SUMMARY

• Over ten years of experience as a Business Analyst with Software Development Life Cycle.
• Highly proficient in Business Analysis, SWOT Analysis, Gap Analysis, Risk Analysis, Disaster Recovery Planning, Testing and Project Planning.
• Strong knowledge with Software Development approaches using Agile and waterfall methodologies. Involved in inception, elaboration, construction and transition phases using rational tools such as Requisite Pro, Clear Case and Mingle during various phases of RUP.
• Extensively worked with Heath Insurance, Medicaid, Medicare, Procedural and Diagnostic codes and Claims Processes.
• Extensive knowledge and experience in conducting presentations and requirement gathering sessions for a large group.
• Coordinated meetings with customers, analyst and developers to identify customer needs, gather requirements and authorize Business Requirement Documents (BRD), Functional Requirement Document (FRD) and Software Requirement Specification (SRS) across multiple projects.
• Planned, organized and conducted Joint Application Development (JAD) sessions, Rapid Application Development (RAD) sessions and Joint Requirement Planning (JRP) sessions, interviews, workshops and requirement gathering sessions with end - users, clients, stakeholders and development team based on BABOK specifications.
• Experience in Conversion of HIPAA 4010 codes to 5010 codes and ICD 9 codes to ICD 10 codes.
• Experience working with HIPAA X12 EDI transaction codes such as 270/271(inquiry/response health care benefits), 276/277(Claim status), 834(Benefit enrollment), 835 (Payment/remittance advice/ Explanation of benefits), 837(Health care claim)
• Experienced in creating Sequence Diagrams, Swim lane Diagrams Collaboration diagrams, Activity Diagrams, Class Diagrams and Process Diagrams using rational tools and Microsoft Visio. Ensured the quality of created diagrams are in accordance to BABOK principle.
• Analyzed and documented business requirements and system functional specifications including Use Cases.
• Exceptional oral and written communication skills.

TECHNICAL SKILLS

Project Management Tools: Microsoft Office tools, including MS Project, MS Visio, MS Word, MS Excel, and MS PowerPoint

Methodology: Unified Modeling Language (UML), Agile, and Waterfall

Languages: C, C++, SQL, PL/SQL, HTML and XML

Requirements/Document Tools: Rational Requisite Pro, HP Quality Center, Deal Interactive, Mingle and Serena Team Track

Database: DB2, MS SQL Server.

Testing Tools: HP Quality Center and Quick Test Pro (QTP), Test Director

Modeling/Design Tools: Microsoft Visio, and I Rise

PROFESSIONAL EXPERIENCE

Confidential, Chicago, IL

Sr. Business Analyst consultant

Responsibilities:

• Assisted with the Business Owners and Management team in the collection of Customer Requirements and System Requirements.
• Assisted with the Business Management team in the collection of User Requirements and Business Requirements to create the Customer Requirement Specifications (CRS) and, using MS Word and MS Visio that provided scope of work for technical team to develop prototype and overall system.
• Worked with requirements for optimizing the performance, configuration, and content enhancements to the Retail Producer Portal (RPP), the website that serves 62,000 users from the agent community and internal users.
• Served as a Product Owner for the RPP, the responsibilities includes issue resolution, defect tracking, defect prioritization, future enhancement planning, approving business and system documentation and user testing to align the current and future needs of the agent community.
• Worked with Requirements, system testing, user acceptance testing and user manuals creation for Vantage Application Processing (VAS), Vantage Data Entry (VDE) and Vantage Membership Systems (VMS).
• Document BRDs, CRS and SRS using MS Word and MS Visio that provided scope of work for technical team to develop the prototype and the overall system.
• Develope change management strategies based on situational awareness and details of the change that potentially impacted the projects/groups.
• Work alongside CMS with 834 data elements to assist the application and enrollment system issues and served as a Point of Contact for CMS related data issues.
• Write requirements in agile story formats and tracked them on HP Quality Center, Mingle and Deal Interactive.
• Apply structured change management approach and methodology for the people side change caused by projects and change efforts.
• Manage measurement systems to track adoption, utilization and proficiency of individual changes.
• Work with Legacy Membership System’s Subject Matter Experts (SME’s) to ensure that the extracts were properly mapped.
• Propose new strategies to implement seamless process to implement Exchange plans instead of current ACA plans.
• Develop Wireframes for User Interface (UI) to capture reporting tool for Migration Database
• Work with cross functional teams to analyze current business capabilities to ensure that the firm stays competitive within healthcare markets.
• Closely work with regulatory Confidential executive groups that concerns with Affordable Care Act (ACA)
• Work with Project Manager to come up with timelines for project implementation.
• Define user stories and acceptance criteria, taking into account functional and nonfunctional requirements
• Work with Vantage Systems that provides relational database and XML-based architecture to support enterprise claims management systems.
• Work with software design and test engineers to breakdown high level epics into granular agile user stories
• Take a holistic approach to user story definition, including things like technical feasibility, resiliency, and information security
• Creatively solve challenging business and technology problems

