SUMMARY

• Senior Business Analyst with 8 years of diversified experience and successful implementations in Information Technology, involving in-depth understanding of Business Process Flows, Software Development Life Cycle, Process design, Business and functional requirements, Business case preparation, Development and Testing.
• Skills Inventory
• Successful in translating business requirements and user expectations into detailed specifications employing Unified Modeling Language UML using Rational Rose, MS Visio, and Visual Paradigm
• Strong Communication and Presentation Skills substantiated in past assignments with developers, project managers, subject-matter experts, stakeholders, system implementers, and application end-users
• Extensive experience creating business documents including BRDs, FRDs, NFRDs and DRDs
• Experienced in working with Insurance Companies in Liaison Team for Health Benefit Exchange
• Knowledge of Health Benefit Exchange system and Obama Care implementation
• Developed Companion Guides for Insurance Companies to assist Health Benefit Exchange System and communicate system requirements
• Profound knowledge of Medicare, Medicaid and Health Insurance
• Knowledge of ICD 9 and ICD 10
• Extensive knowledge of HIPAA 4010 5010, Electronic Data Interchange EDI Transactions ex. 837, 835, 276, 277 etc.
• Ability to gather Business and Technical Requirements from both formal and informal sessions utilizing a variety of elicitation techniques including One-on-One Interviews, Joint App Dev. Sessions, Document Analysis, and Interface Analysis
• Experienced in conducting Requirement Analysis, Use Case Design, Test Plan Design and developed database schemas based on the logical models
• Expertise in using Rational tools for creating Use Cases, Version Control, Defect Tracking, monitoring and extensively used the Agile, Scrum, Rational Unified Process RUP methodologies in all areas of the software development life cycle SDLC
• Good experience in working with QA methodologies and processes
• Experience working as Joint Application Development JAD facilitator and meetings coordinator with excellent interpersonal and communication skills
• Experience working on SharePoint data loading/editing/publishing
• Performed GAP Analysis to check the compatibility of the existing system infrastructure with the new business requirements
• Expertise in conducting User Acceptance Testing UAT

PROFESSIONAL EXPERIENCE

Sr. Business Analyst

Confidential

• Performed impact analysis on business policies
• Participated in gathering high level 834 EDI transaction configuration requirement sessions and created configuration document
• Prepared and maintained Questions Log with product owner and other SME Subject Matter Experts
• Prioritize and developed user scenarios for EDI transactions
• Facilitated daily stand ups and managed task board with user stories and board
• Prepared and tracked burn down charts and velocity charts for timely delivery of projects
• Utilized corporation developed Agile SDLC methodology used Scrum Work Pro and Microsoft Office software to perform required job functions
• Experience in designing and defining User Interface Requirements UIR and visual patterns by creating wire frames and story boards
• Gathered and wrote requirements for Exchange Shopping Portal to identify the functionalities as envisioned by the business owners and communicated them to the design team using various documents
• Worked with the MHBE design team to gather the configuration items for various integration points between issuers and Exchange systems which included web service call, SFTP transfer and web portal redirects
• Prepared GAP documents involved with 834, 820 transactions in collaboration with other team members
• Defined mapping process using the Department of Insurance format for transfer of Provider Directories to the Exchange
• Extracted data from several databases to create a master list of possible level 1 and level 2 error codes for 999 and TA1 acknowledgements.
• Ran reports using Excel and Business Objects to compare and verify data
• Conducted Business Requirements walkthrough with the business owners as well as the Technical Stake holders
• Companion guides Wrote companion guides to help communicate the custom requirements for the MHBE system in addition the HIPPA EDI guidelines
• Documented User Scenarios for the project and worked with Issuer Liaison Team to ensure every possible GAP and error has been identified and communicated to MHBE Business
• Maintained the Traceability Matrix table, Questions Log and to uniquely trace the identified business policies to the Guidelines and Requirements for issuers being engaged working with two types of Exchanges Individual and SHOP Exchange

Environment: Agile, MS Visio, Word, Excel, PowerPoint, SQL, SharePoint 2010, MS Project

Sr. Business Analyst

Confidential

• Participated in the initial Impact Analysis ICD-10 for all the critical functions, i.e. Membership Enrollment, Claims Processing, Utilization Management, Medical Policy, Reporting, Vendor Management, etc.
• Worked with the internal team to build out a high level roadmap and time line to achieve compliance
• Performed impact analysis on 5010 upgrades and ICD-10 conversions
• Participated in ICD 9 to ICD 10 codes conversion requirement gathering sessions and created high level business requirements documents BRD's
• Exposure to all the 75 measures under HEDIS
• Prepared product backlog working with product owner and other SME Subject Matter Experts
• Facilitated daily stand ups and managed task board with user stories and board
• Prepared and tracked burn down charts and velocity charts for timely delivery of projects
• Utilized corporation developed Agile SDLC methodology used Scrum Work Pro and Microsoft Office software to perform required job functions
• Experience in designing and defining User Interface Requirements UIR and visual patterns by creating wire frames, screen mockups and story boards
• Prepared 5010 GAP documents involved with 837 and 835 transactions in collaboration with other team members
• Defined ICD-9 to ICD-10 mapping process using GEM General Equivalency Mapping crosswalk file
• Created custom mapping between ICD-9 and ICD-10 codes
• Extracted data from several databases to create a master list of the ICD-9 codes
• Ran reports using Excel and Business Objects to compare and verify data
• Conducted Business Requirements walkthrough with the business owners as well as the Technical Stake holders
• Change Control Process CCP Led the Change Control Process for changes submitted for the BRD once the document was submitted to IT department
• Documented the UAT Plan for the project and worked with the UAT Team to ensure every acceptance criteria for the requirements has been included in the UAT task plan
• Maintained the Traceability Matrix table to uniquely trace the identified business requirements to general design to testing as proof that requirements requested have been developed into a solution and that it has been tested and tracked

