SUMMARY:

• Senior Business Analyst with 10+ years of industry wide experience in the various domain like Healthcare, Insurance and Mortgage with solid understanding of Business Requirement elicitation techniques, Business Requirements Gathering, Business Process Flow and Business Process Modeling.
• Comprehensive knowledge of software development methodologies such as Waterfall, RAD, RUP and AGILE SCRUM.
• Adept at preparing Business requirements documents (BRDs), Functional requirements documents(FRDs), defining project plans and delivering project reports
• Expertise in Project Planning, Project Design, creating functional specifications and data flow diagrams.
• A Business Analyst/Quality Assurance Analyst with extensive experience in business process design, gathering requirements and system testing in fields as diverse as Healthcare and P & C Insurance.
• Lead and worked with teams to examine and solve business problems by accurately analyzing the needs of clients and helping them achieve improved quality and value for their customers, strong leadership and mentoring skills, and highly proficient organizational and computer skills
• In depth knowledge of RUP's Iterative Software Development Life Cycle (SDLC) process, Agile Software Development and Waterfall models.
• Sub Ledger & General Ledger, Ledger Reconciliations and control, Accrual Processing

  Data Warehouse Data Analysis, SQL, Oracle, Oracle BI, Data modeling.

• Experience in developing Test Plans, Test Scenarios and Test Cases based on functional requirements.
• Experience with health care systems: QNXT, FACETS, Medicare Part A, B, C, D, Medicaid systems, and validating General Equivalency Mappings (GEMs), Technical Report Type 3 (TR3) Implementation Guide, and Companion Guide.
• Very good experience in creating SQL queries to check and review Global Payment Plus (GPP) monthly sample data with raw data stored in “GPP Recon” database for quarterly data quality checks and storage maintenance.
• In - depth knowledge of Healthcare organization operations including outsourced operations, Health Insurance, HIPAA, and Medicaid/MMIS, including MITA.
• Mentored other team members on the development & support of HL7 interfaces for clinical applications.
• Knowledge of HL7 and/or X12 standards, segments and fields required
• Strong background of analysis of HL7 and / or X12 workflow documentation
• Significant Epic EMR work experience, tasked with building, implementing and supporting the Epic application from both the end user (clinical) and technical perspectives.
• Solid Epic experience that includes participation in all phases of EMR implementation; project planning, workflow analysis, design, build, validate (DBV), “go-Live” training delivery, on-site support, and post go-live optimization.
• Extensively worked with different X12 Hierarchical Levels (HL structures) in various inbound claim/inquiry-response transactions (837 P/I/D, 270/271, 276/277).
• Involved in testing HIPAA Database, which incorporates all the HIPAA (Health Insurance Portability and Accountability Act) transaction sets
• Worked on development and implementation of policies, procedures and QA methodologies
• Gathered requirements to check HIPPA- eligible & participation check for individual coverage.
• Technical and business knowledge in multiple disciplines/processes.
• Strong understanding of HIPAA Transactions & Code Sets Standards like (820- Premium Payment for enrolled health plan members, 834- Enrolment /Disenrollment to a health plan, 835, 837 ...etc.)
• Strong understanding of Mortgage banking, Credit Approval System, MBS, SOX and Basel accords and Investment banking (Stock exchange, Fixed income, Stocks/bonds, equities, options/futures, trading operations, mutual funds etc.)
• Experienced in working with SMEs from various business areas related to Loan origination, loan Processing, underwriting, closing, post closing, Loan Monitoring/servicing
• Knowledge of Mortgage Loan Origination, Servicing, Closing, Loss Mitigation, Loan Modification, Appraisal, Credit, Income and Title functionalities.
• Skilled at performing GAP analysis, Financial Analysis, User Acceptance Testing (UAT), SWOT analysis, Cost benefit analysis and ROI analysis.
• Plan, Design and implement application database code objects, such as tables, stored procedures, user defined functions, triggers, SQL, packages, cursor & schedulers etc. in windows environment.
• SQL query optimization and tuning by choosing proper access plan.
• Build SQL scripts, indexes and complex queries for analysis, extraction & creation of data on client server.
• Experience in executing Test Cases to test the application functionality against the requirements manually.
• Excellent skills in Business Analysis, OO Analysis, Data Analysis, Requirement Analysis, Business Modeling and Use Case Development using UML methodology, Project Management Methodologies include RUP, SDLC, and Waterfall
• Excellent communication and presentation skills. Experience working with business user as well as senior management

