SUMMARY:

• Business Analyst and Business Systems Analyst with 8+ years of profound experience in Business Development Process and Systems and Data Analysis. Hands on healthcare domain.
• Certified Scrum Master proven ability to work with cross - functional and self-organizing teams in Healthcare.
• Lean Six Sigma Green Belt certified in process improvement.
• Experienced in working in various software development methodologies as like Waterfall, Agile Scrum and Hybrid of Waterfall and Agile Methodologies, also have fair understanding of other industry standard methodologies like Extreme Programming, SAFE, Spiral and Kanban.
• Specialized in Business and System Analysis, Requirements and Change management.
• Familiar with current healthcare industry standards such as CMS and MMA Guidelines, HIPAA guidelines (4010 & 5010) and EDI Transactions like 820, 834, 835 & 837, DHHS, SOX and FDA regulations.
• Good knowledge of RFP, RFI, RFQ and create deal breakers for multiple procurement activities.
• Experienced with Facets application groups: claims processing, guided benefit configuration, medical plan, provider, subscriber/member, product billing roles, pricing configuration.
• Profound experience in Claims Processing and Claims Scrubbing in HMO, PPO, Medicaid and Medicare.
• Extensive knowledge of Medicaid (MMIS), Medicare, Procedural and Diagnostic codes and Claims Process.
• Experienced in using Confluence and SharePoint for sharing and storing documents. Experienced in using GitHub and Bitbucket for code versions.
• Implementation and conversion of ICD-9 to ICD-10 codes with HIPAA 4010 to 5010.
• Proficient in preparing Business Requirement Document (BRD), Functional Requirement Document (FRD), System Requirement Specification (SRS), Use Case specification, Configuration Document, and RACI matrix.
• Collaborated on creating Work Breakdown Structure (WBS) using MS Project, tracking schedules and milestones.
• Helped business in decision making by providing SWOT Analysis, Feasibility study, Root cause analysis, Cost- Benefit Analysis, AS-IS To-Be business analysis, Pareto analysis, why-why analysis, Regression analysis.
• Proficient in networking with individuals at various levels while organizing, conducting and facilitating requirement elicitation sessions such as survey/questionnaires, interviews, brainstorming, focus group, requirement workshops, document analysis, JAD sessions, Interface analysis, Observation, Reverse engineering.
• Facilitated discussions for decision making and conflict resolution to ensure good work environment.
• Expertise in Graphic User Interface Design (GUI), Mocks-ups using Balsamiq tool, MS-VISIO and Smart Draw.
• Experienced in tracing requirements and verifying to Requirement Traceability Matrix (RTM).
• Proficient in writing effective SQL queries in SQL, Oracle databases for business analysis and review.
• Designed and implemented SQL queries and stored procedures. Used functions like joins, unions, outer joins, group by, order by and aggregate functions to extract data for timely reporting, validation.
• Co-ordinated with IT architects and assisted in creating current and target state enterprise data architectures.
• Experienced in Data warehousing and ETL process. Well aware of the DW creation process including OLTP, OLAP, Data marts, ODS, Staging, Data sources, Normalization, Dimension tables.
• 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, etc. transformation and validation rules.
• Took my part in Data/Dimensional Modeling; Data mapping, Data integration, Data migration, Data Extraction, Transformation & Loading (ETL).
• 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.
• Worked with QA team to design Test plans and Test Cases for User Acceptance Testing (UAT) using Selenium, Cucumber, HP ALM.
• Experienced in Testing Life Cycle, Manual testing, Unit testing, System Testing, Integration Testing, Regression Testing, User Acceptance Testing (UAT), Load/Stress Testing, and Performance Testing.
• Generated multiple reports using different BI tools like Tableau, QlikView and in-house reporting tools.
• Experienced in Effort and Impact Analysis, Pareto Analysis, Regression Analysis, Why-Why Analysis, Kaizen, Control plans, Cause and Effect diagrams, Process mapping, FMEA (Failure Mode Effect Analysis).