Environment: Vantage, .Net, Mainframes, HP Quality Center, Deal Interactive, Mingle MS SharePoint, MS Project, MS Visio.

Confidential, Des Moines, IA

Lead Business Analyst consultant

Responsibilities:

• Worked with requirements for a Compliance Project to remove remaining credit card data from Marsh and Mercer consumer systems and archived records, but still provide participants the option to pay with a credit card.
• Assisted the team with conducting AS-IS and TO-BE analysis and assisted in developed process models and systems integration structure. Researched best practices; identified unnecessary steps as well as where improvements could be made.
• Worked alongside the Project manager with assisting the project team to integrate change management activities into the overall project plan.
• Proposed new strategies to implement seamless process to implement PCI compliance for all Mercer and Marsh consumer systems.
• Facilitated meetings with the technical and Business teams to analyze the current process and gather requirements for the proposed process.

Environment: VRC, .Net, Java, MS SharePoint, MS Project, MS Visio.

Confidential, Plantation, FL

Sr. Business Analyst consultant/Scrum Master

Responsibilities:

• HIPAA compliance and EDI transaction sets and actively participated in the designing of the EDI transactions using the new HIPAA 5010 version also including the use of ICD-10 codes.
• Assisted the project manager in the creation of the Project Charter.
• Facilitates scrum ceremonies (grooming, sprint planning, retrospectives, daily stand-ups, etc.)
• Tracked and communicated team velocity and sprint/release progress, enact change and continuous improvement increasing the productivity of Scrum teams.
• Working with the clinical and technical team, prepare data to support key clinical processes at Magellan Health: physician and hospital performance, reporting to external entities (CMS, Leapfrog, payers, etc.), population health, clinical productivity, key performance indicators, and operational improvement.
• Worked with the integration and implementation all the latest HIPAA standards, Electronic Data Interchange (EDI 835,837,270,271) transaction syntax like ANSI X12, ICD-9, ICD-10 coding and HL7..
• Conducted AS-IS and TO-BE analysis and assisted in developed process models and systems integration structure. Researched best practices; identified unnecessary steps as well as where improvements could be made.
• Developed and operated clinical analytical tools (such as cube, reports, dashboards) to support company projects and functions
• Identified, analyzed, and interpreted trends or patterns in complex data sets for Clinical Reporting data projects. Develop graphs, reports, and presentations to summarize key results.
• Worked with Claims data management and data quality issues from the provider standpoint.
• Worked with IS 01 - Electronic Health Record (EHR) Laboratory Results Reporting.
• Formulated AS-IS and TO-BE analysis of the business process using GAP analysis.
• Conducted and facilitated Joint Application Development (JAD) sessions to reduce time spent in moving information between stakeholders and team members
• Wrote Test Cases and Test Plans for the related and assigned scripts according to the test strategies defined in the project and testing team guidelines in Quality center.
• Created and implemented change management plans that maximized employee engagement.
• Worked alongside the Project manager with assisting the project team to integrate change management activities into the overall project plan.
• Tracked and maintained Stakeholder requested enhancements and changes using Requirement Traceability Matrix (RTM).
• Worked with risk management team and identified and analyzed different critical areas of business and the risk involved and then modified business processes to reduce risk.
• Conducted various types of internal Audits including Financial and other systems audits.
• Gained Compliance audit experience due to exposure to the legal/audit consulting groups. Recommended corrective actions along with the progress against Development/Action Plan routinely to the Project Manager.

