PROFESSIONAL SUMMARY:

• Business Analyst Consultant with 8years of diverse experience in Business Modeling, Document Processing, EDI, Mapping, HIPAA regulatory changes and Application Integration in healthcare domain.
• I am experienced in gathering business requirements, JAD Sessions, Gap Analysis, UML techniques and diagrams using IBM Rational Requisite Pro, Clear Case, Clear Quest & Rational Rose/ MS Visio to create Business Documentation, Claims Processing & Testing and Claims Adjudication for Medicare and Medicaid, Data Mapping / Modeling, and Medical Billing and specialized in ANSI 10 or ICD 9/10 implementation. I am a self - starter with motivation and capable to work independently.
• Experience with Business Analysis, Project Management, Rational Unified Process Methodologies, SDLC Methodologies and Modeling Techniques, Software Validation and Process Re-engineering
• In depth understanding of Software Development Life Cycle (SDLC) starting with requirement gathering, analysis and documenting the requirements as various deliverables and validating output of each phase from the SME’s and Project Manager.
• Experienced in GAP Analysis of HIPAA with particular attention to qualifier, length and required field and situational rules.
• Verified and documented HIPAA regulator changes found when moving from .
• Performed gap analysis and data mapping for HIPAA X12 4010A1 to 5010 migration.
• Expertise in verifying and understanding EDI raw data, both in 4010 and 5010 format.
• Strong understanding of ICD 9 and ICD-10 structures and formats.
• Expertise in Interviews, Joint Application Development Sessions (JAD), Focus sessions for requirements gathering, analysis and design with stakeholders, SME’s, Developers and system architects.
• Performed several levels of testing of the conversion from which included syntax verification, balancing of the segments, situational cases and verification of the loops as per the guidelines of the implementation guides and companion guides.
• Have experience in healthcare industry in working with various modules which include claims processing using EDI X12 transactions like 837, 834, 835, 270/271, and 276 which fall under the HIPAA compliance.
• Experienced on Medicaid, MMIS, HIX, HIPAA, EDI, and ICD.
• Knowledge and good understanding of Federal Regulations like 21 CFR Part 11, 21 CFR Part 203 and Sunshine ACT, provision under the Patient Protection and Affordable Care (PPAC) Act
• Strong Analytical skills in determining and conducting Feasibility Analysis, Cost/Benefit Analysis, GAP Analysis, Risk Analysis and Mitigation and Change & Configuration Management for complex process and systems.
• Adept at gathering Functional requirements and specifications through interviews, facilitated sessions, brainstorming, questionnaires and organizing JAD to accomplish user-client objectives and results
• Performed User Acceptance Testing (UAT) with business users.
• In depth understanding of Software Development Life Cycle (SDLC) starting with requirement gathering, analysis and documenting the requirements as various deliverables and validating output of each phase from the SME’s and Project Manager.
• Proficient in creating UML Diagrams, including Use Case Diagrams, Activity Diagrams, Class Diagrams, Sequence Diagrams using various tools such as MS Visio, Rational Rose.
• Strong Project Management skills including planning, scheduling, monitoring and budgeting with proficiency in MS Project for planning & reporting and assisted Project Managers in the development of weekly and monthly status reports.
• Conducted communication between the client and IT department, involved in gathering, analyzing, and documenting R equirements. Understand the Business Rules and can effectively implement them in Business Process Flow.
• Excellent communication and analytical skills with strong problem solving capabilities to interface with end users, business representatives and development teams.
• Experience in EDI 837 testing which involved writing test cases which forced security, data integrity and usability with special emphasis on 837 syntax validation.
• Considerable experience in preparing the impact analysis due to migration from and ICD-9 and ICD-10 on the business process model and the application.
• Knowledgeable in User Acceptance Testing with experience in performing UAT with business users.
• Clear understanding of testing concepts and hands on experience writing test cases, test plans and planning test strategy using testing tool Quality Center.
• Experience in GUI, Functional and web testing both with manual testing and automation testing using tools as Quality Center and Rational Robot.
• Proficient in writing advanced DML and DDL SQL Queries for Backend Testing to check and analyze data integrity and validation.
• Skilled at reviewing Test Cases making sure they are in accordance with requirements, and assist the overall testing process by activities such as Change and Defect.
• Knowledge and implementation experience of Quality Assurance, Testing Principles, and Configuration and Change Management Disciplines.

