SUMMARY

• Over 8 years of industry experience as a Business Analyst in identifying business needs and determining solutions to business problems for complex software projects.
• Deep knowledge working through the Software Development Life Cycle including Requirement Planning and Management, Requirements Elicitation and Requirements Analysis.
• Expert in creation of Business Requirement Documents (BRDs), Functional Specification Documents (FSDs), Use Case Documents, Acceptance Criteria Documents (ACDs), Business Rules Spreadsheets (BRS) and Requirements Traceability Matrix.
• Successfully conducted interviews, brain storming sessions, group interviews, prototyping, focus group sessions and JAD sessions in order to gather requirements.
• Experienced in all phases of the Software Development Life Cycle (SDLC) Waterfall methodology, Agile methodology (Scrum), Rational unified process (RUP), Rapid Application Development (RAD).
• Excellent knowledge of the AS - IS and TO-BE business processes and experience in converting these requirements into technical specifications.
• Develops problem solutions by describing requirements in a work-flowchart and diagram, studying system capabilities, analyzing alternative solutions, preparing system specifications.
• Extensive knowledge of Medicaid Management Information Systems (MMIS), National Provider Identification (NPI), Health Insurance Portability & Accountability Act (HIPAA) standards, Electronic Data Interchange (EDI), Health Information Exchange(HIX), EMR/EHR, Health Care Reform and Patient Protection and Affordable Care Act (PPACA).
• Excellent understanding of HIPAA standards, EDI (Electronic Data Interchange) syntax of transactions such as ANSI X12, HIPAA code collection implementation and knowledge of HL7.
• Rigid working knowledge of health care sector claims management, HIPAA regulations and 270,271,834, 835,837P EDI transactions specially.
• Designed wire frames, screen mock-ups and Graphical User Interfaces (GUI) for client’s worker portal.
• Professional in the administration and management of a Medicare Prescription Drug Program and Medicare compliance initiatives.
• Knowledge and Experience to Medicare and Medicaid domains of the healthcare systems and industry for inpatients, outpatients, Reimbursement Methodology.
• Extensively participated in verification of EDI file formats against HIPAA Standards.
• Worked on the maintenance of data formats and consents of inbound and outbound files, including HIPAA ANSI X12 transaction sets (837, 835, 270, 271, 276/277, 278, 999) for all regulatory payers (Medicare, Medicaid.
• Proficient in relational databases, SQL queries, reporting tool and data analysis.
• Experienced in SQL Server Reporting Service (SSRS), Executing Queries and Running Store Procedures.
• Experience in various programming languages (SQL, XML) and operating hardware and software applications including TOAD, Crystal Reports, Oracle Discoverer, Query Analyzer and SQL Navigator.
• Experience with Microsoft Team Foundation Server (TFS), updating the task and stories on regular basis.
• Strong Experience in using different requirement management and testing tools including IBM Rational Requisite Pro, JIRA, HPALM/QC.
• Expert in MS Office products with a concentration in Excel, Access, Visio, and Publisher.
• Excellent Exposure to OOAD techniques, Extensible Markup Language XML and developing Use Case diagrams (UML). Knowledge of Software as a Service (SaaS), CSV.
• Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data within the Oracle database. Involved in determining test strategies based on requirements and architecture.
• Followed the RUP based methods by using Visio to create UML Diagrams such as Use Case, Activity and Swimlane Diagrams.
• Good knowledge of identifying various test scenarios. Holds strong ability to handle multiple tasks and prioritize it.
• Knowledge on system testing while performed on the entire system in the context of a Functional Requirement Specification (FRS) and System Requirement Specification (SRS).
• Strong working experience in the Data Analysis and Testing of Data Warehousing using Data Conversions, Data Extraction, Data Transformation and Data Loading (ETL).
• Assisted QA Team in defining the Test Plans, Test Cases and test execution.
• Created the Requirements Traceability Matrix (RTM) by mapping the Test Cases to ensure all the Business Requirements are fully covered by the Test Case.
• Strong understanding in Test Planning, Test Preparation, Test Execution, Issue Resolution and Report Generation to assure that all aspects of a Project follow the Business Requirements.
• Hands on experience in User Acceptance Testing (UAT) to ensure all the User Requirements were met by the application.

