SUMMARY:

• 7+ years of diverse experience in Business Analysis with Healthcare industries.
• Extensive experience in Unified Modeling Language (UML), Rational Unified Process (RUP), Waterfall model. Also worked using various methodologies such as Agile, RAD (Rapid Application Development), JAD (Joint Application Design) and Prototyping.
• Participated in requirements Analysis reviews, Business reviews and working sessions to understand the requirements and system design.
• Extensive experience with Rational Rose, Requisite Pro, Rational Clear Case and MS Visio.
• Experience in negotiating with clients from diverse backgrounds and industries.
• Exposure to Healthcare, Insurance and Finance business domains.
• Experience in development of documents such as Functional Specification Document (FSD), Requirement Specifications (SRS), Standard Operating Procedures (SOPs).
• Extensive experience using tools such as Rational RequisitePro, Rational ClearQuest, MS Project, MS Visio, Rational Rose, Crystal reports.
• Excellent knowledge of HIPAA standards, EDI (Electronic data interchange), transaction syntax like ANSI X12, Implementation and Knowledge of HIPAA code sets, ICD - 9, ICD-10 coding and HL7.
• Worked withANSI X12 5010 as well as ANSI X12 4010 including medical transactions such as 837 (medical claims), 835 (medical claim payments), 270 (eligibility inquiry), 271 (eligibility response), 276 (claim status), 277 (claims status response), 820(enrollment).
• Good knowledge of Health Insurance Plans (Medicare Part A, B, C and D), managed care concepts (Medicaid and Medicare) and experienced in determining the eligibility, billing experience within life and disability in health plans with thorough understanding of CPT coding, CMS-1500 claim forms and reimbursement forms.
• Experience in writing System test plans, defining test cases, developing and maintaining test scripts.
• Developed and maintained databases in SQL/PL-SQl, Oracle and MS Access.

TECHNICAL SKILLS:

Programming Languages: SQL, HTML,.NET

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

Requirement Management Tools: Rational RequisitePro

Business Modeling Tools: Rational Rose,MS Office: Word, Excel, Access, Power point, Project, Visio

Operating systems: Windows, LINUX, UNIX, Mac

Industry Standards: HIPAA, Six Sigma, ISO, CMM, DICOM, SOX, HL7, RAD, JAD, RUP, GAP Analysis

Management skill: Risk management, SDLC, UML

PROFESSIONAL EXPERIENCE:

Confidential, St. Paul, MN

Business Systems Analyst

Responsibilities:

• Responsible for creating and reviewing business requirements, functional specifications, project schedules, documentation and test plans.
• Closely interacted with designers and software developers to understand application functionality, navigational flow and updated them about end-user sentiments
• Perform EDI activities that comply with government reporting requirements and standard.
• Working with management to establish, document and maintain EDI procedures by identifying errors and taking corrective action, reconciling EDI transactions through coordination of information with internal and external customers, Accounting Department, IT Department and external vendors to maintain EDI integrity.
• Overseeing and maintaining the EDI Inquiry Problem database including the evaluation of problems or issues through to resolution.
• Conducting regular audits of EDI transactions to determine accuracy and areas for improvement and maintaining EDI maps.
• Further analysis of the requirements was performed using Rational Rose Rational Rose is anobject-orientedUnified Modeling Language (UML) software design tool intended for visual modeling andcomponentconstruction of enterprise-level software applications through the use of sequence, Entity relationship diagram and class diagrams.
• Generated queries in Oracle and SQL Server.
• Worked closely with Developers, User Representatives and participated in the product design process including specifications and other document reviews.
• Used SoDA - Software Documentation Automation SoDA is a flexible, powerful documentation tool that can help you publish project documents by retrieving information from software tools i.eIBM Rational UML modeling products and use the information to generate customized documents and reports using Microsoft Word and created product documentation including online help, printed user manual, and materials.
• Created and maintained the Requirement Traceability Matrix between the requirements and other products such as design documents and test plans.
• Familiar with User acceptance testing (UAT), System testing, Integration testing. Validated and helped verify defects to weed out cosmetic problems and keep the project on schedule.

