SUMMARY

• 6 Years of diverse experience in information technology as in developing, implementing innovative business processesandworking in Project Management environment
• In - depth knowledge and experience in full SDLC with RUP, agile and waterfall methodologies.
• Functional experience in health Care Industry with vast knowledge on Medicare and Medicaid
• Participates in requirements analysis and verification sessions for complex projects and also lead requirements analysis and verification sessions for less complex projects.
• Experience in creating Process diagram, prototypes, IA and UX using Axure, Visio, and more.
• Conferred with Business Users to Gather Requirements for the development teams.
• Worked closely with Project manager
• Experience in ETL Data Warehousing, database testing using Informatica for Workflowprocess.
• Expertise in creating prototypes and mock-ups for user interface designs with the use of Axure, MSVisio, Photoshop
• Expertise in impact analysis on the key application systems (claims processing, reporting, payments) and business process of health insurance companies.
• Vast knowledge of EDI transaction in claim processing.
• Clear understanding of ICD-9-CM and ICD-10-CM/PCS
• Well versed with ANSI X12, HIPAA and HL7 standards.
• Expertise in creating prototypes and mock-ups for user interface designs with the use of Axure, MSVisio,
• Expertise in impact analysis on the key application systems (claims processing, reporting, payments) and business process of health insurance companies.
• Experience in writing SQL queries to generate reports, extract data from Database and for data mapping.
• Reviews, edits, analyze and create detailed documentation of business systems and user needs. Responsible for writing all documentation in clear and well organized manner
• Participate in the preparation and execution of test plans
• Experience with Data Warehouse/ETL testing by using SQL scripts.
• Experienced in performing UAT testing, Ad- hoc testing to identify any usability problem
• Medical Claims experience in Process Documentation, Analysis and Implementation in 835/837/834/997 (X12 Standards) processes of Medical Claims Industry from the Provider/Payer side
• Exceptional ability to maintain and build client relationships with business owners to identify, prioritize and document business requirements.
• Extensive experience in Healthcare/Claimsadjudication and Member enrollment with knowledge of industry compliance standards like HIPAA and EDI X12 transactions (834, 837, 835)
• Proficient in all phases of Requirement Management, including gathering, analyzing, detailing, and tracking requirements.
• Extensively worked as a UAT tester
• Expertise in Claims, Subscriber/Member, Plan/Product, Claims, Provider ofFacets.
• Experience in Business Requirement and System Specifications Analysis.
• Specialized in creating UML Diagramslike Use Case, Activity and data flow diagrams using Rational Rose and MS-Visio and consistently translate business requirement into IT solutions.
• Extensive knowledge of reporting tools such as SQL and ACCESS for underlying database tables and resolve data issues.
• Expertise in RDBMS concepts and running SQL queries.

TECHNICAL SKILLS

Microsoft Technologies: MS Project, Visio, Excel, Word, Outlook, PowerPoint

Requirements Management: Rational Requisite Pro

Business Modeling: Rational Rose, MS Visio, Axure

Defect Tracking Tools: HP Quality Center, Rational ClearQuest

Languages/Standards: SQL, XML, HTTP, Java, HIPPA 4010/5010, ICD9/10, ANSIX12

Methodologies: Rational Unified Process (RUP), Agile, Waterfall

PROFESSIONAL EXPERIENCE

Confidential, Columbus OH

Business System Analyst

Responsibilities:

• Gathered Requirements from technical and non-technical stakeholders.
• Performing Impact analysis for readiness of ICD-10 conversion.
• Documented future state (Requirements) using Visio diagrams using BPMN diagrams and Excel spreadsheets.
• Prepared Business Requirement Specification Document (BRD) and converted into Technical requirement specifications document (TKD)
• Developed and conducted HIPAA 5010 and ICD-10 awareness program for all staff in Philadelphia.
• Gathered requirements and Performed Analysis of ICD 9 Procedure and Diagnosis Codes in accordance with ICD 10 CM and ICD 10 PCSConversionCompliances.
• Performed impact analysis for deadliness of ICD-10 conversion.
• Worked effectively with fellow scrum team to deliver a good result
• Coordinate in Scrum meetings, Walk through, and JAD session.
• Actively Participate in the requirements management processes
• Create use cases and process flow diagrams for Claim processing
• Created a variety of IA and UX artifacts for claim processing. Deliverables included: wireframes (Axure and Fireworks), process diagrams (Axure and Visio), personas (InDesign and Word), prototypes (Axure and hand-coded HTML / CSS / JS), and more.
• Conferred with Business Users to Gather Requirements for the design and development teams.
• Facilitated Meetings with stake holders.
• Extensively worked with the Project manager
• In dept knowledge of various EDI files, 837, 834, 835.
• Utilized survey assessment results of ICD-10 to create listing constraints, processes, projects and systems, applications and vendor software to be impacted by the ICD-10 Conversion Project.
• Worked with the Management during the Scope and Blueprint stage in creating Business Process and Procedures. Mapping the integrated scenario of client's Business process.
• Ran multiple SQL Queries on SQL Server databases and MS Access databases
• Involved and worked updating the official changes to the tabular list, instruction manual and alphabetical index of ICD- 9 to ICD-10 in regards to data transactions.
• Created, Modified and Deleted tables as needed in MS Access, Created, Modified and Deleted data in tables, edited stored procedures and views
• Involved in creating mappings for conversion ofEDI X12 transactions code sets version and translation of ICD 9 codes into ICD 10 codes.
• Demonstrated excellent understanding of relational DBMS.
• Help in preparing the training material of the providers and insurance companies using the software supporting ICD 10.
• Executed stored procedures.
• User Stories, Use cases, detailed requirements, requirements specification design TSD, TKD, TDD, wireframes/blueprints, business process modeling, process mapping, user stories.
• Created Data mapping documents for ETL.
• Gathered requirements for ETL Specifications.
• Involved in forward mapping from ICD 9 to ICD10 and backward mapping from ICD10 to ICD9 using GEM.
• Wrote ETL Specification documents.
• Identify and address areas of discontinuity between ICD 9 and ICD 10 so as to avoid unnecessary mappings.
• Helped to create a System Development Life Cycle and approval system
• Oversee the preparation of implementation plans and user guides as required
• Tested results of ETL processes for data and process correctness.
• Maintained Product Backlog and Issue lists.

Environment: UML, RUP, Rational Requisite Pro, Microsoft Visio,Rational clearQuest, Excel, SQL, DB2, Crystal Report, HP Quality Center

Confidential, Louisville, KY

Business System Analyst

Responsibilities:

• Responsible for the requirement-gathering phase and project plan.
• Responsible for requirements analysis, design and developing technical requirements.
• Responsible for the full HIPAA compliance lifecycle from gap analysis, mapping, implementation and testing for processing of Medicaid Claims.
• Responsible for GAP analysis of ICD9-ICD10.
• Embrace agile principles. Support iterative user experience design, involving UX research and UX design at all stages of product development
• Created Variety UX artifacts. Deliverables included and wireframes
• Responsible for gap analysis in changing old MMIS and Involved in testing new MMIS.
• Recommended improvements for Business process.
• Developed tests scripts based on the different styles like Low cap value, high cap value etc and analyzing them.
• Used HIPAA 4010 transactions to support the analysis of current business processes and work with management to improve and implement enterprise solutions to ensure compliance and got involved in designing future state processes for HIPAA 5010 transaction processing EDI’s 837, 835, and 834 andICD-10 Code sets.
• Acted as a SME for the application team and the Infrastructure team.
• Analyzed HIPAA 5010 related to 837,835, 834. Transactions and performed gap analysis between the 4010 and 5010.
• Used RequisitePro for writing/analyzing project vision, goals, specifications and requirements.
• Participate in the requirements management processes.
• Conduced Joint Application Development (JAD) sessions and walk in interview with the business users to gather requirements.
• Matched the requirements for programs such as Medicare and Medicaid, which are part of the Social Security Act.
• Created Use Cases diagram and Activity diagram to depict the interaction between the various actors and the system in RationalRose for the Business Use Case and System Use Case.
• Conducted the FRS and URS reviews and walkthroughs with designers, developers and stakeholders. Also conducted feasibility and adaptability study.
• Conducted JAD Sessions with Infrastructure management team, SME, policy holders and stakeholders for issues which were open and pending.
• Extensively Performed UAT testing
• Analyzed forms and successfully crosswalk details to corresponding ANSI X12 formats.
• Tested the changes for the front end screens in FACETS related to following modules, test the FACETS batches (membership, Billing, Provider, etc).
• Developed the business anomalies workarounds and described them in documentation and presented the matter to the upper management for review.
• Developed non-functional and functional requirements and documented them as Business Rules, Quality attributes and constraint documents.
• Interacted with database developers for formulating the ER diagrams and data flow diagrams.
• Held regular JAD meetings with the system architects, developers, database developers, quality testers during the entire project to assure that the critical as well as the minute details of the project were discussed and issues were resolved beforehand.
• Worked With HIPAA compliant ANSI X12 837 formats for both professional claims and institutional claims.