PROFESSIONAL EXPERIENCE

Confidential, Redding, CA

Sr. Business Analyst

Responsibilities:

• Prepared Business Requirement Documents (BRD) based on the gathered requirements and broke it down to SRS in consultation with the technical team.
• Gather Business Requirements and managed them using Requisite Pro.
• Interacted with the Users, Designers and Developers, SMEs, Project Manager to get a better understanding of the Business Processes.
• Performed UAT and regression testing on EDI 835 and formats in Facets.
• Understood and assessed the current EDI Transactions used and the existing Pharmacy Transactions from an NCPDP perspective.
• Analyze, design, document, test, coordinate HL7 implementations and provide support to the team for HL7 interfaces between Health Information Systems (HIS) and ancillary application systems.
• Conducted the SRS reviews and walkthroughs with designers, developers and stakeholders.
• Assisted Project Manager in Project Management Documentation and got MS Project experience.
• Analyzed business needs and developed use-cases &use case diagrams using Rational Rose and compile them into System Requirement Specification (SRS) document.
• Documented Claims processing life cycle and got good exposure of X12 837, 270 transactions for HIPAA. EDI file testing for checking the HIPAA 4010 compliance of the inbound 837 claims.
• Worked on EDI transactions: 270, 271, 834, 835, and 837 (P.I.D) to identify key data set elements for designated record sets. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
• Created and maintained source-to-target Data Mapping and Data conversion spreadsheet.
• Utilized Inner join and Outer Join SQL queries to analyze the integrity of data.
• Assisted the QA team in writing test cases and test scripts for testing the migration of EDI and the processing of member Enrollment and benefits, batch jobs corresponding to the claims (837) and real time transactions like 270/271/276/277
• Prepared Test Strategy, Test Plan, test report and Requirement Traceability Matrix using HP QC.
• Maintained a change request log, conducted impact analysis when a request for change (RFC) was raised, escalated the results to Change Control Board (CCB) and updated documents on to SharePoint.
• Performed extensive data modelling to differentiate between the OLTP and Data Warehouse data models
• Worked on complex SQL queries fordataprofiling forDataETLIntegration tool.
• Gathered requirements and modelled the data warehouse and the underlying transactional database
• Activating accounts for users registered through Life Ray by waiving the verification items in CRM and setting up licenses per certification and access levels.
• Interacted with the SME's to gather information about the health care enrollment, eligibility and health care claims processing and created Use cases/FRS traced to use cases.
• Worked extensively on Gap analysis, Root Cause Analysis and Impact analysis of issues to requirements to meet the gap and redesign of the user interface.
• Involved in mentoring specific projects in application of the new SDLC based on the Agile Unified Process, especially from the project management, requirements and architecture perspectives.
• Worked on many Change Requests, Parking Lot items, Action Items, Process Flow Diagrams (UML), Pain Points, and Use Cases.
• Primary liaison between the development team and thebusinessowner to understand and implement the amendment and modification required through change request or work request.
• Worked on Rally, ALM, TFS and MS Visio and MS Excel for creating user stories and solution design documents document & Participating in Daily Scrum and Sprint Planning.
• Analysis of customer request/complains/suggestion to proposebusinessopportunity and sustainability to the executives by creating SOWs across various functional areas.
• Responsible to maintain the defect log that traces back to the test cases and also to the requirements, involving Agile and Scrum methodology.

Confidential, Abington, PA

Sr. Business Analyst

Responsibilities:

• Interacted with stakeholders to get a better understanding of clientbusinessprocesses and gathered requirements.
• Documented the Use Cases and prepared the Use Case, Activity, Sequence diagrams and Logical views using MS Visio, MS Office and Rational Rose for a clear understanding of the requirements by the development team.
• Conducted requirement-gathering sessions with the purpose of creating and defining theBusiness Requirement Document (BRD).
• Worked on gathering business and application requirements, Business Processes, identifying risks, impact analysis, UML modeling, and Sequence and Activity Diagrams using Rational Rose and Microsoft Visio in Clinical and Health Information Management (HIM) processes.
• Performed Gap Analysis to check the compatibility of the existing system infrastructure with the Analyzed the Business Requirements Document (BRD), modified the Master Test Plan and prepared detailed Test Cases for the UAT.
• In depth knowledge of Medicare/Medicaid Claims processes from Admin/Provider/Payer side which were later part of the training program to vendors. Skilled professional with hands-on experience in producing artefacts like Requirement Traceability Matrix, Test Cases and Flow Charts.
• Created Swim Lane Diagrams andbusinesslogic & calculation spreadsheets for variousbusiness processes.
• Extensively worked with HIPPA X12 EDI transaction codes such as 270/271(inquire/response health care benefits), 276/277(Claim-status), 834(Benefit-enrollment), 835(Payment/remittance advice), 837(Health care claim).
• Performed data mapping to define the Source data on 834 Benefit Enrollment and Employer Group File (EGF) EDI Transfers.
• Worked closely on 837 I/P transaction code for Health care claims and was involved in Validation of HIPAA for 270/271 (health care benefits and eligibility), 276/277 (Claims Status), 835 (Payment/Remittance advice), 834 (Benefits Enrollment) EDI transactions.
• Assisted in development of test cases based on functional requirements for claims for EDI and HIPAA Transactions 837/835, 834, 276/277, 270/271 testing.
• Created Process Models for (a) Initial Enrollment, First Billing and Payment and (b) Post Enrollment - Subsequent Recurring Billing and Payment.
• Responsible for attaining HIPAA EDI validation from Medicare, Medicaid and other payers of government carriers.
• Utilized knowledge of SQL Programming to author over 20 Queries in the HPQC Dashboard.
• Created approach to standardize Excel Reporting using SQL in the HPQC Dashboard.
• Wrote transformations for data conversions into required form based on the client requirement using Teradata ETL processes.
• Incorporated HIPAA standards, EDI (Electronic data interchange), Implementation and Knowledge of HIPAA code sets.
• Manage and analyze data communication channel to ensure compliance security requirements in accordance to ISO, HIPAA and PCI guidelines. Coordinated with Project Managers to resolve risk issues and ensure compliance of Security System related to the HIPAA.
• Worked with PPI Teradata tables and was involved in Teradata specific SQL fine-tuning to increase performance of the overall ETL process
• Involved in requirement gathering phase (Provider, Claim components and HIPAA). Utilized Rational Unified Process (RUP) to configure and develop process, standards and procedures.
• Manage and lead day-to-day operations of system upgrade to comply with new federal reporting requirements and security protocols including HIPAA.
• Developed Test Plans and Test Execution Procedure Document based on the Business & Functional Requirement Document and numerous Test Cases and Test Scenarios to cover overall aspect of quality assurance.
• Validated defects and test results generated by the QA team.
• Assisted End User in performing User Acceptance testing and performed testing of the end result files created by the development team to verifying whether all the User Requirements were catered to by the development effort.

Confidential, NM

Business Analyst

Responsibilities:

• Work as a BusinessAnalystwhile building US Health Care Public Exchange (HIX) & WEM as well as for respective implementation (MA, KY & CO) carved out of Federal Exchange product.
• Working with UI & UX team to define wireframes and visuals reflecting the PRD requirements.
• Responsible for ensuring HIPAA EDI Trading Partner transactions meet established standards and are able to be transmitted and processed.
• Prepared Use Case diagrams using IBM Rational Rose tool.
• Converted Business specifications into Business and Functional Specifications.
• Worked on EDI transactions like 834,270/271, 276/277, 835/837 and EDI's. Worked on Use Cases for Batch processing for EDI's.
• Conduct JAD/JRD with Business and SMEs to come up with BRDs.
• Responsible for ensuring HIPAA EDI Trading Partner transactions meet established standards and are able to be transmitted and processed.
• Performed GAP analysis for EDI transactions such as 837,834,820 to support state specified X12 file formats.
• Performed technical analysis for 834 version control.
• Worked on 837 and 835 projects, including syntax and business rules for X12 HIPAA and validations for loops, segments, elements, qualifiers and code sets.
• Involved in Writing use case based on HIPAA standards.
• Developed effective processes and business strategy to leverage company and SaaS model strengths
• Responsible for creation of Collaboration Diagrams, Activity Diagram, Project Flow Diagram in MS Visio.
• Extensive Analysis of HIPAA rules to in corporate in the Development of Utility application which is not HIPAA compliant.
• Implemented and managed the formal SDLC implementation using the RUP/Agile Methodologies (depending on the client and project).
• Generated Usage Models (i.e., prototyping storyboards, screen mockups, User Interface designs, User stories) based on Agile and SDLC standards.
• Worked with Enterprise Data Warehousing (EDW) Tables and Data Mart Staging Tables.
• Generated Use Case diagrams, Sequence diagrams, Business Objects, Domain Object Model, and Visio to depict process flows and PowerPoint presentations
• Used Microsoft Test Manager and the Microsoft Team Foundation Server (TFS), and prepared, edited, and reviewed test documentation to efficiently regression test the ServSuite product, with over 200 cases to validate functionalities before each release
• Involved in creating reports framework with dimensional data models for the data warehouse and worked with the development team on SQL Server 2005 tools like Integrations Services and Analysis Services.
• Extensively used tools such as Rational Rose, Rational Requisite Pro, UML, MS Visio, MS Project, MS Office, MS Access
• Various versions of the documents generated during the project were maintained and managed using Rational ClearCase and performed defect tracking using Rational ClearQuest.

