SUMMARY

• Over 7 years of experience in Business Analysis in Healthcare domain with advance knowledge of industry standards, SDLC practices and UML tools.
• Worked closely with various stakeholders, SMEs and staff to understand and document Business, Functional and Software requirements.
• Researched, created and reviewed requirement documents along with business Use Cases.
• Excellent knowledge of industry standard methodologies such as SDLC and worked on all the phases of Waterfall, Agile and RUP.
• Excellent in Analytical and Technical skills in gathering business requirements with SME’s for BRD, FRD, SRS, Business Flow Documents and Use case documents.
• Experience in testing Electronic Data Interchange (270, 271, 834, 835, and 837) according to HIPPA Compliance 4010, 5010, ICD - 9 and ICD-10.
• Functional experience in Claim life Cycle and Health care Payer/Provider domain process along with various line of health insurance system like PPO, HMO, POS and CHIP.
• Excellent communication skills, listening, verbal and writing and very flexible with working hours.
• Worked with Medicaid and Medicare and knowledge of CMS MITA and MMIS.
• Extensive experience in conducting requirement gathering sessions of JAD, SCRUM, JRP Brainstorming and interviewing stakeholders with superior organizational and presentation skills.
• Experience of performing as a liaison between the business and the stakeholders.
• Hands on experience working on HL7 Messaging Standard Claims processing, Medicare/Medicaid risk processing, Provider network management, Clinical edits.
• Experienced in Data Analysis techniques such as Data Flow Diagram, Data Mapping, feasibility studies and scope.
• Worked on Change Management by using Impact Analysis, Gap Analysis. Developed Requirement Traceability Matrix using MS-Excel.
• Experience in analyzing and creating Use Cases, Use Case Diagrams, Business Flow Diagrams, Navigational Flow diagrams, Swim Lane Diagram, and Sequence Diagram.
• Extensively worked with the On-site Quality Assurance Groups by assisting the QA team for developing Test Plans, Test Cases, Test Scripts and JIRA.
• Assisted System analysts in Claims Data migration and other ETL concepts.
• Familiar with MS Projects to manage projects plan, scope, schedule deadlines, resources and collaborate with different teams to analyze project information.
• Assisted QA for UAT, IST during the testing phase.

TECHNICAL SKILLS

Methodologies: SDLC, Agile, RUP, Waterfall, JAD, JRP, UML, SWOT, GAP, RTM

Business Modeling Tools: Rational Rose, Microsoft Visio

Requirement Gathering Tools: Rational Requisite pro

Version Control System: Rational Clear Case

MS Office Suite: MS Word, MS Excel, MS Power Point, MS Outlook, MS Project

Team Collaboration Tools: SharePoint

PROFESSIONAL EXPERIENCE

Confidential, Iselin, New Jersey

Business Analyst

Responsibilities:

• Scheduled meeting with project manager and stakeholders for discuuisng the requirement and mae
• Created RTM in Excel to ensure the full coverage and traceability of business requirements.
• Facilitated JAD session with the SME, process owners, stake holders, technical team and prepared training manuals and enhancements to be implemented in current Medicare processing system
• Recommended changes for system design, policies and workflow affecting Medicare/ Medicaid claims processing system in compliance with current government process HIPAA and EDI.
• Served as a liaison between business and the project team in identifying, understanding, and documenting their business needs.
• Followed the sunshine act to track the bills information.
• Developed an implementation guide for EDIx12 transactions such as 834,835,837,270 and 271 in the current claims processing system in accordance with HIPAA regulation.
• Experienced working on MMIS and MITA.
• Coordinated with SME for technical team in development of Claim Handling System Medicare/Medicaid Claim Processing & Pricing, Clinical edits, and Provider Network Management on Facets platform.
• Performed GAP and Impact Analysis on ICD-9 to ICD-10 transition.
• Conducted brainstorming sessions to analyze provider contracts, medical policies and medical management rules for transition of ICD-10 Codes.
• Performed the Impact analysis to identify problems, risks, concerns associated with the ICD-10 implementation.
• Prepared Process flow diagrams and Use Cases for easy interpretation of system functionality.
• Assisted the QA team in preparing test plans, test cases and test scripts
• Assisted the Data Analyst on Data Mapping for ICD-10 implementation.
• Used SQL Queries to validate data at the backend to ensure that all the claims related data has been loaded to the appropriate data sets.

Environment: RUP, UML, JAD, SharePoint, MS-Office MS-Project, HPQC, JIRA, MS Visio, GAP Analysis, Rational Clear Case, Rational Clear Quest.

