SUMMARY:

• Sr. Business Analyst professional with 10+ years of expertise as a Business Systems Analyst, Business Intelligence, Business Analyst, possessing strong analytical, problem solving and communication skills with emphasis on clear & detailed business requirements documentation and functional specifications documentation as well as reports for management, research, and analysis in various domains like Insurance, Finance, and Retail.
• In - depth knowledge and practical experience of using Waterfall, Agile, Scrums, Rational Unified Process, Business Process Reengineering, Unified Modeling Language, System Requirements Specification, Functional Requirements Specification, Rapid Application Development, and MS Visio.
• Highly skilled in transforming the needs of Business Users and Stakeholders to the Functional/Technical Requirements.
• Experienced With HIPAA 5010, EDI 834, EDI 837, EDI 835, EDI 270, EDI 271, EDI 276, EDI 277
• Experienced with ICD 10 codes, HL7, Healthcare eligibility, Enrollment process, Healthcare claims, Medicaid product and Medicare products.
• Served as a critical resource and liaised between Subject Matter Experts and Technologists throughout the project life cycle.
• Experienced with CMS, Obama care and state guidelines.
• Excellent conceptual and technical skills to create Business Requirements Document, Functional Specifications Document, Process Flow Diagram, and Detailed Design Document.
• Analyzed and defined business processes both "AS-IS" and "TO BE".
• Conducted Joint Application Development (JAD) sessions with stakeholders and business partners to resolve open issues.
• Developed Use Cases using UML and MS Visio for an ease with system interaction.
• Worked with the project team to determine appropriate Test Plans & Deployment Plans and supported the product launch.
• Worked with Analysts, Managers, Developers, and Testers for complex projects during the SDLC.
• Prioritized work requests from project team.
• Identified and communicated risks and with possible solutions.
• Modified and changed the User Interface (UI) as per the system requirements and clients' requirements.
• Performed a Change Management Role when the new requirements were proposed performing impact analysis.
• Interacted with QA team for Unit/Integration/System testing.

PROFESSIONAL EXPERIENCE:

Sr. Business Systems Analyst

Confidential - San Antonio, TX

Responsibilities:

• Working extensively with ACA Escalated Case Resolution team and developed processes to efficiently handle the incoming case volumes from MD, DC and VA exchanges. Developed Escalated Issue tracker in SharePoint to capture and track all the escalated cases coming from MD, DC and VA exchanges.
• Trained CSRs on new processes for instance I trained a group of dedicated CSRs to handle 1095B inquiries coming in via phone and Lobby services. Worked with third party vendor Thomson Reuters in setting up the process for generating 1095B forms and then trained dedicated CSRs to work on Thomson Reuters One Source Application to generate a copy of the duplicate 1095B tax form. As a BA/QA, I was involved in end to end testing in this project.
• Working on Facets and Pega Customer Service application for addressing enrollment, eligibility, claims processing issues. Working with Thomson Reuters for the generation and distribution of 1095B tax forms.
• Created TIN Solicitation forms as a part of 1095B project to request SSN from the members in year 2015. Worked extensively on all the TIN Solicitations throughout the year. Also worked on providing solution for storage of iTIN in Facets.
• Documented Standard Operating Procedure Documents (SOPs), BRDs, PRDs, Job Aids, Service Alerts and Training Manuals.
• Developed FAQs and detailed workflows to address different inbound Call scenarios.
• Worked on Facets and Pega Customer Service Application to address the issues coming in to Service team.
• Annually reviewed and updated SOPs to ensure processes are current in Compliance 360 system. It is an auditing tool that acts as a SOP clearinghouse.
• Participated in Stake holder discussions during initiation phase and assisted in preparing the preliminary scope statement.
• Facilitated face to face, teleconference and web-conference meetings for requirement gathering and discussions.
• Extensively working on MS Visio to create cross functional "As-Is and "To-Be" process flows.
• Created issue templates in SharePoint to capture and track the cases sent in by the three different customer service vendors.

Environment: SQL, User Cases, Test Cases, Looker, Toad, Teradata, MS Office, Excel.

