SUMMARY:

• Solutions - driven Business Analyst with over 8 years’ experience in software development, user support, acting as subject matter expert, and as a versatile liaison between business and IT organization. Skilled in Agile Scrum and Waterfall and able to capture stakeholder’s vision through elicitation, requirements gathering and documenting workflow processes, user acceptance testing and implementing technology for various departments.
• Experience with Agile Scrum, Waterfall, RUP.
• Expertise in eliciting requirements, analyzing the requirements and simplifying and translating requirements.
• Excellent experience in developing detailed functional specs through JAD sessions, Requirements workshops, Job shadowing, Prototyping, Document Analysis, Interviews, on site meetings with business users & development team.
• Good experience in interviewing Business users & subject matter expert providing recommendations to resolve issues for various business/technical groups & defining strategic solutions to business problems in a multiple project environment.
• Expert in facilitating all levels of management, developers, QAs, stakeholders, business users and off-site teams in JADs, Brainstorm sessions, White Boarding by conferences and WebEx and having strong project and time management skills.
• Acted as Scrum Master to direct and lead development team from project initiation through delivery of final product, Facilitating Sprint Planning, Backlog Grooming, Sprint Retrospective, and Daily Standup meetings.
• Expertise in analysis techniques such as ‘AS-IS’ and ‘TO-BE’ System Analysis, Business Process Analysis, Gap Analysis (while successfully reengineering key business processes to increase operational efficiency and alignment of business unit objectives), impact analysis, Feasibility Analysis and Risk Management Plan, Cost Benefit Analysis and ROI Analysis.
• Proficient in executing SQL queries using Toad and Oracle SQL Developer. Comfortable in large data analysis using SQL/Excel/SAS and GUI navigation design using MS office tools.
• User training on the changes being released and conducting post production activities like getting feedback from users. In case of any issues - doing root cause analysis, prioritizing tasks with business users.
• Extensive experience on different phases of the Software Development Life Cycle (SDLC) such as Planning, Analysis/Design, Development, Testing and Implementation.
• Good understanding of Health Insurance Portability & Accountability Act (HIPAA) standards and Electronic Data Interchange (EDI)
• Proficient in Risk Management and Data Modeling & Mapping.
• Experienced Scrum Master and hence a great understanding of backlog tracking, burn-down metrics, velocity, and task definitions, Agile practices, service-oriented environments.
• Proficient in identifying, analyzing and documenting Functional Requirement Specification (FRS), Business Requirements Document (BRD), Business process flow, System flow, Project documentation, Wireframes and Use Case Diagrams.
• Competent with HIPAA regulations and HL7 industry standards and managed meaningful use project.
• Produced reports that detailed the progress of the MMIS Implementation.
• Expertise in creation of mapping documents from “As-Is” to “To-Be” processes to assist the testing and technical teams understand the business process and data flows.
• Extensively experienced in producing and maintaining high quality documents including Functional and Technical Specification Documents, Requirements Traceability Matrix (RTM), Data Mapping, Data migration and Transformation logic documents, Change Request document, RACI matrix etc.
• Work with DBAs to create logical and physical data models required for resultant system.
• Experience in developing and imparting pre and post implementation training, conducting GAP Analysis, Cost/Benefit analysis, SWOT Analysis and Risk analysis.
• Experience in Rational Suite including Rational Rose Requisite Pro, Clear Quest and Clear Case and Microsoft Visio.
• Expertize in writing and managing User stories.
• Excellent knowledge of Health Insurance Portability and Accountability Act (HIPAA) transaction, code set rules such as EDI 837, 835, 834, 270, 271, 277, 999, 997 and ICD9-ICD10.
• 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.
• Experience in assisting QA Team in writing test cases, test plans and acceptance criteria to test the final application.
• Experience in assisting users with User Acceptance Testing (UAT) and documenting User manuals, training materials, testing materials and also documenting the Test Results for Audit purposes.
• Good knowledge about Business process automation (BPA) and Business process improvements (BPI).
• Hands on experience in project management tools including MS-Project and JIRA for status reporting, planning and tracking.
• Well versed with Medicaid Management Information Systems (MMIS), National Provider Identification (NPI) and familiar with Patient Protection and Affordable Care Act (PPACA).
• Experience in conducting Quality analysis and implementation of Six Sigma.
• Experienced in business intelligence tools such as QlikView and Tableau.

