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Business Analyst Resume

Newark, DE

SUMMARY

  • 8 years of experience in business process analysis, business requirements modeling and development of Web Based, and Client/Server applications in diverse business domains of Healthcare, Financial Industry Sectors.
  • Expert at analyzing, designing, and re - engineering system applications and business processing.
  • Experienced in management of all phases of System Development Life Cycle (SDLC).
  • Skilled at performing GAP Analysis, Financial Analysis, Market Risk Analysis, Credit Risk Analysis, User Acceptance Training (UAT), SWOT Analysis, Cost-Benefit Analysis, Execution Cost Analysis, and ROI Analysis.
  • Good understanding of MITA and MMIS functional business areas, which include claims, providers services, providers enrollment, recipient services etc
  • Experience inHealthcare and Insurance industries with solid understanding of Business Process Flows, Case Tools, and Business Analysis.
  • Worked with HL7, EDI ANSI 4010 Standards
  • Defined Functional Test Cases, documented, Executed test script in Facets system.
  • Extensive experience in Change Management, Change Request Handling, and Release Management Process.
  • Exceptional business acumen. Ability to adapt to new technologies and learn quickly, and deliver quality products and services on time.
  • Seasoned specialist with Software Development Life Cycle (SDLC), Software Testing Life Cycle (STLC), and Project Management.
  • Expertise in Software Development Life Cycle (SDLC), Use Cases, Business Process Modeling Notation (BPMN), Object-oriented Analysis and Design, Rational Unified Process (RUP) and Rational tools used during all four phases of RUP: Inception, Elaboration, Construction, and Transition.
  • Experience withHealthcare Systems:FACETS, Medicare Part A, B, C, D, Medicaid systems
  • Extensive hands-on andHealthcare management experience in a variety of projects involving the customization, design, development, implementation, and testing of automated systems to support the Medical Management Information System (MMIS) as well as day-to-day business operations.
  • Strong knowledge of managed care payer requirements and procedures.
  • Experience with QNXT 3.4, QNXT 4.6, Facets 4.71, Inbound & Outbound interfaces, EDI configuration, and data mappingusing ANSI X12 4010 and 5010 (834,835,837) .
  • Sound understanding of Gap Analysis, requirement management, risk analysis and project plans.
  • Solid understanding of Rational Unified Process (RUP) using Rational Rose, Requisite Pro, Unified Modeling Language(UML), Object Modeling Technique (OMT), Extreme Programming (XP), and Object Oriented Analysis (OOA).
  • Excellent understanding of Data Models and Information Architecture and sound skills in SQL.
  • Familiar with HIPAA EDI transactions such as 835, 837 (P, D,I) 276, 277, 278 etc
  • Used BEA (BPM Tool) to map Process flows and migrated Visio Process flows into BEA Tool.
  • Experience in development methodologies like RUP, SDLC, AGILE, SCRUM and Waterfall.
  • Expertise in Healthcare- domain. Hands on exp. in HL7 and PACS.
  • Implemented automated COB processing of Medicare claims into Facets
  • Experience in developingand conducted statewide HIPAA 5010 and ICD-10 awareness program for all IDS staff in Tenet.
  • Familiar with FDA Electronic submission standards and CDISC standards.
  • Experience in Forward Mapping and Backward mapping analysis of ICD 9 - ICD 10 Conversion for CM (Diagnosis Codes) and PCS (Procedure Codes).
  • Expertise in broad range of technologies, including business process tools such as Microsoft Project, Primavera, Promodel, MS Excel, MS Access, MS Visio, technical assessment tools, Micro Strategy Data Warehouse Data Modeling and Design.
  • Excellencyin designing business models using UML diagrams such as use case diagrams, class diagrams, activity diagrams, sequence diagrams and collaboration diagrams using Rational Rose and MS Visio.
  • Experience in conducting Joint Application Development (JAD) sessions and White Board Sessions with end-users, Subject Matter Expert (SMEs) team, Architects and design group development and QA team for project meetings, walk-throughs and customer interviews commensurate with excellent communication skills.
  • Creative and aggressive self-starter with integrative thinking skills, capable of communicating creative ideas through graphical analysis charts and statistical data display.

