SUMMARY

• Over 6 years of professional experience as Business Analyst, in the field of Software Development Life Cycle. Experienced in Trizetto Facets on major modules like Claim, Membership, and provider module. Recent project include up gradation of HIPAA 4010 to HIPAA 5010 and ICD 9 to ICD 10.
• Expertise in requirement elicitation using Joint Application Design (JAD), Document analysis, interview, business workshop, observation, interface analysis and reverse engineering, onsite meetings wif business users and development team.
• Very good understanding and working noledge of conducting feasibility study through Root Cause Analysis, Cause and TEMPEffect Diagrams, Impact Analysis, Prototype Development
• Expertise in creating Business Requirement Documentation, Functional Requirement Documentation, Non - functional Requirement Documents
• Hands on experience wif different Methodologies of Software Development such as Rational Unified Process (RUP), Agile & Waterfall life cycle
• Experience in writing Test Cases (manual/automated test cases) and Conducting Tests (Integration testing, Regression testing), Black Box/White Box testing, UAT (User Acceptance Testing).
• Business and System Modeling: UML Diagrams: Context, Use Case, Activity, Class, Sequence Diagram
• Experience wif data analysis, data mapping and dimensional modeling
• Experience in decision support systems (data marts) using Star Schema.
• Experience in using RDBMS, Oracle, SQL, and PL/SQL along wif MS SQL administration, SQL Enterprise Manager, Data analysis and reporting
• Health care Domain experience: Good noledge on different modules wifin health care (membership, billing, enrollment, claims, capitation, providers). Experience wif HIPAA compliance and Healthcare systems. Experience wif Medicare Part A, B, C and Medicaid, commercial insurances in HIPAA ANSI X12 4010, 5010 formats including 270,271, 276, 277, 835, 837, 997,NPI, ICD 9,ICD 10, NDC, DRG, CPT, NCPDP codes & NSF formats for interfaces & images to clearinghouses/ trading partners applications.
• Knowledge of writing manuals like System guides and training materials for business users
• A quick learner wif excellent problem-solving and interpersonal skills
• Ability to work in a cross-functional team environment/different geographical locations teams.

TECHNICAL SKILLS

Methodologies: SDLC, RUP, Agile, Waterfall

Project management tools: Microsoft project, Microsoft Office

Modeling Tools: Rational Rose, Microsoft Visio

Change Management Tools: Rational Requisite Pro, Clear QuestVersion Control Systems Rational Clear Case

Testing Tools: Test Director, Win Runner, Load Runner.

Languages: C, C++, Java, .Net, XML, UML, HTML.

Databases: Oracle, MS SQL Server 2000, MS-Access

Operating Systems: Windows Family, Familiar wif UNIX, LINUX and Mac

RDBMS and Databases: SQL Server, Oracle, Sybase MS Access

Reporting Tools: Business Objects, Crystal Reports

PROFESSIONAL EXPERIENCE

Confidential - Owings Mills, MD

Business Analyst

Responsibilities:

• Conducted HIPAA 4010-5010 requirements gathering sessions for the EDI transaction between providers, payers and employer groups.
• Involved in the documentation of HIPAA 5010 changes to EDI 837, 835, 834,276, 277, 270, 271 transactions.
• Coordinated the upgrade of Transaction sets 837P, 835 and 834 to HIPAA compliance.
• Performed Gap Analysis between ICD 9 and ICD 10.
• Involved in Forward Mapping from ICD 9 to ICD 10 and backward mapping from ICD 10 to ICD 9 using GEM (General Equivalence Mapping).
• Perform Gap Analysis for HIPAA 4010 to 5010 up gradation and prepared solution documents and project plan
• Worked extensively in the FACET modules: Membership module, Claims Module and Provider module.
• Worked on the EDI 834 file load to Facet through MMS (Membership maintenance sub-system).
• Conducted JAD sessions wif business users and stakeholders to define project scope, to identify the business flows and determine whether any current or proposed systems are impacted by the new development efforts.
• Created workflow diagrams, UML diagrams, process models, activity diagrams, use cases for incorporating design changes in the order creation/ management system.
• Created Traceability Matrix to uniquely trace the identified business requirement to general design to testing to ensure dat requirements has been developed into the solution.
• Gatheird Business Requirements from the Subject Mater Experts (SMEs) and documented the requirements in the BRD. Utilized data flow diagrams, use case diagrams and process flow diagrams to represent information provided by the Business users.
• Involved wif Data Mapping between various source systems and staging area and data marts.
• Utilized Rational Unified Process Methodology to configure and develop process, standards and procedures.
• Worked on developing the business requirements and use cases for Facets Batch Processes, automating the billing entity
• Involved in impact analysis of FACET adjudication system as a result of change in EDI transactions.
• Worked in FACET Batch Process such as Eligibility Batch Process, Mass Plan Change Batch Process, and IDcard batch process.
• Involved in claim adjudication process of facet application.
• Worked closely wif both development and testing teams to improve quality of the application.
• Ran SQL queries to retrieve the data for data analysis and reporting.
• Worked closely wif the development team to make sure dat the system is in compliance wif HIPAA Guidelines.
• Analyzed and evaluated the performance of the application from various dimension and conducted User Acceptance Test (UAT) wif business users.

Environment: FACET 4.7, NASCO, Rational Unified Process (RUP), UML, MS Office Tools - MS Word, MS Excel, MS Visio, MS PowerPoint, MS Access dB, Oracle, SQL Navigator.

Confidential, Downers Grove, IL

Business Analyst

Responsibilities:

• Conducted JAD session wif SME business users and stakeholders, held one on one and group interviews, surveys and questionnaire to gather the requirements.
• Documented and prioritized the gatheird requirement in BRD.
• Documented and maintained the RTM (Requirement Traceability Matrix)to uniquely trace the identified business requirements.
• Created various UML diagrams, Use Case Documents, Process Flow diagram
• Executed manual test cases to confirm the logic was implemented as desired.
• Understand and identified the changes wifin EDI transaction and the areas wifin the payer dat will be effected due to transition to HIPAA 5010 and ICD 10.
• Ensured all artifacts compiled wif HIPAA 5010 policies and guidelines.
• Coordinated and conducted meetings wif team member to discuss about the change added and deleted business rules in HIPAA 5010 as compared to HIPAA 4010.
• Worked on EDI transactions 276 (claim inquiry), 277 (claim response), 837 (Institutional and Professional claims) and 834 (enrollment).
• Performed gap analysis between 4010to 5010.
• Interpreted the ICD-9 to ICD-10 and reverse translation logic; fully understanding the GEM (General Equivalence Mappings) for ICD-10 CM and ICD-10 PCS.
• Understood complete claims processing cycle from the payer/provider perspective and the processes impacted by the conversion to ICD-10.
• Used SQL queries for generating reports and data analysis.
• Went through the companion guide of the organization to understand the 837 and 834 segments used by the organization to identify the ones dat need to be changed.
• Worked wif the team to create a project road map/blueprint ensuring TEMPeffective remediation of all applications dat participate in the ICD-10 transactions.
• Analyzed ICD-10 project readiness and recommended best practices for ICD-10 transition based on research conducted.
• Documented, updated and enhancements to IDX, the claim adjudication system.
• Prepared progress report and track deliverable, timelines and maintain documents as per needed.
• Gatheird requirements and feedback from users regarding the enhancements and future functionality of the IDX system.
• Studied and analyzed the conversion information provided by the CMS (Center for Medicare and Medicaid Services)

Environment: s: IDX, RUP Methodology, UML, MS Visio, Rational Rose, MS Office, SQL, Oracle, Toad, PowerPoint, MS Word, MS Excel, Windows

Confidential, Grand Rapids, MI

Business Systems Analyst

Responsibilities:

• Worked on claim processing receipt and verification of the claim forms (837) and claims attachments (275), claim Enquiry and Response (276/ 277).
• Oversee the EDI process, working directly wif trading partners to enhance the secure and HIPAA Compliant electronic flow of information.
• Involved in the procedural identification of erroneous claims utilizing the MCN and ICNnumber and the claim status code.
• Responsible for Claim Editing due to data entry error, enrollment adjustments, configuration errors etc.
• Conducted Claim Validation and Verification Process together wif FACETs Team in compliance wif HIPAA guidelines.
• Conducted Brainstorming and Facilitated Joint Application Development (JAD) session.
• Prepared Business Requirement Documents, Functional Requirement Document, Non functional Documents from the gatheird requirements.
• Adopted AGILE methodology throughout the project.
• Maintained the Traceability Matrix to trace the identified business requirements against functional requirements to use case.
• Attended daily SCRUM and guided QA and Developer regarding the defects, technical specification Documents and Mapping documents.
• Involved in in drawing data flow diagrams and process flow diagram using MS Visio for claim adjudication module.
• Created UML based diagram: Use Case diagrams, Sequence Diagrams, and Activity diagrams using Rational Rose and MS-Visio.
• Participated in entering, tracking system defects using Rational Clear Quest.
• Involved in Configuration Management, Requirement Management and analysis.

Environment: Facet 4.31,Windows XP, SQL, Rational Clear Quest, Requisite Pro, Microsoft Visio, MS office tools, java, Business Object reports

Confidential - Syracuse, NY

Business Analyst

Responsibilities:

• Gatheird business requirement through JAD sessions wif SMEs and end users and in addition through document analysis, brainstorming, interviews and questionnaires
• Conducted weekly SCRUM to discuss about the progress of the project.
• Prepared TRM ensuring the forward and backward traceability of the Business Requirements to the test Case and vice versa
• Reviewed and provided input to the testing scenarios and test cases.
• Involved in writing Test Plan, Test Cases and test scenarios.
• Coordinated on work wif claims and benefits configuration set-up involving Inbound/Outbound interfaces and ETL functions.
• Validated existing workflows written for Member eligibility verification, security access in the portal.
• Created Use Cases, activity and sequence diagrams.
• Worked as an Interface between users and the technical teams involved in the application development for the better understanding of Business and IT processes.
• Provided noledge and support to the development teams to understand HIPAA and EDI transactions and processes.
• Coordinated wif QA team in creating Test Cases and conducted UAT to test the final application for usability, to verify all the user requirements were satisfied.
• Communicated wif the developers and QA’s, and referred to HIPAA guidelines to ensure dat the system complies wif the HIPAA guidelines
• Involved in training and rolling out user guide to halp end users better navigate the newly developed application.

Environment: Agile, XML, MS Word, MS Excel, MS PowerPoint, MS Visio, Oracle, UML, SQL, Rational Requisite, Test Director.

Confidential

Business Analyst

Responsibilities:

• Responsible for gathering requirements and specifications, identifying the resources and implementation of the project.
• Implemented and followed the Waterfall Methodology through the SDLC while working wif multi-functional teams in gathering and analyzing the business requirements and convert it to the FRD and created business process models from the requirements specification.
• Site Survey and prepared site survey report
• Involved in system modeling using UML.
• Created Use Cases Diagrams, Sequence Diagrams and business process models.
• Translated Financial Spreadsheets into process flow diagrams. .
• Responsible for defining the application tiers, frameworks, components types and interfaces.
• Involved in performance measurement of ongoing data collection to determine if a program is implementing activities and achieving objectives.
• Involved in Design of Database and models for the Web Application.
• Conducted requirement workshops among all project stakeholders to verify and validate the business requirements in UI designs.
• Developed Test Plan, Test Cases, Test Scenario and Expected Test Result and assisted QA test in verifying the implementation of all features.

Environment: Java, Waterfall, Scrum, MS Visio, Pumari (Windows NT), MS Excel, MS Power Point, SQL, DB2, ERD, UML, Use Case.