Professional Summary:

• Over 8 years of experience as a Business Analyst in the Healthcare and Pharmaceutical industries.
• Well versed with SDLC methodologies: Agile Scrum, XP, RUP and Waterfall.
• Experience using UML diagrams use case, activity, sequence using Rational Rose and MS Visio.
• Experience conducting GAP analysis, SWOT analysis, Cost Benefit analysis and ROI Analysis.
• Extensive knowledge of MMIS, HIX, EMR, EHR and healthcare reforms like PPACA, EMTALA.
• Deep knowledge of Health Insurance Portability Accountability Act HIPAA standards, Electronic Data Interchange EDI , HL7 and ICD-9 to ICD-10 coding.
• Extensive experience with claim Transactions such as 837 submit medical claims , 835 medical claim payments , 270 benefit/eligibility inquiry , 271 benefit/eligibility response , 276 claim status request , 277 claim status notification , 820 premium payments , and 834 enrollment .
• Well versed with various types of health insurance programs such as: Medicaid, Medicare Part A, B, C and D , PPO, HMO, and POS.
• Proficient in gathering and documenting business and functional requirements.
• Proficient in Requirements Analysis working with techniques such as User Stories, Use Cases, Prototypes, Interviews and Storyboards with a strong ability to facilitate JAD sessions. Experience developing BRD, FRD, and SRS with detailed knowledge of functional and non-functional requirements.
• Organized and facilitated JAD sessions, interviews and workshops with user s , subject matter experts SME's and business stakeholders.
• Highly skilled in working with Data Warehouse, Data Mining, and ETL tools for loading high volumes of data and a smooth structural flow of the data.
• Extensive knowledge in Data Mapping, Data Modeling, Star/Snowflake Schemas, OLTP/OLAP, and designing E-R Models Worked with Erwin for Conceptual, Logical, and Physical designs
• Created Test Plans and Test Cases from the Requirements document. Documentation of the Test Plans, Test Cases, Test Scripts, Test Procedures based on the Design Document and User Requirements Document for the Black Box, Functional, Usability and User Acceptance Testing UAT .
• Ability to manage workload with time sensitive deadlines in addition to handling multiple projects or tasks under minimal supervision.
• Excellent verbal/written communication skills and strong analytical abilities working independently and as a team player.

Confidential

Technical SKILLS

SDLC Agile, Scrum, XP, RUP, Waterfall, Rational tools: Requisite Pro, Rational Rose, Clear Case, Clear Quest, UML, Microsoft Office Suite Word, PowerPoint, Access, Excel - Macros and Pivot tables, Project, Visio , SharePoint, HTML, Trizetto Facets ,XML, HP/Mercury Quality Center, Microsoft SQL Server, Oracle PL/SQL, IBMHP Quality Center, Informatica, Erwin Data Modeler, Congo's.

PROFESSIONAL EXPERIENCE:

Confidential

Role: Business Systems Analyst

The Goal of the project is to create an end-to-end health management platform to be utilized by Cigna's healthcare professionals to deliver holistic health management services to its customers. Served as a Systems Analyst and SME for project.

Responsibilities:

• Facilitated all aspects of the scrum framework, including sprint planning sessions, backlog grooming sessions, daily scrums, product demos, sprint reviews and sprint retrospectives.
• Supported and consulted product owner in developing, maintaining and grooming product backlog.
• Reviewed customer's change requests and worked with business users to gather, analyze and document system requirements and provide solutions to meet those requirements.
• Participated in regular meetings with business managers and staff, clearly communicating results of research findings, recommendations and project status.
• Defined and documented the business rules and systems functional and technical requirements working with users and business technical staff.
• Created business scenarios to articulate desired process and outcome.
• Translated business / technical requirements into content changes in HEV application.

Vendor worked with: TCS

Tools Technologies:

Agile, Rally, SharePoint, MS Visio, MS Project, MS Office.

Confidential

Role: Sr. Business Analyst Lead - Consultant

The goal of this project is to create an on-demand business intelligence reporting tool for analyzing business performance based on financial, operational, and prescription data. Data is used to assist business stakeholders with the ability to proactively manage operations, forecasts and budgets with up-to-date customized reporting. Tools used are Micro Strategy's BI and Self-Service analytical tools and CVS' RxDW data warehouse. Project primarily managed by Infosys.

