SUMMARY:

• Experience Sr. Business analyst with 7 + years of track record analyzing business intelligence in software development. Customized and improved current processes with implementation of new or improved software applications in Healthcare domain . Seek opportunity to transform company practice into fresh, cost effective solutions leading to more efficient opportunities.
• Experienced in all phases of the Software Development Life Cycle (SDLC) including requirements gathering, analysis, design, implementation, testing and deployment as well as software engineering methods like Rational Unified Process (RUP), Agile and Waterfall Method.
• Excellent knowledge of HIPAA ( Health Insurance Portability and Accountability Act ), Medicaid (MMIS), Medicare, Procedural and Diagnostic codes.
• Expertise in EDI and HIPAA testing privacy with multiple transaction exposure such as inbound claims 837, Payment remittance advise, Eligibility Inquiry 270, Eligibility response 271,Claim Status Inquiry 276, Claim Status Response 277, EDI 834 Enrollment and 820 Payment order and remittance advice.
• Experience in conversion of HIPAA X12 4010 to X12 5010 codes and ICD 9 codes to ICD 10 codes.
• Gathered requirements for ICD 10 codes pertaining to Other Payer Liability (OPL), Federal Employee Program (FEP), Claim Processing System ( Diamond) Enterprise Code Management System (ECM) and Maintenance Process.
• Experience with healthcare reform ( HCR) and healthcare payer systems.
• Expertise in Business Modeling using MS Visio/Enterprise Architect/Rational Rose
• Expertise in Requirements Gathering through direct user interviews and workshops
• Facilitating JAD sessions with business users and development team to drive out detailed business requirements
• Expertise in creating wireframes or screen mock ups using MS Visio and Axure
• Highly experienced in creating prototype using Axure.
• Exceptional documentation skills of all aspects of online environment by including site specific workflows, technical specification documents, user interface instructions and writing step - by-step instructions for related end user applications utilizing standards and templates provided
• Exceptional skills for writing Use Cases and Functional Requirement Documents as well as for creating Use Case diagrams, Activity diagrams, State diagrams based on UML Methodology and business process flow diagrams using MS Visio/Enterprise Architect/Rational Rose.
• Experience in doing Gap analysis, SWOT analysis and ROI analysis.
• Experience with sharePoint.
• Defining Test Cases, creating Test Scripts, analyzing bugs, interacting with QA / dev teams in fixing errors and User Acceptance Testing (UAT)
• Using project management tools like MS-Project for status reporting and planning
• Good knowledge of network architecture, web and internet applications and Windows operating systems
• Excellent Team Player with ability to think analytically and troubleshoot issues
• Effective Verbal and Written Communication Skills

TECHNICAL SKILLS:

Requirements Management: MS Word, MS Excel, SQL Quarries. ClearQuest

User Story Management: Rally, JIRA

UML Diagrams: MS Visio, Enterprise Architect

Wireframes & Screen Design: MS Visio, Axure

Defect Tracking: HP Quality Center, TRAC, JIRA

Software Methodology: Agile, Waterfall, Rational Unified Process (RUP)

EXPERIENCE:

Confidential, Washington, DC

Sr. Business Analyst

Responsibilities:

• Documented the “AS-IS” Business Workflows adhering to UML standards
• Performed GAP analysis and data analysis.
• Conducted JAD sessions to define requirements and finalize the Functional Requirement Document (FRD).
• Documented meeting minutes from JAD sessions and obtained sign-offs from JAD participants
• Followed a structured approach to organize requirements into logical groupings of essential business processes, business rules, functional and non-functional requirements
• Identified use cases from the functional requirements, wrote use case specifications and created “TO-BE Business Process Workflow” diagrams (activity diagrams) in MS Visio
• Designed User Interface-level wireframes detailing interaction models and user experience using MS Visio.
• Conducted requirement workshops to verify and validate business requirements
• Developed Functional Requirement Scenarios and Use Case based on business needs.
• Supported all QNXT modules initiatives in improving overall efficiency for Quality Standard and Claims Adjudication.
• Reprocessed incorrect paid and denied claims using Facets.
• Maintained Requirements Traceability Matrix (RTM).
• Created mapping for loading Benefits in Facets.
• Prepared service offerings, Test approach, Road maps, Solution framework for 4010 to 5010, ICD 10 Conversions.
• Performed analysis in membership and billing data from Facets.
• Configured Facets for Provider and performed data analysis on subscriber data in Facets.
• Impact analysis. Gap analysis, risk identification and estimations for 5010 and ICD-10 compliance.
• Assisted QA department to write execute Test Plan and Test Cases.
• Used the guidelines and artifacts of Rational Unified Process ( RUP) to release multiple iterations of the deliverable over the span of the project lifecycle; propounded early development and base lining of a robust executable architecture.

