Professional Summary:

• 8 years of experience as a Business Analyst with expertise in healthcare, Insurance and Banking industry
• Knowledge of EDI, Member portal, Provider portal and System documentation.
• In depth knowledge of HIPAA 4010 5010 , ICD-10 codes, HL7 and Medicare business areas.
• Sound understanding of the SOX, IRC and Treasury Tax Regulations
• Expertise in requirements gathering by conducting interviews with end users
• Comprehensive knowledge of Software Development Life Cycle SDLC including Requirements, Analysis/Design, Development, and Testing
• Proficiency in Agile Scrum methodology of SDLC. Acted as Agile Coach in the Latest Project ensuring the implementation of Scrum smoothly in the Project.
• Experience in tracking and managing requirements using Rational Requisite Pro.
• Solid Experience in Collection, Analysis, Documentation of User Requirements, as well as Organizing interviews, User meetings, Workshops and JAD sessions.
• Proficient in creating UML Diagrams including Use Cases Diagrams, Activity Diagrams, Sequence Diagrams using Rational Rose and MS Visio.
• Hands on experience in mapping and validation of different EDI transaction File formats like 837 I, P, D 835
• Adept at creating and transforming business requirements into functional requirements and designing business models using UML diagrams- Use Case Sequence and Activity Diagrams Data-Flow Diagrams Data Modeling.
• Good conceptual understanding of Data Warehousing. Proven experience in complete project life cycle.
• Experience in defining Test Cases, creating Test Scripts, analyzing bugs, interacting with QA / dev teams in fixing errors and User Acceptance Testing UAT .

TECHNICAL SKILLS:

PROFESSIONAL EXPERIENCE:

REQUIREMENTS ANALYST

ENTERPRISE REPORTING

• Responsible for Data mapping of the reports as the client moved all its data from one database to another. Regulatory Repository to SQL database
• Responsible for Reverse engineering the requirement documents to ensure consistency with the existing standards of the project.
• Analyzed and identified gaps in the existing system with the help of comparing and contrasting documented business requirements, and worked on creating a design for a new revised improved system.
• Analyzed Business Requirements and segregated them into high and low level Use Cases and Activity Diagrams using MS Visio.
• Participated in JAD sessions / conducted interviews for analyzing business requirements and reviewing them with business and technical teams
• Confidential is one of the largest health benefits companies in the United States. Through its affiliated health plans, Anthem companies deliver a number of leading health benefit solutions through a broad portfolio of integrated health care plans and related services, along with a wide range of specialty products such as life and disability insurance benefits, dental, vision, behavioral health benefit services, as well as long term care insurance and flexible spending accounts.
• Worked with the core team to gather business requirements from multiple stakeholders, operations and management groups - and reconciled conflicts by conducting Joint Application Development JAD sessions based on the project scope.
• Created activity diagrams and sequence diagrams using MS Visio to communicate the system activity flow to the Dev team and QA team.
• Conduct test files review meeting with the business owners post peer review by the business lead.
• Coordinate with Development Team, Testing Team and Business for the project/SR to design the report template as per the state requirements.
• Developed UAT strategy, UAT Plan and facilitated UAT.
• Create CNR to ensure the report is ready for production.
• Follow up with business owners post go-live.

Confidential

Sr. Business Analyst

Confidential is one of the world's most globally coordinated tax practices, with network of 29,000 professionals in more than 140 countries dedicated to setting the standard for exceptional client service. The purpose of the project is developing a new web-based system where existing clients can order services, input the necessary information and receive finished work products. The financial and tax experts are enthusiastic about the service particularly because they spend 20-25 of their time working with clients to complete the current standardized but somewhat complex paper-based forms and performing error checking.

Responsibilities:

• Interacted closely with the Business users along with the administration and management to gather business requirements and analyze the functionalities to be incorporated into the system
• Participated in JAD sessions / conducted interviews for analyzing business requirements and reviewing them with business and technical teams
• Conducted Demos and walkthroughs for Confirming Business requirements for the graphical User Interface built with C Sharp.
• Designed User Interface Documents using Snag IT and MS Visio.
• Developed EPIC's from the Themes and Documented the Product Backlog for the release.
• Presented and Detailed Product Backlog Items to the Scrum Team in the Sprint Planning Sessions and assisted them in arriving at the Story Points for the User Stories.
• Reviewed User Stories and Acceptance Criteria with the team
• Assisted the Scrum Master in Creating and Managing the Release Planning Documents in the VersionOne and Share Point Repository.
• Assisted the Technical teams in deriving the Tech Design Tasks and reviewed the tech designs made for the Sprint.
• Assisted Scrum master in Developing the Task Sheet and Burn down Charts.
• Facilitated Demos of the software output of each Sprint and assisted Business in making Decisions on the release during the Sprint Review Meetings.
• Conducted requirements Churns between Sprints to update the product backlog.
• Conducted Analytics and Assessments to derive the Team Velocity based on the various Sprint Outputs.
• Attended demo sessions to understand existing system functionalities
• Arranged interviews with all the stakeholders to review and understand the gathered business requirements
• Developed UAT strategy, UAT Plan and facilitated UAT
• Verified and validated all build or release related issues and resolved them through discussion with business analysts with users' approval

