SUMMARY:

• 7+ years of experience as business analyst performing business requirements modeling, risk analysis, software validation and development of Web Based, and Client/Server applications in diverse business domains of Healthcare/Insurance and Service Industry domains.
• Expert communicator and facilitator with great interpersonal skills - effective in interactions with business and technology professionals as well as executive management.
• Entrepreneurial self-starter capable of functioning with equal efficiency as an individual contributor or a team leader/player.
• Good knowledge on ICD, EDI, HIPAA and CMS.
• Experienced in managing various aspects of the software development lifecycle (SDLC) including requirements gathering, design, development, testing, deployment and support.
• Wide-ranging experience in managing artifacts in methodologies such as Waterfall, RUP, Agile (SCRUM).
• Have worked for evaluating the COTS solutions.
• Extensive knowledge in creating BRD, FRD and RFP documents.
• Experience with business process re-engineering and lean Six Sigma tools and methodologies.
• Worked in close coordination with the technical team in developing use cases, test plans and test cases from functional and business requirements.
• Facilitated and participated in Joint Application Development (JAD) and Joint Resource Planning (JRP) sessions with management, SMEs, vendors, users and other stakeholders.
• Experience working with the business users as well as the senior management for web-based, and client server applications.
• Strong communicator and problem-solver skilled at analyzing/eliciting business needs and transforming them into technical designs, applying technical skills and business knowledge to achieve sound results.
• Extensive knowledge of wireframe and its elements.
• Excellent interpersonal dexterity with proven ability to converse, liaise, negotiate and relate with a wide range of personalities from diverse socio-economic and cultural backgrounds.
• Excellent knowledge and deep understanding of industry standard methodologies like Software Development Life Cycle (SDLC), Iterative Software Development Life Cycle Process as per Rational Unified Process (RUP), CMM (Capability Maturity Models), Market Prominence’s automated solution, Capability Maturity Model Integration (CMMI) and Six Sigma and Rational Tools used during various phases of RUP such as Inception, Elaboration, Construction and Transition.
• Adept at reducing development costs and providing traceability of projects.
• Familiar with current industry standards such as ISO, Six Sigma, and Capability Maturity Model.
• Experience withhealthcare reform (HCR)and healthcare payer systems.
• Result oriented, committed and hard working with a quest to learn new technologies and undertake challenging tasks.
• In-depth knowledge of HL-7 and HIX (Health Information Exchange)
• Good Knowledge of EMR/EHR, Health Care Reform and Patient Protection and Affordable Care Act (PPACA)
• Good Knowledge and Experience withlearning management system.
• Excellent time management and people skills, which aide in conducting project meetings, reviews, walkthroughs, and customer interviews.
• Have an EBS experience with EDI transaction for more than 2 years. Have an experience with MITA(Medicaid information technology architecture).
• Knowledgeable for gap analysis in changing old MMIS and Involved in testing new MMIS.

TECHNICAL SKILLS:

Requirement Management: Rational Requisite Pro, CaliberRM, Rally, DOORS

Methodologies: Agile/Scrum, RUP, Waterfall

Languages: SQL, C, C++, Java, .Net, HTML

Modeling Tools: MS Visio, Rational Rose

Defect Tracking Tools/Change Management Tools: Bugzilla, Rational ClearQuest, Footprints, JIRA

Wireframe/Mockup Tools: Axure, Balsamiq

Mapping Tool: Pervasive PSQL v10

Database: Oracle, MS SQL Server, Teradata, DB2

Testing Tools: HPQC

PROFESSIONAL EXPERIENCE:

Confidential, Windsor, CT

Business Analyst

Responsibilities:

• Document Trading Partner Migration Process Flow from HIPAA 4010A to 5010; create process flow diagrams and presentation materials; and monitor production and release events.
• Interpret Systems Architect and Logical Diagrams to business users and other stakeholders, and assist with change requirements elicitation.
• Assist in writing business requirements and system specification documents.
• Extensively work on EDI transactions 834, 835, 837I, 837P, 820, 270/271, 276/277, and 999.
• Responsible for interpreting ASC X12 Original and Errata version documents such as X12 220, 221A1, 222A2, 222, & 224A2 to business and technical users including the developers.
• Research, track, parse and interpret EDI files 999, Transaction Acknowledgement records, and enrollment and claims files in EDIFECS data repository and UNIX server and analyze them according to the request.
• Conduct operational and implementation assessment of project tasks and prepare budget estimate documents for change request using standard templates.
• Conduct ICD-9/ICD-10 conversion analysis through ICD 9 and ICD 10 proposed mapping documents and HIPAA 5010 system capabilities of EDIFECS tools. Update mapping documents as required for version upgrade and change requests.
• Has actively used to input for HLI LEAP I-10 Tool.
• Work as a liaison between Confidential and Confidential and responsible for all the Cross Functional Communication.
• Monitor various files transfer events and repository records for claims, enrollment, remittance and status inquiry records in Trading Partner Gateway (HIPAA Gateway), transactional, operational and mainframe data repositories.
• A repository for mainframe tape data is a combination of equipment and software tools that operates outside the mainframe environment to provide long-term storage,access,and management of “migrated” legacy tape data.
• Perform AS IS and To BE analysis for EDIFECS Standards- HIPAA 5010 Database Setup for new version releases. Documented proposed changes and coordinated development, testing and production release environments, including end-to-end testing.
• Validating the Log Files (999, X12) for 834/820, 277CA, 837IB and 835 Transactions in UNIX and HTM (Healthcare Transaction Manager).
• Responsible for preparing and presenting technical reports and documents to stakeholders in client facing environments. Moderate teleconferences and JAD sessions.
• Extensively use Quality Center to manage defects, change request and pre-uploaded requirements and mapping documents.
• Being a Risk management business analyst I had spent half of my time in studying the financial risk management.
• Have produced wireframe and User interface mockups. Also have extensively used Information design, navigation design and interface design.
• Have done the claims editing “scrubber” in Facets. Has good knowledge over facets and has worked over it extensively
• Conducted sessions over MITA and practiced it. Worked over Companion guide.

Environment: Oracle, JAVA, XML, Quality Center, Caliber RM, Enterprise Manager,Wireframe, UNIX, Excel, Visio, EDIFECS (Transaction Management, Ramp Management, XEngine, & Spec Builder), C++, FACETS, SharePoint, Rational Requisite Pro, MetaVance, and Confidential Virtual Room

Confidential, Philadelphia, PA

Business Analyst

Responsibilities:

• Gathered requirements from subject matter experts (SMEs) and documented the BRDs; constantly communicated risks/contingencies to project managers and consulted with technical development staff to clarify business requirements from the business users.
• Interviewed business users and SMEs to elicit requirements. Worked on developing the functional requirement documents (FRD) and Use Cases for FACETS batch process; automating the billing entity, commission process and Medicare enrollment.
• Conducted HIPAA Conversion Analysis - contribute in the documentation of HIPAA 5010 changes toEDI 837, 834, 835, 276, 277transactions sets.
• Performed Analysis ofICD 9 Procedure and Diagnosis Codesin accordance withICD 10-CM and ICD 10 PCS Conversion Compliances using GEM.
• PerformedGAP analysis toassess“AS IS”and“TO BE”scenarios between HIPAA 4010 and HIPAA 5010 and conversions of codes from ICD 9 to ICD 10.
• Worked inFACETS Configuration, Data Element Definition and Usage, and completed configuringFACETSApplications such as Related Entity, Parent Group, Group, Subgroup, and Member/Subscriber.
• Have extensively worked over mainframe data repositories.
• Formulatedsystem design, methods, procedures, policies and workflows affecting Medicare/Medicaid claims processing in compliance with government compliant processes such asHIPAA/ EDIformats and accredited standards.
• Extensively worked in customization and configuration ofClaims Processingapplications inFACETS 4.71. Involved in reconfiguration ofFACETSin functional areas, including Membership, Claims, Provider, Enrollment and Service Modules.
• Coordinated the upgrade of EDI Transaction Sets 837, 835 and 834 to HIPAA compliance. Work on EDI 834-file load in Facets through MMS (Membership maintenance sub-system).
• Vendor Management - Worked as a facilitator and point of contact person for Testing Efforts and New Requirements between theHealthcareCompany and its various Vendors.
• Maintained theTraceability Matrix to ensure accuracy and consistency of project success. Deal with data mapping issues between various source systems, staging area and data marts.
• Worked with theUAT and QAteams to conduct an assessment and determine how effective UAT and QA guidelines can help the company achieve timely completion of projects.
• Analyzed dataand create reports usingSQLqueries for all issued Action Items.
• Knowledgeable for gap analysis in changing old MMIS and Involved in testing new MMIS.
• Worked in MMIS for claim processing, reimbursement and claim Edjudication.
• Documentation of business and technical requirements, preparation of cost analysis and implementation of new MMIS automation system.