TECHNICAL SKILLS:

Methodologies: Agile, Waterfall

Requirement management tools: QC, Rally Dev, JiraProject management tools: MS Project, Sharepoint, Visio

Business Modeling: MS Visio

Defect tracking: Rallydev, Jira

Web technologies/languages: SQL, HTML, Java, XMLFront-End tools: Microsoft Excel, Word, Power Point

Database: MS SQL Server, Oracle, Access

Applications: Facets, QNXT

PROFESSIONAL EXPERIENCE:

Confidential, El Paso, TX

Business System Analyst

Responsibilities:

• Submit and gain approval of EDI encounter transactions with State of Texas
• Worked on QNXT including Claim processing (online and batch adjudication), Case management, Customer service, Member/subscriber administration, Provider network management and reporting.
• Analyze change requirements for Providers, Contracts and Claims processing modules configuration in QNXT system for Medicaid and Medicare Advantage.
• Worked on configuration of Providers and Contract - Provider demographics, Provider Contract and Contract Info using QNXT.
• Develop strategic alliances with national payers and local healthcare leadership to achieve market growth opportunities.
• Engage and collaborate with payers in negotiating value-based APMs reimbursement agreements with a population health approach including, bundled payments, gain-sharing, and other shared-risk partnerships with integration of technology solutions.
• Worked on claims, Claim adjudication Membership, Eligibility, Accumulators.
• Responsible for system integration testing of 837 claim files, 834 eligibility files and 270/271 interface files to ensure required interactions are met during the SDLC process.
• Gathering Requirements from business, created BTRDs, BRDs, TDD and supported technical and testing team. Prepared Business Process Analysis/End User Education/Business Requirements Documentation.
• Serve as data/systems expert and share best practices/approaches for statistics, machine learning techniques and data modeling.
• Write simple and complex SQL statements to pull data from various data storages for data validations and analysis. Create data modeling and functional data design translating user requirements into database.
• Manages and leads all aspects of EMS training program including budget management, human resources and student oversight, program planning and regulatory compliance.
• Helped with inclusion of Export Management System (EMS) Guidelines.
• Validated System configuration, including enrollment, provider and benefits modules
• Creation of queries and reports to assist Health Plan Operations with the analysis of data relating to claims, members and providers.
• Execution of daily, weekly and monthly reports and processes and the creation of ad-hoc reports.
• Broad knowledge of CCHP departmental processes, procedures and data.

Environment: QNXT, RUP, Rational Rose, Requisite Pro, MS Visio, RUP, MS Project, SQL, Oracle, MS Access, MS Excel and MS Word.

Confidential, Owing Mills, MD

Business System Analyst/QA Analyst

Responsibilities:

• Responsible for the development and implementation of HIPAA EDI Data Mapping artifacts 270, 271, 274, 276, 277, 820, 834, 835, 837.
• Performed User Acceptance Testing for the ANSI X12 Version 5010 / EDI transactions (HIPAA) for Claims Status and Eligibility (270, 271, 276, 277, 834, 837P, 837I, 837D, 835 remittances and NCPDP Claims).
• Developed HL7 messaging for bi-directional case and disease report exchange, in HTML and XML formats, in accordance with HL7 specifications.
• Performed Gap Analysis by identifying current technology, policies, procedures, documenting the enhancements for the requirements, and analyzing new HIPAA 5010 compliance and developed an action plan for the migration process.
• Worked as a liaison between the business client and development team for the implementation 5010 transition in compliance with HIPAA standards.
• Involved in analyzing and understanding Business Epics.
• Clarifying requirements which are not clear with Business Analyst.
• Collecting test data for requirements to perform testing.
• Analyze requirements to ensure testability, report gaps and discrepancies.
• Creating and executing test cases for GUI, Sanity, Smoke, Functional and Regression testing.
• Performed Peer review for testing related documents Test cases, Test Plan and Release summary document
• Executing test cases and log defects in JIRA.
• Retest the scenarios post defect fix.
• Adding scenarios, test data and screen shots used for testing to Test Ready User Stories in JIRA.
• Prepared and present weekly status reports to management
• Played active role during daily scrum meeting and task planning as part of agile methodology
• Interacted with offshore team to share & provide required information on planned work items for the sprint.
• Internal review of user stories with management for scenarios/test data/screen shots prior demo.
• Participated in Sprint Demo sessions with business.
• Involved in giving KT to the new member of the team.
• Performed Integration testing of ACMP application.
• Well versed with Microsoft SharePoint to manage project related documents.
• Involved in writing complex queries in SQL Server.
• Involved in Functional Design review meetings.
• Participated in daily offshore & onsite meetings on daily task assignments.
• Involved in Sprint retrospective meetings scheduled at the end of each sprint.
• Coordinated with team members to share work items based on the priority and completed in timely manner
• Maintained good relationship with in the team and was active team member
• Involved in UAT & SIT Concerns meetings.
• Involved in Planning & Product Backlog Grooming User Stories with Business Analyst and Team members.
• Participated in Defect Triage call to discuss open defects and Defect clarifications.
• Maintained Defect/Issues/Observations Tracking sheet.

