SUMMARY:

• 8+ years of industry experience as a Sr. Business Analyst in identifying business needs and determining solutions to business problems for complex software projects.
• Extensive knowledge working through the Software Development Life Cycle (SDLC) including Requirement Planning and Management, Requirements Elicitation and Requirements Analysis.
• Excellent communication and interpersonal skills.
• Excellent analytical and problem solving skills in designing, developing and implementing innovative business processes using new approaches and technology.
• Strong knowledge and working experience of industry standards such as HIPAA, ICD - 9, ICD 10 code sets, HIX (Health Insurance Exchange), Affordable Care Act and Facets.
• Exposure to data mining, data mapping and data conversion / migration techniques.
• Experience working on Healthcare Reform Projects such as Health Insurance Exchange (HIX), ICD 10 Remediation and HIPAA 5010 Implementation.
• Expertise in EDI and multiple transactions exposure such as 835-Claim Payment/Remittance Advise and 837 Health Care Claim Status Inquiry/Response Transactions and testing in Client Server systems and Applications.
• Medical Claims experience in Process Documentation, Analysis and Implementation in 835, 837I,(X12 Standards) processes of Medical Claims Industry from the Provider/Payer side.
• Exposure to creation of Business Requirement Documents (BRDs), Functional Specification Documents (FSDs), Use Case Documents, Acceptance Criteria Documents (ACDs), Business Rules Spreadsheets (BRS) and Requirements Traceability Matrix (RTMs)
• Successfully conducted interviews, brain storming sessions, group interviews, prototyping, focus group sessions and JAD sessions in order to gather requirements.
• Excellent knowledge of the AS-IS and TO-BE business processes and experience in converting these requirements into technical specifications for preparing test plans.
• Strong time-management and multi-tasking skills with attention to detail.
• Involved in support of System testing when performed on the entire system in the context of a Functional Requirement Specification (FRS) and System Requirement Specification (SRS)

TECHNICAL SKILLS:

Methodologies: UML, RAD, RUP, JAD, Agile

Performance Testing Tools: Rational Suite Performance Studio

Operating Systems: MS Windows NT/98/2000/XP, UNIX, IOS

Web/Design Tools: HTML, XML, MS Front Page, Adobe Photoshop

Databases: SQL Server, MS Access

Programming Languages: C, C++, COBOL, SQL, PL/SQL

Office Tools: MS Word, Excel, MS Outlook, Team Foundation Server, MS Visio

Applications: HealthRules by Health Edge, Transaction Manager by EDIFECS

PROFESSIONAL EXPERIENCE:

Confidential, Little Rock, AR

Sr. Business Analyst

Responsibilities:

• Conducted detailed rules analysis to document rules for MAGI Medicaid programs utilizing Cúram HCR application (Streamlined Medicaid /CHIP)
• Designed IEG questionnaire to meet requirements for all MAGI programs based on rules defined by CMS
• Conducted JAD sessions to gather NON MAGI requirements for IEG utilizing Cúram global income support application suite
• Designed Income Support Application (IEG) questionnaire to meet screening requirements for all MAGI & NON MAGI programs
• Facilitated Cúram Verification process to verify evidence used in determining eligibility
• Facilitated Cúram Appeals solution to provide support for the appeals and fair hearings process
• Designed processes for registering, tracking and managing all participants in the appeals process
• Conducted JAD sessions to verify Cúram OOTB Evidence mapping program rules.
• Worked on a team to elicit Exchange specific business and functional requirements for each transactional business unit identifying cross-functionalities between business areas.
• Support for, and documentation of, required changes to business processes in connection with ACA ( Affordable Care Act).
• Validated design with stakeholders to validate that the design satisfies the requirements
• Documented Functional Design Documents (FDD) for IEG screens and rules
• Documented Process flow Design Documents using BPMN.
• Researched HIX related materials and websites for understanding of the ACA process.
• Coordinate with Health Insurance Exchange (HIX) program staff and other stakeholders to define and develop requirements for correspondence generation across various business lines.
• Validated FFM requirements with CMS.
• Understanding HIX benefit plans (On-exchanges & Off exchanges), requirements and understand the format in which the data was exchanged with the Client.
• Developed rules to validate Inbound and outbound Payloads
• Validated Payloads and designed Referral Decision responses to FFM from STATE and wrote rules to accept Inbound Payloads from FFM to STATE .
• Enhanced 834/999 EDI file transfers to enable transfer of member data with Exchange platforms.
• Prepared Business Requirement Documents (BRD) as well as high-level project plans and used Rational RequisitePro to manage, analyze, and convert business requirements into functional specifications.
• Worked with Health Care Reform / Customer Service team to establish a dedicated Customer Service Model to address member needs at each point in the customer experience (pre enrollment, during enrollment, post-enrollment etc.)
• Worked on different EDI scenarios for batch processing and ensured day-to-day EDI transmission, Reject tracking and Reconciliation.
• Created and managed project templates, use-case project templates, requirement types and trace-ability relationships in Requisite Pro.
• Followed a structured approach to organize requirements into logical groupings of essential Business Processes, Business Rules, and Information Needs, thus ensuring that Critical Requirements are not missed.
• Created batch job designs for Outbound Account Transfer TO FFM for individuals with higher income.

