OBJECTIVE:

PROFILE SUMMARY:

• Business System Analyst professional with 7+ years of experience providing a strong knowledge of all the phases of Software Development Life Cycle (SDLC) and methodologies such as Agile - Scrum, Waterfall, Waterfall-Scrum Hybrid and Rational Unified Process (RUP).
• Expertise in Business Requirement gathering, Business Process Modeling and Business Analysis and understanding Business Process Flow.
• Proficient in conducting the GAP analysis of AS-IS and TO-BE systems, SWOT, Impact analysis, Feasibility analysis, Cost-benefit analysis as well as Cause & Effect analysis.
• Adept in creating various project artifacts like Business Requirements Document, Functional/Non- Functional Specifications Document and Use Case Document.
• Experience in facilitating Joint Application Development(JAD) sessions, interviews, survey/questionnaires, brainstorming, document analysis as a part of requirement elicitation
• Extensive expertise in Agile software development methodology working as a SCRUM Master and facilitated ceremonies like Sprint Planning, Stand Up, Retrospective, Demo and Backlog Grooming.
• Experienced working with the Centers for Medicare and Medicaid services (CMS), the Healthcare Common Procedure Coding System(HCPCS),Electronic Data Interchange (EDI), Medicare Part D Services, and State Pharmaceutical Assistance Program (SPAP) services.
• Solid experience of creating PL/SQLpackages, Procedures, Functions, Triggers and Views to retrieve, manipulate and migrate complex data sets in Oracle Databases.
• In depth knowledge of health care including Medicare/Medicaid, HIPAA 4010-5010, ICD9 and ICD10, and EDI Transactions.
• Excellent work experience in creating Project Plans, BRDs,FRDs,Use Cases, Activity Diagram, Sequence Diagram, Requirement Traceability Matrix and Test Plans.
• Experience in HIPAA 4010 and 5010 EDI healthcare transactions like 837, 835, 834, 820, 270, 271, 276, 277, and 278.
• Extensive knowledge on the various types of health insurance programs such as Medicaid, Medicare (Part A, B, C and D), PPO, HMO, Dental claim and POS, Health Insurance Portability & Accountability Act (HIPAA) standards, Electronic Data Interchange (EDI), HL7.
• Experienced in project management tools such as Microsoft Project, HP ALM, JIRA, Rally and Version One.
• Knowledge and experience with widely successful Agile techniques and KPI’s: User Stories, Velocity, Product/Sprint Backlog, Burn down/Burn up Charts, Test Driven Development. nowledge and Application in Windows Communication Foundation (WCF) andSOAArchitecture
• Proficient in writing business rules for Client-Side Validation and Server-Side Validation.
• Profound expertise in tracing the requirements through the development process in adherence to RequirementsTraceability Matrix (RTM).

EXPERTISE AREA:

• Statistical Analysis
• Process Improvement
• Conflict resolution
• Change Management

• Business Systems Analysis
• Project life cycle
• Software development life cycle
• Project Management

TECHNICAL SUMMARY:

Operating System: Windows XP/7/8/2000, Mac O.S., UnixSDLC Methodologies Waterfall, Agile-Scrum, Waterfall-Scrum Hybrid, Rational Unified Process (RUP)

Modeling Techniques: Rational Rose, MS Visio,Mock-Up Screens, Draw.io

Business Skills: JAD Sessions, SWOT, Impact Analysis, Conflict Resolution, Project Budgeting, GAP analysis, Change Management, Project planning.

Requirement Management Tools: MS Office, JIRA, HP ALM v11.5, IBM Rational Rose, Team Foundation Server (TFS)

Project Management: MS Project, MS SharePoint 07/10/13, JIRA, Rally

Testing Tools: HP QC v11.0, HP ALM v11.5, Load Runner, Bugzilla, Gherkin

Database: Oracle 9i/10g, My SQL, MS Access, SQL Server 2005/2008/2012

ORGANISATIONAL EXPERIENCE:

Confidential, Tampa, FL

Sr. Business Systems Analyst

Responsibilities:

• As a Business Analyst, I was responsible for defining Report Requirements, Design, Develop, Test and validate the new report requests from users.
• Developed reports using SSRS and crystal reports and used table control, matrix control for cross tab reports.
• Worked closely on 834 transaction code for Benefit Enrollment and was involved in validation of HIPAA for 837, 270/271, 276/277,835, 834 EDI transactions.
• Took action in the process flow to prevent rejected claims from falling out. Mitigated claim denial increases through a complete analysis to ensure 277CA acceptedclaims would not result in an increase in Denials at the payer adjudication level.
• User Interface development andCMSdevelopment
• Strong SQL skills in creating stored procedures, views, functions and developing complex SQL commands to use in crystal reports.
• Creating Unit test cases for testing and working on Claim Processing modules inFacetsto test the configurations infacetsapplication.
• Created data flow diagrams, data mappings from source stage and stage to target indicating all source tables, transformations and business rules to be applied.
• Assisted in development and maintenance of new APIs for integration.
• Utilized agile software development methodology to manage and control software and product development.
• Collaborate with the Product Owner on project/roadmap planning, facilitated daily stand-up meetings, reviews, retrospectives, sprint and release planning, demos and other Scrum-related meetings.
• Participated in various agile meeting such as Product backlog meeting, Sprint Planning, Daily stand-up, Sprint retrospective meeting, etc.
• Experienced writing manual test cases and write them in Gherkin language using TFS.

