Candidates About

Oluwashina Martins

Summary:

• Expertise in translating user requirements into System Specifications and mapping the process design, work flows for SDLC with documenting and managing business requirements.
• Experience in conducting Gap Analysis between “as is” and “to be” systems.
• Expertise in EDI and HIPAA Testing Privacy with multiple transactions exposure such as Inbound Claims
• 834–Membership Enrollment, 837-Institutional, 837-Professional, 835-Claim Payment/Remittance Advise, 270/271-Eligibility Benefit Inquiry/Response, 276/277-Claim Status Inquiry/Response Transactions.
• Good experience in facilitating Joint Application Development (JAD) sessions to expedite and streamline the requirement gathering process.
• Proficient in UML (Unified Modeling Language), extensive experience in modeling business process using Use Case, Activity diagrams.
• Experienced in project planning management and a strong customer focus.
• Experience designing and developing SQL statements and queries for Oracle and SQL Server 2000 database.
• Clear understanding of ICD-9-CM and ICD-10-CM/PCS
• Experienced in Process Modeling (activity, state, object, sequence, class) using UML, UMM, and BPMN notations.
• Thorough understanding and hands-on working experience with standards for medical transactions like 820 (premium payments), 834 (enrollment), 835 (medical claims payments), 837 (medical claims), 270 (eligibility inquiry), 271 (eligibility response), 276 (claim status), and 277 (claim status response).
• Conducted User Acceptance Testing (UAT)
• Strong business analysis skills and thorough understanding of full SDLC
• Excellent communication, liaison and analytical skills
• Detail oriented with good sense of urgency.

Technical Skills:

Education:

BA Media and Communication: Liverpool Hope University, Liverpool England.

Advance Diploma: Business Analysis and Information Systems, Taitec College, Manchester, England.

OAEZ Solutions, Elmont, NY                                                                                                       March 18 – Present

Business Analyst

Project Description:

OAEZ solutions provide IT solutions for start-up business. I liaise between the clients and off-shore dev team on multiple projects, creating requirement document, application UI sketches (wireframes), Test Plans, Test Scenarios and Cases.

Responsibilities:

• Elicited functional and non-functional requirements, conducting and facilitating requirement sessions.
• Analyze the feasibility of clients’ requirements by coordinating with the technical lead.
• Developing strategic partnerships with the clients to develop a solid knowledge base of the business line, including the business plan, products, and process and budget. 
• Identified the scopes and business objectives to document the functional requirements for each release.

·         Design and develop scenarios based on business requirements.

• Directly involved in process improvement, plans and implementing business change.
• Prepared BRD, FRD, NFRD, Use Cases, UML Diagrams and Wireframes.

·         Facilitated Joint Application Development (JAD) Sessions for communicating and managing expectations

• Worked with designers to develop prototype
• Conducted walkthroughs and code reviews with developers, stakeholders and users.
• Create Test Plans, Test Scenarios, and Test Cases, to be used in testing based on business requirements, technical specifications and/or product knowledge.
• Initiate Change Control Process for requirement changes made while work is in Dev.

Environment: Windows XP,MS Visio, MS Word, Excel, PowerPoint, HP ALM, JIRA, Balsamiq Mockups, Outlook, WebEx, SharePoint, Confluence.

Blue Shield California, El Dorado Hills, CA                                                                           April 17 – Jan 18

System Analyst

Project Description:

Blue Shield of California is a health plan provider serving large number of health plan members and providers across California. With BSC acquisition of Care1st Health Plan and introduction of multiple programs to increase their Medicare population, come the need to makes changes to various systems. I was involved in creating System Use Case and Boundary Specification Documents for new database, few interfaces and report jobs for Membership, Claims and Data services as a CDM/Facets System Analyst.

