SUMMARY

• Over 9 years of Experience as Business Analyst in Healthcare include understanding of Business Requirement Gathering, Business Analysis and Joint Application Development (JAD) sessions with clients and referring to accessible documentation and procedure.
• Functional Knowledge of Medicaid Management Information System (MMIS).
• Exposed to Medicare and Medicaid domains of the healthcare systems and industry for inpatients, outpatients, Reimbursement Methodology.
• Extensively Knowledge in the Member Enrollment and Billing information.
• Knowledge and Experience on Membership, Billing, Claims Payment Processing in relation to HIPAA, EDI 4010, ICD - 9 & ICD-10, codes 834, 837,835, and 270, 271.
• Strong knowledge of ICD-9/ICD-10 business analyst with healthcare.
• Able to understand and implement Processing ICD-9 & ICD-10
• Performed gap analysis and data mapping for HIPAA X12 4010A1 to 5010 migration.
• In dept. knowledge of Software Development Life Cycle (SDLC) methodology (such as Agile, Waterfall and RUP).
• Formulated rules, and created flow using Paper free, in the creation of - 837 dental, 837 professional, and 837 institutional maps in accordance with HIPPA compliance
• Created Any to Any Maps to read data from a text file formatted in 'Full Form' (text file formatting data entered HCFA or UB92 form) into our databases. Received information from processed claims and created an outbound map within 837 transaction sets from this data into 4010 Standards.
• Efficient in writing Business Requirements Document, Use Case Specifications, Functional Specifications and Workflows.
• Strong knowledge of Use Cases, and Activity Diagram.
• Involved in Facet Implementation and conversion of 4.21
• Working knowledge in Data Warehousing/Business Intelligence systems for government and, Health Care industries.
• Extensive Experience in Functional, Integration, Regression, User Acceptance (UAT), System.
• Knowledgeable working with ETL process (Extract, Transform and Load) of data into a data warehouse.
• Designed and implemented basic SQL queries for testing and report/data validation
• Experienced in client interaction, deep understanding of business systems functionality and technicality.
• Proficient in Developing and executing Test Plans, Test Case, & Test Scenarios, also performing functional, usability testing and ensuring that the software meets the system Requirement.
• Knowledgeable about preparing RTM documents
• Experienced in Atlassian JIRA and Confluence, and Rationale Quality Manager (RQM) .
• Experience in developing project plan and estimating project timeline.
• Excellent working knowledge in Project Life Cycle and clear understanding of Project Management.
• Experienced in performing Gap analysis by identifying existing technologies, documenting the enhancements to meet the end-state requirements.
• Excellent business communication and presentation skills. Adapt at creating, editing, and coordinating extensive communication networks, to keep executive staff and team members apprised of goals, project status, and resolving issues and conflicts.
• Conducted successful projects with the help of teams to achieve deadlines timely and proficiently.
• Organized, goal-oriented, self-starter, and ability to master new technologies; manage multiple tasks while following through from start to completion.
• Experienced in analyzing business requirement at all stages of Software development of life cycle (SDLC).

TECHNICAL SKILLS

Data Base: SQL, MS Access, Oracle, DB2

Methodologies: Agile, Rational Unified Process (RUP), Waterfall, JAD, UML

Office Tools: MS Word, MS Excel, MS Outlook, MS PowerPoint

Quality Management Language: SQL, Java,N0SQL,TOAD

Operating System: Windows XP/Vista 2000/98/95

Business Modeling Tool: MS Visio, Rational Rose, Irise, Justin mind, JIRA, Rally,BI, IBM Curam software

Software Application: Data Warehouse, ETL, Facets

Testing Tools: ALM/HP Quality Center 11.0

PROFESSIONAL EXPERIENCE

Confidential, Knoxville

Scrum Master/Business System Analyst

Responsibilities:

