Professional Summary

• 7 experience as a Business Analyst working with Healthcare and Banking Industries.
• Strong Project Management skills with experience in implementing Software Development Life Cycle SDLC Methodologies, Rational Unified Processes and Business Analysis.
• Adept in performing GAP Analysis, Impact Analysis to check compatibility of existing system infrastructure with new business requirements like HIPAA 4010 to HIPAA 5010, ICD 9 to ICD 10.
• Expertise in developing detailed requirements specification with skillful coordination of JAD sessions, one on one interviews etc.
• Excellent in Requirement analysis and gathering with strong business and technical writing skills required for constructing Business Requirement Document BRD , Functional Requirement Gathering FRD and Non Functional Requirement Document NFRD .
• Documented Traceability to ensure all the features for the project has been captured and mapped back to the requirements in the BRD.
• Proficient in developing Business Scope, Use Case scenarios, Wire framing, Test plan and Test Cases using testing tools like Quality Center Clear Quest.
• Adept at creating UML diagrams with extensive use of MS Visio, MS Power Point, MS Project, MS Excel, MS Access.
• Excellent Knowledge on Health Insurance Portability Accountability Act HIPAA rules and regulation, ICD 9/ANSI/HL7 and ICD 10/ANSI/HL7 coding standards in Medicare Medicaid Domain.
• Experience with claims processes and adjudication in Medicare Medicaid, with extensive work on EDI transactions like 837 I/P/D Healthcare Claim/Encounter , 835 Payments/Remittance , 270/271 Healthcare Eligibility/Benefits Inquiry/ Response , 276/277 Claim Status Inquiry/Response .
• Excellent analytical and communication ability with strong interpersonal skills to interact with Stake Holders, Business and Development Team and day to day client interactions.
• Proven record for submitting deliverable and meeting deadlines with excellent multitasking abilities.
• Skilled in Interviews, Focus sessions for requirements gathering, analysis and design with stakeholders, SME's, Developers and system architects.
• Excellent communication and analytical skills with problem solving capabilities to interface with stakeholders, business representatives and development teams.
• Broad knowledge of testing concepts and hands on experience writing test cases, test plans and planning test strategy using testing tool Quality Center.
• Quick learner, reliable and confident working independently as well as in a team.

Professional Experience

Confidential

Sr. Business Systems Analyst

Project scope included conversion of ICD-9 to ICD-10 compliant with HIPAA 5010. HIPAA require that all health insurance payers in the United States comply with the EDI standards for health care as established by the Secretary of Health and Human Services. The Addenda version of the ANSI ASC X12 837/835 transaction set was selected as the HIPAA-mandated format for electronic enrollment and de-enrollment within a Health Plan. Claims processing Management for the entire enterprise of EDI X12 837/835 I/P/D was also included.

Responsibilities:

• Responsible for soliciting and eliciting requirements for 4010-5010 conversions.
• Prepared and updated reporting documents such as Business Requirement Document BRD and Functional Requirement Document FRD .
• Carried out Risk Assessment, GAP analysis and Impact Analysis for the 4010-5010-conversion project.
• Involved in one-to-one interview sessions and JAD sessions with stakeholders, SME's and business owners to discuss the scope of the conversion.
• Assisted in identifying project scope, to conform to the regulatory compliance related to X12 837 I/P and 835.
• Produced for transaction sets 835 and 837 I/P a full gap analysis 4010 vs. 5010 against the documented application 5010 enhancements ensuring the upgraded application included the required changes and additions for 5010 compliancy.
• Involved in up-gradation of 4010 transaction to 5010 by conducting Impact Analysis and Risk Assessment and worked on the mitigation plan to avoid the risks.
• Tracked and addressed the problems on timely manner encountered on Acknowledgement 997, Claim Status Inquiry/Response 276/277, Remittance Advice 835, and Eligibility Inquiry/Response 270/271, Prior Authorization 278 claims.
• Worked as a liaison among stakeholders both business and IT side in order to elicit, analyze, communicate and validate requirements for changes to business processes.
• Involved in creating Reports and Documents like Requirements Documents, and Management Plan, Issue/Alternatives documents, Project Summary and Plans with formats like PDF, HTML, Excel and Word.
• Prepared UML diagrams Activity diagrams, Sequence Diagrams, Use case diagrams for Extensions.
• Involved with reviewing defects reported from UAT efforts and analyzed for root cause and took actions based on the findings.
• Identified the master file changes and builds needed to enable the 5010 format to be utilized.
• Conducted Business Process As Is/To Be sessions with various department directors and staff to ensure the Testing Plan and Test Approach would meet the identified Business Requirements, and the Training Program covered all identified new and changed processes.
• Gathered requirements for impacted system and business areas for ICD-10 and their needs to embrace the changes.

