TECHNICAL SKILLS:

• VISIO
• WORD
• Familiar with developing systems via a structured SDLC methodology
• Ability to analyze and document complex business processes and work flows, and propose areas for improvement
• Ability to gather data via diverse means (i.e. interviews, observation, surveys, existing written documentation) and interpret relevant information
• Ability to effectively propose a mechanized solution for existing/modified work flows and business processes.
• Ability to document screen mockups, wireframes, and system flows, interfaces, use cases, and business rules.

PROFESSIONAL EXPERIENCE:

Confidential, Virginia Beach, VA

Sr. Business Analyst/Data Analyst

Responsibilities:

• Played an active and lead role in gathering, analyzing, and writing business requirements.
• Project was implemented in phases, enabling system to deliver as many business requirements as early as possible. Involved in Requirement Scoping and analysis of high priority requirements for implementation.
• Designed the business requirement collection approach based on the business need and requirement priority. Conducted end user surveys and interviews to come up all the relevant fields and information required.
• Conducted JAD workshops to achieve consensus on critical and sensitive issues and members privacy requirements. Consulted with legal SMEs to ensure compliance with state medical privacy laws.
• Worked closely with business team, and identified, analyzed the core requirements and key features of the ongoing project. Extracted, discussed, and refined business requirements and developed comprehensive business requirement document (BRD). Developed Software Requirement Specification (SRS) document using Visio and MS Office.
• Extensively interacted with both business team and development team in coming up with a Sequence diagrams.
• Developed internal algorithms, condition - action tables and decision trees and tables that in corporate member’s personal and medical information.
• Involved in HIPAA EDI transactions such as 270, 271,837 (P, D, I), 276, 277, 834, 820, 278,999/TA1, and 277 CA.
• Analyzed the impact of ICD-10-CM/PCS coding system and Identified General Equivalence Mappings to facilitate the conversion from ICD-9-CM codes to ICD-10-CM/PCS codes to ensure that both the application and Health Record comply with new regulations.
• Actively involved in the creation of comprehensive resource center through collection, documentation and extensive editing of relevant medical literature.
• Prepared high level business use case and developed it into multiple system use cases and Activity diagrams.
• Used UML to perform Use-Case analysis to capture the dynamic aspect of the application.
• Responsible for creating business work flows and processes and creating management reports based on the analysis.
• Developed UI document with UI designs and mock-ups through wireframes. Utilized Story boards and screen mock-ups to obtain client feedback and approval. Suggested changes when the user interface was confusing or needed rewording.
• Authored Companion Guide to support all the information needed to process HIPPA transactions with Confidential Group.
• Worked in conjunction with the project manager, design team and developers to prepare project status reports and presented reports to clients in order to keep them current. Utilized prototypes and structured walkthroughs to ensure that all relevant requirements are properly addressed.
• Involved in designing and developing Data Models and Data Marts that support the Business Intelligence Data Warehouse.
• Prepared user acceptance criterion and testing strategy that will be utilized by QA team to validate the addressed functionality of all critical requirements. Developed and maintained Test Matrix and Traceability Matrix. Utilized Quality Center to plan and execute tests, track defects and create change alerts. Conducted User Acceptance Testing (UAT).

Environment: HIPPA ANSI X12, SDLC, .Net, CPT and ICD-9 Coding, Rational Rose, Rational Requisite Pro, Microsoft Visio, SAS, Java, SDLC, MS word, MS Excel, MS outlook, MS Access, XML, HTML EDI, MS SQL Server.

Confidential, Hartford, CT

Business Analyst/Data Analyst

Responsibilities:

• Worked on changes for HIPAA Transaction and proposed changes to be made in the current system for an easy transition from version 4010 to 5010.
• Conducted Joint Application Development (JAD) process with Stakeholders to analyze deliverables and system constraints.
• Responsible for the full HIPAA compliance lifecycle from gap analysis, mapping, implementation and testing for processing of Medicare/Medicaid Claims.
• Performed Gap analysis for better understanding of transition from HIPAA 4010 to HIPAA 5010.
• Created Use Cases diagram and Activity diagram to depict the interaction between the various actors and the system in Rational Rose for the Business Use Case and System Use Case.
• Documented, organized and tracked the requirements using Rational RequisitePro.
• Documented the detailed business as well as technical requirements to upgrade the current system to 5010 transactions.
• Developed UI document with UI designs and mock-ups through wireframes. Utilized Story boards and screen mock-ups to obtain client feedback and approval. Suggested changes when the user interface was confusing or needed rewording.
• Involved in designing future state processes for HIPAA 5010 transaction processing EDI’s 837,835, 270, and 271.
• Analyzed HIPAA 5010 related to 835, 837, 270, 271, 276 and 277 transactions (both inbound and outbound) and performed gap analysis between the 4010 and 5010.
• Worked with Source system Subject Matter Experts (SMEs) to ensure that the extracts are properly mapped. Used SQL for data mapping and querying.
• Tracked and maintained Stakeholder requested enhancements and changes using Requirement Traceability Matrix (RTM).
• Incorporated Rational Unified Process (RUP) and analyzed User Business Requirement Document (BRD), Technical Requirement Specification and Functional Requirement Specification (FRS) using Requisite Pro, Rational Rose and MS Visio.
• Responsible for creating business work flows and processes and creating management reports based on the analysis.
• Completed a review of existing documentation for orders, referrals and reports and compared it to the clinical details needed for HIPPA 5010.
• Worked with technical experts to prepare test case scenarios for unit testing, integration testing, user acceptance testing and compliance testing.
• Developed ETL logic to transfer data from systems to the Data warehouse environment using the available ETL code and tool set for implementation.
• Assisted with user testing of systems and maintained quality procedures and ensured appropriate documentation is in place.
• Integrated Requisite Pro with Rational Rose to provide all teams visibility and maintain tractability among requirements, use cases and change requests.

Environment: SQL Server, .NET, Windows XP, Rational Rose, Rational Requisite Pro, Clear Case, Clear Quest, SDLC, UML, Rational Suite, Java, MS Visio, MS Project, MS Office (MS Word, MS Excel, MS PowerPoint), MS Access, XML.

Confidential, Baton Rouge, LA

Business Analyst

Responsibilities:

• Responsible for the full HIPAA compliance lifecycle from gap analysis, mapping, implementation and testing for Medicaid Claims.
• Coordinated with the stakeholders and project key personnel to gather functional and non-functional requirements during JAD sessions.
• Studied the existing business process and created AS-IS workflow to illustrate the existing system.
• Assisting the project manager in creating the business case and project plan.
• Responsible for Medicaid Claims Resolution/Reimbursement for state health plans using MMIS.
• Served as a liaison between the internal and external business community (Claims, Billing, Membership, Capitation, Customer service, membership management, provider management, advanced Healthcare management, provider agreement management) and the project team.
• Actively analyzed current business processes (Claims, Recipient eligibility and enrollment etc.) and worked with management to improve and implement enterprise solutions to ensure compliance.
• Developed UI document with UI designs and mock-ups through wireframes. Utilized Story boards and screen mock-ups to obtain client feedback and approval. Suggested changes when the user interface was confusing or needed rewording.
• Recorded requirements in the Requirement Traceability Matrix (RTM) defining each technical requirement in detail from areas like: main hardware, application software, networks, servers, internet and desktop configuration.
• Work with business representatives to understand data marts requirements and priorities and ensure that IT works is appropriately aligned.
• Defects and bug testing by using Rational Clear-Quest, Configuration management and Version control with Clear-Case.
• Responsible for creating business work flows and processes and creating management reports based on the analysis.
• Followed the UML based methods using Rational rose to create use cases, activity diagram, sequence diagram, collaboration diagram that include functional and non-functional specifications to hand off to development teams.
• Propose strategies to implement HIPAA 4010 in the new MMIS system & eventually move to HIPAA 5010.
• Actively involved in updating internal processes (submit claims, check eligibility), updating data collection and data reporting.

Environment: MS Project, ANSI X12- EDI, SDLC, XML, HTML, JAD, .Net, Rational Requisite Pro, MS Word, Sharepoint, Visio, SQL, MS Excel, Java, Mercury Quality Center.

