SUMMARY

• A Business Analyst in the Health Care Industry having over 8 years of experience, a sound knowledge of SDLC methodologies principally AGILE - SCRUM, RUP, Waterfall, with proficiency in conducting interviews, workshops, Joint Application Development (JAD) sessions, and requirement gathering sessions with stakeholders, business users, and development team.
• 8 years industry experience working as a Business Analyst in the Healthcare Domain with solid understanding of Business Requirements Gathering and Business Flow.
• Depth Knowledge of Health Insurance Portability and Accountability (HIPAA) standards, Electronic Data Interchange (EDI), HL7 and ICD-9 to ICD-10 transfer coding, and coding.
• Extensive knowledge on the various types of Healthcare Insurance Programs such as Medicaid, Medicare (Part A, B, C and D), PPO, HMP, and POS.
• Extensive experience with claim transactions such as 834 (Benefit and Enrollment), 835 (Billing Pay and Remittance), 837 (Submit Medical Claims), 820 (Payment Order, remittance advice), 834 (Benefit Enrollment and Adjustment).
• Deep knowledge of the X12 EDI Transaction Sets.
• Strong Knowledge of MMIS, EMR, EHR and healthcare reforms like PPACA, EMTALA.
• Extensive knowledge of SDLC methodologies and exposure to Agile, RUP, and Waterfall.
• Extensive knowledge using UML diagrams (Use Case, Activity, Sequence) using MS Visio and Rational Rose
• Enhancement of an existing Mobile health application.
• Proficient in Requirement Analysis working with techniques such as User Stories, Use Cases, Prototypes, Interviews, and Storyboards with a strong ability to facilitate JAD Sessions.
• Well versed in working with Data Warehouse, Data Mining, and ETL tools for loading high volumes of data and smooth structural flow of the data.
• Proficient in developing BRD, FRD, SRS (with detailed knowledge of functional and non-functional requirements), and RTM.
• Extensive experience in organizing and facilitating interviews and workshops, especially JAD Sessions with Subject Matter Experts, Users, and Business Stakeholders.
• Strong knowledge in Data Warehouse: Data Mapping, Data Modeling, Star/Snowflake Schemas, OLTP/OLAP, and designing E-R Models; Worked with Erwin for Conceptual, Logical, and Physical designs.
• Well versed in creation of Test Plan and Test Cases from the Requirements document.
• Documentation of Test Plans, Test Cases, Test Scripts, Test Procedures based on the Design Document and User Requirement Document for the Black Box, Functional, Usability and User Acceptance Testing (UAT).
• Ability to manage workload with in time sensitive deadlines in addition to handling multiple projects or tasks under minimal supervision.
• Excellent verbal/written communication skills and strong analytical abilities working independently and as a team player.

TECHNICAL SKILLS

• SDLC
• Agile
• Scrum
• RUP
• Waterfall
• XP
• Rational Rose
• UML
• OOAD (Object-Oriented Analysis and Design)Erwin Data Modeler
• Microsoft Office Suites
• Word
• PowerPoint
• Access
• Excel Macros and Pivot tables
• Outlook
• Project
• Visio
• Publisher
• SharePoint 2007
• Mercury Quality Center
• Microsoft SQL Server
• Load Runner
• JIRA Agile
• EPIC
• UML
• MS Office (Word
• Excel
• Visio)
• Windows XP
• HTML
• XML
• JSP
• J2EE

PROFESSIONAL EXPERIENCE

Confidential, New York, NY

Senior Business Analyst

Responsibilities:

• Facilitated JAD session to clarify the business workflow for As-Is and To-Be process for the existing Mobile Health application with the Case Management and Claims department
• Identified and document the Scope and Business Requirements on the BRD and developed process flow diagrams using UML
• Actively involved in development, grooming and sizing of product backlog, release backlogs and sprint backlogs to monitor the development process
• Developed and maintained a Burn down chart to keep track of the efforts versus the sprint timeline to be achieved
• Translated Business Requirements into Technical specifications and documented Technical Requirement Document specifying changes to the workflows related to, Find a doctor or facility, Claims, Coverage and benefits, Personal health records, ID card information and Drug Pricing.
• Developed UI wireframes and data element dictionary related to the screens related to Dashboard and Benefits modules
• Prepared functional requirement/design documentation in support of business need/process.
• Documented requirements/processes using process flows, activity/swimlane diagrams, data/entity flow diagrams and class diagrams using UML
• Facilitated requirements meetings and documenting outcomes/minutes and action items; ensuring appropriate follow-up for action items
• Actively involved in backend testing using simple and complex SQL queries for data validation purposes
• Assisted testing team with documenting Test Plans, Test cases and execution of test scenarios for the Mobile Application and clarified issues which may arise during testing.
• Worked closely and collaboratively with other team Business Analysts, System Architects, Data Architects, Development team, and QA team to clearly articulate defined requirements, and clarification when questions arise.
• Proactively and effectively involved in issue and risk management, ensuring issues and risks are clearly documented and escalated appropriately in a timely fashion, and manage and track issues/risks until closure or corrective action has taken place.

