SUMMARY

• Over 7 plus years of expertise as Business Analyst with sound knowledge of Business Requirement Gathering, Business Process Flow and Business Process Modeling.
• Extensive exposure to Healthcare and Insurance domains.
• Widespread interaction with clients, business users, stake holders and end - users. And have experience in identifying and collecting their needs and requirements.
• Strong knowledge of UML and proficient in creating Use Case Diagrams, Sequence Diagrams, Collaboration Diagrams, and Class Diagrams
• Experienced in organizing Joint Application Development (JAD), Rapid Application Development (RAD) and Joint Requirement Planning (JRP) sessions across deliverables of the project
• Authoring and documenting the Business Requirement Documents (BRD), Functional Requirement Document (FRD) and Software Requirement Specification (SRS) across the deliverables of a project.
• Expertise in various Software Development Life Cycle (SDLC) methodologies like Agile, Rational Unified Process (RUP) and Waterfall models.
• Hands on experience on Iterative methods like RUP. And involved in working in all four phases of it i.e., Inception, Elaboration, Construction & Transition using rational tools like Requisite Pro, Clear Case and Clear Quest.
• Experienced in Business Analysis, SWOT Analysis, Gap Analysis, Risk Analysis and Project Planning
• Experience with accounts receivables and accounts payable.
• Developed managerial skills in Medicare and Medicaid processing as well as in Eligibility, Claims and Billing.
• Sound understanding of HIPAA standards 4010A1 and 5010, and Electronic Data Interchange (EDI) Transaction syntax ANSI X12. Implementation and Knowledge of HIPAA and ICD codes
• Experienced in performing Gap Analysis and developing spreadsheet in identifying the changes between HIPAA 4010A1 and 5010
• Excellent knowledge and experience of creating source to target mapping, edit rules and validation, transformations and business rules
• Experienced with insurance claims processing using main frame legacy system (on Oracle, MS SQL) and paper intensive environment
• Experienced in developing reporting application using ETL (Informatica) and Cognos Business Intelligence Suite with multiple data sources
• Experience and knowledge of Data warehousing & RDBMS concepts including OLAP, dimensional modeling using Star Schema and Snow-Flake Schema designs.
• Experienced in working with QA team to develop the Test plans, Test scenarios, Test procedures, and Test cases. Experienced in conducting User Acceptance Testing (UAT) and Regression Testing (RT).
• Experienced in teaching and mentoring team members with product knowledge, production application and business processes.
• Strong work ethics, taking ownership of all duties and responsibilities and meeting management objectives. Along with maintaining interactive relationships with business and IT colleagues, had a thorough understanding of the constraints, needs, and perspectives of both the business users and the technical team

TECHNICAL SKILLS

Business Skills: Requirements Gathering, Gap Analysis, SWOT analysis, JAD/JRP sessions, Use Case Modeling

Methodologies: Agile, Waterfall, Application Development (RAD), and Rational Unified Process (RUP)Standard and codes: HIPAA 4010A1/5010, ICD-9CM ANSI, X12, HL7.

Languages: C, C++, SQL, PL/SQL, HTML, XML.

Databases: MY SQL, Oracle, MS-Access

Management Tools: MS Visio, Rational Rose, Requisite Pro, Clarity, Clear Quest.

Testing Tools: Test Director, Win Runner, HP Quality Center.

Documentation Tools: MS Office Suite, Adobe suite, Crystal Reports.

Operating Systems: UNIX, Windows 95/2000/NT/XP and MS DOS.

Microsoft Tools: MS Office 2003(Word, Excel, Power Point, Outlook), MS Share Point, MS Visio, MS Project

BI Tools: Business Objects.

