SUMMARY

• A dedicated business analyst with more than 6 years of industry experience.
• Hardworking individual with knowledge in all phases of Software Development Life Cycle (SDLC) including requirement gathering, analyzing, designing, developing and testing.
• Extensive experience in creating and documenting Business Requirements and System Functional Specifications.
• Result oriented Joint Application Development (JAD) facilitator and meetings coordinator with excellent communication and interpersonal skills.
• Deep knowledge of Business Process definition, Risk Analysis, and Use case Analysis.
• Experience working with Rational Unified Process (RUP), Agile Scrum and Waterfall methodologies.
• Extensively worked with use cases and UML diagrams like sequence diagrams, collaboration diagrams, state diagrams and activity diagrams.
• Strong knowledge of managed claims management process, Knowledge of Medicaid and Medicare Services, CMS, HL7 Standards, HIPAA, PPACA, Compliance Issue
• Excellent in tracking and maintaining the changes requested by the Stakeholders.
• Strong presentation skills and ability to tailor presentations towards different functional areas of business.
• Developed training materials and trained end users on newly developed and existing applications.
• Experienced with User Acceptance Testing (UAT) & release skill sets.
• Strong experience with health insurance administration systems including actuarial, policy application, eligibility, enrollment, underwriting, claims, billing, and payments.
• Strong experience of working with Medicare and Medicaid insurance data, Medicare parts A, B, C & D, and Insurance Claims.
• Experienced in report generation using Informatics 7x,8x,9x, Cognos 8x Reporting
• Significant Testing Experience in ASC X12 EDI for HIPAA and electronic healthcare transactions such as 270/271, 274, 276/277, 278, 820, 834, 835, 837 for Version 5010.
• Expert knowledge in Oracle Identity Management (OIM), identifying the organizations, and categorize them into types of organizations, attach them to parent organizations and setting the statuses
• Excellent in organizing groups of users based on their designations and functions
• Highly experienced in defining the resources and their types, defined the rules for allocating and provisioning
• Experienced in defining the processes for approval and its rules in details
• Adept in MS Office ( Confidential, Excel, Access, Visio, Power Point, Outlook, Project) for calculations, graphs, analysis, presentation and documentation.

TECHNICAL SKILLS

Languages: SQL, PL/SQL, VB Script, Java, C#, .NET

Tools: Quality Center, QTP, MS Office, MS outlook

Database: MS SQL Server 2012/2008,MS Access, Teradata

Business Analysis: Waterfall, Agile, RUP, GAP Analysis, Critical Thinking, Decision Making Strategy, Use Case Analysis, Requirement Analysis, Healthcare Domain

Documentation Tools: MS Project 2010, MS Visio, Bugzilla, MS Office Suite, Cognos 8x Reporting

Operating Systems: Windows 2000/XP/ Window 7, Unix, Solaris, Linux

Software: MS Office Suite( Confidential, Excel, Access, PowerPoint & Outlook), MS Visio, Rational Rose, Rational Requisite Pro, Rational Software Architect 9.1, Rally, IBM ODM, Adobe Acrobat, MS Office FrontPage, Lotus Notes, SOAP UI, HP ALM Quality Center

PROFESSIONAL EXPERIENCE

Confidential, Basking Ridge, NJ

Sr. Business Systems Analyst/ Systems Engineer

Responsibilities:

• Conducted and facilitated Weekly Project Status meetings
• Conducted and facilitated weekly Status Report Reviews
• Assessing upcoming changes and reviewing new regulations
• Mobilization of new requirements through the capabilities process
• Review and advise development of requirements and designs
• Increment and milestone planning
• Review and provide advisory support for Accenture increment plans
• Work with OTS to develop annual product roadmap for business milestones
• Advise OTS/CCIIO/CAN in development of the annual operations calendar
• Review and provide feedback for all Accenture deliverables to CMS (BRDs, FDDs, TDDs, Testing documentations, release documentations etc.)
• Manage and track metrics - provide feedback to leadership

