SUMMARY

• Business Analyst with 8+ Years of experience and proven skills of business requirement gathering, requirements documentation, use case development, business process flow and business process modeling.
• Extensive experience in all aspects of SDLC including analysis, design, development, configuring, implementing, functional testing and documentation.
• Good working knowledge of Project Management Office (PMO) principles and processes.
• Excellent knowledge of all 9 areas of PMBOK (Project Management Body of Knowledge).
• Experience with BPM (Business process Modelling).
• Extensive experience in System Life Cycle (SLC), testing methodologies and techniques, Rational Unified Process (RUP), Unified Modeling Language (UML) and Agile Scrum.
• Extensive experience writing Business Requirement Documents (BRD), use cases, functional specifications, use case diagrams, activity diagrams and sequence diagrams using UML modeling tools such as MS Visio and Rational Rose.
• Extensive experience developing use cases, creating screen mockups, and conducting GAP, Impact, SWOT, Cost Benefit and Risk Analysis.
• Experienced in producing wireframes, mock - ups, task flows and UI specifications as needed to assist with business socialization and approval, as well as implementation and testing.
• Created Unified Modeling Language (UML) diagrams such as use case, activity, entity relationship (ER), data flow, class, and sequence diagrams to support development team and business groups.
• Extensively interacted with stakeholders and IT department in finalizing requirements according to CMS compliances/regulations and HIPAA regulations.
• Experienced with Medicare and health care insurance as well as medical standards (HIPAA and HL7).
• Knowledge of HIPAA compliance life cycle, HIPAA insurance regulations and claims processing.
• Prepared Functional Specification Documents, AS-IS and TO-BE workflows.
• Experienced conducting Joint Application Development (JAD) sessions with end users, Business Intelligence team, IT SMEs and QA team for project meetings, walkthroughs, and stakeholders.
• Experienced in Agile SCRUM, Waterfall, Iterative software development process and Rational Unified Process (RUP) environment such as inception, elaboration, construction, and transition.
• Experienced documenting existing process, preparing Business Capability Decomposition (BCD), analyzing business requirements, working with Requirements Traceability Matrix, reengineering business processes, and designing.
• Advanced working knowledge of MS Visio, MS PowerPoint, MS Word, MS Excel, and MS Project to prepare test plans and deliverable timelines.
• Experienced tracking, documenting, capturing, managing, and communicating requirements using Requirement Traceability Matrix (RTM) which assisted in controlling numerous artifacts produced by teams across deliverables for a project.
• Good understanding of Object-Oriented Programming, Data Modeling, Data Mapping and Data-warehousing.
• Experienced developing initiation, scope, requirement documents, FRS, test documents, user and system documentation, process workflows, change management and implementation plans.
• Comprehensive knowledge of system configuration management and change request management to approve/reject changes, risk management, mitigation, and version management processes.
• Worked closely with Project Manager in documenting scope and allocation of resources using Microsoft Office and Visio. Excellent documentation and presentation skills.
• Exposure to Mercury interactive testing tools such as Quick Test Professional, WinRunner, LoadRunner, Test Director and Quality Center.
• Broad Knowledge in reviewing Test Procedures, creating Test plans and detailed test plans for UAT, Test scenario, defining Test cases. Worked on Black box and White box Testing.
• Comprehensive knowledge of testing life cycle within web and client/server environment.
• Facilitated test plan/test case walk-throughs for the Business and Development teams to obtain feedback and/or approval sign-off.
• Solid understanding of database and SQL, expertise executing queries in SQL and experienced in improving performance of database.
• Strong analytical, problem solving and communication skills with particular emphasis on clear, detailed business requirements and functional specifications as well as reports for management.
• Excellent organizational, interpersonal, communications, teamwork, and leadership skills with proven skill to interact across multiple levels of organization.
• Possess excellent soft skills, strong business acumen, conflict resolving, organizational, interpersonal and documentation skills with good process management skills to bring out a quality product.