Responsibilities:

• Lead Business Analyst for creating Business Intelligence tools
• Created BI performance Dashboards and designed report layouts to provide up to date status of metrics and key performance indicators for the enterprise.
• Assisted development team by performing and documenting data mappings to maintain ETL processes for extracting data from multiple source databases and platforms which are transported to the target RxDW data warehouse.
• Created business requirements, use cases, personas, mock-ups, wireframes, requirement traceability matrix, functional requirements, user acceptance test plans including test cases , user guides, and presentations.
• Facilitated meetings with business stakeholders and technical teams to elicit requirements perform gap analysis, prioritized requirements, cost-benefit analysis, and value measurements.
• Performed feature and functionality analysis to determine the appropriate BI tool to utilize for the project.
• Reviewed and approved system level test plans, and other technical documentation with technology teams.
• Assisted project manager with day-to-day management and direction of project.
• Maintained project plan and communicated weekly updates to senior management
• Performed data investigations to resolve issues. Worked with Micro Strategy's business intelligence and self-service analytical reporting tools.
• Vendors worked with: Micro Strategy, Infosys, Randstad

Tools Technologies:

Agile, MicroStrategy, Tableau, Hadoop, SharePoint, MS Visio, MS Project, MS Office.

Confidential

Role: Sr. Business Analyst - Consultant

The goal of the project was to make enhancements to the Claims processing module of the Group Approval Process. The claims processing module incorporated the Receiving and Verification of Claim Forms 837 Claims Enquiry and Response 276/277 , Adjudication, Healthcare Claim Remittance/Payment Advice 835 . Part of the project was to migrate all application functionality and convert data from a mainframe-based system to an open systems environment with Up-gradation of HIPAA 4010 transaction to HIPAA 5010. The project followed Agile Scrum methodology.

Responsibilities:

• Facilitated all aspects of the scrum framework, including sprint planning sessions, backlog grooming sessions, daily scrums, product demos, sprint reviews and sprint retrospectives.
• Supported and consulted product owner in developing, maintaining and grooming product backlog.
• As Scrum Master maintained the capacity plan, iteration board, sprint backlog, velocity charts and burn down charts
• Identified and removed impediments to the success of the sprint by working with every single team member.
• As Scrum Master communicated dependencies and potential risks to the completion of the sprints including resources, costs and systems.
• Conducted JAD sessions, workflow diagrams, UML diagrams, process models, activity diagrams, use cases, for incorporating design changes in the order creation/ management system.
• Worked on developing the business requirements and use cases for Facets batch processes automating the billing entity and commission process.
• Prepared the Business requirement Document BRD and functional requirement document FRD for the enhancement of the existing services.
• Actively participated on creating Migration strategy from existing PDE Microsoft Access files to Gold Data Repository.
• Clearly understood coding standards required for all Medicare Part D Users transactions involving electronic data interchange as provided by department of health and human services and incorporated at every stages of the project wherever found necessary.
• Analysis and Design of existing transaction sets, and modification of these transaction sets to ensure HIPAA compliance.
• Involved in data analysis, created data mapping and data interface documents and kept the documents updated with changes in requirements and functional specifications.
• Coordinated the upgrade of Transaction Sets 837P, 835 to HIPAA compliance.
• Worked on the EDI 834-file load to Facets through MMS Membership maintenance sub-system .
• Involved in gap analysis for HIPAA 4010 837P and 835 transactions and HIPAA 5010 837P and 835 transactions.
• Involved in impact analysis of HIPAA 5010 835 and 837P transaction sets on different systems.

Tools Technologies:

Agile, Microsoft Office, HTML, Microsoft Visio, Share Point, XML schema, UML, Quality Center, QML

Confidential

Role: Sr. Business Analyst - Consultant

The project was to create a Data Hub for processing the Medicare Part D and adjudicate them. In order to process Medicare claims correctly it needs information about individuals' eligibility to receive medical insurance. The Data Hub will be the conduit through which eligibility data is passed from the state eligibility source system. The Data Hub delivery model included a structured iterative approach to design, development, testing and deployment where different parts of the solution are developed and delivered at different times and integrated as they are completed. The project also involved in ICD-9 to ICD-10 conversion.

