PROFESSIONAL SUMMARY:

• 7+ years of IT experience as a Business System Analyst in business consulting and application development with excellent skills in process implementation, client interfacing, requirement gathering, user support, problem solving, and documentation.
• Strong understanding of various SDLC methodologies such as RUP, Waterfall and Agile with hands on experience in all of them.
• Strong at writing requirements in Waterfall and Agile style.
• Proficient in identifying, documenting and analyzing Business Requirements Specifications (BRS), System Design Specifications (SDS) and Software Requirement Specification (SRS).
• Extensive knowledge of Medicaid, Medicare, Procedural and Diagnostic codes, Claims Process, Health information Exchange (HIE), Electronic Health Record (EHR) and Electronic Medical Record (EMR).
• Experienced in gathering requirements for HIPPA (Health Insurance Portability and Accountability Act) EDI (Electronic Data Interchange) Transactions 820, 834, 835, 837 (I, P and D), 270, 271, 276, 277, 278, 997 and 999 in various phases of implementation.
• Experience in conversion of HIPAA ANSI (ASC) - X124010 codes to ANSI (ASC) - X125010 codesandInternational Classification of Diseases (ICD) 9 codes to ICD 10 codes.
• Strong knowledge of Facets and actively involved in end-to-end implementation of Facets Billing, Enrollment, Claim Processing and Subscriber/Member module.
• Good knowledge of Lab Results and HEDIS (Healthcare Effectiveness Data and Information Set).
• Strong Experience with HL7 CDA(Clinical Document Architecture), HL7 file formats, and compliance/SNIP level HIPAA validations.
• Proficient in soliciting requirements, creating architectural diagrams, data model, and driving project through execution.
• Good knowledge of Informatica, SQL Server, Teradata and B2B tools (Informatica B2B, Axway, IBM Sterling).
• Proficient in Requirement Engineering Process, including gathering, analyzing, detailing and tracking requirements.
• Experience in interacting with stakeholders like business clients, end users, vendors, SDLC team, configuration manager and production team to identify information needs and initiate process change.
• Expertise in creating various artifacts like BRDs, Functional Specs, Used Cases, UML Diagrams, Data Mapping Documents, Test Plans and Test Strategies, pre and post RTMs and Status Weekly Reports etc.
• Strong visual modeling and Business Process Modeling (BPM) skills using Rational Unified Process (RUP) with tools like Rational Rose, and MS Visio.
• Expertise in using various tools like Requisite Pro and MS Office for requirement gathering, Quality Centre and Clear Quest for Defect Management/Defect Tracking, MS-Visio for UML Diagrams, MS Outlook, IBM Lotus Notes and SharePoint for information sharing.
• Excellent analytical, organizational, communication and documentation skills along with good project management skill to gather requirements to bring out the quality product.
• Excellent written and oral communication skills with the ability to communicate appropriately in business and technical situations at all levels of project management.
• Effectively used various elicitation techniques to gather requirements like JAD sessions, brainstorming, prototyping, one and one sessions, workshops, surveys, interviews and conferences.
• Hands on experience in the complete Quality Assurance (QA) life cycle from Requirements Gathering and Documentations to developing Test Plan, Test Cases, Traceability matrices and conducting User Acceptance Testing (UAT) for QA Testing.
• Hands on experience with SQL database, SSIS (SQL Server Integration Services), ETL (Extract, transform, load) and ODBC (Open Database Connectivity) connections.
• Hands on experience with SQL in writing joins, triggers, tables, user defined functions, views, indexes, and relational database models and data integrity.
• Strong experience with database structures, table layouts and Data Mapping.
• Strong experience with Contact Center.
• Proficient with data integrations and integration patterns to help identify data requirements for source to target systems.
• Worked with PMO(Project Management Office) to review time line and schedule for the implementation and discussing the milestone.
• Experienced in working with middleware, SOA, Web Services, EAI (Enterprise Application Integration) and Enterprise Integration.
• Excellent analytical, organizational, communication and documentation skills along with good process management skill to gather requirements to bring out the quality product.
• Motivated self-starter, good team member with exceptional team building, leadership, and interpersonal skills to resolve issues.
• Thorough knowledge of Eligibility and membership Affairs for Medicare and Medicaid. Also knowledge of HIPAA, ANSI (ASC) - X12, and HL7 standards, and Medicaid provider best practices.
• Experienced with Medicare and Healthcare Insurance; as well as Medical Standards (HIPAA and HL7).