Environment: Agile, MS-Office, MS Project, Rally, MS SharePoint, Rally, TFS, MS Word, MS Excel, PowerPoint, SharePoint

Confidential

Sr. Business Analyst

Responsibilities:

• Gathered Requirements via formal meetings, brainstorming, interviewing and conducting JAD sessions with business users and subject matter experts (SME’s) in focus groups.
• Provided pharmacies with processing information and assisted providers and members with Prior Authorizations and appeals. Trained in AS400 and utilization management.
• Designed and developed Business Rules Document about the Claim Component and HIPPA.
• Validated that the system claim scrubber included editing based on the CEM published
• Worked closely on 834 transaction code for Benefit Enrollment and was involved in Validation of HIPAA for 837, 270/271, 276/277,835, 834 EDI transactions.
• Documented workflows and executed comprehensive testing and training plans to ensure that the new acknowledgement results demonstrated in the 999 and 277CA were properly interpreted and managed to ensure Payer acceptance of the 837 files.
• Performed data analysis using SQL queries and used MS excel to understand current data metrics and provided information to business users during JAD sessions as inputs.
• Worked with the QA team in designing Test plan and Requirements Traceability Matrix (RTM).
• Created UML diagrams like Use case diagrams, Activity diagrams to depict the data flow and the process flow of the system.
• Work onFACETSBenefits, Claim Processing, Providers Configuration to simplified benefit plan maintenance, renewal processes and open enrollment
• Created data flow diagrams, data mappings from source stage and stage to target indicating all source tables, transformations and business rules to be applied.
• Created and managed Change Control Requests (CCR’s) and documented them efficiently.
• Extensively involved in Black Box, Systems, Integration (SIT) and User Acceptance Testing (UAT).

Environment: Agile, MS-Office, MS Project, Rally, MS SharePoint, Rally, TFS, MS Word, MS Excel, PowerPoint, SharePoint

Confidential, Hartford, CT

Sr. Business Analyst

Responsibilities:

• Compiled the Vision Document and composed detailed Business Requirements Document (BRD), Use Case Specification Documents.
• Worked closely with the PMO (Project Management Office) group in defining timelines & schedules for the project.
• Helped developers with the following list of HIPAA-EDI Transaction Code sets: 837.
• Thorough knowledge about HIPAA ANSI X12 transaction code sets.
• Working knowledge of HTML/CSS, User Interface development tools andCMSdevelopment
• Involved working with the following list of HIPPA-EDI 837 ANSI X12 Transaction Code sets.
• Managed and developed EDI specification, gap analysis and applications structures for data feeds and mappings for integration between various systems to follow ANSI X12 4010 formats.
• Used UML to perform Use-Case analysis to capture the dynamic aspect of the application.
• Extensive knowledge in ANSI X12 EDI 834 file format and in Medicare & Medicaid eligibility requirements.
• Worked extensively in Medicaid eligibility and Medicaid Management Information Systems.

Environment: Waterfall, SharePoint (2007), MS Visio, MS Office, MS Project, SOA, MS Access, Oracle, HP QC, JIRA, Clarity

Confidential, IL

Business Analyst

Responsibilities:

• Involved throughout theSystem Development Life Cycle (SDLC) - SCRUM including sprint planning meetings, review meetings and backlog refinement meetings.
• Managed roles offshore and served as a liaison between development team and business team.
• Identified specifications for billing and accounts receivable requirements, performed gap analysis and presented information to technical team to identify system requirements.
• Facilitated strategic meetings between Perot technical team and hospital administrators resulting in identifying key differences in clinical systems.
• Created and designed SharePoint website to be used as project data repository for the project.
• Created new processes/procedures/guidelines to leverage data.
• Trained all new associates which were on-boarding on how to use SharePoint website.
• Prepared use case diagrams and description documentation based on the analysis, and obtained approvals from the clients
• Prepared activity diagrams on MS Visio to better understand the flow of activities along with the timelines of each actor
• Prepared change request form to provide details of the changes requests, and obtained approvals from the appropriate stakeholders
• Worked on issue tracking and project planning withJIRA.

Environment: Agile, Tableau, Microsoft Office, Oracle, JIRA, HPQC, SQL Server, MS-Visio, UML, UAT Testing, Giffy, Sharepoint

Confidential, MI

Business Analyst

Responsibilities:

• Identified and analyzed business needs using techniques such as JAD Sessions, Document Analysis, Interface Analysis, Requirements Workshops and Interviews with SMEs and stakeholders.
• Prioritized the development of missing tools and content in the existing framework by performing the GAP Analysis for documenting the gap between the existing system and the desired system.
• Developed a high-level Business Requirements Document (BRD) and had them base-lined from the business owner and stakeholders.
• Develop process flow diagrams in accordance with Medicare rules and regulations pertaining to the Facetsconfiguration and evaluated the impact of proposed changes
• Assisting client implementing the MSP (Managed Service Provider) instance for Service-Now and Domain separation for Service-Now Instances.
• Worked with GUI development team to assist them in creating the initial UI wireframes and mockups. Developed Mockup screens and prototypes for the home page requirements document.
• Extensively used MS SharePoint for team collaboration and version control.
• Created activity diagrams to represent the current business process, context flow diagrams to identify the interfaces and data flow of the system and sequence diagrams to specify the order of interactions.
• Created project plans, Work Breakdown Structures (WBS) and identified & managed risks using MS Project.

Environment: Waterfall, MS Visio, MS Office, MS Project, SOA, MS Access, Oracle, HP QC.