Professional Summary

• Over 7 years of professional experience as Business System Analyst working in Banking and Healthcare sectors
• Well versed with all phases of SDLC experience in business process redesign interacting with stakeholders understanding user requirements and articulating them into User Requirements Specifications.
• Thorough Knowledge of various SDLC methodologies like Waterfall Agile such as Agile XP and Agile Scrum.
• Possess excellent business writing skills required for documenting Business Requirements Document BRD Functional Requirement Document FRD Non - Functional Requirement Document NFRD .
• Excellent knowledge of HIPAA standards Electronic data interchange EDI Transaction syntax like ANSI X12 Implementation and Knowledge of HIPAA code sets hospital coding reimbursement methodologies CPT codes ICD-9 ICD-10 coding and HL7.
• Extensive experience with Medicare/Medicaid processing as well as the Claims/Billing.
• Knowledge of EMR/EHR HMO/PPO/POS Health Care Reform and Patient Protection and Affordable Care Act PPACA Medicare Part A B C D Medicaid Medicaid Management Information Systems MMIS Medicaid Information Technology Architecture MITA and Health Care Reform.
• Wide knowledge of Independent Verification and Validation IV V projects MMIS and Data Warehouse .
• Electronic claims knowledge includes ANSI ASC X12 HIPAA compliant formats of 837P 837I 835 834 270/271 276/277 997.
• Knowledge of Explanation of Benefits EOB for a member or Explanation of Payments EOP for a provider.
• Basic understanding of Healthcare Jargons such as Health Insurance Exchange HIX
• Knowledge of various areas like CPT HCPCS General equivalence Mappings GEM ICD9/ICD10 Conversion Healthcare claims processing Medical policies Benefits Network Provider Management Enrollment/Membership and Utilization Management etc.
• Creating project and process specifications working with development team to continually articulate requirements and troubleshooting production issues including new investment products applications data analysis and QA report testing.
• Solid understanding of Rational Unified Process RUP using Rational Rose Requisite Pro Unified Modeling Language UML Object Modeling Technique OMT and Object Oriented Analysis OOA .
• Understanding of Data Models and Data Marts that supports the Business Intelligence Data Warehouse. Understanding of Metadata.
• Knowledge of Capability Maturity Model Integration CMMI Project Management Body of Knowledge PMBOK and applicable knowledge of Six Sigma.
• Excellent Business writing skills in writing Business requirements document USE Case Specifications User stories Functional Specifications Systems Design Specification SDS Systems Requirements Specification SRS Business Continuity Plan BCP and Workflows.
• Excellent skills in Unified Modeling Language UML diagrams such as Use Case diagrams Activity diagrams Class diagrams and Sequence diagrams.
• Familiarity with White-Box and Black-Box testing techniques such as Load Testing Regression Testing Unit Testing System Testing and Performance Testing.
• Knowledge in Web Designing Graphic Designing User Interface Developing Image/Brand Development HTML-Coder.
• Front and Backend Development UI Graphic Design Web Site Cross-Browser Creation.
• Strong project management skills and breaking down complex issues identify solutions and communicate these to the development and management teams.
• Strong knowledge of SQL queries.
• Strong MS Excel skills including making pivot table v-lookup and VBA Macros.

Technical Skills

Databases SQL Oracle SQL Server 2000 DB2 Teradata Sybase

Packages MS Office MS Visio MS Project

MS Office Tools MS Word Outlook Excel Access PowerPoint 2003/07 MS SharePoint

Tools Clear case Clear Quest Rational Rose Requisite Pro HP Quality Center IBM Cognos OBEE ALM rLink

Operating Systems Linux HP UNIX and Windows 2000/XP/Vista/7/8

Methodologies Rational Unified Process RUP Waterfall Model Agile model SCRUM

Business Documentation Skills Documented Business Requirement Use Case Specifications Functional and Non-functional Specification System Requirement Specification UML Diagrams Use case Class and Sequence Traceability Matrix Project Estimate Change- Training and User Manuals Master Test Plan Review Integration System and Acceptance .

Other Areas FIX Protocol Swift FpML Financial Analytic SAP Salesforce Siebel Adobe.

