SUMMARY

• Over 6+ years of experience and expertise as a Business Analyst in various domain namely Health care, Insurance and so on.
• Experienced as a Facets Business Analyst in gathering the business requirements from the existing stored procedures, supporting the Interfaces and reports development in explaining the functional requirements, proposing technical solutions, supporting the unit testing and system integration testing with the functional flow.
• Experience in mapping business requirements, designing customized solutions with strong analytical skills and ability to analyze business practices and define optimal procedures.
• Insightful knowledge of business process analysis and design, domain & technology expertise with strong integration skills.
• Extensively worked on Member Out - of-Pocket Cost (MOP) Estimate tool helps members understand the cost of care. It incorporates their benefits, copayments, coinsurance and deductible information to show the approximate costs associated with a particular procedure or service.
• In-depth knowledge and experience in full SDLC with RUP, Agile/Scrum and Waterfall methodologies.
• Writing & documenting Business Plan, Business Requirements Document and Functional Specification Document
• Proficient in creating Use Case diagrams, Class diagrams, State Transition Diagrams and Activity Diagrams using UML methodology.
• Experience in managing requirements from project inception through release.
• Creating use case models in MS Visio.
• Ability to gather and document Business Requirements, experienced in writing Use Cases. Proficiency in SDLC life cycle, understands the workflow concept, ability to gather and document the 'As-Is' and 'To-Be' processes.
• Hands on experience gathering requirements in the form of User Stories. Ensures stories and acceptance criteria are appropriately defined & documented.
• Requirement gathering through interviews, workshops, JAD sessions with clients, developers and QA Analysts and referring to existing system documentation and procedures.
• Strong ability to elicit, document, validate and transform business requirements at different stages of software development life cycle.
• Strong experience with automation solutions such as Selenium, Cucumber, Gherkin and similar automated testing tools/framework
• Knowledge and experience in implementation of HIPAA and NCPDP standards.
• Experience with Claim/EncounterManagement, claim data collection, claim quality check, filter claims, etc.
• Immense knowledge in Health care payer operations, Interfaces, Reports, Letters and system Migrations, Health Administration - Claims processing (auto adjudication), Claims pricing and testing, HIPAA, enrollment, Medicare, Medicaid, etc
• Expertise in HealthCare Administration/Managed Care Systems working with various Claims Systems/Applications with multiple healthcare client systems, with prime focus on claims adjudication, provider, eligibility.
• Expert in SDLC (System Development Life Cycle) methodologies like the RUP and the waterfall.
• Managing requirements traceability information and tracking requirements status throughout the project.
• Strong knowledge of Project management skills such as time estimation, task identification, risk analysis and scope management and resource management.
• Ability to act as a liaison with different stakeholders of the project as well as business analysts, quality assurance team, technical writing team.
• Performed extensive Cost benefit analysis, Requirement Analysis including data analysis and gap analysis.
• Experience creating and defining test cases and test scenario.
• Involved in unit testing, system testing, integration testing, white box testing and black box testing.
• Involved in maintaining Traceability Matrix and performing GAP analysis
• Knowledge of the following HealthCare EDI Transactions for 4010/5010 like (278) Referral and Authorization, (834) Benefit and Enrollment, (835) Payment & Remittance Advice, (837 I & P) Institutional and Professional HC Claim
• Functional experience with concentration on Use Case modeling using UML, Business Process Modeling, Data Modeling, Change Management, Technical, Software Development methodologies, QA testing, and Systems Testing interfaces, Reports, Letters.
• Good expertise in creating Test Cases on the basis of product features, client requirements and technical documents.
• Developed, executed and maintained Test Scripts, Reviewed and documented system and implementation Test Strategy Documents for Parallel Testing, and system integration testing.
• Great communication skills, client relations, presentation and negotiations with creative approach to problem solving through use of excellent analytical skills.
• Involved in building the Health care center of Excellence across by involving in creating and sharing the knowledge base and conducting sessions across the organizations.
• Managing requirements traceability information and tracking requirements status throughout the project.
• Strong knowledge of Project management skills such as time estimation, task identification, risk analysis and scope management and resource management.
• Ability to act as a liaison with different stakeholders of the project as well as business analysts, quality assurance team, technical writing team.
• Performed extensive Cost benefit analysis, Requirement Analysis including data analysis and gap analysis.
• Experience creating and defining test cases and test scenario.
• Involved in unit testing, system testing, integration testing, white box testing and black box testing.
• Involved in maintaining Traceability Matrix and performing GAP analysis
• Analyzing bugs, interaction with team members in fixing errors.
• Interacted with client regarding project status and feedback on UAT anddiscussed the information with the dev. team.
• Experience in performing end-to-end User Acceptance Testing (UAT).
• Created Mockups of reports using available data resources.
• Created prototypes and mock-ups for the application.