Confidential, Newark, NJ

Senior Business Analyst

Responsibilities:

• Gathered requirements by facilitating JAD sessions with business owners, department heads (Compliance Department) to finalize the high level business requirements and the business rules involved.
• Act as liaison between business and IT and documented FR to define the specifications for data migration from facet tables to clearing house database according to the file specifications provided for claims data extraction for 270/271, 276/277,834,837
• Worked very closely with testing team in house and offshore, clarified requirements, issue resolution, update test matrix, help rewrite test cases on changing needs of business.
• Coordinated SIT and UAT.
• Participated and presented requirement changes to the Change Advisory Board.
• Performed backend SQL queries for claims data extract, root cause analysis for 837, 834.
• Deep knowledge of the X12 EDI transaction sets.
• Validated EDI 270/271, 276/277.
• Worked extensively on Facet data models like claims, membership plan.
• Documented claims extraction process using Visio and worked with provider relation and membership department.
• Performed Root Cause Analysis for errors found in facet for membership and claims status.
• Performed UAT, modified requirements to improve functionality based on user input.

Confidential, Raleigh, NC

Business Analyst

Responsibilities:

• Conducted interview sessions with primary care staff and JAD sessions with stakeholders, and Subject Matter Experts to identify needs of the integrates system.
• Identified data requirements, documented data mapping document and created logical and physical data models associated with the clinical workflows for EPIC Ambulatory Care
• Worked as a liaison between users, management, and IT teams for better understanding of IT processes and effective conflict.
• Outlined security standards for PHI, EPHI, and EDI to facilitate compliance with HIPAA and data standards for PACS to accommodate needs for radiology.
• Ensured Meaningful Use Criteria with the compliance department by documenting the report mapping and report layouts for MU Stage 1 Requirements.
• Worked under the guidance of the project manager for executing various administrative tasks.
• Developed workflows of existing systems and data flow diagrams to capture flow or information between these systems, data stores and processes.
• Participated as the Scrum Master, overseeing the running of different sprints in all phases of the project, facilitating Sprint Planning and Sprint Estimation Meetings come with a print backlog from the user stories and release backlog.
• Facilitate daily scrum meetings to keep track of progress and the project, updating the Burndown Chart after each session.
• Held sprint retrospective meetings to gather relevant information like what could have been done, and used the information gathered to increase efficiency in the next sprint.
• Modeled functional requirements using UML diagrams like Use Case models to contextualize system, structured them as business, system and sub system needs to trace critical requirements, and analyzed them to identify potential risks and consequential impacts.
• Employed simple and complex SQL queries for data retrieval and data validation purposes.
• Participated in the development of test plan, test cases, test scripts, and execution of tests at all levels using HP ALM.
• Documented supplementary specification to underline nonfunctional needs of the system and glossary for future reference of system users and developers.

Confidential, Wellington, CT

Business Analyst

Responsibilities:

• Interview sessions with healthcare clients and other stakeholders to gather requirements.
• Translated business requirements into functional requirements and approaches for developers.
• Provided management support to the offshore End to End integration/ Regression Test Team.
• Workflow documentation and comprehensive training to the healthcare clients.
• Analyzed corporate healthcare business processes to develop customized solutions.
• Ensured the accuracy and consistency of the data during the data loading process.
• Developed Use case, Functional, Object diagrams using Rational Rose.
• Responsible for architecting integrated HIPAA, Medicare solutions, Facets.
• Developed a detailed test plan and test cases to verify all the requirements.
• Used Rational Rose to create UML diagrams such as use case, activity, sequence, class and component diagrams.
• Developed Flowchart and process diagram using Microsoft Visio.
• Analyzed data architecture, documented and delivered data mapping, performed risk and GAP analysis.
• Frequently communicated with developers to resolve technical issues.

Confidential, Collegeville, PA

Jr. Business Analyst

Responsibilities:

• Worked with PMO and helped document enhancement requirements in a form of BRD.
• Reviewed and documented bugs reported by end users and converted them in use cases to be included in BRD.
• Facilitated in Daily Scrum Calls to discuss daily details, helped with meeting minutes.
• Created Use Case Diagrams and Activity Diagrams using MS Visio.
• Responsible for documentation of scrum review meeting minutes.
• Conducted survey to redesign previous user interface.