SUMMARY:

• Over 8+ years of experience in Business Analysis, Operations Management and Project Management with extensive experience in Software Development Life Cycle methodologies (Agile/Scrum, Waterfall).
• Experienced in Requirement Gathering, Elicitation and Analysis, RFP Development, Change Management, Effort Estimation, Functional Testing, Coordinating Quality Assurance and Client Engagement/Relationship Management.
• Experienced in writing Business Requirements Documents (BRD), System Requirement Specifications (SRS), Use Case Modeling and Functional Specifications
• Excellent knowledge of Health Insurance Portability and Accountability Act (HIPAA) transaction, code set rules such as EDI 837, 835, 834, 270, 271, 276, 277 and ICD9 - ICD10.
• Strong knowledge of Health Insurance Portability & Accountability Act (HIPAA) standards, Electronic Data Interchange (EDI), Implementation and knowledge of HIPAA code sets, ICD-9, ICD-10 coding,,HL7, HMO, PPO.
• Extensive experience with Unified Modeling Language (UML) and modeling including Business Process Re-engineering.
• Experienced in conducting Joint Application Development (JAD) sessions through interviews and workshops with subject matter experts and business users.
• Extensive experience in conducting full-fledged training programs for new inductions and process trainings.
• Experienced in conducting Business Process Management, GAP analysis, User Acceptance Testing (UAT), Risk Analysis and Mitigation Plan
• Good knowledge of Health Insurance Plans (Medicare Part A, B, C and D), managed care concepts (Medicaid and Medicare) and experienced in determining the membership eligibility, billing experience within life and disability in health plans. Excellent knowledge of HIPAA standards, EDI (Electronic data interchange), transaction syntax like ANSI X12, Implementation and Knowledge of HIPAA code sets, ICD-9, ICD-10 coding and HL7.

TECHNICAL SKILLS:

Operating Systems: Windows, LINUX

Languages and Platforms: C, C++, Java-J2EE, C#, ASP, .NET

Databases: Oracle 9i, MS SQL server

Tools: Office Word, Excel, Access, Power point, Project, Visio

Test Tools: HP Quality Centre, JMeter

Design: Balsamiq

Industry Standards: HIPAA, SOX, ISO, Six Sigma, CMM

WORK EXPERIENCE:

Sr. Business Analyst

Confidential - Columbia, MO

Responsibilities:

• Gathered requirements by coordinating with external vendor, and internal team.
• Analyzed Gap Analysis of the HIPAA 4010 and HIPAA 5010 processes to identify and validate requirements.
• Coordinated JAD sessions with all the stakeholders to understand the impact of HIPAA 5010 on the existing system.
• Gathered requirements for "Front End" and for "Core Adjudication System" by conducting meetings and brainstorming sessions with end users and Subject Matter Experts (SMEs) and documented them using Requirement Traceability Matrix and later exporting them to HP Quality Center.
• Prepared Business Requirement Documents (BRDs) after the collection of Functional Requirements from System Users that provided appropriate scope of work for technical team to develop prototype and overall system.
• Gathered requirements for ICD 10 transition.
• Organized requirements into High level Use Cases and Low level Use Case Specifications and modeled them into UC, Activity and Sequence Diagrams using MS Visio.
• Assisted the QA personnel in the creation of Test Cases using HP Quality Center.
• Analyzed test cases, test scripts, bugs, interacted with QA/ development teams in fixing errors and conducted User Acceptance Test (UAT)
• Coordinated and prioritized outstanding defects and enhancement/system requests based on business requirements, allowing sufficient time frame to ensure accuracy and consider deadlines
• Streamlined Claims (837 EDI X12) Migration project by gathering functional specifications in Edifecs
• Daily and weekly status reporting to senior management.

Environment: MS Office 2007 to 365, Windows, .NET, Agile, MS Visio, MS SharePoint, TFS, MS Project, MS Analysis Server, Web Services, MS Visio, SQL, Oracle, SOA, HTML.

Business Analyst

Confidential - New York, NY

Responsibilities:

• Gathered requirements from stakeholders for provider management and member management.
• Coordinated JAD sessions for Requirement Validation with Dept. of Cleveland clinic to gather requirements for the new MMIS.
• Identified and validated business rules and data elements.
• Created 837 (P, I, D) claims, and maintained data mapping documents in reference to HIPAA transactions primarily 837 (P, I, D), 835, 270/271, 276/277 and 278.
• Modeled the 'as-is' process flow and the 'to-be' process flow and analyzed the gap and developed the action steps to fill the gaps.
• Worked within project team to identify and interpret state Medicaid policies as applicable to customer defined algorithm research as well as assist with internal development of new healthcare analytics.
• Extensive knowledge of Patient Protection and Affordable Care Act (PPACA)
• Extensive knowledge of Medicaid Information Technology Architecture (MITA)
• Impact analysis when there is any change in the requirements and updated the Business Requirements Document (BRD) and Systems Requirements Specification (SRS)
• Facilitated meetings with the technical team and client team to analyze the current process and gather requirements for the proposed process.
• Analyzed Audit and Change Files of 834, 835, 820, 837 PDI, 270 & 271HIPAA EDI Transactions using MS Word, MS Excel, MS Access and Facets PROD & PPMO
• Created functional requirement specification documents such as UML diagram, use case diagram, scenarios, activity diagrams and mapping.
• Developed the User Interface (UI) prototypes to capture and validate requirements and spike solutions to the current problem.
• Analyzed requirements for developing a crosswalk for understanding major changes from ICD-9 to ICD 10 with the help of SME's.
• Participated in developing test plan, test scripts, and test scenarios and designed user documentation.
• Examine the system design deliverables & validating it against the SLA.
• Maintained and tracked the project plans using MS Project.

