SUMMARY

• Results - oriented professional with good communications, team building, analysis and problem solving skills including 7+ years experience in Business/Systems Analysis, and client relationship management.
• Professional experience in Business Analysis, Software Development Life Cycle: System Analysis, Design, Development, Testing, and Implementation on Business Systems.
• Ability to educe, define, document business user requirements, managing requirements and analyzing requirements, changing requirements and translating requirements and objectives into business/technical requirements based on project scope parameters.
• Responsible for EDI strategies enabling Health Care Providers and Insurance Careers to communicate effectively.
• Proficient in OOAD concepts, General and J2EE Architectural and Design patterns, database design.
• Proficient in the implementation of production change management techniques and service delivery disciplines
• Involved in gap analysis of healthcare portal applications that are developed in house team and developed gap analysis document, logical and physical design and remediation plan.
• Good Working Knowledge of HIPAA Regulations and Claims Processing.
• Strong experience in Requirements elicitation techniques - conducting user interviews, document analysis, JAD sessions and managing the requirements.
• Created design documents like data flow diagrams, process flow charts using MS Vssio and UML.
• Strong Object Oriented Analysis and Design using UML, Rational Unified Process, Rational Rose.
• Comprehensive experience in writing Test Plans, Test Cases and Test Scripts using manual and automated testing tools from Rational and Mercury Interactive such as test Director, Winrunner.
• Actively involved in developing, executing and managing User Acceptance Testing (UAT).
• Good hands on experience testing of inquiry screens to support EDI transactions.
• Outstanding communication skills and the ability to work effectively with technical teammates in order to translate business requirements into an effective technical solution and serve as an effective communication channel between the key IT and business contacts.
• Proven ability to grasp any new technology in any software and Healthcare industry.
• Strong communication, business understanding, critical thinking and analytical skills.

TECHNICAL SKILLS

Business Skills: Business Process Analysis & Design, Requirement Gathering, Use Case Modeling, JAD/JRP Sessions, Gap Analysis and Impact Analysis.

Methodology: RUP, Agile, OOAD and Waterfall.

Standard and Codes: HIPAA, ICD-10, ICD-9, ANSI X12, HL7, CMM, ISO, CPT and CMS form.

Languages: C, C++, SQL, PL/SQL, HTML and XML.

Management Tools: Rational Rose, Requisite Pro, Clear Quest, Clear Case, Serena Team Track and MS Visio, MS Project.

Testing Tools: Test Director, Win Runner, Load Runner and TOAD.

Data Modeling Tools: ERwin, Informatica 7.1.1/6.5

Database: Oracle, DB2, MS SQL Server.

Operating Systems: UNIX, Windows.

Office tools: MS Office 2007 (Word, Excel, Power Point, Outlook), MS Visio, MS Project, and MS FrontPage.

PROFESSIONAL EXPERIENCE

Confidential, Austin, TX

Sr. Business Analyst

Responsibilities:

• Involved in performance testing of Medicaid client server claims processing system, Medicaid MCC / MCO and Medicaid Management Information System (MMIS)
• Preparing System Test Cases from functional and technical requirement and Use case documents and performing System Testing.
• Implemented RUP and followed iterative, Use Case driven process for requirement documentation and deployment.
• Develop and maintain sales reporting using in MS Excel queries, SQL in Teradata, and MS Access.
• Updated the functional design document for NPI related changes in the Encounters project.
• Responsible for: creating artifacts for Rational Unified Process (RUP) - use cases, system architecture document, supplemental requirements document, architecture diagrams; verifying technical production infrastructure; designing and executing performance tests; and documentation.
• Met with various HMO, PPO, Medicaid/Medicare, and Tricare / Champus Representatives discussing benefits of contracts on behalf of facilities or appeals from denials and compliance issues
• Recorded retention stored in Knowledge Link. Ad Hoc reporting, Admin for MS Project, Excel dbase and pivot tables, Clarity and MS Project Server Admin duties.
• Involved in analysing the claims on basis of Primary and Secondary Payers and performed Medicare subsidy eligibility check for employee group plans.
• Created the test data 837P, I, D and tested multiple fields for HIPAA validation and business edits.
• Responsible for architecting integrated HIPAA, Medicare solutions, Facets.
• Worked on EDI transactions: 270, 271, 834, 835, and 837 (P.I.D) to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
• Perform Gap Analysis of the processes to identify and validate requirements.
• Developed reporting specifications by identifying business needs, prototyping sample reports and mapping data elements from reports to data models.
• Used Test Director and Mercury Quality Center for updating the status of all the Test Cases & Test Scripts that are executed during testing process.
• Conversion of data from different database environments, while performing Back End Testing.
• Supervise and manage projects throughout SDLC to ensure that project management methodology based on RUP is followed during the project lifecycle using MS Project and NIKU Workbench.
• Involved in walkthroughs and scheduled meeting with developers, SA’s (System’s Analyst) and testers to collaborate resource allocation and project completion using MS Project.
• Created reports in MS WORD for account processing of each client group.
• Tested the provider interfaces for NPI related changes in the Encounters project.
• Trained new Business analysts about the system and the data model.

