PROFESSIONAL EXPERIENCE:

Confidential, Chattanooga, TN

Sr. Business Analyst

Responsibilities:

• Involved with long term projects from the requirements gathering phase to the implementation phase.
• Interface with clients from Operations, Marketing, Sales, Technologies, and Outside Vendors and act as their customer interface point as the lead of the Projects Highly motivated team player with excellent Interpersonal and Customer Relational Skills, Proven Communication, Organizational, Analytical, Presentation Skills, and Leadership Qualities.
• Worked closely with the project managers and project coordinators to discover project strategies and decision policies.
• Worked on Medicare Part D - In-house implementation. Conducted JAD sessions with vendors to make the decisions on Claims, Determination and Appeals.
• Worked with offshore developers, business owners and project managers.
• Provided services to multiple concurrent projects, project teams, and/or management staff.
• Excellent communication, analytical, interpersonal and presentation skills, expert at managing multiple projects simultaneously.
• Responsible for ensuring that policies, procedures, and workflows accurately reflect how the work is done within the operations areas, and provides critical support for project outcomes.
• Developed requirement change request process along with the program managers and the PMO director.
• Communicate client’s business requirements by constructing easy-to-understand data and process models.
• Managed requirements artifacts templates in blueprint requirements management system. Designed data flow diagram, and as is process v/s to be process using blueprint requirements canter.
• Analyzed business requirements and segregated them into Use Cases.
• Participated in UAT along with the development & testing teams.
• Worked with the procurement team to gather initial requirements and create RFP’s and RFI’s for vendor selections.
• Liaison between the customer, vendor and the business while bringing the programs in-house.
• Gathered requirements from collection, claims, Billing, and insurance appeal departments.
• Maintaining and modifying training documents.
• Responsible for directing and coordinating the tasks of a wide range of personnel depending on the size and scope of the project.
• Experience in preparing and documenting the User Acceptance test (UAT) plan and obtaining the necessary signoffs from the concerned business units.
• Expert in Tracking and Managing the Requirements using Requirement Traceability Matrix (RTM) that controls numerous artifacts produced by the teams across the deliverables for a project.
• Participation in project planning, scope definition, estimation and staffing along with the Project Lead.
• Worked on EDI transaction 270/271 in a Utilization Management project.
• Giving training to the new members about insurance domain skills and applications.
• Develop regular and ad-hoc reports / dashboards as requested by user groups or stakeholders, perform analysis on data as required.
• Worked with the provider portal and member portal.
• Developing project plans, testing plans, production deployment plans, costing and budgeting plans.
• Conducted JAD sessions to gather requirements from the state SMEs in process of creating Business requirement document (BRS) and system requirement document (SRS).
• Worked on different types of insurances such as, Group health insurance, individual health insurance, dental insurance, vision insurance, etc.
• Investigated on issues identified during testing and after go-live and assist with managing stakeholders during each implementation phase.
• Gathered requirements related to but not limited to pharmacy benefit management applications, specialty pharmacy and RxConnect.
• Trained both internal staff and external customers in troubleshooting reports issues.
• Gathered business requirements from the agile teams and converted it into User Stories.
• Developed, analyzed, managed change log of enhancement requests using the Requirement Traceability Matrix (RTM) and Project Tracker system.
• Ability to prototype applications and web sites using tools such as Visio and Dreamweaver.
• Further enhancement of the application based on the feedback received for the prototype.
• Provided live support after GO-live.
• Created test plans and test cases for UAT testing.
• Conducted Scrum meetings and ensured that project deliverables and milestones were met.
• Conducted workshops with stakeholders for writing User Stories and worked closely with our Scrum Master for Product Backlog Grooming.

Environment: MS Visio, MS Excel, MS PowerPoint, HP ALM, Rational Tool Concert, Blueprint, Clear Case.

