SUMMARY:

• Over 10+ years of work experience in the Health care industry as a Sr. Business/Systems Analyst.
• Hands on experience in the field of Business Requirement gathering, Business Process flow, Business Process Modeling, and Analysis, UML methodology.
• Strong experience in end to end Software Developmental Life Cycle (SDLC).
• Proficient in gathering and converting User Requirements into Business Requirements and Functional Requirement Specifications (FRS) and use Modeling tools like Rational Rose and Microsoft Visio for requirements modeling.
• Experienced in all phases of the Software Development Life Cycle (SDLC), Rational unified process (RUP) and Agile.
• In - depth knowledge and experience in working in Medicare and Medicaid process.
• Proficient in implementing HIPAA 4010 and HIPAA 5010 changes in the claims processing system.
• Extensive experience in Provider networks integration, Healthcare Product implementation and their associated networks, Portals (Member, Provider, Employer), Security administration.
• Preparation of Business Process Models including business-modeling activities from top down level that include modeling of all the activities of the business from the conceptual to procedural level.
• Expertise with Business Requirement Matrix (BRM) creating UML diagrams like Use Case Diagrams, Activity Diagrams, Sequence Flow Diagrams and CMM standards.
• Strong knowledge and experience on Team foundation Server TFS.
• Excellent Knowledge of HIPAA and various transaction codes like 270/271 (inquiry/health care benefits), 276/277 (Claim Status), 834 (Benefit Enrollment), 837 (Health Care Claim), 835 (Payment/Explanation of benefits) PPACA (Health Care Reform and patient Protection and Affordable Care act).
• Understand the As Is system and develop the To Be system concept and prepare the System Process Maps.
• Solid understanding of Business Requirements Gathering, Evaluating Data Sources, Translating Requirements into Specifications, Application Design, Business Analysis and Testing various methodologies.
• Experience in creating project-initiation diagrams including business use cases, activity diagrams, workflow diagrams, flowcharts.
• Educate, Guide, and Support Product Development teams to meet the Business Requirements and create Market driven solutions acting as Product Owner.
• Expertise in creating Use Case diagrams, Activity diagrams, Data Flow Diagrams (DFD), Sequence diagrams, State diagrams based on UML Methodology and business process flow diagrams using MS Visio/Enterprise Architect/Rational Rose.
• Experienced in conducting JAD Sessions to provide a solution that could resolve open issues, requests.
• Excellent communication skills both verbal and written.
• Strengths include quick learner, problem-solving capability, and ability to work as team player and ability to lead the team.
• Skilled at building a strong team and achieving the work in tight deadlines with quality product.

TECHNICAL SKILLS:

Business Analysis: MS Visio, Test Manager, ALM/Quality Center

Project Management: MS Project (Server), Creative Pro Office, JIRA

Operating System: Windows XP, Windows 7, UNIX, Linux, Mac OS

Languages: HTML, XML, SQL, SQL, JavaScript

Application: Microsoft Word, Microsoft Excel, Microsoft PowerPoint, Microsoft Access, Visual Studio, Share Point

Database: MS SQL Server, Oracle, MS Access.

Other Tools: SQL*Plus, Tibco, Pega, Business Objects

PROFESSIONAL EXPERIENCE:

Confidential, Owings Mills, MD

Lead Business System Analyst

Responsibilities:

