SUMMARY:

• Over 6 years of Total IT experience as Business Analyst with emphasis on domain logic, identifying implementation requirements and resolving solutions to business processes based on complex software projects, that includes system development module, business process improvement, tactical planning and policy improvement.
• Good Understanding of Full Software Development Life Cycle (SDLC) experience including Analysis, Design and Review of Business and Software Requirement Specifications and Agile software development methodology for Health Care, Insurance Industries.
• Proficient in Creating and Renovating Business Requirement Documents (BRD), Functional Specification Documents (FSD), and converting business requirement into Software Requirement Specifications (SRS) using MS Word and Rational Requisite Pro.
• Possesses good knowledge of healthcare terminology like HIPPA 4010/5010 versions, ICD 9/10, EDI and facets.
• Expertise in using software applications, such as Excel spreadsheets, relational databases, statistical packages, and graphics packages to assemble, manipulates and format data and reports.
• Experienced in GAP Analysis, Cost Benefit Analysis, organizing, facilitating and coordinating many Joint Application developments (JAD), and Rapid Application Development (RAD) sessions, weekly meetings, conference calls and other regular project meetings
• Excellent knowledge of HIPAA (Health Insurance Portability and Accountability Act) transactions such as 837 (health care claim) 270/271 (inquire/response health care benefits), 276/277 (claim status), 835 (payment or remittance advice), and 834 (benefit enrollment).
• Adept at establishing protocol for inventory analysis, conducting SQL testing, and creating ad hoc reporting procedures.
• Good Experience in creating Unified Modeling Language (UML) diagrams such as Use Case Diagrams, Activity Diagrams, Class Diagrams and Sequence Diagrams.
• Expert in creating Use Cases, creating Screen Mock - ups, conducting Gap Analysis, Impact Analysis, SWOT analysis, Cost Benefit Analysis and Risk Analysis.
• Possesses Good Experience in extensive DATA validation using SQL queries and back-end testing where built MINUS queries for Source to Target Databases.
• Possesses Great working experience in documentation of User Requirements, conducting User meetings and requirement elicitation sessions.
• Worked and analyzed to determine if the system abides by the HIPAA regulations.
• Experience in Conducting review sessions on a regular basis with QA and development teams for preparing status and delivery of operational reports.
• Excellent problem solving skills with a strong technical background, providing motivation, guidance and an up to date consultancy service to both colleagues and clients, provided s and support to end users.

TECHNICAL SKILLS:

Business Skills: Business Process Analysis and Design, Requirement Gathering Use Case Modeling JAD/RAD Sessions Gap Analysis, Impact Analysis.

Methodology: RUP, Agile, Scrum and Waterfall, SDLC, UML

Application Languages: SQL, PL/SQL, UML, HTML

Visual Modeling Tools: MS Visio

Databases: Oracle, SQL Server 2008/2005, MS Access.

Project Management Tools: Microsoft Office (MS Word, MS PowerPoint, MS Excel, MS Project, MS Visio, Outlook)Operating System Windows NT, UNIX, Windows XP Professional/2000/98/95

PROFESSIONAL EXPERIENCE:

Confidential, Richmond, VA

Business System Analyst

Responsibilities:

• Worked on the gap analysis for ICD 10 project. processed 837P, 837I & 837D transactions, verified those 837 transactions converted correctly to LPF file format and verified the claims data loaded to Data Acquisition Layer for further processing.
• Analyzed and studied the different Business Processes across various Business Units.
• Gathered detailed business and technical requirements and participated in the defining of business rules and data standards.
• Created SRS (system required specifications) document and analysis document explaining all the aspect of .
• Work with Data Validation team and assist testing and validation.
• Serves as the liaison between the QA team and the technical team for ETL mapping and logic verification.
• Analyzed and collected business requirements identified system interfaces and created the requirements specification documents.
• Identified Use Cases from the requirements and created UML Diagrams including Use Cases, Activity/State Charts, Sequence diagrams, Data Flow Diagrams and ER Diagrams using Rational Rose and MS-Visio thus defining the Business Process Model and Data Process Model.
• Performed requirement analysis by gathering both functional and non-functional requirements based on interactions with the users, stakeholders, document analysis, user interviews, and documented those requirements in the BRD.
• Consistently utilized MS-Project for planning and project tracking purposes.
• Developed Test plans and mapped them to requirements with QA team.
• Developed and updated Requirements Traceability Matrix (RTM) using Rational Rose, mapped the developed Test Cases to the requirements to ensure that the requirements were fully tested and implemented according to the specifications.
• Experience developing, maintaining test plans, detailed test cases, executing tests cases, validating test results, logging defects, tracking defects and also automated testing with experience in using Quick Test Pro and Quality center.
• Evaluated and tested the new and modified software application to verify that programs function according to both technical and business requirements.
• Used the Rational Unified Process (RUP) methodology for the project.
• Developed, executed and validated user acceptance test plans (UAT) and implementation support.
• Performed GAP Analysis to figure out what we have and what we ought to have, to be better-off.
• Developed project schedules, conducted project status meetings and managed resources during all phases of the SDLC.
• Created and maintained the Requirements Traceability Matrix (RTM)
• Part of Health Insurance Exchange (HIX) product team and experience in handling Private and Public Exchange solution.
• Requirements were gathered through interactions and meetings and periodic walkthroughs with SME’s.
• Interacted with Developers and Users in resolving risk factors and other issues.

