SUMMARY:

• An IT professional with over 8 years of experience in the areas of Business Analysis/Quality Analysis, JAD sessions, stakeholder interviews, Business Process Management, risk analysis/management, data analysis, UAT, and Project management.
• Proficient in Business Requirement Gathering, Business Process Flow, Functional Process Flow, with a keen awareness of developer needs and end - users and able to deal with clients efficiently.
• Assist the Senior Analyst and other subject matter professionals in gathering, validating, and documenting various system information and needs
• Responsible to carry out an in-depth evaluation and verification of the capabilities of systems, serving as a middle man between the end-users and software developers, to ensure that product information is properly disseminated.
• Documentation in the form of Artifacts and Specs
• Extensive knowledge of project life cycle, SDLC, project management processes.
• Adept at creating and transforming business requirements into functional requirements.
• Strong knowledge of SQL, data analysis and data validation using SQL.
• Extensive experience in creating and maintaining source to target Data mapping documents.
• Strong documentation, assessing and analyzing the business implications involved.
• Participate in the review of system and business requirements for new projects.
• Extensive experience in design and development of large scale multi-billion-dollar enterprise projects in B2B.
• EDI transactions (810, 832, 850, 855 and 856) and experience with EDI and EDI outputs, IDOCS, ANSI, partner profiles, master data.
• Experience with using SQL, XML, and Oracle JD Edwards. Experience using IBM Sterling Integrator / Biz Manager and AS 400.
• Worked with EDI and Oracle JD Edwards and Trusted link to perform end-to-end testing and troubleshooting of all EDI functionality
• Skilled in MS Office products like MS Word, MS Excel, MS PowerPoint, MS FrontPage, MS Excel and MS Project.
• Worked and got a good exposure over the ANSI X-12 transaction sets like 204, 210, 214, 810, 850, 855, 856, 940, 945, 997 among others.
• Familiarity with communication protocols, including but not limited to FTP, AS2 SFTP and VAN (Value Added Network) services.
• Strong knowledge in preparing presentation slides in MS Power Point
• Assist in preparing presentation slides in MS Power Point, which was extensively used in different JAD sessions and to track progress.
• Adept at creating and transforming business requirements into functional requirements and designing business models using UML diagrams.
• Coordinating User Acceptance testing and submitting them to the Subject Matter Experts (SME's).
• Assist with the development and execution of detailed system and user acceptance test plans, test cases and test scripts for manual and automated testing.
• Organized, goal-oriented, self-starter, and ability to master new technologies, manage multiple tasks while following through from start to completion with limited supervision.

PROFESSIONAL EXPERIENCE:

Confidential, Irving, TX

Business Analyst/EDI Analyst

Responsibilities:

• Responsible for architecting integrated HIPAA, Medicare solutions, Facets. Performed the requirement analysis, impact analysis and documented the requirements using Rational Requisite Pro.
• Utilized knowledge of SQL Programming to author over 20 Queries in the HPQC Dashboard.
• Gather information from different data warehouse systems and loaded into warehouse using Fast Load, Fast Export, Xml import, Multi Load, BTEQ, Teradata parallel transporter (TPT) and UNIX shell scripts.
• Created approach to standardize Excel Reporting using SQL in the HPQC Dashboard.
• Involved in full development of life cycle (SDLC) within Cognos reporting from developing Business requirements to QA and Production support.
• Wrote transformations for data conversions into required form based on the client requirement using Teradata ETL processes.
• Incorporated HIPAA standards, EDI (Electronic data interchange), Implementation and Knowledge of HIPAA code sets.
• Manage and analyze data communication channel to ensure compliance security requirements in accordance to ISO, HIPAA and PCI guidelines. Coordinated with Project Managers to resolve risk issues and ensure compliance of Security System related to the HIPAA.
• Worked with PPI Teradata tables and was involved in Teradata specific SQL fine-tuning to increase performance of the overall ETL process • Involved in requirement gathering phase (Provider, Claim components and HIPAA). Utilized Rational Unified Process (RUP) to configure and develop process, standards and procedures.
• Manage and lead day-to-day operations of system upgrade to comply with new federal reporting requirements and security protocols including HIPAA.
• Skilled in gathering business and application requirements, Business Processes, identifying risks, impact analysis, UML modeling, and Sequence and Activity Diagrams using Rational Rose and Microsoft Visio in Clinical and Health Information Management (HIM) processes.
• Used BTEQ and SQL Assistant (Query man) front-end tools to issue SQL commands matching the business requirements to Teradata RDBMS.
• Sound knowledge of Patient Protection and Affordable Care Act (PPACA), HIX (Health Insurance Exchange), Sarbanes-Oxley Act (SOX), ACORD, SOPs (Standard operating Procedures) and forms, GMP's terms and Practices. Involved profoundly in the GAP Analysis of the transition from HIPAA (EDI 835 and 837) focusing on how current transactions and system will be effected by the new 5010 compliances.
• Incorporated HIPAA standards, EDI (Electronic data interchange), Implementation and Knowledge of HIPAA code sets.
• Interacted with client and the Technical Team for requirement gathering and translation of Business Requirement to Technical specifications.
• Conducted interviews, meetings and JAD sessions during the process of Requirement Gathering.
• Installation of HP Quality Center on the project team members machine, Creating User profile in HPQC and giving the users the desired privileges in QC.
• Planned and documented procedures for data processing and prepared data flow diagrams for the application.
• Analyzed and translated business requirements into system specifications utilizing UML and RUP methodology. Performed Gap Analysis to check the compatibility of the existing system infrastructure with the new business requirements.