• Performed the role of Business System Analyst and Scrum Master and was involved in facilitating rapid development, minimizing impediments, resolving support issues and implementing overall enhancements successfully.
• Incorporated agile methodology and SCRUM techniques to manage requirements.
• Facilitated and contributed in daily Scrum meeting (Stand up meeting), Sprint planning meeting and Sprint review meetings, Release planning meetings and Retrospective with team
• Facilitated Scrum planning meetings to coordinate between Clients, Product Owner, Developers and QA teams.
• Responsible for tracking requirement in RQM and Jira
• Responsible for creating, analyzing and reviewing business requirements, System specifications and project schedule documentation.
• Gathered user and business requirements through interviews, prototyping and worked with team to identify gaps and defects.
• Conducted User Stories Workshops.
• Acted as a liaison between technical team and business clients to accomplish application enhancement and production.
• Assisted the Product Owner in setting realistic expectations, in evaluating the impact of changes on the organization and plans accordingly and conducted project related presentations.
• Developed flowchart and process diagram using MS Visio.
• Wrote SQL scripts for creating performance evaluation reports
• Trained Users by documenting and giving presentations regarding the changes and new functionalities.
• Created Release Notes prior to each implementation.
• Prepared User guide and business rules documents.
• Test Planning and Test Design Sets up Test Plans and Test Cases for assigned modules, builds Test scenarios and automated Test Scripts, projects deliverables for reviewing
• Test Execution Executes functional, regression, automated testing using QTP, Selenium and performance tests using LoadRunner.
• Involved in documentation and end-user training on using of existing templates for Ad hoc reporting
• Involved in the User Acceptance testing (UAT) to check the reliability for end users.

Environment: Rally, Jira, Microsoft Visio, Trello, Microsoft Project, Visual Paradigm, Quality center, Pro Quest SQL, MS Office, Tableau, Oracle, Data Mapping, Java, XML

Confidential - Albany, NY

Sr.Business Analyst/Data Analyst

Responsibilities:

• Conducted weekly meetings for deciding the Policies and Procedures to be followed
• Gathered high-level requirement for all the external projects in a release.
• Performed the requirement analysis, impact analysis and documented the requirements.
• Created As-Is and To-Be process documents includes Visio diagram.
• Created Data element and system design documents.
• Involved in Able to understand and implement Processing.
• Executed the test cases and test scenarios using HP Quality center (QC).
• Prepared Business Requirement Documents (BRD’s) after the collection of Functional Requirements from System Users that provided appropriate scope of work for technical team to develop prototype and overall system.
• As a Senior Business Analyst provided key inputs and identified Gap's on gathered requirements and curam framework and provided a FIT-GAP analysis document
• Facilitated gap analysis sessions to map curam processes to requirements
• Facilitated and led JAD sessions aimed at functional requirement walkthroughs for all the impacting projects and updated the documents based on recommendations (if any).
• Worked with health care department for small Medicaid project.
• Gathered requirement for Medicaid program.
• Created As-is and To- be process for the health care program.
• Implemented and maintained account benefit updates in system as part of National Health Care Reform mandates
• Worked with SME’s and business users to gain in-depth understanding of the business' mission, objectives, purpose and processes
• Prepared documents for the wireframe and prepared a data dictionary for the same
• Use HP Quality Center to house all test documentation and report/track all issues and defects (Defect Management).
• Prepared User guide and business rules documents.
• Involved in the User Acceptance testing (UAT) to check the reliability for end users.

Environment: MS Visio, HP QC, ARIS (UML), MS Office, Agile Scrum, Balsamiq, Curam 6.0

Confidential

Sr. Business Analyst/Scrum Master

Responsibilities:

• Prepared Business Requirements Documents, Functional Requirement Documents.
• Worked extensively with developing business rules engine enabling the business rules such as referral, prior authorization, eligibility, claims processing and billing essential.
• Utilized Agile Software Methodology using Scrum framework. Actively participated in creating the user stories and prioritizing user stories along with tracking of burn up, burn down charts to estimate sprint delivery
• Assisted in gathering and validation of business requirements in relation to curam's screening and case management application
• Performed GAP analysis by performing the system analysis between the scheduling systems and documented the gap items.
• Conducted JAD sessions, meetings, workshops to gather requirements from various stakeholders and SMEs.
• Facilitated all Aspects of scrum framework, including product backlog, release backlog, sprint planning session, daily scrum meeting, sprint reviews and sprint retrospectives.
• As scrum master communicated dependencies and potential risk to the completion of the sprints including resources, costs and systems.
• Created data mappings to transform the data according to business rules.
• Developed Test Cases for unit testing, prepared spreadsheet for testing criteria, including regression, positive and negative testing, process flow testing and screenshot for test results to complete expected and actual results.
• Prepared various diagrams by using MS Visio.
• Performed GAP Analysis of HIPAA with particular attention to qualifier, length and required field and situational rules.
• Prepared documents for the wireframe and prepared a data dictionary for the same
• Managed testing for various functionalities using Quality Center tools.
• Worked closely with QA and Developers to clarify/understand functionality, resolve issues and provided feedback to nail down the bugs.
• Maintained a close and strong working relationship with teammates and management staff to achieve an expected QA result for the project team.
• Conducted project related Presentations periodically to the management and end users during various phases of Software Development Life Cycle (SDLC).

