SUMMARY

• Years of experience in Business Analysis in Healthcare and Pharmaceutical domains.
• A Business Analyst wif years of IT implementation in Health care and industry standards, SDLC practices and UML tools.
• Progressive healthcare experience including: Confidential policy; program analysis; health information technology; public health policy; federal and state regulation compliance ( Confidential / Confidential, Confidential, Confidential ); and claims management.
• Confidential experience including Confidential Management Information Systems ( Confidential ) and Managed Care administration.
• Successfully used Agile/Scrum Method for gathering requirements and facilitated user stories workshop.
• Acted as a person of contact concerning policies and regulations
• Facilitated meetings wif project stakeholder and subject matter experts to elicit business and functional requirements and understand current business process.
• Identified and document impact of proposed system changes to existing business process and provided guidance and suggestions for improvement.
• Developed business process description, detailed functional requirements, analytical reports and other pertinent SDLC artifacts
• Documented User Stories and facilitated Story Point discussions to analyze teh level of effort on project specifications
• Provided project management expertise to ensure overall project plan is successfully executed - including communicating project’s goal, objectives, work plans, schedule, scope and milestones.
• Worked closely wif various stakeholders, SMEs and staff to understand and document Business, Functional and Software requirements.
• Researched, created and reviewed requirement documents along wif business Use Cases.
• Expertise in Information Technology/ Data/ Process Management wif emphasis on Business Systems Analysis.
• Efficient in conducting workshops and Joint Application Development (JAD) sessions, Project meetings, Reviews and walk through sessions.
• Excellent work experience in creating Project Plans, Business Requirements Documents (BRDs), Functional Requirement Specifications (FRS), Use Cases, User Stories, Activity Diagram, Sequence Diagram, Requirement Traceability Matrix and Test Plans.
• Experienced in developing project plans using MS Project and MS Share Point, identifying documents, and validating requirements and reengineering process.
• Experienced in ensuring quality, budget and timeliness of teh project.
• Involved in analyzing and documenting various reports such as ad-hoc reports, drill-down, drill-through, and parameterized reports
• Experienced in creating ad-hoc reports using Crystal Reports and SSRS in data warehouse environment.
• Experienced in creating test plans, test cases, test results analysis wif teh testing team and reporting defect management and test status matrices.
• Worked wif development and QA team in coordinating bug-fixing.
• Experience in functional areas of Pharmacy Benefit Management like - Pricing, Coverage, Co-pay, Indemnities, Dispensing,
• Experienced in Systems Testing, Integration Testing, and Software Quality Standards, Training, Documentation and implementation in a business environment.

TECHNICAL SKILLS

Operating Systems: UNIX, Windows 95/98/NT/2000/XP, 2007, WindowsAutomation Tools: MS Visio, Rational Rose, Rational Clear Case, Rational Requisite ProBusiness Modeling Tools: Provision, Excel, Power Point, UML, Agile, Waterfall, DRAMSBusiness Process Modeling: Blue works live IBM ToolBug Tracking Tools: Rational Clear Quest, Quality Center 9, Guidewire, Rational req. Pro Clear QuestStandards & Methodologies: Waterfall, Scrum, RUP, SDLC, Agile, HIPAA, Claims, EDI837/835/834/ICD 9 and ICD 10Utility Tools: MS Office Suite, MS Project, MS Share Point, Adobe PhotoshopData warehousing Tools: Erwin, DRAMSResponsibilities:

Business Analyst

Confidential

Responsibilities:

• Served as a liaison between teh business team and teh project team by assisting teh business in identifying, understanding, and documenting their business needs
• Gatheird business requirements for teh related enhancements in teh administration process by conducting meetings, interviews, and JAD sessions wif stakeholders.
• Performed Requirement gathering and Business Impact Analysis.
• Wrote teh BRD diagram to ensure high level design is accepted by teh client.
• Created an Eligibility/ claims/ Provider File data layout
• Performed teh standardized control balance check against teh extract and delivered via existing processes used for teh current extract
• Conducted JAD sessions wif management, SME, vendors, users and other stakeholders for open and pending issues.
• performed application testing for both maintenance configuration and project based changes.
• Finalized and documented teh Business Requirement for teh application wif various key stakeholders.
• Led Teams (Remote, Co-located and vendors) in Requirement gathering and SME
• Maintained master project monthly reports
• Documented Business Process Flows in Blue Works Live: current state / Future state
• Isolated and recorded business process improvement recommendations
• Reviewed proposals wif business owner
• Escalated rejected proposals to DIL/Relationship Manager
• Completed BRDs/Work Orders wifin committed timeframe
• Achieved established quality goals
• Collaborated wif members of teh Product, Business and Engineering Teams to develop and maintain Product Backlogs wifin an Agile environment
• improved format and content of documents related to projects
• Participated in training courses, requirements gathering and tool sets, application of acquired skill-set and implementation of recommended Process improvements
• Extremely proficient in Health Care product types
• Highly noledgeable regarding various health care provider types
• Affordable Care Act implementation experience
• Confidential cliams
• Blues experience, including ITS noledge
• Confidential experience and Mandate experience
• Confidential / Confidential noledge proficiency
• Excellent communication and presentation skills
• Expertise in Summary of Benefit Coverage and Portals

Environment: Windows 7 Professional, MS Excel, MS Project, SQL Server Management System 2012 UML, MS Office suite, MS Visio, IBM Blueworks Live Reconciliation, Aggregation, Financial services, CPL, Data analytics, Informatica, HDH, ICOE, Clear quest

Business Analyst, Remote

Confidential, Baltimore, MD,

Responsibilities:

• Worked on Data analytics and intelligence to monitor and solve teh various queries using SQL server
• Updated teh Interface document and wrote new requirements to teh system design document
• Analyzed departmental computing projects, including goal definition, time lines, data, processing, controls and standards
• Utilized Agile Scrum practices to halp teh team increase their velocity
• Solicited requirements from Subject Matter Experts while managing expectations and providing technical leadership/user support requirement
• Worked on Confidential Data tables and created audit reports using queries. Manually loaded data in Confidential and TEMPhas good noledge on Confidential business rules.
• Performed data mapping and data modeling and used canonical data model to map data from X12 834 transactions.
• Did teh forward and backward data mapping between teh fields in mainframe and Confidential .
• Analyzed teh mainframe reports for member/eligibility/claims and mapped teh fields wif Confidential batch jobs and reports.
• Tested teh changes for teh front end screens in Confidential related to following modules
• Used Re-engineering and capturing of transactions wif legacy systems Enrollment -834 .
• Provided support to full Software Development Life Cycle, testing, training and implementation.
• Wide noledge in Health Payer Enrollment/Billing experience
• Worked on Reporting and data integration using SQL server
• Created spreadsheets and reports and solved discrepancies and communicated wif Operations to send teh solutions via a Managed File Transfer
• Expert in ANSI Standards as they relate to HIPAA file formats
• Worked on teh business and technical sides enough to understand teh needs dat arrive from making products
• Teamed wif IT professionals in their own settings, working on problems and enhancements.
• Wrote functional and non-functional requirements for system enhancements.
• Conducted and communicated Cost versus Benefit Analysis for change requests
• Helped in assurance conformance wif federal and state Health laws and regulations
• Produced reports on Data files dat Issuers sent for validation
• Insured dat Files adhere to compliance HIPPA laws and ICD documentation
• Created Excel and word documentation as well training material for teh Data analysts as a set of best practices
• Reviewed requirements wif teh BA and teh QA team to understand teh issues and anomalies dat prevent Issuers from validation of their Reconciliation Files
• Used data mapping and analysis to understand teh trend and best practice to handle issuers inquiries using a mailbox dat is secured and accessed by designated IT Managers

Environment: Windows 7 Professional, XML, MS Access, MS Excel, MS Project, SQL Server Management System 2012 UML, MS Office suite, MS Visio, Reconciliation, Aggregation, Financial services, CMS Recon, SSHOP, Production Support, REGTAP, Remedy

Business Analyst

Confidential, West Avenue Rockville, MD

Responsibilities:

