SUMMARY:

• 6+years ofexperience as a Business Analyst with a solid understanding of Business Requirement gathering, Business Process flow, and Business Process Modeling and Analysis in Health care and Insurance industry.
• Strong knowledge of the Software Development Life Cycle methodologies like Agile and Waterfall models.
• Experienced in database analysis in FACETS Provider model and Membership model using SQL queries to extract and document requirements
• Extensive knowledge of Health Care Reform
• In - depth knowledge of RUP (Rational Unified Process), Agile and Waterfall methodology and its application to health care industry process management.
• Knowledgeable for Gap Analysis and updating and testing the Legacy MMIS system into the new Health Enterprise MMIS .
• Worked on different EDI healthcare transactions like 837-Institutional, 837-Professional, 837-Dental, 835-Claim Payment/Remittance Advise, 270/271-Eligibility Benefit Inquiry/Response, 276/277-Claim Status Inquiry/Response Transactions
• Extensive knowledge of Medicaid, Medicare, Procedural and Diagnostic codes and Claims Process.
• Experience in Conversion of HIPAA X12 4010 codes to X12 5010 codes and ICD 9 codes to ICD 10 codes
• Experienced in data warehouses and data marts for business intelligence reporting and data mining along with developing and documenting process flows for business processes.
• Experience in interacting with business users to identify their needs and gathering Business and Functional Requirements, developing Project Plan, Business Requirement document, Functional Specification document, Test Plans, conducting Gap Analysis and Impact Analysis, preparing training manuals and knowledge transfer manuals.
• Data flow analysis using use cases, dataflow diagrams, sequence diagrams, activity diagrams and class diagrams.
• Worked on Claims, Customer services, Members, Billing-Enrolment interfaces and extensions for FACETS as a part of FACETS implementation team
• Experienced in facilitating Joint Application Development (JAD), Rapid Application Development (RAD) sessions, interviews, workshops and requirement elicitation sessions with end-users, clients, stakeholders and development team.
• Experienced in using UMLand tools like Rational Rose, Visio, and Requisite Pro.
• Excellent knowledge on industry standards such as Six Sigma, CMM andElectronic Health Record.
• Experience in creatingRequirementTraceability matrixto better manage the requirement gathering process and keep track of the milestones.
• Experience in writing SQL queries for the retrieval and management of data.
• Strong knowledge of Business Process Modeling, Business Intelligence and Business Architecture.
• Experience in writingTest Plans and executingUATTest Cases.
• Worked closely with Regression Testing of hardware/software environments patches, fixes, etc.
• Experience with E-filing applications and e-payment
• Good organization & time management skills.
• Proven track record of delivering projects (quality documents/ deliverables) on time.
• Excellent verbal/written Communication skills and strong Analytical abilities to perform well both independently and as a team player.

TECHNICAL SKILLS:

Operating Systems: MS Windows 8/9/95/98/NT/XP/Vista, MS Dos

Languages: SQL, HTML,XML

Database: SQL Server, MS - Access

Testing: Win Runner, Quick Test Pro, Test Director, NASCO

Project Methodologies: Rapid Action Development (RAD), Joint Application Development (JAD), Rational Unified Process (RUP), Unified Modeling Language (UML), System Development Life Cycle (SDLC)

Documentation Tools: MS - Office Suite (Word/Excel/Power Point)

Business modeling tools: Rational Rose, RequisitePro, Clear Quest, MS Visio, MS Project

PROFESSIONAL EXPERIENCE:

Confidential, CA

Business Analyst

ROLES AND RESPONSIBILITIES:

• Worked in the Agilemethodology
• Updated the Design Specification Document (DSD) in SharePoint and linked it in RequisitePro.
• Responsible for creating UML plans, Use cases, process flows, and business requirement documentation using MS Visio, RequisitePro and ClearQuest tools .
• Created Change Request and analyzed defects using Rational Clear Quest
• Responsible for the full mapping, implementation and testing for accurate update in the system.
• Worked on Parallel Testing analyzing the gaps created during the transformation of the system from legacy to enterprise due to which defects were created and resolved.
• Worked on Data Mapping documents explaining the flow of data from one-to-another table for the system enhancement purpose required in the Health Enterprise implementation.
• Analyzed Gaps and studied the existing business process and created AS-IS and To-Be workflow to illustrate the existing system.
• Worked with Data Warehouse in the development and execution of data conversion, data cleaning and standardization strategies
• Conducted business validations covering the following deliverables: Facets Providers, Facets claims and Facets Membership.
• Responsible for identifying and documenting business rules and creating detailed Use Cases .
• Worked on Business Rules Management System (BRMS) to allow properly authorized end users to update and test changes to business rules.
• Analyzed the change detection process on Facets database tables to capture the daily changes done by Users through Online Facets Application.
• Reviewed the data model and reporting requirements for Cognos Reports with the Data warehouse/ETL and Reporting team.
• Used MS Visio to document process flows, use cases and data flow diagrams
• Worked extensively with different phases of Software Development Life Cycle (SDLC)
• Responsible to meet the information demands of business users by delivering timely, accurate, meaningful and standardized data and reporting.
• Gathered requirements and modeled the data warehouse and the underlying transactional database
• Worked with FACETS, eBilling and EDI HIPAA Claims(837/835/834) processing
• Documented analysis, observations and recommendations.
• Attended daily Sprint meetings with the State on strategy, release and iteration on the product conquering the day-to-day deadlines.
• Assisted Business User during deployment in formulating User Acceptance Testing (UAT) for customized application and getting confirmation for product Release.

Environment: MS Office Suite (Word, Excel, Power Point, Visio, Project, Access, Share Point), RequisitePro, Rational Doors, JIRA,Clear Quest, SQL.

Confidential, Tempe, AZ

Business Analyst

ROLES AND RESPONSIBILITIES:

• Understanding the enterprise requirement for the project applicable to AZ Medicare.
• Working with trading partners to finalize the data mapping between the 270/271 and X12.
• Coordinating with other Service Providers and creating RTM for the requirement.
• Facilitate and initiate meetings with other Application Service Groups to make sure that all eligibility and benefits are sent with the right deductible to the providers and other trading partners.
• Analyze the gap between the current state and "to-be state" & create Logical diagram for current and future state using MS Visio.
• Identified/documented data sources and transformation rules required populating and maintaining data warehouse content
• Worked on developing the business requirements and use cases for Facets batch processes; automating the billing entity and commission process.
• Extensive use of Business Process Modeling Notations&Data flow diagrams to represent the flow of data from external entities into the system.
• Reviewed the data model and reporting requirements for Cognos Reports with the Data warehouse/ETL and Reporting team
• Creating test strategy document, finalizing dates for all the test deliverables including System testing,integration testing and regression testing.
• Work closely with Business and trading partners and drive them through all the Waterfall Phase from Designing, Testing to Release Phase.
• Defined test cases for provider updates from legacy flat-file system to FACETS database system
• Making sure all the right Taxonomy & AAA error codes for the benefits are responded for the requested benefits for the Arizona Medicare members with the right verbiage.
• Work with the clearinghouses, and gateway providers to schedule monthly eligible member list.
• Test the environment to have a successful transaction.
• Analyze and document non-functional system requirements.
• Responsible for entering the test cases on HP Quality Center (QC).
• Planned, prepared, facilitated, documented and assessed meetings with the management and the development team to better understand the Business Requirement such that the project can be completed quantitatively and qualitatively.
• Performed and analyzed GAP Analysis of EDI 834, 835, 837 transactions from 4010 to 5010.
• Gather requirements at JAD sessions with the purpose of defining the functional business and system requirements.
• Identified the scope, business objective and documented the functional requirements for each release
• Involved in integration testing on FACETS system to verify HIPAA compliance from 4010 to 5010.
• Developed cross-walk for understanding major changes from ICD-9 to ICD-10 versions. Some of the changes included in Loop 1000A (Submitters contact information), Loop 2000A (billing), Loop 2000B (Claim filing Indicator code) etc.
• Worked alongside with HIPAA-5010 change management team to analyze and define changes which supported the process of developing business and technical requirements within and across transactions.
• Suggested changes to the Physical Data Warehouse Model based on the ETL and Referential Integrity gap requirements.
• Directly involved in process improvement plans and implementing business change, creating and managing Project templates, Use Case project templates, requirement types and traceability relationships in Requisite Pro.
• Used MS-Visio to create Data Flow Diagrams as a Structured Analysis tool.
• Created and assisted in creation of Business flow diagrams, Activity/State diagrams and Sequence diagrams so that the development team and other stake holders can understand the business process.
• Worked with the creation of the following Rational Unified Process (RUP) - system architecture document, supplemental requirements document, architecture diagrams, verifying technical production infrastructure, designing and executing performance tests and documentation.
• Wrote clear, concise and detailed System Requirements Specification (SRS) documents and user documentation in accordance to guidelines and standards of a level where developers can interpret, design and develop the application with minimum guidance.
• Worked alongside the QA team and Developer to establish traceability matrix to ensure the completeness of the enrollment procedure.
• Guided QA team to write test cases and test scripts to confirm the displayed information and also tested to print the image in the paper.
• Responsibilities included source system analysis, data transformation, loading, validation for data marts, operational data store and data warehouse.
• Performed functional testing of the application as per the 5010 changes.
• Documented and analyzed all defects using Quality Center and tracked them to completion by communicating with the team every day.
• Worked with E-filing applications and e-payment .
• Supported development and Installation team.
• Performed Unit and Integration Testing.
• Implemented Alpha Test in order to confirm the functionality of recent conversion.

