Summary of Experience

• More than 8 years of cross-functional progressive experience in the capacities of Business Analyst, Project Coordinator, Implementation Coordinator/Single Point of Contact SPOC for deliverables, and Systems Analyst.
• Expertise in business analysis and planning, documentation, requirement elicitation, requirement management, identification of enterprise business need, business analysis tools and techniques, understanding requirement solution assessment and software development life cycle, including analysis, design, development, testing and implementation of software applications. A smart working, motivated, sincere, committed, quick learner, detail-oriented team player with excellent communication, analytical, leadership, interpersonal and problem solving skills.
• Worked in various Healthcare areas like Enrollment, Benefits, Claims, patient rights responses, provider handling, subscriber, claim processing rules, other payer logic, diagnosis, procedure codes and EDI X12. I have Experience in Healthcare concepts such as HIPAA privacy, ICD-9/ICD10 conversion, patient protection and affordability care act PPACA. Worked on requirements related to the EDI X12 transaction sets 837 I/P, 276/277, 270/271, 834,835. Experience as Business/Systems Analyst with expertise in Insurance, Healthcare processes, health insurance exchange HIX, meeting federal compliance and regulation, understanding client requirements and providing scalable infrastructure.

PROFESSIONAL EXPERIENCE

• In-depth knowledge of Rational Unified Process RUP , risk engineering data modeling and mapping and design using UML, Rational Rose, and Visio.
• Experience in all phases of the Software Development Life Cycle SDLC including requirements gathering, analysis, design, implementation, testing and deployment, as well as software engineering methods like Waterfall Method, agile, agile sprint , scrum.
• Expertise in Business Modeling, business analysis performance, benchmarking, prioritization, Requirements Gathering through direct user interviews and workshops
• Facilitated JAD sessions with business users and development team to drive out detailed business requirements.
• Good Documentation Skills for writing Use Cases and Functional Requirement Documents as well as for creating User story, Use Case diagrams and Activity diagrams based on UML Methodology and business process flow diagrams using MS Visio/Enterprise Architect/Rational Rose writing Test Cases, creating Test Scripts, analyzing bugs, interacting with QA / dev teams in fixing errors and User Acceptance Testing UAT .
• Excellent communication, analytical, interpersonal, and presentation skills expert at managing multiple projects simultaneously

Environment Tools

• MS Visio, Rational Unified Process RUP , Rational Rose, Rational Requisite Pro, Enterprise Architect, User story, UseCase Diagrams, Activity Diagrams, State Diagrams, MS Office, MS Project.
• Environment Microsoft Office PowerPoint, Excel, Word , MS Visio, MS Project, Rational Rose, Rational Requisite Pro, Microsoft .NET, SQL Server,MaxMC-Autorizations, AutoPie, Portico Provider System, Claim Inventory/Processing, Oracle Calligo -Letters ,QNXT, Facets-interfaces, Enrollment, GEMS mapping, SQL Server 2008, T-SQL, SSRS Reports,
• Testing tools - Test director, win runner, load runner, QTP for better sampling of the biological and clinical data available.
• SharePoint,MercuryQuality Center,Costing, Business Analysis Performance,Requirement prioritization.
• HIPAA, HIPAA Privacy, ICD-9/ICD-10 conversion, health insurance exchange HIX, GEMS Mapping,

EXPERIENCE

Confidential

Role Sr. Business Analyst

• Responsible for assisting A A team with the business assessment , business case development, planning and monitoring, eliciting requirements, organization, translating and simplifying requirements, requirements management and communication, and requirements analysis. Work with the Business Process owners to gather, analyze, and develop comprehensive business requirement document.
• Design and implement an Audit Management Module that includes scheduling, consolidated CRCM work papers , standardized notifications and audit reports and metrics reporting capabilities for the L2A, VCAS and IAF work streams.

Responsibilities:

• Serves as primary liaison between business stakeholder to articulate business requirement into technical requirements and desired features.
• Formulates and define scope and objective based on user needs and thorough understanding of business processes.
• Schedule, Lead, Coordinate meetings and Interviews of SME, Business Process Owners, End User, Technical Experts to gather the information for business requirements and Use cases requirement document.
• Knowledge of Vendor Assessment, SOX, non SOX, GxP regulation in Pfizer.
• Collaborates with business and technical stakeholders to define the product road map, and to refine it over time.
• Perform business process modeling, User experience modeling and business process flows of different audit modules in Pfizer.

• Documented Business requirement document with Stakeholder analysis with RACI matrix.
• Current and Future process, business roles in the new audit tool with detailed CRUD analysis
• Defining specific business rules for VCAS, IAF and L2A audit modules.
• Created Use-Cases Diagrams, flow charts, Activity diagrams and Process models for all the three audit modules eg: VCAS, IAF L2A.
• Developed traceability matrix where each requirement will be traceable back to the business goals/objectives to validate whether it should be included or is outside the scope of the project.
• Assist with Project Management tasks such as scope definition, project plans and status updates.
• Participated in different trainings of Vendor Assessment, Internal Audit Function and Level II Audit.

