SUMMARY

• Over 8 years of extensive experience as a Business Analyst, analytical and technical skills to leverage experience in Health Insurance, Financial and Banking sectors.
• Strong communication skills in engaging business stakeholders, SME’s, and users in gathering the intricate flows of the business processes.
• Extensive experience to analyze and document business requirements and system functional specifications including use cases. Experience in writing queries/scripts for data analysis and QA report testing
• Extensive knowledge and experience in all stages of Software Development Life cycle (SDLC), Rational Unified Process (RUP), and Project life cycles, agile and waterfall software methodologies.
• Proficient in developing Use Case Model, Analysis Model, Design Model, based on UML methodology using Rational Rose.
• Experience in writing Request for Proposals (RFP), Statement of Work (SOW) and Standard Operating Procedures (SOP).
• Expertise in analyzing and redesigning business processes and in gathering business process information to create clear, concise and complete business, technical, non - technical and functional requirements.
• Experienced in White Box/ Black Box Testing, User Acceptance Testing (UAT), Unit, Integration, Functional and Load testing.
• Coordinated User Acceptance Testing (UAT) and presentations to end-users
• Strong understanding of medical coding (Diagnostic and procedural) and transition from ICD 9 - ICD 10.
• Reviewed Validation Policy as directed, and reviewed validation assessments for projects (FACETS)
• Familiarity with JAD Sessions, Testing, Deployment process, QA and change management.
• Strong knowledge of testing and implementing MMIS (Medicaid Management Information System)
• Expertise in claims processing and scrubbing in HMO, PPO, Medicaid and Medicare; experienced in EDI X 12 standards
• Familiarity with EDI translators, and EDI and FTP standards
• Strong knowledge of HIPAA/ACA privacy requirements and claims and eligibility transactions
• Excellent communication and professional skills in working independently and as a part of a team in structured as well as unstructured environments.

TECHNICAL SKILLS

Methodologies: RUP methodology, Agile methodology, Waterfall and SDLC.

Business Processing Tools: Rational RequisitePro, Rational Requirements Composer, ARIS, CaliberRM, Trinity, ClearQuest, ClearCase

QA Tools: Test Director, aardvark, Rational Test Manager and Load runner.

Standards: HIPAA, ACA, EDIFACT, ANSII 4010 and 3041 formats

Languages: UML 2.0, C, C++, Java, Visual Basic 6, HTML, XML, COBOL

Databases: SQL Server 2000 (7.0/6.5), Data Warehouse, MS-Access, Oracle 8i, DB2.

Workflow Tools: MS-Visio, MS-Project 2002, MS-OFFICE, MS Excel

Platforms: Windows (2000, NT)., Unix (HP, Solaris8.0) AS/400

PROFESSIONAL EXPERIENCE

Confidential, Oakland, CA

Sr. Business Analyst

Responsibilities:

• Interact with executive team to ensure coordination between stakeholder interests, requirements gathering, documentation, and application development
• Review the existing CPR system to identify gaps between system functionalities and requirements
• Facilitate weekly stakeholder meetings involving members from the consulting firm, DIR (Department of Industrial Relations), DLSE (Division of Labor Standards Enforcement) and State Counsel to gather and validate requirements
• Follow a structured approach to categorize requirements in to business, functional, technical and future requirements. Ensure that the current scope of the project falls within the feasibility of application development in the given timeframe
• Document requirements and update artifacts on RRC
• Identify actors for the system and develop process flows and use cases to depict online CPR submission by external users and their search and export by internal users
• Develop wireframes and UI mock-ups explaining current and future-state features of the CPR system
• Provide documentation for the current system for future references
• Ensure that individual tasks are completed in time as per the project plan
• Provide a clear picture on current and future expectations on the system from features for the users to integration with other systems so as to aid in developing XML specifications
• Work on employee insurance claims; support communication between product owners and suppliers
• Familiarity with MMIS guidelines
• Act as a point of contact for EDI transactions between internal and external customers
• Participate in resolving EDI issues between customer and supplier requirements
• Interacted with the SME’s to gather information about the health care enrollment, eligibility and health care claims processing and created Use cases/FRS traced to use cases.

Environment: MS Project, MS Excel, MS Visio, MS Word, SharePoint, Rational Requirements Composer, IBM Forms, SQL 2008, Oracle database server v11.0.

