SUMMARY

• Extensive 7+ years of experience as a Business Analyst in Healthcare sector, identifying business needs and determining solutions to business problems for complex software projects.
• Extensive knowledge working through the Software Development Life Cycle (SDLC) including Requirement Planning and Management, Requirements Elicitation and Requirements Analysis.
• Solid understanding of the concept of business processes, risk analysis and the methodologies of SDLC (Agile, Waterfall, Scrum).
• Knowledge of implementing SDLC in all phases of a project and experience working in different forms of SDLC like Agile, Waterfall, Scrum and Scrum - Waterfall (Hybrid).
• Experienced in analyzing methods such as GAP Analysis, SWOT Analysis, Risk Analysis, Impact Analysis, Business Project Analysis, Process Flow Analysis, Root cause analysis and Document analysis.
• Extensive Experience in Gap analysis to compare As Is with To Be business processes and offered solutions.
• Experience in designing and evaluating of various documents including the Software Requirement Specifications (SRS), Business requirements document (BRD), Use Case Specifications, Functional Specifications (FSD), Systems Design Specification (SDS), Requirement Traceability Matrix (RTM) and testing documents.
• Functional knowledge in developing and implementing Claim Processing Systems.
• Excellent understanding of HIPAA standards, EDI (Electronic Data Interchange) syntax of transactions such as ANSI X12, HIPAA code collection implementation and knowledge and HL7.
• Strong operational knowledge of Health Insurance Portability and Accountability Act (HIPAA) and experience in HIPAA Transactions.
• Experience providing primary analysis for business processes running on EDI standard.
• Extensive knowledge of Medicaid Management Information Systems (MMIS), National Provider Identification (NPI), Health Insurance Portability & Accountability Act (HIPAA) standards, Electronic Data Interchange (EDI), Health Information Exchange(HIX), EMR/EHR, Health Care Reform and Patient Protection and Affordable Care Act (PPACA).
• Extensive Knowledge on HIPAA (Health Insurance Portability and Accountability Act) transaction codes such as 270/271 (inquire/response health care benefits), 276/277 (claim status), 278 (review information), 835 (payment or remittance advice) and 837 (health care claim) with EDI.
• Extensive knowledge about the various types of health insurance programs such as Medicaid, Medicare (part A, B, C and D), PPO (Preferred Provider Organization), and HMO (Health Maintenance Organization).
• Experience in implementation of payor or provider applications Facets.
• Experience with various Facets modules such as Subscriber/Member, Claims, Plan/ Product.
• Professional in the administration and management of a Medicare Prescription Drug Program and Medicare compliance initiatives.
• Knowledge and Experience to Medicare and Medicaid domains of the healthcare systems and industry for inpatients, outpatients, Reimbursement Methodology.
• Proficient in creating UML diagrams, Context, Use Case, Sequence and Activity diagrams using MS Visio.
• Responsible for GAP Analysis in changing old MMIS and Involved in testing new MMIS.
• Experienced working with EHR (Electronic health record) and EMR (electronic medical record) team for data requirement.
• Experience with various Facets modules such as Subscriber/Member, Claims, Plan/ Product.
• Highly motivated team player with excellent communication, presentation and interpersonal skills, always willing to work in challenging and cross-platform environment.
• Conducted Joint Application Development (JAD) Sessions with IT Groups and Project Team Members, conducting Gap Analysis, Risk Analysis and documentation of Use Cases and User Stories.
• Exceptional collaborator and team player with strong communication and organizational skills.
• Highly Experienced in Microsoft Office Suite including MS Visio, Excel, PowerPoint, Word and Outlook.
• Extensive experience with MS Visio for drawing flow charts and screen mock-ups and MS Project for status reporting and planning.
• Proficient in evaluating SQL queries for data extraction, manipulation, analysis, and validation, generating user reports and proficient knowledge of Relational Database Management Systems (RDBMS), and Data Warehousing.
• Proficient in using version control tools, Team Foundation Server (TFS), GITHUB and agile management tools like JIRA, RALLY.
• Experienced in SQL Server Reporting Service (SSRS), Executing Queries and Running Stored Procedures.
• Experienced in extracting UI based information by querying the Oracle database using SQL queries.
• Worked with defect tracking tools like JIRA, and Quality Center.
• Expertise in designing and developing Test Plans and Test Scripts.
• Experience testing implemented systems and system changes including liaising with QA teams to develop test cases, test plans, test scenarios, and generating test data and conducting manual testing.
• Strong experience in conducting User Acceptance Testing (UAT) and documentation of Test Cases.

