Summary

• Facilitator between Business Systems and Information Technology with more than 8 years of various environment experiences in the field of business analysis.
• Several years of experience and advance knowledge of the Systems Development Life Cycle SDLC , and project life cycles like Waterfall, Agile, Rational Unified Process RUP , Prototyping.
• Strong knowledge and working experience of industry standards such as HIPAA, SOX, ICD-9, ICD-10, EDI, Sunshine Act, transaction syntax like ANSI X12.
• Participated and actively functioned in Joint Application Development JAD . Adept in implementing requirements, creating project status reports and presentations. Conducted Requirement Gathering Sessions and interviewed subject matter experts. Have strong client Interface Skills.
• Strong knowledge of EDI Claims, member enrolment, billing transactions, claims management process, Medicaid and Medicare Services.
• Developed Test plans, Test cases and Test scenarios to be used in testing based on business requirements, technical specifications and/or product knowledge. Proficient with HP Quality Center/ALM 11.0.0.
• Understanding the Business Intelligence concept, using set of methodologies, processes, architectures, and technologies that transform raw data into meaningful and useful information used to enable more effective strategic, tactical, and operational insights and decision-making.
• Strong knowledge and understanding of Medicare and Medicaid insurance data, Medicare parts A, B, C D , and insurance claims.
• Vast experience in requirement gathering for business and application requirements, business processes, identifying risks, gap analysis, impact analysis, UML modeling, Sequence and Activity Diagrams using Microsoft Visio and Rational Rose.
• Adept at writing Data Mapping Documents for Data Transformation and Data Migration.
• Experienced in conducting GAP analysis, User Acceptance Testing UAT , SWOT analysis, Risk Analysis and mitigation plan, Cost benefit analysis and ROI analysis.
• Well versed with ICD9, ICD10, CPT, HIPAA, claim adjustments, claim processing, claim review, identifying claims processing problems, their source and providing alternative solutions.
• Adept in conducting Use Case Analysis, Impact Analysis and Requirements Traceability.
• Strong knowledge of Data Modeling, Data Warehousing and Data Mapping.
• Experience in RDBMS and Data Warehousing experience in design, development, testing, implementation and support of enterprise data warehouse.
• Experience in development of ETL mapping scripts.
• Extensively worked and presented several documents and Use Cases for multiple transactions including 834, 835, 837, 276, 277, 270, 271 transactions for ongoing industry projects.
• Thorough knowledge and expertise in Microsoft Office suite Word, Excel, Access, Visio, PowerPoint and Outlook for documentation, analysis and presentation.

Management tools/skills

• Tools: MS Visio, HP Quality Center, MS Project, Rational Enterprise Suite, Rational Test Manager, Oracle UPK, Rational Rose, Requisite Pro, UML, Microsoft Office, MS Access, Share Point.
• Bug Tracking: Rational Clear Quest, Quality Center/ALM 11.0, Test Manager
• Software Lifecycle Management Methods: Waterfall, Agile, Prototyping, Rational Unified Process RUP , Joint Application Development JAD
• Full Lifecycle Software Development Tools Methods: Object Modeling Technique, Use Case Method, Data modeling techniques
• Methodologies: Rapid Action Development RAD , Joint Application Development JAD , Rational Unified Process RUP , Unified Modeling Language UML , System Development Life Cycle SDLC , Waterfall, Agile, Prototyping.

Professional Experience

Confidential

Business Systems Analyst/UAT Test Lead

The scope of this project was to support the Corporate Compliance function and the Global Spend Transparency GST platform, ensuring that spend data for Healthcare Providers and Organizations is properly captured and reported to regulatory agencies.

