SUMMARY:

Around 7 years of extensive industry experience in the field of Business Analysis, Business Process Modeling, Object Oriented Analysis/Design and Project Management. Excellent analytical and problem solving abilities in designing, developing, and implementing innovative business process and providing solutions using new approaches and technology for Healthcare and Property/Casualty Insurance Industry. Experienced in working with clients in understanding and implementing requirements and providing team leadership for development support. Looking forward to apply my skills as a Business Analyst in a challenging environment and provide effectual solutions to the organization.

EXPERTISE:

• Good knowledge of HIPAA compliance standards, EDI Electronic data interchange , Implementation of HIPAA code sets, ICD-9, ICD-10 coding and HL7.
• 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
• Expert knowledge of Medicare Part A, Part B, Part C and Part D.
• Efficient in preparing Business Requirement Documents BRD's , Functional Requirement Documents FRD's , Requirements Traceability Matrices RTM ,
• Skilled at preparing business and functional requirement document, Use Cases Diagrams, Business Process Flow Diagram and Traceability Matrix.
• Strong experience and understanding of health care industry, claims management process, Knowledge of Medicaid and Medicare Services
• Good knowledge of Business Intelligence, Data Warehousing and Business Architecture.
• Well-versed with MS Visio, Axure RP Pro, MS Project and Mockup screen,
• Well- versed with Microsoft suite Word, Excel, Access, Visio, Power Point and Outlook for analysis and presentation.
• Experienced in GAP Analysis, Cost Benefit Analysis, organizing, facilitating and coordinating weekly meetings, conference calls and other regular project meetings.
• Comprehensive understanding of Rational Unified Process RUP , Software Development Life Cycle SDLC Agile/SCRUM and Waterfall.
• Experienced in creating Data Flow Diagrams DFD , Use Cases, Class Diagram, Activity Diagrams, Sequence Diagram, and UML Modeling.
• Worked closely with stakeholders and SMEs to assist the fulfillment of the project goals and objectives.
• Managing and controlling Project documentation using tools like SharePoint and Clear Case.
• Involved in the development of Test Plans, Test Cases and maintaining the Traceability Matrix.
• Elicitation techniques like interviewing, questionnaires, brainstorming and facilitating JAD sessions.
• Highly motivated team player, possessing an excellent communication and presentation skills with detail oriented analytical abilities and a willingness to work in a cross platform environment.
• Excellent interpersonal, problem solving and analytical skills.
• Expertise in Web and Client Server Applications through all stages of the Software Development Life Cycle
• Interacted with client regarding project status and feedback on UAT and discussed the information with the development team
• Possess strong analytical and problem solving skills with the ability to adapt to a new environment and meet stringent deadlines.

TECHNICAL SKILLS:

• Operating Systems Windows 2000/XP/Vista and Windows 2007, HP UNIX, Linux, SOA
• MS Office Tools MS Word, MS Excel, MS Access, MS PowerPoint 2003/07, MS SharePoint
• Languages C, C , SQL, PL/SQL, XML, JAVA, .Net
• Packages MS Office, MS Visio, MS Project
• Tools Clear case, Clear Quest, Rational Rose, UML, Requisite Pro, HP Quality Center, Axure RP
• Databases SQL Server 2000, Oracle, MS Access, SQL
• Project Methodologies Rational Unified Process RUP , System Development Life Cycle SDLC , Waterfall, Agile,

WORK EXPERIENCE:

Confidential

Business Analyst

Confidential is one of the largest mutual funds and financial services groups in the world. The project was under Fidelity's Personal Investing, Research Services module. I was working on their web sphere message broker application for managing services. This was mainly designed to provide connectivity between applications and services.

Responsibilities:

• Followed the UML based methods using Rational Rose/MS Visio to create Use Case, Activity / State Chart, and Sequence Diagrams.
• Evaluated and tested the Research Services module to verify that all the functionalities were according to both technical and business requirements.
• Analyzed business requirements and created the requirements specification documents.
• Co-ordinated with the business and the third party vendor on a regular basis for requirement clarification.
• Prepared Data Mapping Document, Data Dictionary, System Specification Document
• Participated in defect triage meetings conducted by QA team to review and resolve defects.
• Co-ordinated with the third party vendor to resolve defects and clarify issues.
• Conducted meetings with the Fidelity Research Services Team and the third party vendor to discuss and validate raised defects.
• Extensively used SharePoint for project documentation.
• Participated in User Acceptance Testing.
• Worked closely with Development team and QA team.
• Extensively used Quality Center for defect management purpose.
• Used SOAPUI to validate the request and response against the third party vendor data.
• Used MS Excel to build the Requirements Traceability Matrix RTM's
• Co-ordinated and worked with the Research Services off-shore QA team

Environment:

MS Visio, Java, Windows 2000/2003, MS Word, MS Excel, Quality Center, SOAP UI.

