SUMMARY:

• Accomplished, highly skilled, goal oriented and multifaceted professional offering more than 8 years of experience as a Senior Business Analyst in a variety of projects in Healthcare and Health Insurance.
• Highly motivated and competent in generating creative ideas and methods to accelerate project deliverables, while ensuring product quality, Strategic business - builder offering all-round management perspectives, combined with proven success in leading negotiations.
• Diverse Software Development Life Cycle (SDLC) methodologies experience like traditional methodology such as Waterfall and Agile methodologies such as XP, Scrum, Scrum Waterfall Hybrid, SAFe, Kanban Principles, and good exposure to development practices including Test Driven Development, Behavioral Driven Development.
• Actively involved in an ICD - 9 to ICD - 10 conversion project and well-versed in healthcare laws such as CMS and MMA Guidelines, HIPAA, HITECH, MACRA, GINA, Digital Imaging & Communications in Medicine (DICOM) standards and HL7.
• Ken in various health insurance programs Medicaid, Medicare, PPO, HMO, POS, COBRA, PPACA and expertise in claim adjudication process and EDI transaction like 270/271, 276/277 (claim status), 470, 835, 837 & 834.
• Experienced with Facets application groups: claims processing, guided benefit configuration, medical plan, provider, subscriber/member, product billing roles, pricing configuration.
• Integrated various systems with HEDIS and create design for HEDIS and other systems to pull data in HEDIS.
• Competent in conducting GAP analysis, Impact analysis, SWOT analysis, Cost Benefit analysis, Root Cause analysis, Feasibility study, Risk analysis and As-Is and To-Be, business analysis and drafting reports and collaborated on creating Work Breakdown Structure (WBS) using MS Project, tracking schedules and milestones.
• Adept at working with diverse users and stakeholders to elicit, analyze, communicate and gather requirements using techniques such as Brainstorming, JAD sessions, Document Analysis, Interviewing, Prototyping, Requirement Workshops, Questionnaires, Focus groups, interface analysis and Ethnography.
• Captured and defined the vision and scope of the project with SME, implementation team and documented them as the project scope document using MS Word, Microsoft Excel and Google Docs.
• Designed business rules, vision documents, business glossary, functional and technical specifications in documents such as BRD, FRD, FSD, SRS, RTM, RACI matrix for projects and actively participated in verification and validation of requirements meeting with stakeholders, presented the results to top executives and gained artifacts approval.
• Sound Proficiency in analyzing requirements and creating Use Case Diagrams, Sequence Diagrams, Activity Diagram, Data Flow Diagrams, ER diagrams and Business Flow Diagrams according to BPMN standards.
• Developed Wireframes and Mockups using Balsamiq, MS Visio and SmartDraw to communicate business and functional requirements to the stakeholders and business users.
• Experienced in tracing requirements and verifying with Requirement Traceability Matrix (RTM).
• Proactive in sensing risk and work on a risk mitigation plan and ensure timely communication of updates regarding Sprint/Release progress to the project stakeholders.
• Engaged in Sprint Ceremonies (Product Backlog grooming, Sprint Planning meeting, Daily Scrum/Stand-up meeting, Sprint Review meeting and Sprint Retrospective meeting.
• Possess sound understanding of SQL and executed queries in SQL server for data manipulation and retrieval, table creation as well as Joins, stored procedures and functions.
• Considerable experience gained by extensive client interactions in cohesive and loosely coupled Service Oriented Architecture (SOA) and three tier Architecture.
• Proficient in creating and maintaining data model/architecture standards including Master data management.
• Conversant with database concepts like Data Warehousing, Data Structures, Data Mapping, Data Modeling, Schemas, Data Marts, Entity Relationships and User Administration. Worked with Data warehouses by migrating data from various OLTP’s to OLAP cubes and designing physical and logical models using ETL tools such as Informatica.
• Performed R Programming, SAS and SQL for exploratory analysis, cleaning, transforming, and merging large data sets.
• Good knowledge of the Star and Snowflake schema, different OLAP operations such as slice, dice, roll-up, drill down and pivot, facts and fact tables, transformation and validation rules.
• Experienced in API testing using Postman and SoapUI to check if the API response data is in JSON or XML format as defined in the API documentation and required by workflow and resolve discrepancies.
• Developed and maintained test plans, test scripts, log sheets in and tracked and reported defects in HP QC/HP ALM, Bugzilla and JIRA.
• Acquaintance with working on Manual testing and managing the Testing Life Cycle and performing Integration Testing, Regression Testing, Smoke Testing, Functional Testing, A/B Testing, Load/Stress Testing using Commercial Testing tools.
• Potential in understanding and communicating technical issues related to defects and enhancements.
• Worked closely with end users in performing User Acceptance testing and performance testing using Load Runner to verify whether all the User Requirements were catered to the development effort.
• Worked on Creating Operational Dashboards to monitor frequently changing business processes, Strategic Dashboards to track the KPIs and Analytical Dashboards to analyze large volumes of data using Informatica, Tableau and Power BI.
• Sound Knowledge of Statistical Data Analysis using Data Mining Techniques such as Regression Analysis, Classification, Clustering, Multi Variate Regression, Predictive Analysis using R Studio and SAS.