Environment: MS Office 2007 to 365, Windows, .NET, Agile, MS Visio, MS SharePoint, TFS, MS Project, MS Access 2007, Web Services, MS Visio, SQL, Oracle, SOA, HTML.

Business Analyst

Confidential - Omaha, NE

Responsibilities:

• Gathered requirements from Business Managers, Supervisors, stakeholders, Data Governance Team and the subject matter experts through meetings to understand needs of the system.
• Completed a Business and Technical Requirement Document (BTRD)
• Analyzed the banking laws and regulations (HIPAA, HL7) before implementing the user impression software.
• Developed current and 'to be' business processes and use case documents using MS Visio.
• Involved with project management team in developing project plan.
• Written business flow and work flow diagrams to develop software.
• Involved in Blackbox testing using decision testing and use case testing.
• Created Use case diagrams, Activity, Sequence and Collaboration diagrams using UML.
• Worked directly with quality resources to ensure testing activities are in line with the defined business requirements.
• Defined Quality Assurance Checklist using Oracle Service Contract.
• Coordinated with QA and user acceptance testing.
• Maintained a record of recommendations, communications, activities, and schedules to monitor the progress of project in real time using MS Project.
• Interacted with Subject Matter Experts (SME) and end users and established a business analysis around AGILE methodology.
• Intensively involved in project testing efforts by doing Integration Testing, Regression Testing and by helping UAT team in User Acceptance Testing.
• Ensured that the claims processing is strictly under the HIPAA compliance regulatory document to safe guard patient information.
• Authored Business and Functional requirements with supporting diagram, use cases, traceability matrices, and training manuals for Provider Portal web-based application.
• Developed training material and trained the users on newly developed application.
• Analyzed and wrote technical documentation for risk analysis on customer support issues.
• Part of the team assisting in documentation involved in this project such as RFP, proposal, evaluation criteria, proposal approval, design document, project plan, project scheduling, project report, release document.
• Prepared and presented monthly collection reports.
• Involved in training and quality of the overall workflow process.
• Documenting workflow and results of analysis for the aging accounts.

Environment: RUP, Rational Requisite Pro, UML Use Cases, VB.NET, SQL Server, Rational Rose, XML, Use Case Documentation, Web services, MS. Access 2010, MS Office 365, MS Share point 2007, 2010, MS Visio

Business Analyst

Confidential - Hartford, CT

Responsibilities:

• Gathering requirements from various insurance companies to develop a system to check for the outstanding balance from various accounts using highly efficient RUP process of software development.
• Liaison between the Business needs ( business users and sponsor) and the Technical solutions (development and testing staff), ensuring technical solutions satisfied business requirements.
• Web Page Mock-Ups using MS Visio and thus defining the Business Process Model and Data Process Model.
• Experienced in RUP software development cycle methodology with four consecutive phases - Inception, Elaboration, Construction and Transition.
• Ensured that the claims processing is strictly under the HIPAA compliance regulatory document to safe guard patient information.
• Worked on EDI X 12 transaction set 837 I/P/D, 834, 276/277 feeds to allow for change in the claim number
• Authored Business and Functional requirements with supporting diagram, use cases, traceability matrices, and training manuals for Provider Portal web-based application.
• Developed training material and trained the users on newly developed application.
• Analyzed and wrote technical documentation for risk analysis on customer support issues.
• Part of the team assisting in documentation involved in this project such as RFP, proposal, evaluation criteria, proposal approval, design document, project plan, project scheduling, project report, release document.
• Prepared and presented monthly collection reports.
• Involved in training and quality of the overall workflow process.
• Documenting workflow and results of analysis for the aging accounts.

Environment: RUP, Rational Requisite Pro, UML Use Cases, VB.NET, SQL Server, Rational Rose, XML, Use Case Documentation.

Business Analyst

Confidential - Lincolnshire, IL

Responsibilities:

• Gathering user requirements through research and interviews with client stakeholders and end-users. Client interaction for requirement gathering, system analysis and finalization of technical / functional specifications.
• Conducted requirement workshop with users and provided the inputs on priority and acceptance of project with stakeholders - with development of functional requirements and use-cases.
• Coordinated JAD sessions with all the stakeholders to understand the impact of HIPAA 5010 on the existing system.
• Prepared Business Requirement Documents (BRDs), organized requirements into High level Use Cases and Low level Use Case Specifications, modeling,
• Handling internal resourcing and forward client management with introducing new clients to the organizational processes, forecasting and analysis. Analyzing MIS reports & other statements with latest downloads on the process operations

Environment: UML Use Cases, VB.NET, MS SQL Server, Analysis Reports, XML, Use Case Documentation.