SUMMARY:

• Qualified professional with over 7+ years of extensive experience in the field of EDI/Business Analysis, working with the technical staff to implement management and staff's business requirements into the software application in Healthcare Industry.
• Highly motivated team player with excellent communication, presentation and interpersonal skills, always willing to work in challenging and cross - platform environment.
• Extensive Knowledge of healthcare standard Health Level Seven (HL7).
• Experience in B2B, B2C and Ecommerce portals web application developments.
• Experienced as a Business Analyst in using the iterative software development life cycle principles of Rational Unified Process to manage, develop and test distributed client/server, Internet and intranet applications on heterogeneous environments.
• Highly proficient in working with users to gather requirements, analyze them and subsequently use the Rational project and design tools to model the requirements.
• In-depth knowledge of creating use cases, functional design specifications, activity diagrams, logical, component and deployment views to extract business process flow.
• Used Query Analyzer, Execution Plan to optimize SQL Queries.
• Experience with SOX, Regulatory Compliance and Controls.
• Strong understanding of project life cycle and SDLC methodologies including RUP, RAD, Waterfall and Agile.
• Interviewed SMEs and Stakeholders to get a better understanding of client business processes and gather business requirements.
• Conducted JAD sessions, created Use Cases, work flows, screen shots and Power Point presentations for the Web Applications
• Gathered and documented Non-functional requirements.
• Knowledge of healthcare standard Health Level Seven (HL7).
• Experienced in preparing Business Process Re-engineering Models
• Familiar with HIPAA EDI transactions such as 835, 837 (P, D, I) 276, 277, 278 etc
• Expertise in the EPIC Medical software application (EMR, HER) as it relates to hospital workflows and setting up the infrastructure for a software implementation in a clinic environment.
• In depth knowledge of SDLC and implementation of the Rational Unified Process (RUP) in all four phases of a project: Inception, Elaboration, Construction and Transition.
• Utilized a fusion of industry knowledge and technical programming to provide executive management the development and implementation of interactive busines1s tools, and strategic analysis, vital for use in mission-critical decision-making
• Conducting requirement gathering sessions, feasibility studies and Impact Analysis and organizing the software requirements in a structured way using Rational RequisitePro to track development.
• Interacting regularly with the development team, creative services, database designer, system administrator and the higher management to meet the deadlines of Project milestones.
• Worked in close co-ordination with the testing team in developing test plan and test cases from functional and business requirements.
• Performed UAT and exposure to User Certification Testing (UCT) and Operational Readiness Testing (ORT)
• Expertise in understanding and supporting the client with Project Planning, Project Definition, Requirements Definition, Analysis, Design, Testing, System documentation and user training.
• Used Rational ClearQuest for tracking and prioritizing defects and for enhancements after base lining the requirements.
• Used Rational ClearCase for Version Control of requirement documents.
• Well versed in writing queries/Scripts for Data Analysis and QA reporting and testing.
• Good knowledge of Workflows and Content Management Tools.
• Experience in Change Management Process (Identify, Analyze, Evaluate, Plan, Implement, Review and Close).
• Expertise in Procurement and Management Services
• Excellent skills in Project and Performance Management to support Strategic Planning, Goal Setting, Strengthen Accountability, Enhance Decision Making, and Improve Customer Service.
• Experience in implementing Microsoft Office SharePoint 2010/2013.

TECHNICAL SKILLS:

Programming Languages: C, C++, HTML, XML, SQL.

Data Base: MS Access, Oracle (SQL Series), DB2

Reporting Tools: Crystal Reports 8.0

Operating Systems: MS-DOS, Windows95/98/NT/2000/XP, Apple McIntosh, Linux

Software: MS Office Suite (Word, Excel, Access, PowerPoint & Outlook), MS Visio, Rational Rose, Rational Requisite Pro, Adobe Acrobat, MS Office FrontPage, Lotus Notes

Performance Testing Tools: Virtual User Generator, Load Runner

Processes/Technologies: Rational Unified Process (RUP), Waterfall, UML & Microsoft Office SharePoint 2010/2013

