SUMMARY

• 7+ years of IT experience with strong knowledge of Software Development Life Cycle (SDLC) principles including Waterfall methodology, Rational unified process (RUP) and Agile methodologies.
• Expertise in Business Analysis, Business process modeling, Operations research and Requirements analysis.
• Proficient in Requirements Management, including gathering, documentation, analysis, detailing and tracking requirements, Quality Assurance, Testing and End user support working as Business Analyst mainly in Healthcare sector.
• Specialized experience in healthcare insurance domain including Medicare part A, B, C, D, Medicaid, PBM, Procedural and Diagnostic codes and Claims Process and FACETS. Profound experience with HIPAA X12EDI transaction codes such as 270/271 (inquire/response health care benefits and eligibility), 276/277 (Claim - status), 278 (Transmitting health care service information), 834 (Benefit-enrollment), 820/835 (Payment/remittance advice), 837 P/I/D (Health care claim).
• Implementation and Knowledge of HIPAA code sets Migration, ICD-9, ICD-10 coding.
• Strong understanding of Medicaid Management Information System (MMIS), Patient Protection and Affordable Care Act (PPACA), Health Level Seven International standards (HL7), Health Care Reform, and Claims EDI
• Working experience in Health Insurance Exchange (HIX), Health Information Exchange (HIE) and Encounter Data Processing System (EDPS/RAPS).
• Experience in interacting with business users to identify their needs, gathering requirements, developing detailed functional specs through JAD sessions, interviews, on site meetings and authoring Business Requirement Documents (BRD), Functional Requirement Document (FRD) and Software Requirement Specification (SRS) across the deliverables of a project.
• Expertise in facilitating Joint Application Development (JAD), Rapid Application Development (RAD), interviews, workshops, and requirement elicitation sessions with end-users, clients, stakeholders and development team.
• Experience in creating UML diagrams, Data Flow Diagrams (DFD), Use Cases, Class Diagram, Activity Diagrams, Sequence Diagram, and UML Modeling.
• Experience with ETL (Extract, Transform, and Load), Data Mapping and SOX compliance.
• Extensive hands on experience in creating RTM, Defect Status Report, Change Request Form, Test Plan and Collaboration Diagram and designing User Interfaces (GUI) and wireframes.
• Experience with Rational Rose, Rational Requite Pro, Rational Clear Quest, Rational Clear Case, MS Project, MS Visio, Balsamiq.
• Strong Knowledge with Iterative approach for Software Development as per Rational Unified Process (RUP). Involved in inception, elaboration, construction & transition phases using rational tools like Requisite Pro, Clear Case, and Clear Quest during various phases of RUP.
• Strong knowledge of FDA (GxP), 21 CFR part 11 regulation, cGMPs, GAMP, ICH, ASTM E2500.
• Experienced in SWOT Analysis, Gap Analysis, Impact Analysis, Risk Analysis, and Project Planning. Exceptional Problem Solving and Sound Decision Making capabilities, along with ability to manage and resolve increasingly complex situations through Root Cause Analysis.
• Working knowledge in RDBMS, data validation in SQL by writing SQL queries.
• Good knowledge of NASCO system, SCHIP/CHIP, CMS, HMO, PPO, POS and EMTALA.
• Experienced in writing Test Cases and Conducting various testing like UAT (User Acceptance Testing), Functional Testing, Positive testing, Negative testing, etc.
• Possess a detail-oriented nature with excellent communication, interpersonal, organizational skills and presentation skills. Experience working with business users as well as senior management.
• Recognized for being a valued team player with ability to multi-task.
• Experience managing and working with On-Site and Off-Shore teams
• Technical writing skills including drafting contracts, documentation and editing of user manual.
• Maintained, monitored and assigned tasks of project progress in MS project.

TECHNICAL SKILLS

Business Skills: Business Process Analysis & Design, Process Improvement and Implementation assessment Gap Analysis, Impact Analysis, JAD/JRP Sessions Requirement Gathering, and Use Case Modeling, Tableau, Salesforce.

