Businesss Analyst Healthcare

PRESENT COMPANY: 
CRANE GLOBAL SOLUTIONS LIMITED
 
PRESENT DESIGNATION:  SR. BUISNESS ANALYST 
 
PRESENT PROJECTS:    
HMIS (Health Management Information System)

• Created FRS document.
• EMR Regression Testing.
• Participates every day client video interaction.
• Created BRD and Project Charter. 
• Participated Architecture and technical concepts knowledge sharing training given by Client.
• Provided training for Development and testing team regarding US Healthcare domain and EMR/EHR work flows.
• Scrum meeting.
• Participate every day client video interaction.
• Analyzed project documents. 
• Provided Requirement gathering and Use cases document. 
• Raised queries about the project.
• Daily stand up meeting with the team.
• Participate every day client meeting regarding project related issues.
• Requirement gathering from client regarding this project.
• Client interaction.

 

• Working on BID and proposals.
• Presales-Client demos and client requirement gathering.
• Identify Resource Requirements
• Study and understand customer RFP requirements
• Get an in-depth understanding of product
• Manage the bid qualification process for new opportunities
• Contributing to the written proposal - both in terms of content and presentation (such as preparation of a management summary)
  Understand and help resolve complex technical, strategic and business issues.
   

 
 
PREVIOUS COMPANY: 
Red Lizard Studios, Chandigarh.
 
DESIGNATION:  BUISNESS ANALYST 
 
PRESENT PROJECTS:    
 
Worked on below projects on Agile/scrum methodology.
 

1. PATIENT CENTRIC CORE EMR/EHR –

 

• Created FRS document.
• EMR Regression Testing.
• Participates every day client video interaction.
• Created BRD and Project Charter. 
• Participated Architecture and technical concepts knowledge sharing training given by Client.
• Provided training for Development and testing team regarding US Healthcare domain and EMR/EHR work flows.
• Scrum meeting.

 
 
 

2. PROXY SERVER PROJECT which INTEGRATES EMR with THIRD PARTY WEB SERVERS-

 
 

• Participate every day client video interaction.
• Analyzed project documents. 
• Provided Requirement gathering and Use cases document. 
• Raised queries about the project.
• Daily stand up meeting with the team.
• Participate every day client meeting regarding project related issues.
• Requirement gathering from client regarding this project.

 

3.   APSS Phase 1 and Phase 2 Project which Integrated EMR with Government Hospitals to send a consultation request to specialist.

 
 

• Analyzing the Client  Requirements
• Converting requirements to user stories with acceptance criteria and use cases.
• Reviewing the Test cases for the project.
• Client interaction.
• Providing Demo to Developers and Testers.

 
PAST COMPANY:  VERSANTE SOFTWARE TECHNOLOGIES
 
PAST DESIGNATION:  BUISNESS ANALYST  
 
 
PROJECTS Worked: 
 
 

1. EDI 270/271-Claims Inquiry/response-

 

• Provided 270 and 271 “Data Element and Description of Data Element, LOOP ID, Segment ID, Reference designators information list”.
• Provided the above documents according the client requirements and as per the Insurance companion guidelines.
• Provided 270/271 EDI standards to the Developer and testers.
• Participated meetings with QA, DEV and Project Manager.

 
 
 
 

2. Electro Bills Project.

 
 

• Created Functional Requirement Document.
• Participated client requirements meeting.
• Change Request document.

 
 

3. IIPH Public health project.

 

• Created BRD and FRS.

 
 
 
Roles and responsibilities:
 
 

• Proficient in preparing Business Requirement documents (BRD) and Functional Requirement Documents (FRD).
• Gathered functional, business and technical requirements using individual and group meetings.

 

• Extensive experience with process modeling using UML, flow charts, system data flow, task diagrams, and use cases.

 

• Experienced in all phases of the Software Development Life Cycle (SDLC) including requirements gathering, analysis, design, and implementation.

 

• Worked closely with IT personnel and business partners to identify and maximize opportunities to improve products services and program business processes.

• Participated in Code Reviews, System Testing and UAT followed by production verification, post production testing and support. 

 
PREVIOUS COMPANY:  Lumeris Healthcare India Pvt Ltd (Software solutions for US Healthcare). 
 
Lumeris Locations: Lumeris headquarters is located at 13900 Riverport Drive, St. Louis, Missouri 63043. AUSTIN, TX 9050 N. Capital of Texas Hwy. Suite 210. Austin, Texas 78759; BOSTON, MA 179 Lincoln St. Boston, Massachusetts 0211  & Aditya Trade Center, Ameerpet, Hyderabad.
 
