PROFESSIONAL SUMMARY

• 8+ years of experience with knowledge of Healthcare, and Pharmaceutical Industry, worked with different corporate and Government Sector.
• Excellent writing skills in preparing business requirements documents (BRD), Functional Requirements Specifications (FRS), system design specification (SDS), and defining project plans.
• Proven ability to work with cross - functional team, manage timelines and competing needs, and manage multiple deadlines.
• Hands on experience with Software Development Life Cycle (SDLC), Agile, RAD, RUP, SCRUM, Waterfall SDLC (Software Development Methodologies).
• Good understanding and knowledge of the aspects and complexities involved in testing HIPPA 5010 with direct payers and clearinghouses.
• Experienced in scope elaboration, requirement gathering, use case modeling, Gap Analysis, software testing (Manual & UAT), preparing user manuals and knowledge transfer.
• Proficient in UML for Business Process Modeling, Use Cases, Activity Diagrams, Sequence Diagrams, Data Flow Diagrams, Collaboration Diagrams, Class Diagrams and document them using Microsoft Visio.
• Through understanding and hands on experience with BABOK (Business Analysis Body of Knowledge) and PMBOK (Project Management Body of Knowledge) concepts, tools, techniques and competencies.
• Experienced with industrial standards/compliances such as HL7, EHR, GMP, HIPAA, ICD-10, HIPAA 4010, 5010, and NCPDP.

TECHNICAL SKILLS:

Requirements Management: Rational Requisite Pro, Doors, EnClarity, Atlassian, CA

Modeling Tools: Enterprise Architect, Smart Draw, MS Visio, System Architect, Rational Rose

Modeling Concepts: Business Process Models (BPM), Unified Modeling Language (UML)

Language: PLSQL, SQL, JAVA, .Net, C, C#, UNIX, COBOL

Database Concepts: Oracle, MS SQL Server, MS Access

OS: Windows, Linux, Unix, Red hat, Solaris

Industry Standards/Compliance/Domain: HL7, EHR, GMP, HIPAA, ICD-10-CM, ICD-10-PCS, HIPAA 4010, 5010, and NCPDP, PBM, Medicaid, MITA

Best Practices: BABOK, PMBOK, SCRUM Guide

PROFESSIONAL EXPERIENCE:

Confidential, Boston, MA

Business System Analyst/Quality Analyst

Responsibilities:

• Performed Requirement Gathering & Analysis by actively soliciting and analyzing customer requirements.
• Documented business process work flows, system work flows using Visio and created use cases using Blueprint requirements tool.
• Interacted with the Development team to help write technical specifications to describe Functional Requirement Documents (FRD), Business Requirement Documents (BRD) and Worked closely on Diagnosis-related group (DRG).
• Coordination of numerous project initiatives including: system conversion and integration of a behavioral health acquisition, preparation of numerous RFP responses, other system initiatives related to case management, provider management, eligibility management, claims processing, and prior authorizations.
• Performed In-Death analysis of systems and business processes of Medicare Part D as per CMS rules and procedures.
• Implemented automated COB processing of Medicare claims into Facets.
• Used Requisite Pro for the Requirement Documents Preparation and Prepared Business Process Models that includes modeling of all the activities of the business from the conceptual to procedural level.
• Worked on HIPAA 5010 / ICD 10 version for EDI transactions like 270/271 and 837.
• Prepared and Analyzed AS IS and TO BE in the existing architecture and performed Gap Analysis.
• Developed UML Use Case model for the application using MS Visio and assigned to prepare the detailed Work flow diagram based on the proposed enhancement for the system.
• Create and maintain Use Cases, visual models, including activity diagrams, logical Business process models, and sequence diagrams using UML.
• Involved in the creating the User Interface Specification Document and User Training Manual as per project specification with the help of development team.
• Creating documentation for sustainable custom development strategy. Designed and developed project document templates based on SDLC methodology.
• Queried database using SQL for backend testing. Created SQL reports, data extraction and data loading scripts for different databases and Schemas.
• Gathered requirements from users of the Clear Quest (CQ) tool for any Enhancements or change requests for any defects.
• Prepared Class Diagrams and Interaction Diagrams using Microsoft Visio and Rational Rose.
• Successfully defined and implemented Project Management processes and procedures based on BABOK, and PMBOK for multiple groups.

Development Environment: MMIS, SharePoint, MS Excel, TFS, Agile, Mainframe, MS Word, MS Excel, MS Access, Quality Center, UML, ETL, MS Office suite, MS Visio 2003, EDI Transactions, Business policy documents

Confidential, Montgomery, AL

Business System Analyst/Quality Analyst

Responsibilities:

• 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.
• Worked with Subject Matter Expert from different functional areas to define requirements specification.
• Organized and facilitated Joint Application Development (JAD) Sessions, to discuss impacted areas, to discuss requirement specification, to resolve issues and conflicting solution needs.
• Provided support in though out software development life cycle from vision and scope to design, system development, quality analysis and User Acceptance Test Plan.
• Created business requirements documents and functional requirements documents for impacted different business and solution component such as MMIS, MITA, EDW, etc.
• Implemented automation of key departmental reporting leveraging Crystal Reports.
• Developed reports using Crystal Reports, Desktop Intelligence and Web Intelligence.
• Worked with Medical Coder to resolve coding related discrepancy and facilitated JAD sessions with project team to resolve such discrepancies.
• Participated with QA team to create Master Test Plan document and worked as an aid to conducted feasibility study related to End to End testing.
• Created and maintained traceability matrix and Issue log.
• Reverse engineered codes COBOL codes and PLSQL Codes.
• Worked with different code sets, ICD-9-CM, ICD-10-PCS, ICD-10 CM, HCPCS, CPT, D-Codes, etc.
• Attended CMS webinars for different Healthcare Initiatives.

