PROFESSIONAL SUMMARY:

• Qualified professional with 6+ years of extensive experience in the field of Business Analysis (Healthcare and Banking domains) working with the technical staff to implement management and staff's business requirements into the software application.
• Proficient in Conducting AS - IS, To-Be analysis and suggest Business Process Flow, Business Process Modeling Notations (BPMN), Business Analysis and testing various methodologies.
• Developed Request for Proposal RFP(S), Statement of Work (SOW) to find solution and partners.
• Prepared solution options, risk identification, and financial analyses such as cost/benefit, ROI, buy/build, etc.
• In depth knowledge Agile/Scrum, Waterfall methodology, Use Cases, Software Development Life Cycle (SDLC) processes.
• Conducted Daily Scrum meeting, Planning Sessions, Backlog updates, User Stories updates, Continuous Integration, Continuous Testing.
• Documentation in the form of Artifacts and Specs. Creation of industry standard documents such as BRDs, FSDs, User Stories and Use Case specs.
• Experienced in Scrum Practices like User Stories, Story Slicing, Backlog Grooming, Release Planning, Sprint Planning, Sprint Review and Sprint Retrospective.
• Experience in developing Business Requirement Document (BRD) and Functional Requirement Documents (FRD).
• Experience in facilitating Joint Requirement Planning (JRP) sessions withBusinessUser Groups, conducting Joint Application Development (JAD) sessions with IT Groups and Conflict Management with Project team members.
• Competent in Creating Unified Modeling Language (UML) diagrams such as Use Case Diagrams, Activity Diagrams, Class Diagrams and Sequence Diagrams.
• Facilitated Change Management (CM) across entire process from Project conceptualization to Testing through Project Delivery, Software Development and Implementation Management in diverse Businessand Technical Environments.
• Possess good knowledge Medicare, Medicaid and regulatory standards such as HIPAA, X12, HL7.
• Strong Technical writing skills for Validation Deliverables such as Quality Assurance Plan (QAP), Validation Strategy Document, Requirement Specifications, Design Specifications, Standard Operating Procedures (SOP), Traceability Matrix (RTM), Qualification Protocols (IQ, OQ, PQ) and Validation Summary Report.
• Extensive knowledge of Medicaid, Medicare, Procedural and Diagnostic codes and Claims Process.
• Strong knowledge of Health Insurance Portability & Accountability Act (HIPAA) standards, Electronic Data Interchange (EDI), transaction syntax like ANSI X12, Implementation and knowledge of HIPAA code sets, ICD-9, ICD-10 coding, HL7, HMO, PPO.
• Excellent knowledge of FACETS 4.17 or Later.
• Well versed with Medicaid Management Information Systems (MMIS), National Provider Identification (NPI) and familiar with Patient Protection and Affordable Care Act (PPACA), Health Benefits Exchange.
• Strong knowledge of SQL, data analysis and data validation using SQL, QlikView, Tableau, or SAS.
• Extensive experience in creating and maintaining source to target Data mapping documents.
• Excellent understanding and expertise in writing complex SQL queries to perform back-end testing.
• Strong expertise in Data analysis, Data mapping, Data modeling and development of Databases for business applications in client/server applications.
• Proficient in designing and implementing basic SQL queries for QA testing and report/data validation using Oracle, SQL Server and DB2.
• Involved in Test Planning, Test Preparation, Test Execution, Issue Resolution and Report Generation to assure that all aspects of a Project are in Compliance with theBusiness Requirements.
• Strong experience in conducting User Acceptance Testing (UAT) and documentation of Test Cases. Expertise in designing and developing Test Plans and Test Scripts.
• Providing Training/Knowledge Transfer to the end users.
• Experience with Medicare and Medicaid: Claims processing, Membership, and Eligibility Verification and care management.

TECHNICAL SKILLS

OPERATING SYSTEM: Windows Server, Windows, UNIX, Linux, MAC, MS-DOS

TESTING TOOLS: HPQC, Load Runner, Quick Test pro

FRONT - END TOOLS: Adobe Photoshop, MS Excel, MS Office, MS Project

LANGUAGES: C, C+ +, HTML, XML, UML

REQUIREMENT MANAGEMENT: Rational Requisite Pro, Caliber RM

MODELING TOOLS: MS Visio, Rational Rose, Caliber RDM

PROJECTMANAGEMENT TOOLS: MS Project, Share Point 2010, JIRA, Confluence, Primavera

