SUMMARY

• Over 7+ years of experience in Information Technology as Business Analyst with a focus in Healthcare including Medicaid, Medicare, HIPAA, EDI, eHIT, Data - Warehouse and other supporting applications for insurance providers & service providers.
• Worked for the team that is responsible for receiving, documenting, processing the claims including the eligibility verification. Responsible for making the system changes if there were any changes needed to be made in the current policies, rules & regulations due to the business necessities.
• Involved in requirements analysis, design and testing phases of Software Development Life Cycle (SDLC) and also in agile methodology.
• Carried outProject ManagementActivities likeallocating tasks, reviewing estimation, monitoring and reporting project status, involved in risk management, defect management, knowledge management, configuration management and business continuity planning and conducted internal audits for projects.
• Responsible for converting the programs from version for HIPPA standards, along with the NCPDP 5.1 conversion for drug claims.
• Expertise in gap analysis of 4010/5010 of all transactions such as 837, 835, 834, 270/271.
• Responsible for migrating the codes from ICD9 to ICD10.
• Conducted walkthroughs with the end users and stakeholders to gather the modification requests from the user to upgrade or change the business specification for the product.
• Assisted in modeling and documenting the end-user's AS-IS workflow and TO-BE business processes.
• Strong Data Warehousing, Data Marts, Data Analysis, Data Organization, Metadata and Data Modeling experience in RDBMS databases.
• Good experience with XML files and manually created XML files from Excel spreadsheets.
• Handled the clinical data to implement to different systems.
• Helped the business users to perform the UAT.
• Highly motivated, organized and results oriented with strong interpersonal skills, highly adept at diplomatically facilitating discussions and negotiations with stakeholders.

PROFESSIONAL EXPERIENCE

Business Modeling Tools: Rational Rose, MS Visio, Word, Excel, PowerPoint

Requirement Management Tools: Rational Requisite Pro, CaliberRM, DOORS

Web Servers: Internet Information Server, Apache, XML, XSD, XLST, JQuery

Project Management: Microsoft Project, Microsoft PowerPoint, Open Office.

Languages: SQL, SQA, Visual Basic, Unified Modeling Language (UML)

Software Development Methodologies: Waterfall, Agile, Rational Unified Process (RUP), SCRUM

Testing Tools: HP Quality Center, Test Director, JIRA, ALM, SOAP UI

RDBMS: Mainframe, Oracle, PowerBuilder 5.

Operating Systems: LINUX, UNIX, Windows 95/98/NT/2000/XP, Mac OS

Requirements Gathering Techniques: Interviews, JAD- Joint Application Development/JAR- Joint Application Review/JRP- Joint Requirements Planning

Documentation: Scope Document, Requirements (Business Requirements Document- BRD, Functional Requirements Document/ Functional Requirements Specifications/ Functional Specifications Document/ Software Requirements Specification- FRD/FRS/FSD/SRS), Non-functional Requirements/ Supplementary Specification, Use Cases, Business Rules, Glossary, Data Elements, Test Cases, Requirements Traceability Matrix (RTM), Business Process Maps/Flows- AS-IS (current) and TO-BE (future), User Stories, Defect logging

PROFESSIONAL EXPERIENCE

Confidential, Norwalk, CA

IT Business Analyst

Responsibilities:

• Assisting in planning and designing business processes and assists in formulating recommendations to improve and support business activities.
• Assisting in analyzing and documenting client's business requirements and processes and communicating requirements to technical personnel by constructing Use Cases following the RUP methodology.
• Prepared and presented clients with written proposals addressing business requirements, re-engineering, software application integration, use of multi-media and interactive system solutions. Consulted on issues of Eligibility Determination for Medicaid (Medi-Cal, CHIP, CSR, and APTC), Cal Works, Cal Fresh welfare programs.
• Ensure that all documentation starts from baseline and adheres to standards and communicate back to base team suggestions for changes or enhancements to standard documentation.
• Participating in technical reviews and inspections to verify 'intent of change' is carried through phase of project.
• Designing and developing Use Cases, Activity Diagrams, Sequence Diagrams and Business Process using MS Visio.
• Performing a comparative analysis of DHCS national standards (HIE of 3.0 and 4.0 schema) for source codes and made recommendations on how to update CalHEERS current eHIT for Inbound/Outbound Transactions.
• Converts project specifications into sequence of detailed instructions and develop/write new programs to support the functionality using COBOL, RDBMS and ECL concepts.
• Analyze, design, develop and document embedded SQL and COBOL programs independently and work to gather requirements and supporting the LEADER system.
• Establishing test plan, test conditions and test transactions of electronic health information transfer(eHIT) XML 4.0 schema transactions between LEADER and CalHEERS.
• Analyzing and Testing Web Services using client generated WSDL in SOAP UI to track request (Eligibility Determination Request) and response (Determination Eligibility Response) SOAP Messages for eHIT between LEADER and CalHEERS.
• Performed Back End Testing-using SQL queries, generating reports to ensure data integrity and validate the inserted and updated data.
• Reviewing and analyzing data mapping using PowerBuilder 5.
• Extensively working in Data Requirement Analysis and Data Mapping for Data Conversion process.
• Assisting in development of training materials for new technology and process improvements.
• Maintaining and updating version control of the documentation simultaneously on SharePoint and Rational Clear Case.

