SUMMARY:

• Facilitator between Business Systems and Information Technology with 7 years of various environment experiences in the field of business analysis and project management.
• Advance knowledge of the Systems Development Life Cycle (SDLC), and project life cycles like Agile, Rapid Application Development (RAD), Extreme Programming (XP),Rational Unified Process (RUP)
• Experienced in conducting GAP analysis, User Acceptance Testing (UAT), SWOT analysis, Risk Analysis and mitigation plan, Cost benefit analysis and ROI analysis.
• 4+ years of experience in using Informatica PowerCenter ( 7.1.3/8.6.1 )
• Extensive experience with Business Process Management (BPM).
• Have extensive knowledge on Explanation of Benefits (EOB), Coordination of Benefits (COB), Facets, EMR, EHR, PPACA (Obamacare), MMIS, HIX (Health Insurance Exchange)
• Extensively worked and presented several documents and Use Cases for multiple transactions include 837I, 837P, 835, 276, 277, 270, 271(both inbound and outbound) transactions for ongoing industry projects.
• Good knowledge of Health Insurance Plans (Medicare Part A, B, C and D), managed care concepts (Medicaid and Medicare) and experienced in determining the membership eligibility, billing experience within life and disability in health plans.
• A sincere, committed, quick learner, oriented, motivated team player with excellent communication, analytical, leadership, interpersonal and problem solving and management skills. Exceptional Problem Solving and Sound Decision Making capabilities, along with the ability to resolve difficult situations.
• Strong knowledge and working experience of industry standards such as HIPAA, HL7, Six Sigma, and SOX, ICD - 9, ICD-10 coding, EDI (Electronic data interchange), transaction syntax like ANSI X12
• Participated and actively functioned in Joint Application Development (JAD)
• Strong Experience in Test Plans development, Test Conditions and Test Cases, test data creation and analysis, interaction with the development team for error detection and correction.
• Experience in understanding database structures and write SQL/PLSQL.
• Worked on System Changed Requests Issue resolution related to Medicare and Medicaid.
• Vast experience in requirement gathering for business and application requirements, business processes, identifying risks, impact analysis, UML modeling, Sequence and Activity Diagrams using Rational Rose and Microsoft Visio.
• Have worked intensively on the PL/SQL for creating and working on the database for multiple projects.
• Experience in gathering reporting requirements from the business users for Business Intelligence, Data Warehouse application.
• Experience in writing Test Plans, Creating Test Suites, Test Cases/Test Scripts, Defect Tracking.
• In house experience with project management tools like MS-Project, JIRA, Creative Pro Office for status reporting, planning and error tracking and correcting.
• Proficient in working with UML development tools like MS Visio, Enterprise architecture framework, UML2 Tools, and Power Designer etc.
• Extensive management background within varied sectors of the healthcare industry including HMOs, PPOs, Integrated Hospital Systems, Out-Patient Surgery Centers, Dental and Vision

TECHNICAL SKILLS:

Business Analysis: MS Visio, Test Manager, UML,SQL

Project Management: MS Project (Server), Creative Pro Office, JIRA

Operating System: Windows, UNIX, Linux, Mac OS

Languages: C++, Java, VB, HTML, XML, SQL, PLSQL, C#, JavaScript

Application: Microsoft Word, Microsoft Excel, Microsoft PowerPoint, Microsoft Access, Visual Studio, Eclipse, Share Point

Database: MS SQL Server, Oracle, MS Access

Other Tools: SQL*Plus, Apache Tomcat, Business Objects, Net beans

PROFESSIONAL EXPERIENCE:

Business System Analyst

Confidential, Irving, TX

Responsibilities:

• Attended Live Meetings, daily scrum meetings and JAD sessions with business users and matter experts
• Attended JAD sessions for Requirement Validation to gather requirements for the Patient revenue.
• Documented technical requirement document and functional requirement documents.
• Designed and developed Use Cases, Activity Diagrams and Sequence Diagrams using UML.
• Designed Conceptual, Logical and Physical data flow diagrams using MS Visio tool.
• Documented business requirement document towards Patient Refund system.
• Validating Interfaces for each vendor system and testing interfaces using XML mapping.
• Followed AGILE methodology, created self-organizing team, induced enhanced communication for quick. Obtained & recorded Business Approvals, Quality Review Approvals, and Architectural Approvals for future references & cross validations.
• Data mapping on different Interfaces using with XML and JSON files.
• Analyzed Supply chain management and Human capital management reports using Lawson ERP system by INFOR.
• Worked on GAP analysis for different vendor system analyzing their current state and future state for data transformation in ERP.
• Working with data migration from INFOR cloudsuite to different vendor systems.

