SUMMARY

• Around 7+ years of professional experience as a Business Analyst Healthcare and Insurance Industry wif an understanding and ability to work independently and in cross functional teams
• Extensive experience in Software Development Cycle (SDLC), SCRUM application design, development, system testing and quality control methodologies such as Waterfall, Agile & RUP
• Proficient in creating BRD (Business Requirement Document), TRD (Technical Requirement Document), FSD (Functional Specification Document) and UAT Documents, Use Case Narrative & Use Case Diagram.
• Comprehensive understanding of HIPAA Standards (4010 & 5010), EDI(837 me/P/D, 834, 835, 277/278) and Compliance issues, Medicare, Medicaid, ICD9 & ICD10.
• Proven track record of creating and transforming business requirement into functional requirements and non - functional requirements.
• Well familiar in Claim Processing in Healthcare Industry wif wide noledge of various standards including X 12, Accredited Standard Committee (ASC) and American National standard Institutes (ANSI).
• Detailed noledge of claim adjudication process wifin a healthcare payer and interacting wif different hospitals.
• Led many JAD (Joint Applications Development), RAD (Rapid Application development) and JRP (Joint Requirement Planning Sessions).
• Exceptional presentation skills including verbal and written skills, and flexibility in adapting to new relevant information and changes.
• Extensive experience in data mapping, data modeling, data analysis artifacts and documentations.
• Extensive hands on SQL Query skills using Oracle SQL and SQL Server

TECHNICAL SKILLS

Methodologies: Waterfall, RUP Agile, JAD, SWOT and GAP

Languages: SQL & HTML

Business Modelling Tools: MS Visio, Rational Rose

Testing Tools: HP Quality Center, Load Runner and Clear Quest

Management Tools: Rational Requisite Pro, MS Project, MS Outlook, MS Excel and MS Share Point

PROFESSIONAL EXPERIENCE

Confidential, Maryland

Business Analyst

Responsibilities:

• Held meetings wif business process owners and SME (Subject Matter Expert) team for requirements gathering during project scoping
• Developed teh stakeholder list and created stakeholder assessment matrix to prioritize them
• Modeled teh‘as-is’process flow and teh‘to-be’process flow andanalyzed teh gapanddevelopedtheaction steps to fill teh gaps
• Identifiedandvalidatedbusiness rulesanddata elements
• Evaluated and documented upstream and downstream impacts for teh system
• Created technical specifications for developers
• Assisted project management in project timeline and developer work load
• Worked closely wif project stakeholders to formulate a strategy for UAT. Defined data requirements for testing effort and made data requests to teh appropriate database team. Involved myself in functionality and regression testing during teh various phases of teh development
• Utilized HP Quality Centre which speed up test planning, execution, defect management and reporting
• Validated teh system end-to-end testing to meet teh approved functional requirements
• Created technical documents and led Power Point/Visio presentations for departmental user base and for audit.
• Worked wif enterprise support and business users on data availability SLA
• Document issues, strategies and create noledge base and glossary using company wiki

Environments: Oracle 11g, SQL Server 2008, HP Quality Centre, Business Objects, Microsoft Visio

Confidential, Washington, DC

Business Analyst

Responsibilities:

• Facilitated JAD sessions to collect requirements from system users and prepared business requirement that provided appropriate scope of work for technical team to develop prototype and overall system.
• Developing Automated reports based on Business Requirement by Oracle Report Developer.
• Migrated Oracle Forms using oracle 10g.
• Wrote test plans and test cases based on teh business requirements which involved market risk analysis and risk management like continuous time finance & asset pricing, stochastic processes & simulations, credit derivatives, structured products, documentation, value at risk, risk & return optimization.
• Supply real time asset updates to Senior IT management developed an Integrated Trading System for equity and derivative trading and risk management system for OTC securities. Identified processes for developing and documenting detailed business requirements. Data was collected from end-users, and analysts.
• Created Use-Cases and Requirements documents to document business needs. Requirements were gatheird through interactions and meetings and periodic walkthroughs wif loan analysts, credit analysts and other potential users of teh application.
• Develop, implement and report metrics on all IT purchases and asset management. Conducted Use-Case reviews and identified gaps, leading to improvements/enhancements in teh same. Created and maintained teh Requirements Traceability Matrix (RTM).
• Worked wif teh Project Manager on various Project Management activities like keeping track of Project Status, Deadlines, Environment Request, and Compliance Issues. Used Advanced lending solution to verify teh customer credit line.
• Ensured Use-Cases were consistent and covered all aspects of teh Requirements document. Maintained teh Business Impact Analysis Template (BIAT) to analyze and document teh effect of proposed changes on teh project schedule and costs.
• Used Rational Clear Quest for bug reporting. Was responsible for tracking issues that are detected and updating teh status of existing issues based on teh daily meetings wif teh off-shore team. Identified and analyzed teh data requirements for teh various site teams and made sure that teh required data is available in teh testing environment.
• Worked directly wif software engineers to ensure clear communications on requirements and defect reports. Followed teh RUP methodology for teh entire SDLC. Validated teh scripts to make sure they have been executed correctly and meets teh scenario description.
• Involved in project status meetings, QA review meeting, and System Test meeting. Wrote test cases and test scripts for teh User Acceptance testing. . Design, write and maintain data requests and/or queries to support teh business.
• Identify data process improvements and leverage technology to automate and streamline existing processes. Assist in teh development of ad-hoc reports or presentations as needed by senior management.

