SUMMARY:

• 7+ years of diverse experience as a Business Systems Analyst in the Healthcare Domain.
• Experience in defining business processes, identifying risks, base - lining acceptance criteria, and deliverables.
• Expertise in various SDLC methodologies like Agile, Waterfall and RUP.
• Experienced in manual as well as automated testing of both web based and client based applications on Windows and UNIX environments.
• In-depth knowledge of Medicaid and Medicare Services.
• Excellent knowledge of EDI transaction files such as 270/271, 276/277, 470, 835, 820, 837 and 834.
• Extensive experience on working with ICD 10 and adept understanding of professional, and institutional
• Requirements gathering in compliance with HIPAA 5010 standards.
• Experienced with working on Version 5010—revised HIPAA transaction standards & prerequisite for ICD-10 and EMR/EHR.
• Thorough understanding of HIPAA standards, compliance issues, privacy policy, opts in/opt out policy.
• Experience with various modules of Facets like management, premium billing, enrollment, claims processing & adjudication, coordination of benefits administration.
• Experience in writing Test Cases and Test Plans.
• Experience in testing the HIPAA EDI transactions X12, 834, 820, 837/835, 276/277, 273, 270/271 according to the requirement test scenarios.
• Considerable knowledge in the analysis, design, business processes, data modeling and application development. Applying Unified Modeling Language (UML), and the implementation of performance measures.
• Experience working with FACETS claims processing.
• Adapt at transforming requirements into Business Requirement Document (BRD), Functional Requirement Document (FRD) and Software Requirement Specification (SRS)
• Analyzed and synthesized results from Joint Application Development (JAD), proposed alternative tasks and transformed those into Business Requirement Document (BRD).
• Acted as liaison between management and development team for requirements.
• Experience with Quality Center (QC)
• Knowledge of Healthcare Products and Guidelines. Worked in compliance with HIPAA guidelines.
• Proficient in conducting Functional and user Acceptance Testing.
• Good Knowledge of Web Service Testing using Soap UI
• Tested different web services using SOAP UI
• Performed Defect reporting using reporting tools.
• Worked on healthcare standards such as HIPAA 5010 and ICD 10
• Participated in walkthroughs and meetings with the development team
• Capturedbusinessrules for routing of workflow items based on keybusinessdata elements.
• Created RACI matrix for common suspension issues and related resolution resources.
• Captured requirements for Management Reporting for workflow and productivity
• Excellent analytical skills coupled with interpersonal, communication, presentation, and self-organizing skills, assertive and a committed as a team player

TECHNICAL SKILLS:

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

Testing tools: ALM (Quality Center), Rally

Databases: MS SQL Server, MS Access

Languages: XML, SQL

Requirement Gathering Tools: IBM Rational Requisite Pro

Other Tools: Microsoft Office Project 2007, MS Excel, MS Power point, MS Outlook, Ms. Visio

PROFESSIONAL EXPERIENCE:

Confidential, Baltimore, MD

Business Analyst

Environment: HIPAA, EDI, HPALM/ QUALITY CENTER, SQL, WINDOWS.

Responsibilities:

• Coordinate with the stakeholders and project key personnel to gather functional and non-functional requirements during JAD sessions.
• Record requirements in the Requirement Traceability Matrix (RTM) defining each technical requirement in detail from areas like: main hardware, application software, networks, servers, internet and desktop configuration.
• Experience with AGILE Tooland Methodology
• Responsible for the full HIPAA compliance lifecycle from gap analysis, mapping, implementation and testing for Medicaid Claims.
• Responsible for gap analysis in changing old Medicaid Management Information Systems (MMIS) and Involved in testing new MMIS.
• Involve in HIPAA EDI transactions such as 270, 271,837 (P, D, I), 276, 277, 834, 820, 278,999/TA1, and 277 CA.
• Define Functional Test Cases, documented, executed test script in Facets system.
• Draft the Physical Data Mapping document for the data flow from Facets to the data warehouse.
• Perform extensive data modelling to differentiate between the OLTP and Data Warehouse data models
• Identify opportunities for the creation of algorithms and data models to detect incorrect or fraudulent Medicaid billings.
• Analyze existing business units, business/Application and their Interfaces with their capability through open-ended discussions, brainstorming sessions, and prototyping, prioritizing them and converting them as business requirements that must be included while developing the software.
• Work on IBM mainframe environment for Medicaid Management Information System impact assessment.
• Perform the EDI transaction-835 claims payments and remittance advice, which deals the payment from payer to provider.
• Work closely with business team, and identified, analyzed the core requirements and key features of the ongoing project. Extracted, discussed, and refined business requirements and developed comprehensive business requirement document (BRD). Developed Software Requirement Specification (SRS) document using Visio and MS Office

