- Functional Business Analyst with 8 years of experience in SDLC( Agile, Scrum, Waterfall methodologies) of a project, with primary focus on analysis, design, business process modeling and in writing Business Requirement Document, Functional Requirement Document, Use Cases, Test Plans and Test Cases.
- An effective communicator, quick learner and excellent team player with fine - tuned analytical skills.
- Skilled in determining business requirements and specifications for application development projects, with emphasis on User Requirements and Functional Requirements through user interviews and JAD sessions.
- Good working experience in Medicare and Medicaid Projects.
- Excellent knowledge of HIPAA compliance (Health Insurance Portability and Accountability Act) on HETS (HIPAA Eligibility Transaction Sets) such as 270/271 (Benefit Inquiry/Response), 276/277 (Claim Status), 834 (benefit Enrollment), 835 (Payment or Remittance Advice) and 837 (Healthcare Claim), Medicaid Management Information Systems (MMIS), ICD-9 and ICD-10.
- Good working experience with Facets, QNXT, Claim Adjustments, Claims Processing from point of entry to finalizing the claims(Claims-Paid, Pending, Denied), Claim Review, identifying claims processing issues and providing corresponding solutions.
- Good working knowledge of Rational Unified Process (RUP), Risk Mitigation, UML and Visio.
- Experience in Conducting GAP and SWOT Analysis.
- Created Requirements Traceability Matrix to keep the stakeholders and the team informed of the progress of the project.
- Extensive experience in conducting Joint Application Development (JAD) sessions for project definition that involved analyzing the requirements and creating prototypes.
- Extensive experience in gathering Business/Functional user requirements, creating Use Cases as per user requirements, developing/designing diagrams such as Activity, Class, and Sequence diagrams
- Involved in both High Level (HLD) and Low Level (LLD) design phases.
- Experience in creating prototypes, wireframes and UIDD's.
- Good understanding of Application Life Cycle Management ALM.
- Knowledge of basic SQL queries
- Good Knowledge on HEDIS Measures.
- Thorough knowledge about Scrum meetings, Sprint planning and Story writing.
- Good understanding of HL7.
- Assisted QA team in developing Test Scripts, Test Cases and Test Plans for the User Acceptance testing (UAT) and involved in Regression Testing and Functional Testing to certain extent. Skilled at reviewing test cases, making sure they are in accordance with requirements, and assist the overall testing process by activities such as Change and Defect Management.
- Proficient in the MS Office, MS Visio, MS Project.
Confidential, Louisville, KY
- Gathering and documenting of Business Requirements from Trading Partners, user groups and vendors through workshops, interviews, and surveys.
- To work in close collaboration with the Project Manager and business users to gather, analyze, and document the functional requirements for the project.
- To identify the scope, business objective and documented the functional requirements for each release.
- To create use cases specifications, use case diagrams and context diagrams to define the workflow and segregate high-level and low-level requirements using MS Visio.
- To conduct JAD sessions, Create Workflow and UML diagrams, Process Models, Activity Diagrams.
- To validate EDI transactions 270, 271, 835, 837 to ensure accurate processing of claims.
- To create and maintain the Requirements Traceability Matrix RTM.
- To ensure Use Cases are consistent and covers all aspects of the requirements document.
- To submit change requests in Clear Quest.
- Proficient in using Rational Clear Quest for defect tracking.
- Actively participate in project status discussion, QA review and System Test meeting.
- To conduct Integration Test and UAT through prepared test cases.
- Used HEDIS data collection for Patient-Level-Detail (PLD) file validation process documentation.
- HEDIS measure specific documents were analyzed for record sampling, calculation and overall performance check.
Confidential, St. Paul, MN
- Facilitated JAD sessions to collect requirements from system users and prepared business requirement documents that provided appropriate scope of work for technical team to develop prototype.
- Created Use Cases, various UML Diagrams and Data Flow Diagrams to determine the data flow through various systems. The documents were created based on the descriptions of the current MMIS system, interfaces and business processes elicited during JAD.
- Performed Gap Analysis.
- Developed and maintained the Requirement Traceability Matrix (RTM) for the project deliverables.
- Assisted in designing test plans, test scenarios and test cases for integration, regression and UAT to improve overall quality of the application.
- Worked closely with Business Directors, Project Managers and SME’s in various business areas to gather, analyze and document the requirements and supported the project throughout the development lifecycle.
- Wrote BRD for processing of member enrollment and benefits, batch jobs corresponding to the claims 837 and real time transactions like 270/271/276/277.
- Used Quality Center for tracking defects, enhancement requests, assign work activities and assess real status of project throughout life cycle.
Confidential, Hartford, CT
- Identifying the scope of the project, conform to the regulatory compliance related to 837 and 835.
- Refined the requirement use-cases and business process models to detailed level, to suit technical analysis and system design.
- Identified and analyzed the data requirements for various processes and made sure that the required data is available in the testing environment.
- Worked Facets Data Models and their relationship between all functional areas.
- Analyzed Business Requirements, tracking and enhancing them into functional requirements using Rational Requisite Pro.
- Carried out User Acceptance Testing.
- Carried out Risk Assessment, GAP analysis and Impact Analysis for the 4010-5010 conversion of the project.
- Involved in JAD sessions with stakeholders, SME’s to discuss the scope of the conversion.
- Worked as a liaison among stakeholders on both sides-Business and IT, to elicit, analyze, communicate and validate requirements for the changes into business processes.
- Performed Requirement Analysis by gathering functional and non- functional requirements, based on the interactions with the Process, Product Owners and Stake holders.
- Worked with SME’s in gathering Business Process Requirements and prepared BRD.
- Created Business Use Cases, Use Case Diagrams, Activity Diagrams, Data Flow Diagrams using MS Visio.
- Followed the adaptive RUP framework for the entire Project life cycle.
- Understand the business requirements and map them to functional specifications. Understand the previous system and identify the gap and inefficiency of the legacy system.
- P articipated and scribed the walkthrough of internal and external teams to brief the Functional Specification mapping to Business Requirements.
- Prepared weekly reports for PM including Status updates on all BGS projects and clients.
- Conducted and participated in brainstorming sessions to find solutions in identifying assumptions, constraints, risks and issues.
- Participated in the development of new categories to ease out the sort and search facility.
- Provided regular verbal and written status reports to IT management and the business community.
- Coordinated with the project team and testing team to revise project artifacts (use cases, test scripts, and web content analysis) to reflect requirement changes.
- Worked with the team to design the workflow and the wire frames for the whole process from searching for a product to checkout, payment and delivery.
- Aided in preparing test cases that is in line with functional requirements.
Confidential, Roanoke, VA
- Prepared the Business Requirement Document (BRD) and Functional Requirement Document (FRD) of the application.
- Used MS Visio to create Use Case, Activity Chart, and Sequence Diagrams.
- Worked closely with Development team and QA team.
- Developed, executed and validated user acceptance test plans (UAT).
- Prepared and maintained Requirement Traceability Matrix (RTM).