SUMMARY:

• 10+ years of industry experience as a Business system Analyst with solid understanding of Business Requirements Gathering, Business Process Flow, Business Process Modeling and Business Analysis.
• Advanced level knowledge in software development life cycles followed in CMMI Level 5 Company. Performed Requirement Gathering/Analysis, System analysis, Development, Testing, and Functional Consulting.
• Excellent Business writing skills in developing Business Requirements Document (BRD), Use Case Specifications, Functional Specifications Document (FSD), Systems Design Specification (SDS), Systems Requirements Specification (SRS), Workflows and Project Plan.
• Facilitated User Acceptance Testing (UAT) with QA team , stakeholders and business users. Errors discovered during testing were fixed and then verified via regression testing. Engaged with several units from project manager and technical teams to business end users with extensive coordination and communication throughout testing, participated in daily meetings to follow up on error logs, ensured fixes were in line with requirements and per deliverable time lines.
• Proficient in conducting JAD sessions with management, SME’s, vendors, users and other stakeholders.
• Worked on the conversion of existing legacy system to the FACETS 4.7 in accordance to HIPAA 5010 upgraded version from the HIPAA 4010.
• Good knowledge of the claims process and how that process is related to the FACETS system.
• Hands on experience working with highly matrix, cross - functional and onsite/off-shore teams.
• Experience in HIPAA EDI transactions 837 (Institutional/Professional), 835(Payment Remittance Advice), 270 (Eligibility Request) / 271 (Eligibility Response), 276 (Claims Status Inquiry Request) / 277 (Claims Status Inquiry Response), 834(Benefit Enrollment and Maintenance Transaction), 278 (Prior Authorization), 997/999 (Transaction Acknowledgement) and 824, 277CA reports.
• Knowledge of ICD-9 and ICD-10 systems implementations and upgrades.
• Good experience in performing GAP analysis.
• Proven ability to manage multiple complex projects with minimal oversight and deliver them with high acceptance rate.
• Good knowledge of Business Process Monitor and Map Editor to work with X12 files.
• Strong expertise in using EDI Tools like Edifices (Ramp Management).
• Developed, maintained test plans and executed test Script from Quality Center.
• Participate and contribute to lessons learned sessions and prepare the documents Logged and reviewed Defects, documented the whole Bug life cycle using Quality Centre. Systematized Claims Processing and Claims Scrubbing in HMO, PPO, Medicaid and Medicare
• Strong communicator and creative problem-solver skilled at analyzing business needs and transforming them into technical designs, applying technical skills and business knowledge to achieve sound results.
• Developed, maintained test plans and executed test Script from Quality Center.
• Participate and contribute to lessons learned sessions and prepare the documents Logged and reviewed Defects, documented the whole Bug life cycle using Quality Centre.

AREAS OF EXPERTISE:

Methodologies: Agile, Waterfall, RUP, UML, SDLC, Scrum, Reverse Engineering.

Change Management Tools: Rational Clear Quest, Rational Clear Case.

Business Modeling Tools: Microsoft VISIO, Visual Paradigm.

MS Office: MS Project, Microsoft Word, Microsoft Excel, Microsoft PowerPoint.

Programming Languages: Structured Query Language (SQL).

Operating System: Windows NT/98/2000/XP.

Databases: Access, Oracle 8i/9i/10g, Teradata V2R5.1, DB2, MS SQL Server 7.0/2000

Other known tools: Informatica, Crystal Ball, Expert Choice, Core, Caliber, Rational Rose; Rational Requisite Pro.

OLAP Tools: Business Objects XI, Cognos .

Testing tools: Rational Robot, Test Manager, HP Quality Center, Quick Test Test Professional, LoadRunner, WinRunner.

PROFESSIONAL EXPERIENCE:

Confidential

Senior Business/System Analyst

Responsibilities:

• Interacted with end users and multiple groups (business and technical), elicited requirements using several techniques such as interviews, brainstorming sessions and observing end user processing; assigned priorities to each requirement and conducted walkthrough with technical team.
• Actively involved from initiation to final phase of SDLC for both iterations utilizing agile methodology.
• Preparing Screen Mockups and Demo presentations for the application.
• Communicating frequently with all team members and stakeholders and following up when required to ensure project timelines are met and to ensure project success.
• Created System used case documentation for implementation for projects.
• Work on project management process with team to enhance and uplift the documentation creating user story in JIRA.
• Facilitate and engage in the requirements sessions and development of System Use Case and Boundary Specification documents in support of Shield Advance Core Facets solutions.
• Provide business domain technical expertise consulting services to business architects and IT operates teams.
• Work with external trading partners to define requirements.
• Work with Business and QA to make sure the system requirements intended are being tested.
• Execute the System Use Case and Boundary Specification processes and signoffs to ensure this key functionality meets the business needs.
• Needs to facilitate cross team functional requirement sessions to ensure requirements are captured and transformed into end to end technical design solutions.
• Maintain the System Use Case and Boundary Specification artifacts.
• Perform Data analysis using Oracle SQL developer.
• Responsible for creating requirement deliverables High Level and Detailed Level Functional Requirements.
• Conducted requirement sessions and design reviews with the onsite technical team.
• Reviewed test cases and co-ordinate the defect triage sessions with development and QA team.
• Handled the requirement churn for different projects through a formal Change Request process.

