Candidates About

 

Suhail Gazi

Summary:

·         Experienced Senior Business Analyst with over 8 years of diverse experience in Information Technology with expertise in the Healthcare space.

·         Functional knowledge in developing and implementing Claim Processing Systems.

·         Experience with HIPAA 4010 / 5010, ICD9, and ICD 10.

·         Exposed to ICD 9/ICD 10 coding standards in Medicare and Medicaid domains of the healthcare systems and industry for both Inpatients and outpatients.

·         Experience in various versions of ANSI X12 4010/5010 and worked on EDI (270/271,276/277, 837I) transactions.

·         Experience in Medicaid Management Information System (MMIS).

·         Strong Experience in Claims Processing and Claims Scrubbing in HMO, PPO, Medicaid and Medicare. 

·         Experienced in understanding Business processes and creating As Is models and To Be models and conducting GAP analysis

·         Expertise in implementing the Agile , Rational Unified Process and Waterfall Methodologies throughout the Software Development Life Cycle of the project

·         Interacted with the Stakeholders, End Users to understand and gather stakeholder requirements and create the Business Requirements Document (BRD) and Functional Requirement Document (FRD) and communicating it to the entire team involved

·         Implemented Unified Modeling Language (UML) methodologies to design Use Case Diagrams, Data Flow Diagrams, Activity Diagrams, Sequence Diagram and ER diagrams

·         Lead JAD session and requirements review meetings with all functional groups and participate in industry events.

·         Good experience of Data Warehouse techniques.

·         Strong experience in the creation of Test Plan and Test Cases from the Requirements document. Documentation of the Test Plans, Test Cases, Test Scripts, Test Procedures based on the Design Document and User Requirement Document for the Unit, Integration, Regression, Functional, Performance, and User Acceptance Testing (UAT).

·         Trace and inform business requirement changes through the lifecycle of the project using Rational Requisite Pro while maintaining customer needs and maintain a Requirements Traceability Matrix (RTM) to keep the stakeholders informed of the progress of the project.

·         Expert level skill in VISIO, MS Excel, PowerPoint, Access, Word and MS Project.

 

Work Experience:

 

Rex Healthcare Hospital. Raleigh NC                                                                      Jan 2015 - Current

Senior Business Analyst

The Rex Healthcare Hospital has to comply with CMS mandated ICD-10 requirements within very tight deadlines. The scope of the project is to collect the detailed information from various areas of the hospital and gather the requirement regarding all the applications, which are currently in use in hospital. The purpose of the project is to define the roadmap for implementation and analyze the collected data in order to fulfill the change from ICD-9 to ICD-10.

 

Responsibilities:

·         Perform a baseline assessment of Hospital-Provider systems and related interfaces, the existing service level agreements and/or policies and operational business procedures for readiness to comply with HIPAA as well as ICD-10 requirements.

·         Have strong experience in requirements gathering by conducting interviews with end users

·         Actively worked on Data analysis and Report analysis with respect to ICD-10 impact.

·         Extensively worked on Data Mapping and ETL.

·         Analyzed System flows of various department of the hospital.

·         Identified risks, problems, requirements and concerns of the Hospital in order to comply with ICD-10 changes. Assisted JAD sessions to identify the business flows and determine whether any current or proposed systems are impacted by the EDI X12 Transaction, Code set and Identifier aspects of HIPAA.

·         Highly involved in understanding of department workflows and process flows with respect to applications. Developed business process models in RUP to document existing and future business processes. Improved process for payment of Medicare Secondary Payer claims through revised workflows.

·         Collected the information related to ongoing application upgrade and their impact on ICD-10 implementation and created awareness within the departments regarding the need, impact, benefits and risks of ICD-10 code application.

·         Designed and developed user interface screens for visualization of reports and various user inputs with cross-functional teams.

·         Re-Organized the collected data and prepared documentation for implementation.

·         Involved in providing education about the ICD-10 codes and 5010 standards, its requirements, complexity and accuracy to Physicians and Nurses of the hospital. Figured out the requirement of training in various departments of the hospital based on their daily work.

·         Performed impact analysis on applications for deadliness of ICD-10 conversion.

·         Responsible to meet the information demands of our business users by delivering timely, accurate, meaningful and standardized data and reporting.

·         Mapped the collected data with the existing data provided by the hospital departments.

·         Used Word, Excel and Visio as a working tool.

·         Hands-on experience and good understanding of the hospital working system including Registration, Scheduling, Radiology, Laboratory, Pharmacy, Patient Accounting, HIM, Claim Processing etc.

