SUMMARY

• Qualified professional with over Eight years of extensive experience in the field of Business Systems Analysis, working with the technical staff to implement management and staff's business requirements into the software application in Healthcare Industry.
• Highly motivated team player with excellent communication, presentation and interpersonal skills, always willing to work in challenging and cross - platform environment.
• Experience in B2B, B2C and Ecommerce portals web application developments.
• Experienced as a Business Analyst in using the iterative software development life cycle principles of Rational Unified Process to manage, develop and test distributed client/server, internet and intranet applications on heterogeneous environments.
• Highly proficient in working with users to gather requirements, analyze them and subsequently use the Rational project and design tools to model the requirements.
• In-depth knowledge of creating use cases, functional design specifications, activity diagrams, logical, component and deployment views to extract business process flow.
• Experience withSOX, Regulatory Compliance and Controls.
• Strong understanding of project life cycle and SDLC methodologies including RUP, RAD, Waterfall and Agile.
• Proficient in using Agile Scrum methodologies, performed roles of Scrum Master following sprint/standup sessions and used Excel extensively to write user stories, analyzed the Iteration Burn Down charts and reviewed defects.
• Interviewed SMEs and Stakeholders to get a better understanding of client business processes and gather business requirements.
• Conducted JAD sessions, created Use Cases, work flows, screen shots and Power Point presentations for the Web Applications
• Gathered and documented Non-functional requirements.
• Knowledge of healthcare standard Health Level Seven (HL7).
• Experienced in preparing Business Process Re-engineering Models
• Excellent knowledge ofHIPAA EDI transactions such as 835, 837 (P, D, I) 276, 277, 278 etc.
• Experienced working in Medicare and Medicaid projects.
• In depth knowledge of SDLC and implementation of the Rational Unified Process (RUP) in all four phases of a project: Inception, Elaboration, Construction and Transition.
• Excellent Working knowledge of HIX, MMIS and Facets.
• Conducting requirement gathering sessions, feasibility studies and Impact Analysis and organizing the software requirements in a structured way using Rational RequisitePro to track development.
• Interacting regularly with the development team, creative services, database designer, system administrator and the higher management to meet the deadlines of Project milestones.
• Worked in close co-ordination with the testing team in developing test plan and test cases from functional and business requirements.
• Expertise in understanding and supporting the client with Project Planning, Project Definition, Requirements Definition, Analysis, Design, Testing, System documentation and user training.
• Used Rational ClearQuest for tracking and prioritizing defects and for enhancements after base lining the requirements.
• In depth knowledge of Medicare/Medicaid Claims processes from Admin/Provider/Payer side which were later part of the training program to vendors.
• Well versed in writing queries/Scripts for Data Analysis and QA reporting and testing.
• Good knowledge of Workflows and Content Management Tools.
• Experience in Change Management Process (Identify, Analyze, Evaluate, Plan, Implement, Review and Close).

TECHNICAL SKILLS

• MS Word
• Excel
• Visio
• Project
• Rational Rose
• Rational Requisitepro
• UML
• XML
• Oracle
• Java
• Visual Basic
• Facets
• Sharepoint
• Documentum
• Filenet
• Clear Case
• Clear Quest
• Testmanager
• Rational Suite
• SQL Server
• SSIS
• SSRS
• CMS
• PowerDesigner
• JIRA
• HP Quality Center/ALM
• RUP
• SDLC
• Agile
• Scrum
• Waterfall

PROFESSIONAL EXPERIENCE

Confidential, Tampa, FL

Sr. Business Systems Analyst

Responsibilities:

• Gathered user andbusinessrequirementsthrough open-ended discussions, brainstorming and prototypingto achieve the following goals.
• Involved in configuration of FACETSSubscriber/Memberapplication
• Worked onFACETSData tables and created audit reports using queries. Manually loaded data inFACETSand have good knowledge onFACETSbusiness rules.
• Prototyped the automation and enhancement of the manual processes inmember enrollment, terminations andreconciliation
• Establishbusinessprocesses and supporting infrastructure to onboardnew members
• Facilitated JAD sessions for UpdatingMember Billingcapabilities / processes andreporting, Updates toDelegate/Vendors Interfaces, Develop / Enhance Call Center and Customer Service Processes
• PreparedFutureProcessModelsthat includes modeling of all the activities of business from (a) Enrollment, Initial Billing and Payment and (b) Post Enrollment, Subsequent Billing and Payment
• Ensuredbilling and premiumcollection are modified to support820 HIPAAtransactions set.
• Involved profoundly in theGAP Analysisorganizations’current systems’capabilities andfuture system requirements for facilitating connectivity with theExchange.
• Enhanced834/999EDIfile transfers to enable transfer of member data withExchangeplatforms.
• PreparedBusinessRequirement Documents (BRD)as well ashigh-level project plansand usedRational RequisiteProto manage, analyze, andconvertbusinessrequirements into functional specifications.
• Tested the changes for the front end screens inFACETSrelated to following modules, test theFACETSbatches (membership)
• Worked withHealth Care Reform / Customer Serviceteam to establish a dedicatedCustomer Service Modelto address member needs at each point in the customer experience (pre enrollment, during enrollment, post-enrollmentetc.).
• Worked on differentEDIscenarios for batch processing andensured day-to-day EDItransmissionreject tracking and Reconciliation.
• Analyzed System Impact including MMIS Tables, Windows, Reports and Interfaces to external entities.
• Tested the ability to accept an834 electronic applicationand validate complete transactions.
• Tested the ability to storeIdentification numberreceived from theExchangeand create a unique identifier for members received through the Exchange.
• Worked with IT in developing a new capability that will allow tracking new HIX membership’s alignment across their consumption and utilization within organization’s plans/products
• UsedRational Clear Caseto keep different versions of the documents andRational Clear Questto report bugs or defect.
• Maintained aRequirements Traceability Matrix(RTM)in order to keep the clients and all the teams up-to-date with the current progress of the project.
• Assisted the QA team in designing the test plan and test cases.
• Involved with reviewing defects reported from UAT efforts and analyzed for root cause and took actions based on the findings.
• Conducted final Business Process (As Is/To Be) sessions with various department directors and staff to ensure the Testing Plan and Test Approach has met the User’s expectations and ensured the Training Program covered all identified new and changed processes.

Environment: Rational Rose, Rational Requisite Pro, UML, MS Office (MS Word, MS Excel, MS PowerPoint, MS Visio), Visual Basic, Windows, Java, Oracle, VB.Net, RUP.

Confidential, Detroit

Business System Analyst

Responsibilities:

• Successfully used Agile/Scrum Method for gathering requirements and facilitated user stories workshop. Documented User Stories and facilitated Story Point discussions to analyze the level of effort on project specifications
• Major involvement in requirements elicitation, documentation and management process using Rational Requisite pro.
• Conducted JAD sessions with the stakeholder for requirement gathering that includes business presentations.
• Worked extensively through Agile development methodology by dividing the application into iterations
• Lead the impact analysis, scope lockdown, and requirements gathering phases of the company's transition from ICD-9 to ICD-10 and development phase management of transition from HIPAA 4010 to HIPAA 5010.
• Get theFacetsClaim IDs from X12 in HTM, HP environment and verify them inTIBCOlayer andFacetsClaim Adjudication system.
• Particularly worked on UML modeling and Systems Documentation (Requirements, Functional Specs and System Design).
• Used Rational Rose 2003 and Rational Requisite Pro to make vision document.
• Identified Functional and Non-Functional requirements and Created Process Workflows.
• Did an impact analysis on the programs impacted by this change and list out the changes in the copybook.
• Contributed extensively in developing Use-case, Class and Sequence Diagrams.
• Involved in risk identification and mitigation and creating Risk Management Plan.
• Worked on JIRA to create bug reports.
• Wrote test plans for this requirement and unit tested the code.

Environment: UML, MS Visio, MS Word, HP Quality Center/ALM, MS PowerPoint, COBOL, JCL, File manager, Expeditor.

