SUMMARY

• 6+ years of experience as a Business System Analyst in HealthcareandInsurancedomainwif excellent analytical,communication, decision - making and interpersonal skills, always willing to work in challenging and cross platform environment.
• Well versed wif all phases of Software Development Life Cycle (SDLC) including but not limited to the various concepts such as Requirement Gathering. Proficient in Requirement Management, including gathering, analyzing, detailing and tracking requirements.
• Extensive knowledge of SDLC methodologies like Agile (Scrum, RUP),ITIL, Waterfall Incremental and, Rapid Application Development (RAD).
• Extensive experience in gathering Functional user requirements, creating Use Cases and creating functional Requirement Document(FRD) as per user requirements in addition to creating Business Requirements Document (BRD).
• Experience in working wif product backlogs, sprint backlogs along wif creating userstories and prioritizing user stories and keeping track of burn down charts.
• Organizing and managing meetings between Business users and MMIS staff.
• Functional knowledge ofMedicaid Management Information System (MMIS).
• Exposed to using ICD 9/ICD 10 coding standards inMedicareand Medicaiddomains of the healthcare systems and industry for inpatients, outpatients, Reimbursement methodology.
• Strong knowledge of UML Modeling, including Use Cases, Sequence, State and Activity diagrams, Data mapping, participated in architectural design and class design.
• Gathering business requirements for ICD-10 Groupings/ classes pertaining to maintenance process, ICD-10 Business rules remediation process, Medical Claims Processing System (MCPS).
• Analyzing and understanding ICD-9-CM, ICD-9-PCS to and from ICD-10-CM and ICD-10-PCS GEM’S tool.
• Analyzed 4010A1 and 5010 TR3 Implementation guides to identify and document the changes for HIPAA EDI Transactions such as 837 P, 835, 276/ 277 and 270/271.
• Architected services to align wif business objectives and fit into overall SOA driven program.
• Establishing cross functional teams across to remediate the identified areas of impact wifin MMIS and its business partners.
• Documenting organizational policies and procedures in the context of system requirements.
• Facilitating Scrum meetings wif Technical Analyst to understand and convert the Technical Requirements to Functional and Business Requirements.
• Knowledge in the ETL (Extract, Transform and Load) of data into a data ware house/date mart and Business Intelligence (BI) tools like Business Objects Modules (Reporter, Supervisor, Designer, and Web Intelligence), experience in using RDBMS databases like SQL, Oracle extensively.
• Experienced in conducting Joint Application Development (JAD) and white board sessions wif Business Users and Tech Lead to obtain domain level information of project by Requirement Management Methodology.
• Expertise in working closely wif UI Team to develop Wire Frame for the desired look and feel.Quality assurance center assisting experience in creating test script and Unit Testing, experienced in Test Driven Development (TDD) cycle.

TECHNICAL SKILLS

SDLC Methodologies: SDLC, Agile (Scrum), Waterfall Incremental, RUP, RAD

Business Modeling Tools: MS Visio, Rational Rose, UML language

Requirement/Project Management Tools: MS Word, MS Excel, MS PowerPoint, Rational Requisite Pro, Rational Clear Case, MS Project

Documentation Management Tools: MS SharePoint, Visual SourceSafe, Version 1, Quality Assurance

Business Analysis Tools: SPSS, SAP (SD,MM,PP modules), Excel Miner, Microsoft CRM(Introductory), R-Commander

RDBMS: Oracle 8i/9i, SQL Server 2000, MySQL, MS Access,QuickBooks2011, 2013

Operating Systems: Windows 7/Vista/XP/2000

Operation Research Techniques: SWOT analysis, Impact, Risk analysis, GAP analysis

Environment: al Web Technologies: ASP, JavaScript, HTML, XML and FrontPage, VB.Net, ASP.Net, C#, XML

PROFESSIONAL EXPERIENCE

Confidential, Kennett Square PA

Business System Analyst

Responsibilities:

• Utilized Agile Software Methodology using Scrum framework. Actively participated in creating the user stories and prioritizinguser stories along wif tracking of burn up, burn down charts to estimate sprint delivery.
• Facilitated JAD sessions, user meetings, interviews and Requirement Elicitation Sessions to extract business requirements and to confirm dat those requirements are in alignment wif up gradation of existing system to HIPAA 5010.
• Involved in creating sample mappings for the conversion of EDI X12 transactions code sets - version and translation of ICD 9 codes into ICD 10 codes.
• Worked on HIPAA ANSI X-12, EDI series such as 835/837 for enrollment and disenrollment in plans.
• Conducted GAP analysis to identify and document gaps between existing 4010 compliant system and proposed 5010 compliant system.
• Created User stories for EDI transactions using Epic and acceptance criteria, prioritized user stories from product backlog wif development teamand maintained the burn down chart.
• Worked along wif development team to make sure of 5010 changes implementations while keeping testing team in confidence to have matching Test Cases to user stories.
• Established questionnaires and resource leveling required for implementing HIPAA 5010 and upgrading ICD-9 diagnosis codes to ICD-10 codes.
• Involved in data warehousing projects dealing wif ETL (extraction, transformation, loading) using various databases.
• Involved in analyzing requirements for data migration, data reconciliation, mapping rules, staging rules and transformation rules for the ETL processes.
• Worked closely wif the Enterprise Data Warehouse team and Business Intelligence Architecture team to understand repository objects dat support the business requirement and process.
• Performed workflow analysis toward automated disability claims process.
• Understanding XML request sent in for provider portal, assisting development team to validate XML request for web service call.

Environment: Rational Requisite Pro, SharePoint, Rational Clear Case, UML,MS Project 2000,Quality Assurance, MS Office (Excel, Word), Agile, Test Driven Development (TDD ) cycle

Confidential, NY

Business System Analyst

Responsibilities:

• Participated in White board sessions wif business owners and other relevant system stakeholders.
• Worked on the claims and provider modules of the New MMIS and reviewed artifacts of Medicare Information System.
• Facilitate iteration planning, lead work wifin individual sprints, and coordinate retrospectives and demos.
• Developed plan for data feeds and data mappings for integration between various systems, IncludingXML, to follow ICD code set and ANSI X12 5010 formats.
• Ensure cross functional coordination (analysts, developers, and testers) is occurring early and often. Lead daily stand-ups, resolve conflict, and are “un-blocker” for team.
• Utilized Agile Software Methodology using Scrum framework. Actively participated in creating the user stories from EPIC, prioritizinguser stories and setting the acceptance criteria and most importantly maintaining the Product Backlog.
• Involved in performance testing of Medicaid client server claims processing system, Medicaid MCC / MCO and Medicaid Management Information System (MMIS)
• Assisted in Healthcare ICD-10 HIPAA Gateway and 5010 transactions and migration.
• Participated in LEAN events and facilitated the meetings for identifying quality problems to ensure smooth flow.
• Analyzed CMS comparison documentation highlighting changes of 4010 format and ICD 10 diagnosis and procedure codes.
• Worked as a Data Warehouse consultant in the enhancement of Business Application.
• Involved wif data analysis, data mapping and dimensional modeling experience in decision support systems (data marts) while analyzing change requirements.
• Worked on Pharmacy Benefit Management (PBM) wif the ETL teamto Extract Benefit Plan Data(BPE) from legacy system to transform the data to create the Benefit Plan Feed(BPF) through business transformation rules and load the data(BPL) to claims system.

Environment: MS Visio, Excel, MS office, Rational Rose, ETL, Agile, SQL Server, Informatica.

Confidential, Washington DC

Business System Analyst

Responsibilities:

• Addressed the changes made to the Medicare program and created requirements mapping to dat of the system requirements.
• As a part of agile implementation, been part of weekly standups,scrum meetings, prioritized user stories based on the requirements gathered from Business, validated those user stories and translated those to development team.
• Gathered and documentedbusinessrequirements from SMEs, user groups and vendors via workshops, interviews and surveys.
• Worked in Healthcare Claims Administration - Healthcare Claims Processing (837/835) includes facility claims and professional claims.
• Reviewed the data model and reporting requirements for Cognos Reports wif the Data warehouse/ETL and Reporting team.
• Facilitated and managed meeting sessions wif committee of SME's from various business areas including Benefits Administration, Waiver program, Health Claims Group, HIPAA Administration, Health Policy and Program Evaluation Team and Data Management Group.
• Created Functional specifications for the 834 enrollment files wif their changed benefits in the Medicare program.
• Participated in entering, tracking system defects in Rational Clear quest.
• Submitted change requests and worked wif change request records in Clear quest.
• Involved in Configuration Management, Requirement management and analysis.
• Provide technical and procedural support for User Acceptance Testing (UAT).
• Involved in fetching and displaying data using SQL queries to represent report under claims module.