• Worked as a Senior Business Analyst for PCMH (Patient Centered Medical Home) Plat Form.
• Requirements gathering for enhancements and application updates for Confidential ’s Patient Centered Medical Home (PCMH) platform
• Use Agile Methodology to make sure the business is aware of where the project stands.
• Communicate with the technical team after understanding the Business needs from clients and implementing them in the application as per the Business Requirements
• Understand all Data Schemas in Oracle SQL developer in understanding the backbone of where the information is coming from that will help analyze any post production issues.
• Expert at building strong professional relationships with key stakeholders and team members to ensure a positive and productive work environment
• Write/prepopulate queries for the team in determining the data for each section of the application as well as join tables and extract data for reports as needed by the management
• Use Microsoft Visio and iRise application to create templates and project plans for upcoming project release
• Involve throughout the application’s SDLC process, - particularly the User Acceptance Testing as well as Business Validation process prior to the production deployment
• Analysis the access control for the provider through security access logs
• Handles Authorization & Claims
• Use Splunk Developer to manage system data.
• Monitor day to day incidents and event management applying knowledge related to Healthcare Analytics and adhering to Federal Employee Program
• Manages ICentric reporting database, ensuring data integrity, and supporting the risk analytics function. work daily with FEP, NASCO and FACETS
• Write complex SQL statements to create custom reports
• Analyze data for marketing and risk purposes
• Quality Assurance/ User Acceptance Testing
• Good knowledge about all the health plans and associated networks for all the CFBCBS products - Medical, Mental Health, Dental, Vision and Pharmacy.
• Worked as a lead Business Analyst on the implementation of bringing BCBSA (PCMH Authorization) in Prior Authorizations under Confidential PCMH Icentric application.
• Worked on implementation of bringing CVS providers in house under Confidential My Account Secure/Unsecure FAD application.
• Worked on consuming Facets Authorizations data from Tibco services to be integrated with PCMH Authorizations.
• Worked with UI team on mock ups and angular js development of those mock ups.
• Developed various documents for the projects - Project Requirement Document (PRD), Business Requirement Documents (BRD), Change Requirement Documents, Minutes of Meetings (MOM) and other project related documents.
• Assisted UI team in the process of designing UI, Process flow Diagrams, HTML and other user experience related documents.
• Conducted Risk Analysis and Impact analysis whenever there is any change in the business requirement and maintained the latest version of the business requirement document.
• Worked on Data modelling of raw fields from data source to target fields in local data store.
• Part of team conducting logical data analysis and data modeling JAD sessions, communicated data-related standards.
• Created source to target mappings and business rules implementation.
• Conducted Joint Application Development (JAD) sessions to develop and agree upon a system that focuses on the business requirements
• Involved in the design and development meetings with the technical team.
• Conducted the gap analysis and propose solutions for resolving them.
• Develop UI prototypes for capturing the requirements.
• Worked with Testing team in developing test cases, test plans and test scenarios.
• Worked with the architect to aid in data modeling and defining the conceptual and logical model of the data warehouse.
• Used process models to capture business requirements.
• Conducted Knowledge transfer sessions, Train the Trainer sessions with the Clients, offshore team and other teams.
• Determined the impact of program changes on the business case and reforecast value creation and document in monthly program performance review
• Conducted meetings with the business for the requirement walkthrough sessions and seek approvals.
• Captured current process flow of system through use case documentation and flow charts using Microsoft tools
• Generated Requirement Tractability Matrix (RTM) to track and maintain stakeholders requested requirements and changes.
• Instrumental in capturing the requirements from the clients and publishing them into a requirements document. changes.

Environment: Windows 7, MS Office, UML, MS Visio, MS Project, Rational RequisitePro, Rational Clear Quest,TFS, Quality Center, SQL.Tibco,Pega.

Confidential, Annapolis, MD

Cyber Security Analyst

Responsibilities:

• Managed and answered information gathering questionnaires related to security analysis of organizational security, asset management, access controls, human resources security, physical and environmental controls,
• Worked on incident events & communication management
• Assisted in the development of business continuity and disaster recovery plans, risk management standards, communications and operations management
• Provided customer services to our global client portfolio

Confidential, Baltimore, MD

Business System Analyst/ Requirement Analyst

Responsibilities:

