SUMMARY

• Trace and inform business requirement changes through the lifecycle of the project using Rational Requisite Pro while maintaining customer needs and maintain a Requirements Traceability Matrix RTM to keep the stakeholders informed of the progress of the project
• In depth understanding of the AS-IS and TO-BE and Gap Analysis business processes. Developed ER diagrams, Process Flow Diagrams as precursors to workflow-development, re-engineering, functionality enhancements, migration to new technology and value-addition of existing business solutions.
• Good knowledge of EDI X12, HIPAA and ICD codes.
• Over Eight years experience working as a Business Systems Analyst. In-depth experience and proficiency with business scope definition, developing functional and technical specifications, creating business and application use case documentation, leading business and technical analysis sessions, supporting development and testing teams. Over 7 years of extensive experience in Healthcare Insurance domain Including in-depth understanding of insurance policies, knowledge and experience with HIPPA, EDI transaction - 270/271, 276/277, and 835/837 and ICD-9, 10.
• Good understanding of ANSI X12 4010 and X12 5010 versions of HIPAA transaction standards and ICD-CM and CPT code sets and understanding of mapping semantics for conversion.
• Good understanding and exposure to HL7 interface and standards
• Worked extensively with Epic software and products
• Thorough understanding and experience in Software Development Life Cycle SDLC , and Iterative Software Development Life Cycle Process as per Rational Unified Process RUP and Agile Development.
• Worked extensively on HL7 messenger in facilitating communication
• Extensive knowledge of Object Oriented Analysis and Design using UML, Rational Rose, Requisite Pro, Rational Doors, Rational Clear Case, Visio and Rational Software Development Automation SoDA
• Solid understanding and experience with Business Requirements Gathering, Business Process Flow and Business Process Modeling in diverse domains.
• Expertise in technical and business writing including System Requirements Specification document SRS , File Transfer Specification FTS , Use Case Specification Document, Business Requirements Documents BRD , Interface Requirement Specification IRS .
• Extensive experience in Quality Assurance Life Cycle QALC aspects such as writing Test Strategies, Test plans, Test cases, Defect Status reports, Traceability Matrices and Test Environments.
• Proficient in creating Use Case diagrams, Sequence Diagrams, Activity Diagrams and other UML based diagrams using MS Visio, Rational Rose.
• Knowledgeable in Data Warehousing concepts and design.
• Accommodated and facilitated Joint Application Development JAD sessions, proposed alternative tasks, benefits, determined if qualitative / quantitative standards were met and organized TQM ethics.
• Good understanding of configuration and change management within the corporate environment.
• Solid knowledge of various computer programming languages including C, C , XML, .NET, JAVA
• Familiarity with various testing techniques such as System Testing, Regression Testing, Functional testing, and User Acceptance Testing.
• Professional experience of RDBMS concepts, database relationships to perform back end testing utilizing SQL through query statements. Accessed Manipulated data as per requirements in both SQL Server and Oracle.
• Excellent team spirit and leadership qualities with good verbal and written communication as well as interpersonal skills.

Professional Experience

Confidential

Sr. Business Systems Analyst

In the Incentive Compensation Management System I.C.M.S Project, the existing mainframe Commission System used to pay commission payments to the BCBSMN Agent/Agency was replaced by an outside vendor based Commission System.

Responsibilities:

• Worked on the Incentive Commission Management System Project to migrate the old commission system to the new platform including a third party vendor solution
• Worked in defining Functional, Non-Functional and Supplementary Requirements for the Agent/Agency conversion load to the new commission system outside of Blue Cross Blue Shield.
• Defined Business Rules, Screen layouts, Business Requirements and User Interface designs for the Agent of Record and Book of Business, the new online system interfaces as a part of the ICMS project.
• Intensively used and worked on Clear Quest to create, track and resolve issues, risks, defects and problems related to multiple segments of the project.
• Created File Transfer Specification Documents FTS , Data Mapping Documents, Report Specification Documents for all the necessary requirements around Agent/Agency and Commission data.
• Generated Supplementary Specification Document to gather and document requirements around the one time conversion of the Agent /Agency and Commission data for the new system.
• Conduct Joint Application Development JAD sessions with the business users and vendor to gather requirements
• Worked closely with business management team to understand, capture requirements, rules and information for the CMS and Medicare file systems.
• Worked on generating the solution for Retro Processing for the commission, CMS and agent enrollment transactions for the new system.
• Create mapping/crosswalk documents for mapping data flow between systems.
• Worked with the project team assisting them in completing the project closure documents and documenting the unfinished project tasks for the future kickoff of the ICMS project.
• Created and worked on the Use Cases and related work break down for the compensation management project by analyzing the issues, tasks and work and categorizing them according to specific segments of the project.
• Gather requirements and prepared Business Requirement Documents BRD , System Requirement Specification SRS by interviewing Business Users/SME's, Agents, Clients
• Work closely with the Business Users, Project Manager, Technical Lead, Business Lead, Computer Programmers and Testers to resolve the work problems related to project specifications
• Created Business Requirements Documents BRD , Interface Requirement Specification IRS documents for the project
• Develop Requirements Traceability Matrix between the Requirements and the Test Scripts.
• Extensively used Rational platforms such as Rational Requisite Pro and Rational Clear Quest for requirements
• Environment: MS Word, MS Visio, MS Excel, SharePoint, UML, SQL, Mercury Quality Center, Rational Requisite Pro, Rational Quality Manager, Rational Clear Quest,

Confidential

Business Systems Analyst/ Quality Analyst

• Founded in Confidential is a publicly traded healthcare corporation catering to clients in the Mid-west. Celtic serves more than one million members throughout the state of Illinois and nationwide.
• In ICD 9 to ICD 10 Enhancement project, the current exhaustive Procedural and Diagnostic code sets are being replaced by a new version complying with Federal mandated ICD 10 standards and also worked on HCR project.

Responsibilities:

• Gather requirements and prepared Business Requirement Documents BRD , System Requirement Specification SRS by interviewing Business Users/SME's, Agents, Clients
• Performed Data Mapping on ICD-9 and ICD-10
• Developed extensive documentation regarding Enhancement of ICD9 to ICD 10 project targeting all the major affected areas such as Claims, Adjudication and Reporting.
• Worked on the testing of ICD-10 by building test cases etc.
• Read and analyzed the federal legislation to update the products as per the mandated provisions of HCR Health Care Reform .
• Interacted with senior business teams and legal firms to gather and analyze requirements for HCR Health Care Reform .
• Worked extensively on mandates like Grandfather Rule, Rescissions among others under HCR.
• Conduct Joint Application Development JAD sessions and walk in interview with the business users to gather requirements.
• Work closely with the Business Users, Project Manager, Technical Lead, Business Lead, Computer Programmers and Testers to resolve the work problems related to project specifications
• Performed analysis on ICD 9 and ICD 10 codes.
• Develop and maintain Reports, generated directly via MS Access and MS Excel to perform further Analysis on the data
• Developed File Transfer Specification FTS , Business Requirements Documents BRD , Interface Requirement Specification IRS documents for the project
• Prepared test data for test execution processes.
• Worked on the test strategy preparation for end-to-end System and Unit testing.
• Analyze the business requirement as per the HIPAA rules and regulations.
• Create mapping/crosswalk documents for mapping data flow between systems.
• Develop Requirements Traceability Matrix between the Requirements and the Test Scripts.
• Developed detailed Test plan, Test Cases, Test scripts for testing the functionality, GUI and security testing.
• Extensively used Rational platforms such as Rational Requisite Pro, Rational Quality Manager and Rational Clear Quest for requirements and test case management.
• Monitor Functional, Regression and Integration testing.
• Create Data Flow diagrams and User Interface designs.
• Conducting User Acceptance Testing UAT and verifying performance, reliability and fault tolerance issues.
• Environment: J2EE, MS Word, MS Visio, MS Excel, SharePoint, UML, SQL, Mercury Quality Center, Rational Requisite Pro, Rational Quality Manager, Rational Clear Quest, OSCAR, BDR

Confidential

Sr. Business Systems Analyst

In one of the projects at Cigna which involved Enhancement of the entire Healthcare EDI X12 transactions to be in compliance with HIPAA 5010 from the current HIPAA 4010. The project involved documenting the gap analysis, business requirements and the test strategies. We also implemented HIPAA 4010 to 5010 changes in our system to handle future claims according to HIPAA 5010 standards.

