PROFESSIONAL SUMMARY:

• Over 7 years of IT experience as a Business Analyst/System Analyst in Health care,
• Experienced in system life cycle SLC development, involved in all phases of development from requirements gathering, business case development and maintenance, defining strategic solutions in business needs.
• Extensive experience with documenting business requirements document BRD , Use Case Specifications and Functional Specifications, Systems Design Specification SDS , Systems Requirements Specification SRS , Workflows and Unified Modeling Language UML diagrams use case, activity, sequence, collaboration
• Proficient in Creating Risk Analysis documents, Risk Management Plan, User Requirement Specification, Functional Requirement Specification and Business Process Flows by using Enterprise Architect MS Visio.
• Excellent in performing Gap Analysis to check the compatibility of the existing system infrastructure with the new business requirements prepared using rational unified process RUP
• Extensive experience in business process improvement, re-engineering, change control development process, quality assurance principles and concepts relative to standards and procedures, review process, reporting escalation and continuous improvement from agile method and sprint cycles in scrum.
• Extensive experience in transforming business requirements into functional specifications focused on workflow analysis and design, business process reengineering, user interface design and process flow modeling.
• Extensive experience in conducting Joint Requirement Planning JRP sessions, Joint Application Development JAD sessions with committee of SME's, business groups, senior management and IT groups to converge early towards a goal acceptable to customer and feasible to designer to complete.
• Experienced in System testing, Performance testing, Integration testing to ensure the software meets the system requirement and specifications.
• Dexterous in developing and writing Test Plans, Test Cases and Test Scripts using manual and automated testing tools from Rational Suite and Mercury Interactive to perform User Acceptance Testing UAT and Alpha testing.
• Strong Analytical, methodical and resourceful approach to problem solving, identifying root causes, taking corrective actions to meet short and long-term business, financial and system requirements.
• Expertise in Design and Development of Graphical User Interfaces using C Win Forms and ASP.NET Web Forms, Extensive working knowledge of service oriented architecture utilizing web services on Microsoft platform. Experience in working with XML, HTML end client technologies JavaScript. Experience in the designing of SQL Server, Data Warehousing OLTP and OLAP and Oracle databases.
• Extensive experience in creating Test Approach documents, test plans, test scenarios, test procedures, test cases, test data. Successfully fixed errors and performed User Acceptance Testing UAT working with team members.
• Performed Functionality Testing, Regression Testing, System Testing, Integration Testing, and Performance Testing to ensure that the software meets the exact system requirements and specifications.
• Excellent Documentation and Oral Communication skills. Solid business and presentation skills and can perform well both in independent and team player.

TECHNICAL EXPERTISE:

• Operating System : Windows, UNIX, LINUX, SOLARIS
• Business Analysis : Rational Suite Rose, Requisite Pro, Clear Case, Clear Quest, MS Visio,
• Business Object Crystal Reports , MS Project
• Methodologies : UML, Rational Unified Process RUP , Spiral model, Scrum
• Rapid Application Development RAD , waterfall model, Agile methodology
• Front-End Tools : MS Office Suite Word, Excel, Access, PowerPoint , MS Query,
• Data Bases : Microsoft Access, MS-SQL Server, Oracle 8i/9i, MYSQL, DB2
• Testing Tools : Win Runner, Load Runner, Test Director

PROFESSIONAL EXPERIENCE:

Confidential

Role: Sr. Business Analyst

Responsibilities:

• Analyzed user requirement and impact on exiting system caused by proposed changes, worked with Business Analysts to define business needs, delivered the comprehensive Functional Specifications and System Design Specifications.
• Corrected aspects of child support enforcement program operations which were inconsistent with policy guidelines.
• Planned system tests, analyzed design interpretation, acceptance tested and maintained quality assurance related to the development, change, or enhancement of the Child Support Enforcement system.
• Working in various functions of the Child Support Enforcement System to assure continued compliance with Federal and District Regulations as well as continually meeting the user's needs.
• Managed State Child Support Enforcement Systems strategic planning, innovative performance improvement, system development
• Gathered and documented the Impact Assessment on the project, due to change request, from the work stream owners and the project management team, in terms of man days and project duration.
• Worked with the SME's from different business areas like risk management, decision management agents, technical agents, project manager etc. and 3rd party vendors, to gather User and business requirements, translated them into functional and technical requirements.
• Created Use Cases and used MS Visio to model Use Case Diagrams, Activity Diagrams, business processes, business flow diagrams, work flow diagrams, Class diagrams and Sequence diagrams for the applications design.
• Conducted extensive study on margin, managed lending to understand the requirement of Risk Management Agent and acted as Use case analyst team lead responsible for reviewing and editing proposed guideline for OOAD using the UML methodology.
• Organized program leadership meetings for the top management to discuss issues, risks and assign actions to specific work stream owners.
• Conducted User Acceptance Testing UAT and collaborated with the QA team to develop the test plans, test scenarios, test cases, test data to be used in testing based on business requirements, technical specifications and/or product knowledge.
• Developed user manuals, presentations and training manuals as per project specifications and timelines.

Environment: Rational Tools Suite Rose Requisite Pro, Clear Quest, Clear Case , Windows, XML, HTTP, Business Objects, MS Project, MSOffice.

