•Over 5+ years’ experience working on Mainframe Applications, ASO, Medicaid Claim processing System, Facets Eligibility/Enrollment transactions, Welfare eligibility, HMS applications, Clinical Applications, EMR applications, Billing applications, Healthcare Payer Provider, Managed Health Care(MHC), Management and Care Management, Insurance Applications, Health information exchange (HIE), (HIX) systems and investment application.•Knowledge on healthcare insurance payer systems, Security, Compliance, Healthcare Reform implementation, reporting, integration, equivalent consulting experience•Experience with HIX Application, Benefit Plans, Claims Payment Cycle, Waiver Programs and Reference, Obama Care, Affordable Care Act (ACA) Applications, QNXT configuration, Billing applications, Life Insurance Application, Managed Care Organization system, Epic applications, MMIS, Medicaid and Medicare claims and Eligibility processing systems. •Expert level knowledge of HIPAA X12, 4010 and 5010 / ICD 9, ICD 10, version for all EDI transactions like (820, 834, 835,837, 270, 271) CPT-10 & Medical Terminology.•Business Analyst with solid understanding of Business Requirements Gathering, Business Process Flow and Business Process Modeling, Business Process Analysis.•Experience in Tracking Requirements, Changes and Defects using tools like HP Quality Center 10.0 and JIRA throughout the lifecycle.•Experienced in Medicaid Information Technology Architecture (MITA) & Medicaid Enterprise Certification Toolkit (MECT)•Proficient in using UML for Business Process Modeling, Use Cases, Activity Diagrams, Entity Relationship Diagrams, Sequence Diagrams, Collaboration Diagrams, Class Diagrams and document them using Rational Rose and MS Visio.•Experience working on Facets Healthcare system, Business Intelligence tools, employee benefits, health insurance, defined-benefit pensions, healthcare payer operations and Reporting applications.
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Business System AnalystCvs Care Ltd Nov 2017 - PresentLondon, County (Optional), Gb•Analyzed the claims process, gathered requirements and framed on a functional requirement document.•Acted as a liaison between stakeholders: system users, clients and managers, who have a business problem and software development team to gather requirements.•Created targeted Questionnaires for SME’s to gather requirements.•Conducted JAD sessions with management, SMEs (Subject Matter Experts), vendors, users and other stakeholders for open and pending issues to develop specifications.•Involved in Requirement Scoping and analyzing high priority requirement for implementation.•Created Business Requirements Document and converted them into System Requirement specifications Document.•Followed a structured approach to organize requirements into logical groupings of essential business processes, business rules, and information needs, and insures that critical requirements are not missed.•Attended meetings with the management team to discuss the status of the project and draft strategies for implementation.•Produced functional specifications and led weekly meetings with developers and business units to discuss outstanding technical issues and upcoming deadlines.•Followed the RUP methodology.•Participated in Design walk-through with SME’s to baseline the business architecture.•Prepared Logical Data Models that contains set of diagrams and supporting documents containing the essential business elements, detailed definitions, and descriptions of the relationships between the data elements to analyze and document business data requirements. •Coordinated with the development team, database team, data warehousing team and QA team throughout all phases of the RUP methodology.•Used SQL to query data and generate data and ADHOC reports. Environment: MS Visual Basic, SQL Server, MS Visio, Windows XP, MS Project, MS Access, MS PowerPoint, MS-Word, MS-Excel, Test Director, Load Runner, Rational Suite -
Business AnalystSt. Joseph Health Systems Feb 2017 - Oct 2017•Studied the existing business process and created AS-IS workflow to illustrate the existing system.•Gathered requirements from the users through interviews and surveys.•Involved in the elicitation of user requirements and system specifications for the creation of the Business Requirements Document. •Updated the requirements and prepared comprehensive Business Requirements Document (BRD) that provided the appropriate scope for the users and management to make appropriate decisions.•Defined frameworks for the application developments and analyzed the areas of improvement.•Identified the actors and developed Use Case Diagrams, business flow diagrams using MS Visio.•Created Data Flow Diagrams (DFDs), ER Diagrams for database modeling and Web-page mock-ups using MS Visio for acceptance from analysts, surveyors and customers•Documented the user requirements into Functional Requirements Document (FRD) and Non-Functional Requirements Document (NFRD) for the development team to better understand the application requirements and also managed changes to those specifications. •Acted as a resource in understanding how the upgraded system carries out the business functions for the Development and QA teams, assisted in ensuring the timely and effective implementation. Environment: Windows, MS Office (MS Word, MS Excel, MS PowerPoint, MS Visio), MS Access, UML, SQL, RequisitePro, Agile, Rational Rose, Quicktest Professional
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System AnalystWellcare Group Dec 2013 - Jul 2015Ramat Gan, Tel Aviv, Ru•Created targeted questionnaires for SME to gather requirements and understand the business process goal from them.•Worked with Life Insurance Application, Health Insurance Claims Processing system and HIS Applications.•Involved in reviewing and writing BRD, URS and Functional Requirements for MDM Business and Data Quality Requirements for Health Insurance Exchange (HIX) and Health information exchange (HIE) system.•Collaborated with the stakeholders in defining the scope of the project in context to the MMIS (Medicaid Management Information Systems) regulations.•Worked on analysis of common APIs for IBM Curam Agenda Player and dynamically load agenda pages based on admin configuration.•Worked with data reporting tools, Business Intelligence tools, Cognos 10, Crystal Report.•Monitored day-day activities responsibilities include JAD sessions, leading a team of analysts and MMIS specialists in the development of a requirements analysis, advanced planning document and request for proposal. •Created business requirements and helped system analysts in converting them into System Requirement Specification (SRS) document for MDM Business and Data Quality Requirements.•Used Rational Requisite Pro to document stakeholders’ requests, software requirements specifications and traced it to use cases.•Created formula's for Crystal Report and stored it on the Crystal Repository to be used across the organization. •Discussed defects with analysts and then made decisions about modifications and changes.•Performed JAD sessions and interacted with stakeholders to discuss problem issues and describing common goal of project.•Resolved issues between front-end developers, middle-tier developers, QA team, and provided suggestions/feedback.Environment: SQL, Windows 2000, IIBA, BABoK, AGILE, uniBasic, Linux, ATDD, IBM Curam, BI, Java, SFDC, Facets 4.x, Rational Suite, XML, Power MHC, Epic Cerner, Visio and MS Project Erwin, MS Office Suite (PowerPoint) -
Process Analyst/ Financial AnalystState Government Of Karnataka May 2012 - Nov 2013•Developed budgets for Karnataka State government divisions for employee labour, materials, service vendor costs, and travel.•Worked with SAP BI to generate budget reports, actual versus budget monthly reports, and coordinated budget revisions.•Monthly met with division managers to review budget performance.•Provided analysis, recommendations for cost improvements.•Prepared monthly executive business flash reports.•Created monthly close journal entries, accruals, and variance analysis and cost reports. •Prepared and reported income statement, balance sheet data and cash flow actual/forecast utilizingSAP in accordance with GAAP.•Developed financial forecasts and documented policies and procedures.•Traced and reported project costs.•Tested Business Objects reports gathered and communicated requirements.Environment: SAP Business Intelligence, Business Objects, BEX Analyzer, Microsoft Office: Excel,Access, PowerPoint and Word, Outlook, Lotus Notes.
Frequently Asked Questions about Tj E
What company does Tj E work for?
Tj E works for Cvs Care Ltd
What is Tj E's role at the current company?
Tj E's current role is Business System Analyst at CVS Care Mark, Plano, TX.
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