- Qualified professional with over Seven years of extensive experience in the field of Business Analysis, working with the technical staff to implement management and staff's business requirements into the software application in Healthcare Industry.
- Highly motivated team player with excellent communication, presentation and interpersonal skills, always willing to work in challenging and cross - platform environment.
- Highly proficient in working with users to gather requirements, analyze them and subsequently use the Rational project and design tools to model the requirements.
- In-depth knowledge of creating use cases, functional design specifications, activity diagrams, logical, component and deployment views to extract business process flow.
- Involved extensively in writing Agile User Stories and get them reviewed with Business lead and project manager for Sign Off.
- Good knowledge of Health Plans managed care concepts (Medicaid and Medicare) and experienced in determining the eligibility, billing experience within life and Disability claims in health plans with thorough understanding of CPT coding, CMS-1500 claim forms and reimbursement forms.
- Used Query Analyzer, Execution Plan to optimize SQL Queries.
- Extensively used rational tools for UML, tracking and reporting and applied the Rational Unified Process in all areas of a software development life cycle.
- Gathered and documented Non-functional requirements.
- Experienced in preparing Business Process Re-engineering Models
- Familiar with HIPAA EDI transactions such as 835, 837 (P, D, I) 276, 277, 278 etc
- In depth knowledge of SDLC and implementation of the Rational Unified Process (RUP) in all four phases of a project: Inception, Elaboration, Construction and Transition.
- Utilized a fusion of industry knowledge and technical programming to provide executive management the development and implementation of interactive busines s tools, and strategic analysis, vital for use in mission-critical decision-making
- Conducting requirement gathering sessions, feasibility studies and Impact Analysis and organizing the software requirements in a structured way using Rational RequisitePro to track development.
- Interacting regularly with the development team, creative services, database designer, system administrator and the higher management to meet the deadlines of Project milestones.
- Worked in close co-ordination with the testing team in developing test plan and test cases from functional and business requirements.
- Performed UAT and exposure to User Testing (UCT) and Operational Readiness Testing (ORT)
- Expertise in understanding and supporting the client with Project Planning, Project Definition, Requirements Definition, Analysis, Design, Testing, System documentation and user .
- Used Rational ClearQuest for tracking and prioritizing defects and for enhancements after base lining the requirements.
Programming Languages: C, C++, HTML, XML, SQL.
Data Base: MS Access, Oracle (SQL Series), DB2
Reporting Tools: Crystal Reports 8.0
Operating Systems: MS DOS, Windows95/98/NT/2000/XP, Apple McIntosh, Linux
Software: MS Office Suite(Word, Excel, Access, PowerPoint & Outlook), MS Visio, Rational Rose, Rational Requisite Pro, Adobe Acrobat, MS Office FrontPage, Lotus Notes
Performance Testing Tools: Virtual User Generator, Load Runner
Processes/Technologies: Rational Unified Process (RUP), Waterfall, UML & Microsoft Office SharePoint 2007
Automation Tools: Requisite Pro, Win runner, QTP, Test Director, Quality Center
Confidential, Santa Ana, CA
- Worked in accordance to the activities/roles laid down in each phase of software development life cycle created using Rational Unified Process
- Created specifications for EDI HL7 (A28, A31, ADT) and X12 (834/837) transactions that were transmitted between Claims Editor and Legacy Billing application and external Payers
- Worked as a Technical analyst/Business consultant with HealthEdge Payor system organization specifically for the clients POMCO and Riverside Benefits and claims administrative organization
- Organized meetings to elicit expert knowledge of the TO-BE business process in an effort to generate requirements
- Analyzed business requirements and created Use Cases, activity diagrams using MS Visio
- Conducted JAD Sessions to develop an architectural solution that the application meets the business requirements, resolve open issues, and change requests
- In depth knowledge of Medicare/Medicaid Claims processes from Admin/Provider/Payer side which were later part of the program to vendors.
- Trained the team on JIRA tool for Agile/ Scrum Methodologies.
- Utilized JIRA to develop and track Agile epics, stories and tasks.
- Experience in Medicaid Management Information System (MMIS). Expertise in various subsystems of MMIS- Claims, Provider, Recipient, Procedure Drug and Diagnosis (PDD), Explanation of Benefits (EOB).
- Updated requirements document, Use Cases, and FRS according to Change Control Committee’s approval of CR and the Traceability of the documents
- Work with CMS business owners to define their target goals and propose alternative business solutions
- Worked with 837, UB92, UB04, CMS 1500 claims and HIPAA 835, 270/271, 276/277, 278 transactions.
- Experience in CMS and MMA Guidelines.
- Worked on AGILE Environment with daily scrum meetings, grooming sessions, planning and sprint cycles.
