- Over 7 years of extensive experience as Business Analyst with solid understanding of Business Requirement Gathering, Business Process Flow and Business Process Modeling.
- Exposure to Healthcare and Insurance business domains.
- Experienced in all phases of Software Development Life Cycle (SDLC), including requirement gathering and documentation, use casing, functional specification, business case analysis, quality assurance and testing.
- Extensive knowledge of Rational Unified Process (RUP), Object Oriented Analysis and Design (OOAD) using Unified Modeling Language (UML), MS Visio, MS Project, Visual Paradigm, Waterfall model, Rational Rose, Requisite Pro, Rational Clear Case.
- Experienced in interacting with business users and executives to identify their needs, gathering requirements and authoring Business Requirement Documents (BRD), Functional Specification Documents, Use Case Diagrams, Activity Diagrams and Sequence Diagrams using UML modeling.
- Experienced in facilitating and conducting Joint Application Development (JAD), Rapid Application Development (RAD), interviews, workshops and requirement elicitation sessions with end - users, clients, stakeholders and development team.
- Experienced in Business Analysis, SWOT Analysis, Gap Analysis, Return on Investment, Cost-Benefit Analysis, Risk Analysis, Disaster Recovery Planning, Testing and Project Planning.
- Excellent knowledge of HIPAA standards, EDI (Electronic data interchange) Transaction syntax like ANSI X12, Implementation and Knowledge of HIPAA code sets, ICD-9, ICD-10 coding and HL7.
- Excellent knowledge and experience of creating source to target mapping, edit rules and validation, transformations, and business rules.
- Experienced in developing QA Strategies: Test Cases, Test Scripts and Test Procedures and conducting User Acceptance Testing (UAT) using QTP, HP Quality Center, Win Runner and Load Runner..
Business Skills: Business Process Analysis & Design, Requirement Gathering, Use Case Modeling, JAD/JRP Sessions, Gap Analysis and Impact Analysis.
Methodology: RUP, Agile, OOAD and Waterfall.
Standard and Codes: HIPAA, ICD-10, ICD-9, ANSI X12, HL7, CMM, ISO, CPT and CMS form.
Languages: C, C++, SQL, PL/SQL, HTML and XML.
Management Tools: Rational Rose, Requisite Pro, Clear Quest, Clear Case, Serena Team Track and MS Visio, MS Project.
Testing Tools: Test Director, Win Runner, Load Runner and TOAD.
Data Modeling Tools: ERwin, Informatica 7.1.1/6.5
Database: Oracle 8i/9i/10g, DB2, MS SQL Server.
Operating Systems: UNIX, Windows 95/2000/NT/XP.
Office tools: MS Office 2007 (Word, Excel, Power Point, Outlook), MS Visio, MS Project, and MS FrontPage.
Confidential, Kingston, NY
Sr. Business Analyst
- Extracted the business requirements from the end users keeping in mind their need to request for information about medical services offered to the customers and documented it for the developers.
- Identified system integration requirements, and coordinated the collection and verification of business needs.
- Documented Functional Requirements Specifications (FRS).
- Involved in the day-to-day implementation of the Rational Unified Process (RUP) methodology of application development with its various workflows, artifacts and activities.
- Identified features, Prioritized features, Identified Requirements by features and developed Traceability Matrix.
- Created activity diagrams and sequence diagrams using Rational Rose to communicate the system activity flow to the developer and QA team.
- Followed the Business Rules, and ensured that HIPAA compliant Rules are followed to display minimum benefit information that the Provider is required to pass on the EDI transactions.
- Managed the privacy and security environments of healthcare data that was governed by HIPAA and other government mandates.
- Generated and maintained clinical data security policies and procedures.
- Involved in analyzing the claims on basis of Primary and Secondary Payers and performed Medicare subsidy eligibility check for employee group plans.
- Involved in Documenting and Executing business test cases.
- Assisted developers and testing team to ensure that the requirements are communicated accurately and that the system being developed is verifiable against the requirements gathered.
- Assisted QA Team in executing the test cases and collected the test and process metrics.
- Involved in mapping and validation of different EDI transaction used for claims filing like ANSI X12 837 (I, P, D) for claim submission, ASC X 12 270/271 for the eligibility/benefit inquiry and response, ASC X12 276/277 for the claims status enquiry and response and ASC X12 835 for the healthcare claim payments.