Confidential

Role Technical Analyst BA/QA

Responsible for analysis of employee benefits enrollment program, supporting the organization in developing benefits administration processes, open enrollments and special projects. This includes life, medical, dental, vision benefits administration, changes to payroll, administering the online benefits system and working on weekly errors produced from carrier interfaces. Working collaboratively with clients, carriers, and develop technical and functional specifications, create and execute test plans, and consult on system design, implementations, and business process flows. Responsibilities:

• Primary responsibility include review, gap analysis, statement of work, and costing for IT work to client requests for proposal RFP .Evaluate/research business problems and their relationship to technology.
• Execute change management tasks in systems projects including, but not limited to, communication to key user communities, providing subject matter expertise, providing training and documentation where appropriate.
• Analysis of employee benefit programs, including Health, Life, Dental, Accident and Disability, Medical/Dependent care spending accounts, COBRA, Leave of absence/FMLA, health savings account HSA , federal savings accounts FSA and different retirement plans.
• Assists with the Implementation of new benefit programs advise management for the changes, arrange and conduct enrollments related presentation.
• Gather and document business requirements to develop technical and functional design specifications for new programs or modifications to existing programs per client requirements.
• Analyze technical requirements, test plans, training materials and procedure documents.
• Execute test plans and test case scenarios to ensure requirements are being met.
• Perform data manipulation, mapping, conversions, and validations utilizing internal systems, external files, Access, and Excel.
• Create and execute SQL and/or Access queries to determine proper data logic and file structures.
• Develop and generate carrier files, enrollment counts, payroll files, census files, and billing reports while verifying reports meet quality standards.
• Assist with Project Management tasks such as scope definition, project plans, issue management, and status updates.
• Support client implementations, renewals, and other project initiatives as needed.

Confidential

Role: Business Analyst Consultant

Accounting System, Benefits, Clinical, care management, case management, referrals, MPs, Payments, Loinc, 837,835,834, 270/271, 276/277, policies, contract management, provider, companion guide, hipaa, hipaa 5010, Medicaid, medicare, drgs, procedure codes, service line analysis, professional, institutional claims.

Responsibilities:

• Strong business analysis and requirements gathering experience including leading JAD sessions and SME interviews, use case and technical specification development, wireframe, storyboarding and test script creation.
• Implemented HIPAA/ EDI X12 4010/5010 healthcare-related file formats including 834/835, 837, 270/271, 276/ 277, 278, 999 for acknowledgements.
• Knowledge of claims, enrollment, eligibility and business processes in a commercial, Medicare/Medicaid health plan. Fluent with commonly used EDI concepts, practices and procedures within the heath care industry.
• Interviewing candidate for the respective user area, system and business interview for the icd 9-icd 10 changes.
• Formulates and defines scope and objective based on user needs and thorough understanding of business processes.
• Performs JAD sessions and requirement elicitation, gathers and documents system requirements from users for software selection and development projects.
• Work with stakeholders on process improvement projects designed to improve results, and will lead business process re-engineering efforts.
• Gather and analyze key data and provides recommendations to address and resolve root causes.
• Create current as-is and future to-be state documentation
• Tackle complex business/systems problems and communicates this information to stakeholders includes technical teams for translation into solution design .
• Analyzes and documents business processes relevant to systems projects and improves these processes where appropriate
• Develop business process scripts, use cases, etc. used for configuring software to meet the needs of the user community.
• Negotiate with all levels of stakeholders. Organizing and present ideas in a convincing and compelling manner.
• Responsible for gap analysis, planning, coordination, requirements direction, and scheduling of new software feature development to support migration of numerous classic software application systems to most current product service applications.
• Identifies process, technology and organizational role changes necessary to support business goals and objectives.
• Perform data analysis on the claims data, enrollment data by utilizing T-SQL on the SQL Server 2003.
• Write SQL queries for the reporting , data analysis, code set analysis, identify gaps in the data, financial reconciliation and the data consistency.
• Worked on Claims, Provider, member, OPL, recon databases to extract information for the data fixes , analysis, and OLTP processing, linking and aggregation.
• Worked on various methodologies including Waterfall, Agile, Scrum, RUP. Understanding of business strategy and development techniques.
• Ability to facilitate dialogue across functional areas and provide consultative direction.
• Participate in guiding and mentoring other members of BA Team

Environment : Oracle 6/ 7.x/ 8i/ 9i, SQL server, Oracle- TOAD, MS VISIO, Rational rose, UML, MS Word, MS Powerpoint, MS Project, MS Visual studio, EDI, Sharepoint 2007

Confidential

Role: Business Analyst

Objective of the project was to develop Medicaid Management Information System for State of Washington following HIPAA standards. The web based Health Care Management System is developed using HIPAA guidelines and regulations which keeps track of Healthcare transactions like Eligibility Request/ Response, Request and Response for Status, Prior Authorization, Claims and Claims Payment. This application also keeps record of all transactions, subscriber's medical history and provides data to other State agencies as required.

