SUMMARY

• 7+ years of experience as a Business Consultant in Health Care domain.
• Strong knowledge of the Software Development Life Cycle methodologies like Agile and Waterfall models.
• Worked as a Product Owner in ACA (CMS) for multiple services and maintained documentation ( BSDs, ICDs ) for Employer Group, HIGLAS, MIDAS data exchange, NON - ESI MEC and Exchange Enrollment EDI-834 (Individual and SHOP Market)
• Experienced with Iterative approach for Software Development as per Rational Unified Process (RUP). Involved in inception, elaboration, and construction & transition phases using rational tools like Requisite Pro, Clear Case and Clear Quest during various phases of RUP.
• Experienced in interacting with business users to identify their needs, gathering requirements and authoring Business Requirement Documents (BRD), Functional Requirement Document (FRD) and Software Requirement Specification (SRS) across the deliverables of a project.
• Proficient in creating Sequence Diagrams, Collaboration diagrams, Activity Diagrams, Class Diagrams using Rational tools and Microsoft Visio
• Professional with extensive experience in the development, implementation and integration of strategies within a team oriented environment, utilizing quantitative and qualitative analytical skills.
• Experienced in Business Analysis, SWOT Analysis, Gap Analysis, Risk Analysis, Disaster Recovery Planning, Testing and Project Planning.
• Extensive knowledge of Medicaid, Medicare, Procedural and Diagnostic codes and Claims Process.
• Expertise in EDI and HIPAA Testing Privacy with multiple transactions exposure such as Inbound Claims 837-Institutional, 837-Professional, 837-Dental, 835-Claim Payment/Remittance Advise, 270/271-Eligibility Benefit Inquiry/Response, 276/277-Claim Status Inquiry/Response Transactions and testing in Client Server systems and Mainframe Applications
• Experience in Conversion of HIPAA X12 4010 to X12 5010.
• Experienced in facilitating Joint Application Development (JAD), Rapid Application Development (RAD) and Joint Requirement Planning (JRP) sessions, interviews, workshops and requirement elicitation sessions with end-users, clients, stakeholders and development team
• Experienced in analyzing and documenting business requirements and system functional specifications including Use Cases
• Strong Knowledge of UML, RUP, Rational Tools
• Experienced in handling Change Management
• Strong knowledge of Business Process Modeling, Business Intelligence and Business Architecture.
• Experienced in writing Test Plans and executing Test Cases
• Skilled in validation and testing complex scenarios for the maintenance of quality standards in projects
• Experienced in creating User Manuals and providing training to users.
• Creative and Aggressive person capable of forming and maintaining positive and productive team environments with integrative thinking skills.
• Exceptional Problem Solving and Sound Decision Making capabilities, along with the ability to resolve difficult situations.
• Excellent communication and presentation skills.
• Strong knowledge of ACA (Obama Care)
• Strong knowledge of Metadata
• Worked on electronic health record (EHR) for Ambulatory care.

TECHNICAL SKILLS

Operating Systems: Win 98/ XP/ Vista/ Windows 7, UNIX, LINUX, Mac.

Languages: Java, SQL, XMLDatabases Oracle, MS SQL server, MS Access, IBM DB2, EDIFECS, HADOOP

Tools: MS Office Word, Excel, Access, Power point, Project, Visio, Front Office, Rational Rose,SoDA, Software Modeler, Team Test, Doors, PROLOG, Clearcase, Clearquest, WinRunner,LoadRunner, HP Quality Centre, Ultra Edit, TOAD, Test Director and MMIS.

Industry Standards: HIPAA, SOX, ISO, Six Sigma, CMM, HL7, DICOM, NIEM.

PROFESSIONAL EXPERIENCE

Confidential, Reston, VA

Lead Business Analyst

Responsibilities:

• Analyses of the defect or a new requirement or a change request and perform detailed Impact analysis on the code and UI behavior for the changes
• JAD session with client to refine the analysis and requirements.
• Coordination with offshore team to make sure development is aligned with requirement.
• Think out of the box to accommodate new requirements Specific to 1 state without impact the product functionality.
• Created schema Tron which make sure that all outbound XMLs are in sync with EDI 834.
• Successfully implemented multiple service with minimal or no defects.
• Worked on yearly SERFF updates with successful delivery.
• Worked on integrating with External vendors.
• Designed validation in XML to capture incorrect enrollment with EDI rules.
• Worked on VLP changes suggested By HUB against H88 and S37.
• Worked with Operations team to analyses and detect root cause of any failure.
• Suggested lot of improvements for overall product which was appreciate by all the team members.
• Performed defect analysis.
• Worked with UI UX designing.
• Worked on initial phases of integrated eligibility to determine the eligibility of SNAP and TANF with the assets calculations.
• Developed Test Plan and Test cases based on the Use cases and Functional specifications and performed manual testing of the application by manipulating the data on different test runs.

