SUMMARY:

• Over 7 years of extensive experience as a Business Analyst/ Business System Analyst, in Insurance and Health Care, using IT Business Analytics, Modeling expertise, and SDLC.
• Good experience in Health Administration Claims processing (Auto adjudication), COB< EOB/Drafts, Claims pricing and testing, HIPAA, PPACA (Patient protection and Affordable Care Act) enrollment, EDI, Medicare, Medicaid, CDHP (consumer driven health plans).
• Experience in HIPAA 4010 and 5010 EDI healthcare transactions like 837, 835, 834, 820, 270, 271, 276, 277, and 278 along with ICD - 9/10.
• Excellent skills in gathering business requirements, analyzing them, modeling business flows, facilitating joint application development (JAD), creating business requirements document (BRD), functional specifications document (FSD) and software requirement specifications (SRS).
• Knowledge of relational Database Management system (RDBMS).
• Developed use cases/diagrams, Data Flow Diagrams (DFD’s), Conceptual Model, Behavioral diagrams for order Processing, Billing and payment systems.
• Extensive experience in documentation of business requirements and system functional specifications, including BRD, FRD, and FSD
• Experience with Facets Application Groups: Claims Processing, Guided Benefit Configuration, Medical Plan, Provider, Subscriber/Member, Utilization Management.
• Comprehensive understanding of the Organizational Framework that help to map the AS-IS and TO-BE model using the GAP Analysis and plan & monitor effective approach to build/buy solutions to the business problems/needs/opportunities.
• Executed SQL Statements to extract Data from Tables to verify the output Data of the reports.
• Experienced in RAD, RUP, Agile, Waterfall development methodologies, object-oriented programming (Java, HTML, JavaScript, C++, JSP, Servlets), procedural programming (C), SQL and OOAD principles
• Knowledge in Test Scripts, Test Cases, and SQL QA scripts to perform Unit testing.
• Proficient in query optimization and effective database management of different Database.
• Expertise in Logical Modeling, Physical Modeling, Data warehousing, Dimensional Modeling, Star and Snow-Flake schema.
• Good knowledge of Business Analysis methodologies and Iterative Software Development Lifecycle using RUP. Thorough knowledge of implementing RUP in all four phases of a project.
• Interviewed SME’s and Stakeholders to get a better understanding of client business processes and gather business requirements.
• Experienced in all phases of SDLC including requirement gathering, change control and management, analysis, design, implementation and testing.
• Strong experience in conducting Unit Testing, Integration Testing, System Testing, User Acceptance Testing (UAT) and documentation of test cases. Expertise in designing and developing test plans.
• Ability to organize, document and track changes and defects using JIRA, Rational Clear Quest and archive change request in Clear Case.
• Good communication skills with strong analytical, qualitative, quantitative, and problem solving skills.

TECHNICAL SKILLS:

Business Modeling tools: MS Visio, Business Process Visual Architect 10.0

Project Management: MS Project, Microsoft Office Suite and MS share point.

Management Tools: MS office, JIRA, Rational Clear Quest

Databases: MS Access, Oracle, SQL, PL/SQL

Testing tools: HP AC v 10.0, HP ALM v11.5, Load Runner, Quick Test Pro

Disciplines: SDLC, Rational Unified Process (RUP), JAD, OOAD, Waterfall, Agile, RAD, Change Control Process

PROFESSIONAL EXPERIENCE:

Senior Business Analyst

Confidential, Boston, MA

Responsibilities:

• Interviewed SMEs and Stakeholders to get a better understanding of client business processes and gather business requirements.
• Created use case scenarios and documented work flow and business process using MS Visio.
• Gathered and documented business requirements for existing and future business systems.
• Analyzed and tested various Common Eligibility Outbound Interface Process and other Inbound/ Outbound Facets interfaces.
• Acted as a liaison between business staff and technical staff to articulate needs, issues and concerns.
• Analyzed current MMIS and EDI claims and documented the requirements to implement new MMIS automated system.
• Defined Functional Test Cases, documented and executed manually using quality center.
• Analyzed trading partner specifications and created EDI mapping guidelines.
• Responsible for Data Manipulation and Data Validation using SQL queries in a MS SQL Server.
• Helped with building ICD 9 to ICD 10 crosswalk map by grouping thousands of codes and ranges in Clinical, Benefits, Financial, Medical policy waves.
• Working within a growing environment of X 12 4010/5010 HIPAA Transaction Processing 837 I, P, D, 835, 834, 820, 270, 271, 276, 277, 278, EDI, Privacy, Security, and Medicaid.
• Reviewed EDI companion guides for all payers to ensure compliance, edit integrity and maintain up-to-date list of payer contacts.
• Written test cases, test scenarios, and prepared test data to conduct the manual testing of EDI files and the mainframe screens.
• Involved in creation and execution of manual test cases in HP quality center and automated Test Cases in QTP and analyzed the Test Results.
• Tested the application manually by executing Test Cases in Quality Centre prior to Automation and Involved in automated testing.
• Performed functional testing with the development team as well as User Acceptance Testing and Regression Testing of the application using Quality center and JIRA for prioritizing defects and assigned it to the developer to fix the bugs.