PROFESSIONAL EXPERIENCE

Confidential, Baltimore, MD

Sr. Business Analyst

Responsibilities:

• Actively participated in gathering business requirements by interviewing Subject Matter Experts (SMEs), surveys and interviews and documented them in a format that could be reviewed and understood by business and technical teams.
• Conducted individual and group (JAD) sessions wherein SME’s, Designers, Developers and Testers could communicate to enhance the quality of the desired product.
• Major involvement in assisting the re-engineering of the organization to attain cost-effective treatment with increased efficiency, quality, and satisfied customer service.
• Analyzed client current process methodology for optimizing process performance and cost savings. Worked with the Project Manager to map business processes, identify process deficiencies, and deliver a foundation for implementing process improvements and share knowledge across the organization on how the processes work.
• Created high level and detailed use cases to explain system interaction with users.
• Assisted in creating logo concepts, wireframes, and mock-ups for the AMS icon project.
• Identified and created all necessary business use cases from requirements and created UML diagrams including use case, activity, sequence, and class diagrams.
• Effectively used Rational ClearQuest in identifying and tracking bugs and reporting them to development team.
• Created business requirements and converted into system requirement specifications.
• Anchored all business requirements modeling sessions to gather business requirements to accumulate information beyond what would be documented in business reference document derived from functional requirement specifications based on user requirement specification.
• Excellent knowledge in mapping 4010 and 5010 differences.
• Excellent knowledge of Health Insurance Portability and Accountability Act (HIPAA) transaction and code set rules such as EDI 837,270,271,276,277,834,835.
• Hands on experience with the 837 and 835 ANSI X12 transaction understanding loops segments, elements, and structure.
• Enhanced or developed new documentation of current business process flow and definition of future EDI business information flow.
• Conducted UAT testing at client’s premises after successfully deploying product.
• Extracted business requirements from end users keeping in mind needs for the application and prepared Business Requirement Documents (BRD) using Rational Requisite Pro.
• Functioned as primary liaison between business, operations, and technical teams throughout project life cycle.
• Worked closely with change management team and documented approved/rejected changes along with explanation.
• Participated in Bug Review meetings with Software Developers, QA Engineers and Managers, suggested enhancements to existing application from a business perspective and provided solutions to existing bugs.
• Created user documentation and provided user training on new business software applications.
• Coordinated activities between business house and technical staff in developing new methods, policies, and procedures to meet business needs and acted as primary trainer in educating business house stakeholders as related to automated business applications.
• Performed requirements analysis and created data flow, ER, use case, class, sequence, collaboration, and deployment diagrams.
• Conducted GAP Analysis to derive requirements for proposed system enhancements.
• Extensively used tools such as Rational Rose, Rational Requisite Pro, UML, MS Visio, MS Project, MS Office, and MS Access.
• Presented application walkthrough to higher management, business partners and Project Managers.

Confidential, Burlington, MA

Business Analyst

Responsibilities:

