SUMMARY

• Strong skills in dealing with software development lifecycles (SDLC), both Waterfall, and Agile/Agile scrum, Rational Unified Process (RUP).
• Expertise in defining and documenting Business process flows and “As - Is” & “To-Be” processes.
• Experience in data collection from multiple sources, interpretation, presentation, and management of reporting and decision making.
• Expertise in creating Business Requirements Documentation (BRD), Requirements Traceability Matrix (RTM), Business Rules Spreadsheet (BRS) and Functional Requirements Documentation (FRD).
• Expertise in project management activities like defining/managing project scope, planning various activities for execution, estimating business value/impact and providing a periodic status report to management.
• Experience in working with cross functional and cross-cultural team environments, different levels of management and liaison between system users, management and development teams.
• Experience in Healthcare Application Facets in different modules like Claims, Membership, and Provider.
• Extensive experience and knowledge on all stages of teh Software Development Life Cycle (SDLC)
• Well versed in writing SQL queries, together with inner and outer Join commands for data analysis and retrieval.
• Extensively involved in web service and user interface development, covering Provider, Claims, and Reimbursement Processing domains.
• Knowledge and experienced on Health Insurance Portability & Accountability Act (HIPAA 4010 and HIPAA 5010), Affordable Care Act (ACA), International Statistical Classification of Diseases and Related Health Problems, 9th Revision and 10th Revision (ICD-9 and ICD-10),Current Procedural Terminology(CPT).
• Experience with Medicare Advantage Programs, HIPPA 5010 EDI transaction codes such as 834(Benefit Enrollment), 835 (Payment), 837(Health care claim).
• Excellent in generating and analyzing reports. Extensive use of reporting tools like Tableau, Business Object and Power BI.
• Proficient in Medicaid, Medicare (Part A, B, C, and D), Procedural and Diagnostic codes, and Claims Process.
• Proficient in using UML for Business Process Modeling, Use Cases, Activity Diagrams, Sequence Diagrams, Data Flow Diagrams, Collaboration Diagrams, Class Diagrams and document them using Microsoft Visio and Gliffy.
• Experienced in working in Agile Scrum, Scaled Agile Framework, Agile XP, Waterfall, RAD and SDLC methodology environments.
• Highly skilled in conducting SWOT Analysis, Feasibility Analysis, Cause & TEMPeffect Analysis, Risk Analysis and Impact Analysis.
• Expert in creating database tables, joins, indexes, stored procedures, views, triggers, user defined data types and functions in MS SQL server
• Experienced in developing and executing test cases performing functional testing, usability testing to ensure teh product meets teh system requirements.
• Experienced in preparing test data and validating data using SQL Queries.
• Experience in Data mapping, Data mining, Data warehouse concepts, OLAP and OLTP Technologies.
• Experience in Rational Rose, Clear Case, Requisite Pro, Clear Quest and MS Visio.
• Excellent communication and interpersonal skills.
• Experienced in training users and developing training manuals.
• Experience of Microsoft Word, Excel, PowerPoint, Outlook, Project and HP Quality Center.
• Good Knowledge of Health Care reform - Risk Adjustment
• Strong understanding on Electronic Data Interchange(EDI), both in 4010 and 5010 formats.
• Extensive experience in organizing and facilitating joint application development (JAD) sessions, interviews and workshops with user(s), subject matter experts (SME’s), and business stakeholders.
• Proficient in producing Business Requirement Documents (BRD), Functional Requirement Document (FRD) and Software Requirement Specification (SRS) across teh deliverables of a project.
• Developed business Process flows for different department functions using MS Visio.
• Expertise on website Wireframes and Business Process Modeling with excellent skills on Use Case, Activity, Sequence, Data-Flow diagrams using Unified Modeling Language (UML), in MS Visio and Rational Rose.
• Well versed in Relational Database Management System (RDBMS).
• Skilled user in Clear Quest for defect tracking, bug reporting tools like Test Director and Quality Center.
• Experienced in handling Change Management.
• Working knowledge of Structured Query Language (SQL) for data manipulation and retrieval from data ware house and transform it to required Database like DB2, Oracle and so on.
• Excellent analytical skills with extensive experience on performing GAP analysis, User Acceptance Testing (UAT), Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis, Impact Analysis, Risk Analysis and Mitigation plan, Cost benefit analysis and Return on Investment (ROI) analysis.
• Proficient in handling functional and non-functional requirements with exceptional understanding and skill set in writing Test Scenarios, Test Conditions, Test Cases, and Test Scripts.

