SUMMARY

• 6+ years of experience working as a Business Analyst in Health Care and insurance domain.
• Strong knowledge of applied principle of the iterative methodologies of Software Development Life Cycle (SDLC) including Feasibility Study/Gathering Requirements, Analysis/Design and Development, User Acceptance Testing (UAT), Implementation and Post - Implementation Validation.
• Expertise in 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 data mapping of HIPAA 4010 codes to HIPAA 5010 codes and ICD 9 codes to ICD 10 codes.
• Identified the major differences between HIPAA 4010 and HIPAA 5010 through GAP analysis of implementation guides.
• 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.
• Well versed with Joint Application Development method, Rational Unified Process, have knowledge of Agile Application development methods.
• 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.
• Expert-level experience in writing SQL queries for data retrieval and management.
• Excellent knowledge of Medicare (Part A, B, C and D) and Medicaid Health Insurance Policies, worked using Maintenance Management Information System (MMIS) for claims processing and information retrieval.
• Good knowledge of Health Level Seven(HL7) and Health Insurance exchange (HIX) plans.
• Well versed in EHR/EMR’s and Emergency Medical Treatment and Active Labor Act(EMTALA)
• Proficiency in creating Business Process Modeling including Use Case diagrams, Activity diagrams, Sequence diagrams, Collaboration diagrams, Data-Flow diagrams using UML Methodology, in MS Visio and Rational Rose, as crucial project deliverables.
• Professional experience in writing Test Scenarios, Test Conditions, Test Cases and Test Scripts for Functional and Regression Testing based on the Design Document and User Requirement Document for the Functional, Security, and Performance Testing.
• Experienced with Rational tools like Rational Requisite Pro, Clear quest, Clear Case, JIRA, and Rational Rose.
• Good understanding of Patient Protection and Affordable Care Act (PPACA/Obamacare) and Health Care Reform.
• Strong knowledge of Health Insurance Plans like Health maintenance organization (HMO), Point-of-service (POS) and Preferred provider organization (PPO).
• Managed complex business initiatives to balance requirements for functionality, efficiency and quality.

TECHNICAL SKILLS

Requirements Management Tools: SAP Power Designer, Rational Rose, IBM Rational DOORS, Requisite Pro

Methodologies: RUP, Agile, Scrum

Languages: SQL, UML, XML, HTML, Java

Business Modeling Tools: Smart Draw, MS Visio, Prototyper, UML 2.0, AML

Project Management Tools: MS Project, MS Office Suite (Word, Excel, Powerpoint, Access)

Defect Management Tools: Bugzilla, SILK Central, Jira, HP Quality Center, Load Runner

Databases: IBM DB2, SQL Server 2000, MS Access, Oracle

Operating Systems: Windows 8, Windows 7, Vista, XP, Windows 95/2000, MS-DOS and MAC

Industry Standards: HIPAA, Six Sigma, ISO, CMM, DICOM, SOX, HL7, RAD, JAD, RUP, GAP

PROFESSIONAL EXPERIENCE

Confidential, Plymouth Meeting, PA

Business Analyst

Responsibilities:

• Utilized AGILE (SCRUM) Methodology for execution of the project. Supported SCRUM Master in Sprint Planning, created Product Backlog and participated in SCRUM Meetings.
• Collected meeting minutes and followed up with team members through emails and phone calls.
• Helped project manager in creating the project plan.
• Delivered presentations related to different milestones of project.
• Researched and developed Work Plan Document, detailing the requirements to achieve HIPAA Norm’s to ensure security and privacy to patient’s information and restrict unauthorized users and strict adherence to HIPAA EDI standards such as (834/835).
• Engaged closely with SCRUM Master and Project coordinators to bring information to next sprint cycle such as risks and requirement dependencies and acceptance criteria.
• Gathered user stories (Requirements) for modules Enrollment/Registration (patient demographics, insurance information, medical history, etc.), and medical billing and payments (demographic entry, CPT/ICD-9 coding, claims submission processing, post payment, collections, etc.).
• Documented the enhancements related to patients’ personal information, medical history, insurance information, billing and payments modules.
• Facilitated JAD sessions, conducted stakeholder interviews, had Q&A sessions with the Product Owners and technology team for the Medical Process Automation tool.
• Designed and developed use cases and activity diagrams for capturing and recording patient’s personal information, medical history, insurance information, and Claims submission.
• Created Wireframes/Prototypes/Mock-Ups for User Interface using Balsamiq and MS PowerPoint.
• Utilized MS Visio to communicate with technical and non-technical individuals.
• Performed analysis of the business requirements and created business requirement document (BRD).
• Created Wireframes for enrollment process such as Patient Enrollment Forms.
• Interacted with developers and QA in resolving the reported bugs using Quality Center in different Sprint releases.
• Engaged closely with QA for writing the test plan and test cases.
• Facilitated user acceptance testing (UAT) with the SME’s on business management and SCRUM Master.
• Created UAT test cases. Tracked UAT defects and prioritize the defects based on the criticality.
• Helped on creating user manuals.
• Utilized SVN for document management to revise and update documents by branching, merging, check in, and check out purpose.