- Good understanding of SDLC and STLC methodologies including Waterfall, Iterative, Agile and Scrum methodologies
- Performed GAP Analysis by comparing the existing system to the future system to create “AS-IS” and “TO-BE” flow charts and generating risk assessment
- Drafted a Traceability Matrix in Excel and imported it into Rational RequisitePro
- Worked as a liaison between the developers and the QA team in creating the Test Plan and Test Cases using Rational Test Manager. Generated test data, and assisted QA team with manual testing whenever possible
- Maintained and Reviewed Change Requests and documented all analysis
- Conducted User Acceptance Tests to ensure that all mutually agreed upon user requirements had been met and to gather additional requirements for enhancements to the application for future release
Environment: J2EE, XML, HTML,UAT,WebLogic, Oracle9i, MS Word, MS Outlook, MS PowerPoint, MS Visio, Rational RequisitePro
Confidential, Palo Alto, CA
Business Systems Analyst
- Gathered User and Business Requirements through interviews, surveys, prototyping and observing Stored and modified requirements.
- Liaised between technical and business teams for obtaining status/updates as well as sharing best practices.
- Created Need Analysis Documents of the requirements gathered through JAD and JRP individual elicitation sessions using MS Word.
- Experience in Claims Processing per Medicaid Management Information Systems (MMIS) 42 CFR 433.
- Created User Requirement Specifications (URS), Business Requirement Document (BRD) and Functional Requirement Specifications (FRS) documents.
- Created Use cases, Use Case Diagrams, Activity Diagrams, Business Flow Diagrams and Business flow diagram using Rational Rose and Rational Requisite Pro.
- Utilized JIRA to develop and track Agile epics, stories and tasks.
- Conducted brainstorming sessions with the business users and SMEs to elicit requirements and worked in the creation of Agile Epics, user stories, Acceptance criteria documents.
- Involved in analysis of the technical specifications of the current system and the infrastructure needs performed Gap analysis.
- Created complex stored procedures using SQL with multiple table joins and comprehended and isolated areas problems.
- Made Screen Mockups/Definitions and Dependencies using Excel.
- Extensively used SharePoint to document project processes and procedures, communicate requirement and version control them.
- Collaborated with Quality Assurance Analyst in Rational Clear Quest to track defects and used Rational Clear Case to maintain consistency in the builds.
- Experienced setting up test scenarios and executing on these scenarios and worked closely with testing team to make sure all the changes made to requirements documents are implemented in there Test Cases
- Maintained various versions of the documents generated during the project using Rational Clear Case
- Used Agile development methods to promote development iterations, team work, collaboration and process adaptability and strong experience with Scrum
- Created User Stories to capture all requirements.
- Set up definitions and process for test phases including Product test, Integration test, System test and User Acceptance Test (UAT).
- Provide technical, business, management expertise, and support the Department of Health and Human Services and Centers for Medicare and Medicaid Services \(CMS\) in building and maintaining a comprehensive enterprise architecture program
- Work with CMS business owners to define their target goals and propose alternative business solutions
- Conducted GUI testing, Functional Testing, Smoke Testing, Integration Testing, Performance and User Acceptance Testing on the application.
- Extensively worked on Mercury Test Director for bug reporting/tracking.
- Worked with SQL extensively to test database integrity.
- Involved in maintaining the Requirements Traceability Matrix (RTM) across the deliverables for a project
- Conducted Sessions to familiarize users with system.
Environment: Agile/Scrum, Rational Rose, Rational Requisite Pro, UNIX, MS Visio, MS Project, MS SharePoint, HTML, Windows, Oracle, SQL, people soft, IBM Web sphere, Business Intelligence.
- Gathered, analyzed, documented business and technical requirements from both formal and informal sessions and validate the needs of the business stakeholders.
- Performed Cost benefit, ROI and ROM studies
- Responsible for gap analysis in changing old MMIS and Involved in testing new MMIS.
- Responsible for Medicaid Claims Resolution/Reimbursement for peach state health plan using MMIS.
- Conducted user interviews and documented business and functional requirements.
- Performed Requirement Analysis and developed Use Cases, Activity Diagrams using Rational Rose
- Performed Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data
- Requisite Pro, Rational Rose, Agile, HL7 Interfaces, PL/SQL, HTML, MS Office, MS Visio, EDI, UML.
- Exposed to Agile methodology
- Provided business and mapping expertise during a transition of the EDI applications from the GXS Application Integrator (AI) to GIS
- Involved in creating business processes and modeling diagrams using Rational Unified Process (RUP).
- Created use case scenarios and documented work flow and business process using Rational Rose
- Involved in project management using MS Project
- Documented requirements, associated change requests with requirements and connected requirements with Use cases.
- Incorporated Rational Unified Process (RUP) to create Requirement Document Specifications using Visible Analyst.
- Performed extensive data modelling to differentiate between the OLTP and Data Warehouse data models
- Identified/documented data sources and transformation rules required populating and maintaining data warehouse content.
- Used Rational Clear case for version control
- Responsible for creating test scenarios, scripting test cases using testing tool and defect management for Policy Management Systems, Payables/Receivables and Claims processing.