TECHNICAL SKILLS:

Methodologies: SAFe, Scrum, Waterfall, Scrum Waterfall Hybrid, XP

Languages: SAS, R, SQL, XML, JSON

Scripting and Web Services: HTML, CSS, RESTful and SOAP Web Services.

Project Management Tools: HP ALM, JIRA, Agile CA(Rally), Confluence, Microsoft TFS, Microsoft Office Suite (MS Word, MS Excel, MS Project, MS PowerPoint), MS SharePoint

ETL and Data Warehousing & Reporting: Informatica Power Center, Microsoft Power BI, Tableau, IBM Cognos, MS Excel (lookups, Pivot Tables, Macros)

Architecture/ Framework: Service Oriented Architecture (SOA), N Tier Architecture, Apache Tomcat

Data Warehousing: Data Modeling, Data Marts, Data Mapping, OLTP, OLAP, ETL

Business Modeling Tools: MS Visio, Balsamiq, Lucid Chart, Mockup Screens, Smart Draw

API Documentation and Testing: POSTMAN, Swagger, SOAP UI

Defect Tracking/Testing: Selenium, HP ALM/QC, Load Runner, Bugzilla, Cucumber

Miscellaneous: MS Excel, MS Word, GoToMeeting, Google+

PROFESSIONAL EXPERIENCE:

Confidential, Dallas, Texas

Senior Business Systems Analyst

Responsibilities:

• Performed AS-IS analysis to gain knowledge of the existing system and facilitated JAD sessions, SWOT analysis and GAP analysis workshops to identify the requirements from clinicians, researchers, SMEs, business users and stakeholders.
• Prepared BRD, FRD, SRS based on the gathered requirements, tracked the requirements using an RTM & acted as the mediator between clinicians, SMEs and the team. Assisted Architects in designing the Analytics solution.
• Collaborated with UI/UX developer in capturing GUI requirements from the end-users to determine their preferences and created Mock-Ups, Wireframes of UI components for client verification using MS Visio.
• Resolved queries from data analysts, developers, management and stakeholders regarding metrics.
• Analyzed business needs and developed Epics and worked with the team in developing user stories , acceptance criteria by conducting story writing workshops .
• Used JIRA for allotting tasks and issue tracking, user story management and requirement traceability and formulating and submitting weekly progress reports to the stakeholders.
• Good knowledge of claim elements such as ICD, Procedure codes (CPT), HCPC’s, Diagnosis codes, Taxonomy codes. Good understanding of the data elements of EDI file. Ensured compliance of HIPAA, MACRA, GINA and DICOM.
• Wrote SQL queries on Data Warehouse to perform data retrieval, manipulation and analysis.
• Worked closely with business users, in-house technical team and external to conduct data mapping.
• Assisted Data modelers in creating Data Models and Data Marts that support the Business Intelligence Data Warehouse. Worked with developers in creating Enterprise Data Warehouse (EDW) and assisted in ETL process of data into a data warehouse using Star schema.
• Performed source system analysis, data transformation, loading, validation for data marts, operational data store and data warehouse and ensured the Data Warehouse is compliant with HIPAA 5010 standards.
• Worked on API documentation using Swagger tool. Analyzed domain specific API’s while conducting the Interface analysis, to interpret the data formats in their WSDL/WADL for a thorough understanding of business requirements and supported integration of compliance REST API’s with Business Rules Engine.
• Performed API testing using Postman and SoapUI to check if the API’s are returning the data in JSON, XML format as defined in the API documentation using Swagger tool and required by workflow.
• Documented REST Web Services for EPIC EHR systems, Genome Connect and EHR Connect in Postman.
• Analyzed and wrote test scenarios, test cases based on functional requirements documents (FRD), prepared test reports and Performed Sanity testing to validate reports, dashboards and mapping functionality.
• Developed Test cases manually and generated Automation Scripts using Selenium and documented Test cases for System, Integration and UAT testing.
• Scripted documentation for Google Big Query repositories and Dashboards designs, test results and standard operating procedures (SOP) and managed security privileges (Google IAM System) for subject areas and dashboards.
• Developed Reports / Interactive Dashboards with different Analytics Views (Drill-Down / Dynamic, Pivot Table, Chart, Column Selector, Tabular with Filters) based on user requirements in Tableau.
• Associated with SME’s to understand Key Performance Indicators (KPIs) and Service Level Agreement (SLAs).

