of SDLC (Software Development Life Cycle) through broad knowledge of business requirements analysis, use case modeling, and use case specification. Involved in using MS Office (Word, Excel, Visio, Power Point, Outlook, and Project) for calculations, graphs, analysis, presentation and documentation throughout the project.
Role: Business AnalystClient: Minnesota Department of Health - Saint Paul, MN Oct 2020 to July 2022The primary objective was to design and develop MDH-specific implementation guides for ELR messaging that incorporated MDH-specific file formats and transport mechanisms while adhering to the national standards of HL7 messaging format. Additionally, the project aimed to integrate Logical Observation Identifiers Names and Codes (LOINC) and Systematized Nomenclature of Medicine Clinical Terms (SNOMED) for accurate reporting of test and result codes. An ancillary objective was to create a guide to assist MDH's executive team in the acquisition and maintenance of Object Identifiers (OIDs).Responsibilities: Gathered and analyzed business requirements by interviewing the Subject Matter Experts (SME's), asking detailed questions and carefully recording the requirements in a format that can be reviewed and understood by business and the technical experts as well. Maintained eligibilities for members with Medicaid and Medicare with support of the Medicaid Management Information System (MMIS).
Under general direction, gathered, defined,documented highly complex business requirements for EDW/ MMIS. Worked closely on 834 transaction code for Benefit Enrollment and in Validation of HIPAA for 837, 270/271, 276/277,835, 834 EDI transactions. Conducted JAD sessions for altering custom HIPAA -EDI270/271(Benefit and Eligibility Inquire/Response) & 837 EDI process flows. Helped developers with the following list of HIPAA-EDI Transaction Code Sets: (837, 835, 270/271, and 276/277). Used UML to create use case diagrams, sequence diagrams and activity diagrams Worked on improvement of Claims Reimbursement User Interface for a better experience and incorporated changes as per HIPAA 4010 /5010 guidelines. Managed projects deliveries through full SDLC, from analysis to launch in many disciplines including Agile/ Scrum Methodology, cross-functionally across many internal stakeholders and external clients. Developed Rest Services for the application to get data from upstream applications like ECC and FHIR. Conducted UAT, documented and reported user feedbacks to management team, and developed training materials for different end users and assisted in users training for the new system. Monitored the Product Backlog, Sprint Burndown and Release Burndown charts in JIRA . Updated the team homepage in JIRA Confluence with the recent developments and scrum artifacts to ensure transparency and visibility. Created an MDH specific HL7 message guide for ELR messages to MDH in compliance to HL7 Implementation Guide for ELR to public health. Developed an ELR Registration Form for the interesting trading partners to start the process of ELR and MDH.
Analyzed the source system to understand the source data and table structure along with deeper understanding of business rules and data integration checks. Carried out SQL Scripting, Transactional Data Analysis and Reporting on MS SQL database. Worked on HL7 standard, LOINC and SNOMED codes to provide framework to carry our transfer of electronic healthcare information. Used SDLC (System Development Life Cycle) methodologies like the RUP and the waterfall. Participated in testing of Orion Rhapsody Route to receive and process HL7 ORU^R01 messages to Websurv.
Tested the HL7 ORU^R01 Version to receive messages from HL7 ORU^R01. Gathered requirements for making changes to the existing Electronic Medical Records (EMR), Electronic Health Records(EHR) and Ambulatory Services for the existing Epic Interfaces. Interacted with the client and the Technical Team for requirement gathering and translation of Business Requirements to Technical specifications. Created the Requirement traceability Matrix (RTMs) for tracing the functional and non-functional requirements.
Led and conducted JAD sessions to develop architectural solution that meets the business requirements, resolve open issues and change requests. Developed the ETL Informatica Mappings for importing data from ODS into subsequent data marts. Provided Reports for REST API testing. Validated SOAP UI and Restfull API services.
Requirements elicitation and documentation, Off-shore and local resource management, conducting daily scrum stand-up utilizing the Azure DevOps Work item management Tool.
Prepared test Data sets and performed data testing using the PL/SQL scripts. Also used MS excel for data mining, data cleansing, data mapping, and data dictionary and data analysis. Created implementation plan and test procedures for new ELR messages to MDH. Validating and manipulating data within Oracle using PL/SQL.
Conducted Data Analysis and created Data Mappings for back end systems using SQL on DB2. Used JIRA for the prioritization of tasks, planning of each task, assigning and updating the list of tasks.