TECHNICAL SKILLS:

Project Methodologies: Rational Unified Process (RUP), Waterfall, Agile, Spiral, Scrum

Business Process Modeling Tools: Rational Rose, MS Visio, Axure

Requirement Management Tools: Rational Requisite Pro

Project Management Tools: MS Project

Defect Tracking Tools: Rational Clear Quest, Quick Test Professional, Quality Center, (Application Lifecycle Management) ALM 11

Databases: Oracle, MS SQL Server, IBM DB2

Languages: Visual Basic, Java, XML, SQL

Front End Tools: MS Office Suite(Word, Access, Excel, Outlook, PowerPoint, SharePoint)

Claim Processing Tool: Facets 4.8

Version Control Systems: Rational Clear Case

Operating System: Windows, MAC OS, UNIX/Linux

PROFESSIONAL EXPERIENCE:

Confidential, St. Louis, MS

Business Systems Analyst

Responsibilities:

• Assisted Project Manager in planning the project time-line and scheduled various project deliverable dates according to the various phases of the project.
• Developed and maintain the integrated Master Project Plan for cross-functional teams and outside vendors assigned to the project.
• Prepared Project reports for management and assisted the project manager in the development of weekly and monthly status reports, policies, and procedures.
• Perform a baseline assessment of Hospital-Provider systems and related interfaces, the existing service level agreements and/or policies and operational business procedures for readiness to comply with HIPAA as well as ICD-10 requirements
• Have strong experience in requirements gathering by conducting interviews with end users.
• Actively worked on Data analysis and Report analysis with respect to ICD-10 impact.
• Performed Gap analysis for better understanding of transaction from HIPAA 4010 to HIPAA 5010 inside Trizetto QNXT different modules.
• Worked with providers and Medicare or Medicaid entities to validate EDI transaction sets or Internet portals. This includes HIPAA 4010; 837, 835, 270/271, and others.
• Analyzed System flows of various department of the hospital.
• Identified risks, problems, requirements and concerns of the Hospital in order to comply with ICD-10 changes.
• Highly involved in understanding of department workflows and process flows with respect to applications.
• Collected the information related to ongoing application upgrade and their impact on ICD-10 implementation and created awareness within the departments regarding the need, impact, benefits and risks of ICD-10 code application.
• Analyzed data and created reports using SQL queries.
• Re-Organized the collected data and prepared documentation for implementation.
• Involved in providing education about the ICD-10 codes and 5010 standards, its requirements, complexity and accuracy to Physicians and Nurses of the hospital. Figured out the requirement of training in various departments of the hospital based on their daily work.
• Performed impact analysis on applications for deadliness of ICD-10 conversion.
• Got involved in designing future state processes for HIPAA 5010 transaction processing EDI 820, 834, 835and 999.
• Analyzed HIPAA 5010 related to EDI 837 (I, P and D), 270, 271, 276 and 277transactions (both inbound and outbound) and performed gap analysis between the 4010 and 5010.
• Participated in Agile Planning Sessions and assumed the Product Owner role for the Agile initiative.
• Created and explained the User Stories to the Scrum Team under Agile - Scrum methodology and helped them design the Tasks.
• Extensively involved in Database testing by writing SQL queries.
• Designed acceptance criteria under Agile - Scrum methodology for validating the output of each Sprint.
• Reviewed Team Velocity under Agile - Scrum methodology on a frequent basis and advised Scrum Master at various stages.
• Participated in Sprint Planning and Sprint review meetings under Agile - Scrum methodology for finalizing the Sprint Backlogs and Verifying the Sprint outputs respectively.
• Responsible to meet the information demands of our business users by delivering timely, accurate, meaningful and standardized data and reporting.
• Help the product owners to come up with set of User stories for better understanding for estimate and development.
• Conduct User Story estimation meetings on epic level as well as story level.
• Mapped the collected data with the existing data provided by the hospital departments.
• Experience in working and conducting requirement engineering process and Business process Modelling.
• Used Microsoft Word, Excel, Access and Visio as working tools.
• Analyzed existing reports in order to respond to Change Requests (CR) coming from client side in the form of new business requirements.
• Identified the impacts of the Change Requests on the basis of their specifications given in the CR Reports, number of changes required, and number of hours required for code changes and testing, and creating a document with all these details to be shared with the client.
• Assisted the QA team and worked on Quality Center.
• Responsible for attaining HIPAA EDI validation from Medicare, Medicaid and other payers of government carriers.
• Interacted with developers to report software bugs and re-tested the fixed issues.
• Hands-on experience and good understanding of the hospital working system including Registration, Scheduling, Radiology, Laboratory, Pharmacy, Patient Accounting, HIM, Claim Processing etc.
• Met the deadlines and scheduled day to day meeting sessions.

