OBJECTIVE:

To take a challenging role on business operations as Business Analyst and give an efficient and effective solution that would help the organization to achieve the best solution in business which would increase its productivity in market.

SUMMARY:

• Over 6+ years of experience in IT Business Analysis - gathering, analyzing and accurately documenting software requirements.
• Excellent communication skills, writing skills as well as presentation skills. Experience working with business users as well as senior management.
• Solid understanding of all phases of Software Development Life Cycle (SDLC) methodology (such as requirement, analysis, design, data modeling, business process modeling, implementation and deployment).
• Broad knowledge of Test plans, Test cases and test scripts from the Requirements Document.
• In-depth knowledge of Rational Unified Process (RUP); risk engineering, data modeling and mapping, process improvement and design using UML (Unified Modeling Language), Rational Rose and Visio.
• Good knowledge of SQL.
• Excellent knowledge of HIPAA (Health Insurance Portability and Accountability Act) transaction codes such as 270/271 (inquire/response health care benefits), 276/277 (claim status), 470 (benefit codes), 835 (payment or remittance advice), 837 (health care claim) and 834 (benefit enrollment).
• Capable of managing multiple projects simultaneously.
• Exceptional problem solving and sound decision making capabilities.
• Experience in writing queries/scripts for data analysis ad QA report testing.
• Conducted successful projects with the help of teams to achieve deadlines timely and proficiently.
• Experience in User Acceptance Testing, Regression Testing Performance Testing and Functional Testing.
• Experience in conducting SWOT Analysis, Cost Benefit and ROI Analysis.
• In-depth experience in financial analysis, financial modeling, Research, Accounting, and good knowledge of Assets, Liabilities, Equities, Fixed Income and Taxation.
• Created Requirements Traceability Matrix to keep the stakeholders informed of the progress of the project.
• Strong expertise in Health Insurance Claim process, social services, Medicaid and banking.
• Belief in team work, dedication, and professional ethics within the working environment.
• Extensive experience in conducting Joint Application Development (JAD) sessions for project definition involving analyzing requirements, creating prototypes, user interface, database schema and system design.
• Well versed with HIPAA, claim adjustments, claim processing from point of entry to finalizing, claim review, identifying claims processing problems, their source and providing corresponding solutions.
• Extensive experience in gathering Business/Functional user requirements, creating Use Cases as per user requirements, developing/designing diagrams such as Activity, Class, and or Sequence diagrams, and in addition to creating Business Requirements Document (BRD).
• Organized, goal-oriented, self-starter, and ability to master new technologies, manage multiple tasks while following through from start to completion.
• Flexibility in adaption to a wide range of work environments.
• Good in requirement gathering including Joint Application Development (JAD) and requirement analysis.
• Extensive experience in working in a Customer - oriented environment.
• Ability to inculcate new relevant skills with ease in a time sensitive frame.
• Analysis done to determine if the system abides by the HIPAA regulations.
• Experience in writing Use cases and Functional Requirement Document.

TECHNICAL SKILLS:

Databases: MS SQL, MS Access

Languages: SQL, Visual Basic

Methodologies: SDLC, RUP, UML

Testing Tools: Test Director, Quality Center

Operating Systems: Windows 95/98/2000/XP/Vista/NT

Project Management: MS Office Suite (Microsoft Word, Microsoft PowerPoint, Microsoft Excel), MS Project

Change Management: Rational ClearQuest

Business Modeling Tools: MS Visio, Rational Rose

PROFESSIONAL EXPERINCE:

Confidential, Los Angeles, CA

Business Analyst

Responsibilities:

• Extensively involved in conversion of ICD-9 CM and PCS codes to ICD-10 (Clinical Modification and Procedure Coding System) codes and conversion of all EDI HIPAA X12N-4010 transactions to HIPAA X12N-5010 version and prepare necessary supporting mapping/crosswalk documents as part of project deliverables.
• Conducted weekly meetings for deciding the Policies and Procedures to be followed while constructing new sites.
• Conducted complex documentation and user needs analysis. Interface with team and staff to develop HL7 integration.
• 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.
• Developed the strategy for developing and implementing new EDI (HL7 and X12) interfaces and converting historical clinical and data.
• Reviewed EDI companion guides for all payers to ensure compliance, edit integrity and maintain up-to-date list of payer contacts.
• Performed testing for Medicare, Medicaid and X-Over claims for Medicaid Management Information System (MMIS).
• Developed and implemented the MMIS Third Party Liability (TPL) Subsystem.
• 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.
• 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.
• Involved in gap analysis and implementation of HIPAA 5010, ICD 10 and Claim Validations.
• Conducted Gap Analysis, and Gathered User Requirements by Interviews, user meeting, JAD session, and Requirement Elicitation Sessions.
• Worked on CRM (Customer Relationship Management) project to implement Microsoft Dynamics.
• Worked with the Marketing Management/team members to understanding their needs and requirements in regards to picking the right CRM system.
• Part of the project management team responsible for SWOT analysis.
• Used Scrum Work Pro and Microsoft Office software to perform required job functions and prepare Product back log and sprint back log and conduct all the meetings and discuss and help scrum master.
• Responsible for cost estimation and timelines for various Business Intelligence reports.
• Involved in analyzing activities for a variety of major projects including Medicare Plan part D, Coordination of Benefits, New Client Implementations, Consumer driven and regularly scheduled system upgrades.
• Implemented a mechanism to in corporate business-required data which is not in the core Facets system. NFE (Non-Facets Elements) proved to be of major business importance in implementing state-customizations and underwriting, needs not encompassed by the Facets system.
• Used UML and OO discovery methods to perform discovery for new enterprise wide installation of Trizetto FACETS (both core and extension requirements) using Rational Rose.
• Implemented a mechanism to in corporate business-required data which is not in the core Facets system. NFE (Non-Facets Elements) proved to be of major business importance in implementing state-customizations and underwriting, needs not encompassed by the Facets system.
• Extensively interacted with the stakeholders and the IT Department in finalizing the requirements according to the CMS Compliances/Regulations and HIPAA Regulations.
• Prepared graphical depictions of User stories, Use Case Diagrams, State Diagrams, Activity Diagrams, Sequence Diagrams, Component Based Diagrams, and Collateral Diagrams and creation of technical design (UI screen) using Microsoft Visio.

Environment: HL7, Microsoft Office SharePoint 2007, EA, MS Dynamics CRM, Cognos, Agile, Rational Requisite Pro, MS Office, SQL Server 2008, Cobol, DB2, JAVA, MS Project, MS FrontPage, MS Access, FACETS,EDI, Windows 7.

Confidential, Hartford, CT

Business Analyst

Responsibilities:

• Gathered business requirements from the Business team and generating system workflows.
• Design Impact Analysis Documents (IADs) for GL- AP, GL-AR Summary - Reconciliation and other high level Business Reports Requests.
• Involved in creating the targeted questionnaire for SMEs and Business users for elaborating requirements.
• Initiated with a comparison report of migration of . 270 Eligibility, Coverage or Benefit Inquiry (V4010X092A1) vs. 270 Eligibility, Coverage or Benefit Inquiry (V5010X279), 278 Prior Authorizations.
• Validated the EDI 837-claim billing (professional, institutional and dental claims) & 835 (remittance advice or payment) claims adjudications.
• Participated in JAD sessions / conducted interviews for analyzing business requirements and reviewing them with business and technical teams.
• Designed and developed user stories, Use Cases and UML models using Microsoft Visio and Architect Enterprise.
• Developed current and future state workflows of Ambulatory practices in MS Visio and Architect Enterprise.
• Prepared the cost estimate for the business analysis involvement of the project.
• Prepared product Backlog and Sprintback log and conduct meeting with team and clients.
• Writing change requests & follow up with the respective teams on the impact and action.
• Reviewing the test cases and requirement traceability matrix along with the testing team.
• Tracked the project status in MPP, prepared the project status reports and represented the BA team in the PMO meetings.
• Wrote Test scenarios and test cases for testing the migration of EDI and the processing of member enrollment and benefits, batch jobs corresponding to the claims (837) and real time transactions like 270/271/276/277.
• Involved in forward mapping from ICD 9 to ICD10 and backward mapping from ICD10 to ICD9 using General equivalence Mappings (GEM).
• Involved in Customer UAT along with the Development & testing teams.
• Participated regularly in walkthroughs and review meetings with PM, QA Lead and development teams.
• Assisted the PM in setting up realistic expectations and in evaluating the impact of change requests and risks and conducted project related presentations.