Environment: MS Office, MS VISIO, SQL, XML, XSD, XLST, JQuery, Soap UI, Share Point, LEADER Application, Case Copy portal, Rational Clear Quest, SnagIt, Azure, Wireframes.

Confidential, Bloomington, MN

Sr. Business Analyst /Project Coordinator

Responsibilities:

• Thorough understanding and hands on experience of software development life cycle from Ideation to Implementation.
• Conducted live JAR &JAD sessions with SMEs, and all the placeholders to develop High Level Requirement and then formalized those requirements to Detailed Level Requirements.
• Facilitate project meetings deriving User requirements, creating use cases and user stories, and working as liaison between Business and Technical teams.
• Elicited business requirements and business needs as part of an Agile Scrum team
• Responsible to meet the information demands of business users by delivering timely, accurate, meaningful and standardized data and reporting.
• Perfect understanding of Express 1 Methodology (customized model of software development in Confidential Incorporation).
• Captured Current State and Future State Analysis in the requirement document.
• Created User stories by taking inputs from business users and mapped it to the requirements in High Level Requirement Document.
• Followed Agile methodology and created documents using iDeliver and CMMI template
• Worked in Medicare Part D (Prescription Drug Plans Program), Health Care Reform under Medicaid Program and CMS, Direct Claims Reject Code Adjustments Program for Health Plan Clients and Explanation of Benefits and Language Impacts Project among others.
• Facilitate the Change Authorization Group (CAG) meeting, calendar approved changes and communicate with our stakeholders
• Coordinate the RFC presentations, capture meeting notes and concerns. Send Agenda and Minutes of Meeting.
• Maintain Offshore shift schedules, providing proactive & effective tools & notifications to enable rapid response to avoid Global issues
• Publish Monitoring Team Monthly status on Implementation, Accomplishments, Challenges and Risks
• Analyze Intake Requests from Optimization/Application teams
• Prepared Test Cases (manual/automated) and Conducted Tests (Integration testing, Regression testing), Black Box/White Box testing, UAT (User Acceptance Testing).
• Documented analysis, observations and recommendations.
• Used Quality Center and ALM for defect tracking and reporting.

Environment: MS Office, Agile, MS VISIO, SQL, Business objectives, XML, Outlook, Share Point, Team Foundation Server 2012, Microsoft Test Manager, ALM.

Confidential, Carlin Springs, VA

System Analyst

Responsibilities:

• Analysis for making system compliant with HIPAA. Involved in making the Medicare patient profiles being compliant with the HIPAA regulations.
• Performed clinical workflow analysis interpretation and synthesis of information as well as analysis and interpretation of the EHR product functionality.
• Interpreted clinical processes/tasks and converts them into system processes; designs system templates for multiple clinical specialties and assesses clinical processes recommending automated solutions.
• Involved in analysis, design, and implementation of the following systems: Control Management Reporting and Security Systems: generation of daily, weekly, and monthly reports of hospital patients' activity. Medical Billing and Collection Systems: generation of daily billing activity based on patient records and establishment of collection protocols.
• Identify, analyze, and interpret trends or patterns in complex data sets for specified projects. Develop graphs, reports, and presentations to summarize key results
• Perform basic statistical analyses for projects and reports.
• Oversee routine and ad hoc reports needed according to the Analysis and Requirements.
• Working knowledge of Epic Rx /Epic Lab/Epic Care Inpatient/EPIC ADT Health Information Management and Chart Tracking.
• Validated incoming message in Bridges and confirm storing in EPT master file.
• Responsible for generating error reports in EPIC BRIDGES and troubleshooting the problem.
• Developing interface specifications and updating the master file records through chronicles
• Validated EAP and ORD Master files against the requirement documents.
• Worked on Work flow integration testing for EPIC ADT module.
• Responsible for requirements, analysis and design of the system Leading the HL7 analysis and designing the interface Engine
• Developing interface specifications and updating the master file records through chronicles
• Updating and maintaining Bridges interface translation tables
• Extensively used FTP commands and Putty to generate error reports, transfer and email the error reports to management team
• Running error code frequency reports for multiple EPIC interfaces; investigate and analyze the errors and causes of failure

