SUMMARY:

• Over 8 year’s of experience in all phases of SDLC (Software Development Life Cycle) as Sr. Business Analyst.
• Perform role ofProductOwneron core system initiative, draft and prioritize user stories; lead weekly extended backlog refinement/grooming sessions.
• Work with Scrum Master, Program Manager,ProductManager and Team to define teh project’s definition of ready and definition of done.
• Experience in conducting Joint Application Development (JAD) sessions for requirements gathering, analysis, design and Rapid Application Development (RAD) sessions.
• Assisted in user acceptance testing (UAT) of teh system.
• Experience in creating different artifacts such asProductScope Document, Business Requirements Documents (BRD), Functional Requirement Specifications (FRS) and Requirement Traceability Matrix& Reports.
• Strong functional expertise in teh Healthcare Payer Area - claims, benefits, eligibility, ICD10, HIPAA, ACA and CMS HCPCS Exposure to Health Care Industry standards like HIPAA / PHI and data format like EDI, XML, and HL7 Interface Implementation.
• Broad knowledge of 837 EDI file creation using flat files includes detailed experience working on Pro-EDI and 837 formatter tool.
• Strong knowledge of EDI Claims, member enrollment, billing transactions, claimsmanagement process, Medicaid and Medicare Services
• Developed EDI files for 837I, 837P and 837DME for CMS submission.
• In-depth Understanding of Payer plan sponsor and teh EDI transactions like 837, 835, 834, 999, 277, TA1.
• Develop error resolution and prevention guide for risk adjustment programs.
• Proficient withBusinessAnalysis tools such as designing wireframes (Balsamiq), JIRA, and Github.
• Expert on US Health Care Industry, Electronic Data Interchange (EDI), Health Level 7(HL7) and Health Insurance Portability and Accountability Act (HIPAA).
• Excellent knowledge of Medicare, Medicaid, and MMIS (Medicare Management Information System)
• Good knowledge of Business Process Modeling and Business Process Re-Engineering and experience with SWOT analysis.
• Proficient in data analytics, data modeling and data integration with complete expertise over different ETL tools.
• Expert in iterative software development life cycle AGILE with experience in SPRINT planning, SCRUM meetings, story board management and change management.
• Extensive experience with process modeling using Unified Modeling Language (UML), use case diagrams, including teh business workflow using Rational Suite, Rational Rose and MS Visio.
• Experience in working with Work Breakdown Structure (WBS), in project management and systems engineering.
• Assisted teams in creating different SSIS packages to automate processes in different Control Flow and Data Flows.
• Strong Subject Matter expertise (SME) in Healthcare, ARMS Medical Billing Information System, Market Research, Risk Management, Product Development, Banking, Risk Analysis, Asset Management- risks and returns.
• Experience in conducting GAP analysis, User Acceptance Testing (UAT), SWOT analysis, Cost benefit analysis and ROI analysis.

TECHNICAL SKILLS:

Business Process Automation: JIRA, MS Project, Rally, Blueprint

Requirement Management: Rational Requisite pro, UML, Microsoft Project, JIRA, Microsoft SharePoint, TFS

Modeling & Designing Tools: MS Visio, SnagIt

Business Analysis Structure: Agile/Waterfall/Scrum/SAFe/JAD/RAD/BPM

Testing Tools: Quick Test Pro, Load Runner, Win runner, HP Mercury Quality Center

Informatica, Talend, SSIS, SPSS: Oracle9i/10g/SQL/SQL Server/Microsoft Access/Toad for SQL, SAS, Essbase, SSIS, SPSS

Reporting Tool: Tableau, Jasper Soft, Cognos, Crystal Reports, BRIO Query, SSRS

Languages: VB, SQL, XML, UML, ASP, JSON

EXPERIENCE:

Confidential, Glen Allen, VA

Sr. Business Analyst

Responsibilities:

• Conduct business analysis and product owner functional roles on custom development initiatives using newly adopted agile methodology and Scrum practices.
• Produced BRDs and FRDs for RAPS and EDPS process to automate return file management process and achieved accomplished efficiency in saving processing time by 95%.
• Enhanced business intelligence and data analytics using SQL, Talend, SSIS, Tableau, ETL and SSRS to improve reporting process for audit team, finance team, and higher management.
• Streamlined process of data enrichment, modeling, and management & warehousing.
• Documented Business Requirement Documents and use case specification documents and came across various functional requirements through UML diagrams with teh help of activity, use case and specification diagrams.
• Analyzed and supported BI developers for system data mapping, utilizing Master Data Management (MDM), SQL server, and Hyperion/ HFM.
• As IS analysis via reviewing existing Business units, Business process, System/ Application and their Interfaces through KT session, open-ended discussions, brainstorming sessions, prototyping etc., which helped in designing business process restructure and automation.
• Performed GAP analysis and impact analysis to draft roadmap for business undertakings.
• Developed claim submission and return tracking structure using SQL and SSIS packages used to automate reconciliation report, served to top management in status meetings.
• Extensive knowledge of Pro-EDI tool and generated EDI file for EDPS submission to CMS.
• Lead to development of837 formatter tools for outbound and inbound EDI file conversion; reduce file processing time by 95%.
• Established User stories in product backlog, formalized business prioritization and governance; defined quarterly release plans and product roadmaps.
• Worked with business leaders, clinical, operations and quality teams to identify, evaluate and design enhancements to teh risk adjustment products.
• Processed and correct error on EDPS return files including 999, 277, TA1, MAO 001, MAO 002 and MAO 004.
• Measure/track/report project/productTEMPeffectiveness and made recommendations based on findings. Utilize negotiation skills to evaluate priorities and resolve conflicts.
• Streamlined OPTUM EDPS claim generation and submission process with of 99% acceptance rate.
• Managed and delivered changes and enhancements to teh Web Access Management environment. Comprehensive understanding of client processes and Web Access Management environment
• Functioned as a CMS point of contact for whole RAPS and EDPS claim submission process, which include tracking all claim submission, return file management, regulatory documentation distribution, maintaining clear communication etc.
• Worked with teh business users to successfully translate complex union pay rules into development requirements for teh onshore and offshore development team based in India.
• Claims submission to CMS via IBM Sterling Connect Direct Main frame system.
• Examined errors claims in RAPS and EDPS process and worked on its correction and submitting them followed by 70% acceptance rate.
• Worked on RAPS Errors which includes 450, 451, 455, 400, 500 etc., and EDPS errors which includes 254, 19, 255, 465 etc.
• Created department structure diagram & process diagram which helped in pointing out bottleneck in teh process.
• Improved TFS (Team Foundation Server) functionality by designing efficient hub of documents related to process, SQL scripts, SSIS packages, UAT planning, test cases etc.

Confidential, Miami, FL

Business Analyst

Responsibilities:

• Managed project and was involved in resource management.
• Co-ordinated with documenting processes used agile methodology to write teh Business Requirements documents and designed Functional specifications.
• Served as a liaison between teh internal/external business community and teh IT organization in order to provide technical solutions to meet user needs.
• Participated in design review meetings and translated teh requirements to teh developers and guided teh team when issues related to business requirements arose.
• Worked with Associates and understood teh business rules, systems and integrated them into teh requirements document and assisted in generation of test cases and test data.
• Created workflows, data model diagrams, and other industry standard documents to represent client’s business processes.
• DevelopWebAccessManagement(WAM) requirements to integrate user roles with secured authentication services.
• Team Member of Corporate Integration Project for synchronizing teh Master Data Management (MDM) with teh Customer Data Mart (CDM).
• Conducted JAD sessions between teh business users, Developers, testers & Subject Matter Experts to resolve bottlenecks.
• Maintained product and subject matter expertise on Risk Adjustment solutions so as to identify necessary
• Oversaw and served as liaise with offshore team and internal groups. Primary focus was gathering requirements, creating user stories, managing offshore group and providing walkthrough documentation.
• Implemented & supported IdentityManagement, LDAP Directories, Provisioning/Identity Workflows,AccessManagement, and Single Sign on (SSO)
• Used HL7 guidelines and dictionary for defining business rules associated with pre-defined workflows according to business requirements.
• Played important role into creation of CRUD (Create, Read, Update and Delete) Metric to make analysis and better understand data flows between different systems
• Conducted Risk Analysis to identify teh risks associated with developing teh patches, and formulated a Mitigation Plan to eliminate or reduce risks of high severity and any major TEMPeffects.
• Played an active role in performing of Gap Analysis and its documentation.
• Designed and implemented SSIS packages to translate data from operational systems.
• Work closely with teh application development and design team onsite and offshore to resolve technical issues and interact with them to ensure overall quality of teh project.
• Met with client to present future functionality of teh application, gather information from them to know about their need and send dis information to test manager.
• Worked closely with teh application development and design and testing team to resolve technical issues and interacted with them to ensure overall quality of teh software
• Responsible for creating & maintaining Requirement Traceability Matrix in order to track teh development and QA process.
• Interacted closely with QA to finalize teh Test strategies and maintained quality assurance using HP Quality Center.
• Provided production support pre-production and post- production issue management and defect tracking.