• Conducted meetings with clients and different levels of management for requirement gathering, developing use cases and functional specifications.
• Performed detailed requirement analysis using Requisite Pro and created design artifacts using MS Visio.
• Conducted meetings with development team to discuss several critical issues.
• Worked in Medicare Part D billing records.
• Worked with TriZetto Facets for the claim process.
• Created System Requirements Specification (SRS) document for clear understanding of requirements by the developers.
• Designed state processes for HIPAA 5010 transaction processing EDI 837 and EDI 835.
• Performed scheduling and budgeting of the project using MS Project.
• Conducted Gap analysis between HIPAA 4010 and HIPAA 5010 strategies.
• Created Requirement Traceability Matrix (RTM) enabling to keep track of changes being made to the requirements throughout the project.
• Generated Various Complex Reports in Cognos based on Requirements using different Reporting tools.
• Strong expertise in Health Insurance Claim process, social services, Medicaid, and banking.
• Involved in various Facets Data models like Gateway, Claims, Membership, Provider, Billing, Capitation, Invoice, Benefits, Product and Plan.
• Performed End to End testing for the member, provider and claims modules as per the MITA business process.
• Facilitated User Acceptance Testing (UAT) during deployment for confirmation of product release.
• Executed SQL queries to test data entry into the database and worked with the QA team to execute test cases.
• Migrated Data from MS Excel to SQL Server Reporting Service Using DTS and SQL loader utilities.
• Performed UAT and regression testing on EDI 835 and formats in Facets.
• Modified System flow diagrams using Visio. Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data within the Oracle database.
• Identified and drafted the calculations used for various regions, using their source SQLs for standardization purpose.
• Produced customer functions, complicate SQL commands in Business Object Enterprise XIR2 and Oracle 11g, Crystal Reports XI environments.
• Understood and assessed the current EDI Transactions used and the existing Pharmacy Transactions from an NCPDP perspective.
• Re-engineering the capturing of transactions with legacy systems, Eligibility Transaction 270, 837 Claim Status Request and Response 276.
• Created and maintained requirement documents for Facets for the different modules like Billing, Member enrollment and Claim adjudication.
• Experience in managing and assisting day-to-day operations of system upgrade to comply with new federal reporting requirements and security protocols including HIPAA.
• Conducted interviews, meetings and JAD sessions during the process of Requirement Gathering.
• Created and maintained source-to-target Data Mapping and Data conversion spread sheet.
• Involved in managing the risk adjustment process for Medicare advantage plans throughout the RAPS to EDPS (Encounter Data Processing System) transition.
• Maintained a change request log, conducted impact analysis when a request for change (RFC) was raised, escalated the results to Change Control Board (CCB) and updated documents on to SharePoint.
• Developed project status metrics for weekly evaluation of project status and analyzed the impact of the open issues and change request on the project plan.

Confidential, Confidential, SC

Business Analyst

Responsibilities:

• As a part of the project team interacted closely with business community to define and analyze business requirements to present possible technical solutions.
• Actively involved in all four phases of RUP (Iterative methodology) such as inception, elaboration, construction, and transition.
• Worked closely with business requirements team to identify and correct any deficiencies in business requirements.
• Responsible for performing business analysis at enterprise level working with business teams and major stakeholders to document and model business objectives.
• Developed a detailed TO-BE document.
• Created complex Mock-ups and Wireframes for facilitating understanding between the business team and the technical team.
• Designed and developed use cases and activity, sequence and collaboration diagrams using IBM’s Rational Rose.
• Understood and articulated business requirements from user interviews.
• Worked on process improvements and suggested changes that would improve performance.
• Created dictionary for often used terminologies for benefit of Developers and test team.
• Developed use cases with basic and alternate flows using UML tool such as MS Visio.
• Performed extensive analysis on end-to-end process mapping and impact analysis for understanding upstream and downstream impacts.
• Worked closely with Project Manager in documenting scope and allocation of resources using Microsoft Office and Visio.
• Conducted highly interactive JAD sessions with project stakeholders such as Business Users, QA Analysts and Project Management team, and identified and resolved issues.
• Reviewed test plans, test cases and test case execution using business specification documents.
• Designed test requirements as per business rules for the application under test.
• Participated in requirement and development walkthroughs and reviews.
• Analyzed user requirements, attended change request meetings to document changes and implemented procedures to test changes.
• Reviewed defects reported by the team and assisted in simulation of defects to development team.
• Prepared a report on defect discrepancies in system and user acceptance testing.
• Worked on SQL for data analysis.
• Managed workload and schedules and coordinated status review meetings with Project Managers, Business Managers and Team Members.