Responsibilities:

• Performed GAP analysis to understand the difference between both HIPAA 4010 and 5010 standards and the affected areas of the system
• Worked on HL7 for the integration, exchange and sharing of Electronic health information for Cigna.
• Performed Medicaid claim resolution/reimbursement for Cigna's state client
• Worked with existing HL7 interface standards for Cigna
• Facilitated interface maintenance using Epic Bridge
• Facilitate Joint Application Development JAD sessions with both IBM and HighMark users and clients to identify business rules, business process flows and requirements.
• Expertise in processing claims on Medicaid Management Information Systems MMIS
• Gathered the requirements and transformed them into high-level Process-Flow Diagram using MS Visio
• Created HL7 interfaces between different systems present at Cigna
• Tagged the requirements using PDS and SharePoint for both GAP analysis spreadsheet and requirements document.
• Developed Interface Requirement Specification IRS documents for the project
• Created a task plan for the team identifying the key deliverables and the respective deadlines.
• Facilitate Provided HIPAA integration and applied ANSI ASC X12 standards for 837 P, I, D , 270/271, 276/277, 278, and 835 transactions
• Provided mapping, and gap analysis for HIPAA codes sets and EDI transaction processing between Trading Partners and Cigna.
• Documented the process flow Business Use Case for the EDI transaction 835, 837 tagged them in Requisite Pro
• Created, and/or maintained EDI Business Rules with strict adherence to HIPAA 5010, ANSI ASC X12, BCBSA License criteria and industry standards 837 P/I/D, 270/271, 278, 276/277, 835 transactions
• Facilitated JAD sessions online meetings with the end user, business, developers testers to make sure the requirements are captured accurately
• Developed the wireframe and mockups for the prototype of the web based application in MS Visio
• Documented the Business process flow as per the UML standards using Use Case Diagram, Activity Diagram and Sequence Diagram in Rational Rose MS Visio
• Logged project defects and issues in Rational Clear Quest monitored them till a solution is resolved
• Developed detailed Test plan, Test Cases, Test scripts for testing the functionality
• Supported the testers to create, process and evaluate claims in Facets
• Environment: MS Visio, Rational Clear Quest, Rational Requisite Pro, MS Office, Quality Manager, Power MHS, IPDW, PDS, Share Point, MS Suite.

Confidential

Business Analyst

Gentiva continues to position itself as a leader in the health industry. It provides a full spectrum of health life and dental care plans and services. A company focused primarily on the health industry, delivering value through an array of meaningful choices. The Project involved transitioning the Pharmacy Benefit Management from Medco to Prime Therapeutics.

Responsibilities:

• Gathered requirements and prepared Charter, Business Requirement Documents BRD , System Requirement Specification SRS by interviewing Business Users/SME's.
• Gathered Business Requirements for HL7 integration project
• Worked on defining HL7 interface requirements, performed Gap analysis and developed detailed specification
• Used RequisitePro for writing/analyzing project vision, goals, specifications and requirements.
• Conduced Joint Application Development JAD sessions and walk in interview with the business users to gather requirements
• Created new HL7 interface to facilitate communication between different systems
• Worked extensively on the Membership Billing and Claims to support the PMBS project.
• Created Use Cases diagram and Activity diagram to depict the interaction between the various actors and the system in RationalRose for the Business Use Case and System Use Case.
• Evaluated requests for changes to existing HL7 interfaces, their implications and impact of such changes in terms of other ongoing projects and resource requirements
• Generated SoDa report from the Sequence diagrams to show the sequence of interactions between the actor, boundary and the system using RationalRose and created Use Case Realization.
• Illustrated the business processes using Business Process Modeling Notation BPMN , for both the technical and non-technical observers to understand the processes involved.
• Documented the Business Process Flows, Business Use Cases, System Use Case, Business Rules and Use Case Realization following the Rational Unified Process RUP methodology.
• Tagged and traced the created artifacts Business Use Cases, System Use Case, Business Rules and Use Case Realization in RequisitePro, making requirements available to all team members.
• Created documents like the Business Glossary to facilitate the other teams in understanding client business in RequisitePro.
• Analyzed the business requirement as per the HIPAA rules and regulations.
• Adhered data transition of the payment and remittance advice as per the EDI standard 835.
• Created mapping/crosswalk documents for mapping data flow between systems.
• Assisted the testers to create process and evaluate claims in Facets.
• Created maintenance reports and spreadsheets for business analysis purposes using Microsoft Excel.
• Environment: J2EE, RUP, Requisite Pro, RationalRose, UML, Clear Case, Excel, SQL, DB2, Crystal Report, Facet, Mercury LoadRunner.

