SUMMARY:

• Business Analyst with 7 Years of industry experience in healthcare domain specializing in business modeling, business document analysis and processing executing HIPAA regulatory changes and Integrating Applications. Extensively experienced in gathering business requirements, JAD Sessions, Gap Analysis, UML techniques and diagrams using IBM Rational Requisite Pro, Clear Case, Clear Quest Rational Rose/ MS Visio to create Business Documentation, Claims Processing System, HL7, EHR/EMR, Health Information Exchange, Benefits Administration, Automated Health Care Management System and specialized in ANSI 4010 / 5010 and ICD 9/10 implementation.
• Extensive experience in all stages of Software Development Life Cycle. Extensive experience leading, facilitating conducting Joint Application Development JAD sessions among user community, stake holders and technical management, creating project plans and schedules and managing changes.
• Analyzed and synthesized results from Joint Application Development JAD , proposed alternative tasks and transformed those into Business Requirement Document BRD
• Extensive experience in gathering requirements and authoring Business Requirement Documents BRD , Software Requirement Specification SRS , Functional Requirement Document FRD
• Experience in for requirements gathering, analysis, design in Rapid Application Development RAD sessions to converge early toward a design acceptable to the customer and feasible for the developers.
• Experience in using methodologies such as UML Unified Modeling Language and OOAD Object Oriented Analysis and Design .
• Worked on different EDI scenarios for batch processing
• Ensure day-to-day EDI transmission, Reject tracking and Reconciliation
• Contributed to data assembling for EHR software development.
• Experience in Rational Unified Process RUP , Rational Requisite Pro, Rational Clear Quest, and Microsoft Project
• Experience using Rational Rose and MS Vision for business process modeling and designing data flow diagrams DFD .
• Experience in conducting GAP analysis, System Integrated Testing, User Acceptance Testing UAT , SWOT analysis, Cost Benefit analysis, ROI Analysis and Requirement Traceability Matrix RTM
• Excellent knowledge of Health Insurance Portability and Accountability Act HIPAA transaction, code set rules such as EDI 837,270,271,276,277
• Extensive experience in implementation of Health Information Exchange standards for Eligibility 270/271 and Claim Status 276/277 transactions
• Broad knowledge of Test plans, Test cases and Test scripts
• Experienced with Rational tools like Requisite Pro, Clear quest, Clear Case, Rational soda, Rational Rose.
• Extensive experience in Gap analysis of 4010 to 5010 conversion using the implementation guide and companion guide of 837 EDI transactions.
• In depth knowledge of ICD 9- CM, ICD 10-CM structures and differences.
• Strong Experience in conducting Impact Analysis caused due to migration to ICD 10 on the key business process and key application system like claim processing, payments, reporting in health insurance companies.
• Experience in verifying EDI raw data of 837 transactions as per 4010 and 5010 formats
• Experienced in preparing User Manuals documentation, and Conducting training and support to the users and other stakeholders.
• Communicated and applied project standards and consistently delivers high-quality services to clients.

SKILL MATRIX

PROFESSIONAL EXPERIENCE

Confidential

Role : Business Analyst

The scope of the project was to identify the areas impacted by the transition from ICD-9 to ICD-10 for different subsystems of MMIS.

Encounter Project:

The scope of the project was for MMIS to be able to accept and process Managed Care Organization encounter data through the submission of X12 compliant 837 claim transactions as mandated by HIPAA.

Major Responsibilities

• Performed Gap analysis for the modules in production, conducted feasibility study and performed impact analysis for proposed enhancements and also worked on reporting skill set.
• Produced complete data mappings and data conversion documents needed for the Claims application.
• Compiled the Vision Document and composed detailed Use Case Specification Documents in Rational RequisitePro.
• Created UML class diagrams, use case diagrams and sequence diagrams to view the system from different perspectives.
• Performed Functional and GUI Testing to ensure that the user acceptance criteria are met.
• Co-coordinated the UAT with the SME's to make sure that all the Business Requirements are addressed in the application.
• Professional experience in writing Test Scenarios, Test Conditions, Test Cases and Test Scripts for Functional and non-functional requirements and mapping validation.
• Experienced with Rational tools like Rational Requisite Pro, Clear quest, Clear Case, JIRA, Rational Rose.
• Good knowledge about the Patient Protection and Affordable Care Act PPACA .
• Worked collaboratively with top management and senior team members to discuss project strategies and deliverables.
• Created test cases and testing strategies for System Testing Development Environment , Integration Testing UAT and Production in Agile/Scrum environment.
• Implemented the concepts of HTTPS, SSL, and SOAP MIME functionality to address the security concerns for real time system in Xengine environment EDIFECS .
• Worked extensively with the users and with different levels of management to identify requirements, use cases and to develop functional specifications.
• Documented Requirement Traceability Matrix RTM for requirement elicitation and linkup to deliverables.