Automation Tools: Requisite Pro, Win runner, QTP, Test Director, Quality Center

PROFESSIONAL EXPERIENCE:

Confidential, MI

Sr. Business Analyst

Responsibilities:

• Assisted in the Project manager in creating and updating the Vision Document, Business case, and the Project Plan to define Objective, Scope and Risks. Also assisted in creating RUP iteration plans and phase plans
• Retrieved and manipulated 834 xml’s to create new member for HIX testing.
• Created HIX members and groups manually through FMS (Financial Management System).
• Elicited requirements, and managed Change Configuration to maintain an orderly procedure for managing requirement changes after sign off
• Designing, documenting, configuring and deploying SharePoint intranet solution for corporate documents, client management, issue management and task management.
• Used the Agile methodology to build the different phases of Software development life cycle. (SDLC)
• Followed AGILE methodology viz. Scrum throughout the project.
• Experienced in testing EDI and HIPAA Transactions 837, 835, 820, 276, 277, 278,270.271 code sets testing in Health Insurance.
• Experience with BlueCross, Medicare, Medicaid, and commercial insurances in HIPAA ANSI X12, 4010 and 5010 ICD9 and ICD-10 implementation guidelines & electronic formats including 270/271, 276/277, 700, 701, 810, 820, 834, 835, 837, 997, and NSF formats for interfaces and images to third part vendor applications including NEIC, SSI, ESI, Datatrac, Medtrac, Cube, BlueCross, Medicare, and several others using COBOL, Metafile, Visual Basic, Unix, DOS, Assembler, C, FTP, Windows, Novell, and various other communication packages.
• Created Heat map with alert mechanism. Various KPI graphs were drawn. Kept eye on Qlikview best practice
• Project entailed developing a data model based on MS SQL Server and Tableau Server.
• Worked as Subject Matter Expert (SME) for various projects. Taught the users to get along with Qlikview.
• Elicited functional specifications, conducted feasibility analysis, and performed impact analysis
• Elicited Business Rules and other Non-functional specifications for the new system by interviewing the Subject Matter Experts (Doctors & Nurses) to further understand the business models
• Authored functional specifications for different HL7 system interfaces: ADT (registration), SIU (scheduling), OMG (rad order entry), and ORP/RDS (Rx processing)
• Designed, developed, and implemented innovative & sustainable Tableau reports. Supported effective rollout of reports, including training collateral
• Experience with Trizetto QNXT System implementation, Claims and Benefits configuration set-up testing, Inbound/Outbound Interfaces and Extensions, Load and extraction programs involving HIPAA 834 and proprietary format files and Reports development.
• Worked on HIPAA Transactions 270, 271, 276, 277,834, 835 and 997
• Worked with (ACS) X12 5010 and (ASC) X12 4010A including the various Claims Transactions such as: 837 (submit medical claims), 835 (medical claim payments), 270 (benefit/eligibility inquiry), 271 (benefit/eligibility response), 276 (claim status request), 277 (claim status notification), 820 (premium payments), and 834 (enrollment).
• Responsible for Back-End Testing Using SQL Commands using TOAD.
• Experience with developing HIPAA Companion Guides for 834 Enrollments, 270/271 Eligibility Inquiry/Response & 820 - Health Plan premium payments for MMIS (Texas, Maryland, Illinois and Virginia).
• Responsible for positioning and delivering QlikView projects and cross building applications into new and existing customer base
• Assisted in monitoring ancillary data transactions and addressed problems with HL7 messages.
• Developed gap analysis and risk assessments for the FACETS upgrade project including effects on internally developed extensions and third party software for pricing and contract configuration.
• Gathered requirements from the clients and developed crosswalks for 277/288, 834, 835, 837 P/I claims
• Created Request For Proposal to identify possible vendors and obtained cost and functionality information
• Created UML Activity Diagrams to depict business processes (AS-IS and TO-BE) and analyzed them for their efficiency and productivity.
• Served as a point of contact for CMS and trading partners to do the testing for various types of claims and real time transactions like 270/271/276/277 for Medicare and Medicaid programs in FACETS.
• Tracked UAT issues/bugs and prepared reports.
• Developed test cases based on the crosswalks and compliance guidelines for 277/288, 834, 835, 837 Professional, Institutional and Dental claims and for 270/271 eligibility benefit inquiry and response
• Created Use Case Model using Rational Rose for developers and other stakeholders to understand the business process, depict roles, and procedures
• Daily management activities included educating portfolio managers, financial analysts and risk managers on the cost of third-party financial research using business intelligence dashboards from Tableau Software.
• Support the development and implementation of Affordable Care Act (ACA) and Health Insurance Exchange (HIX)
• SharePoint Training: Trained all staff on tool features and business agreed upon usage.
• Decreased customer complaints and dramatically reduced post-implementation support. Involved in forming strategy for increasing call conversions.
• Worked on customizing the claim module of FACETS for reprising Nursing home claims.
• Reviewed analysis of call center’s achievements of key client goals, ensuring continuous and consistent performance
• Data mapping on Enrollment Module (EDI 834) of FACETS.
• Experience in integrating claims, eligibility, provider and data information using facets.
• Facilitated requirement-eliciting sessions (JAD sessions) with Subject Matter Experts and other Key Users and documented the requirements in an easy to understand format by both the business and technical personnel
• Constructed Use Cases and Wireframes and translated them into a Functional Requirement Specifications document
• Expertise in iterative approach of AGILE development with all the teams members
• Involved in all phases of Software development life cycle (SDLC) using Agile Scrum methodology.
• Establish documentation for agile methodology for implementation with a very water-fall-centric development team.
• Performed manual testing, including validation/smoke testing of HL7 interface messages on each new build before delivering to quality assurance team
• Coordinated daily activities with the IT Developers, QA and Product teams along with the project management group.
• Assisted quality assurance team to functional-test the new HL7 interfaces always keeping in mind HL7 and HIPAA guidelines, and coordinated user acceptance testing using derived test data
• Generated test data using X12 generator for transactions 277/288, 834, 835, 837P/I/D. Conducted Gap Researched and understood the claims adjudication and reimbursement systems based on HIPAA X12 4010 standards.
• Created Online User Guide comprising different scenarios, screenshots, and troubleshooting procedures

