PROFESSIONAL SUMMARY:

• Over 7 years of extensive knowledge as Business Analyst \ Quality Analyst skills - Understanding of Software Development Life Cycle (SDLC), Rational Unified Process (RUP),Agile/Scrum methodology, Unified Modeling Language (UML), Object Oriented Analysis and Design Concepts (OOAD), Business Process Re-engineering (BPR), Test Lifecycle, Data Modeling.
• Experience in writing Business Requirements Documents (BRD), System Requirement Document (SRD), Use Case Specifications, Functional Specifications, and Technical Specifications across the Deliverables of a project.
• Experience in handling Change Management and Release Management.
• Extensive Experience in UML and Process modeling using Use Case Diagrams, Activity Diagrams and Sequence Diagrams.
• Good experience in conducting Joint Application Development (JAD) sessions through interviews and workshops with subject matter experts and business users.
• Good experience with Rational Rose, Rational Requite Pro, Rational Clear Quest, Rational Clear Case, MS Project, MS Visio, Crystal Reports.
• Experienced in conducting GAP analysis, User Acceptance Testing (UAT), Risk Analysis and mitigation plan, Cost benefit analysis and ROI analysis.
• Experienced in various MS Windows platforms, OS, Office Suite, etc.
• Excellent knowledge of Health Insurance Portability and Accountability Act (HIPAA) transaction, code set rules such as EDI 837, 835, 834, 270, 271, 276, 277 and ICD9-ICD10.
• Extensive knowledge of Medical Management Information Systems (MMIS), Medicaid, Medicare, Procedural and Diagnostic codes and Claims Process
• Strong knowledge of Health Insurance Portability & Accountability Act (HIPAA) standards, Electronic Data Interchange (EDI), Implementation and knowledge of HIPAA code sets, ICD-9, ICD-10 coding,,HL7, HMO, PPO.
• 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 with in life and disability in health plans. 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.
• Extensive knowledge of Patient Protection and Affordable Care Act (PPACA).
• Extensive knowledge of Medicaid Information Technology Architecture (MITA).
• Experience with Business Process Management.
• A motivated, committed, quick learning, detail-oriented team player with good communication, analytical, leadership, interpersonal and problem solving skills.

TECHNICAL SKILLS:

Operating Systems: Windows, UNIX, LINUX, Mac

Languages: SQL, C, C++, Java, XML, C#, VB, ASP, .Net, Assembly, VHDL

Databases: Oracle, MS SQL server, MS Access, IBM DB2

Tools: MS Office: Word, Excel, Access, Power point, Project, Visio, Front Office, Rational Rose, SoDA, Software Modeler, Team Test, Doors, PROLOG,Clear case, Clear Quest,, Web Sphere, Business Modeler, HP Quality Centre,Ultra Edit, TOAD.

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

PROFESSIONAL EXPERIENCE:

Confidential

Business Analyst /System Analyst

Responsibilities:

• Worked with branch manager, project manager and team lead to assist with general capability and process document to support RFP.
• Gathered requirements by coordinating with external vendor, and internal team.
• Coordinated JAD sessions with all the stakeholders to understand the impact of HIPAA 5010 on the existing system.
• Gathered requirements for “Front End” and for “Core Adjudication System” by conducting meetings and brainstorming sessions with end users and Subject Matter Experts (SMEs) and documented them using Requirement Traceability Matrix and later exporting them to HP Quality Center.
• Prepared Business Requirement Documents (BRDs) after the collection of Functional Requirements from System Users that provided appropriate scope of work for technical team to develop prototype and overall system.
• Gathered requirements for ICD 10 transition.
• Organized requirements into High-level Use Cases and Low level Use Case Specifications and modeled them into UC, Activity and Sequence Diagrams using MS Visio.
• Assisted the QA personnel in the creation of Test Cases using HP Quality Center.
• Tested diagnosis codes, procedure codes to the related fields in test environment to verify the changes related to ICD9 - ICD10 codes.
• Defined and analyzed test cases, test scripts, bugs, interacted with QA/ development teams in fixing errors and conducted User Acceptance Test (UAT).
• Coordinated and prioritized outstanding defects and enhancement/system requests based on business requirements, allowing sufficient time frame to ensure accuracy and consider deadlines
• Streamlined Claims (837 EDI X12) Migration project by gathering functional specifications in Edifecs
• Tracked the change requests.
• Performed Regression test by submitting claims for different claim types with new ICD-10 codes with range of testing scenarios (positive & negative) and made necessary changes to ensure that claims are getting paid as expected.
• Maintained and tracked the project plans using MS Project.
• Daily and weekly status reporting to senior management.

Environment: Rational Suite (RUP, Requisite Pro, Test Manager, Clear Quest), HTML, Oracle10G XE, MS Visio, MS Project, UML

Confidential, Milwaukee, WI

Business Analyst

Responsibilities:

• Gathered requirements from stakeholders for provider management and member management.
• Coordinated JAD sessions for Requirement Validation with Dept. of Cleveland clinic to gather requirements for the new MMIS.
• Identified and validated business rules and data elements.
• Created 837(P, I, D) claims, and maintained data mapping documents in to HIPAA transactions primarily 837(P, I, D), 835, 270/271, 276/277 and 278.
• Modeled the ‘as-is’ process flow and the ‘to-be’ process flow and analyzed the gap and developed the action steps to fill the gaps.
• Worked within project team to identify and interpret state Medicaid policies as applicable to customer defined algorithm research as well as assist with internal development of new healthcare analytics.
• Analyzed Impact analysis when there is any change in the requirements and updated the Business Requirements Document (BRD) and Systems Requirements Specification (SRS).
• Facilitated meetings with the technical team and client team to analyze the current process and gather requirements for the proposed process.
• Analyzed Audit and Change Files of 834, 835, 820, 837 PDI, 270 & 271HIPAA EDI Transactions using MS Word, MS Excel, MS Access and Facets PROD & PPMO
• Created functional requirement specification documents such as UML diagram, use case diagram, scenarios, activity diagrams and mapping.
• Have utilized Requisite Pro to import word and excel documents in different extension formats.
• Have utilized Clear Quest to repair and detect errors in a program.
• Developed the User Interface (UI) prototypes to capture and validate requirements and spike solutions to the current problem.
• Analyzed requirements for developing a crosswalk for understanding major changes fromICD-9toICD-10 with the help of SME’s.
• Participated in developing test plan, test scripts, and test scenarios and designed user documentation.
• Examine the system design deliverables & validating it against the SLA.
• Maintained and tracked the project plans using MS Project.