TECHNICAL SKILLS

Project Methodologies: Waterfall, Rational Unified Process (RUP), Agile/Scrum

Business Modeling Tools: MS Visio, SnagIt

Requirement Management Tools: Rational Requisite Pro, JIRA, RALLY, MS Project Planner

Defect Tracking Tools: Quality Center, Test Director.

Operating Systems: UNIX, Windows

RDBMS: MS SQL Server, Oracle.

Languages: SQL, XML, .NET, JAVA

Testing Tools: Selenium, Silk, Empirix, JRunner, Gherkin

Business Applications: MS Word, Excel, PowerPoint, Outlook, SharePoint

PROFESSIONAL EXPERIENCE

Confidential, Durham, NC

Sr. Business Analyst

Responsibilities:

• Gathered Business Requirements from the Subject Matter Experts (SMEs) for “ICD 10 Project” and documented the requirements in the BRD.
• Gathered the high level business needs from the directors and prepared the High-level Business Needs.
• Involved in the meeting with Business Process Owners, SME (Subject Matter Experts) and users for Requirement gathering in Definition Stage.
• Used Sales Force for generation of various forms of Interactive Reports for Annual Budget purposes.
• Worked on Huge volumes of Databases for Merging Databases into a single database
• Interacted with multiple clients in Gathering Requirements and Preparing Business Requirements as well as Technical Specifications
• Responsible for writing Functional Requirement Specifications (FRS)
• Assisted for developing the Project Plan
• Conducted the FRS reviews and walkthroughs with designers, developers and stakeholders.
• Analyzed Business Requirements and segregated them into high level and low level Use Cases, Activity Diagrams/State Chart Diagrams (UML).
• Mapped the old requirements with the new requirements and communicated it with the business groups for the gap analysis.
• Created Data Stage jobs to extract, transform and load data into data warehouses from various sources like relational databases, application systems, temp tables, flat files etc.
• Created Process Flow diagrams, Use case diagrams (UML) using MS-Visio
• Collaborate with developers and subject matter experts to establish the technical vision and analyze tradeoffs between usability and performance needs.
• Successful delivery of projects utilizing the Agile software development methodology
• Generate and maintain detailed and complete business requirements and user stories and interpreting those requirements to a functional level to deliver to the core development team or outside vendors for the build cycle.
• Document requirements as User Stories and Tasks in both RALLY/HP Quality Centre.
• Prepared Screenshots and web layouts for the application
• Served as a liaison between the internal and external business community (Claims, Billing,, Capitation, Customer service, management, provider management, advanced Healthcare management, provider agreement management) and the project team.
• Responsible for Requirement Analysis, User Acceptance Testing, Implementation, Data
• Provided information technology consulting services to clients to assure the MMIS system meets all business and technical requirements.
• Creation of Gap/Impact Analysis Document for the Prescription Drug Point of Sale System
• Documentation for the Drug Utilization Review System
• Creation of Gap/Impact Analysis and Operational Analysis, document Medicaid Subrogation and the Drug Rebate Analysis and Management System
• Managed theencounterdata collection effort between the health plan and the medical group.
• Researched, analyzed and resolved intricateencounterdata issues in association with EDI transaction errors.
• Prepare requirement specifications such as Use cases and System requirement specifications and Supplementary specifications; Tag and trace system requirements to business requirements
• Develop functional design details and specifications through collaboration with development teams and using system architecture and other technical considerations
• Maintain test data files and monitor system configuration to ensure data integrity; review data loaded and processed to identify gaps and data anomalies
• Analyzed the current Business Requirements gathering process with BPM and re-established/optimized the process JAR.
• Designed and implemented basic SQL queries for QA Testing and Report / Data Validation
• Used ClearCase to keep different versions of the documents and ClearQuest to report bugs or defect
• Used Rational RequisitePro as requirement gathering tool.
• Participated JAD sessions with developers to review Unit test results. Performed QA including functional testing, System testing and End to End testing.
• Successfully managed the project and released the product.

