- Over 8 years of experience in business process analysis & engineering, business requirements gathering and documentation in Healthcare, Pharmaceutical and Insurance industry.
- Experienced in interacting with stakeholders, user clients, validators and developers.
- Excellent healthcare domain knowledge of Affordable Care Act, healthcare claims system, Medicare, Medicaid, membership and HMO/PPO, Health Insurance Portability and Accountability Act (HIPAA) Rules, BCBSA project, ICD codes.
- Analyzed and synthesized results from joint application development/ design (JAD), joint application requirements/review (JAR), rapid application development (RAD) sessions and proposed alternative tasks and transform those into business requirement document (BRD), project requirements document (PRD) and system requirements specifications (SRS).
- Extensive business process modeling experience in visualizing, documenting, modeling and analyzing business process for system understanding and process execution.
- Extensive experience in software development life cycle (SDLC) and their variants experience including requirements gathering, analysis, design, development, testing, implementation, deployment and maintenance.
- Experience in working with QA (Quality Assurance) teams during all phases of testing and actively involved with UAT (user acceptance testing).
- Extensively worked on unified modeling language (UML), rational unified process (RUP), use case diagrams for diagrammatic representation of the data flow. Worked on preparation of business process flow diagrams.
- Well - versed in using rational enterprise suite’s tool for creating use case diagrams, dataflow diagrams, state diagrams, activity diagrams, flowchart diagrams and collaboration diagrams.
- Worked with data warehouse team on data sources like oracle, DB2, Teradata, and analyzed SQL queries at the database level.
- Experienced in gathering and managing user requirements by coordinating with different business and end-users utilizing tools like rational clear quest, requisite pro etc.
- Involved in research and development of risk management/analysis, project planning and project management.
- Effectively worked in a team environment and adjusted to dynamic schedules.
Business-Modeling Tools: Rational Rose, MS Project, MS Office, MS Visio, Rational Requisite Pro, FTP, Mercury, Clear Quest
Methodologies: Rational Unified Process (RUP), Unified Modeling Language (UML), SDLC, Waterfall, Agile
Testing Tools: Quality Center, HP- Application Lifecycle Management (ALM), Test Director, QTP
Programming Languages: SQL, PL/SQL, HTML, Visual Basic, COBOL, JCL, XML
Operating System: MS Windows, UNIX
Databases: MS Access 97/2003, SQL Server, RDBMS, Oracle 8i/9i/10g, DB2, Teradata, Mainframe, Informatica
Business Analyst/ Business System Analyst
- Working on the Priority Advantage Program’s Medical Management project.
- Working on gathering requirements for the Medical Management project work streams such as Utilization Management, Care Management, Disease Management etc.
- Defining project requirements based upon user needs, and a sound understanding of applicable business or clinical systems and industry requirements.
- Meeting with different subject matter experts of the departments that are well versed in defining Medicare Advantage Plan business processes and guidelines. Documenting the information gathered during these meetings to convert in user stories and requirements.
- Meeting with departments such as pharmacy, clinical, call center, enrollment and eligibility, population health etc. to learn about processes and procedures they follow to comply with CMS Medicare Advantage Plan (Part C) guidelines.
- Collaborating with project manager to document, review and obtain sign-off on project definition document (PDD).
- Preparing Requirements Estimation Template to provide timeline for completion of project business requirements.
- Working on highest priority tasks as they arise such as PDP (Prescription Drug Plan - Medicare Part D) discovery for clients.
- Participating and providing updates during daily stand-up meetings to meet the timeline of the project tasks.
- Organizing meetings, capturing meeting minutes and distributing to all the invitees.
- Assisting project manager in devising or modifying procedures to solve problems, considering software applications capacity, resource availability, operating time and form of desired results.
- Understanding business and user needs, documenting requirements and translating them into functional requirements.
- Providing support to the technical project implementation team, often leading work on new implementations and upgrades of related systems.
- Providing guidance and training to team members as need be.
- Collaborating with QA team and Development team to carry out project requirements implementation.
- Uploading and managing project artifacts and documents on InSite for PA program.
Environment: MS Office, Agile, HP ALM (Application Lifecycle Management) tool, MS Project, Windows 7, InSite.
Lead Business Analyst/ Business Analyst
- Reviewed and assessed Federal Regulations pertaining to ACA (Affordable Care Act) along with regulations and legal teams to identify compliance requirements pertaining to the project. Documented these compliance requirements and reviewed amongst Mandates Implementation SMEs (subject matter experts) at Confidential and obtained sign-offs.
- Documented Small group as-is information process flow and To-Be process flow using MS Visio.
- Worked on the Medicaid, mandates and government regulations driven projects. Worked with the Legal team to interpret the regulation rules.
- Worked on documenting requirements for enrollment and membership project impacting Facets. Worked on gathering requirements for the claims processing and billing related projects.
- Participated in creation of Requirements Management Plan (RMP) for the project, to define, organize and schedule requirements management and development activities.
- Participated in various data mapping tasks as required in the project lifecycle.