Environment: MS Visio, MS Excel, HTML5, CSS3, JavaScript, AngularJS, Apache Traffic Server, Google Compute Engine, Google Genomics, TensorFlow, Apache Tomcat 8.5, Tableau Server, JDBC API, Google Big Query, Google Cloud Dataflow 2.0 (with Apache Beam SDK), Google Cloud Data Store, EPIC EHR, HP ALM, Postman

Confidential, Minnetonka, MN

Senior Business Systems Analyst

Responsibilities:

• Facilitated various Scrum ceremonies like Sprint Planning, Daily Stand-up, Sprint Review Meeting, Sprint Retrospective Meeting, Backlog Grooming and assisted product owner in prioritizing product backlog based on Business Value.
• Developed Business Process Models, UML diagrams like workflow diagrams, activity diagrams, sequence diagrams, use case diagrams using MS Visio and drafted user stories, allotted tasks, tracked issues, and generated reports in JIRA.
• Designed UI Mock-up using Balsamiq tool as a part of Proof of Concept and documented the feedback in JIRA and confluence to maintain the project artifacts and kept the information radiators updated.
• Worked with scrum team for estimation of user stories using Planning Poker and helped the PO in writing Acceptance Criteria, determining Definition of Done, maintaining Task Board and creating sprint Burn-down and Burn-up charts.
• Checked on eligibility files with the Claims department ensuring all the data and enrollments were updated properly.
• Used TriZetto HIPAA Gateway to comply with HIPAA standards (270/271, 276/277 & 837) for EDI transactions .
• Coordinated with the developers and IT architects to design the interface of the new system according to the X12 (270, 276, 278, 834, 837 (I, P, D) and 820) standards.
• Validated the following: EDI 837 (Health Care Claims or Encounters), 835 (Health Care Claims payment/ Remittance), 270/271 (Eligibility request/Response), 834 (Enrollment/Dis-enrollment to a health plan).
• Executed SQL queries to retrieve data from the database to verify that the data stored in database is accurate and not manipulated during the enhancement.
• Involved in Stage Mapping, to create a replica of source table and worked on mapping data from Source systems to the target which only ETL processes can access, resulting in Production Down-time and Performance Benefits.
• Worked with the Data Architect in identifying Dimensions and the appropriate atomic granularity of data required based on the reporting requirements for the Star and Snowflake Schema design of the Data Mart.
• Eased Technical writer in creating API Documentation, which described how to effectively use the software, by thoroughly understanding API, its arguments, its return type and the languages and interface it supports. Performed API Testing using POSTMAN.
• Involved in scripting business logic of the webservices and documenting the WSLA document using XML.
• Developed Test Plans and Test Cases based on requirements to ensure that the application can handle huge data and align with the requirements.
• Performed Manual Testing and Smoke Testing to ensure that the Application components adhere to Project Standards, Performance Criteria and Functional specifications to ensure feasibility of testing effort.
• Assisted in performing Regression testing, to ensure the system’s overall functional stability and module interfaces continue to work properly with external applications and wasn’t negatively impacted by the new enhancement.
• Analyzed the solution claim processing chain to ensure that the Claims filed from the system and the Claims being processed by the system are EDI (ANSI) X12 transaction sets in compliance with HIPAA standards.
• Compared source values and the field level mappings to calculate the expected results at the destination, using sampling data to verify if the data is complete and as per the business rules and HIPAA compliances.