Environment: Windows, XML, SQL, MS Office (MS Word, MS Excel, MS PowerPoint, MS Visio), RUP, RequisitePro, ClearCase, Clear Quest, Gherkin

Confidential, VA

Business Systems Analyst

Responsibilities:

• Worked on requirements, analysis and design, project management, testing (functional and user acceptance tests)
• Analyzed Business Requirements, performed gap analysis and segregated them into high level and low level Use Cases, Activity and sequence diagrams (UML Diagrams).
• Involved in the meeting with Business Process Owners, SME (Subject Matter Experts) and store users for Requirement gathering in Definition Stage.
• Extensively involved in data modelling
• Updated and maintained the project plan, budget spreadsheet, and quality process assurance documentation.
• Assisted the database development team in data modelling, data structure and data table layouts required for consolidation of incongruent databases,
• Responsible for gathering the requirements from a complex set of stakeholders and coordinating them in PMI.
• Responsible for writing Functional Requirement Specifications (FRS) and point of contact for System Requirement Specification (SRS).
• Created Activity diagrams and Use case Diagrams (UML Diagrams) using Rational Rose.
• Worked with the technical architects and database developers to convert the functional specification to technical specification.
• Coordinated with different team members to resolve the issues that are related to the new application.
• Involved in preparing Test Plans based on User Requirements Document (URD) and prepared the Test Cases using Test Director/Quality Center.
• Worked on multiple projects at the same time in agile software development environment using Scrum Methodology.
• Provided key initiatives in working with users in defining project and system requirements.
• Experienced in gathering business requirements and developing user stories, functional requirements and associated test scripts in the appropriate formats
• Review MMIS vendor design document compared to requirements Review Systems Integration testing results and perform user acceptance testing
• Involved in EDI HIPAA 5010 Gap Analysis for ANSI ASC X12.
• Copy original 837s, as created by the 5010 application in partnership with the EDI Clearinghouse, from the Phase II file share’s archive location over to the AGP “O” drive so that all of the AGP scrub tools can be executed directly on the AGP network. that are known to trigger severe rejections and thus should be removed from the submission file.
• Provided inputs in the strategic development of detailed project plans, work assignments, target dates etc.
• Processed annuitant transaction to move their payout investment from one separate account to another
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, etc
• Performed requirement analysis, went through all the use cases and issue logs.
• Developed strategic partnerships with the business unit to prepare a solid knowledge base of the business line, including the business plan, products, and process’ and revenue streams aimed towards problem solving.
• Played a key role in the planning, testing, and implementation of system enhancements and conversions.

