PROFESSIONAL SUMMARY:

• 7 + year’s expertise in Business Analysis/EDI Analyst/Data Analyst, Quality Assurance and Testing with hands on experience in Healthcare and Insurance domain.
• Extensive experience with Medicare/Medicare Advantage/Medicaid processing as well as Claims/Billings.
• Excellent knowledge of HIPAA standards, EDI (Electronic data interchange) Transaction syntax like ANSI X12, Implementation and Knowledge of HIPAA code sets, ICD - 9, ICD-10 coding and HL7.
• EDI (Electronic data interchange) Medical Claims experience in Process Documentation, Analysis and Implementation in 835/837/270/271 processes of EDI (Electronic data interchange) Medical Claims Industry from the Provider/Payer side.
• Strong knowledge of the Software Development Life Cycle (SDLC) methodologies such as Agile, Waterfall and Rational Unified Process (RUP).
• Extensive experience in Business Requirements gathering and writing skills with expertise in developing and documenting Business Requirement document (BRD/BREQS), Functional Requirement Document (FRD),Software Requirement Specification (SREQS) across the deliverables of a project.
• Effectively used Rational Requisite Pro to organize, track and change requirements of the system.
• Expertise of UML in visualizing and documenting the artifacts using Use Cases, Use Case Diagrams, Activity diagrams, Class diagrams, Data Flow Diagrams, Business Flow Diagrams, Sequence Diagrams using MS Visio.
• Experience in MS SQL Server installation, configuration, performance tuning, client/server connectivity, query optimization, running Database Consistency Checks using DBCC commands
• Facilitated Joint Application Development (JAD) sessions, Rapid application development (RAD) sessions, conducting user interviews and acting as a liaison between the customers, development team and testing team.
• Facilitated User Acceptance Testing (UAT) with the stakeholders and the business users as well as trained users to use the system configured.
• Excellent verbal/written communication skills and strong analytical abilities and can perform well both independently and as a team player.

TECHNICAL SKILLS:

Methodologies: SDLC, Agile, Waterfall, RUP HL7, SQL, IDMS, QTP, MS Windows NT 4.0/2000, Windows 95/98, Windows XP, MS Visual Studio.Net, IBM WebSphere 5.0, Power Builder 5, 6.5, 7, Rational Rose, UML 2.0, RUP, OOAD, MS Visio and Visual Studio.Net, Sybase SQL Anywhere 5/6, Adaptive Server Anywhere, MSSQL 7, Oracle 6 / 7.x / 8i / 9i, Oracle - TOAD, Business Object, UNIX, Cognos, Erwin ODBC, Visual Source Safe 6.0, Cobol, FTP, SOAP over HTTP, Source Off-Site, Round-Table, Win CVS, NUnit.net, MS Project, MS-Office

PROFESSIONAL EXPERIENCE:

Senior Business Analyst

Confidential, Livonia, Michigan

Responsibilities:

• Extensive involvement in capturing the requirements from users.
• Preformed the role of facilitator to conduct JAD session for requirement gathering.
• Interact with business people and stake holders to analyze and create business requirement documents.
• Prepared BRD and then converted these requirements into Functional Requirement Specification (FRS).
• Created the As-is and To-be data flow diagrams for different phase of the project
• Initiated communication with the users and development team.
• Assured all artifacts/signoffs were in compliance with corporate policies and guidelines and archived.
• Extensive involvement in the development of application by using RUP.
• Conducted GAP analysis to find out missing things in project.
• Conducted cost benefit analysis of various ETL tools and technologies.
• Implemented complex transformations by creating custom transformations in addition to using built-in ones.
• Oversaw unit and system tests and assisted users with acceptance testing.
• Conducted peer design and code reviews and extensive documentation of standards, best practices, and ETL procedures.
• Played role in design of scalable, reusable, and low maintenance ETL templates.
• Responsible for updating existing application.
• Uses variety of information gathering techniques (e.g, interviews, and facilitated sessions) to determine business requirements and technology needs to fulfill the GAP.
• Involved in updating for the front end application using CAD(Computer Aided Design).
• Performed key role in the planning, testing, and implementation of business enhancements.
• Examined existing data and makes recommendations for improvement/efficiency.
• Resolves requirements and design issues.
• Involved in the UAT process to check the reliability and acceptability for end users against the original requirements.