PROFESSIONAL EXPERIENCE:

Confidential, Upland, CA

Business Analyst

Responsibilities:

• Worked with senior program manager to develop health insurance claims reimbursement system process flows.
• Elicited and gathered user and business requirements through open-ended discussions, brainstorming and storyboarding/prototyping.
• Claim validation and Pend/Denied Claims Analysis for the Health plans Medicaid programs.
• Conducted business analysis, acted as a liaison between project manager, business users, & IT team.
• Expertise understanding in proxy product owing and the benefits related to it.
• Extensively involved in Payer life cycle encompassing Claims, Payments, Provider, Portal, Billing, Benefits.
• Processed a high volume of customer inquiries of One Call Care Management products and services, and resolves a targeted percentage of those inquiries.
• Involved in Medicare management information system to route the Medicaid and Medicare claim process.
• Create various Data Mapping Repository documents as part of Metadata services.
• Interacting with the stakeholders to get a better understanding of client business processes and gather business requirements.
• Adjudicated medical claims for correct pricing to administer payment to medical providers.
• Identified gaps between standard FACETS functions and client specific requirements to write requirements for FACETS extensions.
• Worked for ETL production Support Team for Health care project.
• Experienced in ELT concepts and using Data stage stages to perform ETL activities.
• Prepared documents for business requirements document (BRD), systems requirements specification (SRS), high level design documents (HLDD), and traceability mapping / matrix with the assistance from the business group, and the IT team members.
• Created Mapping Documents, Report Mock-ups and modified existing report mock-ups and finalized for development.
• Experience with the working of Medicare (Part A, B, C and D) and Medicaid Health Insurance Policies, Personal Injury Protection (PIP) insurance, billing experience with life and disability in health plans with thorough understanding of CPT coding, HCFA-1500 and CMS-1500 claim forms and reimbursement forms.
• Implemented Healthcare system including enterprise Electronic Medical Records (EMR) software.
• Expertise in quality management in improving the quality of the business and also dealing with the business scenarios.
• Creating and implementing a strategy focused on Service Delivery Redesign (SDR) and implementation of Data Governance. This includes migrating legacy systems into a proper business intelligence and data management solutions
• Analyzed "AS IS" and "TO BE" scenarios, designed and documented new process flows business process and various business scenarios.
• Gathered requirements from collection, claims, Billing, and insurance appeal departments.
• Participated in JAD sessions with business stakeholders to integrate the requirements of the project.
• Responsible for the Clinical Administration Supervision and management of the High-risk Care Management Team.
• Worked closely with the Enterprise Data Warehouse team and Business Intelligence Architecture team to understand repository objects that support the business requirement and process.
• Performed data analysis and data profiling using complex SQL on various sources systems
• Involved in extensive Data validation by writing several complex SQL queries and involved in back-end testing and worked with data quality issues.
• Prepared Business Context Diagram, Use Case diagrams and corresponding Activity Diagrams.
• Designed and developed Use Cases using UML and Business Process Modeling. Applied Unified Modeling Language (UML) methodologies to design Use Case Diagrams, Activity Diagrams and Sequence Diagrams in Rational Rose.
• Worked with the testing team to create the testing scenarios, Queries and helped them to understand the logic.
• Performed Data Analysis of existing data through SQL and MS Access.
• Performed Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data.
• Planned and documented procedures for data processing and prepared data flow modeling for the application.
• Collected and evaluated business requirements, functional specifications, project schedules, documentation and test plans.
• Participated in UAT and worked with HP Quality Center for bug and defect tracking.

Environment: Windows 2000/XP, Microsoft Office SharePoint 2007,Tableau, Rational Requisite Pro, MS Office, SQL Server, Agile/Scrum, MS Publisher, MS Access, EDI, Documentum 2.0., UML,JIRA.

