SUMMARY

• Strong understanding of Healthcare terms and experience of Claims management process.
• Diversified experience in the following areas: Ability to Elicit, Analyze, gather and document Business Requirements, experienced in writing Use Cases. Proficiency in SDLC life cycle, understands the workflow concept, ability to gather and document the 'As - Is' and 'To-Be' processes
• Experience in creating and maintaining the requirements definition documents that included 5010 business requirements and functional requirements.
• Experience as a Facets Business Analyst in mapping business requirements, designing customized solutions with strong analytical skills and ability to analyze business practices and define optimal procedures.
• Excellent understanding of HIPAA standards (4010 and 5010), HIPAA code sets ICD-9, ICD 10
• Knowledge of the following HealthCare EDI Transactions for 4010/5010 like (278) Referral Certification and Authorization, (834) Benefit and Enrollment, (835) Payment & Remittance Advice, (837 I & P) Institutional and Professional HC Claim
• Experience in developing Use Case diagrams, Sequence diagrams, State Chart diagrams, and Class diagrams.
• Experience facilitating JAD (Joint Application Design) sessions and maintenance of Test Matrix and Requirements Traceability Matrix.
• Expertise in conducting Joint Application Development (JAD), Joint Application Requirement (JAR), Formal Interview and Brainstorming sessions that include Project Sponsor, Subject Matter Experts, End User Representatives, the Project Manager/Leader, Business Analysts (a. k. a. Requirements Analysts)
• Performed planning and development of test plans, test cases and test scenario to meet product’s business requirements.
• Excessive use of documentation to avoid any form of miscommunication or misinterpretation during the entire software development process. Prepared Systems Proposal Reports, Change Request Forms and Business Plans.
• Use of UML/RUP for modeling views in Microsoft Visio
• Involved in maintaining Traceability Matrix and performing GAP analysis.
• Conducted User Acceptance Testing (UAT).
• Good knowledge of SQL queries.
• Creative and aggressive self-starter with integrative thinking skills, capable of forming and maintaining positive and productive working relationships in internal, external, independent, and team environments

TECHNICAL SKILLS

Project Methodologies: SDLC, Agile, Rational Unified Process (RUP), UML, JAD, JAR, RationalBusiness Modeling Tools MS Visio, UML

Operating Systems: Windows NT/XP/2000/2007, UNIX

Database: Oracle, SQL server

Quality Assurance: Quality Center, Test Director

Business Applications: Microsoft Office Suite, MS VISIO, MS Project, Outlook, Lotus Notes

PROFESSIONAL EXPERIENCE

Confidential, Raleigh, NC

Sr Business Analyst

Responsibilities:

• Identified risks, problems, requirements and concerns of the Hospital in order to comply with ICD 10 changes. Actively worked on Data analysis and Report analysis with respect to ICD 10 impact.
• Performed baseline assessment of Hospital-Provider systems and related interfaces. The existing service level agreements and/or policies and operational business procedures for readiness to comply with HIPAA as well as ICD 10 requirements.
• Conducted meetings/interviews and JAD/JAR sessions with stakeholders to collect business requirements, analyzed the root cause of the problems and developed use cases using MS Visio.
• Identified potential business problems and UAT implementation problems.
• Developed project documents based on SDLC methodology-RationalUnifiedProcess (RUP)
• Highly involved in documenting department workflows and process flows with respect to applications. Analyzed System flows of various departments of the hospital.
• Collected the information related to ongoing application upgrade and their impact on ICD 10 implementation and created awareness within the departments regarding the need, impact, benefits and risks of ICD 10 code application.
• Wrote Use Cases, prepared use case diagrams (using Rational Rose) and followed Rational Unified Process at every stage of the process.
• Involved in providing education about the ICD 10 standards, its requirements, complexity and accuracy to Physicians and Nurses of the hospital. Re-Organized the collected data and prepared documentation for implementation.
• Figured out the requirement of training in various departments of the hospital based on their daily work.
• Used the guidelines and artifacts of the RationalUnifiedProcess (RUP) to strategize the Implementation of RationalUnifiedProcess effort in different iterations and phases of the Software Development Life Cycle (SDLC)
• Used Rational tools to document and manage requirements, enhancement requests, and other documentation issues for the application
• Identified Actors, Activities, Artifacts and Workflows and developed use case diagram using Rational Rose.
• Conducted JAD/JRP and Elicitation sessions for user interviews to gather requirements.
• Conducted user interviews, gathered requirements, and analyzed the requirements using Rational Rose & Requisite Pro - RUP
• Responsible for business process modeling, process mapping
• Performed impact analysis on applications for deadliness of ICD 10 conversion. Additionally, was also responsible to meet the information demands of our business users by delivering timely, accurate, meaningful and standardized data and reporting
• Mapped the collected data with the existing data provided by the hospital departments. Also, Used Word, Excel and Visio as a working tool and SQL scripts/queries for data verification and validation.

