SUMMARY:

• 8+ years of experience as a Business Systems Analyst in Healthcare industry.
• Strong knowledge of the Software Development Life Cycle models like Agile and Waterfall software development methodology.
• Experience in interacting with business users to identify business needs, gathering requirements and documenting requirements in Business Requirement Documents (BRD), Functional Requirement Document (FRD) and Software Requirement Specification (SRS) across the project as various deliverables.
• Experienced with Iterative approach for Software Development as per Rational Unified Process (RUP). Involved in inception, elaboration, construction & transition phases using rational tools like Requisite Pro, Clear Case and Clear Quest during various phases of RUP.
• Experienced in interacting with business users to identify their needs, gathering requirements and authoring Business Requirement Documents (BRD), Functional Requirement Document (FRD) and Software Requirement Specification (SRS) across the deliverables of a project.
• Experienced in facilitating Joint Application Development (JAD), Rapid Application Development (RAD) and Joint Requirement Planning (JRP) sessions, interviews, workshops and requirement elicitation sessions with end - users, clients, stakeholders and development team.
• Created Requirements Traceability Matrix (RTM) to keep the stakeholders informed of the progress of the project.
• Experienced in Business Analysis, SWOT Analysis, Gap Analysis, Risk Analysis, Disaster Recovery Planning, Testing and Project Planning.
• Extensive knowledge of Medicaid, Medicare, MMIS, Procedural and Diagnostic codes and Claims Process.
• Expertise in EDI and HIPAA Testing Privacy with multiple transactions exposure such as Inbound Claims837-Institutional, 837-Professional, 837-Dental, 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
• Experience in Conversion of HIPAA X124010 codes to X 12 501 0 codesand ICD 9 codes to ICD 10 codes
• Good indulgent of HIX, HL7
• Experienced in analyzing and documenting business requirements and system functional specifications including Use Cases
• Strong Knowledge of UML, RUP, Rational Tools
• Proficient in creating Sequence Diagrams, Collaboration diagrams, Activity Diagrams, Class Diagrams using Rational tools and Microsoft Visio
• Experienced in handling Change Management
• Strong knowledge of Business Process Modeling, Business Intelligence and Business Architecture.
• Experienced in writing Test Plans and executing Test Cases
• Skilled in validation and testing complex scenarios for the maintenance of quality standards in projects
• Experienced in creating User Manuals and providing training to users.
• Professional with extensive experience in the development, implementation and integration of strategies within a team oriented environment, utilizing quantitative and qualitative analytical skills.
• Excellent communication and presentation skills.

TECHNICAL SKILLS:

Languages: SQL, Java, Visual Basic, C++, JavaScript

Tools: Quality Center, QTP, MS Office,TFS

Database: MS SQL Server 2005/2000,MS Access, Oracle

Business Analysis: SDLC, Critical Thinking, Decision Making Strategy, Analytical thinking, Use Case Analysis, Requirement Analysis.

Documentation Tools: MS Project 2000

Operating Systems: Windows 2000/2003/2007/ XP

PROFESSIONAL EXPERIENCE:

Confidential, Columbus, Ohio

Sr. Business System Analyst/UAT tester

Responsibilities:

• Worked on HIPAA EDI transactions such as 835(medical claim payments), 837(medical claims), 276(claim status), 277(claim status response), 278(Health care service review information), 270(eligibility inquiry), 271 (eligibility response).
• Produced Gap Analysis documents for HIPAA 5010 and HIPAA 4010. Collaborated parallel with SMEs to identify and analyze core requirements and key features of the ongoing requirements in the project. Collaborated with management and external stakeholders to identify and implement changes to systems and processes to increase efficiency.
• ICD-10. Collaborated parallel with SMEs to identify and analyze core requirements and key features of the ongoing requirements in the project. Collaborated with management and external stakeholders to identify and implement changes to systems and processes to increase efficiency.
• Prepared extensive cost benefit analysis to support system and process changes assisting the development team using the Agile Methodology.
• Successfully used Agile/Scrum Method for gathering requirements and facilitated user stories workshop. Documented User Stories and facilitated Story Point discussions to analyze the level of effort on project specifications.
• Provided interpretation of business rules and requirements for technical system upgrades while tracking progress. Ensuring enhanced processes and services are technically, operationally, and legally supported by analyzing and compiling business requirements.
• Created Business Requirement Document (BRD) and Functional Requirement Document (FRD) based on the information gathered from clients.
• Conducted User Acceptance Testing in MMIS environment.
• Used TFS (Team Foundation Server) and irise
• Managed Defects in Quality center Version 11.0 and wrote test cases within the same. Assisted developer in fixing the defects creating back log and many different sprints.
• First one foundation- Parent filters for backlog items. Differentiate the items your team owns from other teams. Re order items and change relations. If any item on your back log is filtered we can move to the top or to a specific position.
• Manage task board where user stories which are pending will show a warning. Rows will show pending work for that user story.
• Irise one is for managing web based applications. I have used the Irise studio and reader. Irise studio ti mimic a requirement or application. Reader to read there prototype.
• Participated in JAD sessions for requirement, feasibility and risk analysis with various stakeholders, including designers, developers, QA and management to identify critical and high risk areas of the application. Documented the requirements to create the implement of the back log and execution of different needs.
• Transformed Business requirements into functional specifications, focused on user interface design, created mockup screens.
• Experienced as a Business Analyst in a role of responsibility encompassing requirement gathering, and Analysis besides Quality Assurance.
• Trained many candidates in various subsystems in MMIS like Claims, Edi transactions, Prior Authorization and others.
• Develop Non-Functional requirements (NFR) along with client SMEs to ensure coverage of requirements such as browser support, load testing and other mandatory US Government norms specific for healthcare industry