Confidential, Nashville, TN

Sr. Business Analyst

Responsibilities:

• Participated in Business Modeling by understanding the needs of the business, and also documenting Business Use Cases as well as System Use Cases.
• Gathered Requirements and documented the proposed additional extension to the existing HIPAA application.
• Facilitated Joint Application Development (JAD) sessions with the Management, Mainframe and HIPAA team to make sure everyone are in sync with the business requirement processes.
• Worked on gap analysis and modifying MMIS as per client needs; analyzed system impact regarding MMIS tables, reports and interfaces with external entities with regards to ICD-9 to ICD-10 conversion
• Worked on identifying ICD-10 initiatives, impacts and solutions related to ACA legislation
• Worked on HIPAA/ACA Transactions 270, 271, 276, 277,820, 834, 835 and 997.
• Analysed processes in medical coding and transition from ICD 9 - ICD 10
• Used MS Visio to create Use Cases and Sequence Diagrams.
• Liaised and Coordinated in resolving EDI mapping issues arising from data transfer process from EWM to ACAS and third party systems.
• Analyzed mandatory and the situational fields and compared with the users manuals for EDI.
• Acted as resource person for Medicaid related claims including acute care, lab procedures, LTSS etc.
• Created and Maintained the Requirement Traceability Matrix (RTM).
• Worked on Facets modules such as billing, capitation, and claims processing
• Strong familiarity with Facets security and formatting from Windows side
• Analyzed and evaluated User Interface Designs, Technical Design Documents and Quality Assurance Test condition the performance of the application from various dimensions.

Environment: MS Visio, MS Project, Windows XP, HIPAA, Facets, Microsoft Office Suite, Quality center, Rational Unified Process (RUP), UML

Confidential, NYC

Sr. Business Analyst

Responsibilities:

• Interaction with the software development team and executive team to liaison the business requirements to ensure that the application under development confines to the business requirement.
• Performed analysis and reporting of marketing and operational data. Develop and monitor web metrics.
• Directly interacted and assisted Stakeholders, SMEs and Development team to allow compliance with successful implementation of project within time and cost.
• Worked as an Interface between the end users and the different teams involved in the application development for the better understanding of the business and IT processes.
• Followed a structured approach to organize requirements into logical groupings of essential Functional Requirements, Non Functional Requirements, Interface Requirements and Report Requirements andensured that critical requirements are not missed.
• Documented Use Cases, Algorithms, Test Plans, test data and expected results for the Integration, Functional, Performance, and User Acceptance Testing.
• Responsible for creating UML modeling plans, Use cases, process flows, Wire Frames and business requirements documentation using Visio.
• Worked on implementing and documenting web-based system interfaces with MMIS; Sound familiarity with MMIS and CMS regulations and architecture
• Worked on Facets for clinical billing as per requirements pertaining to schedule of events and procedures, equipment, items, services and patient visits
• Involved in electronic processing of medical, dental and hospital claims using Facets
• Interviewing business area experts and SMEs asking detailed questions and carefully recording the requirements and performed data analysis.
• Conducted JAD sessions to develop architectural solution that application meets the business requirements, resolve open issues, and change requirements.
• Using GAP analysis, reviewed high level company processes, identified gaps that require operational change in order to optimize the proposed system solutions.
• Documented Test Plans and prepare of Requirements Traceability Matrixes (RTM) that contains test scripts, test cases, test data and expected results for the User Acceptance testing.
• Developed the test plan, test conditions and test cases to be used in testing based on business requirements, technical specifications and/or product knowledge.

Environment: MS Project, MS Excel, Oracle, MS Visio, AS/400, MS Word, Facets, Rational Requisite PRO, MS Excel, CaliberRM

Confidential, Bloomington, MN

Business Analyst

Responsibilities:

• Wrote Business Cases after conducting meetings with business users, risk team and finance team. Acted as IO Analyst and worked closely with IO Manager, BU Sponsor and BU Contact. Measured business opportunity, description of solution and scope. Measured and documented Labor and Material Detail, Skill Set, Budget /Cost To Achieve (CTA) Summary, Inflow Summary and Economic Analysis.
• Conducted JAD sessions and created functional and technical requirement specification for application development based on Solution Delivery Process.
• Performed Impact Analysis and Gap Analysis.
• Recommended changes for improvement after analyzing operational procedures and methods.
• Documented issue list and risk list pertaining to various projects.
• Wrote use cases and verified that they match every single requirement of the application.
• Prototyped the application, provided screen shots for better visualizations.
• Coordinated and collaborated the business, operations and the technical areas throughout the project life cycle.
• Create presentation style reports with chart and graphs which can be used to access any type of data source
• Presented reports to management and provided user training and acceptance tests.
• Performed manual testing and recorded results in Clear Quest and used SQL queries for enhancements.
• Performed the user acceptance testing.

Environment: AUP, Test Director, MS Office, MS Excel, MS Visio, MS Project, Rational Clear Quest, Rational Clear Case, PL/SQL, Oracle Enterprises Business Suite, JAVA.