TECHNICAL SKILLS:

SDLC Methodologies: Traditional/Waterfall, Agile/Scrum, SAFE, Waterfall-Scrum Hybrid

Business Skills: Change Management, Problem & Incident Management, Impact Analysis, JAD Sessions, SWOT Analysis, Risk Management, Conflict Management, Pareto analysis, Effort and Impact analysis, Regression analysis, Why-Why analysis.

Business Intelligence tools: Tableau, IBM Cognos, Power BI, MS Excel

Business Modeling tools: MS Visio, Mockup Screens, Balsamiq, Unified Modeling Language (UML)

Project management tools: MS Project, MS SharePoint, MS Office 365 online

Requirement management tools: JIRA, HP ALM, Agile CA (Rally), Confluence, SharePoint

Reporting tools: Tableau Desktop, IBM Cognos, Qlikview

Architecture/Framework: Service Oriented Architecture (SOA), N Tier ArchitectureCloud Platform (SaaS & IaaS), Apache Tomcat Web Server, RedHat JBOSS.

Testing tools: HP ALM, Rational Clear Quest, Load Runner, Postman, Selenium, Cucumber

Databases: MS SQL Server, Oracle, IBM DB2

MS AccessLanguages: HTML, CSS, XML, SQL, Java/J2EE, JavaScript, JSON, SOAP.

PROFESSIONAL EXPERIENCE:

Confidential, Deerfield, IL

Sr. Business Systems Analyst

Responsibilities:

• Created business and technical requirements, functional specifications, gathered and translate functional requirements into technical requirements using Scrum methodology.
• Worked on 5010 Transactions (837I, P, D, 835, 834,820,270/271, 276/277). Interacted with Claims including COB, Payments and Enrollment and analyzed related business processes to ensure compliance.
• Worked on claims process flow which includes receiving, eligibility and benefit level determination, apply pricing claim edits, apply proprietary claim edits, complete adjudication, generate EOB and send payment.
• Good knowledge of claim elements such as ICD, Procedure codes (CPT), HCPC’s, Diagnosis codes, Taxonomy codes and categories of claims such as Professional claims or Medical claims and Institutional or hospital claims. Good understanding of the data elements of EDI file. Ensured compliance of The Medicare Access and CHIP Reauthorization Act (MACRA) with MIPS and APM for provider payments through QPP.
• Co-ordinated with onshore and offshore development teams for functional requirements specifications in form of use cases, process flows, and prototypes and management reporting requirements using multiple elicitation techniques such as interviews, focus groups, brainstorming, prototyping, JAD, etc.
• Worked with Business Analysis team to prepare a detailed Business Requirement document (BRD), Functional Requirement Document (FRD) and System Requirement Document (SRS) and share uploaded them on Confluence. Created mock-ups, low fidelity and high-fidelity wireframes using Balsamiq tool. Experienced in developing User Stories throughout the Agile Lifecycle as well as created UML diagrams such as Use Case, Activity, ER diagrams with MS Visio.
• Developed the Requirement Traceability Matrix (RTM) for future references and tracking the progress and raised tickets on ServiceNow (SNOW) for resolutions.
• Maintained defects by prioritizing them against the backlog items and tracked them till completion using JIRA.
• Implemented customized CRM tool using salesforce to capture the calls and chats of the customers for analysis. Imported data from excel sheets in to Leads, Accounts, Contacts and Opportunities objects using Data Loader and Import Wizard. Designed various types Email templates for auto response to customers.
• Facilitated meetings with Salesforce developers in presence of Sales and Marketing team to discuss about the data that needs to be ingested into Sales cloud and Marketing cloud.
• Designed and implemented SQL queries and stored procedures. Used functions like joins, unions, outer joins, group by, order by and aggregate functions to extract data for timely reporting and validation.
• Involved in designing and developing Data Models and Data Marts that support the BI Data Warehouse. Performed reverse engineering to finalize the source systems and assisted in extracting the data into ODS.
• Extensively involved in mapping data from various sources to the target database tables. Worked in creating the Enterprise Data Warehouse (EDW) and ETL (Extract, Transform and Load) of data into DWH.
• 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.
• Worked with Development, QA, and Production Support teams to communicate, verify, and test the desired functionality changes. Helped the Testing team in creating Test Plans, Test Scenarios, Test Cases and collected Test Data for successful completion of Integration Testing and Functional Testing.
• Performed Manual testing using, Integration testing, System testing, User Acceptance Testing with UAT cases and resolved issues with the users.
• Created various charts, graphs, reports for business analysis using Tableau Business Intelligence tool. Report extractions to various formats, Snapshots, Dashboards, and Email generation according to application requirements in salesforce.

