SUMMARY:

• Confidential ® certified professional (PMI) with over 10+ years of professional experience in Healthcare Industry as Business Analyst. Vast experience in Business development, Requirement management, Gap analysis, Estimation & Client Relationship Management with effective communication & result orientation.
• Excellent combination of Managerial and Technical skills in different roles as Advisory consultant, Sr. Business Analyst.
• Fully functional knowledge of US Healthcare Industry, Medicaid, Medicare and MarketPlace. Highly skilled in eliciting User Demands, managing User Requirements and translating them into functional and design specifications. Excellent testing skills with system Claims Processing (EDI 837, 835) and Member Enrollment (EDI 834).
• Functional experience concentrating on Business Analysis, Requirements Management, Use Case modeling using UML, Business Process Modeling, Business Process Re - engineering, Data Modeling, Change Management, Gap analysis, Technical Writing, Software Development methodologies, QA testing, and Systems Testing of client server and web-based systems with focus on different industries.
• Experienced in working with all phases of SDLC throughout the project life cycle in Rational Unified Process (RUP), Waterfall and Agile environment.
• Strong experience in requirements elicitation techniques - conducting user interviews, document analysis, JAD sessions. Strong experience in documenting existing process, analyzing business requirements, working with requirements traceability matrix, re-engineering business processes and designing.
• Extensive experience in developing Business Documents, Mapping Documentation and implementing initial QA testing.

TECHNICAL SKILLS:

Concepts & Packages: Facets, RUP, Rational RequisitePro, Rational Rose, Rational ClearCase, Rational ClearQuest, MS Visio, MS Office, MS Project

Programming Languages: Java, JavaScript, NET, Visual Basic 6.0, SQL, PLSQL, XML

RDBMS: Oracle 11g/10g, SQL Server 2000/7.0/6.5/6.0, MS Access

Tools: MS Excel, Informatica PowerCenter, Power Builder

Automation Testing Tool: QTP 8.2 (Quick Test Professional), Quality Centre, WinRunner

Operating Systems: DOS, Windows 8/7/XP/2000, UNIX, LINUX

WORK EXPERIENCE:

Confidential . Long Beach, CA

Business Analyst

Responsibilities:

• Involved in requirement gathering and analysis of the mandates rolled out by CMS for MarketPlace QHP.
• Involved in requirement gathering and analysis by conducting group interviews with users. Writing Business Design Document, System Test Plan and Test Case Documentation for the Work Orders to be implemented.
• Took initiative to propose the cost saving solution for Printed Provider Directory process, which will save USD 350,000 each year for MarketPlace line of business.
• Involved in Systems Testing involving HIX Case management in UAT and Testing Environment.
• Involved in documentation and developed URS and FRS.
• Done Gap analysis for different processes to fix the core and optimize the process.
• Developed Use Case Diagrams, Activity Diagrams and Functional Diagrams using Visio.
• Lead the JAD session for integrated CRM tool with different interacting department managers and refined the requirements.
• Worked with change control board in the implementation of change and extensively interacted with case workers and managers, conducted User group meetings.

Environment: Visio, MS Office suite, HTML, Basic SQL queries, MS project, Powerbuilder.

Confidential, Hill, PA

Sr. Business Analyst

Responsibilities:

• Involved in successful implementation of Healthy Choice Expansion (Obamacare) for State of PA Medicaid Program.
• Involved in requirement gathering and analysis by conducting group interviews with users. Writing Business Design Document, System Test Plan and Test Case Documentation for the Work Orders to be implemented.
• Involved in Systems Testing involving Claims Submission in UAT and Testing Environment.
• Involved in documentation and developed URS and FRS.
• Internet, Electronic and Paper Claims Submission. Writing and Modifying X12s/XMLs for Claims Submission.
• Worked in the RUP framework in requirements analysis management and used standard artifacts and tool mentors suggested in RUP.
• Developed Use Case Diagrams, Activity Diagrams and Functional Diagrams using Visio.
• Interaction with the help desk team, production team and design teams and involved in the change requests and problem report documentation.
• Lead the JAD session with different interacting department managers and refined the requirements.
• Worked with change control board in the implementation of change and extensively interacted with case workers and managers, conducted User group meetings.
• Involved in testing of Internet enabled Java/Application server based system which enabled the client server system to interact with Mainframe/DB2 database.
• Assisted in Designing of test scripts, goals, objectives for the applications and executed them.

Environment: Visio, MS Office suite, Java, JavaScript, HTML, Oracle, MS project, Powerbuilder, .NET

Confidential

Healthcare Business Analyst

Responsibilities:

• Involved in requirement gathering and analysis by conducting group interviews with users.
• Involved in documentation and developed URS and FRS.
• Manage the development, maintenance, and coordination of project master & continuous process improvement of risk, issue and change with PMO. Conduct metrics reporting, including project plan trending metrics, project.
• Worked on Clinical Editing Software (CES) to integrate with Facets.
• Coordinate with Functional Plan Managers to ensure effective overall project.
• Worked for continuous development and oversight of core PMO process that power product development and launches which include: New Product Development stage-gate process, Change Request/Management, Risk Management, Project Management planning
• Involved in Systems Testing involving Claims Submission in UAT and Testing Environment.
• Developed Use Case Diagrams, Activity Diagrams and Functional Diagrams using Visio.
• Interaction with the help desk team, production team and design teams and involved in the change requests and problem report documentation.
• Lead the JAD session with different interacting department managers and refined the requirements.
• Worked with change control board in the implementation of change and extensively interacted with case workers and managers, conducted User group meetings.
• Involved in GAP and Risk Analysis and made recommendations in the implementations of certain security features.
• Associated in Feature List/Boundary/Performance/Stress System and Integration testing of Welfare applications
• Assisted in Designing of test scripts, goals, objectives for the applications and executed them.

Environment: Facets, Visio, MS Office suite, Oracle, MS project, QTP

Confidential

Business Analyst

Responsibilities:

• Formulate requirements for billing, encounter, patient record management, provider access and other health care related features based on new compliance specification.
• Working as a liaison between developers and users.
• Writing complex SQL Queries for data mining and analysis of the data to validate the data used for testing.
• Designing the oracle database, adding, modifying and deleting the existing records in Oracle database. Also involved in the architectural design of the application with proper comparative analysis.
• Conducting Requirement elicitation sessions, writing BRDs and BDD as per the user requirement.
• Creating System Test Plan and Test Case Documentation for the testing.
• Writing Technical Design Document for the coding change required for the software or development.
• Tracking the progress of the Life Cycle of the project I am assigned to. Bridging in the gaps between the users and the developers.
• Conducting JAD sessions between the Developers and the Testing team to making sure of the smooth running of the projects.
• Involved in GAP and Risk Analysis and made recommendations in the implementations of certain security features.

Environment: RUP, Rational RequisitePro, Rational Rose, Rational ClearCase, SQL Server, VB, MS office suite.