SUMMARY

• Over 7+ years of experience as Healthcare business analyst, well versed with in - depth knowledge of SDLC.
• Expertise with Agile, PMO and business analysis techniques.
• Extensive knowledge in HIPAA, MEDICARE, MEDICAID, HL7 standards and other Healthcare reforms
• Experienced in working with diverse healthcare projects MMIS, RCM, PBM, EHR and FACETS
• Strong knowledge in EDI transactions like 270/271, 277/278, 834, 835, 837, 999, Healthcare code sets HCPCS, CPT, ICD-10CM, and NDC and identifiers as NPI, DEA, DRG and NSF
• Good working knowledge of HIX, HIE and EDPS
• Experienced in Waterfall, Agile and Scrum Methodologies
• Proficient in Requirements management life cycle, including Requirements gathering, Requirements elicitation, documentation, validation and tracking
• Profound experience in converting requirements to business models using UML
• Experienced in creating Use case diagrams, activity diagrams, sequence diagrams, class diagrams and object diagrams. Good at framing business process flow diagrams and AS-IS and TO-BE diagrams
• Experienced in designing prototypes, wireframes User Interfaces and creating User stories
• Experienced in business interactions, requirements collection, JAD Sessions, interviews, on site meetings and documenting Business Requirements Document (BRD), Functional Requirements Documents (FRD) across various deliverables
• Extensive knowledge in STLC, hands on experience in creating Test cases, Test plans, RTM, and Defect status report
• Excellent business analytical and problem solving skills, can resolve complex situations through Root cause analysis (RCA)
• Strong knowledge about Gap analysis, Document analysis, Decision analysis, financial analysis and stakeholder analysis
• Extensive knowledge in writing simple to complex SQL JOINS, for testing purpose in QA and UAT environment
• 5 years of experience in working on MS-SQL SERVER 2008 R2, 2010 & 2014
• Strong knowledge in Business Intelligence and Data warehousing concepts
• Possess a detail-oriented nature with excellent communication, interpersonal and organizational skills

TECHNICAL SKILLS

Business Skills: Business Process Analysis, Gap Analysis, Impact Analysis, JAD/JRP Sessions Requirement Gathering, and Use Case Modeling

Methodologies: Agile, RUP, SCRUM Six Sigma and Waterfall

Change Management Tools: Clear Quest, Rational Clear Case, JIRA

Testing Tools: HP Quality Center, Rational Enterprise Suite, Selenium

Databases and RDBMS: DB2, Oracle 9i & 10g, SQL Server, MS Access

Operating Systems: Windows, Mac, MS-DOS

Project management tools: MS Office Suite, MS SharePoint, MS Project

Modeling Tools: Rational Rose, Microsoft Visio, Smart Draw

Quality Management: HIPAA, CMMI, CMM, Six Sigma

Reporting Tools: Tableau, QlikView

PROFESSIONAL EXPERIENCE

IT Data Analyst

Confidential, Newark, NJ

Responsibilities:

• Develop presentations and documents to facilitate Data Governance stakeholder meetings with business and IT teams to promote Data Quality Management initiatives
• Engage multiple data owners to reduce data issues and improve data quality
• Develop enterprise level best practices, guidelines and standards for data integration initiatives
• Perform detailed analysis; identify trends and patterns in enterprise data usage and issues
• Analyze, aggregate and communicate the information to IT and Business stakeholders on varying levels of data granularity
• Analyze user needs and software requirements to determine feasibility of design within time and cost constraints
• Support strategic initiatives (system and process implementations/enhancements) requiring Data Governance input
• Interpret business needs into data requirements, including attribution and naming standards, consistent data definitions, data aliases, associated business rules, data sources, data lineage, retention criteria, derivations, security restrictions, accessibility, reusability, frequency of update, and integration
• Analyzes internal and external customer requirements to determine what procedures, programs and processes need to be used
• Translate data requirements into specifications for development and testing
• Consult with functional and business partners/data steward managers (DSMs) in defining, developing, and documenting policies and business rules for key data stewardship processes and systems
• Analyze, document and confirm data security and HIPAA minimum necessary requirements with Horizon business
• Coordinate with project teams and application owners and ensure that data standards and policies are understood and supported by the proposed solutions
• Create Source to Target (STT) templates/mappings to data modelers; assist in constructing logical data models and process workflows in support of business requirements.

