SUMMARY

• Over 7+ years of extensive experience as a Business Analyst/Business System Analyst in Healthcare using IT Business Analytics, Modeling expertise, and SDLC.
• Experience in working in all phases of project life cycle. Proficient in different SDLC methodologies such as Waterfall, Agile, RAD and RUP.
• Efficient in conducting many workshops and JAD sessions involving company employees and end users.
• In depth knowledge of health care basics including HIPAA, ICD 9 and ICD 10, and EDI Transactions.
• Experience of analysis and documentations of ICD 10 crosswalk using GEM (general equivalence mapping).
• Expertise in all HIPAA transactions (837, 835, 270, 271, 276, 277, 278, 820 & 834).
• Excellent work experience in creating Project Plans, BRDs, FRDs, Use Cases, Activity Diagram, Sequence Diagram, Requirement Traceability Matrix and Test Plans.
• Strong Medicare/Medicaid business configuration experience with focused primarily on claims adjudication, pricing, provider, member, enrollment, prior authorization.
• Experience with UML (unified Modeling Language) to create use case diagrams.
• Experience to various tools such as Rational Rose, Microsoft Visio, Clear Case, Clear Quest, Requisite Pro, SharePoint and Confidential Quality Center.
• Proficient in interacting with the Technical Teams and Developers and converting business needs to technical specs for their understanding.
• Very creative, self - motivated, flexible, knowledgeable, hardworking, patient and detail oriented person.
• Have strong interpersonal skills with ability to resolve issues. Analytical, methodical, and resourceful approach to problem solving, identifying root causes and corrective actions to meet short and long-term business, financial, and system requirements.
• Experience in project planning, management and project plan development in Microsoft project.
• Good understanding of Data Warehousing, Data Mining, and ETL process.
• Capable of writing basic SQL queries.
• Experienced in executing test plans, test cases, test results analysis with the testing team and reporting defect management and test status matrices.
• Extensive documentation skills Experience in conducting User Acceptance Testing, SWOT Analysis, Cost Benefit and ROI analysis.
• Excellent communication and presentation skills and experience working with business users as well as senior management.

TECHNICAL SKILLS

Business modeling: Microsoft Visio, UML

Requirement Management: Microsoft Office (Word & Excel), Requisite Pro

Defect Tracking: Confidential Quality Center, Clear Quest

Query and Languages: SQL, C, C++, VB, XML, HTML, JAVA

Databases: MS Access, SQL Server 2008, Oracle 9i. 10g, IBM DB2

Document Management: SharePoint

Methodologies: Waterfall, Agile, RUP

Tools: Toad, Cognos, Rational Suite (Requisite Pro, Clear Case, Clear Quest, Rational rose), MS Office (Word, Excel, Visio, PowerPoint) and MS Project 2000, Java editor

Operating System: Windows, Unix, Linux

PROFESSIONAL EXPERIENCE

Confidential, Louisville, KY

Sr. Business Analyst

Responsibilities:

• Managed the project as a Business Analyst to update the current insurance system, specifically theAnnuityinsurance system.
• Liaised with business and functional owner during risk engineering and high-level review sessions to derive and execute action plans, meeting deadlines and standards.
• Launched the business requirement collection approach based on the project scope andSDLCMethodology.
• Interfaced with business users to prepare and updateBusiness Requirements Document (BRD)andSoftware System Requirements (SSR).
• PerformedGAP analysisof business rules, business and system process flows, user administration, and requirements.
• Coordinated with Project Managers to resolve risk issues and ensure compliance with HIPAA 5010 standards.
• Analyzed and synthesized results fromJoint Application Development (JAD)session.
• Mapped current state processes usingMS Visioand also interviewed variousSME’s in order to better understand the process.
• UtilizedMicrosoft SharePointfor project teams in order to establish better collaboration and communication and worked onannuities instruments such asIRA, 401(k), TSA, premiumandtaxation.
• Analyzed theAnnuitiesinsurance products such asFixed Annuity, Variable Annuity,andIndex Annuity.
• Conducted business analysis, project assessment and feasibility determination.
• Helped Reporting team withSQL querybuilding for efficient reporting.
• Worked with a team of Data Mining for analytical process.
• Work experience with programing, designing, testing and debugging by using JAVA editor.
• Transformed documentsto UAT Test Plan, UAT Test Case,andUAT Defect Log.
• Involved in automating test cases usingQTP.