Environment: Factes5.0, MS Visio, MS-SharePoint, MS Visio, MS Office, Oracle SQL Developer 4.1.3, ALM,JIRA.

Confidential, Denver, CO

Business Analyst

Responsibilities:

• Analyzed and studied the different Business Processes across various Business Units.
• Analyzed impacts and recommendations to current business processes for Confidential .
• Evaluated solution alternatives and developed HLDs (High Level Documentation).
• Facilitated business users and technical resources in business, requirement gathering, documenting requirements and obtaining sign off on the business requirements.
• Gathered detailed Technical requirements and participated in the defining of business rules and data standards.
• Worked on scope of the project by creating scope item inventory.
• Created the Technical Specifications for the Extensions, Extracts, Interfaces, Boundary applications.
• Created the Process flow diagrams for the extracts that will be made from the FACETS 5.0 databases by the vendors who will require information for their roles as a third party.
• Created Technical specification documentation for interfaces, Extensions, Extracts, GAP HLDs and boundaries.
• Created Custom Development Functional Specification documentation (FSD) & obtained approvals.
• Created process flow diagrams/activity diagrams/use cases using MS-Visio.
• Analyzed and converted the stored Procedures into the Pseudo codes for the extensions provided by the client for better understanding of business logics behind the extensions.
• Completed the HIPAA/HITECH compliance training for the Project.
• Analyzed and assessed the SOW 1(align and confirm phase) for the Project.
• Reviewed, analyzed & participated in the meetings for the System Architecture Development work for the project.
• Conducted brainstorming sessions with the onsite team and remote resources via teleconferences.
• Documented the Confidential assumed inventories and compared with clients MKS repository of assumed inventories by creating a traceability matrix.
• Conducted GAP analysis that is realized from the inventory of the client in the form of Spreadsheet.
• Updated the inventory list, SOW as per the updates from the clients and the Project Manager.
• Extracted the information from the company’s earlier documents that involved the relevant work for different clients using the customer exchange.
• Extracted the information required from the FACETS DATA Model (5.0), Data dictionary for the documentation involving the data and documented it.

Environment: Factes5.0, Oracle, MS Office, MS-Visio, TIBCO, Rapid SQL 7.6.4, Outlook, MS Project 2010 (Work Engine), Agile (Scrum), MS Outlook, Office Communicator, MS Excel 2010, MS Visio 2010, SQL Server 2008, Facets Extensibility Guide, Customer Exchange, MKS Repository, PVCS.

Confidential, Denver, CO

Lead Business Analyst

Responsibilities:

• Participated in Confidential knowledge transfer in preparation for Implementation and Operation of the 5010 standards.
• Coordinated with Project Managers to resolve risk issues and ensure compliance of Security System related to the HIPAA.
• Performed System testing, Regression testing and UAT for several claim types and test scenarios.
• Compared and validated 5010 system test results with 4010 results for the same test scenarios.
• Performed system testing and validation on Confidential third party web-based solution, Confidential, through step down process to validate conversion process by confirming Medicaid claim was process correctly from standards.
• Created X12’s for 4010 and 5010 standards to meet test scenarios.
• Worked with developers to generate builds, merge code, and resolve merge conflicts.
• Frequently resolved the issues with Confidential and ACTTNow, primarily the generation of 997, 999, 824, 277CA reports.
• Good knowledge Business Process Monitor and Map Editor to work with X12 files.
• Hands-on experience in the design, development, implementation, and production activities associated with X12 transaction sets (278 1 7, 834, 837, and 835), and other proprietary data standards.
• Provided support for the critical EDI Gateway translation software environment.
• Converted Business specifications into Functional Specifications.
• Lead the impact analysis, scope lockdown, and requirements gathering phases of the company's transition from ICD-9 to ICD-10. Also monitored revenue cycle process and implemented ICD 9 & ICD-10 mapping and crosswalk analysis.
• Provided business analysis, testing, and system documentation for the 5010 updates for 837I transaction sets for Institutional claims for Adjudication in Confidential ’s Medicaid Management Information System (MMIS).
• Performed Web Portal testing and Web Portal Post Implementation testing for 837PID.
• Created SUC for 278, 270/271,276/277,837I. Review and updated the System documentation based on team.
• Gathered and documented Denver State client business requirements and developed, entered and verified test cases for ANSI 5010 / ICD 10 implementation.
• Created 837I paper claim in the MMIS system.
• Performed system and regression testing for, 270/271,276/277,837I transaction.
• Verified and documented HIPAA regulator changes found when moving from .
• Analyzed results and EDI ANSI X12 file mapping and reported on standard analysis spreadsheet.
• Involved in Business System Analysis for Inbound and Outbound Transactions.
• Provided day-to-day EDI translator support.

