Summary

• As a Business Analyst, Systems Analyst Quality Analyst, I have six years of IT and management experience which includes healthcare information systems development and clinical data management
• Lead, gather, develop, coordinate, and maintain business requirements for various projects and/or systems from initial phase to final implementation, assuring requirements meet standards.
• Well knowledgeable with HIPAA, ICD 9, ICD 10, claim adjustments/processing, identifying claim processing problems, and providing alternative solutions
• Experienced working with Microsoft Office Suite Word, Excel, PowerPoint, Visio, and Outlook for documentation analysis and presentation
• Extensive experience in gathering business and functional requirements, Scope, and Visio document, creating Business Requirement Document BRD , Functional Requirement Document FRD , communication plan, use cases, and showing Gap Analysis
• Well experienced in creating and maintaining of Technical Requirement Document TRD
• Knowledge of the Unified Process and/or Agile process
• Knowledgeable in Gap Analysis of Health Insurance Portability and Accountability 4010 and 5010 with detailed experience in qualifier, length, and required field and situational rules
• Extensive knowledge on HIPAA 4010 and 5010 compliance standards EDI Electronic Data Interchange transactions syntax such as 820, 835, 837, 270, 271, 276, 277 and 999 transactions inbound and outbound transactions for varying Health Care Providers
• Being able to conduct JAD sessions and interviews. Adapting and implementing requirements, creating project status reports, and presentations
• Knowledge of managed care concepts and Acts Medicare and Medicaid , Medicare Part A,B,C,D, and US health care regulations and practices PPACA/Obama HealthCare/Affordable Health Care Act
• Knowledgeable/Experienced in creating sequence diagrams, collaboration diagrams, activity diagrams, and class diagrams using Rational Tools and Microsoft Visio
• Expertise in creating Test Plans, Test Scripts, Test Cases for Manual, and Automated Testing
• Created Data Flow Diagrams, System Use Cases, and UML models
• Strong knowledge of Data Modeling, Data Warehousing, and Data Mapping
• Strong knowledge of SQL database structures
• Thorough understanding of Software Development Life Cycle SDLC , involved in all the phases from planning to the implementation stage. In depth understanding of RUP, Iterative Software Development Life Cycle Agile Methodology .
• Knowledge on Waterfall Software Development Methodology and gathered the requirements
• Knowledgeable in HIX Health Insurance Exchange , Plan Management, Eligibility, and Enrollment Process
• Skillful in MMIS Medicare Management Information System health care standards and International Classification of Diseases ICD 9 ICD 10
• Very well organized and have proven ability to meet deadlines, prioritize workload, and manage own time effectively
• Excellent oral and presentation skills

Technical Skills

Work Experience

Confidential

Sr. Business Analyst

Responsibilities

• Conducting regular meetings with the stakeholders, and SME's Subject Matter Experts to properly define the in scope, and out of scope of the project.
• Operating with Project Manager to identify stakeholders
• Working with the System Team to understand the current working process and possible impact
• Gathering detailed business requirement with functional specification through interviews, facilitations
• Creating all the artifacts like Business Requirement Specification BRS , System Requirement Specification SRS , Impact Analysis, Business Requirement Management Plan, references, meeting minutes and other documents as required
• Coordinating with Connecticut Health Exchange HIX program staff and other stakeholders to define and develop requirements for correspondence generation across various business lines.
• Working on cram functional areas of organization structure, security structure, and location structure for the CT HIX project
• Tracking and updating any requirement updates
• Providing walkthrough to the stakeholders and request signoff for the documents to close the requirement phase activities
• Managing all the document by utilizing Clarity
• Creating business system requirements and as is and to be process flow diagrams
• Developing business team updates for project manager
• Assisted in translating requirements and use cases into test conditions and expected results for the system

Environment: SQL, Rational Requisite Pro, Rational Rose, Quality Center 9.5,10.0,DB/SQL, MS Visio, MS Word, MS Excel, MS Project, and XML

Confidential

Sr. Business Analyst/Quality Analyst

Responsibilities

• Worked on requirements of the 837 HIPAA projects, 276/277, 278, 834 and 835 HIPAA EDI transactions enterprise
• Assisted in the impact analysis of 4.71 and 5.01 plus documented specifics impact on files, database, interface, and screens
• Performed Gap Analysis of existing system and what the business users expected particularly with the member module and claims module
• Followed Waterfall Software Development Methodology and gathered the requirement and interviewed stakeholders and end users
• Used agile development process to deliver software throughout the SDLC life cycle absorbing changes and new requirement as the project proceeds
• Responsible for defining the scope of the project, gathering business requirements and preparing Business Requirement Document BRD , and Functional Requirement Document FRD
• Facilitated Joint Application Design JAD sessions between technical, business and regulatory teams to ensure that requirements were being met, and to resolve issues during the development phase
• Involved in creating Use Case Diagrams and State Diagrams using MS Visio
• Assisted in composing the Test Scenarios and Test Cases for testing the migration
• Was involved in testing EDI transactions like 270, 271, 276, 277, 278, 837P, 837I, 837D and 835
• Designed and applying SQL queries for backstend testing and reporting data validation
• Worked with technical team in generating the required involved in generating Test Plans and Test Specifications as per business requirements.
• Prepared Test Data for positive and negative test scenarios as per application specifications and application requirements and wrote test plans.
• Assisted in writing the detail Test Cases and uploaded in QC and linked the appropriate requirements