Confidential

Sr. Business Analyst

The Confidential is to maintain and improve the health and human services system in Texas and to administer its programs in accordance with the highest standards of customer service and accountability for the effective use of funds. As a part of the Texas Access Alliance team, worked with on TIERS Texas Integrated Eligibility and Redesign Systems, and on Web portal that would determine the integrated eligibility for the various benefit programs such as: Medicaid, TANF, Food- Stamp, Foster Care/Adoption Assistance Medicaid and Children's Insurance programs offered by the State for the Texas Citizens. The web portal would allow easy and quick access for the residents of the state to apply online form from their homes and other public places for the benefits they would be eligible.

Responsibilities:

• Understand the Business Requirements and formulated the Test Plans based on requirements.
• Developed timelines for the project delivery and managed projects and resources to successful completion.
• Worked with analysis team, development team and testing team in completely understanding the requirements and address any design challenges.
• Performed document analysis and conducted Interviews with users from Multiple Business Units to gather requirements, and draft User Requirements Specifications.
• Lead the development team and testing team to address any questions they may have for the new requirements
• Created use cases, work flow and business use case model after accessing the scope and status of the project.
• Prepared and maintained requirements traceability matrix RTM .
• Worked on basis of Data Marts, Data Warehouse and Data mapping in creating the applications.
• Conducted walk-through of the Business Requirements and the Detail Design documents with the Stakeholders.
• Worked with testing team in creating several high level scenarios so that all the potential situations can be tested for the new requirements.
• Followed the based methods using Rational Rose to create Use Cases, Activity Diagrams/Sate Chart Diagrams, Sequence Diagrams, and Collaboration Diagrams.
• Participated in the entire life cycle of projects related with initial situational analysis gap analysis, change management, operation design procedures.
• Worked with management to create and communicate critical information to the user community via email and discussion boards.
• Worked on defining the case fields and Work group functionality that facilitates the organization of groups of users for easier management of users and assignment of cases. E-mail notifications that enable automatic e-mails related to case activity and due date reminders to be sent out to users associated with the case to keep all parties informed.
• Created dashboard summary page that provides graphical representation of report activity for analysis copy, print or save graphical images for use in presentations or for distribution.

Confidential

Sr. Business System Analyst

Project required simultaneous system upgrades of HIPAA X12 4010 transaction to HIPAA X12 5010 and ICD 9- CM Clinical Modification to ICD10 CM/PCS Clinical Modification/ Procedure Coding System .