Environment: UML, MS Word, MS Share Point, MS Access, IBM Service Bus, IBM Router, Rational RequisitePro, Lawson, Quality Center, SQL, FTP, SSTP, MFT, MS Excel, INFOR Financial services.

Business Analyst

Confidential, Tampa, FL

Responsibilities:

• Conducted formal interviews, Live Meetings and JAD sessions with business users and matter experts.
• Designed and developed Use Cases, Activity Diagrams and Sequence Diagrams using UML.
• Documented business requirement document towards new MMIS system.
• Documented, identified, organized and tracked the requirements using Rational Requisite Pro.
• Developed ETL programs using Informatica to implement the business requirements.
• Created Data Flow Diagrams (DFDs), ER diagrams for data modeling and Web-page mock-ups using MS Visio for acceptance from end users.
• Defined project milestones, schedules, and monitored progress using MS-Project, creative pro office and modified, updated the project scheduled plans as required.
• Analyzed and tested Data Interface needs.
• Worked on System Change Request (SCR) sent by the clients to change the current work process and work methodology for some pre entered process using IBM Lotus Notes, Microsoft Access and Microsoft SharePoint.
• Worked extensively on both inbound and outbound transactions, creating test cases for multiple transaction types including 837, 835, 276, 277
• Worked on changes for HIPAA Transaction from version .

  Documented the detailed business as well as technical requirements to upgrade the current system to 5010 transactions.

• Got involved in designing future state processes for HIPAA 5010 transaction processing EDI’s 837,835, 270, and 271.
• Analyzed HIPAA 5010 related to 837,835, 270, and 271. Transactions and performed gap analysis between the 4010 and 5010.
• Intensive working on the current ICD code conversion from ICD 9 to ICD 10, assisting and leading various teams by complying with already going works in the health care domain and work with the conversion.
• Gap Analysis: Analyzed the client’s applications programs to determine the impact of the HIPAA final rule on EDI Transaction Set and Code List implementation and defined the changes to bring the affected systems into HIPAA compliance.
• Performed unit testing at various levels of the ETL and actively involved in team code reviews
• Worked with FACETS Team for HIPAA Claims Validation and Verification Process (Pre-Adjudication).
• Maintained Requirement Traceability Matrix (RTM) and Utilized Clear Quest for change requests and defect tracking.
• Documented reports and sheets for better decision making using Lawson software tool.
• Claim validation and Pend/Denied Claims Analysis for the Health plans Medicaid programs.

Environment: UML, MS Word, MS Share Point, MS Access, IBM Lotus Notes, IBM Main Frame, Rational RequisitePro, Lawson, Quality Center, SQL, FTP, Informatica PowerCenter 7.1.3/8.6.1 , Informatica PowerExchange 8.6.1

Business Analyst

Confidential, Columbus, OH

Responsibilities:

• Conducted requirement gathering sessions with the Information Technology team.
• Attended JAD sessions for Requirement Validation to gather requirements for the new MMIS.
• Developed Use Cases, Activity diagrams and Sequence diagrams from the requirements based on the UML methodologies using MS-Visio.
• Involved in the design and development of User Interfaces (UI) using HTML, JavaScript and JSP.
• Held periodical meetings with the Development team to gather information on the progress and resolve project issues.
• Used Microsoft SharePoint as the version tracking tool for managing the requirements documentation.
• 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.
• Performed the Gap analysis on the earlier systems, generated a detailed Requirements document describing new system architecture through Use Cases and Activity diagrams.
• Requirement Traceability Matrix (RTM) was maintained through RequisitePro to keep the timelines and milestones in check.
• Helped the testing team in carrying out manual testing and also assisted in writing test cases and a Test Plan.
• Tested the final application for Usability testing to verify whether all the User Requirements were catered to by the application.
• Bugs that would enhance the usability of the application were logged using Rational Clear Quest.
• Tested the features and functions based on priority using Rational Quality Manager.
• Involved in preparing a simple and detailed User manual for the application, for an intended novice user.

