SUMMARY:

• 7+ year’s expertise in Business Analysis, Data Analysis, and Quality Assurance with hands on experience in Healthcare and Insurance sectors.
• Complete Understanding of HIPAA Implementation guides and developing Business Specifications according to Mapping Notes for Transformation tools.
• Knowledge of 837, 835, 277, 270, 271, 275, NCPDP, 5010 and ICD - 10.
• Skills include defining P roject Scope, Business Process Analysis, Business Process Reengineering, Requirements Gathering, Data and Process Modeling
• Strong knowledge of the Software Development Life Cycle methodologies (phases and gates) like Agile and Waterfall models
• Experience with Iterative Software Development Life Cycle Process as per Rational Unified Process (RUP), involved in inception, elaboration, and construction & transition phases using rational tools like RequisitePro, ClearCase, and ClearQuest during various phases of RUP.
• Effectively used Rational Requisite Pro to organize, track and change requirements of the system.
• Expertise of UML in visualizing and documenting the artifacts using Use Cases, Use Case Diagrams, Activity diagrams, Class diagrams, Data Flow Diagrams, Business Flow Diagrams, Sequence Diagrams using MS Visio
• Experience in working with QA team to develop the Test plans, Test scenarios, Test procedures, and Test cases to ensure adequate testing of software both before and after completion.
• Proficient in using version control tools such as Clear Case, Bug tracking tools such as Clear Quest, Test Director
• Facilitated User Acceptance Testing (UAT) with the stakeholders and the business users as well as trained users to use the system configured.

PROFESSIONAL EXPERIENCE:

Confidential, Philadelphia, PA

Sr. EDI Business Analyst

Responsibilities:

• Conducted analysis of HIPAA compliance and took part in discussions for designing the healthcare transactions to be HIPAA 5010 compliant.
• Developed plan for data feeds and data mappings for integration between various systems, including XML, to follow ICD 10 Code set and ANSI X12 5010 formats.
• Worked with data modeling and defining the conceptual and logical model of the data warehouse.
• Worked on EDI transactions: 270, 271, 834, 835, and 837 (P.I.D) to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
• Conducted business-impact assessment and the results were compared with the new HIPAA 5010 standards to determine the current level of compliance and developed an action plan for approval by the project steering committee.
• Gathered requirements from the clients and developed crosswalks for 837 P/I claims.
• Responsible for attaining HIPAA EDI validation from Medicare, Medicaid and other payers of government carriers.
• Ensured that the timelines for each database, query and enhancement were adhered to and have always met completed the same well before the deadline date.
• After needs assessment, analyzed the Business Requirements Document and System Requirement Specification and documented the requirements in the Rational Requisite Pro.
• Performed Requirements Traceability and managed changes to requirements for this application using Rational Requisite Pro.
• After Executive confirmation did Gap analysis to assess needs that could not be met by core EHR.
• Performed Requirements Traceability and managed changes to requirements for this application using Rational Requisite
• Provided support for the implementation and maintenance of the Version Control tool, Rational Clear Case; and Change management tool, Rational Clear Quest.
• Defined, communicated, institutionalized and continuously updated the Software Configuration Management (SCM) plans.
• Involved in each phase of SDLC to ensure smooth and proper functioning of the project.
• Held regular meetings with the Development and QA teams and facilitated the team with providing solutions.
• Responsible for Scheduling and Distributing the Testing effort among different Test team members.
• Performed User Acceptance Testing.

Environment: MS Office Suite, MS Visio, Agile - Scrum, Oracle, SQL, PL/SQL, Quality Center, Windows Server 2003, Java, Java Script, Business Objects, QTP, Rational Clear Quest, Rational Clear Case

Confidential, Cleveland, OH

Sr. EDI Business Analyst

Responsibilities:

• Performed Requirement Gathering & Analysis by actively soliciting, analyzing and negotiating customer requirements and prepared the requirements specification document for the application using Microsoft Word.
• Developed Test scripts for testing EDI transactions to run in different environments.
• Analyzed legacy system documentation, file and record formats, system flow charts and other information to develop a comprehensive depiction of the existing environment as it relates to HIPAA rulings.
• Developed the Business Crosswalks for 837(P, I, D), 835 and 276/277 according to HIPAA implementation rules.
• Modified test plans and created test cases to validate functional enhancements on the front-end for client specific changes to programs
• Data mapping, logical data modeling, used SQL queries to filter data within the Oracle database tables.
• Extracted the business requirements from the end users keeping in mind their need for the application and documented it for the developers following the HIPAA Guidelines for individual functional areas.
• Researched the existing client processes and guided the team in aligning with the HIPAA rules and regulations for the systems for all the EDI transaction sets.
• Identified opportunities for business process improvement through various meetings with business users and developers and initiated efforts to make improvements.
• Interacted with the Development team to help write technical specifications to describe Functional Requirement Documents (FRD), Business Requirement Documents (BRD), design specifications and module specifications
• Used Agile Development methodology throughout Project Life Cycle
• Responsible for identifying requirements and translating business requirements to system requirements.
• Understanding of business requirements, current system operations/ functionality and propose new requirements.
• Developed UML Use Case model for the application using MS Visio and assigned to prepare the detailed Work flow diagram based on the proposed enhancement for the system.
• Clarified QA team issues and reviewed test plans and test scripts developed by QA team to make sure that all requirements will be covered in scripts and tested properly.
• Contributed towards preparing functional system test cases that adequately represent the business needs
• Rendered support to staff and affiliates towards the completion of the project as per the Deadlines.
• Responsible for managing the documented system requirements and Requirements Traceability Matrix.
• Responsible for analyzing/preparing technical specifications and ensuring appropriate quality assurance testing is completed.