Tools/Technologies : Microsoft Office MS Word, MS Excel, MS PowerPoint, MS Visio, MS Access , Rational Requisite, RUP, XML, SQL, Test Director, Rational Test Management

Confidential

Role: Sr. Business Analyst

Online Management project involved developing a web application that allows the providers to automate tasks like Patient Management, Appointment Scheduling and Recalls, Accounts receivable management and collections, Reporting, and Filing Claims through EDI ANSI X12 transaction sets in compliance with HIPAA standards which included the conversion of the 837 Benefit Enrollment and Maintenance EDI format from 4010 X12 formats to the 5010 X12 format as per HIPAA compliance

Major Responsibilities

• Wrote clear, concise detailed System Requirements Specification SRS documents and user documentation in accordance to guidelines and standards of a level where developers can interpret, design and develop the application with minimum guidance
• Developed a UAT User Acceptance Testing plan to guide a select group of key end-users in testing the user interface and functionality of the application.
• Executed SQL queries to test the database for records that detect and submit functional acknowledgement and remittance advice in the claims application.
• Conducted JAD sessions to allow different stakeholders to communicate their perspectives with each other, resolve any issues and come to an agreement quickly.
• Created high-level Use Cases from Business Requirements and created UML diagrams like Use Case and Activity diagrams using MS-Visio.
• Documented Requirement Traceability Matrix RTM for requirement elicitation and linkup to deliverables
• Conducted requirement gathering sessions with the purpose of creating and defining the Business Requirement Document BRD and the Functional Requirement Document FRD using Rational Requisite Pro.
• Critically evaluated the information gathered from multiple sources during requirement gathering and analysis and responsible for tracking, tracing and managing requirements using Rational Requisite
• Designed and developed Quality Assurance standard and processes to all levels of project team
• Implemented an integrated RUP solution with complete line of traceability for all the artifacts of web development projects
• Responsible for mapping and Gap Analysis of ICD9 to ICD10.
• Analyzed HIPAA 5010 related to 837,835, 270, and 271. Transactions and performed gap analysis between the 4010 and 5010 focusing on how current transactions and system was going to be effected by the new 5010 compliance.
• Extracted the business requirements from the stakeholders keeping in mind their need for the application and documented them using Rational Requisite Pro
• Prepared Business Process Models that includes modeling of all the activities of the business from the conceptual to procedural level. Followed top down, leveled technique for building Business Process Models
• Used HP Quality Center for tracking Defects and tracing requirement functionality performances.
• Worked with the individual sub-project managers to translate these into PRDs Product Requirement Documents for the development teams
• Conducted SWOT Analysis and Demand Analysis for better market understanding and fool proof project implementation

Tools/Technologies: Microsoft Office MS Word, MS Excel, MS PowerPoint, MS Visio, MS Access , Rational Requisite, RUP, XML, VB.NET, Oracle, UML, SQL, Test Director, RTP

Confidential

Role: Lead Business Analyst

• Confidential Vanguard owns and operates acute care hospitals, complementary outpatient facilities and related health plans principally located in urban and suburban markets. In addition, certain of its facilities provide on-campus and off-campus services, including outpatient surgery, physical therapy, radiation therapy, diagnostic imaging and laboratory services.
• The focus of the project was the replacement of 22-year-old Medicaid Management information System MMIS . It included technical and professional services related to analysis and assessment of the current MMIS and EDI claims, documentation of business and technical requirements, preparation of cost analysis and implementation of new MMIS automation system.

Major Responsibilities

• Propose strategies to implement HIPAA 4010 in the new MMIS system eventually move to HIPAA 5010.
• Responsible for gap analysis in changing old MMIS and Involved in testing new MMIS. Also, accountable for Medicaid Claims Resolution/Reimbursement for peach state health plan using MMIS.
• Responsible for the full HIPAA compliance lifecycle from gap analysis, mapping, implementation and testing for Medicaid Part C and Part D Claims.
• Coordinated with the stakeholders and project key personnel to gather functional and non-functional requirements during JAD sessions.
• Strongly implemented analytical skills like business models, P L, ROI, cost structure.
• Studied the existing business process and created AS-IS workflow to illustrate the existing system.
• Recorded requirements in the Requirement Traceability Matrix RTM defining each technical requirement in detail from areas like: main hardware, application software, networks, servers, internet and desktop configuration.
• Assisting the project manager in creating the business case and project plan.
• Defects and bug testing by using Rational Clear-Quest, Configuration management and Version control with Clear-Case.
• Actively analyzed current business processes Claims, Recipient eligibility and enrollment etc. and worked with management to improve and implement enterprise solutions to ensure compliance
• Responsible for creating business work flows and processes and creating management reports based on the analysis.
• Work with business representatives to understand data marts requirements and priorities and ensure that IT works is appropriately aligned.
• Followed the UML based methods using Rational rose to create Use Cases, Activity Diagram, Sequence Diagram, Collaboration Diagram that include Functional and Non-Functional specifications to hand off to development teams.