Work Experience

Confidential

Sr. Business Analyst/UAT Coordinator

Responsibilities

• Validated and Verified the Project Life Cycle by following industry best practice CMMI-DEV v1.3 IEEE 1012-2004 Standard for Software Verification and Validation and PMBOK.
• Delivered reports in the different Project Lifecycle by following Industry Best Practice checklists e.g. Management Project Development Project Implementation Project and Operation project
• Validated and verified all the high risk business areas requirements Foundation requirements Functional Requirements and Business Process Requirements .
• Contributed to the project s overall understanding of Indiana Medicaid Management Information System Core MMIS .
• Ensured that all project identified processes and methodologies are executed and followed as applicable to their business area.
• Contributed to and managed the planning and execution activities for the following SDLC phases
• Systems analysis and requirements definition Systems design functional Integration and functional verification
• Reviewed General System Design GSD Detailed System Design DSD and Requirement Specification Document RSD Master Test Plan and Deliverables Expectation Documents DEDs .
• Contributed to written IV V project status reports and other deliverable reports e.g. Change Management Cost Management Project Resource Staffing Plan Quality Management Plan Scope Management Plan Communication Plan Configuration Plan Configuration Management Plan Issue Management Plan Project Mgmt. Plan Risk Mgmt. Plan .
• Reviewed and monitored project activities to identify risks high low medium issues and quality assurance concerns through participation in meetings interviews and formal assessment tools
• Reviewed System and Integration Testing SIT Regression Test Cases by using ALM for the Core MMIS s functional areas e.g. Provider Member Web Portal Finance and Reference .
• Contributed in Review of Requirements and Functional Traceability documents.
• Monitored requirements life cycle status e.g. RSD Ready RV Deferred and business processes e.g. Application Informational and Operational .
• Reviewed Section 508 guidelines for the Web Portal.
• Conducted Gap Analysis on the functional areas e.g. Web Portal Member Provider etc. by reading State of Indian s Request for Proposal RFP and HP s response to the proposal.
• Kept the track of the Change Orders COs in the ALM and sent the weekly updates to the team.
• Kept the track of project schedule if business tasks are on time.
• Researched the issues and risks for IV V s monthly project assessment reports.
• Reviewed requirement Basis of Decision Document BDD for any modified requirements.

Environments ALM PPM rLink SharePoint HP AIM Microsoft SharePoint WebEx MS Excel MS Word MS PowerPoint MS Project Oracle Peoplesoft.

Confidential

Business Analyst/UAT Coordinator

Responsibilities

• Conducted User Acceptance Testing UAT of the EDW IBM Cognos to ensure that the system satisfies the needs of the business as specified in the functional requirements and provides confidence in its use.
• Identified the User Acceptance testing areas by their risk involved. High risks areas were new functionalities related to Change Orders Provider facing Member facing and CMS federal requirements.
• Attended EDW training provided by Optum. Used IBM Cognos and Teradata SQL to execute UAT test cases.
• Presented UAT methodology in front of the State of Indiana s stakeholders Optum and PMO for the Phase I and Phase II.
• Defects were entered and tracked via spreadsheet by the Business Analyst during the UAT process. Each entry included detailed information about each defect including a severity level. Optum updated the defects on regularly scheduled touch point meetings.
• Executed UAT test cases for the Phase I. For the phase I tested the highest risk areas of the system. They are as follows
• Verified member month calculations and sample of other transformation rules. Conducted end-to-end source to target validation of a sample of claims encounters pharmacy eligibility and provider by year. Created frequency distributions of provider type claims aid category by year and analyze patterns. Verified claim encounter and pharmacy original voids and replacements logic. Verified spend down accuracy for a sample of claims and pharmacy. Verified pharmacy and claims cross-reference mapping. Verified encounter denials MCO denials and MMIS denials including reason codes and description of reason codes. Wrote SQL queries in Teradata SQL Assistance to perform data analysis.
• Wrote and executed test cases for the UAT Phase II. Under the Phase II we have included the following areas
• Executed test cases related to Episode Treatment Group ETG and Evidence-Based Medicine EBM . Checked if ETGs software have collected data correctly i.e. if one treatment episode has correctly assigned and collected procedural and cost information . Checked concurrent and recurrent episodes e.g. use an individual claim or encounter form as input check if ETG can identify and track the treatment of different conditions which can occur even during the same patient encounter . Checked if shifting episodes have done correctly i.e. during the course of treatment when a treatment condition has changed then patient s entire episode shifts from initially defined ETG to the ETG which includes the change in condition . Checked if ETGs are designed correctly. There are around 574 groups and if they assigned properly rare and chronic conditions complications comorbidities age surgeries e.g. ETG 430 Gastroesophageal infection ETG 431 with without comorbidity . Checked if ICD diagnose CPT-4 procedure NDC drug and HCPCS procedure codes are mapped to each of the ETGs. Verified each EBM conditions Acute Chronic Global and Preventive condition to make sure they are correctly identified and evaluated.
• Coordinated with Indiana Family and Social Services Administration FSSA Optum and PMO regarding CMS Certification for EDW.
• Kept the ownership of the Action Items for the whole CMS Certification for EDW period.
• Reviewed and commented the folders Federal Report Program Management Report and Decision Support for the CMS Certification for EDW.

