SUMMARY

• Experience with project methodologies - Agile (Scrum), Waterfall, Rational Unified Process (RUP), Rapid Application Development (RAD)
• Experience in Software Development Life Cycle (SDLC) with thorough understanding of various phases - Requirement, Design, Implementation, Testing, Deployment, and Maintenance
• Strong knowledge of Health Insurance Portability & Accountability Act (HIPAA) standards, Electronic Data Interchange (EDI), Health Level 7 (HL7), Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Health Insurance Exchange (HIX), Electronic Medical/Health Records (EMR/EHR), Medicare, Medicaid, Medicaid Management Information System (MMIS), Patient Protection and Affordable Care Act (PPACA), Coordination of Benefits (COB), Explanation of Benefits (EOB)
• Good knowledge of ICD-9/ICD-10 and HIPAA 4010/5010 transaction requirements and experience working with HIPAA ANSI X12 Transactions (837/835/834/270/271/276/277)
• Knowledge of X12 format files and its structures including Loops, Segments and Data Elements
• Experience in gathering and documenting test scenarios and ability to translate technical requirements and present them to business stakeholders
• Hands on experience in analyzing and documenting Business Requirement Document (BRD), Functional Requirement Document (FRD), Use Cases and Requirement Traceability Matrix (RTM)
• Prepared AS-IS and TO-BE flows, conducted GAP/Risk/Impact/Feasibility/SWOT/Root Cause Analysis
• Prepared resource estimates, Gantt charts, high-level requirements document and other project deliverables in MS-Project as well as created Responsibility Assignment Matrix (RAM) or Responsible, Accountable, Consulted, and Informed (RACI) Matrix in MS-Excel
• Designed business process models using Unified Modeling Language (UML) such as Use Case, Class, Activity, Sequence, Collaboration using MS-Visio
• Experience with writing use cases, test plans, test cases, user stories as well as conducting User Acceptance Testing (UAT)
• Familiar in enhancement and testing of FACETS application like Enrollment, Membership and Claims
• Comprehensive knowledge of SQL queries in researching, gathering, analyzing data and working on ad-hoc reports
• Created Wireframes using various mock-up tools such as Balsamiq and Lucidchart and presented to business stakeholders
• Facilitated Joint Application Development (JAD), Grooming Sessions, and White Board Sessions
• Experience working with Subject Matter Experts (SME), Developers and Quality Assurance (QA) teams
• Strong Management and Communication skills, demonstrated proficiency in leading and mentoring individuals to maximize levels of productivity, while forming cohesive team environments
• Experience working with on-shore, offshore, on-site and off-site individuals and teams
• Excellent communication, analytical, interpersonal, presentation skills and adept at managing multiple projects simultaneously

TECHNICAL SKILLS

Project Methodologies: Waterfall, RUP, RAD, Agile (Scrum)

Modeling Tools: MS-Visio, Rational Rose, UML

Operating Systems: Windows XP/Vista/7/10

Business Applications: Microsoft Office - Word, Excel, Access, Visio, Project, OneNote, PowerPoint, Outlook

Management/Reporting Tools: Rational ClearCase, Cognos

Testing Tools/Others: Rational ClearQuest, Rational Requisite Pro, Rational Test Manager, LoadRunner, FACETS, SQL, Pulse, ServiceNow, Salesforce, SharePoint, Snagit, JIRA, Rally, Cognos, TOAD, Tableau, Mantis, Balsamiq, Lucidchart, HP QuickTest Professional (QTP), HP Quality Center (QC)

PROFESSIONAL EXPERIENCE

Confidential - North Richland Hills, TX

Business Analyst

Responsibilities:

• Conduct interviews and facilitate Joint Application Development (JAD) sessions with stakeholders to gather requirements
• Evaluate information gathered from stakeholders, reconcile conflicts, analyze high-level information into granular details, and distinguish user requests from the underlying true needs
• Liaison between the business and technical side to convey the business needs
• Create set requirements for transactions such as 270/271, 835, 837, 834, and 820
• Acknowledge HIPAA rules and regulations duringElectronic Data Interchange (EDI) and ensure development team kept up with it
• Analyze Health plan Enrollment and Maintenance (ANSI X12 834) file specifications under HIPAA framework
• ValidateEDI Claim Process according to HIPAA compliance and test HIPAA regulations in FACETS
• Develop various artifacts like BRD, FRD, use case diagrams, and user stories
• Translate business requirements into functional requirements for developers
• Create AS-IS and TO-BE flows to show the current and proposed functionalities of the system using MS-VISIO and present to the stakeholders for review and approval
• Assist Scrum Master in maintaining iteration board, sprint backlog, velocity charts and burn down charts and met with Product Owner in creating user stories
• Participate in all aspects of the scrum framework - sprint-planning sessions, backlog-grooming session, daily scrums, sprint reviews and sprint retrospectives
• Facilitate UAT sessions with stakeholders, log defects in HP Quality Center and work closely with Development team to ensure timely resolution
• Conduct GAP analysis to analyze and identify gaps between current and future process and acknowledge steps to close the gaps
• Prepare ad-hoc reports by researching, collecting, analyzing, and summarizing data and trends
• Work closely with QA Team to create test plans and test cases in order to test the functionality of the system based on the requirements
• Work with cross-functional teams in developing new ways to boost efficiency and delivering results in a fast changing environment to achieve company goals

