SUMMARY

• 7+ year’s expertise in Business Analysis, Quality Assurance and Testing with hands on experience in Healthcare and IT Sector.
• Extensive experience with Medicare/Medicaid processing as well as the Claims/Billing.
• Strong knowledge of the Software Development Life Cycle methodologies (phases and gates) like Agile and Waterfall models.
• Knowledge of using automation tools - Win Runner, QTP, Load Runner, Quality Center and Test Director.
• Good working knowledge of Claims processing, Excellent knowledge of HIPAA standards, EDI (Electronic data interchange) Transaction Set EDI X12 837, 270/271, 276/277, 278, 835, Implementation and Knowledge of HIPAA code sets, ICD-9, ICD-10 coding and HL7.
• Experience with HIPAA 4010 and 5010 EDI healthcare transactions and transition of ICD 9 to ICD 10 codes.
• Broad knowledge of Medicare, Medicaid, PPO, HMO, POS, diagnostic codes and claims process.
• Experience with Iterative Software Development Life Cycle Process as per Rational Unified Process (RUP), involved in inception, elaboration, construction & transition phases using rational tools like Requisite Pro, Clear Case, Clear Quest during various phases of RUP.
• Deep knowledge of RDBMS structures including schema creation, modification, monitoring and performance tuning, backup and recovery techniques, in depth troubleshooting.
• Extensive experience in Business Requirements gathering and writing skills with expertise in developing and documenting Business Requirement document (BRD), Functional Requirement Document (FRD),Software Requirement Specification (SRS) across the deliverables of a project.
• Effectively used Rational Requisite Pro to organize, track and change requirements of the system. Conducted JAD (Joint Application Design) sessions.
• Expertise of UML in visualizing and documenting the artifacts using Use Cases, Use Case Diagrams, Activity diagrams, Class diagrams, Data Flow Diagrams, Business Flow Diagrams, Sequence Diagrams using MS Visio.
• Facilitated User Acceptance Testing (UAT) with the stakeholders and the business users as well as trained users to use the system configured.
• Analytical, methodical and resourceful approach to problem solving, identifying root causes and corrective actions to meet short and long-term business, financial and system requirements.
• Consultant with proven record of over 6 years of experience in Business Analysis, Business Process Modeling, System Analysis, Requirements management using SDLC methodology, UML Modeling, Prototype design, project team management in healthcare, pharmaceutical and other domains.
• Experience in understanding and supporting both the Business and Technical teams in all Phases of Software Development Life Cycle (SDLC) by using different Methodologies like Iterative, waterfall, agile-scrum and Rational Unified Process (RUP).
• Emphasis on requirements gathering from business stakeholders by using methods like Elicitation, conducting Interviews with users as well as Subject Matter Experts (SMEs) by asking detailed functionality aspect of business process, Requirement workshops, organizing Joint Application Development (JAD) sessions and carefully updating the information to create a Business Requirements Document (BRD).
• Extensive experience in gathering business and functional requirements, feasibility studies, risk analysis, Gap impact analysis, creating narrative Use Cases and UML diagrams- Class diagrams, Use Case diagrams, Activity diagrams, Data flow diagrams using UML Tools like MS Visio and Rational Rose.
• Expertise in the areas of writing Scope documents, Request for Proposal (RFP), BRD, Functional Requirements Document (FRD), incorporating use cases in creating System Requirements.
• Experience in Object Oriented Design Technologies and maintain traceability of Requirements using Requirements Traceability Matrix (RTM). Experience in using Tableau to generate Business Intelligence based performance reports.
• Working with QA and testing teams in close co-ordination in developing Test Plans, building Test Conditions and Test cases, creating test data, analyzing bugs, Interacting with development team to fix the errors; Facilitated User Acceptance Testing (UAT) with client representatives.
• Experienced in Data Warehouse Environment including Data Analysis, Data Modeling, Data Mapping, Data Integration and Data Migration using ETL tool- Informatica.

TECHNICAL SKILLS

Business / Modeling Tools: MS Project, MS Visio, MS Excel, MS Word, MS PowerPoint, Rational Rose

Requirements Management Tools: Rational Requisite Pro

Databases: SQL Server, Sybase, MS Access, Oracle

SDLC Methodologies: Rational Unified Process (RUP), Agile, Scrum, Waterfall, Iterative

Operating Systems: Windows 95/98/2k/NT/XP/Vista/Window 7

Web Technologies: Java, JSP, VB Script, VB 6.0

Testing Tools: HP ALM, Quick Test Professional (QTP), Load Runner, Rational Test Manager, Rational Clear Quest

PROFESSIONAL EXPERIENCE

Business Analyst/EDI Analyst

Responsibilities:

• Conducted interviews, meetings and JAR sessions during the process of Requirement Gathering.
• Developed the deliverables using the Agile-Scrum methodology, and helped develop and maintain user stories to track requirements.
• Experienced in performance tuning and optimizing for SQL Server application by using performance monitor
• Experienced in OLTP, OLAP, GUI, Relational Database Management Systems (RDBMS) and Report Development
• Extensive experience in MS SQL Server 2012/2008R 2/2008/2005/2000, BI tools like SQL Server Integration Services (SSIS), SQL Server Reporting Services (SSRS), and SQL Server Analysis Services (SSAS).
• Proficient in using T-SQL for developing complex Stored Procedures, Triggers, Tables, Views, User Functions, common table expressions (CTEs, Relational Database Models and Data Integrity, SQL joins and Query Writing.
• Active participant of all the scrum meetings, and helped maintain the product backlog and scrum backlog. Co-ordinated with scrum team for efficient delivery within designated sprint cycle.
• Performed validation of X-12 270, 271, 835 and 837 Professional and Institutional format files according to EDIFECS engine.
• Created the static mock-up UI screen using Axure and helped the UI/UX team create the dynamic prototype. Coordinated with the developers to create the input and output XML-schema.
• Involved in the conversion of ICD-9 to ICD-10 codes, and vice-versa using GEM. Billing and claims submission were effected due to new rules associated with ICD-10.
• Extensively involved in Conducting Market Research, Feasibility Studies, Data Analysis, System Analyses, Gap Analyses, and Risks Analyses.
• Helped create web-methods for web-services, which used JAVA as the framework.
• Worked on the Data mapping and storing the analytical data using OLAP and updated to the SharePoint 2013.
• Helped create the SQL queries and procedures, tested these for correctness.
• Evaluated testing results for each potential release build using HP-ALM, listing summarized bug information in priority sequence, recommended viability of release for production.
• Created performance reports and interactive visualizations of data using Tableau for data analysis
• Worked with Quality Control Teams to develop Test Plans in HP ALM and Test Cases.
• Interacted with the developers and testers to report and correct bugs.
• Conducted UAT (User Acceptance Testing) to make sure that all the user requirements are catered by the application.
• Use HL7 implementation methodology to create specifications, assist with unit testing, and perform integrated testing for messaging between the state Departments of Health and the location office.

Environment: Agile-scrum, Java2 (JDK 1.3), XML, XSLT, MS Visio, HP ALM, SQL, HTML, CSS, JavaScript, HL7, EDIFECS, Axure, MS Word, MS Excel, MS Access, MS Project.

Confidential, NYC, NY

Business Analyst/ Systems Analyst

Responsibilities:

• Conducted the scrum meetings as the scrum master, and helped maintain the product backlog and sprint backlog. Co-ordinated with scrum team for efficient delivery within designated sprint cycle.
• Extensive experience in using SQL Server Profiler to monitor the SQL server for deadlocks, long running queries and fine tune the same to improve performance.
• Created Use Case Diagrams, and Use Case Specification document (USD). Validated the following: 837 (Health Care Claims or Encounters), 835 (Health Care Claims Payment/ Remittance), 270/271 (Eligibility request/Response), 834 (Enrollment/Dis-enrollment from a health plan).
• Conducted JAD sessions with management, SME, vendors, users and other stakeholders for open and pending issues.
• Worked with relational database models and XML schemas to create technical/system design documents, and developed crystal reports. Performed OLAP and ETL for storing analytical data in the database and helped the DB team in performing data analysis.

Environment: Agile-scrum, MS Project, MS Office Suite, SQL, UML, MS Visio, Requisite Pro, Clear Case, Rational Clear Quest, JAVA/J2EE, XML, ETL, OLAP.

Confidential, Virginia Beach, VA

Business Consultant/ Systems Analyst

Responsibilities:

• Worked in an Agile Development Environment fractioning out the functionalities of Electronic Health Record (EHR) and Practice Management and Insurance verification.
• Created user stories and assigned values to each, coordinated with the client and the team to update the sprint backlog. Ran the sprint cycles and made sure the sprint velocity never decreased to unacceptable levels.
• Documented detailed Business Requirements Documents (BRD) and Functional Requirement Documents (FRD) using Rational Requisite Pro.
• Experience with JAVA and web-services; wrote web-methods for various functionalities.
• Created UML diagrams with the help of MS Visio to understand the process flow.
• Participated in ICD 9 to ICD 10 codes mapping sessions as well as status meetings and provided comments and suggestions on challenges faced with the outsourced medical coding partner company.
• Identified the business flows and determined whether any current or proposed systems are impacted by the EDI X12 Transaction, Code set and Identifier aspects of HIPAA.
• Used Electronic Data Interchange (EDI) codes for verifying patient eligibility and receiving the insurance benefits, patient information, health care claim request, and healthcare claim through the new EHR System.
• Developed Test Plans and Test Cases according to Business Requirements, using HP-ALM.
• Assimilated testing reports from developers and testers and created the RTM; made sure all the test cases were run on the application.

Environment: Agile-scrum, UML, HP-ALM, Rational Clear Quest, Windows, MS Office, HTML, XML, SharePoint, JAVA.

Confidential, Columbus, OH

Business Analyst

Responsibilities:

• Involved in business analysis, coordinating between the team members, and was involved in each phase of SDLC (Agile-scrum) to ensure valid business requirements. Created full life-cycle documentation from product requirements in the developmental stage to functional specifications.
• Expertise in HIPPA, Phases of Clinical trials, Clinical trial designs, safety reports, adverse event management and reporting, Protocol designing and regulatory requirements.
• Followed the Agile-scrum methodology for the entire SDLC.
• Created Use case scenarios according to business needs and specifications and Implemented UML methodologies to design Use Case Diagrams, Data Flow Diagrams, Activity Diagrams, Sequence Diagram and ER diagrams.
• Involved in the Data mapping and Data Modeling, and documented the data architecture of the databases to notify the SMEs’. Used ETL process in helping the DB team in data migration.
• Wrote test plans and test scripts using HP QC, followed up with the developers and testers regarding reported bugs.

Environment: XML, MS Visio, SQL, MS Word, MS PowerPoint, MS Access, MS Visio WSDL, Oracle, Mercury Quality Center, ETL, SharePoint, HP QC.

Confidential, Portland

Business Analyst

Responsibilities:

• Conducted detailed walkthrough of Business requirement and functional requirement.
• Chalked out the scope, timeframe, risk analysis, cost and maintenance procedure.
• Microsoft Visio was used to create various documents such as Use Cases and Activity Diagrams.
• Wrote Test Cases in HP ALM and assisted the testing team in executing them.
• Helped the DB team with data warehousing and data mapping.