BUG TRACKING TOOLS: Rational Clear Quest, Rational Clear Case

METHODOLOGIES (SDLC): Scrum, Agile, Rational Unified Process (RUP), Waterfall Model

DATABASE: Oracle, MS SQL Server, MS Access

PROFESSIONAL EXPERIENCE:

Confidential, Rochester, MN

Senior Business Analyst

Roles and Responsibilities:

• Conducted Joint Requirements planning sessions (JRP) as a facilitator to gather requirements from the Business User and conducted many Joint Application Development (JAD) and Joint Application Management (JAM) and conducted many Rapid application development (RAD) sessions.
• 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.
• Coordinated cross-functional process development and identified opportunities and improve the process.
• Developed As-Is and To-BeBusinessProcessModelsfor complexprocessesby analyzing the currentprocesses, and gathering information from SME's.
• Involved in all phases of software development life cycle (SDLC) in agile framework.
• Used MS-Visio for Flow-Charting, Use Case process model and Architectural design of the application.
• Managed requirements and use cases with the help of Enterprise Architect.
• Used SQL, Toad, Data Warehousing and Data Cleansing for the arrangement of customer data.
• Queried database using Web focus and acted as a Liaison between end users and the data team (Business Intelligence Competency team).
• Performed analysis and data manipulation of source data from SQL Server and other data structures to support the business organization; these departments include planning, evaluation, programs, and administration.
• Continuously monitored the business process using the (BPMN) tools like Appian.
• Arranged sprint grooming, planning, daily scrum, sprint demo, and sprint retrospectives.
• Managed the product backlog with user stories through progressive refinement applying business prioritization, solution approach, and technical delivery considerations.
• Implemented the HIPAA privacy and security regulations to enhance the capabilities of the systems to process new products.
• Conducted walk through sessions to discuss certain issues with stakeholders, architectures and design & development teams and also performed GAP Analysis.
• Participated in the review, creation and updating of HIPAA compliant security policies, procedures and controls.
• Design, analyze and performed Integration and wrote System requirements on different leading healthcare software such as FACETS 4.71 or later.
• Documented all the aspects of Systems validation lifecycle in accordance with the FDA regulations, including Validation Plan and Protocol, Installation Qualification (IQ) Specifications, Operation Qualification (OQ) Specifications, Performance Qualification (PQ) Specification.
• Manage data validation processes to ensure compliance withCMSreporting requirements.
• Managed product backlog within JIRA and Tracked UAT issues/bugs and prepared reports.
• 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.
• Assisted QA team with User Acceptance Testing, develop and maintain quality procedures ensuring that appropriate documentation is in place.

Environment: MS Office, SQL, MS Project, MS Visio, Unix, Rational Rose, Rational Requisite Pro, Facets, XML, Windows, HP Load Runner, HP Quality Center.

Confidential, Chula Vista, CA

Sr. Business Analyst

Roles and Responsibilities:

• Conducted one on one sessions and team meetings with the team leads and SME’s to understand the business requirements.
• Preparing System Test Cases from functional and technical requirement and Use case documents and performing System Testing.
• Trouble shooted file transmission problems and assisted customers in a call center environment with EDI and Medicaid Insurance claim related inquiries explained and enforced guidelines in the X12 Implementation guides.
• Understood the healthcare plans offered, including Medicaid Managed Plans such as Children and Adolescent Care, Women’s Preventive Care, Maternal Care, Asthma Care, Diabetes Care, Cardiovascular Care, and Mental Health.
• Defined overall Architecture for EDI transaction for real-time and batch process
• Have worked with Chevron, delivering Regulatory (EPA) Reporting strategy for Corporate Health & Environment Safety.
• Involved in making Use Case Diagrams, Activity Diagrams, and using analysis and design models tools like MS Visio, Rational Rose through RUP, Agile and Waterfall Model
• Worked with SME close to understand Claim Adjudication Process setup in Facets.
• Followed the standards of PMO which included getting approvals for SOX Compliance at various Gates.
• Monitor departmental policies, processes, and procedural compliance for both in-house and client sites to ensure proper adherence to budget and safety standards.
• Assist with CMS onboarding new BPM, helping to collect data and analyzing the collected data.
• Thorough knowledge of Eligibility and Membership Affairs. Also knowledge of HIPAA, X12, and HL7 standards and Medicaid provider best practices.
• Applied Unified Modeling Language (UML) methodologies to design Communication Diagram, Use Case Diagrams, Activity Diagrams, Sequence Diagram, ER diagrams & Data Mapping.
• Participated in Forward and Backward Mapping analysis of ICD 9 - ICD 10 using GEM provided by CMS.
• Developed tables, Views, Stored Procedures and Triggers using SQL Scripting.
• Established Inner Join, Outer Join and created Indexes whenever necessary.
• Create flow charts forCMSnew model call handling processes.
• Writing Standard SQL queries and optimizing SQL Queries.
• Developed business level activity diagram utilizing UML (according to Agile Unified Process) to visualize use cases, identified gaps between the current model and future model.
• Propose strategies to implement HIPAA 4010 in the new MMIS system & eventually move to HIPAA 5010.
• Conducted JAD sessions with the participation of the users and the stakeholders to gather requirements.
• Used ScrumWork Pro and Microsoft Office software to perform required job functions.
• Involved in Medicare, Medicaid and also in International Classification Disease (ICD).