• Write/prepopulate queries for the team in determining the data for each section of the application as well as join tables and extract data for reports as needed by the management
• Particularly the User Acceptance Testing as well as Business Validation process prior to the production deployment
• Analyze data for marketing and risk purposes
• Quality Assurance/ User Acceptance Testing
• Handles Authorization & Claims
• Use Splunk Developer to manage system data.
• Monitor day to day incidents and event management applying knowledge related to Healthcare Analytics and adhering to Federal Employee Program
• Manages ICentric reporting database, ensuring data integrity, and supporting the risk analytics function. work daily with FEP, NASCO and FACETS
• Write complex SQL statements to create custom reports.
• Worked on the Testing Phase of the project.
• Preform Data analytics on day to day issue regarding the DB.
• Participated in development of new business opportunities
• Responsible for QA when needed
• Create and follow Defects in ALM.
• Involved throughout the SDLC for the application - particularly the User Acceptance Testing as well as Business Validation process prior to the production deployment.
• Work as a team leader in conducting root cause analysis (RCA) for any pre-and post-production issue via an in-house Tier 3 ticketing system - OneStop.
• Strong knowledge of Healthcare Analytics and systems that adhere to NASCO / FACETS / Federal Employees as well as CMS (Center for Medicare and Medicaid Services) members
• Write/prepopulate queries for the team in determining the data for each section of the application as well as join tables and extract data for reports as needed by the management
• Part of JAD session with (DPH, DMH, DMA) in order to collect the Testing Data - Billing Taxonomy, Rendering Taxonomy, Recipients eligibility Criteria and other related information.
• Created requirements analysis and design phase artifacts using, Rational Software Modeler and MS Visio to create DFDs, ER diagrams, Use Case, Activity/State chart, Sequence, Collaboration and Deployment Diagrams.
• As per the collected Data- documented all the Test Scenarios (Professional, Institutional, Dental and Pharmaceuticals).
• Produced Gap Analysis documents for HIPAA 5010 and ICD-10.
• Established questionnaires and resource leveling required for implementing HIPAA 5010 and upgrading ICD-9 diagnosis codes to ICD-10 codes.
• Created Use Case scenarios and work flow diagrams after requirements gathering.
• Analyzed HIPAA 4010/5010 & ICD10 mapping document of Medicaid claims compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims.
• Created RTM (Requirement Traceability Matrix) for each of the Departments in order to ensure all the important Test Scenarios are covered before the beginning of UAT phase.
• Performed and coordinated user acceptance testing with internal business and external partners.
• Used MS Visio for Process modeling and Business Process flow diagrams.
• Worked on EDI transactions: 270, 271, 834, 835, and 837 (P.I.D) to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
• Created Requirements Specification Document that translated business requirements into Technical specification including business and validation logic for ease of understanding to the development team.
• Analyzed and translated business requirements into system specifications utilizing UML and RUP methodology.
• Conducted GAP Analysis& Data mapping for ICD-9 to ICD 10 implementation as well as also developed RFP for vendor analysis.
• Conducted workflow, process diagram and gap analyses to derive requirements for existing systems enhancements using UML.
• Created relationships in Requirement Traceability Matrix linking Business Requirements to Functional requirements and Functional Requirements to Systems Requirements.
• Provide various strategies to implement HIPAA 4010 in the new MMIS system and ultimately move to HIPAA 5010.
• Actively involved in designing EDI transactions using the new HIPAA 5010 version and ICD -10 codes and analyzing HIPAA compliance and EDI transaction.
• 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.
• With the help of SILK wrote all the Test Cases for each of the departments and made sure to cross walk with all our Clients to assure smooth Testing,
• Create SQL scripts to query, cleanse, and prep data for conversion.
• Assigned test cases within the team to execute them in proper manner.
• Worked in the Testing Lab (CSC) and started working on Test Execution Process.
• With the help of XQMF did Data Mining to validate appropriate Providers, Recipients and other related information.
• Worked on Edits and Audits to understand the logic for Claim denial or Claim payments.
• Worked on X12, Operations Portal (UAT1, UAT2), Providers Portal, Share Point and other related tools in order to execute the test cases by validating the correct information.
• Created Defects (Production Defect, Environment Defects) for the test cases with invalid Claim denial or claim payments.

Environment: Share Point, Operations Portal (UAT1, UAT2), SILK, XQMF, X12, Provider Portal, Visio, Quality Center. Pega.