Environment: MS Project, MS Excel, MS Word, Rational Rose, HL7Interfaces, Agile, MS PowerPoint, Facets, Tableau, UAT, Oracle 9i, QlikView, Citrix (server), Epic

Confidential, Long Beach, CA

Sr. Business Analyst

Responsibilities:

• Responsible for defining the scope and implementing business rules of the project, gathering business requirements and documentation.
• Responsible for writing Functional Requirement Specifications (FRS) and User Requirement Specification (URS).
• Analyzed Business Requirements and segregated them into high level and low level Use Cases, Activity Diagrams / State Chart Diagrams using Rational Rose according to UML methodology thus defining the Data Process Models.
• Developed straightforward DBMS queries, knowledge of HL7 and xml interface messaging.
• Assisted in monitoring ancillary data transactions and addressed problems with HL7 messages.
• Responsible for architecting integrated HIPAA, Medicare solutions, Facets.
• Create transaction sets requirements, usually with Microsoft Excel, for transactions such as: HIPAA 270/271, 276/277, 835, 837-(I, P, &D), 835 Remittances and others.
• Identify Member, Provider, Coverage, Medicare, and Medicaid.
• Developing project plan and ensuring all tasks stay on track while maintaining all documents in SharePoint.
• Assisted the database development team in data modeling, data structure and data table layouts required for consolidation of incongruent databases,
• Involved in Service Oriented Architecture (SOA) of the claims processing system
• Understand the As Is system and develop the To Be system concept and also prepare the System Process Maps.
• Performed extensive requirement analysis including Data analysis and Gap analysis.
• Defined Functional Test Cases, documented, executed test script in Facets system.
• Analyzed and translated business requirements into system specifications utilizing UML and RUP methodology
• Established a RUP (Rational Unified Process) centric business analysis methodology.
• Successfully conducted JAD sessions, which helped synchronize the different stakeholders on their objectives and helped the developers to have a clear-cut picture of the project.
• Conducted presentations of the QA test results with analysis to the stakeholders and users and documented modifications and requirements.
• Coordinating and Developing QA activities.
• Developed test plans with QA team and helped test every scenario using Mercury TestDirector Tool for system testing
• Experience with HIPAA 4010 EDI gateway healthcare transactions like 270, 271, 276, 277, 837, 835, 834, 820, and 278.Knowledge of HIX (Health Insurance Exchange), HIPAA 5010 transaction set.
• Assigned tasks among development team, monitored and tracked progress of project following Agile methodology.
• Created Process Flow diagrams, Use Case Diagrams, Class Diagrams and Interaction Diagrams using Microsoft Visio and Rational Rose.
• Used Test Case distribution and development reports to track the progress of test case planning, implementation and execution results.
• Wrote PL/SQL statement and stored procedures in Oracle for extracting as well as writing data.
• Created Use cases, activity report, logical components and deployment views to extract business process flows and workflows involved in the project. Carried out defect tracking using Clear Quest
• Maintained proper communication with the developers ensuring that the modifications and requirements were addressed and also monitored these revisions.
• Involved in compatibility testing with other software programs, hardware, Operating systems and network environments.

