PROFESSIONAL SUMMARY:

• Business Analyst with 7+ years of IT experience in Healthcare & Insurance domain.
• Several years of experience and advance knowledge of the Systems Development Life Cycle (SDLC), Waterfall, Spiral, Rapid Application Development (RAD), Extreme Programming (XP), Rational Unified Process (RUP).
• Experience as a Facilitator in Application Testing.
• Worked on Change Management approach to transition teams and individuals from a current state to a desired future state.
• Facilitated and participated in Joint Application Development (JAD)
• Strong Experience in Developing Test Plans, build Test Conditions and Test Cases, creating test data, analyzing bugs, interacting with development team members to fix errors and issues
• Extensive experience in gathering business and application requirements, business processes, identifying risks, impact analysis, UML modeling, Sequence and Activity Diagrams using Rational Rose and Microsoft Visio.
• Efficient and proven track record of handling Change Requests by the client
• In house experience with project management tools like MS - Project for status reporting and planning.
• Experience with Agile methodology.
• Proficient in working with UML development tools like MS Visio and Eclipse
• Extensive management background within varied sectors of the healthcare industry including HMOs, PPOs, Integrated Hospital Systems, Out-Patient Surgery Centers, In-Patient Facilities, Dental and Vision
• Exposure to Healthcare and Insurance domains for several years.
• Extensive experience with Business Process Management (BPM) and provide assistance in leading large programs like ICD 10.
• Experience with enterprise wide ESE (External Stakeholder Engagement) program to enhance customer experience on payer side.
• In house experience with ICD 10 impact analysis, requirements gathering across impacted systems and over sighting vendor management. Excellent knowledge of HIPAA standards, EDI (Electronic data interchange), transaction syntax like ANSI X12.
• Presented several documents and Use Cases for multiple transactions include 837I, 837P, 835, 276, 277, 270, 271(both inbound and outbound) transactions for ongoing industry projects.
• Good knowledge of Health Insurance Plans (Medicare Part A, B, C and D), managed care concepts (Medicaid and Medicare) and experienced in determining the membership eligibility, billing experience within life and disability in health plans.
• A motivated, sincere, committed, quick learner, detail-oriented team player with good communication, analytical, leadership, interpersonal and problem solving skills.
• Experience in SCCM ensuring excellence and consistency in the practice of critical care.

TECHNICAL SKILLS:

Operating System: Windows, Linux.

Methodologies: Waterfall, Agile XP, SCRUM, RUP.

Requirement Gathering Techniques: JAD, Interviews, Surveys, Brainstorming, Document Analysis, Reverse Engineering, Observation, Rapid Prototyping, and Focus Groups.

Modeling Techniques: UML, Data Modeling Conceptual, Logical, Object Modeling, ERD, Data Flow Diagrams, BPMN, Context Diagrams.

Tools: Rational Suite ReqPro, Rose, ClearCase,RQM,ClearQuest, Test Director, Borland Star Team, MS Office, Visio, Excel, Access, Project, SharePoint.

PROFESSIONAL EXPERIENCE:

Confidential, Louisville, KY

Sr. Business Analyst

Responsibilities:

• Agile Scrum with a 3 week sprint cycle
• Worked with System analysts to create the Code Decomposition documents for the existing Claims Processing System.
• Conducted JAD sessions involving Business Owners/SMEs/Product Owners to identify current functionalities vs new functionalities to identify the GAP and document the same.
• Conducted JAD sessions involving Business partners, Wireframe Designers, and product owners to design and baseline Admin UI prototype.
• Documented High level Requirements and Functional/Non-functional requirements in Mega along with Process flow diagrams.
• Prioritized Use cases and conducted recurring meetings with the Business Analysts Team to ensure consistency use cases.
• Created a Review & Feedback process for Use cases created by the Business Analysts.
• Worked on and analyzed EDI claims for better understanding of the issues.
• Helped Optum with building ICD 9 to ICD 10 crosswalk map by grouping thousands of codes and ranges in Clinical, Benefits, Financial, Medical policy waves.
• Worked with different teams such as HIPAA 5010 to identify any project dependencies or initiatives competing against ICD 10 schedule.
• Identified Business Requirements and Business Rules.
• Created Use Case Model Diagram, Activity Diagram, Sequence and State chart diagrams in MS Visio following UML 2.0 standards
• Created Dependency documents illustrating internal dependencies as well as dependency on other departments/ ongoing projects and communicated with the respective teams.
• Conducted Risk Analysis Sessions and created Risk documents.
• Collaborated with the testing team to develop User Acceptance Test cases and test criteria.

