SUMMARY:

• Facilitator between Business and Information Technology with over 7 years of extensive experience in the field of Business Analysis, System Analysis etc.
• Experience in gathering business and application requirements, Business Processes, Identifying risks, Impact analysis, UML modeling, Sequence and Activity Diagrams using Rational Rose and Microsoft Visio.
• Experience in writing Business Requirements Documents (BRD), Functional Requirement Documents (FRD), System Requirement Specifications (SRS), and Non - Functional Requirement Documents (NFRD).
• Implemented issues tracking in Version One to effectively track impediments against user stories.
• Several years of experience and advance knowledge of the Systems Development Life Cycle (SDLC), Waterfall, Agile, Spiral, Rapid Application Development (RAD), Extreme Programming (XP), Rational Unified Process (RUP).
• Experienced in interacting with business users and executives to identify their needs and authoring Use Case Diagrams, Activity Diagrams and Sequence Diagrams using UML modeling.
• Good experience as SOAP Web Services Tester Great expertise in testing web services via SOAP, using the open source testing tool SoapUI
• Active role in eliciting requirements from users by utilizing methods like Interviews, Requirement workshops, Joint Application Development (JAD) and Participatory Design.
• Proficient in working with project management tools like MS Project for status reporting and planning.
• Did Data Analysis, created Data Mapping and data interface documents and kept the documents updated with changes in requirements and functional specifications.
• Capable of writing SQL queries for the retrieval and manage the data from database in testing environment.
• Involved in designing and developing Data Models and Data marts that supports the Business Intelligence Data Warehouse
• Well versed with Medicaid Management Information Systems (MMIS), National Provider Identification (NPI) and familiar with Patient Protection and Affordable Care Act (PPACA).
• Excellent knowledge of Health Insurance Portability and Accountability Act (HIPAA) transaction, code set rules such as EDI 837, 835, 834, 270, 271, 276, 277.
• Extensive knowledge of Medical Management Information Systems (MMIS), Medicaid, Medicare, Procedural and Diagnostic codes and Claims Process.
• Strong knowledge of Health Insurance Portability & Accountability Act (HIPAA) standards, Electronic Data Interchange (EDI), Implementation and knowledge of HIPAA code sets ICD-9 and ICD-10 integration, HL7, HMO, PPO.
• Good hands-on experience on various test management tools like JIRA, HP-ALM and Quality Centre.
• Facilitated all aspects of the Scrum framework, including sprint planning sessions, Backlog grooming sessions, daily scrums, product demos, sprint reviews and sprint retrospectives.
• Good knowledge of Health Insurance Plans (Medicare Part A, B, C and D), managed care concepts (Medicaid and Medicare) and experienced in determining the membership eligibility, billing experience within life and disability in health plans. Experience with Business Process Management.
• Capable of writing SQL queries for the retrieval and manage the data from database in testing environment.
• Experience in working with Microsoft Office Suite (Word, Excel, Power Point, Access, Visio, and Project) for documentation, analysis and presentation.
• Strong knowledge of Business Process Modeling, Business Intelligence and Business Architecture.
• Experienced in designing test scripts, test plans and test cases for testing of claims in development, integration and production environment.
• Worked on the EDI 834-file load to Facets through MMS (Membership Maintenance sub-system).
• Involved in designing and developing Data Models and Data marts that supports the Business Intelligence Data Warehouse.
• Worked on MS SharePoint to manage the repository of requirement for traceability and version control to collaborate the documents and artifacts

TECHNICAL SKILLS:

Microsoft Technologies: MS Visio, Excel, Word, Outlook, PowerPoint, SharePoint, Balsamiq

Requirements Management Tools: Rational Requisitepro, Rational Rose, Clear Case, Clear Quest

Operating System: Unix, Windows

Business Skills: Business Process Analysis & Design, Process Improvement and Implementation Assessment, Requirement Gathering, Use Case Modeling, JAD Sessions, Gap Analysis, Impact Analysis, Swot Analysis

Languages: C, C++, SQL, Unix, .Net.

