SUMMARY:

• Senior Business Analyst with 7 1/2 years of experience with key focus in Healthcare/Insurance Industry and Excellent knowledge about health care industry and claims management.
• Expertise in understanding business needs and defining creative and useful software solutions.
• Excellent analytical and problem - solving skills in designing, developing and implementing innovative business processes using new approaches and technology.
• Proficient in Data Quality Management techniques like Data Profiling, Data Cleaning, Data Integrity, Data Mining, Data Reference and Security, etc.,
• Experience in conducting Joint Application Development (JAD) sessions and White Board Sessions with end-users, Subject Matter Expert (SMEs) team, Architects and design group development and QA team for project meetings, walkthroughs and customer interviews commensurate with excellent communication skills.
• Expertise in documenting business requirements (BRD) and functional request document (FRD).
• Worked effectively with the QA (Quality Assurance) team for designing and evaluating Use Case Scenarios, Test Plan, Test System, Test Data and Test Cases for the application.
• Created product requirement document (PRD), functional requirement document, system requirement document & technical design document, Creating Request for Proposals (RFP), creating Requirements Traceability Matrix (RTM).
• Hands on experience with UML modeling, Use Case Documents, Use Case Diagrams, class diagrams, interaction diagrams, activity diagrams, state chart diagrams and documentation of every method and attribute.
• Expertise in Software Development Life cycle (SDLC), Project Life cycle and in Software Development Methodologies including Rational Unified Process (RUP), Waterfall, and Agile
• Sound understanding of comprehensive health reform , the Patient Protection and Affordable Care Act (ACA) and medical claim policies and requirements including benefits, membership, enrollment and implementation.
• Expertise in ICD-9 to ICD-10 Conversion & creating a crosswalk between ICD-9 to ICD-10
• Experience in conducting manual testing, unit, system, functional, integration, regression and User Acceptance Testing (UAT) of systems.
• Experience with the working of Medicare (Part A, B, C and D) and Medicaid Health Insurance Policies, Personal Injury Protection (PIP) insurance, billing experience with life and disability in health plans with thorough understanding of CPTcoding, UCR, FS, HCFA-1500 and CMS-1500 claim forms and reimbursement forms.
• Worked on the HIX Program
• Experienced in HIPAA compliance, Electronic Data Interchange (EDI) and implementation of HIPAA code sets, ICD-9, ICD-10.
• Thorough understanding and hands-on working experience with standards of EDI/X12- 270/271 & 276/277, 834, 835, 837
• Experience with QNXT 3.4, QNXT 4.6, Facets 4.71, Inbound & Outbound interfaces, EDI configuration, and data mapping using ANSI X12 4010 and 5010.
• Expertise in maintaining the Requirements Traceability Matrix (RTM) across the Deliverables of a project.
• Good experience with Rational Rose, Rational Requite Pro, Rational Clear Quest, Rational Clear Case, MS Project, MS Visio, Rational DOORS, Crystal Reports.
• Proficiency in preparing Vision Document and User Interface Specification to define system boundary for the project.
• Extensive knowledge of Medical Management Information Systems (MMIS), and National Provider Identification (NPI)
• Strong in writing SQL queries and reporting the results to the business team.
• Analytical, methodical and resourceful approach to problem solving, identifying root causes and corrective actions to meet short and long-term business, financial and system requirements.

TECHNICAL SKILLS:

Operating Systems: Windows 95/98/NT/2000/XP/07, UNIX

Software Methodologies: SDLC, SCRUM, Agile, Waterfall Model, Rational Unified Process (RUP), Rapid Application Development (RAD), IBM Curam

Databases: MS Access, SQL Server, Oracle 10g, DB2, T-SQL

Programming Languages: HTML, Java, C/C++, XML

Microsoft Office Suite: MS Project, MS Word, MS Excel, PowerPoint, MS Visio, MS SharePoint.

Business Modeling Tools: Erwin data modeling, Rational Rose, Requisite-Pro and Use cases

PROFESSIONAL EXPERIENCE:

Enterprise Systems Analyst

Confidential, Chicago

Responsibilities:

• Involved in complete SDLC which includes requirement gathering, architecture, design, document, planning, development, deployment & End to End testing in CCTI.
• Gathered & analyzed the business & technical requirements. Created Functional Requirement Specification Documents (FRS) across multiple projects.
• Profiled data & Worked with the ETL (Ab initio) team to document the transformation rules for data migration from OLTP to Warehouse to marts for reporting purposes (Cognos and CCP).
• Created source to target documents with business rules after conducting Logical & Physical design reviews with SME's. Assisted Development team in creating Data Exchange Documents (DED).
• Created Aggregate and Summary tables that hold Historical Claims data used for Analytical Purposes.
• Identified the missing data in Marts while data is being loading from warehouse, Performed Backfill activities to load the missing data. So that the end users can have all the required data available for reporting purposes.
• Analyzed existing Logical & Physical data models & altered them using Erwin model to support enhancements. Conducted walk throughs with the DBA's & Architect's about the changes made. Reverse Engineered databases schema into Erwin Physical Data Model for re-usability.
• Created tables in DB2, views, Partitions, sequence, Indexes, Constraints & generated SQL scripts for physical implementation.
• Maintained & updated Metadata repository (MDH) based on the CR's. Uploaded XML's in MDH for respective changes in Erwin model & updated MDH sheets regarding new codes.
• Developed S2T mapping documents to support ETL design.
• Attended design, coding, test case & test results review walk-through meetings to provide inputs regarding adherence to technical standards & customer requirements.
• Created and maintained the Requirement Traceability Matrix (RTM)
• Assisted QA, UAT & Development teams to mock up data to meet scenarios.
• Maintained test cases, results and SQL's in HP ALM. Tracked defects in Clear Quest(CQ).
• Performed Root Cause & GAP analysis to fix the defects found during testing.
• Organized touch base calls, Scrum calls, Check point calls and Triage sessions.
• Worked on PHI/PII data that involves Federal Employee Data, data masking.
• Conducted white boarding sessions to have concrete agreement with cross-functional teams.

Environment: Windows 2007, MS Office, SQL Server 2012, DB2, MDH, Ab initio, Query it, Clear Quest, Service Now, Unix, HP ALM, Erwin data Modeling, Cognos, Web EME.

Sr. Business Analyst

Confidential, Albany, NY

Responsibilities:

• Helped in creating Request for Proposal (RFP) and Project Charter.
• Analyzed multiple databases and investigated areas of overlap/duplication.
• Created Excel Spreadsheets for all tables in different databases with Duplicates, Inconsistences, Source, Usage and Linkage by Mapping Manually.
• Created Current State of Procurement Services Database Structure Architecture Diagrams in Visio.
• Interviewed SMEs, Contract portfolio management, Bid Opening team, Bid Posting team, Contract awarding team, Asst. Directors of Customer Service Team along with OGS Management.
• Based on information obtained in these meetings it will help shape the order and depth of deep dive discovery into the following Business Processes.
• Discovered how a contract is awarded and how it is posted in State Wide Financing System (SFS) for public to view.
• Analyzed contract awarding life cycle from Bid Posting to Award winning with what all the Contract Amendments and Vendor Responsibilities involved.
• Identified Gaps in the Business process during JAD Sessions.
• Documented roles of people and their portfolios for those who all are involved in the contract life cycle.
• Organized SharePoint website for Confidential OGS i.e. to be used as project data repository by the client (OGS Team) and various Teams involved in the process
• Provided Final Recommendations Document for Future State Requirements and Options for Improvement

Environment: MS Project, MS Access, MS office 2013, SQL Server 2012, Waterfall, SharePoint, Visio

Sr. Business Analyst

Confidential, Norfolk, VA

Responsibilities:

• Prepared documents for business requirements document (BRD).
• Interviewed SMEs and Stakeholders to get a better understanding of client business processes and gather Business requirements
• Created data Mapping document and crosswalk documents for the Nevada state specifications.
• Assisted to develop the Test Plan, Test Cases and Test Scenarios to be used in testing based on Business Requirements, technical specifications and/or product knowledge.
• Interviewed Nevada state health plan people and Medicaid director of state to get the state specifications.
• Conducted regular walkthroughs, inspections of documents with stakeholders and documented training material for end users.
• Analyzed FACETS application to extract data from AGPDM to DMPROV tables.
• Created Error report with Rule matrix for inclusion and exclusion logics.
• Created and designed SharePoint website for Nevada state i.e. to be used as project data repository for project.

Environment: Informatica, MS Project, MS Access, MS office 2010, SQL Server 2012, Waterfall, Jira, SharePoint

Sr. Business Analyst

Confidential, Pittsburgh, PA

Responsibilities:

• Designed and development of test cases based on functional requirements for Institutional and Professional claims for EDI and HIPAA Transactions 837/835, 834, 276/277, 270/271 testing.
• Performed System testing of the Claims processing systems (Pricing Rules, Duplicate/Limits validation, Member Eligibility, Provider Enrollment, et al).
• Performed testing for Medicare, Medicaid and X-Over claims for Medicaid Management Information System (MMIS).
• Prepared documents for business requirements document (BRD), systems requirements specification (SRS), high-level design documents (HLDD), and traceability mapping / matrix with the assistance from the business group, and the IT team members.
• Prepared graphical depictions of Use Cases, Use Case Diagrams, State Diagrams, Activity Diagrams, Sequence Diagrams, Component Based Diagrams, and Collateral Diagrams and creation of technical design (UI screen) using Microsoft Visio.
• Conduct complex documentation and user needs analysis. Interface with team and staff to develop HL7 integration.
• Involved in full life cycle of Business Objects reporting Application.
• Lead Business Intelligence reports development efforts by working closely with Teradata and ETL teams.
• Assisted JAD sessions to identify the business flows and determine whether the EDI X 12 Transaction, Code set, and Identifier aspects of HIPAA affect any current or proposed systems.
• Developed the strategy for developing and implementing new EDI (HL7 and X12) interfaces and converting historical clinical and data.
• Conducted business-impact assessment and the results were compared with the new HIPAA 5010 standards to determine the current level of compliance and developed an action plan for approval by the project steering committee.
• Developed plan for data feeds and data mappings for integration between various systems, including XML, to follow ICD 10 Code set and ANSI X12 5010 formats.
• Conducted Gap Analysis, and Gathered User Requirements by Interviews, user meeting, JAD session, and Requirement Elicitation Sessions.
• Utilized corporation developed Agile SDLC methodology. Used Scrum Work Pro and Microsoft Office software to perform required job functions.
• Assisted to develop the Test Plan, Test Cases and Test Scenarios to be used in testing based on Business Requirements, technical specifications and/or product knowledge.
• Wrote SQL Queries in MS Access to sort data and analyze the large set of data.
• Used Rational Clear Quest for defects and bug testing.

Environment: Windows 2007, HL7, Business intelligence (BI), Business Objects (BO), Microsoft Office, MS Office, SQL Server 2012, DB2, MS Project, MS FrontPage 2003, MS Access

Sr. Business Analyst

Confidential, Long Beach, CA

Responsibilities:

• Interviewed SMEs and Stakeholders to get a better understanding of client business processes and gather Business requirements.
• Conducted controlled brainstorming sessions with project focus groups for collecting high-level business requirements.
• Conducted several Requirement Gathering Sessions for gaining detailed requirements and finalizing Business Requirement Document (BRD).
• Involved in data mapping, field mapping of the data elements responsible for the BRD.
• Performed GAP analysis of business rules, business and system process flows.
• Responsible for the full HIPAA compliance lifecycle from gap analysis, mapping, implementation and testing for Medicaid Claims.
• Actively involved in updating internal processes (submit claims, check eligibility), updating data collection and data reporting.
• Provide internal departments with monitoring and audit support of Medicare Part D claims to ensure CMS compliance. Provide the necessary support to internal departments during CMS audits to document ongoing monitoring activities.
• Extract pharmacy claims, benefit and eligibility data for studies. Gather any necessary enrollment, formulary, pricing, benefit and trend information from internal departments and the PBM.
• Requirement gathering, Business Process flow development, and Business Analysis
• Created and maintained a project schedule using MS Project showing all target dates (deliverables).
• Creating data load and Upgrade scripts for data migrations, data formatting and data validations.
• Extracted the data from SQL Server, Oracle, Files, and Access into Data warehouse.
• Created ad-hoc management and production reports against the Out-Patient Registration database upon physician and hospital management request.
• Created and executed automated test scripts using Win Runner.
• Worked with the project manager for planning and organizing the project activities, and in communicating with other business center mangers and stakeholders of the project.

Environment: Oracle, MS Project, MS Access, Lotus Notes, MS office 2010, Sql Loader, Agile.

Business Analyst

Confidential, NY

Responsibilities:

• Responsible for complete project documentation and served as a liaison between the business team and the project team by assisting in identifying, understanding, and documenting their business needs.
• Conducted interviews with internal users to generate as Is process flow and prepared the detailed work flow diagram based on the proposed modifications.
• Assisted senior analyst to refine StarPC requirements, drafted Business Requirement Document, and Co-Authored Functional Requirement Document.
• Independently prepared Business and System specifications for RFID tag.
• Followed a structured approach to organize requirements into logical groupings of essential business process, business rules and information needs to ensure that critical requirements are not missed.
• Coordinated the upgrade of Transaction Sets 837P, 835 and 834 to HIPAA compliance.
• Assisted colleague in conforming to HIPPA and CMS standards, rules and regulations on a different module.
• Review each State Medicaid Compliance Policy to ensure that state enrollments are in full compliance and continually adheres to state requirements.
• Created and maintained the Requirement Traceability Matrix between the requirements and other products such as (Use Cases, Design documents and Test plans).
• Prepared behavioral UML diagrams (such as Use Cases, Activity and sequence diagrams).
• Created the static mock-up UI screen using Axure and helped the UI/UX team create the dynamic prototype. Coordinated with the developers to create the input and output XML-schema.
• Worked on the Data mapping and storing the analytical data using OLAP and updated to the SharePoint 2013.
• Worked in conjunction with various stakeholders including senior managers, project manager, developers, QA and other team members to validate complex scenarios and maintain the quality standards of the project.
• Performed Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data. Gathered and validated requirements, resulting in detailed business rules, functional requirements and process design.
• Created Use Case Models, Wireframes & Mock-ups, Analysis Models, Design Models, Use Case Diagrams, Behavior Diagrams (sequence diagrams, activity diagrams) based on UML methodology
• Involved in performing version control and defect tracking activities using Rational ClearCase and Rational ClearQuest.
• Use HL7 implementation methodology to create specifications, assist with unit testing, and perform integrated testing for messaging between the state Departments of Health and the location office.