- Participated in the creation of PRD (Project Requirements Document) for PEGA system that included defining Business, User, functional and non-functional requirements. Obtained approval by Business and IT.
- Participated and provided requirements support in Design, Development and Testing sessions.
- Worked closely with marketing team to verify proposed product portfolio is following ACA regulations.
- Investigated and analyzed feasibility of low to moderately complex enhancements, automations and processes.
- Participated in functionality focused Joint Application Requirements (JAR) sessions and documented gaps and requirements. Prepared MS Visio business process flows.
- Participated in the tracking and management of issues log and assisted in planning for resolution.
- Participated in testing efforts by defining, developing and implementing practices and procedures for complete end user test plans.
- Ensured all user acceptance tests (UAT) are conducted and documented according to standards. Identified and documented system deficiencies and recommended solutions.
- Worked on eliciting and documenting business rules and business processes.
- Worked on BCBSA ( Confidential Association) driven projects.
- Provided assistance and support throughout all project phases.
- Meeting regularly with the project core team and business stakeholders’ team to understand client needs to meet project timelines.
Environment: MS Office, Agile, SQL Server, PEGA, HP ALM (Application Lifecycle Management) tool, Facets 4.3.1, MS Project, Windows 7, SharePoint.
Business System Analyst
- Primary responsibility was to serve as a liaison between client (SSA) and core team to understand and document the legacy system process flows.
- Worked as a healthcare Business System Analyst.
- Worked as a business process modeler to understand and document various legacy systems As - Is process to document and understand To-Be process utilizing IBM business process modeler tool during various workshops, for DCPS project conducted nationwide by social security administration.
- Conducted review sessions with stakeholders and clients (SSA) to elicit requirements that lead to identification of business rules, and documented the requirements into detailed systems specification (DSS) documents for workload case management (WCM) module.
- Gathered and documented business rules in use case documents for WCM module.
- Responsible for performing and documentation of business process gaps between DCPS “As-Is” and “To-Be” business process.
- Conducted requirements elicitation sessions with user(s), SMEs (subject matter experts) and business stakeholders to understand and baseline business, user and functional requirements.
- Managed and uploaded WCM DSSs in IBM rational requisite pro and conducted requisite pro tutorial sessions for team members.
- Worked with testing team and QC lead to enhance QC and requisite pro synchronization. Provided assistance during UAT with business team members.
- Authored use cases, base-lined and documented business requirements and uploaded documents to IBM requisite pro to maintain traceability and version control.
Environment: Rational Clear Quest, MS Office, Oracle, RUP, SQL Server, Rational Requisite Pro, HP Quality Center, Mainframe, MS Project, Windows 7, SharePoint
- Involved in Business Requirement identification sessions with business and technical units.
- Gathered and analyzed requirements coming out of the JAD sessions and created detailed Use Cases based on that information.
- Created and reviewed business requirements and functional specifications.
- Worked with technical staff towards gathering requirements, identified and mapped detailed current processes.
- Extensively worked on MS Visio for creating UML diagrams for project documentation.
- Provided comprehensive consultation to the business and technical areas in recommending business solutions, to improve the efficiency of these processes.
- Involved in UML Modeling with Visio (Use Case Diagrams, Activity Diagrams, and State Transition Diagrams), Use Case Analysis and Documentation (written) as part of the project’s design in developing workflow and business models.
- Facilitated joint application requirements sessions with business SMEs, and reviewed HIPAA version 4010 transactions to maintain all the suitable standards related to the project while assisted in migrating these transactions to HIPAA version 5010.
- Responsible for conducting interviews, scheduling and coordinating work sessions and documenting the outcomes with business users and stakeholders.
- Prepared meeting minutes and circulated amongst the meeting attendees. Worked in a team environment and took personal responsibility for the deliverables.
- Reviewed Business Requirement and Functional Specification documents for writing test cases.
- Was involved in process performance research and consulting to candidate projects needing to clarify their process improvement goals and expected outcomes.
- Worked with QA team in implementing testing process and methodology. Involved in precise meetings with testing team and development team to plan and implement testing efforts.
Environment: Rational Clear Quest, MS Office, Oracle, RUP, SQL Server, HP Quality Center, Mainframe, MS Project, Windows 7.
Confidential, Sunnyvale, CA
- Leading business requirement identification sessions with business and technical experts.
- Gathering and analyzing requirements coming out of the JAR (Joint Applications Review/Requirements) sessions and creating detailed use cases based on information gathered.
- Responsible for recording requirements in rational requisite pro and managing changes and traceability requirements matrix.
- Managing requirement defects in HP ALM tool.
- Creating and reviewing business requirements and functional requirements specifications amongst business subject matter experts.
- Modeling current and to be business processes using tool such as MS VISIO.
- Preparing meeting minutes.
- Ensure working in team environment and taking accountability to complete the deliverables in given timeline.
- Providing assistance to the software development and testing team while coding and testing the functional requirements.
Environment: MS Office, Agile, SQL Server, HP ALM (Application Lifecycle Management) tool, MS Project, Rational Requisite Pro.