SUMMARY

• 10+ years of industry experience as a Business system Analyst with solid understanding of Business Requirements Gathering, Business Process Flow, Business Process Modeling and Business Analysis.
• Advanced level knowledge in software development life cycles followed in CMMI Level 5 Company. Performed Requirement Gathering/Analysis, System analysis, Development, Testing, and Functional Consulting.
• Excellent Business writing skills in developing Business Requirements Document (BRD), Use Case Specifications, Functional Specifications Document (FSD), Systems Design Specification (SDS), Systems Requirements Specification (SRS), Workflows and Project Plan.
• Facilitated User Acceptance Testing (UAT) with QA team, stakeholders and business users. Errors discovered during testing were fixed and then verified via regression testing. Engaged with several units from project manager and technical teams to business end users with extensive coordination and communication throughout testing, participated in daily meetings to follow up on error logs, ensured fixes were in line with requirements and per deliverable time lines.
• Proficient in conducting JAD sessions with management, SME’s, vendors, users and other stakeholders.
• Good knowledge of the claims process and how that process is related to the FACETS system.
• Hands on experience working with highly matrix, cross - functional and onsite/off-shore teams.
• Experience in HIPAA EDI transactions 837 (Institutional/Professional), 835(Payment Remittance Advice), 270 (Eligibility Request) / 271 (Eligibility Response), 276 (Claims Status Inquiry Request) / 277 (Claims Status Inquiry Response), 834(Benefit Enrollment and Maintenance Transaction), 278 (Prior Authorization), 997/999 (Transaction Acknowledgement) and 824, 277CA reports.
• Knowledge of ICD-9 and ICD-10 systems implementations and upgrades.
• Good experience in performing GAP analysis.
• Proven ability to manage multiple complex projects with minimal oversight and deliver them with high acceptance rate.
• Good knowledge of Business Process Monitor and Map Editor to work with X12 files.
• Strong expertise in using EDI Tools like Edifices (Ramp Management).
• Developed, maintained test plans andexecuted test Script from Quality Center.
• Participate and contribute to lessons learned sessions and prepare the documents Logged and reviewed Defects, documented the whole Bug life cycle using Quality Centre. SystematizedClaims ProcessingandClaims ScrubbinginHMO, PPO, Medicaid and Medicare
• Strong communicator and creative problem-solver skilled at analyzing business needs and transforming them into technical designs, applying technical skills and business knowledge to achieve sound results.
• Developed, maintained test plans andexecuted test Script from Quality Center.
• Participate and contribute to lessons learned sessions and prepare the documents Logged and reviewed Defects, documented the whole Bug life cycle using Quality Centre.

TECHNICAL SKILLS

Methodologies: Agile, Waterfall, RUP, UML, SDLC, Scrum, Reverse Engineering.

Change Management Tools: Rational Clear Quest, Rational Clear Case.

Business Modeling Tools: Microsoft VISIO, Visual Paradigm.

MS Office: MS Project, Microsoft Word, Microsoft Excel, Microsoft PowerPoint.

Programming Languages: Structured Query Language (SQL).

Operating System: Windows NT/98/2000/XP.

Databases: Access, Oracle 8i/9i/10g, Teradata V2R5.1, DB2, MS SQL Server 7.0/2000

Other known tools: Informatica, Crystal Ball, Expert Choice, Core, Caliber, Rational Rose; Rational Requisite Pro.

OLAP Tools: Business Objects XI, Cognos .

Testing tools: Rational Robot, Test Manager, HP Quality Center, Quick Test Test Professional, LoadRunner, WinRunner.

PROFESSIONAL EXPERIENCE

Confidential

Senior Business Process/System Analyst

Responsibilities:

• Interacted with end users and multiple groups (business and technical), elicited requirements using several techniques such as interviews, brainstorming sessions and observing end user processing; assigned priorities to each requirement and conducted walkthrough with technical team.
• Actively involved from initiation to final phase of SDLC for both iterations utilizing agile methodology.
• Provided consultation and prepare Screen Mockups and Demo presentations for across the team.
• Identify the data source (BOR/ Facets), gather requirements and analyzes data relevant to processes identified for process improvement initiatives.
• Work with business creating the reports structure for external vendor for audit purpose based upon the requirement.
• Communicating frequently with all team members and stakeholders and following up when required to ensure project timelines are met and to ensure project success.
• Created System used case documentation for implementation for projects.
• Work on project management process with team to enhance and uplift the documentation creating user story in JIRA.
• Facilitate and engage in the requirements sessions and development of System Use Case and Boundary Specification documents in support of Shield Advance Core Facets solutions.
• Provide business domain technical expertise consulting services to business and IT operates teams.
• Work with external trading partners to define requirements.
• Work with Business and QA to make sure the system requirements intended are being tested.
• Execute the System Use Case and Boundary Specification processes and signoffs to ensure this key functionality meets the business needs.
• Interacted with team for the improvement by participating in the development, implementation, and maintenance of standardized tools, templates, and processes across multiple businesses.
• Facilitate cross team functional requirement sessions to ensure requirements are captured and transformed into end to end technical design solutions.
• Worked as SME with business analyst to articulate the requirement.
• Maintain the System Use Case and Boundary Specification artifacts.
• Perform Data analysis using Oracle SQL developer.
• Responsible for creating requirement deliverables High Level and Detailed Level Functional Requirements.
• Conducted requirement sessions and design reviews with the onsite technical team.
• Reviewed test cases and co-ordinate the defect triage sessions with development and QA team.
• Handled the requirement churn for different projects through a formal Change Request process.
• Developed a very effective tracking system using Requirement Traceability Matrix (RTM) to track and maintain stakeholder requests for enhancements and changes during the project life cycle.

