SUMMARY:

• Over six years of Business Analyst experience in Healthcaredomain focusing primarily on Iterative Software Development Lifecycle (SDLC)Rational Unified Process (RUP) and principles of Agile Methodology.
• In - depth knowledge in Billing Module and Claims Processing,Effective analytical and problem solving skills and hands-on experience in creating UML Diagrams including Use Case Diagrams, Activity Diagrams, Context Diagrams,Software Requirements Specifications Documentation, and Scope Documents.
• Extensive experience in the field of Business analysis, Data Warehouse, Business modeling, document processing, process re-engineering and decision support systems.
• Skilled at building a strong team environment and the ability to acclimatize to new technologies, conditions and situations with ease. Excellent verbal and written communication skills.
• Excellent knowledge of industry standard methodologies like Software Development Life Cycle (SDLC), Iterative Software Development Life Cycle Process as perRationalUnifiedProcess (RUP), CMM (Capability Maturity Models) and Rational Tools used during various phases of RUP.
• Understand rules and regulations of HIPAA as imposed during Electronic Data Interchange (EDI).
• Comprehensive knowledge of Patient Protection and Affordable Care Act (PPACA).
• Functional experience in the Health Care Industry with in-depth knowledge on Medicaidand Medicare.
• Developed and managed multi-site surgery centers along withHMO/PPO administrative support functions.
• Creating artifacts like the Business Glossary, Business Architecture Document,Business Vision, Business Use Case Models and Business Modeling Guidelines.
• Followed Rational Unified Process (RUP) methodology in preparing business requirementdocuments (BRD), functional requirement documents (FRD), and use cases.
• Experience with Requirements gathering,System Architecture, Data modeling, Feasibilitystudies, Project plan, ScopeDocuments.
• Expertise in conducting workshops for elicitation and elaboration of requirements to ensure clear and non-conflicting understanding of requirements.
• Dataflow analysis using use cases, state diagrams, dataflow diagrams, activity diagrams, class diagrams and collaboration diagrams.
• Comprehensive knowledge of the testing lifecycle within web, client server & Mainframe environment.
• Created Requirements Traceability Matrix (RTM) to keep the stakeholders informed of the progress of the project.
• AppliedUnified Modeling Language(UML) tools like MS-Visio and Rational Rose to create use case diagram, activity diagrams, flowcharts, state chart diagram, sequence diagram, process flow and ER diagram.
• Experience inconducting and facilitating Joint Application Development (JAD)sessions to decrease time spent in moving information between team members and stakeholders and Rapid Application Development (RAD) sessions to converge early toward a design satisfactory to the customer and feasible for the developers and to limit a project’s exposure to the forces of change.
• Skillful at all Rational tools including Rational Clear Quest, Rational Requisite Pro, Rational Rose, Rational Clear Case.
• Extensive understanding of the AS-IS and TO-BE business processes and experience in converting these requirements into technical specifications for preparing Test Casesand Test plans.
• Skilled in using tools like Clear Case and Clear Quest for monitored changes related to the projects and documenting them and proficient in Change Management process.
• Hands on experience of data manipulation, performance testing on MySQL and MS Access using SQL scripts.
• Experience in conducting SWOT Analysis,User Acceptance Testing, Cost Benefit and ROI analysis.
• Expert level skills in MS Office products like MS Word, MS Excel, MS PowerPoint, MS FrontPage, MS Excel, MS Access, and MS Project.
• Extensive Documentation Skills for use in Standardization of Testing and Programming Procedures and Guidelines.

