- Around 7+years of experience as a Sr. Business Analyst and worked extensively on various domains such as Healthcare and Banking Industry.
- Expertise in gathering requirements, creating functional specifications, and data flow diagrams. Identified processes for developing and documenting detailed business requirements. Experience in Pharmacy or Claims domain.
- Proficient in performing Business Process Reengineering/Gap Analysis to check the compatibility of the existing System infrastructure with the new business requirements.
- In - depth knowledge of SDLC methodologies like Waterfall, Rational Unified Process (RUP), Agile -SCRUM.
- Analyzed valuation of tradable market securities with data mining and data management software (SQL) which led to a significant minimized data error.
- Hands-on experience using Business Intelligence tools such as Excel, Access, and QlikView.
- Extensive experience with authoring Business Requirements Document (BRD), Functional Specification Documents (FSD), Software Requirement Specifications (SRS), Use Case documentation, High level and Low level documents (HLD/LLD), Business Rules Spreadsheet and Data mapping document. Hands-on experience SmartView/ SAP.
- In depth knowledge of UML in visualizing and documenting the artifacts using Use Cases diagrams, Class diagrams, Sequence diagrams and Activity diagrams in MS-Visio.
- Experience with TriZetto Facets 4.51/4.71 and TriZetto HIPAA Gateway 4.11 - supported new business requirements by extending the functionality of the core Facets system using the Facets extensibility architecture feature.
- Familiar with EDI (Electronic Data Interchange), HL7 and ActiveX interfaces.
- Experience with RUP, UML, and AGILE (Sprints), Waterfall, Scrum.
- Extensive knowledge of Medical Management Information Systems (MMIS), and National Provider Identification (NPI).
- Proven expertise in creating test plans, UML diagrams, flowcharts, screen mockups and systems requirements specifications.
- Responsible for EDI strategies enabling Health Care Providers and Insurance Careers to communicate effectively.
- Strong knowledge of FDA QS 21 CFR 820, 211 for Pharmaceutical, Life Science and Health Care Industries and cGMP, GCP, GLP, CAPA, GRP, EMR, EHR & QMS.
- Good working knowledge in Claims processing, Medicare/Medicaid, HIPAA Regulations, Facets and 276, 277, 837P, 837I, 837D, 835 and 834 EDI Transactions for health care industries.
- Solid understanding of Business Process definition, Risk Analysis and SDLC methodologies.
- Excellent in Developing and evaluating business process Models.
- Organized and facilitated Joint Application Design (JAD) sessions and interviews, brainstorming sessions, written correspondence, questionnaire, focus group, implementation requirements, project status report and resolving issues/conflicts.
- Got excellent interpersonal skills with ability to interact with end-users, Subject Matter Experts (SME’s) and Project Stakeholders.
- Facilitated Sprint Ceremonies (Backlog grooming, Sprint Planning, Daily Scrum, Sprint Review and Sprint Retrospective) for Agile Scrum Methodology as Scrum Master.
- Experience in conducting GAP analysis, SWOT analysis, PESTEL analysis, Cost benefit analysis and ROI analysis.
- Expertise in Analysis of Criticality Ranking, Defect tracking and reporting system.
- Strong experience in developing Test Plans, building Test Conditions and Test Cases, creating Test Data, analyzing bugs, and work with development team members to fix errors and resolve issues.
- Proficiency in gathering SMART (Specific, Measurable, Attainable, Realistic, Timely) requirements and transforming them into functional specifications. Expertise in creating Mockup’s and Wireframes.
- Collaborated in various types of testing like Functional (Black Box) testing, Regression testing and User Acceptance Testing (UAT). Accompanied with expertise in developing Test Plans & Test Case Scenarios, Test scripts and Test Objectives in manual and automated test environments.
- Strong skills in building process models, data flow diagrams and entity relationship diagrams.
- Worthy understanding of concepts like Data warehousing, data structures, Schemas, Data Marts, Data-Entity Relationships and User Administration. Worked with data warehouses for migrating data from OLTP’s to OLAP cube using ETL tools such as Informatica Power Center and SSIS.
- Spearheaded training sessions for business users, technical users, stakeholders for better understanding of the applications.
- Conducted feasibility analysis by interacting with Development team, QA team and ETL team to understand software limitations.