Responsibilities:

• Participated as a member of the project team in implementing and rolling out the new GST platform Alanda used for data aggregation and reporting.
• Maintained and enhanced the processes used for collection of external 3rd party spend data, collection of internal spends data, remediation and sub-certification workflow, and jurisdictional reporting. Identified, proposed and implemented solutions as needed.
• Leveraged standard system lifecycle procedures to configure, develop and deploy changes, fixes and enhancements to the platform.
• Created and enhance technical documentation and process flows for the system.
• Coordinated with the GST business owners to develop a strong understanding of the regulatory requirements and associated internal business processes.
• Involved in Unit Testing of the system and defining test plans for functional and quality assurance testing of the Contracting Tool.
• Gathered Business Requirements from the Subject Matter Experts SMEs and documented the requirements in the BRD. Utilized data flow diagrams, use case diagrams and process flow diagrams to represent information provided by the Business Owners.
• Drafted the Functional Requirements Document for integrating the contracting workflow within Helios with the Fair Market Value calculation and reportable spend capture in Apollo.
• Mapped process flows assess as-is processes through user interviews, data collection and analysis, design and evaluation of to-be process solutions.
• Designed and developed Use Cases using UML and Business Process Modeling.
• Created process flows in MS Visio to explain the flow of contracting in Helios and MDM Master Data Management .
• Facilitated in the integration of current systems - Helios Global Healthcare Entity Master for contract creation and Apollo system for capturing HCP/HCO spend .
• Documented Business Requirement Documents and Functional Requirement Documents by interacting with Businesses and various stakeholders.
• Worked on System Design Specification of the Contracting Tool.
• Reviewed, analyzed, and evaluated business systems for end user needs, including documenting requirements and creating process workflows.
• Designed Test Plans and Test Cases for User Acceptance testing. Worked as a lead tester in conducting UAT for the tool.
• Responsible for leading JAD sessions with Subject Matter Experts, stakeholders, project manager, developers, and end-users to identify requirements.
• Gathered requirements and created, executed and documented Test Cases as per requirements.
• Developed test scenarios Positive, Alternative, and Negative that are likely to occur in the use of the application/tool by the end user.
• Played a key role in project planning activities, User Acceptance Testing UAT , and implementation of the system enhancements and conversions.
• Used MS Excel to build the Requirements Traceability Matrix RTM's .
• Trained the team on the functionality of the Contracting Application/Portal.
• Trained the departments Commercial, Clinical, and Compliance on the functionality of the Contracting Tool.
• Created test scripts and test scenarios and facilitated thorough testing of the tool. Created test execution reports. Acted as a single tester responsible for developing test cases to conduct UAT.
• Accelerated QA, Regression, and UAT by using Oracle UPK.
• Involved in weekly defect review meetings to review the status of defect fixes and upcoming build releases.

Confidential

Claims Business Systems Analyst

Confidential initiated and prepared the system for implementation of Health Insurance Exchange. As a BA, I was involved in gathering requirements on system enhancements of Diamond and also on testing new member benefits, products, and system enhancements that resulted from the implementation of HIX. I also worked on gathering requirements and testing the system enhancements for the SSPT tool by adding a new window where diagnosis codes could be imported from internal code repository and promoted to Diamond claims processing system to maintain, review and update codes.

Responsibilities:

• Gathered Business Requirements from the Subject Matter Experts SMEs and documented the requirements in the BRD. Utilized data flow diagrams, use case diagrams and process flow diagrams to represent information provided by the Business Owners. Also, worked towards getting sign offs from business
• Mapped process flows assess as-is processes through user interviews, data collection and analysis, design and evaluation of to-be process solutions.
• Assisted the QA team in designing the Test Plan and Test Cases for User Acceptance testing.
• Designed and developed Use Cases using UML and Business Process Modeling.
• Documented Business Requirement Documents by interacting with Businesses and various stakeholders.
• Performed Data mapping, logical data modeling, created class diagrams and used SQL queries to filter data.
• Reviewed, analyzed, and evaluated business systems for end user needs, including documenting requirements and creating process workflows.
• Coordinated with business owners and states departments to determine project requirements.
• Responsible for leading JAD sessions with Subject Matter Expert, stakeholders, project manager, developers, and end-users to identify requirements.
• Created FRS and system requirement documents, along with diagrams ERD .
• Identified gaps between features when data was being mapped from old system to new system, analyzed issues and provided solutions.
• Wrote SQL queries to pull data from the database in Unit and Test stage, and also for UAT.
• Gathered requirements and created, executed and documented Test Cases as per requirements in Quality Center.
• Reviewed and implemented Test Plans and Test Cases based on user requirements and functional requirement specifications.
• Played a key role in project planning activities, User Acceptance Testing UAT , and implementation of the system enhancements and conversions.
• Used MS Excel to build the Requirements Traceability Matrix RTM's .
• Wrote and managed all of the business and functional requirements of the new applications, as well as the added features for the older application, in Rational RequisitePro.
• Analyzed functional requirements segregated them into use case specifications and created use case diagrams using MS Visio, according to UML methodology.
• Tested HIPAA EDI Transactions and Code Sets Standards such as 837/835 and 834 transactions.
• Used HP Quality Center / ALM 11.0.0 to create and execute test scripts.
• Trained team on functionality testing for SSPT.
• Worked with the local claims processing system, utilizing Diamond, SSPT, DMT and other pricing tools.
• Involved in establishing business rules for claims processing workflow, claims review and approval.
• Tested member benefits for HIX products, including SHOP, Small Group / Large Group, and New / Existing.
• Created test scripts from test cases using Quality Center to facilitate the thorough testing of the application. Created test execution reports using Quality Center.
• Worked on Quality Center for bug status tracking and maintained and created status reports for the application.

Confidential

Sr. Business Systems Analyst

The project at Assurant was a Data Warehousing project that included the warehousing of data from FACETS source system into the target data warehouse. Updated the FACETS Claims Processing System to handle a large number of claims with little change to the system framework, to comply with HIPAA 5010. Old system data was mapped to the new system to route claims out to Gateway Systems, which belonged to different payers.

Responsibilities:

• Worked on processing P, D and I claims in FACETS and gathered requirements for integrating them into the FACETS frontend and backend claims processing system.
• Worked with trading partners, clients, management, technical and non-technical personnel to create Use Cases and system validation artifacts.
• Well known with front-end processing of Claims, Subscriber/Member and Providers application groups.
• Experienced with External claim editing system of Facets 4.71 front-end.
• Created business rules and testing to implement HIPAA 5010 in the new system.
• Analyzed 837 and 835 EDI files including syntax and business rules for X12 HIPAA 4010 and 5010 validation for loops, segments, elements, qualifiers and code sets.
• Tested claims, enrollment, NPI, medical coding, and performed ICD-10 EDI testing.
• Used FACETS to validate HIPAA EDI files. Documented errors and artifacts demonstrating success.
• Managed defects and reviewed reports exported from HP Quality Center.
• Scheduled conferences with SMEs, reporting and ETL teams to clear doubts from QA professionals.
• Performed UAT for HIPAA 5010 projects including HIPAA requirements and compliance mandates.
• Carried out Risk Assessment, GAP analysis and Impact Analysis for the 4010-5010-conversion project.
• Worked with HIPAA transactions sets for 4010/ 5010 support in 837I 837P claims data for ICD-10 compliance.
• Gathered requirement documents for transition from ICD-9 to ICD-10
• Conducted Business Process As Is/To Be sessions with various department directors and staff to ensure the Testing Plan and Test Approach would meet the identified Business Requirements, and the Training Program covered all identified new and changed processes.
• Worked on Trizetto ICD Translator Manager for mapping and maintaining code sets.
• Participated in JAD Sessions and Analyzed the process identified problems and made recommendations to improve the application.
• Incorporated Rational Unified Process RUP and analyzed User Business Requirement Document BRD , Technical Requirement Specification and Functional Requirement Specification FRS using Requisite Pro, Rational Rose and MS Visio.
• Analyzed the changes in the upcoming HIPAA 5010 compliance and made clear Graphical Representation through UML diagrams.
• Performed Gap analysis of the Business needs and business process validation, client requirements, generated workflow process, flow charts and relevant artifacts.
• Involved in Business and Functional Requirements review sessions.
• Prepared Test Scenarios to verify the functionality and confirm if the business requirements are met.
• Performed UAT for 5010 and ICD 10 codes.
• Conducted Defect Tracking and provided required information of defects to Developers for fixing bugs.
• Involved in UAT Testing, Prepared End to End Point-to-Point Scenarios and Test Cases. Executed Test Cases, Escalated and Tracked Defects in HP Quality Center.