Development Environment: 5010 EDI, 837 Institutional, Professional and Dental Claims, Oracle, Mainframe, DB2, COBOL, PLSQL, TOAD, JAVA, Web Sphere, Windows OS.

Confidential, Lawrenceville, NJ

Lead Business Analyst/Product Owner (Agile Analyst)

Responsibilities:

• Conducted research, analysis and impact assessment of claims and system processing issues for client and partner organizations.
• Conducted qualitative, quantitative data analysis and trend break analysis on Prescription claims and eligibility data.
• Elicit requirements from different cross-functional team and clients. Served as liaison between clients and development team.
• Created and maintained log for remediation activities required to ensure issues are identified, and resolved in timely manner.
• Worked with Product Management, Sales and Project Management Office to develop and manage a portfolio of products of PBM customers.
• Worked with client to document Use case scenarios and created through away prototypes such as wireframe diagrams.
• Converted business requirements, functional and non-functional requirements to technical specifications.
• Acted as Pseudo product owner and worked with Product Managers to conduct feasibility assessment, develop new product business case, conducted SWOT analysis and facilitated decision analysis sessions and created supporting documentation.
• Participated in Pharmacy Benefit Management and Health Information Technology webinars.
• Created and maintained product backlog and sprint backlog, attended daily standup meetings and conducted breakout session between cross functional teams as needed

Development Environment: PBM, Benefit Administration, Claims Processing, Eligibility, EDI 270/271, NCPDP,PMO, Product Development, Agile, Oracle, JAVA, Web Logic, MSI, Business Objects, Windows OS.

Confidential, Hickory, NC

EHR Business Analyst

Responsibilities:

• Create business requirements document, translated clinical requirements into functional specifications. Worked closely with end users/subject matter experts such as Physicians, Nurses and other Hospital staff to determine impact of EHR solutions on other systems and process.
• Analyzed workflow of patient, physician, nurses, other hospital staff and created business process models to present workflows to project team/project sponsors.
• Analyzed and resolved EHR solution related problems, issues and concerns. Maintained and managed issue log throughout the project duration.
• Defined end-user needs, assessed business requirements, wrote requirement specifications, test plans, training material, system manuals and provided training to customers on how to use the applications.
• Coordinated with business and IT departments to ensure implementation, development and monitoring of EHR software, applications and system integration.
• Actively involved in the vendor selection, evaluation, and implementation and testing of vendor-supplied utilities applications and system.
• Mentored, cross-trained and provided assistance to Jr. Business Analysts and other resources in related projects.
• Created test plan, test cases to validate solutions against requirements and initiated and executed User Acceptance Testing (UAT).
• Created requirements model using UML and BPM diagraming techniques.

Development Environment: EHR, Ambulatory Healthcare System, XML, UML, ORCL - 10g, Windows OS, SDLC -Waterfall

Confidential, Somerset, NJ

Designation: System Analyst

Responsibilities:

• Gathered requirements and prepared business requirement documents (BRD).
• Responsible for translating BRD into functional specifications and test plans. Closely coordinated with both business users and developers for arriving at a mutually acceptable solution.
• Conducted JAD sessions to define the project and to reduce the time frame required to complete deliverables.
• Developed and maintained all operational and technical flows using Visio and Power point
• Used Rational Rose/MS Office Suite for creating use cases, workflows and sequence diagrams according to UML methodology thus defining the Data Process Models
• Defined Use cases from requirements and helped convert them into software specifications
• Aided in workflow analysis and process design
• Analyze business requirements from Black Box Testing perspective, business process and system architecture/design
• Maintained Requirement Traceability Matrix (RTM).
• Performed Regression Testing and created test scenarios for User Acceptance Testing (UAT)
• Maintained documents for change request and implemented procedures for testing changes

DEVELOPMENT ENVIRONMENT: Rational Rose, MS Office Suite, Oracle9i, Windows NT/XP, Business Objects, Java, J2EE, JMS, Struts, Web Services, UML, CSS, MQ Series, WSAD, Web sphere 5.1

Confidential, Whippany, NJ

Jr. Business Analyst

Responsibilities:

• Interacting with stakeholders, gathering requirements, rating them and assigning priorities to each of them.
• Conducted JAD sessions for effective communication of views between stakeholders and gathered business requirements,
• Communicated and interacted on a regular basis with the project manager and development team during different stages of the product life cycle
• Ensured that all the artifacts are in compliance with corporate SDLC Policies and guidelines,
• Prepared BRD and converted into functional specifications (FRS) using requirement management tool
• Created UML diagrams such as use case diagrams, activity diagrams, and sequence diagrams
• Designed Data Flow Diagrams (DFD’s), Entity Relationship Diagrams (ERD’s), and web page mock ups using modeling tools.
• Provide technical and procedural support for User Acceptance Testing (UAT)
• Helped the business to articulate and prioritize their ideas, while using the Rational Unified Process (RUP) and writing UML-based feasibility studies and Use Case Models to communicate those ideas to the developers.

Development Environment: MES, Honeywell ERP, MS Visio, Windows OS, UNIX, ER Win, Waterfall