Environment: MS Project, Windows NT,, Microsoft Office SharePoint Server 2003, Facets, Agile, Microsoft Content Management Server, ASP .NET, IBM DB2 data server, MS Office, MS Visio, Test Director.

Confidential, Cincinnati, OH

Business Analyst

Roles and Responsibilities:

• Gathered User and Business Requirements through interviews, surveys, prototyping and observing Stored and modified requirements also prepared a use case driven BRD
• Creating Business Requirements Document (BRD) and System Requirement Specification (SRS).
• Coordinate and conduct elicitation techniques like JAD sessions, interviews and walk through sessions involving stakeholders, Product owner and technical team.
• Performed Gap analysis by identifying existing technologies, documenting the enhancements to meet the end state requirements.
• Developing user stories, use cases, functional and non-functional documents.
• Represent the business requirements through user stories, use cases, Entity relationship diagrams and process flow diagrams.
• Authorizing Data Flow diagrams, Activity diagrams, Sequence diagrams, use case diagrams, ER models and Business Process models with special detail to Sub-Processes using UML. Tracking and communicating team velocity and sprint/release progress with the aid of Burndown charts.
• Using MS Visio for process flow diagrams for identifying the gaps in the process.
• Collaborates with Product Owner in backlog refinement and prioritizing.
• Create Requirement Traceability matrix (RTM) post testing to assure compliance with goals. Utilized ETL for Extraction, Transformation and Loading.
• Coordinate with project stakeholders to track the progress of the project, update status and lead review meeting to ensure that schedules and deliverables are met.
• Extensively involved in Data mapping and E-R modeling. Created financial reports of the project using Excel. Used Tableau for analyzing and visualizing as part of data analytics.
• Streamlined clerical work and mapped the automated system.
• Working with SQL queries to extract application data to perform application validations.
• Creating validation rules and provided verbiage to technical team for database validation.
• Working extensively with the QA team for designing Test Plans and for User Acceptance Testing.

Environment: UML, MS Visio 2013, SQL, IBM Content Navigator, IBM Case Manager, MS Office Suite, Windows and Mac OS.

Confidential, Columbus, OH

Business Analyst

Roles and Responsibilities:

• Actively Involved in Pre-Analysis of project with SME (Subject Matter Experts) and Developers
• Conducted Gap analysis for ‘As-in’ and To-be of the process to identify and validate requirements.
• Participating JAD sessions with SME’s and multiple teams for requirement gathering and refinement.
• Analyzed the gathered requirement and reviewed Business Requirement Document (BRD)/Functional Specification Document (FSD).
• Created System Requirement Specification (SRS) document to describe all data, functional and behavioral requirement of the system.
• Used Share point for content management and document management.
• Wrote Use Case and built Use Case Diagram/ Activity Diagram using MS Visio.
• Created Requirement Traceability matrix (RTM) using HP QC tool.
• Involved in Data Extraction from Toad using SQL assistant.
• Designed reports in Access, Excel using advanced functions not limited to lookup, pivot tables, formulas.
• Used SQL, PL/SQL to validate the Data going into the Data Warehouse.
• Used JIRA for allotting task and issue tracking, user story management and requirement traceability.
• Worked with QA team for designingTest Plan and Test Casesfor UAT and regression testing.
• Tableau was used as a data visualization tool to communicate information clearly and efficiently via the statistical graphics, plots, information graphics, tables, and charts selected throughout the project

Environment: Scrum-Waterfall Hybrid, Wireframes, SQL Server, MS Word, MS Excel, MS PowerPoint, and MS Visio, GAP Analysis, HP QC, UAT Testing, SharePoint, ASP.net, Tableau, Ajax, XML, Web Server.