OBJECTIVE

• An excellent Team player with strong interpersonal communication skills, strong work ethics and excellent problem solving skills.
• Seeking a fast paced dynamic environment to share in - depth practical knowledge and skills gained over time, working as a Business Analyst in the Healthcare domain.

SUMMARY

• Over 6 years of experience as a Business Analyst in the HealthCare domain.
• Experienced in Gathering Requirements by using various methods of requirement elicitation techniques.
• Expertise in all areas of software development including client interaction, requirements gathering, analysis and tele-conferencing with the client during the progress of the project.
• Experience in capturing data requirements, data analysis & data mapping for Vendor feeds and Databases.
• Expertise in Claims, Subscriber/Member, Plan/Product, Claims, Provider, Commissions and Billing Modules of Facets.
• Experience in preparing and maintaining the Requirements Definition Documents that included Business requirements and Functional requirements.
• Good Management, Execution and Documentation skills.
• Specific expertise in Business Analysis, GAP Analysis, Data Analysis, Business Rules and developing and creating business process documents.
• Facets support systems were used to enable inbound/outbound HIPAA EDI transaction in support of HIPAA 834, 835 /271 transactions
• Excellent skills of developing Use Case diagrams and Sequence diagrams.
• Specialized in creating UML Diagrams like Use Case, Activity and data flow diagrams using Rational Rose and MS-Visio and consistently translate business requirement into IT solutions.
• Experience in using Joint Requirement Planning (JRP) and Joint Application Deployment (JAD) sessions for gathering requirements and elicitation.
• An excellent knowledge of ICD-9 and ICD-10 structures and formats and vast experience on their conversion process and mapping.
• Strong understanding of EDI Claims, Member Enrollment, Eligibility, and HIPAA 5010 standards.
• Knowledge of different modules within Healthcare Claims Adjudication Process (Membership process, billing process and enrollment & Claims process).
• Experience with HIPAA compliance in the Healthcare systems.
• Functional experience in health Care Industry with vast knowledge on Medicare and Medicaid.
• Experienced in UAT.
• Excellent presentation and communication skills, can act as an excellent mediator between business and technical teams.

TECHNICAL SKILLS

Business Modeling Tools: IBM Doors, JIRA, RALLY, VersionOne, MS Share point

Database: MS SQL Server, Oracle, Netezza, Green Plum

Testing Tools: HP ALM (Quality Center), ClearQuest, Bugzilla, SOAPUI, TFSUML & UI Design Tools MS Visio, Enterprise Architect, Balsamiq, Free Draw

Other: Toad, SSMS, Notepad++, WinSCP, Putty, Edit Plus, FilezillaSynchrony, Autosys, Oxygen

PROFESSIONAL EXPERIENCE

Confidential, NYC

Business Analyst

Responsibilities:

• Worked as a liaison among stakeholders in order to elicit, analyze, communicate and validate requirements for changes to business processes, policies and information systems.
• Interacted with the Business users, SME’s, Developers, PMs and QA teams to better understand the business processes and application knowledge.
• Met with Supervisors and business users and defined the scope of the project, gathered business requirements, and conducted gap analysis
• Worked closely with Business Team, SME’s, Infrastructure team, and coordinated with Offshore Team.
• Wrote BRD’s for 834(member Eligibility),Provider files and Claims tracking system, Use-Case Narratives including business process workflow diagrams and Requirements Traceability based on any of the projects need.
• Worked on theEDI834-file load to Facets through MMS (Membership Maintenance Sub-system)
• Worked on solving the errors ofEDI834load to Facets through MMS.
• Experienced in X12 transactions 837/834/820/271 of medical claims/underwriting for support and point of reference for the vendor inbusinessissues.
• Documented and gathered Functional specifications for 837 (claims), 278(Authorizations) and 270/271 (Eligibility and Benefit Response)
• Conducted Requirements Walk-Thru JAD Sessions and resolved all issues/findings.
• Successfully received Sign-Offs by utilizing Clear Quest tool for all projects on time after resolving all open questions.
• Lead daily team meeting and co-ordinate with different cross-functional teams, offshore as well as onshore.
• Lead & Facilitated numerous meetings to help answer any question on requirements during Design, Development, Testing and Implementation phase.
• Communicated with all the key stakeholders, business teams, contributors, operations and technical experts to ensure help and involvement in completing the assigned task.
• Organized brainstorming and JAD sessions with stake holders, business users, technical teams, testing team to analyze and validate the business requirements, system life cycle and explained the key performance indicators and documented the specifications.
• Created Use Case diagrams by analyzing the business process followed by Activity diagrams using MS-Visio and participate in production of HIPAA 5010 EDI Test data.
• Developed use case Designed process flow diagrams using MS-Visio and also Business Context Diagrams
• Coordinated with users in doing UAT and conducted UAT testing.