·         Met the deadlines and scheduled day to day meeting sessions.

 

Florida Healthcare Plans. Holly Hill, FL                                                                       Jun 2012 – Dec 2014  

Business Analyst

Florida healthcare plans is an HMO that provide services to Volusia and Flagger counties in Florida.

The goal of the project was to make enhancements to the Claims processing module of the Group Approval Process for the ICD-10 program. The claims processing module incorporated the Receiving and Verification of Claim Forms (837) Claims Enquiry and Response (276/277), Adjudication, Healthcare Claim Remittance/Payment Advice (835). This project used agile methodology.

 

Responsibilities:

·         Facilitated all aspects of the scrum framework, including sprint planning sessions, backlog grooming sessions, daily scrums, product demos, sprint reviews and sprint retrospectives.

·         Supported and consulted product owner in developing, maintaining and grooming product backlog.

·         As Scrum Master maintained the capacity plan, iteration board, sprint backlog, velocity charts and burn down charts

·         Identified and removed impediments to the success of the sprint by working with every single team member.

·         As Scrum Master communicated dependencies and potential risks to the completion of the sprints including resources, costs and systems.

·         Conducted JAD sessions, workflow diagrams, UML diagrams, process models, activity diagrams, use cases, for incorporating design changes in the order creation/ management system.

·         Actively participated on creating Migration strategy from existing PDE (Microsoft Access files) to G-old Data Repository.

·         Clearly understood coding standards required for all Medicare Part D Users transactions involving electronic data interchange as provided by department of health and human services and incorporated at every stages of the project wherever found necessary.

·         Prepared the Business requirement Document (BRD) and functional requirement document (FRD) for the enhancement of the existing services.

·         Analysis and Design of existing transaction sets, and modification of these transaction sets to ensure HIPAA compliance.

·         Did data analysis, created data mapping and data interface documents and kept the documents updated with changes in requirements and functional specifications.

·         Worked on developing the business requirements and use cases for Facets batch processes; automating the billing entity and commission process.

·         Coordinated the upgrade of Transaction Sets 837P, 835 to HIPAA compliance.

·         Worked on the EDI 834-file load to Facets through MMS (Membership maintenance sub-system).

·         Involved in impact analysis of HIPAA 5010 835 and 837P transaction sets on different systems.

 

AARP. Washington, DC.                                                                               July 2011 – May 2012 Senior Business Analyst

AARP is a nonprofit, non-partisan membership organization that helps people 50 and over improves the quality of their lives. I worked on Claims processing module of the Group Approval Process (GAP).  The claims processing module involved Receipt and Verification of Claim Forms (837) and Claims Attachments (275), Claims Enquiry and Response (276/277), Adjudication, Healthcare Claim Payment/Advice (835) as per HIPAA guidelines for 4010-5010 conversion.

 

Responsibilities:

·         Addressed the changes made to the Medicare program and created requirements mapping to that of the system requirements.

·         Gathered and documented business requirements from SMEs, user groups and vendors via workshops, interviews and surveys.

·         Worked in close collaboration with the Project Manager and business users to gather, analyze and document the functional requirements for the project.

·         Worked in Healthcare Claims Administration – Healthcare Claims Processing (837/835) includes facility claims and professional claims. Worked with Team for HIPAA Claims Validation and Verification Process (Pre-Adjudication).

·         Facilitated and managed meeting sessions with committee of SME's from various business areas including Benefits Administration, Health Claims Group, HIPAA Administration, Health Policy and Program Evaluation Team and Data Management Group.

·         Created Functional specifications for the 834 enrolment files with their changed benefits in the Medicare program.

·         Gathered and documented requirements for Pharmacy benefit managers (PBMs) for health insurance carriers.

·         Submitted change requests and worked with change request records in Clear quest.

·         Participated in entering, tracking system defects in Rational Clear quest.

·         Involved in Configuration Management, Requirement management and analysis.

·         Provide technical and procedural support for User Acceptance Testing (UAT).

 

Misys Healthcare. Austin, TX.                                                                         Jan 2010 – Jun 2011

Business Analyst

Misys Healthcare Systems, a member of the Misys Group of Companies, develops and supports reliable, easy-to-use software and services of exceptional quality that enable physicians and caregivers to more easily manage the complexities of healthcare. Misys Fast Services System (MFSS) is a HIPAA compliant system designed for both real-time & batch environments, it caters to the needs of the various Misys systems such as Tiger, Vision, Payer path and third party clearing houses. In this project my major role was to prepare the detailed business requirement document, test case documents, test scenarios and data sets. I also had a key role in many business decisions as I worked closely with the Project Manager and Technical leads. The project objectives were achieved by streamlining and standardizing of the business process, the project included upgrading the ADT (Admission, Discharge and Transfer) HL7 messaging system. As a part of the huge scope of the project, I have worked on various ADT messages like A01 (Admit a patient), A04 (Register a patient), A05 (Pre admit patient) and A08 (Update patient information).

