SUMMARY

• Over five (5) years of concretepractices in business analysis,project co - ordination and management with broadunderstanding in, Software Requirement Analysis, Designing and Visualization encompassing different phases oftheSoftware Development Life Cycle (SDLC) in the Health Care domain.
• Sound knowledge of the software development lifecycle (SDLC) with extensive experience in eliciting user requirements, analyzing needs and translating them into business requirements, documentation, team management and testing
• Immaculate skills in creating Business Requirement Documents (BRD), Functional Specifications or Requirement Documents (FRD), Technical Requirement Document (TRD), System Design Documentation (SDD),UAT documents, Requirement Traceability Matrix (RTM), Issues Log, Data and Action List and training manuals.
• Proficient in developing UML artifacts such as Use Case documentation, Use Casediagrams, Class diagrams, Activity diagrams and Sequencediagrams using CASE tools like Rational Rose and MS Visio.
• Extensive use of tools such as Rational Rose, Rational Requisite Pro, UML, MS Visio, MS Project, MS Office, MS Access
• Experienced in coordinating User Acceptance Testing (UAT) /QA testing.
• Experience in Creation and Documentation of Test Plans, Test Cases, Test Scripts based on the Design and User Requirement Documents for - Unit, Integration, Regression, Functional, Performance, and User Acceptance Testing with QA and UAT teams.
• Proficient in medical terminology and coding outpatient and inpatients diagnosis Experience in building applications for ICD and CPT Electronic Data Interchange.
• Experienced working with the centers for Medicare and Medicaid services (CMS), the Healthcare Common Procedure Coding System (HCPCS), Electronic Data Interchange (EDI), Medicare Part D Services, and State Pharmaceutical Assistance Program (SPAP) services.
• Highly motivated team player with proven ability to get up to speed and adapt quickly to complex issues.Able to leverage versatility in the industry while conjoining the business and technology sidesto complete projects.

TECHNICAL SKILLS

Project Methodologies: RUP, Waterfall, Scrum

Business Modeling Tools: MS Visio, MS Project

Requirement Management Tools: Rational Requisite Pro

Defect Tracking Tools: Rational Clear Quest, Quality Center/Test Director

Operating Systems: Mac, Windows NT/XP/2000, Unix

Databases: Oracle, DB2, SQL Server, MS Access

Other Software: MS Word, MS Excel, MS Power point, MS Visio, MS Project, SharePoint 2007/2010

Content Management Tools: IBM Datacap,Filenet

PROFESSIONAL EXPERIENCE

Confidential, Boston, MA

Business Systems Analyst

Responsibilities:

• Coordinated with Business Owner, Application Vendor, Business Project Teams, Payers and Clearinghouses to bring all processes to a level of execution to mitigate any impact to current revenue flow under the 5010-compliancy requirements.
• Conducted and participated in JAD sessions with stakeholders and system users to collect the software requirement specifications (SRS) and used RequisitePro to maintain the requirements.
• Analyzed the testing results to ensure that the results were in accordance with the Gap Analysis expected results for 5010 compliance.
• Gained an understanding of ICD-9/10-CM (Diagnosis), ICD-9/10-PCS (Procedures Codes) - The mapping process: General Equivalence Mapping(s) (GEMs), ICD Code Set Mapping, CMS Reimbursement Mapping and the ICD 9/10 Code Set Maps.
• Helped with building ICD 9 to ICD 10 crosswalk map by grouping thousands of codes and ranges in Clinical, Benefits, Financial, Medical policy waves.
• Prepared use cases and data flow diagrams to analyze the impact of ICD-10 diagnosis codes embedded in different systems and applications.
• Gathered and validated inventory of applications, interfaces, and reports that will need to be modified to comply with ICD-10 requirements.
• 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 business analyze the level of effort for remediation activities and ease resource allocation work.
• Prepared and maintained requirements traceability matrix (RTM) throughout the project lifecycle.
• Created business workflows on the claims module for the client to get a better understanding of the software and prepared a detailed BRD including all functional and non-functional requirements.
• Worked closely on 834 transaction code for Benefit Enrollment and was involved in Validation of HIPAAfor 837, 270/271, 276/277, 835, 834 EDI transactions.
• Performed the Gap analysis of the earlier systems, generated a detailed Requirements document describing new system architecture through Use Cases and Activity diagrams.
• Wrote and tuned advance SQL queries, procedure, cursor, triggers, scripts.
• Designed robust 5010 testing and 4010 regression SIT and UAT Testing Scripts for the 5010 Project. Scripts were written on an application level and subset by payer resulting in over 600 combined scripts with a maximum of 70 testing scripts steps per script.
• Documented workflows and executed comprehensive testing and training plans to ensure the new acknowledgement results demonstrated in the 999 and 277CA were properly interpreted and managed to ensure Payer acceptance of the 837 files.
• Tracked all required resolutions required that were identified as needed from Vendors or Payers based on testing results.
• Wrote SQL Queries for data extraction on the oracle database.
• Identified all risks associated with the project and gave suggestions for mitigating the impact the identified risk posed to the business.