Confidential, Nashville, TN

Sr. Business Analyst

Responsibilities:

• Coordinated daily activities with the IT Developers, QA and Product teams along with the project management group.
• Responsible for gathering, documenting, and prioritizing client’s needs for developers and analyze client'sbusiness requirementsand formulate specifications.
• Defined and documented clear and complete detailedbusiness requirementsandfunctional specificationsusing theSDLC methodology from the business team.
• Worked on impact analysis on837 transactions (I, P & D) 1(Eligibility and Response), 834(Benefit Enrollment and Maintenance), 278 (Authorization Request and Response)for transitioningHIPAAversion from .
• Performing Impact analysis for readiness for the next phase of regulatory changeICD-9toICD-10.
• UsedRequisite Proto organize and analyze the Business Requirements.
• Use Casesand otherProcess Flow Modelswere designed usingMicrosoft Visio.
• TakenAs-Is Process, designedTO-BE Processupdatedfunctional use casesand performed business process modeling(PROVISION)to explain business requirements to improvement.
• PerformedGAP Analysisand documented the current state and potential future state.
• Gathered the Business requirements & converted them intoBusiness Requirement Documents (BRD).
• Maintained constant communication with the testers by assisting the Project Manager in conducting DailyBug Reviewmeetings during and after theQA Test process.
• Worked within tight deadlines in anAgileDevelopment environment.
• ConductedJADsessions with Management,SMEs(Subject Matter Expertise),Vendors,Usersand otherStakeholdersfor open and pending issues to develop specifications.
• Developed and executed several Optimized queries inSQL.
• Worked onTest CasesandTest Plansusing Different Testing Methodology likeFunctional,Regression, Integration, andUser Acceptance testing (UAT).
• UtilizeQuality Centerto track bugs status and analyzed test results using reports and graphs generated.

Confidential, Jackson, MS

Business System Analyst

Responsibilities:

• Actively worked on Business requirement gathering, analysis and Data analysis.
• NPI implementations on MMIS.
• Created Business Rule Comparison (BRC) documents and Side-By-Side (SBS) comparison documents using 10 implementation guides for X12 transactions ( 837 (I, P, D), 834, 835, 276,277,270, 271).
• Created BRCs of EDI inbound and outbound transactions and mapped the provided data.
• Extensively involved in HIPAA 5010 User Acceptance Testing (UAT).
• Defined and maintained Test Cases for EDI transactions.
• Worked with multiple clearinghouses to ensure smooth transition to 5010 standard for their day-to-day EDI X12 transactions.
• Good experience working with JAVA platforms and Oracle servers.
• Manually read through the loops, segments and elements of individual test files from clearing houses using Notepad++ and compared them to Implementation Guide/ Companion Guide to ensure that they met 5010 standards. If errors were found on these, the same were communicated back to the clearinghouse and asked them to resubmit the file after making necessary changes.
• Used Confidential Quality Center for error reporting and communicating between developers, product support and test team members.
• Worked on various subsystems within the MMIS including but not limited to Recipient Payer, EDI etc.
• Used MS Share point for sharing documents, calendars and other data between users in different locations.

Confidential, Bellingham, WA

Business Analyst

Responsibilities:

• Analyzed the business functionality of CMS.
• Development of business rules and testing for HIPAA compliance certification of healthcare standard.
• Recommended tactic to implement of HIPAA 4010 standards into the claim engine.
• Managed various levels of Projects in accordance to SDLC standards, worked with project lead/PM for various central build and regional build projects.
• Worked in waterfall methodology for better quality of the business solutions.
• Development of standard documentation package (Requirements, Specification, Design, Operations and Quality Testing Plans)
• Working Experience in Electronic Submissions in standard format.
• Performed GAP Analysis to derive requirements for existing claim systems enhancements.
• Interacted with the Subject Matter Experts (SMEs) and stakeholders, gathering business requirements to get a better understanding of client's business processes.
• Gathered business requirements and drafted Business Requirement Document (BRD).
• Experience working with web application and Oracle based database.
• Managed and controlled the project documentation using SharePoint.
• Used UML for gathering requirements, created Use Case Diagrams, and Use Case Specification document.
• Prepared test plan and test cases using Test Manager based on the function specifications.