SUMMARY

• Over eight years of experience in business analysis, requirement gathering and testing with a focus in healthcare. Skilled in stakeholder analysis, management and communication by working with senior business sponsors and technical specialists. Acted as an association between the business and development teams for requirements.
• Partnered with operations and PMO to create efficient cross - functional processes by eliminating non-value added activities. Worked with executives and staff to develop culture of continuous improvement (business process improvement).
• In depth knowledge on different phases of Software Development Life Cycle (SDLC), Project Life Cycle (PLC) and Software Testing Life Cycle (STLC).
• Expertise in writing user stories in JIRA, RTC, RRC and TFS using ‘Agile’ and ‘Waterfall’ methodology (including ABRD), root cause analysis, creating workflows and process mapping.
• Possess excellent client interaction and communication skills as well as experience working in complex, cross functional and geographically dispersed team environments.
• Complete understanding of the AS-IS and TO-BE business processes and experience in converting these requirements into technical specifications for preparing test plans.
• Conducted ‘GAP Analysis’ so as to analyze the variance between the system capabilities and business requirements. Managed meeting sessions with the SMEs to review business requirement.
• Expertise in Data Modeling, Data Analysis, Requirement Analysis and Business Modeling.
• Proficient in User Acceptance Testing (UAT), Functionality Testing, Unit testing, System Testing, Integration Testing and Regression Testing.
• Strong experience with HIX, HCR, Medicare, Medicaid, and commercial insurances inHIPAA ANSI X12formats including270/271, 276/277, 835, 837, 834, 997 and NSF formatsfor interfaces and images to third party vendor applications.
• Strong experience in retail, SG, NRSG, NRMM, LG and ASO projects pertaining to quoting, enrollment, renewals and membership (ID Cards).
• Have extensive knowledge in Insurance products like HMO, EPO, PPO, POS and Managed Care.

TECHNICAL SKILLS

Methodologies: SDLC, RUP, UML, JAD, CMM, RAD, Waterfall, Agile (Scrum Approach)

Testing Tools: Rational Enterprise Suite, Quick Test Pro, Win Runner, Load Runner, Test Director and ALM.

Business Modeling Tools: Microsoft Visio, Rational Rose and Power Designer.

Version Control: Rational Clear Case

Databases: SQL Server, Oracle, DB2, MySQL and MS-Access.

Project Management: Microsoft Project, Microsoft Office, TFS, JIRA, RTC and RRC.

Claims Tools: HealthRules, eSD Maintenance, CTE 360, PEGA, RUMBA, Claims Research Tool, Client Benefit Manager, Axiom, Transcend, Pervasive and Bluechip.

eSales Tools: Quoting, Enrollment, Trionfo, Renewals (SGR/BRCx), Actuarial (Rating), Blue Access for Producers (BAP), Blue Access for Employers (BAE), BlueCap (Capitation) and BlueStar (Membership/ID Cards).

PROFESSIONAL EXPERIENCE

Sr. Business Systems Analyst

Confidential, Richardson TX

Responsibilities:

• Interface with business team to gather the business level user stories and upload it in JIRA.
• Responsible for converting the business stories into system level stories pertaining to quoting, enrollment and renewals (SGR/BRCx) for SG, NRSG and NRMM.
• Facilitate grooming session with the scrum master, developers, testers (SIT & UAT) and business to go through the user stories in detail and allot user story points for each sprint cycle.
• Track the progress of the development process for each sprint cycle, documented and reported it to the higher level management.
• Responsible for writing the business test scenarios which acts as the key documentation for the testers to create the test cases document.
• Clarify QA team issues and reviewed test plans to make sure all requirements have been covered and tested properly. Prioritized outstanding defects ensuring accuracy and deadlines were met.
• Responsible for scheduling the defect status call to go over the production defects and work with the developers on fixing the issues.

Environment: MS Office Suite, JIRA, ALM, Clarity, Jabber, eSales and BlueStar.

Senior Associate Consultant

Confidential, Hartford CT

Responsibilities:

• Performed requirements gathering and analysis, interviewed SME (Subject Matter Experts), and ensured that contributors and all key stakeholders are motivated to complete assigned tasks.
• Responsible for analyzing the (LG) downstream system and creating user stories for the same pertaining to renewals and revisions impact.
• Followed agile software developmental methodology, Scrum framework for the project.
• Facilitated the initial scrum team meeting to identify key root causes of claims that required edits.
• Acted as a liaison under the product owner role and assisted in creating and prioritizing the Product backlog.
• Assisted in converting user stories into system requirements under multiple sprint cycles.
• Attended Daily Scrum Meetings for updates on the development of the application.
• Participated in Sprint Review Meetings to review the changes of individual sprints.

Environment: MS Office Suite, RTC, RRC, NURA, CCFE, Quoting and Renewals.

