SUMMARY:

• Over 5+ years of experience in BA profile in diverse domains such as Finance, Banking, Healthcare, Insurance Industries as a Business Analyst and System (Functional) Analyst.
• Functional Knowledge of Medicaid Management Information System MMIS.
• Experience working with JIRA management tools, Crucible and confluence pages development.
• Exposed to Medicare and Medicaid domains of the healthcare systems and industry for inpatients, outpatients, Reimbursement Methodology.
• Extensively Knowledge in the Member Enrollment and Billing information.
• Knowledge and Experience on Membership, Billing, Claims Payment Processing in relation to HIPAA, EDI 4010, ICD - 9 ICD-10, codes 834, 837,835, and 270, 271.
• Strong knowledge of ICD-9/ICD-10 business analyst with healthcare.
• Able to understand and implement Processing ICD-9 ICD-10
• In dept. knowledge of Software Development Life Cycle SDLC methodology such as Agile, Waterfall and RUP.
• Efficient in writing Business Requirements Document, Use Case Specifications, Functional Specifications and Workflows.
• Strong knowledge of Use Cases, and Activity Diagram.
• Involved in Facet Implementation and conversion of 4.21
• Extensive Experience in Functional, Integration, Regression, User Acceptance UAT, System.
• Knowledgeable working with ETL process Extract, Transform and Load of data into a data warehouse.
• Designed and implemented basic SQL queries for testing and report/data validation
• Experienced in client interaction, deep understanding of business systems functionality and technicality.
• Proficient in Developing and executing Test Plans, Test Case, Test Scenarios, also performing functional, usability testing and ensuring that the software meets the system Requirement.
• Knowledgeable about preparing RTM documents
• Experience in developing project plan and estimating project timeline.
• Excellent working knowledge in Project Life Cycle and clear understanding of Project Management.
• Experienced in performing Gap analysis by identifying existing technologies, documenting the enhancements to meet the end-state requirements.
• Excellent business communication and presentation skills. Adapt at creating, editing, and coordinating extensive communication networks, to keep executive staff and team members apprised of goals, project status, and resolving issues and conflicts.
• Conducted successful projects with the help of teams to achieve deadlines timely and proficiently.
• Organized, goal-oriented, self-starter, and ability to master new technologies manage multiple tasks while following through from start to completion.

SKILL:

Agile: XP, Scrum, Waterfall, RUP

Applications: MS Office (Word, Excel, PowerPoint, InfoPath, OneNote, Publisher, Outlook) MS Project 2000, PowerBuilder, Intuit Quick Books, Business objects.

Change Management Tools: Rational Clear Quest, Test Director, Power Designer

Content Management Tools: Share Point Pega

Tools: JIRA, Visio, Rally, Version One, Confidential Quality Centre

Business Modelling Tools: Rational Rose, Wire Frame

Operating System: Mac OSX, Windows 10, Windows 8, Windows 7, Windows XP.

Software Application: Data Warehouse, ETL, FACETS

EXPERIENCE:

Confidential, Jacksonville, TX

Healthcare Business Analyst/Scrum Master

Responsibilities:

• Prepared Business Requirements Documents, Functional Requirement Documents.
• Worked extensively with developing business rules engine enabling the business rules such as referral, prior authorization, eligibility, claims processing and billing essential.
• Utilized Agile Software Methodology using Scrum framework. Actively participated in creating the user stories and prioritizing user stories along with tracking of burn up, burn down charts to estimate sprint delivery
• Performed GAP analysis by performing the system analysis between the scheduling systems and documented the gap items.
• Experience providing training to development teams on how to track, plan and analyze using JIRA
• Conducted JAD sessions, meetings, workshops to gather requirements from various stakeholders and SMEs.
• Facilitated all Aspects of scrum framework, including product backlog, release backlog, sprint planning session, daily scrum meeting, sprint reviews and sprint retrospectives.
• As scrum master communicated dependencies and potential risk to the completion of the sprints including resources, costs and systems.
• Created data mappings to transform the data according to business rules.
• Developed Test Cases for unit testing, prepared spreadsheet for testing criteria, including regression, positive and negative testing, process flow testing and screenshot for test results to complete expected and actual results.
• Prepared various diagrams by using MS Visio.
• Prepared documents for the wireframe and prepared a data dictionary for the same
• Managed testing for various functionalities using Quality Center tools.
• Worked closely with QA and Developers to clarify/understand functionality, resolve issues and provided feedback to nail down the bugs.
• Maintained a close and strong working relationship with teammates and management staff to achieve an expected QA result for the project team.
• Conducted project related Presentations periodically to the management and end users during various phases of Software Development Life Cycle SDLC.