PROFESSIONAL EXPERIENCE

Confidential

Business Analyst

Responsibilities:

• Conducted Interviews and JAD sessions with business stakeholders, project directors and SME’s for gathering the requirements, needs, and any other features of the system.
• Developed business requirement specification documents as well as high-level project plan.
• Developed Use Cases visually to model the system.
• Documented and delivered Functional Specification Document to the project team.
• Participated in formal requirements review sessions to review the system requirements.
• Developed User Interfaces, Data Modeling, Feasibility Studies, Scope Documents, Requests of Proposal, and Defect Status Reports
• Responsible for developing Basic Process Mapping to link IT to Business Performance.
• Involved in project management activities like scheduling the project, meetings, and creating project timeline diagrams using MS Visio.
• Performed Gap Analysis to identify and document the gaps between the existing system 4010A1 compliant and new 5010 compliant system.
• Involved in creating sample mappings for the conversion of EDI X12 transactions code sets version 4010A1 to 5010.
• Involved with the coders in evaluation of CPT and ICD-9 codes to ensure that the diagnosis meets medical necessity for the specific CPT code.
• Facilitated meetings with the technical team and client team to analyze the current process and gather requirements for the proposed process.
• Analyze EDI - X12 data elements captured by the existing system to validate it against the data elements required for new system well versed with ICD9, HCPC, CPT, HIPAA, claim adjustments, claim processing from point of entry to finalizing, claim review, identifying claims processing problems, their source and providing alternative solutions.
• Developed strategic partnerships with the business units to develop a solid knowledge base of the business line; including the business plan, products, and process and revenue streams.
• Worked with the testing team in Functional, CMS, Regression and User Acceptance Testing and responsible for developing test plan, test scripts, and test scenarios and string testing for Provider, Recipient builds and designed user documentation
• Assisted the Project Manager in setting realistic project expectations and evaluating the impact changes on the organization and plans accordingly and conducted project related presentations
• Coordinated with all the teams (Development, Database and IT) to accomplish timely release of products.
• Coordinated and assisted offshore development team to convey the requirements and address them in case of any issue
• Played a key role in the Planning, User Accepted Testing (UAT), and Implementation of system enhancements and conversions

Environment: Java, Rational Clear Case, Clear Quest, Rose, Lab Link RequisitePro, MS Visio, MS SharePoint, MS Office Suite, RUP.

Confidential, Overland Park, KS

Business Analyst

Responsibilities:

• Responsibilities include documenting, identifying the activities, and coordinating with the project team on the activity status.
• Conducted Interviews, User Meetings, and JAD sessions to elicit the project requirements in successfully upgrading the existing with the new system.
• Collecting the project requirements from the client team and documenting them from perspective of technical team following the HIPAA guidelines
• Developed Use Cases, Activity Diagrams, Sequence Diagrams, and Collaboration Diagrams using Rational Rose
• For helping the business team, a through research was conducted on Center for Medicare and Medicaid (CMS) website for formulating the business rules.
• Documented the Process Flow Diagrams and Business Use Cases for the EDI transactions 276/277 and executed them in Requisite Pro
• Worked on different EDI scenarios for batch processing
• Analyzed mandatory and situational fields and compared with the user manuals for EDI
• Involved in up-gradation of HIPAA X12 4010 transaction to HIPAA X12 5010
• Created, and maintained EDI Business Rules with strict adherence to HIPAA 5010 and ANSI ASC X12
• Provided Mapping for HIPAA code sets and EDI transaction processing
• Executed Gap Analysis to check the compatibility of the existing infrastructure with the new business requirements.
• Data mapping, logical data modeling, used SQL queries to filter data within the Oracle
• Assisted Project Manager in updating and maintaining project schedule, assigning project resources and monitoring deliverables using MS Project
• Helped manage risk analysis and mitigation plans, status reports, and client; prepared business process models, defined milestone deliverables, and established critical success factors
• Developed solutions in compliance with the industry standard like Six Sigma, HL7, SOX and System Validation.

Environment: RUP, MS Project, ANSI X12- EDI UML, Rational Requisite Pro, MS Word, MS Visio, SQL, MS Excel, Mercury Quality Center.