SUMMARY:

• 8 years’ experience as a Business System Analyst in the HealthCare industry working with companies like Anthem, Harvard Pilgrim, Govt. of Nebraska, Confidential and Confidential .
• Specific expertise in Business Analysis, GAP Analysis, Data Analysis, Business Rules and developing and creating business process documents.
• In depth knowledge and hands on experience working with SDLC methodologies like Waterfall, and Agile.
• Expertise and experience in preparing Business Requirement Documents, Use Case Specifications and Functional Specifications.
• Good knowledge of important and frequently used UML diagrams such as Use Case Diagram/Template, Activity Diagrams and Sequence Diagrams.
• Experience in facilitating Joint Application Deployment (JAD) sessions for gathering requirements and brainstorm ideas.
• Well experienced with the complex tasks of ICD 9 to ICD 10 conversion and mapping.
• Strong understanding of EDI Claims, Member Enrollment, Eligibility, and HIPAA 5010 standards
• Knowledge of different modules within Healthcare Claims Adjudication Process ( process, billing process and enrollment & Claims process).
• Excellent experience in 837 - Claims processing and Encounters, 834 - Member Enrollment, 835 - Claim Payment/Advice
• Knowledge and experience working with FACETS 4.71 & 5.0claims processing.
• Experienced working with Claims Management System.
• Experience in defect management using Quality Center.
• Hands on experience in writing SQL queries for data extraction and mapping.
• Excellent project management skills and hands on experience working with software like Microsoft Project.
• Excellent working knowledge of requirement management tools like Rational Requisite Pro.
• Strong understanding ofFACETSandFacets Data Modelworking on data model and data extracts.
• Experience with handling UAT.

TECHNICAL SKILLS:

Methodologies: Waterfall, Scrum, Agile XP/UML

Testing Tools: Quality CenterJIRA, Requisite Pro, Share Point

Office Tools: Word, Excel, PowerPoint, Access, Project

Wire framing Tools: Visio

PROFESSIONAL EXPERIENCE:

Confidential, Norfolk, VA

Business System Analyst

Responsibilities:

• Assessed and documented high level business requirements to meet stakeholder’s expectations.
• Gathering requirements and preparing functional documents forFacets4.71.
• Created Source Data Requirement Specification document for Analytics Integrated Warehouse.
• Performed Data mapping of the extracts with the help of data modeling diagram using Facets Tool.
• Participated in facilitation of business process review and developer walkthroughs based on the required feeds.
• Determined the Project Milestones and deadlines and ensured they were adhered to.
• Raised SFTP transfer protocol request for transferring files between two remote systems.
• Following up with the EFX team for successful transfer of files.
• Updating daily Project status reports on company Dashboard.
• Run sequel query to extract raw data, convert to excel file and analyze for duplicates and nulls.
• Work with the developers to remove duplicate data.
• Ensure there are no null values populated for Not Null fields.
• Executed SQL queries to test back end data validation.
• Analyzed testing impact of requirement changes and modifying test scenarios as needed adhering to the system development life cycle and project management life cycle methodologies.
• Executed UAT Testing for the test scenarios.
• Fix the defects logs and provide an updated test files.
• Obtained business sign off after defect resolutions.
• Worked with customers and end-users, appropriate IT personnel and software vendors on a regular basis to align technology functionality to operational processes.
• Coordinated with the operational associates to gather expected values and description for the data using data dictionary.

Environment: Oracle, Facets, SharePoint, JIRA, Agile XP, Quality Center

Confidential, Boston, MA

Requirements Analyst/ Business Systems Analyst

Responsibilities:

• Read and analyzed the federal legislation to update the products as per the mandated provisions of HCR.
• Interacted with senior business teams and legal firms to gather and analyze requirements.
• Participated in various JAD sessions involving various business and technical teams.
• Documented various Use Case scenarios, Process Flows and other diagrammatic representations in MS Visio pertaining to various provisions of HCR.
• Performed Gap analysis for various existing product lines and operations with respect to HCR.
• Worked extensively on all the mandated first phase of provisions of Health Care Reform.
• Responsible for gathering and documenting Legislative, Business, Functional requirements for all the provisions and their impact on the existing products and systems.
• Gathered and documented functional requirements pertaining to Facets
• Extensively used Requisite Pro and other Rational tools for Requirements Management and their traceability.
• Gained extensive experience related to various product lines and impact on the respective products due to HCR.
• Worked on the modification of Pricing Modeler of the various systems.
• Gained extensive experience regarding all phases of Requirements Management and Change Control for various projects.
• Ensured legal compliance of the corporation in regards to the mandates of the Federal and State regulations.
• Worked with Customer Care department to document the User Guides and Corporate Communications regarding policies and products.
• Attended sessions for the latest versions of existing Rational tools such as Rational Requisite Pro 7.1.1, and Rational Clear Quest 7.1.1.
• Analyzed the structural and operational impact of ICD-10 on the current systems.
• Worked for Provider & Quote to Bill team for requirements gathering and documentation phase.
• Interacted with various departments and application admin regarding the impact of ICD 10 into the system.
• Managed all the ICD 10business and functional requirements and related attributes on the latest version of Requisite Pro 7.1.