Project Environment IBM Cognos Teradata SQL Assistance HP AIM Catamaran Oracle PeopleSoft Informatica Milliman MedInsight MS Excel MS Word MS PowerPoint MS SharePoint.

Confidential

Sr. Business Analyst

Responsibilities

• Worked with Business Owner and Business Relationship Manager to define the scope requirements and schedule for the project.
• Worked with Project Manager to Create Project Charter to clearly define the scope objectives and the stakeholders of the project.
• Documented Functional Specifications for Enrolment 834 Health Care Claim Payment and Remittance Advice 835 Customer Service Interface Claim 837 and Capitation Payment 820 and Authorized Representative for Medicaid Members.
• Studied the current Group Health Plan GHP Process to meet the Medicaid demands and conducted a GAP Analysis to cover Medicaid Requirements.
• Involved with EDI automated fast-pass claim adjudication requiring through understanding of claim processing both front and backend operations.
• Worked on Provider Network Management Directory Monthly Quarterly and Annual Files.
• Designed Business and Functional Requirements document Use Cases and Swim-lane Process Flows.
• Involved in Requirement Scoping and analysing high priority requirement for implementation.
• Created Business Requirements Document and converted them into System Requirement specifications Document.
• Involved with the Medicaid Information Technology Architecture MITA team to implement maturity level under MITA Framework 3.0 State Self-Assessment SS-A for State of Utah following Medicaid and CHIP Services CMCS .
• Managed the change management process to clearly document change controls justifications for the changes impact analysis and approvals.
• Worked on User Interface UI graphics layout and content by using HTML/Adobe prototyping used Dreamweaver Photoshop InDesign Illustrator etc .
• Built user experience prototypes and wireframes of the webpage worked on QA session .
• Coordinated between Senior Management and Business Analysts and updated the status of the project
• Participated in Meeting and resolved the pending issues related to File Layouts and its specifications and helped QA in System and Performance testing.
• Conducted User Acceptance Testing UAT and developed the test plans test scenarios test cases and test data to be used in testing based on business requirements technical specifications and product knowledge.
• Developed UAT test cases associated with the functional requirements.
• Created a process flow for Medicaid Member Mailings and Mail Return Indicator.
• Used MS Project to manage the task and resource assignment responsibilities for each project.
• Created Requirements Traceability matrix RTM and used MS EXCEL to trace and analyze the requirements.
• Rigidly followed company SOP and internal SharePoint workflow to create modify maintain archive and retrieve documents required throughout all the phases of SDLC.
• Worked closely with IT and reviewed all the Technical Specifications with them.

Project Environment SQL Visual Basic MS Excel Microsoft Visio Rational Rose Scrum methodologies MS office suite XML Quality Center MS PPT.

Confidential

Sr. Business Systems Analyst

Responsibilities

• Held daily scrum meeting with the Project team and change management team to discuss the requirement updates change requests tasks and assign/re-assign man hours on a daily basis.
• Conducted user interviews and JAD sessions with end users stake holders and developers to gather functional and non-functional requirements of the system and creation of user stories.
• Used Requisite Pro for the Requirement Document Preparation and Prepared Business Process Models BPM that includes modeling of all the activities of the business from the conceptual to procedural level.
• Conducted weekly meetings for deciding the Policies and Procedures to be followed while constructing new sites.
• Assisted JAD sessions to identify the business flows and determine the EDI X12 Transaction Code set and Identifier aspects of HIPAA impacts any current or proposed systems.
• Worked on HIPAA EDI transactions such as 820.
• Identified gaps and performed gap analysis cost analysis with respect to CMS requirements.
• Performed Impact analysis for readiness of ICD-10 conversion.
• Conducted business-impact assessment and the results were compared with the new HIPAA 5010 standards to determine the current level of compliance and developed an action plan for approval by the project steering committee
• Documented user stories and modeled use case diagrams by utilizing MS Visio.
• Developed plan for data feeds and data mappings for integration between various systems including XML to follow ICD 10 Code set and ANSI X12 5010 formats.
• Prepared and maintain Business Rules Spreadsheets BRS identifying Rules Triggers and corresponding data fields from Legacy to target CRM application.
• Involved in gap analysis and implementation of HIPAA 5010 ICD 10 and Claim Validations.
• Conducted Gap Analysis and Gathered User Requirements by Interviews user meeting JAD session and Requirement Elicitation Sessions.
• Utilized corporation developed Agile SDLC methodology. Used Scrum Work Pro and Microsoft Office software to perform required job functions.
• Used General equivalence Mappings GEM to convert ICD-9 to ICD-10.
• Involved in analyzing activities for a variety of major projects including Medicare Plan part D Coordination of Benefits New Client Implementations Consumer driven and regularly scheduled system upgrades.
• Interacted with various HMO PPO Medicaid/Medicare Representatives discussing benefits of contracts on behalf of facilities or appeals from denials and compliance issues.
• Assisted to develop the Test Plan Test Cases and Test Scenarios to be used in testing based on Business Requirements technical specifications and/or product knowledge.
• Conducted User Acceptance Testing UAT and developed the test plans test scenarios test cases and test data to be used in testing based on business requirements technical specifications and product knowledge.
• Prepared graphical depictions of Use Cases Use Case Diagrams State Diagrams Activity Diagrams Sequence Diagrams Component Based Diagrams and Collateral Diagrams and creation of technical design UI screen using Microsoft Visio.
• Analyzed trading partner specifications and created EDI mapping guidelines

