Professional Summary:

• Over 7 years of experience as a Business Systems Analyst. Worked in the Healthcare industry with primary focus on Iterative Software Development Lifecycle SDLC principles of Agile Methodology as well as the Rational Unified Process RUP .
• Expert in Business Process Flows, Case Tools and Software testing.
• Skilled in gathering business and application requirements, Business Processes, identifying risks, impact analysis, UML modeling, and Sequence and Activity Diagrams using Rational Rose and Microsoft Visio.
• Experience in writing requirements and specification like Business Requirements Document BRD , USE Case Realization Document, Functional Requirements Specifications, Systems Design Specification SDS , Systems Requirements Specification SRS , Data Dictionary, Business Continuity Plan BCP , Requirements Traceability Matrix RTM , Defect Traceability Matrix DTM , throwaway prototypes, Knowledge Transfer manuals, User Guides, Release Notes, Training Material.
• Several years of experience and advance knowledge of the Systems Development Life Cycle SDLC , Waterfall, Spiral, Rapid Application Development RAD , Extreme Programming XP , Rational Unified Process RUP
• Experience in conducting GAP analysis, User Acceptance Testing UAT , SWOT analysis, Cost Benefit analysis, Risk analysis and return of interest ROI Analysis.
• Excellent knowledge of Health Insurance Portability and Accountability Act HIPAA transaction, code set rules such as EDI 837,270,271,276,277,834,835 and ICD9-ICD10.
• Very Good understanding of Health Insurance Plans Medicare Part A, B, C and D , managed care concepts Medicaid and Medicare and is also experienced in determining the membership eligibility, billing experience within life and disability in health plans.
• Good knowledge of PPACA Patient Protection and Affordable Care Act and HIX.
• Experience in conducting Joint Application Development JAD sessions for requirements gathering, analysis and design, and Rapid Application Development RAD sessions to congregate early toward a design acceptable to the customer and feasible for the developers.
• Proven track record with handling Change Requests by the Clients.
• Experienced with Rational tools like Requisite Pro, ClearQuest, Rational Rose.
• Expertise in creating Use Case diagrams, Activity diagrams, Data Flow Diagrams DFD , Sequence diagrams, State diagrams based on UML Methodology and business process flow diagrams using MS Visio/Enterprise Architect/Rational Rose.
• Good Knowledge of Test Plan, Test Scripts and Test Cases for Functional, System, Integration, UAT, and Regression Testing based on the Design Document and User Requirement Document for the Functional, Security, and Performance Testing.
• Excellent Analytical skills to understand the Business process and Functionality Requirements and to translate them to system requirement specifications. Developing functional specifications for business process refinement and automation, Data Modeling, System Architecture, Conducting Feasibility Studies.

Confidential

Business/System Analyst

Project Description: The major goal of the project was to implement the Mass Health exchange Eligibility Platform MA HIX Project to build a platform for Massachusetts residents to apply for and obtain subsidized health insurance under Mass Health Medicaid/CHIP. The project is focused on building an end-to-end eligibility, program determination and enrollment system from applying for coverage to eligibility determination, generating notices as well as eligibility case management. The process consists of creating RTMS, business requirement documents, functional specifications, impact assessment, technical specifications and Defect triage.

Responsibilities:

• Created and Maintained Requirement Traceability matrix RTM to map test cases with business requirements throughout the project.
• Worked with developers and SMEs to create an Operation Maintenance manual O M as per the CMS standards.
• Conducted JAD sessions to gather requirements from the state SMEs in process of creating Business requirement document BRS and system requirement document SRS
• Raised defects HIXIR and HIXTT using JIRA and assigned it to responsible dev team in UAT testing phase.
• Constantly review and update the requirements document BRS based on the requirements which are in scope and which are de scoped.
• Worked with SMEs and business analyst to create a Program determination rules document and track the requirements in HP ALM.
• Tracked and traced all the requirements in the Rational Requisite Pro and HP ALM.
• Created test plans and test cases for UAT testing.
• Identify performance testing parameters like peak processing time, expected number of users, System response to failure with the interaction with developers to create a performance test plan.
• Created process flows and use case document to provide a detailed flow of events.

Environment: JIRA, HP ALM, Quality Center, MS-Office Word, Excel, PowerPoint , MS Visio.

Confidential

Business / Systems Analyst

Project Description: The major part of the project was to identify system/ functional requirements to support modification of the current system to perform member policy association, determine member has another Florida Blue policy from existing significant number in the database, and support the system to canvass members for other party liability information to ensure correct and timely claim payments. The major task includes interviewing the business, creating use cases / system requirement specification, participating in team walkthroughs of SDLC artifacts, and performing functions to ensure SDLC standards are met, including quality and timely system release solutions.