Sr. Business Analyst

Responsibilities:

• Managed Requirements artifacts templates in Blueprint requirements management system.
• Coordinate with the offshore development team with change in the environment.
• Designed Data flow diagram, as is process v/s to be Process using Blueprint Requirements canter.
• Preparing project plan and schedules, Creating service request documents and task allocation, Programming and review of offshore deliverable.
• Assess vendor capabilities through Requests for Quotes (RFQ), technical discussions, walkthroughs in order to ensure capabilities comply with company requirement.
• Worked closely with the business community in gathering the data storage needs to establish Third Party Liability Issues. Translated the business needs into system requirements, communicating with the business on a non-technical level, and with the System Analyst on a more technical level.
• Responsible for Gathering the requirements from business and operations to build the End to End claims adjudication system.
• Successfully completed the upgrade including Go live.
• Conducted Scrum meetings and ensured that project deliverables and milestones were met.
• Conducted workshops with stakeholders for writing User Stories and worked closely with our Scrum Master for Product Backlog Grooming.
• Interacted closely with the Business users along with the administration and management to gather business requirements and analyze the functionalities to be incorporated into the system.
• Develop and generate executive reports for Agile teams performances and work towards performance improvement along with Agile coaches.
• Creating the interactive porotype and review the prototype with product and business teams.
• Created reports in SAS and exported to Excel spreadsheets, created web reports using Web Report Studio
• Experience in utilizing SAS Procedures, Macros, and other SAS applications for data extraction, data cleansing, data loading and reporting. Involved in the data analysis, DB creation, applying database constraints and make ready to load onto database.
• Assisted in building a business analysis process model using Rational Rose and Visio.
• Used MS Visio to carry out the Business Use Case Modeling and Business Object Modeling effort to develop the business architecture for rapid and controlled application development.
• Successfully managed Project Backlogs, release scheduling, project duration estimation and fore casting. Practical experience of Business requirements gathering and analysis.
• Working with Product owner on Artifacts such as Product Backlog, Spring Backlog, Sprint burn up / Burn-down, and Release Burn up / Burn-down.
• Help the product owners to come up with set of stories for better understanding for estimate and development
• Documented all the gathered information and prepared AS IS and TO BE process.
• Identify gaps between system capabilities and business requirements.
• Conducted UAT and developing Test Documents, Test Plans, Test Cases, and Test Scripts.
• Developing use cases, sequence diagrams, collaboration diagrams and activity diagrams.
• Gap analysis and structured walk through of work flow with actuaries and underwrites to identify and fill the gaps after merger.
• Involved in creating a detailed system test plans, test cases and test scripts for different modules in the application.
• Excellent documentation skills including writing Business Requirements Documents (BRD) and Functional Requirement Document (FRD), as well as designing business models, Entity-Relation Diagrams, and process flows based on UML methodology.
• Developed prototypes and documented in Business requirement documentation (BRD).
• Interfaced with DFHCP and the IS teams to clarify State billing and claim requirements for new Health Safety Net (HSN) Insurance.
• Map capabilities to requirements to ensure that business needs are met.
• Developed, analyzed, managed change log of enhancement requests using the Requirement Traceability Matrix (RTM) and Project Tracker system.
• Managed backlog and stories using Rational Tool Concert RTC
• Prepare Business Requirement Document (BRD) and business requirement specifications
• Coordinated with system architects and developers to convert business requirements into system requirements
• Good exposure to Clinical systems /EMR/EHR/Practice Management.
• Extensively worked with HIPAA Privacy Facets application groups.
• Designed data models using Erwin. Developed Conceptual, Logical and Physical data models and created DDL scripts to create database schema and database objects.
• Responsible to conduct JAD sessions to gather requirements from various Business users located in multiple geographical locations.
• Creating source and target table definitions. Source data was extracted from Flat files, SQL Server and Oracle Databases.
• Created multiple dashboards and automated presentations using Excel/VBA/PowerPoint/Outlook.
• Responsible for Business and Data Analysis, Data Profiling, Data Conversion, and Master Data Management.
• Analyze healthcare data trends to produce an appropriate improved solution
• Developed and managed advanced ETL processes to acquire and load large healthcare datasets using Microsoft SQL Server.
• Build Payment database for all claims for reporting purposes.
• Assisted in managing and billing Medicare, Commercial HMO/PPO claims on a daily basis.
• Followed Workgroup for Facets Electronic Data Interchange standards for testing that need to comply with the HIPAA guidelines.
• Track vendor adherence to contractual terms and conditions and develop vendor reports.
• Responsible for claim adjudication like Medicare/Medicaid claims, professional claims, institutional claims.
• Responsible for identified and creating Business Use Cases from requirements, created UML Diagrams including Use Cases Diagrams, Activity Diagrams, Sequence Diagrams and Class Diagrams using Lucid chart.
• Maintained and kept track of stakeholder’s requests for enhancements and changes using Rational Clear Quest.
• Cycle (SDLC), Agile Development Methodology, Iterative Software Development Life Cycle Process as per Rational Unified Process (RUP).

