SUMMARY

• Over 8 years of experience in Business Analysis, Business Process Modeling, System Analysis, Requirements management using SDLC methodology, UML Modeling, Prototype design, project team management in healthcare, pharmaceutical and other domains
• Experience in understanding and supporting both the Business and Technical teams in all Phases of Software Development Life Cycle (SDLC) by using different Methodologies like Iterative, waterfall, agile - scrum and Rational Unified Process (RUP).
• Emphasis on requirements gathering from business stakeholders by using methods like Elicitation, conducting Interviews with users as well as Subject Matter Experts (SMEs) by asking detailed functionality aspect of business process, Requirement workshops, organizing Joint Application Development (JAD) sessions and carefully updating the information to create a Business Requirements Document (BRD)
• Extensive experience in gathering business and functional requirements, feasibility studies, risk analysis, Gap impact analysis, creating narrative Use Cases and UML diagrams- Class diagrams, Use Case diagrams, Activity diagrams, Data flow diagrams using UML Tools like MS Visio and Rational Rose
• Expertise in the areas of writing Scope documents, Request for Proposal (RFP), BRD, Functional Requirements Document (FRD), incorporating use cases in creating System Requirements
• Experience in Object Oriented Design Technologies and maintain traceability of Requirements using Requirements Traceability Matrix (RTM)
• Working with QA and testing teams in close co-ordination in developing Test Plans, building Test Conditions and Test cases, creating test data, analyzing bugs, interacting with development team to fix the errors; Facilitated User Acceptance Testing (UAT) with client representatives
• Strong exposure to automated testing tools like Quick Test Professional (QTP), Rational Test Manager, Quality Center, Rational Clear Quest for Software Quality Management Purpose
• Good working knowledge of Microsoft Office Suite including - Word, PowerPoint, Excel, Access, MS Visio, Rational Rose, Rational Requisite Pro
• Worked on healthcare standards such as HIPPA 4010, 5010, ICD-9 ICD 10.
• Good knowledge of HIPPA compliance life cycle, insurance regulations and HIPPA 5010 transaction standards.
• Experience in creating wireframes and mockups. Good understanding of web development process and developing prototypes of web pages using Balsamiq mockups
• Experienced of Data Warehouse Environment including Data Analysis, Data Modeling, Data Mapping, Data Integration and Data Migration using ETL tool- Informatica; Designed and Implemented Ad-hoc SQL queries to extract data from different databases for timely reporting, Data Analysis and Validation.
• Efficient in handling Change Requests by the client.
• Excellent understanding of Data warehousing & RDBMS concepts.
• Skilled in performing Gap analysis and Impact Analysis by identifying existing technologies, documenting the enhancements to meet the end-state requirements.
• Effective in executing multiple tasks and assignments ahead of schedule.

TECHNICAL SKILLS

Business / Modeling Tools: MS Project, MS Visio, MS Excel, MS Word, MS PowerPoint, Rational Rose

Requirements Management Tools: Rational Requisite Pro

Databases: SQL Server 2000/2005, Sybase, MS Access, Oracle 10g/9i/8i

SDLC Methodologies: Rational Unified Process ( RUP), Agile Scrum, Waterfall, Iterative

Operating Systems: Windows X, Mac OS X.

Web Technologies: Java, JSP, VB Script, VB 6.0

Testing Tools: Quality Center (QC), Quick Test Professional (QTP), Load Runner, Rational Test Manager, Rational Clear Quest

Languages/Standards: SQL, PLSQL, ICD9, ICD10, HIPPA 5010, XML

PROFESSIONAL EXPERIENCE

Confidential

Sr. Business Analyst

Responsibilities:

• Worked on Implementing Edifecs for Medicare, NY-WNY, NV, AR, NC, FL, GA, TN & MD.
• Created HLBR and DLBR for the Markets which are going implement or migrated to EDIFECS.
• Worked on 837 - 999, 277CA, TA1, 277U, 835, 8ER, Proprietary Response File.
• Worked on extracting data from multiple repositories (Facets, ODW, EDINET, EDWARD, and WGS) to EIDS (Encounters Integrated Data Warehouse System).
• Hands on experience working with Adjustment/Void/Replacement Claims.
• Experienced in implementing Logics (Provider, Duplicate, Void, Bundling, paid, denied and Adjustments)
• Organized Scrum Ceremony’s (Sprint-planning, Retrospective, Stand-ups and backlog grooming) and helped team to participate.
• Created JIRA projects, Scrum Boards and Epics/Stories/Test/Defects. Integrated JIRA with Confluence for an easy understanding for Business/State about the Sprint Activities.
• Created RTM for traceability of Epics/Stories/Test.
• Experienced on working with Edifecs and implemented and updated the KP (Knowledge packs) for Markets.
• Created UAT test cases to test the transformation of CSV to EDI 837 files from EIDS to Edifecs.
• Created defects in JIRA and helped the team to solve the defects.
• Facilitated Facets/Macess (Front end) to validate the data.
• Conducted extensive analysis on migration and conversion of Provider and Member data, Group configurations, plan codes, benefit set-ups, fee schedules, provider pricing, capitation set-ups, etc from Source System (FACETS) to EDIFECS (Source System).
• Hands on experience with Ramp Management and FacilEDI to validate HIPAA Errors.
• Worked on SNIP Level (1-7) and validated files with ANSI X12 Standards.
• Experienced working with SQL to validate the data (SQLSMS 2014/Oracle12g).
• Actively involved in designing EDI transactions (837, Proprietary).
• Analyzed encounters claims file (837 P, I, D) using Edifecs Spec Builder.
• Hand on experience in conducting internal exception analysis of encounters to improve the encounters submission performance without any data alteration and as per HIPPA guidelines.
• Reviews data to ensure data integrity and accuracy.
• Performs ad hoc reporting functions for special needs and requests.
• Performs other data reporting duties as directed by Supervisor.
• Submission of Test files (837I, 837P, 837D, Proprietary and pharmacy(NCPDP)) to state with state specific requirements and analyzing the State rejection to get better encounters submission accuracy.
• Provided post implementation support and performed root cause analysis and fixed post implementation issues.
• Excellent analytical, decision making, organizational, creative problem solving, verbal and written skills are required.