Confidential, Rochester, NY

Business Analyst

Responsibilities:

• As a Business Analyst for Confidential worked on HIPAA5010 claims project and related subprojects which includes testing of 5010 claims processing through the clearinghouse & EHP legacy systems LRSP, TOPPS, ICPS, CAPS, U-Win.
• Worked with the full SDLC, elicit, analyze and define requirements.
• Conducted JAD sessions with the clients to identify the requirements.
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, OOAD using UML and Business Process Modeling.
• Used Rational Unified Process (RUP) for streamlining the team’s development activities.
• Researched the existing client processes and guided the team in aligning with the HIPAA rules and regulations for the systems for all the EDI transaction sets.
• Consulted with healthcare insurance company to develop conversion specifications for other insurance Coordination of Benefits (including Medicare).
• Working within a growing knowledge of X12 4010 HIPAA 837 I, P, D, 835, 834, 820, 270, 271, 276, 277, 278, EDI, Privacy, Security, and Medicaid.
• Followed the UML based methods using Rational Rose to create: Use Cases, Activity Diagrams/State Chart Diagrams, Sequence Diagrams, and Collaboration Diagrams.
• Worked extensively with insurance brokers
• Participated Testing and Evaluation of projects at established integration points to assess progress and identify key functionality issues.
• Performed the requirement analysis, impact analysis and documented the requirements using Rational Requisite Pro.
• Obtained Data requirements, identified data sources, determined the content of data fields and created Data Mapping Documents and performed Data Extraction and Data Compilation using SQL queries.
• Responsible for integrating with Facets. Designing test scripts for testing of Claims in Development, Integration and production environment.
• Assisted JAD sessions to identify the business flows and determine whether any current or proposed systems are impacted by the EDI Transaction, Code set and Identifier aspects of HIPAA.
• Tested claims adjudication and group and enrollment in Amisys for New Medicare advantage members
• 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.
• Worked with Claims, enrollment, eligibility verification for members and providers, benefits setup, and backend payment cycle in facets.
• Establish documentation for agile methodology for implementation with a very water-fall-centric development team.
• Work with project manager to build out plans using project management tool.
• Researched the existing client processes and guided the team in aligning with the HIPAA rules and regulations for the systems for all the EDI transaction sets.
• Interacted with Business Users to conduct thorough Requirements Analysis.
• Created Interface test cases, report test cases, expected results validation, defect tracking using clear quest, version control using Clear Case VOB.
• Responsible for creating a business process and workflow documentation using BPMN standards.
• Worked in Data Analysis, Data Reconciliation and Data Mapping for ETL process
• Created standard test case template according to the company requirements and standards.
• Documented monthly status reports for enhancement and modification requests for the development team to assist them in efficient tracking and monitoring of open issues of the project.

Environment: Windows XP Professional, Oracle9i, MS Access 2000, MS Excel, RUP, Oracle, UML, Rational Rose, Requisite Pro, Clear Case 2002, Rational Clear Quest 2002, MS Office suite, MS Visio 2003.

Confidential

QA/BA

Responsibilities:

• Worked in EBOS (Extended Business Office Solutions) department under FCC (Financial Clearance for client) project as a QA Tester.
• Supporting providers in financial clearance department for US health care and revenue protect application and client systems.
• Main focus was working on four major modules 1.Eligibility 2.Benefits 3.Authorizations 4.Referrals testing
• We took authorizations from Insurance Companies for particular CPT Codes and ICD 9CM codes and validate them using SQL.
• Extensively involved in calculating benefits in patient calculator using Current procedure terminology (CPT) codes.
• Also worked for Medicare part A&B, Medicaid, HMO, PPO, POS plans and used to validate the claims using CS (Claims Management System) and PAS (Patient Accounting System).
• Verifying with Insurance companies by troubleshooting the reason for denied claims that were received from the providers and resending the claims by Providing Action Codes and Denial Codes with correct and accurate information.
• Involved in daily meetings with on-site team and discuss on new updates which would benefit the project team for a productive output.
• Involved in preparing Test Plans, test cases and test conditions.
• Worked on testing of claims module and claims adjudication process
• Created High Level Scenarios and test cases based on requirements we get from Business Analyst.
• Worked on executing System, Regression, End to End test cases.
• Performed Smoke, Integration, functional, Regression, and system testing.
• Used SQL queries for to retrieving data from tables and to perform back end testing.

Environment: Java, J2EE, EJB, XML, XML Spy, SOAP, SQL Server 2000, Oracle 8i, Mainframes, Test Director 8.0, Winrunner 7.6, Windows NT, MS-Word, MS-Excel