- Self-Motivated and Objective driven with excellent communication and interpersonal Skills with a sound understanding of the balance that must exist between customer satisfaction and technical excellence.
- Good Understanding of Project Management activities, proficient with Project Management Tools, testing tools and defect reporting tools.
- Excellent Communication, problem solving, public speaking, critical thinking, conflict resolution, facilitation and documentation skills.
- A proactive and dedicated team player, with proven track record in producing high quality work under tight deadlines and multi-tasking to meet business goals. Experience in scheduling meetings, negotiating and co-ordination with Developers, Application Architects, Subject Matter Experts, business users and senior executives.
Project Management Tools/ Methodology: Unified Modeling Language (UML), MS-Project, MS Share Point, Rally, JIRA, Agile-Scrum, Waterfall-Scrum, Waterfall.
Requirement Management: MS Office, JIRA,Confluence, HP ALM 11.5.
Reporting Tools: IBM Cognos, Tableau, MS office Suite, Spotfire, Qlikview
Database: MS-Access, DB2, SQL Server 2000/2005
Office Tools: MS Word, MS Excel, MS PowerPoint, MS SharePoint 2013, MS Project, MS Visio
Testing Tools: HP QC, HP ALM 11.5, Load runner, Bugzillla and SOAP UI
ETL Tools: Informatica, SQL Server Data Tools-Business Intelligence (SSDT-BI)
Languages: HTML, XML, SQL version 2014 and Java
Databases: MySQL version 2012, MS Access, Oracle 9i, DB2
Defect Tracking tools: JIRA, HP ALM, HP QC
Lead Business System Analyst
Confidential - Schaumburg, Illinois
- Created use case, data flow, sequence and entity diagrams
- Used software methodologies including Agile (Scrum).
- Organized and Conducted the JAD team and in conducting the weekly sessions from requirement gathering to sign-off of the application after testing.
- Developed a vision plan that defined and procedures are primary goals of the project.
- Elicited demands from the stakeholders and analyzed them for consistency, completeness and flexibility.
- Interacted with SME’s, asking detailed questions and carefully recording the requirements in a format that can be understood and reviewed by both technical and business people.
- Conducted User Story Writing Sessions to decompose BRD into User Stories and determine Acceptance Criteria for Potentially Shippable Product Output.
- As experienced Scrum Master anticipated and removed obstacles from project team’s path and pushed them to deliver quality results based on schedule.
- Used JIRA for issue tracking, user story management and requirement traceability.
- Developed use case documentation for system requirements, business process flows, and screen mockups using MS Visio.
- Assisted with User Acceptance Testing, developing and maintaining quality procedures, and ensure that appropriate documentation is in place. Assisted in Black box, UAT and Regression testing.
- Communicated effectively across company contacts and clients, internal team about the project requirements, schedules and launches.
- Assisted the project manager to construct a project plan that included Project Schedules, Milestones tracking, and Meeting minutes using MS Project.
Environment: Scrum Agile, MS Visio, QlikView, MS Project, MS office, Risk, Asp.net, C#net 4.5, MS SQL server 2012. Visualstudio2013,JIRA 5.2, Tableau 8.3, MS Office Suite (MS word, MS Excel, PowerPoint), MS Project.
Sr. Business Analyst
Confidential - Baton Rouge, LA
- Conducted one on one sessions and team meetings with the team leads and SME’s to understand the business requirements.
- Preparing System Test Cases from functional and technical requirement and Use case documents and performing System Testing.
- Trouble shooted file transmission problems and assisted customers in a call center environment with EDI and Medicaid Insurance claim related inquiries explained and enforced guidelines in the X12 Implementation guides (837P, 837I, 837D, 270/271).
- Understood the healthcare plans offered, including Medicaid Managed Plans such as Children and Adolescent Care, Women’s Preventive Care, Maternal Care, Asthma Care, Diabetes Care, Cardiovascular Care, and Mental Health.
- Defined overall Architecture for EDI transaction for real-time and batch process
- Have worked with Chevron, delivering Regulatory (EPA) Reporting strategy for Corporate Health & Environment Safety.
- Implemented RUP and followed iterative, Use Case driven process for requirement documentation and deployment.
- Involved in making Use Case Diagrams, Activity Diagrams, and using analysis and design models tools like MS Visio, Rational Rose through RUP, Agile and Waterfall Model
- Worked with SME close to understand Claim Adjudication Process setup in Facets.