Environment: PL/SQL, MS OFFICE, MS ACCESS, SHAREPOINT, REQUISITE PRO, MS PROJECT, WINDOWS XP, OOAD, USE CASE, RUP, UML, ORACLE, XML, DATA STAGE, WINRUNNER.

Confidential, Irvine, TX

Business Analyst

Responsibilities:

• Created systems requirement functional (FRS), technical requirement specification for application development
• Created Use cases, activity report, logical components to extract business process flows and workflows involved in the project using Rational Rose, UML and flow chart tools such as Microsoft Visio.
• Full understanding of Unified Modeling Language (UML) and SDLC models like Rational Unified Process (RUP), Waterfall, Prototyping and Agile.
• Proactively managed Software development, Requirements Analysis & Design, RFP/ RFI creation using Rational Rose and Requisite Pro; Created Use Cases using UML and managed the entire functional requirements life cycle using Rational Unified Process and Requisite Pro.
• Gathered, Analyzed and Translated systems requirements into technical specifications utilizing UML and RUP methodology.
• Used MS Sharepoint for the purpose of managing documents and for hosting websites which was used to access shared work spaces and documents.
• Developed Use-Cases, Activity and Sequence diagrams to demonstrate software architecture and interaction of system components before prototyping using Rational Rose and MS Visio
• Created Use Case Diagrams, Activity Diagrams and Sequence Diagrams in MS Project.
• Done research to understand some facts behind the AMS icon requirement.
• Worked on designing the screens and developing screen shows, and prototyping of the user interface and usability testing using Snag It
• Designed and developed Use Cases Diagrams, Sequence Diagrams, OOAD using UML and Business Process Modeling.
• Documented existing and proposed process flow, analyzed current and target system, and conducted GAP analysis.
• Evaluate development and maintenance of application documentation and source code management, along with participating in and supporting change management processes as required.
• Gathered and documented the requirements that are critical to the business mission and using those requirements to design application software using Use Cases in Requisite Pro.
• Played a substantial role in the process definitions and business and functional requirements gathering, in an effort to develop a practical technology solution for automating sales methodology.
• Worked on the overall project management by designing and developing higher level project plans and schedules, phase plans, iteration plans, weekly and monthly phase & iteration assessment meetings with the project team and steering committee, respectively
• Introduced and successfully demonstrated Object Oriented Analysis and Design (OOAD) techniques which included Domain Modeling.

Environment: HIPAA, MS PROJECT, CLARITY, JAVA/J2EE, PL/SQL, OOAD, MS OFFICE,TESTDIRECTOR, XML, WINDOWS XP.

Confidential, PA

Business Systems Analyst

Responsibilities:

• Facilitated collection of functional requirements from business users, and prepared business and technical requirement specification documents.
• Facilitated review of Enrollment, Claims, Commissions, and membership portlets’ designs with architects and developers to ensure that the goals of the portal requirements were satisfied
• Used UML, for gathering requirements, created Use Case Diagrams, and Use Case Specification document (USD).
• Tracking and managing requirement changes using Requisite Pro.
• Created client documentation, acceptance tests plan and user procedures.
• Used Prototyping method to gather additional requirements from the users in order to describe the business needs in terms of the system being created.
• Consulted with healthcare insurance company to develop conversion specifications for other insurance Coordination of Benefits (including Medicare).
• Developed various artifacts such as use cases, workflow diagrams, business process models and prototypes by interacting with end users, development personnel, project team and the subject matter experts.
• Interaction with underwriters to understand multiple data points. Prepared data flow diagrams using MS Visio for better clarity and to ensure documented process
• Maintaining Workbench project plans and Project Management Plans (PM Plan) including configuring new projects, new users and create project reports and administrative functions
• Prioritized project efforts, developed project plans, process flows, Use Cases and SRS using RUP.
• Responsible for researching and documenting existing system features and capabilities and documented findings in user guide for the purpose of various stakeholders and team members in the project to understand the features and functionality of the application accurately.
• Involved in making Use Case Diagrams, Activity Diagrams, and using analysis and design models tools like MS Visio, Rational Rose through RUP, Agile and Waterfall Model
• Used Unified Modeling Language (UML) for process modeling and use cases.
• Generated daily, weekly, and monthly reports using MS OFFICE Tools and submitted to the Team Leads and Manager for reporting, status reporting and analyzing purpose.
• Developed gap analysis document, logical and physical design and remediation plan.
• Followed the RUP based methods using Rational Rose to create: Use Cases, Activity Diagrams / State Chart Diagrams, Sequence Diagrams.
• Developed automated Test Scripts in Win Runner using Test Script Language (TSL) for Functional Testing, Regression Testing, Data Driven Testing, Usability Testing, and Verifying Specific content through using Checkpoints
• Successfully implemented AGILE methodology for application development.
• Execution of test scripts using WINRUNNER, TESTDIRECTOR.

Environment: EDI ANSI/HIPAA, MEDISTAT, XML, MERCATOR, REQUISITE PRO, AGILE, MS OFFICE, MS PROJECT, RATIONAL ROSE, JAVA/J2EE, CLARITY, TESTDIRECTOR, WINDOWS NT/XP.

Confidential

Business Analyst

Responsibilities:

• Analyzed user requirement documents (URD), software requirement specification document (SRS) and prepared Business test plan by dividing the application into manageable units.
• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims.
• Performed testing for Medicare, Medicaid and X-Over claims for Medicaid Management Information System (MMIS)
• Created and managed project templates, Use Case project templates, requirement types and traceability relationships in Requisite Pro.
• Implemented a modified RUP process for managing requirements
• Enhanced the Test Cases by analyzing the Specification Documents.
• Prepared test Data sets and performed data testing using the PL/SQL scripts. Also used MS excel for data mining, data cleansing, data mapping, data dictionary and data analysis.
• Developed, implemented and executed test methodologies and plans to ensure software product quality as per the (RUP) methodology. Test some of the Extensions in Facets application manually.
• Collected and processed quantitative and qualitative data analysis.
• Prepared spreadsheets with the help of MS Office Excel to show like specific geographic regions etc.
• Analyzed business and technical requirements, thus creating the Business Use Case and Functional Use Case documents.
• Perform Object Oriented Analysis and Designing (OOAD) of systems object model.
• Incorporated Project Solutions (CPS) Methodology, which was based on an Agile Methodology to create Business Requirement Document Specifications using MS Visio and MSWord.
• Conducted several demos driven by MS PowerPoint Presentations.
• Defining Software Development Lifecycle (SDLC) and planning the entire process using MS Project.
• Designed workflows and allocated permissions within SharePoint.
• Documented existing applications with the creation of UML sequence diagram and class diagram to document.
• Involved in the User Acceptance Testing to make sure the defects raised by the business users were resolved up to the Management Expectation by the developer group. Prepared documentation using MS Word.
• Responsible writing Test Plans, Test Cases and Test Scripts using manual and automated testing tools from Rational and Mercury Interactive such as test Director, Winrunner.
• Worked with the quality assurance group through out the company identifying the major changes with the greatest opportunity for cost reduction. Involved in generating Test Plans, Test Scripts and Test Cases manually in Excel.

Environment: RATIONAL REQUISITE PRO, RATIONAL CLEARQUEST, MS PROJECT, MS OFFICE SUITE, RATIONAL CLEARCASE, VB, JAVA, SHAREPOINT, OOAD, WINDOWS NT, UNIX