SUMMARY

• More than 8 years of professional experience as a “Business Analyst” and “Certified Scrum Master’ in healthcare domain such as Healthcare Units, Health Insurance and exposure of pharmaceutical industry.
• Strong experience in Software Development Life Cycle (SDLC) methodologies, Waterfall, Agile and RAD (Rapid Application Development).
• Experience in conducting JAD sessions, project meetings, and walk throughs.
• Created various documents such as Business Requirement Document (BRD), Functional Requirement Document (FRD), Use Case Specification, RTM (Requirement Traceability Matrix), Test Cases and User Stories.
• Expertise in UML (class diagrams, object diagrams, use case diagrams, state diagrams, sequence diagrams, activity diagrams, and collaboration diagrams) as a business analysis methodology for application functionality designs using MS Visio and IBM’s Rational Rose.
• Experience in conducting User Acceptance Testing (UAT), Black box testing, and reviewed Backend testing using SQL Querying.
• Excellent knowledge of Health Administration - Claims processing (auto adjudication), EOB/Drafts, Claims pricing and testing, HIPAA, Enrollment, EDI, Medicare, Medicaid, HMO, POS, PPO, ObamaCare (Affordable Care Act).
• Worked on healthcare standards such as HIPAA 4010, 5010, ICD-9 and ICD-10 codes. Excellent knowledge of HIX and EDI Transactions (270, 271, 278,820, 834, 835, 837).
• Worked on Trizetto Facets for Medicare enrollment and claims.
• Strong knowledge of healthcare standard Health Level Seven (HL7), Health Information Exchange (HIE) or Marketplace.
• Experience with healthcare systems, Medicaid, and with prime focus on claims adjudication, provider, eligibility and prior authorization.
• Strong experience working with Medicaid and Medicare Part A, B, C, D (Medicare Prescription Plan) and have good knowledge and understanding of MMIS, and Electronic Medical Health Record (EMHR).
• Experience in conducting SWOT analysis, cost benefit and ROI.
• Excellent analytical, methodical, and resourceful approach to problem solving.
• Excellent team player with positive outlook, adaptable, time management and leadership skills.

TECHNICAL SKILLS

Methodologies: SCRUM, Agile, Waterfall, RAD

Agile Tools: JIRA, ServiceNow, RALLY, VersionOne

DBA Tools: My SQL, MS SQL Server 7.x/2000, MS-Access.

Documentation Tools: MS Office (Word, Excel, PowerPoint).

Collaborations: Tool SharePoint, Requisite Pro.

Reporting Tools: MS Access Reports.

Industry Standards: HIPPA, HL7

Designing Tool: MS Visio, Mock-Up Screens, e Draw, Excel

PROFESSIONAL EXPERIENCE

Confidential

Business Analyst

Responsibilities:

• Helped business owners understand and interpret complex government regulations and translate into the creation of new business processes.
• Customized a business process mapping and responsibility handoffs document to support business compliance in a large government program.
• Created glossary of business terms and definitions to help cross-functional business and IT support teams understand new government-defined, highly regulated and audited processes.
• Performing Stakeholder Analysis to identify key players for project success and stakeholder management to communicate effectively with the right stakeholders.
• Facilitating JAD sessions and scheduling meeting with developers and testers to collaborate resource allocation and project completion using MS Project.
• Drafting Business Requirements Document, validating business requirements with project stakeholders and conducting walkthrough meetings.
• Performed Requirement Analysis by gathering functional and non-functional requirements based on interactions with the process owners & stake holders and document analysis, represented them in Requirements Traceability Matrix (RTM).
• Providing implementation assessment for Rational Requisite Pro, Rational Rose, UML and RUP.
• Facilitate Story estimation and help with detailed tasks creation.
• Participating in providing user training, conducting user acceptance testing, recording and resolving issues and validating test scenarios with business users.
• Customized business rules, processes, and data requirements for integrating new product offerings specific for largest customer account.
• Predominantly worked on HEDIS rating tool in “Effectiveness of Care” domain to evaluate the healthcare plans performance.
• Worked on System Integration (X12 EDI-HIPAA 835) with Health plans eligibility and claim.
• Managed annual requirements and design updates to Product Management Catalogue (application and database) and downstream systems integration.
• Work on JIRA to monitor and update task, generate burn down chart as well as scrum board.
• Worked with product owner and scrum team to groom user stories in advance of each sprint.
• Helped the scrum team finalizes Sprint Backlog during planning and communicate committed user stories for the upcoming sprint to the Senior Management, stakeholders.
• Ensured that team vacations and holidays are reflected in available capacity, velocity and appropriate production and other support requirements are considered while determining the actual Sprint load.
• Scheduled and facilitated daily stand up meetings.
• Represented the team at the Scrum of Scrums (SoS) meeting to report progress. If deviating from the ideal burn down, then communicate team's plan/commitment to get back to the line.

Environment: MS Visio, Rational Requisite Pro, JIRA, Oracle 9i, SQL, PL/SQL, Quality Center MS Office, MS Project, Windows 2000.

