SUMMARY

• 8+ years of experience, discipline and highly - motivated Business System Analyst and Quality Analyst with healthcare domain who TEMPhas worked on a wide range of projects.
• An accomplished and fluent communicator with strong investigation, problem-solving and decision-making skills, combined with a pragmatic approach and sound business acumen.
• Highly accomplished in fields such as IT knowledge specific to Healthcare and have complete knowledge of all phases of the software development life cycle (SDLC) gained over working on various projects for different clients.
• I prepare, analyze, and gather business requirements, business processes, mapping and the development of interactive prototypes.
• Strong knowledge of HIPAA standards 4010 & 5010, ICD-9, ICD 10, EDI, FACETS, HL7, HIX (Health Insurance Exchange), EMR/EHR, Health Care Reform.
• Develop different EDI healthcare transactions like 837 for submitting claims, 835 for payments, 834 for benefit enrollment, 270, 271 for health care benefits and eligibility, 276, 277 for claims status and 278 for transmitting health care service information.
• Proficiency in the child welfare and case management business area, policies and domain knowledge in child welfare programs.
• Experienced on Claims, Payments, Medicaid, Medicare, Provider, Portal, Billing, and Benefits.
• Extensive experience in performing GAP analysis, SWOT analysis, Cost benefit analysis, Risk analysis.
• Hands on experience in analyzing and documenting Business Requirements Documents (BRD), Functional Requirements Documents, Use Cases and Requirements Traceability Matrix (RTM)
• Broad knowledge on Waterfall, RUP and Agile methodologies.
• Incomparable analytical skills in understanding the business process, understanding the functional requirements and translating them to system requirement specifications (SRS)
• Information and understanding in conducting Joint Application Development (JAD) and Rapid Application Development (RAD) sessions. Conducted Requirement Gathering Sessions and interviewed Subject Matter Experts, gatheird detailed functionality aspects of business process and updated the information to the requirements in an easily comprehensible format.
• Broad experience in creating business process flow diagrams, UML (Unified Modeling Language) tools to create Activity, Sequence and Collaboration diagrams.
• Robust experience in writing SQL queries for Data Analysis and QA report testing.
• Robust knowledge in Content Management Systems (CMS)
• Business Analysis, Supporting Strategy management, Client relations, Business modeling, CRM & Workflow, Test planning MS Office, MS Project, MS Visio, MS Excel.
• Develop workflows dat demonstrate current and proposed business requirements.
• Knowledge and expertise in system design and development required for business process.
• Aptitude to construct process models including data dictionaries and volume estimates.
• Able to test business applications from a business perspective to ensure dat all client requirements are incorporated into the design.
• Understanding service objectives and capturing business requirements through active listening & questioning techniques.
• Keeping abreast of new legislation, company strategy and policy and being able to identify its impact on business projects.
• Extensive knowledge and work experience with Clinical works.
• Experience in creating User Manuals and providing training to users.
• Inventive and Aggressive person capable of forming and maintaining positive and productive team environments with integrative thinking skills.
• Exceptional Problem Solving and Sound Decision Making capabilities, along with the ability to resolve difficult situations.
• Professional with extensive experience in the development, implementation and integration of strategies within a team oriented environment, utilizing quantitative and qualitative analytical skills.
• Outstanding communication and presentation skills.
• Capable to prepare written proposals, requirements specifications, invitations to tender and solution specifications.
• Able to identify business & systems process improvements from Big Picture to detail level.
• Excellent communication skills to manage and liaise with business and technical consultants to explore business process improvement opportunities.
• Served as a technical & scientific resource to therapeutic area scientists like immunology & neurology, and translated scientific requirements into successful technical solutions and processes,
• Strong knowledge in parallel testing and CR tracing.