Confidential - Louisville, KY

Business Analyst

Responsibilities:

• Facilitated JAD sessions to gather requirement with stakeholders and reviewed documents in detail
• Assisted in identifying project scope and regulatory compliance related to X12 837 and 835
• Involved in the day-to-day implementation of the Agile methodology of application development with its various work flows, artifacts and activities
• Documented ICD 9 to ICD 10 mappings according to the GEM files from Centers for Medicare and Medicaid (CMS) with the functional and structural changes related to the conversion
• Created ICD-9/ICD-10 comparison document and worked on the conversion in FACETS
• Performed forward and backward mapping between the two standards and documented the required changes
• Tracked and addressed issues that were encountered on Acknowledgement (997), Claim Status Inquiry/Response (276/277), Remittance Advice (835), Eligibility Inquiry/Response (270/271), Prior Authorization (278) claims
• Worked on the implementation of Medicaid Management Information Systems (MMIS) Health Enterprise System and met with various stakeholders to gather requirements
• Responsible for Medicaid Claims Resolution/Reimbursement for health plan using MMIS
• Facilitated the implementation of patient Electronic Medical Record (EMR) from different medical organizations
• Incorporated stakeholder feedback throughout project lifecycle to ensure project quality and customer satisfaction

Confidential - Oakland, CA

Business Analyst

Responsibilities:

• Conducted weekly meetings in reviewing and discussing Policies and Procedures to be followed while constructing new portals
• Performed requirement analysis, impact analysis and documented the requirements with the stakeholders
• Worked on EDI transactions 835 and 837 to identify key data set elements for designated record set
• Interacted with Claims, Payments and Enrollment - analyzed and documented businessprocesses
• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims
• Executed test cases and test scenarios using HP Quality center (QC)
• PreparedRequirement Traceability Matrix (RTM), BusinessRequirement Documents (BRD) after meeting with Stakeholders
• Created Functional Requirement documents (FRD) and provided appropriate scope of work to technical team
• Led JAD sessions aimed at functional requirement walkthroughs for all the impacting projects and updated documents based on recommendations
• Documented detailedbusinessand technical requirements regarding the conversion from 4010 to 5010 transactions
• Involved in designing future state processes for HIPAA 5010 transaction processing EDI 837, 835, 270, and 271
• Produced gap analysis 4010 vs. 5010 for transaction sets 835 and 837 (Institutional/Professional) against the documented application 5010 enhancements, as well as prepared mapping documents ensuring the upgraded application included the required changes and additions for 5010
• Worked on day to day ad-hoc requests and inquiries
• Used HP Quality Center to house all test documentation and report/track all issues and defects

Confidential - Dublin, OH

Junior Business Analyst

Responsibilities:

• Conducted meetings, facilitated Joint Application Development (JAD) sessions and interviews with the business users to gather requirements
• Validated documentation to ensure that it was in compliance with Patient Protection and Affordable Care Act (PPACA)
• Worked in conjunction with lead Business Analyst and created Business Requirement Documents (BRD)
• Created use case diagrams, activity diagrams, and flow charts to depict the interaction between various actors and the system
• Implemented SDLC that included requirements specifications, design, analysis and testing
• Assisted QA team in writing test plans and helped them with testing the application using HP QuickTest Professional (HP QTP)
• Involved in database interactions for retrieving appropriate data using SQL
• Logged defects and was involved in all stages of software testing life cycle (STLC)
• Conducted GAP analysis both at the time of requirement gathering and later after development with the Testing team to identify areas and possible scenarios that might have been overlooked
• Assisted QA team with unit/functional/performance/stress/usability testing
• Developed functional and non-functional requirement documents and presented to the stakeholders
• Informed various stakeholders regarding issues encountered during the project