SUMMARY:

• An IT professional with over 3 years of experience in the areas of Business Analysis, JAD sessions, stakeholder interviews, Business Process Management, risk analysis/management, data analysis, UAT, and Project management
• Expertise in multiple Software Development Life Cycle - Waterfall, Hybrid, Rational Unified Process, and Agile methodology.
• Efficient in writing Business Requirements Documents (BRD), System Requirements Document (SRD), Use Case Specifications, Functional Specifications, and Technical Specifications across the Deliverables of a project.
• Extensive Experience in UML and Process modeling using Use Case Diagrams, Process Flow Diagram, System Context Diagram, Activity Diagrams, and Sequence Diagrams.
• Experienced in conducting Joint Application Development (JAD) sessions through interviews and workshops with subject matter experts and business users.
• Experienced in conducting GAP analysis, User Acceptance Testing (UAT), Risk Analysis and mitigation plan, Cost benefit analysis and ROI analysis.
• Performed AS-IS and TO-BE business process flow for clear translation of Functional to system requirement specification.
• Support the Test Team and the rest of the Development Team in compliance related issues while working with them in the development phases of the projects.
• Experienced in various MS Windows platforms, OS, Office Suite, etc.
• Excellent knowledge of Health Insurance Portability and Accountability Act (HIPAA) transaction, code set rules such as EDI 837, 835, 834, 270, 271, and 277.
• Extensive knowledge of Medical Management Information Systems (MMIS), Medicaid, Medicare, Procedural and Diagnostic codes, and Claims Processes.
• Strong knowledge of Health Insurance Portability & Accountability Act (HIPAA) standards, Electronic Data Interchange (EDI), Implementation and knowledge of HIPAA code sets.
• Strong knowledge of Health Insurance Plans, 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)
• Quick learner, detailed-oriented team player with good communication, analytical, leadership, interpersonal, and problem-solving skills.
• Experience in multi-tasking such as managing numerous simultaneous projects with great attention to detail.
• Experience in solution assessment, validation and applying critical thinking for problem solving approach.

PROFESSIONAL EXPERIENCE:

Confidential - Warwick, RI

Business Analyst

Responsibilities:

• Involved with the phases of Software Development Life Cycle (SDLC) methodologies like Waterfall, Agile, Hybrid throughout the project life cycle which involved gathering, analysis and documenting business and technical requirements.
• Created Use Cases and Business Requirement Document after accessing the status and scope of the project and understanding the business processes.
• Performed Feasibility Study and Risk Analysis to identify the critical requirements from the user's perspective.
• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicare Claims. • Authored business system analysis reports based on state regulations, HIPAA compliance and product business rules
• Validated 837 (Health Care Claims or Encounters), 835 (Health Care Claims payment/ Remittance), 270/271 (Eligibility request/Response) and 834 (Enrolment/Dis-enrolment to a health plan
• Assisted JAD sessions to identify the business flows and determine whether any current or proposed systems are impacted by the EDI X12 Transaction, Code set and Identifier aspects of HIPAA.
• Interacted with Claims, Payments and Enrollment, analyzing and documenting related business processes.
• Worked with the SMEs (Subject Matter Experts), IT managers, software architects to identify the key changes pertaining to HIPAA, and participated in Health Management to communicate effectively with them.
• Used MS Access, MS Excel (Pivot tables), and SQL for data analysis and data validation.

Environment: MS Visio, Word, Excel, PowerPoint, SQL, EDI

Confidential - San Francisco, CA

Jr. Business Analyst

Responsibilities:

• Teamed with clients to gather requirements; changed into Epics and later to User stories; translated into functionality. Liaised with end-users during UAT.
• Helped user experience team to understand the requirements for wireframes
• Created workflow diagrams using Visio.
• Wrote User acceptance for user stories via Jira.
• Handled issue log & tracked to closure; reviewed & managed all change control requests and liaised with end-users during UAT.
• Consulted with functional unit management and personnel to identify, define and document business needs and objectives, current operational procedures, problems, input and output requirements, and levels of systems access.
• Acts as a liaison between end-users, technical analysts, information technology analysts, consultants and other governmental organizations in the analysis, design, configuration, testing and maintenance of case management systems to ensure optimal operational performance.
• Responsible for managing and mentoring team for each sprint cycle phases.
• Responsible for programs or projects involving department or cross-functional teams focused on the delivery of a product or program through the design process and into a finished state for internal or external customers.
• Oversee and coordinate all aspects of project and serves as manager for project team who are the liaison between project management, line management and other departments and reported to Sr. Manager.
• Highlight project issues and develop resolutions to meet productivity, quality, and client-satisfaction goals.