OBJECTIVE

• To take a challenging role on business operations as Business Analyst and give cost effective and efficient solution that would enable organization increase its productivity and lead the market.

SUMMARY

• 7+ years of experience as a Business Analyst and worked extensively in Healthcare domain in diverse business and technical environments.
• Extensive knowledge of HIPAA transaction codes4010/5010 (Standard Transactions) and X12EDI transaction codes such as 270/271 (Eligibility Transaction Processing), 276/277 (Claims Inquiry Transaction Processing), 278(Service Authorization Processing), 835 (payment or remittance advice), 837 (Claims Submission Processing) and 834 (benefit enrollment).
• Knowledge of Healthcare insurance including Medicaid information technology, Medicare part A, B,C, D and Medicaid management information system (MMIS).
• Strong knowledge of EDI formats and HIPAA 4010 to HIPAA 5010 changes to these formats. Hands on experience with ICD - 9 to ICD-10 conversion, CPT and other code sets.
• Detailed knowledge of standard EDI messaging protocols (FTP, SFTP, X12, XML, HL7. CSV, SOAP and others).
• Solid understanding of all phases of Software Development Life Cycle (SDLC) methodology (such as requirement, analysis, design, data modeling, business process modeling, implementation and deployment), Waterfall and Agile Methodologies.
• In-depth knowledge of Rational Unified Process (RUP); risk engineering, data modeling and mapping, and design using UML (Unified Modeling Language), Rational Rose and Visio.
• Extensive experience in conducting Joint Application Development (JAD) sessions/ workshops for project definition, requirement analysis and user interface.
• Profound experience in preparing Use Cases, diagrams (Activity, Class, Sequence), Business Requirements Document (BRD), Functional Requirement Document (FRD), Requirements Traceability Matrix (RTM). Experience in conducting SWOT Analysis, Cost Benefit and ROI Analysis.
• Excellent oral and written communication skills with a demonstrated capability for dealing with all levels of client management personnel and staff.
• Comprehensive knowledge of Test plans, Test cases and test scripts from the Requirements Document. Experience in User Acceptance Testing, Smoke Testing, Regression Testing Performance Testing and Functional Testing.

TECHNICAL SKILLS

Databases: MS SQL, MS Access, Oracle

Languages: Visual Basic, JavaScript and HTML

Methodologies: SDLC, RUP, UML, CMM

Operating Systems: Microsoft Windows (XP and above)

Project Management: MS Office Suite (Word, PowerPoint, Excel, MS Project)

Change Management: Rational Clear Quest

Business Modeling Tools: MS Visio, Rational Rose

Other Packages: Business Objects Crystal Reports, BMC Remedy AR System and ITSM application suit

PROFESSIONAL EXPERIENCE

Confidential, Virginia Beach

Sr. Business Analyst

Responsibilities:

• Leading the implementation of Tennessee Market for Enterprise reporting.
• Requirement analysis of complex ad-hoc reports to enable process and trend analysis and provides recommendations for the implementation of new/revised operational and/or reporting processes. Prioritize analytical and reporting requests from senior business leaders.
• Managing resources of business analyst and developers to research, gather requirements, develop and test regulatory and operational reports for Tennessee Expansion and Medicare in multiple domain including, Claims, Members, Providers, Appeals and Grievances and Pharmacy.
• Develop and analyzes business performance reports for claims data, provider data, utilization data and develops ad-hoc reports to conduct data analysis and validation.
• Facilitating dialogue and collaboration efforts through SDLC between multiple stakeholders and conducting JAD sessions.
• Managing business owner and state expectations of report scope and timelines.
• Managing and communicating a prioritization plan to prevent state sanctions and fines.
• Continuing to improve internal departmental processes, tools, documentation standards, and metrics
• Researches methodologies and conducts advanced metric reporting.
• Prepares detail and summary level reports including written interpretation of analytic results.
• Lead the design and data delivery of a new set of business insights and analytics which will be used for quarterly reporting: initial requirements gathering, data discovery / gap analysis and the development of accurate and insightful reports and analysis.
• Create and prepare regular monthly, quarterly and ad-hoc reports; proactively assess data, identify trends and recommend solutions.
• Develop new ways of bringing together complex sets of analytics and business intelligence into compelling data visualizations, info graphics and other creative ways to tell our story.
• Identify opportunities to drive efficiencies in reporting processes, including the automation of existing manual data sets. This includes everything from developing requirements to testing new reports.
• Interface with internal customers to gather business requirements and deliver complete reporting solutions.
• Perform and/or drive actual development of approved solution. Identifies and drives associated data mining and analysis using tools such as MSSQL, SQL Queries, Excel and Access.
• Document developed solution(s) and provide solution knowledge to other team members; responsible for developing and executing test plan associated with developed solution or reporting effort.
• Work with business stakeholders to ensure solution meets business requirements and can be successfully implemented and maintained.
• Team Building and Leadership - Successfully transformed a 35 person waterfall based organization to sustainable SCRUM based teams functioning at high levels while transforming a client server system to modern cloud based SOA architecture for commercial viability on a SAS platform.
• Created and executed test plan and scripts by using SQL queries and front end of Facets.
• Provided technical and procedural support for User Acceptance Testing.
• Reporting solution implemented using Agile Scrum methodologies.