Confidential, Oklahoma City, OK

Business Analyst

Responsibilities:

• Gathered high level requirements and developed scope of the project for the implementation of Microsoft Office Share Point 2007.
• Conducted weekly meetings for deciding the Policies and Procedures to be followed while constructing new sites.
• Performed the requirement analysis, impact analysis and documented the requirements using Rational Requisite Pro.
• Documented the server farm requirements and requirements related to security within Share Point and using Windows Active Directory.
• Worked on billing system a cash management module and enhanced the encrypting standards that are required for the application.
• Followed a systematic approach to eliciting, organizing, and documenting requirements of the system.
• Reviewed the Joint Requirement Documents (JRD) with the cross functional team to analyze the High-Level Requirements.
• Used Query Analyzer, Execution Plan to optimize SQL Queries.
• Meticulously assessed data from various sources and generated conceptual and logical database designs using Erwin data modeling tool.
• Interacted with client and the Technical Team for requirement gathering and translation of Business Requirement to Technical specifications.
• Conducted interviews, meetings and JAD sessions during the process of Requirement Gathering.
• Planned and documented procedures for data processing and prepared data flow diagrams for the application.
• Analyzed and translated business requirements into system specifications utilizing UML and RUP methodology.
• Interacted with line of business managers and coordinated the transition into the security database to assure business compliance with SOX.
• Expertise with supply chain strategies/vendor manufacturing process methods to determine level of procurement and strategic sourcing strategies/plans and worked with vendors/peers to determine lead times, schedules, and cycle counts, established requirements needs.
• Analyzed trading partner specifications and created EDI mapping guidelines.
• Documented the Traceability Matrix for tracing the Test Cases and requirements related to them.
• Developed Data Conversion Strategy for converting data from the existing site to the new site.
• Designed and developed project document templates based on SDLC methodology.
• Prepared Demo on SharePoint for various Business to get new approvals like the Therapist and Nursing divisions.
• Designed workflows and allocated permissions within SharePoint.
• Performed Unit Testing and User Acceptance testing (UAT) and documented detailed results.
• Provided input (scope, goals, risks, constraints, timelines, and interfaces) to PM for project planning and control.

Confidential, St Louis, MO

Business Analyst

Responsibilities:

• Performed SWOT and Gap analysis for the new functionality requirements.
• Worked with HIPAA rules and regulations to draft business rules and claim processes.
• Interacted with the client and the Technical Team for requirement gathering and translation of Business Requirements to Technical specifications.
• Conducted the JAD sessions, daily meetings, brainstorming sessions to solve the problems and enhance the workflow.
• Gathered Functional Requirements from users and the management. Coordinated all the requirements in team-based environment.
• Gathered Business Requirements upon clearly analyzing the scope of the project.
• Used Electronic Medical Record (EMR) to extract useful information regarding patients for claim submission to the insurance company.
• Hosted the application online using Microsoft share point excluding some functionality those were developed to use by employees only.
• Identified and documented the dependencies between the business processes.
• Documented the Use Cases and prepared the Use Case, Activity, Sequence diagrams and Logical views using MS Visio, MS Office, and Rational Rose for a clear understanding of the requirements by the development team.
• Responsible for Medicaid Claims Resolution/Reimbursement for peach state health plan using MMIS.
• Responsible for checking NPI and approval of claim payment.
• Data modeling using UML.
• Worked on Lotus notes for getting feedback, web-based requests, and bill approval.
• Working with Medicare operational management to monitor, trend, and report on operational metrics such as timeliness, workload, and staff trending, customer satisfaction, and other key measures to facilitate performance excellence.
• Responsible for teaching sessions for end user to tell how to use tools.
• Used MS Project for various planning and budgeting activities.
• Conducted Requirement Gathering Sessions with the stakeholders.
• Involved in Interacting with the project team to help define the Business and System Objectives, confirmation of scope, identify constraints and the measures of success for the system to be developed.
• Assisted in building a business analysis process model using Rational Rose and Visio.
• Acted as liaison between the senior management and different teams with effective presentations.
• Experience in Rational Rose & HP Quality Centre.
• Monitored change requests and documented requirements, integrating them with Use Clear Cases.
• Incorporated stakeholder feedback throughout project lifecycle to ensure project quality and customer satisfaction.
• Utilize SQL server to run basic queries and obtain necessary data for Medicaid and Medicare Encounters.
• Did Technical documentation for the project using tools like Visio, Word, etc.
• Used MS Project for managing schedules, resources, and collaboration.