SUMMARY

• Business Analyst with seven plus years of experience in IT projects and expertise in Business Analysis, Requirement Gathering, and Business Process Modeling.
• Analyzed compliance and state reporting requirements and other regulatory reporting for Worker’s Compensation claims.
• Defined models and rules for Medical Billing and Adjudication.
• Created data mapping and translation rules between EDI (, 277, 999) ANSI ASC X12, XML, CSV, flat file formats for both inbound and outbound transactions.
• Practiced Software Development Life Cycle (SDLC) methodologies like Waterfall, Agile, and Rational Unified Process (RUP).
• Gathered requirements using varieties of elicitation techniques such as Workshop, Joint Application Development (JAD), prototyping, and interview.
• Skilled in Business Process Modeling with expertise in creating Use Cases, Class Diagrams, Activity Diagrams, State Diagrams, Sequence Diagrams, Unified Modeling Language(UML) using MS Visio to extract business process workflows.
• Created Business Requirement Document (BRD), Client Requirement Document, and Functional Requirement Document (FRD) based on the analysis of business needs, objectives, and existing system infrastructure.
• Conducted gap analysis and created AS - IS and TO- BE workflow to clarify and demonstrate the mechanics of the existing system.
• Worked in Agile/SCRUM environment and collaborated with product owner to write user stories; participated in sprint planning meeting, daily scrum meeting, sprint review meeting, sprint retrospective meeting; created burn down chart to track progress of work.
• Collaborated with Database and Software Development team and quality assurance (QA) team to ensure requirements and functional designs are translated accurately into working technical designs, and that test plans and scripts served customer needs; worked with QA team to write test plan and test cases; performed User Acceptance Testing (UAT).
• Created Requirement Traceability Matrix (RTM) with RequisitePro and updated documents to in corporate changes.
• Assisted manager in project planning, and task assignment with clear roles, milestones, budgets, and measures of success; created business case document and project charter.
• Experienced in XML, Service Oriented Architecture (SOA), ETL mapping, and extract, transform, and loading (ETL) process, created Data Mapping Document and worked with business to write transformation rules.
• Wrote complex SQL queries to acquire necessary data for analysis and validation; implemented SQL scripts, stored procedures, triggers and indexes for various database operation.

TECHNICAL SKILLS

Methodologies: Agile, Scrum, Waterfall

Requirement Management Tools: Microsoft TFS, Rational RequisitePro, ClearQuest, HP Quality Center, DOORS, Rally, VersionOne, JIRA

Modeling Tools: MS Visio, Rational Rose

Database: MS SQL Server, MS Access, Oracle 9i

Language: VB.NET, VB, HTML, XML, C, C++, Java, CSS

Operating Systems: Windows, Mac OS, Linux, Unix

Others: MS Office Suite (Word, Excel, PowerPoint), SharePoint, MS Project, Confidential OCR solutions, Microsoft Dynamics CRM, Case Manager

PROFESSIONAL EXPERIENCE

Confidential

Business System Analyst

Responsibilities:

• Acted as a liaison between multi- disciplinary team such as Production Technology team, Account Management team, Quality Assurance team, Database and Software Development team, and business clients in gathering, defining, and understanding client’s requirements.
• Collaborated with Supervisor, Subject Matter Experts (SMEs), and Product Managers to find the best approaches to address the client’s requirements.
• Performed Gap Analysis to clarify requirements for change in current systems.
• Conducted feasibility study to understand the goal, mission, and strategy of the business.
• Created workflow diagram for various processes such as bill adjudication process.
• Elicited, analyzed, validated, specified, verified, and managed the requirements of the client.
• Transformed the business requirements and solution into Client Requirements Document (CRD), Functional Specifications Document (FSD), and Software Change Request (SCR).
• Conducted and Participated in Joint Application Design (JAD) sessions with clients, Product Support team, Development team, and Quality Assurance team.
• Conducted the User Acceptance Test (UAT) on assigned Projects/SCRs.
• Participated, and collaborated and engaged with teams, throughout the Software Development Lifecycle (SDLC) to ensure quality software delivery.
• Identified, tracked, reported, and resolved issues in a timely manner to meet the release date for each SCR.
• Implemented various EDIs (837, 835, 277, 999) for new client and vendors.
• Helped quality assurance team to develop an optimized Test Plan and Test Cases to prioritize the test effort.
• Maintained and monitored Requirements, Defects, SCRs using Microsoft Team Foundation Server (TFS) & CRM.
• Extensively used SQL to test the data mapping between various EDI and database.
• Identified and created necessary business use cases; created UML diagrams including Use Case Diagrams, Activity Diagrams, Sequence Diagrams, and Class Diagrams using Microsoft Visio.
• Performed cost-benefit analysis to allow management to make an informed decision.

