SUMMARY

• Over 7+ years of experience as Business Systems Analyst in the Health Care domain with knowledge of Business Case Development, Development of IT Enabled Business Solutions and Business Analysis.
• Strong knowledge of Software Development Life Cycle (SDLC), waterfall, Agile/Scrum and Rational Unified Process (RUP).
• Extensive experience in gathering Business and Functional Requirements, Business Scope & Vision Document, developing Business Requirement Document (BRD), Functional Requirement Document (FRD), and communication plan, Use Cases, conducting Gap Analysis and Risk Analysis.
• Conducted JAD sessions and Interviews. Adapt in implementing requirements, creating project status reports and presentations.
• Experienced in creating Sequence Diagrams, Collaboration diagrams, Activity Diagrams, Class Diagrams using rational tools and Microsoft Visio.
• Worked with Software Development Life Cycle (SDLC) including Feasibility Study/Gathering Requirements, Analysis, Design, Development, Testing, User Acceptance Testing (UAT), Implementation and Post - Implementation Validation.
• Expertise in creating and executing Test plans, Test scripts, Test cases, for Manual and automated testing.
• Experience creating Traceability matrix to better manage the requirement gathering process and keeping track of the milestones.
• Experienced in Medicare and Health Care Insurance as well as Medical Standards (HIPAA and HL7)
• Knowledgeable in Obama Care.
• Knowledge of HIPAA compliance life cycle, HIPAA insurance regulations and claims processing.
• Thorough understanding and experience in EDI transactions and Codes like: 837 (Health care claims), 270/271 (Inquire/response health care benefits), 276/277 (Claim-status), 834 (Benefit-enrollment), 835 (Payment/remittance advice) mainly Professional and Institutional Claims
• Knowledge of ICD 9-CM (Clinical modification) to ICD-10-CM/PCS (Clinical modification/procedure coding system)and CPT codes for mental and medical health.
• Experience in Conversion of HIPAA X12 4010 transactions to X12 5010 transactions.
• Hands on experience in Claims Adjudication System and Complete Revenue Life Cycle.
• Excellent understanding of Healthcare Jargons like HIX (Health Insurance Exchange), EMR/EHR, HMO/PPO/POS, Health Care Reform and Patience Protection Affordable Care Act (PPACA), Medicare (Part A, B, C, D),/ Medicaid, Medicaid Management Information Systems (MMIS) and Health Care Reform.
• Worked withClaims (NASCO), provider, enrollment, finance, benefits and Vendor ManagementBusiness Areas.
• Knowledge of the current industry methodologies like SEI-Capability Maturity Model(CMM), HIPAA, EDI and Foreign exchange.

TECHNICAL SKILLS

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

Requirements Management Tools: Rational Requisite Pro, Rational Rose, ClearCase, ClearQuest

Operating System: Unix, Windows 2000/XP/Vista

Business Skills: Business Process Analysis & Design, Process Improvement and Implementation Assessment, Requirement Gathering, Use Case Modelling, JAD Sessions, Gap Analysis, Impact Analysis

Languages: C, C++, SQL, JAVA, .Net.

Databases: SQL, Oracle, SQL Server 2000

Methodologies: Rational Unified Process(RUP), Agile, Waterfall, Joint Application Development(JAD)

PROFESSIONAL EXPERIENCE

Confidential, Dallas, TX

Sr. Business Systems Analyst

Responsibilities:

• Participated in Business Modeling by understanding the needs of the business, and also documenting Business Use Cases as well as System Use Cases.
• Facilitated Joint Application Development (JAD) sessions with the Management, Mainframe and HIPAA team to make sure everyone are in synchronous with the business requirement processes.
• Created and Maintained Requirement Traceability Matrix (RTM).
• Conducted meetings with different vendors in order to gather and document system requirements.
• Worked with Data stage developer to extract data from Facets 5.01
• Worked on ASC X12 Benefit Enrollment and Maintenance (834) transaction.
• Extensively used MS Visio to create Use Cases and Sequence Diagrams.
• Assisted development team to translate requirements into technical specifications.
• Prepared mock-up for paper bill both for On Exchange and Off Exchange Members.
• Gathered and documented business requirement for federally facilitated exchange (FFE) members.
• Interacted with Subject Matter Experts (SME) and end users to establish a business analysis around AGILE methodology.
• Used HP Mercury Quality Center 11.0 to report any bugs found and communicate to the developers and product support team.
• Worked with HIPAA rules and regulations to draft business rules and claim processes.
• Conducted User Acceptance Testing (UAT) sessions with business users and prepared document for enhancements and bug fixes.
• Worked with Architect to developed High level system design.
• Created technical specifications for new and existing members from on and off Exchange federal program.
• Worked with Test Coordinator to prepared Test plan and test cases.
• Actively participated in Change Board Meeting for any changes in the business requirements.
• Updated BRD based on Change Request and manage Change Request Document using Microsoft Office.

Environment: MS Visio, MS Project, MS Outlook, Windows XP, HIPAA, Microsoft Office Suite, Microsoft SharePoint, Quality center, Rational Unified Process (RUP), UML.