Environment: MS Visio, MS Project, Architect Enterprise, MS Office Suite, (Word, Excel, Access, Power Point, Outlook)., MS Dynamics CRM, Sybase, SQL Server, FACETS 4.41 & 4.51, Agile, DB2, .NET, SAS, Lotus Quickr, IBM Process Modeler, UML, HP Quality Center, Windows XP.

Confidential, North Broke, IL

Business Analyst

Responsibilities:

• Fully responsible for understanding business logic and designing requirements, assisting other business analysts in generating Functional Requirement specifications (FRS) and User Requirements Specifications (URS) and communication with the developers.
• Developed use cases, workflow, screen mock-ups and conversion requirements.
• Coordinated work plans between project manager and client using MS Project.
• Helped in reviewing and editing of the test scripts.
• Followed UML based methods using Rational Rose to develop use cases and activity diagrams; assisted developers in creating sequence diagrams and collaboration diagrams.
• Reviewed business process, URS, and functional requirements.
• Assisted in process modeling; conducted and participated in JAD sessions with system users; helped with design walkthroughs with stakeholders for base lining architecture.
• Created and tested scripts for the premium calculations and claim limits and deductible.
• Involved in detailing project mission, data process flow diagrams, and timelines.
• Developed Test plans and Test cases according to business requirements with the help of Mercury Test Director.
• Used Rational Clear Quest for handling change requests.
• Participated in automated regression and Non-functional test plans.
• Provided assistance in building EDI’s 270, 271, 276, 277, 470, 835, 837 and 834 transactions.
• Maintained Requirement Traceability matrix throughout the project.

Environment: RUP, Rational Requisite Pro, Rational ClearQuest, MS Office, Visio, Project, Windows XP, UML, SQL.

Confidential, New Hudson, MI

Advanced Business Analyst

Responsibilities:

• Assisted in writing efficient and effective Test Plans, Test Strategy, System testing, End-to-End testing and User Acceptance testing.
• Participated in the planning, development, coordination and presentation of specific testing needs as appropriate to the quality assurance needs of the end user.
• Assisted business users in defining UAT test cases and plans; Established and maintained test cases and test data in Quality Center.
• Coordinated with the QA Team for testing activities across multiple systems and managed Conversion test execution.
• Interfaced with business users to prepare and update Business Process Requirements for the new release of Healthcare tools.
• Developed use cases, activity diagrams and sequence diagrams for a clear understanding of the vision document.
• Prioritized outstanding defects and systems problems, ensuring accuracy and deadlines were met.
• Used the Waterfall Technology to develop the different phases of Software Development Life Cycle
• (SDLC).
• Helped in conducting Gap Analysis (GAP), User Acceptance Testing (UAT), and System Integration testing (SIT).
• Managed list of vendors and trading partners that will impacted by 5010 version and require remediation work to be compliant.
• Kept track of customer information regarding their name, addresses, phone number and email address and have access to communications and actions related to them so that we could review and add more comments to it by using the client information system called HP Service center.
• Involved in implementation of HIPAA EDI Transactions (835,837)
• Facilitated Electronic Data Interchange.
• Performed GAP Analysis for HIPAA 4010 and 5010 transactions.
• Used EDI tools to verify mapping to X12 format.
• Recommended changes for system design, methods, procedures, policies and workflows affecting Medicare/Medicaid claims processing in compliance with government compliant processes like HIPAA/ EDI formats and accredited standards ANSI.
• Analyzed HIPAA EDI transactions in X12 responses and of 837, 835, 277CA and 999 and looked-for defects.
• Did data analysis for various version changes of EDI messages on different sub-systems.
• Provided the required test data for the developers to fix the defects.
• Participated in QA team meeting and bug tracking meetings.

Environment: User Acceptance Testing (UAT), Rational Clear Quest, MS Access, Windows, Rational Test Manager, MS Office.