SUMMARY:

• Sr. Business Analyst Professional with 9+ years’ experience in the Healthcare, Retail and Financial Industries. Most recently wrapped up with Prime Therapeutics in which was a Sr. Business Analyst.
• Focused mainly on multiple Capability Expansion Projects for an in - house claims management application called RxCLAIM. Worked on projects involving Medicare Part-D scope with BCBSMN, BCBS Arkansas, BCBS Alabama as external clients to Prime Therapeutics, handling client participations on BRS sessions.
• Worked on addition of third party interfaces and data exchanges from databases like Search America in the current workflow to assist in productivity of agents and a smooth SOA. Tejas is very experienced working with the development as well as the business side to create complete technical and functional specs.
• In-depth noledge and a practical experience of using Waterfall, Agile, Scrums, Rational Unified Process, Business Process Reengineering, Unified Modeling Language, System Requirements Specification and Functional Requirements. Specification, Rapid Application Development, and MS Visio.
• Highly skilled in transforming the needs of business users and stakeholders to the functional/technical requirements.
• Worked with vendors of off the shelf software to fine tune features and alignment with requirements, setup automated process with vendor management systems.
• Served as a critical resource and liaised between subject matter experts and technologists throughout the project life cycle.
• Was a process mentor and trainer for junior BAs.
• Excellent conceptual and technical skills to create Business Requirements Document, Functional Specifications Document, and Process flow Diagram, Process change notifications and Detailed Design Document.
• Analyzed and defined business processes both “as is” & “to be”.
• Conducted Joint Application Development (JAD) sessions with stakeholders and business partners to resolve open issues.
• Developed use cases, Process flows using UML and MS Visio for an ease with system interaction.
• Worked with the project team to determine appropriate test plans, deployment plans and supported the product launch.
• Worked with Vendors, Analysts, Managers, Developers and Testers for complex projects during the SDLC.
• Prioritized work requests from project team.
• Identified and communicated risks and with possible solutions.
• Modified and changed the User Interface (UI) as per the system requirements and clients’ requirements.
• Performed a Change Management Role when the new requirements were proposed performing impact analysis.
• Interacted with QA team for Unit/Integration/System testing.

TECHNICAL SKILLS:

• Rational Unified Process
• UML
• Agile, Waterfall (Systems Development Life Cycle)
• MS SQL Server
• Master Data Management
• Team Foundation server(TFS)
• SharePoint
• .NET
• API validation, mapping
• XML JSON mapping - Altova
• EDIX12 Validation
• Solution feasibility analysis
• Process Change Management
• & Mentoring
• UI - IRISE
• MS Visio
• MS Project
• MS Office (Word, Excel, PowerPoint, Outlook, Access)
• Rational Requisite Pro
• Rational Clear Quest
• HP Quality Center
• IBM Lotus notes
• Test Director

PROFESSIONAL EXPERIENCE:

Business Analyst

Confidential, Minneapolis MN

Responsibilities:

• Prepare for, conduct, and document elicitation sessions using a variety of techniques (Interviewing, requirements workshops, reviewing existing documentation, Observation, brainstorming, etc.) during the Software development lifecycle stages of the Projects (SDLC)
• Performed requirements change management with changing CMS guidelines resulting in multiple releases for RxCAIM and Surround code.
• Prepare UAT plans documenting in detail the responsible parties and multiple milestones in the timeline.
• Elicit requirements for tweaking the existing extracts from Middle ware system, Surround code, like PDE and MCEF according to CMS mandates, in order to keep the mandate deadline.
• Worked with Analysis of Databases on MS SQL server for pulling data for testing needs.
• I worked on a project dat overhauled the Pharmacy data according to NCPDP load files, dat was a compare and update process in a loop till the data accuracy is achieved.
• Manage solution scope, changes to requirements, and requirements conflicts.
• Worked on projects involving Medicare Part-D scope, BCBS Arkansas, BCBS Alabama as external clients to Prime Therapeutics.
• Worked on the complete consolidation of BCBSMN PA process project with high client interaction during every step of the process.
• Managed requirements traceability of requirements back to solution scope and objectives, and forward to system requirements and testing.
• Defined the business need and business case.
• Prepared Activity diagrams, Use cases, State charts, Class Diagrams.
• Planned the business analysis approach & activities for personal work and/or contribute to the overall BA approach.
• Participated in the stakeholder analysis and identify subject matter experts needed for the work effort, how they are impacted, and what their needs and role are to effectively engage in the effort.
• Assessed capability gaps, determine solution options and approach, and define solution scope.
• I prepared DTPs and SOPs based on Project need.
• I also worked on a Wiki uplift project, for the department’s enterprise Wiki page (Media Wiki).
• Other duties as assigned.

