SUMMARY

• Over 8 years of experience in IT field as a Business Analyst and Quality Assurance in various Client/Server environment, IBM Mainframes, Web based products and B2B applications. Strong Design, Documentation and Analysis skills wif experience over 8 years in Healthcare Industry
• Expertise in Healthcare areas like Enrollment, Benefits, Claims, Medicare, Medicaid and implementation of HIPAA key EDI (ANSI X12) transactions.
• Involved in HIPAA gateway transactions 997/999 and converting HIPAA 4010 messages into HIPAA 5010.
• Experience in all EDI transactions like 837, 835, 834, 820, 27x
• Strong knowledge of HMO, PPO, HIX (Health Insurance Exchange), EMR/EHR, Health Care Reform
• Experience wif FACETS, healthcare management tool to run different healthcare module.
• Deal wif teh complexity of migrating from teh ICD - 9 set of diagnostic codes to ICD-10.
• Expertise in documenting teh Business Requirement Document (BRD), Technical Requirement Document (TRD), System Requirement Specifications (SRS), Creating and Maintaining Requirement Traceability Matrix (RTM), generating teh User Acceptance Test (UAT) Plan
• Expertise in all phases of Software Development Life Cycle (SDLC) and SDLC methodologies such as RUP, Waterfall and Agile wif hands on experience in all of them.
• Excellent communication and writing skills and adept at facilitating walkthrough and training sessions.
• Finalized teh requirements after extensive interaction wif stakeholders and IT department according to teh Center of Medicare and Medicaid (CMS) Compliances/Regulations and HIPAA Regulations.
• Conducted several one-to-one and group JAD sessions, and prioritized requirements using interviews, document analysis, and requirements workshops.
• Experienced in documenting requirement using Unified Modeling Language, UML, (Use Case, Sequence Diagram and Activity Diagrams) and building Business Process Flow Charts.
• Strong Knowledge of Business Intelligence, Data Warehousing and Business Architecture.
• Experience in conducting GAP analysis, User Acceptance Testing (UAT), SWOT analysis, Cost benefit analysis and ROI analysis.
• Extensively used Salesforce to set up various healthcare modules.
• Defining and documenting integration protocols (Web Service, XML, BD, HL7)
• Extensive knowledge and use of Structured Query Language (SQL) to update teh Database, to perform Data mapping, data ware housing, logical data modelling, created class diagrams and ER diagrams and used SQL queries to filter data wifin teh Oracle database.
• Strong understanding of test plans, test cases, test scripts and defects tracking/reporting.
• Strong knowledge of Unit, Integration, System, Parallel and Regression testing.

TECHNICAL SKILLS

Operating System: Windows, UNIX, LINUX

Methodologies: Waterfall, Agile, RUP, UML

Requirement Management, Testing and Reporting Tools: Quality Center, JIRA, Rational Requisitepro, Rational Enterprise Suit, Test Director, LoadRunner, Crystal Reports, QTP, SSRS

Change Management Tools: Rational ClearQuest, Test Director, fogbugz

Business Modeling Tools: Rational Rose, Microsoft Visio

Case Tools: Rational ClearCase, SODA

Project Management: Microsoft Project, Microsoft Office, SharePoint

Programming Language: SQL, Visual basic, Java, JavaScript, HTML, dBase, Cobol, XML

Quality Management: Six Sigma, CMM and Lean Manufacturing

Data Bases: Oracle, MS SQL, MS-Access

Hardware: IBM/HP/DELL, RAID, Sun & EMC, LAN, WAN & Legacy

Relation Management: CRM, ERP, SalesForce, SharePoint

PROFESSIONAL EXPERIENCE

Confidential, Nashville, TN

Business Analyst

Responsibilities:

• Prepare Business Requirement Document (BRD), manage and trace teh requirements using teh Requirement Traceability Matrix (RTM),
• Work on requirements of teh HIPAA 835, 276/277, 278, 837 and HIPAA EDI Transactions across enterprise.
• Test teh ANSI X12 Version 5010 / EDI transactions (HIPAA) like 270, 271, 276, 277 P, 837I, 837D
• Involve in impact analysis of HIPAA and 837P transaction sets on different systems.
• Re-engineering and capturing of EDI transactions wif legacy systems Eligibility Transaction (270/271), Claims (837), Claim Status Request and Response (276/277), Remittance (835) .
• Knowledge of regulatory requirements HIPAA, EMR, Health industry standards of MRA based funding and evaluation of diagnosis codes and teh HCC scores
• Work extensively on EDI 837, 276 & 277, to halp optimize claims and denial process.
• Use Pivot Table to create weekly, monthly and yearly roll-up sheet
• Validate EDI 837 file status for accepted and rejected claims
• Conduct surveys, interviews, and JRP, JAR and JAD sessions and translated them into system Requirements. Suggested measures and recommendations to improve teh current application performance of teh system.
• Design and developed Use Cases, Activity Diagrams and Sequence Diagrams usingUML.
• Work wif PM to prepare Project charter, Project plans, daily, weekly and monthly team deliverables for each phase, drafting WBS and RBS systematically using MS Project.
• Develop straightforward DBMS queries, knowledge of HL7 and XML interface messaging.
• Work wif teh business/functional unit to assist in teh development, documentation, and analysis of functional and technical requirements wifin FACETS.
• Support in designing integratedEDI batch processingandreal-time EDI transactional databasesusingFACETS.
• Perform GAP analysis as pertains to membership management and enrollment processing to evaluate teh adaptability of teh new application wif teh existing process
• Expert in broad range of technologies, including business process tools such as Microsoft Project, MS Access, MS Visio, technical assessment tools and various other tools such as MS Project, to create project deliverable designs, MS Suite
• Ensure all artifacts complied wif teh corporate SDLC Policies and guideline.
• Practice CMM and Six Sigma processes to ensure teh quality of processes meets teh corporate standards