Confidential, CT

Business Analyst

Responsibilities:

• Facilitated Working sessions, articulated requirements, make recommendations for process andbusinessflows, develop consensus on requirements, performed analysis of requirements, by developing use cases, andcollaborating with users to reduce project risk and to increase quality.
• Worked on analyzing and designing a Claim Management System to improve Member/Enrollment data & Total Covered Drug Cost for Medicaid and Medicare Plans.
• Independently analyzed and defined solutions for complexbusinesssituations that will include all aspects of life and healthbusinessincluding Actuarial, Underwriting, Valuations, Reinsurance Administration and Technical Accounting.
• Produced functional specifications and lead weekly meetings with developers and business units to discuss outstanding technical issues and deadlines that had to be met, used RequisitePro for gathering the requirements, Clear Quest to track the business process and Rational Rose to create UML Diagrams.
• Conducted Joint Application Development (JAD) process with Stakeholders to analyze deliverables and system constraints.
• Developed test plans, test cases for Quality Assurance and developed root-cause analysis reports, ensured proper placement of business controls, re-engineered business processes, implemented performance measures, presented project presentations to executive management, provided user training, and performed a variety of ad-hoc project.
• Analyzed business processes, documented workflows and developed functional specifications for FACET provider report.
• Worked on MS-Visio and Excel for defining business use cases and activity diagrams for FACET migration
• Worked on X-12 N278 inbound and outbound authorization and referrals and X-12N 276/277 claims status enquiry and response
• Worked on implementing HIPAA 4010 in new web-based MMIS system and gradually moving to HIPAA 5010
• Performed logical mapping for EDI requirements; managed EDI training manual and documentation
• Managed project risk management and business process analysis reviews over the implementation of different applications.
• Created transaction sets requirements using MS Excel for transactions including HIPAA 270/271, 276/277, 278/278, 820, 834, 271U, 835, 837-(I,P, & D), and 835 Remittances
• Constructed the Business Requirement Document and the Technical Requirement Document for837Professional, Institutional andDentalClaims, 835 (Outbound) transactions, 270/271 (Eligibility Request and Response), 277CA (Health Care Claim Acknowledgment), per SOX compliance.
• Worked on EDI transactions 820 (payment reconciliation), 834 (enrollment processing) and 837 (claims processing), among others
• Worked on troubleshooting and resolving errors in 834 and 820
• Participated in implementation and companion guides for EDI import/export (834, 835, 837, 820, 270, 271, 276, 277)
• ConductedGAP analysisof the different reports that are being presented to clients to accommodate their requirements for the new enhancements using Six Sigma implementation to cover gaps.

Environment: MS Office, MS Excel, MS Visio, MS Project, Rational Clear Quest, Rational Clear Case, Facets, PL/SQL, JAVA.

Confidential, Oakland, CA

Business Analyst/EDI Analyst

Responsibilities:

• Defining Software Development Lifecycle (SDLC) and planning the entire process using MS Project.
• Defining functional requirements and specifications for use by the development team.
• Conducting Joint Application Development sessions for communicating with the all project leads and stakeholders the proposed process workflows.
• Creating design document (UML diagrams) using Microsoft Visio for proposed system.
• Identified Use cases from the requirements and wrote Use Case Specifications.
• Used Rose to carry out the business modeling and object modeling effort to develop the business architecture for the application for rapid and controlled Application development. Responsible for creating the Gap Analysis of As -Is and To-be process using Rose.
• Participated in meetings with Developers, Project Managers and Quality Analyst to discuss business requirements, test planning, resource utilization, and defect tracking.
• Tracking and managing requirement changes using Requisite Pro.
• Involved in walkthroughs and meetings with development team to discuss related issues.
• Used Rational Rose to visually determine the proper structure, key elements and optimal design for your database and to aid efficient creation of tables, stored procedures.
• Wrote clear, concise detailed System requirements specification (SRS) documents and user documentation in accordance to guidelines and standards of a level where developers can interpret, design and develop the application with minimum guidance.
• Worked on gap analysis in changing old MMIS and involved in testing new MMIS; responsible for Medicaid Claims Resolution/Reimbursement using MMIS
• Developed EDI requirements into functional specifications
• Worked on resolving issues regarding ANSI X12 EDI transactions
• Analyzed EDI transactions 810, 820, 834, 850, 856, 860, 944, 945 and 997
• Familiarity with EDI standards, mapping and architecture
• Verified the functional aspect as per the Business Process and validated the interfaces with the other systems and data conversion from the legacy system.
• Performed Back end testing, performance testing and load testing via navigation and workflow of the Application.
• Used Rational Clear Case, Configuration Management tool, to maintain different builds of the application with descriptions about all changes and versions.

Environment: RUP, Windows 2000, MS Visio, ASP, C#.Net, SQL, PL/SQL, Oracle 8i, SQL server 2000, Requisite Pro and Rational Rose

Confidential

Business Analyst

Responsibilities:

• Interacted with the software development team and executive team to liaison the business requirements to ensure that the application under development confines to the business requirement.
• Served as a liaison between the business and technical team.
• Perform analysis and reporting of marketing and operational data. Develop and monitor web metrics.
• Directly interacting and assisting project manager and team members to allow compliance with successful implementation of project within time and cost.
• Managed project risk management and business process analysis reviews over the implementation of different applications.
• Work with Oracle databases to create data objects necessary to analyze and report findings, including tables, functions, stored procedures, views, and indexes.