Responsibilities:

• Elicited functional and non-functional requirements, conducting and facilitating requirement sessions.
• Identified the scopes and business objectives to document the functional requirements for each release.
• Directly involved in process improvement, plans and implementing business change.
• Created and updated System Use Case and Boundary Specification Documents.
• Collected business requirements to set rules for proper data transfer from Data Source to Data Target in Data Mapping.
• Acted as a liaison between the business and offshore Dev. Team.
• Analyze requirements utilizing various methods. (E.g. sample data from SQL queries, Screen Shots, reports, prototype screens, sourcing information, and other data models.)
• Participated in sprint planning session to identify the features and functionalities that should be achieved, to set priorities and determine level of work in line with Agile Scrum methodology.
• Performed analysis on enterprise data/report integration & provided functional specification to the development team to build Enterprise Reporting Systems.
• Collected business requirements to set rules for proper data transfer from Data Source to Data Target in Data Mapping.
• Analyzed Facets Billing, Claim Processing and Subscriber/Member module to create solution for different interfaces and report jobs.
• Investigated system incidences to identify cause of issues, and made fix recommendations.
• Managed CDM, and performs CDM Accumulation Mapping.
• Produced clear user manuals & training guides for User Acceptance Testing (UAT) and deployment for end-clients with step-by-step instructions and appropriate GUI screenshots.
• Participated and supported system releases.
• Queried Facets backend to pull data and create system solution logics.
• Worked on Data Mapping to map Facets data to outbound 837 – Redirect Claims.

·         Facilitated Joint Application Development (JAD) Sessions for communicating and managing expectations

• Conducted walkthroughs and code reviews with developers, project managers and stakeholders and users to comprehend business work flow of applications.
• Created Use Cases diagram and Activity diagram to depict the interaction between the various actors and the systems for the Business Use Cases and System Use Cases, using Visio.
• Provided support to BSAs, Developers, QAs on their work and documentation. Reviewed and provided approval for their documents.

Environment: Windows XP,MS Visio, Facets, XML, MS Word, Excel, PowerPoint, Oracle SQL Developer, HP ALM, JIRA, SQL Plus, HPxR, Vivaldi QMS, Outlook, WebEx, SharePoint, Confluence.

Celtic Health Insurance, Chicago, IL                                                                                        Nov 15 – Jan 17

Business Analyst

Project Description:

Celtic Insurance Company is one of the leading health insurance providers in Chicago. The company currently runs its business on Facets for claims adjudication and billing and provides medical plans. I was involved in the data mapping and enhancement when the company decided to migrate from Facets 4.71 to 5.01.

Responsibilities:

• Gathered Business Requirements, reviewed design requirements to validate that Health Exchange /Medicaid/ICD projects to meets all the requirements.
• Elicited functional and non-functional requirements, conducting and facilitating requirement sessions
• Worked on Configuration Management, Requirement management and analysis.
• Participated in sprint planning session to identify the features and functionalities that should be achieved by the new application.
• Created Business Requirement Documents as a result of meetings with the Business SMEs and obtained business sign offs on the documents after reviewing the final documents with them.
• Analyzed and evaluated User Interface Designs, Technical Design Documents and the performance of the application from various dimensions.
• Maintained the Traceability Matrix Table to uniquely trace the identified business requirements to general design and testing, as proof that requirements requested have been developed into a solution and that it has been tested and tracked.
• Initiated Change Control Process for changes submitted for the BRD once the document was submitted to IT department.
• Responsible for creating solution and support for the development of  QCPR electronic healthcare/medical record (EHR/EMR) system applications encompassing order entry for physicians and other clinicians, all clinical patient data including results reporting & medication management, and ancillary department management.
• Applied working knowledge of patient registration, medical records, and other non-clinical applications for analysis work.
• Documented the UAT Plan for the project and worked with the UAT Team to ensure every acceptance criteria for the requirements has been included in the UAT task plan.
• Lead client discussions relating to the Facets configuration of a standard Medicare Advantage plan.
• Supported new business requirements by extending the functionality of the core Facets system using the Facets extensibility architecture feature.
• Involved in Facets Implementation, including end to end testing of Facets Billing, Claim Processing and Subscriber/Member module.
• Prepared Use cases and Activity flow diagrams and Work flow diagrams, considering the scope of the project with MS VISIO.
• Used SQL to test various reports and ETL load jobs in development, QA and production environment