Environment: Windows server, MS-SQL Server, MS Office, FACETS, Business Objects, SQL server reporting service, SSIS.

Confidential, Long Beach

Business Analyst

Responsibilities:

• Analyze data spread sheets to map the Ika systems Claims, Members, Benefit, Provider, Billing, Payment, Contract, Capitation modules with Confidential enterprise data ware house.
• Performed multiple source system analysis to identify the source data that needs to be moved into the target tables.
• Created data flow diagrams, data mapping from Source to stage and Stage to Target mapping documents indicating the source tables, columns, data types, transformations required and business rules to be applied.
• Worked on EDI transactions (270,271, 276,277, 834, 835,and 837). Performed front end to backend mapping and analyzed the start to end of transaction.
• Developed data requirements for data dictionary and data discovery document. Used SQL queries for data discovery.
• Acted as liaison between business owners, developers and QA team to ensure enterprise data needs were met and worked closely with IT Project Managers to report project progress. Validated data mappings, data discovery with development team.
• Worked closely with systems analysts to ensure functional specifications are properly accounting for business needs. Facilitated meetings, as necessary, to review captured business needs and obtain approvals.
• Develop business use cases, business and data requirements, and related documentation in support of Enterprise Data Management.
• Responsible for review of business capabilities and requirements in order to define data needs and enterprise data management. Includes data analysis of business and user needs and documentation of data and mapping requirements.
• Coordinates with both business and IT partners to ensure business, data needs and views are properly represented throughout the project lifecycle and coordinate communication regarding implementations.
• Prepared Mapping document, data flow diagram, Process flow diagram using MS Visio.
• Conducted reporting requirements from the data ware house and analyzed the tables and columns to be added in the oracle data ware house from the sql server through transformation engine.
• Agile Methodologies is used to implement the project.

Environment: Windows server, MS-SQL Server, Oracle SQL Developer, MS Office

Confidential, NJ

Business Analyst

Responsibilities:

• Analyze raw document generated from worldwide internal groups and trace individual requirements. Conducted requirement analysis sessions to confirm the requirements from the document are still valid and/or need any update. Prepared business requirements & functional requirement documents, process flow, status and use case diagrams, data access/ security model, mockup screens, report requirements document.
• Demonstrated products comparison to management that fulfills most of the requirements off the shelf with high ROI and short implementation time, easy to manage, support and extend in future. This enabled management to choose right product, Column Case Management which is built on BMC’s AR System.
• Conducted Joint Application Development sessions with Vendor, IT Support, QA Team to transmit correct functional requirements with clarity on group/ individual data access control, global/local regulations.
• Coordinated different group to get standard master data as per vendor data template.
• Validated design and implementation document, Application management, User and Administration help guides.
• Participated in UAT, Smoke Testing, retesting of bug fixes.
• Managed go-live, change control and releases.
• Developed basic and intermediate reports using business objects crystal reports to help management to make business decisions, evaluate support performance, organization level service agreements and accomplish organization goals.
• Project was implemented using Agile Methodologies.

