Professional Summary:

• 8 years industry experience working as a Business Analyst in the Healthcare and Pharmaceutical domains with solid understanding of Business Requirements gathering and business flow.
• Extensive knowledge of SDLC methodologies and exposure to Agile, RUP, and Waterfall.
• Extensive knowledge using UML diagrams Use Case, Activity, Sequence using MS Visio and Rational Rose
• Well versed in Health Insurance Portability Accountability Act HIPAA standards, Electronic Data Interchange EDI , HL7 and ICD-9 to ICD-10 coding.
• Extensive knowledge on the various types of health insurance programs such as: Medicaid, Medicare Part A, B, C and D , PPO, HMO, and POS.
• In-depth in conducting GAP analysis, SWOT analysis, Cost Benefit analysis and ROI Analysis.
• Extensive experience with claim transactions such as 834 Benefits Enrollment , 835 Billing/ pay/ Remittance , 837 Submit medical claims
• Strong experience analyzing current claims and authorization application
• Experience working with developers and QA team gathering and facilitating requirements while analyzing the current application.
• Proficient in Requirements Analysis working with techniques such as User Stories, Use Cases, Prototypes, Interviews and Storyboards with a strong ability to facilitate JAD sessions.
• Well versed in working with Data Warehouse, Data Mining, and ETL tools for loading high volumes of data and a smooth structural flow of the data.
• Proficient in developing BRD, FRD, and SRS with detailed knowledge of functional and nonfunctional requirements.
• Extensive experience in organizing and facilitating interviews and workshop, especially JAD sessions, with subject matter experts, users and business stakeholders.
• Strong knowledge in Data Mapping, Data Modeling, Star/Snowflake Schemas, OLTP/OLAP, and designing E-R Models Worked with Erwin for Conceptual, Logical, and Physical designs.
• Well versed in creation of Test Plan and Test Cases from the Requirements document.
• Documentation of Test Plans, Test Cases, Test Scripts, Test Procedures based on the Design Document and User Requirement Document for the Black Box, Functional, Usability and User Acceptance Testing UAT .
• Ability to manage workload with in time sensitive deadlines in addition to handling multiple projects or tasks under minimal supervision.
• Excellent verbal/written communication skills and strong analytical abilities working independently and as a team player.

Technical Skills

SDLC, Agile, Scrum, RUP, Waterfall, XP, Rational Rose, UML, OOAD Object-Oriented Analysis and Design Erwin Data Modeler, JAVA, Microsoft Office Suites Word, PowerPoint Access, Excel Macros and Pivot tables, Outlook, Project, Visio, Publisher SharePoint 2007 , Mercury Quality Center, Microsoft SQL Server, T-SQL Business Objects, IBM Cognos, Oracle PL/SQL, IBM, HTML, XML, Mainframes, Rally, Photoshop, Illustrator, Acrobat, Dreamweaver , HP Quality Center, Informatica.

Professional Experience:

Confidential

Role: Senior Business Analyst

CSR Project

The purpose of the Controlled Substance Regulations CSR project was to ensure that CVS stores are operating within the regulations by implementing a real time enhancements to the RxConnect application that supported changes to help solve Regulatory/Compliance Audits, Lack of state specific licensure and prescriptive authority validations, Inefficient messaging to facilitate exception handling and problem resolution and Out of sync prescriber information compromising data quality.The goal of the Enhanced Pharmacy Credentials project was to create a Central Repository that contains employee specific attributes on RPh State License, Technician State License, Intern State License, RPh Immunizing license information and verify their validity against Workflow Checks at Data Entry, Production and Verification to ensure that employees are up to date with their HR compliance and Drug specific trainings by instituting Hard and Soft stops and sending near real time notification to supervisors about these deficiencies.Waterfall was used for the 2 projects

Responsibilities:

• Acted as a liaison between the Business and Technical teams to deliver requirements Deliverables
• Involved in all four phases of the requirements development including Elicitation,Analysis, Specification and Quality Validation.
• Conducted Gap analysis and impact Analysis to identify employees channel usage trends and interactions focusing on best performance practices
• Facilitated Joint Application Development JAD sessions with SMEs from Business, CVS Stores, Pharmacists, Pharm Techs, Pharmacy Board/Regulatory experts
• Developed Screen Mock-ups/Prototypes to provide demonstration to the Business teams.
• Developed BRD for Functional and Non-Functional Specifications
• Developed New Used Cases and updated existing ones
• Worked with development team during requirements session to understand system enhancement.
• Liaised with HMS Prescriber License Vendor to work on the new Prescriber Remediation Process
• Developed BI and DI reports/metrics in Data Warehouse to capture incidents of violation
• And auditable events
• Supported Design and Development activities, by providing walkthroughs and feedback.
• Ensured that the clients adhere to the change Management Notification CMN process.
• Responsible for managing the Change Request Log and RTM.
• Extensively involved in writing and executing Test Cases and User Acceptance Testing UAT .
• Assisted in developing end user training material sessions.

