SUMMARY

• Experience of over 7 years as a business analyst in the Healthcare industry.
• Expertise and strong knowledge of ISO, Six Sigma standards.
• Possess good understanding of the HIPAA regulations, transactions and the standard claim forms.
• Understanding and implementation of ICD - 9 and ICD-10 in accordance to HIPAA compliance.
• Identified the major differences between HIPAA 4010 and HIPAA 5010 through GAP analysis of implementation guides.
• Contributed in documentation of data mapping from HIPAA .
• Well versed wif 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 the iterative methodologies of Software Development Life Cycle (SDLC) including Requirement gathering, Design, Development, Testing and Deployment.
• Conducted formal interviews, surveys, questionnaire, and JAD sessions wif the subject matter experts (SME’s) and stakeholders of the projects for developing required software solutions.
• Managed complex business initiatives to balance requirements for functionality, efficiency and quality.
• Well versed wif Joint Application Development method, Rational Unified Process, has knowledge of Rapid Application Development and Agile Application development methods.
• Experienced in interacting wif business users to identify their needs, gathering requirements and authoring Business Requirement Documents (BRD), Functional Requirement Document (FRD) and Software Requirement Specification (SRS) across the deliverables of a project.
• Extensively used SQL queries for the data retrieval and management.
• Contributed to data assembling for EHR software development.
• Expert in working wif Medicare and Medicaid benefits in accordance wif 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 wif Rational tools like Rational Requisite Pro, Clear quest, Clear Case, JIRA, Rational Rose, and FACETs.
• Aware of the Health Insurance exchange (HIX) plans.
• Good knowledge about the Patient Protection and Affordable Care Act (PPACA).
• Worked collaboratively wif top management and senior team members to discuss project strategies and deliverables.
• Personally, an active, open minded, and a responsible professional wif highly developed; planning, management, analytical, technical, communication, decision-making and leadership skills, driven wif the 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 wif the statisticians and underwriting team to analyze and validate run-time decision models.
• Gathered and analyzed requirement for HIPAA 5010 and ICD 10 changes.
• Analyzed and documented the changes in the 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.
• Gathered 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 the requirements, making requirements available to all team members.
• Created requirements analysis and design phase artifacts using Requisite Pro and MS Visio.
• Worked extensively wif the users and wif different levels of management to identify requirements, use cases and to develop functional specifications.
• Created Use cases, Activity, Sequence and Collaboration diagrams.
• Interacted wif various cross-functional teams for building business use-cases.
• Conducted Asset Management, Risk Analysis of the Requirements and Traceability focus areas of the various projects and worked wif the project team to help them identify the high-risk areas.
• Traces and manage all the requirements wif Metadata to ensure the delivery of deliverables on time.
• Data mapping, logical data modeling, used SQL queries to filter data wifin the Oracle and Sybase.
• Responsible for co-coordinating business meetings and generating monthly status reports etc.
• Used the Agile methodology to build the different phases of Software development life cycle.
• Assisted QA team wif 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 the 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 the business rules for the international user subscription and impact of localization.
• Worked according to the activities/roles laid down in each phase of software development life cycle created using agile methodology.
• Provided technical Expertise on the use of Rational Clear Case and Requisite pro, which were used for Data archiving and Requirements Management.
• Defect Tracking wif Clear Quest, Configuration Management wif 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 the claims processing and the information retrieval.
• Managed the privacy and security environments of healthcare data that was governed by HIPAA and other government mandates.
• Maintained a record of recommendations, communications, activities, and schedules to monitor the progress of project in real time using MS Project.
• Worked wif Business users to come up wif 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 the development team.
• As member of system architecture team designed and reviewed user interface.
• Developed Business case and assessed the 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:

• Gathered requirements and prepared business requirement documents (BRD).
• Responsible for translating BRD into functional specifications and test plans. Closely coordinated wif 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 the project and to reduce the time frame required to complete deliverables.
• Gathered 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 the Data Process Models.
• Defined Use cases from requirements and helped 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 the requirements for HETS
• Involved in HIPAA/EDI Medical Claims Analysis, Design, Implementation and Documentation
• Involved in preparing the 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 wif the project team, sponsor, and stakeholders to baseline the scope of the work and enable development of the plan
• Performed SWOT and Gap analysis for the new functionality requirements by identifying existing technologies, documenting the enhancements to meet the end state requirements.
• Involved in preparing project plans and identifying major milestones for each stage as per the 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 wif 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 the 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 wif external systems.
• Analyzed, manipulated and updated Database using SQL.
• Gap Analysis: Analyzed the client’s applications programs to determine the impact of the HIPAA rule on EDI Transaction Set and Code List implementation and defined the changes to bring the affected systems into HIPAA compliance.
• Assisted wif 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 the Health plans Medicaid programs.
• Worked closely wif the technical team to look up for the 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