Environment: MS Office, Windows, .NET, Agile, MS Visio, MS SharePoint, TFS, MS Project, MS Access 2007, Web Services, MS Visio, SQL, Oracle, SOA, HTML.

Confidential, Chicago, IL

Business Analyst \ Quality Assurance Analyst

Responsibilities:

• Prepared Business Requirement Document and functional requirement document for the enhancement of existing services.
• Performed GAP Analysis for HIPAA up gradation and prepared solution documents and project plan.
• Initiated with a comparison report of migration of HIPAA .
• Conducted HIPAA requirements gathering sessions for the EDI transaction between providers, payers and employer groups.
• Co-ordinated the upgrade of transaction sets of EDI 837 (I/P), 835 and 834 to HIPAA compliance.
• Involved in testing all the loops, segments and elements within each hierarchal loops for EDI 837 I, and 837 P.
• Worked on solving the errors of EDI 834 load to FACETS.
• Analyzed and documented the requirements for MMIS and CMS.
• Involved in forward mapping from and backward mapping.
• Tested EDI transaction like 270, 271, 276, 277, 837, and 835.
• Designed business process models (BPM) using UML diagrams such as use case model, class diagrams, activity diagram, sequence diagrams and collaborative diagrams in MS Visio.
• Involved in writing Test Plan, Test cases, and test steps.
• Mapped the test cases with requirements in test Link.
• Used SHOVEL as a data-mining tool to mine the test data to execute the test cases.
• Created Test data sheet and reviewed with testing and development team.
• Assisted SME’s pre-determined Business User to execute UAT testing.
• Created tickets to log UAT Testing Defects using TRAC as a tool.
• Involved in Adhoc and exploratory Testing with SME’s and Business Lead.
• Provided actual results of UAT testing and reviewed System Testing actual results and reports.
• Attended daily SCRUM meeting and guided QA and Developer regarding the defects, technical Specification Documents, and Mapping documents.

Environment: Mainframe, Microsoft SharePoint, Microsoft Outlook Microsoft Office, test Link, Shovel, TRAC, MS SQL Server

Confidential, Little Rock, AR

Business Analyst

Responsibilities:

• Liaison between the Business needs (business users and sponsor) and the Technical solutions (development and testing staff), ensuring technical solutions satisfied business requirements.
• Web Page Mock-Ups using MS Visio and thus defining the Business Process Model and Data Process Model.
• Experienced in RUP software development cycle methodology with four consecutive phases - Inception, Elaboration, Construction and Transition.
• Experienced with MS SharePoint and Team Foundation Services (TFS). TFS is utilized to effectively manage software developments projects throughout the IT lifecycle.
• Ensured that the claims processing is strictly under the HIPAA compliance regulatory document to safe guard patient information.
• Authored Business and Functional requirements with supporting diagram, use cases, traceability matrices, and manuals for Provider Portal web-based application.
• Developed material and trained the users on newly developed application.
• Analyzed and wrote technical documentation for risk analysis on customer support issues.
• Part of the team assisting in documentation involved in this project such as RFP, proposal, evaluation criteria, proposal approval, design document, project plan, project scheduling, project report, release document.
• Prepared and presented monthly collection reports.
• Involved in and quality of the overall workflow process.
• Documenting workflow and results of analysis for the aging accounts.

Environment: RUP, Rational Requisite Pro, UML Use Cases, VB.NET, SQL Server, Rational Rose, XML, Use Case Documentation, Web services, MS. Access, MS Office, MS Share point, MS Visio

Confidential

EDI analyst/ Quality Analyst

Responsibilities:

• Created business requirement document (BRD), functional requirement document (FRD), wrote the use cases for the requirements.
• Reviewed Business requirements, IT Design documents and prepared Test Plans for all assigned project releases for provider module.
• Strategized implementation of Agile with Scrums throughout SDLC.
• Arranged interviews with all the stakeholders to review and understand the gathered business requirements.
• Conducted meetings to document Change Requests for new requirements.
• Analyzed business requirements and segregated them into use cases, Created use case diagrams and documented Use case specifications.
• Maintained various versions of the documents generated during the project using Rational Clear case.
• Responsible for creating and updating project schedule and managing resources and timeline using MS Project.
• Prepared the project status reports and represented the BA team in the PMO meetings.
• Participated in creating and reviewing Requirements Traceability Matrix (RTM), technical Requirements Specifications (TRS), and proposal for resolution (PFR).
• Generated Weekly status report to Business/ System Project manager and BA lead.
• Prepared the project status reports and represented the BA team in the PMO meetings.
• Participated in UAT along with the development & testing teams,
• Followed prototype model of SDLC in developing software.
• Attended daily SCRUM meetings and guided QA and Developer regarding the defects, Technical Specification Documents and Mapping document.

Environment: Agile, C, C++, MS Visio, MS Project, MS Office Suite, Microsoft SharePoint, Lotus Notes, Quality Center, DB2