Environment: Agile Scrum, MS Word, MS Excel, MS Power Point, Outlook, MS Visio, MS Project, SharePoint, JIRA, UML, HPALM, HPQC, Apache Tomcat 7.0, MS SQL server, POSTMAN.

Confidential, Louisville, Kentucky

Business Systems Analyst

Responsibilities:

• Performed GAP Analysis to better understand the existing features and documenting enhancements to meet requirements
• Conducted interviews with project managers, SME’s business users to collect requirements and business process information. Reviewed and documented Functional Requirements, business requirements.
• Used Rational Rose and implemented UML methodologies to design Use Case, Sequence and Data Flow diagrams.
• Created Mockup Screens and Wireframes using UI components such as Drop-down list, check boxes for retrieving data from the user for client-side verification.
• Created PowerPoint Presentations using MS office Suite and presented to the stakeholders and business users.
• Involved in Scrum Ceremonies and Grooming meetings. Well accustomed with estimation techniques like planning poker, T-shirt sizing and prioritization techniques such as Moscow, KANO, Value based, risk-based methods.
• Functioned on loading 834 data into the staging area and performed data validation to check that all the data is loaded and gained experience on 834 ANSI X12 transaction items like loops, segments, elements and structure.
• Wrote multiple SQL queries using functions such as joins, aggregate, order by, union, group by, like, triggers. Created stored procedure for frequently used queries.
• Worked on Data mapping, logical data modeling, class diagrams and ER diagrams and used SQL queries to filter data within the database.
• Performed source system analysis, data transformation, loading, validation for data marts, operational data store and data warehouse.
• Validated XML using SOAP UI and documented the SOAP protocol using POSTMAN tool.
• Worked with QA team for creating the Test scenarios condition for the online enrollment and HIE (CMS Health Insurance Exchange) group/member by uploading EDI X12 834 file to Edifecs for the HIPAA Validation.
• Reviewed Use Case, Test Plans and Test Cases and performed manual testing. Supported and assisted QA in developing Quality Control (QC) test plans and test scripts, as well as supporting and assisting clients in all testing phases through UAT.
• Managed and assigned the defects to development team in Microsoft Team Foundation Server.
• Created various charts, graphs, reports for business analysis using SAS reporting and Tableau. Report extractions to various formats, Snapshots, Dashboards, and Email generation

Environment: Waterfall- Scrum, MS Visio, UML, HP ALM, Informatica Power Center, MS outlook, UAT, MS office Suite, TFS, HIPAA, EDI, ETL, XML, SOAP, POSTMAN

Confidential, Cincinnati, Ohio

Business System Analyst

Responsibilities:

• Performed GAP Analysis to identify the deficiencies of the current system and to identify the requirements for the change in the proposed system and Involved in Gap analysis and Impact analysis for HIPAA 4010 and HIPAA 5010 transactions sets on different systems, and for the facets up gradation from 4.48 to 4.60.
• Facilitated JAD sessions with SMEs’, Product owner, and Development managers to understand the business process, gather Business Requirements and identify whether any current or proposed systems are impacted by the EDI X12 Transaction Code set and Identifier aspects of HIPAA and to determine the enhancements of the FACETS system.
• Prepared graphical depictions of Use Cases, State Diagrams, Activity Diagrams, Sequence Diagrams, Component Based Diagrams, and creation of technical design (UI screen) using Microsoft Visio.
• Worked on FACETs in customizing screens/reports, terminate or reinstate coverage for the subscriber and Provider enrollments.
• Executed SQL queries like Select, join, order by to retrieve data from data warehouse and validate the data Integrity.
• 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.
• Assisted in Data profiling and checking for data integrity by looking for various data anomalies and doing data normalization and data verification using Informatica Data Quality Center.
• Involved in Data mapping to define how the Source data is modified before it reaches the Target object.
• Worked on validating and customizing Claims daily load into FACETS for processing the transactions and in Facets Configuration to make sure all information will be sent without any error.
• Extensively used Soap UI to validate SOAP/WSDL and web services for Request and Response data validation.
• Facilitated the QA team in writing test cases and test scripts 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.
• Tracked daily issues and dependencies and coordinated with common team to work on the impediment list and created traceability matrix to map requirements with test cases.
• Assisted in performing User Acceptance Testing for the ANSI X12 Version 5010/EDI transactions (HIPAA) for Claims Status and Eligibility (270, 271, 276, 277, 834, 837P, 837I, 837D, 835 remittances and NCPDP claims), for the Facets upgraded system with emphasis on ensuring that the HIPAA regulation are met across all the modules.
• Performed Automated Testing using Cucumber and created feature files following Given, When, Then format.
• Operated Automation Testing, White-Box and Black-Box Testing, Business functionality and created Automation scripts using Selenium.
• Instituted Usability Testing by serving as the User, to help ensure that the system is performing as the User expectations and updated the status of all Test Cases & Test Scripts that are executed during testing process.
• Facilitated the QA team in logging defects, monitoring their status and tracking them to closure using Rally.