Responsibilities

• Capture detailed business, functional and technical requirements e.g. via JAR/JAD session through a systematic process to document system requirements for multiple projects.
• Worked with business/Technical partner to capture requirements in a standard format that can serve as the foundation for developing technical documentation.
• Used Rational Requisite Pro for tagging and tracing of system requirements with the respective business requirement specifications.
• Capture detail business requirements in a system use case with complete flow of events.
• Worked with developers and other IT staff to determine system components and functional flow of components and data between components.
• Create unit and system test plans, execute and verified test results and work directly with developers on uncovered issues.
• Review the test plans with Quality Assurance testers and verified acceptance testing at the system level.
• Created a data clean up matrix/spreadsheet to identify and record bad data in the system by opening a Defect ID to each identified issue.
• Entered risk and issues through the use of Project center and open Change requests for issues in business requirements while documenting system requirement.
• Used Quality Center to manage testing and defect life cycles, and map requirements to test cases.
• Used Quick Development Case and Quality Review tool QDQ to send document for sign offs.
• Experience using Service Manager to create SRTs.
• Reviewed and participated in defining test strategies, as well as coordinate user acceptance testing UAT efforts.

Environment: Rational Requisite Pro, Microsoft Visio, RUP, CMM, MS-Access, MS-Office Word, Excel, PowerPoint , MS Project, QDQ, HP ALM, Service Manager, Mainframe TSO .

Confidential

Senior Business Systems Analyst

Project Description: The project was to perform gap analysis and identify the changes proposed in HIPAA 5010 to upgrade the secured web portal to comply with the new standards mandated by the Health Insurance Portability and Accountability Act HIPAA while insuring ICD-9 to ICD-10 changes have been accommodated. The process consisted of gap analysis, compilation of results, impact assessment and designing new screens for secured web portal.

Responsibilities

• Incorporated and implemented all the HIPAA standards, Electronic Data Interchange EDI , transaction syntax like ANSI X12, ICD-9, ICD-10 coding.
• Used the Rational Unified Process RUP to build the different phases of Software development life cycle
• Created Project management plans for managing on-time delivery using MS Project along with writing test cases, unit and systems integration test plans in Win Runner and used Load Runner to check if application works fine with load.
• Conducted AS-IS and TO-BE analysis and assisted in developed process models and systems integration structure.
• Involved in the analysis of HIPAA compliance and EDI transaction sets and actively participated in the designing of the EDI transactions using the new HIPAA 5010 version also including the use of ICD-10 codes.
• Conducted and facilitated Joint Application Development JAD sessions to reduce time spent in moving information between stakeholders and team members.
• Wrote test cases and test plans for the related and assigned scripts according to the test strategies defined in the project and testing team guidelines in Quality center.
• Conducted the AS-IS and TO-BE analysis of the business process using GAP analysis.
• Tracked and maintained Stakeholder requested enhancements and changes using Requirement Traceability Matrix RTM .
• Identified critical areas of business risk and modified business processes to reduce risk by using the Risk-Management Process.
• Knowledge of the complete EDI format used in electronic documentation that was part of the knowledge transfer program to the vendors as per the requirements.
• Wrote SQL queries SQL Server database in TOAD for comparison between short-term and long-term fixed income strategies.
• Used Quality Center to manage testing and defect life cycles, and map requirements to test cases.
• Reviewed and participated in defining test strategies, as well as coordinate user acceptance testing UAT efforts.

Environment: Rational Rose, Microsoft Visio, Oracle, RUP, CMM, MS-Access, MS-Office Word, Excel, PowerPoint , MS Project, Lotus Notes.

Confidential

Senior Business Systems Analyst

Project Description: The project was to incorporate the changes proposed in HIPAA 5010 and upgrading the current system from HIPAA 4010 to HIPAA 5010 converting ICD-9 to ICD-10 so that the system is in accordance with the new standards mandated by Health Insurance Portability and Accountability Act HIPAA .

Responsibilities

• Conducted JAD sessions with Subject Matter Experts SME's .
• Incorporated Rational Unified Process RUP and analyzed User Business Requirement Document BRD , Technical Requirement Specification and Functional Requirement Specification FRS using Requisite Pro, Rational Rose and MS Visio.
• Performed Gap analysis for better understanding of transition from HIPAA 4010 to HIPAA 5010.
• Designed and developed Use Cases, Activity Diagrams and Sequence Diagrams using UML.
• Documented, organized and tracked the requirements using Rational Requisite Pro.
• Worked on changes for HIPAA Transaction and proposed changes to be made in the current system for an easy transition from version 4010 to 5010.
• Documented the detailed business as well as technical requirements to upgrade the current system to 5010 transactions.
• Got involved in designing future state processes for HIPAA 5010 transaction processing EDI's 837,835, 270, and 271.
• Analyzed HIPAA 5010 related to 835, 837, 270, 271, 276 and 277 transactions both inbound and outbound and performed gap analysis between the 4010 and 5010.
• Worked on ICD conversion from 9 to 10 with respect to the claims related to Medicare Part A, Part B, Part C, Part D .
• Worked with Source system Subject Matter Experts SMEs to ensure that the extracts are properly mapped. Used SQL for data mapping and querying.
• Tracked and maintained Stakeholder requested enhancements and changes using Requirement Traceability Matrix RTM .
• Integrated Requisite Pro with Rational Rose to provide all teams visibility and maintain tractability among requirements, use cases and change requests.
• Completed a review of existing documentation for orders, referrals and reports and compared it to the clinical details needed for ICD-10.
• Assisted in writing test case scenarios for unit testing, integration testing and compliance testing.
• Assist end users and IT staff in the use of data to satisfy informational and reporting requirements and implementing and using SQL and DBMS.

