SUMMARY

• Over 7 years of experience as Sr. Business Systems Analyst with emphasis on domain logic, identifying implementation requirements and resolving solutions to business processes based on complex software projects, that includes system development module, business process improvement, tactical planning and policy improvement.
• Expertise in Software Development Life Cycle (SDLC) including Waterfall, Agile (Scrum), and RUP methodology.
• Proficient in creating and renovating Business Requirement Documents (BRD), Functional Specification Documents (FSD), and converting business requirement into Software Requirement Specifications (SRS) using MS Word and Rational Requisite Pro.
• Excellent analytical and problem solving skills in designing, developing, and implementing business innovative business processes using new approaches and technology.
• Experienced in GAP Analysis, organizing, facilitating and coordinating many Joint Application developments (JAD), Joint Requirement Planning sessions (JRP), and Rapid Application Development (RAD) sessions, weekly meetings, conference calls and other regular project meetings.
• Worked closely with stakeholders and SMEs to fulfill the project goals and objectives as well as able to manage multiple initiatives, projects and deadlines on time.
• Goal - oriented professional with excellent Interpersonal Skills with verbal and written communication, presentation skills and flexibility in adapting wide range of work environments by inculcating new relevant skills with ease in a time sensitive frame.
• Experienced in creating Data Flow Diagrams (DFD), Use Cases, Class Diagram, Activity Diagrams, Sequence Diagram, and UML Modeling methodology using tools such as Rational Rose and MS Visio.
• Familiarity with White-Box and Black-Box testing techniques such as Load Testing, Regression Testing, Unit Testing, System Testing, Quality Center and Performance Testing.
• Developed test scenarios and implemented test plans for system testing and user acceptance testing (UAT).
• Involved closely with the Developer and Testing team during defect resolution phase.
• Excellent understanding of HIPAA standards (4010 and 5010), HIPAA code sets ICD-9, ICD 10 and HL7.
• Experience in Process Documentation, Analysis and Implementation in 835, 837IPD, 834, 270/271, 276/277, 999/TA1 (X12 Standards) processes of Medical Claims Industry from the Provider/ Payer side.
• Captured allHIPAA-relatedEDI datain the repository usingFACETS and supported integrated EDI batch processing and real-time EDI usingFACETS.
• Proficient understanding of Medicare Part A, Part B, Part C and Part D products and procedures managed care concepts (Medicaid and Medicare) and experienced in determining the membership eligibility, billing experience within life and disability in health plans.
• Comprised with Health Insurance Exchange, products develop and successfully release of private HIX and public HIX under Obama Care (PPACA).

PROFESSIONAL EXPERIENCE

Confidential, Phoenix, AZ

Sr. Business System Analyst

Responsibilities:

• Responsible in providing Business Requirement Document (BRD) and Functional Requirement Document (FRD).
• Analyzed inpatient and/or outpatient medical records using International Classification of Diseases, Ninth Revision (ICD-9/10) and Update ICD-9 and CPT code changes.
• Maintained reimbursement summaries from third parties and compare with clinic fees, Updated reimbursement regulations, Notified Business Manager of significant changes, conduct periodic medical record audits to ensure documentation is consistent with billing.
• Well-defined and produced inclusive, accurate conversions of ICD-9 codes into equivalent ICD-10 codes with the option to adjust system application for ICD-10 specificity.
• Assisted with the User Interface (UI)prototypes to capture and validate requirements and spike solutions to the occurring problem.
• Tested claim billing processes as well as other healthcare processes such as enrollment, eligibility, andclaims-to-remittance adjudication processes.
• Performedproviderimpact analysis and work with trading partners, clients, management, technical and non-technical personnelto createrequirements,use cases and system validation artifacts and testing documentation, medical coding testing.
• Worked with providers and Medicare/Medicaid entities to validatehealthcare processes, including end-to-end claims processing, payment processes and eligibility where special focus on procedure and diagnosis coding.
• Created technical documentation,reviews, analysis, and evaluations ofbusiness systemsfor end user needs, including Companion Guides,business process reengineering,GAP analysisandmedical forms processing andworkflows.
• Worked on Unit Testing, trading Partners for connectivity issues, liaisonbetween client and corporate staff.
• Created EDI Export and Import processes and worked with EDI Trading Partners, Payers/Vendors.
• Used Agile Methodology.
• Created Testcases, testplan and Companion Guide from stage to production.
• Performed Unit testing documentation developed using Excel and created Artifacts and listing for UAT validation,and writing and validating Use Case Documents.
• Managed financial Processingwhich serves as primary lead for corporate financial systems, including accounting processes for accounts receivable and accounts payable systems. Manage financial spread sheets and vendor accounts. Spearhead collection processes and manage accounts receivable personnel.
• Complete knowledge in Medicaid and Commercial entities which include claims, enrolment testing, as well as NPI and medical coding and ICD-9 EDI testing.
• Captured allHIPAA-relatedEDI datain the repository usingFACETS and supported integrated EDI batch processing and real-time EDI usingFACETS.