Identified changes needed in the existing Minnesota Electronic Disease Surveillance System (MEDSS) to adopt ELR implementation at MDH through GAP analysis. Create mapping documents with XML tags for inbound and outbound interfaces. Worked closely and effectively with existing messaging and MEDSS staff and other multifunctional terms. Created & Maintained Requirement Traceability Matrix in order to track the development and QA process.Role: Business AnalystClient: Cleveland Clinic Foundation Cleveland, OH Feb 2018 to Aug 2020The project was based on enhancing the efficiency and accuracy of patient care and administrative processes at the Cleveland Clinic Foundation (CCF) by implementing the EPIC Bridges (BREC) Interface application. The Cleveland Clinic, a leading multi-specialty academic medical center and one of the top hospitals in the United States, sought to optimize its existing EPIC systems to better support patient care, registration, scheduling, clinical systems, and billing functions.Responsibilities: Worked on Bridges Regional Error Correction Application for Error Correction process in EPIC. UAT the BREC application in UAT & Test environment and worked in Production environment. Worked on errors made by doctors in hospitals on Orders, H & P, Notes. Developed and manage necessary UAT Test Cases. Bridges is an EPIC Interface application. Bridges is the Interface that allows HL7 messages to be sent out and to be accepted by EPIC. Worked exclusively on Reconcile Reports to match the data in both systems (In EPIC and Invision systems). Maintained SDLC standards by documenting Project Request Document, Project Planning Document, BRD, FRD, and Scope. Monitore all EM components through E-Gate monitore where all components interface connected to central e-gate tool.
Monitored all components ORM, ORD, Context based ADT, Bridges Tables, ambulatory clinical work flows through system, Results of lab, , Radiology, , Agfa, Lab Results etc manage through In Bound and Out Bound Epic.
Wrote PL/SQL procedures for processing business logic in the database. Tuning of SQL queries for better performance. Make sure EHR & EMR, ADT, PID, OBR, OBX, Providers ID (Verified through NPI Lookup) are correct. Worked in agile/scrum methodology for better and rapid delivery of the business enhancements.
Worked with other Business Team / Units to resolve issues. Coordinated with other team members on issues as-needed and worked with clinical R&D team. Administered the JIRA and Confluence instances on a day to day basis including performance tuning/scaling the instances, JIRA tools administration. Assisted JAD sessions to identify the business flows and determine whether any current or proposed systems are impacted by the EDI X12 Transaction, Code set and Identifier aspects of HIPAA. Involved in GAP Analysis for ICD 9 and ICD 10 pay or crosswalk involving job submissions and batch processing for validated data in EDI transaction. Worked on error of different regions like East, West, and Central regions. Central comprise of Medina and Ashtabula county hospitals. East comprise of Euclid, Lakewood, Marymount Hospitals. West comprise Fairview, Lakewood, Lutheran, Marymount Hospitals Worked on EPIC interface engine for Orders from EPIC and Results from LAB System, Radiology System, and Pharmacy System. Errors get loaded to the EPIC system, BREC team resolves the errors and corrects the errors in EPIC ADT, ORU Delete and Process Reports were tested in all regions. MED Image Reports were also tested in all regions. Logged issues in EPIC defect tracking system called Sherlock and discussed the issues in daily and weekly status meeting.Role: Systems AnalystClient: Medstar Health Columbia, MD Apr 2016 to Dec 2017Project Description: The scope of the project was to implement Epic, EHR (Electronic Health Records) system, for a better communication between different hospitals affiliated with Medstar. Provided project timelines, managed, and coordinated between business and development teams to ensure business requirements implementation.Responsibilities: Gathered business requirements by driving user-group meetings and working with various global, cross-functional, and virtual teams. Prepared project deliverables through business workflow analysis, process analysis, user requirement documents (Use Cases & Use case diagrams) and managed the requirements. Documented artifacts including, but not limited to, Functional Specifications, and the Use Case Specifications. Identified all use case components including basic, alternate and exception flows. Worked on Health Level-7 or HL7 international standards for transfer of clinical and administrative data between software applications used by various healthcare providers. Prepared Business Process Models, which included modeling of all activities of the business from conceptual to procedural level.EDUCATION B.S. In Information Systems and Operations Management
George Mason University, Fairfax, VA GPA: 3.3CERTIFICATIONS Certified Scrum Master (CSM) May 2019 CompTIA Security+ (SEC+) August 2020 Interim Public Trust Clearance Apr 2019 |
