SUMMARY

• About 8 years of extensive Business Analysis experience in Healthcare, Retailing and Financial domain, all of which include core BA skills of facilitation, requirements gathering and writing, creating Use Cases and communicating with key stakeholders, IT and Test team.
• Key strengths in complete Software development life cycle SDLC include gathering business requirements, while supporting the technical analysis of the requirements, leading cross-functional teams and strong work ethics.
• Expertise in technical business writing including system requirement specification document, business requirement document thus performing extensive duties of Business Analyst.
• Experience with Health Insurance Portability and Accountability Act HIPAA , Medicare Parts A, B, C D.
• Good understanding of ANSI X12 4010 , X12 5010 , EDI versions of HIPAA transaction standards including 837, 835, 834, 820, 270, 271, 276, 277, 278 and 997 as well as ICD-9, ICD-10 and CPT code sets.
• Experience with Unified Modeling Language UML methodologies to design Use Case Diagrams, Activity Diagrams, Sequence Diagram, Data Flow Diagrams and Process Flow Diagrams.
• Excellent knowledge of industry standard methodologies like Iterative Software Development Life Cycle Process as per Rational Unified Process RUP , Scrum, CMM Capability Maturity Models and Rational Tools such as Rational Requisite Pro, Clear Case used during various phases of RUP.
• Conducted individual and group Joint Application Development JAD sessions with business stakeholders and technical units.
• Acted, as liaison between Business and IT teams to gather requirements and identify needs.
• Used iRise to quickly build working simulations of business software that mimic the exact look, feel and behavior of the final product.
• Worked with various business units like Health Insurance, Billing, Finance, Customer Care and Sales.
• Strong communication, observational, analytical and process engineering skills applied to the successful completion numerous consulting engagements.

Technical Skills

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WORK EXPERIENCE

Confidential

Business Analyst

• New York State Department of Health is enhancing the ability of the MMIS systems environment to quickly implement major changes referred to as eMedNY, this Web-enabled system processes eligibility verifications, claim submissions, and prior-authorization requests from the state's 75,000 participating healthcare providers. It manages over 450 million claims and encounters, and 150 million eligibility and prior authorization transactions.
• The Department of Public Health and Human Services DPHHS intends to replace its aging Medicaid Management Information System MMIS .. The system processes over 6 million claims annually for 120,000 Montana citizens who receive healthcare services from 15,000 enrolled Medicaid providers.

Roles and responsibilities

• Identifying the gaps between current and proposed solutions assisting of technical product owner and NYS business product owner in the prioritization and sizing of user stories.
• Writing User stories based on the requirements and does so the language of business so that the business may prioritize them according to the business area.
• Preparing agendas for story session and the point of contact follow up on action items and parking lot.
• Analyzing the requirement with current HE system as matched, partial, enhancement and configuration.
• Meeting with the NY state client in order to validate the requirement and presenting demo of the product requirement.
• EDMS Doc finity management, Implementation of letters and cascade structure, Move IT task and verification, troubleshooting letters, Object importer, EDMS batch jobs, Single Sign on, Cascade structure for reports, Index file converter, Electronic SDO, Migration, Simple find feature, web file using API.
• Working on multi-level functional areas including Benefit plan, EDI Data conversion, Claims pricing, Adjudication, Managed care and Contact management.
• Analyzed the requirements using Rational Requisite Pro and DOORS.
• Reviewing Use Case Survey and System Vision using Rational Requisite Pro.
• Created and updated Use-Cases using Rational Requisite Pro. Translated the Business Requirements into Use Cases.
• Updating the GAPS for State BA team and closing action items to prepare for the sprint.
• Acting as liaison between the business and application development for better understanding of the project.
• In direct contact with Business on the data flow and system functionality to deliver a quality product.
• Attending daily standup and functional meeting with the team.
• Active communication on the technical team to fulfill the client's requirement.
• Supporting Test plans and Test cases based on Use cases and Functional Specifications Documented.
• Trouble shooting on Electronic Document Management System EDMS and work closely with the testing team.