Environment: HIPAA, ICD9/ICD10, HCPCS, EDI, Agile, Requisite Pro (ReqPro), Rational Rose, Clear Quest (CQ), UML, SQL Queries, Oracle 9i, MS Word, MS Excel, MS Office, MS Visio, MS Project, Adobe Acrobat, SharePoint 2007, Lotus Notes, Windows XP

Confidential, Watertown, MA

Business Analyst

Responsibilities:

• Analyzed Business requirement and developed Business Requirement Document (BRD), Technical and Functional Requirement Specification (FRS) and Software Requirement Specification (SRS).
• Create metric reports to effectively and efficiently convey project information, and work with large amounts of datafor manipulation and reporting.Monitor documentation uploaded to Filenet Systems.
• Works closely with Confidential staff to accurately report and analyze company and industry trends through effective planning, analysis and project support.
• Conducted surveys and interviews with sales representatives to gather requirements, developed and finalized test plans and use cases.
• Consulted with Claims&Benefits Management Team, and develop project plan, time frames, communication plans, milestones and deliverables.
• Analyzed requirements for making the system compliant with HIPAA standards, Medicare eligibilities and benefits
• Planned and defined system requirements to Wire Frames with Use Case, Use Case Scenario and Use Case Narrative using the UML (Unified Modeling Language) methodologies.
• Transformed the business requirements maintained in the RequisitePro into Functional Requirements and prepared the Functional Requirement Document (FRD).
• Worked as an Interface between users and the technical teams involved in the application development for the better understanding of Business and IT processes.
• Facilitated with business and technical requirements involving multiple stakeholders’business partners, IT Organizational units and technical analysts in an environment with different applications/IT Systems based.
• Involved in testing HIPAA EDI Transactions and mainly focused on 270/271 eligibility transactions.
• Tested all HIPAA transactions for multi version support (4010) and validated the database to file elements.
• Experienced with documenting Business transformations and business logic involved in Report data analysis.
• Developed, documented, and analyzed ‘as is’ and ‘to be’ process flows for GAP analysis covering all the functionality to satisfy business requirements.
• Created SQL queries, tables, file feeds and links as needed to maintain data integrity of the Claims Database in an effort to facilitate the programming requirements for the new system
• Contributed to process re-engineering and improvement. Interviewed business users, interface development team, risk Managers, and operations staff to understand and document business requirements and functional specifications for new pricing excellence fare management projects.
• Analyzed systems and data to identify functionality gaps. Liaised with developers and users to clarify specifications as necessary.
• Analyzed test results using reports and graphs generated in Quality Center.