Confidential, New York

Business Analyst

Responsibilities:

• Assisted the project manager in project management activities like defining scope, timelines and work plans using MS-Project.
• Utilized Agile/Scrum methodology and documented the artifacts throughout various phases.
• Assisted the scrum master in planning the iterations, sprints, scrum sessions and standup meeting.
• Conducted Joint Requirement Planning (JRP) with management and SME users to develop specifications for HIPAA 5010 implementation with the sunshine act consideration.
• Gathered user stories for each sprint and prepared BRD and FRD for critical user requirements in each iteration.
• Tracked and maintained stakeholders request enhancements and changes using Requirement traceability matrix (RTM) on MS Excel.
• Acted as a liaison between the business and the tech team for following the sunshine act.
• Performed GAP analysis of 4010 and 5010 for EDI transactions 270,271,835,837 and finalized the customization needed for implementation of 5010.
• Understood the process for implementing 5010 HIPAA transactions and identified the new segments changes required with the minimum changes to the existing system.
• Worked on Facets to validate the membership data and claims data.
• Created test scenarios, test plans and developed test cases for testing the products in order to verify that client requirements are incorporated in to the system design and performed UAT.

Environment: SDLC, UML, MS Office, MS Project, SWOT, RML, JIRA, JRP, Agile and Scrum.

Confidential, Milwaukee, WI

Business Analyst

Responsibilities:

• Scheduled meetings with developers, Project managers and Quality analysts to discuss business requirements, test planning, Feasibility Study resource utilization and defect tracking.
• UtilizedRational unified processto create BRD and FRD.
• Worked with cross functional business teams and stored project artifacts using MS SharePoint.
• Developed business requirement and specification documents as well as high-level project plan and translated business requirements into Process models and Use cases using MS Visio.
• Conducted JAD sessions with stakeholders throughout SDLC to resolve open issues.
• Implemented Environmental Health and Safety System (EHSS) in claims processing system in order to prevent incidents that might result from abnormal operating conditions.
• Worked with the management for improving and giving new ideas for designing future process of the HIPAA format dealing with EDI Transactions on Facets platform.
• Processed EDI test files and verified system is able to validate certified and non certified trading partners. Created detailed level test scenarios on HIPAA Compliance testing.
• Reviewed relational database design of the application and conducted multiple SQL querying.
• Reviewed Test scripts, Test scenarios and performed UAT of the application.

Environment: MS Project, RUP/UML, SQL Server, MS Power Point, JIRA, MS Office, Gap analysis, Rational clear Quest.

Confidential, Boca Raton, FL

Business Analyst

Responsibilities:

• Utilized Waterfall and Agile methodology and documented the artifacts throughout various phases.
• Worked on HIPAA 5010 compliance and EDI 837transactions, ICD - 10 Codes
• Studied and analyzed competitor’s applications and brainstormed to gather effective requirements for a quality product.
• Generated various SQL queries as and whenever required.
• Participated in Design walk-through with end users to baseline the business architecture.
• Used Rational Rose to carry out the business modeling and object modeling effort.
• Created Business Requirements and converted them into SRS.
• Created data flow and sequence diagrams to describe how EDI Healthcare Transaction set (837) was used to submit health care billing information.
• Involved in preparing a simple and detailed User manual for the application, for an intended novice user.
• Use HP Quality Center to create test plans and procedures
• Analyzed Requirements and created Use Cases, Use Case Diagrams, Activity Diagrams using Rational Rose.
• Assist QA Project managers in creating test schedules and identify any issues or risks
• Tested the final application for Usability testing to verify the application.

Environment: Waterfall, Agile, UML, MS Visio, Excel, SharePoint, RTM, GAP, Test Director, UAT and GUI.

Confidential

Business Analyst

Responsibilities:

• UtilizedWaterfall and Agile to configure and develop process, standards, and procedures.
• Participated in creation ofBusiness Process workflow diagramswith Stakeholders.
• Conducted meetings and JAD sessions with SMEsto identify key requirements and translated them into BRD and FRS.
• Extensive knowledge of claim life cycle and utilize the knowledge in meeting client’s goals.
• ConductedGAP Analysisof the present system and to be future system and presented to the clients their requirements for the new enhancements.
• Created artifacts such asUse Cases and Sequence Diagramsusing MS Visio.
• Developed RTM using MS excel to trace each software design requirement to test case.
• ReviewedSystem Test Plans and worked with business folks to validate and execute the test scripts. Performed UAT of the upgraded claims processing system.

Environment: Agile/scrum, UML, MS Visio, MS Excel, SharePoint, RTM, GAP, Test Director.