SUMMARY

• Business Analysis Professional with more than 7 years of experience in the areas of Business Analysis, Project Management, Data Warehousing, Business Process Modeling, Business Process Improvement, Business Process Reengineering, Design, Development, & Testing.
• Strong experience in working in SDLC for Various methodologies included RUP, Agile,Scrum and other internal methodologies.
• Strong experience in working as liaison between Marketing, Customer Care, Finance, IT development, Clinical Trial Management Systems, Regulatory Submissions, Accounting, Claims, Billing and Field Sales Professionals.
• Strong experience with SQL Server Reporting Strong experience with developing Use Cases, Test Cases and Traceability Matrix.
• Expert in translating business requirements & user expectations into detailed Functional Requirements Specifications by employing Unified Modeling Language (UML).
• Expert in Developing Software Requirements Specifications (SRS)with detailed Business Rulesfrom Business Requirements Document.
• 5+ years of diverse experience in Insurance Claims, Healthcare and Pharmacy organization as a Business Analyst including payer/agent operations and complete understanding of Business Process Flows and Case Tools.
• Strong experience of working with Medicare and Medicaid insurance data, Medicare parts A, B, C &D, and Insurance Claims.
• Excellent in creating Use Cases, Sequence Diagrams, Collaboration diagrams, Activity Diagrams, and Class Diagrams.
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
• Experience in creating and maintaining the Requirements Traceability Matrix (RTM).
• Design specifications and Test Case usages for the HIPAA 837i, 270/271, 276/277, 835, 824, 275 and others.
• Followed the UML based methods using MS Visio to create: Use Cases, ad - hoc reports Activity Diagrams/State Chart Diagrams, Sequence Diagrams, Collaboration Diagrams.
• Familiar with CPT, ICD-9 or ICD-10 coding with overall ability to analyze complex issues, understand findings and present to management.
• Lead requirements analysis and verification; ensuring that requirement statements are complete, consistent, concise, comprehensible, traceable, feasible, unambiguous, and verifiable and that they conform to standards
• Profound knowledge of FDA regulation like 21CFR part 11 (Electronic record and electronic signature, Check corrupted data, human readable representation, maintenance of electronic records, restricted access, Significance of Validation and consequences of falsification).

TECHNICAL SKILLS

Business Modeling Tools: Rational Rose, Microsoft Visio, MS Project, UML

SDLC Methodology: Agile, Scrum, Waterfall, RUP, RAD, JAD sessions

Languages: C++, Visual Basic, SQL

Operating Systems: Windows 98/XP, Windows NT 4.0, Windows 2000 and Linux

Databases: Oracle, MySQL and MS Access

UML: Activity Diagrams, Use Cases, Class diagrams, Object Oriented, Analysis and Design RDBMS.

Testing: User Accepting Testing, Black Box testing, Regression Testing.

PROFESSIONAL EXPERIENCE

Business Analyst

Confidential, Maine

Responsibilities:

• Research and develop reports and analysis for senior management pertaining to areas such as finance, membership, utilization, claims and authorizations, contracting and profitability; communicate analysis and supporting data in a manner that is meaningful to the recipient.
• Work with internal, external and enterprise clients as needed to provide analytic support, develop and document new standard reports, develop innovative strategic planning models.
• Analyze data to provide recommendations and solutions based on advanced analytics methodology and an intimate understanding of the data and how it applies to healthcare initiatives; utilizing MS Excel, SQL and SRSS
• Assist with regular refresh and QA of Med Insight data. Become knowledgeable in the use of Med Insight
• Demonstrate proficiency in using Microsoft Excel, Access and SQL to respond to ad hoc needs and to develop production processes requiring minimal manual intervention.
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
• Implemented RUP, which included requirements, specifications, design, and analysis.
• Created and maintained the Requirements Traceability Matrix (RTM).

Environment: MS Visio, MS Project, MS Excel, Rational Rose, HTML, SQL Server Reporting Services 2005, Visual Basic, Windows, Microsoft .net, MS Access, Erwin, MS Office.