Environment: HIPAA X 12 501 0 Clear Quest, SQL Server, Agile, TFS,SDLC, Quality Center, Itrace.

Confidential, Overland Park, KS

Sr. Business System Analyst /Ecommerce Portal Consultant

Responsibilities:

• Developed BRD and FRD for illustrating storefront experience for individual users, broker and Medicare segment users
• Prepare use case documents and utilized MS Visio to create UML diagrams including use case, activity and class diagrams to extract business process flows and workflows, thereby assisting development and quality assurance teams in understanding the requirements.
• Participated in JAD sessions for requirement, feasibility and risk analysis with various stakeholders, including designers, developers, QA and management to identify critical and high risk areas of the application.
• Created Statement of Work (SOW) and project execution plan for entire development and testing phase which included multiple iterations
• Developed, coordinated and implemented Agile methodology and scope for multiple complex projects.
• Involved in one-to-one interview sessions and JAD sessions with stakeholders, SME’s and business owners to discuss the scope of the conversion.
• Worked on gathering requirements for creating the Medicare website.
• Responsible for working with technical architects to create demos to demonstrate IBM WebSphere Commerce configurable storefronts. This included demonstrating features such as promotions management, catalog management, user registration and shopping cart
• Along with client SMEs, developed the product catalog hierarchy for 20+ medical and dental plans for multiple user segments. The product catalog hierarchy was later used to demonstrate the catalog management features of IBM WebSphere Commerce
• Develop Web Access Management (WAM) requirements to integrate user roles with secured authentication services.
• Worked with User Interface (UI) team from Cognizant and client to develop wireframes and HTML prototypes of new web portal
• Documented the Traceability Matrix for tracing the Test Cases and requirements related to them.
• Develop Non-Functional requirements (NFR) along with client SMEs to ensure coverage of requirements such as browser support, load testing and other mandatory US Government norms specific for healthcare industry
• Analyzing feasibility and Risk to identify the business critical and high-risk areas of the application.
• Worked as a liaison between business users and developers to submit requirements and changes, clarify questions and issues.
• Worked on team environment to finalize use cases to develop functional and detail design specifications of the application.

Environment: Rational Rose, Rational Requisite Pro, Agile, SQL,UML, MS Project, MS Visio, MS Office Suite, PL/SQL Developer, HTML, Java, TFS,Visual Basic, Toad, Windows XP, Unix, Outlook, Test Director.

Confidential, Sacramento, CA

Sr. Business Systems Analyst

Responsibilities:-

• Used Requisite Pro for the Requirement Documents Preparation and Prepared Business Process Models that includes modeling of all the activities of the business from the conceptual to procedural level. Followed top down, leveled technique for building Business Process Models.
• Created Product backlog, Sprint back log and managed user stories. Participated in sprint planning, daily, scrums, testing, retrospectives and sprint reviews.
• Created user stories to assist with the development new requirements that will impact the stakeholders and end users.
• Communicate with clients and inform the organization about the customer business needs.
• Implemented new Change control process with executive team.
• Highly responsive to client needs and changing software requirements.
• Worked on HIPAA EDI transactions such as 835(medical claim payments), 837(medical claims), 276(claim status), 277(claim status response), 278(Health care service review information), 270(eligibility inquiry), 271 (eligibility response).
• Worked on Data Mapping document explaining flow of data from source to destination for system enhancement purposes required by ICD 10 implementation.
• Performing Impact analysis for readiness of ICD-10 conversion.
• Produced Gap Analysis documents for HIPAA 5010 and ICD-10.
• Improved the new revenue cycle management and Electronic Medical Record (EMR) for PARTNERS.
• Prepared the Business requirement Document (BRD) and functional requirement document (FRD) for the enhancement of the existing services.
• Strong Experience in Claims Processing and Claims Scrubbing in HMO,PPO, Medicaid and Medicare
• Extensive experience in configuring data mapping of files using Edifices Spec builder.
• Identified gaps and performed gap analysis with respect to CMS requirements.
• Performed Unit Testing and User Acceptance testing and documented detailed results. Provided input (scope, goals, risks, constraints, timelines and interfaces) to PM for project planning and control.
• Created Use Cases / Activity Diagrams / State Chart Diagrams, Sequence Diagrams, and Collaboration Diagrams thus defining the Data Process Model and Business Process Model.
• Met with various HMO, PPO, Medicaid/Medicare Representatives discussing benefits of contracts on behalf of facilities or appeals from denials and compliance issues.
• Worked in mainframe environment and used SQL to query various reporting databases.
• Used SDLC (System Development Life Cycle) methodologies like the RUP and the Agile Methodology.
• Acted as User Acceptance Testing coordinator and monitored business testing and interfaced with the development team regarding defect status and fixes on a daily basis.