Environment: Agile/Scrum, Service Oriented Architecture (SOA), MS Visio, JIRA, Confluence, Tableau, Swagger, Salesforce CRM, Informatica, UML, and UAT Testing.

Confidential, Denver, CO

Sr. Business Systems Analyst

Responsibilities:

• Performed critical evaluation of the information aggregated from different sources, reconcile conflicts, decompose high level information into more granular details using Scrum process.
• Ensured compliant data exchanges with HIPAA and HL7 regulatory transactions in the both the medical and pharmacy industries. Documented all aspects of IT, compliance to FDA regulations, particularly CFR 21, part 11 and GCP regulations. Ensured the compliance of regulations set forth by FDA, DHHS, SOX, etc.
• Documented functional specifications for Patient Clinical Information, Health Records, Pathology Test Ordering and Results, Physician Requirements and Hospital needs.
• Worked with Business Analysis team to prepare a detailed Business Requirement document (BRD), Functional Requirement Document and System Requirement Document (SRS). Gathered, defined, and organized business and functional requirements including acceptance criteria for use by developers to implement a capability.
• Shared and saved the documents on Confluence for future reference.
• Created User stories using JIRA based on the requirement and updating acceptance criteria and escalated tickets for resolution using SNOW.
• Created mock-ups, low fidelity and high-fidelity wireframes for the allocation module, order module, transaction module, reconciliation module, reports module, analytics module, dashboard module.
• Assisted Product Owner to Prioritize the Product Backlog items for developing Sprint tasks by taking suggestions from the cross-functional development team. Experienced in writing and prioritizing user stories in Product Backlog with Product Owner. Analyzed the Iteration Burn Down charts and reviewed defects.
• Delivered the technical user stories to the developers within an Agile environment resulting in delivery of small enhancements, programs, features, modules and/or project components in a timely and cost-effective manner.
• Monitored change requests and documented requirements, integrating them with Use Cases. Identified and documented Issues, risks and gaps and their descriptions and impact, and provided recommendations.
• Performed SQL queries using functions like joins, unions, outer joins, group by, order by and aggregate functions to extract data for timely reporting, validation and also created stored procedures.
• Worked closely with business users, in-house technical team and external vendor to conduct data mapping and migration, system configuration/customization for the ERP system.
• 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 (Extract, Transform and Load) of data into a data warehouse using Star schema.
• Integrated third party data sources for business processing and analysis using REST and SOAP web services. Documented the API requirements using Swagger tool and performed API testing using POSTMAN tool.
• Assisted the QA team in designing Test plans and Test Cases for Manual testing and User Acceptance Testing (UAT) using Selenium, Cucumber, HP ALM.
• Performed Manual testing of System, Integration, Regression, User Acceptance Testing (UAT), Load/Stress Test, and Performance Test.
• Performed business analysis and created various reports, charts, dashboards and graphs using QlikView.

Environment: Agile/Scrum, Service Oriented Architecture (SOA), MS Visio, JIRA, QlikView, Swagger, Informatica, UML, UAT Testing, Selenium, Cucumber, HP ALM, Pareto analysis, Effort and Impact analysis, Regression analysis.