Senior Business Analyst

Confidential, Richardson TX

Responsibilities:

• Interfaced with business users to prepare and update the Customer Requirements Specification (CRS) document and the technical specialists to find out the downstream system impacts.
• Created the Software Requirements Specification document for the following application pertaining to 2017 new product changes: 1. Quoting 2. Enrollment 3. Trionfo 4. Renewals (SGR/BRCx) 5. Actuarial (Rating) 6. BAP and 7. BlueStar (including ID cards).
• Tracked and maintained stakeholder requested enhancements and changes using Requirement Traceability Matrix (RTM).
• Participated in the planning, development, coordination and presentation of specific testing needs as appropriate to the quality assurance needs of the end user.
• Worked closely with multiple vendors (Prime, DNOA & EyeMed) to gather the providers (medical, dental, vision and pharmacy) information and formulary list (drugs).
• Worked with the data analyst and developer to convert the source files into JSON format by embedding the necessary plans for each provider and drug. Validated the final JSON files to verify whether it complies as per the CMS schema.
• Conducted JAD sessions with stakeholders throughout SDLC to resolve open issues.
• Responsible for writing user stories and assigning the tasks to the team members.
• Frequently communicated with developers to resolve technical issues.
• Performed GAP analysis of business rules, business and system flows, user administration and requirements.
• Recommended corrective actions, if necessary, along with the progress against development/action plan routinely to the Project Manager.
• Worked with the management for improving and giving new ideas for designing future state processes.
• Functioned as the primary liaison between the business line, operations, and the technical areas throughout the project cycle.

Environment: MS Visio, MS Office Suite, RTC, ALM, Clarity, eSales, BlueStar and SQL Server.

EDI Lead Business Analyst

Confidential, Austin TX

Responsibilities:

• Gathered and prioritized the customer's product requirements and worked closely with the business owners and other high level stakeholders in addition to development, QA and production support to ensure revenue and that the customer satisfaction goals were met.
• Worked closely with the project manager to discuss the resources, scope, cost (budget) and time (deadlines) during the project kick off meeting. Created and updated project schedules and managed resources and timeline using MS Project.
• Tracked down the status of each project (R/Y/G meeting) and reported it to the senior level management on a weekly basis.
• Interacted with the vendor’s to document the mapping specifications which acts as a key documentation for the developers to produce the data files (Institutional and Professional claims, medical claims, provider’s data, member’s data and Pharmacy data).
• Conducted structured walk through and JAD sessions for consensus on baseline.
• Provided subject matter expertise in areas including EDI, proprietary flat files and system integration to the development, QA and production support teams on core system enhancements.
• Provided knowledge transfer training sessions to key shareholders and worked with partner companies where applicable to deliver solutions.
• Supported baseline system documents for roll-out activities and assisted in the creation of companywide SDLC standards to utilize agile methodologies.
• Designed and implemented basic SQL queries for QA testing and report / data validation.
• Prepared the project status reports and represented the EDI team in the PMO meetings.
• Participated in UAT along with the development & testing teams
• Played an integral role as part of core program management team for the turnover to a new outsourcing vendor.

Environment: MS Visio, MS Office Suite, HealthRules, Samanage, TFS and SQL Teradata.

Project Lead/Business Analyst

Confidential, St Louis, MO

Responsibilities:

• Interacted with the business users along with the administration and management to gather business stories and analyzed the functionalities that needed to be incorporated into the system.
• Conducted meetings with various stakeholders to gather requirements (High Level Business and Functional Needs) for creating the BNTS.
• Responsible for creating the ruleset, workgroups and users in PRPC and assigned the work (to the work list). Performed rule edit/object validation and managed the reports through PRPC.
• Conducted structured walk through and JAR sessions for creating the Detailed Level Requirements (DLR) and Detailed Level Design (DLD).
• Responsible for reviewing and approving the IT QA test plans and detailed test cases.
• Responsible for post-production monitoring and validation of all code enhancements and set up changes in support of government program groups.
• Collaborated with the Business Systems Analysis Specialist team members to monitor the business project portfolio in an effort to identify synergies between projects.
• Acted as a TAG (Technology Alignment Group) lead for IMS (Issue Management System) issues assigned and worked in liaison between the IT team working on the issue, and the issue owner(s) on the business side.
• Developed procedures according to the product needs and state guidelines.
• Drafted reports and created diagrams on the business process.
• Conducted GAP analysis in understanding how the upgraded system carries out the business functions and assisted in ensuring the timely and effective implementation.
• Interacted with the top management and business users on daily basis with regards to how the application functions, troubleshooting incidents for the users and completed defect and enhancement requests on a daily basis.
• Conducted functional walkthroughs and User Acceptance Testing (UAT).
• Created post implementation feedback loops to update the senior executives on lessons learned to support ongoing organizational continuous improvement efforts.

Environment: MS Visio, MS Office Suite, MS Project, Rational Clear Case, Rational Requisite Pro, Test Director, Rational Tool, eSD Maintenance, eSD Production, Claims Research Tool POS, RUMBA, CBM, PEGA (Adjustments front end tool), IW and SQL Teradata.