Environment: Agile (SCRUM), MS-Excel, MS Visio, C#, HTML, XML, CSS, HIPAA, EDI(834 & 835), Balsamiq, Oracle11g, TOAD 9.0, SQL, MS Project, MS PowerPoint, ALM/Quality Center, SVN 1.6.11

Confidential, McLean, VA

IT Business Analyst

Responsibilities:

• Conducted user interviews for OAS application project at both in-house and client locations, gathered and analyzed requirements
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams using UML
• Identified, researched, investigated, and documented business processes and Use Case Scenarios.
• Performed Gap analysis by identifying existing technologies and subsequently documented the enhancements to meet the end state requirements.
• Conducted workflow, process diagram and gap analysis to derive requirements for existing systems enhancements
• Assisted with user testing of systems (UAT), with developing and maintaining quality procedures, and with ensuring that appropriate documentation was in place.
• Undertook responsibilities for identifying and documenting business rules and creating detailed Use Case and conducted User Acceptance Testing.
• Worked with development and testing teams to accomplish timely release objectives.
• Integrated an external credit score carding system into internal risk management system by identifying management requirements and implementing automatic information upload.
• Used detailed knowledge of application features and functions to assess the scope and impact of business needs throughout analysis.
• Supported OAS system Integration Testing for test team. Conducted UAT with the business users.
• Assisted with Test Cases and developed strategies with Quality Assurance group to implement them. Efficiently responded to client inquiries and resolved discrepancies.
• Identified, prioritized, tested and proved essential business functions to assure compliance with vendor and internal auditing. Acted as an intermediary in understanding how IS carried out business functions and assisted in ensuring the timely and effective implementation
• Collaborated with Quality Assurance Analyst in Rational Clear Quest to track defects and maintain consistency in the builds.

Environment: HTML 4, HP Quality Center, MS Visio, Windows, Java/J2EE, MS Office, Rational Clear Quest, Microsoft SQL Server 2000, QTP, MS Office Suite.

Confidential, Wichita, KS

Business Analyst

Responsibilities:

• Analyzed current business process flow by understanding preset business rules and conditions.
• Conducted formal interviews, Live Meetings and JAD sessions with business users Subject Matter Experts (SME’s)
• Designed and developed Use Cases, Activity Diagrams and Sequence Diagrams using UML.
• Involved in Backend Testing to verify data integrity by using SQL.
• Documented, organized and tracked the requirements using Rational Requisite Pro.
• Created Data Flow Diagrams (DFDs), ER diagrams for data modeling and Web-page mock-ups using MS Visio for acceptance from end users.
• Defined project milestones, schedules, and monitored progress using MS-Project and updated plans as required.
• Analyzed and tested Data Interface needs with external systems.
• Analyzed, manipulated and updated Database using SQL.
• Gap Analysis: Analyzed the client’s applications programs to determine the impact of the HIPAA rule on EDI Transaction Set and Code List implementation and defined the changes to bring the affected systems into HIPAA compliance.
• Assisted with user testing of systems and maintained quality procedures and ensured appropriate documentation is in place.
• Maintained Requirement Traceability Matrix (RTM) and Utilized Clear Quest for change requests and defect tracking.
• Claim validation and Pend/Denied Claims Analysis for the Health plans Medicaid programs.
• Worked closely with the technical team to look up for the best possible solution on requirements by keeping business needs and technical constraints in mind.
• Updating, transferring and sharing Files using FTP between Windows and UNIX machines.

Environment: UML, MS Word, Rational Requisite Pro, Rational Clear Quest, Quality Center, SQL, FTP, TelNet.

Confidential, Virginia Beach, VA

Business Analyst

Responsibilities:

• Employed Rational Rose to visually determine the proper structure, key elements and optimal design for database and to aid efficient creation of tables, stored procedures.
• Employed impact analysis, data analysis and risk analysis for User Acceptance Testing (UAT).
• Strong Knowledge and understanding of ICD-9-CM and ICD -10-CM coding and claims processing. Also, well versed in Medicare Part A, Part B, Part C and Part D enrollment.
• Reviewed information gathered from multiple sources during requirement gathering and analysis and employed rational requisite for tracking, tracing and managing requirements
• Accountable for designing future state processes forHIPAA 5010 transaction processing EDI’s 837 and 835.In addition Reviewed HIPAA 5010 related to 837,835, 834 Transactions and conducted gap analysis between HIPAA 4010 AND HIPAA 5010.Proficient in creating and maintaining Workflow plans and artifacts.
• Enforced an integrated RUP solution with complete line of traceability for all the artifacts of web development projects
• Employed MS Project for various planning and budgeting activities.
• Supervised, reviewed and model Test plans, Use Case Model cases & Test procedures based on RUP methodology
• Wrote viable detailed user documentation and System Requirements Specification(SRS) documents with the purpose that developers could formulate application with minimum guidance
• Organized SWOT Analysis for better market understanding and fool proof project implementation
• Conducted UAT and registered test results according to the test plans using Test Director.
• Create Business Process Models that includes modeling of all the activities of the business from the conceptual to procedural level. Followed top down, leveled technique for building Business Process Models
• Supervised the functional aspect in accordance with the Business Process and validated the interfaces with the other systems and data conversion from the existing system
• Conducted Requirement Traceability Matrix(RTM) for requirement elicitation and linkup to deliverables
• Formulated Quality Assurance standard and processes for all levels of project team
• Conducted Gap analysis for the modules in production, organized feasibility study and conducted impact analysis for proposed enhancements
• Proficient in creating and maintaining Workflow plans and artifacts

Environment: Rational Requisite, Microsoft Office( MS Word, MS Excel, MS PowerPoint, MS Visio, MS Access), RUP, XML Oracle, RUP, UML, SQL.