Confidential, Hartford, CT

Business Data Analyst

Responsibilities:

• Develops End-to-End Business Process Flows for data flow from different systems into MLR DB
• Facilitates Joint Application Development (JAD) Sessions for communicating and managing expectations from SME's and Business Owners
• Organizes technical sessions with Solution Architects, Plan/Member/Billing SME's and Business Owners
• Manages requirements in Requisite Pro and Rational Clear case.
• Works with the Development and Solution Architect team to ensure understanding adherence to the user requirements
• Transferred data from various sources like MS Excel, MS Access, and SQL Server usingSSISand then created reports using this data usingSSRS.
• Configured and maintained Report Manager and Report Server for SSRS.
• Facilitates the review meeting with business analysts and SME's.
• Takes responsibility for the requirements and follows up with the testing team to validate
• Makes changes to requirements and use cases based on testing results and working with PM to submit change control if required
• Performs Defect Tracking, GAP analysis, Risk closures and Change Control Procedures
• Works with the Project Manager on various Project Management activities like Resource Planning, Resource Request, keeping track of Project Status, Deadlines and Issues.
• Managed off-shore project teams to ensure the timely delivery of quality products /functions which met user requirements.
• Managed multiple projects and tasks simultaneously in a high-pressure environment.
• Extensively worked with Enterprise Content Management and Data models and Meta data definitions for content management.
• Helped business in coordinating handling of manually booked paid premium transactions in GL in MLR DB.
• Helped business in validating data on files from different systems.
• Worked on Documentum and used it for Version Control.
• Rescued a new User Interface UI for resolving Medicaid encounter submissions. Corrected and enhanced business requirements and functional specifications.
• Managed all phases of testing including development of test plans, scenarios, data, and test scripts for facilitation of System Integration Testing (SIT) and User Acceptance Testing (UAT).
• Validating QA testing results with business being tied up with other critical activities.
• Helping architects/development teams to solutions in quick time using prior expertise on Plan systems.
• Providing warranty support and UAT support for business
• Coordinating with and addressing development/testing team queries.

Environment: SQL Server, Windows XP, Rational Rose, Rational Requisite Pro, Rational TestManager, Clear Case, Clear Quest, UML, XML, Rational Suite, MS Visio, SharePoint, CMS, Documentum, Filenet, MS Project, MS Office (MS Word, MS Excel, MS PowerPoint

Confidential, Las Vegas, NV

Sr. Business System Analyst

Responsibilities:

• Used Agile/SCRUM for managing the SDLC for project.
• Used Rational TestManager throughout the project for testing, planning, execution and reporting.
• Conducted requirement gathering sessions with the purpose of creating and defining theBusiness Requirement Document(BRD) and theFunctional Requirement Document(FRD).
• Recommend changes for system design, methods, procedures, policies and workflows affecting Medicare/Medicaid claims processing in compliance with government compliant processes like HIPAA/ EDI formats and accredited standards ANSI. ments. Followed top down, leveled technique for building Business Process Models (BPM).
• Tracked stakeholder requested enhancements and changes using Requirement Traceability Matrix (RTM).
• Conducted interviews, live meetings and JAD sessions with business users and Subject Matter Experts (SME’s) to understand the As-Is system and gather requirements for the To-Be system.
• Analyzed the laws and regulations (HIPAA, HL7, EDI X12) before implementing the electronic medical record software Analyzed Claims adjudication related transactionslike 835, 837, 270, 271, 276 and 277 transactions (both inbound and outbound).
• Implemented SDLC, which included requirements specifications,SPRINT, design, analysis and testing. Agile/SCRUM.
• Managed the testing phase (inbound and outbound) with various Medicaid claims, group claims by various employers, Pharmacy Benefit Management (PBM) claims etc.
• Organized daily scrum calls to keep the team on track and the stakeholders updated.
• Assisted in writing test case scenarios, developed Use Cases, Activity Diagrams, Sequence Diagrams and End to End Scenarios using UML and MS VISIO. Planned and defined system requirements to Wire Frames with Use Case Scenario and Use Case Narrative using the UML (Unified Modeling Language).
• Excellent skills in Data Warehouse Application software, using Data Warehouse Design, Analysis, Architecture.
• Tested the Medicaid Encounter submission process due to a SQL and server upgrade.
• Developed ETL logic to transfer data from systems to the Data warehouse environment using the available ETL code and tool set for implementation.
• Analyzed trading partner specifications and authored Companion Guide.
• Documented, organized and tracked the requirements using Rational RequisitePro.
• Worked with Source system Subject Matter Experts (SMEs) to ensure that the extracts are properly mapped.
• Developed detailed gap requirements to bring the project up to speed including details content data model documentation and application flow.
• Documented various key elements of HIPAA compliance and made sure that they were understood by the development teams and ensured that the test cases written for the project were HIPAA complaint.
• Worked on JIRA to create bug reports.
• Managed all phases of testing including development of test plans, scenarios, data, and test scripts for facilitation of System Integration Testing (SIT).
• Extensively used SQL for data extraction and took part in User acceptance Testing (UAT).

