SUMMARY:

• 7+ years of successful background in Business/System Analysis, Requirement gathering, requirements elicitation, technical process flow, data modeling, data mapping, communicated with SME's and Stakeholders, Business Process analysis and Technical Documentation.
• Having extensive domain knowledge in MMIS, EPIC, EDI X12, HL7, HIPAA, System, Medicare and Medicaid, CMS Compliances/Regulations.
• Spearheaded projects on Waterfall, Waterfall - RUP, Waterfall-Scrum, and Agile-Scrum.
• Broad experience in Medicaid and Medicare Claims, Supplemental benefits and reimbursement, health insurance plans like indemnity, Managed Care plans (HMO, PPO, POS)
• Experienced in agile mentoring, improving development team motivation, process innovation, SCRUM based emergency procedures, removal of project impediments, working with business/product owner to maximize business value.
• Well versed with in MS Office suite (Excel, PowerPoint, Visio, and Word).
• In depth knowledge and understanding about Business Requirement gathering, Business process improvement, Technical Process flow, Business Process Modeling and Analysis, design documentation
• Facilitated Sprint Ceremonies (Sprint Planning, Daily Scrum, Sprint Review and Sprint Retrospective) for Agile Scrum Methodology.
• Well versed with Presentation, Communication, Business Intelligence, Analytical and Requirements Elicitation.
• Experience to design as acceptable to the customers and feasible for the developers to limit a project's exposure to the forces of change and generating requirements traceability matrix (RTM).
• Experience working under agile team to ensure all team member to understand business need.
• Well versed in dealing with RDBMS and executed SQL queries and PL/SQL blocks.
• 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.
• Good experience with data analysis and analytics, data mapping and data modeling.
• Comprehensive working experience on SQL queries
• Experienced working with the centers for Medicare and Medicaid services (CMS), the Healthcare Common Procedure Coding System (HCPCS), Electronic Data Interchange (EDI) and Medicare Part D Services.
• Worked closely with agile team member, developers, PM, Scrum master and developers to accomplished Organizational goal.
• Posses strong Time management and planning Skills
• Great team player with excellent Interpersonal and Customer Relational Skills, Organizational, Analytical, Presentation Skills, Proven Communication and Leadership Qualities.

TECHNICAL SKILLS:

Business Modeling Tools: Visual Paradigm, MS Visio, PowerPoint, Rational Rose

Requirements Gathering Tools: Rational Requisite Pro, MS Word, MS Excel

Microsoft Tools: MS Office, MS Visio, MS Project

SDLC Methodologies: RUP, Prototyping, RAD, Waterfall

Testing Tools: Mercury Test Director, Quality center, QTP

Database: MS Access, Oracle 9i, My SQL, ETL, SAS

Operating Systems: Windows 2000/XP, Vista, DOS

Programming Languages: PL/SQL, VB.Net, QBasic, HTML, PHP, ASP.Net

Defect Management Tools: Test Director, Rational Clear Quest

Business Modeling Tools: Visual Paradigm, MS Visio, PowerPoint, Rational Rose

PROFESSIONAL EXPERIENCE:

Confidential - San Antonio, TX

Business System Analyst

Responsibilities:

• Worked with the Product Owners to manage dependencies and prioritizing the Product Backlog through business cases.
• Performed a detailed in-depth GAP analysis and created As-Is and To-Be documents.
• Consulted with Claims & Benefits Management Team, and develop project plan, time frames, communication plans, milestones and deliverables.
• Participated in Daily-Scrum, Backlog Refinement Meeting, Sprint Review, Sprint Retrospective meetings.
• Facilitated architect in resolving business concerns regarding billing on-line payment system enhancements.
• Involved throughout the Software Development Life Cycle, (SCRUM) including sprint planning meetings, review meetings and backlog refinement meetings.
• Extensively interacted and gathered requirements by conducting meetings with key stakeholders, IT departments, end-users and SMEs ensuring CMS compliance and HIPAA Regulations.
• Conducted meetings with business users and SMEs to identify and gather various functional and non-functional requirements.
• Utilized agile methodology to configure and develop process, standards, and procedures to create a Business Requirement Document (BRD) and conducted GAP analysis.
• Used JIRA to story point each story and prioritize story backlog based on Business Goals and objectives during the Sprint Workshop.
• Wrote SQL scripts for creating performance evaluation reports.
• Prepared detailed requirements as user stories and use cases to provide details of each business and functional requirement, development and implementation plan of these requirements, timelines, owners, etc.
• Used MS Visio to create use case diagrams, sequence diagrams and activity diagrams.
• Designed and developed Use Cases, User stories, and created UML diagrams like Activity Diagrams, Sequence Diagrams using MS Visio.
• Developed test cases and test plans on the basis of requirements and also did manual testing of the functionality of the application to ensure that the application is able to handle a lot of data.
• Working closely with QA Team to specify acceptance criteria for user stories.
• Extensively worked on ANSI X12 EDI 834 & 837 file format and in Medicare & Medicaid eligibility requirements.

Confidential - Jacksonville, MO

Business System Analyst

Responsibilities:

• Prepared scope of the project and developed new business process along with process mapping and user task analysis. I also evaluated documentation analysis and business process analysis to identify the problem with existing system and find out new and advance way to develop business process, which was able to make the process more accurate.
• Worked on Facets including Claim processing (online and batch adjudication), Case management, Customer service, Member/subscriber administration, Provider network management and reporting.
• Worked on claims, Claim adjudication Membership, Eligibility, Accumulators.
• Worked with developing team to create advance claim submission process for Medicare and Medicaid patients as well as EDI transaction such as: 837 (P, I, D), 835, and 276/277.
• The process included importing claims into Facets that had been adjudicated and setting them in a "PAY" status so that a payment cycle could be run to create checks on Facets.
• Garnered information and knowledge to develop the transaction process that is more accurate and real time regarding 837 including HIPAA Government Regulatory Compliance and also integrated the system with HL7 process.
• Used Electronic Medical Record (EMR) to extract useful information regarding patients for claim submission to the insurance company.
• Conducted JAD session with business side to identify and gathered high level requirements and evaluated the priority level on the basis of meeting discussions and comments on requirements.
• Developed a vision plan that defined the primary goals and objectives of the project. Analyze user stories and segregated them into high level and low level.
• Utilized corporation developed Agile SDLC methodology used scrum work pro and Microsoft office software to perform required job functions.
• Wrote various SQL queries to create, update, modify tables, create reports and retrieve information from the database. Derive the required data by SQLs and export into Excel files
• Developed user guides, provides user training, and supports the user in development of work processes.
• Supported UAT to evaluate the system performance and also developed system plan to quality center, review design, view test cases.
• Generated reports for quality metrics using SQL Queries.
• Maintained Change and Traceability Matrix throughout the project keeping track of the scope, timelines and budget of the project as well as collaborated with development team to determine the security access and it's tracking to ensure privacy of End users.
• Provided weekly status updates to project stakeholders on the progress of project development activities

Confidential - Springfield, MO

BSA

Responsibilities:

• Analyzed the requirements using Rational Suite (Rational Rose, Requisite Pro) and performed the iterative process to develop Use Cases.
• Created RUP activity diagrams and sequence diagrams to analyze the requirements and recommend solutions.
• Involved in testing HIPAA Transactions & Code Sets Standards like (820- Premium Payment for enrolled health plan members, 834- Enrollment /Dis-enrollment to a health plan, 835, 837 etc.)
• Was responsible for reviewing and documentation of crosswalk/mapping documents for 834, 837 I, P, D and NCPDP.
• Extracted data from Oracle database with MS Access, and performed SQL query, data analysis and verification
• Worked closely on 834 transaction code for Benefit Enrollment and was involved in Validation of HIPAA for 837, 270/271, 276/277, 835, 834 EDI transactions
• Identified and recognized opportunities to resolve problems related to EDI transactions
• Creating and Maintaining Technical process flow and giving a walkthrough with all the stake holders of the project.
• Analyze and validate functional and business requirements, identify risks and track mitigation plan, facilitate requirements elicitation and design sessions with stakeholders to ensure that requirements are implied through.
• Created XML data mapping documents to map the XML request and response from the tables in database
• Provide robust reporting for the Grievance and Appeals business area to ensure all regulatory timeframes are being met.
• Assisted IT management and the SCRUM Master as an agile team member in the company as we transitioned from a Waterfall approach to agile methodologies.
• Involved in prepared the UML Use Cases using Rational Rose
• Created a test plan and a test suite to validate the data extraction, data transformation and data load and used SQL and Microsoft Excel.
• Worked with BSA lead to develop requirements elicitation plan and defined the timelines for BRD completion.
• Played an active and lead role in gathering, analyzing, and writing business requirements.
• Provided key input in working with users in defining project and system requirements.
• Conducted JAD sessions between the end users and the development team.
• Translated the business needs into system requirements and communicated with the business on a non-technical level.
• Developed timelines for project delivery, and managed projects and resources to successful completion.
• Perform Object Oriented Analysis and Designing (OOAD) of systems object model.
• Assisted in building a business analysis process model using Rational Rose and Visio.
• Assisted the PM in setting realistic project expectations, Gap Analysis, and in evaluating the impact of changes on the organization and plans accordingly.

Confidential - Austin, TX

Business Analyst

• Wrote Business Requirements Document (BRD), Functional Requirements (FRD) and Non Functional Requirements (NFD) Systems Specifications (SSD) and documented them in the Requirements Traceability Matrix (RTM)
• Wrote Business Requirements, analyzed them and tested them.
• Worked with user story to respond faster and with less overhead to rapidly changing real-world requirements in an Agile environment.
• Used MS-Visio BPMN for developing Medicaid AS-IS and TO-BE business process flow.
• Refined the requirements (use-cases) and Business Process Models to detailed level appropriate for technical analysis and system design.
• Coordinated with management and subject matter experts to document compliance with regulatory requirements.
• Managed GAP analysis around the identification of business rules, business and system process flows, user administration, requirements and assumptions.
• Followed the UML based methods using Rational rose to create use cases, activity ER diagram, sequence diagram, collaboration diagram that include functional and non-functional specifications to hand off to development teams.
• Facilitated kick off sessions with scrum team to give a walkthrough on user stories and acceptance criteria to ensure that team is clear on what needs to be done from the business user perspective and everyone has the information they need to accomplish the tasks during sprint.
• Develop Mapping rules, Design specifications and Use Cases for the HIPAA 834i/p/d; 820; 835, 824, 275 and others.
• Worked on multiple 837, 820 and multiple Eligibility (270/271) and healthcare claim status (276/277). Create EOB systems (835).
• Was aligned it with regulatory requirements while working with senior level product managers, stakeholders, and the agile team.
• Worked with the account managers, managements, and report requestors to gather requirements, get report requests.
• Analyzed trading partner specifications and created EDI mapping guidelines.
• Performed job of contact point for all stakeholders (business, legal, compliance, development).
• Conducted RAD sessions for the report users, requestors, and the developers.
• Created and managed project templates, Use Case project templates, requirement types and traceability relationships in Requisite Pro.
• Prepared Business Requirement Documents (BRD) and used Requisite Pro to manage, analyze, and convert business requirements into functional specifications.
• Conducted Functional Walkthroughs, User Acceptance Testing (UAT), and supervised the development of User Manuals for customers.
• Supported the data governance team in conducting moderately complex data analysis to help drive data quality improvement initiatives.
• Documented Use Cases, Activity diagram, and process flow diagrams in MS Visio.
• Prepared Need Analysis Documents of the requirements gathered through JAD sessions.