Environment: MS Visio, MS Project, Rational Requisite Pro, Rational Clear Case, MS Project, UML, Oracle, MS Office, Oracle, SQL, XSLT, XML, HTML, CSS, Lombardi, MS Visio

Confidential, Deerfield, IL

Sr. Business Analyst

Responsibilities:

• Responsible for requirement and design documentation review, test plans, identifying and reporting software anomalies and test results.
• Rapid Application Development (RAD) principle was used in acute functionalities to design, document and manage requirements throughout the lifecycle of the project, i.e. definition, design and testing phases.
• Attended and conducted meetings and workshops to discuss high level requirements and developed User Requirements Specification Document.
• The URS contained detailed requirements, which were formatted such a way that a set of traceability could be matched from features to test cases.
• Developed business use cases and also extensively worked on Rational Requisite Pro in gathering the requirements. Coordinated with Project Managers to resolve risk issues and ensure compliance of Security System-Related to the HIPAA.
• Responsible for implementing the Key process areas and Impact analysis. Generated Use Case diagrams, Sequence diagrams, Business Objects, Domain Object Model using Visio, to depict process flows and PowerPoint presentations.
• Worked with ANSI X12 5010 as well as ANSI X12 4010 including medical transactions such as 837 (medical claims), 835 (medical claim payments), 270 (eligibility inquiry), 271 (eligibility response), 276 (claim status), 277 (claims status response), 820(enrollment).
• Used code sets such as HIPAA code sets, ICD-9, ICD-10 coding and HL7 - Health Level Seven International (HL7) HL7 provides standards for interoperability that improve care delivery, optimize workflow, reduce ambiguity and enhance knowledge transfer among all of our stakeholders, including healthcare providers, patients etc
• Managed Version Control, each version of the application was stored in Clear case and necessary modifications, updates, analysis was done. Developed ER diagrams for depicting relationships between entities. Mapped ER Diagrams to relational database.
• Worked in various other technologies such as XSLT XSL stands for EXtensible Stylesheet Language, and is a style sheet language for XML documents XSLT stands for XSL Transformations CSS, XML and HTML.
• Worked extensively with Oracle and SQL Server.
• Worked closely with Developers, User Representatives and participated in the product design process including specifications and other document reviews.
• Used Test Director to invoke the scripts, initially performed the baseline testing, organized all the scripts systematically and generated reports.
• Queried Oracle Databases to verify test case results. Randomly executed test scripts developed by QA team to check main functionality of application. Interacting with Development and QA Team to ensure overall quality of the software.

Environment: MS Visio, MS Project, Rational Requisite Pro, MS Project, Rational Clear Case, UML, Oracle 9i, MS Office, Windows, Crystal Reports, SQL, XSLT, XML, HTML, CSS - style sheet for HTML

Confidential, Fort Pierce, FL

Business Analyst

Responsibilities:

• Responsible for requirements gathering, creating requirements document, maintaining vision document, supplementary specification document and developing use cases from the functional specifications using Requisite Pro
• Responsible for the analysis, design, system integration testing and implementation of the project with emphasis on use-case driven SDLC approaches
• Analyzed, collected and prepared user requirements, definition, scope and expectations for project deliverables. Delivered system documents, processes, diagrams and test cases
• Worked closely with teams of BA’s, developers and testers throughout the entire development life cycle to elicit and manage requirements using Requisite Pro
• Utilized the business and financial requirements to develop detailed user interface for the application prototype
• Assisted Project Manager in educating all the team participants to extensively implement Project management methodology and tools to improve standardization and eliminate inefficiencies
• Implemented RUP methodology along with its six best practices for iterative and incremental development of the system
• Actively worked with user community during requirements elicitation through numerous interviews, focus groups and JAD sessions
• UML was used for visual modeling and a detailed use-case specification was developed to describe the design, architecture and dynamic behavior of the system
• Performed use-case analysis using UML to capture the dynamic aspect of the application
• Developed an information model for the architecture incorporating the reporting needs for business, clients and corporate users
• Extensively utilized business process improvements and other operational management tools like DMAIC and PDCA to eliminate inefficiencies and enhance user/customer experiences
• Assisted in coordinating work plan between project manager and client using MS Project, implemented and managed migration process and developer fixes, retested fixes, scheduled and tracked progress of project team members through completion
• Assisted QA team in developing Test plan and Test cases
• Assisted in complete documentation ofsystem and business requirements, specifications, design and development of use-cases and test cases scenario and helped in developing test plans for user acceptance testing (UAT)

Environment: Requisite Pro, RUP, ClearQuest, JAD, UML, HIPAA, MS Visio, Excel, PowerPoint, SQL Server and