Moumita Hore

Professional Summary:

 Business Analyst with 8+ years of proven skills in for requirement gathering, interacting with developers,
documenting various business processes, coordinating various projects within healthcare.

 Experienced in interfacing with stakeholders and senior management with excellent communication and
interpersonal skills.

 Experienced working in Medicare and Medicaid projects.

 Excellent knowledge of Health Insurance Portability and Accountability Act (HIPAA) transaction and code
set rules such as EDI 837,270,271,276,277,834,835.

 Attended the business configuration and technical training programs at Health Edge

 Proficient in ICD-9-CM and ICD -10-CM coding and claims processing.

 Involved in working at all stages of system development Life Cycle. Extensive experience leading, facilitating
conducting Joint Application Development (JAD) sessions among user community, stake holders and
technical management, creating project plans and schedules and managing changes.

 Analyzed and synthesized results from Joint Application Development (JAD), proposed alternative tasks and
transformed those into Business Requirement Document (BRD).

 Experience in using methodologies such as UML (Unified Modeling Language), OOAD (Object Oriented
Analysis and Design) and APM(Agile Project Management).

 Experience using Rational Rose and MS Visio for business process modeling and designing data flow
diagrams (DFD).

 Expertise in writing Requirements, Test Plans and Test Cases.

 Prepared Functional Specification Documents, AS-IS and TO-BE workflows.

 Well versed with both Agile and Waterfall SDLC processes.

 Thorough knowledge in Requirement analysis, Planning, Scheduling &Tracking projects.

 Concrete understanding of Business Requirement gathering, Business Process flow, Business Process
Modeling and Analysis, design documentation.

 Strong problem solving and analytical skills with in-depth understanding of system development
methodologies, techniques and tools.

 Work with the development team to provide an environment ready for testers and end-users.

 Facilitated test plan/test case walk-throughs for the business and development teams to obtain feedback and/or
approval sign-off.

 Excellent organizational, interpersonal, communications, teamwork with proven skill to interact across
multiple levels of organization.
 Facilitated UAT efforts.

Professional Experience:

Sentara Healthcare - Norfolk, VA Jan 2020 - Present

Business System Analyst
Responsibilities:

 Analyzed the existing claims process and specific business rule logic will be applied.

 Worked with Subject Matter Expert from different functional areas to define requirements specification.

 Created and Maintained Requirement documents for 270/271(inquire/response health care benefits),
834(Benefit enrollment- HMO, PPO, Medicare, Medicaid, Group), 837(Health care claim)

 Facilitated Joint Application Development (JAD) Sessions for communicating and managing expectations
involved in FACETS Implementation, involved end to end analysis of FACETS Billing, Claim Processing and
Subscriber/Member module

 Manual Testing experience involves Test Planning, Test scenario creation, Test case writing, Test data
creation using MS Excel, SQL and Perl, DB validation, Defect reporting with Test and Defect management in
TFS/Quality Center/Test director

 Working with Marketing managers and converting their strategy into implementations using Confidential

 Experience in creating Workflow Documentation for Utilization Management

 Conducted backend testing using SQL queries to validate data for database and Used SQL queries for
retrieving data from database for executing user specific test cases

 Analyze medical and claim data from various EMR/EHR, and PMS (practice management software) systems.

 Conducted impact analysis on AS IS system, identified impacted business and functional areas, including
policy changes, web interfaces, database changes, claims process and reports changes.

 Conducted User Acceptance Testing with stakeholders and system users to uncover latent defects in the
system. The defects were corrected and verified through a new cycle of regression testing.
 Involve in analyzing defects that have been reported in the JIRA and sending them over to the developers for
a fix

 Configured SSO (Single-Sign-On) in Marketing Cloud and Identity Access Management tool with internal
teams.