Environment: EPIC Hyperspace, EPC Bridges, Chronicles, Ambulatory, MQ Series, AIX, Putty, MS Access, Excel, Windows, Remedy, VC++, Visual basic, MFC, COM, XML, PL/SQL, Oracle 8i, UML with Rational Suite Enterprise, Windows NT/2000/98.

Confidential, Hartford, CT

Business Analyst

Responsibilities:

• Conducted JAD sessions with Subject Matter Experts (SME's).
• Incorporated Rational Unified Process (RUP) and analyzed User Business Requirement Document (BRD), Technical Requirement Specification and Functional Requirement Specification (FRS) using Requisite Pro, Rational Rose and MS Visio.
• Did Presentations making Stakeholders understand how the changes would affect different modules with respect to Medicare and Medicaid.
• Performed Gap analysis for better understanding of transition from HIPAA 4010 to HIPAA 5010 inside trizetto QNXT different modules.
• Revised HCFA 1500 and MCS 1500 forms with stakeholders.
• Worked on changes for HIPAA Transaction and proposed changes to be made in the current system for an easy transition from version .
• Documented the detailed business as well as technical requirements to upgrade the current system to 5010 transactions.
• Conducted User Acceptance Testing (UAT) prior to and after implementation phase.
• Analyzed HIPAA 5010 related to 835, 837, 270, 271, 276 and 277 transactions (both inbound and outbound) and performed gap analysis between the 4010 and 5010.
• Worked on ICD conversion from 9 to 10 with respect to the claims related to Medicare (Part A, Part B, Part C, Part D)
• Worked with Source System Subject Matter Experts (SMEs) to ensure that the extracts are properly mapped. Used SQL for data mapping and querying.
• Played a key role in planning UAT and implementation of system enhancements and data migration and conversions.
• Confidential Requisite Pro with Rational Rose to provide all teams visibility and maintain tractability among requirements, use cases and change requests.
• Completed a review of existing documentation for orders, referrals and reports and compared it to the clinical details needed for ICD 10.
• Assisted in writing test case scenarios for unit testing, integration testing and compliance testing.
• Assist end users and IT staff in the use of data to satisfy informational and reporting requirements and implementing and using SQL and DBMS

Environment: MS Visio, MS Office Suite, Facets, Agile, MS Project, Outlook, Oracle, ALM Quality Center.

Confidential

IT Data Analyst

Responsibilities:

• Understood and articulated business requirements from user interviews and then convert requirements into technical specifications. Effectively communicated with the SMEs to gather the requirements
• Involved in translating the functional requirements to specific functionalities and chalking requirement feasibility
• Followed the RUP based methods using Rational Rose to create Use Cases, User Stories, Activity Diagrams / State Chart Diagrams, Sequence Diagrams
• Worked on the client-server model and gathered the requirements and documented accordingly
• Worked extensively on Technical writing and documentation
• Provided guidance in business practices to improve the manufacturing management practices
• Identified test execution method, Manual/Automated Read and Understood Test Cases and identified the frequent functions
• Participated in meetings with Developers, Project Managers and Quality Analysts to discuss business requirements, test planning, resource utilization, and defect tracking
• Worked closely with the UI team to model the screens, which met user, defined requirements and also company standards
• Created Use cases, activity report, logical components to extract business process flows and workflows involved in the project using Rational Rose, UML and Microsoft Visio
• Develop user manuals, presentations and training manuals as per project specifications and timelines

Environment: Agile (SCRUM), RUP (Rational Unified Process), Gap Analysis, Wireframes, Visio, Excel, Word, Power Point, Microsoft Project and MS Excel.