 

Responsibilities:

·         Responsible for writing Functional Requirement Specifications (FRS).

·         Worked with business representatives to understand requirements and priorities and ensure that software development work is appropriately aligned

·         Involved in the meeting with Business Process Owners, SME (Subject Matter Experts) and Health Center users for Requirement gathering in Definition Stage using Rational Requisite Pro.

·         Facilitated Joint Application Development (JAD) Sessions, as well as weekly client & team meetings

·         Interacted with the Subject Matter Experts (SME) and stakeholders to get a better understanding of client business processes and gather business requirements.

·         Performed Gap Analysis to identify the deficiencies of the current system and to identify the requirements for the change in the proposed system.

·         Involved in creating sample mappings for the conversion of ADT HL7 Transaction code sets(A01,A04,A05 and A08)

·         Organized impacted systems into high, medium and low impact to help business analyze the level of effort for remediation activities and ease resource allocation work.

·         Prepared use cases and data flow diagrams to analyze the impact of ICD 9 diagnosis codes embedded in different systems and applications

·         Managed list of vendors and trading partners that were impacted by HL7 Version 2.3 Messaging system and required remediation work to be compliant.

·         Worked with the compliance and audit team to make sure we were following correct HIPAA guidelines/protocols throughout the project lifecycle.

·         Worked with a large amount of clinical data in a data warehousing project.

·         Responsible for making data mapping documents and data profiling including column assessment, natural key finding and business rule validation system

·         Worked very closely with the data modelers during the physical and logical data model creations.

·         The project involved mapping and analyzing the clinical data and other patient information required to process the HL7 messages.

·         Independently drafted documents like Data mapping documents, Release notes and data dictionaries.

·         Served as a liaison between technical and business team for explaining the structure and composition of the data warehousing concepts and analysis.

·         Participated in user meetings, gathered Business requirements for the Data- warehouse design.

·         Created various Use Cases and workflow diagrams, sequence diagrams, and Class diagrams using MS Visio and used UML methodology to define the Data Flow Diagrams (DFD.)

·         Developed user stories, project backlog, and prioritization for timely & smooth execution of the project.

·         Maintained Traceability Matrix in Excel.

·         Used IBM Rational Clear Quest as Version Control/Change Management Tools.

 

Fallon community Health Plan. Worcester, MA                                             Oct 2007 – Dec 2009

Business Analyst

Fallon community Health Plan, a not-for-profit HMO provides health insurance products and related services to more than 200,000 members throughout Massachusetts and New Hampshire. Company’s health insurance offerings include HMO, PPO, Point of service (POS), traditional indemnity, Medicaid and Medicare. Project involved developing Online Account Creation application, which dealt with billing application, checking billing history, updating customer profile, placing order for insurance ID cards and changing load provider details.

 

Responsibilities:

·         Conducted focused interview sessions with SMEs, project stake holders and Business users so as to obtain maximum details of requirements and involved in documenting business Requirements Documents.

·         Ensured credibility and accuracy of business specifications by carrying out brainstorming sessions, development meetings and other collaborative efforts.

·         Developed thorough Functional Requirements Document (FRD) by applying analytical questioning and critical reasoning to business user requirements.

·         Conducted interview sessions with SME’s and different application owners so as to ensure the credibility of GAP analysis.

·         Business Process Modeling: Business process improvement and optimization, Document and model business processes, automated workflows and Manage business rules.

·         Careful documentation of business requirements ensured that they are aligned with UI from the initial stage itself.

·         Substituting legacy systems which were originated through unplanned, stovepipe development with detailed enterprise architecture models.

·         Developed various modeling diagrams using UML.

·         Detailed knowledge of business process to help determine the user needs.

·         Proper use of RTM (Requirement traceability matrix) so as to capture all the features of the project.

·         Performed application functionality user acceptance testing experience (i.e. front-end application testing) in a controlled testing environment that replicates the end user usability of the application.

·         Documentation of test plan, test cases and test summary to confirm the credibility of application functionality.

·         Discussed and documented post implementation summary with senior management regarding Gaps found during the project.