PROFESSIONAL SUMMARY:

• Solution Oriented Business Analyst with over 8 plus years of experience in Business Analysis, Functional Requirements Gathering, defining specifications across the project lifecycle (Software Development Life Cycle and Rational Unified Process).
• Excellent knowledge in the areas of healthcare, insurance and retail industries.
• Expertise in diverse software engineering practices such as System Development Life Cycle (SDLC), Rational Unified Process (RUP) and Agile Method in delivering artifacts pertaining to requirement analysis.
• Experience in conducting Gap Analysis between “as is” and “to be” systems.
• Expertise in HEDIS and HIPAA Testing Privacy with multiple transactions exposure such as Inbound Claims
• 834 - Membership Enrollment, 837-Institutional, 837-Professional, 835-Claim Payment/Remittance Advise, 270/271-Eligibility Benefit Inquiry/Response, 276/277-Claim Status Inquiry/Response Transactions and testing in Client Server systems and Mainframe Applications.
• Ability to work with the team offshore and onshore.
• Good experience in facilitating Joint Application Development (JAD) and Rapid Application Design (RAD) sessions to expedite and streamline the requirement gathering process.
• Good working experience in healthcare domain specialty in Membership, billing, product, provider and claims.
• Vivid knowledge in EDI 820 Payment Order/Remittance Advice (Financial Transaction).
• I was involve working with my team with Providing solutions to solve gaps between external expectations and system limitations, to include implementing configuration improvements or streamlined maintenance processes.
• Authored Application and System Use Cases to document scenarios of functional requirements and business rules for system development.
• Experienced in working closely with User Experience team to create user friendly User Interface (UI) based on usability studies.
• Experience in Coordinating with the development team in realizing the use case model to create Entity Relationship Diagrams (ERD).
• Good Knowledge in Structured Query Language (SQL) and data modeling principles.
• Extensive experience in working closely with testers and collaborated in the creation of test plans, test scenarios and test cases for system and integration testing.
• Good understanding of change management using IBM Rational Clear Quest and repository management using
• IBM Rational Clear Case.
• Worked on JIRA SAFe product ALM Platform with the Scaled Agile Framework to develop a tool and process configuration for clients
• Acted as a liaison between business owner and development teams. Supported user training, call center and back-office processing personnel in assisting business operations.
• Team player, result-oriented, fast learner, excellent written and verbal communication skills with strong research capability.
• Excellent problem solving, conflict resolution, analytical and presentation skills.

TECHNICAL SKILLS:

Business Modeling Tools: UML CASE Tools, Rational Rose, MS Visio

Process: RUP, SDLC, BPM, Relation database management (RDM)

Modeling Languages: UML, HTML, Java, XML

Defect Tracking Tools: Quality Center/ALM, JIRA, SharePoint

Testing Automation Tools: Quick Test Professional, Doors

Requirements Management: Rational Requisite Pro, Rational Test Manager

Repository/Version Management: Rational Clear Case, Visual SourceSafe (VSS),TFS

Change Management: Rational Clear Quest

Databases: MS Access, MS-SQL Server, Oracle, SharePoint, Power point, Outlook

PROFESSIONAL EXPERIENCE:

Confidential, Washington, DC

Business Analyst

Responsibilities:

• Involved in gathering, documenting and verifying business requirements.
• Organized JAD Sessions to collect requirements from system users and prepared business requirement that provided appropriate scope of work for technical team to develop prototype and overall system.
• Worked closely with stakeholders and SME’s for requirements gathering.
• Identified end to end requirements for all systems and business units that may be impacted by the project.
• Created Requirement Traceability Matrix (RTM) for end to end tracking of business requirements from Analysis to implementation phase.
• Worked on Data Mapping among different interfaces.
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, and Object Oriented Design (OOD) using UML.
• Followed Software development life cycle with Agile and waterfall methodology.
• Created numerous documents working with Architects, Tech Leads and Developers during analysis and design phase, like System Requirement Document (SRD), Software Architecture Document (SAD), Supplementary Specification documents.
• Good experience in assisting configuration staff and managers in establishing criteria relating to deliverability, maintenance and design with SDLC (software development life cycle).
• Provided solutions on configuration issues and guidance and feedback with best practices .
• In our project I was involve working in Facets systems and its components facilitate such as Medical and dental claims processing, Claims re-pricing Capitation, risk fund management, Premium billing Provider network management Group, membership administration, Referral management, Hospital and medical pre-authorization .
• Worked as Senior Business analyst at Onshore and implemented task of Leading a team of 4 working offshore
• Worked on care advance enterprise software.
• Good working experience with benefits of Confidential clinical care advance such as disease management, case management and utilization management.
• Worked on Data ware house environment and generate ETL Reports.
• Clinical Care Advance business rules helps reduce cost and improve care management by providing personalized information and services and streamlining utilization management workflows in clinical system.
• Wrote BRD, FRD, use cases, test scenarios, test cases for testing the functional requirement.
• Excellent knowledge working with business rules engines to their BPM engines or OEM business rules management systems.
• I was involve working with my team on JIRA SAFe solutions it provides a critical component to technology transformation.
• Defined the timeline for gathering business matrix until business requirements were signed off.
• Conducted walkthrough and lead work sessions.
• Expertise in different views of business operations, Common functions of business intelligence technologies and reporting, analytical processing, analytics, data mining, process mining,, business performance management, benchmarking .
• Responsible for working closely with internal clients in all facets of project life cycle to deliver a useful application supporting the business need.
• Using MS-Visio analyzed business requirements and process through Use Cases, Class, Sequence, and Activity diagrams, and adapted UML standards to define modularized Data Process Models.
• Good working experience with all kind of diagrams swim line diagrams, Activity flow diagrams, ER diagrams Demonstrate use cases, UML diagrams and business modeling techniques, Data flow diagrams.
• Ensured Use-Cases were consistent and covered all aspects of the Requirements document.
• Developed a Business Acceptance testing strategy and plan.
• Created test files and analyzed test results using MS-Excel.
• Owned issues resolution and worked as a liaison between Business and IT for clarification of the project business requirements and change controls.
• Created a User Guide and Operations Guide for the Annuities Group and IT.
• Held regular meetings with the system architects, developers, and database quality testers, Life insurance annuities SME during the entire project to assure that the critical as well as minute details of the project were discussed and issues were resolved beforehand.
• Involved in project status meetings, QA review meeting, and System Test meeting.
• Coordinated and facilitated the execution of User Acceptance testing.

Environment: Facets, Windows 2003, Oracle, QTP, MQC, MQJ Explorer, Facets, Unix, SQL, HP ALM,DOORS

Confidential, Newark, NJ

Business Analyst

Responsibilities:

• Prepared requirements documents for conversion of to HIPAA compliant 5010.
• Involved in business analysis and project management, coordinating between the team members, addressing budget issues and creating test plans according to the business requirements.
• Involved in gathering the requirements that were critical to the business process flow and using those requirements for the Business Requirements Document (BRD)
• Worked with the project manager for planning and organizing the project activities, and in communicating with other business center mangers and stakeholders of the project.
• Gap Analysis of client requirements, generated workflow process, flow charts and relevant artifacts.
• Worked with FACETS Team for HIPAA Claims Validation and Verification Process (Pre-Adjudication)
• Involved in claim adjudication process of facets application
• Worked on the EDI 834-file load to Facets through MMS (Membership maintenance sub-system).
• Assisted the HEDIS team in the development and documentation of the test strategies for the EDI transactions which included all standard transactions, auditing and error correction processes, and the creation of the transactions.
• I was involve working with SAML for testing different application with all kind of testing such as user acceptance testing and End to End testing .
• Monitor and analyzed activity report. Created reports for Server monitoring and Transaction time
• Worked on HIPAA Transactions and Code Sets Standards according to the test scenarios such as 270/271, 276/277,837/835 transactions.
• I was involved working with Confidential care advance on care advance system management.
• Confidential Clinical Care Advance application helps achieve cost-savings in care management by automating processes and integrating data that once resided in disparate systems.
• Involved in Data Analysis & Mapping to track all data elements used in the application from the user interface through different interfaces to the target databases in which they are stored.
• Coordinated with the team in developing and documenting the detailed testing work plans and created the various testing documents for the assigned transactions.
• Defined and documented the vision and scope of the project.
• Gathered requirements, developed Process Model and detailed Business Policies.
• Designed Use Cases using UML and managed the entire functional requirements life cycle using RUP.
• Worked with the project manager to estimate best/worst case scenarios, track progress with weekly estimates of remaining work to do, conducting informal meetings ad hoc and as needed.
• Followed the RUP methodology for the entire SDLC with design develop and implementation.
• Involved in writing and implementation of the test plan, and various test cases for UAT.
• Initiated, proposed and implemented critical analytical and technical turnkey solutions extensively increasing the quantitative and qualitative value of the application.
• Involved in data ware house dictionary management, extraction, transformation and loading (ETL) of data from various sources. Participated in ETL requirements process during data transition from source systems to target systems.
• Involved in project planning, coordination and implemented QA methodology.
• Provided overall project management to multiple projects successfully completing them on-schedule and on-budget.
• Worked with FACETS, E-Billing and EDI HIPAA Claims (837/835/834) processing.
• Prepared the Business Workflow using MS-Visio with input, output, Pre and Post conditions.
• Enhanced test cases and scripts by adding the required functionality as per the new business requirements.
• Defect Tracking and Bug Reporting was performed using Quality Center.
• Performed manual testing on different modules of the application.
• Worked with Data Sheet to facilitate the automation testing.
• Developed Test Matrix to give a better view of testing effort.
• Verified that the data outputs and transformations between systems remain true and not compromised as systems are bundled together.
• Participated in various meetings and discussed Enhancement and Modification Request issues.
• Attended weekly meeting to discuss progress and modification to test plans due to change in business requirements.
• Tested the HIPPA EDI, 834, 270/271, 276/277, 837/835 transactions according to test scenarios and verify the data with Facets on different modules.

Environment: Facets, Windows 2003, Oracle, QTP, MQC, Unix, SQL, HP ALM,DOORS

Confidential, Austin, TX

Business Analyst

Responsibilities:

• Gathered requirements from the Business users; interacted with them on constant basis.
• Worked along with Project Manager in scheduling the project flow.
• Defined and documented the vision and scope of the project.
• Conducted one on one interviews with high level management team and participated in the JAD session with the SME’s.
• Administered Service Manager to manage, track and deliver fixes for post-production defects and enhancement.
• Conducted JAD sessions with Subject Matter Experts (SME’s) to obtain domain level information, interviewing and asking detailed questions and carefully recording the requirements in a format that can be reviewed an understood by both business and technical team.
• Entered numerous claims for testing purposes to ensure accurate and quality adjudication and implementation of business and operational requirements
• Implemented the full project life-cycle with all phases from requirements gatherings to development and quality assurance standards.
• Familiarity with data ware house environment and ETL data processing
• Designed and Developed SharePoint tool for business and production support team to store, coordinate, manage, and maintain documentation, and tasks via workflow.
• Worked on Business Requirement Documents, business use cases, and test strategy.
• Kept assure whether the aggressive timeline of the project is maintained,
• Worked on Technical design documentation (TDD) of the claims processing system.
• Daily Status reports to the Business owner, Project executives & Team,
• Gap Analysis of client requirements, generated workflow process, and relevant artifacts.
• Worked on conversion of, 834 compliant transactions.
• Receiving, 834 transactions from vendor benefit focus and testing those transactions.
• Managed the entire UAT set up & UAT testing effort with the Business users,
• Participated in weekly status meetings to present status and in corporate any digressions from the original scope
• Created UI Documents as supporting documents for the Business Requirements Documents
• Implemented the full project life-cycle with all phases from requirements gatherings to development and quality assurance
• Carried out a thorough target organization assessment and risk analysis.
• Analyzed the “As is” and “To be” system documents to show the current and proposed functionalities of the system using MS Visio.
• Worked with the clients on the final signing process in the User Acceptance stages

Environment: UNIX, Facets, Oracle, Mainframe, XML, QTP, MQC, SharePoint,, HP ALM,DOORS