SUMMARY

• About 7 years’ experience in Healthcare Industry with strong operational knowledge of Health Insurance Portability and Accountability Act (HIPAA) with updated knowledge of recent code sets ICD - 10 and focus on understanding business logic, identifying implementation requirements and determining solutions to business processes based complex software projects, that includes system development component, business process improvement, strategic planning and policy development
• Excellent understanding of HIPAA standards (4010 and 5010), HIPAA code sets ICD-9, ICD 10 and HL7.
• Experience on National Plan and Provider Enumeration System (NPPES), Medicaid Management Information Systems (MMIS), managing National Provider Identification (NPI) and Electronic Health Record (EHR).
• Proficient understanding of broad range of health insurance products including Medicare ( A, B, C & D), Medicaid Health Insurance Policies, Personal Injury Protection (PIP) insurance, group healthcare plans and disability insurance with thorough understanding of CPT coding, UCR, FS, HCFA-1500 and CMS-1500 claim forms and reimbursement forms.
• Strong analytical, architectural and problem solving skills for design, development and testing business process IT- solutions.
• Strong command over conducting Enterprise Requirement Analysis including Requirements Planning and Management, Requirements Gathering and Communication, Solution Assessment, Risk Analysis, Business Impact Assessment, Testing and Validation of Projects.
• Proficient knowledge of Object Oriented Analysis and Design(OOAD) using Unified Modeling Language (UML),Rational Unified Process (RUP), Waterfall model, CMMI, Six Sigma (DMAIC).
• Extensive experience with Magic Draw, MS Project, MS Visio, Rational Rose, Rational ClearQuest, Rational Clear Case, Rational DOORS, Crystal Reports.
• Proficient in learning new tools and technology.
• Experienced in interacting with business users and executives to identify their needs, gathering requirements and authoring Business Requirement Documents (BRD), Use Case Diagrams, Activity Diagrams and Sequence Diagrams using UML modeling.
• Expertise in facilitating and conducting Joint Application Development (JAD), Rapid Application Development (RAD) and Joint Requirement Planning (JRP) sessions, interviews, workshops and requirement elicitation sessions with end-users, clients, stakeholders and development team.
• Experienced in performing ETL processes. Worked on projects involving Data warehousing using Informatica Power Center (Source Analyzer, Warehouse Designer, Mapping Designer & Transformation Developer, Workflow Manager, Workflow Monitor and Server Manager).
• Efficient in handling Change Requests by the client.
• Excellent understanding of Data Warehousing & RDBMS concepts.
• Experienced in developing QA Strategies: Test Cases, Test Scripts and Test Procedures and conducting User Acceptance Testing (UAT).
• Responsible and strong work ethics, fulfilling all duties and responsibilities and meeting deadlines.
• Good interpersonal and communication skills facilitating a great team member and a great liaison.

TECHNICAL SKILLS

Business Skills: Business Process Analysis & Design, Process Improvement and Implementation assessment, Requirement Gathering, Use Case Modeling, JAD/JRP Sessions, Gap Analysis, Impact Analysis.

Methodology: RUP, Agile, OOAD and Waterfall.

Standard and Codes: HIPAA 4010A1/5010, ICD-10, ICD-9, ANSI X12, HL7, CPT, CMS form.

Languages: C, C++, SQL, PL/SQL, HTML and XML.

Management Tools: Rational Rose, Requisite Pro, ClearQuest, ClearCase, MS Visio, Magic Draw

Testing Tools: HP Quality Center, TOAD, Win Runner, Load Runner.

Data Modeling Tools: Erwin, Informatica.

BI Tools: Cognos, Cognos Report Net, Series, SSRS & SSAS 2005.

Database: Oracle, DB2, MS SQL Server.

Web Server: Microsoft Internet Information Server (IIS), Sun One Sever

Operating System: UNIX, Windows, MS-DOS

Office Tools: MS Office (Package), MS Visio, MS Project, MS FrontPage.