Confidential

Role: Business Analyst

Responsibilities:

• Conducted user interviews, gathered requirements, analyzed the requirements using RUP methodology involving Rational Suite Rational Rose, Requisite Pro and performed the iterative process to develop Use Cases.
• Direct and manage team specializing in identifying fraud and abuse within the CA Medicaid program
• Assumed responsibility for all operational aspects of Medicare recovery audits being conducted under the Medicare Recovery Audit Contractor RAC demonstration project.
• Base responsibilities included Claims, Provider Enrollment, Customer Service, QA, Adjustments, Appeals, all Mailroom and Data Entry functions.
• Created and facilitated the implementation of an Intranet worksite that captured the plan and policy documents and all updates on a daily basis, ensuring that all claims were processed utilizing the most current guidelines.
• Responsible for building, maintaining, and troubleshooting the data warehouse with Medicare MMR and Medicaid MMIS revenue, enrollment files, monthly claims data, and other medical expenses
• Executed analyses on claims vs. in-house systems to isolate and correct discrepancies. Improved process to automate solutions.
• Used HIPAA 4010 transactions to support the analysis of current business processes and work with management to improve and implement enterprise solutions to ensure compliance and got involved in designing future state processes for HIPAA 5010 transaction processing EDI's 837,835, 270, and 271.
• Analyzed HIPAA 5010 related to 837,835, 270, and 271. Transactions and performed gap analysis between the 4010 and 5010.
• Responsible for GAP analysis of ICD9-ICD10. Involved with ICD10 implementation testing.
• Performed analysis on medical/pharmacy claims in order to determine key trends such as increases in preventable diseases
• Developed SQL reports to meet client requirements and CMS regulations. Built workflows, trended, researched and analyzed claims at client and payer level using various research methodologies such as creating and analyzing queries using SQL
• Worked with the SME's Financial Analysts, Risk Managers, Project Managers to define business requirements and analyze the possible technical solutions.
• Created Business Requirement Document BRD , Functional Requirement Specification, and User Requirement Specification URS for application development.
• Conducted joint requirements planning JRP sessions as a facilitator to gather requirements from the business area and conducted JAD sessions with IT group.
• Used Rational Suite to analyze business requirements and segregated them into Use Cases and activity diagrams using Rational Rose according to UML methodology thus defining the Data Process Models.
• Performed Gap analysis for the modules in production, conducted feasibility study and performed impact analysis for proposed enhancements.
• Performed all kinds of testing including regression, system, integration testing and functional testing, backend, front end testing and unit testing.
• Involved in the creating the User Interface specification document with specification team.
• Participated in Bug-Review meetings with software developers, QA engineers, managers, suggested enhancements to the existed application from business perspectives, provided solutions to existing bugs

Environment: Rational Tools Suite Rose Requisite Pro, Clear Quest, Clear Case , Windows, XML, HTTP, Business Objects, MS Project, MSOffice, Win Runner, Load Runner, Test Director, Java, Oracle

Confidential

Role: Business Analyst

Role Responsibilities:

• Defined and developed business functional requirements and participate in technical walk-through meetings to develop the functional design for the implementation.
• Proposed strategies to implement HIPAA 4010 in the new MMIS system
• Assisted in gap analysis in changing old MMIS and tested the new MMIS.
• Assisted the project manager in creating the business case and project plan.
• Facilitated and walked through requirement gathering sessions with the business team to collect the business reporting, reporting standards, security and service level requirements and documented them using Requisite Pro. Functioned as a liaison to the business, ensuring that issues important to customers are identified and addressed by the team.
• Conducted JRP sessions with clients and technical units and JAD sessions with IT Group.
• Worked closely with project management to keep track of the status of project and draft strategies for the near future.
• Created Use Case specifications, business flow diagrams, Activity/State diagram and Sequence diagram using Rational Rose, so the developers and other stake holders can understand the business process according to their perspective with possible alternate scenarios.
• Performed Gap analysis for the modules in production and also conducted feasibility study for the performance impact analysis.
• Collected test metrics weekly from the TestDirector database that reflected the current status of the test execution and the state of the defects.
• Coordinated activities between business unit and technical staff, developing new methods, policies and procedures to meet the business needs and business requirements.
• Provided extensive staff development training on products, applications, tools utilized by the department to support clients.
• Conducted User Acceptance Testing UAT and collaborated with the QA team to develop the test plans, test scenarios, test cases, test data to be used in testing based on business requirements, technical specifications and/or product knowledge.

Environment: MS Office Suite, MS Visio, Oracle, Test Director, XML.

Confidential

Role: Business Analyst

Role Responsibilities:

• Served as a liaison between business team and the project team by assisting the business in identifying, understanding and documenting their business needs.
• Experience in an outsourced healthcare insurance operations environment and understanding of MECT and MITA.
• Responsible for processing Medicare claims and COB claims.Responsible for checking Medicare eligibility and verifying claim payment
• Managed the privacy and security environments of healthcare data that was governed by HIPAA and other government mandates.
• Collected and documented business processes as well as business rules. Participated in the identification, understanding and documentation of business requirements including the applications capable of supporting those requirements.
• Designed and developed Use Cases, and using UML modeling techniques such as Use Case Diagrams, Activity Diagrams and Sequence Diagrams
• Involved in testing on all stages of System Life Cycle SLC . Performed Integration testing, Build Verification testing, System testing manually.
• Translated the business needs into system requirements, communicating with the business on a non-technical level and with the System Analyst on a more technical level.
• Collaborated with development architect and the business to develop both high-level and detailed application architecture to meet the business needs.
• Assisted the PM in setting realistic project expectations and in evaluating the impact of changes on the organization and plans accordingly.
• Provided technical assistance in identifying, evaluating and developing systems and procedures that are cost effective and meet business requirements. Defined Validations to be built into applications per the functional requirements.
• Developed test scenarios and implemented test plan. Providing key input in working with users in defining project and system requirements.
• Managed and maintained database, updated site content and maintained overall visual and functional balance.

Environment: RUP, Rational Requisite Pro, Rational Clear Quest, MS office, Visio, Project, Clear Quest, Clear Case, Windows XP, HP Quality Center, Test Manager.