Designation : Sr. Business Analyst Name : Bharath Kumar
Visa Staus : H1 Experience : 8+ yrs. Rate : 60/hr. Relocate : Yes. Email: [email protected] SUMMARY: •8 years of experience in Business Analysis, Requirements Management, Design, Development and Testing in health care and health insurances related assignments and also as system analyst in pharmaceutical related assignments for drug compliance and testing with FDA. Hands on experience in integrated Claims Management applications for various insurance product lines. (FACETS). •Proficiency in RUP (Rational Unified Process) and Unified Modeling Language (UML), applied RUP concepts in ECS project and have created UML artifacts like Context Diagrams, Event List, Process Maps, Use Cases and analysis models like waterfall and agile, conducted JAD and JAR sessions independently if required. •As a Business system analyst and Onsite coordinator, coordinated thousands of hours of support and development activities for P&C applications and projects. Coordination involves understanding the requirements of business partners, converting them in system requirements, impact analysis, estimation, communicating the requirements to offshore system Analysts and getting them implemented. •Expert in Claims reporting claims processing lifecycle from Insurers unique Identifiers number to Subject matter expert (SME) for the claims reports on functions and other statistics reports, Facets application system. •Experience in Drug safety system implementation such as SAS, ARIS-G, Clint race, Oracle AERS, FACETS. •Knowledge on EPIC and EPIC Interface systems, EPIC medical record system. •Experience in designing dietary, physiotherapy, Labs, Radiology, Emergency, ICU health care systems. •Extensive experience in SQL Query, PLSQL, Proc SQL, Data manipulation & Data query on RDBMS, SAS, and SPSS, UNIX and Crystal reports, FACETS. •Experienced in developing and maintaining systems documentation such as design specifications, description of application operations, methodology documentation using Lotus Notes, Jet forms & MS Visio. •Good knowledge of SOX laws, HIPAA laws and Guidelines related to electronic data transfer system by Depart of health services (DHHS) and health Insurances business, (Fundamentals of health Insurances, Insurance operations, Insurance Contracts, Loss Exposure and Risk Management) •Expert knowledge on Medicare (part A, B, D), Medicaid, HMOs, PPOs, Medical, Medigap Insurance business, FDA policies, Medicare Modernization Act (MMA) of 2003, Title 21 CFR Part 11, 21 CFR Part 820, ISO, DCF, Six Sigma, and Capability Maturity Model (CMMI), HL-7, Extensive Managed Care and Health Care systems domain experience and (Pharmacy claims processing and benefits management (three stages in the drug coverage scheme). •Expert on Claims enrollment, Editing, Authentication and arbitration, membership and provider data conversion on eligibility. •Expert on Center for Medicare and Medicaid guidelines for compliance and marketing analysis. •Expert on Siebel (OBIIE) tools and Business objects reporting applications, Crystal reports, Data Modeling, Data mapping, Designer and Central Management Console. (as a business analyst -roles and responsibility) •Experience in providing requirements for creating membership enrollment module for community members to enroll in to the plan (HIPAA270 Module): COB, Co pay, deductibles. •Good knowledge on membership enrollment and health care regulations (HIPAA). •Self-starter and hands on problem solver with excellent communication skills capable of delivering in a dynamic and demanding work environment. Have experience also as domain expert providing information to software companies to design User and customer friendly MIS for health care entity and at the same time make sure that corporate compliance and HIPAA compliance were met while designing health care MIS. •In depth knowledge of Software Development Life Cycle (SDLC) with thorough understanding of various phases like Requirements Analysis, Design, Development and Testing •Well versed in documentation of Business Requirements Documentation (BRD), Functional Specification Documentation (FSD), Context Diagrams, Current- and Future-State Process Models, Performance Indicators. •Excellent presentation and communication skills combined with a proficiency in problem abstraction, business modeling, interpersonal, leadership skills, and ability to work in a cross functional team •Ability to perform independently and write coding or query and discrepancy testing in SAS and also in SQL. •Ability to perform independently on reports and analysis tools such as Seibel analytics, crystal reports with the requirements. •Implemented: MYOB system for VP pharmacy, Advance physician software for O Connor hospital, SAS for Merck pharmaceuticals, business objects division like crystal reports, data integrator, budgeting. •Integrated QNXT environment (Facets), wrote test queries into Facets for eligibility verification for claims enrollments, validation, claims editing, arbitration, and adjudication, claims processing, leads with multiple level users through interfaces within and outside the organization. •Evaluated core systems and provided recommendations, expert in process integration between two companies. Performed as a BA to write BRD for system integration between two application. •Extensive experience in financial concepts like Income statement accounts, balance sheet statement and reconciliation statements, breakeven and marginal cost calculations, ROI and DCF for future cash flow projections. •Reviewed the HIPAA (270, 271, 275, 276, 835, 837) / X12/ NSDC compliance documents and provided data mapping requirements for migration. •Expert on health policy reviews, provide value added options on top of requirements based upon evaluation and assessment conducted through HL-7 and FACETS Claim data interfaces with all the covered networked hospitals to increase the enrolments. EDUCATION: •Masters in Health service Management •Masters in Health care Administration •HIPAA & HL-7 License •Bachelor in Pharmacy