Environment: HIPAA X 12 501 0, RUP Methodology, Rational RequisitePro, MS Visio 2003/Rational Rose, Rational Clear Case, Java, Rational Clear Quest, SQL Server, SDLC. Agile,TFS

Confidential, Hartford, CT

Sr. Business Systems Analyst

Responsibilities:

• Conducted Interviews, user meetings, JAD sessions, and Requirement Elicitation Sessions to extract the Business Requirements to understand their need to upgrade the existing system to 5010 compliant.
• Performed gap analysis to identify and document the gaps between the existing system 4010A1 compliant and new 5010 compliant system.
• Analyzed and categorized the impacts of new HIPAA standards and applied changes on the targeted systems, processes, business-associate relationships and Providers.
• Analyzed trading partner specifications and created EDI mapping guidelines.
• Involved with project management team in developing project plan.
• Attended JAD sessions to define System Requirement Specifications (SRS) and Detailed Designed Discussions with the technical team.
• Developed strategy for upgrading and implementing the user interfaces to be 5010 compliant.
• Maintained Requirements Traceability Matrix (RTM) throughout the project.
• Prepared the Business requirement Document (BRD) and functional requirement document (FRD) for the enhancement of the existing services.
• Create transaction sets requirements, usually with Microsoft Excel, for transactions such as: HIPAA 270/271, 276/277, 835, 837-(I, P, & D), 835 Remittances and others.
• Followed the Business Rules, and ensured that HIPAA compliant Rules are followed to display minimum benefit information.
• Managed the privacy and security environments of healthcare data that was governed by HIPAA and other government mandates.
• Maintained a record of recommendations, communications, activities, and schedules to monitor the progress of project in real time using MS Project.
• Understand rules and regulations of HIPAA as imposed during Electronic Data Interchange (EDI).
• Documented various key elements of HIPAA compliance and made sure that they are understood by the development teams.

Environment: MSProject, SQL, Rational Unified Process (RUP), Rational Requisite Pro, Rational Rose, Clear Quest, Microsoft Visio, C++, Java, Windows 2000/XP, Mercury Test-Director, MS Visio, Business Objects

Confidential, Minneapolis, MN

Business Systems Analyst

Responsibilities:

• Created Business Requirement Document (BRD), Functional Requirement Documents (FRD) and supporting documents that contain the essential business elements and detailed definitions.
• Worked on Medicare Part C and Part D transactions.
• Conducted meeting with the EDI team and other stakeholders, team members to discuss the requirements.
• Performed Requirement Analysis to Develop Use Cases, Activity Diagrams and Sequence Diagrams.
• Extensively used Waterfall software development lifecycle methodology during the project
• Collected requirements usingBrain storming, Document Analysis, Interviews and JAD session.
• Identify, analyze, define and created business processes and use case scenarios using MS-Visio.
• Helped the Project Manager with project estimation, resource and financial Planning of the system.
• Implemented data access, storage and validation routines on the database server using SQL.
• Coordinated QA reviews, sign-off, and validation migration from UAT to production environment. Also coordinated business review, sign-off and production validation.
• Evaluated alternative solutions and recommend solution that best meets the need of the business.
• Worked extensively through Agile development methodology by dividing the application into iterations.
• GAP Analysis of client requirements, generated workflow process, flow charts and relevant artifacts.
• Used Rational Requisite Pro for overall Requirements Management and to build the Requirements Traceability Matrix (RTM’s)
• Experienced as a Business Analyst in a role of responsibility encompassing requirement gathering, and Analysis besides Quality Assurance.
• Evaluated and analyzed various solutions and provided recommendations that best suits the business.

Environment: XML, Agile, TFS,MS Excel, MS Word, MS Visio, MS Project, HP Quality Center.