SUMMARY:

• Over 8 years of healthcare industry experience as a Business Analyst in identifying business needs and determining solutions to business problems for complex software projects.
• Deep knowledge working through the Software Development Life Cycle including Requirement Planning and Management, Requirements Elicitation and Requirements Analysis.
• Expert in creation of Business Requirement Documents (BRDs), Functional Specification Documents (FSDs), Use Case Documents, Acceptance Criteria Documents (ACDs), Business Rules Spreadsheets (BRS) and Requirements Traceability Matrix.
• Successfully conducted interviews, brain storming sessions, group interviews, prototyping, focus group sessions and JAD sessions in order to gather requirements.
• Experienced in all phases of the Software Development Life Cycle (SDLC) Waterfall methodology, Agile methodology (Scrum), Rational unified process (RUP), Rapid Application Development (RAD).
• Excellent knowledge of the AS - IS and TO-BE business processes and experience in converting these requirements into technical specifications.
• Excellent understanding of HIPAA standards, FHIR, Long Term Care (LTC) workflow, EDI (Electronic Data Interchange) syntax of transactions such as ANSI X12, HIPAA code collection implementation and knowledge of health level HL7-CENSUS Message and on technical report type 3 TR3 in healthcare industry.
• 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).
• Excellent understanding of HIPAA standards, EDI (Electronic Data Interchange) syntax of transactions such as ANSI X12, HIPAA code collection implementation and knowledge and HL7.
• Rigid working knowledge of health care sector claims management, Long term care workfl

PROFESSIONAL EXPERIENCE:

Confidential

Sr. Business Analyst

Responsibilities:

• Conducted multiple JAD sessions between various organizations such as DHS, HHC, DCCA, and OIMT/OIT to elicit system requirements using stakeholder analysis, RACI chart, user stories and prototypes. Created BRD, FRD/FSD and SDD for the implementation of functional areas across IF/Notifications and Languages. Active member for the policy review to implement the blueprint requirements for Medicaid/MMIS,
• Medicare, CHIP and Tax Credits benefits per CMS guidelines. Compile, validate and report system - wide metrics to attest meaningful use of EHR to the Centers for Medicare and Medicaid Services. Gathered analyzed, documented business and technical requirements from both formal and informal sessions and validate the needs of the business stakeholders. Responsible to maintain the defect log that traces back to the test cases and also to the requirements, involving Agile and Scrum methodology. Worked on FHIR, HL7 and EDI transactions: X12, 835, and 837 P.I to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes. Intricately involved in Business Process Flow development, Business Process Modeling, and ad hoc
• Analysis Update the existing system with new 834 data allocation for Health Care Reform Health Insurance Exchange (HIX) Population.
• Reviewed 834 companion guide (NYS of Health EDI 834) and other documents to complete the data gap between the existing and new data elements. Worked on HIPAA Transactions and Code Sets Standards according to the test scenarios such as 270/271, 276/277,837/835 transactions. Assisted in configuring the EDI 837, 835, 270/271, 276/277, 278, 820 and 834 transactions processing flow from the Trading
• Partners to the translator. Assigned tasks among development team, monitored and tracked progress of project following Agile methodology.
• Experience at writing complex SQL queries and understanding requirements for complex queries and procedures. Conducted interviews with key stakeholders to analyze existing data and gather requirements. Facilitated Scrum meeting with technical/non-technical team, Accounts updating, data analysis and sharing with XML patterns, SME's to clarify business rules & solve impediments, rectifying the regulatory issues with SME's and translated Functional requirements into User stories using JIRA. Mapped the user requirements with the SaaS solution, ide

Confidential

Business Analyst

Responsibilities:

• Interacted with stakeholders to get a better understanding of client business processes and gathered requirements. 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. Conducted requirement - gathering sessions with the purpose of creating and defining the Business Requirement Document (BRD). Conducted JAD sessions, Medicaid meetings, workshops to gather requirements from various stakeholders and SMEs. Skilled in gathering business and application requirements, Business Processes, identifying risks, impact analysis, UML modeling, and Sequence and Activity Diagrams using Rational Rose and Microsoft Visio in Clinical and Health Information
• Management (HIM) processes. Performed Gap Analysis to check the compatibility of the existing system infrastructure with the Analyzed the
• Business Requirements Document (BRD), modified the Master Test Plan and prepared detailed Test Cases for the UAT. Planned and documented procedures for data processing and prepared data flow diagrams for the application Created Swim Lane Diagrams and business logic & calculation spreadsheets for various business 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 in accordance with the Safe Agile/Scrum methodology for various phases of the business and created business vision, business architecture documents and mock reports. Worked closely on 837 I/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. Met with client groups to determine requirements and goals. Utilized Rational Unified Process (RUP) to configure and develop process, standards, and procedures and create a Business requirement Document. Assisted in development of test cases based on functional requirements for claims for EDI and HIPAA Transactions 837/835, 834, 276/277, 270/271 testing. Created Process Models for (a) Initial Enrollment, First Billing and Payment and (b) Post Enrollment - Subsequent Recurring Bil