Confidential, Boston, MA

Business Analyst

Responsibilities:

• Conducted interviews with key business users to elicit, collect and manage requirements and business process flows. Created RFPs and evaluated vendor proposals.
• Developed business requirement and specification documents as well as high-level project plan and translated business requirements into data and process models, and developed process decomposition diagrams, data models, data flow diagrams, entity relationship diagrams and state diagrams.
• Actively worked on large database maintenance activities including data modeling, data mapping, development, integration, analysis and testing.
• Worked with FACETS team for HIPAA Claims validation and verification process (Pre-Adjudication).
• Defined and documented operational control and security procedures, including those required for backup and recovery.
• Worked with Facets software for maintaining data about the enrollment, billing and health care claims management and to store, send, receive HIPPA transactions and facilitate the administration of HIPAA privacy rights.
• Worked with Medicare and Medicaid Encounter Pro to obtain Encounter from the main server to be submitted to Medicare and Medicaid.
• Set up work flows for users for the procedures in claims with the help of SME.
• Extensively worked with FACETS Implementation, FACETS Billing, Claim Processing and Subscriber/Member module.
• Performed GAP Analysis and event modeling and constructed Remediation.
• Used strong verbal and written communication skills and analytical skills to perform tasks and interact with users, technical personnel and all levels of management.
• Automated Smoke and Functional test cases using Selenium Web driver, TestNG, java and Java script
• Followed Agile Iterative development approach and was involved with all iterations of the development life cycle and risk management.
• Worked on the Rewrite Scoring Engine project where we shifted the predictive model from SAS to Ratabase. Speed, cost to market and better version control were some of the key benefits. Additionally, we were able to improve the Predictive Modeling system speed by 80%.
• Utilized a structured approach to uncover additional campaign needs in the Financial Advice Center Complementary group with the Universal Life/Variable Universal Life Worked with developers, product managers and sales leaders to gather, document and manage user requirements for enhancements and new tools. Led weekly meetings and coordinated production with the development team.
• Performed usability testing to confirm and continually improve the experience.
• Utilized waterfall and agile methodologies along with Continuous Improvement, to improve best practices and increase efficiencies and effectiveness of BA role.

Environment: Rational Tools suite, MS Visio, UML, Windows, Unix, XML, HTML, MS EXCEL, MS ACCESS GUI testing, functional testing, system testing, Java,Javascript.

Confidential, Baltimore, MD

Business Analy st

Responsibilities:

• Designed, developed key performance indicators and act as a liaison between the business units, support teams to gather requirements.
• Collate & Summarize data using tools such as MS Excel, MS Access to create artifacts such as Tables, Charts and Involved in the Business Analysis methodology using waterfall and Agile.
• Used MS-Visio to document current work flows using swim lanes, manual processes and end-to-end processing of system interactions.
• Functioned as the primary liaison between the operations and the technical team and resolved process issues throughout the project cycle
• Conducted power point presentations.
• Created Data Sources for various external applications. Used Import sets and Transform maps to import data into Service Now.
• For User Acceptance Testing (UAT) developed &executed associated project plans & test scripts.
• Utilized ServiceNow Problem Management, Project management and worked and billing system of customers.
• Developed solutions using JavaScript, Web Services, SOAP and other web technologies to integrate Service Now with internal/ external systems and tools.
• Designed, developed key performance indicators and act as a liaison between the business units, support teams to gather requirements.
• Testing: Develop system integration test plans and execute system and integration testing.
• Documented the Business Requirements (BRD), Functional Specifications Document along with UML diagrams.
• Perform any other integration design and development activities assigned by the Integration Manager
• Performed Gap Analysis to check the compatibility of the existing system infrastructure with the new business requirements
• Played a pivotal role in conducting sessions helping to develop detailed solutions and to verify if the Application Development Process
• Used the Unified Change Management (UCM) tool, BPM Remedy to maintain and track the Stakeholders requested enhancements and changes.
• Worked with the QA team through the Testing Cycle to verify complete and rigorous testing of requirements.
• Worked on basic SQL queries for report validation.
• Helped the testing team in documenting the technical requirements and testing system development.

Environment: Agile, UML, Java, Java Script, Requisite Pro, Rational Rose, Clear Quest, SQL, Windows XP, MS Office Suite (Word, Excel, Access, Power Point, Outlook), PL/SQL, Oracle, SQL and Windows.

