Description
Professional Summary * Over 8+ years of diverse experience as a Business System Analyst in developing and implementing innovative business processes. * In-depth knowledge and experience in full SDLC with RUP, agile and waterfall methodologies. * Functional experience in health Care Industry with vast knowledge on Medicare and Medicaid. * Expertise in creating the companion guides on various EDI transactions. * Specialize in HIPAA 5010 implementation including GAP analysis * Worked with HMO and PPO data. * Knowledge of MITA Business Framework * Expertise in impact analysis on the key application systems (claims processing, reporting, payments) and business process of health insurance companies. * Clear understanding of ICD-9-CM and ICD-10-CM/PCS * Facets support systems were used to enable inbound/outbound HIPAA EDI transaction in support of HIPAA 834, 835, 837 270/271 transactions. * Medical Claims experience in Process Documentation, Analysis and Implementation in 835/837/834/270/271/277/997 (X12 Standards) processes of Medical Claims Industry from the Provider/Payer side. * Have extensive knowledge in Insurance products like HMO, PPO, POS and HIPAA and Regulations. * Exceptional ability to maintain and build client relationships with business owners to identify, prioritize and document business requirements. * Extensive experience in Healthcare/Claims adjudication with knowledge of industry compliance standards like HIPAA and EDI X 12 transactions (834, 837, 835, 270/271, 276/277) * Proficient in all phases of Requirement Management, including gathering, analyzing, detailing, and tracking requirements. * Great understanding of HMO and PPO networks. * Expertise in creating prototypes and mock-ups for user interface designs. * Expertise in Claims, Subscriber/Member, Plan/Product, Claims, Provider, Commissions and Billing Modules of Facets. * Experience in Business Requirement and System Specifications Analysis. * Specialized in creating UML Diagrams like Use Case, Activity and data flow diagrams using Rational Rose and MS-Visio and consistently translate business requirement into IT solutions. * Extensive knowledge of reporting tools such as SQL, ACCESS for underlying database tables and resolve data issues, Sharepoint and ALM for documenting requirements. * Expertise in RDBMS concepts and running SQL queries. * Worked on Sharepoint and ALM DXC Technologies (previously HPE) - State of TennCare - Division of HealthCare Administration Claims TN January 2015 - Current
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