Confidential

Business Analyst

Responsibilities:

• Work as a Business Analyst while building US Health Care Public Exchange (HIX) & WEM as well as for respective implementation (MA, KY & CO) carved out of Federal Exchange product. Working 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. Conduct 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. Developed effective 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 are not HIPAA compliant. Implemented and managed the formal SDLC implementation using the RUP/Agile Methodologies (depending on the client and project). Generated Usage Models (i.e., prototyping storyboards, screen mockups, User Interface designs, 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 Planned, directed and coordinated the activities of multiple teams utilizing agile methodology best practices (Scrum). Supported product owners to maximize ROI and meet the organizations objectives through Agile. Participate in architecture and design sessions. Involved in coaching, teaching and guiding teams to adopt the Scrum methodology.
• 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 Involved in creating reports framework with dimensional data models for the data warehouse and worked with the development team on SQL Server 2005 tools like Integrations Services and Analysis Services.
• Extensively used tools such as Rational Rose, Rational Requisite Pro, UML, MS

Confidential

Business Analyst

Responsibilities:

• Interacted with stakeholders and gathered requirements as per the business needs. Implemented RUP methodology for iterative and incremental development of the system. Worked on Required Traceability Matrix (RTM) in Rational Requisite Pro for traceability of requirements through test cases Successfully conducted JAD sessions, which helped synchronize the different stakeholders on their objectives and helped the developers to have a clear - cut picture of the project. Was involved in the planning of the RUP iterations and documenting of the artifacts throughout the various phases of the development process. Reviewed the user requirements in SOX context and validated the
• SOX compliance. Writing stored procedures, triggers, cursors, and views to improve the quality of application, and manage mission-critical information using T-SQL. Involved in system requirement analysis and conceptual design of the CURAM implemented Web application.
• Created Business Requirement Document (BRD), Functional Requirement Specification (FRS) document, and Traceability Matrix document for system application development Conducted GAP analysis by understanding the AS-IS system and the TO-BE system requirements by having discussions with the SME's. 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 Facilitate the Change Authorization Group (CAG) meeting, calendar approved changes and communicate with our stakeholders Prepared Test Cases (manual/automated) and Conducted Tests (Integration testing, Regression testing),
• Black Box/White Box testing, UAT (User Acceptance Testing). Used Quality Center and ALM for defect tracking and reporting. Compiled the
• Vision Document and composed detailed Use Case Specification Documents in Rational Requisite Pro. Used UML to perform Use-Case analysis to capture the dynamic aspect of the application. Ensured the accuracy and consistency of the data during the data loading process. Developed State Diagrams, Activity diagrams and Class Diagrams in MS Visio using UML for various modules of the project.

Confidential

Business Analyst

Responsibilities:

• Conducted working sessions to gather and document detailed and high level business requirements for different business units impacted

  FACETS, Utilization Management, Case management and Provider Reimbursement/Provider Payment. Involved in managing the risk adjustment process for Medicare advantage plans throughout the RAPS to EDPS (Encounter Data Processing System) transition. Designed wire frames, screen mock - ups and Graphical User Interfaces (GUI) for client's worker portal. Prepared use cases and data flow diagrams in

  Rational Jazz, MS Visio and MS Word to analyze the impact of diagnosis codes embedded in different systems and applications. Contacted SME's to collect and finalize all system and business process requirements for incorporating changes to existing Medicaid Management Information System (MMIS). Prepared and maintained requirements traceability matrix (RTM) throughout the project lifecycle. Worked closely with project manager and team leads to coordinate resources and document cost estimates throughout the project. Worked with PBMs to monitor prescription safety across several pharmacy networks and reviewed formularies. Worked on pharmacy claims processing and facilitated reconciliation. Coordinated with Business Project Teams, Business Owner, Application Vendor, Payers and Clearinghouses to bring all processes to a level of execution to mitigate any impact to current revenue flow Performed Accounts Receivable Data entry with specific involvement in Cash Posting and closely interacted with Revenue Cycle Management team. Worked closely on 837 I/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. Designed and developed Business Rules document about the

  Claim Component and HIPAA. Created business workflows on the claims module for the client to get a better understanding of the software and prepared a detailed BRD including all functional and non-functional requirements. Performed the Gap analyses of the earlier systems, generated a