Summary:

• More than Seven years of professional experience as a Business Analyst/ Quality Analyst in Healthcare Industry
• Adequate knowledge in Health Administration Claims processing auto adjudication , COB, EOB/Drafts, Claims pricing and testing, HIPAA, enrollment, EDI, Medicare, Medicaid, CDHP consumer driven health plans
• Expertise in SQL and PL/SQL programming -Functions, Stored Procedures and Triggers.
• Experience with healthcare system, Medicaid and with prime focus on claims adjudication, provider, eligibility and prior authorization.
• Extensive experience in analyzing and requirements gathering and writing system functional specifications including use cases.
• Extensive hands-on and HealthCare 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.
• Excellent in Developing and evaluating business process Models.
• Proven success as a business analyst through the years, providing a well-balanced understanding of business relationships, business requirements, and technical solutions.
• Strong experience in RUP Business Modeling process.
• Experience in Data Analysis using PL/SQL.
• Expertise in UML class diagrams, object diagrams, GAP Analysis, use case diagrams, state diagrams, sequence diagrams, activity diagrams, and collaboration diagrams as a business analysis methodology for application functionality designs using IBM's Rational Rose.
• Experience in writing SQL queries and optimizing the queries in Sybase, Oracle and SQL Server 2000.
• Strong experience in conducting User Acceptance Testing UAT and documentation of Test Cases. Expertise in designing and developing Test Plans and Test Scripts.
• Excellent in Developing and evaluating business process Models.
• 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
• Familiar with HIPAA EDI transactions such as 835, 837 P, D, I 276, 277, 278 etc
• Proven success as a business analyst through the years, providing a well-balanced understanding of business relationships, business requirements, and technical solutions.
• Professional experience in business analysis, operations management and development, design, documentation and testing.

Software/Hardware:

• OOAD OOA/OOD , RUP, UML, SDLC, Waterfall, QA, WAP, CVS,
• TEAMMATE, MS Access, SQL Server, MySQL, PL/SQL, Oracle DBA, DB2. Windows 98/2000/XP, basic UNIX, HTML, basic DHTML, basic XML, MS Office Suite-Excel Macros, Project, SQL Server, Visio, Adobe Photoshop, Flash, Rational- Rational Rose, Rational XDE, DOORS, Cobol, RequisitePro, CaliberRM, Crystal Reports, various NIKU products, C, C , Sharepoint, Docushare, BASIC, Intermediate level-Visual Basic

Professional Experience:

Confidential

Sr.Business Analyst/ QA

Responsibilities:

• Gathered analyzed, documented business and technical requirements from both formal and informal sessions and validate the needs of the business stakeholders.
• Involved in creating sample mappings for the conversion of EDI X12 transactions code sets version 4010 to 5010 and translation of ICD 9 codes into ICD 10 codes.
• Performed Cost benefit, ROI and ROM.
• Performed testing for Medicare, Medicaid and X-Over claims for Medicaid Management Information System MMIS
• using Rational Rose to understand the requirements.
• Used Critical Chain project management technique for planning, tracking and managing project tasks.
• Consulted with healthcare third-party Administrator Company to develop conversion specifications for member, enrollment, and authorizations.
• Involved in creating sample mappings for the conversion of EDI X12 transactions code sets version 4010 to 5010 and translation of ICD 9 codes into ICD 10 codes.
• Involved in creating business processes and modeling diagrams using Rational Unified Process RUP .
• Created use case scenarios and documented work flow and business process.
• Documented requirements associated change requests with requirements and connected requirements with Use cases.
• Created SQL tables with referential integrity, constraints and developed queries using SQL, SQL PLUS and PL/SQL
• Understood the requirements of the Sales and Marketing team
• Incorporated Rational Unified Process RUP to create Requirement Document Specifications using Visible Analyst.
• Facilitated preliminary sessions with the client SMEs for the upcoming 5010 transaction sets on Claims and Payment. Identified needed modifications for upcoming ICD9/ICD10 directives from the then available documents from World Health Organization, and CMS.
• Responsible for creating test scenarios, scripting test cases using testing tool and defect management for Policy Management Systems, Payables/Receivables and Claims processing.
• Involved with all the phases of Software Development Life Cycle SDLC methodologies throughout the project life cycle.
• Had good understanding of the Teradata Data Model.
• Developed plan for data feeds and data mappings for integration between various systems, including XML, to follow ICD 10 Code set and ANSI X12 5010 formats.
• Preparing Weekly action report QA feed back to QA team Manager.