Methodologies: Rational Unified Process (RUP), Agile, Waterfall, Rapid Application Development (RAD).Six Sigma, CMM

Languages: SQL, XML, HTTP, HIPPA 4010/5010, ICD9/10, ANSI X12, CPT, CMS form

Change Management Tools: Clear Quest, Clear case, SharePoint and Rational Requisite Pro

Version Control: Rational Clear Case

Testing Tools: HP Quality Center, Rational Enterprise Suite, Load Runner, Win Runner

Defect tracking tools: Rational Clear Quest and Test Director, Quality Center

Databases and RDBMS: DB2, Oracle, SQL Server, Sybase MS Access

Microsoft technologies: Project, Visio, Excel, Word, Outlook, PowerPoint

Project management tools: MS Office Suite, MS SharePoint, MS Project, MS FrontPage

Modeling Tools: Rational Rose, Microsoft Visio, Balsamiq

PROFESSIONAL EXPERIENCE

Confidential, Rockville, MD

Business Analyst

Responsibilities:

• Worked with BI (Benefit Investigation) Delivery Manager and Operations to analyze and document business processes and requirements.
• Established, reviewed, revised, interpreted and implemented policies, procedures and program standards supporting the Program.
• Created system and training documentation to include instructions on new features, release notes, and user manuals
• Assessed and analyzed state and federal Medicaid and CHIP policies impacting the implementation of Medicaid health IT initiatives.
• Prepared policy recommendations, updates and process improvements to enhance operations and to ensure compliance with federal and state regulations.
• Prepared written communication and reports for internal and external stakeholders, including Congressional committees, Federal and State agencies.
• Developed operations plan, training material, and reference guides for use during the incentive program transition.
• Conducted policy and procedure training modules for the Medicaid Incentive Program outreach staff
• Created and Executed a Requirements Management Plan (RMP)
• Analyzed and translated business requirements into reporting technical requirements
• Designed and developed Business Investigations and solutions using best practices and standards.
• Collaborated well with project team business partners Reporting Delivery Manager and senior level executives
• Reviewed reports for trends for quality data structure, report validity and data details
• Communicated clearly and effectively in a timely manner with Operations and IT partners
• Ensured the full workflow of the reporting request is followed, documented and closed.
• Planned and managed business requirements and functional requirements as well as documentation activities
• Gathered application requirements from users and subject matter experts, and prioritized required features to contain scope
• Created Business Requirements Documents, for review and approval from responsible parties
• Translated business requirements into detailed functional specifications as input to design and development.
• Maintained frequent communication with client teams regarding project deliverables and to gauge completion of pending projects. Ensured existing documentation is kept up to date as requirements changed.
• Ensured adherence to Reporting processes and performance metrics.
• Assessed reporting needs and provided recommendations for enhanced solutions and matched needs to Reporting tools and capabilities.
• Followed the guidance of FDA (GxP), 21 CFR part 11 regulations, cGMPs, GAMP, ICH and ASTM E2500.
• Performed Ad-hoc query development to support program needs
• Worked with Reporting and Information Technology team members to communicate requirements and ensured delivery of quality well defined requirements.

Environment: Patient Plus CRM, Thera call, Windows 7, MS Access, EDM Quality, EDM CRF, MS Excel, MS Project, RUP, Oracle, UML, MS Office suite, MS Visio, RSL, EDIFECS, PTR System

Confidential, Plano, TX

Business Analyst

Responsibilities:

• Interfaced with, and interviewed, cross-functional stakeholders to generate requirements.
• Supported the EDI (x12). Concentrated on 270/271 (eligibility, coverage and benefits). Also, experience with the 837 (claim). Ensured the data was formatted correctly and researched errors. Validated the data was accurate by comparing it to the source system.
• Prepared Data mapping document for EDI 834 toCigna Healthinternal format.
• Gathered high level requirements from the business, created user stories, and prioritizedthe backlog with project manager.
• Collaborated with the development team through iteration and attended every Scrummeetingto represent the product team.
• Enabled product-centric testing and facilitated QA team's understanding of acceptance criteria and test scenarios.
• Developed Activity Diagrams, Use Case Diagrams, and Workflow Diagrams using Microsoft Visio.
• Accountable for extensive User Acceptance Testing.
• Interfaced between users and diverse teams and was involved in application development to enhanceunderstanding of both business and IT processes.
• Utilized technical writing skills to create effective documentation and training materials.
• Performed a baseline assessment and related interfaces, existing service level agreements, policies,andoperational business proceduresfor readiness to comply with ICD-10requirements.
• Identified risks, problems, requirements and concerns in order to comply with ICD-10 changes byconducting interviews. Activelyworked on Data analysis and Report analysis with respect to ICD-10 impact.
• Collected the information related to ongoing application upgrade. Studied their impact on ICD-10implementation.
• Responsible for defining the scope and implementing business rules of the project, gathering businessrequirements and documentation.
• Responsible for writing Functional Requirement Specifications (FRS) and User RequirementSpecification (URS).
• Created Test Plan, Test Cases and Test Scripts with respect to Test plan.
• Analyzed Business Requirements and segregated them into high level and low level Use Cases,Activity Diagrams, State Chart Diagrams using UML methodology. Clearly defined the Data Process Models.
• Capturedanddocumentedgovernance requirements.

Environment: Windows XP, RUP, UML, SQL, Rational Tools, MS Visio, MS Word, Excel, PowerPoint, Access

Confidential, Grand Rapids, MI

Business Analyst

Responsibilities:

• Gather requirements and document the proposed processes to the existing system. Modules included: Claims Processing Files and HIPAA Guidelines adherence across the company.
• Enhanced applications associated with Claim Numbers so that duplicate Claim Numbers could be allowed in the system. Updated the Electronic Claims, Patient Screen and Sales Administration processes.
• Claim Transactions and Billing Transactions - Created flows for adequate matching of Claims. Matched Billing File and EDI Claim File records upon receipt.
• Duplicate Claim Number Project - Enhanced three different applications - EDI Feeds and Patient Screen App to allow duplicate claim numbers to exist in the database.
• Drug Card Project - Worked in a project involving Miami Systems to create Drug Cards.
• Created Test File to be sent to the Drug Card Vendors for approval. Worked on a Paid without prejudice project for various States.
• User Acceptance Testing (UAT) - Performed UAT tests using the MORAE Usability Testing Tool using the Observer and the Manager Mode.
• Testing - Developed Test Scripts using Test Director/Quality Center and coordinated with developers to quickly resolve the defects associated with them.
• Conducted JRP sessions and JAD sessions with the management, users and other stakeholders for open and pending issues to develop specifications.
• Analyzed and evaluated User Interface Designs, Technical Design Documents and Quality Assurance Test Conditions the performance of the application from various dimensions.
• Helped create the 'Business Glossary' to facilitate efficient understanding of the business process amongst the other teams.

Environment: MS Visio, Word, Excel, PowerPoint, CMMI, Rational Rose, Requisite Pro, Clear Case, Clear Quest, SQL

Confidential, Watertown, MA

Business Analyst

Responsibilities:

• Facilitated sessions with senior agency staff to identify the business flows and determined whether any current or proposed systems are impacted by the EDI X12 Transaction Code Sets and Identifier aspects of HIPAA.
• Produced reports through Impact Analysis on system, data, technology, providers and clearing houses, enabling recommendations and best practices for becoming HIPAA compliant.
• Involved in developing work plan, detailing the tasks and effort required to achieve HIPAA compliance.
• Elicited, documented and managed Business and System requirements for HIPAA 5010 version 837, 834, 835, 270, 271, 276, transactions through requirements gathering sessions with stakeholders.
• Performed Gap Analysis between HIPAA 4010 and 5010 and involved in evaluating benefits of new system with the Management team to strategize solutions to the process of HIPAA compliance.
• Created Vision, Scope, and Use Case documents, Business Process Models, Use Case diagrams, Activity diagrams, and State Chart diagrams depicting software architecture and interaction of system components before prototyping.
• Involved in developing Business Requirement Document, System Requirement Specification document for application development.
• Coordinated work plans between project manager and stakeholders using MS Project.

Environment: Windows/XP, MS Office, Share Point, SQL Server, Oracle, MS Project, MS Access, Facets & Agile Methodology.