Environment: Rational Rose, Rational Requisite Pro, Clear Case, Clear Quest, UML, Rational Suite, MS Visio, MS Project, MS Office MS Word, MS Excel, MS PowerPoint , MS Access, XML

Confidential

Business Systems Analyst

Project Description: The project was to upgrade the system that currently uses HIPAA 4010 to comply with HIPAA 5010.Gap Analysis was performed and changes were identified in HIPAA 5010 so as to upgrade the Medicaid Management information System MMIS to comply with the new standards mandated by HIPAA.

Responsibilities:

• Responsible for the requirement-gathering phase and project plan.
• Responsible for requirements analysis, design and developing technical requirements.
• Responsible for the full HIPAA compliance lifecycle from gap analysis, mapping, implementation and testing for processing of Medicaid Claims.
• Responsible for gap analysis in changing old MMIS and Involved in testing new MMIS.
• Used HIPAA 4010 transactions to support the analysis of current business processes and work with management to improve and implement enterprise solutions to ensure compliance and got involved in designing future state processes for HIPAA 5010 transaction processing EDI's 837, 835, and 834.
• Analyzed HIPAA 5010 related to 837,835, 834. Transactions and performed gap analysis between the 4010 and 5010.
• Used RequisitePro for writing/analyzing project vision, goals, specifications and requirements.
• Conduced Joint Application Development JAD sessions and walk in interview with the business users to gather requirements.
• Created Use Cases diagram and Activity diagram to depict the interaction between the various actors and the system in Rational Rose for the Business Use Case and System Use Case.
• Conducted the FRS and URS reviews and walkthroughs with designers, developers and stakeholders. Also conducted feasibility and adaptability study.
• Developed non-functional requirements and documented them as Business Rules, Quality attributes and constraint documents.
• Interacted with database developers for formulating the ER diagrams and data flow diagrams.
• Organized regular JAD meetings with the system architects, developers, database developers, quality testers during the entire project to assure that the critical as well as the minute details of the project were discussed and issues were resolved beforehand.
• Worked with QA lead in validating Test Plan and Test Scenarios.
• Used HP Quality Center for tracking Defects and tracing requirement functionality performances.
• Executed test cases manually. Compared and analyzed actual with expected results and reported all deviations to the appropriate individual s for resolution.
• Assisted Business User during deployment in formulating User Acceptance Testing UAT for customized application and getting confirmation for product Release

Environment: UML, RUP, Rational Requisite Pro, Rational Rose, Rational Clear Quest, Excel, SQL, HP Quality Center

Confidential

Business Systems Analyst

Project Description: AARP is nonprofit, nonpartisan membership organization that helps people, 50 and over improves the quality of their lives. Worked on Claims processing module of the Group Approval Process. The claims processing module incorporated the Receiving and Verification of Claim Forms 837 Claims Enquiry and Response 276/277 , Adjudication, Healthcare Claim Remittance/Payment Advice 835 .

Responsibilities:

• Addressed the changes made to the Medicare program and created requirements mapping to that of the system requirements.
• Gathered and documented business requirements from SMEs, user groups and vendors via workshops, interviews and surveys.
• Prepared a comprehensive Functional Requirements Document and Supplementary Specification Document nonfunctional from the gathered requirements. All documentation was created using the AGILE methodology.
• Worked in Healthcare Claims Administration Healthcare Claims Processing 837/835 includes facility claims and professional claims.
• Worked on HIPAA Claims Validation and Verification Process Pre-Adjudication
• Facilitated and managed meeting sessions with committee of SME's from various business areas including Benefits Administration, Health Claims Group, HIPAA Administration, Health Policy and Program Evaluation Team and Data Management Group.
• Created Functional specifications for the 834 enrollment files with their changed benefits in the Medicare program.
• Gathered and documented requirements for Pharmacy benefit managers PBMs for health insurance carriers.
• Participated in entering, tracking system defects in Rational Clear quest.
• Submitted change requests and worked with change request records in Clear quest.
• Involved in Configuration Management, Requirement management and analysis.
• Provide technical and procedural support for User Acceptance Testing UAT .
• Involved in fetching and displaying data using SQL queries.

Environment: Rational Requisite Pro, Clear Case, MS Visio, MS Project, SQL, Windows, MS Office.