SUMMARY:

• Over 6+ years of extensive experience as a Sr. Business Analyst and Business Systems Analyst
• Expert knowledge in traditional and agile project management methodologies and software development life cycles (SDLC) such as Waterfall, RUP, Scrum, and Kanban.
• Experienced with Project planning activities like Cost estimation, creating charters, finding requests, creating Project schedules, WBS.
• Experienced in working with Sr Executives, Stake holders and multiple teams.
• Experienced in conducting GAP analysis, User Acceptance Testing (UAT), SWOT analysis, Risk Analysis and mitigation plan, Cost benefit analysis, and ROI analysis.
• Experienced in understanding database structures and write SQL.
• Experienced with Agile, RUP and waterfall SDLC methodologies.
• Experience with lotus notes in processing data and storing it.
• Excellent knowledge in MS Project, Excel - Pivot tables, graphs and MS PowerPoint
• Informational understanding of relational database
• Strong knowledge on SharePoint and Change management
• Work with client departments to configure and maintain SharePoint site collections, document libraries, lists, and site pages
• Work with client departments to configure and maintain SharePoint site collections, document libraries, lists, and site pages
• Knowledge of Claims and Policy systems like Insurity(EPIM), Gain, XM, WINS (CCWINS, SRWINS, NPWINS), Beeline,
• Served as the SharePoint project lead responsible for organizing, directing, and managing all aspects of requirements support functions across multiple projects
• Experience with developing RACI charts, Communication Plans, and Project Charters
• Comprehensive understanding of the Organizational Framework that help to map the AS-IS and TO-BE model using the GAP Analysis and plan & monitor effective approach to build/buy solutions to the business problems/needs/opportunities.

PROFESSIONAL EXPERIENCE:

Confidential, Berkeley, CA

Sr. Business Analyst

Responsibilities:

• Assisted project manager in deciding upon the best approach for requirement gathering.
• Involved in gathering Data Requirements and interacted with the users, IT analysts, developers, project manager and SME’s to get a better view of the Business Processes.
• Participated in project review meetings and gathering Data Analysis Documents.
• Managed work streams relating to updates within many Government Pricing, including project planning, requirements, design, development, unit testing, user acceptance testing, and deployment activities.
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, OOD (Object oriented Design) using MS Visio.
• Participated in JAD sessions and interacted with technical leaders from various departments (Drug Design and Discovery-R&D division, Clinical trials etc.)
• Responsibility included overall technical and project/program life cycle, cost, earned value performance reporting, and schedule management using Microsoft Project.
• Involved in pharmaceuticals contracts and pricing business processes and information systems. Managed relationships between contracts and pricing team, business team and external trading partners.
• Defined various scenarios for testing the application and wrote test cases based on these scenarios as well as ad-hoc test cases based on interactions with users Involved in coordination of offshore activities related to practice of defect tracking, test execution to providing consultation to IT and business teams.
• Conducted User Acceptance Testing (UAT), Maintained the Requirement Traceability Matrix (RTM).
• Created a detail Requirements, Test plan and procedures for application testing using Rational Test Manager.
• Involved in Data Analysis, Data Mapping and Data Modeling and Performed data integrity, Data Portability testing by executing SQL statements.
• Excellent working knowledge of regulatory requirements (HIPAA).
• Assisted in the development of training materials for new technology and process improvements and conducted end-user training sessions for exercising full use of application.

Environment: Window, Microsoft Office suite, Microsoft Visio, PowerPoint, Rational RequisitePro, UML, Oracle, SQL, Informatica, Scrum, Rational Test Manager.

Confidential, Boston, MA

Business Analyst

Responsibilities:

• Interviewed SMEs and Stakeholders to get a better understanding of client business processes and gather business requirements.
• Created use case scenarios and documented work flow and business process using MS Visio.
• Maintained a E mail database for adding and manipulation information with others.
• Experience with lotus notes document repositories.
• Gathered and documented business requirements for existing and future business systems.
• Created various business process flows and done re- engineering
• Worked in Agile methodology.
• Experience retrieving CICS logs and DB in Mainframe to check for errors.
• Experience with JCL/CICS for calculating working units.
• Helped with building ICD 9 to ICD 10 crosswalk map by grouping thousands of codes and ranges in Clinical, Benefits, Financial, and Medical policy waves
• Analyzed and tested various Common Eligibility Outbound Interface Process and other Inbound/ Outbound Facets interfaces.
• Acted as a liaison between business staff and technical staff to articulate needs, issues and concerns.
• Analyzed current MMIS and EDI claims and documented the requirements to implement new MMIS automated system.
• Defined Functional Test Cases, documented and executed manually using quality center.
• Analyzed trading partner specifications and created EDI mapping guidelines.
• Responsible for Data Manipulation and Data Validation using SQL queries in a MS SQL Server.
• Reviewed EDI companion guides for all payers to ensure compliance, edit integrity and maintain up-to-date list of payer contacts.
• Prepared use cases and data flow diagrams to analyze the impact of ICD 10 diagnosis codes embedded in different systems and applications.
• Gathered and validated inventory of applications, interfaces, and reports that will need to be modified to comply with ICD-10 requirements.
• Written test cases, test scenarios, and prepared test data to conduct the manual testing of EDI files and the mainframe screens.
• Involved in creation and execution of manual test cases in HP quality center and automated Test Cases in QTP and analyzed the Test Results.
• Tested the application manually by executing Test Cases in Quality Centre prior to Automation and Involved in automated testing.
• Performed functional testing with the development team as well as User Acceptance Testing and Regression Testing of the application using Quality center and JIRA for prioritizing defects and assigned it to the developer to fix the bugs.
• Worked on Financial Analysis of DRG shifts from ICD 9 to ICD 10 to avoid any over or under payments to the providers.
• Used General Equivalence Mappings (GEM) to convert ICD 9 to ICD 10
• Developed plan for data feeds and data mappings for integration between various systems, including XML, to follow ICD 10 Code set and ANSI X12 5010 formats
• Environment: Agile / SCRUM, MS Office Suite, MS Visio, MS access, SQL, CICS, Quality Center, JIRA, Java Script, Project Management, QTP