Confidential - Dallas, TX

Business Analyst

Responsibilities:

• 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.
• Used Crystal Reports for .NET and Crystal Report Viewer to create quick-in-time reports.
• Participated in project meetings to support the team as required, Organized various meeting with SME's and testing Team to ensure that we are on track with all of our deliverables, tracked all our deliverables on a daily basis by using Deliverables tracking Template.
• Teamed up with both internal and external software development teams to provide functional requirements specifications in the form of use cases, business process flows, and prototypes and management reporting requirements.
• Designed Data Flow Diagrams (DFD's), Entity Relationship Diagrams (ERD's), and web page mock ups using modeling tools. Involved in formatting data stores and generate UML diagrams of logical and physical data. Used Query Analyzer, Execution Plan to optimize SQL Queries.
• Produced Gap Analysis documents for HIPAA 5010 and ICD-10.
• Networked with Subject Matter Experts, Project Manager, Developers, and Process Analysts to understand the business process, gathered Business Requirements and identified enhancements.
• Extensively developed project documentation, process flow documents, formal proposals, RFQ's and RFP's. Formulated methodologies and developed SDLC phases, strategies, time & cost estimates with milestones for each phase.
• Prepared Business Requirement Documents (BRD's) after the collection of Functional Requirements from System Users that provided appropriate scope of work for technical team to develop prototype and overall system.
• Worked with ICD-9 encoding to verify the validity of incoming claims, documented ICD-9 codes presently used by the system.
• Understanding and assessment of the current ICD 9 codes used by the State
• Creation of a Gap/Impact Analysis Document for changes of the EDI Transactions (837, 835, 276/277, 270/271)
• Creation of a Gap/Impact Analysis Document for changes to Pharmacy Transactions (real time and batch) based on NCPDP 5.1 to NCPDP D.0, specifically concerning the data elements
• Creation of a Mapping Document for ICD9 Codes to ICD 10 Clinical Modifications and Procedural Codes.
• Creation of Gap/Impact Analysis Document for the Prescription Drug Point of Sale System

Environment: MS Office Suite, POS, GEMS, Document Analyzer, SharePoint, MS-Visio, MS Excel, MS Access, Mainframe, ETL, UML, Rational Requisite Pro, Rational Rose, Rational Clear Case, Rational Clear Quest, html, JAVA, Asp, MS Window Server.

Confidential

Business Analyst

Responsibilities:

• Reviewed and analyzed data from various sources. Reviewed test results and coordinated with testing and development team to correct the issues.
• Provided support to senior business analyst in planning, designing, programming, testing, and executing client's projects.
• Responsible for writing functional Requirements and Use cases. Developed use case diagrams using Microsoft Visio, Rational Rose.
• Interacted thoroughly with a set of Stakeholders and Subject Matter Experts (SMEs) to document Business, Functional and Non-Functional Requirements.
• Conducted GAP Analysis in order to check the current applications of an existing system with the purpose of exposing the benefits of applying the proposed business requirements to the new system.
• Conducted user interviews, brainstorming sessions to gather, analyze and document the business requirements using Rational Requisite Pro.
• Designed and developed Use Cases, Activity Diagrams and Sequence Diagrams using UML modeling tool like MS Visio.
• Established Requirements Traceability Matrix (RTM) using Rational Requisite Pro to trace completeness of requirements in different SDLC stages.
• Created Work Breakdown Structures (WBS), Project Schedule and Project Timelines using MS Project.
• Monitored bugs in the system using tools like Bugzilla to ensure that the quality of the system meets the industry standards and business user's requirements.
• Worked with QA team for designing Test Plan and Test Cases for Integration, Smoke, Regression and User Acceptance Testing to improve the overall quality of the application.
• Involved with teams for Root Cause Analysis activities and data collection plans.
• Functioned as a primary liaison between the business line, operations, and the technical areas throughout the project cycle.
• Participated in production support and handled issues appropriately.
• Served as a focal point of contact between customer and company; conducted presentations focusing on making key decisions

Environment: Business Object, Mercury, Waterfall, SQL management Studio, MS Visio, MS Office, Rational Rose