Environment: Windows XP Professional, Oracle9i, MS Excel, RUP, Oracle, UML, Rational Rose, Requisite Pro, MS Office suite, XML, MS Visio 2003, HP Quality centre.

Confidential, San Francisco, CA

Business Analyst

Responsibilities:

• Documented the “AS-IS” Business Workflows adhering to UML standards
• Performed GAP analysis and data analysis.
• Conducted JAD sessions to define requirements and finalize the Functional Requirement Document (FRD).
• Documented meeting minutes from JAD sessions and obtained sign-offs from JAD participants
• Followed a structured approach to organize requirements into logical groupings of essential business processes, business rules, functional and non-functional requirements
• Identified use cases from the functional requirements, wrote use case specifications and created “TO-BE Business Process Workflow” diagrams (activity diagrams) in MS Visio
• Designed User Interface-level wireframes detailing interaction models and user experience using Axure.
• Conducted requirement workshops to verify and validate business requirements
• Developed Functional Requirement Scenarios and Use Case based on business needs.
• Involved in gathering Data Mappin Requirements from Technical Teams.
• Worked with data migration and file mapping for various EDI transactions.
• Enhanced the Provider/Patient verification criteria using additional parameters based on the information retrieved from the EDI 837 I/P transaction files.
• Translated the EDI X 12 data into XML format for initial transformation/migration.
• Reloaded multiple business rules form the Legacy System into the new system.
• Worked on Child Support Obligations and benefits and prepared process flows and data flow diagrams.
• Participated in writing test cases for testing Medicare system.
• Participated in the Change Control Board Meeting for any changes in the business requirements.
• Updated BRD based on and Change Request made by SME’s.
• Worked with Quality Analysts for proper working of functionalities.

Environment: Enterprise Architect, Microsoft Office Suites (MS Word, PowerPoint, Access, Excel, Outlook, Project, Visio), RUP, Windows, Microsoft SQL Server, UML.

Confidential, Camp Hill, PA

Business Analyst

Responsibilities:

• Worked with different business users to develop Vision Document and Business Requirement Specifications and gathered Business and Functional Requirements.
• Documented the AS-IS Business Workflow adhering to UML standards.
• Performed GAP analysis, data analysis.
• Participated in JAD Sessions for gathering requirements from SME’s. Played the role of a Facilitator as well as Scribe in the JAD session.
• Documented Meeting Minutes from the JAD Session as well as responsible for getting a sign-off on them from the JAD participants.
• Followed a structured approach to organize requirements into logical groupings of essential Business Processes, Business Rules, Functional and Non-Functional Requirements.
• Identified Use cases from the Functional Requirements and wrote Use Case Specifications and created “TO-BE Business Process Workflow” diagrams (Activity diagrams) in MS VISIO.
• Created Use Case Diagrams using MS VISIO in order to show the interaction between the Actors and Use Cases as well as showing the relationship between the Use Cases.

Environment: Rational Enterprise Suite (Rose, RequisitePro, ClearCase, ClearQuest), Mercury, MS Office, Oracle, SQL Server Reports, WinRunner, LoadRunner, Quick TestPro

Confidential, Pleasanton, CA

Business Analyst

Responsibilities:

• Interacted extensively with various business groups, stakeholders and users to develop the Vision Document that is aligned with corporate strategic objectives
• Documented the “AS-IS” Business Workflows adhering to UML standards
• Performed GAP analysis and data analysis.
• Documented meeting minutes from JAD sessions and obtained sign-offs from JAD participants
• Created Business Requirement Document (BRD), Functional Requirement Document (FRD) also identified use cases with use case narratives.
• Designed and developed Use Case Diagram, Activity Diagram, Swimlane Diagram using MS Visio.
• Used HIPPA 4010 transactions to support the analysis of current business processes and work with managementto improve and implement enterprise solutions to ensure compliance ad got involved in designing future state processes for HIPPA 5010 transaction processing EDI’s 837,835,270 and 271.
• Responsible for Gap analysis of ICD9-ICD10.
• Involved in mapping disease codes from ICD system to EHR.
• Validated all health data in EHR as per HIPAA 5010.
• Participated in testing disease code and health information in EHR.
• Helped in improving EHR as per customer service perspective and developed user guide for our customer support team.
• Participated in ICD10 implementation testing.
• Consulted with healthcare insurance company to develop conversion specifications for other insurance coordination of Benefits ( like Medicare).
• Helped QA team to develop test cases to validate the requirements and documented the Traceability Matrix for Test Cases and Requirements.
• Performed UAT Testing to have proper coverage of requirements.
• Helped management support to off-shore End to End Integration/ Regression Test Team.

Environment: Windows XP, Business Objects, MS Excel, Word, Visio, power point, SQL, DB2, SAS database, Winn Runner, Quality Centre. RUP.