Environment: MS-Project, Visio, MSOffice Suite (Word, Excel, Access, OneNote, PowerPoint, and Outlook), Quality Center, SharePoint Portal.

Sr. Business/System Analyst

Responsibilities:

• Acted as Scrum Master: conducted daily stand up meetings, developed burn down chart, product backlogs and release backlog.
• Customized and incorporated grasshopper with the existing JIRA in the project for better communication and clarity. Raised bugs and issues throughout the project.
• Coordinated activities between the business house and technical staff, in developing new methods, policies, and procedures to meet the business needs, and has acted as a Subject Matter Expert.
• Coordinate between client and offshore team to enable system support from offshore, Develop production support (24X7) guidelines describing mechanism for production call reporting, resolution, escalation etc.
• Knowledge transition and Responsibility transition to offshore team, responsibility to establish a strong working relationship with the client.
• Created process flow diagrams using Blueprints.
• Elicited requirements by analyzing the blueprints already available to document business and functional requirements documents.
• Creating service request documents developing project documentation. Training offshore team members and developing mirror resource.
• 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
• Experience in working with SAS ENTERPRISE GUIDE SOFTWARE for reporting and analytical tasks.
• Hands on experience working with SAS Enterprise Guide, Information Map Studio, Data Integration Studio and Web Report Studio.
• Performed burst of Reports against the regions, districts, and stores for delivering by email; appropriate outputs to the concerned District Managers & Team Ambassadors in Cognos Connection.
• Conducted walkthroughs with the different department heads to have a deeper understanding of the requirements.
• Analyzed and documented the business requirements and generated reports for the Manager
• Participated in the Daily Scrum meetings, Sprint Review, Sprint Retrospective Meetings and ensuring that all the deliverables and milestones were met.
• Developed User Stories/ Acceptance criteria, Use Cases for unit testing, spreadsheet for testing criteria, including regression, positive and negative testing & process flow testing.
• Gathered User Interface feedback to improve on the next release.
• Worked with developers and SMEs to create an Operation Maintenance manual (O&M) as per the CMS standards.
• Daily Stand up calls, Sprint Planning, Sprint Review and Sprint Retrospective sessions for the project with globally distributed teams
• Conduct Story estimation meetings on epic level as well as story level
• Creating a story board which will provide the user stories BA's working on for future projects
• Schedule and WBS development and management for on time delivery of the project.
• Helping the team to maintain their Scrum tools Story board, Action board, charts, backlogs, etc.
• Developing project plans, testing plans, production deployment plans, costing and budgeting plans.
• Conducted JAD sessions to gather requirements from the state SMEs in process of creating Business requirement document (BRS) and system requirement document (SRS).
• Was responsible to document User stories in JIRA and detailed requirements for each User story in the Story Board Editor SBE tool.
• Used JIRA tool to story point each story and prioritize story backlog based on Business Goals and objectives during the Sprint Workshop.
• Was responsible to create sub-tasks in JIRA for each User story during the Sprint Planning sessions and assign sub-tasks to the developers.
• Constantly reviewed and updated the requirements document (BRS).
• Worked with SMEs and business analyst to create a Program determination rules document and track the requirements in HP ALM.
• Tracked and traced all the requirements in the Rational Requisite Pro and HP ALM.
• Created test plans and test cases for UAT testing.
• Designed and developed Use Cases, Activity Diagrams and Sequence Diagrams using MS Visio.
• Identified performance testing parameters like peak processing time, expected number of users, System response to failure with the interaction with developers to create a performance test plan.
• Created process flows and use case document to provide a detailed flow of events.