Environment: JAVA, Oracle, Windows NT, UML, Requisite Pro, MS-Visio, Rational Clear Quest, Congo’s, MS Access, MS Visual

Confidential, Ohio

Business Analyst

Responsibilities:

• Interacted wif stakeholders to get a better understanding of client business processes and gatheird requirements.
• Conducted requirement gathering sessions wif teh purpose of creating and defining teh Business Requirement Document (BRD) and teh Functional Requirement Document (FRD) using Rational Requisite Pro.
• Conducted JAD sessions to allow different stakeholders to communicate their perspectives wif each other, resolve any issues and come to an agreement quickly.
• Incorporated HIPAA standards, EDI (Electronic data interchange), Implementation and Knowledge of HIPAA code sets, ICD-9, ICD-10 coding.
• Recommended changes for system design, method, procedures, policies and work flows affecting Medicare/Medicaid claims processing in compliance wif government compliant processes like HIPPA/EDI formats.
• Experienced Working on Pharmacy Benefit Management(PBM) as part of Medicare Part D.
• Gatheird noledge onPharmacy benefit management cost saving strategies such as Mail Pharmacies, Formularies, Generics, Electronic prescription and manufactures discount.
• Experienced working on MMIS (Medicaid Management Information System) for Insurance Claims Filing and patient information using MITA (Medicaid Information Technology Architecture) as a platform.
• Developed (UAT) User Acceptance Testing plan to guide a select group of key end-users in testing teh user interface and functionality of teh application.
• Also developed Requirements Traceability Matrix (RTM) mapping UAT plan and BRD.
• Developed Functional Testing Approach for ICD-10 Remediation and included in UATP Plan.
• Conducted Smoke Testing of teh new ICD-10 UAT region and recorded all teh testing results in RTM.
• Coordinated wif Project Managers to resolve risk issues and ensure compliance of Security System related to teh HIPAA.
• Compared and validated 5010 system test results wif 4010 results for teh same test scenarios.
• Documented teh Use Cases and prepared teh Use Case, Activity, Sequence diagrams and Logical views using MS Visio, MS Office and Rational Rose for a clear understanding of teh requirements by teh development team.
• Generated Use Case Diagrams, Sequence Diagrams, Business objects, Activity Diagram, ER Diagrams, Domain Object Model using MS Visio to demonstrate business flows and Power Point Presentations.
• Clarified QA team issues and reviewed test plans and test scripts developed by development team and QA team to make sure all requirements have been covered in scripts and tested properly.
• Executed SQL queries to test teh database for records that detect and submit functional acnoledgement and remittance advice in teh claims application

Environment: HP Quality Center, MS Office, Windows XP, UML, Share Point, Rational Rose,HIPPA, Oracle & SQL

Confidential

QA Analyst

Responsibilities:

• UtilizedAgile/Scrumto configure and develop process, standards, and procedures.
• Participated in creation ofBusiness Process workflow diagramswif Stakeholders.
• Conducted meetings and JAD sessions wif various business users andSMEsto identify key requirements and translated them into BRD and FRS.
• Extensive noledge of claim life cycle and utilize teh noledge in meeting client’s goals.
• ConductedGAP Analysisof teh present system and to be future system and presented to teh clients their requirements for teh new enhancements.
• Created artifacts such asUse Cases and Sequence Diagramsusing MS Visio.
• Developed Requirements Tractability Matrix (RTM) using MS excel to trace each software design requirement to test case.
• ReviewedSystem Test Plans and worked wif business folks to validate and execute teh test scripts. Performed UAT of teh upgraded claims processing system.

Environment: Agile/scrum, UML, MS Visio, MS Excel, SharePoint, RTM, GAP, Test Director