Environment: EDI 835, 837, FACETS 4.7, Agile, MS Office Tools, MS Visio, HP Quality Center, and Waterfall

Confidential

Sr. Business Analyst

Responsibilities

• Extensive experience and knowledge for defining the scope of the project, gathering business requirements and preparing Business Requirement Document BRD , and Functional Requirement Document FRD
• Collected and analyzed business requirements and identified system interfaces, and created functional requirements specification documents
• Identified Use Cases from the requirements. Extensively created UML diagrams including Use Cases, Data Flow Diagrams, ER Diagrams, and MS Visio which helps define the business process model and data process model
• Developed Test plans and mapped them to Requirements with QA team
• Mapped the developed Test Cases to the requirements to ensure that the requirements were fully tested and implemented according to the specifications
• Evaluated and tested the new and modified software application to verify that programs function according to both technical and business requirements
• Prepared Gap Analysis to understand what we have to and what we ought to have or to be better off
• Developed project schedules, conducted project status meetings, and managed resources during phases of SDLC
• Requirements were achieved and collected through interactions, meetings, and periodic walkthroughs with SME's
• Interacted with developers and users in resolving risk factors and other issues

Environment: MS Visio, SQL, Java, Windows 2000/2003, MS Project, MS Word, MS Excel, Rational Requisite Pro

Confidential

Sr. Business Analyst

Responsibilities

• Examined the HIPAA 4010 and 5010 standards for 837P, 837I, and 835 transactions and also prepared Gap Analysis document for every transaction
• Performed operational business procedures for readiness to be able to fulfill with HIPAA as well as ICD 10 requirements
• Assisted in writing requirements for converting from web portal to mainframe
• Well experienced knowledge on gathering all the Business Requirement Document BRD , and Functional Requirement Document FRD
• Made Joint Application Design JAD sessions between technical, business and regulatory teams to ensure that requirements were being met
• Used Waterfall Software Development Methodology and gathered the requirement and interviewed stakeholders and end users
• Worked on analysis of the Facets claims processing application in order to gather requirements to comply with HIPAA 5010 requirements
• Vigorously worked on Data Analysis and Report Analysis with respect to ICD 10 impact
• Identified risks, problems, requirements and concerns of the Hospital in order to comply with ICD 10 changes
• Greatly involved in understanding of department workflows and process flows with respect to applications
• Re-Organized the collected data and prepared documentation for implementation.
• Highly involved in giving education about ICD 10 codes and 5010 standards. Also performed impact analysis for deadliness of ICD 10 conversions
• Being able to meet the information demands of business users by delivering timely, accurate, meaningful and standardized data and reporting.
• Good understanding of hospital working system scheduling, patient accounting, and claim processing

Environment: Windows XP, RUP, Quality Center, SQL Server, Rational Requisite Pro, Clear Quest, MS Office, MS Visio, Waterfall

Confidential

Business Analyst Intern

Responsibilities

• Led user interviews, and JAD sessions with end users, stakeholders, and developers to collect the functional and non-functional requirements of the system
• Involved in developing the business model for expediting the claim settlement process
• Performed document analysis involving creation of Use Cases and Use Case narrations using Microsoft Visio, in order to present the efficiency of the gathered requirements
• Involved in the analysis of the functional, technical specifications, data mapping document and conceptual diagrams
• Highly interacted with the development team and claim settlement experts making sure that the development of the project is meeting the business requirements.
• Identified critical areas of business risk and modified the business process to reduce the same
• Wrote Business Requirements Specification BRS and Functional Requirements Specification FRS documents as per the business requirements and process flow
• Conducted daily interaction with both the development team and stake holders
• Documented user stories and modeled use case diagrams by utilizing MS Visio
• Prepared Test Data for the Functional Test Cases
• Evaluated test results and prepared test summary report
• Interacted with developers various members of my team to discuss and resolve defects and their priorities

Environment: SCRUM, Windows Vista / NT, Oracle, Java, HTML, MS Office, MS Visio, MS Project, Mercury Suite of Testing Tool, MS Excel