TECHNICAL SKILLS

Project Methodologies: Rational Unified Process (RUP), UML, Agile

Business Modeling Tools: Rational Rose, MS Visio, MS Project

Requirement Management Tools: Rational Requisite Pro

Defect Tracking Tools: Rational ClearQuest and Mercury Test Director

Operating Systems: Windows NT/XP, MS Dos, UNIX

Databases: SQL Server, MS Access

Quality Assurance: Software Application Testing Life Cycle

Business Applications: Microsoft Office Suite- Word, Excel, Project Outlook, Exchange server and PowerPoint

Testing Tools: LoadRunner, Test Director

PROFESSIONAL EXPERIENCE

Confidential, El Segundo, CA

Sr. Business Analyst

Responsibilities:

• Gatheird requirement through workshops and JAD sessions.
• Developed documents like BRD, FRD, Data specification document, technical specification documents, file transfer document, Data mapping document etc.
• Participated in analysis workshops for ICD 9 Procedure and Diagnosis Codes in accordance with ICD 10 CM and ICD 10 PCS Conversion Compliances.
• Developed Use case diagrams, activity diagram and system design diagrams.
• Validated CPT, HCPC, ICD 9 code sets from Data Flat files to support configured benefit plan building.
• Managed global administration and support of the Documented based Regulatory Electronic Document Information System (EDMS).
• Facilitated Electronic Data Interchange (EDI) and storage in the ICD-10.
• Worked on HIPAA Transaction Sets 837P and 837I Standards according to the test scenarios.
• Created Test Conditions from business requirement document and functional requirement document.
• Processed Medicaid claims and worked on X12 format of EDI 837 and EDI 835 for Medicaid claims.
• Accessed Diagnosis Master File and Crosswalk Mapping file to use ICD Diagnosis and Surgical Procedure Codes.
• Performed GAP Analysis to make sure dat all requirements were covered by test cases.
• Prepared and submitted weekly test status reports to QA Lead.
• Analyzed the System Impact including MMIS Tables, Windows, Reports and Interfaces on external entities.
• Worked on EDI 834 to validate new enrollment and dismiss the enrollment.
• Accepted and validated messages in EDI 999 form like accepted, rejected, and accepted with error.
• Coordinated System and Regression testing schedules and completed the same.
• Ensured the functionality meets business requirements as defined in test results logged in RQM.
• Developed Test Cases to test the functionality of the system based on the test conditions.
• Extensively used Rational Quality Manager to monitor the progress of assignment of testing activities and Reported executed results.
• Logged the defects in Clear Quest tool, assigned the right severity level and managed the defects through it.
• Performed parallel testing comparing unmatched fields from the ND MMIS Enterprise subsystem and the Legacy subsystem and analyzing why the fields were unmatched by looking up unmatched reasons on the Enterprise subsystem and business rules.
• Performed CR tracing by matching the use cases related to the CR’s, CTC’s, Test Plan, Test Case idsto the location on the Final DSD using Rational Clear Quest.
• Analyzed several defects related to Edits & Audits functional area along with the halp of a SME.
• Conducted KT sessions for Member, Provider and Service Authorization.

Environment: MS Office, Rational ClearQuest, Oracle database, Windows 7, Environment 63, Citrix.

Confidential, New York, NY

Business Analyst

Responsibilities:

• Conducted user interviews, gatheird requirements, analyzed and documented business requirements in BRD for HIPAA 5010 and ICD10.
• Created System Requirement Specifications (SRS) document entailing business rules, conditions, calculations, triggers, visual representation, type of text (smart text, static text, free text, special formatting, metrics) of various dynamic elements present within the reports.
• Conducted meetings to work in coordination with DBA’s, Developers, Tech Leads and Data Architects to achieve enhanced clarification, consistency and assist in design sessions.
• Followed AGILE methodology, created self-organizing team, induced enhanced communication for quick issue resolution & minimization of change control processes & its impacts. Obtained & recorded Business Approvals, Quality Review Approvals, and Architectural Approvals for future references & cross validations.
• Played a key resource as Business Analyst, Systems Analyst & Data Analyst during the entire SDLC phases of the project.
• Conducted meetings with business/ corporate editor to capture information and create Large & Small Group Renewal Package Mockups (reports) in Power Point.
• Worked on Analyzing defects in Quality center for HIPAA 5010 EDI 837 and 835(Payment and remittance).
• Validated Backward and forward mapping for ICD9-ICD10 and logged when I found bug in it.
• Performed walkthroughs of the prototype with end users to better understand user needs.
• Ledpolicy changes or implementation of new child welfare programs intocurrent business operations in field or central offices
• Worked with the developers to make sure dat the mapping for the transition from the ICD-9 code sets to ICD-10 code sets was implemented properly and also made sure dat the new ICD-10 code sets were compliant with the new 5010 standards.
• Wrote policy or procedure handbooks/manuals for use in a child welfare business operations
• ConductedGAP analysisof thetransitionfromHIPAA EDI 835(Payment and remittance) and 837 focusing on how current transactions and system was going to be effected by the new5010compliance.
• Followed a structured approach to organize requirements into logical groupings of essential business processes, business rules, and information needs, and ensured dat critical requirements are not missed.
• Worked with Facets team for HIPAA Claims validation and verification process (Pre-Adjudication).
• Conducted claim validation and end/denied claims analysis for the health plans Medicaid programs.
• Tracked requirements in a RTM capturing Req ID, BRD Number, BRD high level description, BRD grouping id, SRS id, Design element, Implementation Module, System Test Case id, UAT Test Scenario, Deployment Module, Comments.
• Created Business Process Flows (Current State & Future State), Flow Chart diagrams, Data Flow Diagrams, Use Case diagrams, Activity Diagrams using MS Visio.
• Wrote test cases and executed them for ICD9-ICD10 and HIPAA 4010-HIPAA 5010.
• Created Test Scenarios and Test Cases to perform SIT & UAT.
• Reviewed Test results pertaining to the specific desired functionality of the application. Recorded & reported defects& produced daily Test Status Reports.

Environment: MS Office, Quality Center, SQL Server, Facets, MS Project, Server, MS Visio, Unix, SQL, HTML, Java, XML, Rational ClearQuest, Windows XP.

Confidential, Madison, WI

Business System Analyst

Responsibilities:

• Implemented RUP methodology for iterative and incremental development of the system.
• Involved in the creation of the Mockups and Use Cases for MACD quotes and Orders using MS Visio.
• Coordinated with the stakeholders and project key personnel to gather functional and non-functional requirements during JAD sessions.
• Recorded requirements in the Requirement Traceability Matrix (RTM) defining each technical requirement in detail from areas like: main hardware, application software, networks, servers, internet and desktop configuration.
• Planned RUP iterations and documented the artifacts throughout the various phases of the development process.
• Propose strategies to implement HIPAA 4010 to HIPAA 5010 changes in the System.
• Developed an implementation guide for Partners for HIPAA 5010EDI X12 transactions such as 837 (medical claims), 835 (medical claim payments), 270 (eligibility inquiry), 271 (eligibility response), 276 (claim status), 277 (claim status response), 820 (enrollment), and 834 (premium payments).
• Studied the existing business process and created AS-IS workflow to illustrate the existing system.
• Prepared Logical Process and Data Models dat contained set of diagrams and supporting documents containing the essential business elements, detailed definitions, and descriptions of the relationships between the data elements to analyze and document Business Data Requirements.
• Compiled the Vision Document and composed detailed Specification Documents in Rational RequisitePro.
• Created UML class diagrams, use case diagrams and sequence diagrams to view the system from different perspectives.
• Incorporated stakeholder feedback throughout project lifecycle to ensure project quality and customer satisfaction.
• Created Technical documentation for the project using tools like Visio, Word, etc.
• Used MS Project for managing schedules, resources and collaboration.
• Produced complete data mappings and data conversion documents needed for the Claims application.
• Performed Functional and GUI Testing to ensure dat the user acceptance criteria are met.
• Co-coordinated the UAT with the SME’s to make sure dat all the Business Requirements are addressed in the application.
• Formed detailed UAT and QA test plans, managed system testing and preserving testing documentation.