Environment: Windows XP, RUP, UML, SQL, Rational Tools, MS Visio, Facets, XML, MS Word, Excel, Access, PowerPoint, SharePoint, SQL Plus, Oracle SQL Developer, Visual Studio, UNIX

South Shore Health Care, Long Island, NY                                                                            Oct 14- Oct 15

Business System Analyst

Project Description:

South Shore Health Care is the Long Islands Leading provider of healthcare services and PT Services include skilled nursing services, physical, occupational, neurological and speech therapy, home health aides and personal care assistants. I was part of the IT Design and Support Team for South Shore Health systems. Systems provide complete solution for electronic billing and interfaces to EMR software and lab systems. The system includes different packages like Electronic Statement, Electronic Claims Billing, and Eligibility Verification. The system was HIPAA compliant and included features like Advance Appointment Scheduler and Eligibility Verification and Referral Tracking.

 Responsibilities:

• Identified the scope, business objective and documented the functional requirements for each release.
• Directly involved in process improvement Plans and implementing business change.
• Produced clear user manuals & training guides for User Acceptance Testing (UAT) and deployment for end-clients with step-by-step instructions and appropriate GUI screenshots.
• Performed analysis on enterprise data/report integration & provided functional specification to development team to build Enterprise Reporting Systems.
• Collected business requirements to set rules for proper data transfer from Data Source to Data Target in Data Mapping.
• Architected Extract, Transformation and Load processes (ETL) to populate an operational data store from various sources including other databases like Teradata, SQL, Oracle, spreadsheets, and flat files.
• Extensively worked in the performance tuning of programs, ETL procedures and processes.
• Analyze requirements utilizing various methods. (E.g. sample data from SQL queries, Screenshots, reports, prototype screens, sourcing information, and other data models.)
• Created Data mapping documents for integration of every application with MEDITECH including EHR.
• Developed Use cases, Use case diagram, flow charts, BRD, FRD, File transfer file, Data integration document etc.
• Worked closely with the Enterprise Data Warehouse team and Business Intelligence Architecture team to understand repository objects that support the business requirement and process.
• Created use cases specifications, use case diagrams, component diagram and context diagrams to define the workflow and segregate high-level and low-level requirements using MS Visio.
• Performed data analysis and ran various SQL queries to critically evaluate test results
• Designed and implemented basic SQL queries for QA Testing and Report / Data Validation.
• Developing strategic partnerships with the business unit to develop a solid knowledge base of the business line, including the business plan, products, and process and revenue streams. 
• Facilitated the resolution of project-related issues, identified risks and mitigation steps to manage risk using PLSQL in RDBMS.
• Used Rational Requisite Pro for overall Requirements Management and to build the Requirements Traceability Matrix.
• Conducted walkthroughs and code reviews with developers, project managers and stakeholders and users to comprehend business work flow of applications.

Environment: Windows XP, RUP, UML, SQL, Rational Tools, MS Visio, Informatica, XML, SharePoint, MS Word, Excel, Access, PowerPoint, UNIX, Access, Cognos, TFS.

Premera Blue Cross, Seattle, WA                                                                                             Oct 13- Sep 14

Business System Analyst

Project Description:

PREMERA Blue Cross is a nonprofit, independent regional health plan providing members, employers, providers and brokers with high-quality coverage and service. PREMERA deals with Mainframe Applications that has different types of Transactions that supports the HC - Claims Adjudication Process System. I worked as a Business Analyst for the Meredian-Accums Project for the conversion of claims to FACETS.