Environment: JIRA, HP ALM, Quality Center, MS-Office, MS Visio.

Sr. Business Systems Analyst

Responsibilities:

• Incorporated and implemented all the HIPAA standards, Electronic Data Interchange (EDI), transaction syntax like ANSI X12, ICD-9, ICD-10 coding.
• Used the Rational Unified Process (RUP) to build the different phases of Software development life cycle
• Worked closely with the client base to understand and meet their needs by incorporating new functionality and features into the systems
• A major part of the responsibility included interacting with the Users and Business relationship managers and facilitating implementation of changes using ERD diagrams created MS Visio on the database in order to ensure approval from process owners.
• Coordinated testing, rollout & deployment of Cognos 10.1 Business Intelligence reporting solutions.
• Worked closely with business users to define reporting requirements and documenting the requirements in order to design, develop and maintain, and secure Cognos reports.
• Created Project management plans for managing on-time delivery using MS Project along with writing test cases, unit and systems integration test plans in Win Runner and used Load Runner to check if application works fine with load.
• Performed data analysis, statistical analysis, generated reports, listings and graphs using SAS tools e.g., SAS Integration Studio, SAS/Graph, SAS/SQL, SAS/Connect and SAS/Access
• Conducted AS-IS and TO-BE analysis and assisted in developed process models and systems integration structure.
• Involved in the analysis of HIPAA compliance and EDI transaction sets and actively participated in the designing of the EDI transactions using the new HIPAA 5010 version also including the use of ICD-10 codes.
• Conducted and facilitated Joint Application Development (JAD) sessions to reduce time spent in moving information between stakeholders and team members.
• Wrote test cases and test plans for the related and assigned scripts according to the test strategies defined in the project and testing team guidelines in Quality center.
• Conducted the AS-IS and TO-BE analysis of the business process using GAP analysis.
• Tracked and maintained Stakeholder requested enhancements and changes using Requirement Traceability Matrix (RTM).
• Identified critical areas of business risk and modified business processes to reduce risk by using the Risk-Management Process.
• Knowledge of the complete EDI format used in electronic documentation that was part of the knowledge transfer program to the vendors as per the requirements.
• Wrote SQL queries (SQL Server database) in TOAD for comparison between short-term and long-term fixed income strategies.
• Used Quality Center to manage testing and defect life cycles, and map requirements to test cases.
• Reviewed and participated in defining test strategies, as well as coordinate user acceptance testing (UAT) efforts.

Environment: Rational Rose, Microsoft Visio, Oracle, RUP, CMM, MS-Access, MS-Office (Word, Excel, PowerPoint), MS Project, Lotus Notes.

Sr. Business Systems Analyst

Responsibilities:

• Constructed WBS and tracked project progress on a monthly SPRINT schedule
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams and Business Process using MS Visio or Rational Rose Modeler.
• Prepared screenshot GUI using Photoshop and Visio.
• Conducted Surveys and Brainstorming sessions with SMEs for requirement gathering and prepared Business requirements document .Prepared Low level requirements document.
• Prepare end user documentation for training and assistance including release documentation, process flows, and help screens on a daily basis
• Directly interacted with the stakeholders to elicit the requirements and translate them into technical user stories, user stories and acceptance criteria for teams and documented them in tools like Wiki and Jira.
• Organized and led daily stand-up meetings, project planning, sprint planning, provide high level estimates, prioritize user stories & defects for the sprint, and maintain backlogs and release plans.
• Managed UAT efforts for the team including writing the UAT test plan and test cases, executed test cases, managed defects to resolution, and provided executive level reporting on UAT progress.
• 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.
• Performed Gap analysis for better understanding of transition from HIPAA 4010 to HIPAA 5010.
• Designed and developed Use Cases, Activity Diagrams and Sequence Diagrams using UML.
• Documented, organized and tracked the requirements using Rational Requisite Pro.
• 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.
• Documented the detailed business as well as technical requirements to upgrade the current system to 5010 transactions.
• Got 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 on ICD conversion from 9 to 10 with respect to the claims related to Medicare (Part A, Part B, Part C, and Part D).
• Worked with Source system Subject Matter Experts (SMEs) to ensure that the extracts are properly mapped. Used SQL for data mapping and querying.
• Integrated Requisite Pro with Rational Rose to provide all teams visibility and maintain tractability among requirements, use cases and change requests.
• Completed a review of existing documentation for orders, referrals and reports and compared it to the clinical details needed for ICD-10.
• Assisted in writing test case scenarios for unit testing, integration testing and compliance testing.
• Assist end users and IT staff in the use of data to satisfy informational and reporting requirements and implementing and using SQL and DBMS.
• Strong Project Management skills to understand the project scope, objectives, and timelines with MS Project and explain them to various teams and prepared the “As is” and “To be” document to help identify the benefits and project requirements.