Confidential, Tampa, FL

Business Systems Analyst

Responsibilities:

• Prepared business requirements document (BRD), which involved market risk analysis and credit risk management like continuous time finance& asset pricing and documentation.
• Assisted project manager in conducting GAP analysis and SWOT analysis.
• Facilitated Joint Application Development (JAD) Sessions for communicating and managing expectations.
• Created and modified schedules and notified users through E mails
• Involved to prepare the to TO-BE process flow of the application, using MS Visio.
• Worked on CICS/VSAM RLS for several transactions.
• Used CICS for insurance processes and claims transactions.
• Worked w.r.t Financial markets (Primary, Secondary and Capital Markets), Mutual funds, Derivatives
• Created Use-Cases and Requirements documents to document business needs.
• Enhancing the online customer facing portal application to make it more effective for both customers and business users.
• Managed and tracked Defects using Rational Clear Quest.
• Prepared requirement traceability matrix for tracking the project updates.
• Integrated Hybris and Endeca for the search capabilities for better and faster customer experience
• Worked with various CICS tools CICS Deployment Assistant, CICS Performance Analyzer
• Involved in facilitating requirements elicitation sessions for customer facing MS dynamics CRM (Salesforce) interfaces which led to re-design of customer portal.
• After JAD session worked with development teams to build the collaborative portal and web content management solutions using SPS.
• Functioned on IAM that securely controls the access of AWS cloud (NetIQ).
• Involved to work on account receivable reporting enhancements and reconciliation procedures of bank transactions
• Performed risk analysis with the requirements to identify the key business risk areas for the project and prioritized the application development and testing.
• Successfully managed web analytics, forecasting, supply chain optimization and escalate potential risk for the business.
• Prepared Mockups and Prototyping to present the GUI representation using Balsamiq, Axure
• Involved to work with development teams in controlling and modeling to connect sitecore API’s and custom DB’s
• Used SQL queries to for pulling out files and reports as required for the project upgrade.
• Environment: Windows, HL7, Business Objects (BO), Microsoft Office SharePoint, CICS, lotus Notes Agile, Rational Requisite Pro, MS Office, SQL Server 2005, DB2,MS Project, MS FrontPage, MS Access, HP Quality Center.

Confidential, Chicago, IL

Business Systems Analyst

Responsibilities:

• Coordinated with Business Owner, Application Vendor, Business Project Teams, Payers, and Clearinghouses to bring all processes to a level of execution to mitigate any impact to current revenue flow under the 5010-compliancy requirements
• Facilitated Workshops for requirements analysis
• Working within a growing environment of X 12 4010/5010 HIPAA Transaction Processing 837 I, P, D, 835, 834, 820, 270, 271, 276, 277, 278, EDI, Privacy, Security, and Medicaid.
• Conducted Impact analysis when there is any change in the requirements and updated the Business Requirements Document (BRD), and Systems Requirements Specification (SRS).
• Conducted requirement gathering sessions for MMIS Mainframe Claim processing screens.
• Strong Understanding of State/Commercial Medicaid Claims, Benefit Plans, Claims Payment Cycle, Waiver Programs and Reference
• Knowledge of Laboratory Information Management Systems(LIMS)
• Claims Intake, Medical Management- Utilization Management, Case management, and Provider Reimbursement- Provider Payment.
• Facilitated JAD and JRP sessions with management, development team, users, and other stakeholders to refine functional requirements.
• Used UML for Specifications, Documentation, and Construction of systems.
• Designed and developed Business Rules Document about the Claim Component and HIPPA.
• Created business workflows on the claims module for the client to get a better understanding of the software and prepared a detailed BRD including all functional and non-functional requirements.
• Validated that the system claim scrubber included editing based on the CEM published edits to ensure a positive 999 and 277CA transaction.
• 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.
• Knowledge on Affordable Care Act project.
• Designed robust 5010 testing and 4010 regression SIT and UAT Testing Scripts for the 5010 Project.
• Analyzed the testing results to ensure that the results were in accordance with the Gap Analysis and expected results for 5010 compliance.
• Documented workflows and executed comprehensive testing and training plans to ensure that the new acknowledgement results demonstrated in the 999 and 277CA were properly interpreted and managed to ensure Payer acceptance of the 837 files.
• Took action in the process flow to prevent rejected claims from falling into “limbo”.

  Mitigated claim denial increase through a complete analysis of the application “Claims Scrubber” to ensure 277CA accepted claims would not result in an increase in Denials at the payer adjudication level.

• Identified all risks associated with the project and proposed suggestions for mitigating the identified risk related to the business.
• Environment: MS Project, MS Visio, MS Access, MS Excel, MS Word, MS Power Point, Rational Requisite Pro, LIMS, Clear Case, Clear Quest, RUP, MS Share Point, Oracle PL/SQL