 Developed Data Model in Marketing Cloud for the Data Extensions using Synchronized Data Extensions,
Shared Data

 Successfully implemented Sales Cloud, Service Cloud, Analytics Cloud, Financial Services Cloud,
Community Cloud, Commerce Cloud and Pardot in sync with Marketing Cloud while implementing digital
marketing strategies

 Maximized software efficiencies for hospital end users by utilizing the Medical Terminology knowledge to
lower cost of care and reducing stays caused by adverse events.

 Used the Agile methodology to build the different phases of Software development lifecycle. (SDLC)

 Created test plan, test cases to validate solutions against requirements and initiated and executed User
Acceptance Testing (UAT).
 Supported the corporate IT goal to migrate all Utilization Management (UM) lines of business, integrations,
and related departments off the existing MCPS database and install an integrated Utilization Management UM
medical management system
 Facilitating priority meetings with stakeholders to help business understand the impact of the JIRA in
prioritizing them

 Performing manual testing in Retail/front end, customer serv. POS systems and Self-Checkout, credit card,
debit card, gift card processing, credit certification Etc..

 Excellent 3 years of experience in Business and Data Analysis, Data Extraction, Data Manipulation ,Data

 Profiling, Data Migration, Data Integration and Metadata Management Services.

 Expertise in creating various project documents like BRD, FRD, Data mapping, data definition

 document, Data migration related documents , Test Plan, Test case, UAT Document etc

 Created specialty EHRregistries for diseases and disorders being treated, procedures performed,
 medication and their codes according to compliances for communication among pharmacy, insurance, and
billing serverand another EHR system to help decision support system (DSS) and fast health interoperability
resources (FHIR) exchange
 Implemented Data Loader to load data from Marketing Cloud to Service Cloud.
 Involved in manual testing of front end functionality, hyperlinks, navigation, GUI and system integration
testing of the application
 Performed Utilization Management tasks such as consult and coordinate with healthcare team members to
assess, plan, implement and evaluate patient care plans
 Developed HIPAA EDI Transmissions. Work includes complete business cycle management and hands-on
production as well. Create EDI Testing process, documentation, and performance matrices.
 Worked to configure following EDI transaction 277, 837I, P &D, 834. Varied experience including Medicaid
MMIS, MITA , Medical Billing Champus , Medicare, Eligibility Information Systems EIS, ISD2 Hospital and
Professional Applications. Other: Public Utility CIS, Plant Property, Rates , Child Support Enforcement CSE ,
State Government DES, DHS, DSS.
 Involved in writing SQL Queries for backend testing
 Ran SQL quiries to validate Benefits configuration
 Continuous communication with the team to track requirements on rally and discuss to fix defects with
JIRA tools, and corrected lesson learnt from each sprint
 Ensure all the staff and the EMR are compliant to HIPAA regulatory and compliance requirements.
 Validated various applications with Memberships of Enrollment, Cancellation, Termination, Reinstatement
etc. for commercial, Medical and Billing in Facets.
 Performed Gap Analysis and created test plans for clients for conversion from data collection to EMR
solution. 
 Performed Manual testing before converting them into automated scripts
 Ability to analyze data in legacy applications to determine data migration/integration complexity, to identify
data gaps against new requirements or conflicts across multiple legacy applications.
 Program Manager interfacing with HealthEdge account staff and providing management and implementation
of fulfillment requirements from 15 business work streams, 3 vendor handoffs and coordination of multiple
in-house administrative groups using HealthRules, integrated with
 Creating UI Mockups for the Data Visualizations and presenting to the Stakeholders.
 Responsible to review,audit,and benfit configuration , as well as corrections to SEPY and service rule to
endure accury and tight internam controls to minimize fraud and abuse overpayment related issues
 Database Change Verification testing using Oracle-Toad and SQL queries.

 Design, analyze and performed Integration and wrote System requirements on different leading health care
software’s such as FACETS

 Used advanced data visualization and representation techniques in Tableau to provide an easy to
understand interface for end users to quickly identify key areas within their data.
  Worked as a User/Customer advocate and negotiated with user as well as the technical team and management
staff to resolve any outstanding requirement conflict during the whole SDLC process.