Environment: Rational Requisite Pro, Clear Case, MS Visio, MS Project, SQL, Windows 2000, MS Office.

Confidential

Business Analyst

Responsibilities:

• Conducted focused interview sessions and JAD wif SMEs, project stake holders and Business users so as to obtain maximum details of requirements and involved in documenting business Requirements.
• Studied business requirements and conduced User Interviews to identify and document the data discrepancies and their sources as related to Government Contract Compliance (GCC),Government Disclosures, Government Pricing, Customers, Products, Product pricing.
• Planned and defined system requirements to Wire Frame wif Use Case, Use Case Scenario and Use Case Narrative using the UML (Unified Modeling Language) methodologies.
• Developed thorough Business Requirements Document (BRD) by applying analytical questioning and critical reasoning to business user requirements.
• Business Process Modeling: Business process improvement and optimization, Document and model business processes, automated workflows and Manage business rules.
• Careful tracing of business requirements (BRD) ensured dat they are aligned wif UI from the initial stage itself while substituting legacy systems which were originated through unplanned, stovepipe development wif detailed enterprise architecture models.
• Proper use of RTM (Requirement traceability matrix) so as to capture all the features of the project.
• Performed application functionality user acceptance testing(UAT) experience (i.e. front-end application testing) in a controlled testing environment dat replicates the end user usability of the application.
• Discussed and documented post implementation summary wif senior management regarding Gaps found during the project.

Environment: MS Visio, Excel, MS office, Waterfall Incremental Methodology, SQL Server

Confidential

Jr. Business Analyst

Responsibilities:

• PhaseI of dis project, I was involved in documenting rating requirements for a new business complex scenarios.
• In Phase II I was involved in creating and analyzing requirements for To Be system for policy change forms.
• Understand the business requirements from end users regarding property and causality, and documenting them to translate in software design using agile software Approach.
• Planned and defined system requirements to Wire Frame wif Use Case, Use Case Scenario and Use Case Narrative using the UML (Unified Modeling Language) methodologies.
• Worked wif business team to create Project need, Business scope, Resources to mitigate the risks involved in dis project.
• Documented Requirements for Management Reporting out of Clear Quest using Crystal Reports
• Derived Business Process modeling based on High level and low level requirements analysis.
• Documented and maintained Requirements Traceability Matrix (RTM) using Version 1 tool to validate dat all requirements have been tested.
• Maintained all requirements in Share point and also in quality Assurance center for version control and further accessibility.
• Developed Test plans, Test cases wif QA team and helped to develop test scenarios for system testing and performance testing.
• Data mapping, logical data modeling, created class diagrams and ER diagrams and used queries to filter data wifin the Oracle database.

Environment: MS Office, MS Excel, UML, Version Control, JAD,.net, MS Visio, MS Project, MS Power Point, Share point, Windows XP, Oracle.

Confidential

Jr. Business Analyst

Responsibilities:

• Elicit requirements by employing Information gathering techniques (e.g. Interviews, surveys, Business process analysis, competitive product analysis etc.).
• Communicated Project Requirements, Business Issues, created Solutions and made recommendations for To Be banking loan application module.
• Developedbusiness flow diagrams, Use Case diagrams, Activity diagrams, Sequence Diagrams and assisted to define the workflow of accepting the loan process.
• Defined Functional Requirements and segregated them into high level and low level use cases, activity diagrams using UML.
• Actively involved wif PM in developing Timelines for Project Delivery and Managed Projects and Resources to successful completion.
• Developed the training material for functional and process improvements.
• Actively participated in User Acceptance Testing while accepting critical criteria to test.
• Prepared and Reviewed BRD and the Technical Specifications using Quality center.
• Created User guides and “How To” power point presentations of product features

Environment: MS Visio,.Net, Microsoft Excel, MS Power Point, Share point, Windows XP, SQL