Confidential, Minneapolis, MN

Business Analyst

Responsibilities:

• Launched the business requirement collection approach based on the project scope and SDLC Methodology.
• Assisted in all phases of the project in all phases to review project deliverables for completeness, quality and compliance.
• Worked on Electronic health record system as a web based application.
• Analyzed and synthesized results from Joint Application Development ( JAD ) session.
• Analyzed As-Is system and gathered user and business requirements through interviews, surveys and prototyping to create the process flows and designs for the To-Be system.
• Clarified client requirements, business needs and project objectives, via feedback sessions and client meetings, in collaboration with all stakeholders.
• Performed extensive requirement analysis including data analysis, gap analysis, conducted business analysis, project assessment and feasibility determination.
• Understand and articulated business requirements from user interviews, and workshops and then convert requirements into technical specifications.
• Assigned work to team based on the client requirements.
• Functioned as the primary liaison between the business line, operations and the technical areas throughout the project cycle.
• Worked with User Interface (UI) team to create report mockups from wire frames to ensure that functionalities are captured and presented on the front end as per the BRD's.
• Responsible for creating business work flows and processes and creating management reports based on the analysis.
• Applied Unified Modeling Language (UML) methodology tools such as Rational Rose and MS Visio to design Use Cases and Business Process Flow diagrams.
• Developed Business Requirement document and Functional requirement document and maintained the Requirement Traceability Matrix (RTM).
• Designed and implemented basic SQL queries for QA Testing and Report / Data Validation.
• Developed test cases and scripts based on business requirements for the GUI, functional, User Acceptance & System Back-end testing.
• Worked closely with the architects, database administrators and technical team during Data Mapping and Data Integration.
• Developed UI document with UI designs and mock-ups through wireframes. Utilized Story boards and screen mock-ups to obtain client feedback and approval. Suggested changes when the user interface was confusing or needed rewording.

Environment: Microsoft Office Suite, Rational Rose, Java, Visio, MS Word, SDLC, UML, .Net, SQL Server, Windows, Load Runner.

Confidential, Framingham, MA

Business Analyst

Responsibilities:

• Claimed validation and Pending/Denied Claims Analysis for the Health plans of Medicare and Medicaid programs.
• Responsible for creating business work flows and processes and creating management reports based on the analysis.
• Worked on modifying Organization Policy for an employer and fee tables i.e. making changes in fee amount, effective and terminate fields etc.
• Conducted Joint Application Development (JAD) sessions between the end users and the development team.
• Implemented Traceability Matrix and Business Requirement Specification Document and verified the functionality coverage.
• Involved in evaluating the scope of application, defining relationship within and between groups of data.
• Collected and documented business processes as well as business rules.
• Provided key input in working with users in defining project and system requirements.
• Developed UI document with UI designs and mock-ups through wireframes. Utilized Story boards and screen mock-ups to obtain client feedback and approval. Suggested changes when the user interface was confusing or needed rewording.
• Translated the business needs into system requirements and communicated with the business on a non-technical level.
• Documented the Functional Specifications Document and Designed and developed Use Cases, Activity Diagrams, and Sequence Diagrams using UML.
• Performed tests to ensure the claim processing time is maintained and reported it to the development team.
• Supported the business and the technical team in the product development and delivery process and successfully managed cross- departmental relationships.
• Intensively involved in project testing efforts by doing Integration Testing, Regression Testing and by helping UAT team in User Acceptance Testing.
• Performed tests to ensure the claim processing time is maintained and reported it to the development team.
• Conducted project related presentations and provided reports to the higher management.

Environment: Windows NT4.0 and Windows 2000, Quality Center, Java, SDLC, MS Projects, MS Office suite, Rational Rose, Rational RequisitePro, MS Word, Visio.

Confidential

Business Analyst

Responsibilities:

• Researched and assessed client systems and business processes
• Explored all aspects of the claim processing lifecycle, starting from identifying a claim to its closure
• Used Healthcare payer/provider services, Emids for payment cycle management and clinical information exchange solutions, connecting payers, providers and patients in healthcare system.
• Developed UI document with UI designs and mock-ups through wireframes. Utilized Story boards and screen mock-ups to obtain client feedback and approval. Suggested changes when the user interface was confusing or needed rewording.
• Responsible for creating business work flows and processes and creating management reports based on the analysis.
• Used MS Word document for requirement gathering
• Worked intensively on various phases in the project lifecycle to design the system in such a way that the high risk claims could be easily identified and monitored
• Participated in preparing basis for Project Vision documentation
• Involved in walkthroughs with business team, architects and developers to refine the requirements
• Generated use-case diagrams using MS Visio
• Implemented Traceability Matrix and User Requirement Specification Document (URS) to verify the functionality

Environment: MS Visio, SQL, MS Word, Java, SDLC, MS Office and Windows XP.