- Followed the standards of PMO which included getting approvals for SOX Compliance at various Gates.
- Responsible for Medicaid Claims Resolution/Reimbursement for state health plans using MMIS.
- Prepared the Charter/BUR and functional design document.
- Monitor departmental policies, processes, and procedural compliance for both in-house and client sites to ensure proper adherence to budget and safety standards
- Experience with Medicare and Medicaid: Claims processing, Membership, and Eligibility Verification and care management.
- Thorough knowledge of Eligibility and membership Affairs. Also knowledge of HIPAA, X12, and HL7 standards and Medicaid provider best practices.
- Updated the functional design document for NPI related changes in the Encounters project.
- Applied Unified Modeling Language (UML) methodologies to design Communication Diagram, Use Case Diagrams, Activity Diagrams, Sequence Diagram, ER diagrams & Data Mapping
- Analyzed encounters claims file (837 P, I, D) using SpecBuilder.
- Created SQL queries to check the updates in Oracle database and executed SQL queries in Oracle to check the redundancy of data. Setup runbook for Inbound and Outbound EDI transactions.
- Developed business level activity diagram utilizing UML (according to Agile Unified Process) to visualize use cases, identified gaps between the current model and future model.
- Propose strategies to implement HIPAA 4010 in the new MMIS system & eventually move to HIPAA 5010.
- Conducted JAD sessions with the participation of the users and the stakeholders to gather requirements.
- Utilized corporation developed Agile SDLC methodology. Used ScrumWork Pro and Microsoft Office software to perform required job functions.
- Trained new Business analysts about the system and the data model.
Environment: MS Project, Windows NT,, Microsoft Office SharePoint Server 2003, Agile, Microsoft Content Management Server, ASP .NET, IBM DB2 data server, MS Office, MS Visio, Test Director.
Sr. Business Analyst
Confidential - Haven, CT
- Conducted weekly meetings for deciding the Policies and Procedures to be followed while constructing new sites.
- Performed the requirement analysis, impact analysis and documented the requirements using Rational Requisite Pro.
- Was responsible for data mapping of HL7 messages into relational database.
- Documented the server farm requirements and requirements related to security within Share Point and using Windows Active Directory.
- Updated/Modified Facets Fee Schedules
- Performed Gap Analysis to check the compatibility of the existing system infrastructure with the new business requirements.
- Built business requirements into the Medicare Advantage (MA) requirements database and created the Project Requirements Document for the three functional areas
- Worked on billing system a cash management module and enhanced the encrypting standards that are required for the application.
- Performed Analysis on NextGens EPM/EMR application.
- Generated test cases in Claims Analyzer Editor Professional to ensure unification with CPT-4 and ICD-9 codes
- Followed a systematic approach to eliciting, organizing, and documenting requirements of the system.
- Loads new contracts/ authorizations/ benefit configuration into Facets.
- Reviewed the Joint Requirement Documents (JRD) with the cross functional team to analyze the High Level Requirements.
- Used Rational Clear case for version control.
- Manage changes to requirements through change control -clear case, MQC, Documentum.
- Been a part of Architecture and modeling team and have used SOA (Service Oriented Architecture)
- Used Query Analyzer, Execution Plan to optimize SQL Queries.
- Meticulously assessed data from various sources and generated conceptual and logical database designs using ERwin data modeling tool.
- Utilized Facets Data Model to document, map and query data required for the 271 benefit response
- Interacted with client and the Technical Team for requirement gathering and translation of Business Requirement to Technical specifications.
- Held, Facilitated and Moderated JAD sessions and meetings with SME's, Program and Project Managers, Directors and executives related to all areas of Core Facets
- Conducted interviews, meetings and JAD sessions during the process of Requirement Gathering.
- Planned and documented procedures for data processing and prepared data flow diagrams for the application.
- Analyzes medical management requirement to determine best approach for loading authorization rules into Facets.
- Analyzed and translated business requirements into system specifications utilizing UML and RUP methodology
- Expertise with supply chain strategies/vendor manufacturing process methods to determine level of procurement and strategic sourcing strategies/plans and worked with vendors/peers to determine lead times, schedules and cycle counts, established requirements needs.
- Interacted with line of business managers and coordinated the transition into the security database to assure business compliance with SOX.
