SUMMARY:

• Highly accomplished Business Analyst with over 7 years of experience with proficiency in BusinessProcess Engineering and Software Development Life Cycle including analysis, design, testing and implementation of software applications
• Proficient in different software development life cycle (SDLC) methodologies such as Waterfall and Agile/Scrum models
• Good knowledge of Health Insurance Plans (Medicare Part A, B, C and D), managed care concepts (Medicaid and Medicare) and experienced in determining the membership eligibility, billing experience within life and disability in health plans.
• Experience in SQL to perform data analysis, data mapping, data verification & data validation
• Experience in BI Reporting, structure and mapping data from multiple sources to single Confidential data store
• Experience in implementing HIPAA Gateway EDI X12 Transactions. Experience in HIPAA transactions EDI 837 (Dental/Institutional/Professional), 835(Payment Remittance Advice), 270 (Eligibility Request) / 271 (Eligibility Response), 276 (Claims Status Inquiry Request) / 277 (Claims), Status Inquiry Response), 834(Benefit Enrollment and Maintenance Transaction), 997/999 (Transaction Acknowledgement).
• Experienced in creating Business Requirement Document (BRD), Functional Requirement Document (FRD), Technical Specification Document (TSD), Requirement Traceability Matrix (RTM), Scope Statement and other project related documents
• Demonstrated leadership abilities and teamwork skills as well as the ability to accomplish tasks under minimal direction and supervision. Strong analytical skills with detailed follow - through and skills in business process mapping and analysis.
• Experience in performing GAP Analysis and Impact Analysis on various projects.
• Prepared test scenarios and test cases for testing the functional and non-functional aspects
• Proficient in developing use cases, user stories, process workflows and activity diagrams
• Excellent communication and presentation skills with experience in the development, implementation and integration strategies within a team oriented environment, utilizing quantitative and qualitative analytical skills.

TECHNICAL SKILLS:

Business Skills: Business Process Analysis & Design, Requirement Gathering, Use Case Modeling, JAD Sessions, Gap Analysis, Impact analysis and Data Mapping

Defect Tracking: HP Quality Center

Query and Programming: SQL

Databases: SQL Server 2008 & 2012, Oracle 11g & 10g, MS Access, MySQL

Document Management: MS Office (Word, Excel, Power Point, Outlook), MS Visio, Lotus Notes, Microsoft Share Point, RALLY, JIRA, TFS

Methodologies: Agile, Waterfall

Reporting Tools: Tableau, Excel Pivot Tables

PROFESSIONAL EXPERIENCE:

Confidential

Business Analyst

Responsibilities:

• Interact with client and gather business requirement for updating the rules in EZ-Cap and Admin Utility
• Closely work in an Agile team and conduct daily stand up, estimation planning and prioritization meeting to groom the product backlog
• Performed As-Is/Current-State analysis and drafted To-Be/Future-State processes based on identified requirements. Worked on developing Process and Data Flows.
• Initiate change requests and make sure to adhere to the timelines promised.
• Documented various Use Case scenarios, Process Flows and other diagrammatic representations in MS Visio.
• Validated the following: 837 (Health Care Claims or Encounters), 835 (Health Care Claims payment/ Remittance), 270/271 (Eligibility request/Response).
• Prepared 834 Inbound elements mapping companion guide to implement 834 Benefits enrollment and Maintenance for CCA.
• Extensively worked within varied sectors of the healthcare industry including HMO, PPO, POS, Medicaid, Medicare, Integrated Hospital Systems, Out-Patient Surgery Centers, Dental and Vision.
• Performed UAT Testing with QA and Business Team.
• Create data flow diagrams, data mapping from source to stage and stage to Confidential mapping documents indicating the source tables, columns, data types, transformation required and business rules to be applied.
• Performed data validation using SQL queries.
• Served as a liaison between business team and the project team by assisting the business in identifying, understanding, and documenting their business needs.
• Converted Business Requirements documents into Functional Requirements Specification and Technical Specification.
• Worked on developing the process flows for the web application to make it optimized in terms of user interaction.
• Identified all necessary Business Use Cases from requirements, created UML Diagrams including Use Cases Diagrams, Activity Diagrams, and Sequence Diagrams, using Microsoft Visio.
• Assisted in developing GUI for the new application. Developed mockup screens.
• Performed gap analysis to understand the improvement strategy of business.
• In house experience with project management tools like MS-Project and TFS for status reporting, planning and error tracking and correcting.
• Conducted User Acceptance Testing (UAT) with user group. Provided support for problems reported by users. Worked with both users and development team to resolve the issues.