TECHNICAL SKILLS:

Testing tools: Requisite Pro, Robot, Clear Case, Test Manager, Quick Test ProfessionalLoad Runner, Win Runner

Quality Center:, Rational Clear Quest

Web Technologies: XML/XSL, HTML

Operating Systems: MS Windows, DOS, UNIX, XP, Vista, Mac OS

SQL: MS Access

Tools: MS Visio, MS Office Suite, MS Project, Excel, MS Word

Requirement Management Tools: Rational Clear Quest, ReqPro, MS Project, VISIOMercury Quality Center

WORK EXPERIENCE:

Confidential, Madison, WI

System Analyst

Responsibilities:

• Analyzed use-case document and functional requirement specification document.
• Prepared and maintained the Requirement Traceability Matrix to ensure completeness.
• Created test cases and test data from the functional requirement specifications.
• Primarily responsible for reviewing the approved Change in Requirements and analyzing and identifying the impact to existing test cases and scripts.
• Primarily responsible for reviewing the approved Change in Requirements and identifying and preparing the new test cases and test scripts.
• Involved in Black box, Manual Testing and prepared Test Suite for all the Test Cases.
• Created different document and matrices like test log, test incident report, test coverage matrix, tractability matrix etc.
• Validated if EDI 820 has been send to supplier or not after electronic fund transfer.
• Generated test reports and test cases using QC.
• Tested the system to verify the compliance with HIPAA in terms of privacy, security and standards
• Involved in detailed Functional and GUI testing and User acceptance testing (UAT).
• Involved in writing SQL queries for Backend data verification, retrieving data from related tables and Testing.
• Conducted End-to-End testing of the system manually.
• Detected bugs and reviewed them with business and developers and classified them based on the severity.
• Generated various Reports for PMO including Weekly Status Report and Open Defect Report using Excel.
• Conducted the Regression tests for already reported Bugs and change requests to test whether fix has been applied or not and to test and ensure the fix does not cause a new problem or break existing functionality.

Environment: Windows XP, HP Quality Center, UNIX, Oracle, Java, MS-Office.

Confidential, Virginia Beach, VA

Business/Quality Analyst

Responsibilities:

• Implemented the SDLC for the developing life cycle and followed the Standards process in the application
• Facilitated collection of business requirements from business users and prepared business requirements doc that provided appropriated scope of work for technical team to develop overall system
• Worked on Facet implementation team and involved in process modeling, prepared Business Process Models that includes modeling of all the activities of the business from the conceptual to procedural level
• Conducted JAD session to track and resolve major issues, attended change request meetings, created change request tracking logs to satisfy additional requirements
• Analyzed data architecture, documented and delivered data mapping, performed risk analysis
• Created and delivered functional specification document to the development team
• Collaborated with development team and the business to develop both high-level and detailed system architecture to meet the business needs. Identified gaps, performed gap analysis
• Developed a detailed test plan and writing test cases to cover all the requirements
• Performed execution of test cases manually to verify expected results
• Developed data mappings from source to target for assigned ETL process
• Developed test cases and scripts for front end testing (GUI & Functionality)
• Analyzed system design and structure, identified, understood, and documented business requirements, including the system functionalities capable of supporting those requirements
• Analyzed test results using various Online Graphs in Load Runner
• Administrated and customized various aspects of Test Director like: Create a new project, upgrade and repair a project database, test user privileges for this project
• Frequently communicated with developers to resolve technical issues

Confidential, Columbus, OH

Sr. Business analyst

Responsibilities:

• Coordinated with the stakeholders and project key personnel to gather functional and non-functional requirements during JAD sessions.
• Created BRD, FRD/FSD and SSD for implementation of functional areas across IF/notifications and languages.
• Responsible for the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation and testing for Medicaid Claims.
• Responsible for gap analysis in changing old MMIS and involved in testing new MMIS.
• Performed Gap analysis pertaining to conversion to accommodate the ICD-10-CM and ICD-10-PCS code sets. Involved in associating ICD 10 code sets to CPT, HCPCS code sets and modifiers.
• Assisted with building the EDI 837, 835, 270/271, 276/277, 278, 820 and 834 transactions processing flow from the Trading Partners to the translator.
• Actively participated in the designing of the EDI transactions using the new HIPAA 5010 version also including the use of ICD-10 codes.
• Worked on HIX member's enrollment, billing claims and customer services process that are required to participate in the federal health insurance exchange (HIX). This exchange was according to the compliance with Patient Protection and Affordable Care Act (PPACA).
• Responsible for implementation of Affordable Care Act (ACA) in the Confidential and setting up of Marketplace / Healthcare Information Exchange (HIX).
• Recorded requirements in the Requirement Traceability Matrix (RTM) defining each technical requirement in detail from areas like: main hardware, application software, networks, servers, internet and desktop configuration.
• Assisting the project manager in creating the business case and project plan.
• Served as a liaison between the internal and external business community (Claims, Billing, Membership, Capitation, Customer service, membership management, provider management, advanced Healthcare management, provider agreement management) and the project team.
• Actively analyzed current business processes (Claims, Recipient eligibility and enrollment etc.) and worked with management to improve and implement enterprise solutions to ensure compliance.
• Creative problem solving for system and process failures during extraction of data and resolving customer problems through research.
• Worked with MS Office (MS Word, Outlook, Excel, PowerPoint, and Project) and MS Visio.
• Creating and managing project data sheets on Excel.
• Communicated and lead the Business Analysis team to ensure process, definitions, metric designs, and metadata are used consistently, and that documentation is updated accurately and available for all team members.
• Lead cross-functional linked teams to address business or systems issues and resolved complex analyses.
• Worked extensively on Gap analysis, Root Cause Analysis and Impact analysis of issues to requirements to meet the gap and redesign of the user interface.
• Involved in mentoring specific projects in application of the new SDLC based on the Agile Unified Process, especially from the project management, requirements and architecture perspectives.
• Worked on many Change Requests, Parking Lot items, Action Items, Process Flow Diagrams (UML), Pain Points, and Use Cases.
• Created and maintained specifications and process documentation to produce the required data deliverables (data profiling, source to Client maps, flows).
• Primary liaison between the development team and the business owner to understand and implement the amendment and modification required through change request or work request.

