SUMMARY:

• Business Analyst with over 7 years of experience, in healthcare industry.
• Strong at effective facilitation of information flow between the key stakeholders and functional teams engaged on various project deliverables, experienced through roles directly engaging sales and IT teams.
• Worked in cross - functional team environment and with teams (and various client-sites) located at various geographical locations.
• Capable of managing multiple projects simultaneously.
• Excellent knowledge of Health Insurance Portability and Accountability Act (HIPAA) transaction, code set rules such as EDI 837,270,271,276,277,834,835, NCPDP and ICD9-ICD10.
• Extensive exposure to unified modeling language (UML) tools such as MS Visio, Rational Rose and Requirement Management tools such as Rational RequisitePro.
• Experience in writing queries/scripts for data analysis ad QA report testing.
• Lead development of functional specifications through Joint Application Development (JAD) and Rapid Application Development (RAD) sessions and user interviews.
• Experience in User Acceptance Testing, Smoke Testing, Regression Testing Performance Testing and Functional Testing.
• Experience working in Medicare and Medicaid projects.
• Experience in conducting SWOT Analysis, Cost Benefit and ROI Analysis.
• Working knowledge in financial analysis, financial modeling, Research, Accounting, and Assets, Liabilities, Equities, Fixed Income and Taxation.
• Practical understanding of software development lifecycle in its different facets, methodologies and implication in the industrial (business) scenarios.
• Substantiated Object Oriented Analysis and Design representation techniques in UML using Rational Rose, Dataflow Process Modeling, and Analysis & Design with Interaction and Class diagrams.
• Scheduled meetings and reinforced business analysis with developers, system analyst and testers to collaborate rescore allocation and project completion using MS Project
• HIPAA (4 years), RAD (6 years), JAD(7 years),SDLC (3 years), Agile (Scrum) (5 years)

SKILL:

Core Competencies: SDLC, Business Analysis, Process Mapping, Systems Analysis, Business Case Development, JAD Facilitation, Requirements Management, Workflow Analysis, Use Case Modeling, Test Management, Communication, Change Management, Problem Root Cause Analysis, Problem Management, Risk Management, Team Building, RUP, Agile (Scrum) Projects.

Technical Profile: Modeling Tools IBM Rational RequisitePro, IBM Rational Rose, MS Visio

Testing Tools: WebRunner, LoadRunner, Test Track Pro

Methodologies: RUP, Waterfall, Agile, XP, SDLC, BDD, TDD

Change Management: SharePoint, ClearQuest, JIRA, Subversion

Languages: C/C++, XML, SQL, XPath, HTML, Visual Basic, .Net

Dev Software: Eclipse, IntelliJ, Visual Studio, Brio-Hyperion, Net Beans, Web Software Dreamweaver, Adobe Photoshop/Illustrator, PDF Maker

DBMS: MS Access, SQL Server, MySQL, Oracle 10g, Toad, Squirrel SQL

Operating Systems: Windows NT/XP/Vista, UNIX, Linux

WORK EXPERIENCE:

Sr. Business System Analyst

Confidential, Madison, WI

Responsibilities:

• Worked with client to gather Business/Technical Requirements, Approval of CR (Change request), Design and Implementations for State MMIS.
• Responsible for designing future state processes for ICD 9-10 Crosswalk Table and drafted High Level Business Requirements for ICD 9-10 conversion mapping.
• Worked extensively on the Procedure and Diagnosis Pricing and worked on the Reimbursement processing.
• Gained extensive experience in designing/modifying the CICS screens for various areas such as Enrollment, Billing, Provider Record and Reimbursement Status in MMIS.
• Analyzed HIPAA 5010 related to 837 (I/P), 835, 834, 270,271 transactions and performed gap analysis between HIPAA 4010 and 5010.
• Wrote clear, concise detailed System Requirements Specification(SRS) documents and user documentation in accordance to guidelines and standards of a level where developers can interpret, design and develop the application with minimum guidance
• Experience in implementation of ICD-9-CM codes and ICD-10-CM codes changes in the current claim processing modules in MMIS.
• Worked on HP Quality Center 10.0 which includes Defects Management, Test Plan and Dashboard.
• Talking to the client based on requirements of that particular defect, uploading document required, checking history, status notes, setting up resources to handle and fix it.
• Worked on Rational Requisite Pro application to handle various requirements including Functional requirements, High-level requirements, Non-functional requirements, Scope statement and User requirements.
• Provided online support to users for various applications such as IPCS (Internet Professional Claims Submission).

Environment: HP Quality Center 10.0, Caliber RM, SAP, MS Office, Windows XP, Windows Vista, MS Visio, HP SharePoint, MS Project, MS Visio, SQL, SOA Infra, XML, Specbuilder, MMIS.

Business System Analyst

Confidential, Oakland, CA

Responsibilities:

• Implemented the SDLC for the developing life cycle and followed the standards process in the application.
• Translated business requirements into functional requirements and approaches for developers.
• Provided management support to the off-shore End to End integration/ Regression Test Team.
• Workflow documentation and comprehensive to the healthcare clients.
• Analyzed corporate healthcare business processes to develop customized solutions.
• Working with Medicare operational management to monitor, trend and report on operational metrics such as timeliness, workload, and staff trending, customer satisfaction, and other key measures to facilitate performance excellence.
• Interacted with healthcare clients to gather requirements, objectives, and input and output requirements.
• Developed test cases and scripts for front end testing.
• Performed execution of test cases manually to verify expected results.
• Ensured the accuracy and consistency of the data during the data loading process.
• Developed Use case, Functional, Object diagrams using Rational Rose.
• Responsible for architecting integrated HIPAA, Medicare solutions, Facets.
• Was involved in managing the Daily Standup meetings and also ensured that quality standards were enforced as per the build-release schedule.
• Developed a detailed test plan and test cases to cover all the requirements.
• Used rational Rose to create UML diagrams such as use case, activity, sequence, class and component diagrams.
• Developed Flowchart and process diagram using Microsoft Visio.
• Analyzed data architecture, documented and delivered data mapping, performed risk analysis.
• Frequently communicated with developers to resolve technical issues.