Environment: Java, SQL, Windows XP, MS Project, RUP, Rational Rose, RequisitePro, UML, MS Visio, Waterfall.

Confidential, Atlanta, GA

Business Analyst

Responsibilities:

• Utilized Rational Unified Process (RUP) to configure and develop process, standards and procedures.
• Prepared the Business Requirement Document (BRD) and System Requirement Document (SRD).
• Facilitated Provider Enrollment, Setting up Provider profile & Trading Partner Agreement.
• Set up Provider's Access to the System. (Security Setup).
• Helped creating Provider Reports i.e. Financial, Claims processing.
• Prepared the Business requirement Document for the enhancement of the existing services.
• Wrote FRDs for the defects and enhancements and got approval from business for the developers.
• Worked on Technical Design Documentation (TDD) of the claims processing system.
• Performed task estimations and documentation of procedures.
• Designed, prepared and implemented test cases for system testing as well as for User Acceptance testing.
• Involved in the testing of web portal of New MMIS system.
• Used SQL Navigator for Writing and execute Queries.
• Responsible for Medicaid Claims Resolution/Reimbursement for peach state health plan using MMIS.
• Conducted integration testing and regression testing with developers in development and QA, also conducted user acceptance testing with UAT team. Safety reporting on system-based projects, acted as a liaison, writing documentation and increased project coordination.
• Analyzed and documented system release/deployment issues according to version management, backward compatibility, load balancing of components in production environment.
• Did impact analysis for changing requirements and coordinated with business users for prioritizing the testing/release of the changes.
• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims.
• Used Query Analyzer, Execution Plan to optimize SQL Queries.
• Maintained a very close interaction between business users and developers to avoid any gaps in understanding or implementation of requirements.
• Did data analysis, created data mapping and data interface documents and kept the documents updated with changes in requirements and functional specifications.
• Performed Risk Analysis based on defect severity and priority.
• Tested User Interface inconsistency and application functionality.
• Developed Reports and Graphs to present the Stress Test results to the management.
• Created BPR charts for AS IS and TO BE processes of different business functionalities.

Environment: Windows XP, SQL, MS-Visio, Rational Rose, Requisite Pro, Clear Quest, UML, Axure, Java, Agile.

Confidential, New York City, NY

Business Analyst

Responsibilities:

• Performed Requirements Gathering and Analysis, interviewed the SME (Subject Matter Experts), and ensured that contributors and all key stakeholders were motivated to complete assigned tasks.
• Facilitated Joint Application Development (JAD) Sessions for communicating and managing expectations.
• Manage the Requirements (Business as well as System requirements), performed requirements analysis along with the creation of Use Case Scenarios. Modeling of the business and application using Rational Unified Processing (RUP) and Unified Modeling Language (UML).
• Performed Gap analysis and assessed risks of the project.
• Gathered Requirements through interviews and JAD sessions with business owners.
• Analyzed and worked with HIPAA specific EDI transactions for claims, member enrollment, billing transactions. Worked specifically with270, 271, 276, 277 and 999.
• Observed extensive troubleshooting for the failures in mapping systems for outbound claim payment transactions (835).
• Checked the data flow through the front end to backend and used SQL Queries to extract the data from database.
• Involved in up gradation of HIPAA ANSI (ASC) - X12 4010 transactions to HIPAA ANSI (ASC) - X12 5010.
• Ensured that application was created and maintained in a manner that supports the departmental, user and overall business objectives in coordination with other system vendor products.
• Performed System Integration and Regression Testing for the Microsoft BizTalk 2002 applications. These are developed to perform Electronic Data Interchange (EDI) translation from ANSI (ASC)(American National Standards Committee) ASC(Accredited Standards Committee)ANSI (ASC) - X12 layout to MMIS fixed-width record format.
• Worked as liaison between software developers and users of Electronic Medical Record (EMR) systems to create better electronic medical record systems.
• Involved in creating mappings for the conversion of EDI ANSI (ASC) - X12 transactions 820, 834, 835 and 837 (I, P and D)code sets version .
• Worked on changes for HIPAA Transaction and proposed changes to be made in the current system for an easy transaction from version .
• Documented the detailed business as well as technical requirements to upgrade the current system to 5010 transactions.
• Performed Backend Testing using SQL queries.
• Created test scenarios for EMR systems executed those tests cases and evaluated the results.
• Translated and transferred requirements from Business Requirements Document (BRD) to Functional Requirements Document (FRD).
• Designed Activity, Sequence and Process Flow Diagrams using MS Visio to simplify and elaborate certain selection criteria and filter conditions.
• Extensively worked with HIPAA Privacy Facets application groups.
• Enabled successful implementation and usage of the FTP(File Transfer Protocol) for the extract submission to the corresponding vendor.
• Was involved in User Acceptance Test using the test cases given by the client before releasing the application.
• Worked with the Project Manager on various Project Management activities like keeping track of Project Status, Deadlines, Environment Request, and Compliance Issues.

Environment: Rational Requisite Pro, Rational Clear Quest, MS Visio, MS Project, Java, Windows XP, Oracle, Axure, Facets, Waterfall.

Confidential, Freeport, NY

Business Analyst

Responsibilities:

• Part of the team for migration of HIPAA - EDI ANSI (ASC) - X12 4010 series to ANSI (ASC) - X125010 series for EDI Transaction code sets: 820, 834, 835 and 999.
• Developed Incident documents and portrayed the as-Is reporting structures versus To-be Reporting needs for data integrity and accuracy.
• Identified the scope, business objective and documented the functional requirements for each release.
• Worked on analysis of Facets claims processing system and to gathered requirements to comply with HIPAA 5010 requirements.
• Directly involved in process improvement Plans and implementing business change.
• Documented the Business Requirements Document (BRD) and the Functional Specification Document (FSD).
• Coordinated with the different teams distributed at different geographic locations for various releases.
• Identified Actors, Activities, Artifacts and Workflows and developed use case diagrams using Rational Rose.
• Prepared and performed training to Client and Internal staff as a result of system changes.
• Produced clear user manuals & training guides for User Acceptance Testing (UAT) and deployment for end-clients with step-by-step instructions and appropriate GUI screenshots.
• Interacted with the development team on regular basis to ensure and balance practicalities with innovative and efficient business systems solutions.
• Created use cases specifications, use case diagrams, swim lane diagrams, component diagram and context diagrams to define the workflow and segregate high-level and low-level requirements using MS Visio.
• Conducted and Participated JAD sessions to gain consensus on various issues related to the project. Acted as a facilitator on different occasions.
• Held regular meetings with the Business users and SME’S to priorities the business Requirements.
• Worked with issues coming from Reference, Cross Reference, Operational tables in the Oracle Database and updating the tables per the requirements using Oracle, SQL.
• Conducted walkthroughs and code reviews with developers, project managers and stakeholders and users to comprehend business workflow of applications.

Environment: Rational Requisite Pro, Clear Quest, UML, MS Visio, Axure, Quality Center, SQL, MS Office, Java, Facets, Waterfall.