PROFESSIONAL EXPERIENCE

Confidential, Deerfield, IL

Sr. Business Analyst

Responsibilities:

• Worked as a BusinessAnalystwhile building US Health Care Public Exchange (HIX) & WEM as well as for respective implementation (MA, KY & CO) carved out of Federal Exchange product.
• Worked with UI & UX team to define wireframes and visuals reflecting the PRD requirements.
• Responsible for ensuring HIPAA EDI Trading Partner transactions meet established standards and are able to be transmitted and processed.
• Prepared Use Case diagrams using IBM Rational Rose tool.
• Converted Business specifications into Business and Functional Specifications.
• Worked on EDI transactions like 834,270/271, 276/277, 835/837 and EDI's. Worked on Use Cases for Batch processing for EDI's.
• Conducted JAD/JRD with Business and SMEs to come up with BRDs.
• Responsible for ensuring HIPAA EDI Trading Partner transactions meet established standards and are able to be transmitted and processed.
• Performed GAP analysis for EDI transactions such as 837,834,820 to support state specified X12 5010 file formats.
• Performed technical analysis for 834 (EDI file for Enrollment and Benefit Maintenance) 4010A to 5010 version control.
• Worked on 837 and 835 projects, including syntax and business rules for X12 HIPAA 4010 and 5010 validations for loops, segments, elements, qualifiers and code sets.
• Involved in Writing use case based on HIPAA standards.
• Developed TEMPeffective processes and business strategy to leverage company and SaaS model strengths.
• Responsible for creation of Collaboration Diagrams, Activity Diagram, Project Flow Diagram in MS Visio.
• Extensive Analysis of HIPAA rules to in corporate in the Development of Utility application which is not HIPAA compliant.
• Implemented and managed the formal SDLC implementation using the RUP/Agile Methodologies (depending on the client and project).
• Generated Usage Models (me.e., prototyping storyboards, screen mockups, User Interface designs, and User stories) based on Agile and SDLC standards.
• Extensively worked with Enterprise Data Warehousing (EDW) Tables and Data Mart Staging Tables.
• Generated Use Case diagrams, Sequence diagrams, Business Objects, Domain Object Model, and Visio to depict process flows and PowerPoint presentations.
• Used Microsoft Test Manager and the Microsoft Team Foundation Server (TFS), and prepared, edited, and reviewed test documentation to efficiently regression test the ServSuite product, with over 200 cases to validate functionalities before each release.
• Extensively used tools such as Rational Rose, Rational Requisite Pro, UML, MS Visio, MS Project, MS Office, MS Access.
• Supporting the design team for designing the best UI/UX for the web portal.
• Created use-case scenarios and storyboards in MS Word and MS PowerPoint for better visualization of the application.
• Used SQL queries to filter data within the Oracle database tables for Data mapping, logical data modeling.
• Documented the evaluation of various reporting tools like Oracle Analytics/Business Objects, made recommendations about the product depending on the reporting requirements.
• Manage the development of multiple reports in order to consolidate information that would assist upper management of various departments in making enterprise decisions via Tableau.
• Tracked bug fixes using JIRA.
• Worked with QA testing teams, while interacting with business users and gathering user's requirements to develop necessary Test plans, Test Cases and Test script.
• Involved in GUI testing, Integration testing and Unit testing.
• Performed Unit Testing and User Acceptance testing (UAT) and documented detailed results.

Confidential, Milwaukee, WI

Business Analyst

Responsibilities:

• Responsible for business analysis, requirement specifications and identifying the resources and implementation of the project.
• Interacted with stakeholders and gathered requirements as per the business needs.
• Involved in preparing project plans and identifying major milestones for each stage as per the SDLC model (Agile Methodology).
• Created a task plan for the team identifying the key deliverables and the respective deadlines.
• Analyzed Business Requirements and segregated them into high level and low-level Use Cases, Activity Diagrams using Rational Rose according to UML methodology.
• Conducted requirement-gathering sessions with the purpose of creating and defining the Business Requirement Document (BRD).
• Conducted AS-IS and TO-BE analysis of the business process using GAP analysis.
• Conducted and facilitated Joint Application Development (JAD) sessions to reduce time spent in moving information between stakeholders and team members.
• Worked with Source System Subject Matter Experts (SMEs) to ensure that the extracts are properly mapped.
• Responsible for architecting integrated HIPAA, Medicare solutions, Facets.
• Wrote Business Requirements, analyzed them and tested them.
• Created Swim Lane Diagrams andbusinesslogic & calculation spreadsheets for variousbusiness processes.
• Extensively worked with HIPPA X12 EDI transaction codes such as 270/271(inquire/response health care benefits), 276/277(Claim-status), 834(Benefit-enrollment), 835(Payment/remittance advice), 837(Health care claim).
• Performed data mapping to define the Source data on 834 Benefit Enrollment and Employer Group File (EGF) EDI Transfers.
• Worked closely on 837 me/P transaction code for Health care claims and was involved in Validation of HIPAA for 270/271 (health care benefits and eligibility), 276/277 (Claims Status), 835 (Payment/Remittance advice), 834 (Benefits Enrollment) EDI transactions.
• Owned the entire reporting process. Interacted with the ETL team, developer(s), management, and account holders to get the requirements, document them, design templates, and write specifications.
• Designed report templates based on the requests by account managers. Designed Functional Specification Documents for the reports.
• Worked in RUP environment using Rational Requisite Pro. Analyzed trading partner specifications and created EDI mapping guidelines.
• 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.
• Migrated Data from MS Excel to SQL Server Reporting Service Using DTS and SQL loader utilities.
• Used JavaScript for client side validations extensively along with .NET validation controls. Used Rational Rose to model the process using UML to create behavioral and structural diagrams.
• Used MS Visio to create Flow diagrams and Use Case Diagrams. Created presentations explaining the entire report development process, while drawing a comparison between the legacy & the new report.
• Used MS Office for creating Vision, Use Cases, and Supplementary Specification Documents. Reviewed requirements & deliverables for delivery timeline.
• Developed and conducted statewide HIPAA 5010 and ICD-10 awareness program for all IDS staff in Confidential . Coordinated with the developer, on day-to-day basis, during the development process.
• Created Test Scripts & Test Scenarios to check report content, layout, and parameters. Wrote PL/SQL statement and stored procedures in Oracle for extracting as well as writing data.
• Performed Unit Testing and User Acceptance testing and documented detailed results.
• Provided input (scope, goals, risks, constraints, timelines and interfaces) to PM for project planning and control.
• Assisted QA team in developing test strategy, and test cases and actively monitored various types of testing - functional testing, Progression testing, system testing, load testing, smoke testing, and regression testing.
• Managed Requirement Traceability Matrix to ensure test cases are traceable to requirement specifications.
• Actively facilitated complete UAT process - creating UAT schedules, testing guidelines, managing feedback, follow-up, and resolving open issues.

Confidential, Tampa, FL

Business Analyst

Responsibilities:

• Interacted with client and the Technical Team for requirement gathering and translation of Business Requirement to Technical specifications.
• Gathered analyzed and documented business and technical requirements from both formal and informal sessions and validate the needs of the business stakeholders.
• Elicited, analyzed, documented and communicated requirements for implementation of the trading system in the Agile Environment.
• Studied established Trading System to understand the processes and challenges in STP, which halped define project scope.
• Gathered Business Requirements, Interacted with the Users, Designers and Developers, Project Manager to get a better understanding of the Business Processes.
• Responsible for the full HIPAA compliance lifecycle from Gap Analysis, mapping, implementation and testing for TennCare processing of Medicaid Claims.
• Responsible for gap analysis in changing old MMIS and Involved in testing new MMIS.
• Developed gap analysis document, logical and physical design and remediation plan for State.
• Responsible for mapping documents, creation of test plan, test scenarios, test cases for unit, system and system integration testing.
• Worked with business owners, content staff, IT and other stakeholders in creating a content management solution for managing the information in the supplier portal using WebSphere Application Server.
• Built and customized SoDA for Word templates and extract information from information sources such as RequisitePro and Rose, and created a highly automated system for handling approvals, exceptions and priorities.
• Used the Rational Unified Process (RUP) to build the different phases of Software development life cycle
• Created Project management plans for managing on time delivery using MS Project along with writing test cases, unit and systems integration test plans in Quality Center.
• Create and maintain Use Cases, visual models including activity diagrams, logical Business process models, and sequence diagrams using UML.
• Well versed with HIPAA, claim adjustments, claim processing from point of entry to finalizing, claim review, identifying claims processing problems, their source and providing alternative solutions using best practice model and principles.
• Involved in preparing project plans and identifying major milestones for each stage as per the SDLC model (RUP Methodology).
• Implemented the HIPAA privacy and security regulations to enhance the capabilities of the systems to process new products.
• Conducted gap analysis and made As-is-to-be diagrams to understand new business requirements and challenges in implementing new modules.
• Conducted interviews, meetings and JAD sessions during the process of Requirement Gathering.
• Reviewed the Joint Requirement Documents (JRD) with the cross functional team to analyze the High Level Requirements.
• Planned and documented procedures for data processing and prepared data flow diagrams for the application.
• Documented the Traceability Matrix for tracing the Test Cases and requirements related to them.
• 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.
• Designed and developed Activity Diagrams, and Sequence Diagrams utilizing MS Visio.
• Documented the server farm requirements and requirements related to security within Share Point.
• Followed a systematic approach to eliciting, organizing, and documenting requirements of the system.
• Rewrite, Add and Define, Rewrite existing requirements, breakout into new requirements, and create additional documentation where appropriate.
• Prepared functional requirements to define thesystemrulesby creating Use cases, interface design and data dictionaries.
• Worked with a team of 5 qualityanalyst/testers within Agile Methodology.
• Defined and delivered test strategy, plans, andsystemsscripts.
• Conducted through testing to make sure the application is developed as per the business requirements.
• Created UAT test plans and test scenarios & cases.
• Actively facilitated complete UAT process - creating UAT schedules, testing guidelines, managing feedback, follow-up, and resolving open issues.