 Worked on FHIR healthcare Interoperability for member and provider access. Created crosswalk documents
with the common consumer data sets.

Premise Health - Atlanta, GA June 2018 – Dec 2019

Business Analyst
Responsibilities:
 Gathered requirements from stakeholders for provider management and member management.
 Worked on change request for lab claims module.
 Reviewed Test Scripts, Technical Specification Documents, and worked on application’s input / output data
definitions.
 Worked with Salesforce Marketing Cloud to gather customers from social media.
 Set up Marketing Campaigns, Campaign Hierarchies, and Lead Queries, Assignment rules, Web-to-Lead and
Auto-Response rules
 Add a comment to the JIRA Tools that need more Clarification if the Business Owner is not reflected in the
JIRA
 Performed rigorous manual testing such smoke testing, Integration testing, Regression Testing, End to End
Testing and System Testing.
 As a Data Visualization (Tableau), responsible for creating interactive visualizations tohelp strategy/case
teams to take their decisions faster at first look
 Implemented data migration using Informatica on demand.
 Conducted Manual Testing for checking the flow of the application functionality
 Worked alongside the Utilization Management and Business Intelligence team to define key performance
metrics for operational and regulatory reports, reflected to the Micro Strategy dashboard
 Involved extensively inTrizetto facets implementation, claims and benfit configuration setup testing
 Good experience in Back End testing using SQL queries and Cross Browser Testing
 Documents the results of the audit and make recommendations as needed
 Configure provider contracts for Aetna as business is moved to the HealthEdge software platform
 Prepare detailed system requirements, specifications and documents and provide consultative services through
all phases of the System Development Life Cycle
 Performed extensive manual testing on critical functionalities of the application.
 Elicit and prepare detailed system requirements through conducting JAD sessions, interpreting business
requirements and working with business partners and development teams
 Experience in performing GAP Analysis between AS IS and TO BE workflow models.
 Ensures coding and Configuration, meets current business policies and practices, and supports the efforts of
compliance review and audit of employer group benefits.
 Delivered business requirement documents (BRD), functional specification documents, Use Cases, test plans,
and requirement traceability matrices.
 Performed rigorous manual testing such smoke testing, Integration testing, Regression Testing, End to
 End Testing and System Testing.
 Prepare requirement specifications such as User stories and System requirement specifications and
Supplementary specifications
 Add the JIRA Tools number, date, Initials and a brief description to the comments section when I modified,
added or struck-thru a requirement
 Worked on the database analysis part by helping the technical team in identifying the data sources required for
the application and coordination with the IT team in migration of the data within the databases.
 Prepared BRD, FRD, SRD for the Confidential Lifecycle customer engagement program
 Conceptualizing and developing functional specifications across different business areas such as Claims,
Membership.
 Modeled the ‘as-is’ and the ‘to-be’ process flow and analyzed the gap and developed the action steps to fill
the gaps.
 Working with Marketing managers and converting their strategy into implementations using Confidential
 Develop source-to-target mapping documents by analyzing data content and physical data structures in the
legacy and downstream applications. Develop mappings to enable data migration, application integration
  Gathered requirement on the Health Management Utilization Management, Quality integration Symmetry
Gaps in Care (STARS and HEDIS)
 Worked with legacy team in developing BRD and FRD for system change requests and participated in system
testing.
 Use JIRA Tools to track and report defects to developers. Before Logging the Defect, working with BA
people
 to find out any requirement changes
 Worked within project team to identify and interpret state Medicaid policies as applicable to customer defined
algorithm research as well as assist with internal development of new healthcare analytics.
 Involved in preparing project plans and identifying major milestones for each stage as per the SDLC model
 Prepared behavioral UML diagrams (such as Use Cases, Activity and sequence diagrams).
 Facilitated requirement gathering sessions and created high level business requirement document.
 Conducted Impact analysis when there is any change in the requirements and updated the Business
Requirements Document (BRD) and Systems Requirements Specification (SRS).
 The entire Ruby scripting done using Cucumber framework Wrote and executed SQL queries to verify the data
updates to various tables and ensure data integrity.
 Developed UAT test cases associated with the functional requirements.