Environment: Oracle, Teradata, SQL Server, DB2, Mongo DB, Hadoop, SQL Developer, Teradata Studio, Teradata SQL Assistant, TechScape

Business Analyst

Confidential, Chicago, IL

Responsibilities:

• GatheredBusinessRequirements by using JAD Sessions and interviewing clients
• Worked on Sentinel Axway B2BI tool for mapping services
• Worked on medical and pharmacy claims data, eligibility and member enrollment process
• Designed and documentedBusinessRequirements by using HIPAA EDI guides and reviewing or interviewingbusinessprocess owners and companion guides
• Worked on different EDI transactions like Claims (837), Premium Payment (820), Enrollment (834) and Eligibility (270) to send outbound file to external vendor
• Validation of the EDI claim in Sentinel Axway
• Prepared and updated theBusinessprocess flow, Functional requirement document (FRD) and Technical specification document (TSD) for enhancing the existing product
• Hands on experience with multiple data mapping sheets from multiple source system
• Worked on SQL and Informatica databases for the flat file generation of the required elements from the source systems
• Worked on FACETS modules such as pricing, payer, eligibility under claims processing system
• Created use cases diagrams andbusinessprocess workflows using Visio.
• Experienced in EDI - X12 file validation for the required and situational segments in the EDI- files.
• Worked closely with EDI team which deals with Axway tool where the tool generates the EDI file
• Worked on Test plan document, test case creation and test case execution for all provider types in the flat file and EDI file format.
• Worked on Level of Effort for additional work involved in the project
• Worked closely with the developer for the final deliverables to the customer/business
• Worked on waterfall methodology for the final product deliverables of the EDI - x12 file
• Conducted JAD sessions between the end users and the development team
• Performed User Acceptance Testing (UAT) and reporting the bugs to the development team.
• Conducted project related presentations and provided reports to the higher management.
• Created Test cases using HP Quality Center
• To automate productivity and high services, coordinated with Service Now team

Systems Analyst

Confidential, New York City, NY

Responsibilities:

• Employed best practices in project management & requirement gathering techniques
• Utilized Agile software development methodology to manage and control software and product development
• Documented business functionality requirements in User Stories
• Collaborate with the Product Owner on project/roadmap planning, facilitated daily stand-up meetings, reviews, retrospectives, sprint and release planning, demos and other Scrum-related meetings
• Worked on patient case management system and updated them on web-portals
• Organized and conducted Joint Requirements Planning sessions (JRP) as a facilitator to gather requirements from the Business User
• Facilitated Joint Application Development (JAD), Joint Application Management (JAM), and Rapid Application Development (RAD) sessions when needed
• Experienced in managing case records and patient records, maintained their database and systems
• Managed the product backlog with user stories through progressive refinement applying business prioritization, solution approach, and technical delivery considerations
• Experience creating Mock ups based on the discussion withBusinessand provided the same to UX and Development team
• Used agile methodology to Conduct Data Analysis to find missing data fields in the application and customize them and extensively used Rational Requisite Pro
• Regularly interacted with the Testing team for executing the Test Plans, providing Test Data, creating Test Cases, and resolving issues upon detection of bugs and collecting the Test Metrics
• Responsible for providing business events & rules, process information for workflow, external interfaces, and data definition requirement
• Perform extensive Data Analysis, Data Requirement Analysis and Data Mapping
• Analyzed Business Requirements and created Use Cases, Use Case Diagrams, Navigation Flow, Business Flow Diagrams and Work Flow Diagrams for applications and created Activity Diagrams / State Chart Diagrams using MS Visio
• Conducted walk through sessions for Business Requirement Document (BRD) and Use Cases to discuss certain issues with stakeholders, architectures and design & development teams and also performed GAP Analysis
• Managed product backlog within JIRA, and project information and artifacts using Confluence
• Defined validations to be built into application in line with the functional requirements
• Assisted QA team with User Acceptance Testing, develop and maintain quality procedures ensuring that appropriate documentation is in place.

