Description
Summary * 7+ years of experience as Business Analyst in the Healthcare Industry with expertise in Affordable Care Act (ACA), HL-7, EDI Transactions (834, 835, 837), HIPAA, MMIS, Medicare and Medicaid. * Adequate knowledge in Health Administration - Claims processing (auto adjudication), COB, EOB/Drafts, Claims pricing and testing, HIPAA, enrolment, EDI, HIX, HMO, PPO, POS, Medicare, Medicaid, CDHP, MMIS system implementation and upgrade, ICD-9, ICD-10. * Profound knowledge of healthcare standards such as HIPAA 4010, 5010, ICD-9 and ICD-10 codes. * Implemented transactions 834, 835, 837, 270, 856, 940, 943, 945, 110, 210, 204, 211, 214, 997 & 999 using X 12 standards. * In depth knowledge of HIPAA 5010 transaction processing's and ICD-10 compliance, code set mapping, General equivalence mapping, performed gap analysis and impact analysis of HIPAA 4010 to HIPAA 5010 and Used General Equivalence Mappings (GEM) to convert ICD 9 to ICD 10 and data ware housing. * Solid understanding of Membership, Claims Processing (FACETS platform), Configuration, Billing, Benefit/Eligibility, Authorization/Referrals, COB, and have experience in HIPAA standards and corresponding EDI transactions (837, 834 and 820). * Strong experience of Trizetto QNXT (Benefits, Contracts, Provider, Enrollment or Claims). * Experienced working with EHR (Electronic health record) and EMR (electronic medical record) team for data requirement. * Hands on experience on Software Development Life Cycle (SDLC) of the project using methodologies like Waterfall, Agile, RUP and hybrid methods. * Expert in translating business requirements & user expectations into detailed Functional Requirements Specifications (FRS) by employing Unified Modelling Language (UML). * Highly experienced in performing Feasibility Studies, Impact analysis, GAP analysis and Risk Analysis and Data Mapping. * Created Encounter Data flow diagrams and process flow diagrams using Microsoft Visio. * Chaired and conducted JAD sessions with business and technical teams. * Efficient in writing Business requirements document (BRD) Functional requirements document (FRD), Business Process Document (BPD), Meeting Notes and Use Cases. * Prepared Use Case Document, assisted testing teams with Test Plans, Test Cases and Test Scenarios, conducted User Acceptance Testing (UAT), and managed defects using defect-tracking systems. * Expert in Gathering Requirements and document, track, manage and communicate requirements using Requirements Traceability Matrix (RTM). * Proficient in Structured Query Language (SQL) for data manipulation and retrieval.
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