Environment: MS Visio, RUP, JAD, GAP, MS office, Windows, Linux, Mac, SDLC, SQL

EDI Business Analyst

Confidential, Denver, Colorado

Responsibilities:

• Conducted weekly meetings for deciding the Policies and Procedures to be followed while constructing new sites.
• Worked on ICD conversion from 9 to 10. Complete a review of existing documentation for orders, referrals, and reports and compare it to the clinical details needed for ICD-10
• Created EDI documents for EDI maps to generate requirement documents and Project Charter, and logical UI design documents for EDI transactions and code sets.
• Experience in EDI (Electronic data interchange) automated first-pass claim adjudication, requiring thorough understanding of claim processing, both front and backend operations
• Designed and development of test cases based on functional requirements for Institutional and Professional claims for EDI (Electronic data interchange) and HIPAA Transactions 837/835, 834, 276/277, 270/271 testing.
• Providing recommendations for resolution of production problems
• Prepare required documentation before implementing software applications
• Understand and create the process flows which relates to the business system
• Developing and executing various test plans which would further demonstrate the proficient usage of project life cycle
• Providing on-call technical support
• Created classes and dimension and measure objects according to business requirements.
• Generated effective reports using formulae, sections, breaks, alerters, and filters.
• Utilized Agile/ SCRUM and PMI methodologies to monitor steer and develop project objectives. Used Rational Requisite Pro as requirement gathering tool.
• Worked on project life cycle and SDLC methodologies including RUP, RAD, Waterfall and Agile.
• Meet the decided deadlines for the assigned tasks
• Mentoring analyst and fellow analyst
• Learn new tools and processes whenever required
• Conduct business according to the defined standards and policies
• Uploading and Modifying document on SharePoint 2010.

Environment: Windows Vista, Business Objects, MS Excel, MS Word, Visio, MS Power Point, SharePoint 2010.Agile

Senior Business Analyst

Confidential, Boise, ID

Responsibilities:

• Reviewed and analyzed business processes associated with IT application requirements.
• Conducted and facilitated JAD session to develop and coordinate the requirements, specifications, design and testing efforts for medium and large projects.
• Analyzed business workflow and system needs for conversions and migration as well as assisted in data mapping.
• Involved in gathering Business Requirements by conducting brainstorming sessions and interviews with the stakeholders.
• Conducted complex documentation and user needs analysis.
• Defined, developed specs for federal reporting specific to Medicare Advantage.
• Prepared graphical depictions of Use Cases, Business process diagrams, Use Case Diagrams, State Diagrams, Activity Diagrams, Sequence Diagrams, Component Based Diagrams, and Collateral Diagrams and creation of technical design (UI screen) using Microsoft Visio.
• Maintained SQL Script for creation of Database Objects using VSS (Visual Source Safe).
• Involved in gap analysis and implementation of HIPAA 5010, ICD 10 and Claim Validations
• Extensively interacted with the stakeholders and the IT Department in finalizing the requirements according to the CMS Compliances/Regulations and HIPAA Regulations.
• Assisted to develop the Test Plan, Test Cases and Test Scenarios to be used in testing based on Business Requirements, technical specifications and/or product knowledge.
• Acted as a EDI Analyst for the CDS implementation the backbone for data integration among myriad systems, including ERP, CRM, Portal, Workflow Engine, Payroll and related interface
• Worked with SOA meta- model, SOA governance and SOA reference architecture and maintained SOA standards.
• Analyzed trading partner specifications and created EDI (Electronic data interchange) mapping guidelines

Environment: Windows 2000/XP, HL7, Microsoft Office SharePoint 2007, Cognos, Agile, Rational Requisite Pro, MS Office, SQL Server 2005,UNIX, Cobol, DB2, JAVA, J2EE, MS Project, MS FrontPage 2003, MS Access, EDI (Electronic data interchange).