Environment:, HP Quality Center, Slick Edit, Rational Clear Quest 7.1.1,Agile XP

Confidential

Business System Analyst

Responsibilities:

• Analyzed the impacts of HIPPA 5010 project on enrollment, Claims and Benefit.
• Gathered, defined and documented highly complex business requirements forNPI crosswalk implementation.
• PerformedGap Analysisfor HIPAA 5010 enhancement using the TR3 implementation guides, Washington Publications and side-by-sideHIPAA guides provided by CMS (Center for Medicare & MedicaidServices).
• Review and understand theclaims processand complex requirements for the enhancement of the current system created under theRequirement Specification Documentsafter conducting interviewswith End Users, JAD Sessions and analyzed their current systems.
• Documented complexBusiness requirementsand madeprocess flowdiagram for the837, 820, 834, 278REQ transactions as per the implementation for the Medicaid claim processing system enhancement.
• Worked onData Mappingdocuments explaining flow of data from one-to-another table for the system enhancement purpose required by HIPAA 5010 implementation.
• Worked with technical staff and business users to problem-solve and identify workable solutions.
• Worked as an Interface between the users and the different teams involved in the application development for the better understanding of the business and IT processes.
• Maintained Requirements Traceability Matrix (RTM) throughout the project.
• Performed manual testing bybuilding 837 claims, converting them into EDI file, uploading them intomainframe regionand doing error resolution & testing for 5010 requirements & NPI crosswalk.
• EDI file testingfor checking the HIPAA 5010 (X12) compliance of the inbound 837 claims.
• Testing of outbound 820, 834, 278RESP EDI files.
• Working on As-Is To-Be analysis ofICD-9 to ICD-10conversion for the new qualifiers used in the 837 claims for the Diagnosis and Surgical Procedure codes.
• Working on Impact Analysis of ICD-09 to ICD-10 on the current Legacy Systems.
• Working on the GAP Analysis of PHASE I and PHASE II rules of AS-ECS (As Simplification Electronic Claims Status).
• Conducted User Acceptance Testing and User for the HIPAA 5010 Project.

Environment: Agile methodology, MS Project, FACETS, Quality Center, MS SQL Server 2005, MS Share Point, MS Office 2007 (Word, Excel, MS Access, PowerPoint), MS Visio

Confidential, Dublin, OH

Business Analyst

Responsibilities:

• Conducted meetings with business process owners, SME (subject matter experts) and Trading Partners for requirement gathering during the definition stage.
• Analyzed the data movement between systems in order to validate the Business Requirements.
• Worked on data mapping to bring data from one system and reside in another system.
• Carried out forward/ backward mapping when necessary.
• Participated in daily scrum meetings, product estimation and grooming sessions, determined acceptance criteria for user stories.
• Created Use Cases and maintained the traceability matrix.
• Worked on FACETS claims processing, payment adjustments, claims inquiry, benefits,
• Conducted JAD sessions to understand the detailed requirements.
• Actively participated in status report meetings and interacted with developers to discuss the technical issues.
• Helped developers with the following list of HIPAA-EDI Transaction Code Sets: (837, 835, 270/271, and 276/277)
• Conducted walkthroughs and defect meetings periodically to assess the status of the testing process.
• Followed workgroup for EDI standards for testing that need to comply with the HIPAA guidelines.

Environment: Facets 4.71, Windows, MS office, MS-Visio, Microsoft Project, HP Quality Center.

Confidential, Woodland Hills, CA

Junior Business Analyst

Responsibilities:

• Interacted with the stakeholders and end users in order to define the purpose and scope of application and gather User Requirements.
• Developed Process/workflow analysis by understanding the process modeling.
• Validated business requirements by facilitating JAD sessions.
• Designed and documented Business Requirements (BRD) by using ASCI ASX X12 EDI guides, reviewed and interviewed business process owners and companion guides.
• Prepared business requirement documents and functional requirements using Rational Requisite Pro.
• Facilitated meetings with users for requirement collection, design changes and feedbacks.
• Escalated issues and reported them as appropriate to Project manager and management for support and guidance.
• Identified issues and worked with application and data team to resolve.
• Prepared Project Plan and Production deployment schedule using MS office tools (Word & Excel).
• Followed UML based methods using MS Visio to develop use cases and activity diagrams; assisted developers in creating sequence diagrams and collaboration diagrams
• Prepared user instructions and use cases to conduct User acceptance testing (UAT).
• Facilitated the requirement changes and fixes along with the release management team.

Environment: Waterfall, MS Office, SQL Server 5.0, QTP, Quality Center