Project Environment Windows 2000/XP HL7 Microsoft Office SharePoint 2007 Agile Rational Requisite Pro MS Office SQL Server 2005 GEM DB2 JAVA J2EE MS Project MS FrontPage 2003 MS Access.

Confidential

Sr. Business Analyst/UAT Coordinator

Responsibilities

• Performed the requirement analysis impact analysis and documented the requirements.
• Followed a systematic approach to eliciting organizing and documenting requirements of the system.
• Reviewed the Joint Requirement Documents JRD with the cross functional team to analyse the High Level Requirements.
• Performed UAT and exposure to User Certification Testing UCT and Operational Readiness Testing ORT .
• Experience in EDI automated first-pass claim adjudication requiring thorough understanding of claim processing both front and backend operations.
• Interacted with stakeholders and the Technical Team for requirement validations and kept track of Requirement Specification Documents RSD .
• Conducted interviews meetings and JAD sessions during the process of Requirement validation.
• Kept the track of Basis of Decision Document BDD for any modified requirements.
• Coordinated with Department of Health and Human Services DHHS IV V team and PMO regarding CMS Certification for MMIS.
• Kept the ownership of the Action Items for the whole CMS Certification for MMIS period.
• Involved with the requirement validation for Enterprise Data Warehouse EDW with the state stakeholders.
• Involved with the Gap Analysis of the State s Request for Proposal RFP and vendor s responses.
• Developed and evaluated data design and repository creation. Involved in Data Modelling of both Logical Design and Physical design of data warehouse and data marts in Star Schema and Snow Flake Schema methodology. used Erwin
• Worked extensively with the end users team in understanding the business rules and writing requirement specs technical specs and data mapping documents from staging to data mart cubes and reporting needs to the end user community.
• Created Data Mapping Document and Metadata for the Enterprise Data Warehouse EDW .
• Performed data analysis by using Cognos.
• Coordinated with PMO team to provide design input and schedule project deliverables and review progress at defined phases.
• Managed requirements traceability RTM information and track requirements status throughout the project Prepared and tracked a project plan using Microsoft Projects and Excel.
• Identified/documented data sources and transformation rules required to populate and maintain data warehouse content.
• Created documentation for system requirements for assigned projects enhancements and defects including user interface specifications user workflows business rules data capture and validations.

Environment MS Project ANSI X12- EDI XML HTML .Net Rational Requisite Pro MS Word Sharepoint Visio SQL MS Excel MS Project Mercury Quality Center Cognos Informatica.

Confidential

Business Analyst Financial and credit services

Responsibilities

• Developed Business requirements by exploratory methods from existing system existing statement of work client change requests and other documents like screen specifications etc.
• Developed use cases security and functional requirements using MS Excel Word and PowerPoint.
• Migrated Word requirements into Rational Requisite Pro.
• Facilitated JAD sessions for defining business requirements and follow-up for Project Plan updates.
• Managed QA resources and QA management plan and Project risk management plans.
• Updated Project scope documents according to the approved change requests and fixed defects.
• Determined system testing needs and generated test outline and specifications.
• Identified and gathered test data needed to support the testing effort.
• Held daily scrum meeting with the Project team and change management team to discuss the requirement updates change requests tasks and assign/re-assign man hours on a daily basis.
• Led the UAT testing schedules depending on the system testing deadlines and product support.
• Managed and updated Project plan documents including project schedule and cost management.
• Automated web front end and web services testing using Mercury Winrunner.
• Monitored offshore development team in implementing the WEB front end user interface requirements.

Project Environment Java DB2 XML Mercury Winrunner Swift Test Director Requisite Pro ASP .net Load Runner Caliber RM PC Client UNIX