SUMMARY

• Experience of over 7 years as a business analyst in teh Healthcare industry.
• Expertise and strong noledge of ISO, Six Sigma standards.
• Possess good understanding of teh HIPAA regulations, transactions and teh standard claim forms.
• Understanding and implementation of ICD - 9 and ICD-10 in accordance to HIPAA compliance.
• Identified teh major differences between HIPAA 4010 and HIPAA 5010 through GAP analysis of implementation guides.
• Contributed in documentation of data mapping from HIPAA .
• Well versed with code set rules such as 837-Institutional, 837-Professional, 835-Claim Payment/Remittance Advise, 270/271-Eligibility Benefit Inquiry/Response, 276/277-Claim Status Inquiry/Response Transactions and testing in Client Server systems.
• Experience in all phases of teh iterative methodologies of Software Development Life Cycle (SDLC) including Requirement gathering, Design, Development, Testing and Deployment.
• Conducted formal interviews, surveys, questionnaire, and JAD sessions with teh subject matter experts (SME’s) and stakeholders of teh projects for developing required software solutions.
• Managed complex business initiatives to balance requirements for functionality, efficiency and quality.
• Well versed with Joint Application Development method, Rational Unified Process, have noledge of Rapid Application Development and Agile Application development methods.
• Experienced in interacting with business users to identify their needs, gathering requirements and authoring Business Requirement Documents (BRD), Functional Requirement Document (FRD) and Software Requirement Specification (SRS) across teh deliverables of a project.
• Extensively used SQL queries for teh data retrieval and management.
• Contributed to data assembling for EHR software development.
• Expert in working with Medicare and Medicaid benefits in accordance with Federal Regulations using Maintenance Management Information System (MMIS) for claims processing and information retrieval.
• Proficient in creating Sequence Diagrams, Collaboration diagrams, Activity Diagrams, Class Diagrams using Rational tools and Microsoft Visio
• Professional experience in writing Test Scenarios, Test Conditions, Test Cases and Test Scripts for Functional and non-functional requirements and mapping validation.
• Experienced with Rational tools like Rational Requisite Pro, Clear quest, Clear Case, JIRA, Rational Rose, and FACETs.
• Aware of teh Health Insurance exchange (HIX) plans.
• Good noledge about teh Patient Protection and Affordable Care Act (PPACA).
• Worked collaboratively with top management and senior team members to discuss project strategies and deliverables.
• Personally, an active, open minded, and a responsible professional with highly developed; planning, management, analytical, technical, communication, decision-making and leadership skills, driven with teh ability to multitask and deliver effectively, in a fast paced environment.

TECHNICAL SKILLS

Languages: C, C++, Java, SQL, ASP, VB Script, HTML

RDBMS/ Database: MS SQL server, MS Access, IBM DB2

Tools: Rational Rose, Test Director(Quality Center), Requisite Pro, Clear Quest, MS Office: Word, Excel, Access, Power point, Project, Visio

Operating systems: Windows, LINUX, UNI, Mac

Industry Standards: HIPAA, Six Sigma, ISO, CMM, DICOM, SOX, HL7

Management skill: Risk management, SDLC, UML

PROFESSIONAL EXPERIENCE

Confidential, Avon, CT

Sr. Business Analyst

Responsibilities:

• Worked with teh statisticians and underwriting team to analyze and validate run-time decision models.
• Gatheird and analyzed requirement for HIPAA 5010 and ICD 10 changes.
• Analyzed and documented teh changes in teh compliance rules for adverse action redesign.
• Worked on different EDI scenarios for batch processing.
• Ensure day-to-day EDI transmission, Reject tracking and Reconciliation.
• Run EDI Reconciliation reports daily and document in MS Excel.
• Involved in up-gradation of HIPAA X12 4010 transaction to HIPAA X12 5010 and ICD 9-CM (Clinical modification) to ICD-10-CM/PCS (Clinical modification/procedure coding system) simultaneously.
• Gatheird and analyzed requirements for HETS
• Maintained and monitored project progress and status through MS Project.
• Extensive use of Use cases, written business flows, and work flow diagrams for effective plans.
• Integrated Requisite Pro to provide all teams visibility and maintains tractability among requirements, use cases and change requests.
• Managed all teh requirements, making requirements available to all team members.
• Created requirements analysis and design phase artifacts using Requisite Pro and MS Visio.
• Worked extensively with teh users and with different levels of management to identify requirements, use cases and to develop functional specifications.
• Created Use cases, Activity, Sequence and Collaboration diagrams.
• Interacted with various cross-functional teams for building business use-cases.
• Conducted Asset Management, Risk Analysis of teh Requirements and Traceability focus areas of teh various projects and worked with teh project team to halp them identify teh high-risk areas.
• Traces and manage all teh requirements with Metadata to ensure teh delivery of deliverables on time.
• Data mapping, logical data modeling, used SQL queries to filter data within teh Oracle and Sybase.
• Responsible for co-coordinating business meetings and generating monthly status reports etc.
• Used teh Agile methodology to build teh different phases of Software development life cycle.
• Assisted QA team with Test Plans and executing Test Cases.
• Involved in preparing application for ambulatory care using DICOM for RIS (radiology information system) & HIS (hospital information system) PACs (picture archiving & communication system)
• Design specifications and Test Case usages for teh HIPAA 837i, 270/271, 276/277, 835, 824, 275 and others.
• Involved in assembling, organizing and analyzing patient information, including medical history, symptoms, examination results, test results and prior treatments for EHR software development.