Environment: SQL, HP Quality Center, Agile, ALM, Windows XP, MS Excel, MS word, VM ware.

Confidential, Louisville, KY

Business Analyst

Responsibilities:

• Gather requirements and document the proposed processes to the existing system. Modules included: Claims Processing Files and HIPAA Guidelines adherence across the company.
• Experience in configuration of claims processing applications, claim adjudication process, claims management process, real time claims adjudication, Electronic Medical Records / Electronic Health Records (EMR/EHR) and Medicaid Management Information System (MMIS), and Medicaid Information Technology System (MITS).
• Worked on claims, Claim adjudication Membership, Eligibility, Accumulators.
• Enhanced applications associated with Claim Numbers so that duplicate Claim Numbers could be allowed in the system. Updated the Electronic Claims, Patient Screen and Sales Administration processes.
• Claim Transactions and Billing Transactions - Created flows for adequate matching of Claims. Matched Billing File and EDI Claim File records upon receipt.
• Worked on claims, Claim adjudication Membership, Eligibility, Accumulators.
• Responsible for system integration testing of 837 claim files, 834 eligibility files and 270/271 interface files to ensure required interactions are met during the SDLC process.
• Involved in creating and executing test cases, test plans and test scripts for EDI 837 Claims (I & P) Transactions.
• 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.
• 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.
• Performed Data mapping to validate and customize Claims daily load into the system for processing the transactions.
• Validated Inbound and outbound 837 transactions, including but not limited to the loading and correcting any errors with the process of EDI inbound and outbound files
• Created Test File to be sent to the Vendors for approval. Worked on a Paid without prejudice project for various States.
• Testing - Developed Test Scripts using Quality Center and coordinated with developers to quickly resolve the defects associated with them.
• Conducted JRP sessions and JAD sessions with the management, users and other stakeholders for open and pending issues to develop specifications.
• Planned the entire Data Warehousing initiative from requirements gathering, analysis, design, identifying and analyzing the source systems, to data quality, to ETL, and to the end user data access.
• Provided release management strategy checklists and change management techniques.
• Presented and assisted end users for education and training about the new system.
• Generated reports using SQL and MS Excel spreadsheets.
• Involved in Source Data Analysis, analysis and design mappings for data extraction.

Environment: Windows, Oracle, MS Office (MS Word, MS Excel, MS PowerPoint, MS Visio), MS Access, Agile, SQL, ETL, UML, Quality Centre, and SharePoint.

Confidential, NYC, NY

Business Analyst/ Systems Analyst

Responsibilities:

• Facilitated collection of functional requirements from system users, and prepared business and technical requirement specification documents.
• Interacted with the Subject Matter Experts (SMEs) and stakeholders at the JAR session, gathering business requirements to get a better understanding of client’s business processes.
• The Agile-scrum SDLC was used and I participated in writing user stories to track requirements and used SharePoint to share and maintain the document versions.
• Conducted the scrum meetings as the scrum master, and helped maintain the product backlog and sprint backlog. Co-ordinated with scrum team for efficient delivery within designated sprint cycle.
• Created Use Case Diagrams, and Use Case Specification document (USD). Validated the following: 837 (Health Care Claims or Encounters), 835 (Health Care Claims Payment/ Remittance), 270/271 (Eligibility request/Response), 834 (Enrollment/Dis-enrollment from a health plan).
• Prioritized project efforts, developed project plans, process flows and SRS using scrum. Researched the existing client processes and guided the team in aligning with the HIPAA rules and regulations for the systems for all the EDI transaction sets.
• Conducted JAD sessions with management, SME, vendors, users and other stakeholders for open and pending issues.
• Assisted with the implementation of web services meant for Long Term Support for Inpatient Psychiatric Services for Individuals under age 21 and Services for individuals age 65 or older in an institution for mental diseases.
• Used Unified Modeling Language (UML) for process modeling and use cases.
• Generated daily, weekly, and monthly reports using MS Office Tools and submitted to the Team Leads and Manager for reporting, status reporting and analyzing purpose.
• Developed gap analysis document, logical and physical design and remediation plan.
• Captured, communicated, managed system requirements and maintained requirement tractability matrix to keep team members up to date with the latest testing results.
• Responsible for training and testing of transactions. f member enrollment and benefits, batch jobs corresponding to the claims (837) and real time transactions like 270/271/276/277.
• Analyzed existing procedures and reported to management to improve productivity.
• Involved in creation of test plan, test scenarios, test cases for unit, system and system integration testing using HP-ALM.

Environment: Agile-scrum, MS Project, MS Office Suite, QNXT, SQL, UML, MS Visio, Requisite Pro, Clear Case, Rational Clear Quest.

Confidential, Louisville, KY

Business Analyst

Responsibilities:

• Worked and acted as a liaison between business users, all internal IT staff, program managers and clients to elicit and document business, functional and non-functional requirements using agile methodology.
• Worked on multiple projects at a time and successfully handling the deployment dates.
• Interacted with Pharmaceutical and Healthcare clients and working on enhancement of the healthcare projects.
• Involved in HIPAA/EDI Medical Claims Analysis, Design, Implementation and Documentation.
• Involved in preparing the Test Scenarios for Health Care Claim Payment/Advice.
• Developing specifications, diagrams and flowcharts to assist the process.
• Assisting with the documentation and reporting of defects, errors and issues.
• Assisting and providing support during User Acceptance Test and Deployment phase.
• Helped in controlling and coordinating release scope, coordinating change requests and change tracking.
• Helped in developing and maintaining team processes, procedures, and templates to continuously improve release quality and deployment schedule.
• Wrote test plans and test cases for the projects.
• Acted as a Project manager whenever the project demanded.

Environment: Windows, MS Office (MS Word, MS Excel, MS PowerPoint, MS Visio), MS Access, Agile, SQL and SharePoint.

Confidential, Plano, TX

Business Analyst

Responsibilities:

• Obtained a detailed knowledge of business process involved in the project environment.
• Gathered requirements from Business Partners.
• Established Business Analysis methodology using Agile Extreme Programming to create Architecture and Interaction models.
• Interacted with numerous internal groups and formed productive and positive working relationships with staff with varying technical and business backgrounds and skill levels across the organization.
• Used business process modeling techniques for reengineering.
• Conducted Gap Analysis to show the current and proposed functionalities of the system.
• Generated reports using business objects.
• Extensively involved in JAD sessions to converge early towards a design acceptable to the customer and feasible for the developers.
• Involved in the back office operations using data from Bloomberg.
• Generated advanced reports related company's performance that would help the business users in managing their portfolio.
• Helped the business users in portfolio management by giving additional information such as; beta value, Confidential price and performance charts for the last five years.
• Created artefacts and defined milestones and iterations plan for inception and elaboration phases.
• Assisted in testing the application whether all the user requirements were catered to by the application.
• Reviewed loan applications and analyzed data required to process loan documents and performed validation to ensure loan documents are transmitted to appropriate departments.
• Created Test Plans and Test Cases for GUI and database testing by analyzing the Business requirements specification document.
• Involved in preparing a simple and detailed User manual for the application for intended users.
• Expertise knowledge of pricing and selling of stocks, bonds, securities, investment assets.
• Developed database triggers, procedures and functions to monitor the business functionality and needs.