Business Analyst

Confidential, Philadelphia, PA

Responsibilities:

• Utilized Rational Unified Process (RUP) to configure and develop process, standards, and procedures and create a Business requirement (BREQS) Document.
• Created new database objects like Tables, Procedures, Functions, Indexes and Views using T-SQL in Development and Production environment for SQL Server 2000.
• Converted MS Access database to MS SQL database using MS SQL 7.0 Server Enterprise Manager. Created SQL scripts for uploading procedures.
• Designed and development of test cases based on functional requirements for Institutional and Professional claims for EDI (Electronic data interchange) and HIPAA Transactions 837/835, 834, 276/277, 270/271 testing.
• Created Process Work flows, Functional Specifications documents and documented system requirements (SREQS).
• Performed all necessary programming, testing and documentation for COBOL, DB2 batch programs and sub-routines.
• Conducted interviews, meetings and JAD sessions during the process of Requirement Gathering.
• Involved in Conducting Market Research, Feasibility Studies, Data Analyses, System Analyses, Gap Analyses, and Risks Analyses.
• Created EDI Testing process, documentation, and performance matrices.
• Developed detailed unit test plans and scripts and conducted rigorous testing per requirements and assisted in data mapping.
• Created EDI documents for EDI maps to generate requirement documents and Project Charter, and logical UI design documents for EDI transactions and code sets.
• Provided implementation assessment, strategy, and mentoring services for Rational Rose, UML and RUP.
• Interacted with various cross-functional teams on building business use cases, and understanding expenses and revenue stream.
• Performed extensive Requirement analysis and developed use cases and workflows.
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, and OOD
• Worked with Quality Control Teams to develop Test Plan and Test Cases.
• Interacted with the developers to report and correct bugs.
• Developed Test Plans and Test Cases according to Business Requirements.

Environment: Servlets 2.2, JMS, Java2 (JDK 1.3), STRUTS,JDBC2.0, DB2, XML, XSL, XSLT, Rational Rose, PL/SQL, HTML, CSS, JavaScript, Cognos, UNIX, HL7, MS Word, Excel, Access, Project, Visio. AGILE

Business Analyst

Confidential

Responsibilities:

• Performed the requirement analysis, impact analysis and documented the requirements using Rational Requisite Pro.
• Carried out UAT and exposure to User Certification Testing (UCT) and Operational Readiness Testing (ORT)
• Documented the server farm requirements and requirements related to security within Share Point and using Windows Active Directory.
• Assisted a Lead ETL Developer/Data Architect in the enhancement of an existing custom ETL framework that collected, cleansed, and integrated the company’s performance data (i.e., cash-flows, liquidity positions) from various operational Source Systems.
• Followed a systematic approach to eliciting, organizing, and documenting requirements (BREQS/SREQS) of the system.
• Reviewed the Joint Requirement Documents (JRD) with the cross functional team to analyze the High Level Requirements.
• Implemented data access, storage and validation routines on the database server using Procedural Language/Structured Query Language (PL/SQL).
• Developed HL7 messaging for bi-directional case and disease report exchange, in text and XML formats, in accordance with HL7 specifications;
• Developed & executed several Optimized queries in SQL on this data.
• Managed the team of consultants responsible for developing on-demand Medicaid Management System reports.
• Designed the online screens/UI and reports for the Medicaid Online Electronic Claims Submission System.
• Planned and defined system requirements (SREQ) to Wire Frames with Use Case, Use Case Scenario and Use Case Narrative using the UML (Unified Modeling Language) methodologies.
• Optimized SQL Queries by using Query Analyzer
• Interacted with client and the Technical Team for requirement gathering and translation of Business Requirement (BREQS) to Technical specifications (SREQS).
• Conducted interviews, meetings and JAD sessions during the process of Requirement Gathering.
• Planned and documented procedures for data processing and prepared data flow diagrams for the application.
• Identified/documented data sources and transformation rules required to populate and maintain data warehouse content.
• Analyzed and translated business requirements into system specifications utilizing UML and RUP methodology
• Participated in the development of the data modeling methodology to be used in the project.

Environment: Windows 2000/XP, Microsoft Office SharePoint, Cobol, DB2, Cognos, Java/J2EE, HL7, Rational Requisite Pro, MS Office, SQL Server, UNIX, MS Project, MS FrontPage, MS Access, EDI (Electronic data interchange).