Responsibilities

• Prepared the Business requirement Document BRD and functional requirement document FRD for the enhancement of the existing services.
• Carried out Analysis and Design of existing transaction sets, and modification of these transaction sets to ensure HIPAA compliance.
• Implemented Agile Methodology to configure and develop process, standards and procedures.
• Conducted JAD sessions workflow diagrams, UML diagrams, process models, activity diagrams, use cases, for incorporating design changes in the order creation/ management system.
• Clearly understood coding standards required for all Medicare Part D Users transactions involving electronic data interchange as provided by department of health and human services and incorporated at every stages of the project wherever found necessary.
• Performed data analysis, created data mapping and data interface documents and kept the documents updated with changes in requirements and functional specifications.
• Attended daily SCRUM and guided QA and Developer regarding the defects, Technical Specification Documents and Mapping Documents.
• Coordinated the upgrade of Transaction Sets 837P, 835 and 834 to HIPAA compliance. Responsibilities include :
• Completed Data Mapping for Group and detail Product analysis and report writing
• Work closely with EDI to ensure accuracy in data transmissions and shared processes.
• Transaction sets processed 837P, 835, 834 .
• Used General equivalence Mappings GEM to convert ICD 9 to ICD 10.
• Involved in forward mapping from ICD 9 to ICD10 and backward mapping from ICD10 to ICD9 using GEM.
• Did Gap Analysis for HIPAA 4010 837P and 835 transactions and HIPAA 5010 837P and 835 transactions.
• Involved in impact analysis of HIPAA 5010 835 and 837P transaction sets on different systems
• Worked closely with business users and IT team in War room to solve the issues in time
• Provided Production support and post-production support/explained the changes to the business users/did one on one sessions/one to many sessions to make the business uses aware of the system changes.

Confidential

Business Analyst

The project involved generating reports on various service providing systems such as Financial Eligibility, Claims Budget System, Claims Processing System, Automated Authorization System, Insurance and Third Party System, Correspondence, Liquidation and Encumbrance. The system primarily aimed at handling Medicare / Medicaid insurance claims and process exceptions.

Responsibilities:

• Extracted the Business Requirements from the client and end users keeping in mind their need for the application Internet, Claims, Provider, and Recipient and documented it for the developers following the HIPAA Guidelines for an Individual functional area by conducting JRD and JRM sessions.
• Facilitated collection of User Requirements and Business Requirements from Business User Group such as to document Business/User/Functional/Technical Requirement Specification using MS Word and MS Visio that provided appropriate scope of work for technical team to develop prototype and overall system.
• Created Use Case diagram, Sequence diagram and Activity diagram for understanding the business processes.
• Involved in the day-to-day implementation of the Rational Unified Process RUP methodology of application development with its various work flows, artifacts and activities.
• Identified system integration requirements, coordinated the collection and verification of business needs to reach the Requirement Analysis Requirement Validation Specification , Detailed System Design Documentation Milestones.
• Involved in Independent verification and validation of requirements IV and V to ensure that all the requirements are satisfied and meet the security objectives.
• Developed Traceability Matrix using Rational Requisite Pro.
• Analyzed if the system abides HIPAA regulations as portal displays member's private information.
• Reviewed and approve technical recommendations related to software and hardware proposals RFP .Also written Request for proposal RFP for getting new MMIS system.
• Involved in development of Advance Planning Document APD to request for federal funds and participated in the Implementation of Advance planning document IAPD and released RFP for new MMIS system.
• Well versed with HL-7, HIPAA, claim adjustments, claim processing from point of entry to finalizing, claim review, identifying claims processing problems, their source and providing alternative solutions
• Managed and developed EDI specifications, gap analysis, and applications structures for data feeds and mappings for integration between various systems, including XML, to follow ICD 10 Code set, ANSI X12 4010 formats including 270 Eligibility/Benefit Inquiry , 271 Eligibility/Benefit Information, 276 Claim Status Request, 277 Claim Status Response, 700 Attachment Request, 701 Attachment Response, 810 Invoice, 820 Payment Order/Remittance Advice, 834 Benefit Enrollment, 835 Remittance Advice, 837 Claims and Encounter, and 997 File Transmission Acknowledgement, to meet and exceed HIPAA requirements set forth by the federal government.
• Involved in Documenting/Executing business test cases and once the Unit testing was performed and after the results are reviewed, The Functional and System Integration testing is executed in Model Office, by which the EDS was able to systemically test and validate the system through any combination of data or cycles deemed appropriate for the Implementation and User Acceptance Testing.
• Followed Six Sigma discipline and methodology for eliminating defects in process.
• Actively Participated in the Weekly Defect Status meetings, to review and prioritize the defects with in a Functional area.
• Performed detailed analysis of data issues encountered during business acceptance testing.