Environment: Factes5.1, MS Visio, MS-SharePoint, MS Visio, MS Office, Oracle SQL Developer 4.1.3, ALM,JIRA.

Confidential, Denver, CO

Business /System Analysis

Responsibilities:

• Analyzed and studied the different Business Processes across various Business Units.
• Develop and prepare business analyses and plans.
• Coordinated process of validating technical architecture and specifications based on input from client and team.
• Created highly persuasive presentations and presented them to stakeholders and steering committee, and gained approvals in a timely manner.
• Analyzed impacts and recommendations to current business processes for Topaz.
• Evaluated solution alternatives and developed HLDs (High Level Documentation).
• Delivered multiple presentations on MS PowerPoint to gain consensus from stakeholders and train end Users.
• Facilitated business users and technical resources in business, requirement gathering, documenting requirements and obtaining sign off on the business requirements.
• Conducting JAD sessions with the client BCBSKC and BCBSNC for gathering requirement for Topaz.
• Gathered detailed Technical requirements and participated in the defining of business rules and data standards.
• Worked on scope of the project by creating scope item inventory.
• Created the Technical Specifications for the Extensions, Extracts, Interfaces, Boundary applications.
• Created the Process flow diagrams for the extracts that will be made from the FACETS 5.0 databases by the vendors who will require information for their roles as a third party.
• Created Technical specification documentation for interfaces, Extensions, Extracts, GAP HLDs and boundaries.
• Created Custom Development Functional Specification documentation (FSD) & obtained approvals.
• Created process flow diagrams/activity diagrams/use cases using MS-Visio.
• Analyzed and converted the stored Procedures into the Pseudo codes for the extensions provided by the client for better understanding of business logics behind the extensions.
• Completed the HIPAA/HITECH compliance training for the Project.
• Analyzed and assessed the SOW 1(align and confirm phase) for the Project.
• Reviewed, analyzed & participated in the meetings for the System Architecture Development work for the project.
• Conducted brainstorming sessions with the onsite team and remote resources via teleconferences.
• Documented the Confidential assumed inventories and compared with clients MKS repository of assumed inventories by creating a traceability matrix.
• Conducted GAP analysis that is realized from the inventory of the client in the form of Spreadsheet.
• Updated the inventory list, SOW as per the updates from the clients and the Project Manager.
• Extracted the information from the company’s earlier documents that involved the relevant work for different clients using the customer exchange.
• Extracted the information required from the FACETS DATA Model (5.0), Data dictionary for the documentation involving the data and documented it.

Environment: Factes5.0, Oracle, MS Office, MS-Visio, TIBCO, Rapid SQL 7.6.4, Outlook, MS Project 2010 (Work Engine), Agile (Scrum), MS Outlook, Office Communicator, MS Excel 2010, MS Visio 2010, SQL Server 2008, Facets Extensibility Guide, Customer Exchange, MKS Repository, PVCS.

Confidential

Lead Business Analyst

Responsibilities:

• Participated in CO-MMIS (Colorado - Medicaid Management Information System) knowledge transfer in preparation for Implementation and Operation of the 5010 standards.
• Coordinated with Project Managers to resolve risk issues and ensure compliance of Security System related to the HIPAA.
• Performed System testing, Regression testing and UAT for several claim types and test scenarios.
• Compared and validated 5010 system test results with 4010 results for the same test scenarios.
• Performed system testing and validation on ACS third party web-based solution, EDIFECS, through step down process to validate conversion process by confirming Medicaid claim was process correctly from 5010 to 4010 standards.
• Created X12’s for 4010 and 5010 standards to meet test scenarios.
• Worked with developers to generate builds, merge code, and resolve merge conflicts.
• Frequently resolved the issues with EDIFECS and ACTTNow, primarily the generation of 997, 999, 824, 277CA reports.
• Good knowledge Business Process Monitor and Map Editor to work with X12 files.
• Hands-on experience in the design, development, implementation, and production activities associated with X12 transaction sets (278,270 / 271, 276 / 277, 834, 837, and 835), and other proprietary data standards.
• Provided support for the critical EDI Gateway translation software environment.
• Converted Business specifications into Functional Specifications.
• Lead the impact analysis, scope lockdown, and requirements gathering phases of the company's transition fromICD-9 to ICD-10. Also monitored revenue cycle process and implementedICD 9 & ICD-10 mapping and crosswalk analysis.
• Provided business analysis, testing, and system documentation for the 5010 updates for 837I transaction sets for Institutional claims for Adjudication in ACS’s Medicaid Management Information System (MMIS).
• Performed Web Portal testing and Web Portal Post Implementation testing for 837PID.
• Created SUC for 278, 270/271,276/277,837I. Review and updated the System documentation based on team.
• Gathered and documented Denver State clientbusinessrequirements and developed, entered and verified test cases forANSI 5010 / ICD 10 implementation.
• Created 837I paper claim in the MMIS system.
• Performed system and regression testing for 5010 278, 270/271,276/277,837I transaction.
• Verified and documented HIPAA regulator changes found when moving from 4010 to 5010.
• Analyzed results and EDI ANSI X12 file mapping and reported on standard analysis spreadsheet.
• Involved inBusiness SystemAnalysis forInboundandOutboundTransactions.
• Provided day-to-dayEDItranslator support.

Environment: MMIS portal, EDIFECS(Ramp-management), FileZilla Grabit, HIPAA, MS Office, MS-Visio, Outlook.