SUMMARY:

• A Business Analyst with 6 years of experience and solid understanding of Business Process Flows, Case Tools and Business Analysis
• Excellent knowledge of Software Development Life Cycle (SDLC).
• Highly experienced in agile/scrum methodology
• Excellent experience in analyze and document business requirements and system functional specifications including use cases.
• Good understanding of gap analysis, requirements management, risk analysis and project plans. Proven expertise in creating UML diagrams, flowcharts, screen mockups, systems requirements specifications, and test plans.
• Experienced in data mapping document and functional design document and worked with stakeholders and helped during the project.
• Experience in Project Management, Project Schedule, Project Tracking and Team Management. Submit Risks, Issues, Dependencies documents, Project status.
• Working knowledge of requirement gathering by conducting personal interviews, developing questionnaire, brainstorming, conducting JAD (Joint Application Development) sessions, or role playing to get a better understanding of client business processes and creating requirements traceability matrix for tracking the requirements.
• Had excellent communication skills, leadership and presentation skills, time and group management skills.
• Experienced on Health insurance exchange programs during the project and worked with many insurance clients and companies for the billing and claiming issues.
• Highly experienced in Health care domain like Medicaid, Medicare.
• Deep knowledge of Medicare - Medicaid rules, NCPDP, HIPAA, ICD9/ICD10 codes, CPT, EMR, EDI transactions ( 276/277, 820, 834, 837/835)
• Extensive knowledge on the various types of health insurance programs such as: Medicaid, Medicare (Part A, B, C and D)
• Highly experienced in ICD9, ICD10 codes.
• Deep knowledge in conversions from HIPAA .
• Excellent skills in writing SQL on SQL Server.
• Solid understanding of the ETL process from QA perspective, testing the aspects of ETL transformation using SQL.
• Conducted User Acceptance Testing (UAT)

TECHNICAL SKILLS:

Methodologies: RUP, Agile, Waterfall, Six Sigma,, UML, Business Process Modeling and Data Modeling

Office Tools: MS Word, MS Excel, MS PowerPoint, MS Access, MS Project, M Outlook, Lotus Notes

Process/Modeling tools: MS Visio, Rational Rose, Rational Requisite Pro, Smart Draw, Clear Case, ClearQuest

Database: MS Access, SQL Server 2008, 2012 Oracle 9i & 10g

Testing tools / QA: Selenium, EDI Fecs, HPALM

Quality Management: HIPAA, CMMI, CMM, Six Sigma, TQM

Operating System: Windows Vista, NT/2000/2003/ XP/98, MS DOS

Languages: C/C++, Java, SQL, PL/SQL, HTML, XML

PROFESSIONAL EXPERIENCE:

Confidential, Nashville, TN

Sr. Business Analyst

Responsibilities:

• Worked on gathering requirements, gap analysis.
• Worked on EDI 837 & 275 claim attachments.
• Worked on AS3 (Administrative Simplification) project by using EDI 837 claims and 275 attachment.
• Worked on SQL queries and oracle toad analysis for getting the member information from the database.
• To align front-end functional requirements with HL7 2.3v interface requirements
• Document review sessions with the stakeholders which includes SME (Subject matter experts), business, stake holders, Sponsor for the project and project manager, Developers and QA.
• Prepared UAT test plan for the project.
• Prepared test cases for all iterations throughout the project.
• Worked on defect tracker by creating defects.
• Prepared EDI 837 & 275 test files for the testing purpose.
• Experienced in Scrum Methodology.
• Processed EDI 837P, 837I and 837D transactions, verified 837 transactions were converted correctly to XML file format and verified the claims data loaded to Facets for further processing.
• Actively involved in designing EDI transactions using the new HIPAA 5010 version and ICD -10 codes and analyzing HIPAA compliance and EDI transaction.

Confidential, Scottsdale, AZ

Business System Analyst

Responsibilities:

• Worked on patient assistance program.
• Worked on pharmacy benefit management (PBM).
• Worked on prescription drugs, Medicare part B & Medicare part D program.
• Worked on Confidential program, mail order pharmacy program.
• Worked on SQL queries, Oracle toad application.
• Worked on SQL queries regarding the patient, insurance and Advocate tables in different servers and Database.
• Worked on BTA (Bridges to Access) and CTA (Commitment to Access) program for the patients who don’t have insurance coverage for the Medications.
• Worked on ProPbm set up.
• Worked on pharmaceutical drugs, sun setting (end dating) of brand drugs.
• Document preparations which includes business requirements and as well as system requirements.
• Worked on scrum methodology and worked on project plans and created project chart and worked efficiently with the stake holders.
• Document review sessions with the stakeholders which includes SME (Subject matter experts), business, stake holders, Sponsor for the project and project manager, Developers and QA.
• Used to prepare test cases, test case reviews sessions.
• Worked on test plans and test cases and UAT (User Acceptance Testing) testing for the deployment process.

Confidential

Business System Analyst

Responsibilities:

• Worked on EDI transactions like 275, 276, 277, 820,834, 835 and 837.
• Worked on ICD - 9 and HIPAA - 5010 modules.
• Experienced in gathering requirements for the project from the stake holders.
• Conduct meeting sessions with the stake holders to know regarding the project.
• Participated in the Requirement Gathering Session (RGS) with the clients to know the requirements.
• Worked on Gap Analysis during the project.
• Worked on Data mapping document during the project and helped the stakeholders and business experts.
• Worked on scrum methodology and worked on project plans and created project chart and worked efficiently with the stake holders.
• Document review sessions with the stakeholders which includes SME (Subject matter experts), business, stake holders, Sponsor for the project and project manager, Developers and QA.
• Used to prepare test cases, test case reviews sessions.
• Worked on several claims issues and reimbursement issues and conducted JAD sessions to understand the requirements.
• Highly experienced in Health care domain like Medicaid, Medicare.
• Worked on hands on analysis during the project. .
• Worked on SQL queries / ORACLE Queries and highly experienced in different SQL modules and database, server and tables in the EDI tables and QNXT tables.
• Worked on test plans and test cases and UAT (User Acceptance Testing) testing for the deployment process.

Confidential

Jr. Business System Analyst

Responsibilities:

• Facilitated planning, testing, and implementing system enhancements and conversions.
• Provided key project inputs by working with users in defining the project and system requirements.
• Assisted in process modeling; conducted and participated in JAD sessions with system users; helped with design walkthroughs with stakeholders for base lining architecture.
• Reviewed business process, and functional requirements.
• Worked on Pharmaceutical 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 system audit, Change Control and Request, CAPA and managed complaints to ensure customer satisfaction.
• 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.
• Assisted in building a business analysis process model using MS Visio .
• Aided documentation of Computer system validation lifecycle per FDA regulations .
• Designed and developed Use Cases, Activity Diagrams and Sequence Diagrams.