- Analyzed trading partner specifications and created EDI mapping guidelines
- Documented the Traceability Matrix for tracing the Test Cases and requirements related to them.
- Developed Data Conversion Strategy for converting data from the existing site to the new site.
- Designed and developed project document templates based on SDLC methodology
- Prepared Demo on SharePoint for various Business to get new approvals like the Therapist and Nursing divisions.
- Designed workflows and allocated permissions within SharePoint.
- Performed Unit Testing and User Acceptance testing and documented detailed results.
- Provided input (scope, goals, risks, constraints, timelines and interfaces) to PM for project planning and control.
Environment: Windows 2000/XP, Microsoft Office SharePoint 2007, MS Office, SQL Server, Agile, MS Project, MS FrontPage 2003, MS Access, EDI, Documentum 2.0., Rational Clear Quest, Rational Clear Case, Rational Requisite Pro, Rational Rose, UML,RUP, Microsoft Excel, Microsoft Word, Microsoft Power Point, Visio.
Sr. Business Analyst/ QA Analyst
Confidential - Bristol, CT
- Worked as BA and QA for web based and mobile banking application called Online and customer service application.
- Had worked with e banking for Content Management System (CMS) preparing a Confidential bank website having a new look and feel.
- Analyzed valuation of tradable market securities with data mining and data management software (SQL) which led to a significant minimized data error
- Developed and iterated a full compendium of requirements for the portal, including a business requirements document, iRise simulation, and complete set of use cases.
- Communicating with SME's, Business users, testers, UI team and developers to complete the project on schedule by providing solutions through group meetings, JAD session's and one to one meetings.
- Was involved in Risk Management ventures, document management and requirement management for the core functionalities of the portal.
- Participated in and contributed to As-Is and To-Be Process Modeling Sessions, and build process models responsible for analysis and reporting.
- Analyzed business requirements and segregated them into Use Cases. Created Use case diagrams, activity diagrams, Sequence Diagrams using MS Visio and Snag-it tools.
- Extensive experience using SQL for querying andanalysis purposes on various source tables and conditions applied.
- Assist development team to work through data-mapping and integration requirements between UI applications and mobile services.
- Support QA team in ambiguity reviews, and in understanding of requirements.
- Created Test Plan and define features to be tested requirements.
- Extensively worked on Quality Center for requirement mapping and testing.
- Responsible for managing the documented System Requirements and Requirements Traceability Matrix using Rational Requisite Pro.
Environment: Rational Rose, iRise, SharePoint,QlikView, UML, MS Office, MS Visio, MS Project, MS Access, Snag-it, Java, Java Script, SQL, Quality Center.
Senior Business System Analyst
Confidential - Oakland, CA
- Gathered Business Requirements through brainstorming sessions on global calls.
- Facilitated JAD sessions for Requirement Validation.
- Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims.
- Analyze, and document business and functional requirements via uses cases for Medicare billing transaction-based middleware/database layers with SOA & XML.
- Validating the EDI 837 claim billing (professional, institutional and dental claims) & 835 (remittance advice or payment) claims adjudications.
- Mapped provider data from source to target Facets data layout for the claims and benefit configuration.
- Assisted in monitoring ancillary data transactions and addressed problems with HL7 messages.
- Exposed to using ICD 9/ICD 10 coding standards in Medicare and Medicaid domains of the healthcare systems and industry for inpatients, outpatients, reimbursement methodology.
- Designed and developed Use Case Diagrams for the Facets process modules.
- Assisted JAD sessions to identify the business flows and determine whether any current or proposed systems are impacted by the EDI X10 Transaction, Code set and Identifier aspects of HIPAA.
- Documented and tracked requirements in Mercury Quality Center.
- Designed and implemented HIPAA 835 Payment Advice Transaction, 837 Health Care Claim Transaction. Populated ICD-9, NDC Disease code sets as per the standards. Experience with transaction sets 835, 837, 270, 271, 276, 277 and 5010.
- Provided suggestions and ideas more from a strategic and long term perspective.
- Developed data conversion programs for membership, claims, and benefit accumulator data converted thirteen corporate acquisitions. Developed data field mappings. Provided programming and support for claims processing functions and auto-adjudication.
- Effectively implementation of the System Development Life Cycle SDLC, the BABOK and RUP methodologies from Initiation to Deployment.