Environment: Requisite Pro, Rational Rose, Agile, HL7Interfaces, UNIX, PL/SQL, HTML, MS Office, MS Visio, EDI, UML.

Confidential, Chicago, IL

Business System Analyst

Responsibilities:

• Gathered, analyzed, documented business and technical requirements from both formal and informal sessions and validate the needs of the business stakeholders.
• Performed Cost benefit, ROI and ROM studies
• Conducted user interviews and documented business and functional requirements.
• Performed Requirement Analysis and developed Use Cases, Activity Diagrams using Rational Rose
• Defined, developed specs for federal reporting specific to Medicare Advantage
• Performed Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data
• Upgraded HMO Medicare EDI and reporting.
• Completed the documentation of Claims Scenario’s for the source system
• Analyzed the existing claims process and specific business rule logic will be applied in the ACP model.
• Prepared for GAP Analysis; identified and documented improving areas to meet capital requirement regulations.
• Conducted interviews, meetings and JAD sessions during the process of Requirement Gathering
• Designed High level design, for New process, integrating with legacy and Facets
• Involved in creating business processes and modeling diagrams using Rational Unified Process (RUP).
• Involved in Service Oriented Architecture (SOA) of the claims processing system
• Created use case scenarios and documented work flow and business process using Rational Rose
• Involved in project management using MS Project
• Collaborated with External Auditors and documented SOX compliance requirements
• Documented requirements associated change requests with requirements and connected requirements with Use cases.
• Used Test Director, PL/SQL for testing the application.
• Wrote test cases and test scripts for the User Acceptance Testing
• Incorporated Rational Unified Process (RUP) to create Requirement Document Specifications using Visible Analyst.
• Performed extensive data modelling to differentiate between the OLTP and Data Warehouse data models
• Identified/documented data sources and transformation rules required populating and maintaining data warehouse content.
• Maintained benchmark controls to policies, company standards and contracts, performed vendor sourcing, pricing and contract negotiation, performed procurement, ensured compliance with service/joint interest contracts.
• Used Rational Clear case for version control
• Responsible for creating test scenarios, scripting test cases using testing tool and defect management for Policy Management Systems, Payables/Receivables and Claims processing.
• Involved with all the phases of Software Development Life Cycle (SDLC) methodologies throughout the project life cycle.
• Served as conduit for managing system requirements between the business and the software development team.
• Queried database using SQL for backend testing
• Used Rational clear quest for defect management

Environment: Windows XP Professional, Oracle9i, MS Access 2000, MS Excel, RUP, UNIX, Oracle Pl/SQL, UML, Rational Rose, Requisite Pro, Clear Case 2002, Rational Clear Quest 2002, MS Office suite, SharePoint, MS Visio 2003.

