PROFESSIONAL SUMMARY:

• Committed and result - oriented Business Analyst with 7+ years of experience as a client-facing professional in the healthcare as well as P&C insurance industry. Strong verbal and written communication skills.
• Highly motivated, organized and target oriented team player who enjoys working with multifunctional teams towards a common goal. Possesses a well-balanced understanding of the business relationship, business requirements, and technical solutions with the ability to work collaboratively with business analysts, software testers, developers, stakeholders and other team members even in an extremely aggressive project environment.
• Extensive working experience with Business Users, Senior Management and Technical teams.
• Adept with different Software Development Life Cycle (SDLC) methodologies including Agile, Waterfall and Rational Unified Process (RUP).
• Experienced in performing Impact Analysis, Gap Analysis (As Is-To Be), SWOT Analysis and Risk Analysis.
• Facilitated Joint Application Development (JAD) Interviews, Workshops and Requirement facilitation sessions with end-user/clients/stake holders and the IT group.
• Proficiency in documenting Business Process Design, authoring Business Requirements Document (BRD), Use case Specifications, Functional/Systems Design/Software Requirements Specification (SRS), Detailed Design Specifications (DDS), User Interface Specification (UIS) and analyzing them.
• Extensive design experiences in UML, using MS Visio and Rational Rose focusing on Activity Diagram, Class Diagram, Use Case diagrams.
• Proficiency in writing SQL queries for testing and data validation.
• Experience in User Acceptance Testing (UAT) and verifying performance, reliability and fault tolerance issues. Also familiar with testing tools to design and develop Test Plans and Test Scripts.
• Involved in post implementation support and training of end users.
• Thorough understanding of various subsystems including but not limited to, claim processing/ adjudication, member enrollment, provider management, Third Party Liability (TPL), Service Authorization, etc. in the Medicare, Medicaid and Private Insurance Sector.
• Knowledge of health care services regulatory environment including HIPAA.
• Specialized experience in healthcare insurance domain including Medicare and Medicaid. Profound understanding of insurance policies like HMO and PPO and proven experience with HIPPA X12 EDI transaction codes such as 270/271(inquire/response health care benefits), 276/277(Claim status), 834(Benefit enrollment), 835(Payment/remittance advice), 837(Health care claim).
• Extensive understanding of group benefits.
• Experience with HIPPA compliance 5010 and EDI transaction set 270/271/276/277/997.
• Excellent understanding of Medicare part A, B, C, D.
• Extensive knowledge of Medicaid Management Information Systems (MMIS)/Replacement Medicaid Management Information System (RMMIS), Medical Information Technology Architecture (MITA).
• Medical claims experience in process documentation, Analysis and implementation in 835, 837IPD, 834, 270/271, 276/277, 999/TA1 (X12 Standards) processes of medical claims industry from the provider/payer side.

TECHNICAL SKILLS:

Databases: MS SQL, MS Access, Oracle, Sybase

Languages: SQL, Visual Basic, HTML, XML, JAVA

Project Management: Microsoft Project, Microsoft Office, Microsoft Visio

Methodologies: SDLC, RUP, UML, CMM, SIX SIGMA

Operating Systems: Windows 2000/XP/Vista/NT

Tools: JIRA, Test Director, Quality Center, MS Office Suite, MS Project, Rational ClearQuest, MS Visio, Rational Rose

Market Data Sources: Bloomberg, Reuters, Moody s and ADP.

PROFESSIONAL EXPERIENCE:

Confidential, Bloomington, IL

Senior Business Analyst

Responsibilities:

• Gathered the functional and non-functional requirements for various releases and phases of the project.
• Created product backlogs and business scenarios based on the JAD sessions with the client.
• Created use cases for functional requirements based on the client’s template.
• Involved actively in the UI specs and wireframe meetings to make sure they match with the requirements and create feedback tracker to keep the project aware of the changes.
• Created CBA (Cost Benefit Analysis) for one of the project releases.
• Prepared activation/implementation information and the ability to work with claims management and enterprise stakeholders.
• Conducted interviews with key business users to collect requirement and business process information.
• Worked as a liaison in an agile environment between technology and the business clients to improve business processes and support critical business strategies.
• Conducted audience analysis and GAP analysis to create training materials for the internal end users.
• Involved in overview Interview sessions, training presentation sessions and detailed interviews.
• Worked with State-Client to gather the information about the documents and business processes.
• Held JAD sessions to collect software requirement specifications and requirements and use case management tools to maintain the requirements and offer a variety of financial products on Property and Casualty experience in the project
• Created knowledge management articles for claim handlers, claim representatives and agents to enable them to serve the policyholders effectively.
• Created reports for business analysis purposes using Visio and Microsoft Excel.
• Participated in usability testing meetings and created a tracker to document users’ feedbacks, provide solutions and presented those to the project team.
• Involved in post-implementation training and support.
• Conducted gap analysis and audience analysis to recognize the end users of the product.
• Created user manuals and other training documents.
• Authored end-user questionnaires to ensure that product users understand the product functionalities.
• Designed and implemented basic SQL queries for QA testing and report, data validation.
• Worked closely with the UI team to model the screens that met user, defined requirements and company standards.
• Addressed production, UAT issues and took proper actions accordingly based on priority and requirement.

Environment: Ms Visio, MS Project, MS Excel, GAP Analysis, Agile, SQL, Oracle, UAT and Windows.

