SUMMARY:

• Business Analyst and Business Systems Analyst with 8+ years of profound experience in Business Development
• Certified Scrum Master proven ability to work with cross - functional and self-organizing teams in Healthcare.
• Lean Six Sigma Green Belt certified in process improvement.
• Experienced in working in various software development methodologies as like Waterfall, Agile Scrum and Hybrid of Waterfall and Agile Methodologies, also have fair understanding of other industry standard methodologies like Extreme Programming, SAFE, Spiral and Kanban.
• Specialized in Business and System Analysis, Requirements and Change management.
• Familiar with current healthcare industry standards such as CMS and MMA Guidelines, HIPAA guidelines (4010 & 5010) and EDI Transactions like 820, 834, 835 & 837, DHHS, SOX and FDA regulations.
• Good knowledge of RFP, RFI, RFQ and create deal breakers for multiple procurement activities.
• Experienced with Facets application groups: claims processing, guided benefit configuration, medical plan, provider, subscriber/member, product billing roles, pricing configuration and error handling.
• Profound experience in Claims Processing and Claims Scrubbing in HMO, PPO, Medicaid and Medicare.
• Extensive knowledge of Medicaid (MMIS), Medicare, Procedural and Diagnostic codes and Claims Process.
• Experienced in using Confluence and SharePoint for sharing and storing documents. Experienced in using GitHub and Bitbucket for code versions.
• Implementation and conversion of ICD-9 to ICD-10 codes with HIPAA .
• Proficient in preparing Business Requirement Document (BRD), Functional Requirement Document (FRD), System Requirement Specification (SRS), Use Case specification, Configuration Document, and RACI matrix.
• Collaborated on creating Work Breakdown Structure (WBS) using MS Project, tracking schedules and milestones.
• Helped business in decision making by providing SWOT Analysis, Feasibility study, Root cause analysis, Cost- Benefit Analysis, AS-IS To-Be business analysis, Pareto analysis, why-why analysis, Regression analysis.
• Proficient in networking with individuals at various levels while organizing, conducting and facilitating requirement elicitation sessions such as survey/questionnaires, interviews, brainstorming, focus group, requirement workshops, document analysis, JAD sessions, Interface analysis, Observation, Reverse engineering.
• Facilitated discussions for decision making and conflict resolution to ensure good work environment.
• Expertise in Graphic User Interface Design (GUI), Mocks-ups using Balsamiq tool, MS-VISIO and Smart Draw.
• Experienced in tracing requirements and verifying to Requirement Traceability Matrix (RTM).
• Proficient in writing effective SQL queries in SQL, Oracle databases for business analysis and review.
• Designed and implemented SQL queries and stored procedures. Used functions like joins, unions, outer joins, group by, order by and aggregate functions to extract data for timely reporting, validation.
• Co-ordinated with IT architects and assisted in creating current and target state enterprise data architectures.
• Knowledge in Data warehousing and ETL process. Well aware of the DW creation process including OLTP, OLAP, Data marts, ODS, Staging, Data sources, Normalization, Dimension tables.
• Good knowledge of the Star and Snowflake schema, different OLAP operations such as slice, dice, roll-up, drill down and pivot, facts and fact tables, etc. transformation and validation rules.
• Took my part in Data/Dimensional Modeling; Data mapping, Data integration, Data migration, Data Extraction, Transformation & Loading (ETL).
• Experienced in API testing using Postman and SoapUI to check if the API response data is in JSON or XML format as defined in the API documentation and required by workflow and resolve discrepancies.
• Worked with QA team to design Test plans and Test Cases for User Acceptance Testing (UAT) using Selenium, Cucumber, HP ALM.
• Experienced in Testing Life Cycle, Manual testing, Unit testing, System Testing, Integration Testing, Regression Testing, User Acceptance Testing (UAT), Load/Stress Testing, and Performance Testing.
• Generated multiple reports using different BI tools like Tableau, QlikView and in-house reporting tools.
• Experienced in Effort and Impact Analysis, Pareto Analysis, Regression Analysis, Why-Why Analysis, Kaizen, Control plans, Cause and Effect diagrams, Process mapping, FMEA (Failure Mode Effect Analysis).