Confidential, Chicago, IL

Business Analyst

Responsibilities:

• Gathered Business Requirements, reviewed design requirements to validate the Health Exchange /Medicaid/ICD projects to meet all the requirement.
• Elicited functional and non-functional requirements, conducting and facilitating requirement sessions
• Participated and led daily stand-up meetings in line with Agile Scrum methodology.
• Worked on Configuration Management, Requirementmanagementand analysis.
• Collaborated in building a business analysis process model using Rational Rose and Visio.
• Led sprint planning session to identify the features and functionalities that should be achieved by the new application where I prioritized and determined level of work for PBIs in line with Agile Scrum methodology.
• Created Business Requirement Documents as a result of meetings with the Business Areas and obtained business sign offs on the documents after reviewing the final documents with them.
• Organized weekly and biweekly meetings with testers to discuss testing progress and address any major concerns with the testing effort.
• Worked closely with SME’s and provided business team with technical suggestions and recommendations.
• Involved and led as a Scrum Master in daily scrum meeting to discuss any roadblocks or impediments in the project path.
• Worked closely with the business team, development team and the quality assurance team to ensure that desired functionalities will be achieved by the application.
• Analyzed and evaluated User Interface Designs, Technical Design Documents and the performance of the application from various dimensions.
• Maintained the Traceability Matrix Table to uniquely trace the identified business requirements to general design to testing as proof that requirements requested have been developed into a solution and that it has been tested and tracked.
• Led the Change Control Process for changes submitted for the BRD once the document was submitted to IT department.
• Documented the UAT Plan for the project and worked with the UAT Team to ensure every acceptance criteria for the requirements has been included in the UAT task plan.
• Identified various points of integration among the new and existing applications and required integration with other IT components.
• Lead client discussions relating to theFacetsconfiguration of a standard Medicare Advantage plan.
• Tracked the progress of work item number (WIT) in Team Foundation Server (TFS) and updated the team members accordingly.
• Supported new business requirements by extending the functionality of the core Facets system using the Facets extensibility architecture feature.
• Perform troubleshootingand resolving errors in EDI 834 and 820 transactions for health insurance exchanges and performed root causes analysis
• Involved in FACETS Implementation, including end to end testing of FACETS Billing, Claim Processing and Subscriber/Member module.
• Involved in writing complex SQL queries to check the data integrity
• Wrote business case scenarios for HIPAA EDI Transactions.
• Assisted customers on their migration to new or revised system, applications and platforms.
• Validated HIPAA Transactions and Code Sets Standards according to the test scenarios such as 270/271, 276/277, 837/835, 834, 999 acknowledgment for enrollment transactions and performed UAT.
• Tested data to check HIPPA- eligible & participation check for individual coverage.
• Logged defects in Quality Center (QC) and interacted with the developers to resolve technical issues.
• Involved in writing the Test Cases and Test Scenarios based on the Functional Specification and Technical Specification in Excel and exported them in HP Quality Center.
• Tested the messages published by Informatica and data loaded into various databases
• Extensively used the ETL tool like Informatica for data integration and data quality services

Confidential, Dublin, OH

Business Analyst

Responsibilities:

• Prepared BRD by eliciting requirements through holding meetings with product owners, SMEs’ and trading partners.
• Analyzed the data movement between systems in order to validate the Business Requirements.
• Worked on data mapping to bring data from one system and reside in another system.
• Assisted in database validation by providing mapping documents and advise.
• Ensured that EDI files were in compliance with new ICD-10 standards
• Carried out forward/ backward mapping when necessary.
• Validated log files (999, x12) for 834/820
• Wrote Use Cases and maintained the traceability matrix.
• Analyzed data/workflows, defined the scope, and performed GAP analysis
• Worked on FACETS claims processing, payment adjustments, claims inquiry, benefits,
• Attended JAD sessions to help developing team understand the detailed requirements.
• Extensively involved in updating the official changes to the tabular list, instruction manual and alphabetical index of ICD- 9 to ICD-10 in regards to data transactions.
• Created Test Suite, added assertions in Soap UI tool to validate the response XML.
• Actively participated in status report meetings and interacted with developers to discuss the technical issues.
• Conducted walkthroughs and defect meetings periodically to assess the status of the testing process.
• Followed workgroup for EDI standards for testing that need to comply with the HIPAA guidelines.
• Conducted UAT.

Confidential, Columbus, OH

Business Analyst

Responsibilities:

• Interacted with the stakeholders and end users in order to define the purpose and scope of application and gather User Requirements.
• Developed Process/workflow analysis by understanding the process modeling.
• Designed and documented Business Requirements (BRD) by using ASCI ASX X12 EDI guides, reviewed and interviewed business process owners and companion guides.
• Prepared business requirement documents and functional requirements using Rational Requisite Pro.
• Created Supplemental Specifications in RequisitePro and updated the RequisitePro Global Glossary.
• Performed detailed analysis for the functional areas that will be impacted by implementation of ICD-10 codes
• Created test plans and scripts, facilitated UAT and tested strategies with developers and testing team.
• Performed comparative analysis and gap analysis to identify variation in the process as per HIPAA X12 4010 and 5010 guidelines to in corporate updates as per 5010 guidelines.
• Performed Backend testing on Membership Enrollment of Facets functionality
• Established Inner Join, Outer Join and created Indexes whenever necessary.
• Used RUP iterative process to conduct Data Analysis on the client profile data to find missing data fields in the database and customize them.
• Facilitated meetings with users for requirement collection, design changes and feedbacks.
• Escalated issues and reported them as appropriate to Project manager and management for support and guidance.
• Identified issues and worked with application and data team to resolve.
• Followed UML based methods using MS Visio to develop use cases and activity diagrams; assisted developers in creating sequence diagrams and collaboration diagrams.
• Prepared user instructions and use cases to conduct User acceptance testing (UAT).
• Facilitated the requirement changes and fixes along with the release management team.