PROFESSIONAL SUMMARY

• 7 years of experience as a Business Analyst in Health Care domain.
• Strong knowledge of the Software Development Life Cycle methodologies like Agile and Waterfall models.
• Experienced with Iterative approach for Software Development as per Rational Unified Process (RUP). Involved in inception, elaboration, construction & transition phases using rational tools like Requisite Pro, Clear Case and Clear Quest during various phases of RUP.
• Experienced in interacting with business users to identify their needs, gathering requirements and authoring Business Requirement Documents (BRD), Functional Requirement Document (FRD) and Software Requirement Specification (SRS) across the deliverables of a project.
• Proficient in creating Sequence Diagrams, Collaboration diagrams, Activity Diagrams, Class Diagrams using Rational tools and Microsoft Visio
• Professional with extensive experience in the development, implementation and integration of strategies within a team oriented environment, utilizing quantitative and qualitative analytical skills.
• Experienced in Business Analysis, SWOT Analysis, Gap Analysis, Risk Analysis, Disaster Recovery Planning, Testing and Project Planning.
• Extensive knowledge of Medicaid, Medicare, Procedural and Diagnostic codes and Claims Process.
• Expertise in EDI and HIPAA Testing Privacy with multiple transactions exposure such as Inbound Claims 837 - Institutional, 837-Professional, 837-Dental, 835-Claim Payment/Remittance Advise, 270/271-Eligibility Benefit Inquiry/Response, 276/277-Claim Status Inquiry/Response Transactions and testing in Client Server systems and Mainframe Applications
• Experience in Conversion of HIPAA X12 4010 codes to X12 5010 codes and ICD 9 codes to ICD 10 codes.
• Experienced in facilitating Joint Application Development (JAD), Rapid Application Development (RAD) and Joint Requirement Planning (JRP) sessions, interviews, workshops and requirement elicitation sessions with end-users, clients, stakeholders and development team
• Experienced in analyzing and documenting business requirements and system functional specifications including Use Cases
• Strong Knowledge of UML, RUP, Rational Tools
• Experienced in handling Change Management
• Strong knowledge of Business Process Modeling, Business Intelligence and Business Architecture.
• Experienced in writing Test Plans and executing Test Cases
• Skilled in validation and testing complex scenarios for the maintenance of quality standards in projects
• Experienced in creating User Manuals and providing training to users.
• Creative and Aggressive person capable of forming and maintaining positive and productive team environments with integrative thinking skills.
• Exceptional Problem Solving and Sound Decision Making capabilities, along with the ability to resolve difficult situations.
• Excellent communication and presentation skills.
• Strong knowledge of HETS (HIPPA eligibility tracking system)
• Strong knowledge of Metadata
• Worked on electronic health record (EHR) for Ambulatory care.

TECHNICAL SKILLS

Operating Systems: Win 98/ XP/ Vista/ Windows 7, UNIX, LINUX, Mac.

Languages: C, C++, Java, SQL, HTML, XML, C#, VB, ASP, .Net

Databases: Oracle, MS SQL server, MS Access, IBM DB2

Tools: MS Office Word, Excel, Access, Power point, Project, Visio, Front Office, Rational RoseSoDA, Software Modeler, Team Test, Doors, PROLOG, Clearcase, Clearquest, WinRunnerLoadRunner, WebSphere, Business Modeler, HP Quality Centre, Ultra Edit, TOAD, Test Directorand MMIS.

Industry Standards: HIPAA, SOX, ISO, Six Sigma, CMM, HL7, DICOM.

PROFESSIONAL EXPERIENCE

Confidential, Avon, CT

Business Analyst

Responsibilities:

• Worked with the statisticians and underwriting team to analyze and validate run-time decision models.
• Gathered and analyzed requirement for HIPAA 5010 and ICD 10 changes.
• Analyzed and documented the changes in the compliance rules for adverse action redesign.
• Worked on different EDI scenarios for batch processing.
• Ensure day-to-day EDI transmission, Reject tracking and Reconciliation.
• Run EDI Reconciliation reports daily and document in MS Excel.
• Involved in up-gradation of HIPAA X12 4010 transaction to HIPAA X12 5010 and ICD 9-CM (Clinical modification) to ICD-10-CM/PCS (Clinical modification/procedure coding system) simultaneously.
• Gathered and analyzed requirements for HETS
• Maintained and monitored project progress and status through MS Project.
• Extensive use of Use cases and written business flows and work flow diagrams for effective plans.
• Created Use-Cases after accessing scope of the project and understanding the business processes.
• Integrated Requisite Pro to provide all teams visibility and maintains tractability among requirements, use cases and change requests.
• Managed all the requirements, making requirements available to all team members.
• Created requirements analysis and design phase artifacts using Requisite Pro and MS Visio.
• Worked extensively with the users and with different levels of management to identify requirements, use cases and to develop functional specifications.
• Created Use cases, Activity, Sequence and Collaboration diagrams.
• Syndicated with various cross-functional teams for building business use cases.
• Conducted Asset Management, Risk Analysis of the Requirements and Traceability focus areas of the various projects and worked with the project team to help them identify the high-risk areas.
• Traces and manage all the requirements with Metadata to ensure the delivery of deliverables on time.
• Data mapping, logical data modeling, used SQL queries to filter data within the Oracle and Sybase.
• Responsible for co-coordinating business meetings and generating monthly status reports etc.
• Assisted QA team with Test Plans and executing Test Cases.
• Involved in preparing application for ambulatory care using DICOM for RIS (radiology information system) & HIS (hospital information system) PACs (picture archiving & communication system)
• Design specifications and Test Case usages for the HIPAA 837i, 270/271, 276/277, 835, 824, 275 and others.
• Involved in assembling, organizing and analyzing patient information, including medical history, symptoms, examination results, test results and prior treatments for EHR software development.

Environment: MS SQL, Windows XP, Requisite Pro, Clear Case, UML, Business Objects, MS Visio, MS Project, MS Excel

Confidential, New York, NY

Business Analyst

Responsibilities:

• Gathered requirements and prepared business requirement documents (BRD).
• Responsible for translating BRD into functional specifications and test plans. Closely coordinated with both business users and developers for arriving at a mutually acceptable solution.
• Responsible for processing Medicare claims and COB claims.
• Responsible for checking Medicare eligibility and verifying claim payment.
• Conducted JAD sessions to define the project and to reduce the time frame required to complete deliverables.
• Gathered requirement for HIPAA 4010-HIPAA 5010 and ICD 9 (clinical modification) to ICD10 conversion.
• Analyze HIPAA 4010 -HIPAA 5010 changes.
• Developed and maintained all operational and technical flows using Visio and Power point.
• Used Rational Rose/MS Office Suite for creating use cases, workflows and sequence diagrams according to UML methodology thus defining the Data Process Models.
• Defined Use cases from requirements and helped convert them into software specifications
• Aided in workflow analysis and process design.
• Analyze business requirements from Black Box testing perspective, business process and system architecture/design.
• Analyze and documented the requirements for HETS
• Involved in HIPAA/EDI Medical Claims Analysis, Design, Implementation and Documentation
• Involved in preparing the Test Scenarios for Health Care Claim Payment/Advice.
• Written multiple Use Cases and test cases for multiple transactions include 837, 835, 270, 271, 276, 277.
• Design, build and test maps to translate X.12 EDI to and from transaction formats such as EDIFACT, SAP IDOC, and various proprietary formats.
• Maintained Requirement Traceability Matrix (RTM).
• Performed Regression Testing and created test scenarios for User Acceptance Testing (UAT).
• Maintained documents for change request and implemented procedures for testing changes
• Defined program and project goals, objectives, products, services, constraints, assumptions, risks and facilitated processes by working with the project team, sponsor, and stakeholders to baseline the scope of the work and enable development of the plan
• Performed SWOT and Gap analysis for the new functionality requirements by identifying existing technologies, documenting the enhancements to meet the end state requirements.
• Involved in preparing project plans and identifying major milestones for each stage as per the SDLC model (RUP Methodology).

Environment: Rational Unified Process (RUP), UML, Rational Test Manager, Rational Clear Quest, Windows, MS Office, HTML, Windows 2003

Confidential, Massachusetts

Sr. Business Analyst

Responsibilities:

• Gathered requirements from stakeholders for provider management and member management.
• Identified and validated business rules and data elements.
• Developed the stakeholder list and created stakeholder assessment matrix to prioritize them.
• Developed and maintained a requirements work plan and assessed the performance metrics of the team members.
• Modeled the ‘as-is’ process flow and the ‘to-be’ process flow and analyzed the gap and developed the action steps to fill the gaps.
• Conducted Risk analysis and developed mitigation plans.
• Conducted Impact analysis when there is any change in the requirements and updated the Business Requirements Document (BRD) and Systems Requirements Specification (SRS).
• Facilitated meetings with the technical team and client team to analyze the current process and gather requirements for the proposed process.
• Developed the User Interface (UI) prototypes to capture and validate requirements and spike solutions to the current problem.
• Designing Functional Specifications for the target physical database.
• Facilitated JAD sessions for Requirement Validation and requirement gathering for the new MMIS.
• Responsible for claim processing in MMIS.
• Developed UAT test cases associated with the functional requirements.
• Maintained a bi-weekly status report for the requirements team and incorporated the same to the PMO status reports send to CMS.
• Analyze EDI - X12 data elements captured by the existing system to validate it against the data elements required for new system.
• Participated in developing test plan, test scripts, and test scenarios and designed user documentation.
• Involved in requirement gathering of clinical health record
• Worked with legacy team in developing BRD for multiple system change requests and participated in system testing.
• Used Microsoft SharePoint as the version-tracking tool for managing the requirements documentation.
• Create monthly/weekly status reports to update the project schedules & deliverable plan.
• Examine the system design deliverables & validating it against the Request for Proposal (RFP).

Environment: MS Office, Windows 2000, .NET, MS Visio, MS SharePoint, TFS, MS Project, MS Visio, SQL, Oracle, SOA, HTML.

Confidential, VA

Sr. Business Analyst

Responsibilities:

• Interacted with stakeholders and gathered requirements as per the business needs.
• Implemented RUP methodology for iterative and incremental development of the system.
• Worked on Required Traceability Matrix (RTM) in Rational Requisite Pro for traceability of requirements through test cases
• Was involved in the planning of the RUP iterations and documenting of the artifacts throughout the various phases of the development process.
• Conducted GAP analysis by understanding the AS-IS system and the TO-BE system requirements by having discussions with the SME’s.
• Compiled the Vision Document and composed detailed Use Case Specification Documents in Rational Requisite Pro.
• Used UML to perform Use-Case analysis to capture the dynamic aspect of the application.
• Ensured the accuracy and consistency of the data during the data loading process.
• Developed State Diagrams, Activity diagrams and Class Diagrams in MS Visio using UML for various modules of the project.
• Created Process Flow Charts, Business Requirements Documents, Functional Specification Documents.
• Was involved in managing the Daily Standup meetings and also ensured that quality standards were enforced as per the build-release schedule.
• Developed Test Plan and Test cases based on the Use cases and Functional specifications and also performed manual testing of the functionality of the application by inserting varying data on different test runs.
• Developed Flowchart and process diagram using Microsoft Visio.
• Was in regular contact with Business partners on the status of issues, action plans and timeframe for resolution throughout the development cycle.
• Contributed in reviewing and editing of the test scripts.

Environment: Windows, MS Office (MS Word, MS Excel, MS PowerPoint, MS Visio), MS Access, MS Project, RationalRose, Community Manager, BPML, SQL, ClearCase, Agile

Confidential, Tampa, FL

Business Analyst

Responsibilities:

• Elicited demands from the stakeholders and analyzed them for consistency, flexibility and completeness.
• Conducted JAD sessions with Subject Matter Experts to obtain domain level information.
• Involved in converting the User requirements into business requirements, functional requirements and technical requirements and also created business process modes from the requirement specification. Managed requirement using Rational Requisite-Pro.
• Presented and conducted functional requirement reviews and walkthroughs with the designers, developers, and stakeholders.
• Managed all the requirements in Requisite-Pro, creating a Requirements Matrix and making requirements available to all team members and also urge communication and collaboration among team members.
• Identified Use Cases from Business Requirements and created UML diagrams like use case diagram and activity diagram using MS-Visio for various stakeholders.
• Worked with HIPAA compliant ANSI X12 270 formats for both professional claims and institutional claims.
• Analyzed forms and successfully crosswalk details to corresponding ANSI X12 formats
• Involved in resolving and documenting issues related to these EDI transactions including 271 transactions using Test Director.
• Tested the final application for usability testing to verify whether all the user requirements were catered to, by the application.
• Managed change request and analyzed the impact of change request on the application in regards to Project Plan, Project Scope, and Project Schedule.

Environment: Rational Unified Process (RUP), UML, Dream weaver, Rational Test Manager, Win-Runner, Rational Clear Quest, Windows, MS Office, HTML, Windows.