SUMMARY:

• Business Analyst with over 7 plus years of experience as in focusing mainly on the Software Development Lifecycle (SDLC) principles of Agile Methodology and Rational Unified Process (RUP).
• Interacted with stakeholders, gathering requirements, rating them and assigning priorities to each of them
• Excellent in preparing UML diagrams - Use cases, Activity diagrams, Sequence diagrams, Class diagrams, Data Flow diagram, Process Flow diagram, etc using modeling tools like Rational Rose and MS Visio.
• Proficient in user stories, scrum and Agile. Familiar with user stories and concept design documents.
• Exposed to Medicare and Medicaid domains of the healthcare systems and industry for inpatients, outpatients, Reimbursement Methodology.
• Knowledge and Experience on Membership, Billing, Claims Payment Processing in relation to HIPAA, Confidential 4010, HL-7, ICD-9 & ICD-10, codes 834, 835 and 270, 271.
• Created data mapping documents based on Red Cards specification which involved working with FACETS, claims, membership& plan data model.
• Experienced in conducting Joint Application Development (JAD) sessions for requirements gathering, analysis and design. Organized weekly Project Status and Task Review meetings.
• Extensive use of structured techniques for analysis and design with tools like Enterprise Architect, Rational Requisite Pro, MS Visio and Rally.
• Proficient in creating Sequence Diagrams, Collaboration diagrams, Activity Diagrams, Class Diagrams using Rational tools and Microsoft Visio.
• Efficiently carried out SDLC (Software Development Life Cycle) implementation.
• Experienced in creating Business Requirement Document, Functional Requirements Specifications Documentation, and Scope Documents.
• Derived functional specifications document based on the User Requirement Specification and used JIRA for documenting requirements.
• Experience executing SQL Queries for database testing.
• Experience with writing Test Cases, Test Plan, and Test Scripts.
• Experience in Web sphere and Java platforms, Oracle and DB2 database.
• Participated in the daily stand-ups, developed the user stories and tested the user stories.
• Expertise in Agile methodology (Scrum)- creating user stories, facilitating planning meetings, sprint retrospective, backlog grooming, sprint reviews and maintaining the product backlog
• Exclusive involvement in a formal review of representative set of user stories and Business rules from a batch with the Product Owner and Quality Analyst Team.
• Strong experience with Scrum methodology and well versed in writing user stories.
• Technical writing skills including drafting contracts, documentation and editing of user manuals.
• Proficient in using Agile Scrum methodologies, performed roles of Scrum Master following sprint/standup sessions and used Excel extensively to write user stories, analyzed the Iteration Burn Down charts and reviewed defects.
• Participated and contributed in daily Scrums, Sprint meeting and Sprint review meetings.
• Knowledge on Power BI and Tableau.

TECHNICAL SKILLS:

Methodologies: SDLC, RUP, UML, RAD, JAD, Agile (SCRUM), Waterfall

Requirement Tracking: Rational Requisite Pro, Quality Center, MS Access, Version One (V1), BIZ APP

Defect Tracking Tool: SQUIDS, BIZAPP, JIRA and IPAR (Incorrect Payment Audit Tool), Quality Center and Jira

Change Management Tools: Rational Clear Quest, Test Director, Quality Center and Clarity, Code Translator tool (Main Frame) and ARGUS (Real Time tool) used for Pharmacy transactions.

Operating Systems: MS Windows UNIX

Databases: Oracle, MS Access, SQL

Office Tools: MS Word, Excel, MS Project, MS Outlook, Microsoft Lynch and SharePoint

UML Diagram Tools: Rational Rose, Microsoft Visio.

WORK EXPERIENCE:

Confidential, Dallas, TX

BUSINESS ANALYST

Responsibilities:

• Gathered business, system, and functional requirements by conducting detailed interviews with business users, stakeholders, and Subject Matter Experts (SME's).
• Conducted group (JAD) sessions with business units and stakeholders to define project scope and deliverables.
• Validate the Business -to-Business data exchanges between data exchange partners; validate the internal processing of the MMIS, or other transaction processing system.
• Provide technical support for the Minimum Data Set ( Confidential ) and the Outcome and Assessment Information Set ( Confidential ) Systems to enable the electronic transmission for patient data for the purpose of payment and quality of care analyses for the Medicare and Medicaid Programs.
• Responsible for: creating artefacts for Rational Unified Process (RUP) - use cases, system architecture document, supplemental requirements document, architecture diagrams; verifying technical production infrastructure; designing and executing performance tests; and documentation.
• Worked on Medicare Advantage ( Confidential ), Medicare Part D ( Confidential ), Medicaid Options (Under 65 and Over 65) and Managed Care (Care, Disease and Case Management and also in Insurance regulations and Claims Processing and claim scrubbing in HMO, PPO, Medicare and Medicaid.
• Assisted in loading managed care contract rates into managed care contracting information systems.
• Also, worked with other departments to provide managed care information and identify improvement opportunities.
• Also performed complete reconciliation of the Explanation of Payments (EOP) and check remittances as they received from Managed care Contracts
• Entered Minimum Data Set ( Confidential ) into computer database and transmitted them to the Medicare website
• Designed and maintained managed care contract databases to streamline collection, analysis, and dissemination of contract information.
• Performed the requirement analysis, impact analysis and documented the requirements using Rational Requisite Pro.
• Prepared client process maps for the consumer, broker, employer and provider transactions for the Facets process.
• Developed and wrote test script walkthroughs with developers and Quality Analyst .
• Set and continually managed project expectations with team members and stakeholders.
• Worked on Confidential transaction 835 to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrolment hence analysing and documenting related Business processes.
• Incorporated HIPAA standards, Confidential (Electronic data interchange), transaction syntax like Confidential X10
• Developed straightforward DBMS queries, knowledge of HL7 and xml interface messaging.
• Assisted in monitoring ancillary data transactions and addressed problems with HL7 messages.
• Involved in analysis for wide range of Six Sigma and Web-based initiatives, including user requirements.
• Data mapping, logical data modelling, created class diagrams and ER diagrams and used SQL queries to filter data within the Oracle database.
• Analysed and Documented Business Requirement Document ( Confidential ), Functional Specification Documentation, and System Requirement Documentation, using UML methodologies
• Conducted meetings to understand the workflow, their processes and assisted in gap analysis to derive requirements for existing systems enhancements.
• Reviewed test scripts and made sure that the Test scripts covered all scenarios of the requirements.
• Create technical design documentation for the data models, data flow control process, metadata management.

Confidential, Long Beach, CA

Business Analyst

Responsibilities:

• Performed analysis on the Affordable Care Act ( Confidential ) law & corresponding Centers for Medicare and Medicaid Services (CMS) and Connecticut Health Insurance Exchange (HIX)Business requirements.
• Built Product roadmap for delivering and implementing HIX features and functionality.
• Working knowledge in membership, employer groups, benefits, providers, claims, and provider networks areas of Healthcare industry with projects involving Health Exchange (HIX), ICD-10 implementation, Confidential transactions and codes.
• Successfully used Agile/Scrum Method for gathering requirements and facilitated user stories workshop.
• Involved in meeting with Provider communities to discuss the conversion of the Legacy System to New MMIS system.
• Was responsible for data mapping of HL7 messages into relational database.
• Monitored contracts and payments and worked with the Billing, Claims, Benefits and Authorization departments and the Managed Care companies to resolve differences and ensure correct reimbursement.
• Participated in providing implementation assessment for Rational Requisite Pro, Rational Clear Quest using Unified Modelling Language (UML) and Rational Unified Process (RUP).
• Developed Use Cases, Sequence Diagrams, Activity Diagrams and Class Diagrams.
• Facilitated Joint Application Development (JAD) Sessions for communicating and managing expectations and to gather the Business requirement.
• Designed Activity, Sequence and process flow diagrams using MS Visio to simplify and elaborated certain selections and filter conditions.
• Worked closely with QA and Developer Team to understand a Business Requirement Document.
• Performed Gap Analysis to identify the deficiencies of the current system and to identify the requirements for the change in the proposed system.
• Documented Requirement Traceability Matrix ( Confidential ) for traceability of requirements.
• Ensured that Confidential files were in compliance with ICD-10 standards.
• Worked on Confidential 834, 837/835 transactions according to test scenarios and verify the data on different modules.
• Worked on impact analysis on 834, 270/271, and 837 (P-I) for transitioning from Confidential to ICD10.
• Worked on As-Is To-Be analysis of ICD-9 to ICD-10 conversion for the new qualifiers used in the 837 claims for the Diagnosis and Surgical Procedure codes.
• Conducted Back-End Testing Using SQL Com American privately owned online health company mands.
• Extensively used SQL statements to query the Oracle Database for Data Validation and Data Integrity.
• Logged defects (QC/ALM) and worked collaboratively with the business analyst & Developers to resolve issues identified during the System and Regression testing.
• Created Use Case diagrams using UML and Business Process Models using MS-Visio.
• Experience in Confidential -ICD10 conversion and expertise in forward and backward mapping using GEM.
• Worked within a growing knowledge of X12 4010 HIPAA 837 I, P, D, 835, 834, 820, 270, 271, 276, 277, 278, Confidential, Privacy, Security, and Medicaid.