Areas of Expertise

• Analytics & Reporting
• Problem solving
• Documentation
• Communication
• Relationship management
• Business strategy planning
• Change management
• Business process analysis & design
• Negotiating & delegating

TECHNICAL SKILLS

Project Methodologies: RUP, SDLC, Agile Methodology

Business Modeling: Rational Rose, MS Visio, MS Project

Requirement Management Tools: Test Director (Quality Center), Rational Requisite Pro, Clear Quest, SoapUI

Programming Languages: C++, SQL, PL/SQL, UML, HTML, VB Script

Defect Tracking Tools: Rational Clear Quest and Mercury Test Director

RDBMS/ Database: MS SQL, MS Access, Oracle, Facets

Operating Systems: Windows 2000/XP/ME/VISTA, LINUX, UNIX

Project Management Tools: MS Office Suite, MS Project, MS SharePoint, Power BI

PROFESSIONAL EXPERIENCE

Confidential, Michigan

Business Systems Analyst

Environment: UML, MS Word, Rational RequisitePro, Rational ClearQuest, Quality Center, SQL, FTP, TelNet, Facets, Microsoft SharePoint.

Responsibilities:

• Read Project Charter and planned further steps with teh project manager.
• Interacted with various stakeholders to collect their user stories; document, manage and ensure real-time tracking of them as project proceed.
• Performed extensive GAP Analysis to understand teh As-Is and To-Be conditions and determine teh feasibility of teh new project with teh existing system.
• Consulted with business team to identify, define and document business needs and objectives, current operational procedures, problems, input and output requirements.
• Studied teh current system functionalities & behavior and documented “As-Is” process; later upon business requirements and identifying teh application shortcomings developed “To-Be” processes.
• Carried out User Acceptance Testing and extensively used SQL to perform Backend Testing to verify data integrity.
• Interacted with teh QA team to perform Unit and Integration.
• Worked with Trizetto to resolve teh issues identified at analysis state while building teh Custom components for Claim life cycle.
• Acted as a Claims Analyst was responsible for researching, analyzing, documenting and updating teh claims data on teh PCL legacy claims portal with respect to teh research and analysis in updating and integrating teh findings of customer's claims data.
• Analyzed EDI Transactions such as claim 837 P/me/D - medical claims, 835 - Health Care Claim Payment/Advice, 270 - Eligibility, Coverage or Benefit inquiry, 271 - Eligibility, Coverage or Benefit response, 276 - Claim status request, 277 - claim status response, 820 - Payment Order/Remittance Advice, and 834 - Benefit Enrollment and Maintenance.
• Updated, analyzed, and manipulated teh SQL database.
• Worked with teh developers to add technical information during teh grooming process to validate teh user story's technical acceptance criteria.
• Collected, documented, organized, and tracked teh business requirements using Rational RequisitePro.
• Made business requirements document, change requests, and use cases available to all teams using MS Visio.
• Developed business flow diagrams, activity diagrams, and interaction diagrams so that teh development team and other stakeholders could understand teh business process clearly.
• Maintained project milestones, schedules, and project progress using MS Project.
• Held presentations and participated in walkthroughs with teh development team and teh QA team to halp them understand teh requirements and formulate test plans and test scripts.
• Maintained Requirement Traceability Matrix (RTM) to check whether teh requirements of teh system were met accordingly and to produce RFPs.
• Performed claim validations and Pend/Denied claims analysis for teh Health plans Medicaid programs.

Confidential, Southfield, MI

Business Analyst

Environment: MS Office, Quality Center, SQL Server, Facets, MS Project, Server, MS Visio, Unix, SQL, HTML, Java, XML, Mainframes and Rational ClearQuest, ClearCase, Windows XP

Responsibilities:

• Determined how teh changes in 4.71 impacted teh current business operations, defined and developed business and technical requirements within and across transactions.
• Performed Gap Analysis to identify AS-IS processes of 4.71 standard and TO-BE processes of 5.01
• Worked extensively with teh users, development team and different levels of management to clarify/understand functionalities and ensure that teh developers clearly understood teh business requirements that teh system was designed to fulfill.
• Using Rational Rose, teh business requirements were segregated into high level and low-level Use Cases, Activity Diagrams.
• Designed and developed state diagrams, activity diagrams and class diagrams in MS Visio for various modules of teh project.
• Created Data Stage jobs to extract, transform and load data into data warehouses from various sources like Relational databases, application systems, temp tables, flat files etc.
• Review requirements and understand technical recommendations and constraints, and develop. Comprehensive and accurate functional specifications; Data Mapping, and process flow.
• Built Process improvement flows for Business entities.
• Responsible for Documentation in each phase of RUP Methodology, Risk Assessment, and Validation & Verification process. Worked with Claims, enrollment, eligibility verification for members and providers, benefits setup, and backend payment cycle in FACETS.
• Assisted teh data analyst in data mapping for ICD- 10 implementation.
• Used SQL Queries to validate data at teh back end to ensure that all teh claims related data TEMPhas been loaded to teh appropriate data sets.
• Gained a clear understanding of teh claims adjudication and reimbursement systems based on HIPAA X12 5010 standards
• Interacted with teh QA team to developed Test plan and Test cases based on Use cases and Functional Specifications.
• Served also as focal point for external vendors and internal business partners regarding daily call routing or proposed strategic changes to teh call routing or IVR services being performed.
• Organizes and defines parameters of multiple assigned projects. Assembles relevant data for said projects and validates information with other departments to include teh business unit, telecom or teh IT department responsible for teh IVR.
• Conducted Claims and HIPAA Compliance Training to run teh test cases.
• Maintained a Traceability Matrix to ensure that all Functional Requirements were addressed at teh Use Case Level as well as teh Test Case Level.
• Assisted in EDI 835/837/270/271 transactions of medical claims/underwriting for support and point of reference for teh providers in business issues.
• Performed Unit and Integration Testing and implemented Alpha Test to confirm teh functionality of recent conversion.

Confidential, Troy, MI

Business Analyst

Environment: Rational RequisitePro, Rational Rose, RUP, UML, Load, MS-Project, MS Visio, Java, MS Office, Windows XP.

Responsibilities:

• Reviewed and analyzed business requirements and interacted with teh business users to resolve conflicts.
• Performed initial functional and business analysis to determine scope and document review for teh technical team.
• Constructed, developed, and deployed ACH for Overseas Business Unit, created functional and technical specifications (mid-level), highlighting chief actors, process flows, and exception errors.
• Worked with various Overseas Funds Transfer Applications.
• Interacted with Offshore development team, and incorporated teh analysis and requirements in teh final detailed design documentation.
• Played key role in System Development Life Cycle Process consisting of: Design and Gap Analysis, Business Requirements, Systems Requirements, Test Criteria, and Implementation to have teh outputs of project dealt with teh automation of correspondence directed to policy owners.
• Analyze business requirements, provide time estimates, create and modify Call Flow Diagrams, preparation of design documents, system development, and production handover.
• Developed and implemented training material.
• Actively assisted in teh acceptance and validation of teh stories by testing teh delivered stories in teh development environment before release to teh business area for Integration Testing.
• Created management reports to oversee daily operations to improve quality customer service
• Reviewed and provided critical document feedback to team members, communicated document analyses to team lead and stake holders.
• Chaired and participated in project conferences for coordinating group efforts leading to teh development and testing phase.
• Developed activity, sequence and Use Case Diagrams Using MS Visio.
• Used MS Project to develop project schedules and tasks.
• Participated in developing Use Cases, activity and sequence diagrams to define teh functionality scope of teh applications during walkthroughs and JAD sessions.

Confidential, Cleveland, Ohio

Health Care Analyst

Environment: MS Office, Agile methodology, MS Visio, MS Project, UML, WinRunner, MS Office, Microsoft SharePoint, Requirements Gathering.

Responsibilities:

• Congregated requirements from different levels of management, stakeholders, and SMEs through JAD sessions and Live meetings.
• Incorporated AGILE methodology to establish a business analysis by interacting SMEs and end users.
• Completed a Business and Technical Requirement Document (BTRD).
• Specializes in teh EDI 270/271 (Eligibility, Benefit and Coverage Inquiry/Response) and 834 (Benefit Enrollment and Maintenance) and minimally exposed to teh 276/277, 278U, 820, 837D, 837I, 837P, 277CA and 835.
• Deliverable documents are standard templates peer reviewed internally before delivery to designated project team members for approval.
• Executes transmittals from our client for MMIS configuration updates and Systems tickets for improvements to our internal Systems Team processes. Supports teh BA Team as its EDI BA and backs up Operations staff dedicated to teh EDI process. Rotates duties for BA On-call and Security Sweep.
• Developed Use Case documents using MS Visio of As-Is and To-be business.
• Designed and developed business flow and work flow diagrams to develop teh software.
• Created Use case diagrams, Activity, Sequence and Collaboration diagrams using UML.
• Participated in walkthroughs with teh development team and QA team, to halp them understand teh requirements and halp them formulate teh test plans and test scripts on EDI 834 benefit enrollment.
• Involved in verifying EDI 834 raw data from different portals such as fax, websites or email.
• Conducted JAD sessions to define System Requirement Specifications (SRS) and Detailed Designed Discussions with teh technical team to design teh user interface (UI) for Facets System.
• Worked with Facets Application Groups, e.g., Claims Processing, Subscriber, Provider, Medicaid Program, Enrollment, Quick Member and Mass Plan Change Application.
• Participated as a core team member of a Clinical Development initiative to create an architectural business end-to- end solution for clinical trials as a standard for all remote data capturing clinical trials
• Identified IVR (HAPAY) system enhancements, defined systems scope and objectives based on both user needs and a thorough understanding of business systems and industry requirements. Troubleshoot, document and resolve any issues related to determining teh requirements. Researched HAPAY call distribution business processes and system flows to determine client needs.
• Selected Contributions:
• Participated in project team meetings, requirements sessions and status meetings as well as facilitated walk through sessions to receive sign-off.
• Analyzed business and user needs to establish proper system requirements specifications and limitations.
• Created and documented teh business requirements and entered into a testing tool (JIRA) for teh QA team to derive test scripts.
• Designed Data Flow Diagrams (DFD's), Entity Relationship Diagrams (ERD's), and web page mock ups using modeling tools.
• Created a Data Dictionary Mapping teh Reportable Health Conditions with LOINC/SNOMED codes and Master Data Management Documents.
• Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data within teh Oracle database.
• Designed and implemented basic SQL queries for QA Testing and Report / Data Validation.
• Experienced in Blackbox testing using decision testing and use case testing.
• Defined Quality Assurance Checklist using Oracle Service Contract.
• Utilized MS Project to maintain a record of recommendations, communications, activities, schedules to monitor teh progress of project in real time.
• Intensively involved in project testing efforts by doing Integration Testing, Regression Testing and by halping UAT team in User Acceptance Testing.
• Maintained traceability of requirements through to teh testing phase; created and executed test cases; coordinated with testing teams during QA and UAT testing activities.
• Presented documentation on key elements of HIPAA compliance to ensure teh development teams were on track.
• Worked with Claims, enrollment, eligibility verification for members and providers, benefits setup, and backend payment cycle in Facets.
• Created User manuals and provided one-on-one training to end users.

Confidential

Business Process Analyst/ Documentation Specialist

Environment: Rational Rose, RequisitePro, Test Manager, Clear Quest, RUP, MS Visio, MS Project

Responsibilities:

• Adhered to teh guidelines laid out by teh Water fall methodology of development through teh Entire Software Development Life Cycle
• Gathered Business and Functional Requirements and elicited them in teh form of Use Cases and other Requirements Documents.
• Identified/documented data sources and transformation rules required populating and maintaining data warehouse content.
• Wrote PL/SQL statement and stored procedures in Oracle for extracting as well as writing data.
• Implemented data access, storage and validation routines on teh database server using Procedural Language/Structured Query Language (PL/SQL).
• Involved in teh testing phase right from teh Unit testing to teh User Acceptance testing.
• Analyzed and optimized teh Business Requirement Documents and then converted teh business requirements into Functional Requirements
• Supported Amazon.co.uk as a blended agent in various skill sets including teh retail, digital and Kindle device technical support.
• Listen to teh customer voice and respond to queries and issues with an empathetic view and resolve them at teh earliest.
• Partnered with telecom and IVR teams to establish routing for new toll-free numbers for client specific routing. Participated in teh planning, research, analysis, development, testing and implementation of new complex call routing as well as modifications to existing call routing to facilitate improved capabilities, products, and/or services.
• Managed daily operations of call center activities performing customer oriented telephone activities and various background operational duties.
• Provide feedback to management, vendors and technical operations as appropriate to assess computing needs and system requirements as they pertain to administration of teh contact center systems.
• Provide recommendations by offering product and order related support, provide technical troubleshooting when needed and ensure customer satisfaction.
• Team member of teh Kaizen team, gathering requirements from various stakeholders including teh customer support team, development team and teh feedback team and building consensus, raising tickets in critical scenarios thereby directly involved in teh continuous improvement.
• Used teh Unified Change Management (UCM) tool, BPM Remedy to maintain and track teh Stakeholders requested enhancements and changes.
• Worked with teh QA team through teh Testing Cycle to verify complete and rigorous testing of requirements.
• Operative report management for data analysis and problem-solving platform