Environment: MS Office, MS Project, MS Visio, SQL, Oracle, Test Director, Rational Unified Process (RUP), Rational Suite (RequisitePro, ClearQuest, ClearPro), Business Objects, Windows XP.

Confidential, Tampa, FL

Senior Business Analyst

Responsibilities:

• Analyzed current business process flow by understanding preset business rules and conditions.
• Conducted formal interviews, Live Meetings and JAD sessions with business users and SME’s.
• Designed and developed Use Cases, Activity Diagrams and Sequence Diagrams using UML.
• Involved in Backend Testing to verify data integrity by using SQL.
• Created Data Flow Diagrams (DFDs), ER diagrams for data modeling and Web-page mock-ups using MS Visio for acceptance from end users.
• Defined project milestones, schedules, and monitored progress using MS-Project and updated plans as required.
• Analyzed and tested Data Interface needs with external systems.
• Analyzed, manipulated and updated the Database using SQL.
• Wrote multiple Test-Cases (unit, compliance, integration) for multiple transactions including837, 835, 276, 277 transactions.
• Conducted Gap Analysis to analyze the client’s applications programs to determine the impact of the HIPAA final rule on EDI Transaction Set and Code List implementation and defined the changes to bring the affected systems into HIPAA compliance.
• Worked with FACETS Team for HIPAA Claims Validation and Verification Process (Pre-Adjudication).
• Assisted with user testing of systems and maintained quality procedures and ensured appropriate documentation is in place.
• Maintained Requirement Traceability Matrix (RTM) and Utilize ClearQuest for change requests and defect tracking.
• Conducted claims validation and Pend/Denied Claims Analysis for the Health plans Medicaid programs.
• Worked closely with the technical team to look up for the best possible solution on requirements by keeping business needs and technical constraints in mind.
• Updated, transferred and shared files using FTP between Windows and UNIX machines.

Environment: UML, MS Word, Rational RequisitePro, Rational ClearQuest, Quality Center, SQL, FTP, TelNet

Confidential, New York, NY

Business Analyst

Responsibilities:

• Conducted user interviews, gatheird requirements, analyzed the requirements and managed change requirements by implementing change management methodology.
• Contracted with the HCFA (Health Care Financing Administration)/ Medicare Centers and Medicaid Services to provide quick, easy, and affordable access to the health care service of their choice.
• Improvised HL7 for the exchange, integration, sharing, and retrieval of electronic health information.
• Worked with the UI developer to implement UI and create enhancements to optimize user experience.
• Prioritized system impact analysis for web portal experience development.
• Identified and documented issues, risk and gaps, their descriptions, their impact and provided recommendation and alternatives to develop the application to meet the user requirements.
• Worked in a team to develop use cases for their newly added application layout and understood all the business processes related to newly added layout and designed use cases dat halped developers to build application.
• Interacted with the developers on resolving the reported bugs and various technical issues.
• Involved in UAT to confirm dat the system under test meets the user needs and provides confidence in its use.
• Performed verification tests to validate the data integrity.
• UML diagrams such as activity and use case diagram were used to document the requirements and ensure creation of high level business requirements documentation.
• Worked cross functionally with developers, QA and project managers to make sure each data could address their needs.
• Performed verification tests to validate sure integrity of data.
• Developed documents and implemented appropriate policies and procedures related to patient accounting, including follow-up on all patient accounts receivable. Actively participated in and monitored the accounts receivable management activities.

Environment: Agile, Rally, MS. Visio, SQL Server, MS Office Suite, HP Quality Center Automation tool