Confidential

Business / Systems Analyst

Confidential is a holding company that owns and operates 63 hospitals in the United States. The project was to develop an application for the hospitals to use as a central repository for storing reports from different departments of the hospital. Major modules included Enrollment/Registration, Billing and Reports. This System was being developed using HIPAA guidelines and regulations which keeps track of Healthcare transactions like Eligibility Request/Response 270/271 , Request and Response for Claims Status 276/277 , Prior Authorization 278 , and Claim/Encounter 837I/837P .

Responsibilities

• Involved in reviewing the business process and possible improvements based on user requirement. Interviewing the HOD's and other end users, asking detailed questions and carefully recording the requirements in a format that can be reviewed and understood by both business people and technical people
• Used MS Visio to create business process flowcharts and workflow diagrams.
• Involved in detailing project mission, Data Process Flow Diagrams and timelines.
• Formed a bridge between the Project Manager and different teams with effective presentations.
• Prepared Workflow diagrams analyzed AS IS and TO BE scenarios, designed new process flows and documented the business process and various business scenarios.
• Utilized Rational Unified Process RUP to configure and develop processes, standards, and procedures.
• Involved in the calculations and documentation using MS Excel, MS word, MS Access and PowerPoint.
• Participated in data modeling planning, designing, implementation of the data warehouse, and conducted testing UAT . Produced data mapping and data definition documentation.
• Analyze business requirements and segregated them into high level and low level Use Cases, activity diagrams / State Chart Diagrams according to UML methodology thus defining the Data Models.
• Involved in process modeling, conducted Participated in Joint Application Development JAD sessions with System Users.
• Performed the user acceptance test UAT and suggested recommendations for the applications.
• Worked with SQL queries for data manipulations.
• Thorough documentation of the entire process along with all its activities
• Coordinated and conducted system requirements walkthroughs/sessions JADs with business Owner/stakeholders/SMEs as well as design/development teams.
• Analysis of key business requirements and assisted in the development of BRD.
• Managed and maintained Requirements Traceability Matrix RTM .
• Created activity diagrams and sequence diagrams and other UML diagrams.
• Analysis for making system compliant with HIPAA, involved in making Medicare patient profiles being compliant with the HIPAA regulations.
• The elicitation of the requirements for a replacement MMIS.
• Error handling using MySQL queries in Oracle.
• Worked with business area SMEs/analysts to develop and finalize test plans/use cases.
• Developed Test Plans for the Business users and QA team and recorded the user observation about the testing and release.

Confidential

Sr. Business Analyst

• StateFarm Insurance is a well-known Insurance company. The company also provides products and services such as property and life insurance, banking products and mutual funds. I have been involved as a Rating Business Analyst in the UAX project under the auto insurance segment UAX Unified Auto Experience to achieve the unique quotation AQP Auto Quote Purchase rolls out of the insurance from all platforms.
• Facilitated the senior business team with the data operations team and Actuarial.
• Conducted JAD and elicitation sessions for user interviews to gather requirements. Worked with business partners to document detailed business requirements.
• Defined and created a wide range of documentation: business requirements, system requirements, test cases, Visio flows, training manuals, and user guides.
• Participated in daily Scrum meetings, JAD sessions and documented to update the daily sprint status.
• Responsible for the updating the SharePoint site for the project changes.
• Performing the premium checkout by comparing the agent emails leads with the issued premium on the Host system Rumba.
• Documenting the defect using the defect tracking tool and addressing it to respective development teams for fixes.
• Created reports using SQL Server Reporting Services SSRS 2008R2 and used MS SQL server and ran queries to validate the results and generate the different reports.
• Created/Opened Service tickets based on the Ad hoc requirements from the Agents directed them and took follow up for the resolution using HP Service Center.