Environment: Rational Rose, Rational Requisite Pro, UML, MS Office (MS Word, MS Excel, MS PowerPoint, MS Visio), Visual Basic, Win Runner, Test Director, Windows 2000, Java, Oracle, RUP.

Business Analyst

Responsibilities:

• Acted as a liaison between several business units and information systems department, and created project scope requirements by working with various global, cross-functional and virtual teams.
• Created GAP analysis or Data Transformation Analysis (DTA) for accurate mapping of the existing 4010 system to the new 5010 system.
• Creating Business Requirement Document (BRD), Statement of Work and User Requirement Specification (URS)
• Prepared UAT Materials/Test Cases to include steps involved for UAT and have proper coverage of requirements.
• Worked within a growing knowledge of X12 4010 HIPAA 837 I, P, D, 835, 276, and 277.
• Create Mapping Documents, Report Mockups and modified existing report mockups as to requirements and finalized for development, strong SQL skills.
• Performed step up (4010 to 5010) and step down (5010 to 4010) conversions on Electronic Data Interchange (EDI) transactions using Claredi and Faceledi.
• Teamed up with both internal and external software development groups to provide functional requirements specifications in form of use cases, process flows, and prototypes and management reporting requirements
• Performed HIPAA Strategic National Implementation Process (SNIP) Level 1-4 Testing, User Acceptance Testing (UAT), and documented detailed defects.
• Conducted presentations on business requirements, test scenarios, &test results with analysis to the payers and documented modifications and requirements.
• Worked on EDI transactions: 835, and 837 (P.I.D) to identify key data set elements for designated record set. Interacting with claims and payments, analyzing and documenting related business processes and requirements.
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, using UML Visio.
• Developed business process models in Agile to document existing and future business processes.
• Involved in all meetings and phases of software development life cycle in agile framework. Assigned tasks among development team monitored and tracked progress of project following agile methodology.
• Conducted daily scrum meeting with the project team, prioritizes health plans according to backlog, sizing, resources, and revenue.
• Conducted deployment meetings on weekly basis with the project team for resolving problems and concerns in the project team.
• Created ESP tickets on errors seen while working on payer specific requirements.
• Extensive experience in tools like Mercury Quality Center to facilitate development across disparate teams.
• Provided management support to the offshore End-to-End Integration/ Regression Test Team.
• Conducting deployment meetings, which helped synchronize the payer edits (errors) and helped the developers to have a clear-cut picture of the project.