Environment: Agile Scrum, MS Office, MS Visio, MS Project, JIRA, SharePoint, Rally, ARIS (UML), SQL, IBM Curam software

Confidential, Cordele, GA

Business Analyst

Responsibilities:

• Propose strategies to implement HIPAA 4010 in the new MMIS system and eventually move to HIPAA 5010
• Created BRD Documents
• Coordinate with stakeholders and project manager to gather functional and non-functional requirements during JAD sessions.
• Performed a High-level analysis of the requirements from a business perspective to determine the feasibility of constructing the new application.
• Responsible for gap analysis in changing old MMIS to new MMIS.
• Served as a Relationship between internal and external business community (Claims,Billing, Membership, Customer service, Healthcare Management) and the project team.
• Assisting the project manager in creating the business case and project plan.
• Followed the UML based methods using Rational rose to create Use Cases, Activity Diagram, that include Functional and Non-Functional specification to hand off to development teams.
• Recorded requirements in the Requirement Traceability Matrix (RTM) defining each technical requirement in detail.
• Analyzed business processes and worked with management and improved and implemented the solution to ensure compliances.
• Assisted in Conducting UAT (User Acceptance Testing) to make sure that all the user requirements are catered by the application.
• Involved in preparing a simple and detailed User Manual for the application, for an intended novice user.

Environment: RUP, SQL, MS Office, MMIS, MS Visio, SharePoint, Lotus Notes, Rally. Rational Tools

Confidential, Medford, MA

Business Analyst

Responsibilities:

• Facilitated interview, one on one and brainstorming sessions with SME’s & User’s in understanding the requirements pertaining to billing Origination to billing Processing.
• Assisted and written System Requirements Documents (SRD), including Functional and Non-Functional requirements.
• Gathered business requirements through interviews, surveys, prototyping and observing from account managers, finance manager, and independent advisors and got an accurate understanding of their needs.
• Developed Use cases and activity diagrams and analyzed business requirements.
• Created UML-based feasibility studies and Use Case Models to communicate those ideas to the developers.
• Followed the Aris (UML) based methods using Microsoft Visio to create: Use Cases Diagrams, Activity Diagrams, and Sequence Diagrams.
• Worked with SME’s and business users to gain in-depth understanding of the business' mission, objectives, purpose and processes.
• Experience in EDI 837 testing which involved writing test cases which forced security, data integrity and usability with special emphasis on 837 syntax validation
• .Responsible for sales and marketing specializing in practice management, managed care systems, thin-client technology, Electronic Media Records (EMR/EHR/PHE/PMR), ASP technology, and full integration tools.
• Enhanced the business to articulate and prioritize their ideas, and assisted in development of training materials for new technology and process improvements.
• Collaborated with the QA testing team to develop the test plan, test conditions and test cases to be used in testing based on business requirements, technical specifications and/or product knowledge.
• Conduct project related Presentations periodically to the management and end users during various phases of Software Development Life Cycle (SDLC).
• Involved in the User Acceptance testing (UAT) to check the reliability for end users.

Environment: Rational Requisite Pro, SharePoint, ARIS (UML), MS Visio, Win Runner, MS Access

Confidential

Business Analyst

Responsibilities:

• Gathering requirements for a data collection and reporting system
• Researching various topics, scheduling meetings and documenting meeting minutes.
• Analyze patient accounts and clarify any information needed to correctly answer patient’s questions regarding their account.
• Performing application support monitoring system interfaces, generating reports, researching data issues, documenting support requests
• Performing business process support reviewing user questions, making data updates, providing one-on-one user training, identifying process improvements
• Managed multiple Patients Accounts across various platforms.
• Provided good customer service to the patients by proving answers to their question in a timely and courteous manner.

Environment: MS Office, Windows, ARIS(UML), MS Visio. MS Project, Java