Environment: Windows operating systems, Microsoft Server (IIS), Visual Studio 2010, TFS, SharePoint, UltraEdits, CRM, OCR

Confidential, Philadelphia, PA

Business Analyst

Responsibilities:

• Developed requirement strategy, direction, scope, and priorities in partnership with the business and technology teams; used techniques such as interviews, JAD, focus group meeting, and brainstorming for elicitation.
• Conducted JAD session; involved in identifying session’s objective, agenda, guidelines, participants, and necessary visual aids; acted as a facilitator and created the final document containing all decisions made by the group.
• Performed Gap Analysis as per the as-is and to-be business model.
• Created workflow for adequate matching of claims between claim transactions and billing transactions.
• Verified various transactions according to HIPAA rules/EDI (835, 837, 834, 270, 271, and 278) and X12 standards.
• Created Use Cases and Use Case Diagrams using Microsoft Visio.
• Prioritized, rationalized, and validated requirements and defined acceptance criteria for completion of the solution.
• Documented business requirements in Business Requirement Document (BRD) and detailed functional requirements in Functional Requirement Document (FRD).
• Collaborated with the businesses, application development team, and other business delivery teams to ensure that all business requirements and needs were incorporated into design and test cases.
• Assisted Quality Assurance (QA) team in translating use cases into test plan, test case, and user acceptance test (UAT).
• Researched, analyzed, and documented issues that rose during development; initiated request for requirement change in Rational ClearQuest; used ClearCase and ClearQuest for version control and defect tracking.
• Updated and redistributed appropriate documents to affected parties.
• Wrote SQL queries to get data to create various reports.

Environment: Windows operating systems, Microsoft Server, XML, WSDL, SOA, Rational ClearQuest, ClearCase

Confidential, Reston, VA

Business Analyst

Responsibilities:

• Analyzed client's system and business processes to develop customized solutions; gathered, reviewed and validated (for completeness and accuracy) metrics for reporting to executive management.
• Collaborated with product owner, scrum master, software development team, and testing teams to determine best approach for the project and provided support to full development lifecycle, testing, training and implementation in Agile Healthcare System Development Life Cycle with understanding of a variety of technologies and platforms such as web, client/server, relational database concepts, and object-oriented programming.
• Worked on multiple HIPAA/EDI transactions including Health care Eligibility /Benefit Enquiry (270) and EDI Health care Eligibility/Benefit response (271) and other claim transactions including 837I, 837P, 835.
• Collaborated with product owner to analyze business needs and documented those needs as epics and user stories, gathered acceptance criteria, and defined boundaries for user stories.
• Prioritized and ranked user stories and added them to product backlog; ensured that product backlog is visible, transparent, and clear to all; ensured that development team understood items in the product backlog to the level needed.
• Facilitated scrum planning meeting with product owner, scrum master, and development team to select user stories for implementation and prepared sprint backlog.
• Documented issues and problems identified during daily scrum meeting.
• Created burnt down/up chart as a means of visual control to communicate percentage of task completed.
• Contributed in sprint review meeting, and tracked completed user stories; computed value delivered to stakeholders.
• Planned for improvements to be implemented during next sprint as identified during sprint retrospective meeting for current sprint.
• Communicated project scope change requests to Project Manager and implemented the change management procedures.
• Supported QA in development of specific testing scenarios and validation that the system is functioning appropriately; supported User Acceptance Testing (UAT), and operational readiness testing as required.
• Applying the SQL scripts to the test database and execution of the scripts on the database; used SQL queries to filter data within the database tables.

