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Muhammed
Hasnanhq1680@gmail.com
469-546-5233
Dallas, TX 75398
Project Analyst / Business Analyst
5 years experience W2
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Summary

An accomplished IT Professional with good experience as a Business System Analyst / Project Coordinator in all phases of Software Development Life Cycle with solid understanding of Business Requirement Gathering, Business Process Workflow and Business Process Modelling.

  • Strong experience in all phases of Software Development Lifecycle (SDLC) using Waterfall, Agile/Scrum, RUP (Rational Unified Process) and Software Testing Life Cycle (STLC).
  • Expert in analyzing, elicitation and management of requirements. Highly experienced in creating Business Requirement Document (BRD) and Functional Requirement Specifications (FRS) document.
  • Involved in maintaining performing GAP analysis, Requirement Analysis, Document Analysis.
  • Proficient in all phases of Requirement Management, including gathering, analyzing, detailing, and tracking requirements.
  • Experienced in methodologies like Agile, Waterfall Model and Data Modelling Creating Process mapping, Use Cases, Sequence diagrams, Activity diagrams
  • Solid understanding of Membership, Claims Processing, Billing, Benefit/Eligibility, Authorization/Referrals, COB, and have experience in HIPAA standards and corresponding EDI transactions.
  • Experienced in Healthcare/Claims adjudication with knowledge of industry compliance standards like HIPAA and EDI X 12 transactions (834, 837, 835, 270/271, 276/277). Thorough knowledge about QNXT and Facets.
  • Good understanding of health care industry, Claims Management process, Medicaid and Medicare Services PBM incorporate complete Member Enrollment and Eligibility check, Drugs Prescription, Plan design, Claim adjudication and Verification, Call chain, Rx enquiry, Clinical requests handling etc.
  • Experienced working on HIPAA implementation guides relate to Claim Testing and Medical Billing
  • Involved in Test Planning, Test Preparation, Test Execution, Issue Resolution and Report Generation to assure that all aspects of a Project are in Compliance with the Business Requirements.
  • Experience in writing and reviewing Test Cases and Test Plans and performing User Acceptance Testing
  • Proven ability to analyze complex problems, identify risks and develop effective solutions to improve productivity, reduce cost and track progress through all phases of SDLC
  • Exceptional ability to maintain and build client relationships with business owners to identify, prioritize and document business requirements.
  • Effective Communicator with good Interpersonal and Customer Relational skills.
  • Highly motivated team player with excellent communication, presentation and interpersonal skills, always willing to work in challenging and cross-platform environment. TECHNICAL COMPETENCIES:

Experience
Project Analyst / Business Analyst
Aug 2018 - present
Dallas, TX
The project was to develop a system that educate and act as a resource for clinical staff for Medicare and Home Health guidelines, policies and procedures. The other part of the project was to implement a web based claim processing application and give the users the clear vision of claim life cycle from submission through payer adjunction. It helped the organization increase its claim processing capacity and scalability. Responsibilities:
  • Provided direction and leadership to management, staff and clinicians to provide maximum outcome results, positive survey results, and agency growth
  • Enforce home health model by following workflow process as established and holding accountable team members to task assignments. Review key benchmark reports with team members, set clear expectations on performance, provide training/resource to achieve expectations and hold firm accountability.
  • Ensure an effective quality assurance program is established and maintained
  • Manage activities of the agency in a manner that is fiscally responsible and that supports the accomplishment of business objectives.
  • Provided input and planning of the overall development and administration of the agency as set forth in the policies and procedures relating to the agency. Direct implementation of approved work methods, patient care model and procedures that reflect elements essential to rendering high quality care
  • Conducted Impact Analysis and Gap Analysis to derive and document requirements for Web based Claim Processing System (CPS) and identified AS-IS and TO-BE business processes based on which created business process models.
  • Identified gaps between current policies and procedures and new HIPAA 5010 compliance, to check the compatibility of the existing system capabilities with the new requirements and developed an action plan for the migration process.
  • Implemented Test Driven Development (TDD) to ensure quality of application is maintained through SDLC.