Environment: UML, MS Word, MS Excel, MS Access, MS PowerPoint, Quality Center, SQL, FTP, SFTP, UNIX, Claredi, Faciledi, ANSI X12- EDI, Agile/SCRUM

Business Analyst

Responsibilities:

• Met with client groups to determine requirements and goals. Utilized Rational Unified Process (RUP) to configure and develop process, standards, and procedures and create a Business requirement Document.
• Responsible for preparing Software Requirement Specification (SRS) and documenting them.
• Created Process Work flows, Functional Specifications documents and documented system requirements.
• Provide implementation assessment, strategy, and mentoring services for Rational Rose, UML and RUP.
• Interacted with various cross-functional teams on building business use cases, and understanding expenses and revenue stream.
• Working with clients to better understand their needs and present solutions using structured SDLC approach.
• Interaction with the developers to report and correct bugs. Contributed on the design of mainframe batch processes using DB2, JCL, COBOL, IBM Utilities, advanced BMC Scheduling techniques, and Connect Direct processes/jobs.
• Gathered requirements for the inputs in the Competitive Intelligence System from the stakeholder’s including methods like personal interviews, questionnaires, surveys, JAD sessions and joint team meetings. Identified systems requirements that would help create the CI System by meeting up with the technology team and then having a JAD session to include SME’s from the business side.
• Developed the systems implementation project management plan with milestones and steps from procurement of vendors to project implementation and maintenance.
• Followed a structured approach to organize requirements into logical groupings of essential business processes, business rules, and information needs. Ensured that critical requirements are not missed.
• Aided management in standardizing web applications by preparing GUI standards and recommending alternatives for in corporation in a phased, iterative manner.
• Interacted with client and the Technical Team for requirement gathering and translation of Business Requirement to Technical specifications.
• Analysis of new Business Requirements and preparation of the Functional Design Specifications
• Analysis of the new requests specified by the end users for the future releases and discussion with the functional and technical teams.
• Communicated changes to requirements promptly and precisely to all personnel involved.
• Analyzed and translated business requirements into system specifications.

Environment: Rational Clear Quest, Rational Clear Case, Rational Requisite Pro, Rational Rose, UML,RUP, Microsoft Excel, Microsoft Word, Microsoft Power Point, Visio.

Business Analyst

Responsibilities:

• Conducted vendor evaluation analysis based on decision matrix and contributed in preparing Request for Proposal for service procurement.
• Used XML/WSDL to transmit and store SBC requests and responses via Informatica.
• Regularly involved in regulatory trainings with CMS to understand the business process around 834 and 820 reconciliation.
• Provide various weekly & month-end reports including labor spend, R&M spend, production pounds, scrap, and purchase price variance, using CyberQuery.
• Responsible for working with the manager and business users and creating Process Flow diagrams in MS Visio.
• Worked as a Subject Matter Expert and analyzed all aspects of the Software Development Life Cycle including business requirement analysis, application Logical & Physical design, development milestone determination, code implementation and all various levels of testing (unit, integration & UAT) along with end user training for Trizetto Facets Healthcare system.
• Extensively interacted with the stakeholders and the IT Department in finalizing the requirements according to the CMS Compliances/Regulations and HIPAA Regulations.
• Developed business intelligence and strategic planning information for senior management regarding opportunities in Healthcare Exchange Markets under the ACA / Healthcare Reform
• Established a business analysis methodology around the SDLC, helped to develop use cases, project plans and manage scope for Coram health and human services applications.
• Wrote and ran Cyberquery reports for the Business Unit on a daily basis.
• Worked on Creating Business Requirement Documents (BRD), Functional Requirement Specification (FRS) document, User Requirement Specifications (URS) document, UML Modeling - Use Case Diagrams, object diagrams, Activity Diagrams, and Sequence Diagrams, SOA Orchestration Charts.
• Worked on Data Warehousing and Mining: Concepts, Methodologies, Tools, and Applications.
• Case study follow up, review information obtained from FDA, GCP, HIPAA, IRB and other regulatory compliances, recourses management, cost procurement.
• Performed UAT based on Requirements Document and prepared the Test Cases using Quality Center.

Environment: Curam, Connecture, COTS, MS Project, MS Visio, MS Word, MS Excel, MS PowerPoint, Infopath Designer, MS, Oracle 11i, Visual Basic, Windows XP, Unix, HP Quality Center, Test Director, UML.