Environment: Windows, XML, SQL, MS Office (MS Word, MS Excel, MS PowerPoint, MS Visio), Claredi and Faciledi, Gherkin

Confidential, Danville, PA

Business Systems Analyst

Responsibilities:

• Extensively involved in implementation of effective requirements practices, including gathering User Requirements, and analyzing User Requirement Document (URD), and functional specification document (FSD), use and continuous improvement of a requirement gathering processes.
• AppliedRUP methodology with its various workflows, artifacts and activitiesto manage life cycle from Inception to Transition phase.
• Provide information technology consulting services to clients to assure the MMIS system meets all business and technical requirements
• Acted as liaison between external clients and SMEs to generate and standardize product requirements specification documents such as URS/FRS/Use Cases.
• Wrote and discussed the user stories to gain agreement and understanding of the requirement across the project team.
• Responsible for documentation of different Medicare Benefit terms and Programs Configuration library.
• Employed UML methodology in creating UML Diagrams such as Use Cases, Sequence Diagrams, State Diagrams, Activity Diagrams andbusiness process and workflows.
• Was engaged in applying CMM standards which provided guidance for improving organization's processes and the ability to manage the development, acquisition, and maintenance of products or services was providing to its clients.
• Guide and advise SAS programmers to identify and improve the efficiency of current SAS programming practices Contribute to knowledge sharing, ideas and information relating to SAS technologies and be a key technical expert within the team
• Performed unit, system and regression testing for SAS programs for quality assurance
• Assisted JAD sessions to identify thebusinessflows and determine whether any current or proposed systems are impacted by the EDI X12 Transaction, Code set and Identifier aspects of HIPAA. Involved in GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims.
• Worked on EDI transactions: 270, 271, 835, and 837 (P.I.D) to identify key data set elements for designated record set.
• Involved in designing & determined3-tier architecture for the claim processing system.
• Assisted team lead in developingRequirements Traceability Matrix (RTM)to trace the relationship betweenbusinessand functional requirements to test cases. Prepared and executed different Test Cases and Test Scripts.
• Involved in conducting Functionality testing, Integration testing, Regression testing and User Acceptance testing (UAT). Provided analysis and insight to QA Team in defects and bugs tracking.

Environment: Windows, MS SQL Server, Rational Unified Process (RUP), CMM, UML, Rational Rose & RequisitePro, Mercury Quality Center & Test Director, Clear Quest, MS Office Tools, MS Outlook, Java, Gherkin

Confidential, Columbus, Ohio

Business Analyst

Responsibilities:

• Conducteduser interviews, gathered requirements, and analyzed the requirements for existing legacy application forpatient enrollment and care management
• Gathered high level requirements and createdbusinessuse casesandfunctional requirements documentsfor care program administration ad patient enrollment using Microsoft Visio and word
• Conductedworkshopswith legacy teams as well as customer service teams around care management
• Evaluates high-level cost-benefit analysis throughout the release to ensure the right investments are being made at the product, release, and sprint levels. Partners with various other groups (e.g., legal, third party vendors) to refine user stories and to determine development alternatives.
• Createdwire framesto visually represent specific functionality such aspayer, patient and prescriber search and set up
• Worked closely with the Administration team to identify, document and set upquestions for care plansof various specialty diseases (Multiple Sclerosis, Diabetes, Cancer)
• Involved in documentingbusinessprocesses such as setting up the care plan, enrolling the patient, initiating drug therapy management by identifying requirements and also finding the system requirements
• Worked with end users to identifyreporting requirements
• Created andreviewed test cases and traceability matrixesfor setting up and administering care plans
• Coordinated testing efforts and updated management on the test plan on a daily basis
• Provided full support to user community bypreparing documents and communication materialson the release processes.
• Researched and documented the laboratory’sexistingbusinessprocesses ensuring that a clear and accurate picture of the current state is captured prior to initiation of LIMS upgrading process
• Participated in laboratory engagements and workgroup kick-off meetings to help bridge the gap between the lab experts and the LIMS Implementation Specialists

Environment: MS Office, SQL, Oracle, Microsoft Visio, Mainframe, Custom Java applications