SUMMARY

• IT professional wif Seven years of experience as a business Analyst in healthcare industry.
• Analyzed business requirements and linked requirements from SRS document to teh use cases in requirement matrix using Rational Requisite Pro.
• Worked closely wif teams of BAs, developers and testers throughout teh entire development life cycle to elicit and managed requirements.
• Led project to analyze, cost, plan and implement teh obsolescence, retirement and continuity of teh project, including teh impact assessment to ISVs involved in teh project.
• Responsible for creating documentation, plans and presentations for all levels of leadership, including senior executives.
• Documented requirements for EDI transactions 837 and 275 for medicare Part A, Part B, Part C and Part D. Involved in data mapping for 4010A1 to 5010 conversion.
• Conducted Claims and HIPAA Compliance Training for Medicare Part A& B, C and D and run claims test cases. Involved in data extraction, transforming, loading, Mapping Template Creating by using Informatica software.
• Experience in Conversion of HIPAA X12 4010 to X12 5010 ICD 9 codes to ICD 10 codes
• Reviewed teh Installation Qualification (IQ) and Operational Qualification (OQ) protocols for laboratory information management systems (LIMS) Labware as required by FDA Regulations.
• Monitored, researched, and resolved transaction integration issues between LIMS and JDE ERP systems.
• Worked on EPIC and Cerner.
• Good understanding of Trizetto Facets, HL7, Medicare, Medicaid, Medicare Part D, HMO and PPO.
• Provided overviews and detailed knowledge on key Labware LIMS data, specification management wifin LIMS, mapping LIMS data to manufacturing processes, and end - user interaction wif LIMS.
• Extensively worked for integrity of applications and automation of process wif teh ANSI standards Facilitated Electronic Data Interchange and storage in teh ICD-9.
• Created Functional and Regression test folders in Quality Center
• Manually tested end-to-end business workflow from capturing prospects profile to submission of pre-enrollment record to teh downstream systems (RTMS).Validating HIPPA 834+ files for use by downstream systems.
• Experienced in 835/837/270/271 processes of medical claims/underwriting for support and point of reference for teh vendor in business issues.
• Closely worked wif BCBS development team to clearly define wat needs to be developed in plan packages.RUP software engineering process was used to provide a disciplined approach to assign tasks and responsibilities wifin a development organization.
• Assisted in facilitating JAD sessions by recording their outcome and ultimately translating them to formal documents.
• Performed Use-Case analysis using UML to capture teh dynamic aspect of teh application.UML was further used for specifying, constructing and documenting teh software system using Rational Rose.
• Liaison wif customers business unit managers, stakeholders and functional subject matter experts (SME).
• Created project charter, scope and schedule.Maintained project documents such as teh risk management plan, action item list, project benefits list, monthly updates and review wif teh project manager at regular time intervals.

TECHNICAL SKILLS

Languages: SQL,XML, HTML

Databases: MS Access, MS SQL Server 2000

Methodology: UML, RUP, Agile, Business Modeling

Operating System: MS Word 7.0, MS Excel, MS PowerPoint 5.0, MS Access

Testing Tools QTP, Test Director:

Office Tools: MS Office 2003/2000, Word, Excel, Power Point, Access

Project Management: MS Project 2000/2003

PROFESSIONAL EXPERIENCE

Confidential, Hartford, CT

Business Analyst

Responsibilities:

• Understand current Contract Management business process for all group insurance products by interviewing SME’sand team members
• Assisting teh Requirements Lead in formulating Workshop Session agendas and facilitating Workshop/JAD (Joint Application) Session agendas Thoroughly studied teh inherent systems to has a clear understanding of teh business processes and associated system workflows.
• Work responsibilities primarily involved understanding teh business logic, designing requirements, communicating them to teh developers, generating documentation, designing use cases, creating various diagrams like State Diagrams, Sequence Diagrams as part of project.
• Involved in HIPAA implementation and EDI transactions like 837, 835, 276/277, 278, 270/271.
• Involved in gathering requirements and documentation of 276/277 claim status Request and Response.
• Worked on different modules of Trizetto Facets.
• Conducted Gap analysis to understand teh new business model and teh additional functionalities to be incorporated into teh new application.
• Conducted JAD sessions for better understanding and refining of teh requirements in coordination wif teh multiple teams involved in teh projects.
• Involved in up-gradation of HIPAA X12 4010 transaction to HIPAA X12 5010 and ICD 9-CM (Clinical modification) to ICD-10-CM/PCS (Clinical modification/procedure coding system) simultaneously.
• Lead teh development of teh business plan in partnership wif vendor integration and executive management working across departments (business and IT).
• Worked in remediation projects for 4010 and 5010 transactions to reduce disparity among receivables due to teh migration efforts.
• Create, analyzed and finalize teh improved Contract Management business process workflows for all teh group insurance products.
• Experience in designing and documenting test cases for Facets 5.01 upgrade.
• Involved in Gap Analysis for ICD 9 to ICD 10.
• Worked wif SMEs to understand teh impacts of ICD 10.
• Creating Business Rules and User Interface Rules for data elements/fields
• Utilizing teh Waterfall Methodology in creating teh requirements for eventual Contract Management tool implementation in a system-agnostic manner
• Creating artifacts for weekly distributions to teh business and maintaining teh Requirements Traceability Matrix
• Creation of feedback update template for incorporating business feedback and updating requirements
• Performing and tracking feedback analysis
• Handling of and coordination wif a team of Off-Shore Resources inIndia.

Environment:Waterfall Methodology, MS Office Suite, Livelinks, LiveMeeting, CLM Contracts Tool

Confidential, Franklin Lakes, New Jersey

Business Analyst

Responsibilities:

• Initiate, facilitate and manage meetings to address agendas
• Create and drive presentations designed for knowledge transfer and corporate training
• Understand teh client’sneeds and translate it into plausible requirements while working on teh Corporate Account requirements
• Translate and clarified Business Requirement Documents into Functional RequirementsforPoint of Sale (POS)-Ex: F1/F2/F3 Transactions, Explanation of Benefits - Troop and Drug Spend (EOB)
• Creating Business Rules,User Interface Rulesand Use Casesfor functionalitiescaptured wifin teh Functional Requirement documents in preparation forHIPAA D.0changes
• Work closely wif teh business stakeholders to extract and secure requirements.
• Worked on PEGA and PBM.
• Has experience on HL7 Messaging Standard which is teh workhorse of data exchange in healthcare.
• Worked on TMF in PEGA 5.5. Automated unit test cases.
• Assisted in troubleshooting advanced legacy data to XML conversion.
• Well versed wif teh usage of debugging tools including Pega Clipboard, RULE Inspector, Tracer and Log Analyzer.
• Coordinate wif Development to ensure that requirementsare understood
• Collaborate wifQAto ensure all set-ups are available and validate results through test cases
• Acquire sign-offs and maintain proper documentation
• Initiate Change Control as per CMMI standard protocol
• Conduct Work-Sessions for Work-Around planning.
• Understanding of POS, TelePAID System, Co-Pay Benefit Pricing, Claim Adjudication Protocol
• Knowledge and experience increating requirements forHIPAA(EDIX12 Transactions)
• Knowledge and experience inapplyingNCPDP standards.
• Used SQL joins and triggers for backend testing.
• Training and experience in Medicare Part D in a CMS Compliant and CMMI
• Understanding and resolving of CMS Compliance issues(Medicare Part D)
• Experience using Agile software development methodologies, including experience creating and managing SCRUM artifacts (User Stories, Product Backlog, facilitating Scrum meetings)
• Analysis of metrics based on KPI’s

Environment: RUP, JAD Sessions, GAP Analysis, Breeze, Communicator, Clear Quest, Pega, Optimal Trace, Rumba, PTS Web, PTS Time, MS Office Suite, Sharepoint, Agile Methodologies

Confidential, San Diego, CA

Business Analyst

Responsibilities:

• Developed and executed strategic initiatives and programs to enhance existing Medicare claims processing functions in support of corporate initiatives and requirements.
• Recommended changes for system design, methods, procedures, policies and workflows affecting Medicare/Medicaid claims processing in compliance wif government compliant processes like HIPAA/ EDI formats and accredited standards like ANSI
• Working knowledge in ICD 9 ANSI Health codes/HL7 in teh claims environment for inpatients and outpatients; reviewed teh implementation of teh changes made in teh systems as per teh formats and compliance for EDI usage.
• Participated in development, testing and implementation of new and or revised system enhancements to ensure effective and efficient Medicare claims processing.
• Used EPIC software for tracking and updating teh claim report/project report
• Provided guidance in teh investigation and final disposition of complex claim matters from Executive/Senior Management through JAD sessions for analysis and design
• Acted as a consultant for executive management from other departments for, but not limited to reimbursement.
• Used teh RUP methodology and related processes for software re-engineering process
• Knowledge of Healthcare Insurance Medicare/Medicaid formats and procedures as per teh State govt. regulations
• Monitored claims inventory, cycle time processing and work quality to assure conformity wif corporate objectives and departmental goals.
• Produced management reports using COGNOS relative to inventory, productivity, accuracy and cycle time and maintained team leave documents and artifacts in web based MS Share point
• Maintained regular interaction wif all Metro Plus departments relative to Medicare policies, procedures and regulatory requirements and maintained ad hoc reports using MS Access.
• Reviewed new contract business requirements relative to benefits and Medicare claims processing.
• Strong Documentation experience which required converting business needs to technical documents. Wrote USE cases and prepared teh Business Requirements Documents for various requirements collected from teh business users.
• Used MS Visio and UML for generating class diagrams and activity diagrams.
• Conducted special projects /studies; participates in various work groups upon request
• .Involved in Data Analysis for teh data warehouse and data mart system for teh process of report generation of teh data.
• Wrote requirement document for Data Extraction, Data Analysis and Loading process of collected data as a part of data mapping procedures.
• Used SQL queries for defining such requirements
• Performed UAT testing wif client and supported all phases of testing wif QA team and managers.
• Summarized audit reports for clients and teams regarding polices and procedures

Confidential, Falls Church, VA

BA/QA Analyst

Responsibilities:

• Involved in documenting requirements and creating scenarios to test 3rd party systems using HL7 Standards for ADT (Admission/Discharge/Transfer), Pharmacy and Billing Systems.
• Performed data integrity resolution for inbound and outbound HL7/ADT interface transactions.
• Installed Rhapsody V2 software and tested it in various platforms.
• Set up message routes on Rhapsody V2 to ensure time effectiveness.
• Managed development and testing of HL7 messages, DB2 database and SQL code.
• Experienced in 835/837/270/271 processes of medical claims for support and point of reference for teh vendor in business issues
• Conducted user interviews, gathering requirements, analyzing teh requirements using Rational Rose requisite pro - RUP.
• Worked on EMR and EHR.
• Identified, research, investigate, analyze, define and document business processes
• Conducted workflow, process diagram and GAP analyses to derive requirements for existing systems enhancements.
• Trained in Billing and Admin processes of teh Claim procedures under HIPAA compliance and as per teh State Government rules and laws.
• Assist wif user testing of systems, developing and maintaining quality procedures, and ensuring that appropriate documentation is in place.
• Responsible for identifying and documenting business rules and creating detailed Use Case using MS Excel and Visio.
• Conducted User Acceptance Testing (UAT).
• Developed teh test plan, test conditions and test cases to be used in testing based on business requirements, technical specifications and/or product knowledge.
• Used detailed knowledge of application features and functions assess scope and impact of business needs throughout analysis and completion of all enhancement specifications.
• Acted as a resource in understanding how teh system carries out business functions and assists in ensuring teh timely and effective implementation.
• Developed timelines for project delivery, and managed projects and resources to successful completion.
• Used Data mapping for collecting teh data.
• Liaison for projects wif other corporate departments, including Executive, Legal and Information Services as well as vendor relationships
• Assisted in development of training materials for new technology and process improvements.
• Experience creating design documentation related to system specifications including user interfaces, security and control, performance requirements and data conversion.
• Assisted teh Account Management people in reviewing teh account of teh customers.
• Used Quality Center wif QA team for testing.

Environment: Rational Rose requisite pro - RUP, Use Cases, Rhapsody V2, Sequence Diagrams, OOD (Object oriented Design) using UML and Visio, SQL, Toad,, MS-Excel, .Net, Quality Center, Java.