Environment: C#.Net Waterfall and Agile, .Net, HP Quality Center, SQL Server, MS Project, MS Visio, Mainframes, and Windows XP

Confidential, Oklahoma City, OK

Business Analyst consultant

Responsibilities:

• Gathered requirements from stakeholders for provider management and member management.
• Developed the stakeholder list and created stakeholder assessment matrix to prioritize them.
• Developed and maintained a requirements work plan and assessed the performance metrics of the team members.
• Conducted Impact analysis when there was any change in the requirements and updated the Business Requirements Document (BRD) and Systems Requirements Specification (SRS).
• Facilitated meetings with the technical team and client team to analyze the current process and gather requirements for the proposed process.
• Facilitated JAD sessions for Requirement Validation with Dept. of Health & Human Services (DHHS) to gather requirements for the new MMIS.
• Developed UAT test cases associated with the functional requirements.
• Maintained a bi-weekly status report for the requirements team and incorporated the same to the PMO status reports send to CMS.
• Analyzed different data cross-walks, complicated logic and look ups required by different fields for the source to target transformations.
• Worked with legacy team in developing BRD for multiple system change requests and participated in system testing.
• Used Microsoft SharePoint as the version tracking tool for managing the requirements documentation.
• Created monthly/weekly status reports to update the project schedules and deliverable plan.
• Examined the system design deliverables and validated it against the Request for Proposal (RFP).

Environment: Waterfall, HP Quality Center, Windows, SQL, RUP, MS Visio

Confidential, Lansing, MI

Business Analyst consultant

Responsibilities:

• Gathered requirements from stakeholders for provider management and member management.
• Identified and validated business rules and data elements.
• Developed the stakeholder list and created stakeholder assessment matrix to prioritize them.
• Developed and maintained a requirements work plan and assessed the performance metrics of the team members.
• Modeled the ‘as-is’ process flow and the ‘to-be’ process flow and analyzed the gap and developed the action steps to fill the gaps.
• Conducted Risk analysis and developed mitigation plans.
• Conducted Impact analysis when there is any change in the requirements and updated the Business Requirements Document (BRD) and Systems Requirements Specification (SRS).
• Facilitated meetings with the technical team and client team to analyze the current process and gather requirements for the proposed process.
• Propose strategies to implement HIPAA 5010 in the new MMIS system.
• Developed the User Interface (UI) prototypes to capture and validate requirements and spike solutions to the current problem.
• Designing Functional Specifications for the target physical database.
• Facilitated JAD sessions for Requirement Validation with Dept. of Health & Human Services (DHHS) to gather requirements for the new MMIS.
• Developed UAT test cases associated with the functional requirements.
• Maintained a bi-weekly status report for the requirements team and incorporated the same to the PMO status reports send to CMS.
• Analyze different data cross-walks, complicated logic & look ups required by different fields for the source to target transformations.
• Participated in developing test plan, test scripts, and test scenarios and designed user documentation.
• Worked with legacy team in developing BRD for multiple system change requests and participated in system testing.
• Used Microsoft SharePoint as the version tracking tool for managing the requirements documentation.
• Create monthly/weekly status reports to update the project schedules & deliverable plan.
• Examine the system design deliverables & validating it against the Request for Proposal (RFP).

Environment: Mercury Quality Center, Windows. MS SQL, RUP, MS Visio