SUMMARY

• Business Analyst with 7 years of experience in Healthcare. Focused on Business Analysis, System Analysis, Enterprise Solution, Business process redesign/reengineering and improvement.
• Hands on experience with in - depth understanding of Business Requirement gathering, Business Process flow, Business Process Modeling (BPM) and database/data warehouse experience.
• Strong experience working in key phases of the Software Development Life Cycle(SDLC) such as the Planning, Design, Analysis, Development and Testing for the software/system development process.
• Advanced business writing skills for preparing Business Requirement Document (BRD), Use Case Specifications and Functional Specifications.
• Well acquainted with Workflows and Unified Modeling Language (UML) diagrams such as, Use case diagrams, Activity Diagrams, State, Collaboration / Sequence Diagrams.
• Actively used Joint Application Development (JAD) and Rapid Application Development (RAD) Sessions to converge early toward a design acceptable to the customer and feasible for the developers and to limit a project’s exposure to the forces of change.
• Experienced in multiple SDLC methodologies such as Waterfall, Agile, SCRUM and Rational Unified Process (RUP).
• Proficient in writing test cases and test scripts and executing tests.
• Expertise in gathering /eliciting business requirements, detailing, converting business requirements to technical requirements using different tools and techniques.
• Compelling Multi-Tasking and organizational ability, with the capability to develop and implement strategies.
• Ability to work cohesively with all Stakeholders to formulate Functional models and prototypes to meet stakeholder expectations, and Workflow optimization.
• Excellent Communication and interpersonal skills, capable of acting as the arbiter between client and developer with respect to project implementation.
• Extensive experience working with end users to answer their questions and gather feedback for requirements during all phases of project.
• Hands on experience of performing quantitative data modeling, forecasting based on available data, and decision analysis.
• Experience in multi-tasking such as managing numerous simultaneous projects with great attention to detail.
• Experience in solution assessment, validation and applying critical thinking for problem solving approach.

TECHNICAL SKILLS

Business Modeling Tools: Axure Pro, MS Visio, MS Office Suite, Enterprise Architect, Balsamiq, Smart Draw.

Methodologies: Agile, Scrum, RUP, Waterfall

Requirement Management Tools: Rational Requisite Pro, SharePoint

Applications/Environments: MS Office, Crystal Reports, Oracle, SQL Server, Oracle Work Flow, Microsoft TFS

Languages: HTML, XML, SQL, Shell Scripts, JAVA/J2EE in Eclipse and IDE transition

Defect Management Tools: JIRA, RALLY, Bugzilla, SharePoint, HP Quality Center, Microsoft TFS

PROFESSIONAL EXPERIENCE

Confidential - Deerfield

Sr. Business Analyst

Responsibilities:

• Acted as a liaison between Business Area Subject Matter Experts (SMEs) & development team throughout all phases to SDLC.
• Presented new Business solutions to stakeholders before initiating the project.
• Development and maintained project plans and contributed to project being on schedule and meeting client’s needs.
• Key player in gathering and documenting the requirements that were critical to the business process and using those requirements to design application software using a Use Case approach.
• From the preliminary phase analysed the GAP’s and other issues (from requirement) that could arise in future during project being build and individually solved them.
• Conducted JAD sessions to identify the business flows and determined whether any current or proposed systems were impacted by the EDI X12 Transaction, code set and identifier aspects of HIPAA.
• Involved with the pre-implementation tasks coordinating with project coordinators for contractual work, change management, quality and impact analysis.
• Created project status reports to implementation managers as and when needed.
• Handled ICD-10 claim processing in test environment.
• Interviewed several business area experts and SME’s, asking detail questions and carefully recording the requirements in a format that can be reviewed and understood by both technical team and the business people.
• Facilitated Functional Requirement reviews and walkthroughs with the designers and the developers.
• Planned, coordinated, and monitored project levels of performance and activities to ensure project goals are met on time
• Interviewed business people to gather business wants and needs around project ideas and translated them into business and technical requirements.
• Build project schedule after charter approval using MS Project.
• Interacted both with clients and as well as end users to capture the process and gather User Requirements.
• Worked with HIPAA compliance ANSI X12 837 formats for both professional claims and institutional claims.
• Matched the requirements for Medicare and Medicaid programs which are related to the Social Security Act
• Coordinated and helped the developers with the HIPAA-EDI Transaction Code sets: 837,834,835,270/271,277/275 & 276/277.
• Analysed forms and successfully crosswalk details to corresponding ANSI X12 formats.
• Created work flow diagrams using MS Visio, Project, PowerPoint.
• Identifying the number of payers and clearing house where claims get submitted electronically or paper format and provide the in scope and out of scope list of payers for ICD-10 testing.
• Maintained dashboards through software’s like Tableau and Jira.
• Coordinated and prioritized outstanding defects and enhancement/system requests based on business requirements, allowing sufficient time frame to ensure accuracy and consider deadlines.