Environment: MS Office Suite (Word, Excel, PowerPoint, Outlook), SQL, MS Project, Rational Rose, Windows, HP Load runner, MMIS.

Confidential, New Haven, CT

Business System Analyst

Responsibilities:

• Interacted with stakeholders to get a better understanding of client business processes and gathered requirements.
• Experience in conducting scrum meetings and sprint planning.
• Collaborating with business partners and cross-functional teams and supporting system documentation.
• Experience with COB (coordination of benefits) application with in facets, testing of claims status for selected subscribers.
• Involved working with HIPPA-EDI ANSI X12 Transaction Code sets EDI 834, 835 and EDI 837.
• Involved in Testing (271, 277,820, 834,835 & 837) Transactions.
• Involved profoundly in the GAP Analysis of the transition from HIPAA focusing on how current transactions and system was going to be effected by the new 5010 compliance.
• Organized and facilitated meetings with the management and development teams.
• Conducted requirement gathering sessions with the purpose of creating and defining the Business Requirement Document (BRD) and the Functional Requirement Document (FRD) using Rational Requisite Pro .
• Responsible for mapping of ICD9 to ICD10 and also did GAP Analysis.
• Converting reports to more contemporary programs such as Business Objects, MS Excel, MS Access, and SQL, and condensing number of reports to simplify processes.
• Wrote SQL queries to extract claims and eligible member level information from databases.
• Used data mining to determine ways to maximize the detection and prevention of frauds.
• Created activity diagrams using MS Visio.
• Created presentations using MS PowerPoint.
• Conducted functional requirement reviews and walkthroughs with the designers, developers, and stakeholders.
• Incorporated and implemented all the HIPAA standards, Electronic Data Interchange (EDI), transaction syntax like ANSI X12, ICD-9, ICD-10coding and HL7.
• Involved in Requirement Scoping and analyzing high priority requirement for implementation.
• Created high-level Use Cases from Business Requirements and created UML diagrams like Use Case and Activity diagrams using MS-Visio.
• Conducted JAD sessions to allow different stakeholders to communicate their perspectives with each other, resolve any issues and come to an agreement quickly.
• Tracked stakeholder requested enhancements and changes using Requirement Traceability -Matrix (RTM).
• Executed SQL queries to test the database for records that detect and submit functional acknowledgement and remittance advice in the claims application.
• Knowledge and implementation experience of Quality Assurance, Testing Principles, and Configuration and Change Management Disciplines.

Environment: Agile, MS Office suite (Word, Outlook, Access, Excel), MYSQL, MS Project, MS Visio, HP Quality Center, IBM Caliber.

Confidential, New York, NY

Responsibilities:

• Involved in business analysis and project management, coordinated between the team members, addressing budget issues and created test plans according to the business requirements.
• Worked with the project manager for planning and organizing the project activities and communicated with other business partners and stakeholders of the project.
• Gathered requirements, analyzed data/workflows, and defined the scope.
• Assisted the EDI team in the development and documentation of the test strategies for the EDI transactions that included all standard transactions, auditing and error correction processes, and the creation of the transactions.
• Worked on HIPAA transactions and set code standards according to the test scenarios for transactions such as 270/271, 276/277, 837/835.
• Coordinated with the EDI team in developing and documenting the detailed testing work plans and created the various testing documents for the assigned EDI transactions.
• Designed Use Cases using UML and managed the entire functional requirements life cycle using RUP
• Involved in drafting and implementation of the test plan and various test cases for UAT
• Worked with billing and EDI HIPAA 835 and 837 processing.
• Followed the UML based methods using MS Visio to create Use Case Diagrams, State Chart Diagrams and Sequence Diagrams
• Enhanced test cases and scripts by adding the required functionality as per the new business requirements.
• Verified data outputs and transformations between systems remained true and were not compromised as systems were integrated.
• Participated in various meetings and discussed enhancements and modifications request to resolve issues and expand capability of the systems.
• Tested the HIPAA EDI834, 270/271, 276/277, and 837/835 transactions according to test scenarios

Environment: MS Office Suite (Word, Excel, PowerPoint, Outlook), SQL, MS Visio, MS Project, Rational Rose, Windows, HP Load runner, MMIS.