PREVIOUS PROJECT:  EHR/EMR
 
PREVIOUS DESIGNATION:  My role as a ”Associate Business Analyst  ” for EHR/EMR for PMS system for 2 years from June 2014 to August 2016.
.
 
Roles and responsibilities:
 

• Interacting with team leads ,Managers for requirement gathering
• Involved in EMR sync-up meeting with Product ,QA, Interface and CDSS teams to discuss on EMR related issues and deliver the quality product to providers.
• Report issues & follow up with the developer until issues are closed
• Coordinating the Offshore/ Onshore teams.
• Claims Testing.
• Involved in meetings, walkthrough’s and Peer reviews.
• Worked in Medicaid, Medicare, Business Rules team to document various requirements, functional, non-functional, business rules.

 
Additional Roles and responsibilities:

• Worked in Medicaid, Medicare, Business Rules team to document various requirements, functional, non-functional, business rules.
• Worked on GAP analysis of ICD 9 and ICD 10.
• Analyzed the detailed user needs, gathered requirements during inception phase, documented and delivered Functional Specification Documents (FSD) and assisted architecture analysis and design using UML and Rational tools.
• Hands on experience on electronic medical record management system (EMR) and electronic health record (EHR).
• Performed gap analysis of ICD 9 to ICD 10 conversion for procedure and diagnosis codes in accordance with the HIPAA compliant, CPT, HCPCS modifiers and HL7 compliance.
• Designed and developed Use Cases, Activity Diagrams, and Sequence Diagrams using UML.

• Validate practice billing information provided on System Setup Spread-sheet, Identify potential risk for practice claims and work with customer to make corrections as needed.
• Create test claims and submit to respective clearinghouse.
• Work with Internal Teams (EDI) to resolve any errors found in the Practice Management system (Clear practice EMR product used for Medical Billing), ensuring that system is 100% accurate before client is live.
• Reviewing live claim submissions of client, reviewing Clearing house & payer level claim acceptance and rejection numbers, analyzing claim rejections.
• Work with EDI Team & other internal teams to fix Claim rejections.
• Presenting the analysis & solutions to client on Cash Flow calls & also helping client to resolve their billing related queries.
• Ensuring Optimized cash flow for client by delivering highest level of customer service post go live.
• Documentation of client functional requirements.
• Worked on ICD AND CPT Code analysis.
• Worked on PMS module of EHR Issues.
• Worked on ICD 9 to ICD 10 crosswalk for EMR/EHR application.
• Worked on HIPPA 4010 conversion to 5010.
• Worked as an end user to suggest improvements in the system.
• Support to the Senior Business Analysts.
• Recommending changes/upgrades.
• Worked on all EMR/EHR work flow analysis.
• Provided UML diagrams using ms-office and power point tools.
• Update Developers and testers during release about system bugs and client application issues.

 
Worked for 5 years as a “EMR Application Analyst for US Healthcare Insurance/Clinical/ Hospital administration (EMR/EHR Practice Management System)” in Purkinje (Lumeris) Healthcare Private Ltd since 2007 December to 2014 June.
 
 
Additional Roles and Responsibilities:
 

• Worked as “Healthcare Analyst“ Hospital/inpatient and outpatient billing services” like in-depth back office billing experience, including a thorough understanding of the requirements for generating appropriate patient bills, including knowledge of Medicare, Medicaid, private insurance requirements.
• Good understanding knowledge of front office scheduling and access management, including the requirements for ensuring proper scheduling and registration of the patient. 
• Serve as the revenue cycle demo team's application expert, ensuring the system set up supports workflow decisions and prospective client needs 
• Demonstrate expert level knowledge of EMR revenue cycle management, access management and enterprise scheduling solutions.
• Communicate with end users of the EHR system to understand issues encountered and develop solutions.

• Responsible for the accounts receivable of 5 different clients i.e.[Primary care Joliet, Dr. Neskovic LLC, Dr. Kemp Family Practice LLC, Dr. Carlton Family Practice and Dr. Lawson Family Practice]  Posting, credentialing, denial management and follow up’s.
• Working on Denial Management and Month-end-Work Reports.
• ERA (Electronic Remittance Advice: Checking ERA payments of insurance like Medicare and Commercial Insurance (BCBS) in our application applied correctly or not.  If payment applied wrongly by ERA, need to analyze the claim and manually we will correct the claim.  If the claim is denied, as per ERA denial code/remark code and remit codes, we will give the appropriate action for that denial in our application.
• Clearing House Reports:  Working CH reports on daily basis which includes Claim exclusion reports and Standardized
• Responsible for entire billing process, accounts receivables management, coordinating with the team members for resolving day-to-day issues, coordination with US team and  maintaining process flow and ensuring that all processes are followed / executed and that deadlines are met.