Confidential

Business Analyst

• The online portal at Emblem Health enabled members, providers, producers and employers to sign up for an account and have easy access to all their medical information and facilitated them to make swift online payments. The portal also serviced to the Medicare and Medicaid users.
• The web application needed an upgrade as the current system identified vulnerabilities and errors in the security system and called for being HIPAA compliant, protecting patient privacy. The new system required better efficiency and improved ease-of-use features in order to save time, effort and expense.

Responsibilities:

• Involved with the project from its inception phase to transition and production rollout phase.
• Project was implemented using the Agile SCRUM Methodology to produce artifacts in the different phases of the Software Development Life Cycle SDLC .
• Involved in daily scrum meeting for daily status updates of the project and the issues.
• Analyzed and identified gaps in the existing system with the help of comparing and contrasting documented business requirements, and worked on creating a design for a new revised improved system.
• Facilitate JAD sessions and meetings with end users, Stakeholders, SME's, and project manager to gather requirements.
• Installation, configuration, administration, and maintenance of applications MS-SQL, VISIO, SharePoint, Visual Studio
• Prepared necessary business use cases after analyzing the gathered requirements, and created UML diagrams including process models, use case diagrams, activity diagrams, and sequence diagrams using Microsoft Visio.
• Created EPICs document and updated the Product Backlog with the EPICs.
• Used Rational Requisite Pro for User Story management and functioning on new project requests.
• Assisted Dev teams in deriving the Story points for the User Stories and Task identification.
• Conducted Data Mapping between the source and target system for ICD-9 to ICD 10 upgrades.
• Development of project work plans throughout SDLC while adhering to extensive methodology requirements set by HIPAA.
• Closely interacted with technical team and development team to ensure they understood the User Stories and navigational flow on the GUI.
• Created User Interface Document with Screen Descriptions and Portal Flow Diagram for the Online Portal.
• Assisted Scrum QA in designing test plans for task based Sprint testing.
• Involved in UAT and Black Box Testing and prepared user acceptance test cases.
• Interacted extensively with the end users to successfully and swiftly identify and resolve problems, and integrate system enhancements.
• Conducted Impact Analysis to determine the systems and areas that would be affected due to changes made on our project.
• Reviewed the build demonstrations for each Sprint to make sure the business requirements are implemented appropriately in the software.

Confidential

Business Analyst DWH BI

The Investment Management Information System IMIS , an Oracle-based Data warehouse system with a front-end reporting tool BusinessObjects BO for investment reconciliation, reporting and analysis of a number of different assets mortgages, real estate, agriculture, policy loans, fixed maturities, etc. . The main goal of this project is to consolidate all assets into a single system for accounting and reporting which is easy to load and reconcile, contains all asset detail at the same level, and will serve as the source for accurate and flexible reporting for all users within the Investment Accounting Group.

Responsibilities:

• Worked with the core team to gather business requirements from multiple stakeholders, accounting, operations and management groups - and reconciled conflicts by conducting Joint Application Development JAD sessions based on the project scope.
• Analyzed Business Requirements and segregated them into high and low level Use Cases and Activity Diagrams using MS Visio.
• Performed GAP analysis involving the current state and proposed state.
• Worked closely with other BAs and ETL Leads/Managers and was responsible to perform detailed data requirements analysis and create design specifications and operational documentation.
• Provided the ETL team with the Data mapping document and assisted them to create the mappings.
• Worked closely with the architects, database administrators and technical team during Data Mapping and Data Integration
• Involved with Analysis of reference data from Accounting Systems and Investment Accounting Groups.
• Analyzed and presented the Business with information on data anomalies, issues, input errors, field value ranges, data patterns, referential integrity gaps and the level of record incompleteness that is in the source systems.
• Organized meetings with the SMEs and Data Owners to walk through the findings and determine the cleansing process.
• Participated in various sessions with Business to understand the business rules and to come up with naming conventions to standardize the data.
• Played a key role in the user acceptance testing UAT , and implementation of system.
• Extensively used SQL scripts/queries for data verification and Validation at the backend.
• Project 2: Data Migration
• The need was identified to move reference data from file system into the data base by means of ETL process in order to provide better maintainability and control of the process for reference data from Accounting Systems and Investment Accounting Groups.

Responsibilities:

• Authored Requirements documentation BRD, FRD workflow design and analysis.
• Provided TO-BE process design, Gap analyses.
• Provided ETL process design and requirements, Data Mapping and BI reporting requirements.
• Provided DTD Document Type Definition for XML files to be used in the ETL process.
• Participated in Change Management Board meetings to ensure deliverability of functional requirements change and to assign priority to approved changes.