Environment: Unified Modeling Language (UML), Microsoft Word, Microsoft Excel, Microsoft PowerPoint, Microsoft Project 2010, Microsoft Visio, Microsoft Outlook, Adobe Reader, Quality Center, MySQL, QTP, DOORS

Confidential, Louisville, KY

Business Analyst

Responsibilities:

• Assisted Project Manager in creating project charter and project plan.
• Led JAD sessions taking into consideration the agenda and meeting minutes with stakeholders to analyze system needs and integrate requirement to develop a consistent navigation structure.
• Conducted GAP analysis and created AS- IS and TO- BE workflow to understand existing and future system.
• Created Business & Functional Requirement Document (BRD) and (FRD) and Physical and Logical Data models for Claims process/Membership from legacy and unstructured data sources.
• Analyzed Healthcare Claim Processing including the extraction of Member and Provider data and finalize data mapping.
• Applied the SQL scripts to the test database; used SQL queries to filter data within the Oracle database tables.
• Gathered client specific business requirements and translated it in a technical specification document for the benefit of software development team & QA team, and ensured that these requirements were fully tested and implemented for each production cycle by creating Traceability Matrix using Requisite Pro.
• Followed the UML based methods using Rational rose to create use cases, activity diagram, sequence diagram, collaboration diagram that include functional and non-functional specifications to hand off to development teams.
• Created flow charts and process flow to fully demonstrate the business rules.
• Participated in “Life of a Claim” training, detail Claim process tour included HIPAA compliance, electronic (EDI 837, EDI 835, 270, 271), and paper claim processing CMS 1500, UB04, ADA Claim form.
• Provide the overall coordination and support of all internal Electronic Data Interchange (EDI) objectives and tasks.
• EDI analysis on cost-benefit to allow management to make an informed decision on strength and weaknesses of existing systems, reference to alternatives, data as per the EDI standards, and implementation schedule.
• Worked with QA team to test the application quality.
• Created UAT test cases and performed UAT testing.

Environment: Rational Unified Process (RUP), Rational Suite (RequistePro, ClearQuest, Clearcase), MS Office Suite, MS Visio, MS Project, Oracle 9i, Mercury Test Director, MS SQL Server 2005,Rational Rose, MS Access, MS SharePoint, Business Objects

Confidential, Silver Bay, MN

Business Analyst

Responsibilities:

• Collaborated with stakeholders, business teams, SME, technical/development team and the QA team throughout all phases of SDLC methodology; was instrumental in resolving conflicts between them.
• Extensively analyzed segments and data elements of EDI inbound and outbound files for transaction (837, 835, 270, and 271).
• Conducted feasibility study to understand the goal, mission, and strategy of the business.
• Created requirements charter, requirements source template, and elicitation plan.
• Archived elicitation documents for future references
• Prepared various UML diagrams like Use Cases and Data Flow diagrams using MS Visio.
• Performed JAD session, interviews to gather user Requirements and wrote BRD and FRD.
• Verified and validated the documents with the key stakeholders, before sign-off.
• Maintained requirements traceability matrix to reflect project progress.
• Coordinated between test team, development and business team in clarifying the functionality issues and requirement specification.
• Created and managed project templates, use case project templates, requirement and traceability relationships in RequisitePro.
• Used SQL Queries to retrieve data from the databases for the data validation and provided monthly capacity reports reflecting on the utilization of EDI infrastructure.
• Helped quality assurance team to develop an optimized Test Plan and Test Cases to prioritize the test effort using Quality Center.
• Monitored Defect tracking using Rational Clear Quest for Change Management.
• Actively participated in the User’s Acceptance Testing (UAT) process.

Environment: RUP, Rational Suite, EDI, Oracle, Clear Quest, MS Visio, HIPPA, UNIX, Quality Center, MS Office Suite