Environment: RationalUnifiedProcess (RUP), UML, SQL server, Blueprint, Cognos, MS Office Tools - MS Word, MS Excel, MS Access, MS Visio, Clear Case, Quality Center, Etc

Confidential, Baton Rouge, LA

Business Analyst

Responsibilities:

• Studied existing business application and processes, collected end user requirements and suggested the improvised business process model.
• Participated in project review meetings and gathering Business Requirement Documents (BRD)
• Reviewed new and modified program, including documentation, diagram, and flow chart, to determine if program performed according to user request and conform to guidelines.
• Involved in gathering, documenting and verifying business requirements
• Conducted user interviews, gathered requirements, analyzed the requirements using Rational Rose requisite pro - RUP
• Involved in project management using MS Project
• Organized JAD Sessions to collect requirements from system users and prepared business requirement that provided appropriate scope of work for technical team to develop prototype and overall system.
• Worked in a RUP environment using Rational Requisite Pro for requirement management
• (SRS), Business requirements document (BRD), Project Requirement Document (PRD), Use Case Specifications, Functional Specifications (FSD), Systems Design Specification (SDS), Requirement Traceability Matrix (RTM), Requirements Management Plan (RMP) and testing documents.
• Conducted User Acceptance Testing (UAT)
• Worked closely with stakeholders and SME’s for requirements gathering.
• Was responsible for developing and managing project plans: system requirements, change management policy standard and procedures by utilizing RationalUnifiedProcess (RUP)
• Worked on developing the business requirements and use cases for Facets batch processes; automating the billing entity and commission process.
• Involved in both Manual and Automated Testing of RUP, with focus on Quality Assurance including Unit Testing, System Testing, Integrated Testing and Acceptance Testing.
• Extensively interacted with the QA Team in executing the Test Plans, Providing Test Data, Creating Test Cases, and Issuing MR upon detection of bugs and collecting the Test Metrics.
• Wrote Use cases and test cases for testing and the processing of member enrollment andbenefits.
• Facilitated JAD sessions and brainstorming sessions, as requirement elicitation techniques.
• Involved in interactions with Subject Matter Expert, Project Manager, Developers, and the end-users in more than one JAD sessions.
• Worked with the QA (Quality Assurance) team for designing Test Plan and Test Cases for the User Acceptance testing - Defined test cases, creating test scripts, analyzing bugs, interacting with QA / development teams in fixing errors and User Acceptance Testing (UAT).
• Developed UML Use Case model for the application using MS Visio and assigned to prepare the detailed Work flow diagram based on the proposed enhancement for the system.
• Identify the business requirements, functional requirements, non-functional using Rational Requisite Pro.
• Developed requirements integrating Use Case diagrams and designed the testing process flows.
• Followed the RUP methodology for the entire SDLC.

Environment: Facets, Windows, MS Office, MS Visio, Quality Center, HIPPA Gateway, PL/SQL, MS Project, SQL, SQL, Server, Clear Case, UML, Etc

Confidential, Minnetonka, MN

Business Analyst

Responsibilities:

• Worked with the account managers, managements, and report requestors to gather requirements, get report requests.
• Wrote Business Requirements, analyzed them and tested them.
• Owned the entire reporting process. Interacted with the ETL team, developer (s), management, and account holders to get the requirements, document them, design templates, and write specifications
• Conducted live JAR&JAD sessions with SMEs, and all the placeholders to develop High Level Requirement and then formalized those requirements to Detailed Level Requirements.
• Facilitated JAD sessions to allow different stakeholders to communicate their perspectives with each other, resolve issues and come to an agreement quickly.
• Worked in a RUP environment using Rational Requisite Pro for requirement management
• Designed report templates based on the requests by account managers.
• Designed Functional Specification Documents for the reports.
• Followed the UML methodology to generate Activity Diagrams, Sequence Diagrams, Class Diagrams and Collaboration Diagrams using Rational Rose.
• Analyzed trading partner specifications and created EDI mapping guidelines.
• Extensive use of Excel to create Functional Specification Documents & Templates.
• Designed the process flow diagrams for flow of information and report creation process.
• Conducted RAD sessions for the report users, requestors, and the developers.
• Used MS Project to manage project time lines
• Prepared Need Analysis Documents of the requirements gathered through JAD sessions.
• Documented all the changes in the initial templates and was responsible for Release Management.
• Assured that all artifacts are in compliance with corporate RationalUnifiedProcess (RUP) policies and guidelines.
• Reviewed Requirements & deliverables for delivery timeline.
• Used MS Visio to create Flow diagrams and Use Case Diagrams.
• Created presentations explaining the entire report development process, while drawing a comparison between the legacy & the new report.
• Coordinated with the developer, on day-to-day basis, during the development process.
• Tested the report for its content.
• Created Test Scripts & Test Scenarios to check report content, layout, and parameters.
• Involved in creating business processes and modeling diagrams using RationalUnifiedProcess (RUP)
• Worked on Report Re-engineering Project and made enhancements to the system flow.
• Modified System flow diagrams using SDLC.
• Develop business requirements document (BRD) based on user interviews and review of current state workflow/systems
• Tracked the defects in legacy reports as per account managers and end users. Compared the results and tracked the differences in excel
• Reviewed Stored Procedures for reports and wrote test queries against the source system (SQL Server) to match the results with the actual report against the Data mart (Oracle)
• Worked with ETL team during the upload process.
• Helped with Data Mapping between the data mart and the Source Systems.
• Used SDLC (System Development Life Cycle) methodologies like the RUP and the waterfall.
• Worked as a liaison between the Business and Technology Department.
• Enhanced communication lines between executives, managers, and peers

Environment: SQL Server, Rational Suite, Windows, Crystal Reports, Oracle, UML, MS Office, MS Visio, Clear Case, UML, Etc

Confidential, Nashville, TN

Business Analyst

Responsibilities:

• Prepared the Business requirement Document (BRD) and system requirement document (SRD) for the enhancement of the existing services.
• Gathered requirements by conducting interviews with end users. Prepared use cases, functional & system requirement specifications so that developers can understand the businessprocess and rules according to their perspective.
• Created requirements analysis and design phase artifacts usingRequisitePro and RationalRose
• Created workflow diagrams, UML diagrams, process models, activity diagrams, use cases, for incorporating design changes in the system.
• Established RUP (RationalUnifiedProcess) methodology and provided assistance in developing Use cases and project plans.
• Used Rational Tools for creating use cases, version control and defect tracking, monitoring. Use RationalUnifiedProcess (RUP) methodology in all areas of the software development life cycle (SDLC).
• Developed an automated approach for capturing all 837 data received that supports claim utilization and reporting.
• Developed business requirement for online web form for capturing application information
• Requirements Gathering & Analysis always ensured HIPAA Compliance Auditing.
• Analysis and Design of existing transaction sets, and modification of these transaction sets to ensure HIPAA compliance.
• Created, executed and translated manual test cases and scenarios into automated test scripts in order to validate functional requirements using Quality stage.
• Extensively worked Claims, Enrollment, Eligibility verification for Members and Providers, benefits setup, and backend payment cycle.
• Conduct Proof Of Concepts as and when required
• Conducted Risk Analysis to identify the risks associated with developing the patches, and formulated a Mitigation Plan to eliminate or reduce risks of high severity and any major effects.
• Conducted JAD sessions with business SMEs and developer.
• Collaborated with Quality Assurance Analyst in testing.
• Utilized RUP methodology during the project life cycle
• Developed test cases and performed UAT testing for all the files and reports

Environment: SQL Server, Windows, XML, Excel, Access, Visio, UML, Etc