Environment:

Windows XP Professional, Oracle9i, MS Access 2000, Teradata, MS Excel, RUP, Oracle, UML, Rational Rose, Requisite Pro, Clear Case 2002, Rational Clear Quest 2002, MS Office suite, MS Visio 2003.

Confidential

Business Analyst/Quality Analyst

Responsibilities:

• Worked with the account managers, managements, and report requestors to gather requirements, get report requests.
• Wrote Business Requirements, analyzed them and tested them.
• Used Business Objects free hand SQL to generate Ad-hoc reports and tested in Teradata for QA.
• Analyze requirements utilizing various methods. E.g. sample data from SQL queries, Screen Shots, reports, prototype screens, sourcing information, and other data models.
• Used Rational Rose to model the process using UML to create behavioral and structural diagrams.
• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims. Worked on EDI transactions: 270, 271, 834, 835, and 837 P.I.D to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
• Consulted with healthcare insurance company to develop conversion specifications for other insurance Coordination of Benefits including Medicare .
• Assisted Project Management in developing Scope/ Vision Documentation and Project Plan, tracking project process, and developed Risk Mitigation Plan
• Designed Functional Specification Documents for the reports.
• Analyzed CMS comparison documentation highlighting changes of 4010 format and ICD 10 diagnosis and procedure codes.
• Implemented the logical data Model for the reporting engine OBIEE back end on Teradata driven by 3NF principles and implement the same physically
• Conducted meetings with insurance broker.
• Analyzed the requirements of data marts. Worked with business users to understand their reporting requirements, worked with Reporting team to develop report prototypes, demonstrated report prototypes to the business users, came up with FRDs for the data.
• Knowledge of electronic HIPAA X12 standards-270, 271, 275, 276, 277, 278, 835, 837, and 997 and paper claim forms such as UB04, HCFA-1500, CMS1500, etc
• Analyzed trading partner specifications and created EDI mapping guidelines.
• Extensive use of Excel to create Functional Specification Documents Templates.
• Designed the process flow diagrams for flow of information and report creation process.
• Worked with a cross functional team including Sales and Marketing
• Developed plan for data feeds and data mappings for integration between various systems, including XML, to follow ICD 10 Code set and ANSI X12 5010 formats.
• Conducted RAD sessions for the report users, requestors, and the developers.
• Performed Black Box testing and conducted Functionality and Regression testing on various phases of the Management software
• Created various checkpoints in the script using Win Runner
• Created reports using Mercury Interactive Test Director
• Application and network performance testing analysis

Environment:

SQL Server 2000, Windows, HL7 v2.X,Crystal Reports, Oracle, Mantis Defect Tracking, UML, MS Office, MS Visio

Confidential

Business Analyst/Quality Analyst

Responsibilities:

• Studied the CMS regulation for reporting requirements.
• Attended HIPAA training
• Performed User Acceptance Test UAT for 5010 and ICD 10 codes.
• Work closely with Business Owners and Stakeholders to outline Business Requirements using rational requisite pro.
• Involved in mentoring specific projects in application of the new SDLC based on the Agile Unified Process, especially from the project management, requirements and architecture perspectives.
• Designed Defined profiles, record types, page layouts, role hierarchy and account teams. Data Stage ETL jobs for extracting data from heterogeneous source systems, transform and finally load into the Data Marts.
• Work with System analyst and IS teams to understand the flow of data.
• Reviewed and analyzed data from various sources.
• Assisted JAD sessions to identify the business flows and determine whether any current or proposed systems are impacted by the EDI X12 Transaction, Code set and Identifier aspects of HIPAA.
• Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data within the Oracle database
• Used Business Objects free hand SQL to generate Ad-hoc reports and tested in Teradata for QA.
• Created Mapping Documents, Report Mockups and modified existing report mockups as to CMS requirements and finalized for development
• Worked with system user in understanding billing guidelines with respect to standards of ICD 9 Coding.
• Used MS-Visio for flow-charting, Use- Case process model and architectural design of the application.
• Involved in creating automated Test Scripts representing various Transactions, Documenting the Load Testing Process and Methodology. Created meaningful reports for analysis and integrated the Performance Testing in the SDLC.
• Extensively used Test Director Quality Center to write Test Cases and for reporting. All the Scripts are maintained using Test Director Quality Center.
• Extensively uploaded test cases from MS Excel, MS Word to Test Director Quality Center.