Confidential, Hartford, CT

Business Systems Analyst

Responsibilities:

• Worked with the Stakeholders, Product Manager and senior Business Users in defining, documenting and diagramming the business needs and Business Process flow. Followed agile methodology for project execution and used Storyboards as one of the requirements elicitation technique.
• Worked on Claims Processing and Claims Scrubbing in HMO, PPO, Medicaid and Medicare using Facets. Automated the claim processing and payment process including basic and detailed edits of the received claims.
• Created business process models using BPMN 2.0 on Current State and Future State for functional and technological process improvements. Elicited and gathered user and business requirements through open-ended discussions, brainstorming and storyboarding/prototyping. Generated User Stories, Business Rules, and Storyboards for multiple agile projects. Developed flowchart and process diagram using MS Visio.
• Used JIRA for planning and tracking the portfolios, stories, roadmaps, themes, ideas, defects, tasks, tests and issues. Generated User Stories, Business Rules Version One and UI Mockups using JIRA.
• Pre-groom user stories by gathering requirements through facilitated meeting sessions with stakeholders and bring user stories to ready state. Used JIRA to maintain traceability of requirements and defects.
• Assisted Product Owner in prioritizing the backlog using different techniques such as Moscow and Kano.
• Assisted developers in Continuous Integration and Continuous Deployment (CICD) using Jenkins.
• Wrote SQL scripts for creating performance evaluation reports. Pulled data from different databases and migrated data back and forth using SQL. Used various functions such as joins, triggers, aggregate, union, index.
• Created SQL scripts and stored procedures for enhancing the performance of the query.
• Extensively used Visual Basic to create Macros to make Data Migration Testing more useful and compared results from the legacy databases to the new database.
• Extensively involved in mapping data from various sources to the target database tables.
• Used API’s to integrate various service providers through RESTful API services. Performed the API documentation and completed the API testing using POSTMAN.
• Involved in scripting business logic of the webservices and documenting the WSLA document using xml.
• 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.
• Test data setup and Executing the test cases using test lab in HP ALM follow-up with testing team with the reports.
• Defect logging and tracking, Retesting the defects Creating Daily status report.
• Generated different reports for predictive and exploratory analysis using IBM Cognos reporting tool.

Environment: SharePoint, XML, Agile Scrum, Rational Requisite Pro, Cognos, MS Office Suite, MS Project, MS Visio, HTML, MS Windows, HP ALM, Agile CA (Rally), RedHat JBOSS, Mockup Screens, Balsamiq, Unified Modeling Language (UML).

Confidential

Business Intelligence Data warehouse

Responsibilities:

• Established a Waterfall-Scrum hybrid analysis and development methodology. Conducted user interviews, gathering requirements, analyzing the requirements using Requisite pro.
• Ensured compliance of HIPAA, ACA, ICD-10-CM and ICD-10-PCS compliance requirements, EDI HIPAA X12N-5010, HIX. Conducted analysis of HIPAA compliance and took part in discussions for designing the healthcare transactions system and data warehouse to be HIPAA 5010 compliant.
• Identified/documented data sources and transformation rules required to populate and maintain data warehouse content. Responsible for indexing of the tables in the data warehouse.
• Wrote multiple SQL queries using functions such as joins, aggregate, order by, union, group by, like, triggers. Created stored procedure for frequently used queries.
• Data mapping, logical data modelling, created 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.
• Played a key role in the planning, testing, and implementation of system enhancements & conversions. Developed the ETL Informatica Mappings for importing data from ODS.
• Co-ordinated with the data modelers and data architects regarding the architecture and schema (Star schema or snowflake schema).
• Performed analysis on enterprise data/report integration & provided functional specification to development team to build Enterprise Reporting Systems. Assisted in presenting reports and analysis to help guide the management. Generated multiple reports for analysis and testing of the EDI conversion using Tableau.
• Tested the ETL Informatica mappings and other ETL Processes (Data Warehouse Testing). Involved in setting up different configuration environment for compatibility testing and manual testing. Prepared Test Plans for each release, wrote Test Cases and executed them as part of Functional Testing. Prepared Test Reports and Deliverables and submitted for version releases.
• Evaluated testing results for each potential release build using HP Quality Center and Bugzilla reports, listing summarized bug information in priority sequence, recommended viability of release for production.
• Developed various reports, graphs, charts, dashboards for business analysis using Tableau.