PROFESSIONAL EXPERIENCE

Confidential, Bismarck, ND

Business Systems Analyst

Responsibilities:

• As a Business Analyst, I acted as a primary liaison between Business & the development team throughout all phases of SDLC.
• Assisted in data modeling, data mapping and produced the data definition documentation.
• Maintained documents as per Project Management Methodology (PMM).
• Engaged in different phases of SDLC of the project executing RUP methodology of iterative software development from Inception to Transition phase.
• Developed a Requirements Traceability Matrix recording the requirements through each stage of requirements gathering process.
• Extracted the business requirements from the stakeholders keeping in mind their need for the application and documenting them.
• Responsible for processing Medicaid claims and CHIP claims & checking Medicaid eligibility and verifying claim payment.
• Responsible for Extensively used MMIS for the claims processing and the information retrieval.
• Conducted one on one and group interviews to understand Business Requirement and subsequent documentation.
• Involved in gathering high level requirements.
• Involved in up-gradation of HIPAA X12 4010 transaction to HIPAA X12 5010 and ICD 9-CM (Clinical modification) to ICD-10-CM/PCS (Clinical modification/procedure coding system) simultaneously.
• Involved user interface design by providing detailed functional requirements.
• Gathered functional requirements for Medicaid, TANF, SNAP, CCAP, and LIHEAP.
• Extracted Business Rules from Medicaid and SNAP policy manuals.
• Used Business Requirements to write Functional Specification documents.
• Modeled AS IS and TO BE Business process models for Medicaid, TANF, SNAP, CCAP, and LIHEAP.
• Conducted JAD Sessions to develop an architectural solution to ensure that the application meets business requirements to resolve any open issues, and manage change requests.
• Design specifications and Test Case usages for the HIPAA 837i, 270/271, 276/277, 835, 824, 275 and others.
• Created Use Cases, Activity Diagrams, State Chart Diagrams, Sequence Diagrams, and Collaboration Diagrams for ACA thus defining the Data Process Model and Business Process Model using MS Visio and Business Process Model tools.
• Ensured that all artifacts are in compliance with corporate SDLC policies and CMS guidelines.
• Developed customized SQL reports and queries for management decision-making and operational management.
• Worked on documents for version controlling, to maintain up to date changes in the documents.
• Trained in Ralph and Kimball methodology for gathering requirements.
• Worked on gathering requirements for certain MMIS reports.
• Documented Bus Matrix for various reports.

Environment: RSA, MS Office Word/Excel/PowerPoint/Outlook, MS Project, MS Visio, Windows, XP/Win 7, SharePoint, Power Designer.

Confidential, Minneapolis, MN

Business Data Analyst

Responsibilities:

• Gathered requirements and assembled Project Initiation Plan including identified project goals and critical success factor from Business Cases, the Terms of Reference, the project tolerances and the Project plan.
• Identified stakeholders' requirements and validated them with implementation and Quality-of-service requirements.
• Developed a Requirements Traceability Matrix recording the requirements through each stage of requirements gathering process.
• Carried out Disaster Recovery Plan (DRP) to avoid any catastrophic transition implementations.
• Conducted Risk Analysis by developing Business Impact Analysis (BIA) report and updating it throughout the transition cycle to keep track of every change in the requirements and alteration in Business Requirement Document (BRD) and System Requirements Specifications (SRS).
• Collaborated with technical experts and business units to determine best possible reporting mechanisms for competitive analysis of the current system to the proposed New Claim Processing System.
• Worked as a liaison between the product development, technology and internal business units.
• Developed problem requirements and specifications and validated it with the EHR standard to develop a strategic plan for signing off by the project steering committee.
• Performed a bench-mark analysis between “as-is” and “to-be” process flows to realize higher levels of conformance with updated HIPAA and EHR versions..
• Involved in assessment of transition of standards from HIPAA 4010 to HIPAA 5010 and implementing ICD -10 codes to identify an efficient process flow for the transition.
• Following divide-&-conquer ideology decomposed the transition complex requirements into a series of simple tasks that suited ease of implementation onto a running system.
• Facilitate HIPAA integration and applied ANSI ASC X12 standards for 837 (P, I, D), 270/271, 276/277, 278, and 835 transactions.
• Used RequisitePro, to document the process flow and Use Cases for the EDI transaction 835, 837.
• Developed Change Request forms for alterations in Requirements and Design on the course of transition.
• Facilitated JAD sessions for Requirement Validation to gather requirements for the new HIS.
• Extensively analyzed the transition data cross walks, improved complicated process decomposition, for the source to target transformation.
• Involved in HIPAA 5010 gap analysis of ANSI X12 4010 as well as migration of ICD 9 to ICD 10.
• Analyzed EDI-X12 translation interface for validation of the data elements required for the new system.
• Generated periodic status report for the requirements team and PMO status reports for CMS.
• In agile environment of JAD sessions, regularly maintained the performance metrics of various team-units as well as maintained a requirements work plan.
• Formulated various test cases to not only validate the compliance of the new system with the Business Requirement Documents (BRD) and SRS, but also to ensure smooth transitioning onto the currently running system without affecting the day-to-day processes.
• Developed UAT test cases associated with the functional requirements.
• Participated in developing test plan, test scripts, and test scenarios and designed user documentation.