Sr. Business Analyst

Confidential - Eagan, MN

Responsibilities:

• Utilized RFP (Request for Proposal) to gather financial information's estimates on internal/external labor and sketching timeline for project management phases assisting program manager.
• Helped Technology Team Integrate all the IT Process and Data to the Central Server through cloud uploads and transfer and syncing.
• Managed entire project lifecycle and performed GAP Analysis to differentiate between the "as-is" and "to-be" systems. Also involved in Business Process Reengineering (BPR).
• Managed critical deliverables and performed channelized communication to IT management, executive management, and client stakeholders.
• Wrote test scripts and executes test cased for UAT testing of different EDI like 270, 271, 276, 277, 837, 835, 834 etc.
• Analyzing of web services through functional and design documents and prepared test cases based on user requirements.
• Worked with Pharmacy benefit management (PBM) vendors like prime therapeutics to develop and maintain process for cost effective medicine using rebates system.
• Analyzed and Validated HIPAA 5010 EDI 837, EDI 835, EDI 834 using spec builder.
• Strong working knowledge of the HIPAA 820 EDI, 835 EDI and 834 EDI healthcare files and transactions.
• Collaborate with stakeholders and IT teams to align ETL transformation rules with reporting.
• Involved in validating the web services to customer, account and transaction management using the SOAP user interface.
• Wrote Business requirements to receive claim from different trading partner using EDI 837 to make sure the data is received as expected from the trading partner.
• Wrote Business requirements to send processed claim data to different trading partner using EDI 835 to make sure the data is received as expected from the trading partner.
• Integrated applications, such as Salesforce, so that data elements were shared and displayed in JIRA dashboards and Confluence pages.
• Performed Mapping between different HIPAA EDIversion like HIPAA 4010 vs. 5010, EDI vs. HL7 etc.
• Served as a business analyst on multiple initiatives involving maintenance and system changes for HIPAA implementation.
• Designed and developed mappings to load the data from flat file to SQL server tables for reporting purposes.
• Also generated periodic reports, charts based on the statistical analysis of the data from various time frame and division using SQL server reporting services (SSRS).
• Responsible for preparation, review and approval of all tests including UAT test plans, Test cases and test scripts.
• Coordinated and contributed to all the aspects of business process designs including evaluating and preparing strategies for improving the current system to ensure compliance with the company's rules and regulations.
• Interview, hire, and manage all employees for the Workstation Support and Asset Management groups.
• Facilitate quarterly asset update meetings for administration in the Financials and IT and Customer Support Departments.
• Assisted in formulating external and internal project kick-off presentation deck and wire-frames for proposed workflow.
• Gathered CICD Prod statistics, interact with multiple 3rd party software applications and make appropriate modifications
• Developed business cases for enhancement requirements and tracking of project financial results and data analysis.
• Elicited and drafted requirements for financial system transaction posting for SAP FS-CD (SAP for insurance collection and disbursement).
• Used Sybase Power Designer/ MS Office Suite to articulate and design UML: Use Cases Diagrams, Activity Diagrams and Sequence Diagrams adopting Agile/Scrum methodology
• Worked with developers on updating project management application based in Access and Oracle DB using RDBMS (Relational Database Management System) techniques.
• Managed requirements of data analysis under established enterprise requirements management guidelines (Rational Unified Process) and managed technical using Requisite Pro.

Environment: .Net, RUP, HTML, UML, MS Office, Use Cases, SharePoint, Rational Requisite Pro, Tableau, Quality Center, MS Visio.

Sr. Business Analyst

Confidential - Hartford, CT

Responsibilities:

• Followed a hybrid methodologybut was primarily based on an Agile approach with 90-day release cycles and 2-week sprints.
• Worked with the product management team in order to ensure effective scope management and resource planning.
• Provided portfolio management analysis on proposed brokerage product and formulated recommendations to improve customer experience, reduce operational impacts, reduce cost and improve productivity.
• Worked as a Data Analyst while using various ETL tools to extract and load data then doing various analysis using SQL and finally representing the data in Reports.
• Prepared and reviewed UAT test artifacts such as Test plans and test scripts with project stakeholders.
• Produced testing estimates for UAT projects based on complexity and testing resources along with the project timelines.
• Created Use Case diagrams by analyzing the business process followed by activity diagrams using MS-Visio and participate in production of HIPAA 5010 EDI test data.
• Helped developers with the following list of HIPAA-EDI transaction code 837 /271 and 276/277.
• Designed and programmed several electronic claims processing to a variety of platforms.
• Assisted with effort to document end-to-end process flow for brokerage account features. Effort included interviewing impacted business areas and documenting their processes. An analysis was conducted to identify gaps and recommendations were presented to senior leaders.
• Responsible for ensuring the business requirements are captured, documented, maintained, and met throughout the life of the program.
• Created multiple workflows utilizing the JIRA scripting suite to script workflow behavior. Also, installed and configured JIRA Agile.
• Worked with various teams on setting new JIRA & Confluence instances for new teams. Worked on integrating(migrating) JIRA with Confluence.
• Experience in consuming REST/SOAP based web services with JSON/XML formatted data.
• Created business cases for enhancement requirements, which may be as a result of either brainstorming session between the Stakeholders, Users and BA's, through client feedback or both.
• Worked with software development method tools such as DOORS, and also worked with process tools such as Vision and Client Quality center to better develop the products.
• Analyzed and fully understood user requirements and current procedures in order to improve system capabilities, automate process workflows and address scheduling limitations throughout the development and delivery of the Service Now roadmap
• Managed entire project lifecycle and performed GAP Analysis to differentiate between the "as-is" and "to-be" systems. Also involved in Business Process Reengineering (BPR).
• Interviewed Subject Matter Experts (SMEs) and carefully recorded the requirements by asking questions and documented all the requirements so that they could be understood by both business people and technical teams.
• Held JAD sessions to facilitate resolving of conflicts and discussed the release notes for every build during the course of the projects.
• Elevated to high customer satisfaction levels through assessment, analysis, and continual improvement initiatives.
• Tracked record of involvement in successful on-time and on-budget delivery of projects.
• Developed Standard Upgrade Guides, Procedures, and Presentations for major version upgrades for current brokerage accounts.
• Responsible for representing the organization for escalated issues, developing agents, and ensuring quality. Responsible for processing equity trades, communicating policies, problem resolution, and documenting complex issues.
• Guided and motivated the scrum team on the sprint goals and deliverables.
• Designed Web Pages/User Interface for the application using iRise.
• Interacted and effectively communicated with project managers, customers, and management team.
• Actively involved in walkthroughs and meetings with development team to discuss related issues.
• Worked on user training manuals and reference materials at the end of the project.
• Conducted training workshops and acted as first point of contact for support.