Business Analyst

Confidential, Houston, TX

Responsibilities:

• Act as a liaison between the business team and technical team, was instrumental in resolving conflicts between them
• Involved in documentation and communicating with third party vendors to be incorporated with GCS EMR product
• Performing Gap analysis for both previous and current Business Requirement Document and designing business rules and requirements for GCS EMR on HIPAA compliancy basis.
• Involved with the making screen design and all user interface issues by providing detailed functional requirements.
• Creating Business Flow Diagrams, Dataflow diagrams, UML Activity diagrams and USE cases diagrams using MS Visio.
• Coordinated between test team, development and business team in clarifying the functionality issues and requirement specification.
• Prepared use case models based on Business Requirement documentation gathered through interaction with users and the stakeholders.
• Implemented RUP, which included requirements, specifications, design, and analysis.
• Created and maintained the Requirements Traceability Matrix (RTM).
• Worked with the Project Manager on various Project Management activities like keeping track of Project Status, Deadlines, Environment Request, and Compliance Issues.
• Involved in project status meetings, QA review meeting, and System Test meeting.

Environment: Rational Requisite Pro, MS Visio, Java, Windows NT.

Business Analyst

Confidential, Houston, TX

Responsibilities:

• Documented workflows and results of business analysis and obtain sign-off from client on specifications.
• Worked at different stages of the Software Development Life Cycle (SDLC) with business users, developers, and stakeholders.
• Performed Gap Analysis by identifying existing technologies, documenting the enhancements to meet the end-state requirements.
• Responsible for the Design and execution of test plans to ensure that business requirements and functional specifications are tested and fulfilled.
• Complete Understanding of the long-term business objectives and suggest technical strategies to meet those objectives.
• Responsible for the back-end testing of the application (Used Toad and Access).
• Managed multiple aspects of product design and end user analysis objectives for Work Smart MD Java based medical practice management &HIPPA compliance applications.
• Design specifications and Test Case usages for the HIPAA 837i, 270/271, 276/277, 835, 824, 275 and others.
• Used HIPPAregulations to prevent the changes made to the insured rates.
• Analyzed Test Scripts to check if it has covered the functionalities, which need to be in compliance with rules set by FDA.
• Interacted with clients to gather all requirements to formulate business specifications and translate those into application functionality, decide when to advocate and when to compromise to arrive at a mutually acceptable solution.

Environment: Java, Microsoft Office Suite, MS Visio, MS Project, UML, SQL Server, Windows NT/2000

Business Analyst

Confidential, Houston, TX

Responsibilities:

• Performed Market analysis and Market strategic planning for the product
• Arranged JAD sessions with product management team and sales team to drive out detailed business requirements for product promotion
• Implemented the RUP methodology to help analyze the problem, understand user needs, and manage requirements.
• Exceptional documentation skills for writing use cases and functional requirement documents as well as for creating Use Case diagrams, Activity diagrams, Sequence diagrams, State diagrams based on UML Methodology and business process flow diagrams using MS Visio.
• Defined test cases, creating test scripts, analyzing bugs, interacting with QA teams in fixing errors and User Acceptance Testing (UAT).
• Worked on Test Cases and Test Plans using Different Testing Methodology like Functional, Regression, Integration, and User Acceptance testing (UAT).
• Performing Gap analysis for both previous and current Business Requirement Document and designing business rules and requirements for GCS EMR on HIPAA compliancy basis.
• Worked at different stages of the Software Development Life Cycle (SDLC) with business users, developers, and stakeholders
• Creating Business Flow Diagrams, Dataflow diagrams, UML Activity diagrams and USE cases diagrams using MS Visio.

Environment: Rational Requisite Pro, MS Visio, Java, Windows NT.

Business Analyst

Confidential

Responsibilities:

• Participated in Business Modeling by understanding the needs of the business, and also documenting Business Use cases as well as System Use cases.
• Worked closely with the deployment team for roll out the project - external releases, packaging, distributing, installing, user assistance, beta testing, migration of software & data.
• Created class diagrams, use case diagrams and sequence diagrams to view the system from different perspectives.
• Responsible for the creation of reports/cubes using SQL Server 2005 Reporting Services and Analysis Services
• Created class diagrams, use case diagrams and sequence diagrams to view the system from different perspectives.
• Followed the UML based methods using MS Visio to create: Use Cases, ad-hoc reports Activity Diagrams/State Chart Diagrams, Sequence Diagrams, Collaboration Diagrams.
• Lead and actively participate in the development of written, detailed business requirements, Interviewed Clients and defined the Functional and non-Functional requirements.
• Identified the Pain points, process flaws and work around in the existing process and provided solutions.
• Performed requirements elicitation and systems and business analysis to implement a database.
• Performed Unit testing of code as required by test plan and Produce high quality documentation

Environment: Java, Rational Unified Process, UML, UNIX, Visio, Rational Rose, and MS Project.