Confidential, Tampa, FL

Business Analyst

Responsibilities:

• Gathered requirements and prepared business requirement documents (BRD)
• Responsible for translating BRD into functional specifications and test plans.
• Closely coordinated with both business users and developers for arriving at a mutually acceptable solution.
• Conducted JAD sessions to define the project and to reduce the time frame required to complete deliverables.
• Created and maintained data mapping document (s) in reference to the claim process transactions.
• Involved in processing the claims to ensure claims are being processed correctly
• Used Rational Rose/MS Office Suite for creating use cases, workflows and sequence diagrams according to define the Data Process Models.
• Involved in /EDI transactions Analysis, Design, Implementation and Documentation.
• Reviewed in preparing the Test Scenarios for Health Care Claim Payment/Advice.
• Maintained Requirement Traceability Matrix (RTM)
• Presented the nursing outcomes to C-Level executives in Gentiva Nursing and Data Management group using Crystal Reports XI.
• Use Case development using modelling tool MS Visio.

Confidential, Boston, MA

Business Analyst

Responsibilities:

• Analyzed and tested business workflows that organize and integrate clinical information for each of its member's clinical records, pharmacy information, charts, and clinical practice guidelines and EDI-X12 transactions in the HIPAA 4010/5010 Version.
• Performance tuning for TERADATA SQL statements using Teradata EXPLAIN command.
• Created High Level Test Scenarios, Test Cases and Test Scripts for Data Hub requirements as described in RSD (Requirement Specification Documents) and DSD (Design Specification Documents) as well as HIPAA.
• Troubleshooted errors/issues with Production reports. Used Oracle and Teradata database stages extensively in the DW development, instrumental in achieving significant performance milestones.
• Analyzed 4010A1 and 5010 TR3 Implementation guides to identify and document the changes for HIPAA EDI Transactions such as 837 P, 835, 276/ 277 and 270/271.
• Responsible for using best practice PMO methodology to develop project plans to fit the stakeholders/sponsor's needs and deliver on desired outcomes.
• Provide a full range of health care services to business clients, enrolling and assisting with applications and regulations for the Affordable Care Act.
• Good Extensive knowledge of subprime mortgages and relative concepts in debt-service coverage ratio and loan to value ratio (LTV) for enhancing the insurance market.
• Extensive experience in EDI/HIPAA implementation, Insurance regulations and Claims Processing.
• Trouble shooted file transmission problems and assisted customers with EDI and Medicaid Insurance claim related inquiries explained and enforced guidelines in the X12 Implementation guides (837P, 837I, 837D, 270/271).
• Provided EDI interfaces with Commercial and Government Insurance Payers that included Medicare and Medicaid.

Confidential, New York, NY

Business Analyst

Responsibilities:

• Gathered Business Requirements from the Subject Matter Experts (SMEs) and documented the requirements in the BRD. Utilized data flow diagrams, user story/ use case diagrams and process flow diagrams to represent information provided by the Business Owners.
• Involved in documenting changes to the Benefits Administration, Enrollment Processing and Claims Processing Systems based on the Medicare Plan Changes initiative.
• Organized meetings and led JAD sessions to ensure legal and compliance deadlines of CMS (Centers for Medicare and Medicaid Services) are met.
• Worked with Business Owners of Market Prominence, the Enrollment Processing System, to ensure that the enrollment process for the new members is updated with changes.
• Worked with the UAT and QA teams to conduct an assessment and determine how effective UAT and QA guidelines can help the company achieve timely completion of projects.
• Worked with Business Owners of Quality Care, the Claims Adjudication Process, and documented updates and enhancements.
• Professional working knowledge of X12 5010 HIPAA 837 I, P, D, 835, 834, 820, 270, 271, 276, 277, 278, EDI, Privacy, Security, and Medicaid.
• Effectively elaborated the current process and gave a clear picture of the proposed process for the projects in the organization. Worked aggressively towards timely completion of High Priority Tasks.
• Vendors and Delegates - Worked with Business Owners and Relationship Managers for Vendors and Delegates, e.g. Davis Vision, Montefiore, HCP, to ensure that Eligibility and Membership File exchanged on daily and weekly basis is updated with the Medicare changes.
• Change Control Process - Led the Change Control Process for changes submitted for the BRD once the document was submitted to IT department.
• Worked with Development Team to resolve issues and clarify Business Requirements from the Business Owners.
• Documented the UAT Plan for the project and worked with the UAT Team to ensure every acceptance criteria for the requirements has been included in the UAT task plan.
• Maintained the Traceability Matrix table to track the Business Requirements to the design to the testing keeping track of all requirements in the BRD.

Environment : QCARE, MS Access, MS Word, Excel, and PowerPoint.