Description
Summary: * Qualified professional with more than 7 years of experience as a IT Business Analyst in Healthcare and Banking Industry. * Highly motivated team player with excellent communication, presentation and interpersonal skills, always willing to work in challenging and cross-platform environment. * Demonstrated ability to work actively in different phases of Software Development Life Cycle (SDLC) using Waterfall, RUP and Agile / Scrum / Iterative Development. * Experience in creating mapping rules from source to target with transformations. * Strong Knowledge in creating Process Flow Diagrams and UML diagrams Using MS Visio. * Generated Traceability Matrices to ensure that all the requirements are covered by the test cases, And Maintained RTM throughout the project. Experienced with Medicare and Healthcare Insurance as well as Medicaid Standards (HIPAA and HL7). * Experience in EDI automated claim adjudication, requiring thorough understanding of claim processing, both front and backend operations. Experienced with Enterprise Data Warehouse, Data Integration, ETL Tools and Data Mart Reporting. * Experience in designing and developing reports using Crystal Reports. * Strong knowledge in Health Administration, Claims processing, Claims pricing, HIPAA Compliance, Enrollment, EDI, Medicare/Medicaid Systems, CDHP (consumer driven health plans), FACETS Systems at Payer Side. * Proficient with rational tools (includes Rational Requisite Pro and Rational Quality Manager) and Microsoft office tools (includes MS project, MS Visio, MS access, MS Excel, MS word, MS PowerPoint.) * Proficient in Project management, Project coordination, Change management and change Requests. * Facilitated JAD sessions with business owners, IT team & Users to Elicit detailed business requirements, experienced in Systems Testing, Integration Testing, and Software Quality Standards, Training, Documentation and implementation in a business environment. * Knowledge of healthcare standard Health Level Seven (HL7 2.3.1). * Familiar with HIPAA EDI transactions such as Payment/Remittance (835), Status Response (277), Status Inquiry (276), Claim/Encounter (837), Certification Response/Certification Request (278), Eligibility Response (271), Eligibility Inquiry (271). * Knowledge in documenting Preventive, Basic, Major, Ortho American Dental Codes (ADA), Dental Charting, Clinical notes, Billing, Insurance Management, e-Insurance Claims in Patterson Eaglesoft Software. * Expertise in the EPIC Medical software application (EMR, EHR) as it relates to hospital workflows and setting up the infrastructure for a software implementation in a clinic environment at Provider Side. * Performed UAT (User Acceptance Testing). * Expertise in understanding Project Planning and Coordination, Requirements Definition, Analysis, Design, Testing, System documentation and user training. * Used Rational Quality Manager for tracking and prioritizing defects. * Used Rational Requisite Pro for Documenting Requirements. * Well versed in writing SQL Queries to extract data from databases. * Experience in Change Management Process (Identify, Analyze, Evaluate, Plan, Implement, Review and Close).
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