TECHNICAL SKILLS

  • Business Analysis
  • Business Architecture
  • Data Mapping
  • Data Modeling
  • Requirements Gathering
  • Functional Specification
  • Design
  • Testing (Test Cases) (Manual Testing & Automated Testing tools)
  • Quality Assurance (QA)
  • Documenting Process Flow
  • Process Re-Engineering
  • Process Mapping
  • Business Contingency/ Business Continuity Planning (BCP)
  • GAP Analysis
  • SDL
  • Rational Team Test
  • OOAD (OOA/OOD)
  • RUP
  • UML
  • Rational Rose
  • Clear Case
  • Clear Quest
  • Win Runner
  • Load Runner and Test Director
  • C
  • C++
  • Java
  • HTML
  • J2EE
  • VB 6.0
  • SQL
  • Windows 9x/NT/2000/XP
  • Facets
  • Access macros
  • Excel macros
  • Active Reports
  • Unix
  • Informatica
  • Six Sigma
  • Linux
  • Solaris
  • Oracle
  • SQL Server and MS Access
  • TSL
  • SQL Basic
  • IBM Mainframe
  • Shell Scripts
  • MS Visio
  • MS office
  • Adobe PageMaker
  • Adobe Photoshop
  • MS Project 2002
  • Adobe workflow systems
  • Web logic Server iRise
  • Mercury Quality Center
  • MS Office SharePoint Server 2007
  • Quick Development Case and Quality Review Tool(QDQ)

PROFESSIONAL EXPERIENCE

Confidential, Newark, DE

Business Analyst

Responsibilities:

  • Responsible for the requirement-gathering phase and project plan.
  • Responsible for requirements analysis, design and developing technical requirements.
  • Responsible for the full HIPAA compliance lifecycle from gap analysis, mapping, implementation and testing for processing of Medicaid Claims.
  • Embrace agile principles. Support iterative user experience design, involving UX research and UX design at all stages of product development
  • Responsible for gap analysis in changing old MMIS and Involved in testing new MMIS.
  • Created customized reports with complex calculations that were used to study the potential financial impacts of changes to Medicare and Medicaid payments.
  • By using theBABOK approved processes for business requirements gathering
  • Used HIPAA 4010 transactions to support the analysisof current business processes and work with management to improve and implement enterprise solutions to ensure compliance and got involved in designing future state processes forHIPAA 5010 transaction processing EDI's 837, 835, and 834 and ICD-10 Code sets.
  • Acted as aSMEfor the application team and the Infrastructure team.
  • Analyzed HIPAA 5010 related to 837,835, 834. Transactions and performed gap analysis between the 4010 and 5010.
  • Used RequisitePro for writing/analyzing project vision, goals, specifications and requirements.
  • Experience with Trizetto Facets System implementation, Claims and Benefits configuration set-up testing, Inbound/Outbound Interfaces and Extensions, Load and extraction programs involving HIPPA 837 and proprietary format files and Reports development.
  • Became exposed and experienced in Business Analyst Book of Knowledge (BABOK), and the use of the various methodologies and tools within an organization.
  • Used the BPMN to GAP Analysis to bridge the gapbetween business processes.
  • Conduced Joint Application Development (JAD) sessions and walk an interview with the business users to gather requirements.
  • Built business requirements into the Medicare Advantage (MA) requirements database and created the Project Requirements Document for the three functional areas
  • UsedFACETSAnalytics for fast and easy retrieval, display and grouping of information for performing queries and generating reports.
  • Matched the requirements for programs such as Medicare and Medicaid, which are part of the Social Security Act.
  • Created Use Cases diagram and Activity diagram to depict the interaction between the various actors and the system in RationalRose for the Business Use Case and System Use Case.
  • Conducted the FRS and URS reviews and walk-throughs with designers, developers and stakeholders. Also conducted feasibility and adaptability study.
  • Write SQL scripts for adding, changing or deleting various benefit or contract data to or from QNXT that would take several man hours to complete via the front end software
  • Createdan automation Framework solution to automate provider contract migration to facilitate the pricing engine onNetworXPricer(Trizetto Product) to apply the configured pricing rules to determine claim pricing and configured routing rules during claim processing from the mainframe systems.
  • Incorporated HIPAA standards, EDI (Electronic data interchange), transaction syntax like ANSI X12, Implementation and Knowledge of HIPAA code sets, ICD-9 ICD-10 coding and HL7.
  • Conducted JAD Sessions with Infrastructure management team,SME, policy holders and stakeholders for issues which were open and pending.
  • Interacted with database developers for formulating the ER diagrams and data flow diagrams.
  • Responsible for GAP analysis of ICD9-ICD10.
  • Held regular JAD meetings with the system architects, developers, database developers, quality testers during the entire project to assure that the critics as well as the minute details of the project were discussed and issues were resolved beforehand.
  • Created current and future state processes, along with prototype BPM solution at medical device company
  • Worked With HIPAA compliant ANSI X12 837 formats for both professional claims and institutional claims.
  • Analyzed the mainframe reports for member/eligibility/claims and mapped the fields withFACETSbatch jobs and reports.
  • Extensively involved in testing Trizetto Facets and mainly involved in Enrollment and Eligibility modules.
  • Performed configuration/ compatibility and user interface testing manually.
  • Worked with QA lead in validating Test Plan and Test Scenarios.
  • Used HP Quality Center for tracking Defects and tracing requirement functionality performances.
  • Executed test cases manually. Compared and analyzed actual with expected results and reported all deviations to the appropriate individual(s) for resolution.
  • Performed extensive data modelling to differentiate between the OLTP and Data Warehouse data models
  • Assisted Business User during deployment in formulating User Acceptance Testing (UAT) for customized application and getting confirmation for product Release
  • Review of high-level design document and low level design of classes and sequence diagrams.
  • Ensuring that deliverables were delivered on time as scheduled.