Environment: SQL Server, Windows XP, Rational Rose, Rational Requisite Pro, Rational TestManager, Clear Case, Clear Quest, UML, XML, Rational Suite, MS Visio, CMS, Documentum,JIRA, SharePoint, MS Project, MS Office (MS Word, MS Excel, MS PowerPoint

Confidential, Greenwood Village, CO

Business Data Analyst

Responsibilities:

• Met with client groups to determine user requirements and goals. Utilized Rational Unified Process (RUP) to configure and develop process, standards, and procedures.
• Analyzed business requirements and segregated them into high-level and low-level Use Cases.
• Derived Functional Requirement Specifications (FRS) based on User Requirement Specification URS. Understand and articulate business requirements from user interviews and then convert requirements into technical specifications.
• Interviewing Subject Matter experts, asking detailed questions and carefully recording the requirements in a format that can be reviewed and understood by both business people and technical people.
• Resolved or escalated business process issues, item management issues or technical issues.
• Worked with Management to create and communicate mission-critical information to user community through emails.
• Followed the UML methods to create Use Cases.
• Conducted technical/non-technical presentations to the management and training workshops for the clients.
• Monitored the development and testing process to ensure that final product meets all the desired functionality requirements.
• Thorough documentation of the entire process along with all its activities.

Environment: SQL Server, Windows XP, Rational Rose, Rational Requisite Pro, Rational TestManager, Clear Case, Clear Quest, UML, XML, Rational Suite, MS Visio, SharePoint, MS Project, MS Office (MS Word, MS Excel, MS PowerPoint

Confidential, Woodland Hills, CA

Business Analyst

Responsibilities:

• Created and reviewed business requirements, functional specifications, project schedules and documentations.
• Prepared Business Process Models (BPM) that includes modeling of all the activities of the business from the conceptual to procedural level.
• Involved in gathering, analyzing and documenting business requirement, specifications and Requirements Traceability Matrices (RTM) throughout the project lifecycle.
• Facilitated JAD sessions with management, development team, users and other stakeholders to refine functional requirements.
• Prepare schedule workflow following agile methodology of software development.
• Involved in constructing an integrated IVR CRM (Customer Relationship Management) application to provide system access to real time customer data and information.
• Performed Gap Analysis to identify the gap between the optimized allocation and integration of the inputs, and the current level of allocations, cost analysis.
• Extensively used SharePoint for project documentation
• Reproduce, verify and validate issues documented in a defect tracking system and writing tractability matrices based on use cases and business requirements (BRDs) performed the requirement analysis and documented the requirements using Rational Requisite Pro.
• Involved in designing and developing Data Models and Data Marts that support the Business Intelligence, Data Warehouse.
• Created use case models, analysis models, implementation models, authored use cases, use case diagram, behavior diagrams(sequence diagrams, activity diagrams) based on UML methodology using Rational Software Modeler and MS Visio.
• Solid understanding of computing environment, systems engineering concepts, architectural framework diagrams, QA testing, building test plans, test cases, scripts, UAT, systems integration with multiple sources including outside vendors.
• Analyzed the test results from QA teams using Performance Studio Analysis to create various scenarios.
• Involved in UAT sessions to test and validate the system with stakeholders.
• Interacted with the compliance and audit team to make sure we were following correct HIPAA guidelines/protocols throughout the project lifecycle.