Confidential

Business Analyst

Priority function was to identify Potential transaction problems and send outbound transactions to their Medicare/Medicaid trading partner. This involved compliance checking, any business validation, training client's Systems/Business Analysts on the job, etc. Involved interaction to all involved stakeholders teams by JAD sessions, figuring out mapping, syntactic and semantic errors, monitoring relevance per Business Rules and eventually correcting them. Project Focus on NCPDP project, the company's client Clearing House Switch sends Claims, Reversal, Re-bill, Eligibility and Prior Authorizations files.

Responsibilities

• Performed Requirement Analysis by gathering both functional and non-functional requirements based on interactions with the process owners stake holders and document analysis, represented them in Requirements Traceability Matrix RTM .
• Interacted with department heads to finalize business requirements, functional requirements and technical requirements and also created Business process model.
• Facilitated JRP sessions between technical and regulatory teams for meeting requirements as well as solving problems on a daily basis.
• Fine-tuned search engines and pulled data from different databases and migrated data back and forth using SQL.
• Worked on following applications Business Objects, Enterprise Architect, Toad, Plan View project management , Microsoft Suite Word, Excel, PowerPoint, Visio, Access, Project .
• Involved in creation and reviewing of Functional Specifications and created a Functional Requirement Document
• Used Rational Requisite Pro to improve the communication of project goals, enhance collaborative development, reduce project risk and increase the quality of application before deployment.
• Created and maintained Narrative Use Cases Business Use Cases, System Use Cases and modeled Use Case Diagrams, Activity Diagrams, Data Flow Diagrams using MS Visio.
• Followed the adaptive RUP framework for the whole Project life cycle PLC Involved with the QA team to conceptualize, determine and develop test approaches and methods for unit testing, integration and functional testing, load and usability testing according to the application complexity and test requirements.
• Plan view administrator Responsible for end user training, report development, process documentation, and software administration.
• Employed Rational Clear Quest for effective Change Management Requirements Creep and bug tracking during the testing lifecycle.
• Involved in creation and execution of manual test cases in Mercury Test Director and automated Test Cases in QTP and analyzed the Test Results.

Confidential

Business Analyst

Company's Project required development of a web based application that provides online insurance services to their members and clients. The application enabled customers to purchase the insurance online after insurance plan, policy and location details were selected. The system also allowed involving quotation tools allowing agents the flexibility to complete the application on behalf of the customer. The application included service modules for Claims, Health Insurance Plan and Policies.

Responsibilities

• Documented High Level Logical Data Models and BRD supporting documents containing the essential business elements, detailed definitions, and descriptions of the relationships between the actors to analyze and document business data requirements.
• Worked closely with the UI team to model the screens, which met user defined requirements, organizational and regulatory standards.
• Created Use-Case diagram, Sequence Diagram and Activity Diagram after accessing the scope of the Project and understanding the business processes.
• Conducted user interviews, JAD sessions with stakeholders, SME's to gather requirements and analyzed the requirements using Rational Rose, Requisite Pro RUP.
• Modeled the AS-IS system and performed GAP Analysis for the existing system in order to map it to the To-Be system.
• Reviewed test cases written by QA team and made modification for better execution of test cases.

Confidential

Business Analyst

Confidential provides a full range of commercial banking products and services to individuals, corporations, institutions and governments. The scope of the project was to develop enhance the online banking services provided by the bank. It involved development of online payment system and automation of paperless statement generation.

Responsibilities

• Assisted project managers with the development of Project Schedules, development of business case and test plan.
• Conducted JAD sessions to identify business requirements and analyzed the possible technical solutions and also conducted project related presentations.
• Worked with development and QA teams to accomplish timely release objectives.
• Tracked defects at every stage for the smooth flow of the project. Defects were tracked using Clear Quest, which is a customized defect and change management system.
• Designed the business requirement collection approach based on the project scope and using agile methodology.
• Developed Test Scenarios and implemented UAT Test Plan.