SUMMARY

• Over Nine years of experience as a Sr. Business Analyst/Quality Analyst.
• Solid understanding of Business Requirement gathering, Business Process flow, Business Process Modeling and Analysis, design documentation.
• Experience in all phases of the Software Development Life Cycle (SDLC) including Requirement gathering, Design, Development, Testing and Deployment.
• Organized Joint Application Development (JAD), workshops and interview sessions.
• Expertise in Documentation and Review of Software and Business/Technical Requirement Documents.
• Managed complex business initiatives to balance requirements for functionality, efficiency and quality.
• Excellent knowledge of Health Insurance Portability and Accountability Act (HIPAA) transaction, code set rules such as EDI 837,270,271,276,277,834,835, NCPDP and ICD9 - ICD10 with FACETS.
• Experienced with Rational tools like ReqPro, Clearquest, Clear Case, Rational soda, Rational Rose.
• Experienced working in Obama care, Medicare and Medicaid projects.
• Exceptional Documentation Skills for writing Use Cases and Functional Requirement Documents.
• Experience in working on the Content Management software solutions including Microsoft SharePoint Server 2013/2007 and OpenText Livelink.
• Design and review of various documents including the Software Requirement Specifications (SRS), Business Requirements Document (BRD), Use Case Specifications, Functional Specifications (FSD), Systems Design Specification (SDS), Requirement Traceability Matrix (RTM) and testing documents.
• Strong experience with MS Visio for creating visual representation of Software/Data Architecture, Use Case diagrams (specially in an Agile environment), Sequence diagrams, Class diagrams, Business Process Flows and basic flowcharts.
• Extensive experience in configuring data mapping of files using Edifecs Specbuilder.
• Through knowledge of various phases of Edifecs Specbuilder- Analyzer and Mapper.
• Conducted JAD Sessions to develop an architectural solution that the application meets the business requirements, resolve open issues, and change requests.
• Good Knowledge of Test Plan, Test Scripts and Test Cases for Functional, System, Integration, UAT, and Regression Testing based on the Design Document for the Functional, Security, and Performance Testing.
• Excellent written and verbal communication.
• Consistently demonstrated ability to achieve tight deadlines.

TECHNICAL SKILLS

Operating Systems: Win 98/XP/Vista/Windows 7, UNIX, LINUX, Mac.

Languages: C, C++, Java, SQL, HTML, XML, C#, VB, ASP, .Net

Databases: Oracle, MS SQL server, MS Access, MY SQL

Tools: MS Office Word, Excel, Access, Power point, Project, Visio, Front Office, Rational Rose, SoDA, Software Modeler, Team Test, Doors, PROLOG, Clearcase, Clearquest, WinRunner, LoadRunner, WebSphere, Business Modeler, HP Quality Centre, Ultra Edit, TOAD and Test Director, MMIS, JIRA, Facets4.82, Facets5.1x.

Industry Standards: HIPAA 5010, ICD 10, PPACA (Patient Protection and Affordable Care Act)

PROFESSIONAL EXPERIENCE

Confidential

Lead Sr.Business Analyst/ Product Owner

Responsibilities:

• Work with business stakeholders and partners to help identify and understand their requirements within the scope of a project.
• Generate user stories and/or deep functional and technical requirements that are sufficient to capture the essence of what is being asked, why it is important and who benefits from the effort.
• Worked on claims adjudication, provider configuration, EDI 835/837 and Member Group Enrollments.
• Work on researching Foundational configuration of job grades, classifications, locations, and other attributes that may be used to drive variances in plan availability in member group contract.
• Create parent/child structure within a member group to Vary contracts by unique child member group, allow for variances in reporting by subset populations within the broader group so that individual members may be associated to any member group record in this structure.
• Draft process flows, work with architect on business and solution architects on IT.
• Defining scope, high level process flows and business context for Claims Processes.
• Define user stories and elicit high level and detailed requirements from business stakeholders.
• Assist the team in system analysis, quality analysis and issue diagnosis as necessary.
• Support application testing with project teams to ensure solution meets business requirements.
• Conduct Grooming sessions with the technical teams for the Capabilities assigned.
• Maintained Product Backlog and updated it before start of each Sprint.
• Provides analytical guidance to the project team throughout the project lifecycle.
• Assisting with the translation of business requirements into system requirements.
• Produce artifacts that may include feature definitions, user stories, flow-charts, swim-lanes, SIPOCS, and feasibility studies.
• Assist with data analysis in support of issue resolution or solution options on highly complex projects.
• Working with the Scrum Master for keeping the team and business stakeholders on track for meeting commitments.
• Drive decision making, compromise and agreement by identifying deliverables that provide value.
• Clarify the approach for gathering requirements and managing issues and risks.
• Work with technical teams to identify solution options that best meet business need.
• Explore ideas, assess current business processes to identify improvement opportunities (technical and operational), conduct gap analysis, and help to develop business cases.
• Partner with the technical team to outline solutions and provide estimates and identify risks.
• Support creation of test plans / scenarios, post-implementation support requirements, and lessons-learned.
• Assist peers to continue to define and develop practice improvements and apply them to the delivery process.
• Conduct Daily Stand Ups with the Claims team.

