SUMMARY

• 7 years of healthcare experience as a Business Analyst.
• Outstanding communication, writing and presentation skills. Experience working with internal and external stakeholders including senior management.
• Solid understanding of all phases of Software Development Life Cycle (SDLC) methodology (such as requirements gathering, analysis, design, development, data modeling, business process modeling, implementation and deployment).
• Conducted user interviews, gathered requirements, and analyzed the requirements using Rational Requisite pro. Maintained and kept track of stakeholder’s requests for enhancements and changes using Unified Change Management tool (UCM) such as Rational ClearQuest.
• Knowledge of Rapid Application development and Agile Application development methods.
• Broad knowledge of Test plans, Test cases and Test scripts from the Requirements Document.
• In - depth knowledge of Rational Unified Process (RUP), Agile/Scrum; risk engineering, data modeling and mapping, and design using UML (Unified Modeling Language), Rational Rose and Visio.
• Good knowledge of Oracle and Microsoft SQL databases.
• Provided direction to Data Warehouse team members in adopting new technologies and developing new business solutions.
• Proficient in medical terminology and coding outpatient and inpatients diagnosis and procedures by using ICD-9 codes. Knowledge of ICD 10.
• Excellent knowledge of HIPAA (Health Insurance Portability and Accountability Act) transaction codes such as EDI 270/271 (inquire/response health care benefits), 276/277 (claim status), 835 (payment/remittance advice), 837 (health care claim) and 834 (beneficiary enrollment).
• Capable of managing multiple projects simultaneously.
• Exceptional problem solving skill and sound decision making capabilities.
• Experience in writing queries/scripts for data analysis and QA report testing.
• Conducted successful projects by collaborating with multiple teams to achieve deadlines in a timely and efficient manner.
• Experience in User Acceptance Testing (UAT), Smoke Testing, Regression Testing, Performance Testing and Functional Testing.
• Experience working in Medicare and Medicaid projects.
• Experience in conducting SWOT Analysis, Cost Benefit and ROI Analysis.
• Created Requirements Traceability Matrix to keep the stakeholders informed of the progress of the project.
• Experience in Health Insurance Claim process including Claims Billing, Claims re- pricing, Claims Payment Processing, social services, Medicaid and Disease Management.
• Belief in team work, dedication, and professional ethics within the working environment.
• Extensive experience in conducting Joint Application Development (JAD) sessions for project definition involving analyzing requirements, creating prototypes, user interface, database schema and system design.
• Well versed with FACETS claim adjustments, claim processing from point of entry to finalizing, claim review, identifying claims processing problems, their source and providing corresponding solutions.
• Extensive experience in gathering Business/Functional user requirements, creating Use Cases as per user requirements, developing/designing UML diagrams such as Use Case, Activity, Class and Sequence diagrams, and in addition to creating Business Requirements Document (BRD) and FRD.
• Organized, goal-oriented, self-starter, and ability to master new technologies, manage multiple tasks while following through from initiation to completion.
• Flexibility in adapting to a wide range of work environments.
• Extensive experience in working in a Customer - oriented environment.
• Ability to inculcate new relevant skills with ease in a time sensitive frame.

TECHNICAL SKILLS

Methodologies: RUP, Agile, SCRUM, UML, Six Sigma

Testing Tools: Rational Enterprise Suite, Test Director, Load Runner, HP Quality Center, Quick Test Pro (QTP)

Change Management Tools: Rational Clear Quest, Test Director

Business Modeling Tools: Rational Rose, Microsoft Visio

Version Control Systems: Rational Clear Case

Project Management: Microsoft Excel, Microsoft Project, Microsoft Office, Crystal Reports

Programming Languages: SQL, PL\SQL, Visual Basic, Java, C, C++, HTML

Databases: Oracle, MS SQL Server, MS-Access.

Web Technologies: Microsoft FrontPage, Facets, SharePoint

Mathematical Packages: Matlab, MathCAD

Multimedia: Adobe Photoshop and Fireworks

Platforms: Windows NT/2000/XP/Vista/7, MSDOS, Mainframe, Linux, UNIX

PROFESSIONAL EXPERIENCE

Confidential, Baskin Ridge, NJ

Business Analyst Lead

Responsibilities:

• Conducted user interviews, gathered requirements, analyzed and documented business requirements based on the analysis of loan processing workflow model
• Prioritized the requirements gathered from business users, domain experts through interviews and JAD sessions
• Developed Use cases, Test Cases for the Business users and QA team.
• IRS 1095-A form generation and verification process.
• CMS scenarios requirements.
• Review, analyze and create detailed documentation of business systems and user needs, including workflow, program functions and steps required to develop or modify application programs.
• 820 Premium payments system integration process.
• 834 generation and validation with Carriers.
• Assist in End to End testing for business scenarios.
• Conducted JAD sessions with State BA.
• Review Product Require Document with State Business users.