Environment: MS SQL, Windows XP, Requisite Pro, Clear Case, UML, Business Objects, MS Visio, MS Project, MS Excel

Confidential, Austin TX

Business Analyst

Responsibilities:

• Fully responsible for requirements gathering and documentation.
• Created use case narratives to record Subscription business rules.
• Analyzed teh business rules for teh international user subscription and impact of localization.
• Worked according to teh activities/roles laid down in each phase of software development life cycle created using agile methodology.
• Provided technical Expertise on teh use of Rational Clear Case and Requisite pro, which were used for Data archiving and Requirements Management.
• Defect Tracking with Clear Quest, Configuration Management with Clear Case.
• Involved in preparing test plan, test script and test cases based of functional requirements using Rational Test Manager.
• Executed test cases and saved result.
• Responsible for processing Medicaid claims and CHIP claims.
• Responsible for checking Medicaid eligibility and verifying claim payment.
• Extensively used MMIS for teh claims processing and teh information retrieval.
• Managed teh privacy and security environments of healthcare data dat was governed by HIPAA and other government mandates.
• Maintained a record of recommendations, communications, activities, and schedules to monitor teh progress of project in real time using MS Project.
• Worked with Business users to come up with Reporting Requirements. Reports were developed in Cognos.
• Produced various artifacts e.g. Functional Requirement Specifications (FRS) and Wireframes.
• As a point person responsible for resolving business rules/conflict resolution for teh development team.
• As member of system architecture team designed and reviewed user interface.
• Developed Business case and assessed teh ROI.

Environment: RUP, Agile, Rational Requisite Pro, Rational Clear Quest, MS office, Visio, Project, Clear Quest, Clear Case, Windows XP, HP Quality Center, Test Manager.

Confidential, New York, NY

Business Analyst

Responsibilities:

• Gatheird requirements and prepared business requirement documents (BRD).
• Responsible for translating BRD into functional specifications and test plans. Closely coordinated with both business users and developers for arriving at a mutually acceptable solution.
• Responsible for processing Medicare claims and COB claims.
• Responsible for checking Medicare eligibility and verifying claim payment.
• Conducted JAD sessions to define teh project and to reduce teh time frame required to complete deliverables.
• Gatheird requirement for HIPAA 4010-HIPAA 5010 and ICD 9 (clinical modification) to ICD10 conversion.
• Analyze HIPAA 4010 -HIPAA 5010 changes.
• Developed and maintained all operational and technical flows using Visio and Power point.
• Used Rational Rose/MS Office Suite for creating use cases, workflows and sequence diagrams according to UML methodology thus defining teh Data Process Models.
• Defined Use cases from requirements and halped convert them into software specifications
• Aided in workflow analysis and process design.
• Analyze business requirements from Black Box testing perspective, business process and system architecture/design.
• Analyze and documented teh requirements for HETS
• Involved in HIPAA/EDI Medical Claims Analysis, Design, Implementation and Documentation
• Involved in preparing teh Test Scenarios for Health Care Claim Payment/Advice.
• Written multiple Use Cases and test cases for multiple transactions include 837, 835, 270, 271, 276, 277.
• Design, build and test maps to translate X.12 EDI to and from transaction formats such as EDIFACT, SAP IDOC, and various proprietary formats.
• Maintained Requirement Traceability Matrix (RTM).
• Performed Regression Testing and created test scenarios for User Acceptance Testing (UAT).
• Maintained documents for change request and implemented procedures for testing changes
• Defined program and project goals, objectives, products, services, constraints, assumptions, risks and facilitated processes by working with teh project team, sponsor, and stakeholders to baseline teh scope of teh work and enable development of teh plan
• Performed SWOT and Gap analysis for teh new functionality requirements by identifying existing technologies, documenting teh enhancements to meet teh end state requirements.
• Involved in preparing project plans and identifying major milestones for each stage as per teh SDLC model (RUP Methodology).

Environment: Rational Unified Process (RUP), UML, Rational Test Manager, Rational Clear Quest, Windows, MS Office, HTML, Windows 2003

Confidential, Minneapolis, MN

Business Analyst

Responsibilities:

• Analyzed current business process flow by understanding preset business rules and conditions.
• Conducted formal interviews, Live Meetings and JAD sessions with business users Subject Matter Experts (SME’s)
• Designed and developed Use Cases, Activity Diagrams and Sequence Diagrams using UML.
• Involved in Backend Testing to verify data integrity by using SQL.
• Documented, organized and tracked teh requirements using Rational Requisite Pro.
• Created Data Flow Diagrams (DFDs), ER diagrams for data modeling and Web-page mock-ups using MS Visio for acceptance from end users.
• Defined project milestones, schedules, and monitored progress using MS-Project and updated plans as required.
• Analyzed and tested Data Interface needs with external systems.
• Analyzed, manipulated and updated Database using SQL.
• Gap Analysis: Analyzed teh client’s applications programs to determine teh impact of teh HIPAA rule on EDI Transaction Set and Code List implementation and defined teh changes to bring teh affected systems into HIPAA compliance.
• Assisted with user testing of systems and maintained quality procedures and ensured appropriate documentation is in place.
• Maintained Requirement Traceability Matrix (RTM) and Utilized Clear Quest for change requests and defect tracking.
• Claim validation and Pend/Denied Claims Analysis for teh Health plans Medicaid programs.
• Worked closely with teh technical team to look up for teh best possible solution on requirements by keeping business needs and technical constraints in mind.
• Updating, transferring and sharing Files using FTP between Windows and UNIX machines.

Environment: UML, MS Word, Rational Requisite Pro, Rational Clear Quest, Quality Center, SQL, FTP, Telnet