Environment: HP ALM, VersionOne, Salesforce, MS Office, Windows 7, MS Visio, HP SharePoint, MS Project, MS Visio, SQL, SOAP, XML, Agile

Confidential

Sr. Business Analyst/ Product Owner

Responsibilities:

• Developed and managed project management plan using CA Rally.
• Developed project delivery plan and work project status report for governance team.
• Performed user storytelling and grooming using CA Rally.
• Conducted JAD sessions between multiple cross functional team to resolve problem and requirements pass on.
• Experience with process definition (flow charts, activity diagrams), feature and user story definition, and acceptance testing
• Worked on Integration of Healthcare programs like MAGI and NON MAGI Medicaid, QHP (APTC, CSR), CHIP, Refugee Medicaid and Emergency Medicaid.
• Gathered and managed XML elements for portals.
• Created PRD and MVP for different featured of the product.
• Identified source system, target system and performed analysis to find data for MDM.
• Interviewed the Business to understand importance of data to identify reference and analytic data and to decide the right processes for implementation of MDM data.
• Worked on creating project end to end process flow using BPMN 2.0 in JBPM tool and Visio.
• Prioritize user stories for each release and sprint
• Worked on aligning product features for different release so BA can associated user stories to the parent features.
• Research to gather business requirements from valid sources by myself and convert them in Business, functional and non-functional requirements.
• Helped Salesforce team updating their table by providing Mapping document with added element from rules weekly.
• Create and validated XML, XSD, JSON file format.
• Supported in architecture, High level UML diagrams and prototype of proposed solution.
• Test rules service requests and response using REST and SOAP.
• Data analysis to provide reports to business related to DSS programs.
• Created HL Design and low level design for project different Eligibility programs like Medicaid, TANF, SNAP, Child welfare, QHP, CHIP, and LIHEAP etc.
• Reviewed and provided signoff for Test plans in each release

Confidential

Quality Assurance

Responsibilities:

• Support all phases of the MMIS during the implementation cycle and/or maintenance and operations as assigned.
• Tested (Validated and Verified) Louisiana Medicate Management Information System (MMIS) and Integrated Eligibility System (IES) based on CMS requirements and State policies.
• Supported Independent Verification and Validation process based on CMM, CMMI, Six Sigma, PMBOK, IEEE industry standards and IT best practice.
• Provided guidance, review and testing based on HIPAA standards.
• Validated and Verified State Requests for Information (RFIs) and Request for Proposals (RFPs) of all healthcare related projects.
• Participated in Independent Verification and Validation(IV&V) Testing
• Lead a validation (IV&V) effort that comprises of 10 test resources. This effort includes IV&V/UAT for three CMS applications.
• Manage and facilitate meetings that include pulse check on Validation and UAT readiness of the environments, build status, defect management and triage process, daily UAT calls to provide daily UAT status to all the stakeholders. Facilitate the Go/No Go decision call at the end of the UAT test cycle.
• Develop customer deliverables in accordance with contract requirements and company documentation standards.
• Research and provide recommendations to the client on critical business decisions
• Review and assess documents and artifacts for quality, completeness, compliance, and effectiveness
• Review Functional specification for accuracy and thoroughness and recommend quality improvement for production optimization, performance risk mitigation, and system integration activities.
• Work within the QA team to provide ongoing consultation (identification of Noncompliance Issues and Concerns, Recommending Corrective Actions, Identifications of Lessons Learned for Process improvement) and project management support.
• Review MDW project artifacts from SDLC’s start to end stage from FRD, Assessment workbook, PDD, PCR, RTM, Test Package, to ROCs & Invoices, and document the observations & findings using standard Cognosante checklists and comment matrices.
• Drive improved quality of products and services through application of the methodology, continuous improvement, and dynamic and progressive approach.
• Collaborate with QA Project Manager and QA team to develop, implement, and improve innovative QA capabilities, approaches, and services.
• Identify, monitor, manage, report and escalate QA risks, issues, and recommendations related to the MMIS/Data Warehouse.
• Develop QA deliverables as assigned.
• Interact effectively with customer business technical team members.
• Ensure identified processes and methodologies are executed and followed
• Employee is expected to undertake any additional duties as they are assigned by their Manager.
• Work on the Service Level Agreements and generate monthly performance reports and identifying the penalties for the SLAs not met.
• Used and developed SQL queries to acquire or modify data from SQL database and access database.