Databases: SQL, Oracle, SQL Server

Methodologies: Rational Unified Process(RUP), Agile, Waterfall, Joint Application Development(JAD)

PROFESSIONAL EXPERIENCE:

Confidential, Baltimore, MD

Sr. Business Analyst

• 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
• Involved in Data Analysis & Mapping to track all data elements used in the application from the user interface through different interfaces to the target databases in which they are stored.
• Used HL7 level standards for developing EHR for healthcare facilities to store, access and update patient’s health record electronically.
• Tested integrated software (Web Services (SOAP and REST), and messages..
• Worked on Enrollment and Billing Module through both 834 EDI transactions as well as Facets Online/enrolling members in Facets from Facets front end screens, web portal application and EDI 834 transactions. Also made appropriate changes to records by resolving enrollment system rejects.
• Validated the following Transaction Processing: 837 (Health Care Claims or Encounters), 835 (Health Care Claims payment/ Remittance), 270 / 271 (Eligibility request/Response), 834 (Enrollment/Disenrollment to a health plan).
• Develop Prototypes of new information processing application and as well as GUI prototypes using mockup screens.
• Experience in requirements gathering, analyzing them, Writing Business Requirements Documents (BRD), Use case specifications, Systems Requirements Specification (SRS), Workflows using UML and RUP methodology, Project planning, scheduling and management.
• Performed data analysis on Excel
• Identify and prioritize business and systems issues by applying analytical tools such as Impact Analysis, Root-Cause Analysis.
• Implementation of Agile Framework ( SDLC ) using Scrum methodology
• Application development and Managing geographically distributed teams.
• Knowledge on basic Unix / Linux commands and experience on interacting with Unix / Linux servers.
• Conducted SMART analysis and Facilitated Joint Application Development ( JAD ) sessions to resolve issues.
• Understanding of Business Intelligence and Data Warehousing concepts with emphasis on ETL and life cycle development including requirements analysis, design, development, testing and implementation.
• Worked on MMIS (Medicaid Management Information System) for insurance claims filling and patient information and gained good understanding of MITA (Medicaid Information Technology Architecture).
• Highly motivated team player with excellent communication, presentation and interpersonal skills, always
• Willing to work in challenging and cross-platform environment.

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

Confidential, El Paso, TX

Sr. Business Analyst

• Applied advanced Excel skills (pivot tables, macros, lookups, charts) and Access database querying skills in streamlining and automating accounting processes.
• Developed Forms using MS Access using Forms and Reports for reporting
• Modeled functional requirements using UML and MS Visio to create Use Case Diagrams, Activity diagrams, Sequence Diagram and logical Class Diagram for interaction between the various actors and system and to supplicate the Workflow Models .
• Gathered requirements for impacted system and business areas for ICD-10 and their needs to embrace the changes
• Worked with end users, SMEs, and stakeholders to fully understand issues with older application and the requirements of the new application being built.
• Held meetings and constantly updated the BRD as per the changes requested by the stakeholders and approved by the Change Control Board (CCB).
• Data mapping, logical data modeling, used SQL queries to filter data within the Oracle database tables.
• Perform research on Member, Provider, Claims and Authorization data from Facets back end and front-end application system for reporting purposes.
• Worked with IT in developing a new capability that will allow tracking new HIX membership’s alignment across their consumption and utilization within organization’s plans/products.
• Used HP ALM to report any bugs found and communicate to the developers and product support team.
• Effectively managed change by deploying change management techniques such as Change Assessment, Impact Analysis and Root Cause Analysis.
• Led the development of a training program to train users on a custom web application and a Congo’s ad-hoc reporting environment.
• Worked on a solution to establish a system that COB teams can use to maintain accurate TPL coverage
• Worked on HIPAA ANSI X-12 EDI 837 transaction and EDI 820 Transactions claims for billing.
• Performed testing for Medicare, Medicaid and Crossover claims for Medicaid Management Information System (MMIS).
• Conducted complex documentation and user needs analysis. Interfaced with team and staff to develop HL7 integration.
• Reporting and verification of bug fixes using defect tracking tool JIRA and VersionOne tool
• Led Business Intelligence reports development efforts by working closely with Teradata and ETL teams.
• Assisted JAD sessions to identify the business flows and determine whether any current or proposed systems were impacted by the EDI X12 Transaction, Code set and Identifier aspects of HIPAA.
• Developed the strategy for developing and implementing new EDI (HL7 and X12) interfaces and converting historical clinical and data.
• Excellent Communication, Interpersonal and presentation skills

Environment: Java, Agile, Rational Requisite Pro, UML Use Cases, SQL Server, Rational Rose, XML, Use Case Documentation, Clear case, Clear quest, HP Quality center, EDI, SharePoint, MS Access, MS Excel.