Confidential

Business Analyst

Confidential is one of the many companies that have been in the technology field with a purpose of providing better technical solutions to its wide variety of clients. The project was related to the creation of the Physical Data Model for Program Management Module of Medicaid Management Information System MMIS . MMIS is an Enterprise Medical Management System that is responsible for processing Medicare, Medicaid and Pharmacy Claims for a number of states.

Responsibilities:

• GAP Analysis of client requirements, generated workflow process, flow charts and relevant artifacts.
• Coordinated QA reviews, sign-off, and validation migration from UAT to production environment. Also coordinated business review, sign-off and production validation.
• Implemented data access, storage and validation routines on the database server using SQL.
• Collected requirements usingBrain storming, Document Analysis, Interviews and JAD session.
• Created Business Requirement Document BRD , Functional Requirement Documents FRD and supporting documents that contain the essential business elements and detailed definitions.
• Worked on Medicare Part C and Part D transactions.
• Conducted meeting with the EDI team and other stakeholders, team members to discuss the requirements.
• Performed Requirement Analysis to Develop Use Cases, Activity Diagrams and Sequence Diagrams.
• Extensively used Waterfall software development lifecycle methodology during the project
• Identify, analyze, define and created business processes and use case scenarios using MS-Visio.
• Helped the Project Manager with project estimation, resource and financial Planning of the system.
• Evaluated alternative solutions and recommend solution that best meets the need of the business.
• Used Rational Requisite Pro for overall Requirements Management and to build the Requirements Traceability Matrix RTM's
• Experienced as a Business Analyst in a role of responsibility encompassing requirement gathering, and Analysis besides Quality Assurance.
• Evaluated and analyzed various solutions and provided recommendations that best suits the business.
• .

Environment:

XML, MS Excel, MS Word, MS Visio, MS Project, HP Quality Center.

Confidential

Business Analyst

Confidential is one of the leading names in the health care sector. The company aims at providing a better life to its members and their communities through its extensive range of health plans, medical and specialty products. This project mainly involved in bringing WellPoint's systems and business process in compliance with the HIPAA transaction standards. The project goal was related to the transition from HIPPA EDI X12 4010 to HIPPA EDI X12 5010 format. My responsibility was also associated in making changes from ICD-9 to ICD-10.

Responsibilities:

• Developed Use Cases using UML based on the needs of Business Users. Used MS Office for project tracking, documentation, and presentation
• Interacted with the developers and involved in walkthrough meetings with them.
• Analyzed HIPAA EDI 4010 and HIPAA EDI 5010 standards for 276/277transactions and prepared gap analysis document for each X12 transaction.
• Engaged in GAP Analysis workshops to facilitate requirement strategies.
• Worked on analyzing claims processing application in order to gather requirements to comply with HIPAA 5010 requirements
• Prepared the Business Requirement Document BRD and Functional Requirement Document FRD for the enhancement of the existing services.
• Conducted JAD sessions with business units and stakeholders to define project scope and identify the business flows.
• Formulated Data Mapping Guide for the technical team.
• Developed Data Flow, Work Flow, Process Flow, and Entity Relationship Diagrams in MS Visio, and analyzed them to create AS IS and TO BE scenarios.
• Tracked project progress using Requirement Traceability Matrix RTM using MS-Excel
• Supported the QA team in preparing the test plan,test scenarios and test cases to be used in manual testing based on business requirements and simultaneously supported on tracing the requirements in relation to the test cases.
• Strong Knowledge in writing test cases and test scripts as per the requirement and conducted User Acceptance Testing UAT with clients.
• Used the mapping tools to map 4010 and 5010 transactions along with ICD 9 and ICD 10 codes.
• Extensively used SharePoint for project documentation.
• Have worked very closely with the Quality Assurance and the Development Team

Environment

Net, XML, MS Excel, MS Power point, MS Word, MS Project, MS Visio, Quality Center, Pro, SharePoint, MS Visio.

Confidential

Business Analyst

• Confidential is one of the many renowned names in the health industry sector. The company serves a broad range of individuals, employers, government agencies and insurance carriers through its extensive range of products and services.
• With an aim to better serve and quickly deliver time critical information to its members, Coventry Healthcare developed an IVR system that spontaneously seizes the customer's phone number and response with the help of a touch-tone telephone. It was designed with a custom greeting and a step by step instruction to use the service as well as was able to help the customers from finding a doctor to claim information.

Responsibilities

• Gathered and analyzed the User Requirements from walkthroughs and interviews with the business groups and in-house stakeholders, and many other departments like accounting, fund management, human resource and thus converted User Requirements into Business Requirement Documents BRD .
• Created Use-Cases, requirement documents and BPM, to document the business needs using tools like MS-Visio.
• Created business process workflow diagrams Activity diagrams in Rational Rose
• Developed the following documentations in different stages of the requirement gathering process and presented to the SME to get signoff prior to moving to the next stages: Business Use Case Diagrams, Business Use Case Activity Diagrams, Business Use Cases, Use Cases, Use Case Activity diagrams
• Performed GAP analysis to assess the flaws in the existing system and made clear recommendations of business process improvements and incorporated them in the future to-be system design.
• Involved in feasibility analysis and risk analysis of the project
• Involved in UAT sessions to test and validate the system with stakeholders.
• Collaborated with the QA team to develop the test plan, test conditions and test cases.
• Created and managed project templates, use case templates, requirement types and traceability matrix in Rational Requisite Pro.
• Gathered and documented business requirements to define business needs and defining business deliverables
• Participated in Joint Application Development JAD sessions with the SME's and stakeholders.
• Supported in the design and implementation and deployment phase, as well as helping in maintaining the application in post deployment period.
• Involved in SWOT analysis of project plan.
• Ensured proper management and control of contents of project documentation using MS-SharePoint.