- Used Requisite Pro for the Requirement Documents Preparation and Prepared Business Process Models that includes modeling of all the activities of the Business from the conceptual to procedural level. Followed top down, leveled technique for building Business Process Models.
- Designed and developed Use Cases using UML and Business Process Modeling.
- Used MS-Visio for flow-charting, process model and architectural design of the application.
Environment: SQL, HTML, C, C++, WINDOWS 98/2000/NT/XP/ 7, MS Word, MS Excel, MS PowerPoint, MS Access, MS Project, MS Outlook, SharePoint.
Business System Analyst
- Elicited business requirements by participating in JAD sessions, interviewing business users and stakeholders, conducting focus group sessions and consulting existing systems documents.
- Structured investment portfolio to match the full range of company's insurance products.
- Conducted fundamental credit and broad economic research on companies within assigned sectors.
- Used MS Visio for Process modeling, Process mapping and Business Process flow diagrams. Understood the As-Is system, developed the To-Be system concepts and also prepared the System Process Maps.
- Designed Use Case diagrams and also involved with design team in creation of Activity Diagrams and Sequence Diagrams to depict process flows.
- Assisted in design review meetings to make sure all the requirements are covered in the development phase.
- Involved in writing UAT Test Plans, Test Cases and Test Scripts using HP Quality Center.
- Worked on JIRA for bug tracking, issue tracking and project management functions.
- Involved in tracking and managing the complete working of Onsite and Offshore teams.
- Worked on front-end and back-end Application Programming Interface (API) to define the functionalities of user interface (UI).
- Delivered ESB and API Gateway infrastructure and implementation to standardize the response for API Calls.
- Facilitated the Scrum ceremonies: Daily standup meeting, the Sprint Planning meeting, Sprint Review Meeting, Retrospective, and Product Backlog Refinement meeting.
- Responsible for monitoring and managing the work progress and ensured to deliver systems demos as per release plan.
- Improved team velocity by incorporating capacity planning into sprint planning sessions with sanity checks at the end of the planning meeting.
- Tracked and maintained an Impediments List to effectively resolve impediments using Control approach.
- Used Story Mapping technique in order to prioritize product backlog and facilitate spring planning meeting.
- Helped the teams to determine Story Points for User Stories using Estimation Techniques like Planning Poker, T-shirt Sizing, Relative Mass Valuation and Dot Voting.
- Facilitated and coached teams on the importance of Continuous Integration, TDD and Continuous testing.
- Worked closely with Product management and Program manager in designing the change management plan and analyzed impact, incorporated feedback from business focus groups at each phase.
Environment: Agile Scrum Waterfall Hybrid, HP QC/ALM, Mule ESB, JIRA, Oracle, DW, MS Visio, SharePoint, HTML, XML, MS Office Suite
- Conducted interviews with key business users to collect requirement and business process information.
- Performed gathering, analysis, review and signoff of business requirements and conducting of interviews, sessions etc.
- Created Process flows based on the requirements to define the user interface and written activity steps.
- Documented the Business requirements into the Functional specification document.
- Have participated in Requirements Walkthroughs, Defect Review Meetings, and Status Meetings.
- Supervised and developed documentation effort from an analysis standpoint. Utilized Use Cases, stated requirements documents, feature specifications, workflow diagrams etc. throughout the analysis phase of the project.
- Followed a structured approach to organize requirements into logical groupings of essential business process, business rules, information needs and insured that critical requirements are not missed.
- Performed Gap analysis to determine the as is system, documented the Gaps and consulted the development team and project manager to fix the issues.
- Re-engineered the system to document the User interface based on the current functionality of the application.
- Made Screen Mockups/Definitions using MS Visio.
- Experienced setting up test scenarios and executing on these scenarios and worked closely with testing team to make sure all the changes made to requirements documents are implemented in their Test Cases.
- Involved in maintaining the Requirements Traceability Matrix (RTM) across the deliverables for a Project.
- Worked closely with lead to create the Impact matrix to document the impacts on other blocks.
- Worked with application development team to identify bottlenecks that could hinder progress of development.
- Collaborated with developers as needed to determine the root cause of defects
- Checked validation of the application against the requirements
- Involved in meetings and walkthroughs.
Environment: Waterfall, MS Office, MS Project, MS Visio, Oracle, Windows NT, LINUX, HTML, Web based tools, Windows/Unix, Load Runner.