SUMMARY

• Over 7 years of extensive experience as Sr. Business Systems Analysis with hands on experience in integrating business needs into IT solutions with core activities like: Requirement Gathering &Analysis, GAP Analysis, Designing, Software Development, Implementing, Software Validation/Testing, Project Cycle Management (PCM) in industries like Healthcare, Insurance and Pharmaceuticals and extensively worked on Insurance Claims, Medicare/Medicaid Claims.
• Extensive experience in gathering requirements by conduction of JAD sessions(Joint Application Development), Interviews, Workshops and Requirement Elicitation sessions with end - users, clients, stakeholders and development team and converting them in to BRDs (Business Requirement Documents) and FRDs (Functional Requirement Documents) or NRFD (Non-Functional Requirement Document).
• Thorough Understanding of SDLC (Software Development Life Cycle); involved in all phases from Planning to the Implementation stage. In depth knowledge and experience in Classic Waterfall, Rational Unified Process (RUP), Agile, Scrum, RAD (Rapid Application Development) methodology.
• Expertise in defining Scope of projects based on gathered Business Requirements including Documentation of Constraints, Assumptions, Business Impacts, Project Risks & Scope Exclusions.
• Expert in working with SME’s (Subject Matter Experts) across each group during entire SDLC with strong experience in conducting GAP Analysis,, Cost Benefit Analysis, SWOT Analysis and Return of Interest (ROI) Analysis.
• Proficient in developing Data Flow Diagrams (DFD), Use Case Diagrams, Flowchart Behavior Diagrams (Sequence diagrams and Activity diagrams) based on UML methodology using Rational Rose and MS Visio.
• Very Strong PL/SQL skills (writing queries and verifying data) with solid understanding of Databases, Data Warehouse, OLTP, OLAP, Data Modeling, Business process design, application systems analysis, object oriented analysis, Business Intelligence tools like Business Objects & involved in gathering data mart requirements from business users
• Experience in Change Management Process (Identify, Analyze, Evaluate, Plan, Implement, Review and Close)
• Experienced with HIX (Health insurance Exchange), PPACA (Patient Protection and Affordable Care Act), Plan Management, Eligibility and Enrolment process, SHOP (Small Business Health Options Program) as well as Financial Management.
• In depth understanding of the HIPAA 4010 and 5010 compliance standards, CPT/ HCPCS, HIPAA insurance regulations and claims processing, ICD-9, ICD-10 coding and HL7.
• Excellent knowledge of Medicare Part A, Part B, Part C and Part D.
• Thorough Understanding & Experience in EDI (Electronic Data Interchange) transactions and Codes like: ANSI X12; 837 (Health care claims), 820, 835, 270/271 (Inquire/response health care benefits), 276/277 (Claim-status), 278 (Health Care Services Review Information), 834 (Benefit-enrollment), 835 (Payment/remittance advice), 999 (Implementation Acknowledgement document) transactions andICD-10 Code sets, and CMS.
• Experience with conducting assessments and impact/gap analysis concerning State Medical Management Information System (MMIS).
• Experienced in Conversion of HIPAA X12 4010 codes to X12 5010 codes.
• Experienced & in-depth knowledge in Conversion of, ICD 9-CM (Clinical modification) to ICD-10-CM/PCS (Clinical modification/procedure coding system) and CPT codes for mental and medical health.
• Adjudicated Medical (Professional and Institutional) and Pharmacy Claims in Claims adjudication and procedures, pay professionals and members, select Individual claims for payments, change the claims status of an individual payment to hold or release, create, print, or display EOB (explanation of benefits) for a member or EOP (explanation of payments) for a provider.
• Experience in White Box, Black Box, Unit, Functional, Integration, User Acceptance Testing (UAT), Back End and System Level Load and Stress Testing for many types of applications including web and client-server applications.
• Assisted QA (Quality Assurance) team in writing test plans, defining test cases, test scenario and data sets.
• Possess strong business & technical writing skills required for documenting Business Process Documents.
• Excellent communication, business understanding, critical thinking and analytical skills with the ability to communicate appropriately in business and technical situations at all levels.
• Highly motivated, organized and target oriented team player who enjoys working with multi-functional team towards a common goal.

TECHNICAL SKILLS

Databases: SQL, Oracle, MS Access, SQL Server 2000, DB2, Teradata, Sybase

Microsoft Technologies: MS Project, MS Visio, Microsoft Office 2003/07/10/13 (Excel, Word, PowerPoint, Access, Outlook) Microsoft Project, MS SharePoint.