Environment: MS Office Suite, IBM Lotus notes, Surround code, MS-Visio, AT&T Connect, MS-Project, MS SQL server, and Tumbleweed Secure file transfer protocol, Team Foundation server(TFS)

Sr. Business Data Analyst

Confidential, Raleigh NC

Responsibilities:

• Analyzed Design documents, BRD, FRS, Requirements, and Mapping Documents during the Software development lifecycle stages of the Projects (SDLC), resulting in Master Data Management.
• Reverse engineered legacy claims management system application to a new in-house developed claims management system, while achieving enhanced functionality and usability.
• Gatheird Application re-writes requirements for the new claims management system.
• Performed requirements change management with changing CMS guidelines resulting in multiple releases.
• Prepared Activity diagrams, Use cases, State charts, Class Diagrams.
• Worked closely with Insurances APIs to map the data interchange into the in house application modules, for supporting the Service Oriented Architecture (SOA).
• Actively worked on EDI transactions and on the reconciliation processes.
• Validated the EDI X12 file in Transaction Management.
• Worked with Analysis of Databases on MS SQL server for pulling data for testing needs.
• Experienced process mentor and trainer for junior Bas.
• Worked for API mapping requirements modules to third party websites.
• Created UI specifications, initial overview, display rules and evaluated different links.
• Created overall working screen with IRISE.
• Generated test plan, test scenario and test script, executed and log defects.
• Worked on claim adjudication process with different clients applying different adjudication process and methodology.
• Claim validation and Pend/Denied Claims Analysis for the Health plans Medicaid programs.
• Worked on integration for in house claims management system.
• Design, development and implementation of an Enrollment Resolution and Reconciliation process for health.
• Analysis of discrepancies in the eligibility reconciliation process.
• Extract the data from different sources base on scenario and analyze them and trigger the matrix base on requirements, business rules.
• Validate the enrollment reconciliation process conciliation with CMS and CEERS if any discrepancy occurs.
• Involved in design of future state processes for HIPAA 5010 transaction processing EDI's 837,835,270, and 271.
• Worked on both inbound and outbound transactions, creating test cases for multiple transaction types including 837, 835, 276, 277, 270 and 271.
• Actively worked on SharePoint portal to update the case status, Run the job and track the log file and analyze the root cause.
• Update the project progress report and walkthrough with the client.
• Worked closely with team lead to resolve identified issues and the status report in a timely manner.
• Attended daily/weekly status meeting, review meetings, defect meeting and new release meeting.
• Defects tracking, review, analysis and compares results, communicate to the developer.

Environment: MS Office Suite, MS Project, MS Visio, FTP, Altova Map force, FileZilla, XML, JSON, MS SQL server, Web Services.NET, RUP, HTML, UML, Use Cases, Sharepoint, Rational Requisite Pro, Quality Center, Team Foundation server(TFS)

Sr. Business Analyst

Confidential, Richmond, VA

Responsibilities:

• Worked on creating the project plan, which included information like project activities, anchors, efforts, etc. and tracked the developments of the project and provided regular updates to senior management during the Software development lifecycle stages of the Projects (SDLC).
• Worked on creating detailed business requirement documents incorporating complex shared saving calculations for qualified physicians, Scorecard use cases, mock ups, test cases etc. The requirements were written for data being pulled from Oracle databases on .NET platform.
• Proactively undertook activity of calculating shared saving paid out to the physicians who will use the Scorecard to manage their patients upon its successful release.
• Prepared Scorecard documentation using Microsoft Visio, PowerPoint and Excel Pivot Tables for data comparison.
• Led and participated in technical JAD sessions with the technical team.
• Used AGILE project management methodology to plan the Scorecard release
• Involved in presenting weekly presentations on the Scorecard to external stakeholders (pilot groups) and various internal teams reviewing new features, enhancements, forecasting, and trends.
• Facilitated daily Scrum meetings in the absence of PM and worked towards eliminating impediments of team members
• Developed test cases working with internal testing teams creating UAT scripts for different phases of testing, as well as participating in the UAT testing process.
• Participated in the recording and analysis of the business requirements for the COB project
• Expertise in writing test cases on Microsoft Test Manager, experience in identifying defects.
• Managed change requests by conducting impact analysis, and formulate the implementation plan
• Prepared change request form to provide description of the change requests, the results of the impact analysis, workarounds, if changes are not feasible, and the additional efforts required
• Coordinated with all stakeholders of the projects to update them about the progress of the project, reviewed the developments, discuss change requests, and obtained approvals