Environment: UML, RUP, Rational Requisite Pro, Rational Rose, Facets, Rational ClearQuest, Excel, SQL, DB2, Crystal Report, HP Quality Center

Confidential, Herndon, VA

Business Analyst

Responsibilities:

  • Facilitated gathering and analyzing business requirements, and translating the same into system / technical requirements.
  • Facilitated creation of Process Flow, Workflow, and Data Flow Diagrams using IBM Rational Rose / MS Visio / BPMN towards documenting the business process.
  • Prepared Business Object Models and Business Process Models that included modeling of all the activities of business from the conceptual to the procedural level.
  • Used IBM Rational Req Pro for overall requirements management and to build the Requirements Traceability Matrix (RTM).
  • Employed UML methodology and thus facilitated the creation of Use Case, Class, Object, Activity, State, Sequence, and Collaboration Diagrams, using IBM Rational Rose / IBM Rational Software Architect / MS Visio.
  • Utilized RUP to configure and develop processes, standards, and procedures, to employ software development best practices, and hence to provide technical leadership and expertise in organizing the entire software development effort.
  • Analyzed ETL and database requirements and hence created specifications such as Source to Target Data Mappings for the ETL Development Team
  • Created other project artifacts like Business Requirements Document (BRD), Use Case documents, Technical Specification documents, Data Management Plan, and Detailed Design documents.
  • Involved in implementing the business rules using the ILOG Rules Engine.
  • Facilitated Meetings and JAD sessions to allow users / stakeholders from multiple teams to communicate with each other, resolve issues, and reaching consensus.
  • Liaised between the business users and technical teams towards providing feedback to both on implication of requests and escalating / resolving issues and conflicts.
  • Involved in planning and executing the UAT, and subsequently creating the relevant documentation.
  • Involved in Project Management activities like defining / managing project scope, estimating time, scope, and LOE, resource planning, gap analysis, risk analysis, budgeting, creating project plans, and tracking project status, deliverables, milestones, schedules, and issues.
  • Worked together with the developers and testers towards tracking / resolving defects and bugs.
  • Mentored junior business analysts and supervised their activities.