Programming Languages: SQL, C,C++, PL/SQL, JAVA, HTML,DHTML,,XML, VB,.NET,JSP

Scripting Languages: HTML, JavaScript, VBScript, PHP, GUI Scripts, C++

BI Tools: Business Objects(Designer, Webi, Dashboard), Cognos, Informatica, OBIE

Requirements/ Management Tools: Rational Requisite Pro, Rational Rose, MS Visio, Balsamiq, Mockup Screen

Testing Tools: HP ALM/ Quality Center, QTP ( Quick Test Pro), SoapUI, Pro, RMT

Operating System: Windows, DOS, Unix, Linux, MacOS/OS X Sun Solaris.

Business Documentation Skills: Documented Business Requirement, Use Case Specifications, Functional and Non-functional Specification, System Requirement Specification, UML Diagrams (Use case, Class and Sequence), Traceability Matrix, Project Estimate, Change- Training and User Manuals, Master Test Plan Review (Integration, System and Acceptance).

Standards: HIPAA 4010/5010, ICD9/10, ANSI X12, CPT, CMS form., Six Sigma, CMMI, PMBOK

Methodologies: OOAD, Joint Application Development (JAD), Rapid Action Development (RAD), Rational Unified Process (RUP), Unified Modeling Language (UML), System Development Life Cycle (SDLC), Crystal Reports, 1Visual Source Safe, Waterfall Model, Agile Model, SCRUM, Rational Unified Process (RUP).

Healthcare: ANSI X12, HL7, HIPAA, HIX, PPACA, EDI, HL7, Enrolment/Claims, Medicare, Medicaid, CHIP, DHR, Facets.

PROFESSIONAL EXPERIENCE

Confidential, Milwaukee, WI

Sr. Business Analyst

Responsibilities:

• Worked as a liaison between the Business and Technology Department.
• Worked with the account managers, management and report requestors to gather requirements.
• Validated the following Transaction Processing: 837 (Health Care Claims or Encounters), 835 (Health Care Claims payment/ Remittance), 270/271 (Eligibility request/Response), 834 (Enrollment/Dis-enrollment to a health plan)
• Gathered requirements, analyzed them and created formal Business Requirement Document (BRD) & Functional Requirement Document (FRD)
• Constantly researching best practices for health insurance issuer accreditation, reinsurance, and risk adjustment.
• Creating of Business Process Workflow Diagrams with Stakeholders throughout the Business System Development Life Cycle (SDLC), to create the provider portal which allows providers to access patient information to increase convenience.
• Involved inrequirements gathering sessionswith Business Analysts and Architects tounderstand requirements in terms of business change.
• Owned the entire reporting process and interacted with the ETL team, developer(s), management, and account holders to get the requirements, document them, design templates, and write specifications.
• Designed Functional Specification Documents for the reports and worked in RUP environment using Rational Requisite Pro
• Analyzed trading partner specifications and created EDI mapping guidelines.
• Conducted JAD sessions for the report users, requestors, developers and prepared Need Analysis Documents of the requirements gathered through JAD sessions. .
• Created presentations explaining the entire report development process, while drawing a comparison between the legacy & the new report.
• Developed and conducted statewide HIPAA 5010 and ICD-10 awareness program for all IDS staff in Assurant.
• Coordinated with the developer, on day-to-day basis, during the development process.
• Helped with Data Mapping between the data mart and the Source Systems.
• Facilitating the Enrollee Satisfaction Survey Vendor Contracting Oversight, Health care issuer Accrediting Entity Management, Health Plan Issuer Accrediting Verification for the FFE Quality Team
• Developed Health Plan Issuer Accreditation Mapping to Qualified Health Plan (QHP)
• Participated in workshops and update meetings with Insurance carriers
• Conducted Claim/Encounter Management, claim data collection, claim quality check, and filter claims for Risk Adjustment.
• Facilitated Cost Sharing Reduction (CSR) Reconciliation and reporting, Federal Exchange, Qualified Health Plan (QHP) User Fee, Risk Adjustment Claims processing, Risk Adjustment Factor calculation, Risk Adjustment Annual Issuer Charge and Payment, Risk Adjustment reporting, Risk Adjustment User Fee, Reinsurance Contribution (Issuer, State and TPA), Reinsurance Quarterly payment calculation and reporting.
• Conducted Stakeholder Analysis.
• Facilitated Health Insurance Form Filing requirement sessions.
• Developed Preliminary Business Object Model for Health Insurance Form Filing, Requirement Document for Health Insurance Form Filing and Preliminary Business Process Model for Medical Loss Ratio (MLR) CD Administration.
• Wrote and maintained project requirements, facilitated meetings, built business and system flows, managed defects and wrote test scripts and use cases.
• Successfully used Scrum Analysis Model (Agile) for gathering requirements by facilitating Use Case Workshops and sessions.
• Provided subject matter expertise for the implementation of Health Exchange Business Process with a special focus on Medicaid Integrated Eligibility, Plan Management, SHOP/SHOPPING, and Financial Management Business domains.
• Followed the Agile Scrum SDLC (System Development Lifecycle) methodology, Validated QHP Benefits, Rates, Network Adequacy, Essential Community Providers, Prescription Drugs and Service area Information with their templates for data submission by insures.
• Validated System requirements for the Certifications, Accreditations and Attestations of Insurance Carriers and system integrations with the Department of Insurance (DOI).
• Involved in communicating with the software development team for the online application.
• Created Test Scripts & Test Scenarios to validate report content, layout, and parameters using VBScript and JavaScript and Conducted weekly meetings to validate and verify the testing process
• Wrote PL/SQL statement and stored procedures in Oracle for extracting as well as writing data
• Migrated Data from MS Excel to SQL Server Reporting Service Using DTS and SQL loader utilities.
• Modified System flow diagrams using Visio.
• Reviewed Stored Procedures for reports and wrote test queries against the source system (SQL Server) to match the results with the actual report against the Data mart (Oracle).