Environment: MS Visio, MS Office, iRise, UML, Agile, Oracle, .NET, Requisite Pro, Clear Case, MS office suite, Java.

Business Analyst

Confidential, Richmond VA

Responsibilities:

• Verified, consolidated, documented and tracked requirement capture and implementation during the Software development lifecycle stages of the Projects (SDLC)
• Reported completed requirements artifacts to stakeholders for approvals and communicated them with technical team including architects, developers and testers for clarification and acceptance.
• Created clearly defined user stories with acceptance criteria for validity purposes.
• Involved in overall tracking of project management\Test management activities like work plan management, consolidation of overall project related activities.
• Created as-is and to-be documents as part of gap analysis for requirements for all applications and worked on solutions for closing the gaps.
• Created implementation plan for Implementation of Process, methods and Tool to ensure dat all applications follow the process, methods and tools as established by the quality management team of Magellan.
• Followed Up on SDLC to ensure dat implementation is going smoothly as per software development life cycle as charted in project charter.
• Created and maintained RAID logs for risk management and smooth closure of Implementation activities.
• Responsible for tracking hardware/software acquisitions and purchase as per necessity to provide productive working environment for developers/testers and to ensure deployment process goes as smoothly as possible.
• Performed UAT testing and was heavily involved in UAT coordination including scheduling setting up environments and creating test scenario.
• Worked with system testers to ensure requirement are completely and accurately implemented and tested.

Environment: MS Word, MS Excel, MS Visio, Windows XP, Quality Center, Clear Quest, JIRA

Systems Analyst

Confidential, Fort Worth TX

Responsibilities:

• Scheduled stakeholder-meeting sessions along with the vendors to understand the business need and define the scope of the project during the Software development lifecycle stages of the Projects (SDLC)
• Worked with requirements of the Vendor management systems bridge to the Preferential bidding system.
• Defined clearly Vendor information systems risks and catalogued well thought of scenarios for further examination and decision making by the stakeholders.
• Communicated with Developer, Product Management and Marketing to gather business requirements and worked to get vendors expectations and stakeholders’ requirements in line.
• Reviewed the requirements with all the business stakeholders.
• Responsible for achieving all the project milestones within the time frame specified by project plan.
• Reviewed and mapped business requirements documents created for the business and technical teams to develop the preferential bidding system (specific project)
• Advised any changes of the requirements to the management team
• Communicated with developers regarding project development
• Used SQL to access and manipulate the crew members database in order to analyze and keep the crew members database current

Environment: /Tools: HTML, MS Office, Dreamweaver, Rational Rose, Rally, MS Project, RUP, and UML.

Business Data Analyst

Confidential, Plano, TX

Responsibilities:

• Facilitated User meetings to gather requirements, Workflow Analysis, Business Process Models and Functional Design Definitions and High Level Analysis and Designs during the Software development lifecycle stages of the Projects (SDLC)
• Creating requirements and updating in JIRA for conversion process.
• Collaborated with project stakeholders, technical teams regarding enhancements, changes, issues and defects dat may impact development, data, workflow & functionality.
• Coordinating with testing team to validate the source - target databases after ETL conversion.
• Performed Use Case Analysis and Documentation (written) as part of the project’s design in developing Workflow and Business Models and coordinated efforts between external and internal project teams.
• Created the requirement as user stories and prioritized the requirement and defects
• Worked closely with business and development to resolve any requirement deficiencies for the integrating applications.
• Created and updated Master Test Plan facilitated with teams and business to get sign-off.
• Created, updated and maintained conceptual and detailed test cases, test scripts, test steps and test sets based on business and system requirements and uploaded to Quality Center.
• Reviewed test cases in the Quality Center with business to assure complete test coverage for Integration and system testing.
• Created test data requirements and partnered with data teams to load required data in the Test, QA, and UAT environments for production fixes, regression, integration and system testing.
• Created and update test entrance and exit criteria checklists reviewed with business for various testing.
• Trained resources to follow strictly SDM process for test processes documentation and test execution.
• Responsible to determine which test environment to utilize and communicate requirements and expectations to stakeholders
• Conducted Impact analysis on complex systems flows for the enhancements and product support issues.
• Created new and updated existing documentation (e.g. procedures, use cases, business processes, user guides).