Confidential, Dublin, Ohio

Business Analyst

• Translated business requirements into functional specifications and documented the work processes and information flows of the organization.
• Used TriZetto HIPAA Gateway to comply with HIPAA standards ( 270/271, 276/277 & 837 ) for EDI transactions.
• Coordinated with the developers and IT architects to design the interface of the new system according to the X12 ( 270, 276, 278, 834, 837 ( I,P,D ) and 820 ) standards
• Participated in all phases of the Facets Extended Enterprise administrative system implementation to include the planning, designing, building, validation, testing, and Go-live support phases
• Created detailed use cases, use case diagrams, and activity diagrams using MS Visio.
• Created test plan, test data and conducted manual testing to validate functionality and performed regression testing.
• Clarified to claims personnel the new Affinity payments and Explanation for payments (EOPs) for same claim processing cycle.
• Designed and implemented complex SQL queries for QA testing and data validation.
• Performed testing for Medicare, Medicaid and X-Over claims for Medicaid Management Information System ( MMIS ).
• Created and maintained Narrative Use Cases (Business Use Cases, System Use Cases) and modelled Use Case Diagrams, Activity Diagrams, Data Flow Diagrams using MS
• Visio.
• Identified and suggested necessary solutions or process changes to improve efficiency.
• Strong MS Excel skills including making pivot table, v-lookup.
• Gathering requirements using Rational Requisite Pro and designing structure and behavioral diagrams such as class and activity diagrams using Use Cases and use case diagrams using Rational Rose.
• Effectively managed change by deploying change management techniques such as Change Assessment and
• Impact Analysis.
• Validate system performance through audits for MMIS files.
• Excellent communication, analytical, interpersonal and presentation skills; expert at managing multiple projects simultaneously.

Environment: MS Office, SQL Server, FACETS, Agile, MS Project, MS FrontPage, HP ALM, MS Access, EDI, Microsoft Excel, Microsoft Word, Microsoft PowerPoint, Visio.

Confidential, NJ

Business Analyst/QA Analyst

• Executed an integrated RUP solution with a complete line of traceability for all the artifacts of web development projects, experience with Six Sigma methodology.
• Gathered business requirements and use cases for all projects and conducted prioritization; Working with business stakeholders and data stewards to drive requirements gathering for metadata and data quality criteria, thresholds and reporting for enterprise and departmental projects. Assisted in
• Business process flow.
• Worked extensively in Agile environment creating user stories, sprint lifecycles documents, and essential business use cases.
• Document, Functional Technical Specifications, Use Cases, Screen and Interface Design Document, scenarios document and others as identified.
• Designing and analysis of HIPAA 5010 related to 837,835, 834 transactions and ran GAP analysis between HIPAA 4010 and 5010 for professional claims, conducted feasibility study and performed impact analysis for proposed enhancements by understanding the AS-IS system and the TO-BE system requirements by having discussions with the SME’s.
• Documented Functional/Technical data flow of 4010/5010 HIPAA Transactions.
• Responsible for developing formats for the KPIs involved in the business. Conducted SWOT Analysis for better market understanding and fool proof project implementation.
• Verified the functional aspect as per the Business Process and validated the interfaces with the other systems and data conversion from the existing system.
• Performed UAT and logged test results according to the test plans using Quality Center.
• Effort estimation for the change request for Requirement gathering and requirement management within Requisite Pro and Rational DOORS
• Worked on FACETS Data tables and created audit reports using queries. Manually loaded data in FACETS and have good knowledge on FACETS business rules.
• Analyzed the mainframe reports for member/eligibility/claims and mapped the fields with FACETS batch jobs and reports.
• Use MS Office extensively (Word, Excel, Visio, Power Point, Outlook, and Project) for
• Analysis, presentation and documentation throughout the whole project.
• Designed and developed Quality Assurance standard and processes to all levels of project team.
• Conducted project related Presentations periodically to the management and end users
• During various phases of Software Development Life Cycle SDLC.
• Communicated with the Project Leader of the project to understand the business functions
• Involved in the project for presenting in the user manual.
• Excellent communication skills, Interpersonal skills, interacting with team members, leadership qualities, mentoring, ability to work independently.

Environment: MS Office, SQL Server, FACETS, Agile, MS Project, MS FrontPage, HP ALM, MS Access, EDI, Microsoft Excel, Microsoft Word, Microsoft, Power Point, Visio.