SUMMARY

• 8 years of IT experience as a Business Analyst within the healthcare industry, with knowledge of SDLC methodologies, such as, RUP, AGILE - SCRUM, Waterfall and skilled in conducting Joint Application Development (JAD) sessions, interviews, workshops and requirement gathering sessions with business users, stakeholders and development team.
• Also have experience in identifying business needs and determining solutions to business problems for complex software projects, including system development component, business process improvement, strategic planning and policy development.
• HIPAA (Health Insurance Portability and Accountability Act) transaction codes such as EDI 834 (Benefit Enrollment and Maintenance), 270/271 (Eligibility Benefit Inquiry/Response), 276/277 (Claim Status), 835 (Payment or Remittance Advice), and 837 (Health Care Claim).
• Last three years of experience working on Health Care Reform projects such as Health Insurance Exchange (HIX), ICD-10 Remediation and HIPPA 5010 Implementation.
• Highly well versed in creating functional specification documentation on EDI 834 and creating EDI 834 feed configuration either on flat files, or proprietary feed which is the traditional Excel Spreadsheet.
• Strong expertise in reviewing the test files of EDI 834 on EDI notepad and reporting the defects.
• Experience with various ICD codes (Diagnosis and Procedures) and EDI transactions under HIPPA environment.
• Extensively involved in data validation between 834 Membership file toFacetsbackend tables and fromFacetsBackend tables to different external EDI extracts based on MS CHIP plan requirement.
• Proficient in conducting product reviews based on the CMS specification guidelines.
• Expert in Data quality Management, Data profiling, Data Cleansing, Data Integrity, Document management and Identity Management.
• Experienced in Implementing Normalization/Denormalization techniques for optimum performance in OLTP/OLAP database environments for Business Intelligence’s function.
• Extensively used JIRA and SharePoint to update the status of the project and maintained the latest versioning of the files.
• Comfortable in working with different requirement gathering techniques. For example, Brainstorming, JAD sessions, Document Analysis, Interview, Prototyping and Observation.
• Strong expertise in designing and reviewing of various documents including, Software Requirement Specifications (SRS), Business requirements document (BRD), Functional Requirements document (FRD), Requirement Traceability Matrix (RTM), Testing documents, Data Analysis, Gap Analysis and UML Diagrams.
• Proficient in UAT (User Acceptance Testing), Functionality Testing, Unit testing, System Testing, Integration Testing and Regression Testing.
• Creating Use Cases, Sequence Diagrams, Activity Diagrams, etc.
• Experience in different phases ofSoftware development Life cycle (SDLC)including Strategic Systems Planning Designing, Programming, Testing, Documentation, andPresentation to clients and preparing customer specifications as part of software technical requirements and Customer support.
• Good expertise in the review and documentation of systemtest plans, creating and executingtest scripts, test casesand data sets on the basis of product release features requirements and technical documents.
• Well versed in documenting Manual Test Scripts and tracking and logging the defects usingQuality Center.
• Exceptional ability to quickly master new concepts, very co-operative team player, fluent communicational skills, and interpersonal skills, innovative and self-motivated.

TECHNICAL SKILLS

Methodologies (SDLC): Agile SCRUM, Waterfall, RUP, V-shape modeling

Business Modeling & Versioning Tools: MS VISIO, Visual Paradigm, Rational Rose; Rational Requisite Pro, MS SharePoint, Power Designer, Visible Analyst

Change Management Tools: Rational Clear Quest, Rational Clear Case

Documentation & Project Management Tools: MS Project, MS Word, MS Excel, MS PowerPoint, Rational Plan

Database Management Tools: MS Access, SQL Server 2008

OLAP and Data Analysis Tools: MS Excel Analysis, SQL Analysis Server

Programming Languages: SQL Server and Oracle PL/SQL, VB 6.0

Testing Tools: Test Director, HP Quality Center, HP ALM

Operating System: Windows NT/98/2000/XP, 7, 8

PROFESSIONAL EXPERIENCE

Confidential

Sr. Business Analyst

Responsibilities:

• Interacted with stakeholders to get a better understanding of client business processes and gathered requirements.
• Gathered requirements based on what was in-scope for open enrollment and documented requirements in a BRD.
• Conducted JAD sessions involving SME’s, business users, data administrators, system architects, managers and development team in order to create a good business process model.
• Worked closely with project team and to ensure project deliverables are met in an efficient and timely manner.
• Collaborated with business analysis team members in understanding existing business processes and requirement management process.
• Attended Defect Triage call to identify the defects and provided possible solution.
• Also developed Requirements Traceability Matrix (RTM) mapping UAT plan and BRD.
• Developed Scope Breakdown Structure to validate which requirements are in and out of scope.
• Performed GAP Analysis with system functionality and existing Business Processes.
• Responsible for reviewing the Test Cases and providing the feedback to the Quality Analyst Team.

Confidential, Chicago, Illinois

Sr. Business System Analyst

Responsibilities:

• Interacted with stakeholders to get a better understanding of client business processes and gathered requirements.
• Gathered requirements based on what was in-scope for open enrollment and documented requirements in a BRD.
• Conducted JAD sessions involving SME’s, business users, data administrators, system architects, managers and development team in order to create a good business process model.
• Maintained the capacity plan, iteration board, sprint backlog, velocity charts and burn down charts.
• Worked closely with project team and to ensure project deliverables are met in an efficient and timely manner.
• Facilitated all aspects of the scrum framework, including sprint planning sessions, backlog grooming sessions, daily scrums, product demos, sprint reviews and sprint retrospectives.
• Collaborated with business analysis team members in understanding existing business processes and requirement management process.
• Responsible for writing and reviewing Functional Specs (Use Cases and User Stories).
• Designed and developed Use Cases, Activity Diagrams, and Sequence Diagrams.
• Communicated/coordinated with carriers and internal parties related to interface projects.
• Configured complex existing EDI 834’s.
• Extensively prepared the functional specification document, either in Flat file format or the traditional Excel format.
• Reviewed the test files sent over by the developers to identify the gap.
• Facilitated User Acceptance Testing by creating UAT test scripts in order to test end-user functionality and to ensure that business requirements were met.
• Worked on data modeling and produced data mapping and data definition documentation.
• Designed and implemented basic SQL queries for testing and report/data validation.
• Performed SQL queries for backend testing and data validation.
• Gathered relevant information on various products such as Dental, Vision, Medical, and HSA and completed a feed configuration based on the Companion Guide and Account Structure of the products.
• Sent over the feed configuration document to the developer to complete the coding.
• Monitored the bugs after the testing and provided feedback.

Confidential, Albuquerque, NM

Business Analyst

Responsibilities:

• Interacted with stakeholders to get a better understanding of client business processes and gathered requirements.
• Collaborated with business analysis team members in understanding existing business processes and requirement management process.
• Followed a structured approach to organize requirements into logical groupings of essential business processes, business rules, and information needs, and insured that critical requirements were not missed.
• Facilitated JADs for requirement walkthrough, identification of nonfunctional requirements from system users and updated business requirements that provided appropriate scope of work for technical team to develop prototype and overall system.
• Conducted Product Review on various aspects of the business documents that were submitted by clients, to see the progress of the project.
• Worked as a primary lead on Data Management and secondary lead on Requirement Management, and System and Acceptance Testing to help the lead of the designated areas to accomplish the task.
• Analyzed the requirements for Data Management focusing on the software components, security measures, versions of the software’s and answered to questions based on the specification documents provided by CMS to identify the GAPS and provided solutions.
• Designed use cases and activity diagrams for the processes highlighted specifically by the business.
• Ensured clear communication via Activity Diagrams (Swim Lanes), Workflows, Use case Diagrams.
• Worked on the consolidation of the Oversight Checklist area based on the Product Review to identify the process of the business and identify the gap to provide feedback to the client.
• Identified the Gaps and conducted GAP analysis.
• Identified test execution method: Manual/Automated. Read and understood Test Cases and identified the frequent functions.
• Used Data warehousing for Data Profiling to examine the data available in a Source Database.
• Worked on data modeling and produced data mapping and data definition documentation.
• Planned the meetings by providing advanced meeting Agendas and previous minutes.
• Kept record of the meeting minutes and action items.
• Prepared Weekly and Monthly Report with the guidance of Project Manager to be submitted to the client.
• Maintained the Daily Meeting Log to keep track of the Meetings attended and assuring that a Meeting worksheet has been submitted.
• Mapped the test scenarios to business requirements as part of creating traceability matrix.
• Verified the Business Scenarios on new builds to allow extended testing by the QA team.
• Attended various meetings with the NMHIX, GetInsured, CMS and Public Consulting Group (CMS).
• Attended a two day Final Design Review Meeting with NMHIX, PCG, CMS, Deloitte, HSD (Human Services Department) to see the progress of the project.
• Ensured that the Project SharePoint site is up-to-date and versioning of the documents are clearly maintained.

Confidential, Brooklyn, NY

Sr. Business Analyst

Responsibilities:

• Conducted requirement-gathering sessions with the purpose of creating and defining the Business Requirement Document (BRD). As the processes and methodology moved from waterfall towards agile, wrote requirements in form of User Stories and Acceptance Criteria Documentation.
• Interacted with stakeholders to get a better understanding of client business processes and gathered requirements.
• Developed UAT Test Plan to guide select group of key end-users in testing the business processes on the application.
• Performed System testing, Regression testing and UAT for several claim types and test scenarios.
• Tested the ability to accept an 834 electronic application and validate complete transactions.
• Tested the ability to store Identification number received from the Exchange and create a unique identifier for members received through the Exchange.
• Created Swim Lane Diagrams and business logic & calculation spreadsheets for various business processes.
• Created data mapping document for ETL process (data extraction and data validation), to define the Source data on 834 Benefit Enrollment and Employer Group File (EGF) EDI Transfers.
• Created Process Models for (a) Initial Enrollment, First Billing and Payment and (b) Post Enrollment - Subsequent Recurring Billing and Payment.
• Collaborated with vendors (CURAM, CONNECTURE & PWC) in order to ensure smooth transition of requirements from State to Vendors.
• Involved in Small Business Health Option Plans (SHOP) activities across vendors -
• CURAM - Emphasis on Employee Application and Case Worker Portal with customized triggers to send notices via EP Notify.
• CONNECTURE - Emphasis on Quality Health Plan (QHP) Presentment, Employer Application and Enrollment, DEED Interfacing for Employer Eligibility Determination, Group Plan Administration and Employee Enrollment with customized triggers to send notices.
• Worked on streamlining SharePoint to meet project policies and processes.
• Performed Data Mapping for State Administration Enrollment Management function to define the data elements, their source and read only/editable parameters.
• Documented and Analyzed impact upstream and downstream when change in editable data elements in State Administration Enrollment Management function is recorded.
• Documented the “Configure Billing Cycle” scenarios and billing rules for the employer.
• Mapped Employer Subscription Service with Enrollment data from CONNECTURE and identified gaps.

Confidential, Rochester, NY

Business Analyst

Responsibilities:

• Incorporated HIPAA standards, EDI (Electronic data interchange), Implementation and Knowledge of HIPAA code sets, ICD-9, ICD-10 coding.
• Interacted withstakeholdersto get a better understanding of clientbusiness processesandgathered requirements.
• ConductedJAD sessionsto allow different stakeholders to communicate their perspectives with each other,resolveanyissues and come to an agreement quickly.
• Conducted requirement gathering sessions with the purpose of creating and defining theBusiness Requirement Document(BRD) and theFunctional Requirement Document(FRD) usingRationalRequisite Pro.
• Developed Use Cases for each of the Service Types for each of the application - Inpatient, Outpatient, DME, Transportation, Homecare, Referrals, ER Notifications, and Office.
• Responsible for the UAT testing of the ICD 9 to ICD 10 Diagnostic and Procedure codes while reviewing the information to ensure accuracy.
• Developed (UAT) User Acceptance Testing plan to guide a select group of key end-users in testing the user interface and functionality of the application.
• Also developed Requirements Traceability Matrix (RTM) mapping UAT plan and BRD.
• Designed Test Input Sheet for entering cases in different applications.
• Conducted Fields Mapping by explaining each column name in the backend database tables.
• Developed Functional Testing Approach for ICD-10 Remediation and included in UATP Plan.
• Conducted Smoke Testing of the new ICD-10 UAT region and recorded all the testing results in RTM.
• Develop Test analysis report from ALM/Quality Center after test execution.
• Developed UAT Test Cases to cover overall quality assurance testing.
• Performed System testing, Regression testing and UAT for several claim types and test scenarios.
• Compared and validated 5010 system test results with 4010 results for the same test scenarios.
• Reporting experience with business intelligence tools such as Cognos products, Crystal Reports.
• Performed reviews of the test scripts written by others team members against the requirements and suggested any enhancements required.
• Documented the Use Cases and prepared the Use Case, Activity, and Logical views using MS Visio, MS Office and Rational Rose for a clear understanding of the requirements by the development team.
• 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.
• ExecutedSQL queriesto test the database for records that detect and submit functional acknowledgement and remittance advice in the claims application.
• Checked files in Electronic Data Interchange (EDI) transaction support tool and reporting tool and modified the files based upon the errors and also checked them if they were loaded successfully in CIS.
• Conducted extensive Functional and Regression testing.

Confidential, Harrisburg, PA

Business Analyst

Responsibilities:

• Identified the business needs of their clients and stakeholders to help determine solutions to business problems.
• Managed the process of gathering functional requirements from key stakeholders and Subject Matter Experts (SME’s).
• Involved in Joint Application Development (JAD) sessions to define technology applications for business requirements.
• Involved in gathering requirements and mapping the business process to create documentation on workflows.
• Functioned as the primary liaison between the business line and the technical areas throughout the project cycle.
• As a Business systems Analyst, extensively written Use Cases and Business Flows and work flow diagrams for effective plans.
• Performed GAP Analysis with system functionality and existing Business Processes.
• Managed changes to requirements using Change Control processes.
• Used UML and RUP process for productivity in communicating specifications to design & development team.
• Attend weekly change request meetings to document changes and implement procedures to test changes upon completion.
• Ensure projects are delivered to production timely with approvals from business, development, and subject matter experts with all issues resolved or deferred with a resolution plan for a future release.
• Involved in analysis and design with team members to make Use Case diagrams, Activity diagrams using UML/Visio to depict process flows and PowerPoint presentations.
• Analyzed the Business Requirements Document (BRD), modified the Master Test Plan and prepared detailed Test Cases for the UAT.
• Involved extensivelyinUser Acceptance Testing (UAT), andRegression Testing.
• Prepared implementation check out plans and involved in the deployment of the application.
• Extensive use of MS Office, UML and Visio for creating software Architecture documentation.
• Managed scope and requirements throughout the project lifecycle.

Confidential

Jr. Business Analyst

Responsibilities:

• Reviewed the Business Requirements document with the business and development team to understand the architecture and functionality of the application.
• Involved in understanding of functionality and design of different applications based upon the Requirement Specification document.
• Participated and scribed requirements in Joint Application Development (JAD) sessions.
• Acted as liaison b/w end users/business owners and technology team.
• Involved in developing Performance QA strategy and in writing and implementation of the test plan and various test cases.
• Involved in testing of the application manually and tested the design and functionality of the application.
• Created Test Scenarios based on business requirements.