Environment: MS Visio, MS Office, iRise, UML, Agile, Oracle, Requisite Pro, Clear Case, Java.

Business Analyst

Confidential - Richmond, VA

Responsibilities:

• Gathered requirements from Stakeholders and Users by meeting them personally and by interviewing them. Utilized Requisite Pro to prepare a BRD by complying with the HIPAA regulations.
• Served as the primary liaison between the CCAR Regulatory Reporting production teams and the Financial Data Solutions team.
• Knowledge of Medicare, Medicaid federal and state regulations as it pertains to claims processing.
• Developed functional specs, gathered requirements, and communicated with the developers.
• Developed Use Case Diagrams using ERD and depicted clear relations associated between the entities.
• Prepared Work Breakdown Structures (WBS) to comply with the triple constraint: Time, Cost, And Scope.
• Documented the gathered business requirements and functional specifications in support of financial services brokerage operations.
• Successfully migrated Web Services to REST based API's for digital banking platform. Managed and delivered one of the top priority technology initiatives by delivering REST based API's
• Helped develop, manage and enforce XML security policies for web API's and provided services authentication via LDAP's, threat protection and data transformation.
• Prepared a roadmap for a product that can exceed market and user expectations.
• Followed Prototype model of SDLC in developing software.
• Extensive experience in report writing using SQL server reporting services such as Maxim report, chart report, pie charts, etc.
• Designed User Interfaces and mock up screens using HTML to validate the requirements.
• Created and implemented a test plans and thereby assisted Quality Analysts to test the product in a timely manner.
• Defined and planned software releases in accordance with other software applications.

Environment: MS Visio, MS Office, .Net, VB.NET, ASP.NET, Java, PHP, XML, HTML, SQL, DHTML.

Business Analyst

Tops Friendly Market - Erie, Pam

Responsibilities:

• Functioned as a liaison between the TOPS and HP to create a roadmap and project plan (SDLC) for this initiative.
• Conducted GAP Analysis in the existing architecture to understand the "as-is" and "to-be" process and created workflow scenarios, designed new process flows and documented the Business Process and various Business Scenarios and activities of the business from the conceptual to procedural level.
• Understood the workflow involved within various groups, nature of work performed, and validated the change process deliverables translating the strategies into project and programs on IT Strategic roadmap.
• Created a process document to depict the flow of critical information and wrote Use Case that described the flow of events.
• Worked on Tagging and also fixed the Tagging issues using Adobe Dynamic Tag Management using the technologies like HTML, JQuery and JSON.
• Worked with cloud security and tenant set-up activities, data classification, data tagging, organizational change management and training resource coordination, also analyzed workflow optimization analysis and AD integration.

TECHNICAL SKILLS:

Languages: C, C++, SQL, PL/SQL, JAVA, HTML

Operating Systems: Windows, Linux

SDLC Methodologies: Waterfall, Agile, Scrum, RUP

Databases: Oracle, MS SQL Server, Microsoft Access

Modeling Tools: Rational Rose and Microsoft Visio

Requirement Management Tools: Rational Requisite Pro

Testing Tools: Quality Center (Manual and Automatic), Quick Test Pro, Rational Clear Quest

Version Control: Rational Clear Case, SharePoint

MS Suite: Microsoft Word, Excel, Power Point, Outlook & Project