Environment

DOORS, Rational Suite Rose, Requisite Pro , Rational Unified Process RUP , Windows XP/2000, MS-Project, MS Share Point, MS-Office Suite, MS Visio, Quality Center, MS Word, MS Excel, MS Access, JIRA, MS Outlook.

Confidential

Business Analyst

Overview

Well Care Health Plans, Inc. provides managed care services exclusively for government sponsored healthcare programs, focusing on Medicaid and Medicare. It offers a range of Medicaid and Medicare plans, including health plans for families, children, the aged, blind and disabled, and prescription drug plans. WellCare's Medicare plans include stand-alone prescription drug plans and Medicare Advantage plans, which include both Medicare coordinated care MCC plans and Medicare private fee-for-service plans. MCC plans are plans that are administered through a health maintenance organization and generally require members to seek health care services from a network of health care providers.

Roles and responsibilities

• Conducted user interviews, gathered requirements in JAR/JAD sessions with Business team to help create Business Requirement Documentation, using MS Word and MS Visio.
• Analyzed the requirements using Rational Requisite Pro.
• Created Use Case Survey and System Vision using Rational Requisite Pro.
• Created and updated Use-Cases using Rational Requisite Pro. Translated the Business Requirements into Use Cases.
• Created the System Design Documentation using MS Word.
• Researched and understood the claims adjudication and reimbursement systems based on HIPAA X12 4010 and 5010 standards.
• Designed and implemented HIPAA 835 Payment Advice Transaction, 837 Health Care Claim Transaction. Populated ICD-9, EDI X-12 transaction sets 835, 837, 270, 271, 276, 277 and 5010, PGP encryption and responsible for Claims processing, coordination of benefits and pricing process.
• Ensured that the application could be upgraded to X12 5010 Standard Code set.
• Understood the Provider Contracts and Pricing of claims as well as the Member Benefits to be applied on the claims.
• Good understanding of pricing tools.
• Understood the ICD-9 and ICD-10 differences and upgrades.
• Used API Tool for adjudication of Professional as well as Institutional claims.
• Acted as liaison between the business and application development for better understanding of the project.
• In direct contact with Business on the data flow and system functionality to deliver a quality product.
• Supporting Test plans and Test cases based on Use cases and Functional Specifications Documented.

Environment

Rational Suite Rose, Requisite Pro , Rational Unified Process RUP , Windows XP/2000, MS-Project, MS-Office Suite, MS Visio, Quality Center, MS Word, MS Excel, MS Access, MS Outlook.

Confidential

Business Analyst

Overview

Dean Health Plan is one of the largest and most diversified HMO's in the Midwest. It maintains a position of leadership in insurance services through a physician-led integrated health system that delivers a superior level of service and care.

HEDIS - The Healthcare Effectiveness Data and Information Set HEDIS is a rating tool used by more than 90 percent of America's health plans to measure performance on important dimensions of care and service.

Roles and responsibilities

• Performed Requirement Analysis by gathering functional and non-functional requirements based on interactions with the process owners stake holders and document analysis, represented them in Requirements Traceability Matrix RTM .
• Worked on System Integration X12 EDI-HIPAA-835 with Health plans eligibility and claim CPT, ICD 9 codes .
• Performing Stakeholder Analysis to identify key players for project success and stakeholder management to communicate effectively with the right stakeholders.
• Facilitating pre-scoping and scoping sessions with all relevant stakeholders.
• Identifying and involving all key stakeholders in the project and ensuring that contributors are motivated to complete assigned tasks within the parameters of project plan.
• Drafting Business Requirements Document, validating business requirements with project stakeholders and conducting walkthrough meetings.
• Facilitating JAD sessions and scheduling meeting with developers and testers to collaborate resource allocation and project completion using MS Project.
• Used IRise Software for Simulation Purposes.
• Providing implementation assessment for Rational Requisite Pro, Rational Rose, UML and RUP
• Participating in providing user training, conducting user acceptance testing, recording and resolving issues and validating test scenarios with business users.