TECHNICAL SKILLS:

SDLC Methodologies: Traditional/Waterfall, Agile/Scrum, SAFE, Waterfall-Scrum Hybrid

Business Skills: Change Management, Problem & Incident Management, Impact Analysis, JAD Sessions, SWOT Analysis, Risk Management, Conflict Management, Pareto analysis, Effort and Impact analysis, Regression analysis, Why-Why analysis.

Business Intelligence tools: Tableau, IBM Cognos, Power BI, MS Excel

Business Modeling tools: MS Visio, Mockup Screens, Balsamiq, Unified Modeling Language (UML)

Project management tools: MS Project, MS SharePoint, MS Office 365 online, MEGA, BLAST

Requirement management tools: JIRA, HP ALM, Agile CA (Rally), Confluence, SharePoint

Reporting tools: Tableau Desktop, IBM Cognos, Qlikview

Architecture/Framework: Service Oriented Architecture (SOA), N Tier ArchitectureCloud Platform (SaaS & IaaS), Apache Tomcat Web Server, RedHat JBOSS.

Testing tools: HP ALM, Rational Clear Quest, Load Runner, Postman, Selenium, Cucumber

Databases: MS SQL Server, Oracle, IBM DB2, MS Access

PROFESSIONAL EXPERIENCE:

Confidential, NY

Sr. Business Systems Analyst

Responsibilities:

• Created business and technical requirements which led to creating business requirements document and System requirements Specifications document
• Co-ordinated with the foreign teams to gather requirements by using various techniques like Interviews, JAD sessions. Maintained up to date items tracker and issue tracker.
• Involved in configuration of the complete front end system CMDM Assessments, customer setup, Appeals, configuring the care plans, Differential Care Management, Clinical Management configuration.
• Part of Error Log management by creating SRD which includes current state and future state error retention feeds and performed modifications in stored procedure to count the retained authorizations during the runtime.
• Worked with Business Analysis team to prepare a detailed Business Requirement document (BRD) and System Requirement Document (SRS) and share uploaded them on Confluence. Created mock-ups, low fidelity and high-fidelity wireframes using Balsamiq tool. Experienced in developing User Stories throughout the Agile Lifecycle.
• Implemented customized CRM tool using salesforce to capture the calls and chats of the customers for analysis. Imported data from excel sheets in to Leads, Accounts, Contacts and Opportunities objects using Data Loader and Import Wizard. Designed various types Email templates for auto response to customers.
• Designed and implemented SQL queries and stored procedures. Used functions like joins, unions, outer joins, group by, order by and aggregate functions to extract data for timely reporting and validation.
• Worked on API documentation using Swagger tool. Analyzed domain specific API’s while conducting the Interface analysis, to interpret the data formats in their WSDL/WADL for a thorough understanding of business requirements and supported integration of compliance REST API’s with Business Rules Engine.
• Performed API testing using Postman and SoapUI to check if the API’s are returning the data in JSON, XML format as defined in the API documentation using Swagger tool and required by workflow.
• Worked with Development, QA, and Production Support teams to communicate, verify, and test the desired functionality changes. Helped the Testing team in creating Test Plans, Test Scenarios, Test Cases and collected Test Data for successful completion of Integration Testing and Functional Testing.

Environment: Agile/Scrum, Service Oriented Architecture (SOA), MS Visio, JIRA, Confluence, Swagger, Salesforce CRM, Informatica, UML, and UAT Testing.

Confidential, IL

Sr. Business Systems Analyst

Responsibilities:

• Created business and technical requirements, functional specifications, gathered and translate functional requirements into technical requirements using Scrum methodology.
• Worked on 5010 Transactions (837I, P, D, 835, 834,820,270/271, 276/277). Interacted with Claims including COB, Payments and Enrollment and analyzed related business processes to ensure compliance.
• Worked on claims process flow which includes receiving, eligibility and benefit level determination, apply pricing claim edits, apply proprietary claim edits, complete adjudication, generate EOB and send payment.
• Good knowledge of claim elements such as ICD, Procedure codes (CPT), HCPC’s, Diagnosis codes, Taxonomy codes and categories of claims such as Professional claims or Medical claims and Institutional or hospital claims. Good understanding of the data elements of EDI file. Ensured compliance of The Medicare Access and CHIP Reauthorization Act (MACRA) with MIPS and APM for provider payments through QPP.
• Co-ordinated with onshore and offshore development teams for functional requirements specifications in form of use cases, process flows, and prototypes and management reporting requirements using multiple elicitation techniques such as interviews, focus groups, brainstorming, prototyping, JAD, etc.
• Worked with Business Analysis team to prepare a detailed Business Requirement document (BRD), Functional Requirement Document (FRD) and System Requirement Document (SRS) and share uploaded them on Confluence. Created mock-ups, low fidelity and high-fidelity wireframes using Balsamiq tool. Experienced in developing User Stories throughout the Agile Lifecycle as well as created UML diagrams such as Use Case, Activity, ER diagrams with MS Visio.
• Developed the Requirement Traceability Matrix (RTM) for future references and tracking the progress and raised tickets on ServiceNow (SNOW) for resolutions.
• Maintained defects by prioritizing them against the backlog items and tracked them till completion using JIRA.
• Worked on API documentation using Swagger tool. Analyzed domain specific API’s while conducting the Interface analysis, to interpret the data formats in their WSDL/WADL for a thorough understanding of business requirements and supported integration of compliance REST API’s with Business Rules Engine.

Environment: Agile/Scrum, Service Oriented Architecture (SOA), MS Visio, JIRA, Confluence, Tableau, Swagger, Salesforce CRM, Informatica, UML, and UAT Testing.

Confidential, Denver, CO

Sr. Business Systems Analyst

Responsibilities:

• Performed critical evaluation of the information aggregated from different sources, reconcile conflicts, decompose high level information into more granular details using Scrum process.
• Ensured compliant data exchanges with HIPAA and HL7 regulatory transactions in the both the medical and pharmacy industries. Documented all aspects of IT, compliance to FDA regulations, particularly CFR 21, part 11 and GCP regulations and eTMF maintenance. Ensured the compliance of regulations set forth by FDA, DHHS, SOX, etc.
• Worked with Business Analysis team to prepare a detailed Business Requirement document (BRD), Functional Requirement Document and System Requirement Document (SRS). Gathered, defined, and organized business and functional requirements including acceptance criteria for use by developers to implement a capability.
• Assisted Product Owner to Prioritize the Product Backlog items for developing Sprint tasks by taking suggestions from the cross-functional development team. Experienced in writing and prioritizing user stories in Product Backlog with Product Owner. Analyzed the Iteration Burn Down charts and reviewed defects.
• Delivered the technical user stories to the developers within an Agile environment resulting in delivery of small enhancements, programs, features, modules and/or project components in a timely and cost-effective manner.
• Monitored change requests and documented requirements, integrating them with Use Cases. Identified and documented Issues, risks and gaps and their descriptions and impact, and provided recommendations.
• Performed SQL queries using functions like joins, unions, outer joins, group by, order by and aggregate functions to extract data for timely reporting, validation and also created stored procedures.
• Worked closely with business users, in-house technical team and external vendor to conduct data mapping and migration, system configuration/customization for the ERP system.
• Integrated third party data sources for business processing and analysis using REST and SOAP web services. Documented the API requirements using Swagger tool and performed API testing using POSTMAN tool.
• Assisted the QA team in designing Test plans and Test Cases for Manual testing and User Acceptance Testing (UAT) using Selenium, Cucumber, HP ALM.

Environment: Agile/Scrum, Service Oriented Architecture (SOA), MS Visio, JIRA, QlikView, FREYR, Swagger, Informatica, UML, UAT Testing, Selenium, Cucumber, HP ALM, Pareto analysis, Effort and Impact analysis, Regression analysis.