Environment: Rational Rose, Rational Requisite Pro, Clear Case, Clear Quest, UML, Rational Suite, MS Visio, MS Project, MS Office (MS Word, MS Excel, MS PowerPoint), MS Access, XML

Business Systems Analyst

Responsibilities:

• User Business Requirement
• Responsible for the requirement-gathering phase and project plan.
• Responsible for requirements analysis, design and developing technical requirements.
• Responsible for the full HIPAA compliance lifecycle from gap analysis, mapping, implementation and testing for processing of Medicaid Claims.
• Responsible for gap analysis in changing old MMIS and Involved in testing new MMIS
• Used HIPAA 4010 transactions to support the analysis of current business processes and work with management to improve and implement enterprise solutions to ensure compliance and got involved in designing future state processes for HIPAA 5010 transaction processing EDI’s 837, 835, and 834.
• Analyzed HIPAA 5010 related to 837,835, 834. Transactions and performed gap analysis between the 4010 and 5010.
• Used Requisite Pro for writing/analyzing project vision, goals, specifications and requirements.
• Conduced Joint Application Development (JAD) sessions and walk in interview with the business users to gather requirements.
• 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.
• Conducted the FRS and URS reviews and walkthroughs with designers, developers and stakeholders. Also conducted feasibility and adaptability study.
• Developed non-functional requirements and documented them as Business Rules, Quality attributes and constraint documents.
• Interacted with database developers for formulating the ER diagrams and data flow diagrams.
• Used HP Quality Center for tracking Defects and tracing requirement functionality performances.
• Executed test cases manually. Compared and analyzed actual with expected results and reported all deviations to the appropriate individual(s) for resolution.
• Actively involved in UAT planning, designing UAT scripts, preparing the test cases and selecting the testing team.
• Logged defects and issues during UAT and assigned it to the respected developers.
• Assisted Business User during deployment in formulating User Acceptance Testing (UAT) for customized application and getting confirmation for product Release.
• Conducted project closure with milestones achieved, lessons learned, and project team member hour’s allocation review for business sponsor and product owners.

Environment: UML, RUP, Rational Requisite Pro, Rational Rose, Rational Clear Quest, Excel, SQL, HP Quality Center

Business Systems Analyst

Responsibilities:

• Worked on Claims processing module of the Group Approval Process.
• Conducted Gap Analysis on the AS-IS and TO-BE business processes and technology; and identified potential pitfalls, risks, and issues.
• Developed Screen Mock-ups/Prototypes to provide demonstration to the Business teams.
• Developed BRD for Functional and Non-Functional Specifications
• Gathered and documented business requirements from SMEs, user groups and vendors.
• Prepared a comprehensive Functional Requirements Document and Supplementary Specification Document (nonfunctional) from the gathered requirements.
• Facilitated and managed meeting sessions with committee of SME's from various business areas including Benefits Administration, Health Claims Group, HIPAA Administration, Health Policy and Program Evaluation Team and Data Management Group.
• Participated in entering, tracking system defects in Rational Clear quest.
• Involved in Configuration Management, Requirement management and analysis.
• Involved in fetching and displaying data using SQL queries.
• Verified outputs against the Oracle database using SQL queries.
• Validated back-end data using SQL.

Environment: Rational Requisite Pro, Clear Case, MS Visio, MS Project, SQL, Windows, MS Office.