Confidential, Sacramento, CA

Sr. Business Systems Analyst

Responsibilities:

• Test various change orders of Medicaid applications received from the System Engineer's
• Regression Testing of Web applications and applications dealing with MEDICAID and MEDICARE Services
• Conduct weekly meetings for deciding the Policies and Procedures to be followed while constructing new sites.
• Conduct complex documentation and user needs analysis. Interface with team and staff to develop HL7 integration
• Assist JAD sessions to identify the business flows and determinethe EDI X12 Transaction, Code set and Identifier aspects of HIPAA, impacts any current or proposed systems.
• Develop the strategy for developing and implementing new EDI (HL7 and X12) interfaces and converting historical clinicaland data.
• Conduct business-impact assessment and the results compared with the new HIPAA 5010 standards to determine the currentlevel of compliance and develop an action plan for approval by the project steering committee
• Develop plan for data feeds and data mappings for integration between various systems, including XML, to followICD 10Code set andANSI X12 5010formats.
• Prepare and maintain Business Rules Spreadsheets (BRS) identifying Rules, Triggers and corresponding data fields from Legacy to target CRM application.
• Involve in gap analysis and implementation of HIPAA 5010, ICD 10 and Claim Validations.
• ConductGap Analysis,and GatheredUser Requirements by Interviews, user meeting, JAD session, and Requirement Elicitation Sessions.
• Utilize corporation developed Agile SDLC methodology. Used ScrumWork Pro and Microsoft Office software to perform required job functions.
• Store stakeholder conversations as part of CRM Activities in detail using ACT 5.0.
• Proven Strength in Creating guidelines and templates for designing & developingCRMapplications.
• Involve inanalyzing activities for a variety of major projects includingMedicare Plan part D, Coordination of Benefits, New Client Implementations, Consumer driven and regularly scheduled system upgrades.
• Extensively interact with the stakeholders and the IT Department in finalizing the requirements according to theCMSCompliances/Regulations andHIPAA Regulations.
• HIX enrollment for EDI 834 and 820 transactions.
• Assist to develop the Test Plan, Test Cases and Test Scenarios to be used in testing based on Business Requirements, technical specifications and/or product knowledge.
• Act as a BusinessAnalyst forthe CDS implementation the backbone for data integration among myriad systems, including ERP, CRM, Portal, Workflow Engine,Payroll andrelated interface
• Prepare graphical depictions of Use Cases, Use Case Diagrams, State Diagrams, Activity Diagrams, Sequence Diagrams, Component Based Diagrams, and Collaboration Diagrams and creation of technical design (UI screen) using Microsoft Visio.
• Analyze trading partner specifications and create EDI mapping guidelines.

Environment: HIPPA 5010, EDI X12, Rational Rose, Rational Requisite Pro, Microsoft Visio, Microsoft SharePoint, Microsoft Excel, HTML EDI, XML, HIX, SDLC, ETL, .NET, MS SQL Server

Confidential, Bismarck, ND

Sr. Business Analyst

Responsibilities:

• Defined a complete set of metrics report requirements including a framework that will meet the needs of regional and national business leaders
• Provided analytical data to enable management to make informed decisions to drive continuous revenue cycle improvements by realizing gains in operational efficiency, cost savings and member experience
• Performed GAP AnalysisofEDI 837 transactionfromHIPAA 4010 to HIPAA 5010.
• Created drill down from the high level summary metrics to the supporting detail in the current report format
• Identified performance indicators that provide reliable daily trend information as a primary input towards the monthly executive dashboard report.
• Developed HIPAA EDI Transmissions. Work includes complete business cycle management and hands-on production as well. Create EDI Testing process, documentation, and performance matrices.
• Technical Specification Creation for EDI. Schedule meetings with technical personnel to determine technical parameters for EDI and other related processes, including communication, security, and privacy.
• Create transaction sets requirements, usually with Microsoft Excel, for transactions such as: HIPAA 270/271, 276/277, 835, 837-(I,P, &D), 835 Remittances and others.
• Drafted the existing and known requested list of metrics to the Revenue Cycle process context map
• Analyzed and drafted a functional and technical features list for each vendors, thus identifying the best to send out a RFP
• Created a prototype presentation in Visio for the SCAL region, thus showing a pictorial representation on the various drill downs from the report to the metrics to the database.
• Identified and drafted the calculations used for various regions, using their source SQL’s for standardization purpose.
• Performed Requirement Analysis and developed Use Cases, Activity Diagrams using Rational Rose
• Prepared for GAP Analysis; identified and documented improving areas to meet capital requirement regulations.
• Developed UML Use Cases using Rational Rose and developed a detailed project plan with emphasis on deliverables.
• Involved in interactions with Subject Matter Expert, Project Manager, Developers, and the end-users in more than one JAD sessions. MS Project proved useful in coordinating activities with project manager and various other team.
• Modelled the information and then came up with the requirements prioritization. Eliminated false requirements by screening out multiple versions of user input. Final prioritization was based on both, product and process requirements.
• Provided clear and concise documentation regarding requirements management plans, functional requirements, supplemental requirement
• Performed GAP analysis for the modules in production, conducted feasibility study and performed impact analysis for proposed enhancements.
• Coordinated JAD session with system analysts, development team, project manager for application development and Pre-validation specifications