Environment: Rational RequisitePro, Rational Rose, UML, MS-Project, MS Visio, Java, MS Office, Windows, Microsoft SharePoint, RQ, Lawson

Business Analyst/ ETL Informatica Developer

Confidential, Lemoyne, PA

Responsibilities:

• Gathered Business Requirements. Interacted with the Users, Designers and Developers, and the Project Manager to get a better understanding of the Business Processes.
• Collected, documented and managed business requirements, functional requirements and non-functional requirements using MS Word.
• Performed data manipulations using various Informatica Transformations like Filter, Expression, Lookup (Connected and Un-Connected), Aggregate, Update Strategy, Normalizer, Joiner, Router, Sorter and Union.
• Facilitated meetings with the technical team and client team to analyze the current process and gather requirements for the proposed process.
• Presented several documents and Use Cases for multiple transactions and worked with ANSI X12 5010 and ANSI X12 4010 including the standards for medical transactions like 837I, 837P, 835, 276, 277, 270, 271 (both inbound and outbound) transactions.
• Created System Requirement Specifications (SRS) document entailing business rules, conditions, calculations, triggers, visual representation, type of text (smart text, static text, free text, special formatting, metrics) of various dynamic elements present within the reports.
• Followed AGILE methodology, created self-organizing team, induced enhanced communication for quick issue resolution & minimization of change control processes & its impacts. Obtained & recorded Business Approvals, Quality Review Approvals, and Architectural Approvals for future references & cross validations.
• Played a key resource as Business Analyst, Systems Analyst & Data Analyst during the entire SDLC phases of the project.
• Conducted meetings with business/ corporate editor to capture information and create Large & Small Group Renewal Package Mockups (reports) in Power Point.
• Responsible for the HIPAA 4010/5010 compliance lifecycle from gap analysis, mapping, implementation and testing process of Medicaid Claims in the new MMIS system.
• Responsible for mapping documents, test plan, test scenarios, test cases for unit, system and system integration testing.
• Develop the mappings using needed Transformations in Informatica tool according to technical specifications.
• Analyzing supply chain and financial reports for the system by using Lawson tool.
• Developed UAT test cases associated with the functional requirements.
• Used the Rational Unified Process (RUP) to build the different phases of Software development life cycle.
• Involved in GAP analysis around the identification of business rules, business and system process flows, user administration, requirements and assumptions.
• Worked with the developers to make sure that the mapping for the transition from the ICD-9 code sets to ICD-10 code sets was implemented properly and also made sure that the new ICD-10 code sets were compliant with the new 5010 standards.
• Wrote policy or procedure handbooks/manuals for use in a child welfare business operations
• Conducted GAP analysis of the transition from HIPAA EDI 835 (Payment and remittance) and 837 focusing on how current transactions and system was going to be effected by the new 5010 compliance.

Environment: Rational Unified Process (RUP), SQL, MS Visio, MS Project, MS Office, UML, Windows, HP Quality Center, Lawson, Informatica 8.6 .1

Business Analyst

Confidential -- New York, NY

Responsibilities:

• Conducted Gap analysis, SWOT analysis, Decision Point Analysis, Communication Analysis, Business Rules Analysis, Document Analysis and other related analysis such as Scope creep assessments and Goal Orientation Assessments.
• Involved in assisting Project Manager in the analysis of resource utilization, Budgets and project planning using MS Project.
• Resolved pre-UAT and post-UAT issues for the final acceptance document to be signed by the client/ Business Owners.
• Gathered analyzed and documented business and technical requirements from both formal and informal sessions and validated the needs of the business stakeholders. Conducted user interviews and documented business and functional requirements into the Product Backlog.
• Performed Requirement Analysis by gathering both functional and non-functional requirements based on interactions with the process owners & stake holders and document analysis, represented them in Requirements Traceability Matrix (RTM).
• Performed Gap Analysis to check the compatibility of the existing system infrastructure with the new business requirements.
• Extracted, discussed, and refined User and Business Process Requirements from SME's from Business User Groups. Also, co-authored User and Functional Requirements Documents by interacting with development team.
• Providing part time support to testing team to implement business logic into system at the time of testing & execution
• Used Electronic Medical Record (EMR) to extract useful information regarding patients for claim submission to the insurance company.
• Gathered information and knowledge on ICD 9-10 and HIPAA 4010/5010 as well as Developed the transaction process more accurate and real time regarding 837 including HIPAA Government Regulatory Compliance and also integrated the system with HL7 process.
• Analyzing of system requirements and Use cases involved in the product development for writing of Test cases
• Performing GAP analysis to derive requirements for existing systems enhancements.
• Designed and developed Use Cases and Use Case Scenarios using the UML methodologies
• Synthesized User Interface and Business Process Requirements and translated it into the Business Requirement Document (BRD), to be use as input to the functional design specifications
• Creating Test Plan, Test Cases, Test Scripts, and Test Procedures as per the requirements.
• Work with upper management of medical management department to identify and brainstorm solutions for bottlenecks and errors of ongoing reports.
• Conduct elicitation meetings gather/refine specifications and design reports that would satisfy business needs.
• Worked on all phases of data warehouse development lifecycle, from gathering requirements to testing, implementation, and support.
• Upgrade and QA reports in order to make sure they accommodate various new health care plans and data.
• Manage the development of multiple reports in order to consolidate information that would assist upper management of various departments in making enterprise decisions via Tableau.
• Creating of verifying Tableau reports by writing complex SQL statements with joins, aggregate functions, and filter &search criteria to verify the integrity and correctness of the report outputs.
• Worked in the Agile methodology-using Scrum, which has its primary focus on the management part of the software development in small iterations of four weeks' sprint. Created user stories for all the release, sprint planning, daily standups, grooming & planning sessions with team.
• Involved in advising other groups in organization on SSIS development, data warehouse development, and ETL development best practices.

Business Analyst

Confidential

Responsibilities:

• Drove the requirement-gathering phase (Provider, Claim components and HIPAA).
• Interaction with the business user and the IT team for understanding the requirements.
• Work with business representatives to understand data marts requirements and priorities and ensure that IT work is appropriately aligned
• Conducted workflow, process diagram and gap analysis to derive requirements for existing systems enhancements
• Conducted joint discussion sessions with business users, stakeholders to understand the requirements in more detail
• Responsible for creating business work flows and processes and creating management reports based on the analysis.
• Used the Rational Unified Process (RUP) to build the different phases of Software development life cycle.
• Analyze the market trends, behavior, habits etc by collecting relevant data at various point and organizing the data into appropriate data warehouses and data marts the processing the data into various statistical reports (ad-hoc/canned for strategic management decision making) by utilizing SAS
• Applying the SQL scripts to the test database and execution of the scripts on the database
• Studied Oracle 11i data elements and provide a mapping from the existing legacy system.
• Worked with ANSI X12 4010 including medical transactions such as 837 (medical claims), 835 (medical claim payments), 270 (eligibility inquiry), 271 (eligibility response), 276 (claim status), 277 (claims status response), 820 (enrollment).
• Incorporated HIPAA standards, EDI (Electronic data interchange), transaction syntax like ANSI X12
• Worked on Medicaid and other claims processing division of the company.
• Followed the UML based methods using Rational rose to create use cases, activity diagram, sequence diagram, collaboration diagram that include functional and non-functional specifications to hand off to development teams.
• Data mapping, logical data modeling, used SQL queries to filter data within the Oracle database tables.
• Created and tested Scripts for the premium calculations and Claims limits and deductibles (Claims calculations).
• Developed Base line scripts for testing the future releases of the application
• Came up with test cases for various reports on the data marts and identified that the test case documents are updated timely.
• Clarified QA team issues and reviewed test plans and test scripts developed by development team and QA team to make sure all requirements have been covered in scripts and tested properly.
• Maintained Test Matrix with the test results obtained.

Environment: Windows, UNIX, C++, Java, HTML, XML, Oracle, Rational Requisite Pro, UML