Confidential, Basking Ridge, NJ

Sr. Business Systems Analyst

Responsibilities:

• Heavily involved in the rule discovery phase and created a detailed BRD for projects
• Facilitated JAD sessions with the State to gather and clarify requirements using various methods including user stories
• Researched and analyzed the State and government requirements and guidelines
• Created RTM’s for requirements traceability
• Created and maintained workflows
• Created Use Cases using Rational Software Architect
• Tracked and logged defects using HP ALM
• Bugged defects using IBM ODM
• Worked collaboratively with QA team to help manage and create Test Cases along with resolving defects
• Worked in conjunction with the DEV team on creating the BOM (Business Object Model) and XOM (Execution Object Model)
• Wrote rules in IBM Rules Designer software and created any missing verbalizations to help facilitate the rule writing process
• Used Rally for creating and managing User Stories
• Conducted daily SCRUM meetings to track progress of all parties involved in the project
• Developed functional specification documents which fully describe the current structure of the system, along with impacts to the system resulting from proposed changes.
• Maintained Requirements Traceability Matrix (RTM) throughout the project.
• Identified gaps and performed gap analysis with respect to requirements
• Performed Unit Testing and User Acceptance Testing and documented detailed defects.
• Lead UAT Testing
• Developed UML Use Case model for the application using MS Visio and assigned to prepare the detailed Work flow diagram based on the proposed enhancement for the system.
• Reviewed sprint activities to demonstrate new functionality and provide feedback that could influence next sprint.
• Conducted technical review sessions and facilitated project meetings as required.

Confidential, Orange County, CA

Sr. Business Systems Analyst

Responsibilities:

• Maintained project Plan using MS Project. Created progress reports for multiple audiences and identified and proactively managed project risks & issues.
• Worked with client to identify reporting requirements and develop needed detailed business requirements
• Gathered business needs and turned it into a requirement that can be turned over for development
• Created and maintained HIX Compliance documentation and educated other team members about regulatory compliance with all government agencies (including HIPAA) involving the Obama care Reform by writing summaries of those regulations and their updates.
• Researched and analyzed the State and the government requirements and guidelines
• Created and maintained workflows and timelines for Vice President and management using MS Visio and also created list of letters, notifications, invoices, and other documentations that would be sent out to the customers.
• Created and maintained Service Level Agreements (SLA’s) and wrote business rules pertaining to the HIX project.
• Work on HL7 Message Validation, ICD 9, Electronic Health Records, And Electronic Medical Records.
• Created Use cases diagrams and process workflows using Visio
• Developed the User Interface (UI) prototypes to capture and validate requirements and spike solutions to the current problem.
• Identified and tracked Project Issues and Risks.
• Ensured billing and premium collection are modified to support 820 HIPAA transactions set.
• Implemented HIPAA/EDI X12 Transactions like 834,835,837,271,276,277.
• Worked on implementing EDI Health Care Eligibility/Benefit Response (271)to respond to request inquiries about the health care benefits and eligibility associated with a subscriber or dependent.
• Involved in data mapping of EDI X12 Transactions, creating work flow and activity and use case diagrams. Created validation documentations for the claim process.
• Provided in-class training to end-users and marketing partners in the areas of EDI Logical Mapping Fundamentals
• Worked on creating CMS historical payment files
• Design and document Business Requirements by using HIPAA EDI guides and reviewing or interviewing business process owners and companion guides
• Transferring files through FTP to vendor for Data verification for printing purposes
• Used a GUI tool, called Plum’sQuickFuse platform, to design IVR call flows by visually mapping all the menu options and commands a caller can access while navigating through an IVR application.
• Used Plum’sQuickFuse platform to do audio file management to store all recorded prompts
• Worked in ETL Tool to extract data from Teradata, Oracle, ASCII files, XML and MS excel
• Conducted JAD sessions between the end users and the development team.
• Executed, monitored, and documented functional activity
• Responsible for overseeing the design and documentation of the business requirements by the contracted vendor
• Performed User Acceptance Testing (UAT) and reporting the bugs to the development team.
• Conducted project related presentations and provided reports to the higher management.
• Created Test cases using Mercury Quality Center
• Authored and monitored progress reports on a weekly basis
• Developed Training materials and assisted in training the end users.
• Creating PowerPoint presentations and project updates using MS Project for management review.