Environment: HIPAA, MMIS,EDI, Agile, Requisite Pro, Rational Rose, Clear Quest, UML, Oracle 9i, SQL Queries, MS Word, MS Excel, MS Office, MS Visio, SharePoint 2010, Quality Center, Windows XP, UNIX

Confidential, Omaha, NE

Business Systems Analyst

Responsibilities:

• Carried out queries from customer data base using SQL, data mapping, field mapping, data integration and sorted extracts as per insurance application status, age, gender, time services, demographics, lead aggregator sources, agent IDs, and call-center division to help design an effective, efficient and theme oriented online quoting engine.
• Understand and articulate business requirements thru user interviews, JAD Sessions and convert them into Technical Specifications. Conducted joint requirements planning sessions as a facilitator to gather requirements from the business area.
• Implement RUP by following iterative, Use Case driven process for requirement documentation and deployment.
• Modeled use-case diagrams in Rational Rose to show end-user interaction with the personal information, loan information andproperty information modules
• Analyze and integrate processing and central database systems for Underwriting, Actuary, Insurance Agents and Customer Service deploying Web Services and Service Oriented Architecture
• Facilitate JAD Sessions with the system architects, developers, database developers, QA team thru SDLC for defects’ resolution
• Coordinate with the Release Manager in defining scope/ planning releases.
• Analyze Business Requirements and create Use Cases, high and low level Activity/ Sequence/ State Chart Diagrams, using Rational Rose
• Define validations for applications in line with the functional requirements.
• Participate in meetings with Developers, PMs and QAs to discuss BRs, test planning, resource utilization, and defect tracking.
• Designed and developed Use Cases, Activity Diagrams using MS Visio
• Work closely with the UI team to model the screens, as per BRD’s usability requirements.
• Interacted with the Subject Matter Experts (SME) and stakeholders to get a better understanding of client business processes and gather business requirements.
• Coordinate model office cycle runs in different test regions before implementing them into the live production environment.
• Ran SQL queries using SQL Navigator and produce reports from Oracle Database using SQL Plus.
• Provided management with metrics, reports and schedules as necessary and participated in the design walkthroughs meeting using MS Project
• Participated in entering, tracking system defects in Rational Clear Quest.

Environment: RUP, RequisitePro, Rational Rose,ClearQuest, UML, SQL Queries, SQL Navigator, Quality Center, SharePoint 2007, Oracle 9i, MS Word, MS Excel, MS Office, MS Visio, MS Project, Windows XP

Confidential, Columbia, MO

Business Analyst

Responsibilities:

• Facilitated meetings with Subject Matter Experts (SME) for Requirements Gathering and transforming them to functional specification.
• Acted as a primary liaison between business lines, operations, and technical areas throughout the project cycle.
• Conducted several Requirement Gathering Sessions for gaining detailed requirements and finalizing Business Requirement Document (BRD).
• Created User Requirement Specifications (URS) and Functional Requirement Specifications (FRS) documents.
• ConductedJAD sessions and meetings with developers, QA team, and users for communicating primary requirements, discussed different versions of requirements, queries, and clarified the issues.
• Reviewed Business Requirements Documents and the Technical Specification.
• Design UML diagrams like Use Case Diagram, Class Diagram, Sequence Diagram, and State - Diagram for project documentation using MS Visio.
• Set up definitions and process for test phases including Product test, integration test, system test and User Acceptance Test (UAT).
• Wrote SQL Queries to perform Data Validation.
• Implement business modeling using MS Visio to develop screens for the application.
• Extensively used MS-Office and SQL Queries for data handling
• Ensured that project followed Business Rules and was compliant with HIPAA rules to display minimum benefit information.
• Extensive use of MS Project to maintain record of recommendations, communications, activities, schedules and to monitor progress of project in real time.
• Used Rational Rose and UML to produce use case models, and sequence diagrams, as part of the detailed design of interfaces.
• Established strategic partnerships with the business units to develop a solid understanding of the business line; including the business plan, products, and process and revenue streams.
• Involved in defect tracking and bug management using Rational Clear Quest.
• Planned, scheduled, and controlled projects based on plans and requirements outlined by the business.

Environment: RUP, Rational Rose, ClearQuest, UML, SQL Queries, SharePoint 2007, Oracle 9i, MS Word, MS Excel, MS Office, MS Visio, MS Project, Windows XP