Responsibilities:

• Conducted detailed and comprehensive Business Analysis by working with end users and other stakeholders to identify the system, operational requirements, and proposed enhancements and managed the requirements through IBM Rational DOORS.
• Validated the business process flow for the claims processing EDI transactions which included prescription drug claims Part D for NJ state.
• Facilitated Joint Application Development JAD sessions with all IT group members for communicating managing expectations and to discuss various means for integrations with current system using an adoption through execution strategy.
• Conducted Gap Analysis on the AS-IS and TO-BE business processes and technology and identified potential pitfalls, risks, and issues.
• Mitigated risks and developed contingency plans for risk management
• Identified all necessary Business and System Use Cases from requirements, created UML diagrams including Use Case Diagrams, Activity Diagrams, and Sequence diagrams using Microsoft Visio.
• Understood the Business Logic, User Requirements and test-objectives to develop Test plans, Test cases, Use Case Scenarios.
• Involved in comprehensive testing of the system to check it satisfies functional specifications.
• Responsible for checking the benefit set and adjudication of claims.
• Created High Level Test Scenarios, Test Cases and Test Scripts for Data Hub requirements as described in RSD Requirement Specification Documents and DSD Design Specification Documents as well as HIPAA.
• Gathered Data Hub requirements and responsible for creating test cases and test scripts under Quality Center Test Plan and Test Lab modules.
• Worked with ICD 9 codes and CPT codes required for processing the claims required in compliance with HIPAA 5010.
• Analyzed ICD-9 code set structure and body systems, along with the ICD-10 code set structure and body systems for mapping using GEMs, reimbursements, and adjudication.
• Developed Test Scripts using Test Director and coordinated with developers to quickly resolve the defects associated with them.
• Analyzed and evaluated User Interface Designs, Technical Design Documents and Quality Assurance to test the performance of the application from various dimensions.
• Documented the UAT Plan for the project and worked with the UAT Team to ensure every acceptance criteria for the requirements has been included in the UAT test plan.
• Data Hub testing scope includes testing the Data Hub requirements, documenting and testing source system records, change requests and assist SMEs with validation of daily error files.
• Verified and validated all the build or release related issues and resolve them through discussion with business analysts with the user's approval.

Tools Technologies:

Agile Scrum, MS Project, MS Office, UML, MS-Visio, Rational DOORS, SQL, WinRunner, LoadRunner.

Confidential

Role: Sr. Business Analyst

The goal of the project was to implement Epic which is an EHR system. Epic is customized to satisfy Physicians and Office staffs for easy access of lab results, radiology results and documents. EHR is implemented to reduce the time invested for clinical data review and they by helps Physicians to provide more time for patient's healthcare.

Responsibilities:

Inception:

• Organized JAD sessions between key surgeons, Pharmaceutical Research Scientists and Technology team.
• Performed requirements gathering process in iterative approach using RUP methodology.
• Worked with Physician and Nursing Informatics people to understand their current performing technology and provided inputs in Epic applications.

Construction:

• Coordinated between Test team, Development and Business team in clarifying the Functionality issues and Requirement Specification.
• Involved in testing using SQL and worked with QA team to develop test scenarios and test cases.
• Involved in defect tracking and maintaining RTM

Transition:

• Coordinated UAT with the stakeholders for Pilot and Go Live implementations.
• Conducted training sessions to ensure user acceptance.

Tools Technologies:

RUP, MS Excel, Visio, SQL, Rational Request Pro, Adobe Photoshop and other MS Office.

Confidential

Role: Business Analyst -

The goal of the project was to implement I Know Med EHR to achieve the functionalities for scheduling, check-in, charts, labs, ePrescribe, referrals, billing and patient workflow. This EHR system is specific to the needs of oncologists and hematologists to create a system that improves the overall quality of cancer care delivery. The project followed RUP methodology.

Responsibilities:

Inception

• Met with users and stakeholders to understand the problem domain, gathered customer requirements through interviews group and one-on-one along with JAD sessions.
• Performed requirements gathering process in iterative approach using RUP methodology.
• Worked effectively with physicians, nurses, and engineers to solve problems related to EMR, EPM, and ICS to make software more user-friendly to staff and doctors.
• Work with Compliance and Regulatory operations to follow and monitor different IT process bound by CMS Regulations.

