PROFESSIONAL SUMMARY:

• Senior Business Analyst with around 9 years of experience in IT industry.
• Experience in healthcare industry in working on various projects which include claims processing, Capitation Payments, using EDI X12 transactions like 837, 834, 835, 270/271, and 276 which fall under the HIPAA compliance.
• Extensive knowledge on the various types of health insurance programs such as: Medicaid, Medicare (Part A, B, C and D), PPO (Preferred provider organization), HMO (Health maintenance organization) etc.
• Worked extensively on healthcare Payer and Provider side applications.
• Experience working on Center for Medicare and Medicaid Services ( CMS ), Electronic Health Record ( EHR), Electronic Medical Record ( EMR), Healthcare Common Procedure Coding System ( HCPCS), PPACA(Patient Protection and Affordable Care Act and HL7 interoperability standards.
• Liaison between clients, subject matter experts and technical team
• Conducted group meetings, interviews and JAD sessions to identify customer needs, coordinating activities with diverse teams, creating and managing BRD, SRS/FSD and Use Case Narratives (UCN)
• Hands on experience on performing Gap Analysis & Risk Analysis, Data Modeling, Feasibility Studies, Scope and Project planning
• Exhibited competence in studying AS - IS models and developing TO-BE models for various projects on Business Process Modeling Experienced in demonstrating workflow design using Use Cases
• Extensive knowledge of SDLC methodologies
• Exhibited competence in processing Test Plans, executed Test Cases, validated and tested complex scenarios for quality purposes including Unit, Integration, System, UAT testing roll-out/support and third-party integrations. Conducted Defect Prevention (DP) activities like Root cause analysis, and finalizing the action items to improve the overall quality
• Extracted data using PLSQL and validated data to perform quality checks; created Source to Target/Data mapping document to expand Data Warehouse for reporting needs
• Coordinated with external vendors and handled their needs
• Build team by interviewing and internal and client employees
• Problem solver to develop workable solutions by envisioning business and technical perspective
• Have working understanding of Java/J2EE and Mainframe frameworks
• A quick learner who always puts forth the extra effort to learn new processes & domain

EMPLOYMENT OVERVIEW:

Business Analyst

Confidential, VA

Responsibilities:

• Extensively involved in all stages of the SDLC right from Project planning, to stakeholder identification to documenting business and functional requirements.
• Created, managed, tracked and analyzed different chart to estimate sprint velocity, development team's capacity and release planning respectively, to improve and maximize value while focusing to achieve the Sprint Goal.
• Created Data Stage jobs to extract, transform and load data (ETL) into data warehouses from various sources like relational databases, application systems, temp tables, flat files etc.
• Analyzed CMS comparison documentation highlighting changes of 5010 format and ICD10 diagnosis and procedure codes.
• Created Data mapping documents between various data elements, XML files, flat files, excel files, HIPAA EDI files X12 837, 270, 271, 276, 277, 278, 835, 275, and 5010 and web services, to perform verification and validation.
• Performed GAP analysis to identify the AS-IS process and TO-BE processes required to achieve the targeted goal.
• Identified gaps between current policies and procedures and new HIPAA 5010 compliance requirements and application of HEDIS NCQA standerds.
• Conducted discussion sessions to make sure that systems are in compliance to HIPAA and FDA CFR Part 11 regulations.

Sr. Business Analyst/Scrum Master

Confidential, Chicago, IL

Responsibilities:

• Facilitated the Product Development process used for designing the application that included making Use Cases & Use Case Diagrams and other UML models
• Involved in creating and analyzing current state flow diagrams of processes & UML Diagrams using MS Visio. Thereby, depicting the future state flow diagrams using MS Visio by interviewing various SMEs and feedback from IT solution existing system capabilities with the new requirements and developed an action plan for the migration process.
• Extracted data using SQL queries on an MS Access database.
• Conducted discussion sessions to make sure architects.
• Performed User Acceptance Testing
• Participated in various agile ceremonies as part of a Safe Agile team contributing towards program goals.
• Extensively involved in UAT planning and creating UAT scripts for Alpha and Beta testing.
• Used confluence software for document storage along with Share Point.
• Actively analyzed current business processes (Claims, Recipient eligibility and enrollment) and the impact on the enhancements on these processes to get the desired results
• Worked on modules which include claims processing using EDI X12 transactions like 837, 834, 835, 270/271, and 276 which fall under the HIPAA compliance.

Business Process Analyst

Confidential, NJ

Responsibilities:

• Implemented medication adherence solutions including methodologies for assessing medication adherence, outcomes/costs, interventions to improve medication adherence, and research and clinical Implications.
• Served as the scrum master, facilitating the ceremonies of agile, sprint planning/ release planning, daily stand-ups, demonstrations, and retrospectives. Delivered coaching to technical leads, developers, and testers on how to estimate story points, break down stories into tasks and keep track of their hours.
• Responsible for the work plan management, evaluating it on an ongoing basis and determining the current state of the pharma manufacturing project.
• Involved in organizing workshop with the end users for requirement gathering, limitations of existing system and proposed the solutions.
• Analyze and test integration with 3rd Parties and legacy systems
• Conducted UAT and User for Implementation and integration with Clinical trial management system.
• Analyzed user needs, conferred with users to improve procedures and identified and solved problems
• Developed custom reports and deployed them on server using SQL Server Reporting Services.
• Developed and managed SEM activities, including optimizing on page, optimization of text ads and keywords to drive web and mobile traffic, increasing overall sales conversions.
• Involved in mapping SOR’s to target Risk and regulatory reporting applications
• Worked with client to agree and document detailed design and acceptance criteria for both functional and non-functional requirements and for project deliverables.

Systems Analyst

Confidential, NY

Responsibilities:

• Created System Design Documents and Systems Integration Plans for Mobile Apps tech stack.
• Created wireframes and storyboard to serve as a guide for the backend structures like APIs, data diagrams, servers, data integration, and push notification services, needed to support mobile apps development.
• Implemented SDLC, agile (SCRUM) methodology for the developing life cycle and followed the standards process in the application and elicited requirements from Business users and stakeholders
• Used JIRA for issue tracking, User Story management and requirement traceability
• Created, managed, tracked and analyzed different chart to estimate sprint velocity, development team's capacity and release planning respectively, to improve and maximize value while focusing to achieve the Sprint Goal.
• Performed GAP analysis to identify the AS-IS process and TO-BE processes required to achieve the targeted goal.
• Created various UML diagrams on Visio.