Environment: Windows, SQL, Microsoft Office tools, Business Objects, Rational Requisite Pro, Rational Clear Case, UML, Office 365,Compliance Calibrator, Open pages, Informatica Power Centre, DOORS

Confidential, Roanoke, VA

Business Analyst

Responsibilities:

• Identified processes for developing and documenting detailed business requirements. Data was collected from end-users, and analysts.
• Created Use-Cases and Requirements documents to document business needs.
• Requirements were gathered through interactions and meetings and periodic walkthroughs with loan analysts, credit analysts and other potential users of the application.
• Implemented new Account Transfers Training Documentation with 10-day training plan which was used to train new associates at the St Louis, Richmond, and Philippines sites.
• Conducted Use-Case reviews and identified gaps, leading to improvements/enhancements in the same.
• Worked on implementing of testing and migration and configuration for GPP.
• Worked on the implementation of the GPP process.
• Created and maintained the Requirements Traceability Matrix (RTM).
• Worked on Guidewire, extensively worked on Guidewire Policy center & Guidewire Claim Center
• Used GuideWire software to track the claims of the policyholders.
• Guidewire was specifically used by the team to implement the enhancement to expedite the claim process for unregistered users
• Used Guidewire to upgrade the current Claim system to track the claim of the policyholders and third party applications
• Involved with the testing team to check the augmentations done previously using Guidewire.
• Ensured Use-Cases were consistent and covered all aspects of the Requirements document.
• Maintained documents and the effect of proposed changes on the project schedule and costs.
• Used Rational Clear Quest for bug reporting.
• Documented the Use Cases and Activity diagram worked on COTS Integration and Application Architecture design. Created and maintained workflow plans and business process flows using MS Visio 2013.
• Worked directly with software engineers to ensure clear communications on requirements and defect reports.
• Designed and developed scenarios based on business requirements.
• Developed requirements integrating E-R diagrams and designed the testing process flows.
• Followed the RUP methodology for the entire SDLC.
• Used the guidelines and artifacts of the Rational Unified Process (RUP) to strategize the implementation of Rational Unified Process effort in different iterations and phases (Inception, Elaboration, Construction and Transition) of the Software Development Life Cycle.
• Interacting with other teams through walkthroughs, teleconferences, meetings, etc. to resolve various issues.
• Validated the scripts to make sure they have been executed correctly and meets the scenario description.

Environment: Windows2000, Rational Rose, Guidewire, Rational Unified Process, Rational Clear Quest, Oracle, and Microsoft Project 2000.

Confidential, Minneapolis, MN

E-commerce Business Systems Analyst

Responsibilities:

• Interfaced with Team Leaders to identify and analyze the given information, procedure and decision Flows.
• Worked with end users to Map Business Processes (BPM) to technical specification.
• Worked on BRD, and FSD.
• Created daily, weekly and summary reporting and performance insights for the following programs: even performance for tab, including Advertised vs. non-advertised sales, Power Hours, Early Birds, BOGO and like-themed events.
• Generated dashboards, metrics, analytics, goals, alerts using Business Objects XI enterprise edition to streamline processes and procedure.
• Responsible for POS installation in the Confidential store in Minneapolis area.
• Conducted previews and User Acceptance Test (UAT) sessions with the marketing team.
• Worked with system Analysts to create application’s Functional and Non- Functional requirement document.
• Developed USE Cases for the application and prepared the detailed Workflow Diagram based on the proposed enhancements, business logics and rules and translated them to USE Cases for Live Archive.
• Worked with application team in developing Test Plans, Test Scenarios, Test Cases, Test Matrixes, Test Reports and documentation of Manual and Automated Testing for POS implementation
• Devised extensive E-mail marketing campaigns regularly & kept a track of positive as well as negative feedback for improvisation.
• Collected Requirements Interviewing Stakeholders, Business Partners, and End Users.
• Organized JAD sessions with Business stakeholders/SMEs for gathering requirements for the new upgraded platform: estimated project resources, timing, and sequence of deliverables.
• Building templates and dashboards for customized views of the data specific to each group and line of business.
• Generated Real time statistics available to Upper management- via “Dashboards”.
• Produce different levels of prototypes to aid the design and usability testing process: interactive HTML prototypes, and wireframes.

Environment: MS- Project, Visio, Word, Access, Power Point, Excel, SharePoint, Office 365, Quick Base, Jira, Confluence Wiki, Outlook, Quality Center ;MS Access, Oracle, SQL Server; Windows, Server.