Confidential, Philadelphia, PA

Systems Analyst

Responsibilities:

• Interacted with business heads to finalize the Business Requirements for the application.
• Performed the requirement analysis and documented the requirements using Rational Requisite Pro.
• Used the requirement attributes (priority, effort, and risk) as the basis for negotiating the inclusion of the requirement, to manage the scope of the system efficiently.
• Developed UML Use Cases using Rational Rose and developed a detailed project plan with emphasis on deliverables.
• Successfully conducted JAD sessions, which helped synchronize the different stakeholders on their objectives and helped the developers to have a clear-cut picture of the project.
• Used SDLC (System Development Life Cycle) methodologies like the RUP and the waterfall.
• Understand the As Is system and develop the To Be system concept and also prepare the System Process Maps.
• Support the development, validation an ongoing monitoring of reports required to support HIX activities
• Managed changing requirements, which included establishing a baseline, keeping track of the history, determining dependencies that are important to trace, tracing relationship between related requirements and maintaining version control.
• Prepared and documented System Requirements and workflows for the Content Management Application tool.
• Responsible for integrating with Facets. Designing test scripts for testing of Claims in Development, Integration and production environment.
• Checked Business Readiness and determined activities of flow.
• Developed & executed several Optimized queries in SQL on this data.
• Implemented data access, storage and validation routines on the database server using Procedural Language/Structured Query Language (PL/SQL).
• Performed Unit Testing and User Acceptance Testing and documented detailed defects.
• Wrote Procedure Manuals and was responsible for continuity preparedness.
• Managed various tests, stored test information, reviewed and analyzed test results.
• Conducted presentations of the Q/A test results with analysis to the stakeholders and users and documented modifications and requirements.
• Helped in writing Training manuals and helped business with the Training on one to one sessions.
• Employed Rational Clear Quest for effective Change Management (Requirements Creep) and bug tracking during the testing lifecycle.

Environment: Rational Rose and Requisite Pro, MS Visio, MS Project, SharePoint, UML, XML, Windows XP, NT/2000, HTML, Vignette Content management Tool, Oracle Pl/SQL, J2EE (JSP1.2), XML, XSL, XSLT, HTML, Oracle 9i.

Confidential, Dallas, TX

Business Analyst

Responsibilities:

• Met with client groups to determine requirements and goals. Utilized Rational Unified Process (RUP) to configure and develop process, standards, and procedures and create a Business requirement Document.
• Responsible for preparing Software Requirement Specification (SRS) and documenting them.
• Created Process Work flows, Functional Specifications documents and documented system requirements.
• Provide implementation assessment, strategy, and mentoring services for Rational Rose, UML and RUP.
• Interacted with various cross-functional teams on building business use cases, and understanding expenses and revenue stream.
• Working with clients to better understand their needs and present solutions using structured SDLC approach.
• Interaction with the developers to report and correct bugs.
• Developed the systems implementation project management plan with milestones and steps from procurement of vendors to project implementation and maintenance.
• Followed a structured approach to organize requirements into logical groupings of essential business processes, business rules, and information needs. Ensured that critical requirements are not missed.
• Aided management in standardizing web applications by preparing GUI standards and recommending alternatives for in corporation in a phased, iterative manner.
• Wrote PL/SQL statement and stored procedures in Oracle for extracting as well as writing data.
• Interacted with client and the Technical Team for requirement gathering and translation of Business Requirement to Technical specifications.
• Analysis of new Business Requirements and preparation of the Functional Design Specifications
• Interacted with clients like SPF Securities to finalize their website look and contents.
• Analysis of the new requests specified by the end users for the future releases and discussion with the functional and technical teams.
• Communicated changes to requirements promptly and precisely to all personnel involved.
• Identified and clearly defined functional issues and support IT development staff throughout the design, development, unit testing, and implementation phases of the software development life cycle.
• Analyzed and translated business requirements into system specifications.

Environment: J2EE (JSP 1.1), EJB (2.0), Servlets 2.2, JMS, Java2 (JDK 1.3), STRUTS, JDBC2.0, XML, XSL, XSLT, Rational Rose, PL/SQL, SharePoint, UNIX, HTML, CSS, JavaScript, Websphere4.0, Oracle 8.0, WebSphere Studio Application Developer v5.0, Win2000, Unix (AIX)