Environment: Agile / SCRUM, MS Office Suite, MS Visio, MS access, SQL, Quality Center, JIRA, Java Script, Project Management, QTP

Senior Business System Analyst

Confidential, Hartford, CT

Responsibilities:

• Prepared questionnaires for interviews, meetings and JAD sessions.
• Gathered business requirements from Business and SMEs from the Underwriting Property & Casualty, Product in auto insurance.
• Performed in depth Gap analysis with different business groups to ensure that the system initiatives are met.
• Analyzed, documented and managed all project requirements with RUP methodologies.
• Coordinated and Conducted individual and group (JAD) sessions with business stakeholders and technical units.
• Worked with PM to prepare Project charter, Project plans, daily, weekly and monthly team deliverables for each phase, drafting WBS and RBS systematically using MS Project.
• Created critical Use Cases and did intensive use case analysis.
• Developed activity diagrams, use case diagrams and other UML notations with RUP methodologies.
• Authenticated technical designs, User Interface (UI) created by IT developers and ensured if they tallied with the functional specifications.
• Communicated with stakeholders throughout the lifecycle of the project and kept them updated with the progress of the same.
• Ensured that all the artifacts are in compliance with corporate SDLC Policies and guidelines.
• Coordinated with the Project Manager and prioritized outstanding defects and enhancement/system requests based on business requirements, allowing sufficient time to ensure accuracy and consider deadlines.
• Conducted the meetings with the review teams to continuously improve the Quality Assurance process for the application development.
• Explain plan to improve database performance.
• Involved extensively in the analysis and tuning of the Application code (SQL).
• Performed database testing using SQL, developed the test scenarios and test plan to be used in testing based on business requirements, technical specifications.
• Coordinated with the QA team in using HP Quality Center for defect tracking for issue and rating module.
• Executed test cases: Ensured all high-priority defects are fixed prior to deployment. Executed Functional and Regression Testing.

Environment: RUP, Java, J2EE, Web sphere, DB2, SQL, XML, HTML, PHP, JavaScript, MS Office, UML, Visio, Quality Center, QTP, UAT.

Business Analyst

Confidential, Marietta, GA

Responsibilities:

• Gathered analyzed, documented business and technical requirements from both formal and informal sessions and validate the needs of the business stakeholders.
• Performed Cost benefit, ROI and ROM studies.
• Conducted user interviews and documented business and functional requirements.
• Performed Requirement Analysis and developed UML Use Cases, Activity Diagrams using Rational Rose to understand the requirements.
• Worked with the management for improving and giving new ideas for designing future processes of the HIPAA transactions dealing out with EDI’S 271, 276 and 270, 470, 835, 837, 834, HIPAA 4010, 5010, claim adjustments, claim processing from point of entry to finalizing, claim review, identifying claims processing problems, their source and providing alternative solutions using best practice model and principles and also well versed with ICD10, Facets.
• Completed the documentation of Claims Scenario’s for the source system.
• Analyzed the existing claims process and specific business rule logic will be applied in the requirement model.
• Responsible for architecting integrated HIPAA, Medicare solutions, Facets .
• Involved in creating business processes and modeling diagrams using Rational Unified Process (RUP).
• Created use case scenarios and documented work flow and business process.
• Documented requirements associated change requests with requirements and connected requirements with Use cases.
• Understood the requirements of the Sales and Marketing team.
• Incorporated Rational Unified Process (RUP) to create Requirement Document Specifications using Visible Analyst.
• Developed gap analysis and risk assessments for the FACETS upgrade project including effects on internally developed extensions and third party software for pricing and contract configuration.
• Served as a point of contact for CMS and trading partners to do the testing for various types of claims and real time transactions like 270/271/276/277 for Medicare and Medicaid programs in FACETS.
• Performed extensive data modeling to differentiate between the OLTP and Data Warehouse data models.
• Designed the UI of the application, prototyping and wire framing in MS Visio for better illustration of the application.
• Responsible for creating test scenarios, scripting test cases using testing tool and defect management for Policy Management Systems, Payables/Receivables and Claims processing.
• Knowledge on handling QA tickets and analyzes trouble tickets.
• Involved with all the phases of Software Development Life Cycle (SDLC) methodologies throughout the project life cycle.
• Served as conduit for managing system requirements between the business and the software development team.
• Prepared UAT Materials UAT Test Cases to include various steps involved for UAT and to have proper coverage of requirements.
• Used Test Director and Mercury Quality Center for updating the status of all the Test Cases & Test Scripts that are executed during testing process.
• Evaluated testing results for each potential release build using Test Director, Quality Center and Bugzilla reports, listing summarized bug information in priority sequence, recommended viability of release for production.
• Involve in preparing Trace Matrix to design test cases.
• Preparing Weekly action report & QA feed back to QA team & Manager.

Environment: Windows XP Professional, Oracle9i, MS Access 2000, MS Excel, RUP, Oracle, UML, Rational Rose, Requisite Pro, Clear Case 2002, Rational Clear Quest 2002, MS Office suite, MS Visio 2003.