Confidential, MD

Senior Business Analyst

Responsibilities:

• Worked as a Product Owner for multiple services and maintained documentation ( BSDs, ICDs ) for Employer Group, HIGLAS, MIDAS data exchange, NON-ESI MEC and Exchange Enrollment EDI-834 (Individual and SHOP Market)
• Writing SQL Queries to extract data from Database to perform analysis on a problem.
• Prepared 834 Spreadsheet with most of the business and implementation guide information for EDI support team.
• Assisted and reviewed the responses from EDI support team to the daily queries/tickets from Issuers.
• Understand the project technical architecture and be accountable for providing linkage to overall Business and IT Strategic objectives
• Highly accountable for ensuring QA organization is adequately prepared to test new systems requirements
• Gathered and analyzed requirement for Exchange enrollment XML ( EDI 834 ) and wrote the XSD for same.
• Manage and tracked the entire CCB requests and make sure the no other piece is impacted by current change.
• Analyzed and documented the changes in the compliance rules for adverse action redesign.
• Worked on different EDI scenarios for enrollment processing.
• Ensure day-to-day EDI transmission, Reject tracking and Reconciliation.
• Worked with SOAP UI for XML testing
• Wrote and analyze the test Scripts for different EDI transaction such as (834, 820, 999, 824, 835)
• Developed the XSD for Employer Group service
• Created Use cases, Activity, Sequence and Collaboration diagrams.
• Managed all the requirements, making requirements available to all team members.
• Assisted QA team with Test Plans and executing Test Cases.
• Prepared and maintain RTM for all the services.
• Conducted JAD sessions to define the services and to reduce the time frame required to complete deliverables.
• Using EDIFECS Transaction manager to analyze day to day enrollments and the issues reported by external entities.
• Analyze and documented the requirements for Employer Group, NON-ESI MEC (Non Employer Sponsor Insurance Minimum Essential coverage) Exchange enrollment, HIGLAS, 820.
• Conducted Risk analysis and developed mitigation plans
• Involved in preparing project plans and identifying major milestones for each stage as per the SDLC model (Agile Methodology).
• Worked with reconciliation services to make sure all the Entities/Partners have the same and correct data.

Confidential

Business Analyst

Responsibilities:

• Worked with the statisticians and underwriting team to analyze and validate run-time decision models.
• Gathered and analyzed requirement for HIPAA 4010 to HIPPA 5010 .
• Analyzed and documented the changes in the compliance rules for adverse action redesign.
• Worked on different EDI scenarios for batch processing.
• Ensure day-to-day EDI transmission, Reject tracking and Reconciliation.
• Run EDI Reconciliation reports daily and document in MS Excel.
• Involved in up-gradation of HIPAA X12 4010 transaction to HIPAA X12 5010 and ICD 9-CM (Clinical modification) to ICD-10-CM/PCS (Clinical modification/procedure coding system) simultaneously.
• Gathered and analyzed requirements for HETS.
• Created electronic claims for testing.
• Gathered and analyze high-level FACETS requirements from mainframe system.
• Maintained and monitored project progress and status through MS Project.
• Extensive use of Use cases and written business flows and work flow diagrams for effective plans.
• Created Use-Cases after accessing scope of the project and understanding the business processes.
• Integrated Requisite Pro to provide all teams visibility and maintains tractability among requirements, use cases and change requests.
• Managed all the requirements, making requirements available to all team members.
• Created requirements analysis and design phase artifacts using Requisite Pro and MS Visio.
• Worked extensively with the users and with different levels of management to identify requirements, use cases and to develop functional specifications.
• Created Use cases, Activity, Sequence and Collaboration diagrams.
• Syndicated with various cross-functional teams for building business use cases.
• Conducted Asset Management, Risk Analysis of the Requirements and Traceability focus areas of the various projects and worked with the project team to help them identify the high-risk areas.
• Traces and manage all the requirements with Metadata to ensure the delivery of deliverables on time.
• Data mapping, logical data modeling, used SQL queries to filter data within the Oracle and Sybase.
• Responsible for co-coordinating business meetings and generating monthly status reports etc.
• Assisted QA team with Test Plans and executing Test Cases .
• Involved in preparing application for ambulatory care ( HL7 ) using DICOM for RIS (radiology information system) & HIS (hospital information system) PACs (picture archiving & communication system)
• Design specifications and Test Case usages for the HIPAA 837 i, 270/271, 276/277, 835, 824, 275 and others.
• Involved in assembling, organizing and analyzing patient information, including medical history, symptoms, examination results, test results and prior treatments for HER (HL7) software development.

Confidential, Cleveland, OH

Sr. Business Analyst

Responsibilities:

• Interacted with stakeholders and gathered requirements as per the business needs.
• Implemented RUP methodology for iterative and incremental development of the system.
• Worked on Required Traceability Matrix (RTM) in Rational Requisite Pro for traceability of requirements through test cases
• Was involved in the planning of the RUP iterations and documenting of the artifacts throughout the various phases of the development process.
• Conducted GAP analysis by understanding the AS-IS system and the TO-BE system requirements by having discussions with the SME’s.
• Compiled the Vision Document and composed detailed Use Case Specification Documents in Rational Requisite Pro.
• Used UML to perform Use-Case analysis to capture the dynamic aspect of the application.
• Ensured the accuracy and consistency of the data during the data loading process.
• Developed State Diagrams, Activity diagrams and Class Diagrams in MS Visio using UML for various modules of the project.
• Created Process Flow Charts, Business Requirements Documents, Functional Specification Documents.
• Was involved in managing the Daily Standup meetings and also ensured that quality standards were enforced as per the build-release schedule.
• Developed Test Plan and Test cases based on the Use cases and Functional specifications and also performed manual testing of the functionality of the application by inserting varying data on different test runs.
• Developed Flowchart and process diagram using Microsoft Visio.
• Was in regular contact with Business partners on the status of issues, action plans and timeframe for resolution throughout the development cycle.
• Was involved in application for the enrollment of e-vendors, e-brokers and clearinghouses.
• Contributed in reviewing and editing of the test scripts.