Environment: Waterfall-Scrum, SharePoint, XML, Rational Requisite Pro, MS Office Suite, MS Project, MS Visio, HTML, MS Windows, HP Quality Center, Bugzilla, Tableau.

Confidential

Business Analyst

Responsibilities:

• Acted as primary liaison between Business & the development team. Involved in complete Software Development Life Cycle (SDLC) with Waterfall methodology- requirements gathering, conceptual design, analysis, high and low-level design, development, system testing.
• Draft and maintain business requirements and align them with functional and technical requirements.
• Involved with creation of UML diagrams such as activity and sequence diagrams by using MS Visio. Developed use case model using MS Visio. Created a development plan for the overall project and prototypes.
• Conducted user interviews and JAD sessions to gather and analyze requirements. Conducted GAP analysis to document requirements for existing system enhancements. Created business requirements document and functional requirements document after gathering both functional and non-functional requirements.
• Completed the DMAIC process for Six-sigma project. Performed Effort and Impact analysis, SIPOC and CTQ in the define phase. Performed the sigma calculation to define the operational and process capability in the measure phase.
• Performed multiple tests to analyze the data such as process mapping, Cause and Effect diagram, FMEA, XY matrix, Pareto analysis, Regression analysis, Paired T test, Hypothesis test, Why-Why analysis, RCA summary.
• Developed Kaizen action plan, Solution matrix and Risk register in the Improve phase. Developed Control plan, X-bar and R charts for continuous data, P chart for Discrete data and Project closure in the control phase.
• Involved during data migration from legacy system to Hr.net application and integration of Freedom and HR.net applications.
• Involved in SQL scripts for creating performance evaluation reports. Extracted data from multiple databases and migrated data back and forth using SQL. Used various functions such as joins, triggers, aggregate, union, etc. performed data mapping documents for the movement of data from production databases to the warehouse. Involved in designing and developing Data Models and Data Marts that support the Business Intelligence Data Warehouse. Worked in creating the Enterprise Data Warehouse (EDW) and assisted in Extraction, transformation and loading (ETL) process.
• Developed and executed test cases verifying data transfer quality. Assisted the Testing team in creating Test Plans, Test Scenarios, Test Cases and collect Test Data for successful completion of Integration and Functional testing. Provided support for User Acceptance Testing with UAT cases and resolved issues with the users.
• Generated multiple reports using SQL and in-house reporting tool for analysis and decision making.

Environment: MS SQL, MS Visio, MS word/power point, MS Excel, SWOT Analysis, Risk Management, Conflict Management, Pareto analysis, Effort and Impact analysis, Regression analysis, Why-Why analysis.

Confidential

Jr. Developer

Responsibilities:

• Legacy systems work flow evaluation and study, analysis for the design and development of the new system.
• Analyzed and worked closely with Business Users to identify business requirements.
• Developing Web application using VB.NET.
• Methodologies used are Agile, OOPS, OOAD.
• Worked on Crystal Reports for Reports Module. Maintained Version control using Team Foundation Server.
• Iteration planning and Estimating story items, deciding the Iteration velocity and driving the team to achieve the progress.
• Involve in Web Service unit testing using SoapUI tool and generated the test reports.
• Translate the Flat XML message to formatted XML message using XSLT mapping.
• Liaised with production team to analyze bugs and resolve issues.
• Worked with Oracle databases and designed stored procedures.

Environment: Microsoft Visual Studio 2008/2010, C#.Net, ASP.Net 2.0, VB.NET, C#, Oracle Forms, SQL Server 2000, HTML, CSS, Webservices, Crystal Reports, TFS, SoapUI tool.