Environment: Waterfall-scrum hybrid, MS Office suite, MS Project, Oracle Platform, Oracle Application server, SQL server, MS Visio, Bugzilla, HP Quality center, Selenium, Rally, Cucumber, Informatica Data Quality Center, HIPAA, SOAP UI.

Confidential

Business Analyst

Responsibilities:

• Performed Business Process engineering and Gap Analysis to check the compatibility of the existing system infrastructure with the new business requirements
• Elicited the business requirements for the project using One-One Interviews, Document analysis, Surveys, JAD sessions and used the standard template of the organization to develop requirements.
• Interacted with SME’s, asking detailed questions and carefully recording the requirements in a format that can be understood and reviewed by both Technical users and Business users/ Stakeholders. Analyzed and documented those requirements by prioritizing and tracking the business case.
• Used wireframes and screenshots for the application to easily communicate it to the users using MS Visio .
• Conduct project related Presentations periodically to the management and end users during various phases of SDLC.
• Analyzed source systems, business requirements and identified business rules and compliances like HIPAA for building the data warehouse.
• Used DDL, DML and DQL SQL queries to perform data analysis, data validation and data manipulation.
• Working with Data warehouse team and source systems in preparing Data mapping documents and data models to procure the required data feeds into the Application.
• Involved in data analysis techniques to validate business rules and identify low quality missing data in the existing enterprise data warehouse (EDW).
• Used API’s to integrate various service providers through RESTful API services. Performed the API documentation and completed the API testing using POSTMAN.
• Identified bugs during the test phase and reported using JIRA. Assisted the Testing team in creating Test Plans, Test Scenarios, Test Cases and collect Test Data for successful completion of Integration and Functional testing.
• Conducted User Acceptance Testing with UAT cases and resolved issues with the users.
• Assisted developers in Continuous Integration and Continuous Deployment (CICD) using Jenkins.
• Generated different reports for predictive and exploratory analysis using IBM Cognos reporting tool.

Environment: Waterfall, Mock-up screens, SQL Server, MS Visio, GAP Analysis, Data Warehouse, JIRA, IBM Cognos, UML, and UAT Testing.

Confidential

Junior Business Analyst/Data Analyst

Responsibilities:

• Created questionnaires for SMEs to gather requirements & understand the business process; Worked on Clinical Business Process Management, trial analysis, design, development, testing, & implementation.
• Helped to Create business and clinical study requirements; Aided a team of analysts & clinical investigators in the formulation of requirements, advanced planning document & a proposal for study and helped system analysts in their conversion into a System Requirement Specification (SRS) document.
• Used Tableau to create visualizations like tables, graphs, and listings for inclusion in clinical study reports.
• Assisted in Implementation of the Complete Study from end to end in Rave; Helped to plan, build, test and maintain clinical databases in Medidata Rave for assigned studies.
• Participated in reviewing the Case Report forms & Data validation plans and worked on standardizing the forms as per organizational guidelines and CDSCO regulations.
• Supported Reporting Specialists during custom reports development regarding required functionality and worked with SAS programmers during outputs configuration.
• Aided training group in preparation of course materials and delivery of courses both internally and externally at clinical sites and investigator meetings as needed.
• Planned and facilitated User Training sessions; solicited, documented & interpreted feedback from users.

Environment: SQL, Windows 7, Visio and MS Project, MS Office Suite (PowerPoint), RAVE Medidata EDC Product, Sharepoint