Environment: Windows XP/2000, Oracle, PL/SQL, MS-Project, MS-Office Suite, MS Visio, Rational Requisite Pro, UML, Clear Case, Clear Quest, ETL, MS Visual Source Safe

Confidential, Roanoke, VA

Business Analyst

Responsibilities:

• Prepared Business and Technical Requirement Document (BTRD).
• Worked on HIPAA Transactions 270, 271, 276, 277, 834, 835 and 837.
• Developed current and ‘to be’ business processes and use case documents in compliance with HIPAA policies and procedures using MS Visio.
• Involved with project management team in developing project plan.
• Written business flow and work flow diagrams to develop software.
• Created Use case diagrams, Activity,Sequence and Collaboration diagrams using UML.
• Worked directly with quality resources to ensure testing activities are in line with the defined business requirements.
• Defined Quality Assurance Checklist using Oracle Service Contract.
• Coordinated with QA and user acceptance testing.
• Maintained a record of recommendations, communications, activities, and schedules to monitor the progress of project in real time using MS Project.
• Interacted with Subject Matter Experts (SME) and end users and established a business analysis around AGILE methodology.
• Gathered requirements from Business Managers, Supervisors, stakeholders, Data Governance Team and subject matter experts through meetings to understand needs of the system.
• Intensively involved in project testing efforts by doing Integration Testing, Regression Testing and by helping UAT team in User Acceptance Testing.
• Effectively communicated user acceptance test (UAT) results between users and development team and provided recommendations for Application change requests (ACR).
• Dealt with HIPAA 4010/HIPAA 5010 transactions.
• Documented various key elements of HIPAAcompliance and made sure that they are understood by the development teams. Test cases written for the project were HIPAA complaint.

Environment: Agile methodology, ETL, MS Visio, MS Project, UML, Win Runner, Microsoft Office, Microsoft Share point.

Confidential, Mayfield Village, OH

Business Systems Analyst

Responsibilities:

• Gathered User and Business level Requirements from various departments and designed the functional specific requirement collection approach based on the project scope using RUP.
• Conducted JAD Sessions periodically with various stakeholders at various phases of the Software Development Life Cycle (SDLC) to discuss open issues and resolve them.
• Documented Business requirement documents, functional requirements documents based on User Requirement Specification and created non-functional requirement documents.
• Prepared Use Case, Briefs & Specifications for all of the functional requirements
• Designed Use case diagrams, Design Models, Activity diagrams and sequence diagrams to analyze the system using UML.
• Designed screens and visual charts during web system development.
• Held regular meetings with business user groups, developers, database developers, quality testers during the entire project to keep track of project and explain future data modules.
• Validated technical designs created by IT developers against functional specifications.
• Worked with QA team to design the test plan and test cases to be implemented.
• Facilitated UAT and test strategies with developers and testers and performed manual front-end testing to check all the functionalities incorporated with the different modules.
• Trained Users on the new applications, using PowerPoint.

Environment: RUP, MS Word, MS Excel, MS outlook, HTML, CSS, MS PowerPoint, MS Project, MS Visio, Rational Rose, SQL Server, Quality Center 10.0

Confidential, Davenport, IA

Business Analyst / UAT

Responsibilities:

• Effectively usedRationaltools for Requirements Management Practices.
• Communicated extensively with the Subject Matter Experts (SME) to gain further knowledge in completing user requirements.
• Planned and defined system requirements, Use Case Scenario and Use Case diagrams for web-based application based onHIPPAcompliancy.
• Prepared Test Plan and Test cases usingQuality Centerfor all the User Stories.
• Participated walkthroughs with the development team to make them understand the requirements and help them formulate test plans and test scripts onEDI 834benefit enrollment.
• Verification ofEDI 834raw data from different portals such as fax, mail or web-sites.
• Performed and analyzedGAP AnalysisofEDI 834 and EDI 835 transactions.
• Participated in meetings with developers and business analysts and reviewed the test cases written, and made changes where necessary.
• Had to make sureHIPAAnorms were addressed along with specific transaction sets.
• Set-up Sprint Planning with theScrum Master.
• Actively participated in Iteration Burn down Chart to accomplish the project in time.
• Conducted dailyScrumMeetings.
• Helped QA team execute test cases as per the user stories.
• Executed ActiveBatchjobs to run Data Conversion procedures for moving data from old system to new system.
• Verified the data on the destination database after conversion usingSQLQueries.
• Tested Image Now application by making changes at central
• UsedQuality Centerfor Defect reporting and tracking, attended daily defect review meetings.
• Involved inMock-go-Liveprocedures to analyze issues that may arise while going pilot and live.
• Developed business cases and providedUse Caseand Activity Diagrams inMS Visio.
• Worked with the end users during theUser Acceptance Testing.
• Verification ofEDIraw data as per the guidelines of implementation guide.

Environment: Quality Center, MS Excel, MS Word, Rational Requisite Pro, ClearCase, MS Visio, Gap Analysis, SCRUM