Cardinal Health, OH March 2017-March 2018

Business System Analyst 

Responsibilities:

 Involved in gathering, documenting and verifying business requirements.

 Developed, coordinate and support Information Technology Division on all operational requirements of FA-
CETS claims processing system and production management.

 Participated in user meetings, gathered Business requirements & specifications for the Data-warehouse
design. 
 Setup Marketing Cloud Connector and Sales Cloud Setup of API user and Marketing Cloud API user and
performed all the steps of Connecting Marketing Cloud Connector.

 Established a business Analysis methodology around the SDLC, helped to develop use cases, project plans
and manage scope.

 Involved in the meeting with Business Process Owners, SME (Subject Matter Experts) and store users for Re -
quirement gathering in Definition Stage.

 Assisted in developing Project Proposal, Business Case and Business rules.

 Gathered business requirements from stakeholders and translate them into detailed requirement specifications.

 Assisted JAD sessions to identify the business flows and determine whether any current or proposed systems
are impacted.

 Used SDLC (System Development Life Cycle) methodologies like the Agile and the waterfall.

 Performed requirements gathering process in iterative approach using Agile methodology.

 Prepared Business Requirement Document (BRD) and Software Requirement Specification (SRS)

 Analysed Business Requirements and segregated them into high level and low level Use Cases, Activity Dia -
grams/State Chart Diagrams (UML).
  Worked in designed and development of Project document templates based on SDLC methodology.

 Helped with data modelling and defining the conceptual and logical model of the data warehouse.

 Work with architects and Business Analyst to design SRS.

 Performed Gap analysis and implemented updates for the Data Warehousing Application.

 Managed and documented the change requests.

 Maintained Requirement Traceability Matrix.

 Understanding the key concepts of SWIFT messaging and the routing rules set up for delivering the trade
messages to the providers.

 Involved in User Acceptance testing (UAT) and validation of the application

 Analysed Business Requirements and segregated them into high level and low level Use Cases, Activity Dia -
grams/State Chart Diagrams (UML).

 Created Data Stage jobs to extract, transform and load data into data warehouses from various sources like re-
lational databases, application systems, temp tables, flat files etc.

 Created  Process Flow  diagrams, Use case diagrams  (UML) using MS-Visio 

 Prepared wireframe  and web layouts for the application

 Prepared Test Strategy, Test Plan, test report and Gap Report 

 Performed UAT based on Requirements Document and prepared the Test Cases using Quality Centre.

 Maintained Traceability Matrix in Excel.

 Used MS-Visio analysed business requirements and process through Use Cases, Class, Sequence, and Activity
diagrams, and adapted UML standards to define modularized Data Process Models.

 Developed a Business Acceptance testing strategy and plan.

 Created test files and analysed test results using MS-Excel.