Tools and Technologies:

Microsoft Office Suites Word, PowerPoint, Access, Excel Macros and Pivot tables, Outlook, Project, Visio, Publisher SharePoint 2007 , Microsoft Visio, MicroStrategy,

Role: Sr. Business Analyst /Scrum Master

The Providence Center is an outpatient mental health and substance abuse agency. The goal of the project was to produce a EHR system that allowed clinical documentation interface with scheduling and service to simultaneously produce MEDICAID billing, thereby improving efficiency and cutting down on human and material resources involved in the old system. The system was also used to manage clinical documentation, including physician orders, progress notes, medication profiles, and psychosocial assessment, medical and psychiatric admission. In addition, the project involved designing a Data Hub for reporting purposes. Agile Scrum was used for this project.The goal was to produce an application that will link the State database on narcotics prescription to providers in order to reduce the alarming prescription drug abuse, dependence and addiction problems in the State. The System provided features that restricted/constrained the ability of individuals who seek narcotics prescription from Doctors across the spectrum due to the lapse in process.Agile Scrum was used for these projects

Responsibilities:

• As the Scrum Master, facilitated and conducted SPSE, Sprint Review, Daily Scrum and the Sprint Retrospective Meetings ensuring that the deliverables and milestones were met and the Team stayed on task by monitoring the Burn Down charts.
• Validated the business process flow for the clinical workflow.
• Facilitated Joint Application Development JAD sessions with all IT group members for communicating managing expectations and to discuss various means for integrations with current system using an adoption through execution strategy.
• Conducted Scrum meetings and ensured that project deliverables and milestones were met
• Conducted Gap Analysis on the AS-IS and TO-BE business processes and technology and identified potential pitfalls, risks, and issues.
• Identified all necessary Business and System Use Cases from requirements, created UML diagrams including Use Case Diagrams, Activity Diagrams, and Sequence diagrams using Microsoft Visio.
• Understood the Business Logic, User Requirements and test-objectives to develop Test plans, Test cases, Use Case Scenarios.
• Responsible for checking the benefit set and adjudication of claims.
• Created High Level Test Scenarios, Test Cases and Test Scripts for Data Hub requirements as described in RSD Requirement Specification Documents and DSD Design Specification Documents as well as HIPAA.
• Developed Test Scripts using HP ALM and coordinated with developers to quickly resolve the defects associated with them.
• Analyzed and evaluated User Interface Designs, Technical Design Documents and Quality Assurance to test the performance of the application from various dimensions.
• Documented the UAT Plan for the project and worked with the UAT Team to ensure every acceptance criteria for the requirements has been included in the UAT test plan.
• Verified and validated all the build or release related issues and resolve them through discussion with business analysts with the user's approval.

Tools Technologies:

Agile Scrum, MS Project, MS Office, UML, MS-Visio, Visual SourceSafe, VSTF, Rally, SQL, HP ALM

Role: Sr. Business Analyst

The scope was to produce a financial system that established a link between mental health organizations and Social Security Administration SSA to dispense and utilize Social security benefits mainly SSI and SSDI, current and retroactive for beneficiaries. The System eliminated manual Accountability Report, thereby improving on processing times and effective mandatory monitoring of Representative Payee process while enforcing HIPAA and IRS regulations.