TECHNICAL SKILLS:

Business Modeling Tools: Microsoft Visio, Rational Rose, Rational Requisite Pro

Databases: Oracle, SQL Server, MS Access, IBM Mainframe, DB2

Defect Tracking Tools: Rational Clear Quest, Test Director

Languages: C, C++, Java, Visual Basic, SQL, PL/SQL, VHDL

Methodologies and skills: SWOT Analysis, Cost Benefit Analysis, GAP Analysis, Cost Effect Analysis, Agile Development, CMM, UML, RUP, SDLC, Six Sigma, SharePoint, SOAP, ISO 9001

Operating Systems: Windows, UNIX, Linux, Mac

Testing Tools: Rational Test Manager, Rational Enterprise Suite, Rational Robot

Version Control Tool: Rational Clear Case

Web Technologies: HTML, XHTML, XML, JavaScript, CSS, PHP, Perl

PROFESSIONAL EXPERIENCE:

Confidential

Responsibilities:

• Analyze the Business Modules and their impact on the current system.
• Accountable for starting RUP and UML Processes for Creation of Documentation to use by IT Team.
• GenerateRequirement Specification Documents after conducting sessionswith End Users, JAD Sessions and analyzed their current systems.
• GenerateWork Flows,Use Cases, Use Case Models, and System Specification Document Using RUP Methodology.
• Use Component business modelingto improve strategic planning and efficiency.
• Comprehend end-user requirements, strategies, and objectives to create Requirement Specification Documents, Use Cases.
• Assistwith constructing the EDI 837(I, D, P), 835, 277-U, 270/271, 276/277, 278, 820 and 834 transactions processing flow from the Trading Partners to thetranslator to the Mainframe and back to the Trading Partner.
• Maintain Traceability matrix throughout the project.
• Work responsibilities primarily involved understanding the business logic, designing requirements, communicating them to the developers, generating documentation, designing use cases, creating various diagrams like State Diagrams, Sequence Diagrams as part of project.
• Create standards and guidelines for business process modeling, Use Cases, Work Flows, Data Dictionary, and requirements specifications.
• Experience in ICD 9 to ICD 10 and knowledge of HIPAA conversions.
• Comprehend HIPAA X12 EDI transactions codes such as 270/271 (Inquiry/Response health care benefits), 276/277 (Claim status), 834(Benefits enrollment), 835(Payment/remittance advice/ Explanation of benefits), 837 (Health care claim).
• Advise end-users on requirements specifications techniques and the software development life cycle.
• Comprehensive knowledge HL7, HIX (Health Insurance Exchange), EMR/EHR, and Health Care Reform.Comprehensive knowledge of Trizetto Facets and MMIS.
• Schedule meetings with technical personnel to determine technical parameters for EDI and other related processes, including communication, security, and privacy. Resource for UB92 and HCFA1500 billing format, transaction sets requirements, EDI development and Design, X12 protocols through Version 4010A1 and newer, conversion needs and understanding of legacy EDI formats, such as UB92 Versions 4, 5, 6 and NSF.
• Comprehend rules and regulations of HIPAA as imposed during Electronic Data Interchange (EDI).
• Analyze requirements and formulated a Test Planfor testing the functionality, navigation, and integration testing of the application.
• Involved in creating requirements that comply with HL7 and ANSI X12 format regulations to protect the privacy of the employee insured under any policy.

Environment: SQL, MS Project, MS Visio, Rational Requisite Pro,Rational Unified Process (RUP), Rational Rose, Clear Quest, Windows, Mercury Test-Director, Business Objects

Confidential

Responsibilities:

• Collected, documented and managed business requirements, functional requirements, and non-functional requirements using MS Word.
• Gathered Business Requirements, Designers and Developers,Interacted with the Users, and the Project Manager to gain a better understanding of the Business Processes.
• Facilitated meetings with the client team andtechnical team to examinecurrent process and gather requirements for proposed process.
• AnalyzedEDI - X12 data elements captured by existing system to authenticate it against the data elements required for new system.
• Presented documents and Use Cases for multiple transactions and worked with ANSI X12 5010 ANSI X12 4010 including standards for medical transactions like 837I, 837P, 835, 276, 277, 270, 271(both inbound and outbound) transactions.
• Developed UAT test cases associated with the functional requirements.
• Responsible for mapping documents, test plan, test scenarios, test cases for unit, system and system integration testing.
• Used the Rational Unified Process (RUP) to build different phases of the Software development life cycle.
• Involved in GAP analysis around identification of business rules, user administration,business and system process flows, requirements and assumption.
• Worked with Developersand QA to clarify/understand functionality, resolved issues and provided feedback to minimize issues.
• Trained and performed as point of contact for new employees.