Environment: MS Visio, MS Office, Rational Rose, SQL, Oracle, FACETS 4.71, Requisite Pro, BizTalk Server, PowerPoint, MS Excel, MS PM, Java

Confidential, Louisville, KY

Business Analyst

Responsibilities:

• Assisted in the initial project planning with the management along with project scope, budget, timelines and other parameters.
• Used Rational Rose to assist in engineering and development of Logical, Activity and Component views to better understand the requirements.
• System requirement specification documents, Test Cases and Test plans were extensively reviewed and analyzed.
• Conducted GAP analysis to determine the project’s current status against the expected.
• Extensively used Rational Unified Process (RUP) guidelines through the SDLC
• Produced wire frames, UI mockups or functional prototype to demonstrate requirements to Project stakeholders.
• Used Rational Clear Quest to maintain and track changes and enhancements done by the stakeholders.
• Business Use Cases Models, Use Cases and Vision Document were presented and explained to the development team.
• Developed Class, Activity and Sequence Diagrams and Collaboration diagrams to better visualization of the project by various teams.
• Rational Requisite Pro was used to reviewing and analyzing user requirements
• Traceability Matrix was used throughout the project to track changes.

Environment: Rational Unified Process (RUP), UML, Dreamweaver, Rational Test Manager, WinRunner, MS Office, HTML, SharePoint 2007.

Confidential, IL

Business Analyst

Responsibilities:

• Involved in the analysis of the existing credit card processing system, mapping phase according to functionality and data conversion procedure.
• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims.
• Followed solely RUP methodologies during the course of the project.
• Upgraded the existing Test Scripts and created new scripts for client application to be able to work for new versions and patches, which improved product quality.
• Provider inquiry about the status of Remittance Vouchers (RVs). This involved checking the MMIS provider subsystem and checked the setup of their Remit Media
• Created Data Stage jobs to extract, transform and load data into data warehouses from various sources like relational databases, application systems, temp tables, flat files etc.
• Accumulated system requirements from various departments through surveys and interviews.
• Performed Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data
• Conducted JAD sessions with management, SME, vendors, users and other stakeholders for open and pending issues.
• Created Use Case Diagrams, Activity Diagrams, Sequence Diagrams and ER Diagrams in MS Project.
• Assisted in the development, design and implementation of new relational or multi-dimensional databases, including the analysis of user needs.
• Created and managed project templates, Use Case project templates, requirement types and traceability relationships in Requisite Pro.
• Involved in writing the detailed Test Plan using Mercury Quality Center, after analyzing business requirements and software/functional requirement artifacts.
• Worked extensively with MS Excel and MS access
• Performed data analysis by using SQL queries using the DB Artisan tool
• Suggested measures and recommendations to improve the current application performance.

Environment: Rational Enterprise Suite (Rose, RequisitePro, ClearCase, ClearQuest), MS Office, Oracle, DB2, MS Visio, MS Project, RUP, Lotus Notes.