Environment: MS Office Suite, Agile, Oracle, SQL, Windows XP, Quality Center, Java, Java Script, Win Runner, Business Objects, MS Visio, Rational Clear Quest, Rational Clear Case

Confidential

Business Analyst

Responsibilities:

• Worked with HIPPA rules and regulations to draft business rules and claim processes.
• Interacted with the client and the Technical Team for requirement gathering and translation of Business Requirements to Technical specifications.
• Conducted JAD sessions. Involved in preparing project plans and identifying major milestones for each stage as per the SDLC model (RUP Methodology).
• Participated in UAT testing with end clients
• Assisted JAD sessions to identify the business flows and determine whether any current or proposed systems are impacted by the EDI X12 Transaction, Code set and Identifier aspects of HIPAA
• Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data within the Oracle database
• Tested HIPAA Gateway Application Interface for all inbound and outbound messages (Healthcare Eligibility 270 and 271, Healthcare Claim Status request 276 and 277, Healthcare Claim 837 and 835)
• Identified and documented the dependencies between the business processes.
• Documented the Use Cases and prepared the Use Case, Activity, Sequence diagrams and Logical views using MS Visio, MS Office and Rational Rose for a clear understanding of the requirements by the development team.
• Was involved for monitoring and reporting project metrics by EDI HIPAA transactions that are specific to individual LOB for any issues, risks and overall progress
• Performed extensive data modelling to differentiate between the OLTP and Data Warehouse data models
• Create and maintain Use Cases, visual models, including activity diagrams, logical Business process models, and sequence diagrams using UML.
• Well versed with HIPAA, claim adjustments, claim processing from point of entry to finalizing, claim review, identifying claims processing problems, their source and providing alternative solutions using best practice model and principles.
• Participated in testing or acts as a liaison with QA team to complete testing and ensures test results meets requirements.
• Implemented the HIPAA privacy and security regulations to enhance the capabilities of the systems to process new products.

Environment: Rational Unified Process (RUP), UML, Rational Test Manager, Quality Center, Win Runner, Rational Clear Quest, Crystal Reports, MS Office, SQL Server 2000, HTML, Photoshop, Windows Server 2003, .NET

Confidential, Milwaukee, WI

Business Data Analyst

Responsibilities:

• Collected and documented business processes as well as business rules.
• Provided key input in working with users in defining project and system requirements.
• Translated the business needs into functional requirements and communicated the same to the business users, to baseline the initial high-level requirements.
• Data modeling using UML. Used MS Project for various planning and budgeting activities.
• Understanding of health insurance products (Medicare, Medicaid, Claims, Adjudication, HIPPA regulations, Underwriting, EDI etc)
• Prepared test Data sets and performed data testing using the PL/SQL scripts. Also used MS excel for data mining, data cleansing, data mapping, and data dictionary and data analysis.
• Prepared test data as per design of test cases
• Planned, scheduled and implemented requirement gathering surveys at multiple locations
• Documented FRS (Functional Requirement Specifications) and assisted Systems analyst to come up with SRS (System Requirement Specifications).
• Created business process models using MS Visio.
• Created a Key Indicator Report to monitor customer activity and associated risks.
• Assisted the SQA team to write the Test plan and Test cases.
• Conducted project related presentations and provided reports to the project sponsors.
• Involved in risk analysis in identifying and documenting business controls in the various business processes in question.
• Interacted with the Help Desk team to investigate and resolve production issues.
• Prepared documents with Traceability matrix, and Change Request form
• Prepared reports from data warehouse.
• Created Use Case Diagrams and Data Flow Diagrams to provide the development team with a better view of the requirements
• Involved in walkthroughs and meetings with development team to discuss related issues.
• Collected Business requirements (BRD) from Business owners for applications

Environment: RUP, Windows 2000, MS Visio, SQL, PL/SQL, Oracle 8i, SQL server 2000, Test Director & MS Office Suite