SUMMARY

• As a Business Analyst, Systems Analyst & Quality Analyst, me has seven plus years of IT and management experience which includes healthcare information systems development and clinical data management
• Lead, gather, develop, coordinate, and maintain business requirements for various projects and/or systems from initial phase to final implementation, assuring requirements meet standards.
• Well noledgeable with HIPAA, ICD 9, ICD 10, claim adjustments/processing, identifying claim processing problems, and providing alternative solutions
• Experienced working with Microsoft Office Suite (Word, Excel, PowerPoint, Visio, and Outlook) for documentation analysis and presentation
• Extensive experience in gathering business and functional requirements, Scope, and Visio document, creating Business Requirement Document (BRD), Functional Requirement Document (FRD), communication plan, use cases, and showing Gap Analysis
• Well experienced in creating and maintaining of Technical Requirement Document (TRD)
• Knowledge of teh Unified Process and/or Agile process
• Knowledgeable in Gap Analysis of Health Insurance Portability and Accountability 4010 and 5010 with detailed experience in qualifier, length, and required field and situational rules
• Extensive noledge on HIPAA 4010 and 5010 compliance standards EDI (Electronic Data Interchange) transactions syntax such as 820, 835, 837, 850,870,270, 271, 276, 277 and 999 transactions inbound and outbound transactions for varying Health Care Providers
• Being able to conduct JAD sessions and interviews. Adapting and implementing requirements, creating project status reports, and presentations
• Knowledge of managed care concepts and Acts (Medicare and Medicaid), Medicare Part A,B,C,D, and US health care regulations and practices (PPACA/Obama HealthCare/Affordable Health Care Act)
• Knowledgeable/Experienced in creating sequence diagrams, collaboration diagrams, activity diagrams, and class diagrams using Rational Tools and Microsoft Visio
• Expertise in creating Test Plans, Test Scripts, Test Cases for Manual, and Automated Testing
• Created Data Flow Diagrams, System Use Cases, and UML models
• Strong noledge of Data Modeling, Data Warehousing, and Data Mapping
• Strong noledge of SQL database structures
• Thorough understanding of Software Development Life Cycle (SDLC), involved in all teh phases from planning to teh implementation stage. In depth understanding of RUP, Iterative Software Development Life Cycle (Agile Methodology).
• Knowledge on Waterfall Software Development Methodology and gathered teh requirements
• Knowledgeable in HIX (Health Insurance Exchange), Plan Management, Eligibility, and Enrollment Process
• Skillful in MMIS (Medicare Management Information System) health care standards and International Classification of Diseases ICD 9 & ICD 10
• Very well organized and has proven ability to meet deadlines, prioritize workload, and manage own time TEMPeffectively
• Excellent oral and presentation skills

TECHNICAL SKILLS

Business Skills: Business Process Analysis & Design,Requirement Gathering, Use Case Modeling,JAD/JRPSessions,GapAnalysis andImpactAnalysis.

Standards and Methodologies: C++, SQL,SDLC, Agile, Waterfall, HIPAA, EDI, CPT, and ICD10, Joint Application Development (JAD), Unified Modeling Language (UML), and Rapid Action Development (RAD)

MS Tools: Microsoft Project, MS Excel, MS Word, MS PowerPoint, and SharePoint, and MS Visio

Testing Tools: HP Quality Center, and Quick Test Professional

Health Care: HIPAA EDI, Enrolment/Claims/Benefits/Remittance

Database: SQL, and SQL server 2000

PROFESSIONAL EXPERIENCE

Confidential, Farmington, CT

Sr. EDI/ Business Analyst

Responsibilities:

• Conducting regular meetings with teh stakeholders, and SME’s (Subject Matter Experts) to properly define teh in scope, and out of scope of teh project.
• Operating with Project Manager to identify stakeholders
• Working with teh System Team to understand teh current working process and possible impact
• Gathering detailed business requirement with functional specification through interviews, facilitations
• Creating all teh artifacts like Business Requirement Specification (BRS), System Requirement Specification(SRS), Impact Analysis, Business Requirement Management Plan, references, meeting minutes and other documents as required
• Coordinating withConnecticutHealth Exchange HIX program staff and other stakeholders to define and develop requirements for correspondence generation across various business lines.
• Working on cram functional areas of organization structure, security structure, and location structure for teh CT HIX project
• Tracking and updating any requirement updates
• Providing walkthrough to teh stakeholders and request signoff for teh documents to close teh requirement phase activities
• Managing all teh document by utilizing Clarity
• Creating business system requirements and as is and to be process flow diagrams
• Developing business team updates for project manager
• Assisted in translating requirements and use cases into test conditions and expected results for teh system

Environment: SQL, Rational Requisite Pro, Rational Rose, Quality Center 9.5,10.0,DB/SQL, MS Visio, MS Word, MS Excel, MS Project, and XML

Confidential, Shelton, CT

Sr. EDI/Business Analyst/Quality Analyst

Responsibilities:

• Responsible for defining teh scope of teh project, gathering business requirements and preparing Business Requirement Document (BRD), and Functional Requirement Document (FRD)
• Facilitated Joint Application Design (JAD) sessions between technical, business and regulatory teams to ensure dat requirements were being met, and to resolve issues during teh development phase
• Used agile development process to deliver software throughout teh SDLC life cycle absorbing changes and new requirement as teh project proceeds
• Followed Waterfall Software Development Methodology and gathered teh requirement and interviewed stakeholders and end users
• Performed Gap Analysis of existing system and what teh business users expected particularly with teh member module and claims module
• Assisted in teh impact analysis of 4.71 and 5.01 plus documented specifics impact on files, database, interface, and screens
• Worked on requirements of the837 HIPAAprojects,276/277, 278, 834and835HIPAA EDI transactions enterprise
• Involved in creatingUse Case DiagramsandState DiagramsusingMS Visio
• Assisted in composing teh Test Scenarios and Test Cases for testing teh migration
• Was involved in testing EDI transactions like 270, 271, 276, 277, 278,837P, 837I, 837D,835, 850 and 870
• Designed and applying SQL queries for backstend testing and reporting data validation
• Worked with technicalteam ingenerating teh required involved in generatingTest Plans and Test Specificationsas per businessrequirements.
• Prepared Test Data for positive and negative test scenariosas per application specifications and application requirements and wrote test plans.
• Assisted in writing teh detail Test Cases and uploaded in QC and linked teh appropriate requirements

Environment: EDI 835, 837,FACETS4.7, Agile, MS Office Tools, MS Visio, HP Quality Center, and Waterfall

Confidential, Topeka, KS

Sr. EDI/Business Analyst

Responsibilities:

• Extensive experience and noledge for defining teh scope of teh project, gathering business requirements and preparing Business Requirement Document (BRD), and Functional Requirement Document (FRD)
• Collected and analyzed business requirements and identified system interfaces, and created functional requirements specification documents
• Identified Use Cases from teh requirements. Extensively created UML diagrams including Use Cases, Data Flow Diagrams, ER Diagrams, and MS Visio which helps define teh business process model and data process model
• Developed Test plans and mapped them to Requirements with QA team
• Mapped teh developed Test Cases to teh requirements to ensure dat teh requirements were fully tested and implemented according to teh specifications
• Evaluated and tested teh new and modified software application to verify dat programs function according to both technical and business requirements
• Prepared Gap Analysis to understand what we has to and what we ought to has or to be better off
• Developed project schedules, conducted project status meetings, and managed resources during phases of SDLC
• Requirements were achieved and collected through interactions, meetings, and periodic walkthroughs with SME’s
• Interacted with developers and users in resolving risk factors and other issues

Environment: MS Visio, SQL, Java, Windows 2000/2003, MS Project, MS Word, MS Excel, Rational Requisite Pro

Confidential, High Point, NC

Sr. EDI/Business Analyst

Responsibilities:

• Examined teh HIPAA 4010 and 5010 standards for 837P, 837I, and 835 transactions and also prepared Gap Analysis document for every transaction
• Performed operational business procedures for readiness to be able to fulfill with HIPAA as well as ICD 10 requirements
• Assisted in writing requirements for converting from web portal to mainframe
• Well experienced noledge on gathering all teh Business Requirement Document (BRD), and Functional Requirement Document (FRD)
• Made Joint Application Design (JAD) sessions between technical, business and regulatory teams to ensure dat requirements were being met
• Used Waterfall Software Development Methodology and gathered teh requirement and interviewed stakeholders and end users
• Worked on analysis of teh Facets claims processing application in order to gather requirements to comply with HIPAA 5010 requirements
• Vigorously worked on Data Analysis and Report Analysis with respect to ICD 10 impact
• Identified risks, problems, requirements and concerns of theHospital in order to comply with ICD 10 changes
• Greatly involved inunderstanding of department workflowsandprocess flowswith respect to applications
• Re - Organizedthe collected data and prepareddocumentationfor implementation.
• Highly involved in giving education about ICD 10 codes and 5010 standards. Also performed impact analysis for deadliness of ICD 10 conversions
• Being able to meet teh information demands ofbusinessusers by delivering timely, accurate, meaningful andstandardized data and reporting.
• Good understanding of hospital working system scheduling, patient accounting, and claim processing

Environment: Windows XP, RUP, Quality Center, SQL Server, Rational Requisite Pro, Clear Quest, MS Office, MS Visio, Waterfall

Confidential, Iselin, NJ

Business Analyst (Intern)

Responsibilities:

• Led user interviews, and JAD sessions with end users, stakeholders, and developers to collect teh functional and non-functional requirements of teh system
• Involved in developing teh business model for expediting teh claim settlement process
• Performed document analysis involving creation of Use Cases and Use Case narrations using Microsoft Visio, in order to present teh efficiency of teh gathered requirements
• Involved in teh analysis of teh functional, technical specifications, data mapping document and conceptual diagrams
• Highly interacted with teh development team and claim settlement experts making sure dat teh development of teh project is meeting teh business requirements.
• Identified critical areas of business risk and modified teh business process to reduce teh same
• Wrote Business Requirements Specification (BRS) and Functional Requirements Specification (FRS) documents as per teh business requirements and process flow
• Conducted daily interaction with both teh development team and stake holders
• Documented user stories and modeled use case diagrams by utilizing MS Visio
• Prepared Test Data for teh Functional Test Cases
• Evaluated test results and prepared test summary report
• Interacted with developers & various members of my team to discuss and resolve defects and their priorities

Environment: SCRUM, Windows Vista / NT, Oracle, Java, HTML, MS Office, MS Visio, MS Project, Mercury Suite of Testing Tool, MS Excel