Environment:

Windows XP, Business Objects, MS Excel, Teradata, Word, Visio, power point, SQL, DB2, SAS database

Confidential

Business System Analyst

Responsibilities:

• Gather requirements by conducting meetings and brainstorming sessions with end users and SME and document them using Requisite Pro - the documentation tool offered by Rational.
• Extensively involved in data modeling
• Identified needed modifications for upcoming ICD 10 directives from the then available documents from World Health Organization, and CMS.
• Assisted Project Management in developing Scope/ Vision Documentation and Project Plan, tracking project process, and developed Risk Mitigation Plan
• Gathered requirements and modeled the data warehouse and the underlying transactional database
• Perform Gap Analysis of the processes to identify and validate requirements.
• Developed an implementation guide for Partners for EDI X12 transactions such as 834, 835,837,270 and 271.
• Worked on exporting data using Teradata.
• Identified/documented data sources and transformation rules required populating and maintaining data warehouse content.
• Defining test cases, creating test scripts, analyzing bugs, interacting with QA / dev teams in fixing errors, SIT and UAT .
• Develop Conceptual Data Model Logical Data Model in alignment with MITA Information Architecture.
• Conducted meetings and understood the requirements of the sales and marketing team
• Organize requirements into high level Use Cases and low level Use Case Specifications and modeled them into UC, Activity and Sequence Diagrams using Rational Rose and MS Visio.
• Apply UML notations and methodology in developing models that accurately represent the business process and workflows and clearly communicate them to the stakeholders.
• Worked with various users including insurance brokers
• Analyzed HIPAA 4010 and 5010 standards for 837P EDI X12 transactions, related to providers, payers, subscribers and other related entities.
• Lead Business Intelligence reports development efforts by working closely with Microstrategy, Teradata, and ETL team

Environment:

PL/SQL, SQL Server, XML, Windows 95/98/2000, ODBC, Internet Explorer and Netscape, Web Logic, UNIX, Rational Req. pro, clear case, Rational Rose, Clear Quest, UML, Ms Visio, and Ms Project

Confidential

Business Analyst

Responsibilities:

• Gathered user requirements and directed developers for practical deliverables.
• Worked with the full SDLC, elicit, analyze and define requirements.
• Conducted JAD sessions with the clients to identify the requirements.
• Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data within the Oracle database
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, OOAD using UML and Business Process Modeling.
• Develop and maintain sales reporting using in MS Excel queries, SQL in Teradata, and MS Access.
• Used Rational Unified Process RUP for streamlining the team's development activities.
• Followed the UML based methods using Rational Rose to create: Use Cases, Activity Diagrams/State Chart Diagrams, Sequence Diagrams, and Collaboration Diagrams.
• Worked extensively with insurance brokers.
• Develop MITA Maturity Model MMM Business Capability Matrix BCM to identify the maturity level of SD Medicaid Enterprise.
• Provide ad-hoc reporting and analysis from data sources including PeopleSoft SET and Teradata
• Tracked UAT issues/bugs and prepared reports.
• Performed job of contact point for all stakeholders business, legal, compliance, development .
• Documented monthly status reports for enhancement and modification requests for the development team to assist them in efficient tracking and monitoring of open issues of the project

Environment:

UNIX, MS Power Point, MS Excel, Rational Rose, System Analysis, Load Runner, Crystal reports, SQL.