Environment: Java / J2EE,UML,JSP, Java Servlets, EJB, JMS, JMX, JavaScript, Struts, Sessions Bean, Share point, CORBA, JDBC, Beanshell,IBM RationalTools Suite,RUP,Business Objects,BPMN, MS Visio, ILOG, IBM Web sphere Business Modeler, Windows, Unix, SQL, PL / SQL, Perl, Web Logic, Web Methods, XML, HTML, Ab Initio, TOAD, Autosys, EPF, Oracle, ODBC, CMMI, TCP / IP, FTP, HTTP, MS Project, MS Office, Crystal Reports, MS Outlook.

Confidential

Business Analyst

Responsibilities:

  • Involved in Requirement gathering for CIWRS and EPM and worked closely with business and technology groups to identify best methods for promoting/implementing new process.
  • Participated in developing solution by formulating objectives, planning deliverables and preparing functional specification and leading the exploration, evaluation, and design of technical solutions.
  • Managed and documented Business requirements and dependencies by thoroughly analyzing the systems to have a clear understanding of the business processes and associated system workflow.
  • Estimated deliverables based upon the Business requirements.
  • Maintained development plans/schedules.
  • Conducted Gap analysis to understand new business model and additional functionalities to be incorporated into the new application.
  • Participated in various architectural development sessions to provide technical teams with a better understanding of the business requirements.
  • Responsible for the preparation and submission of Functional Requirement Document based on the Business Requirements with details of proposed screens, and Functional aspects of the Application developed.
  • Presented weekly updates to senior management on development progress and project status, current risks and risk-reduction plan, solution to technical and development problems for timely business decisions.
  • Creating new Process definitions and Run control pages for crystal reports.
  • Masked data from production to Development and Testing Environments.
  • Review and track application accomplishment against procedure and Standards
  • Communicated intensively with clients, sub-contractors and vendors to establish cordial/effective working relationship.

Environment: Peoplesoft CRM 8.9, EPM 8.8 and Peopletools 8.45, DB2 8.0

Confidential

Business Analyst

Responsibilities:

  • Used UML diagrams for data capture activities which required working with SMEs to ensure consistency and accuracy of data during the data loading process and that the data passes validation and integrity constraints with corporate database repositories.
  • Clear understanding of Medicare (Part A, Part B and Part D) and Medicaid benefits as well as business processing.
  • Involved in process analysis and defined executed data migration plans for local data for global applications.
  • Worked with UB92/UB04, CMS 1500 claims and HIPAA 834, 835,837, 270/271, 276/277, 278 transactions.
  • Database support that includes activities required correcting, deleting or summarizing medical history of members as well as provider information.
  • Experience in CMS and MMA Guidelines.
  • Collaborated on the development of user requirements and design specifications using standard UML techniques such as use case, activity, sequence, and class diagrams.
  • Conducted JAD sessions, Focus groups and individual interviews to facilitate elicitation with regards to analysis, specifications, and design of the relevant business processes and systems.
  • Thorough understanding of health benefit products, assisted in consolidating the summary of Benefits.
  • Executed Smoke, Functional, Integration, End-to-end and Regressions Tests in each environment by tracking the test status in Quality Center (Test Director).
  • Applied advanced Excel skills (pivot tables, macros, lookups, charts) and Access database querying skills in streamlining and automating accounting processes.
  • Documented detailed business, functional, and User Interface system specifications using standardized company templates for the business, development, and QA team.
  • Build relationships with Information Systems and other relevant business partners, balancing practicalities with innovative and efficient business systems solutions.
  • Helped developers with the following list of HIPAA-EDI Transaction Code sets: (837, 835, 270/271, and 276/277).
  • Created test cases and performed manual testing of the functionality of the application by inserting varying data on different test runs.
  • Documented Requirement Traceability Matrix in Requisite Pro for traceability of requirements through test cases.
  • Developed Forms using MS Access using Forms and Reports for reporting.
  • Produced clear user manuals & training guides for User Acceptance Testing (UAT) and deployment for end-clients with step-by-step instructions and created appropriate GUI screenshots.

Environment: HP ALM, SQL Server, UML, Rational Requisite Pro, Test Manager, Clear Quest, Windows XP, MS Visio, MS Access, MS Project, UAT, JAD, MS Visio.

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