Business Analyst

ADITI KHAREL

(IT Business Analyst)

Email: adcjhf@r.postjobfree.com Phone: 469-***-****

Over 5 years of IT experience as a Senior Business Analyst with good understanding of business requirements elicitation, analysis and quality assurance.

Experience in all phases of the Software Development Life Cycle (SDLC) including requirements gathering, analysis, design, implementation, testing and deployment as well as software engineering methods like Rational Unified Process (RUP), RAD, Waterfall, and Agile.

Successfully used Agile/Scrum Method for gathering requirements and facilitated user stories workshop.

Working closely with the scrum teams and larger organization on how to get the most out of Agile/Scrum practices

Documented Claims processing lifecycle and got good exposure of X12 837, 270 transactions for HIPAA 4010& 5010.

Excellent knowledge of Health Insurance Portability and Accountability Act (HIPAA) transaction, code set rules such as EDI 837, 835, 834, 270, 271, 276, 277 and ICD9-ICD10.

Used Agile-testing methodology for achieving deadlines in UAT.

Knowledge of SDLC (Software Development Life Cycle) including Agile, Waterfall.

Extensive knowledge of Medical Management Information Systems (MMIS), Medicaid, Medicare, Procedural and Diagnostic codes and Claims Process.

Strong knowledge of Health Insurance Portability & Accountability Act (HIPAA) standards HL7, HMO, PPO.

Presented several documents and Use Cases for multiple transactions and worked with ANSI X12 5010 and ANSI X12 4010 including the standards for medical transactions like 837I, 837P, 835, 276, 277, 270, 271(both inbound and outbound) transactions for ongoing industry projects.

Good knowledge of Health Insurance Plans (Medicare Part A, B, C and D), managed care concepts (Medicaid and Medicare) and experienced in determining the membership eligibility, billing experience within life and disability in health plans.

Expert in tuning the performance of SQL queries and ETL process.

Well versed in testing Enrolment, Billing and claims processing in FACETS.

Involved in testing Member, provider, Claims Processing and Utilization Management, Contracts and Benefits modules.

Strong healthcare system testing experience

Knowledge of PBM / Rx claims and associated data requirements

Experience in data mining, mapping and manipulation of healthcare data

Extensive experience in creating Business Requirement Documents (BRD), Use Cases, Software Requirements Specifications (SRS), Functional Requirements Specification (FRS), Project Plans, Requirements Traceability Matrix (RTM) throughout the Life Cycle of the project.

Implementation of the Rational Unified Process (RUP) in all four phases of a project: Inception, Elaboration, Construction and Transition. Expertise in requirements gathering using Water fall and agile methodology, root cause analysis, creating workflows, process map, activity flows.

Developed customs reports using SQL

Hands-on experience with statistical data collection and quality administration.

Complete understanding of the AS-IS and TO-BE business processes and experience in converting these requirements into technical specifications for preparing test plans

Participate in the full lifecycle for multiple Data Mapping data project analysis, design, documentation, development and testing.

Managed meeting sessions with the SMEs to review business requirements.

Developed Use Case UML modelling using modelling tools like Rational Rose/MS Visio

Experience and skilled in creating and analyzing Data flow diagrams, Entity Relationship diagrams, and Logical Data Flow Diagrams

TOOLS AND TECHNOLOGIES:

Methodologies: Agile, Waterfall

Requirement management tools: QC, Jira, Rational Requisite Pro

Project management tools: MS Project

Business Modeling: MS Visio, MS Project, MS Visio, MS Excel, MS Word, MS PowerPoint, Jira, Confluence Wiki, Kronos, office 365, QuickBase, SharePoint

Web technologies/languages: SQL, XML,

Front-End tools: Microsoft Excel, Word, Power Point, SharePoint

Database & BI: MS SQL Server, Oracle, Informatica, SSIS, SSAS, SSRS

EXPERIENCE:

Business Analyst

Colorado Access - Aurora, CO June 2018 – Present

As a Business Analyst for the Business System Delivery (BSD) team, I was engaged in providing support through the entire lifecycle for multiple projects involving web service and user interface development. This covered the Provider, Claims and Reimbursement Processing domains. The project was specifically related to upgrading HIPAA X12 4010 transaction to X12 5010 and ICD 9-CM to ICD 10-CM/ PCS simultaneously.

Responsibilities:

Acted as a liaison between Business Area Subject Matter Experts (SMEs) & development team throughout all phases of SDLC; starting from Inception to Transition phase of Rational Unified Process (RUP) methodology

Accomplished projects and design documents on HIPAA 835 and 837 calculations and EDI transactions, Health Statements and Explanation of Benefits, Healthcare Reform and 5010 CMS occurrence and field expansion for 835 and 837 EDI formats

Worked on EDI transactions: 270, 271, 834, 835, and 837 (P.I.D) to identify key data set elements for designated record set.

Coordinated the upgrade of EDI Transaction Sets 837, 835 and 834 to HIPAA compliance.

Work on EDI 834-file load in Facets through MMS (Membership maintenance sub-system).

Experienced in software development life cycle such as Waterfall, Agile-SCRUM methodologies, Business Analysis and Modelling.

Generated numerous Business Requirement Documents & Functional requirements specification documents, Use cases, system flow and work flow diagrams.

Worked with the Managed Care Subject Matter Expert (SME) and Users to ensure that all the requirements for system change are covered.

Wrote business case scenarios for HIPAA EDI Transactions.

