SUMMARY

• Experienced as a Business Analyst in Health Care, Facets and Banking Industry.
• Experience in Healthcare Application Facets in different modules like Claims, Memebrship, Provider and Billing.
• Experience in Finance/Mortgage industry,Customer Support and HR payroll system,
• Extensive experience and knowledge on all stages of the Software Development Life Cycle (SDLC) and Object Oriented Analysis and Design (OOAD) utilizing project life cycles such as Agile, Rational Unified Process (RUP), and Rapid Application Development (RAD).
• Well versed in writing SQL queries, together with inner and outer Join commands for data analysis and retrieval.
• Knowledge and experienced on Health Insurance Portability & Accountability Act (HIPAA 4010 and HIPAA 5010), Affordable Care Act (ACA), Six Sigma Standard, International Statistical Classification of Diseases and Related Health Problems, 9th Revision and 10th Revision (ICD - 9 and ICD-10), Current Procedural Terminology(CPT).
• Proficient in Medicaid, Medicare (Part A, B, C, and D), Procedural and Diagnostic codes, and Claims Process.
• Experienced working with Claim Transactions such as 837 P/I/D - medical claims, 835 - Health Care Claim Payment/Advice, 270 - Eligibility, Coverage or Benefit inquiry, 271 - Eligibility, Coverage or Benefit response, 276 - Claim status request, 277 - claim status response, 820 - Payment Order/Remittance Advice, and 834 - Benefit Enrollment and Maintenance.
• Strong understanding on Electronic Data Interchange(EDI), both in 4010 and 5010 formats
• Extensive experience in organizing and facilitating joint application development (JAD) sessions, interviews and workshops with user(s), subject matter experts (SME’s), and business stakeholders.
• Proficient in producing Business Requirement Documents (BRD), Functional Requirement Document (FRD) and Software Requirement Specification (SRS) across the deliverables of a project.
• Expertise on website Wireframes and Business Process Modeling Notations with excellent skills on Use Case, Activity, Sequence, Data-Flow diagrams using Unified Modeling Language (UML), in MS Visio and Rational Rose.
• Well versed in Relationship Database Management System (RDBMS).
• Skilled user in Clear Quest for defect tracking, bug reporting tools like Test Director and Quality Center.
• Experienced in handling Change Management and Release Management.
• Excellent analytical skills with extensive experience on performing GAP analysis, User Acceptance Testing (UAT), Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis, Impact Analysis, Risk Analysis and Mitigation plan, Cost benefit analysis and Return on Investment (ROI) analysis.
• Proficient in handling functional and non-functional requirements with exceptional understanding and skill set in writing Test Scenarios, Test Conditions, Test Cases, and Test Scripts.
• Possess understanding and experience in using Rational Requisite Pro to trace and update business requirements throughout the lifecycle of a project and keep stakeholders informed about the progress of the project utilizing Requirement Traceability Matrix (RTM).
• Experience in writing requirements and generating Software Requirement Specification (SRS) in requirements management tool CaliberRM.
• Well versed in developing Mock-ups in Balsamiq and Axure.
• Energetic and creative. Dynamic team player with integrative thinking skills.
• Excellent problem solving, conflict managing, decision making, and leadership skills.
• Excellent analytical, written, communication, presentation and interpersonal skills

TECHNICAL SKILLS

Project Methodologies: RUP, SDLC, Agile Methodology

Business Modeling: Rational Rose, MS Visio, MS Project

Requirement Management Tools: Test Director(Quality Center), Rational Requisite Pro, Clear Quest,SoapUI

Programming Languages: C++,SQL, PL/SQL, UML, HTML, VB Script

Defect Tracking Tools: Rational Clear Quest and Mercury Test Director

RDBMS/ Database: MS SQL, MS Access, Oracle

Operating Systems: Windows 2000/XP/ME/VISTA, LINUX, UNIX

Project Management Tools: MS Office Suite, MS Project, MS SharePoint

PROFESSIONAL EXPERIENCE

Confidential, Grand Rapids, MI

Business Systems Analyst

Responsibilities:

• Analysis on the impacts for Reporting Database as a result of Facets Upgrade
• Analyzed the impacts on the Downstream process
• Claim Disbursement Process, Claims Adjudication, Claims Payment, 837, 834 Membership Eligibility, ID cards, Provider, Billing and EDI
• Performed extensive GAP Analysis in order to understand the As-Is and To-Be conditions and determine the feasibility of the new project with the existing system.
• Carried out User Acceptance Testing and extensively used SQL to perform Backend Testing in order to verify data integrity.
• Interacted with the QA team to performed Unit and Integration.
• Worked with Trizetto to resolve the issues identified at analysis state while building the Custom components for Claim life cycle.
• Updated, analyzed, and manipulated the SQL database.
• Collected, documented, organized, and tracked the business requirements using Rational Rally.
• Made business requirements document, change requests, and use cases available to all teams using Rally, and MS Visio.
• Developed business flow diagrams, activity diagrams, and interaction diagrams so that the development team and other stakeholders could understand the business process clearly.
• Maintained project milestones, schedules, and project progress using MS Project.
• Held presentations and participated in walkthroughs with the development team and the QA team to help them understand the requirements and formulate test plans and test scripts.
• Maintained Requirement Traceability Matrix (RTM) to check whether the requirements of the system was met accordingly and to produce RFPs.
• Performed claim validations and Pend/Denied claims analysis for the Health plans Medicaid programs.

Environment: MS Office, Quality Center, SQL Server, Rally, Facets, MS Project Server, MS Visio, HTML, XML, Rational Clear Quest, Windows XP, 7

Confidential

Business Systems Analyst

Responsibilities:

• Enrollment Life Cycle Impact Analysis (EDI 834)
• Worked on existing documentation to get information on legacy system
• Created custom batch for Enrollment lifecycle steps.
• Analysis on the impacts for database as a result of Enrollment Upgrade
• Analyzed the impacts on the Downstream process
• Responsible for writing and reviewing the BRD/FRD documents, 'As-Is' / 'To-Be' Process flows with the Core team, Business owners, SMEs and all required signatories.
• Worked on Enrollment, Claims and provider departments to analyze impacts.
• Analyze and remediate as needed Reports.
• Determined how the changes impacted the current business operations, defined and developed business and technical requirements within and across transactions.
• Performed Gap Analysis to identify AS-IS processes of claims transactions standard and TO-BE processes of standard.
• Worked extensively with the users, development team and different levels of management to clarify/understand functionalities and ensure that the developers clearly understood the business requirements that the system was designed to fulfill.
• Using Rational Rose, the business requirements were segregated into high-level and low-level Use Cases, Activity Diagrams.
• Designed and developed state diagrams, activity diagrams and class diagrams in MS Visio for various modules of the project.
• Interacted with the QA team to develop Test plan and Test cases based on Use cases and Functional Specifications.
• Conducted Claims and HIPAA Compliance Training in order to run the test cases.
• Helped requirement documentation for Data Extraction, Data Transformation, and Loading processes as a part of data mapping procedures.
• Assisted in writing test scripts and verifying test results to fulfill business requirements.
• Directly involved in process improvement plans and implementing business change, creating and managing Project templates, Use Case project templates, requirement types and traceability relationships in Requisite Pro.
• Maintained a Traceability Matrix to ensure that all Functional Requirements were addressed at the Use Case Level as well as the Test Case Level.
• Performed Unit Testing and implemented Alpha Test in order to confirm the functionality of recent conversion.