Business Analyst

Confidential, Virginia Beach, VA

Responsibilities:

• Interacted with stakeholders and gathered requirements as per thebusinessneeds.
• Gathered and documentedbusinessrequirements from SMEs, user groups and vendors via workshops, interviews and surveys.
• Prepared a comprehensive Functional Requirements Document and Supplementary Specification Document (nonfunctional) from the gathered requirements.
• All documentation was created using the AGILE methodology.
• Worked in Healthcare Claims Administration - Healthcare Claims Processing (837/835) includes facility claims and professional claims.
• Worked on HIPAA Claims Validation and Verification Process (Pre-Adjudication)
• Facilitated and managed meeting sessions with committee of SME's from variousbusinessareas including Benefits Administration, Health Claims Group, HIPAA Administration, Health Policy and Program Evaluation Team and Data Management Group.
• Created Functional specifications for the 834 enrollment files with their changed benefits in the Medicare program
• Submitted change requests and worked with change request records in Clear quest.
• Was in regular contact withBusinesspartners on the status of issues, action plans and timeframe for resolution throughout the development cycle Provide technical and procedural support for User Acceptance Testing (UAT)
• Was involved in managing the daily meetings and ensured that quality standards were enforced as per the build-release schedule
• Involved in fetching and displaying data using SQL queries

Environment: Rational Requisite Pro, Clear Case, MS Visio, MS Project, SQL, Windows, MS Office, MS Excel, MS Word, UML, SQL, HIPAA.

Business Analyst

Confidential, Boston, MA

Responsibilities:

• Leading the team consisting of 4 Business Analysts and coordinated with the Development team.
• Acted as a liaison for UI development by conducting interviews and brainstorming sessions for the following modules: Claims Adjudication, Claims Payment, Claims Receipt, Eligibility Verification, Member Management, Provider credentialing and Third Party Liability.
• Involved in “As-is” and “To-be” business process data gathering, documentation (i.e., use cases, process mapping), business process analysis (BPA), regulatory review and signoff.
• Technical writing skills - including documents, charts, flows, and specifications.
• Meeting and JAD workshop design and facilitation to define objectives; evaluate alternative software vendor solutions; define and design business processes, application functionality and interfaces; and reach consensus among cross-functional teams.
• Involved with interviewing different groups to determine the Impact to Data warehousing migration.
• Reviewed and analyzed the “to-be” system processes to identify potential gaps. Participated as the Process SME in the Detail System Design acceptance process
• Met aggressive deadlines by demonstrating strong project management skills and through building and maintaining strong stakeholder relationships

Environment: MS Visio2003, SQL, MS Office, Share point, DB2, Java

Business Analyst

Confidential, NY

Responsibilities:

• Conducted and Managed JAD sessions with SMEs and Business departments, for planning and Requirements Gathering
• Responsible for Requirement gathering and writing use cases
• Used JAD sessions, and one-on-one meetings to identify business and System Requirements, and documented using Use Case Modeling, Process Flow diagrams and documentation.
• Used FACETS to provide a rich suite of client side components to develop rich web applications as simple as developing GUI applications in RAD tools
• Mentored several of the team members on best practices of HIPAA documentation requirements when Process Flow diagrams and Uses Cases
• Conducted GAP analysis and assessed the status of the organization to determine the scope of the application.
• Interacted with the customers and internal stakeholders to gather user requirements and their expectations from the AS-IS system for the TO-BE model.
• Assisted the teams to develop the test plan, test cases and test scenarios to be used in testing based on business requirements, technical specifications and/or product knowledge
• Provided the flow diagrams for various modules of the project using MS Visio
• Scheduled meetings with developers, system analysts and testers to collaborate resource allocation and project completion using MS Project
• Assisted the technical team in understanding and developing the appropriate functionality of system
• Identify business issues and define the required solution to ensure delivery.
• Reviewed detailed test cases with in-depth description of each test scenario of the system as per HIPAA guidelines
• Played a key role in planning, testing, and implementing system enhancements and conversions

Environment: Windows, MS Visio, Rational Requisite Pro, Rational Clear Case, Rational Clear Quest, MS Office Suite, MS Projec