Environment

MS Visio, Rational Requisite Pro, Rational Rose, RUP, I rise, UML, Oracle 9i, SQL, PL/SQL, Quality Center MS Office, MS Project, Windows 2000.

Confidential

Business Analyst

Overview

Sprint is a leading global integrated communications provider serving more than 26 million customers and over 70 countries with nearly 27 billion in annual revenues. It focuses on individual consigner customers, business customers and focused on its local telephone service for both residential and small business customers . These projects is developed and as implemented on customer billing data mart for their business rules that help to take business strategies decisions.

Roles and responsibilities:

• Gathering functional requirements from the clients. Experience with all the business rules and business process. Participated in integrated systems planning and recommends alternative technologies that will enhance current or anticipated information systems that support overall corporate and business goals. Participates and Lead review and design concept work for new systems and develops and documents technical design for solution integration and implementation. Created documents for IT projects with its business and non -functional requirements. Extended support for clients in planning, marketing and training. Extensively developed project plans, evaluates risks and follow Service Level Agreements. Developed the analysis and definition of efficient, cost effective solutions that support client business processes and functional requirements and resource costs.
• Analyzed existing data and used tools available to successfully forecast the pricing models.
• Responsible for addressing, diagnosing, and resolving issues that arise on a day-to-day basis for the team. Also responsible for documenting the causes, analysis and final resolution to the issues/errors.

Environment

RUP, Rational Requisite Pro, UML, MS-Office, MS-Visio, MS-Project, SQL, PL/SQL, Quality Center, Rational Rose, Excel, CRM.

Confidential

Business Analyst

Overview

Medica is a non-profit, taxable corporation that provides health insurance products for the individual, family, group, senior and government markets as well as a health management company, a charitable grant-making foundation and a research institute.

Roles and responsibilities

• Conducted user interviews, gathered requirements to help create Business Requirement Documentation, using MS Word and MS Visio.
• Analyzed the requirements using Rational Rose Requisite Pro RUP in Clinical Phases
• Performed Use-Case analysis using UML. Worked on the Flowchart and process diagram along with sequence diagram using Microsoft Visio.
• Researched and understood the claims adjudication and reimbursement systems based on HIPAA X12 4010 and 5010 standards.
• Ensured that the application could be upgraded to X12 5010 Standard Code set.
• In depth knowledge of Medicare/Medicaid Claims processes.
• Worked with EDI transaction 837 and 835.
• Researched on System Integration of X12 EDI-HIPAA-835.
• Conducted Claims and HIPAA Compliance Training to run the test cases.
• Involved in the Daily Standup Meetings.
• Analyzed business Requirements, performed gap analysis and segregated them into high level and low-level Use Cases, Activity Diagrams using Rational Rose.
• Maintained a good working relationship with departments such as, Research, Clinical Trial, and Regulatory departments and often communicated with them and provided technical support throughout the product development.
• Identified and documented issues, risks, gaps and their impact to the project life cycle. Provided recommendations and alternatives.
• Maintained and submitted periodic/monthly status reports to the Program Manager to serve as the team's assessment of the project and its schedule.
• Involved in developing Test plan and Test cases based on Use cases and non- Functional Specifications Documented, reviewed, and verified testing procedures for compliance to Interface Quality Assurance and Development standards and policies.

Environment

MS Office Excel, Word, PowerPoint, MS Project, MS Visio, UML, SQL, Oracle, SDLC, Rational Unified Process RUP , Rational Suite Requisite Pro, Rational Rose, Windows XP.HTML.

Confidential

Business Analyst

Overview

Macy's research and analytics over the past year has confirmed that significant opportunity for sales growth in strengthening relationship with current customers and driving their visits to Macy's. In short, this project translates purchase insights and customer experience feedback into relevant, customer-focused actions in all areas of business.