- Involved with all the phases of Software Development Life Cycle (SDLC) methodologies throughout the project life cycle.
- Strong knowledge and experience in Healthcare industry. Functional knowledge of Medicaid Management Information System (MMIS).
- Served as conduit for managing system requirements between the business and the software development team.
- Queried database using SQL for backend testing
- Used Rational clear quest for defect management
Environment: Windows XP Professional, Oracle9i, MS Access 2000, MS Excel, RUP, Oracle, UML, Rational Rose, Requisite Pro, Clear Case 2002, Cognos, Rational Clear Quest 2002, MS Office suite, MS Visio 2003.
Confidential, Chicago, IL
Business Analyst/Systems Analyst
- Responsible for defining the scope and implementing business rules of the project, gathering business requirements and documentation.
- Responsible for writing Functional Requirement Specifications (FRS) and User Requirement Specification (URS).
- Analyzed Business Requirements and segregated them into high level and low level Use Cases, Activity Diagrams / State Chart Diagrams using Rational Rose according to UML methodology thus defining the Data Process Models.
- Understand the As Is system and develop the To Be system concept and also prepare the System Process Maps.
- Interacted with the developers to report and track bugs using Test Director.
- Successfully conducted JAD sessions, which helped synchronize the different stakeholders on their objectives and helped the developers to have a clear-cut picture of the project.
- Conducted presentations of the Q/A test results with analysis to the stakeholders and users and documented modifications and requirements.
- Being able to adapt and work efficiently in an agile environment where the cumulative Standard Operative Procedure (CSOP) and Policy directives and decision Matrix documents were in process and unstable during the initial phase of the project.
- Knowledge of EMR/EHR, HMO/PPO/POS, Health Care Reform and Patient Protection and Affordable Care Act PPACA, Medicare Part A, B, C, D, Medicaid, Medicaid Management Information Systems MMIS, Medicaid Information Technology Architecture MITA.
- Provided data modeling support to each logical data model according specifications of EDM.
- Coordinating and Developing QA activities.
- Created Process Flow diagrams, Use Case Diagrams, Class Diagrams and Interaction Diagrams using Microsoft Visio and Rational Rose.
- Wrote Test Cases and performed User Acceptance Testing, documented the in detail defects using the Defect Tracking report.
- Used Test Case distribution and development reports to track the progress of test case planning, implementation and execution results.
- Wrote PL/SQL statement and stored procedures in Oracle for extracting as well as writing data.
- Created Use cases, activity report, logical components and deployment views to extract business process flows and workflows involved in the project. Carried out defect tracking using Clear Quest
- Maintained proper communication with the developers ensuring that the modifications and requirements were addressed and also monitored these revisions.
- Involved in compatibility testing with other software programs, hardware, Operating systems and network environments.
Environment: Requisite Pro, Rational Rose, PL/SQL, HTML, MS Office, MS Visio, EDI, UML.
Confidential, Washington, DC
- Met with client groups to determine requirements and goals. Utilized Rational Unified Process (RUP) to configure and develop process, standards, and procedures and create a Business requirement Document.
- Responsible for preparing Software Requirement Specification (SRS) and documenting them.
- Created Process Work flows, Functional Specifications documents and documented system requirements.
- Provide implementation assessment, strategy, and mentoring services for Rational Rose, UML and RUP.
- Interacted with various cross-functional teams on building business use cases, and understanding expenses and revenue stream.
- Successfully used Agile/Scrum Method for gathering requirements and facilitated user stories workshop. Documented User Stories and facilitated Story Point discussions to analyze the level of effort on project specifications
- Working with clients to better understand their needs and present solutions using structured SDLC approach.
- Interaction with the developers to report and correct bugs.
- Extensive knowledge of Medicaid, Medicare, Procedural and Diagnostic codes, Claims Process, Health information Exchange (HIE), Electronic Health Record (EHR) and Electronic Medical Record (EMR).
- Followed a structured approach to organize requirements into logical groupings of essential business processes, business rules, and information needs. Ensured that critical requirements are not missed.
- Aided management in standardizing web applications by preparing GUI standards and recommending alternatives for in corporation in a phased, iterative manner.
- Interacted with client and the Technical Team for requirement gathering and translation of Business Requirement to Technical specifications.
- Analysis of new Business Requirements and preparation of the Functional Design Specifications
- Interacted with clients like SPF Securities to finalize their website look and contents.
- Analysis of the new requests specified by the end users for the future releases and discussion with the functional and technical teams.
- Project Management Tools: MS Word, MS Excel, MS Power Point, Agile, Waterfall, RUP, Rally, Sharepoint, JIRA
- Communicated changes to requirements promptly and precisely to all personnel involved.
- Identified and clearly defined functional issues and support IT development staff throughout the design, development, unit testing, and implementation phases of the software development life cycle.
- Analyzed and translated business requirements into system specifications.