Confidential

Business Systems Analyst

Assurant Health is a leading provider of wide range of employee benefits that includes health, dental, group, life, disability, consumer directed and long-term health care benefits. The project involved streamlining and standardizing of the claims process which was achieved by incorporating the business rules to increase automation, enhanced interfaces for seamless integration with back-office systems and claims tracking system.

Responsibilities:

• Developed business requirement updates while working with different user groups to define priorities concerning project development.
• Documented business requirements, and communicated these requirements to the development team for the design and implementation of business solutions.
• Conducted brainstorming and JAD sessions with stakeholders and end-users for requirement analysis and documented the same
• Gathered AS-IS and TO-BE information about Cigna's Health Plans work processes and information flows Claims process, Membership, Enrollment , and conceptualized using process flow diagrams
• Created EDI documents for EDI maps to generate requirement documents and Project Charter, and logical design documents for EDI transactions 834, 837, 835, 270, 271.
• Associated with full HIPAA Compliance life-cycle from gap analysis, mapping, implementation and testing for processing of Medicare, Medicaid and Tri-care claims.
• Used UML during requirements gathering and created Use Case Models and Use Case Diagrams for the purpose of stakeholders in the project to help them understand the workflow of the system associated with the requirements.
• Analyzed, coordinated, documented and managed project requirements, project processes and procedures and its changes throughout the software development lifecycle.
• Performed Requirements Analysis and traceability using Rational Req Pro.
• Involved in writing test plans, defining test cases, test scenarios and data sets developed and maintained test scripts, analyzed bugs and interacted with development team in fixing the errors.
• Worked with Subject Matter Experts SME , project team members business and technical , to define technology application for the business and system requirements. Also worked with the QA Team Lead to develop QA standards and ensured compliance with all regulatory requirements.
• Developed several MS Excel spreadsheets and applications to automate manual calculations and optimize reporting structure.
• Created and segregated SQL views and stored procedures for obtaining meaningful set of data.
• Created Gantt charts and project charters, and followed the Software Development Life Cycle SDLC methodology to complete projects on time and within budget.
• Extensively used MS Project 2007 for status reporting and planning throughout the project lifecycle.
• Environment: MS Visio, MS Excel, MS Power Point, Windows NT, UML, ERWIN 4.0, SQL, Rational Requisite Pro, Test Director, MS Project, MS Office Suite.

Confidential

Business Systems Analyst

• State of California partnered with EDS HP to complete the tax portion of the Unemployment Compensation Modernization System UCMS project. The new Audit system will replace a 40 year old technology with improved business processes and efficiencies that will save the state money and vastly improve services to the many customers that the state serves.
• My scope in UCMS pertained to the part of the 'Laptop Application', which is the application the Auditor uses while auditing the users.

Responsibilities:

• Gathered requirements and prepared Use Cases General System Design documents and Detailed System Design document by interviewing tax agents, users and clients.
• Participated in Joint Application Development JAD sessions with the users and clients to identify business rules, business process flows and requirements.
• Conducted GAP analysis to understand the deficiency of the existing audit application and evaluated the benefits of the new audit application.
• Gained excellent experience with CA-Medicaid processes and methodologies.
• Modeled the requirements into high-level Use Case diagram for the GSD use cases General System Design documents and transformed them into low-level Activity Diagram for the DSD use cases Detailed System Design documents according to UML methodology.
• Assisted the UI designer to create html for user interfaces via Dreamweaver.
• Documented the user-defined requirements into Business Rules Document and Wire Frames.
• Defined web service interfaces using WSDL and XML schemas
• Tagged and Traced requirements using Requisite Pro for both Use Case and Business Rules.
• Created Test Cases/Test Scripts and executed them to test the application.
• Monitored client expectations and conducted user interviews to improve overall quality of the Application.
• Environment: MS Word, MS Excel, MS Power Point, UML, QuickPlace, Rational Software Modeler, Requisite Pro, IBM Mainframe, HTML, Dreamweaver.