Tenet Healthcare, Dallas, TX July 2015 – Dec 2016

Role: Business Analyst
Responsibilities:
 Involved in requirements gathering sessions with Business Analysts and Architects to understand
requirements in terms of business change.
 Actively worked on Business requirement analysis and Data analysis.
 Created Business Rule Comparison (BRC) documents and Side-By-Side (SBS) comparison documents using
5010 implementation guides for X12 transactions in Excel spreadsheet.
 Got hands on experience on GAP analysis between current HIPAA 4010 and HIPAA 5010 requirements.
 Analyzed HIPAA 4010 and 5010 standards for 837P EDI X12 transactions, related to providers, payers,
subscribers and other related entities.
 Dealt with the EDI transaction-835 claims payments and remittance advice, which deals the payment from
payer to provider.
 Ensure the UAT test scripts review sessions with business owners to test the application functionality and
providing necessary training material.
  Analyzed HIPAA 5010 impact on external Data Warehouse and data warehouse extract process and mapping
of MMIS database and data warehouse.
 Got exposure to EDI, Web Portal, DSS and System documentation.
 Strong knowledge of managed claims management process, Knowledge of Medicaid and Medicare Services.
CMS, Health Assessment Systems , Hl7 Standards, HIPAA , Message Validation, ICD 9, Electronic Health
Records, Electronic Medical Records
 Medical Claims experience in Process Documentation, Analysis and Implementation in
835/837/834/270/271/277/997 (X12 Standards) processes of Medical Claims Industry from the Provider/Payer
side.
 Use Master Document with work objects. MS Office, XP, Visio, Excel, Word, Power point
 Analyzed MMIS system impact for Windows and Interfaces.
 Functional Knowledge of Medicaid Management Information System MMIS.
 Analysis of inbound and outbound interfaces and extensions to FACETS Claims Processing system.
 Defined project objectives, requirements and assumptions to structure effective integration and presented to
the EHR
 Excellent writing skills in preparing business requirements documents (BRDs), system requirements
specifications (SRS), system design specification (SDS), functional specifications, and defining project plans.
 Gathered all the needed data (table names, column names, field names, notes) from the Windows and
Interfaces documents.
 Elicited business requirements and business needs as part of an Agile Scrum team
 Responsible to meet the information demands of business users by delivering timely, accurate, meaningful
and standardized data and reporting.
 Documented analysis, observations and recommendations.
 Attended daily meetings and dealt with day-to-day deadlines.
 Define business requirements and business process and policy changes related to the client Medicaid system
during the conversion from the existing HIPAA 4010A formats to the future HIPAA 5010A format
 Attended daily meetings and dealt with day-to-day deadlines.

LetsDoc Healthcare, Chhattisgarh, IN June 2013 – Apr

2015
Business Analyst
Responsibilities:
 Understanding the current business process, defining scope of the project along with vision statement.
 Met with users and stakeholders to understand the problem domain, gathered customer requirements through
surveys, interviews (group and one-on-one) along with JAD sessions.
 Applied Unified Modeling Language (UML) methodologies to design Use Case Diagrams, Activity Diagrams
and Sequence Diagrams in Rational Rose.
 Established RUP (Rational Unified Process) methodology and provided assistance in developing Use cases
and project plans.
 Accepted inbound transactions from multiple sources using FACETS.
 Develop Conceptual Data Model & Logical Data Model in alignment with MITA Information Architecture.
 Tested the ANSI X12 Version 4010 / EDI transactions (HIPAA) like 270, 271, 276, 277 P, 837I, 837D, 835
remittances)
 Developed Use Case diagrams, business flow diagrams, Activity/State diagrams and Sequence diagrams so
that developers and other stakeholders can understand the business process.
 Assure that all Artifacts are in compliance with corporate SDLC Policies and guidelines
 Responsible for architecting integrated HIPAA, Medicare solutions, Facets.
 Supported integrated EDI batch processing and real-time EDI using FACETS.
 Direct contact with the payer on behalf of the provider to discuss claim rejection reasons concerning claims
and enrollment
 Wrote the BRD, completed the walkthrough, and delivered the final version to the team.
 Solid experience in Claims Processing 837 transactions and remittance 835 EDI files
  Worked on the HIPAA 4010 conversions and worked on the EDI 834, 837, 835 and 278 files and validated
the functionality according to the new HIPAA 4010 changes.
 Performed cost-benefit analysis, generated reports for analyzing various investments and their profitability
and also for analyzing various lost opportunities due to time delay in investing.
 Validated business rules and all artifacts with users, approval and sign off.

Education:
 Bachelors from Guru Ghasidas University, Chhattisgarh, India
 Masters from Guru Ghasidas University, Chhattisgarh, India