Environment: Windows, IIS7/Tomcat, MS-SQL Server, BMC AR System, Case Management, MS Office

Confidential, Hartford, CT

Business Analyst

Responsibilities:

• Generated requirements through JAD sessions, discussions and one-on-one interviews with stakeholders. Interacted with business managers and other stakeholders to determine project scope thus defining key challenges, risks and project deliverables.
• Performed GAP Analysis for HIPAA 4010to 5010 Migration. Also carried out gap analysis for the various loop, segments, elements like ICD 9, ICD 10 diagnostic codes, mapping of NPIs under the NM108 segment and removal of REF*IG segment were performed under the latest addenda versions of 5010X223A2 and 5010X222A1 and documenting the BRD for the same
• Created process flow diagrams for all “As Is” and “To Be” scenarios using MS Visio
• Extensively used MS Visio and UML for generating class object, component, deploying, use-case, sequence, collaboration, state and activity diagrams.
• Worked on EDI X 12 transaction set 837 I/P/D, 834,276/277 feeds to allow for change in the claim number.
• Participated in Forward Mapping and Backward Mapping analysis ofICD 9 - ICD 10.
• Implemented EDI maps using Trusted Link Enterprise. Use of Sterling Integrator Map Editor for both: get flat file layout and after data extraction translate input to EDI invoice (810)
• Reviewed and validated requirements and technical specification, developed test plan and executed test cases for performance benchmarking.
• Identified and reported project issues, risks and communicated among team members. Recorded, tracked defects using standard test tools.
• Analyzed the FACETS (claim engine) data for new requirements and enhancement.
• Working knowledge of the data mode, data fields of the FACETS system and worked on FACETS tables such as Provider, Contract, Benefit, Claim details and Member. Worked on Claims attributes, Provider attributes, enabling EOB & Remit rules associated with Provider configuration process in FACETS.
• Resolved project related technical questions and issues with collaborating development and infrastructure teams.
• Provided test execution results and analyzed test results to ensure existing functionality.
• Conducted User Acceptance Testing (UAT) and after interacting with the end users and collecting their feedback: documented the changes/enhancements required.
• Worked on generating the companion guide for the various trading partners depending on the SNIP WEDI edits from level 1 through 7 and generating Business edits for the 5010 837P and 837I Transactions sets for the HCFA and UB ( Inbound and Outbound).

Environment: UNIX, PL/SQL, Quality center, QTP, Oracle, PVCS, FACETS, Trusted Link6

Confidential, OH

Business Analyst

Responsibilities:

• Organized JAD (Joint Application Development) and RA sessions, interviewed business users to capture requirements and business process flow.
• Developed UML Use Case model for the application using Rational Rose and assigned to prepare the detailed work flow diagram based on the proposed enhancement for the system.
• Identified the use cases from the gathered requirements and prepared a comprehensive Use Case Specifications document.
• Involved in all phases of software development life cycle in RUP framework.
• Analyzed, documented, and managed all project requirements and requirement change control.
• Extensively interacted with both user group and development team to prepare structured charts, class and sequence diagrams.
• Assist QA for executing System/ Integration testing and on working with Test Director.
• Chaired project status, defect tracking and release meetings.

Environment: Windows, IIS 6, Oracle, ASP.NET, Win Runner, MS Office

Confidential, NY

Business Analyst

Responsibilities:

• Conducted detailed and comprehensive business analysis by working with the IT staff, senior SME tellers, supervisors, and end-users, in order to identify system and operational requirements and enhancements.
• Demonstrated business requirements, process improvement and optimization of business processes with new enhancements.
• Analyzed and documented business requirements and prepared functional requirement document for developers, project managers, quality assurance engineers, and technical writers to build an application.
• Drafted UML diagrams to illustrate clearly, the workflow of the online services, both for the management, and technical departments (design, developers, etc.).
• Tracked and maintained stakeholder requested enhancements and changes using Rational Clear Quest.
• Reviewed development plans, quality assurance test plans, and user documentation to ensure correct interpretation of original specifications.

Environment: Linux, Apache/tomcat, Java, Oracle, MS Office