- Involved in mapping data from different EDI files onto database using different routing transformations.
- Involved in evaluation of CPT codes and CMS-1500 claim forms used for billing.
- Involved with the coders in evaluation of CPT and ICD-9 codes to ensure that the diagnosis meets medical necessity for the specific CPT code.
- Assisted in developing help guide and presentations as per project specifications and timelines
Business Systems Analyst
- Mapped process flow; assess as-is processes through user interviews, data collection and analysis, design and evaluation of to-be process solutions.
- Prepared Business Object / Business Process Models that included modeling of all the activities of business from conceptual to procedural level.
- Designed and developed Use Cases using UML and Business Process Modelling.
- Consulted with healthcare insurance company to develop conversion specifications for other insurance Coordination of Benefits (including Medicare).
- Validated the following: 837 (Health Care Claims or Encounters), 835 (Health Care Claims payment/ Remittance), 270/271 (Eligibility request/Response), 834 (Enrollment/Dis-enrollment to a health plan)
- Identified gaps in the business process.
- Performed Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data
- Planned and defined system requirements to Wire Frame with Use Case, Use Case Scenario and Use Case Narrative using the UML (Unified Modeling Language) methodologies.
- Coordinating with the development team to set up test environment for issue escalation and issue resolution process for SIT and UAT testing to enable smooth operation
- Interacted with the users and logged any defects, enhancements from the UAT.
- Wrote test cases and test scripts for the User Acceptance Testing
- Led and conducted JAD sessions for requirements gathering, analysis and design of the system.
- Created context and workflow models, information and business rule models, Use Case and Object Models during the analysis using Rational tools.
- Designed and developed project document templates based on SDLC methodology
Confidential, Harleysville PA
- Create functional business specifications for all new features and enhancements to output related to Annuities in client-server based environment.
- Performed SAT, UAT, Production testing, and Report and track the defects in HP Quality Center.
- Identified the Requirements by conducting stakeholder interviews, JAD Sessions, workshops and Created Business Requirements and Functional Requirements Document including specific Usecases.
- Used MS Word tool for documenting the Business and Functional Requirements.
- Responsible for managing communication and expectations of system vendor, the former parent company IT and business departments, and Allied Worlds various business units (underwriting, claims, reinsurance, actuary, accounting, and IT)
- Created the Test Plan and Strategy which were reviewed with the business area for their feedback
- Design and development of Data Modeling: Star-Schema Modeling, Snowflakes Modeling, Fact and Dimension Tables
- Developed Manual test cases, test scripts and test scenarios for the UAT.
- Involve in Business Process Optimization Techniques, Business Process modeling and Mapping.
- Used Test Manager to store test cases, scripts, keep track of the results of testing and to create reports for the same.
- Updated the User Manual based on new Enhancement Requirements in the Application. (UPS).
- Involve in Business Process Optimization Techniques, Business Process modeling and Mapping.
- Involved in research on data flow as a part of analyzing the requirements.
- Constantly interacted with the Development and Test Team to conduct Requirements Knowledge Transfer Sessions.
- Created RTM (Requirements Traceability Matrix) and managed all use cases and test cases matrix using MS Excel.
- Conducted project kick off meetings with team members to explain roles/responsibilities, relationships with other groups, deliverables, timelines, assignments and status reporting.
- Budget Management Project
- Standardization of Television Network Placement Contracts & Budgets and Approval workflows.
- Planning, forecasting & analysis of Budgets for Cost - Benefit Reports.
- Digital Addressable System (DAS) Project
- Operator User Migration, from paper-based Contract System to Digital Addressable System (DAS).
- Finance Reports Project
- Invoice and Billing for Operators/Vendors.
- Placement YTD reports for consolidating placement savings by Payments.
- Carriage Payments Reconciliation.
- Travel and Expense Project
- Automated Travel & Expense system using SAP Concur.
- Managed risk and action log, weekly meetings with Concur team and testing of Concur functionality as per business requirements.
- Managed change management process from a manual process to Concur Travel and Expense system.
- Worked with IT on interfaces between Concur and PeopleSoft.
- Documented success factors for the implementation of Concur Travel and Expense module.
- Responsible for Functional and Go-live support for Concur.