Responsibilities:

• Agile methodology was used throughout the project, with daily status report, queries and updates by the Scrum master.
• Conducted JAD sessions, meetings, teleconferences to gather business requirements from various stakeholders and SMEs.
• Extracted, transformed and loaded data from SSA, State Dept. Of Health and mental agencies databases to be used for analysis of SSI and SSDI benefits for the purpose of predicting average monthly balance in a data warehouse.
• Involved in Financial Data Gathering, Data Analysis and Management for SSI beneficiaries and their families.
• Performed GAP analysis by the performing the system analysis between the scheduling systems and documented the gap items.
• Prepared the Business Requirement Specifications, System Requirement Specification, Interface documents, Architecture Specification and documented environment setup for various environments Development, QA, UAT, Implementation, Testing and Production .
• Developed Use Cases for unit testing, prepared spreadsheet for testing criteria, including regression, positive and negative testing, process flow testing and screenshot for test results to complete expected and actual results.
• Prepared various diagrams and Swim Lane diagrams using MS Visio and INKSCAPE tools.
• Prepared documents for the wireframe and prepared a data dictionary for the same.
• Prepared various SOA for diagrams for various systems in Sandata.
• Prepared architecture document for system.
• Documented environment setup for system.
• Managed testing for various functionalities using JIRA and Quality Center tools.

Tools Technologies:

Agile Scrum, MS Office, TFS Team Foundation Server , SharePoint, QuickView, Visual Studio, MS Visio, Case Complete, INKSCAPE, JIRA, Tracker, MS Project, Linux RHEL , Rally Scope of the project was to enhance existing Web-services for Claim Transaction like EDI 270-271 for Claims Eligibility Inquiry, EDI 276-277 for Claims Status Check, EDI 837 for Claim Submission to comply with the HIPAA 5010 standards, Wherein integrated all HIPAA 5010 rules with ICD10. RUP was used for this project.

Responsibilities:

• Closely interacted with business users for requirement gathering
• Developed understanding of various transactions involved in transition from HIPAA 4010 to HIPAA 5010 like Eligibility, Benefit, Claim submission transactions.
• Initiated discussions with Clients Business/IT team for Functional query resolution.
• Analyzed and validated requirement for HIPAA 5010 and gathered requirement for ICD10.
• Analyzed and documented differences between the AS-IS and TO-BE processes.
• Worked on EDI 270/271 Claim Eligibility Inquiry /276/277 Claim Status Check /837 Claim Submission /835 Claim Remittance .
• Worked on different EDI 270/271/ 835/837/834 and ICD 10 Procedural and Diagnosis codes.
• Developed mapping documents for ICD 9 to ICD 10 application.
• Analyzed all ICD10 codes and validated the outcomes.
• Analyzed Business requirement document, developed functional requirement document FRD and got it approved by the client.
• Created help documentation in accordance with the client's documentation guidelines.
• Facilitated sessions on Group Insurance, Eligibility, Benefit and Claims transactions in HIPAA.
• Created and maintained Issues Log and ensured timely resolution of all items.
• Supported User Acceptance testing UAT and collaborated with the QA team to develop test plans, test scenarios, test cases and test data to be used in testing, based on business requirements and application knowledge.
• Reviewed Integration Test Plan for integration between modules.
• Interacted with the developers to report and correct bugs.
• Efficiently interacted with designers and software developers to understand application functionality and navigational flow and keep them updated about business user's specifications.
• Performed UAT, Regression testing on EDI 835 and 837 X12 format.
• Managed all the requirements effectively and made them available to all team members and presented the testing defects and resolution in the project review meetings.

Tools Technologies:

RUP, MS Project, MS Office, MS Visio, MS Excel, SQL, UML, QTP.

Role: Business Analyst

The project goal was to provide onsite ad remote support in the implementation of Medical Billing Application in Physician office practice. It involved high-level coordination of all implementation components including project management, pre-implementation, system build, and post implementation.

Responsibilities:

• Conducted JAD sessions with physicians and other health care professionals to elicit requirements for patient billing and accounting
• Created system modules and flows for entering patient profile data, assigning ICD/CPT codes, entering insurance information, and tracking billing payments.
• Created process workflows and designed end-user screens based on use cases.
• Wrote BRD and system Level Test Plan. Also executed test cases and scenarios.
• Created System level test plan and executed test cases to test web-based application designed as a business to business platform to source telecom equipment manufacturers and service providers. Front-end was developed using PHP scripting. Back-end was SQL Server.
• Performed a mix of manual and automated testing QTP . Testing included, regression testing, white box testing, and black box testing.
• Tracked defects using Test Director.
• Conducted weekly status meetings by relaying test results to off-shore development team. Coordinated software release schedule and executed relevant test cases.
• Maintain issue log to track issues based on priority critical, high, medium, low and impact.