Confidential, Bloomfield, CT

Business Systems Analyst

Responsibilities:

• Function as a business & reporting analyst in Agile Methodology.
• Gather business requirements and formulate them into reporting requirements
• Schedule & conduct meetings with marketing and sales teams to gather business requirements
• Closely work with marketing and sales teams, making sure that they understand the reports developed and address any questions
• Perform data analysis to create reporting requirements by specifying inclusion & exclusion criteria, conditions, business rules and data elements to be included into the report
• Created mapping document which contains source, formulate transformational rules to populate Confidential fields
• Perform SQL query to extract data from warehouse for data analysis
• Interact on day to day basis with the business team and translate the business requirements into technical deign document
• Support the business team and QA team with any questions on the Tableau dashboards and reports
• Develop SQL scripts to validate the metrics and data points before passing the dashboard tointegration testing
• Facilitated the Scrum Ceremonies - Backlog Grooming, Release and Iteration Planning Meetings, Daily Scrum Calls, and Retrospective Meetings.
• Extensively worked with SQL queries to create benchmark document, Validation scripts.
• Participated in quality assurance activities like reviews, walkthroughs etc

Environment: Agile - Scrum, Tableau, SQL Server 2012, Microsoft Word, Excel, PowerPoint, MS project, RALLY

Confidential, Oakland, CA

Business Systems Analyst

Responsibilities:

• Engaged as the primary link between business line, operations and the technical areas throughout the project.
• Analyzed data coming in from various Sources and mapped the necessary data to the Confidential .
• Data Analysis and requirements gatherings, including meeting with the business unit stakeholders, subject matter experts and engineering
• Developed numerous Teradata SQL Queries by using Inner and Outer Joins, Using Date Function, String Function and Advanced techniques like sub-queries
• Preparation of technical documentation, including process flows, data mapping etc
• Technical assistance during the implementation of Extract Transform Load (ETL) process
• Conducted meetings to gather requirements from Business Managers, Supervisors, stakeholders and subject matter experts to gain knowledge about needs of the system.
• Created gap analysis document to specify changes to be introduced in the campaign management tool
• Identified, researched, investigated and documented businesses processes and use case scenarios.
• Responsible for ensuring that privacy and security environments of campaign data remained intact

Environment: Teradata SQL Assistant 7.0, Power Point, Excel, Agile- Scrum, MS- Project

Confidential, Boston, MA

Business Analyst

Responsibilities:

• Engaged as a Business Analyst to support various Massachusetts Health Connector work streams including enrollment, Notices, Appeal and Integration
• Conducted face to face meetings, JAD sessions to gain process & modeling understanding
• Elicited information from stakeholders and converted into requirement
• Created scenarios to check Medicaid, Medicare program determination based on income, dependent, size of family, residency, citizenship, incarceration, disability, and pregnancy status.
• Prepared data validation to verify values of 834 XML data feeds with acceptance, rejection, error and effectuate messages and codes
• Involved in Auto-enrollment batch runs including preliminary eligibility, final eligibility and renewal eligibility to determine eligibility for the members
• Conducted walkthrough session to review requirements, process flows and scenarios with business team to obtain approval/ signoff.
• Defects analysis to determine business and technical impact and providing input on the priority of fixing the defects.
• Incorporated changes to the approved documents through integrated change request procedures.

Environment: MS-VISIO, Agile - Scrum, SQL Server, Microsoft Word, Excel, PowerPoint, MS project

Confidential

Business Analyst

Responsibilities:

• Worked with thebusinesscommunity to definebusinessrequirements and analyze the possible technical solutions.
• Co-authoredbusinessrequirements document (BRD) with project teams. Extracted, discussed, and refinedbusinessrequirements frombusinessusers and team members.
• Conducted workflow, process diagram and gap analysis to derive requirements for existing systems enhancements.
• Collaborated with the QA team to ensure adequate testing of software both before and after completion, maintained quality procedures, and ensured appropriate documentation is in place.
• Helped the testing team documenting the system requirements and testing system development. Designed and implemented basic SQL queries for QA testing and report / data validation.