Environment: MMIS portal, Confidential (Ramp-management), FileZilla Grabit, HIPAA, MS Office, MS-Visio, Outlook.

Confidential, Minnesota, MN

Business /Benefit Analyst

Responsibilities:

• Performed source data analysis for claims system business unit and performed GAP analysis for current claim system and NPS.
• Worked with data creation team to fetch data for Benefit SIT Testing.
• Facilitated meetings with different Business unit to identify and complete data requirements for Benefit SIT Testing.
• Prepared Test Plan for Benefit SIT Testing to identify the scope, approach, resources and schedule of the Benefit testing activities for Benefits Migration from Confidential STAR system to Confidential .
• Conducted meeting with Confidential and Confidential team for Benefit SIT test plan review .
• Created Test Scenarios for Benefit SIT Testing, and review with Confidential and Confidential team.
• Provide direct support and input to different Technical teams during various phases of the Project.
• Created strategy and design steps provided with the high level technical specification details for the process of preparing and integrating Claims system data to NPS.
• Involved in reviewing the Statement of Work (SOW).
• Performed and created impact analysis before deriving an integration roadmap.
• Performed data analysis and conducted root cause analysis.
• Gather information needed for business reporting requests and establish the business requirements needed to extract data.
• Created and reviewed Test scenarios and Test cases for Benefit SIT Testing with Confidential and Confidential team.
• Followed and provided input in regard to Agile SDLC methodology and keep aligned all aspects of the Project.
• Identified issues and worked with application and data team to resolve any issues.

Environment: NPS, Confidential, Requisite Pro, Rational Rose, ClearCase MS Office, MS-Visio, Lotus Notes.

Confidential, Denver, CO

Senior Business System Analyst

Responsibilities:

• Analyzed and studied the different Business Processes across various Business Units.
• Gathered detailed business and technical requirements and participated in the defining of business rules and data standards.
• Created SRS (system required specifications) document and analysis document explaining all the aspect of .
• Participate in regular FACET patches weekly meeting and work with FACET SA’s to find the solution for proposed fixes.
• Assist testers to perform mock up test for patch fixes.
• Worked on Business Process Monitor and Map Editor to work with X12 files.
• Work with Data Validation team and assist testing and validation.
• Participate in regular ODS team meeting for updates coming up for the project.
• Worked extensively for 837 Multiplan Inbound and outbound transactions for 5010 migrations.
• Responsible for requirement input in Caliber and created S.R.S (system required specifications) document and analysis document explaining all the aspect of .
• Created maps & layouts for HIPAA as imposed during Electronic Data Interchange (EDI): 837 Claims and Encounters, 834 Benefit Enrollment and Maintenance, 835 - Claim Payment/Advice, 270/271 - Eligibility Benefit Inquiry and Response.
• Worked with the Business Users through interviews and (Joint Application Development) JAD sessions.
• Did extensive data analysis and converted the full logic to plain SQL codes and put it in data selection strategy document for Data Validation team.
• Prepared test plan for Data validation team and Confirm that all test scripts and results have been documented and presented to internal project personnel.
• Involved in Regression Testing every new build in UAT, QA and Pre-Production Environments.
• Participated in writing data mapping documents and performing gap analysis on the systems.

Environment: Confidential FACETS, Caliber, Clarity, Mercury Quality center, TOAD, SQL, ANSI X12, XML,,MS office and Outlook.