Environment: Scrum, Business Process Design/ Workflow Analysis, Reverse Engineering, MS Project, Office, MEGA, SharePoint, Lotus Notes, Mainframe, Java

Confidential, Plano, TX

Business Analyst

Responsibilities:

• Worked on comprehensive Business Process Model which included all the process steps ranging from Scheduling appointments to Claims preparation processes. This was done to facilitate effectual scope analysis followed by cost estimation. This was the key component in highlighting issues around business impact analysis.
• Facilitated meetings with Key Business users to discuss complex process and risk analysis including researching alternative processes.
• Project cost estimation was done on a feature by feature basis which helped the business in prioritizing the features to be included in the current scope.
• Created Functions Specification document.
• Performed requirements management activities, including change requests, facilitating stakeholder meetings, business process modeling, and use case development.
• Developed an implementation guide for Partners for EDI X12 transactions such as 834, 835,837,270 and 271.
• Created traceability matrix and use case models illustrating use case structure Include, Extend .
• Assisted the Project manager in project planning.
• Created high detail screen mockups to help IT and Business in arriving at preliminary consensus.
• Contributed effectively to the Process management meetings with business users.
• Created test cases and worked with QA Lead to facilitate DDTs Data Driven Tests
• Worked with practice manager to find effective IT tools that would help in effective implementation.

Environment: - RUP, Business Process Design/ Workflow Analysis, Reverse Engineering, System Integration, Rational Requisite Pro, Rose, Clear Case, Clear Quest, Data Warehousing, MS Project, Office, Access, Enterprise Architect.

Confidential, Bloomfield, CT

Business Analyst

Responsibilities:

• Agile Scrum with a 2 week sprint cycle
• Conducted JAD sessions with Business Owners/SMEs for the product backlog
• Authored Business Requirement Document illustrating all Business needs captured from the Business users.
• Responsible for the analysis, design, system integration testing and implementation of the project with emphasis on use-case driven SDLC approaches.
• Coordinated with Project Managers to resolve risk issues and ensure compliance of Security System-Related to the HIPAA.
• Perform analysis on 837, 270/271, ANSI-X12N etc. HIPAA code sets.
• Perform EDI activities that comply with government reporting requirements and standard.
• Working with management to establish, document and maintain EDI procedures by identifying errors and taking corrective action, reconciling EDI transactions through coordination of information with internal and external customers, Accounting Department, IT Department and external vendors to maintain EDI integrity.
• Overseeing and maintaining the EDI Inquiry Problem database including the evaluation of problems or issues through to resolution.
• Conducting regular audits of EDI transactions to determine accuracy and areas for improvement and maintaining EDI maps and business rules for HIPAA validation software.
• Responsible for requirements gathering, creating requirement document, maintaining vision document, supplementary specification document and developing use cases from the functional specification using Requisite Pro.
• Analyzed, collected and prepared user requirements, definition, scope and expectations for project deliverables. Delivered System Requirement Specifications, Processes Diagrams and Test Cases.
• Worked closely with teams of BA’s, developers and testers throughout the development life cycle to elicit and manage requirements using RequisitePro.
• Designed message formats, system interfaces and worked with business users through interviews and JAD sessions
• Authored data flow diagrams, sequence diagrams and business process models.
• Assisted QA team in developing Test plan and Test cases based on the business requirement.
• Assisted documentation of system and business requirements, specifications, design and development of use-cases and test cases scenario and helped in developing test plans for user acceptance testing (UAT).
• Generated the prioritized product backlog
• Created the sprint backlog and elaborated them in to User Stories
• Identified the dependencies for each of the User stories, Risks and the risk mitigation strategies
• Created mockups where required
• Conducted document review meetings with the Project Team.
• Contributed in developing Test cases, Test plans
• Performed Regression Testing of the system.
• Collaborated with the testing team to develop user acceptance test cases and test criteria.
• Assisted business users and business process consultants to execute user acceptance tests.

Environment: Agile, Business Process Design/ Workflow Analysis, Reverse Engineering, MS Visio, Office, Access, SQL Server and .NET.

Confidential, St. Louis, MO

Business Analyst

Responsibilities:

• Interacted with the Business Development Team for requirement gathering, establishing feasibility and to identify critical and high risk areas of the application.
• Created Business Requirement Document (BRD).
• Facilitated JAD sessions involving stakeholders to review the BRD and to jointly develop a design pattern to be followed for the project.
• Authored System Requirement Specifications (SRS) including Data Requirements and GUI Requirements based on BRD and feed backs from the JAD Session.
• Analyzed impacts of business rules, and configuration decisions on downstream systems and interfaces.
• Identified and prepared Use Cases.
• Developed Use Case diagrams, business flow diagrams, Activity/State diagrams and Sequence diagrams using Rational rose enabling developers and other stakeholders to understand the business process.
• Facilitated Requirement Artifacts Review Sessions involving the project team.
• Worked extensively on Rational Clear Quest to track Project status, monitor workload and detect issues including defect submissions and enhancement requests.
• Performed Document Management and version control using Share Point.
• Contributed in developing Test cases, Test plans and Requirement Traceability Matrix (RTM).
• Participated in User Acceptance Testing and Business-to-Business Transaction testing for the project.
• Supported Infrastructure team in deployment process.

Environment: RUP, Share point, Business Process Design/ Workflow Analysis, Rational Requisite Pro, Rose, Clear Case, Clear Quest, Data Warehousing, MS Project, Office, Access.