Confidential, Irving Texas

Business Analyst

Responsibilities:

• Worked on Implementation of MMIS Health Enterprise System.
• Acted as a liaison between Business area Subject Matter Experts (SMEs) & development team throughout all phases of SDLC; starting from Inception to Transition phase of the life-cycle.
• Gathered requirements by different methods such as conducting JAD sessions, passing questionnaires and interviewing with the purpose of defining the business and functional business requirements. related to changes to be made to the claim entry screens, including Practitioner, Crossover Practitioner, Dental and Hospital Claim Entry Screens.
• Developed business and functional requirements for the National Provider Identifier (NPI) Crosswalk and Crossover Claims Crosswalk solution. Analyzed HIPAA EDI 4010 and HIPAA EDI 5010 standards for EDI 276/277 & 278 transactions and prepared gap analysis document for each X12 transaction.
• Good understanding and hands on experience with EDI transactions.
• Monitored the flow of data through EDI applications to ensure all operational systems are functioning properly when needed.
• Writing high-quality business andfunctional requirements documents for use by report developers in FACETS.
• Updated data processes, data reporting, data collection tools and other processes such as problem lists, writing orders, referrals according to ICD-10 code set.
• Contributed in ICD-10 Awareness Training Management Plan, created evaluation tool, and survey questions.
• Reported impediments for escalation identify and share risks/concerns for review at program level.
• Conducted time to time meetings with IT skill team to transfer business knowledge.
• Lead and coordinated activities of data architects, analysts and ETL developers for SQL.
• Monitored SQL for back end testing, data retrieval and data analysis.

Environment: MS Office, Facets 5.5, Oracle, SQL Developer.

Confidential, Oklahoma

Business Analyst

Responsibilities:

• Conducted JAD sessions for communicating with all Project stakeholders.
• Interacted with Subject Matter Expert’s (SME’s), Business users, Architects, Data Modelers to gather business process requirements and to translate them into functional specifications.
• Designed Business Requirement Documents (BRD) and Functional Requirement/Specification Documents (FRD)/ (FSD).
• Conducted Request for Information (RFI) and Request for Proposal (RFP) process for vendor products and facilitated Business and Technical teams in Vendor Selection Process.
• Developed Data Flow, Work Flow, Process Flow, and Entity Relationship Diagrams in MS Visio, and analyzed them to create "AS IS" and "TO BE" scenarios.
• Conducted Gap Analysis.
• Prepared data models that involved a set of diagrams and supporting documents that contained essential business elements, detailed definitions and descriptions of the relationships between that data elements to analyze and document business data requirements.
• Facilitated backlog refinement meeting, sprint Planning meeting, daily stand ups, sprint review and retrospective meeting.
• Performed User Acceptance Testing (UAT), created test scenarios/plans and developed test cases for testing the products to verify that client/vendor requirements are incorporated in to the system design.
• Performed regression testing to ensure the product integrity.
• Assisted in defining implementation and deployment tasks for the new platform as per requirement.
• Provided technical assistance in identifying, evaluating, and developing systems and procedures that are cost effective and meet business requirements.

Environment: Rational Rhapsody, MS SQL Server, SQL Server Management Studio, MS Office.

Confidential

Business Analyst

Responsibilities:

• In depth knowledge of Health Insurance process, Claims, HIPAA & its approved transaction codes.
• Interacted with business owners to identify business system needs, evaluated solutions for business problems and proposed alternate methods to increase efficiency
• Analyzed and documented requirements and the corresponding impact on business processes
• Analyzed and transmitted the business requirements into detailed project plans.
• Analyzed business requirements and organized high-level and low-level Use Cases, represented Activity, and State Charts
• Analyzed the business requirements for ICD 9 and ICD 10 conversion for the claims system
• Gathered user requirements and directed developers for practical deliverables.
• Worked with the full Software Development Life Cycle and its phases using Agile methodology
• Participated in eliciting, analysis and defining requirements.
• Conducted JAD sessions with the clients to identify the requirements.
• Followed the UML based methods using Rational Rose to create: Use Cases, Activity Diagrams/State Chart Diagrams, Sequence Diagrams
• Participated in Testing and Evaluation of projects at established integration points to assess progress and identify key functionality issues.
• Tracked UAT issues/bugs and prepared reports in Excel
• Performed job of contact point for all stakeholders (business, legal, compliance, development).
• Documented monthly status reports for enhancement and modification requests.
• Co-ordinated in development team to assist in efficient tracking.
• Participated in monitoring of open issues of the project.

Environment: MS Office, Balsamiq Mockups, BIG Data.

Confidential

Business Analyst

Responsibilities:

• In depth knowledge of Health Insurance process, Claims, its approved transaction codes.
• Interacted with business owners to identify business system needs, evaluated solutions for business problems and proposed alternate methods to increase efficiency
• Analyzed and documented requirements and the corresponding impact on business processes
• Analyzed and transmitted the business requirements into detailed project plans.
• Analyzed business requirements and organized high-level and low-level Use Cases, represented Activity, and State Charts
• Gathered user requirements and directed developers for practical deliverables.
• Worked with the full Software Development Life Cycle and its phases using Agile methodology
• Participated in eliciting, analysis and defining requirements.
• Performed job of contact point for all stakeholders (business, legal, compliance, development).
• Documented monthly status reports for enhancement and modification requests.
• Co-ordinated in development team to assist in efficient tracking.
• Participated in monitoring of open issues of the project.

Environment: MS Office, PlantUML, Oracle