Construction

• Involved in Testing by using SQL and work with QA together to develop test Scenarios and test cases.
• Involved in defect tracking and maintaining Requirement Traceability Matrix

Transition

• Facilitated UAT and documented User manuals for the user community.
• Conducted training sessions to ensure user acceptance.

Tools Technologies:

Windows XP, Rational Unified Process RUP , MS Excel, Word, Visio, UML, power point, SQL, Rational DOORS, Rational Rose, Erwin.

Confidential

Role: Business Systems Analyst - Consultant

The project was to make enhancements to the existing Content Management System - Documentum to store the patent information, drug details, research and development and sales information. The basic objective of this project was to migrate to a new system that offers the opportunity to clean up the system-remove redundancy, separate or combine repositories, update object models, taxonomy and security, and review data anomalies. The project followed Agile Scrum methodology.

Responsibilities:

• Responsible for facilitating the identified risks, and issues, by tracking these through the SDLC, scheduling, and recapping team meetings.
• Assisted business analysts in leading JAD sessions, and developing documentation of technical requirements, functional specifications for all automated workflow using Visio.
• Involved in gathering requirements and translated the business details into the functional specification documents that described the different types of processes.
• As Scrum Master assisted team with making appropriate commitments through story selection, sizing and tasking.
• As Scrum Master proactively identified and removed blockers, facilitate frequent retrospectives, sharing metrics to identify and implement improvements.
• Provided coaching on Agile values and practice to other teams within the company.
• As Scrum Master involved in Scrum Sprint Planning Sessions, Backlog Grooming, Sizing, Sprint Retrospectives Reviews, Daily Standups, User Stories and Acceptance Criteria.
• Created business process, and activity diagrams using Visio. As well as leading client JAD sessions to ensure validation and usability with the new technological platforms.
• Obtained detailed understanding of data sources, Flat files and various schemas and modeling.
• Extensively worked with Facts and Dimension tables - architecture to produce source to target mappings based upon business specs.
• Developed test plans, test scripts and use cases for testing of workflow automation tool in conjunction with business users and IT development staff.
• Reviewed necessary technical specifications, requirements and work breakdown structure documents using Visio.
• Prepare Functional requirement specification documents which includes flow charts, formulas, definitions, sample tables with real data, well designed color Graphs including drilldown views and mockup screens.
• Strictly followed the change control methodologies while deploying the code from development, Quality Assurance and Production.

Tools and Techniques

Agile, UML, MS Visio, MS Project, Windows 2000, MS Office, Oracle, SQL, Erwin, Quality center.

Confidential

Role: Business Analyst Medical Billing Application

The goal of the project was to provide onsite and remote support in the implementation of Medical Billing Application in physician office practices. It involved high-level coordination of all implementation components including project management, pre-implementation, system build, and training and post implementation.

Responsibilities:

• Conducted focus meetings with physicians and other health care professionals to elicit requirements for patient billing and accounting.
• Created system modules and flows for entering patient profile data, assigning ICD/CPT codes, entering insurance information, and tracking billing payments.
• Created process workflows and designed end-user screens based on Use Cases.
• Wrote BRD and System Level Test Plan. Also executed test cases and scenarios.
• Tracked defects and worked with off-shore development team to fix defects and develop enhancements based on project change requests. Front-end was created in JAVA. Back-end database done in Oracle.
• Created System Level Test Plan and executed test cases to test web-based application designed as a business-to-business platform to source telecom equipment manufacturers and service providers. Front-end was developed using PHP scripting. Back-end was SQL Server.
• Performed a mix of manual and automated testing QTP . Testing included, regression testing, white box testing, and black box testing.
• Tracked defects using Test Director.
• Conducting weekly status meetings by relaying test results to off-shore development team. Coordinated software release schedule and executed relevant test cases.
• Maintain issue log to track issues based on priority critical, high, medium, low and impact.

Tools Technologies:

Waterfall, MS Project, MS Office, MS-Visio, MS Excel, SQL, UML, QTP.