Environment: Windows, UNIX, Oracle, ALM, MS VISIO, MS Office, RUP, SQL

Confidential, Nashville, TN

Business Analyst

Responsibilities:

• Expertise in EHR/HIPAA health information & health care services regulatory environment working knowledge and compliance experience along wif proficiency in using HL7 coding standards.
• FacilitatedJoint Application Development (JAD) Sessions for communicating and managing expectations from SME's and Business Owners
• Produced Activity diagrams wif defined swim lanes as part of claims process analysis
• Translated business requirements into functional specifications and documented teh work processes and information flows of teh organization
• Workedwif teh Development andSolution Architect team to ensure understanding adherence to teh user requirements
• CreatedFunctional Design Document and teh Conceptual System Design Document, which is used as teh reference by teh development team
• Created test schedules for teh complete system testing and oversee teh implementation of teh new EHR.
• Created detailed use cases, use case diagrams, and activity diagrams using MS Visio
• Led and managed teh User Acceptance Testing (UAT) for teh implementation of Facets Extended Enterprise administrative system wif emphasis on ensuring that teh HIPAA regulation are met across all teh modules
• FacilitatesQuality Review session wif Business Owner and SMEs
• Takenresponsibility for teh requirements and follows up wif teh testing team to validate
• Performed a complete ROI analysis wif clients to come up wif teh best strategies
• Madechanges to requirements and use cases based on testing results and working wif PM to submit change control if required
• PerformedDefect Tracking, GAP analysis, Risk closures and Change Control Procedures using Rational Clear Quest
• Workedwif teh Project Manager on various Project Management activities like Resource Planning, Resource Request, keeping track of Project Status, Deadlines and Issues.

Environment: MS Office, MS Visio, CMMI, JIRA, Agile, Rational Rose, Quality Center, Requisite Pro, Oracle, J2EE Technology, Perl.

Confidential, Dayton OH

Business Analyst

Responsibilities:

• Gathered, analyzed, documented business and technical requirements from both formal and informal sessions and validate teh needs of teh business stakeholders.
• Performed Data mapping on teh extracted data, logical data modeling, created class diagrams and ER diagrams
• Involved in teh full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Health Insurance Claims.
• Conducted Risk Assessment for teh Electronic Medical Record (EMR) by collaborating wif Centre’s for Medicare and Medicaid Services (CMS) and IT department.
• Worked on HIPAA Standard/EDI standard transactions: EDI 834
• Helpedin Data Mapping sending Agent Agency data elements via file format
• Verified Enrollment wifin Medicare and Medicaid by coordinating wif teh agency
• Designed and developed Use Cases and Use Case scenarios, Activity Diagrams, Sequence Diagrams, High Level and Low Level Process Flow Diagrams, Object Oriented Analysis and Design (OOAD) using UML and Business Process Modelling.
• Responsible for creating test case scenarios, creating test data plan and writing test scripts for teh UAT using testing tool and defect management for Policy Management Systems
• Gathered requirements and modelled teh data warehouse and teh underlying transactional database
• Responsible for preparing Business Requirement Document (BRD), Functional Requirement Document (FRD) and tan translating into functional specifications and test plans.
• Responsible for teh coordination wif both business users and developers for arriving at a mutually acceptable solution.
• Performed Gap Analysis in every phase and stages to check teh compatibility of teh existing system infrastructure wif teh new business requirements.
• Involved in FACETS 4.8 Implementation, involved end to end testing of FACETS 4.8 Enrollment Claim Processing and Subscriber/Member module.
• Proposed and came up wif teh RAID document to identify teh Risks, Assumptions, Issues and Dependencies involved wif every tasks assigned.
• Monitored teh Defect Tracking Process and generated customized graphs and reports for teh client using Mercury Quality Center
• Design and implement basic SQL queries for QA testing and report / data validation.

Environment: SharePoint, MS Visio, MS Suite, UML, CMMI, Rational Requisite, Rational Rose, RAID

Confidential, Madison WI

Business Analyst

Responsibilities:

• Acted as theprimary liaisonbetween Business Partners and IT teams to mentor and share their specialized knowledge base on a daily basis.
• ConductedJADsessions wif business users and development team to drive out detailed business requirements and prepared theBRD(Business Requirement document), UCN (Use case narrative) and Project document for teh project.
• Implemented theRUP methodologyto halp analyze teh problem, understand user’s needs, and manage requirements.
• Interacted closely wif End users fromUnderwriting&Claimsteams and SMEs through facilitated meeting to understand and gather teh business needs and requirements.
• Worked wif teh users toprioritizeand schedule teh enhancement requests considering teh business impacts and implications on teh project timeline.
• Analyzed data and createdclass diagramsandER diagramsfor designing teh application.
• Closely interacted wif technical team and development to ensure they understood teh application’s functionality and navigational flow.
• Prepared and analyzed teh Test plans and Test cases to successful perform teh system integration testing, functional testing.
• Gathered requirements for upgrading theshort term insurance module systemand created UML diagrams for teh short term Insurance Portal.
• Responsible for meetings wif users and stakeholders to identify problems, resolve issues and improve teh portal to ensure a stable and accurate solution.
• Designed teh look-n-feel requirements of this application throughwire framingusingMS Visiofor better illustration of teh application to research team and portfolio managers.
• Worked wif business users and technical team to monitor teh deployment of teh application.

Environment: MS Visio, Rational Unified Process (RUP), UML, Use Case Diagrams, MS Office, Windows, Load Runner