Environment: J2EE,MS Word, MS Visio, MS Excel, SharePoint, UML,HTML, CSS,XML, PL/SQL, Javascript, JSP,VB Script, Mercury Quality Center/HP ALM, Rational Requisite Pro, Rational Quality Manager, Rational Clear Quest.

Confidential, Baltimore, MD

Sr. Business Analyst

Responsibilities:

• Conducted user interviews, gathered requirements, and analyzed the requirements.
• Workedwith the businessteam to collect the businessrequirements, security and service level requirements and documented those using Requisite-Pro & Visio.
• Analyzed set behavior and contribution toperformance, criticalbusinessmetrics & tracking underlying business trends usingBusinessObjects.
• Worked with different IT & Businessgroups to understand and determine the Impacts to the DataWarehouseand/orDataMarts for different projects
• Working experience in theAnalytical CRMfor health care customers andtheir custom data management.
• Worked heavily onClinical Trials using IVR (Interactive voice response) to conduct global clinical trials and manage the large volumes of data generated.
• Participated in the logical and physical design sessions and developed design documents.
• Designed new process flows for the existing system as well as for the enhanced system.
• Conducted and lead status report meetings with thebusinessand the IT team on a weekly basis.
• Assist with creation and maintenance all necessary documentation and training materials for Epic Ambulatory application
• Performed analysis, design, development and maintenance of the Epic Ambulatory applications and other clinical information systems.
• Assisted inClinical Data ManagementandClinical Trials Management.
• Performedcollection, coding, assessment and reporting of adverse event data usingARISg.
• Worked in theARISgfor the implementation of the EHR-Pharmacy Module.
• Used Safety Mart for Clinical Safety Data Management.
• Captured allHIPAA-relatedEDI datain the repository usingFACETS.
• Supported integrated EDI batch processing and real-time EDI usingFACETS.
• Worked on Electronic Health Record (EHR) system on a CRM web based application.
• Working Experience in Electronic Submissions in standard format E2B.
• Worked on Data design, Architecture design and Staging requirements for the Data warehouse environment.
• Exposure toHIPAA Compliancerequirements andHL 7 standards.
• Assisted project managers with the development of project schedules. Developed requirements and preliminary design for client applications.
• Performed analysis and designed projects using a systems development methodology. Worked with all levels of client staff in solution definition.
• Managed Scope and change throughout the life cycle of the product.
• Translated customer/client needs into new features and new services
• Developed UAT test cases associated with the functional requirements.
• Maintained a bi-weekly status report for validating the requirements with the team and incorporated the same to the PMO status reports.
• Participated in developing test plan, test scripts, and test scenarios and designed user documentation.
• Conducted daily scrum meeting with the project team and change management team to discuss the requirement updates, change requests, tasks and assign/re-assign man hours on a daily basis.

Environment: MS Project, Microsoft Visio, MS SQL Server, FACETS, RUP/SCRUM, Rational Suite (RequisitePro, ClearQuest, Clearcase),Rational Rose,Oracle 11i/10g, ARISg,,SharePoint, Business Objects, VBScript, JavaScript.