Environment: MS Office, Quality Center, SQL Server, Rally, Facets, MS Project Server, MS Visio, HTML, XML, Rational Clear Quest, Windows XP, 7

Confidential

Business Analyst/ Process Analyst

Responsibilities:

• Interact extensively with various business groups, stakeholders and users to develop the Vision Document that is aligned with corporate strategic objectives
• Document the “AS-IS” Business Workflows adhering to UML standards
• Manage application support product backlog using JIRA cards
• Conduct Monthly Business Prioritization meetings with the stakeholders
• Identify JIRA cards to be scheduled for the upcoming release.
• Document User Story using JIRA to detail the business need.
• Conduct requirement workshops to verify and validate business requirements
• Create use case diagrams using MS Visio to show interaction between the actors and the use cases as well as to demonstrate the relationship between the use cases
• Perform functional and UI testing to ensure that the user acceptance criteria are met
• Conduct weekly sprint planning meeting with the developers and quality assurance analysts to review user story, assign story points and assign cards to a respective sprint.

Environment: Agile, Jira, SharePoint, MS Visio, Oracle, SQL, UML, MS Project, MS Office

Confidential, Indianapolis

Business Analyst

Responsibilities:

• Determined how the changes in HIPAA-5010 impacted the current business operations, defined and developed business and technical requirements within and across transactions.
• Performed Gap Analysis to identify AS-IS processes of claims transactions of 4010/4010A standard and TO-BE processes of 5010 standard.
• Worked extensively with the users, development team and different levels of management to clarify/understand functionalities and ensure that the developers clearly understood the business requirements that the system was designed to fulfill.
• Using Rational Rose, the business requirements were segregated into high-level and low-level Use Cases, Activity Diagrams.
• Designed and developed state diagrams, activity diagrams and class diagrams in MS Visio for various modules of the project.
• Gained a clear understanding of the claims adjudication and reimbursement systems based on HIPAA X12 5010 standards
• Interacted with the QA team to develop Test plan and Test cases based on Use cases and Functional Specifications.
• Conducted Claims and HIPAA Compliance Training in order to run the test cases.
• Helped requirement documentation for Data Extraction, Data Transformation, and Loading processes as a part of data mapping procedures.
• Assisted in writing test scripts and verifying test results to fulfill business requirements.
• Directly involved in process improvement plans and implementing business change, creating and managing Project templates, Use Case project templates, requirement types and traceability relationships in Requisite Pro.
• Maintained a Traceability Matrix to ensure that all Functional Requirements were addressed at the Use Case Level as well as the Test Case Level.
• Assisted in EDI 834/837/270/271 transactions of medical claims/underwriting for support and point of reference for the providers in business issues.
• Performed Unit and Integration Testing and implemented Alpha Test in order to confirm the functionality of recent conversion.

Environment: MS Office, Quality Center, SQL Server, Rally, Facets, MS Project Server, MS Visio, HTML, XML, Rational Clear Quest, Windows XP, 7

Confidential

Business Analyst

Responsibilities:

• Created a test schedule to conform to the confines of the Project Schedule and also deliver value to client.
• Shopped and procured automated testing tools facilitating Program Policy and Standards and compliance; support repeatable testing procedures.
• Developed project delivery schedule, managed projects and identified resources to successful completion
• Managed Project Management staff, Quality Assurance and Technical Writing staff.
• Managed open enrollment technical projects for 20,000.
• Acquired comprehensive knowledge of Banking activities and operating processes
• Collected and documented business processes as well as business rules.
• Participated in the identification, understanding, and documentation of business requirements, including the applications capable of supporting those requirements.
• Translated the business needs into system requirements, communicating with the business on a non-technical level, and with the System Analyst on a more technical level.
• Collaborated with development architect and the business to develop both high-level and detailed application architecture to meet the business needs.
• Documented and delivered Functional Specification Document to the project team.
• Performed GAP Analysis and conducted User Acceptance Testing (UAT).
• Developed test scenarios and implemented test plan. Providing key input in working with users in defining project and system requirements.
• Conducted project related presentations.

Environment: Rational Rose, MS PowerPoint, Test Director, Rational Requisite Pro, RUP, UML, Rational ClearCase