Confidential, Columbus, OH

Business Analyst

Responsibilities:

• Built relationship with Product owner and other stake holders to facilitate team's interaction and coached them in creation and maintenance of product backlog on this new Instant Answer Insurance product to improve rate adequacy.
• Facilitated sprint planning, review, retrospective and daily scrum meetings, documented acceptance criteria, definition of done.
• Identified and communicated risks and issues to management during project execution resulting in minimal project delay created insightful automated dashboards and data visualizations to track key Business metrics
• Organized, planned, and documented bi-weekly production defect and enhancement deployments.
• Developed new process data flows and the new to-be architecture, performed gap analysis
• Communicated Business process requirements to IT staff, program staff and stakeholders
• Analysed the sources and targets, transforming the data, mapping the data and populating the data into targets by using Informatic Designer, Workflow Manager and Workflow Monitor
• Ensured that requirements and deliverables are verified and validated at each testing phase and final acceptance
• Translate the Business requirements into various functional documentation, Use Cases, interface mockups, flowcharts, and other process flows.
• Work directly with developers and designers to ensure requirements are met
• Participate in the testing process by verify QA test cases and executing test cases to ensure all requirements all met before client release.
• Work closely with data architects, developers, test managers, Business stakeholders and project managers to achieve project objectives in defined time frames.
• Participate in User Acceptance Testing (UAT) of system modifications; document findings to defined scenarios; ensure that changes.

Environment: Agile, SQL server, Microsoft Suite, Share Point, HP Service Manager, HP Quality Centre, Java, Adobe, JIRA, Microsoft office suite, Visio, Test Link, Message Point., Mock plus, MS Visio, PL/SQL

Confidential, Wilmington, DE

Business Analyst

Responsibilities:

• Gathered requirements using various elicitation techniques.
• Fixed the flaws of the previous website and incorporated changes in the new website by performing GAP analysis.
• Finalized the content management system to be used for the website and the application with the help of JAD sessions.
• Prepared Business Requirement Document ( Confidential ) and Functional Requirement Document (FRD) by gathering requirements through detailed discussions with Business users and Subject Matter Experts (SMEs).
• Participated in various meetings and discussed enhancements and modifications with Business users and stakeholders.
• Used Power Designer for the Business Requirement Documents' Preparation.
• Created Use Cases, Activity Diagrams, and Sequence Diagrams thus defining the Data Process Model and Business Process Model.
• Converted Business requirements to the Functional Specification from UML. Managed changes with the help of Requirement Traceability Matrix and impact analysis.
• Served as a liaison between SME's and the project team, gathering requirements for Checking (CHE), Savings (SAV), Demand Deposits (DD), and Center Responsible for Lending (CRL).
• Developed strategic Business solutions which included: mission statements, value propositions, critical success factors, work break down structure, statements of work, project management, gap and risk analysis, process re-engineering, facilitated functional design meetings and documenting requirements, use cases and change management.
• Created and managed project templates, Use Case project templates, requirement types and traceability relationships.
• Tracked bugs in the testing phase using Silk Central.
• Conducted Client Acceptance Testing (CAT) to ensure all the Business requirements have been fulfilled by the application.
• Conducted quick Smoke Test after each bill in testing and Planned User Acceptance Test (UAT).
• Participated in several testing phases including the creation of Test Case (TC) documents, Progression Testing, Regression Testing, Integration Testing and created the User Acceptance Test document.

Confidential, Columbia, MD

Business Analyst

Responsibilities:

• Extensively involved in implementation of effective requirements practices, including gathering User Requirements, and analysing User Requirement Document ( Confidential ), and functional specification document (FSD), use and continuous improvement of a requirement gathering processes.
• Applied agile methodology with its various workflows, artefacts and activities to manage life cycle from inspection to transition phase.
• Involved in development of Business and Technical Requirements in preparation of Design and Functional Specifications for Business Needs and Processes.
• Worked as liaison between external clients and SMEs to generate and standardize product requirements specification documents.
• Employed UML methodology in creating UML Diagrams such as Use Cases, Sequence
• Diagrams, State diagrams, Activity Diagrams and Business process and workflows.
• Assisted JAD sessions to identify the Business flows and determine whether any current or proposed systems are impacted by the Confidential X12 Transaction, Code set and Identifier aspects of HIPAA.
• Involved in GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims.
• Worked on Confidential transactions: 270, 271, 835, and 837 to identify key data set elements for designated record set.
• Assisted team lead in developing Requirements Traceability Matrix ( Confidential ) to trace the relationship between Business and functional requirements to test cases.
• Prepared and executed different Test Cases and Test Scripts.