Environment: MS-Project, MS Visio, UML,SQL

Confidential

Responsibilities:

• Conducted meetings with the clients for gathering requirements and evaluation/analysis of their data. Converted the business requirements into IT specifications.
• Assisted in defining the initial common terminology to be utilized throughout the project lifecycle.
• Performed GAP Analysis, conducted walkthroughs and acted as a contact between the business users, stakeholders and the team to perform requirements, quality and risk analysis.
• Network with the internal and external stake holders to ensure deadlines are met and signed off on completion of projects.
• Set up internal/external status meetings and postmortem meetings.
• Documented and reported the progress to management on an ongoing basis.
• Applied guidelines and artifacts of the Rational Unified Process (RUP) to strategize the Implementation of Rational Unified Process effort in different iterations and phases of the Software Development Life Cycle (SDLC).
• Prepared Activity, Logical, Component and Deployment views to assist development and engineering in understanding the requirements using Rational Rose.
• Worked on multiple 837s and multiple Eligibility (270/271) and healthcare claim status (276/277). Create EOB systems (835).
• Extensive use of Rational Requisite Pro for reviewing and analyzing user requirements.
• Maintained Traceability matrix throughout the project.
• Analyzed and reviewed the System requirement specification document, Test plans and Test cases.
• UtilizedRational Clear Quest to maintain and track the requested enhancements and changes by the stakeholders.
• Interrelating with the development team to explain various design documents: Business Use Case Model, Detailed Use Cases, and Vision Document.
• Created detailed design of the system with the project team including class diagrams, activity diagrams, and sequence and collaboration diagrams.
• Converted detailed use cases into test cases in the pre-testing phase.

Environment: Rational Unified Process (RUP), UML, Dreamweaver, Rational Clear Quest,Rational Test Manager, Windows, MS Office, HTML, Windows

Confidential

Responsibilities:

• Involved in process analysis and defined executed data migration plans for local data for global applications.
• Used UML diagrams for data capture activities which required working with SMEs ensure consistency and accuracy of data during the data loading process and ensuring the data passes validation and integrity constraints with corporate database repositories.
• Comprehensive knowledge of Medicaid andMedicare (Part A, Part B. Part C and Part D) benefits and business processing.
• Thorough understanding of health benefit products, assisted in consolidating the summary of Benefits.
• Worked with 837, UB92, UB04, CMS 1500 claims.
• Detailed knowledge of PPO,POS, CMS, EMTALA, and HMO.
• Database support that includes activities required to correct, delete or summarize medical history of members as well as provider information.
• Experience in MMA and CMS Guidelines.
• Collaborated on the development of user requirements and design specifications using standard UML techniques such as use case, activity, sequence, and class diagrams.
• Conducted JADsessions, Focus groups and individual interviews to facilitate elicitation with regards tospecifications, analysis, and design of the relevant business processes and systems.
• Executed Smoke, Functional, Integration, End-to-end and Regressions Tests in each environment by tracking the test status in Quality Center (Test Director).
• Knowledge of HCFA1500 and UB92 claim forms.
• Created test cases and performed manual testing of the functionality of the application by inserting varying data on different test runs.
• Documented Requirement Traceability Matrix in Requisite Profor traceability of requirements through test cases.
• Documented detailed business, functional, and User Interface system specifications using standardized company templates for the business, development, and QA team.
• Applied Access database querying skills in streamlining and automating accounting processes.
• Utilized advanced Excel skills (pivot tables, macros, vlookup, charts).
• Developed Forms using MS Access for reporting via Forms and Reports.
• Built relationships with Information Systems and other relevant business partners, balancing practicalities with innovative and efficient business systems solutions.
• Produced clear user manuals & training guides for User Acceptance Testing (UAT) and deployment for end-clients with step-by-step instructions and created appropriate GUI screenshots.

Environment: SQL Server, UML, UAT, JAD, UML Diagrams,Rational Requisite Pro, Test Manager, Clear Quest, Windows XP, MS Visio, MS Access, MS Project