Business Analyst

Confidential, Marietta, GA

Responsibilities:

• Designed and development of test cases based on functional requirements for Institutional and Professional claims for EDI and HIPAA Transactions 837/835, 834, 276/277, 270/271 testing.
• Performed System testing of the Claims processing systems (Pricing Rules, Duplicate/Limits validation, Member Eligibility, Provider Enrollment, et al).
• Performed testing for Medicare, Medicaid and X-Over claims for Medicaid Management Information System (MMIS).
• Prepared documents for business requirements document (BRD), systems requirements specification (SRS), high level design documents (HLDD), and traceability mapping / matrix with the assistance from the business group, and the IT team members.
• Prepared graphical depictions of Use Cases, Use Case Diagrams, State Diagrams, Activity Diagrams, Sequence Diagrams, Component Based Diagrams, and Collateral Diagrams and creation of technical design (UI screen) using Microsoft Visio.
• Conduct complex documentation and user needs analysis. Interface with team and staff to develop HL7 integration.
• Involved in full life cycle of Business Objects reporting Application.
• Lead Business Intelligence reports development efforts by working closely with Teradata, and ETL teams.
• 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.
• Conducted business-impact assessment and the results were compared with the new HIPAA 5010 standards to determine the current level of compliance and developed an action plan for approval by the project steering committee.
• Developed plan for data feeds and data mappings for integration between various systems, including XML, to follow ICD 10 Code set and ANSI X12 5010 formats.
• Conducted Gap Analysis, and Gathered User Requirements by Interviews, user meeting, JAD session, and Requirement Elicitation Sessions.
• Utilized corporation developed Agile SDLC methodology. Used Scrum Work Pro and Microsoft Office software to perform required job functions.
• Assisted to develop the Test Plan, Test Cases and Test Scenarios to be used in testing based on Business Requirements, technical specifications and/or product knowledge.

Environment: Windows 2000/XP, HL7, Business Objects (BO), Microsoft Office SharePoint 2007, Agile, Rational Requisite Pro, MS Office, SQL Server 2005, DB2,MS Project, MS FrontPage 2003, MS Access, HP Quality Center.

BA/QA Analyst

Confidential

Responsibilities:

• Worked closely with the hospital staff to gather the requirements of the Out Patient Registration and provided technical support and training for the new online system.
• Participated and facilitated meetings with business and technical Subject Matter Experts (SMEs) to capture the high level function points and business practices.
• Responsible for facilitating and arranging Conference Calls, and Business Interviews and worked with a team of physicians to determine functional and technical requirements designed for the development of a new in-house built Out-Patient & Billing System.
• Performed analysis on the existing system logic difficulties and the proposed system and created as-is and to-be business process flow diagrams.
• Extensive data validation on the back end using SQL queries to verify the data has been loaded in the correct tables.
• Created ad-hoc management and production reports against the Out-Patient Registration database upon physician and hospital management request.
• Engaged in preparing the flow chart of the design and documented user requirements with MS Word as the editing tool.
• Involved as a Test Engineer in testing team for Manual and Automated Testing.
• Developing and executing test cases for the Maintenance, Sharing requirement and DBA modules
• Preparation of test cases for the out-patient modules.
• Documented problems found during test and communicated recorded problems to the responsible development personnel.
• Extensively used ETL to Extract, Transform and load data.
• Developed Scripts for Regression Testing and System Testing.
• Actively attend meetings with fellow testers and other groups to evaluate the progress and performance of the application.
• Performed Back-end testing using SQL Queries.
• Executed test cases manually and reported defects.
• Performed Sanity testing for each new build of the application.
• Eventually created and executed automated test scripts using Win Runner.

Environment: ASP.NET, C#.NET, Web service, Win Runner, MS Office, MS Visio, Quality Center, Agile Methodology, SQL, .Net, XML, WINDOW 2003

Business Analyst

Confidential

Responsibilities:

• Worked on Hospital data processing for improving database for storing user files.
• Analyzed business needs, created and developed new functionality to meet real time data integration that facilitated decision.
• Worked on functions such as Change Control and Request, and managed complaints to ensure customer satisfaction.
• Active involvement in ETL design for data integration and master data management.
• Experience of managing multiple stakeholders across the organization, and in QA integration of systems.
• Involved in detailing project mission, data process flow diagrams, and timelines.
• Worked with SQL queries for data manipulations.
• Created Entity relationship diagrams for the proposed database.
• Participated in the development and creation of the data warehouse.
• Participated in creation of database objects.
• Assisted in building a business analysis process model using Rational Rose, Requisite Pro and Visio.
• Designed and developed Use Cases, Activity Diagrams and Sequence Diagrams.

Environment: Oracle, PL-SQL, IBM Cognos, Framework Manager, IBM Cognos, Business Intelligence Suite 10.2, Jira, Rally, IBM BPM, SQL Developer, MS Project, Excel, Word, Outlook, Visio, XML, AS400, Windows 8/XP, Mainframe, IBM Data manger.