Environment: MS Office Suite (Word, Excel, Power Point, Visio, Project, Access, Share Point), QNXT, BizTalk, Quality Center, SQL, XML.

Confidential, Davenport, IA

BusinessAnalyst

ROLES AND RESPONSIBILITIES:

• Analyzed the Business Modules and their impact on the current system.
• Responsible for going throughSCRUMwith Agile Methodologiesand UML Processes for Creation of Documentation to be used by IT Team.
• Designs and develops the logical and physical data models to support the Data Marts and the Data Warehouse
• Gathered requirementsand analyzed the federal legislation to update products as per the provisions of Health Care Reform system.
• Created Requirement Specification Documents after conducting Interviews with End Users, organized JAD Sessions for documenting AS-IS and TO-BE scenarios for Electronic Health Records project and analyzed their current systems.
• Created Use Cases, Use Case Models, Work Flows and System Specification Document using RUP Methodology.
• Done analysis according to the SRS, on our own database called EDW( Enterprise Data warehouse)
• Interacted with various departments and business groups to update and configure Facets.
• Worked on claim Adjudication module of FACETS.
• Understand end-user requirements, their strategies and their goals to create Requirement Specification Documents and Use Cases.
• Worked with SQL for database design and management for the consolidated database due to EHR.
• Used Component business modeling for improving strategic planning and efficiency.
• Assisted with building EDI 837(I, D, P), 835, 270/271, 276/277, 278, 820 and 834 transactions processing flow from the Trading Partners to the translator, mainframe and back to the Trading Partner meeting HIPAA 5010 standards.
• Worked on Automated system data migration interface requirement and formulated Test Plan for testing the functionality, navigation and integration testing of the application.
• Validated member eligibility and eligibility inquiry in the facets application to the legacy application in order to confirm the migration successful or not.
• Work responsibilities primarily involved understanding the business logic, designing requirements, communicating them to the developers, generating documentation, designing use cases, creating various diagrams like State Diagrams, Sequence Diagrams as part of project.
• Maintained Traceability matrix throughout the project.
• Created standards / guidelines for Business Process Modeling, File Transfer Document, and InterfaceRequirement Specification document, BRD, FRS and Report Requirement Specification.
• Worked with Government data security protocols for internet transactions
• Involved in creating requirements that comply with HIPAA, HL7 and ANSI X12 format regulations to protect the privacy of the employee insured under any policy.

Environment: MS-Office, MS Access, Quality Center,UAT,NASCO, FACETS, HIQK,HEHK

Confidential, Olympia, WA

Business Analyst

ROLES AND RESPONSIBILITIES:

• Documented the detailed business as well as technical requirements to implement new functionalities for MMIS application
• Assisted in defining the initial common terminology to be used throughout the project lifecycle.
• Conducted interviews with the clients for gathering requirements and evaluation/analysis of their data. Converted the Business Requirements Documents into Functional and Non-functional requirements.
• Performed GAP Analysis to check compatibility of existing system infrastructure with new business requirements.
• Conducted walkthroughs and acted as a liaison between the business users, stakeholders and the team to perform requirements, quality and risk analysis.
• Interacted with the internal and external stake holders to ensure deadlines are met and signed off on completion of projects.
• Documented and reported the progress to the management on an ongoing basis.
• Used the guidelines and artifacts of the Rational Unified Process (RUP) to strategize the Implementation of Rational Unified Process effort in different iterations and phases of the Software Development Life Cycle.
• Prepared Activity, Logical, Component and Deployment views to assist development and engineering in understanding the requirements using Rational Rose.
• Extensive use of Rational Requisite Pro for reviewing and analyzing the user requirements.
• Maintained Traceability matrix throughout the project.
• Analyzed and reviewed the System requirement specification document, Test plans and Test cases.
• Interacting with the development team to explain various design documents: Business Use Case Model, Detailed Use Cases, and Vision Document.
• Creating detailed design of the system with the project team including class diagrams, activity diagrams, and sequence and collaboration diagrams.

Environment: MS Office, Windows 2000, .NET, MS Visio, MS Access, Business Objects, MS SharePoint, MS Project, SQL, SOA, HTML.

Confidential, Detroit, MI

Business Analyst

ROLES AND RESPONSIBILITIES:

• Assisted in designing policies and procedures to protect the privacy of Electronic Protected Health Information to ensure data integrity as per HIPAA guidelines.
• Involved in creating the business case and project plan.
• Played an active and lead role in gathering, analyzing, and writing business requirements.
• Created use cases using UML and managed the entire functional requirements life cycle using Rational Unified Process and Requisite Pro.
• Created and managed project templates, use case project templates, requirement types and traceability relationships in Requisite Pro.
• Reviewed detailed test cases with in-depth description of each test scenario of the system according to HIPAA guidelines.
• Conducted GAP analysis and assessed the status of the organization to determine the scope of the application.
• Assisted in building a business analysis process model using MS Visio.
• Designed and developed Use case diagrams & narrative, Activity diagrams and Sequence diagrams using UML.
• Documented the Functional Specifications Document (FSD).
• Developed Test Cases, test plans and strategies with Quality Assurance group to implement them.
• Facilitated JAD sessions with stake holders, developers, systems analyst and testers to collaborate resource allocation and project completion using MS Project.
• Identified and involved all key stakeholders, contributors, business, operations and technical resources that must participate in a project and ensured that contributors are motivated to complete assigned tasks within the parameters of the project plan.
• Conducted interviews with client to ensure developed functionality complied with user requirements.
• Worked closely with E-filing applications and e-payment
• Collected and documented business processes as well as business rules.
• Experienced User Acceptance Testing (UAT) and System testing.
• Used Test-Director for testing requirements, test cases, reporting bugs, work completion status.
• Analyzed, organized, and updated database using SQL.

Environment: Rational Requisite Pro, Microsoft Office Suite (Word, Excel, Power Point, Access, Visio, Project), Business Objects, Windows XP, XML, SQL, Test Director.

Confidential, Toledo, OH

Application Business Analyst

ROLES AND RESPONSIBILITIES:

• Implemented an integrated RUP solution with complete line of traceability for all the artifacts of web development projects.
• Created and updated tasks in the MS Project and Project Management Directory for the senior management reviews.
• Performed GAP analysis and documented business and system level use cases to derive the requirements illustrating the functional behavior.
• Collaboration and reviews with different application owners and SME’s to ensure the GAP Analysis was performed accurately.
• Business Process Modeling: Business process improvement and optimization, Document and model business processes, automated workflows and Manage business rules.
• Involved in documenting Business Requirements Documents by conducting interviews with the project stakeholders, SME’s and Business users.
• Involved in documenting various modeling diagrams using UML.
• Thorough understanding of business process to help determine the user needs.
• Documented Traceability to ensure all the features for the project has been captured and mapped back to the requirements in the BRD.
• Performed application functionality user acceptance testing (i.e. front-end application testing) in a controlled testing environment that replicates the end user usability of the application.
• Documented test plan, test cases and test summary to ensure the desired application functionality.
• Ensured UAT test scripts review sessions with business owners to test the application functionality, providing necessary training material.
• Clear quest and HP quality center to log defects and assign to the right team to ensure the defects are addressed on a timely manner.

Environment: RUP, Rational Rose, Business Objects, Clear Quest, RequisitePro, UML, SQL, MS-Office, MS Project.