Environment: Agile, MS Visio, Word, Excel, PowerPoint, SQL, SharePoint 2010, MS Project

Sr. Business Analyst

Confidential

• Define and implement the requirement gathering activities throughout the requirements process
• Assist the project managers with the development of project management plans including scope identification, WBS, change control, risk analysis project estimates
• Work with Business user to define Functional Requirements and Business Process flows
• Interface with SMEs to prepare Functional FR and Non-Functional Requirement NFR documents
• Conducted JAD/JRD sessions with business users and development teams to gather Business, Application Quality requirements
• Developed Business Requirement Document BRD and Use Case Document UCD .
• Interact with the users of the application to collect real time performance baseline data
• Involved in documentation during various phases of development life cycle including Project charter, BRD, SRS user training Actor catalogue
• Designed and Developed Use Cases, Activity Diagram and Sequence Diagrams using UML
• Create screen mockups for the new platform using MS Visio
• Create System Requirement Specification SRS and Requirement Traceability matrix documents
• Conducted GAP analysis around the identification of business rules, Risks involved, business and system process flows, user administration, requirements, product customization and assumptions
• Actively participated in Change Board Meeting CAB for any changes in the business requirements.
• Assisted the testing team in developing the test plan, test conditions, and test cases based on business requirements and technical specifications in UAT
• Assisted in defining implementation and deployment tasks for the new platform as per the requirements

Environment: Waterfall, UML, Use Case Analysis, MS Word, MS Power Point, MS Excel, Windows XP/2000/2003/Vista, Share point, MS Visio, MS Project, Quality Centre

Business Systems Analyst

Confidential

• Managed project and was involved in development of a Health care Access EHR project and implementation of an automated inter-operable web application that tracks patient medical history and health care plans via electronic health records
• Served as a liaison between the internal/external business community and the IT organization in order to provide technical solutions to meet user needs
• Analyzed existing Business units, Business process, System/ Application and there Interfaces with their capability through open-ended discussions, brainstorming sessions, and prototyping
• Mainly assisted with documenting processes, used Agile methodology to write the Business Requirements documents and designed Functional Specifications
• Created operational workflows, data diagrams, and other industry standard documents to represent client's business processes
• Conducted JAD sessions between the business users, developers, testers Subject Matter Experts to resolve bottlenecks
• Worked intensively with Medicare and Medicaid claims for 5010 X12 transactions on MMIS
• Exposure to all the 75 measures under HEDIS and enhancing the measures in the EHR to record useful data for healthcare quality improvement
• Exposure to LONIC database and codes for identifying clinical information in electronic reports
• Exposure to Meditech software for health information management, Revenue cycle, scheduling and referral management
• Used HL7 guidelines and dictionary for defining business rules associated with pre-defined workflows according to business requirements
• Played an important role into creation of CRUD Create, Read, Update and Delete Metric to make analysis and better understand data flows between different systems
• Conducted Risk Analysis to identify the risks associated with developing the patches, and formulated a Mitigation Plan to eliminate or reduce risks of high severity and any major effects
• Performed Data Analysis and Data validation and data cleansing by writing complex SQL queries using SSIS on SQL database
• Played an active role in the UAT and assisted in generation of test cases and test data
• Responsible for creating maintaining Requirement Traceability Matrix in order to track the development and QA process
• Interacted closely with QA to finalize the Test strategies and maintained quality assurance using HP Quality Center
• Provided production support pre prod and post prod issue management and defect tracking

Environment: UNIX, EPIC System, SQL Advantage, MS Visio, MS Word, KRONOS, HIPPA 4010/5010, ICD 9/10, Clear Case, FACETS, Agile

Business Analyst

Confidential

• Analyzing the existing policies and procedures and providing the inputs to Executive Management Team to fit into the compass project goals
• Conducting JAD sessions with different Business Users to develop new policies and procedures for the Service Catalogue, Charge Capture and Service Worklist / Charge Router, Hospital billing, coding, special coding requirements for BCBS and Claim processing
• Performing GAP analysis between Meditech and Soarian application for the Data Migration and Conversion
• Identifying the impacts and training the users on new policies /procedures changes.
• Developed Use cases, Test Cases for the Business users and QA team
• Identifying the Security Risks in the application that being built and address them in the requirement document to avoid the security breaches
• Improved the new revenue cycle management and Electronic Medical Record EMR for the RWJ Hospital
• Designed the flexible solution for patient treatment plan and patient care plan
• Designed the tight user authentication and application security
• Modified Existing policies and procedures for patient access such as Enterprise Scheduling,
• Patient Check-in/Out and Encounter automation
• Supporting the Business Users after go live

Environment: Agile, MS Visio, Word, Excel, PowerPoint, SQL, SharePoint 2010, MS Project