Tools/Technologies: Microsoft Office MS Word, MS Excel, MS PowerPoint, MS Visio, MS Access , RUP, MS Project, ANSI X12- EDI UML, Rational Requisite Pro, MS Word, Visio, SQL, MS Excel, Mercury Quality Center.

Confidential

Role: Business System Analyst

• Confidential offers a range of health insurance and managed care products and services, primarily to the Medicare population. Our family of companies offers affordable healthcare products and programs, including Medicare Advantage plans and traditional health insurance.
• The insurance Application involves quotation tool and also enables the customer to complete the transaction after selecting the insurance plan, pricing, location details etc. Also agents are allowed to quote or complete the application online on behalf of the customer. This includes Health insurance, Policy and Claim Service modules. Health insurance claims automation was the module I focused on. The existing mainframe based batch processes were gradually replaced with distributed processes.

Responsibilities:

• Fully responsible for requirements gathering and documentation.
• Created use case narratives to record Subscription business rules.
• Analyzed the business rules for the international user subscription and impact of localization.
• Implemented SDLC, which included requirements specifications, design, analysis and testing. Followed RUP methodology with Agile/Extreme Programming and using Rational Test Suite for various phases of RUP.
• Provided technical Expertise on the use of Rational Clear Case and Requisite pro, which were used for Data archiving and Requirements Management.
• Defect Tracking with Clear Quest, Configuration Management with Clear Case.
• Involved in preparing test plan and test cases based of functional requirements using Rational Test Manager.
• Worked with Business users to come up with Reporting Requirements. Reports were developed in Cognos
• Produced various artifacts e.g. Functional Requirement Specifications FRS and Wireframes.
• As a point person responsible for resolving business rules/conflict resolution for the development team.
• As member of system architecture team designed and reviewed user interface.
• Developed Business case and assessed the ROI.

Tools/Technologies: RUP, Rational Requisite Pro, Rational Clear Quest, MS office, Visio, Project, Clear Quest, Clear Case, Windows XP.

Confidential

Role: Business Analyst

• Confidential subsidiaries that operate skilled nursing facilities, assisted living facilities, hospices, home health providers and a rehabilitation therapy business. It operates skilled nursing facilities, assisted living facilities, a rehabilitation therapy business, hospice businesses, and home health care businesses, all which focus on creating a culture that attracts and retains an innovative, caring and ethical team that provides high-quality care to patients and residents
• Involved in Claims Processing System, this project consisted of providing various reports to the management to track how many claims are we processing and what are the efforts being done to contain claims cost.

Responsibilities

• Involved in the creation of the Mockups and Use Cases for MACD quotes and Orders using MS Visio.
• Documented business requirements, and communicated these requirements with the development team for design and implementation of business solutions.
• Worked with Business Analysis team to prepare a detailed Business Requirement Document.
• Analyzed Business Requirements to develop Functional and detail Design Specifications of the application.
• Conducted Requirement Gathering Sessions with the stakeholders.
• Interacted with the project team to help define the Business and System Objectives, confirmation of scope, identify constraints and the measures of success for the system to be developed.
• Conducted the JAD sessions, daily meetings, brainstorming sessions to solve the problems and enhance the workflow.
• Assisted in building a Business analysis process model using Rational Rose and Visio.
• Gathered Functional Requirements from users and the management. Coordinated all the requirements in team based environment.
• Acted as liaison between the senior management and different teams with effective presentations.
• Monitored change requests and documented requirements, integrating them with Use Clear Cases.
• Incorporated stakeholder feedback throughout project lifecycle to ensure project quality and customer satisfaction.
• Did Technical documentation for the project using tools like Visio, Word, etc.
• Used MS Project for managing schedules, resources and collaboration.

Tools/Technologies: Microsoft Office MS Word, MS Excel, MS PowerPoint, MS Visio, MS Access ,RUP, MS

Project, Toad, Visio, Oracle, HTML, Test Director, Rational Rose, UML 2.0, MS Project