Confidential, Nashville, TN

Lead Business Analyst

Responsibilities:

• Interacted and coordinated with stakeholders and key project personnel to gather the functional and non-functional requirements during JAD sessions. Analyzed the current business process, created AS-IS work flow chart to illustrate the current system.
• Created Business Requirement Document (BRD) by gathering user requirements and business requirements.
• Developed Requirement Traceability Matrix (RTM) to define each technical requirement and to track stakeholder requested enhancements and changes.
• Proposed strategies to implement HIPAA 4010 in the new MMIS and eventually transform to HIPAA 5010.
• Responsible for 100% HIPAA compliance by conducting GAP analysis, process mapping, implementation and testing of Medicaid claims.
• Instrumental in assisting the project manager in creating the business case and project plan.
• Acted as a liaison between the internal and external business community such as customer service, membership management, advance healthcare management, provider agreement management and the project team.
• Analyzed the current business process - claims, recipient eligibility, enrollment etc. and worked with management to improve and implement enterprise solutions to ensure highest compliance rate; Ensured IT and business representatives are properly aligned by understanding the data requirements and priorities.
• Created Use Cases, Activity diagram, Sequence diagram, Collaboration diagram that include functional and non-functional specifications by using UML based Rational Rose.
• Extensively involved in updating internal processes data collection and data reporting; Used Rational Clear-Quest, Configuration management and Version control with Clear-Case to test for any defects and bugs.

Environment: MS-Project, UML, SQL, MS Office Suite, Visio, JSP, Rational Rose, IIS, Oracle, SQL Server, DB2, Microsoft Outlook.

Confidential, Atlanta, GA

Business Analyst

Responsibilities:

• Identified and engaged the appropriate key stakeholders in working with the business requirements
• Conducted and facilitated interviews Development sessions with the Subject Matter Experts to identify and prioritize all business processes impacted by migration.
• Conducted and facilitated interviews, brainstorming, and Joint Application Development (JAD) sessions with the Subject Matter Experts to identify and prioritize all business processes impacted by migration.
• Created Business Requirement Documents, updated Functional Specifications (TRD) for each Strategic Business Unit and critical Operation (Enrollment, Membership, Group Benefits, Claims, EDI Transactions, Customer Service)
• Conducted Current - Desired State analysis (As-Is, To-Be process flows), GAP analysis, and documented Detailed Business Needs (file format, data mapping) compliance to HIPAA mandates (837, 835, 834)
• Worked on data mapping, identified all data feeds generated by the legacy system to Confidential Processing Systems Claim Engines and EDI Gateways.
• Created Business Requirement Documents, updated Functional Specifications (TRD) for each Strategic Business Unit and critical Operation (Enrollment, Membership, Group Benefits, Claims, EDI Transactions, Dental billing, Customer Service)
• Perform a Hex Dump, View Pending and History Claims, View Suspended Claim Summary Screen (SCSS) in Online Inquiry HIQK
• View/Update CSR logs in PDM (Project Data Manager)
• Access carrier information, View/update COB Comments File Maintenance records HROK
• Participated in weekly status meetings, daily production reviews and conducted walkthroughs for team members, and documented the proceedings
• Completed testing for member and provider reject codes
• Participated in the bug review meetings, Updated requirement document as per business user feedback and change in functionality of the application
• Assisted client in developing content and training materials; recommended enhancements and identified new business requirements ensuring appropriate documentation
• Provided Post-Go-Live Support to users, and helped end-users in solving their problems in live environment.

Confidential, Hoboken, NJ

Business Analyst

Responsibilities:

• Validated business requirements by facilitate JAD sessions.
• Performed data editing/manipulation to remove errors for further processing.
• Worked on digitizing the geographical data.
• Performed Cataloging method and procedure development for managing files/data.
• Performed Data restructuring to convert data into different formats.
• Prepared business requirement documents using Rational Requisite Pro.
• Worked closely with ETL developers and business to in corporate the requested changes.
• Performed data analysis using TOAD and conducted root cause analysis.
• Facilitated meetings with users for requirement collection, design changes and feedbacks.
• Performed GAP analysis and differentiated “must have” and “good to have” functionalities.
• Prepared and implemented communication plan for business and internal team.
• Prepared data comparison report (Worldwide Insurance Monitor vs. Market Master) and migration statistics report.
• Analyzed, validated ratings data of various rating agencies (S&P, AMBEST and Moody’s).
• Escalated issues as appropriate to management for support and guidance.
• Prepared user instructions and use cases to conduct User acceptance testing (UAT).
• Managed, maintained UAT defect log and conducted review meetings for defect resolutions.
• Identified issues and worked with application and data team to resolve.
• Developed test conditions and test cases for UAT.
• Performed sanity test in different stages of software development life cycle (SDLC).
• Prepared Playbook, Project Plan and Production deployment schedule using MS office tools.
• Followed UML based methods using Rational Rose to develop use cases and activity diagrams; assisted developers in creating sequence diagrams and collaboration diagrams
• Worked closely with release management to manage the requirement changes and fixes.

Environment: Java, JSP/Servlet, Oracle 9i, MS Office Tools, Windows XP, MS Project, RequisitePro, Rational Rose, ClearCase, MS PowerPoint, MS-SharePoint, MS-Word, MS-Excel, Business Objects 5.1/6.5, Informatica 7.1.