Environment: Share Point, MS Visio, Rational Rose, GAP Analysis, UML, Use Case Analysis, SQL Server, Microsoft Office Suite, Quality Center, JSP, Java Script, XML, HTML, Agile, and Scrum Master, test Director, Agile MS Access, and DB2.

Confidential, Calabasas, CA

Sr. Business Analyst

Responsibilities:

• Project management to manage several mobile solutions projects.
• Worked as a Business Analyst for Mobile team for iOS and Android application.
• Mapping requirements and providing them best solutions involving evaluation and definition of scope of project and finalization of project requirements.
• Weekly monitoring of applications supported by Team and uploading reports into team SharePoint.
• Documented and updated the scope of the project and Final Requirements with the timely changes in the requirements.
• Took part in creating Product Backlog which was shared to the functional team as well as development team for detailed testing and development on the business application. The backlog was maintained and prioritized as per the requirements addition or deletion.
• Performed User Acceptance Testing and Regression Testing before deploying the application to the Users.
• Holding JAD sessions to monitor progress of the project as per schedule, and ensuring timely completion and delivery of project to the client. Extending production support for applications.
• Experience in locking bugs in the Bug reporting tool Bugzilla.

Environment: Windows 98/2000/XP/Vista/7/8/MAC/Ubuntu, Agile & Scrum, SDLC, Bugzilla, Basecamp, Microsoft Visio, Microsoft Office Suite (including Microsoft Word, Microsoft Excel, Microsoft PowerPoint®, and Microsoft Outlook®).

Confidential, Chicago, IL

Business Systems Analyst

Responsibilities:

• Participated in the initial Impact Analysis for all the critical functional areas within the Health Plan, i.e., Claims Processing, Utilization Management, Medical Policy, Health Care Management, Reporting, Vendor Management, etc.
• Worked with Big 3 consulting firm to build out of a high level roadmap and time line to achieve compliance.
• Worked onClaims and Remittanceprojects, including syntax and business rulesfor HIPAA4010and 5010validation for loops, segments, elements, qualifiers and code sets.
• Facilitated ICD 9 to ICD 10 codes conversion requirement gathering sessions and created high level business requirement document.
• Defined ICD-9 to ICD-10 mapping process using GEMs (General Equivalency Mapping) crosswalk file and incorporated that into a Translator tool.
• Performed UAT testing for ICD10 and legacy testing for HIPAA 4010 and 5010 projects for HIPAA requirements and compliance mandates.
• Documented current state processes for Claims Processing, Medical Policy, Benefits Coding, Healthcare Management, Provider Contracting, and Vendor Management.
• Conducted Business Requirements walkthrough with the business owners as well as the Technical Stakeholders.
• Participated in the monthly Steering Committee meetings to update the business sponsors on the Project Schedule and financials.
• Helped in the development and rollout of the ICD-10 Training and Curriculum Development plan.
• Performed detailed analysis for the followingICD-10 impacted streams
• EDI and non EDI claims
• Suspend Claims Review
• Processing Referrals/Authorizations
• Medical Case Management
• Provider Contract Development
• Customer/Provider Inquiry Resolution
• Benefits
• Provider Payments
• Claims Adjudication and Payment
• Clinical Case Management
• Data Warehouse and Business Intelligence

Environment: J2EE, MS Word, MS Visio, MS Excel, SharePoint, UML, SQL, Mercury Quality Center, Rational Requisite Pro, Rational Quality Manager, Rational Clear Quest, OSCAR, BDR.