Confidential, New York, NY

Business Analyst

Responsibilities:

• Interacted with stakeholders and gathered requirements as per thebusinessneeds.
• Implemented RUP methodology for iterative and incremental development of the system.
• Worked on Required Traceability Matrix (RTM) in Rational Requisite Pro for traceability of requirements through test cases
• Was involved in the planning of the RUP iterations and documenting of the artifacts throughout the various phases of the development process.
• Reviewed the user requirements in SOX context and validated the SOX compliance.
• Writing stored procedures, triggers, cursors, and views to improve the quality of application, and manage mission-critical information using T-SQL.
• Involved in system requirement analysis and conceptual design of the CURAM implemented Web application.
• Created Business Requirement Document (BRD), Functional Requirement Specification (FRS) document, and Traceability Matrix document for system application development
• Conducted GAP analysis by understanding the AS-IS system and the TO-BE system requirements by having discussions with the SME's.
• Conducted live JAR &JAD sessions with SMEs, and all the placeholders to develop High Level Requirement and then formalized those requirements to Detailed Level Requirements.
• Facilitate project meetings deriving User requirements, creating use cases and user stories, and working as liaison between Business and Technical teams.
• Elicited business requirements and business needs as part of an Agile Scrum team
• Facilitate the Change Authorization Group (CAG) meeting, calendar approved changes and communicate with our stakeholders
• Prepared Test Cases (manual/automated) and Conducted Tests (Integration testing, Regression testing), Black Box/White Box testing, UAT (User Acceptance Testing).
• Used Quality Center and ALM for defect tracking and reporting.
• Compiled the Vision Document and composed detailed Use Case Specification Documents in Rational Requisite Pro.
• Used UML to perform Use-Case analysis to capture the dynamic aspect of the application.
• Ensured the accuracy and consistency of the data during the data loading process.
• Developed State Diagrams, Activity diagrams and Class Diagrams in MS Visio using UML for various modules of the project.
• Created Process Flow Charts,BusinessRequirements Documents, Functional Specification Documents.
• Was involved in managing the Daily Standup meetings and also ensured that quality standards were enforced as per the build-release schedule.
• Developed Test Plan and Test cases based on the Use cases and Functional specifications and also performed manual testing of the functionality of the application by inserting varying data on different test runs.
• Developed Flowchart and process diagram using Microsoft Visio.
• Was in regular contact withBusinesspartners on the status of issues, action plans and timeframe for resolution throughout the development cycle.

Confidential, San Antonio, TX

Business Analyst

Responsibilities:

• Conducted working sessions to gather and document detailed and high level business requirements for different business units impacted by EDI Claims Intake, FACETS, Utilization Management, Case management and Provider Reimbursement/Provider Payment.
• Involved in managing the risk adjustment process for Medicare advantage plans throughout the RAPS to EDPS (Encounter Data Processing System) transition.
• Designed wire frames, screen mock-ups and Graphical User Interfaces (GUI) for client’s worker portal.
• Prepared use cases and data flow diagrams in Rational Jazz, MS Visio and MS Word to analyze the impact of diagnosis codes embedded in different systems and applications.
• Contacted SME’s to collect and finalize all system and business process requirements for incorporating changes to existing Medicaid Management Information System (MMIS).
• Prepared and maintained requirements traceability matrix (RTM) throughout the project lifecycle.
• Worked closely with project manager and team leads to coordinate resources and document cost estimates throughout the project.
• Worked with PBMs to monitor prescription safety across several pharmacy networks and reviewed formularies. Worked on pharmacy claims processing and facilitated reconciliation.
• Coordinated with Business Project Teams, Business Owner, Application Vendor, Payers and Clearinghouses to bring all processes to a level of execution to mitigate any impact to current revenue flow under the compliancy requirements.
• Performed Accounts Receivable Data entry with specific involvement in Cash Posting and closely interacted with Revenue Cycle Management team.
• Worked closely on 837 I/P transaction code for Health care claims and was involved in Validation of HIPAA for 270/271 (health care benefits and eligibility), 276/277 (Claims Status), 835 (Payment/Remittance advice), 834 (Benefits Enrollment) EDI transactions.
• Designed and developed Business Rules document about the Claim Component and HIPAA.
• 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.
• Performed the Gap analyses of the earlier systems, generated a detailed Requirements document describing new system architecture through Use Cases and Activity diagrams. Specifications, Documentation and Construction of systems heavily relied on UML.
• Tracked all required resolutions that were identified as needed from Vendors or Payers based on testing results.
• Identified all risks associated with the project and gave suggestions for mitigating the impact the identified risk posed to the business.