Business Systems Analyst

Confidential, Dallas TX

Responsibilities:

• Defined the scope of the project and developed a vision plan that defined the primary goals and objectives of the project.
• Worked with Rational Unified Process right from the initiation to transition phase.
• Gathered and analyzed business requirements for inbound and outbound files, managing all requirements using Rational Requisite Pro (RRP).
• Conducted research to make and approve updates regarding appropriate enterprise standards.
• Took charge of process definition and results of applicable enterprise IT metrics; organized education events to aid with broad skill development.
• Kept track of each entity’s usage of the enterprise project management standard processes.
• Conducted brain storming sessions to analyze provider contracts/reimbursement, benefit rules, medical policies and medical management rules to see the impact of ICD 10 diagnosis codes.
• Conducted working sessions to gather and document high level business requirements and detailed level business requirements for different business units impacted by ICD10 such as EDI claims intake, medical management-utilization management, case management and provider reimbursement- provider payment.
• Organized impacted systems into high, medium and low impact to help businesses analyze the level of effort for remediation activities and ease resource allocation work
• Analyzed healthcare transaction flow for HIPAA healthcare transactions like 834, 835, 270, 271, 276, 277, and 278.
• Conducted impact analysis gap analysis and assisted in Risk-Management analysis.
• Designed and developed all Use Cases and UML models.
• Developed business requirement specification documents as well as high-level project plan.
• Experience in gap analysis, data mapping and manually tested the interfaces and functionalities.

Environment: Rational Rose, Rational Clear Case, Rational Requisite Pro, Test Director, Rational Tool, MS Visio, MS Office Suite, MS Project, Oracle 10g, SQL loader.

Business Analyst

Confidential, Boston, MA

Responsibilities:

• Attended demo sessions to understand the existing system functionalities.
• Arranged interviews with all of the stakeholders to review and understand the gathered business requirements.
• Coordinated with system architects and developers to convert business requirements into system requirements.
• Conducted meetings to document Change Requests for new requirements.
• Analyzed business requirements and segregated them into Use Cases.
• Created Use case diagrams and documented Use case specifications.
• Maintained various versions of the documents generated during the project using Rational Clear Case.
• Responsible for creating and updating project schedule and managing resources and timeline using MS Project.
• Prepared the project status reports and represented the BA team in the PMO meetings.
• Participated in UAT along with the development & testing teams.
• Gathered requirements from collection, claims, Billing, and insurance appeal departments.

Environment: Windows 7, MS Office Tools 2010, MS Project 2010, Windows Server 2003, Microsoft SQL Server 2008, MS Visio 2010, Rational Requisite Pro.

Business Analyst

Confidential, Wilmington, DE

Responsibilities:

• Involved in Business Process Reengineering (BPR) - analyzed existing business processes and implemented new improved processes.
• Analyzed business needs and drafted process maps.
• Created Use cases diagrams using Microsoft Visio.
• Involved in technical designing to develop blueprints.
• Conducted requirement gathering using focus groups, document analysis, interviews, prototyping and authoring blueprints (to create the business requirement document).
• Involved in designing of the system with the system architecture and the development team, implementing technology based solutions.
• Conducted the initial study of Health Care Management to collect customers’ information like data about existing systems at customer site and specific customer requirements.
• Designed and implemented basic SQL queries for QA testing and report / data validation.
• Authored and monitored progress reports on a weekly basis.
• Developed Sequence Diagrams, Activity Diagrams.
• Conducted JAD sessions between the end users and the development team.
• Performed User Acceptance Testing (UAT) and reporting the bugs to the development team.

Environment: Rational Rose7.0, JAD, UML, Microsoft Office Visio, Microsoft Office Project 2010, UAT, SQL Server 2005, MS Access, Windows Server 2003, Mercury Quality Center, Visual studio 2005, Power Center.

Business Analyst

Confidential, Providence, RI

Responsibilities:

• Responsible for requirement and design documentation review, identification of customer management software anomalies and test results, customer interaction and IT management.
• Managed all of the requirements and change requests and made updated requirements available to all team members involved in the project.
• Worked extensively through agile development methodology by dividing the application into iterations and working on each iteration through full SDLC.
• Conducted GAP analysis in understanding how the upgraded system carries out the business functions and assists in ensuring the timely and effective implementation.
• Conducted feasibility study and performed impact analysis for proposed enhancements.
• Worked closely with Developers and User Representatives, participated in the product design process including specifications, end-user reviews and application walk-through.
• Developed business use cases in most instances, worked extensively on Rational Requisite Pro in gathering user Requirements, manage Workflows and elicit Communication plans.
• Generated Use Case diagrams using MS Visio to depict process flows, timelines and cost-benefit models.
• Interacted with Development and QA Team to ensure overall quality and scalability of the software.

Environment: HTML, Oracle 10g, MS Office, MS Project 2010, MS Visio, UML2.2.