Confidential

Senior Business Analyst

Responsibilities:

• Worked with client to gather Business/Technical Requirements, Approval of CR (Change request), Design and Implementations for State MMIS.
• Worked with team members to perform Independent Verification and Validation (IV&V) or new fiscal agent contract.
• Helped conduct Independent Validation and Verification (IV&V) of Virginia’s Medicaid system.
• Responsible for designing future state processes for new MCO and transaction between MMIS and MCO.
• Active member for the policy review to implement the blueprint requirements for Medicaid/MMIS, Medicare, CHIP and Tax Credits benefits per CMS guidelines.
• Act as a liaison between the client, and other support groups (State of Virginia’s Medicaid, Medicare, Stake Holders, External Vendors, Sister Agencies, CMS, etc.
• Worked on creating State based Rule requirement document with Rule ID (CFR number).
• Gathered business and functional requirement for eligibility determination for SNAP, TANF and Medicaid program.
• Assisted IV &V (Testing team) in understanding the various business rules across the applications
• Created functional design for SNAP, TANF and Medicaid eligibility programs.
• Worked on Child Support Incentive Benefits delivered through Electronic Benefit Transfer.
• Researched on state based rules, configuration to be implemented in integrated eligibility system.
• Worked on Facets, EDI claims 837 Submissions and Transactions.
• Gained extensive experience in designing/modifying the CICS screens for various areas such as Enrollment, Billing, Provider Record and Reimbursement Status in MMIS.
• Wrote clear, concise detailed System Requirements Specification (SRS) documents and user documentation in accordance to guidelines and standards of a level where developers can interpret, design and develop the application with minimum guidance.
• Experience in implementation of CPT codes changes in the current claim processing modules in MMIS.
• Works on Various Claims Analysis (Medical, Pharmacy, and Institutional) and provided federal audit reports to CMS.
• Worked on JIRA which include Defects Management, Test Plan and Dashboard.
• Talking to the client based on requirements of that particular defect, uploading document required, checking history, status notes, setting up resources to handle and fix it.
• Worked on Rational Requisite Pro application to handle various requirements including Functional requirements, High-level requirements, Non-functional requirements, Scope statement and User requirements.
• Point of Contact of the Content Management software solutions including Microsoft SharePoint Server 2013/2007 and OpenText Livelink.
• Provided online support to users for various applications such as IPCS (Internet Professional Claims Submission).

Environment: HP ALM, JIRA, Salesforce, MS Office, Windows 7, MS Visio, HP SharePoint, MS Project, MS Visio, SQL, SOAP, XML, MMIS, Agile

Confidential

Senior Business Analyst

Responsibilities:

• Responsible for gathering and documenting Legislative, Business, Functional requirements for all the provisions and their impact on the existing products and systems.
• Claims Examiner III, IV&V.
• Involved in Independent Verification and Validation of Requirements (IV&V) to ensure that all the requirements are satisfied and meet the security objectives.
• Responsible for integrating with FACETS. Designing test scripts for testing of Claims in Development, Integration and production environment.
• Interact with current MMIS vendors and collected necessary information regarding their creative and industry best practice solutions.
• Work with a few state MMIS. Medicare, CMS clients and state PMOs.
• Analyzed a wide range of FACETS configuration change requests for the purposes of determining the technical scope of the change, its impact on existing systems configuration.
• Participated in the CORE (Committee on Operating Rules for Information Exchange) compliance process for the company.
• Responsible for gap analysis in updating existing Claims Management System and Involved in testing new CMS. Also, accountable for Claims Resolution/Reimbursement.
• Works closely with the MMIS testing team to ensure that test scenarios and test cases fully represent the requirements being tested for assigned projects.
• Assist supervisor with special projects, work flow and motivation.
• Responsible for creating test scenarios, scripting test cases using testing tool and defect management for Policy Management Systems, Payables/Receivables and Claims processing.
• Worked on the PPACA for various mandates such as Grandfather Rule, Rescissions, D-26, Pre Ex-19, Preventive Care, Operating Rules, and Early Retirees Fund etc.
• Wrote test cases and test scripts for the User Acceptance Testing.
• Performed Requirement Analysis and developed Use Cases and Activity Diagrams.
• Traced High Level Requirements (HLR) to Detailed Level Requirements (DLR) using MKS Integrity.
• Performed testing for Medicare, Medicaid and X-Over claims for Medicaid Management Information System (MMIS).
• Conducted meetings with SME's to understand current business process and performed Gap Analysis to meet future business needs.
• Partner with IT team to plan and prepare future state architecture for SharePoint and enterprise content management technology solution.
• Created and managed project templates, use case project templates, requirement types and traceability relationships in MKS Integrity.
• Developed Systems Specifications document to define the impact of the new requirements on the existing system.
• Developed and managed creation of product documentation to communicate features, benefits, positioning and impacts to different audiences and ensured that documentation deliverables from various groups are produced as needed.
• Created Business Requirement Document (BRD), Functional Requirement Specification (FRS) document, User Requirement Specification (URS) and Change Request (CR) document for system application development.

Environment: SQL, Rational Unified Process (RUP), Facets, Rational Requisite Pro, Rational Rose, Clear Quest, Microsoft Visio, Windows Vista, Mercury Test-Director, Share Point