Roles and responsibilities

• Performing Stakeholder Analysis to identify key players for project success and stakeholder management to communicate effectively with the right stakeholders.
• Facilitating pre-scoping and scoping sessions with all relevant stakeholders.
• Identifying and involving all key stakeholders in the project and ensuring that contributors are motivated to complete assigned tasks within the parameters of project plan.
• Drafting Business Requirements Document, validating business requirements with project stakeholders and conducting walkthrough meetings.
• Facilitating JAD sessions and scheduling meeting with developers and testers to collaborate resource allocation and project completion using MS Project.
• Providing implementation assessment for Rational Requisite Pro, Rational Rose, UML and RUP
• Participating in providing user training, conducting user acceptance testing, recording and resolving issues and validating test scenarios with business users.

Environment

Oracle SQL Developer, Oracle, RUP, Rational Requisite Pro, Rational Rose, Quality Center, MS Word, MS Excel, MS Visio, UML, Test Director, Win XP.

Confidential

Business Analyst

Overview

• Catalyst Microfinance Investors CMI is a private equity fund that invests in emerging, high potential microfinance institutions, selected and managed by a team of globally renowned microfinance practitioners and corporate finance specialists.
• By encouraging efficient, for-profit processes in its investees, CMI seeks to create and enable the next generation of market-leading, high-performing, scalable microfinance institutions around the world, and to deliver an attractive proposition to investors looking for a combination of financial and social returns.

Roles and responsibilities

• Played pivotal role in preparation of BRD. Interacted with various business owners to understand their requirements.
• Extensively used the concepts of Business Process Reengineering.
• Managing client communication unmistakably. Organizing the status calls and review calls for understanding and communicating the daily problems faced by the team members and taking remedial actions and risk mitigation.
• Developed Requirement Traceability Matrix RTM .
• Worked on functional requirements to be inculcated in the project.
• Negotiated various deliverables with the stakeholders.
• Wrote Use cases skillfully. Developed Activity diagrams and process flow diagrams. Developed Business Processes. Helped process engineering. Conducted many sessions with client to figure out actors and cases.
• Identified and assisted to create Test Data for execution of Test Cases.
• Mentoring and training other business units.
• Coordination in writing test cases for UAT.
• Followed Agile RUP methodology.
• Conducted JAD sessions with management, SMEs Subject Matter Experts , vendors, users and other stakeholders for open and pending issues to develop specifications.

Environment:

Rational Suite Rose, Requisite Pro , Rational Unified Process RUP , Windows XP/2000, MS-Project, MS-Office Suite, MS Visio, MS Word, MS Excel, MS Access, MS Outlook.

Association for Social Advancement ASA , Dhaka Bangladesh Date: Nov' 04 - Feb' 06

QA Analyst

Overview

• ASA is a non-governmental organization in Bangladesh originated to alleviate poverty by empowering underprivileged community thru ensuring proper access of capital. ASA committed to the society for the socio-economic contribution in enhancement of daily life in the poverty prone community. ASA has topped the famous US-based magazine's first-ever list of 50 top MFIs considering Scale, Efficiency, Risk and Returns.
• Design and Implementation of ASA Microfinance Management System AMMS software solution. The workflows, policies, procedures, staffing requirements, specific job role activities and technology setup required to produce consolidated management information and financial reports through AMMS software.

Roles and responsibilities

• Wrote Test case plan and executing Test Run.
• Worked on reporting bug/issue and preparing document as per requirement using JIRA, Snagit and Camtasia.
• Prepared software validation documents including System Installation Qualification Protocol, System operational Qualification Protocol and system performance Qualification Protocol..
• Prepared software documents including User Requirements Specifications, Use case Analysis and Software Design and implementation document.
• Developed IT Policy Including SOP for Software Development, Data Backup Policy, Security policy and Password Management Policy.
• Ensured quality and performance for the service being delivered by the Engineers.
• Conducted software's user training including user manuals, training materials, training schedule and training plan.

Environment:

QTP, Test Director, JIRA, Sangit, Camtasia, Win Runner, and RPG400, Rational Test Manager and Load runner.