Confidential, Minneapolis MN

Business Analyst

Responsibilities:

• Assisted in identifying project scope, to confirm to the regulatory compliance related to X12 837 (I/P) and 835.
• Responsible for soliciting and eliciting requirements for 4010-5010 conversions.
• Carried out Risk Assessment, GAP analysis and Impact analysis for the 4010-5010-conversion project.
• Produced, for transaction sets 835 and 837 (I/P), a full gap analysis 4010 vs. 5010 against the document application 5010 enhancements ensuring the upgraded application included the required changes and additions for 5010 compliancy
• Involved in up-gradation of 4010 transaction to 5010 by conducting Impact Analysis and Risk Assessment and worked on the mitigation plan to avoid the risks.
• Involved in one-to-one interview sessions and JAD sessions with stakeholders, SME’s and business owners to discuss the scope of the conversion.
• Worked as a liaison among stakeholders both business and IT side in order to elicit, analyze, communicate and validate requirements for changes to business processes.
• Involved in creating Reports and Documents like Requirements, Documents, and Management Plan, Issue/Alternatives documents, Project Summary and Plans with formats like PDF, HTML, Excel and Word.
• Prepared UML diagrams (Activity diagrams, Sequence Diagrams, Use case diagrams) for Extensions.
• Involved with reviewing defects reported from UAT efforts and analyzed for root cause and took actions based on the findings.
• Used extensively of HP Quality Center for Test Scripts, Test plans and defect management.
• Identified the master file changes and builds needed to enable the 5010 format to be utilized.
• 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.
• Raising the bar for the client on code quality via education in best practices for coding, unit testing, integration testing, and acceptance testing, teaching Agile techniques and development practices such as Test-Driven Development, and pair-programming, continuous integration.
• Gathered requirements for impacted system and business areas for ICD-10 and their needs to embrace the changes.

Environment: MS Project, MS Access, MS Excel, MS Word, MS Power Point, Rational Requisite Pro, Clear Case, Clear Quest.

Confidential, Boston, MA

Business Analyst

Responsibilities:

• Conducted User interviews, gathered requirements and analyzed the requirements using Rational Unified Process (RUP) methodology and managed the requirements using Rational Requisite Pro.
• Created Business Requirement Document (BRD), Functional Requirement Specification (FRS) document and Change Request (CR) document for system application development.
• Conducted Joint application development/ Joint requirement planning (JAD/JRP) sessions acting as a facilitator to gather requirements from the business area and to discuss different critical success factors of the project like Operational Feasibility Analysis, Technical Feasibility Analysis and Cost Benefits Analysis.
• Authored various UML diagrams such as Use Cases and activity diagrams using MS Visio and defined the Data Flow Diagrams (DFD)
• Performed GAP analysis for the modules in production, conducted feasibility study and performed impact analysis for proposed enhancements.
• Coordinated JAD session with system analysts, developer’s team, project manager for application development and Pre- validation specifications.
• Coordinated/ Assisted in different testing such as User Acceptance Testing (UAT), system testing, Integration testing and functional testing.
• Authored test plans, test cases for various test scenarios and helped testing team to better understand the scripts, and live environment constraints.
• Used Mercury Quality Center to manager defects and issues log during the testing phase.
• Worked as a User/Customer advocate and negotiated with user as well as the technical team and management staff to resolve any outstanding requirement conflict during the whole SDLC process.

Environment: MS Visio, MS Project, My SQL database, Windows, MS Visio, MS Project, MS Access, Rational Requisite Pro, Mercury Quality Center, Agile, and waterfall.

Confidential, San Francisco, CA

Business Analyst/Web Analyst/UAT Tester

Responsibilities:

• Gatheringand updatingrequirements for new web interfaces, handling defects and security audits.
• Coordinated work plan between project manager and client with Microsoft Project, implemented and managed migrationprocess and developer fixes, retested fixes, scheduled and tracked progress for team members of project through completion.
• Was part of the security audit team in designing Integration security architecture tounderstand each of the interfaces being developed.
• Worked in cross-functional agile development teams with teammates who were developers, quality-assurance specialists, and business analysts. Also responsible for working through usability design, mock up-generation, and full-scale interactive design.
• Performed integration testing, product testing, data driven testing, and User Acceptance Testing (UAT).
• Enhanced web applications by search engine optimization, performance tuning and load balancing forwebapplications.

Environment: Rational Rose, Rational Requisite Pro, Quality Center 8.2, DB/SQL, MS Project, MS Visio, Rational Clear Quest, XML, JAVA, Microsoft SQL Server.