Environment: Windows 8, Agile, MS SQL, Rational Requisite Pro, Microsoft Visio, JIRA, SharePoint, Visual Studio, JavaScript,Rational SODA, Selenium, Microsoft Project, SSIS, ClearCase.

Confidential - Philadelphia, PA

Business Analyst

Responsibilities:

• Responsible for proactively identifying opportunities for improvement throughout the business which could include working with department management to create a business case detailing the cost/benefit of the improvement.
• Created role-based matrix, decision tables when required as per the requirements through the project.
• Strong understanding of the business functionalities like Medicare, Medicaid, Tricare, Workers Comp, Commercial Claims, Bulk Billing, Denial Analysis and Insurance specific trends.
• Excellent knowledge and enacting of HIPPA transaction sets such as 270/271 (inquire/response health care benefits), 276/277 (claim status), 835 (Payment or remittance advice).
• Successfully interpreted data to draw conclusions for managerial action and strategy.
• Optimized data collection procedures and generated reports on a weekly, monthly, and quarterly basis.
• Analyzed massive and highly complex data sets, performing ad-hoc analysis and data manipulation.
• Collaborate with both technical and business stakeholders to understand reporting and data requirements based on customer and internal needs.
• Responsible for identification and analysis of errors/inconsistencies in the data and provides timely resolutions.
• Reviewed MMIS (Maintenance Management information System) documents to understand the customer requirement.
• Worked on payer plan sponsor and EDI transaction like 837.
• Provide ad-hoc and structured reporting document to partners and stakeholders.
• Was involved in maintaining dashboards, reports, visualizations, and alerts that concerned business decisions.
• Create and maintain data sources.
• Identify, designed, coded and testedETL operations to support business analysis objectives.
• Identifiedgaps between 4010 and 5010 specifications.
• Tested and implemented HIPAA 4010 and 5010 and ICD 10, version for all EDI transactions.
• Acted as an SME on different subject areas including state reporting, death benefits, Medicare, Bill review and RX eligibility.
• Involved in creating sample mappings for the conversion of EDI x12 transactions code sets.
• Assisted clients in resolving billing issues for Medicare,Medicaid, and private insurance.
• Created lists of ICD 10 CM/PCS codes with reference to the usage percentile and provided to Stakeholders to determine if codes were best fit or all possibilities.
• Tested claims to ensure that the system would recognize and accept the ICD-10 changes.
• Used complex SQL queries to analyze the data pattern to accommodate the variousbusinessscenarios.
• Designed and documentBusinessRequirements by using HIPAA EDI guides and reviewed as well as interviewingbusinessprocess owners and companion guides.

Environment: Windows, Microsoft Project, Microsoft Visio, Balsamiq, HP Quality Centre, Rational Clear Quest, Quick Test Pro, JIRA, Python, Lucid Chart, Java Script, SharePoint.

Confidential - Philadelphia, PA

Business Analyst/ Quality Analyst

Responsibilities:

• Co-ordinate/develop/maintain test plans, statuses, defects, reports, matrices, strategies with business, developers and senior team members.
• Attended architectural reviews, JAD sessions and provided valuable contribution from a BA perspective.
• Trouble shooting, various real time issues of customers overall in a given region to specific location to single account or setup box; identified high quality and critical bugs and exceptions using Jira, Charles web proxy tool and Splunk.
• Used JIRA for requirement management, planning, execution, defects tracking and reporting.
• Logged, maintained & tracked defects, assigned type & severity levels, regressed scripts to assign status to defects, configure Test Director to auto-notify developers.
• Worked on X1 mainframe systems for integration, system, end to end testing.
• Participated and contributed in daily scrum meetings to track daily progress and performance.