Confidential

Business Analyst

As a part of the project I worked on Claims processing module to help expedite and improve the accuracy of processing claims on a CMS 1500 claim form. Claim module can process professional and institutional claims CMS-1500 UB-04 for many practice types including physicians, surgery centers, therapy practices, chiropractors, podiatrists and DME providers. This module requires our Practice Management Software and processes HIPAA compliant ANSI format claims and remittances, direct to any number of payers with no per claim fees. Claims go direct to the payer, eliminating the hassle and expense of clearing house operations, and leaving you in complete control of the billing process.

Responsibilities:

• Elicited requirements from Subject Matter Experts and documented them as per the needs and requirements of the project. Prepared BRDs and FRDs for the enhancement of the existing services.
• Managed all the requirements in Requisite Pro, making requirements available to all team members.
• Analyzed the functional details of various modules in mainframe and did the GAP Analysis with the new system.
• Reviewed claims processing procedures and made recommendations for business process improvements.
• Built benefit plans for all lines of business and conducted unit systems integration and regression testing of those plans.
• Part of Business Process Reengineering Support Team of 6 personnel that leveraged Lean Six Sigma, Change Management and other Continuous Process Improvement methodologies to improve Claim Processing Cycle.
• Work closely with Underwriting and other internal departments to coordinate medical and dental responses to RFPs.
• Performed research and trouble-shooting for claims transactions or software issues for CMS Change Requests and Medicare Secondary Payer MSP claim adjudication processes.
• Validated data at the Backend to ensure that all the Claims related data has been loaded as per the Standards.
• Good knowledge of medical billing codes such as ICD-9, Revenue, HCPCS and CPT codes that are used on the UB04 and CMS1500 claim forms and various systems and applications for claims adjudication. Assist and troubleshoot daily medical billing/contract issues on a more technical level.
• Monitor daily processing of medical billing data on a daily basis to proactively identify potential client service issues related to Managed care, Medicare, Medicaid, Tricare and Workers Compensation contracts/claims.
• Confidential Business Analyst
• The project with HNE involved working in the Enrollment group to develop a new enrollment system as per HIPAA 5010 standards. The goal of the project was to enable HNE to add, manage and terminate members via multiple channels, specifically through EDI. The project also involved working with a third-party vendor to develop the enrollment engine as per EDI standard.

Responsibilities:

• Gathered and documented business requirements for the enhancements related to eligibility and benefits application for providers and Members as input for Functional Requirements Specification FRS .
• Created activity diagrams and sequence diagrams using MS Visio to communicate the system activity flow to the Dev team and QA team.
• Perform a baseline assessment and related interfaces, the existing service level agreements and/or
• policies and operational business procedures for readiness to comply with HIPAA as well as ICD-10 requirements.
• Ensured HIPAA compliance related to display of minimum benefit information that the Provider is required to pass on the EDI transactions.
• Conducted analysis of HIPAA compliance and took part in discussions for designing the healthcare
• transactions to be HIPAA 5010 compliant.
• Identified risks, problems, requirements and concerns to comply with ICD-10 changes.
• Involved in mapping and validation of different EDI transaction used for claims filing like 837 I, P, D for claim submission, 835 for the healthcare claim payments and 834 for Enrollment.
• Worked on Claim Data for Medicare Advantage Plans for Part A, Part B for 837 and 834 formats.
• Involved in mapping data from different EDI files onto database using different routing transformations.
• Actively worked on Data analysis and Report analysis with respect to ICD-10 impact.

Confidential Business Analyst

The Project deals with the Patient Cases reviewed by Doctors, Nurses and Panelists there by providing the feedback with the Patient cases for various Health Insurance Companies.

Responsibilities:

• Participated in requirements discussions with business units, ensuring all business requirements were satisfactorily met.
• Gathered user/business requirements by meeting with business users and generated business models and use case analysis.
• Prepared the Software Specification Document SSD for the application based on business user information.
• Created use case document to elaborate user experience taking into account the business objective.
• Created User Interface documents with screen descriptions.
• Reviewed the UI mockups with the Business Teams for confirmation of the UI requirements.
• Developed Functional requirements for the Content Management System Ektron.
• Documented requirements for the Templates, Widgets and Smart forms for the CMS.
• Conducted Joint Application Development JAD sessions periodically with various stakeholders at various phases of the Software Development Life Cycle SDLC to discuss open issues and resolve them.
• Feature identification, defining and documenting business requirements and priorities.
• Critically evaluated the information gathered from multiple sources during requirements and analysis and responsible for tracking, tracing and managing requirements using Requisite Pro.
• Participated in the bug review meetings. Updated requirement document as per business user feedback and changes in functionality of the application.
• Created project milestones and deliverable due dates based on a fixed project completion date.