Environment:

SQL, Axure RP Pro, Rational Rose, Windows XP, MS Project, MS Word, MS Excel, MS Visio, Rational Requisite Pro, SharePoint.

Confidential

Business Analyst

Confidential is responsible towards improving the health and welfare of the residents of Confidential, The Confidential Health and Human Services Commission's Confidential is responsible for the entire Confidential Medicaid plans. The main objective of the project is that the available MMIS should be able to meet the functionality required to electronically send/receive and process the HIPPA compliant standard transaction. My role with the project was involved in providing support throughout the complete lifecycle which also included development of user interface, web service and covering provider Medical/Dental/Institutional , claims Dental/Medical and reimbursement processing domains.

Responsibilities:

• Worked closely with the business team, development team and the quality assurance team to ensure that desired functionalities will be achieved by the application
• Conducted meeting with the team members to discuss the requirements and mock-up screens
• Performed GAP Analysis.
• Followed the UML based methods using Rational Rose/MS Visio to create Use Case, Activity / State Chart, and Sequence Diagrams.
• Performed GAP Analysis to figure out what we have and what we ought to have, to be better-off.
• Evaluated and tested the new and modified software application to verify that programs function according to both technical and business requirements.
• Analyzed and collected business requirements identified system interfaces and created the requirements specification documents.
• Identified Use Cases from the requirements. Created UML Diagrams including Use Cases, Activity/State Charts, Sequence and diagrams, Data Flow Diagrams and ER Diagrams using Rational Rose and MS-Visio thus defining the Business Process Model and Data Process Model.
• Performed requirement analysis by gathering both functional and nonfunctional requirements based on interactions with the users, stakeholders, document analysis, user interviews, and documented those requirements in the BRD.
• Consistently utilized MS-Project for planning and project tracking purposes.
• Developed Test plans and mapped them to Requirements with QA team.
• Developed and updated Requirements Traceability Matrix RTM using Rational Rose, mapped the developed Test Cases to the requirements to ensure that the requirements were fully tested and implemented according to the specifications.
• Developed, executed and validated user acceptance test plans UAT and implementation support.
• Developed project schedules, conducted project status meetings and managed resources during all phases of the SDLC
• Created and maintained the Requirements Traceability Matrix RTM
• Requirements were gathered through interactions and meetings and periodic walkthroughs with SME's.
• Interacted with Developers and Users in resolving risk factors and other issues.
• Environment: MS Visio, SQL, Java, Windows 2000/2003, MS Project, MS Word, MS Excel, Rational Requisite Pro, Rational Rose.
• Confidential
• Business Analyst
• Responsibilities:
• Prepared the Business Requirement Document BRD and Functional Requirement Document FRD of the application.
• Conducting meetings with the business to get a clear understanding of the problem to developed requirements for.
• Worked closely with Development team and QA team.
• Successfully received sign-offs by providing walk-thru to the team and successfully traced them to the high level business requirements by utilizing ReqPro.
• Developed, executed and validated user acceptance test plans UAT and implementation support.
• Developed Project schedules, conducted project status meetings and managed resources during all phases of the SDLC
• Developed wire-frames for user interfaces for the workflow
• Prepared and maintained Requirement Trace ability Matrix RTM in Rational ReqPro.
• Highly motivated team player with excellent problem solving, team building, judgment and decision making skills

Environment: MS Visio, Java, Windows 2000/2003, RUP, Rational RequisitePro, Rational Rose, MS Office.

Confidential

Business Analyst

Responsibilities:

• Business Analyst internally representing software clients to technical staff.
• Participated in facilitation of Joint Application Design JAD sessions and interviews, written correspondence, reports, implementation requirements, project status reports, oral presentations, e-mails, to keep executive staff and team members apprised of goals, project status, and resolving issues and conflicts.
• Conducted weekly team meetings and prepared weekly Status Reports.
• Analyzed, planned, implemented various aspects of the sales and marketing department.
• Managed the entire marketing department, which included starting up a new division, qualifying and managing leads, product development, territory development, trade shows, evaluating sales performance and some advertising.
• Coded and mapped business processes in order to track all corporate information through various data models. .
• Assisted in the management of a 40 member direct sales force.
• Involved in SWOT analysis of project plan.

Environment:

Net, MS Office Suite, MS Project, UML, Use Case Analysis.