Environment: Agile, UML, MS Office, MS Windows, MS Project, MS Visio, SQL, SOA Infra, XML, Specbuilder, MMIS.

Business Analyst

Confidential

Responsibilities:

• Work closely with the Business owners to gather their financial needs
• Organize information and develop business cases offering recommendations to clients
• Facilitate and gather requirements and create Use Cases by extensive requirement gathering sessions and JAD sessions
• Extensive experience in Oracle Configurator developer - User Interface Design, Rules & Functional Companions
• Use the guidelines and artifacts of the Rational Unified Process (RUP) and Zachman framework to strategize the implementation of Rational Unified Process efforts in different iterations and phases of the Software Development Life Cycle
• Work extensively with the QA team for designing Test Plan and Test Cases for the User Acceptance testing (UAT)
• Work in SQL and Oracle dealing with extraction, analysis and processing of SQL Queries
• Create Use Case specifications, Business Flow diagrams, Activity/state diagram and Sequence diagram using Rational Rose, so the developers and other stakeholders can understand the business process according to their perspective with possible alternate scenarios
• Facilitate in the overall management of the projects including risk analysis and mitigation, status reports, client presentations, defining milestone deliverables and establishing critical success factors

Environment: MS Windows, MS Office, SharePoint, MS Project, MS Visio, SQL, SOA Infra, XML, SpecbuilderMMIS

Business Systems Analyst

Confidential, Colorado Springs, CO

Responsibilities:

• Defined scope of the project and developed a vision plan that defined the primary goals and objectives of the project.
• Worked with Rational Unified Process right from the initiation to transition phase.
• Gathered and analyzed business requirements for inbound and outbound files, managing all requirements using Rational Requisite Pro (RRP).
• Assisted Baylor Healthcare in determining the right approach to carry out ICD 10 operations by assessing their business and IT operations
• Conducted brain storming sessions to analyze provider contracts, provider reimbursement, benefit rules, medical policies and medical management rules to see the impact of ICD 10 diagnosis codes.
• Helped Baylor Healthcare in building ICD 9 to ICD 10 crosswalk map by grouping thousands of Codes and ranges in Clinical, Benefits, Financial, Medical policy waves.
• Conducted working sessions to gather and document high level business requirements and detailed level business requirements for different business units impacted by ICD 10 such as EDI Claims Intake, FACETS- Claims Adjudication, Medical Management- Utilization Management, Case management and Provider Reimbursement- Provider Payment.
• Organized impacted systems into high, medium and low impact to help business analyze the level of effort for remediation activities and ease resource allocation work
• Prepared use cases and data flow diagrams to analyze the impact of ICD 10 diagnosis codes embedded in different systems and applications
• Defined and prioritized the critical functionality required by the users (What-if analysis, Need analysis).
• Conducted Impact analysis and gap analysis
• Assisted in Risk-Management analysis.
• Designed and developed all Use Cases and UML models.
• Developed business requirement specification documents as well as high-level project plan.
• Manually tested the interfaces and functionalities.
• Involved in drawing process flow diagrams and work flow diagrams in all phases of the SDLC.
• Involved in preparing Software Requirement Specifications (SRS) and User Interface Design.
• Also assisted Technical team in designing of Application Architecture.
• Evaluated the Design Quality (Physical design checks, Standards, Security).
• Conducted functional walkthroughs, User Acceptance Testing (UAT)
• Assisted the project manager with risk lists, action items etc.
• Made presentations to the senior management executives several times during the course of the project

Environment: MS Windows, MS Office, SharePoint, Tole Servers, MS Visio

Business/Requirements Analyst

Confidential, San Francisco, CA

Responsibilities:

• Worked with a cross functional and diverse team of business users and developers to enable accurate communication of requirements and ensure consensus.
• Attended the sessions provided by Confidential to make sure that I have an understanding of all the modules in QNXT for example: Members, Providers, Claims, Utilization Management, Finance, Underwriting etc.
• Had meetings with business users and managers to understand the process what is required/to understand the AS IS process and providing them with the best solutions
• Conducted JAD sessions with management, SMEs, developers and users for open and pending issues. Worked on
• Was involved in the documenting the BRDs for letters to be sent out to members. Had meetings with developers and managers to make sure that letters are coming out of QNXT using SSRS. Users were able to generate letters from reporting services or letters were sent directly to folder using subscription.
• Was involved in QA the reports/letters before user testing and was communicating with developers if correction needed.
• Facilitated User Acceptance Testing (UAT) with the stakeholders and the business users, and the errors discovered were fixed and then verified via regression testing.
• Used SharePoint to for documentation and saved all the BRD, Sign off documents and other documents in it.

Environment: Agile, UML, MS Office, MS Windows, MS Visio, MS Project, MS Visio, SQL, SOA Infra, XML, Specbuilder, MMIS.