Environment: MS Office (Word, Excel, PowerPoint, Outlook, Visio, Project), SQL, UML, RUP, SDLC, Quality Center

Business Analyst

Confidential, Melbourne, FL

Responsibilities:

• Identified and validated high potential business opportunities for stakeholders.
• Gathered business Requirements, analyze data/workflows. Defined the scope and progressed from problem Statement to well-documented Designs
• Utilized Rational Req Pro as a user to analyze the business requirements
• Worked on MS CRM Dynamics for handling the customer claim inquiries, Validation and case creation.
• Facilitated with JAD sessions with the management groups, vendors, users and the IT Group for open and pending issues to develop specifications.
• Conducted Functional Walkthroughs as well as User Acceptance Testing (UAT) sessions.
• Developed Use Case diagrams with MS Visio and created Business Flow Diagrams, Activity/State diagrams, and Sequence diagrams, which enabled developers and other stakeholders to understand the business process
• Created business process workflow diagrams (Activity diagrams) in Rational Rose.
• Worked through Software Development Life Cycle (SDLC) from Requirements, Analysis, Design, and Implementation through Testing.
• Worked as an Interface between the users and the different teams involved in the application development for the better understanding of the business and IT processes
• Conducted iterations, communicated results, and milestone achievements to the stakeholders while keeping the developers closely updated on all documented refinements.
• Created and maintained a project schedule using MS Project showing all target dates for deliverables.
• Created and maintained complete development plans that included functional specifications, requirements engineering, Use Case modeling, risk assessment and mitigation, internal and external workflow.
• Extensively used ETL to Extract, Transform and load data.
• Developed Scripts for Regression Testing and System Testing.

Environment: Windows, UNIX, C++, HTML, XML, Rational Rose, Rational Requisite Pro, SQL, MS-Project

Business Analyst

Confidential

Responsibilities:

• Acted as an interface with different stakeholders of the project.
• Defined Business Rules by interacting with stakeholders and users through Surveys & Brainstorming.
• Developed a vision plan that defined the primary goals and objectives of the project.
• Conducted Joint Application Development (JAD) sessions.
• Performed Gap Analysis, conducted walkthroughs and acted as a liaison between the business users, stakeholders and the team to perform requirements, quality and risk analysis.
• Involved extensively in the inception phase for understanding the Scope of the Project, feasibility of the implementation and define the risk factors involved in the project.
• Gathered business requirements through sessions and analysis by interviewing users and Subject Matter Experts
• Analyzed business/system requirements using requirement arbitrage and assigned appropriate priorities.
• Documented AS-IS and TO-BE analysis and conducted process evaluations and write recommendations based on the analysis.
• Applied Unified Modeling Language (UML) notations and methodology in developing models that accurately represent the business process and workflows to communicate effectively them to the stakeholders.
• Assisted Test Lead, Testers understanding business process and help them successful completion of Unit Testing, Integration Testing, Functional Testing and SIT.

Environment: Unified Modeling Language (UML), Microsoft Word, Microsoft Excel, Microsoft PowerPoint, MS Project, Microsoft Visio, SQL, SDLC, SCRUM methodology.

Business Analyst

Confidential

Responsibilities:

• Played a key role in the planning, testing, and implementing system enhancements and conversions.
• Provided key project inputs by working with users in defining the project and system requirements.
• Worked on Hospital data processing for improving database for storing user files.
• Analyzed business needs, created and developed new functionality to meet real time data integration that facilitated decision.
• Experience of managing multiple stakeholders across the organization, and in QA integration of systems.
• Involved in detailing project mission, data process flow diagrams, and timelines.
• Worked with SQL queries for data manipulations.
• Assisted in building a business process model using Rational Rose, Requisite Pro and Visio.
• Designed and developed Use Cases, Activity Diagrams and Sequence Diagrams.
• Assisted in process modeling; conducted and participated in JAD sessions with system users; helped with design walkthroughs with stakeholders for base lining architecture.
• Developed strategic partnerships with the business unit to develop a solid knowledge base of the business line, including the business plan, products and processes.
• Research operational procedures and methods and recommended procedures for improvement - with an emphasis on automation and efficiency.

Environment: RUP, Rational Rose, Requisite Pro, MS Visio, RUP, MS Project, SQL, MS Access, MS Office