Confidential, OH

Healthcare Business Analyst

Responsibilities:

• Conducted weekly meetings for deciding the Policies and Procedures to be followed while constructing new sites.
• Gathered high-level requirement for all the external projects in a release.
• Performed the requirement analysis, impact analysis and documented the requirements.
• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims.
• Developing a single application to process data from multiple integration points, convert the data for reporting purposes and feed data into mainframe system to be compliant to reporting requirements.
• Performed Analysis on Data mapping between different data models.
• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims.
• Helping Scrum master across the company to customize JIRA for their requirements.
• Used different ad-hoc analysis, the Reports assist in defining strategy for each customer category. Informatics was used for ETL process and Business Objects.
• Created ICD-9-CM/ICD-10-PCS comparison document and dealt with DRGs.shift through CMS files.
• Documented ICD9 to ICD 10 mappings one to one/one to Many according to the GEM files from CMS with the functional and structural changes related to the conversion
• Involved in Able to understand and implement Processing ICD-9 ICD-10
• Worked on EDI transactions: X12,835, and 837 P.I to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes
• Executed the test cases and test scenarios using Confidential Quality center QC.
• As Scrum Master maintained the capacity plan, iteration board, sprint backlog, velocity charts and burn down charts.
• As Scrum Master facilitated all aspects of the scrum framework, including sprint-planning sessions, backlog-grooming session, daily scrums product demos, sprint reviews and sprint retrospectives.
• Prepared Business Requirement Documents BRD's after the collection of Functional Requirements from System Users that provided appropriate scope of work for technical team to develop prototype and overall system.
• Facilitated and led JAD sessions aimed at functional requirement walkthroughs for all the impacting projects and updated the documents based on recommendations if any.
• Created various reports such as billing payment reports, Billing Grouping Payment and discount reports
• Use Confidential Quality Center to house all test documentation and report/track all issues and defects Defect Management.

Confidential, OH

Business Analyst

Responsibilities:

• Interacted with Business Users and stakeholders to gather the requirements and Creating application Prototypes and screen mock-ups and experience in using VISIO, MS office
• Gap analysis of all dimensions required to build the new Data Warehouse and worked extensively in Fixed Income, Securities, Derivatives, Equities etc.
• Involved in developing mapping document indicating the source tables, transformation required, business rules, and target table's columns and data types for Data models dealing with Swift.
• Involved in documenting the business requirements and data specifications for Business Objects Universes and Reports and documented functional and non-functional requirements
• Conducted JAD sessions involving the user community to identify, analyze and formalize requirements and establish working relationships with business functions and solution delivery teams to meet the individual needs of the business functions
• Managed all the requirements in RequisitePro, making them available to the whole project team and also developed requirements traceability matrices
• Developed the workflows using Workflow Manager to run the sessions and monitor them using Workflow monitor and also used MS Project and Clarity and also experience with 21 CFR Part 11 Compliance and documented functional and non-functional requirements
• Developed the reports using features like drill capabilities, Functions, slice and dice, and cross tab tables with multiple breaks.
• Created Test Scenarios and developed strategies with QA team to track and resolve defects.
• Used SQL tools like TOAD to run SQL queries and validate the data in warehouse.
• Keep track of scheduled environment refreshes and coordinate/communicate with Dev, Ops, and Analysts and Creating graphical representations of complex business processes.

Environment: Abinitio, Business Objects 6.5, Rational Requisite Pro, Oracle 9i, Win2K

Confidential

Business Analyst

Responsibilities:

• Conceive overall Project plan, including resource plans, delivery management and team mgmt.
• Track the project according to the plan through its various life cycle stages.
• Manage the requirements stage by directing the team, conducting interviews, formulating questionnaires and ensuring that all requirements are documented at a sufficient level, as required by the project.
• Responsible for managing communications between all stakeholders of the project, external & internal.
• Act as facilitator and interface between the business and the development/ testing team.
• Requirements gathering of the entire project functionality using Use Cases Regular stakeholder interactions to understand their needs, constraints and requirements
• Documenting Functional requirements, High level design and Detail Design document
• Project team management and mentoring, as also responsible for project knowledge transfer
• Communicating with the external vendor’s s to assign and resolve client issues
• Project planning using Microsoft Project
• QA testing of developer code to ensure that it functioned as per the business and technical requirements.
• Handled business and technical requirements for the new system
• Conceived the overall project specifications for the entire process and designing the final output for the database, search interfaces, application interfaces and the GUI front end
• Monitoring real time data feeds to the website using automated tools and test plans
• Involved in the project to implement time based window process for the trading platform
• Was a part of the team that successfully re-designed nyse.com in 2003 with new Fatwire CMS
• Managed development process, maintenance, production support and implementation of different features
• Participated in the analysis, design, development, implementation and maintenance of various modules.
• Documented the technical & functional design specifications for application
• Design team structure per the client’s/projects requirements and utilizing the resources optimally
• Identify process gaps, perform root cause analysis, involve, suggest and implement the new processes to optimize the cross functional team efficiencies
• Manage clients expectations/SLAs consistently on all deliverables, quality and timelines are top priority