Confidential, Pittsburgh, PA

Business Analyst

Responsibilities:

• Gathered analyzed, documented business and technical requirements from both formal and informal sessions and validate the needs of the business stakeholders.
• Co-authored business requirements document with project teams. Extracted, discussed, and refined business requirements from business users and team members.
• Modeled AS IS and TO BE processes using MS Visio.
• Analyzed Business Requirements and segregated them into high level and low level Use Cases, Activity Diagrams / State Chart Diagrams using Rational Rose according to UML methodology thus defining the Business Process Models.
• Supervised and managed project throughout SDLC to ensure that project management methodology based on RUP is followed during the project lifecycle using MS Project.
• Created EDI documents for EDI maps to generate requirement documents and Project Charter, and logical design documents for EDI transactions and code sets.
• Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data within the Oracle database
• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims.
• Interacted with the “Users” by interviewing them, by preparing questionnaire and getting feedback. Attending Client Meetings Project Steering Committee Meetings and Project Management Committee Meetings.
• Ensured that all Lines of Business specifications were consistent in form and function to the Diamond Base System.
• Produced Gap Analysis documents for HIPAA 5010 and ICD-10. Wrote PL/SQL statement and stored procedures in Oracle for extracting as well as writing data.
• Maintained a traceability matrix of the requirements and created test cases, as well as testing matrix of the test cases and any corresponding defects conducting business validations, covering the following deliverables: FACETS Providers, Facets Claims and Facets Membership and Operational reports.
• Conducted extensive data analysis of different data bases which were going to be part of the application to understand the attributes, schema and data structure.
• Organized weekly Project Status and Task Review meetings, created PowerPoint presentations and project updates using MS Project for management review.
• Organized the project into phases to impose management control using stage-gate reviews such as high-level user stories, test scenarios, Dimension modeling, Client reference data, Data Mapping, ETL etc.
• Created project charter and project plan, presented different solution and time lines with the halp of project manager.
• Created flow chart diagrams using MS-Visio and BPM modeling.
• Created data mapping document for the application after finalizing the attributes and tables with business users
• Identified and communicated dependencies and potential risks to the completion of the project including resources, costs and systems.
• Conducted Joint Application Development (JAD) sessions with IT groups. Identified the Key Changes, and participated in Stakeholder Management to communicate TEMPeffectively with them.
• Facilitated JAD sessions with management, development team, users and other stakeholders to refine functional requirements.
• Managed workload, schedules and coordinated status review meetings with project managers, business managers and team members.
• Used Rally tool for requirements management and tracking user stories in a sprint and product backlog.
• Tracking business reporting issues on JIRA by creating problem statements that halp breakdown the underlying issue.
• Involved in maintaining project progress and status through MS Project. Extracted periodic/ monthly status reports to the Project Manager to serve as the team's assessment of the project and its schedule.
• Worked on Traceability Matrix table to uniquely identify and trace the business requirements to general design to testing as to prove that the requirements has been developed into a solution and that it TEMPhas been tested and tracked.
• Developed customized SQL reports and queries for management decision-making and operational management.
• Assisted with the development of test plans and strategies, coordinated testing events, and executed test cases in support of changes to business systems.
• Participated user acceptance testing cycle; worked withbusinessusers to definebusiness scenarios, user acceptance test cases and user acceptance criteria.