SUMMARY:

• Seasoned Business Analyst with around 8 years of expertise in Healthcare and Retail domains.
• In - depth knowledge and practical experience of using Waterfall, Agile, Scrums, Rational Unified Process, Business Process Reengineering, Unified Modeling Language, System Requirements Specification, Functional Requirements Specification, Rapid Application Development, and MS Visio.
• Proficient in using UML for Business Process Modeling, Use Cases, Activity Diagrams, Sequence Diagrams, Data Flow Diagrams, Collaboration Diagrams, Class Diagrams and documenting them using MS Visio.
• Expertise in Process Analysis, System Analysis, Object Oriented Analysis, Functional Design & Documentation (FDD), GAP Analysis, Requirements Traceability, Use Case Analysis & Design.
• Highly proficient in working with Users and Stakeholders to elicit, analyze, communicate and validate requirements using JAD, JAR, and Brainstorming sessions.
• Solid knowledge and experience of Business Process Engineering/Re-engineering (BPR).
• Expertise in using various tools like MS Visio for Functional Flow Charts, Business Process Diagrams.
• Comprehensive understanding of the Organizational Framework that help to map the AS-IS and TO-BE model using the GAP Analysis, and plan effective approach to build/buy solutions to the business problems/needs/opportunities.
• Skilled in Object Oriented Analysis and Design with experience in creating Use Cases, Class Diagrams, Activity Diagrams, Object Diagrams, State Diagrams, Sequence Diagrams, Unified Modeling Language (UML) using MS Visio and Rational Rose.
• Expertise in Client Relationship Handling, Project and Release Management, Configuration and Change Management, Defect Tracking and Control.
• Extensive knowledge in data collection, analysis and evaluation, analytical problem solving, decision making, and interpersonal skills with ability to interact with individuals at all levels.

WORK EXPERIENCE:

Sr. Business Analyst

Confidential, Minneapolis, MN

Responsibilities:

• Interacted closely with end-users and SMEs from Underwriting & Claims teams to understand and gather the business needs and requirements.
• Performed GAP Analysis for new functionality requirements and worked as per HIPAA rules and regulations to draft business rules and claim process.
• Attended system requirements walkthrough sessions with business owner, stakeholders, SMEs as well as design & development teams.
• Used Business Process Modeling (BPM) to streamline the existing channels through which customers contact Confidential (phone, web, email, through doctors, pharmacies, etc.).
• Involved in business requirement gathering, analysis and creating functional specifications for the portal enhancements.
• Actively participated in all the Agile Scrum ceremonies such as sprint planning meetings, sprint estimation meetings, daily scrum meetings, sprint demos and retrospective meetings.
• Created Use Case document that contained the Use Case defining role of users receiving claims, processing claims and adjudicating claims.
• Created UML diagrams to validate EDI claim process as per HIPAA compliance.
• Responsible for validating & functional testing of HIPAA 834, 835 and 837 Transactions (incoming/outgoing data from EDI interfaces).
• Analyzed and identified gaps/issues in claims, encounters and remittance advice process flow.
• Conducted User Acceptance Testing (UAT) to ensure system designed for checking member eligibility, provider enrollment, member enrollment for Medicaid and Medicare claims.
• Worked closely with user experience team for creation of wireframes and prototyping for web portal.

Environment: MS Project, MS Word, MS Excel, MS Power Point, MS Visio, MS SharePoint, Power designer, JIRA, Java, J2EE, Oracle.

Business Systems Analyst

Confidential, Indianapolis, IN

Responsibilities:

• Responsible for creating business workflows and processes and created management reports based on the business rules and the business case analysis.
• Supported for an inventory management value assessment to improve financial performance and the customer experience by reducing working capitals, supply chain costs and improving shelf availability.
• Used ERP business user information to create prototype business models and related business objects for Human Resources, Sales, Supply Chain and Finance, which strongly supported ERP configuration using Business Process Modeling tool with UML and OOD.
• Worked together with other team members in interviewing various business groups and identified and prioritized Business/Functional Requirements.
• Performed extensive data analysis with other functional analysts on data received from various sources and in different formats.
• Worked together with SMEs, architecture group and technical team leads to detail the interface and customized based on different user roles and functions.
• Mapped the current and proposed process and conducted thorough GAP Analysis.
• Generated Use Cases, Use Case Scenarios, Activity Diagrams, and Data Flow Diagrams.
• Performed Business Process Mapping and performed AS-IS and TO-BE Analysis.
• Co-authored Functional Requirements and Specification Document.
• Worked with information architects and creative groups in detailing the wireframes and depicting GUI design.
• Assisted the database development team in data modeling, data structure and data table layouts required for consolidation of incongruent databases.
• Involved in writing Test Plan, Test Cases and Test Scripts for end-to-end testing.
• Reviewed Test Results and reported bugs/issues using Mercury Test Director.
• Assisted in UAT and end-user training.
• Involved in various other enhancement initiatives to include new functionalities and redesign.
• Served as a liaison between various business units and IT groups.
• Worked with various COTS and worked on projects to integrate them with already present applications.
• Conducted Architectural discussions to prepare the Proposed Architecture and provided insight in the Business Case to the Architecture Review Board (ARB).

Environment: MS Visio, MS Office Suite, .Net, VB.NET, ASP.NET, Java, PHP, XML, HTML, DHTML.