Confidential

Sr. Business Analyst

• Project: The project was on American Express Bank which Integrated On-Line Transaction Processing System IOTPS , which includes mortgage loan processing application.
• Effectively communicate project expectations, project goals and scope to the team.
• Facilitated team meetings to coordinate activities for project schedules, presented deliverables to the management, conducted to elicit requirements.
• Define, prioritize, and track requirements throughout the project lifecycle, software development teams are able to respond rapidly to ever-changing requirements without risking the project success.
• Perform analysis on project scope parameters gap analysis, usability, cost /benefit etc.
• Conducted JAD sessions with SMEs, system architects, technical teams and other stakeholders for open and pending issues
• Responsible for managing the documented system requirements and mapped using MS Excel for Requirements Traceability Matrix
• Worked with developers in design/development activities in converting SSRS reports into the SQL database and manage all the electronic records in the system.
• Managed requirements to minimize scope issues. Understand all systems requirements within deliverable and provide feedback, collected requirements from customers, users and prioritized them.

Confidential

Business Analyst

• Project: Ohio National Insurance Company is one of largest company in its class with approximate 3000 contractor agents. The requirement was to integrate and upgrade the claim processing system and various disparate systems on common environment to enhance CRM customer Relation Management by providing real-time monitoring and service for their clients.
• Strongly understand annuity and annuity process, to gather requirement have to possess 4-40 License .
• Studied deeply process of client system and business system to extract needs and requirement to smooth the process.
• Established a business analysis methodology, used waterfall traditional method due to high regulations.
• Researched various steps in lifecycle and then documented and created SRS to implement in next phase.
• Developed project scope, held JAR session to brainstorm and prioritize the requirement and needs.
• Used MS Visio to create business process flowcharts and workflow diagrams.
• Function as a primary liaison between the business line, operations and the technical team.

Confidential

Functional Analyst

• Project: The focus of the project was to upgrade the existing website to provide a wide range of features like policy value, rider information, billing option, beneficiary information and agent information for current policyholders and new customers. I worked on enhancements of the already available online products of AIG as well as implemented new products like opening accounts online, policy value comparison, etc.
• Acted as liaison between Information Systems group and Business User group.
• Conducted business requirements, functional and technical walk-through meetings.
• Met with key business unit stakeholders to gather requirements and needs.
• Coordinated with SME's to gather requirements and document Gaps in functionality.
• Developed written requirements to clearly, define and detail the needs of the business unit. Requirements included screen design and process flow charts.
• Created and updated use cases, use case diagrams and work flows.
• I was Involved in the entire project life cycle from evaluation, installation, development, testing to production of end user reports.
• Defined user and system requirements for existing and proposed system during existing system integration and new system development initiatives.
• Worked with GUI team for designing the screens and assisted in developing mockup screens and prototyping of the user interface and usability testing.
• Designed the System Flow, Data Flow diagrams, using these as the base to obtain requirements and wrote Use Cases.
• Built catalog using Impromptu Administrator and created joins, custom folders for easy access and understanding.
• Assisted the business unit and teammates with resolving production issues.
• Used Flat Files at a very basic level for configuration of data storage.
• Managed Portia report writing for trading and operations business units. Managed import and reconciliation of historical performance data.
• Used MS SharePoint for the purpose of managing documents and for hosting websites, which was used to access shared workspaces and documents.
• Experienced in creating training materials, SOP and handling documentation.
• Documented business processes and communicated potential business and systems impact based on analysis of the data.
• Tasked with documenting, storing, and sharing the issues and documentation using Rational Clear Case.
• Created Export Archives to deploy reports and packages from development to test environment.
• Assisted QA Team in designing the Test Cases, and collecting the Test Metrics.
• Documented functional and technical designs and user guides.