Confidential

System and Data Analyst

Responsibilities:

• Perform detailed analyses of HIPAA claims for compliance with processing regulations.
• Process health-care data using advanced systems and technology to produce written reports, recommendations, and system modifications.
• Worked intensively with Medicare & Medicaid claims and claims processing for transactions.
• Worked with Claims, enrollment, eligibility verification for members and providers, benefits setup, and backend payment cycle in facets.
• Documented the "AS-IS" Business Workflows adhering to UML standards.
• Created As-Is Business Process Models using MS Visio.
• Converted Business Requirements to the Functional Specification and Conducted JAD Sessions to develop an architectural solution that the application meets the business requirements, resolve open issues, and change requests.
• Interacted with clients (SME’s) and gathering requirements.
• Responsible for maintaining the Backlog and adding any new user stories to the existing functionalities in the TFS.
• Elicited requirements via interviews, document analysis, requirements sessions, business process descriptions, use cases, business analysis, task, and workflow analysis.
• Created Use-Cases, Sequence, and Collaboration Diagrams to demonstrate software architecture and interaction of system components before prototyping.
• Created high quality functional requirement specifications and supporting documents for business systems.
• Involved in GAP analysis around the identification of business rules, business and system process flows, user administration, requirements, and assumptions.
• Gathered and documented UX/UI (visual) requirements (using Microsoft Excel and PowerPoint), created simple UX designs and UI wireframes. Also, gathered and documented Functional and Non-Functional requirements in Business Technical Requirement Document.
• Used MS-Visio for flow-charting, process model and architectural design of the application.
• Created user stories, process flows and wireframes to clearly communicate a set of functional requirements.
• In Depth knowledge of Medicaid Claims processes from Provider/Payer side which later became training program to vendors.
• Designed and developed Use Cases, Activity Diagrams and Sequence Diagrams using UML.
• Created Business Requirement Document (BRD), Functional Requirement Specification (FRS) document, User Requirement Specification (URS) and Change Request (CR) document for system application development.
• Involved in Backend Testing to verify data integrity by using SQL.
• Streamlined 3rd party business processes for Medicaid Subrogation and Medicare Secondary Payor for both the Medical and Hospital Claims processing platforms.
• Responsible for Documentation in each phase of RUP Methodology, Risk Assessment, and Validation & Verification process. Worked with Claims, enrollment, eligibility verification for members and providers, benefits setup, and backend payment cycle in facets.
• Worked on EDI and HIPAA with multiple transactions involving Health care Benefits, claims handling and processing, with payer and provider experience (270 & 271, 276 & 277 P/I/D, 834, 835)
• Evaluated and analyzed EDI transaction sets 276/277 (Claim Status Request/Response), 270/271 (Eligibility Inquiry/Response), 837 (Claim Transaction) and 278 (Healthcare Service Review Information).
• Produced complete data mappings and data conversion documents needed for the Claims application.
• Actively analyzed current business processes (Claims, Recipient eligibility and enrollment etc.) and worked with management to improve and implement enterprise solutions to ensure compliance
• Created Data Flow Diagrams (DFDs), ER diagrams for data modeling and Web-page mock-ups using MS Visio for acceptance from end users.
• Responsible for the collection of functional requirements, nonfunctional requirements, data mapping, and light data modeling.
• Written complex SQL queries for querying data against different data bases for data verification process.
• Actively analyzed current business processes (Claims, Recipient eligibility and enrollment etc.) and worked with management to improve and implement enterprise solutions to ensure compliance.
• Worked with Requisite Pro to analyze and document all the project requirements throughout the SDLC life cycle.
• Conduction JAD sessions and ultimately reducing the time spent in moving all the information from stakeholders and other team members.

Environment: UML, MS Word, MS Visio, MS Project, Rational RequisitePro, Rational Clear Quest, Quality Center, SQL, FTP, TelNet.

Confidential

Business System Analyst

Responsibilities:

• Conducted formal interviews, Live Meetings and JAD sessions with business users and matter experts.
• Designed and developed Use Cases, Activity Diagrams and Sequence Diagrams using UML.
• Involved in Backend Testing to verify data integrity by using SQL.
• Documented, identified, organized, and tracked the requirements using Rational RequisitePro.
• Working with UI/UX designer to develop mockups and designs for mobile functionality/screen workflows.
• Created Data Flow Diagrams (DFDs), ER diagrams for data modeling and Web-page mock-ups using MS Visio for acceptance from end users.
• Conducted JAD sessions and elicited customer requirements by organizing interviews with internal/external stakeholders and subject matter experts (SMEs).
• Created architectural styles such as application architecture, enterprise architecture, and service-oriented architecture with the help of Service - Oriented modelling (SOA).
• Defined project milestones, schedules, and monitored progress using MS-Project, creative pro office and modified, updated the project scheduled plans as required.
• Analyzed and tested Data Interface needs.
• Responsible for the full HIPAA compliance lifecycle from gap analysis, mapping, implementation and testing for Medicaid Part C and Part D Claims.
• Conducted Asset Management, Risk Analysis of the Requirements and Traceability focus areas of the various projects and worked with the project team to help them identify the high-risk areas.
• Worked extensively on both inbound and outbound transactions, creating test cases for multiple transaction types including 837, 835, 276, 277
• Intensive working on the current ICD code conversion from ICD 9 to ICD 10, assisting and leading various teams by complying with already going works in the health care domain and work with the conversion.
• Worked with exposure to Electronic Medical and Health Records (EMR & EHR)/Automated Health Care Systems, ICD-10 conversion, HIPAA and other HIT standards.
• Worked on new Pharmacy Benefit Management System Medical Claim Data feed, Data Dictionary layout and definition, Eligibility files and various File Transfer Specifications
• Gap Analysis: Analyzed the client’s applications programs to determine the impact of the HIPAA final rule on EDI Transaction Set and Code List implementation and defined the changes to bring the affected systems into HIPAA compliance.
• Worked with FACETS Team for HIPAA Claims Validation and Verification Process (Pre-Adjudication).
• Worked intensively on FACETS for audit trails made on the used account and check and store information related to the HIPPA authorizations.
• Maintained Requirement Traceability Matrix (RTM) and Utilized Clear Quest for change requests and defect tracking.
• Claim validation and Pend/Denied Claims Analysis for the Health plans Medicaid programs.
• Worked closely with the technical team to look up for the best possible solution on requirements by keeping business needs and technical constraints in mind.
• Updating, transferring, and sharing Files using FTP between Windows and UNIX machines.
• Experience with business process modeling
• Familiarity with general business functions
• Problem solving and strong communication skills
• Elicit and document requirements using document analysis, requirements workshops, business process descriptions, use cases, scenarios, business analysis, task and workflow analysis
• Proactively communicated and collaborated with internal customers to analyze information needs and functional requirements and identify areas that needed improvement or updating
• Successfully engaged in multiple initiatives simultaneously
• Strong analytical skills required, including a thorough understanding of how to interpret business needs and translate them into application and operational requirements in the healthcare industry
• Served as the IT Department’s liaison between the business community and stakeholders and the IT team members through which requirements and specifications will flow
• Developed requirements specifications according to standard templates, using natural language.
• Collaborated with IT team members and other subject matter experts to establish the solution vision and analyze tradeoffs between usability, cost and efficiencies gained

Environment: UML, MS Word, MS Visio, MS Project, Rational RequisitePro, Rational Clear Quest, Quality Center, SQL, FTP, TelNet

Confidential

Credit Business Analyst

Responsibilities:

• Prepared, facilitated, documented and participated in client meetings/workshops
• Conducted structured gathering, research and analysis
• Developed and evaluated procedures, controls, user requirements and functional specifications to identify gaps between current state and future state
• Created business requirement documents (BRD’s) into use cases/functional specifications for customization
• Worked on requirements gathering, functional requirements, user stories and documentation business/data/application/technology architectures, requirements and business rules
• Used business process models/design, logical data models, standards and guidance
• Documented and explained problems and worked to resolve software defects, whilst ensuring technical compatibility and end user satisfaction
• Analyzed, developed and proposed enhancements to current business processes, reports and applications to optimize system effectiveness
• Conducted customer interviews and drafted meeting summaries
• Participated in development of new business opportunities
• Responsible for QA when needed
• Produced high-quality verbal and written consulting deliverables (including proposals, customer presentations, consulting reports) to effectively communicate project findings
• Generated re-usable intellectual capital in the form of consulting methodology and templates, blueprints and business cases

Environment: UML, MS Word, MS Visio, MS Project, Rational RequisitePro, Rational Clear Quest, Quality Center, SQL, FTP, TelNet