Business Analyst

Confidential, Woodland Hills, CA

Responsibilities:

• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, OOD using UML.
• Created Mapping Documents, Report Mockups and modified existing report mockups and finalized for development.
• Worked with Compliance and Regulatory operations to follow and monitor different IT process bound by CMS Regulations.
• Extensively interacted with the Stakeholders and the IT Department in finalizing the requirements per the CMS Compliances/Regulations and HIPAA Regulations.
• Validated the following: 834 (Health Care Claims or Encounters), 834 (Health Care Claims payment/ Remittance).
• Reviewed and analyzed data from various sources.
• Used Rational Rose for creating the Use Cases Diagrams, Activity Diagrams, Class Diagrams, and Sequence Diagrams, etc.
• Worked closely with Business Owners and Stakeholders to outline Business Requirements.
• Worked with System analyst and IS teams to understand the flow of data.
• Conducted the change request and defect tracking using Bugzilla for utilization by the developers and the QA team.
• Developed plan for data feeds and data mappings for integration between various systems, including XML, to follow ICD-10 Code set and ANSI X12 5010 formats.
• Worked on project life cycle and SDLC methodologies including RUP, RAD, Waterfall and Agile.
• Identified gaps and performed GAP Analysis.

Environment: MS Word, MS Excel, MS PowerPoint, MS Visio, MS Project, RUP, UML, HIPAA.

Business Systems Analyst

Confidential, New York, NY

Responsibilities:

• Created Use Case Models, Wireframes & Mock-ups, Analysis Models, Design Models, Use Case Diagrams, Behavior Diagrams (Sequence Diagrams, Activity Diagrams) based on UML Methodology.
• Wrote process flow and business case documents of existing processes.
• Actively involved in design of wireframes for the different UI’s with UX architects by mitigating the requirement and business validation rules.
• Defined frameworks for the application development and analyzed the areas of improvement.
• Interacted with the development team and claim settlement experts making sure that the development of the project was meeting the business requirements.
• Wrote System Requirements Specification (SRS) and Functional Requirements Specification (FRS) and Data Requirement Matrix (DRM) Documents as per the business requirements and process flow.
• Documented User Stories and modelled Use Case Diagrams by utilizing MS Visio.
• Involved in the analysis of the Functional/Technical Specifications, Data Mapping Document and Conceptual Diagrams.
• Conducted Joint Application Development (JAD) sessions to develop and agree upon a system that focuses on a Business Requirement.
• Worked with the data architecture and data analyst team in designing the model and in creation of the data mapping documents.
• Worked on MS CRM Dynamics for handling the customer claim inquiries, Validation and Case Creation.
• Prepared Test Data for the functional Test Cases, Manual Test Planning and creation of the Test Cases based on the user expectations.
• Evaluated test results and prepared test summary reports.
• Jointly responsible for monitoring the progress of the system development by preparing status reports.
• Conducted daily interaction with the development team, stake users, business executives and Quality assurance to coordinate all the engineered process.
• Analyzed the security implementation of the application with respect to user’s perspective.

Environment: Agile/SCRUM, SQL Server, MY SQL, PL/SQL, Java, J2EE, MS Office Suite, MS Visio, UAT, HP Quality Centre, Oracle 10g, MS Project.

Business Analyst

Confidential, New York, NY

Responsibilities:

• Created file layouts for the inbound interfaces and the outbound interfaces for the Agency and Membership system.
• Wrote Use Cases, prepared Use Case Diagrams (using Rational Rose & UML) and followed Agile at every stage of the processes.
• Performed requirements modeling and developed Analysis Diagrams, Activity Diagrams, Sequence Diagrams, State Diagrams, Data Models, and Use Case realizations using RUP tools in Agile.
• Utilized Agile/SCRUM and PMI methodologies to monitor steer and develop project objectives.
• Involved in the day-to-day implementation of the Rational Unified Process (RUP) methodology of application development with its various workflows, artifacts and activities.
• Working with clients to better understand their needs and present solutions using structured SDLC approach.
• Analyzed User Requirement Document, Business Requirement Document (BRD) and Technical Requirement Document.
• Responsible for conducting research and root cause analysis for customers with the goal of recommending and implementing new processes and solutions to problems. Resolved issues and improve operational performance.
• Created Functional Specification Documents for the Agency and Membership system.
• Developed the Business Crosswalks for 837(P, I, D), 835 and 276/277 according to HIPAA implementation rules.
• Conducting user interviews, gathering requirements, analyzing the requirements using Requisite Pro.
• Wrote Test Plan and Test Cases for Integration Testing and System Testing.
• Successfully conducted JAD sessions, which helped synchronize the different Stakeholders on their objectives and helped the developers to have a clear-cut picture of the project.
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, OOAD using UML and Business Process Modelling.
• Extracted the data from SQL Server, Oracle, Files, and Access into Data Warehouse.
• Translated business requirements and assisted IT with the development of technical specifications.
• Developed complex forecasting tools using current technology/systems (Access, Excel, Monarch, etc.).
• Recommend solutions based on data analysis to increase business efficiency and/or improve existing processes.
• Conducted User Acceptance Testing (UAT) for projects, implementations, system fixes and enhancements, etc.
• Conducted analysis of HIPAA compliance and took part in discussions for designing the healthcare transactions to be HIPAA 5010 compliant.
• Analyzed the impact of new HIPAA standards on targeted systems, processes, and business associate relationships.

Environment: Clarity, IBM Mainframe, MS Access, MS Visio, RUP, OOAD, SQL, Agile, Scrum, MD 3270 Mainframe, MS Office Suite, HP Open View.