Confidential, Pittsburgh, PA

Business Analyst

Responsibilities:

• Extensively interacted with the stakeholders and the IT Department in finalizing the requirements according to the CMS Compliances/Regulations and HIPAA Regulations.
• Assisted JAD sessions to identify the business flows and determine whether the EDI X12 Transaction, Code set and Identifier aspects of HIPAA, impacts any current or proposed systems.
• Worked on requirements, analysis and design, project management, testing (functional and user acceptance tests)
• Worked on EDI transactions: 270, 271, 834, 835, and 837 (P.I.D) to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
• Preparing UML artifacts viz. Use Cases, Activity Diagrams, recommended by RUP (Rational Unified Process) for Requirements.
• Involved with all the phases of Software Development Life Cycle (SDLC) methodologies throughout the project life cycle.
• Involved in the meeting with Business Process Owners, SME (Subject Matter Experts) and store users for Requirement gathering in Definition Stage.
• Conducted the FRS and SRS reviews and walkthroughs with designers, developers and stakeholders.
• Created Activity diagrams and Use Case Diagrams (UML Diagrams) using Rational Rose.
• Involved in preparing Test Plans based on User Requirements Document (URD) and prepared the Test Cases using Test Director/Quality Center.
• Maintained Traceability Matrices
• Performed extensive data modeling to differentiate between the OLTP and Data Warehouse data models
• Resolved issues related to requirements during system testing and UAT plan preparation.
• Participated in the planning of the User Acceptance testing effort.
• Creation of Test Cases for functional testing of the system.
• Performed GAP Analysis to analyze the current system and worked with internal users to help define system requirements.
• Helped with data modeling and defining the conceptual and logical model of the data warehouse.
• Involved with the Test planning, test development and test execution.
• Responsible for scheduling meetings with users, SME’s and stakeholders to identify problems resolve issues and improve the process to ensure a stable and accurate solution.
• Performed extensive Manual Testing to verify the application is complete and stable.
• Identify timelines for the different kinds of testing to be performed and estimate the risks involved.
• Performed test data analysis and ensure data requirements are met prior to start of various testing phases.

Environment: Rational Requisite Pro, Microsoft Project, MS Excel, MS Word, Power Point, Rational Software Architect, Rational Software Modeler, Clear Quest, Oracle, Quality Center, Windows.

Confidential, Bloomington, IL

Business Analyst (Healthcare)

Responsibilities:

• Interacting with the stakeholders to get a better understanding of client business processes and gather requirements.
• Involved in Requirement Scoping, RFP documenting and analyzing high priority requirement for implementation; Created BRD, functional Requirement documentation and use case documents
• Interaction with the business users in understanding the current application and process
• Used rational Requisite Pro to manage the requirement and keep the Traceability Matrix.
• Prepared logical data model in the form of Business Context diagram to include various entities and attributes in order to facilitate the design of Data model in the form of ER Diagrams.
• Conducted Joint Application Development (JAD) and Rapid Application Development (RAD) sessions for communicating and managing expectations.
• Involved in HIPPA assessment and HIPAA X12 EDI transaction (835, 837, and 270/271) mapping and identified changes that needed to be done to comply with HIPAA regulations.
• Involved in gap and feasibility analysis for the design and architecture of the new application.
• Worked with HIPPA compliant ANSI X12 837 formats for all the types of claims.
• Gathered the business requirements for Medicare Part D and managed the requirements using Rational Requisite Pro.
• Responsible for testing the HIPAA Transactions and Code Sets 837 transactions.
• Executed SQL queries to test the database for records that detect and submit functional acknowledgement and remittance advice in the claims application.
• Prepared test cases, test script and coordinated with the QA team for testing and Interacted with the developers to report and track bugs using Test Manager
• Involved in GUI Design sessions with Usability Team; Browser compatibility and navigation were tested manually.
• Tested the final application for usability testing to verify whether all user requirements were catered to, by the application.
• Managed the change request and analyzed the impact of the change request on the application regarding Project Plan, Scope, and Schedule.

Environment: MS Access, MS Excel, MS Visio, Test Manager, MS Project, Rational requisite Pro, HTML, Oracle.