  • Developed Mockup screens and wireframes using UI components such as Radio Buttons, Down lists, Check Boxes, and Data Entry Fields for web based custom dashboard of the CPS application for Business Users and Stakeholders.
  • Created Data mapping documents between various data elements, XML files, flat files, excel files, HIPAA EDI files X 12 834, 837, 270/271, 276, 277/276,999, 835 and 5010 and web services, to perform verification and validation.
  • The process included importing claims into QNXT that had been adjudicated and setting them in a "PAY" status so that a payment cycle could be run to create checks on QNXT.
  • Defined Data Maps to validate and customize Claims daily load into QNXT for processing the transactions.
  • Validated outbound 835 transactions including but not limited with vendor on QNXT mapping and system configuration.
  • Reviewed Stored Procedures for reports and wrote test SQL queries for Joins, Unions, Group By functions against the source system (SQL Server) to match the results with the actual report against the Data mart. Environment: SCRUM Methodology, QNXT, JIRA, MS Visio, UML, HP ALM, MS Outlook, MS Office Suite (Excel, Word, Power point), MS Project
Business Analysis Compliance Data Mapping EDI HIPAA JIRA Microsoft Excel MS Project Scrum SQL Stored Procedure UML XML 837 834
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Business System Analyst/ Project Coordinator
Information Technology
Jan 2017 - Jul 2018
Cleveland, OH
Philips Healthcare is a company providing customers with benefits, expertise and service that improves the health, well-being and productivity. The project was to develop a system that would allow efficient and timely management of all the relevant data which includes clinical, financial and administrative throughout the entire organization which would enable the sharing of the information among subsystems. Updating an existing quoting and enrolling program based on the business requirements and also integrated eligibility check application so application can check before offering plans. Responsibilities:
  • Extensively involved in implementation of effective requirements practices, including gathering User Requirements, and analyzing User Requirement Document (URD), and functional specification document (FSD), use and continuous improvement of a requirement gathering processes.
  • Applied agile methodology with its various workflows, artifacts and activities to manage life cycle from inspection to transition phase.
  • Involved in development of Business and Technical Requirements in preparation of Design and Functional Specifications for Business Needs and Processes.
  • Worked as liaison between external clients and SMEs to generate and standardize product requirements specification documents.
  • Have experience in working in high end project with multi million dollars budget.
  • Created and maintained specifications and process documentation to produce the required data deliverables (data profiling, source to Client maps, flows)
  • Employed UML methodology in creating UML Diagrams such as Use Cases, Sequence Diagrams, State diagrams, Activity Diagrams and business process and workflows.
  • 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.
  • Involved in GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims.
  • Worked on Facets including Claim processing (online and batch adjudication), Case management, Customer service, Member/subscriber administration, Provider network management and reporting.
  • Worked on claims, Claim adjudication Membership, Eligibility, Accumulators.
  • The process included importing claims into Facets that had been adjudicated and setting them in a "PAY" status so that a payment cycle could be run to create checks on Facets.
  • Responsible for system integration testing of 837 claim files, 834 eligibility files and 270/271 interface files to ensure required interactions are met during the SDLC process.
  • Assisted team lead in developing Requirements Traceability Matrix (RTM) to trace the relationship between business and functional requirements to test cases.
  • Prepare and execute different Test Cases and Test Scripts.
  • Used Rational Rose to visually determine the proper structure, key elements and optimal design for database and to aid efficient creation of tables, stored procedures.
  • Critically evaluated the information gathered from multiple sources during requirement gathering and analysis and responsible for tracking, tracing and managing requirements using Rational Requisite
  • Created project plans for information technology development.
  • Worked with systems area to translate business needs into system requirements.
  • Conducted requirement gathering session with the stake holders.
  • Involved in the QA testing process and address any question that QA has for the development team on the requirements.
  • Weekly team meetings the key stakeholders to provide project status updates.
  • Involved in the testing phase right from the Unit testing to the User Acceptance testing.
  • Responsible for creating business work flows and processes, creating management reports based on the analysis. Environment: RUP, Rational Requisite Pro, UML Use Cases, VB.NET, SQL Server, Rational Rose, XML, Use Case Documentation.