• Worked with the clearinghouse and the payers to ensure all claims were processed and received by the insurance companies in a timely manner. Reduce clearinghouse denials.
• Supervising the day to day operational and administrative activities, ensuring that all processes are followed / executed and deadlines are met.
• Analyze the top denials for each client and identified solutions to increase cash and decrease A/R days.
• My job involves attending the EMR sync-up meeting to update the new enhancement or issues in current EMR software make it as user friendly.
• Maintained a strong relationship with all clients and presented trends to them on a monthly basis.
• Conducting team meetings (process updates, metrics, and targets for the day...).
• And also work 835 ERA edits files, No Pay Claims and Credit Balance Claims (Refunds to Insurance). Coordinating with QA and Development teams at the time of software realizes to fix the bugs.
• Run the Moth End Financial Packets: on 1st day of every month run the month end financial packets and updating to onsite manager to submit the clients for payments.

           

• Worked on AR Analysis of clients outstanding work on above 180+ days claims to find out
• Analysis of Credit Balances Claims (Refund to Insurances): Analysis the overpayments claims and prepare statement in spread sheet and send to client for issue of return payment to the insurances.
• NO PAY Claims from 835 Remittances.

• POSTING EOB'S: After receiving the Remittance Advices from payer, posting the payments the payments to the respective patient a/c's balances (Co-pay, deductible, coinsurance) bill to Secondary Insurance through Paper claim with attaching the Primary insurance EOB copy or bill to Patients a/c's. 
• INSURANCE DENIALS: After submitting claims to insurance. Payer will reject the claim with many reasons with rejection codes, analyze the claim rejection codes and make the correction and re-billing the insurances. I am familiar with BCBS, Medicare, Medicaid & all other Commercial Insurances denials codes.

 

• Worked on insurance data related to Medicare, Medicaid claims and reimbursement and other and insurance claims.

 
 
Worked for 5 years (February 2002 to December 2007) as a Medical Language Data Analyst in US Healthcare BPO . Having good knowledge in medical terminology and having been trained in Medical Coding ( ICD & CPT  CODING) by a CPC certified doctor.  I am internally certified on HIPAA.  Trained in Surgery coding for all specialties in Medical Coding.
 
Clinical documentation work handled for specialties:
 
1). Constitutional.  2). Eyes. 3). HEENT. 4). Cardiovascular. 5). Respiratory. 6). Gastrointestinal. 7). Genitourinary(Men/Women). 8). Musculoskeletal. 9). Integumentary. 10). Neurological.  11). Psychiatric.  12). Endocrine. 13). Hematology/Lymphatic.  14). Allergies/Immunology.
 
 
Additional Healthcare Skills: 
 
Strong Knowledge on US healthcare documentation codes includes ICD 9CM, CPT4, SNOMED CT & ANSI X12 EDI transactions & security and confidentiality compliance HIPAA.
 
Knowledge in EHR interfaces which includes HL7 interface, New Corp, Sure Script, , DIACOM, PACS, Emdeon, First data bank, , CPT  & ICD code analysis, SNOWMED CT, NCPDP, and Rxnorm.  Good understanding on EHR interfaces developed for billing application, Providers, lab orders, Pharmacies (eRx).
 
Business Analysis & Requirements documentation for HIS Products.
Expertise in E&M Guidelines 1997 & Good understanding in MUG stage 1 & stage 2 requirements. 
 
 
Core Activity includes: EHR/EMR work flow Analysis and physician specific Clinical Configurations.  Problem solving & analytical skills for understanding the business requirement, work flows process and design of the application flow.
 
Worked on EMR/EHR PMS application in different aspects of US Healthcare like Revenue Cycle Management and EHR clinical application.
 
 
Clinical Content Development for EHR application:  Can create 15 specialties clinical templates which includes specific HPI’s, examination, ROS & procedure templates. Developing Clinical content & Revision of existing clinical content in live clients.  Validating of clinical templates to meet the level of E&M guidelines 1997.
 
 
Clinical Content Development Templates/questionnaires includes symptom specific HPIs & physical Exams & Procedures, custom Hx templates, Specialty wise Standardization of ICD &CPT date & Building of clinical forms using Visual Form Editor.
 
Good understanding in AAMT rules and Medical terminology.