Environment: Windows, MS Office 2013 (MS Word, Advance MS Excel, MS PowerPoint, MS Visio), MS Access, MS Project, Apache Subversion, Erwin, SSIS, Rational Rose, MySQL, Clear Case, Requisite Pro

Confidential, Long Beach, CA

Business Analyst

Responsibilities:

• Conducted Joint Application Development(JAD)sessions and walk in interview with teh business users to gather requirements.
• Did impactanalysisforchanging requirementsand coordinated withbusiness usersand Project Manager for prioritizing teh testing/release of teh changes through CAB.
• Work as part of anAgile teamto solve problems and deliver projects in a fast paced environment
• Helpedcreating Reportsusing Tableau for Claims processing, Provider and Member.
• Responsible for data management, submission and reconciliation as well as analyzing and reporting for Medicare and Medicaid RAPS and EDPS risk adjustment programs.
• Assist with maintaining teh database of all risk adjustment data.
• Prepared theBusiness requirement Documentfor teh enhancement of teh existing services. WroteTRDfor teh requirements and RTM for testing anddefect tracking.
• Modeled theAS-IS systemand performedGAP Analysisfor teh existing system in order to map it to theTO-BE system.
• Managed and coordinated offshore resources in teh development of teh Freight Auditing System.
• Worked on improvement of Claims Reimbursement User Interface for a better experience and in corporate changes as perHIPAAguidelines using teh gap analysis.
• In-depth knowledge, understanding and practical implementation of Data Governance and Master Data management concepts, data analysis, quality, compliance, risk management, and operations supporting medical device and biologic development at various points along teh supply chain and product life-cycle
• Assisting business users in definingUAT test cases and plans; Established and maintained test cases and test data inQuality Center.
• Coordinated with teh QA Team for testing activities across multiple systems and managed Conversion test execution.
• Helps in conducting User Acceptance Testing(UAT), and System Integration testing(SIT)andSWOT analysis.
• Performed GAP Analysis forHIPAA 5010transactions and Performed Analysis ofICD 9Procedure and Diagnosis Codes in accordance withICD 10 CM and ICD 10 PCSConversion Compliances
• ProvidedSQLqueries to developer as source queries to identify teh data provided logic to assign.
• Responsible for providing theData Mapping documentand rewrite of theSQLqueries fromAs-Is To-Be and validating teh data throughSQL.
• Lead through UAT procedure and also conducted sessions for teh end users along with teh necessary documentation
• Createdtest planand facilitated its implementation, createTest casesand assisted manual testing
• Worked closely with teh testing team to discuss teh functionality and fix any defects found in teh Crystal reports created
• UsedSharePointto ensure all team members have easy access to all teh documents created

Environment: Blueprint, Rational Rose, Rational Requisite Pro and UML, Rational Clear Quest, SQL, Microsoft Visio, Test Director, HP Quality Center, Crystal reports, MS SharePoint, MS Project, ER-Win, MS Office.

Confidential, Hartford, CT

Business Analyst

Responsibilities:

• Thoroughly studied teh incumbent systems to get an understanding of teh processes and teh functional workflow in order to analyze and initiate teh project.
• Defined vision and scope of teh project and transformed them into documents to better analyze and understand teh rationale for teh application.
• Facilitated Gap analysis to get a hold of teh new business model and to extract additional functionalities dat would be incorporated into teh module.
• Worked closely with claim system processing to in corporate claim approval/denial and claim reimbursement and evaluated teh claim system with which teh data would be interfaced for teh user.
• Conducted JAD sessions for clarity and gathered requirements through brainstorming sessions with teh stakeholders and SMEs and with teh help of rational requisite pro, prioritized these requirements.
• Worked with User Interface (UI) team from Cognizant and client to develop wireframes and HTML prototypes of newwebportal
• Aggressively participated in teh design process along with teh architect in attaining technical requirements to provide technical expertise to teh developers for teh development phase of teh application.
• Collaborate with UX to analyze and refine User Stories to develop workingwireframeprototypes of teh business solution.
• Create wireframes and User Interface (UI) documents for better visualization and understanding of teh software solution through teh utilization of tools such asBalsamiqMockups and MS Visio.
• Developed reports using Crystal Reports and SSRS.
• Dealt with ICD 9 encryption to verify and confirm teh validity of teh incoming claims and documented them by saving it in teh database.
• Acts as organization's and client's Subject Matter Expert for questions or issues related to risk adjustment programs as well as file submissions and processes
• Helped streamline teh 276/277 transaction in order to enable easier and faster exchange of information between teh payer and teh provider.
• Liaise with offshore Programming and QA Staff, tracking their progress for teh ongoing New Hampshire project and reporting those metrics up to teh Senior Vice-President of IT.
• Assisted QA team by reviewing test cases and test protocols for verifying teh requirements to ensure complete coverage of all functional and technical requirements. Used Requirement Traceability Matrix to conduct thorough testing and verification.
• Managed offshore teams in different geographical places.
• Designed SSIS Packages to transfer data from flat files to SQL Server using Business Intelligence Development Studio.
• Provided to teh end users, conducted Regression testing and User acceptance testing sessions to gain user approval and feedback.

Environment: Windows, MS Office 2010 (MS Word, MS Excel, MS PowerPoint, MS Visio), MS Access, SSIS, MS Project, Rational Rose, MySQL, Crystal Reports, SSRS, Clear Case, Requisite Pro.