Confidential, Harrisburg, PA

Senior Business Analyst

Responsibilities:

• Gathered requirements from the functional designs, meetings and business analysts followed by drafting them into the Requirements documents.
• Identified/documented data sources and transformation rules required for populating and maintaining data warehouse content.
• Followed agile development methodology during the project life cycle.
• Conducted JAD sessions with extensive involvement from Business, Development, testing teams, Architects, SME’s (Subject Matter Experts) and managers of various Business Units.
• Co-ordinated with multiple teams and integration architects, in performing analysis for issues regarding speed and stability.
• Worked on different batch job processes including Time Clocks, Third Party Liability, AD-HOC, Customer Service Representative, Report a Change, PSI/ARD.
• Gathered functional and non-functional requirements in collaboration with end clients and internal project managers as well as SME(s).
• Involved in the analysis of HIPAA compliance and EDI transaction sets and actively participated in the designing of the EDI transactions using the new HIPAA 5010 utilizing the ICD-10 codes.
• Involved in 835 files validations for HIX at Claim level, Line level, Service level and Transaction level.
• Created detailed business scenarios and wrote master use cases, which covered step-by-step process of interaction between user and system.
• Designed granular Visio diagrams to show the flow of events as well as BPM documents for benefit of offshore developers.
• Created wireframes using Prototyper software based on collaboration with use cases and MS Visio flows.
• Designed detailed storyboards based on the client template.
• Followed the project progress and made sure that everything is going to be done on time by creating various trackers and keeping it updated based on daily agile stand up meetings.
• Identified system’s bugs and deficiencies by doing production clean up and data fixing.
• Conducted GAP analysis to find out what needs to be done for the next step.
• Communicated with the project’s PMO to make sure all deliverables are consistent with the clients’ templates and expectations.
• Analyzed client’s data and information by using their templates and tools and translated them to various requirements and use cases as well as wireframes to be used by offshore developers.
• Reviewed the clients’ comments and feedbacks for each deliverables and resubmitted the documents on time and get them signed off.
• Assigned action items within each JAD sessions and war rooms and following up with the client to get the right response.
• Collaborated with different aspects of the project such as worker portal, individual portal or CSR portal to make sure about the project consistency.
• Created Unit test plan, system integration plan, wrote functional test cases and participated in module checking using SQL queries.
• Gained solid knowledge of clients’ policies and business rules and translated them into the understandable concept to use for use case and business requirement creation.
• Worked with UAT team to create test cases for batch testing.

Environment: Ms Visio, MS Project, MS Excel, GAP Analysis, HIPPA, ICD, EDI, Agile, SQL, Oracle, UAT and Windows.

Confidential, Indianapolis, IN

Business Analyst

Responsibilities:

• Worked as a liaison between technology and the business clients to improve business processes and support critical business strategies.
• Involved in overview Interview sessions, training presentation sessions and detailed interviews.
• Worked with State-Client to gather the information about the documents and business processes.
• Contributed to ICD-10 Awareness Training Management Plan, created evaluation tool, and survey questions
• Involved in forward mapping from ICD 9 to ICD 10 and backward mapping from ICD 10- ICD 9
• Responsible for writing Functional Requirement Specifications (FRS) and User Requirement Specification (URS).
• Contributed in process development, issue solving process, and creation of the process flow documents and diagrams
• Conducted JAD sessions with management, vendors, users and other stakeholders for open and pending issues.
• Created reports for business analysis purposes using Crystal Reports and Microsoft Excel.
• Helped with building ICD 9 to ICD 10 crosswalk map by grouping thousands of codes and ranges in Clinical, Benefits, Financial, and Medical policy waves.
• Working within a growing environment of X 12 4010/5010 HIPAA Transaction Processing 837 I, P, D, 835, 834, 820, 270, 271, 276, 277, 278, EDI, Privacy, Security, and Medicaid.
• Reviewed EDI companion guides for all payers to ensure compliance, edit integrity and maintain up-to-date list of payer contacts
• Extensively involved in HIPAA 5010 User Acceptance Testing (UAT). Defined and maintained Test Cases for EDI transactions.
• Reported the bugs in ClearQuest, interacting with the developer for resolving the same and retesting the resolved bug.

Environment: HIPPA, Crystal Reports, MS Excel, MS Project, MS Visio, ICD, EDI, ClearQuest, Windows.

Confidential, Austin, TX

Business Analyst

Responsibilities:

• Interfaced between Business Users and the different teams involved in the application development for better understanding of the business and IT processes.
• Conducted JAD sessions for requirement gathering, and analysis.
• Conducted GAP Analysis and formulated the TO-BE features based on the business requirements.
• Responsible for the delivery of Business Requirements Documents (BRD) and Functional Requirements Documents (FRD).
• Analyzed system requirements and created Use Case Diagrams, Activity Diagrams using Rational Rose.
• Responsible for continuous process improvement and for identifying and maintaining a clear and measurable Development Process that is deployable throughout the enterprise.
• Created scenarios for User Acceptance Testing and conducted UAT.
• Designed and implemented SQL queries for testing and reporting.
• Involved in documenting defects and responding to IT in defect clarifications and resolution.
• Designed and implemented test scenarios for the application.

Environment: Rational Rose, Gap Analysis, UAT, MS Project, MS Visio, SQL and Windows.