Environment: MS Office Excel, Word, PowerPoint, MS Project, MS Visio, UML, JIRA, Rational Suite Requisite Pro, Rational Rose, Windows XP, HTML, VBScript, XML, Json, Web Services.

Business Analyst

Confidential, Dallas TX

Responsibilities:

• Conducted interviews/group discussions with SMEs for detailed domain noledge.
• Worked with production staff to identify and map detailed current processes, identify gaps and failure points, perform root cause analysis and develop functional requirements dat supported overall strategy, goals and objectives.
• Worked with sales and marketing team and documented validation rules, workflow rules, complex formula fields, custom settings and look-ups.
• Troubleshoot issues and identify bugs using HP Quality Center in code.
• Developed conceptual models and detailed UI design specifications for web-based applications based on the requirements. Verified functional aspect as per the Business Process and validated the UI.
• Hosted user and held interactive feedback sessions to resolve problems. Documented specific workflows and functional requirements.
• Analyzed Business requirements and also wrote Use Cases and System specifications.
• Involved in writing test cases and test script for GUI, Functional, Security, Recovery and Performance.
• Acted as a resource in understanding how systems carried out business functions and assisted in ensuring timely and effective implementation.
• Supported the Marketing team by providing visual design support in the creation of images, demonstrations and presentations.

Environment: Rational Requisite Pro, UML, Rational Unified Process (RUP), MS Office Excel, Word, PowerPoint

Claims Processor/Business Analyst

Confidential, Raleigh NC

Responsibilities:

• Performed in multiple roles & responsibilities such as claims billing, reviewing, follow-up, quality check, and eventually Business analysis.
• Focused on automations which helped in bulk billing the claims out and reduced manual intervention
• Assisted SMEs in providing inputs in documenting process flows, created an FAQ database which suggests a probable next action while following up on claims
• Reviewed and provided feedback on a portion of A/R dat directly goes to the client intervention bucket to reduce number of reworks.
• Identify, resolve & escalate any issues dat hinder adherence to the Service level agreements (SLA) and HIPAA.
• Consolidated sensitive payers listing according to the contract between the provider and payer groups and updated on a regular basis.
• Accompanied business managers in the requirements elicitation meetings with BAs in providing requirements for application development.
• Attended sessions on SDLC, agile and Project management techniques for transitioning into a BA role.
• Conducted JAD sessions with cross functional teams for requirements elicitation.
• Prepared use case diagrams, Business requirement documents and functional requirements documents.
• Assisted systems analyst in preparing the technical specification document for upgrading legacy systems.
• Supported QA teams in preparing test cases and involved in UAT along with the business users.
• Prepared Business process documents, process redesign documents and glossary.
• Worked on Improving the existing claim follow-up process by using techniques like faxing reprising sheets to Third Party Administrators, sending control sheets of high dollar US Healthcare claims to the responsible insurances.
• Performing random quality checks on claims worked by operations, reporting discrepancies and errors to Team leads to improve claims follow-up overall quality.
• Data analysis of A/R to identify trends in claim rejections & resolved their toughest portfolios dat includes payers like CIGNA, AETNA, BCBS and Third party carriers.
• Coordinating with the Quality and team to document process changes and notify operations.
• Coordinating with the Business reporting team to generate the reports they need using the client software dat is inaccessible at the offshore billing office.

Environment: MS Visio, MS Office Suite, UML, HP QC, XML, Altova XMLSpy, Altova Mapforce, VBA, MS SSRS