Environment: J2EE, UML, Rational RequisitePro, Rational ClearQuest, MS Office, Windows 2000, .NET, MS Visio, MS SharePoint, MS Project, MS Visio, SQL, Oracle, HTML.

Confidential, Oakland, CA

Business Analyst

Responsibilities:

• Facilitated and documented the business process for clinical procedures through a series of interviews with stakeholder and medical representatives.
• Conducted group sessions to gather and document the functional and non-functional requirements with the SMEs and business units.
• Generated Requirement Specification Document and validated it with EMR standards HL7.
• Developed use-cases to formulate Project Initiation Plan.
• Compiled the Vision Document and composed detailed Use Case Specification Documents in Rational Requisite Pro.
• Gap Analysis: Analyzed the client’s applications programs to determine the impact of the HIPAA rule on EDI Transaction Set and Code List implementation and defined the changes to bring the affected systems into HIPAA compliance
• Carried out UML based Use-Case analysis on Magic Draw to identify the basic entities of the application.
• Designed business transactions and procedures and documented the requirement enhancements using a Requirement Traceability Matrix in Rational requisite Pro through test cases.
• Ensured the accuracy and consistency of the data during the data loading process.
• With the help of various business model diagrams, such as State-Activity Diagrams, Process Flow Diagrams and Class Diagrams developed in MS Visio, decomposed the complex business logic into small and simple tasks, easy to understand and implement.
• Created use-case narratives and process walk-through narratives in association with the business model diagrams to avoid any functional discrepancy.
• Represented the business units in the daily scrum meetings and provided the needed insight on the validation of the current progress.
• Carried out Cost-benefit analysis and Return-on-Investment analysis and generated periodic status reports send to Project lead.
• Actively participated in unit testing, system testing and regression testing. Also provided test cases for User Acceptance Testing.
• Conducted Root-cause Analysis for any defects and proposed improved design and use cases to avoid similar errors in next phase.

Environment: Windows, MS Office (MS Word, MS Excel, MS PowerPoint, MS Visio), MS Access, MS Project, RationalRose, Community Manager, SQL, ClearCase, Agile.

Confidential, Springfield, IL

Business Analyst

Responsibilities:

• Conducted formal interviews and JAD sessions with business users and SMEs to understand and formulate the artifacts of the security requirements needed to be incorporated in the current running system.
• Using formal questionnaires documented and prioritized the requirements and changes needed in the current IEC system.
• Documented various key elements of HIPAA compliance and made sure that they are understood by the development teams. Test cases written for the project were HIPAA complaint.
• Understood the Business Logic, User Requirements& developed Design & User Interface Specifications.
• Involved in Joint Session meetings with Technical lead to develop a maintenance process plan and documented a dynamic Requirements Traceability Matrix.
• Validated the compliance of new Requirements with the Security Rule in HIPAA, documented many Change Request and Enhancement Request Reports using ClearCase for approval from Project lead.
• With consent of business units and technical leads, drafted the new Business Requirement Document and System Requirement Specification for the Maintenance process.
• Generated simplified Business and System use cases to ensure high degree of compliance with Business Requirement Document.
• Worked on HIPAA Transactions 270, 271, 276, 277, 834, 835 and 837.
• Maintained a continuous follow-up with the technical leads and stakeholder, generating periodic brief reports and validating the Requirement Documentation.
• Carried out a dynamic Gap analysis to determine the proficiency of the new process plan in comparison to the old one, as well as conformance to the requirements.
• Implemented an incremental maintenance process plan to enable user acceptance testing on the go.
• Actively involved in generating test cases for each phase deliverable and documented the results in Test Reports.
• Used these test reports for performing Root Cause Analysis in case of high priority fault occurrence.
• Conducted Postmortem after every phase and documented the Postmortem Reports for keeping track of Do's and Don'ts.
• Provide support during development, resolve issues related to configuration management during system test/QA phase.
• Primarily responsible in managing deployment of each phase deliverable and successful fusion into the current running system.

Environment: Windows, SQL Server, ClearQuest, ClearCase, Cognos, Informatica, MS Office, MS Visio, MS Project, RequisitePro.