Agile Methodology BSA EDI HIPAA Project Coordinator Project Planning Quality Assurance Requirements Gathering SDLC SQL Stakeholder Engagement System Analysis System Requirements UML 837 834
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Jr. Analyst / Billing Analyst
Information Technology
Feb 2016 - Dec 2016
Houston, TX
American Income new Life Insurance's Product Selector is a new web and mobile based project where the user has the choice of selecting the Life Insurance, which seems the most appropriate for him. This module helps to narrow down the various categories available as per the user's needs. Project was to develop online application system for customers so this project was based to B2C. The application generates comparative quote statements. This quote, which is selected by the user, is sent to a randomly picked customer care representative to finalize the insurance, depending on the pricing policy and cost effectiveness in that region. Responsibilities:
  • Worked with Requirement Gathering Team and produced Initial Requirement Data to produce User Interface and Business Process Requirements.
  • Designed the business requirement collection approach based on the project scope and System Lifecycle (SDLC) Methodology, documented the same in Business Requirement Document (BRD)
  • Employed Waterfall and Agile Methodology to conduct the system development
  • Reporting in E-commerce and order management domain
  • Working with Rating and Pricing system
  • Planned and defined the system requirements to Narrative Use Cases and Use Case Scenarios using the UML methodologies. Created Use Case Diagrams Activity Diagrams, Flow Diagrams in MS Visio
  • Assisted Quality Assurance Team in documenting and analyzing their current process and then make recommendations for improvements in their functional areas.
  • Carried out UAT by developing test plans, test scenarios, test cases, test data to be used in testing based on business and user requirements, technical specifications and/or product knowledge
  • Researched premium balances, reviewed against the paid estimated premium and completed or supervised the completion of offsets
  • Managed all aspects of reinsurance systems implementations including discussing changes with developers and coordinating with reinsurance group
  • Managed updates to the master claims list that included all losses of half a million dollars or more and directed that notice be sent to the broker or to the reinsurance carrier as needed
  • Responsible for reinsurance recoveries, including providing updates to facilitate loss payment and negotiation of disputed balances
  • Facilitated and managed meeting sessions with committee of SME's from various Business areas
  • Developed project document templates based on SDLC methodology..
  • Authored progress and completion reports, which were then submitted to project management on a weekly basis.
  • Conducted training sessions to familiarize users with system.
  • Involved in analysis of the technical specifications of the current system and the infrastructure needs performed Gap analysis.
  • Worked as an Interface between the users and the different teams involved in the application development for better understanding of the business and IT processes.
  • Set up definitions and process for test phases including Product test, integration test, system test and user acceptance test (UAT).
  • Created exceptions report which were then submitted to project lead and stakeholders on a regular basis.
  • Updated and modified progress and resources allocation in MS project for the team.
  • Facilitated user acceptance testing and test strategies with Information Technology Group.
  • Performed manual front-end testing to check all functionalities of different modules.
  • Suggested measures and recommendations to improve the current application performance. Environment: UML, MS Vision, MS SharePoint, RUP, MS Project, SQL, Oracle, MS Access, MS Excel and MS Word.
Microsoft Excel Requirements Gathering SQL UML Agile Methodology Billing
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Non-cloudteam Skill
Education
Business Administration with Interdisciplinary Studies
Texas A&M University 2022
Skills
SQL
2021
4
UML
2021
4
834
2021
3
837
2021
3
EDI
2021
3
HIPAA
2021
3
Agile Methodology
2018
2
Microsoft Excel
2021
2
Requirements Gathering
2018
2
BSA
2018
1
Business Analysis
2021
1
Compliance
2021
1
Data Mapping
2021
1
JIRA
2021
1
MS Project
2021
1
Project Coordinator
2018
1
Project Planning
2018
1
Quality Assurance
2018
1
Scrum
2021
1
SDLC
2018
1
Stakeholder Engagement
2018
1
Stored Procedure
2021
1
System Analysis
2018
1
System Requirements
2018
1
XML
2021
1
Billing
2016
1
Waterfall
0
1