Confidential, Detroit, MI

Business Analyst Lead

Responsibilities:

• Conducted JAD sessions. Focus groups and individual interviews to facilitate elicitation with regards to analysis, specifications, and design of the relevant business processes and systems.
• Conducted workflow, process diagram and gap analysis to derive requirements for existing systems enhancements.
• Modeled functional requirements using MS Visio to create Use Case Diagrams, Activity diagrams, Sequence Diagram and logical Class Diagram for interaction between the various actors and system and to supplicate the Workflow Models.
• Researched on the medical disciplines and documented Business Requirements Document.
• Traced High level into Detailed Requirements in Functional Requirements Document (FRD).
• Working on the activity diagrams, File Transfer Specification (FTS), Required Repository Template (RRT) in Coordination of Benefits, Benefits translations, Utilization Management and Referrals.
• Aided in workflow analysis and process design.
• Developed plan for data feeds and data mappings for integration between various systems, to follow ICD 9/ICD 10 Code set
• Responsible for conducting gap analysis as is to be for ICD9 and ICD10.
• Assisted with user testing of systems (UAT) and ensuring that appropriate documentation is in place
• Executed UAT test cases with Business users to ensure proper data mapping and data load into the systems.
• Facilitated and reviewed test plans during system development and quality assurance testing; participated in User Acceptance Testing (UAT) and facilitated issue resolution including communicating end state solutions to business.
• Conducted joint discussion sessions with business users and stakeholders to understand the requirements in more detail.
• Developed project plans and managed project scope.
• Interacted with Data Warehousing team in Metadata Modeling and gathering requirements for product catalogue data load specifications for Data mapping and Data Modeling.
• Gathered requirements and prepared Business Requirements Document (BRD).
• Created RRTs for the claims migration pricing process.
• Helped in determining the application flow (activity diagram) of various entry point in enrollment application.
• Helped in determining and documenting the marketing strategies to retain current subscribers and attract new subscriber.
• Determining the correct route to sent various letters for 2013 subscribers at various point in letters and emails campaign.
• Acquiring the business rules related to Group Drop, Enrollment Reminder and Last Call letters to 2013 Group and Individual subscribers.

Environment: MS Office Excel, Word, PowerPoint, MS Project, MS Visio,UML, Rational Unified Process (RUP), Rational Suite Requisite Pro, Rational Rose, Windows XP.

Confidential, Tampa, FL

Business Analyst

Responsibilities:

• Used UML diagrams for data capture activities which required working with SMEs to ensure consistency and accuracy of data during the data loading process and that the data passes validation and integrity constraints with corporate database repositories.
• Clear understanding of Medicare (Part A, Part B and Part D) and Medicaid benefits as well as business processing.
• Involved in process analysis and defined executed data migration plans for local data for global applications.
• Worked with UB92/UB04, CMS 1500 claims and HIPAA 834, 835,837, 270/271, 276/277, 278 transactions.
• Database support that includes activities required to correct, delete or summarize medical history of members as well as provider information.
• Experience in CMS and MMA Guidelines.
• Collaborated on the development of user requirements and design specifications using standard UML techniques such as use case, activity, sequence, and class diagrams.
• Conducted JAD sessions, Focus groups and individual interviews to facilitate elicitation with regards to analysis, specifications, and design of the relevant business processes and systems.
• Thorough understanding of health benefit products, assisted in consolidating the summary of Benefits.
• Executed Smoke, Functional, Integration, End-to-end and Regressions Tests in each environment by tracking the test status in Quality Center (Test Director).
• Applied advanced Excel skills (pivot tables, macros, lookups, charts) and Access database querying skills in streamlining and automating accounting processes.
• Documented detailed business, functional, and User Interface system specifications using standardized company templates for the business, development, and QA team.
• Build relationships with Information Systems and other relevant business partners, balancing practicalities with innovative and efficient business systems solutions.
• Helped developers with the following list of HIPAA-EDI Transaction Code sets: (837, 835, 270/271, and 276/277).
• Created test cases and performed manual testing of the functionality of the application by inserting varying data on different test runs.
• Documented Requirement Traceability Matrix in Requisite Pro for traceability of requirements through test cases.
• Developed Forms using MS Access using Forms and Reports for reporting.
• Produced clear user manuals & training guides for User Acceptance Testing (UAT) and deployment for end-clients with step-by-step instructions and created appropriate GUI screenshots.

Environment: HP ALM, SQL Server, UML, Rational Requisite Pro, Test Manager, Clear Quest, Windows XP, MS Visio, MS Access, MS Project, UAT, JAD, MS Visio.