Over six (6) years of solid experience in business analysis,project co-ordination & management with extensive knowledge in, Software Requirement Analysis, Designing & Visualization at different stages of Software Development Life Cycle (SDLC) in HEALTHCARE website. · Immaculate skills in creating Business Requirement Documents (BRD), Functional Specifications, or Requirement Documents (FRD), Technical Requirement Document (TRD), System Design Documentation (SDD), UAT documents, Requirement Traceability Matrix (RTM), Issues Log, Data, and Action List and training guides.
· Proficient in developing UML artifacts such as Use Case documentation, Use Case diagrams, Class diagrams, Activity diagrams, and sequence diagrams using CASE tools like Rational Rose and MS Visio. · Experience in conducting Jointrequirement Planning (JRP) sessions and Joint Application Development (JAD) sessions with end-users, expert team, qA, and development team for project meetings, walkthroughs, and customer interviews. · Experience in conducting and documenting the As-Is/To-Be processes and Business Process Re-engineering (BPR) exercises according to the Rational Unified Process (RUP) and UML development methodology. · Experienced in coordinating UAT consumer approval / QA testing.
· Experience in Creation, and Documentation of Test Plans, Test Cases, Test Scripts predicated on the Design and User Requirement Documents for – Unit, Integration, Regression, Functional, Performance, and User Acceptance Testing with QA and UAT groups. · Knowledge of health health and information-care services regulatory environment including HIPAA, Medicaid/Medicare, CCHIT, XML, and EDI. · Strong HIPAA EDI 4010, and 5010 with ICD-9 and ICD-10, analysis & compliance experience from payers, providers, and exchanges perspective, with a primary concentrate on Coordination of benefits. · Experienced in medical terminology and coding outpatient and inpatients diagnosis Experience in building applications for ICD and CPT Electronic Data Interchange.
· Experienced dealing with the centers for Medicare and Medicaid services (CMS), the Healthcare Common Procedure Coding System (HCPCS), Electronic Data Interchange (EDI), Medicare Part D Services, and State Pharmaceutical Assistance Program (SPAP) services. · 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 aspect. · Experience in FACETS with various applications regarding Sales & Enrollment, Claims Processing (Dental, Medical/Hospital), Customer Service, and Billing areas. · Experience in health care FACETS data model and construction.
· Highly motivated team player with excellent communication, display, and social skills, always prepared to work in a challenging and cross-platform environment. Project Abstract: Highmark Blue Cross Blue Shield provides insurance for folks, and families, Medicare, companies. Optimum System for Claims Adjudication and Reporting in any other case known as OSCAR is the claims system utilized by Highmark for most of its health business.
Supported the OSCAR statements system as a business analyst. Worked on OSCAR Legacy Modernization projects including modernization of Claims Validation and Finalization subsystems of OSCAR, integrating a Medicare Supplemental claims system into OSCAR, and integrating a new Provider/Facility database into OSCAR. The areas of experience include BlueCard ITS, BlueSquared, BlueExchange, HiPAA 276/277 Transactions, HIPAA 5010 / ICD 10 Implementation. · Worked with Business users and specialized business lead for gathering requirements and data transaction information. · Evaluated/Analyzed Mainframe Claims OSCAR System Screen displays and created Mock-Up screens illustrating content and format for the team, customer, and development areas.
- Phasing out the National Policing Improvement Agency (NPIA)
- Purchasing business interruption insurance
- An outward facing API
- Project Charter (Popular in Six Sigma)
- Click on Architect on the BAM Home screen
- Date of borrowing or financing and date of come back
· Worked in a team for Claims control and was involved with prioritized claims, identified problems, ready an action plan, applied the solution, recognized claims beyond your benchmark. · Created the business process model using MS Visio and present it to SME’s for validation and getting the sign-offs. · Gathered requirements and examined requirements for documenting reviews which spotlights payer’s performance.
· Participated in Billing System Process Flow analysis and discovered revisions to the billing system documentation. · Performed data quality analysis on data by writing questions to ensure data integrity across furniture in DB2 database environment. · Documented System Design Documentation (SDD) describing the system’s requirement, working environment, database, and file design, input format, result layout, detailed design. · Analyzed customer needs and existing functions in the certain part of HIPPA transactions to determine feasibility, persistence with the set-up range of work. · Configured FACETS to stick to customers work flow for claims processing, promises automation and group administration. · Used FACETS Workflow to route the claims according to the priority.