• Worked wif BI (Benefit Investigation) Delivery Manager and Operations to analyze and document business processes and requirements.
• Established, reviewed, revised, interpreted and implemented policies, procedures and program standards supporting teh Program
• Coordinated testing efforts between US and offshore QA teams.
• Created system and training documentation to include instructions on new features, release notes, and user manuals
• Assessed and analyzed state and federal Confidential and CHIP policies impacting teh implementation of Confidential health IT initiatives.
• Experience in JIRA and Qtest as part of Test Management.
• Prepared policy recommendations, updates and process improvements to enhance operations and to ensure compliance wif federal and state regulations.
• Prepared written communication and reports for internal and external stakeholders, including Congressional committees, Federal and State agencies.
• Developed operations plan, training material, and reference guides for use during teh incentive program transition.
• Conducted policy and procedure training modules for teh Confidential Incentive Program outreach staff
• Created and Executed a Requirements Management Plan (RMP)
• Analyzed and translated business requirements into reporting technical requirements
• Designed and developed Business Investigations and solutions using best practices and standards.
• Collaborated well wif project team business partners Reporting Delivery Manager and senior level executives
• Reviewed reports for trends for quality data structure, report validity and data details
• Communicated clearly and TEMPeffectively and in a timely manner wif Operations and IT partners
• Ensured teh full workflow of teh reporting request is followed, documented and closed.
• Planned and managed business requirements and functional requirements as well as documentation activities
• Gatheird application requirements from users and subject matter experts, and prioritized required features to contain scope
• Wrote test plans, setup test data, execute test scenarios, document and evaluated defects
• Created Business Requirements Documents, for review and approval from responsible parties
• Translated business requirements into detailed functional specifications as input to design and development.
• Maintained frequent communication wif client teams regarding project deliverables and to gauge completion of pending projects. Ensured existing documentation is kept up to date as requirements changed.
• Ensured adherence to Reporting processes and performance metrics.
• Assessed reporting needs and provided recommendations for enhanced solutions and matched needs to Reporting tools and capabilities.
• Elicited technical documentation and software specification documents
• Performed Ad-hoc query development to support program needs
• Worked wif Reporting and Information Technology team members to communicate requirements and ensured delivery of quality well defined requirements.

Environment: Patient Plus CRM, Thera call 1.0 and 2.0, Windows XP Professional, XML, MS Access, EDM Quality, EDM CRF, MS Excel, MS Project, RUP, Oracle, UML, MS Office suite, MS Visio, RSL, EDIFECS, PTR System, Qtest

Business Analyst

Confidential, El Segundo, CA,

Responsibilities:

• Worked on Confidential, EDI, Pharmacy OS+, Claims, remittance advice and payments
• Performed Change requests and traced all changes in teh DSD
• Provided analysis and reviewed documents to track defects and CTC's
• Met wif SME's and PMP's to plan out teh resolution of deliverables per state requirements
• Participated in hundreds of meetings either wif functional teams or developers and state partners
• Identified, evaluated and documented business needs and objectives, operational processes and procedures, problems and requirements.
• Recommended operational and process improvements based on efficiencies and available technologies.
• Maintained a repository of performance metrics, and generates management reports illustrating statistical data, text and graphics
• Conducted secondary research using a variety of publications, services and health statistic databases.
• Produced documentation, including project plans, analytical reports, decision backup, information research reports, budget analyses, training plans, business justifications, and graphics.
• Was responsible for project modeling and forecasting. May manage a singular effort on a given project or lead a team to address a specific concern.
• Was assigned to lower level management functions.
• Used Qtest to review teh Test Suite, test scenarios and test cases traceable to requirements to validate teh application or customer deliverables
• Coordinated wif stakeholders to develop business cases for potential new products or initiatives.
• Documented and maintains workflow and business process models related to assigned projects.
• Worked wif other departments to identify and document business requirements, workflow, policies and procedures
• Evaluated or assessed vendor features, functions, products, and attributes.
• Identified, reviewed, analyzed, and documented program policy, state rules & regulations to support teh Confidential and other healthcare programs
• Created and executed user test plans.

Environment: Windows XP Professional, XML, MS Access, EDM Quality, EDM CRF, MS Excel, MS Project, RUP, Oracle, UML, JD Edwards, MS Office suite, MS Visio, Crystal Reports, DRAMS, Oracle Client, Req. Pro, CQ, Clear Quest, EDIFECS, Doors, Qtest