SUMMARY

• 6 years of experience in the Healthcare, Manufacturing and Operations; Business consulting experience in all the stages of SDLC including Requirements Gathering, Analysis, Design, Architecture, Development, Integration, Implementation, Administration, Enhancement, Testing, Production Support and Customer Liaison and Training
• Excellent knowledge of Agile, Waterfall, SDLC methodologies
• Supported Scrum Master in prioritizing requirements for each scheduled sprint
• Solid expertise to analyze and synthesize results from Joint Application Development (JAD) and in Rapid Application Development (RAD), design solutions that are acceptable to the customer and feasible for the developers
• Experience in using methodologies such as UML (Unified Modelling Language), OOAD (Object Oriented Analysis and Design) and APM (Agile Project Management)
• Expertise in Rational Unified Process (RUP), Rational Requisite Pro, Rational Clear Quest, Microsoft Project, Rational Rose and MS Visio for business process modelling and designing data flow diagrams (DFD)
• Proven skills in conducting GAP analysis, User Acceptance Testing (UAT), SWOT analysis, Cost Benefit analysis, ROI Analysis, Requirement Traceability Matrix (RTM), Rational Unified Process (RUP) and SCRUM methodology
• Excellent knowledge with preparing graphical depictions of use cases including State Diagrams, Activity Diagrams, Sequence Diagrams, Use Case Diagrams, and Component - Based Diagrams, Collateral Diagrams, including the Business Workflow Chart
• Very good understanding of Relational Database, Object Oriented Programming, Data Modelling, ETL, Data Mapping and Data-warehousing; Excellent skills in data analysis, impact analysis, risks analysis
• Created action filters, parameters and calculated sets for preparing dashboards and worksheets in Tableau
• Provided 24/7-production support for Tableau users
• Excellent knowledge of Tableau to create Dashboard Reports, data discovery, Visualization, Self Service BI and reports to show statistical trends for forecasting
• Experience using SSRS (SQL Server Reporting Services), SSIS (SQL Server Integration Services), SSAS (SQL Server Analysis Services) and MSQL tools for various reporting functions
• Advanced knowledge of creating Functional specification Documents (FSD), AS-IS and TO-BE workflows, Test Plans and Test Cases
• Experience in transformation of HIPAA 4010 to HIPAA 5010 in the existing claims processing integrated system; Medicare and Medicaid projects; Changing to and testing of new MMIS;
• Excellent knowledge of Patient Protection and Affordability Care Act (PPACA), HL7, Health Insurance Exchange (HIX), EMR/EHR
• Excellent knowledge of HIPAA X12 EDI transaction codes such as 270/271 (Inquiry/Response Healthcare Benefits), 276/277 (Claim status), 834 (Benefit enrollment), 835 (Payment/remittance advice/ Explanation of benefits), 837 (Health care claim)
• Knowledge of ICD-9-CM and ICD -10-CM coding and claims processing; Managing Test Director for the test team, SQL, Oracle EBS R12, Supply chain analysis
• Worked extensively on B2B applications and B2C applications in transaction processing and E-commerce applications
• Experience in handling Change Management and Release Management.
• Extensive Experience in UML and Process modeling using Use Case Diagrams, Activity Diagrams and Sequence Diagrams.
• Knowledge of all modules and functional areas of Facets.
• Excellent Analytical, Interpersonal, Communication and Presentation skills

PROFESSIONAL EXPERIENCE

Confidential

Senior IT Business Analyst

Responsibilities:

• Created Business Requirement Document (BRD) by aiding in the collection of the User Requirements and Business Requirements; Provided appropriate scope of work for the technical team to develop the prototype.
• Incorporated and implemented HIPAA standards, Electronic Data Interchange (EDI 835, 837, 270, 271), transaction syntaxes such as ANSI X12, ICD-9, ICD-10 coding and HL-7.
• Worked on 835, 837 files to debug and correct any fall out records
• Conducted AS-IS and TO-BE analysis and assisted in developing process models and system integration structure; Conducted business process analysis using GAP analysis.
• Extensively involved in the analysis of HIPAA compliance and EDI transaction sets and actively participated in designing the EDI transactions using the new HIPAA 5010 version including the ICD-10 codes.
• Conducted peer reviews and verified all requirements for all assigned project(s)
• Facilitated Joint Application Development (JAD) sessions to speed up information flow among the stakeholders as well as the project team.
• Test cases and test plans preparation according to the test strategies defined in the project guidelines.
• Extensive knowledge with testing software’s using Selenium and Load Runner
• 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.
• Identified critical areas of the business risks, modified business processes to manage and reduce risk using Risk Management Process.
• Handled the knowledge transfer of EDI format used in electronic documentation to vendors as per the requirements.
• Worked with Subject Matter Expert (SME) to ensure the extracts are properly mapped; Used SQL for mapping and querying; Assisted in creating requirement document for ETL - Data Extraction, Data Analysis and Data uploading process.
• Involved extensively in various types of Audits in different stages; Gained Compliance Audit experience through exposure to different legal and audit consulting groups
• Developed the stakeholder list, created a stakeholder assessment matrix, and gathered requirements from stakeholders for provider management and member management
• Identified and validated business rules and data elements; Developed and maintained a requirement work plan and assessed the performance metrics of the team members
• Modeled the ‘AS-IS’ and the ‘TO-BE’ process flow and analyzed the gap; Developed and initiated the action plan steps to fill in the gaps
• Conducted Risk analysis and developed mitigation plans; Conducted Impact analysis when there is any change in the requirements and updated the Business Requirements Document (BRD) and Systems Requirements Specification (SRS)
• Developed FRD (Functional Requirement Document) to accurately specify the functions that a system or component must perform
• Created different data flow diagrams and UML diagrams to describe the overall EDI transaction sets for different claims
• Created Underwriting, Claims and Administrative reports in Excel using SQL queries.
• Facilitated meetings with the technical team and client team to analyze the current process and gather requirements for the proposed process
• Developed the User Interface (UI) prototypes to capture and validate requirements and spike solutions to the current problem
• Designed Functional Specifications for the target physical database.
• Facilitated JAD sessions for Requirement Validation with Dept. of Health & Human Services (DHHS) to gather requirements for the new MMIS
• Developed UAT test cases associated with the functional requirements.
• Maintained a bi-weekly status report for the requirements team and incorporated the same to the PMO status reports send to CMS
• Analyze EDI - X12 data elements captured by the existing system to validate it against the data elements required for new system
• Participated in developing test plan, test scripts, and test scenarios and designed user documentation
• Worked with legacy team in developing BRD for multiple system change requests and participated in system testing using HP Load Runner
• Used Microsoft SharePoint as the version-tracking tool for managing the requirements documentation
• Create monthly/weekly status reports to update the project schedules & deliverable plan.
• Designed reports using Tableau and used MS BI tools to analyze claims data for various project upgrades
• Created test database environment for non-technical users in PostgreSQL
• Examine the system design deliverables & validating it against the Request for Proposal (RFP)
• Worked with developer to create requirements surrounding C# and .Net code for website and mobile applications

Environment: SQL Server 2016, MS Office, Quality Center, Facets 4.21, MS Project, Server, MS Visio, Unix, J2ee, Java, .NET, XML, Mainframes and Rational Clear Quest, ClearCase, Windows XP, Jira, Selenium, Oracle RDBMS, pgAdmin, PostgreSQL, Tableau, Apache Hadoop, Cognos, SharePoint, Power BI, Azure SQL, ALM, RallyDev, Balsamic, iRise, Python, SAS, Load Runner

Confidential

Lead Business Analyst

Responsibilities:

• Created Business Requirement Document (BRD) by aiding in the collection of the User Requirements and Business Requirements; provided appropriate scope of work for the technical team to develop the prototype
• Incorporated and implemented HIPAA standards, Electronic Data Interchange (EDI 835, 837, 270, 271), transaction syntaxes such as ANSI X12, ICD-9, ICD-10 coding and HL-7
• Conducted AS-IS and TO-BE analysis and assisted in developing process models and system integration structure; Conducted business process analysis using GAP analysis
• Extensively involved in the analysis of HIPAA compliance and EDI transaction sets and actively participated in designing the EDI transactions using the new HIPAA 5010 version including the ICD-10 codes
• Facilitated Joint Application Development (JAD) sessions to speed up information flow among the stakeholders as well as the project team
• Test cases and test plans preparation according to the test strategies defined in the project guidelines
• Documented in state and out of state claims processing workflows
• 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
• Identified critical areas of the business risks, modified business processes to manage and reduce risk using Risk Management Process
• Handled the knowledge transfer of EDI format used in electronic documentation to vendors as per the requirements
• Worked with Subject Matter Expert (SME) to ensure the extracts are properly mapped; Used SQL for mapping and querying; Assisted in creating requirement document for ETL - Data Extraction, Data Analysis and Data uploading process
• Involved extensively in various types of Audits in different stages; Gained Compliance Audit experience through exposure to different legal and audit consulting groups

Environment: MS Office, Quality Center, SQL Server 2014, Facets 4.21, MS Project, Server, MS Visio, Unix, J2ee, Java, XML, Mainframes and Rational ClearQuest, ClearCase, Windows XP, Tableau, Apache Hadoop, Cognos, SharePoint, Power BI, Azure SQL, ALM, RallyDev