Responsibilities:

• Ensure the ongoing integration of information security with business strategies and requirements.
• Define business details for provider handling, subscriber claim processing rules, other payer logic, and diagnosis procedure codes. Ensure consolidation of information security with business plans and necessities.
• Work with different stakeholders, outside business teams and other third parties to improve information security within the organization.
• Implemented, managed, and enforced information security directives as mandated by HIPAA. Provide architectural advice to management for HIPAA claims.
• Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies also reviewed security plans.
• Involved in implementation of HIPAA EDI Transactions 835, 837, 820,276
• Facilitated Electronic Data Interchange and performed GAP Analysis for HIPAA 4010 and 5010 transactions.
• Recommended changes for system design, methods, procedures, policies and workflows affecting Medicare/Medicaid claims processing in compliance with government compliant processes like HIPAA/ EDI formats.
• Analyzed HIPAA EDI transactions in XML and X12 responses and of 270 and 276 and looked for defects for amendment. Develop applications which accept different claims like Medical claims, Dental claims, and vision claims from different vendors.
• Have worked in Waterfall, Agile methodologies.Create, define and maintain data life cycle documentation representing data elements across multiple upstream and downstream systems.
• Develop use cases from requirements and created UML diagrams such as use case diagram, activity diagram and sequence diagram.
• Participated in the planning, development, coordination and presentation of specific testing needs as appropriate to the quality assurance needs of the end user.

Environment: MS Access, EDI, SQL Server 2003, MS visio, MS Office, Powerpoint,MS project, Windows 2000/XP, Sharepoint.

Confidential

Role: Business Analyst

Responsibilities:

• Developed and implemented processes and tools for requirements gathering, analysis, planning, tracking and delivery.
• Responsible for the delivery of Business Requirements Documents BRD within project timelines.
• Analyzed user problems, including automated and manual business processes and identified, researched, investigated, defined and documented business processes
• Designed and developed User stories, Use Cases and created diagrams using Visio
• Modeled the detailed design of the system using UML and Rational Rose, Use Case Diagrams, Activity Diagrams and State Chart Diagrams
• Identified, researched, investigated, analyzed, defined and documented business processes and Use Case Scenarios.
• Documented Existing Processes.
• Preparation of AS IS and TO BE Business and System Process Maps
• Performed Gap Analysis by identifying existing technologies, documenting the enhancements to meet the end state requirements.
• Assisted with User Acceptance Testing, developing and maintaining quality procedures, and ensured that appropriate documentation is in place.
• Worked with development and testing teams to accomplish timely release objectives.
• Maintained a Traceability Matrix to ensure that all Functional Requirements are addressed at the Use Case Level as well as the Test Case Level.
• Created and updated project status in MS Project and shared it with stakeholders.
• Performed Functional and GUI Testing to ensure that the user acceptance criteria are met.
• Co-coordinated the UAT with the SME's to make sure that all the Business Requirements are addressed in the application.

Environment : MS Visio, MS Office, MS Project, MS Word, Powerpoint, SQL server, Oracle 8.0, EDI, Windows XP, Windows 95/98.

Confidential

Business Analyst

The project involve migration of credit card functionalities to TSYS, this requires complete understanding of credit card services dealing with VISA and MasterCard line of services for Small Businesses and Client Service Applications. Migration of all letters and customer correspondence, Embossing Details for Plastic, CIF updates, Card-Receipt-Verification, Data Security, Batch Processes setup with VISA for reconciliation, Customer Interface updates involving login and view-account information, online payments, balance transfers, manage account etc.

Responsibilities:

• Identify Project needs, Affected Business functions, gathering business requirements
• Create Scope document related with Account Acquisition, Card-Receipt-Verification, collection efficiency, expansive data capture, speed to market business function.
• Define Business needs using Requisite Pro, Conduct and participate in JAD sessions
• Provide inputs to Design Decisions. Work with Developers and Architect to resolve pending issues.
• Involved in creating the Use Cases Diagrams, flow charts, Activity diagrams and process models Identify test case and log it in the Clear Quest
• Manage changes in the project and work as a single POC for TSYS migration. Identified Use Cases and wrote Use Case Narratives.
• Worked closely with the development team to help them understand Use Case Narratives.
• Conducted requirement workshops among all project stakeholders to verify and validate the business requirements
• Handled the development of business requirement documents BRD resulting from JAD sessions.
• Gathered Business Requirements from users and used Rational Requisite Pro for documenting the requirements.
• Involved in maintaining Requirements Traceability Matrix RTM .
• Participated in identifying opportunities and parameters for business process improvements.
• Used the guidelines and artifacts to release multiple iterations of the deliverable over the span of the project lifecycle propounded early development and base-lining of a robust executable architecture. SOA design principles are used during the phases of systems development and integration for consumers of services in web-based applications.
• Created Use Case Diagrams and Activity Diagrams using MS Visio.
• Assisted QA department to write and execute Test plans and Test Cases.

Environment: MS Visio, MS Office, MS word, MS Powerpoint, UML, Test director.