Environment: MS Visio, MS office ( Confidential, Excel, Access), Oracle 11g, MySQL, Facets, Windows 7, Unix, MS Project, UML, Wireframe, HIPAA 5010, EDI, CMS, Project, Agile, RUP, UML.

Confidential, Philadelphia, Pennsylvania

Business Analyst

Responsibilities:

• Conducted Interviews, user meetings, JAD sessions, and Requirement Elicitation Sessions to extract the Business Requirements to understand their need to upgrade the existing system to 5010 compliant.
• Provided functional expertise and guidance during the project to ensure proper design techniques are used and that all resources are used appropriately
• Excellent oral and written communication skills, including the ability present to groups and to speak clearly and persuasively in positive or negative situations.
• Teamwork and Issue Resolution skills -- showing strengths in balancing team and individual responsibilities, exhibiting objectivity and openness to others’ view, providing and welcoming feedback, contributing to building a positive team spirit and building morale and group commitments to goals and objectives, supporting every team member’s effort to success, and exhibiting an ability to obtain resolution by team consensus when differences in business processes are discussed. (can be in any project) it is the main requirement for BA
• Lead UAT Testing
• Performed gap analysis to identify and document the gaps between the existing system 4010A1 compliant and new 5010 compliant system.
• Analyzed and categorized the impacts of new HIPAA standards and applied changes on the targeted systems, processes, business-associate relationships and Providers.
• Analyzed trading partner specifications and created EDI mapping guidelinesfor batch / real time processing.
• Involved with project management team in developing project plan.
• Attended JAD sessions to define System Requirement Specifications (SRS) and Detailed Designed Discussions with the technical team.
• Developed strategy for upgrading and implementing the user interfaces to be 5010 compliant.
• Maintained Requirements Traceability Matrix (RTM) throughout the project.
• Prepared the Business requirement Document (BRD) and functional requirement document (FRD) for the enhancement of the existing services.
• Create transaction sets requirements, usually with Microsoft Excel, for transactions such as: HIPAA 270/271, 276/277, 835, 837-(I, P, & D), 835 Remittances and others.
• Followed the Business Rules, and ensured that HIPAA compliant Rules are followed to display minimum benefit information.
• Managed the privacy and security environments of healthcare data that was governed by HIPAA and other government mandates.
• Maintained a record of recommendations, communications, activities, and schedules to monitor the progress of project in real time using MS Project.
• Understand rules and regulations of HIPAA as imposed during Electronic Data Interchange (EDI).
• Documented various key elements of HIPAA compliance and made sure that they are understood by the development teams.

Environment: MS Project, SQL, Rational Unified Process (RUP), Rational Requisite Pro, Rational Rose, Clear Quest, Microsoft Visio, Windows 2000/XP, Mercury Test-Director, MS Visio, Business Objects, CMS, ICD 10, Medicaid

Confidential, Hartford, CT

Business Analyst

Responsibilities:

• Provide advanced problem solving and functional support, and work with the team to resolve complex functional problems.
• Collaborate with project team members to develop common processes across the program and facilitate the development and implementation of support procedures. (JAD)
• Develop Functional Requirements
• Developing test scripts
• Planning and organization skills, as exhibited by an ability to coordinate many different project tasks, to prioritize and plan work activities and set appropriate deadlines to complete key activities, and to effectively manage time and resources.
• Interacted with business heads to finalize the Business Requirements for the application.
• Performed the requirement analysis and documented the requirements using Rational Requisite Pro.
• Used the requirement attributes (priority, effort, and risk) as the basis for negotiating the inclusion of the requirement, to manage the scope of the system efficiently.
• Developed UML Use Cases using Rational Rose and developed a detailed project plan with emphasis on deliverables.
• 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.
• Used SDLC (System Development Life Cycle) methodologies like the RUP and the waterfall.
• Understand the As Is system and develop the To Be system concept and also prepare the System Process Maps.
• Managed changing requirements which included establishing a baseline, keeping track of the history, determining dependencies that are important to trace, tracing relationship between related requirements and maintaining version control.
• Prepared and documented System Requirements and workflows for the Content Management Application tool.
• Assisted the database development team in data modeling, data structure and data table layouts required for consolidation of incongruent databases,
• Responsible for integrating with Facets .Designing test scripts for testing of Claims in Development, Integration and production environment.
• Identified gaps and performed gap analysis with respect to requirements
• Checked Business Readiness and determined activities of flow.
• Developed & executed several Optimized queries in SQL on this data.
• Performed Unit Testing and User Acceptance Testing and documented detailed defects.
• Wrote Procedure Manuals and was responsible for continuity preparedness.
• Managed various tests, stored test information, reviewed and analyzed test results.
• Conducted presentations of the Q/A test results with analysis to the stakeholders and users and documented modifications and requirements.
• Helped in writing Training manuals and helped business with the Training on a one to one sessions.
• Employed Rational Clear Quest for effective Change Management (Requirements Creep) and bug tracking during the testing lifecycle.

Environment: Windows, MS Office (MS Confidential, MS Excel, MS PowerPoint, MS Visio), MS Access, MS Project, Rational Rose, Community Manager, BPML, SQL, ClearCase, Agile

Confidential, State of NJ

Business Analyst

Responsibilities:

• Performed Requirement Gathering & Analysis by actively soliciting, analyzing and negotiating customer requirements and prepared the requirements specification document for the application using Microsoft Confidential .
• Performed testing for Medicare, Medicaid and X-Over claims for Medicaid Management Information System (MMIS)
• Coordination of numerous project initiatives including: system conversion and integration of a behavioral health acquisition, preparation of numerous RFP responses, other system initiatives related to case management, provider management, eligibility management, claims processing, and prior authorizations.
• Designed and developed project document templates based on SDLC methodology
• Identified opportunities for business process improvement through various meetings with business users and developers and initiated efforts to make improvements.
• Conducted Business Requirements meets to identify and document business requirements.
• Perform analysis on project scope parameters (gap analysis, cost /benefit etc)
• Interacted with the Development team to help write technical specifications to describe Functional Requirement Documents (FRD),Business Requirement Documents(BRD), design specifications and module specifications
• Worked as a liaison to in corporate the CMS mandated change of adding new fields into the Medicare part D - Prescription Drug Event Claim Data and all the system it passes through.
• Created Business process workflow diagrams using IBM business process modeler
• Interaction with underwriters to understand multiple data points. Prepared data flow diagrams using MS Visio for better clarity and to ensure documented process
• Used Agile Development methodology throughout Project Life Cycle
• Responsible for identifying requirements and translating business requirements to system requirements.
• Created DTS Packages for migration of data between MS SQL Server database and other databases like MS Access, MS Excel and Flat Files.
• Developed UML Use Case model for the application using MS Visio and assigned to prepare the detailed Work flow diagram based on the proposed enhancement for the system.
• Tested the provider interfaces for NPI related changes in the Encounters project.
• Contributed towards preparing functional system test cases that adequately represent the business needs
• Rendered support to staff and affiliates towards the completion of the project as per the Deadlines.
• Organized meetings to discuss outstanding issues with QA and developers
• Highly involved in user acceptance testing (UAT).
• Experience with business process design
• Facilitate team activities

Environment: MS Project, SQL, Microsoft Visio, Windows 2000/XP, Mercury Test-Director, MS Visio, Business Objects, BO XI (CMC, CMS, Designer, Desktop Intelligence, WebI), CMS, ICD 9/10, HIPAA 4010/5010, Medicaid, Medicar