Confidential, Jersey City, NJ

Business Systems Analyst

Responsibilities:

• Implemented project using the Rational Unified Process (RUP) Methodology to produce artifacts in the different phases of the Software Development Life Cycle (SDLC).
• Documented Business Requirements for the loan origination systems using Rational Requisite Pro for the application. Created and maintained the traceability matrix document
• Worked in tandem with internal and external users to define requirements and coordinated user management and developer expectations.
• Created and maintained complete development plans that included functional specifications, requirements engineering, Use Case modeling, risk assessment and mitigation, internal and external workflow.
• Developed use case diagrams, activity diagrams and sequence diagrams and state transition diagram with Rational Rose.
• Created wireframes and screenshots for the application to easily communicate it to the users using MS Visio.
• Conducted JAD sessions with management, vendors, users and other stakeholders for open and pending issues.
• Developed prototype of new information processing application. Facilitated collection of functional requirements from system users and preparation of business requirement documents using Rational Requisite Pro.
• Managed the changes in requirements through the change control process.
• Developed a wire transfer capability for making payments using SWIFT message format MT 103.
• Developed a chat message functionality using SWIFT message format MT199.
• Involved in the design and development of the database application, GUI and reports using Visual Basic 6.0, as front-end and Oracle 8i/10g/11i as backend.
• Facilitated weekly meetings with the review teams to continuously improve the QA process for the application development.
• Created the UAT plan and participated in the UAT process.
• Ensured all applications were tested for functionality and were adequately controlled in production.

Environment: Rational Test Suite, MS-Project, MS-Visio, HTML, SharePoint, Oracle, CRM, UNIX and VB, ERWIN

Confidential, Indianapolis, IN

Business Analyst

Responsibilities:

• Conducted user interviews, gathered requirements, analysed the requirements using RUP methodology and documented the requirements using Rational Requisite Pro.
• Supported web design and user-interface layout for public and internal web based solutions.
• Analysed the system for the effectiveness of the E- commerce operations
• Responsible for all web development, E-commerce and optimization and web strategy and corporate website and self-service intranet site.
• Provided recommendation for use of ATG Commerce for B2B and B2C business.
• Data mapping, logical data modelling, created class diagrams and ER diagrams and used SQL queries to filter data within the Oracle database
• Used SDLC (System Development Life Cycle) methodologies like the RUP and the waterfall.
• Oversight of process & purchase order management
• Daily conducted Scrum to take updates from team members and attended Scrum of Scrums to give User Story status updates as well prepared burn down charts to know the daily progress of work.
• Followed agile methodology and maintained user stories.
• Followed Agile (XP) Methodology for the release.
• Created Process Flow diagrams, Use Case Diagrams, Class Diagrams and Interaction Diagrams using Microsoft Visio and Rational Rose.
• Created Use cases, activity report, logical components and deployment views to extract business process flows and workflows involved in the project. Carried out defect tracking using Clear Quest

Environment: Rational Suite (Rose, Requisite Pro), Windows, SQL, XML, MS-Project, MS-Office Suite, SharePoint, MS Visio, Win Runner, Scrum, Load Runner.

Confidential, Chicago, IL

Business Analyst

Responsibilities:

• Analyzed current business process flow by understanding preset business rules and conditions.
• Designed and developed Use Cases, Activity Diagrams and Sequence Diagrams using UML.
• Involved in Backend Testing to verify data integrity by using SQL.
• Documented, organized and tracked the requirements using Rational RequisitePro.
• Created Data Flow Diagrams (DFDs), ER diagrams for data modeling and Web-page mock-ups using MS Visio for acceptance from end users. sAnalyzed and tested Data Interface needs with external systems.
• Analyzed, manipulated and updated Database using SQL.
• Wrote multiple Test-Cases (unit, compliance, integration) for multiple transactions include 837, 835, 276, 277 (both inbound and outbound) transactions.
• Gap Analysis: Analyzed 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 Utilized ClearQuest for change requests and defect tracking.
• Claim 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.
• Updating, transferring and sharing Files using FTP between Windows and UNIX machines.

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