Responsibilities:

• Conduct gap analysis between the current system and new requirements to be implemented thereby mapping the business requirements to the application
• Involved in training and test session on HIPAA Privacy policy.
• Prepared high level and detailed system requirements documents for the application
• Identified the requirements for accommodating HIPAA 5010 standards for 837P transactions and captured these requirements to develop new GUI for the internet based application
• Set claim processing data for different Facets Module.
• Involved HIPAA regulations in Facets HIPAA privacy module
• Involved EDI Claim Process according to HIPAA compliance.
• Coordinated with the Release Management Team in order to complete the overall release plan.
• Used Requisite Pro for writing/analyzing project vision, goals, specifications and requirements.
• Compiled Vision and Scope documents to better define the rationale for the project. Gathered requirements from business to determine the functionality that should be provided to the users.
• Mapped EHR data with other applications.
• Created business requirement documents as well as system requirement specification after the JAD session.
• Also created/executed SQL scripts to validate the business requirements for ETL and Reporting requirements.
• Involved in testing the Medical and Hospital claims in Facets based on Service, Agreement and Pricing.
• Executed queries in test databases using SQL queries.
• Provide implementation assessment, strategy, and mentoring services for Rational Rose, UML and RUP.
• Served as a resource for analytical services utilizing SQL Server, TOAD/Oracle, and SQL Developer.
• Developed and maintained the project plan using MS Project
• Designed and implemented SQL queries for QA testing;
• Tested the Web interfaces and Web Service Applications
• Worked with ANSI X12 (835, 837, 834) EDI Transactions
• Extensively used UNIX shell scripts
• Responsible in providing regular test reports to the management
• Reported the defects to the developers using Quality Center

Environment: Windows XP, Unix, RUP, Rational Rose, Facets, MS Visio, Informatica, HTML, UML, MS Word, Excel, Access, PowerPoint, SharePoint, Quality Centre, Crystal Report, SQL.

Specialized Health Care Inc., Augusta, GA                                                                           Jan 12 – Aug 13

Business Analyst

Project Description:

SHC Inc, a division of United Health Group oversees a variety of healthcare companies engaged in care management, insurance, and other support services. The company offers a diversified portfolio of health insurance products and related services to employer groups, government-sponsored groups, and individuals.

I was part of the IT Design and Support Team for E-care, a web-based technology uses databases to provide an extremely cost effective tool to validate patient demographics and verify insurance eligibility in real-time conforming to HIPAA standards. The features of E-care include online appointments, Medicare/Medicaid Eligibility, Billing Verification, Self-Pay/Commercial Eligibility, Real Time Processing, Billing Address Verification with Address History and Insurance Eligibility Verification. 

Responsibilities:

·         Elicited and documented business, user, functional and non-functional requirements.

·         Developed, communicated, and validated requirements package with business and developers.

·         Engaged with clients to understand business processes and determine their specific requirements.

·         Facilitated Joint Application Development (JAD) Sessions for communicating and managing expectations

·         Identified processes for developing and documenting detailed business requirements.

·         Ensured Use-Cases were consistent and covered all aspects of the Requirements document.

·         Made regular status presentations to senior management.

·         Worked collaboratively with business analysts, developers, testers to perform a gap analysis of the company’s existing system functionalities.

·         Worked directly with software engineers to ensure clear communications on requirements and defect reports.

·         Validate EDI Claim Process according to HIPAA compliance.

·         Tested HIPAA regulations in Facets HIPAA privacy module.

·         Conducting business validations, covering the following deliverables: FACETS Providers, Facets Claims and Facets Membership and Operational reports.

·         Tested the HIPPA EDI, 834, 270/271, 276/277, 837/835 transactions according to test scenarios and verify the data with Facets on different modules.

·         Designed and developed scenarios based on business requirements.

·         Followed RUP methodology for the entire SDLC.

·         Interacting with other teams through walkthroughs, teleconferences, meetings, etc. to resolve various issues.  

·         Validated the scripts to make sure they have been executed correctly and meets the scenario description.

·         Wrote SQL queries to perform the Back End Testing of the Oracle database.

·         Extensively worked on all kind of joins and operators to fetch data from multiple tables.

·         Assisted in implementation plans related to new/revised applications/services.

·         Worked with the client to create and execute the acceptance test strategy.

·         Obtained signoff from project stakeholders on tasks completion

Environment:  MS Project, MS Office, Quality Center, UML, JAD, SQL, SDLC, Agile, Scrum, HIPPA, Facets, HTML, Oracle SQL Developer, Visio, Jira.