Environment: Windows, MS Project, MS Office MS Visio, SQL, Facets, Oracle, s, Quality Center.

Confidential, Jacksonville, FL

Business System Coordinator

Responsibilities:

• Managed requirements from system users and preparation of business requirement documents using Telelogic DOORs that provided appropriate scope of work for technical team to develop prototype and overall system.
• Created UML diagrams using Rational Rose and MS-Visio for Use Cases and Activity Diagrams, for better understanding of the layout of the new process.
• Gathered the functional and business requirements by conducting JAD sessions and participatory Design Sessions involving major leads from the Technical Department.
• Developed Business Requirement Document and Use Cases Scenarios for various Use Cases.
• Utilized RUP methodology and RUP best practices for Software Development.
• Gathered requirements and participated in database design and development as well as report design and development, testing plan co-development and quality assuranceDeveloped Documentation Plan and Strategy.
• Helped testers to create Test scenarios and test cases for testing migration.
• Translated business requirements to functional specifications for IT, managed changes for the specifications.
• Defined Logical Data Model.
• Developed end user training Plan.
• Prioritized business requirements and translated them into technical requirements.
• Gathered requirements from business users and wrote Business Requirement Document and Technical Requirement Documents.
• Use different Data Analysis techniques to understand if there is any gap
• Created Use Cases from Business Requirements and designed traceability matrix to make sure that all the intended functionality has been implemented.
• Created Functional Specification Document, Technical Requirement Documents.
• Extensively used Unified Modeling Language (UML) to draw the business logic
• Created Process Flows and Entity Relationship(ERD) diagrams for brainstorming purposes
• Created Business Requirement and Technical Requirement documents using existing templates.
• Created Mockups of reports using available data resources.
• Created test data from Development and Production Data.
• Performed walkthroughs with Development and QA.
• Testing data and processes through running and scripts using IBM’s Rational Test Manager.

Environment: Windows, MS Project, MS Office MS Visio, SQL, Facets, Oracle, Quality Center.

Confidential, Rockville, MD

Business System Analyst

Responsibilities:

• Gathered Requirements, Developed Process Model and detailed Business Policies.
• The SDLC Methodology used was Agile or Scrub.
• Gathered functional business requirements from process owners and developed functional specifications for application enhancements.
• Good Understanding of the EDI (Electronic data interchange), Implementation and Knowledge of HIPAA code sets.
• Identified the impacts and assisted in training users on new policies / procedural changes.
• Conducted and substantiated JAD sessions with different Business Users to develop new policies and procedures for the Service Catalogue, Charge Capture and Service Worklist /Charge Router, Hospital billing, coding, special coding requirements and claim processing.
• Performed GAP analysis between 2 application for the Data Migration and Conversion.
• Developed Use Cases and Test Cases for the Business Users, Developers and QA team.
• Performed Impact analysis for readiness of ICD-9 standards.
• Attributed claims processing and payments to third-party providers, monitoring charges and verified correct payment of claims.
• Streamlined and transcribed denial letters on claims followed-up requests for information.
• Identified security risks in medical billing and addressed in requirement document to avoid the security breaches.
• Developed an implementation guide for Partners for EDI X12 transactions such as 834, 835,837,270 and 271.
• Computed flexible solution for patient treatment plan and patient care plan.
• Designed the tight user authentication and application security.
• Co-ordinate business activities with Subject Matter Expertise (SME) and identify business issues, best practices and performance of other competitors using MS Visio..
• Worked with developers to test the iterations of the system under development (SUD) to ensure it met the user’s needs.
• Interacted and assisted the entire team on the testing tools and processes.
• Written and executed Test cases for the application when in (UAT) Environment.
• Involved in evaluation of the user request for new or modified program to determine feasibility, cost and compatibility with current system, and computer capabilities.

Environment: MS Office, Visio, SharePoint, UNIX, SQL, Toad, DB2, CMR, Citrix, Rational Suite, Windows 2000/XP,QC