Confidential, Hartford, CT

Business Systems Analyst

Responsibilities:

• Worked with the Stakeholders, Product Manager and senior Business Users in defining, documenting and diagramming the business needs and Business Process flow. Followed agile methodology for project execution and used Storyboards as one of the requirements elicitation technique.
• Worked on Claims Processing and Claims Scrubbing in HMO, PPO, Medicaid and Medicare using FACETS. Automated the claim processing and payment process including basic and detailed edits of the received claims.
• Inspecting the compatibility and quality of data processed into FACETS.
• Wrote SQL scripts for creating performance evaluation reports. Pulled data from different databases and migrated data back and forth using SQL. Used various functions such as joins, triggers, aggregate, union, index.
• Created SQL scripts and stored procedures for enhancing the performance of the query.
• Extensively used Visual Basic to create Macros to make Data Migration Testing more useful and compared results from the legacy databases to the new database.
• Extensively involved in mapping data from various sources to the target database tables.
• Used API’s to integrate various service providers through RESTful API services. Performed the API documentation and completed the API testing using POSTMAN.
• Involved in scripting business logic of the webservices and documenting the WSLA document using xml.
• Identified bugs during the test phase and reported using JIRA. Assisted the Testing team in creating Test Plans, Test Scenarios, Test Cases and collect Test Data for successful completion of Integration and Functional testing.
• Conducted User Acceptance Testing with UAT cases and resolved issues with the users.
• Test data setup and Executing the test cases using test lab in HP ALM follow-up with testing team with the reports.
• Generated different reports for predictive and exploratory analysis using IBM Cognos reporting tool.

Environment: SharePoint, XML, Agile Scrum, Rational Requisite Pro, Cognos, MS Office Suite, MS Project, MS Visio, HTML, MS Windows, HP ALM, Agile CA (Rally), RedHat JBOSS, Mockup Screens, Balsamiq, Unified Modeling Language (UML).

Confidential

Business Analyst

Responsibilities:

• Established a Waterfall-Scrum hybrid analysis and development methodology. Conducted user interviews, gathering requirements, analyzing the requirements using Requisite pro.
• Identified/documented data sources and transformation rules required to populate and maintain data warehouse content. Responsible for indexing of the tables in the data warehouse.
• Analyzed data obtained from DNA sequences using Molecular Evolutionary Genetics Analysis (MEGA).
• Checking the quality of eTMF files for electronic clinical trial records and manage the records quality
• Performed analysis on enterprise data/report integration & provided functional specification to development team to build Enterprise Reporting Systems. Assisted in presenting reports and analysis to help guide the management. Generated multiple reports for analysis and testing of the EDI conversion using Tableau.
• Evaluated testing results for each potential release build using HP Quality Center and Bugzilla reports, listing summarized bug information in priority sequence, recommended viability of release for production.
• Developed various reports, graphs, charts, dashboards for business analysis using Tableau.

Environment: Waterfall-Scrum, SharePoint, XML, Rational Requisite Pro, MEGA, BLAST, NCBI, MS Office Suite, MS Project, MS Visio, HTML, MS Windows, HP Quality Center, Bugzilla, Tableau OASIS.

Confidential

Business Analyst

Responsibilities:

• Acted as primary liaison between Business & the development team. Involved in complete Software Development Life Cycle (SDLC) with Waterfall methodology- requirements gathering, conceptual design, analysis, high and low-level design, development, system testing.
• Draft and maintain business requirements and align them with functional and technical requirements.
• Involved with creation of UML diagrams such as activity and sequence diagrams by using MS Visio. Developed use case model using MS Visio. Created a development plan for the overall project and prototypes.
• Conducted user interviews and JAD sessions to gather and analyze requirements. Conducted GAP analysis to document requirements for existing system enhancements. Created business requirements document and functional requirements document after gathering both functional and non-functional requirements.
• Involved in SQL scripts for creating performance evaluation reports. Extracted data from multiple databases and migrated data back and forth using SQL. Used various functions such as joins, triggers, aggregate, union, etc. performed data mapping documents for the movement of data from production databases to the warehouse. Involved in designing and developing Data Models and Data Marts that support the Business Intelligence Data Warehouse. Worked in creating the Enterprise Data Warehouse (EDW) and assisted in Extraction, transformation and loading (ETL) process.
• Developed and executed test cases verifying data transfer quality. Assisted the Testing team in creating Test Plans, Test Scenarios, Test Cases and collect Test Data for successful completion of Integration and Functional testing. Provided support for User Acceptance Testing with UAT cases and resolved issues with the users.
• Generated multiple reports using SQL and in-house reporting tool for analysis and decision making.

Environment: MS SQL, MS Visio, MS word/power point, MS Excel, SWOT Analysis, Risk Management, Conflict Management, Pareto analysis, Effort and Impact analysis, Regression analysis, Why-Why analysis.