Confidential, Hartford, CT

Business Analyst

Environment: MS-Visio, Oracle, SQL, MS Access, Test Manager, Office, MS Project, Requisite Pro, Agile, RUP, UML

Responsibilities:

• Dealt with the 837 and 835 ANSI X12 transaction understanding loops, segments, elements, and structure
• Experienced with EDI files 834,835,270/271, 276/277 file formats
• Conducted daily Control and balancing procedures to balance 834 and 820 transactions for audit purposes and interacted with the internal client on daily basis beyond working hours to resolve issues regarding 834, 837 and 820 transactions and performed End to End Validation process for 834 and 820 transactions
• Get the Facets Claim IDs from X12 in HTM, HP environment and verify them in TIBCO layer and Facets Claim Adjudication system
• Conducted user acceptance testing and validation to see if the system meets ACA provisions as well
• Read and interpreted 997/999 acknowledgments
• Helped QAs to write test cases, test plans, run tests, log defects, track defects, and generate test report
• Performed Requirements Gathering and Analysis and facilitated JAD sessions with Subject Matter Experts (SMEs), and ensured that contributors and all key stakeholders were motivated to complete assigned tasks
• Designed and developed Use Cases, Activity Diagrams, and Sequence Diagrams using UML tools
• Used General Equivalence Mapping, both forward mapping and backward mapping, to convert from ICD 9 to ICD 10.
• Tacked and maintained Stakeholder requested enhancements and changes using Requirement Traceability Matrix (RTM).
• Actively involved in the creation of comprehensive resource center through collection, documentation and extensive editing of relevant medical literature.
• Participated in agile process - planned iterations, created tasks, assigned tasks to quality assurance team based on the priorities and estimated capabilities of quality assurance team for every iterations
• Core member for conception, implementation of Business Intelligence initiatives
• Prepared high-level business use case and developed it into multiple system use cases and Activity diagrams.
• Used UML to perform Use-Case analysis to capture the dynamic aspect of the application.
• Developed UI document with UI designs and mock-ups through wireframes. Utilized Story boards and screen mock-ups to obtain client feedback and approval. Suggested changes when the user interface was confusing or needed rewording

Confidential, San Diego, CA

Business Analyst

Environment: MS-Visio, Oracle, SQL, MS Access, Test Manager, Office, MS ProjectRequisite Pro, Agile, RUP, UML

Responsibilities:

• Analyzed existing reports and defined systems requirements and process workflows
• Analyzed current processes and did Gap Analysis for gathering requirements for new Healthcare reforms and standards
• Conducted JAD sessions with PM, SMEs; facilitated interviews with end users and hospital administrators to collect systems requirements
• Created Project management plans for managing on time delivery using MS Project along with writing test cases, and systems integration test plans in Test Director.
• Developed test scripts and test cases with different scenarios and organized them per the Functional Requirements Specifications.
• Assisted in designing and validating source target mappings and transformation logical data model required to support information requirements.
• Assisted the project manager in preparing the project schedules, milestone tracking, resource allocation using Microsoft project.
• Perform Gap Analysis of the processes to identify and validate requirements.
• Performed GAP analysis to identify AS-IS a process EDI transaction set 834,837 and 835 of 4010A and TO-BE processes of 5010 standards and based on that developed Business Requirement Documents.
• Used the Data Stage Designer to develop processes for extracting, cleansing, transforms, integrating and loading data into data warehouse database.
• Responsible for architecting integrated HIPAA, Medicare solutions, Facets.

Confidential, San Diego, CA

Business Analyst

Environment: HIPAA, EDI, HPALM/ QUALITY CENTER, SQL, WINDOWS, Agile, Oracle.

Responsibilities:

• Acted as a primary contact in all the phases of Software Development Life Cycle (SDLC) including Quality Assurance Testing, Performance & User Acceptance testing.
• Interacted extensively with Subject matter experts (SMEs), Business stakeholders, Users to define accurate requirements and developed the detailed Business Requirement Documents (BRD) for the Application.
• Created and maintained Requirement Traceability Matrix.
• Processed X12 EDI transactions such as 834, 835, and 837.
• Utilized agile methodology in the implementation of the system as well as analyzed and designed business process flow diagrams using Visio.
• User Acceptance Testing (UAT) - Helped conduct UAT testing with stakeholder groups and presented the results to the business members.
• Generated SQL reports and Business Objects reports to maximize system capabilities for tracking and reporting on information.
• Involved in creating database objects like tables, views, procedures, triggers, and functions using T-SQLto provide definition, structure and to maintain data efficiently.
• Extensively used brainstorming sessions to generate ideas.