Conducted brainstorming sessions with the business users and SMEs to elicit requirements and worked in the creation of Agile Epics, user stories, Acceptance criteria documents.

Extracted and refined user requirements by conducting JAD sessions, facilitating meetings & interview with Business Units and Technical Supports & Development team, identifying the business flows and process flows, conducting detailed and comprehensive business, functional & system analysis to determine High Level and Low-Level artifacts & deliverables.

Developed business and detailed functional requirements related to changes to be made to the claim entry screens, including Practitioner, Crossover Practitioner, Dental and Hospital Claim Entry Screens.

Worked on solving the errors of EDI 834 load to Facets through MMS.

Involved in remediation of the legacy MMIS to meet the minimal functionality necessary to electronically send, receive and process the HIPAA compliant standard transactions, and fully implement all components of NPI Compliance.

Incorporated and updated all MMIS screens for NPI Implementation within the MPS1 subpart used for paying claims

Conducted knowledge transfer sessions which were used to make the users and other teams aware of all the changes being made in the system as part of various projects.

Developed workflows that demonstrate current and proposed business requirements.

Provided weekly status updates to project stakeholders on the progress of project development activities.

Environment: RUP, Rational Rose, Requisite Pro, MS Visio, RUP, MS Project, SQL, MS Access, MS Excel and MS Word.

Business Analyst

Cox HealthPlan - Springfield, MO Aug 2016 – May 2018

Project: Claims system development and enhancements, commercial, Medicare and Medicaid projects

Responsibilities:

Act as a strategic partner between the business community and IT development teams to resolve functional and technical issues related to business applications to troubleshoot data or transaction issues and to review opportunities to leverage new functionality

Work with clients to document functional test scenarios, test plans and end-user acceptance testing criteria.

Identified the business functions and processes, and prepared system scope and objectives based on user needs and industry regulations.

Defined terms conducted stakeholder analysis, elicited business needs, conducted business process modeling, and facilitated JAD sessions.

Elicited, documented requirements and use cases. Analyzed, validated & prioritized requirements; traced requirements to related project documentation (process models, designs, test scenarios & scripts).

Actively analyzed current business processes (Claims, Recipient eligibility and enrollment etc.) and worked with management to improve and implement enterprise solutions to ensure compliance

Documented the Requirements and circulated them to Business & Technical teams for Signoffs.

Maintained traceability through updates to the Requirement Traceability Matrix (RTM) using Requisite Pro.

Identified testing scenarios and defined Test Cases for detailed functional testing.

Facilitated claims processing while passing 837 claims for a compliance check and running through load processing.

Developed a Schedule and identified project milestones.

Analyzed business scenarios to track possible business outcomes for the functions which could be incorporated into more detailed test scripts.

Reported project progress to the team, senior management and all stakeholders periodically.

Identified risk and project impact and performed risk assessment and mitigation.

Environment: SQL, MS Word, Excel, Access, File Viewer, MS Visio, SharePoint.

Business Analyst/ Systems Analyst

Yourcare Health Plan - Buffalo, NY Feb 2014-July 2016

The goal of the project was the development of a state-of-the-art web-based technology-engineered from a legacy database technology, including the business functions. The project involved re-engineering of the existing billing System along with achieving HIPAA compliance. The deliverables in the project included core billing functionality and standard reports.

Responsibilities:

Played an active role in gathering, analyzing, and writing business requirements.

Project was implemented in phases, enabling system to deliver as many business requirements as early as possible.

Involved in Requirement Scoping and analysis of high priority requirements for implementation.

Worked on Transaction-835 claims payments and remittance advice, which deals the payment from payer to provider.

Engaged on the loading EDI 834-file to Facets through Membership module.

Knowledge on HIPAA Compliance EDI Transaction Sets 834, 837 and Good understanding of the EDI transaction sets 834, 837

Expertise in EDI files transferred to Trading Partners in HIPAA 5010 standards

Identify Member, Provider, Coverage, Medicare, and Medicaid.

Involved extensively in writing Agile User Stories and get them reviewed with Business lead and project manager for Sign Off.

Worked on AGILE Environment with daily scrum meetings, grooming sessions, planning and sprint cycles.

Good understanding of SDLC and STLC methodologies including Waterfall, Iterative, Agile and Scrum methodologies.

Strong testing Quality Assurance experience within agile environment.

Participate in the UAT efforts for IT enhancement and break fix items as required by the IT change control process.

Manages process improvement initiatives, seeking root cause and developing appropriate corrective action related to system configuration and claims.

Assists with operations activities for a large region of the organization in compliance with the organization's and government policies. Defined complex information systems solutions to address business needs as it relates to system Configuration setup, maintenance and Claims operational activities

Administer UAT activities within the change control process for zero defect system configuration deployments, coordinate adequate product testing prior to implementation. Make recommendations to superiors regarding the acquisition and/or implementation of software changes.

Ensure successful execution with JADS to collect and report requirements, perform data analysis/reconciliation.

Reviewed logical design documents and use cases and making sure the enhancements based on the Prescriptive authority changes with business team

Performed GAP analysis for the modules in production, conducted feasibility study and performed impact analysis for proposed enhancements.

Performed Gap analysis and was involved in analysis of the technical specifications of the current system and the infrastructure needs.

Environment: Windows, Oracle, MS Office (MS Word, MS Excel, MS PowerPoint, MS Visio), MS Access, Agile, SQL and SharePoint.

EDUCATION:

MBA (University of Amberton; Garland, Texas)

Bachelor in Computer Science (LMU, Nepal)

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