SUMMARY

• Over 7 plus years of experience as a Business Analyst with complete knowledge in various methodologies including Business Analysis, Requirement gathering, ITIL and focusing on the Healthcare Insurance.
• Skilled in stakeholder analysis, management and communication by working with Executive, and senior business sponsors, and technical specialists.
• Extensive experience in creating Business Requirement Documents BRD , Use Cases, Software Requirements Specifications SRS , Functional Requirements Specification FRS , Project Plans, Requirements Traceability Matrix RTM throughout the Life Cycle of the project.
• Acted as association between the business and development teams for requirements.
• In depth knowledge of SDLC and implementation of the Rational Unified Process RUP in all four phases of a project: Inception, Elaboration, Construction and Transition. Expertise in requirements gathering using Water fall and agile methodology, root cause analysis, creating workflows, process map, activity flows. Strong in documentation and communication of business design on business requirements using various methodologies.
• Strong experience of working with Medicare and Medicaid insurance data, Medicare parts A, B, C D, and Insurance Claims.
• Excellent in creating Sequence Diagrams, Collaboration diagrams, Activity Diagrams, and Class Diagrams.
• Possess excellent client interaction and communication skills as well as experience working in complex, cross functional and geographically dispersed team environments
• Handle and resolve critical quality problems using research abilities.
• Hands-on experience with statistical data collection and quality administration.
• Complete understanding of the AS-IS and TO-BE business processes and experience in converting these requirements into technical specifications for preparing test plans
• Hands on experience of Medicare and Medicaid Management Information System MMIS , HIPAA rules and transaction code sets enforced during EDI - Electronic data Interchange and ICD 9 to ICD 10
• Participate in the full lifecycle for multiple Data Mapping data project analysis, design, documentation, development and testing.
• Managed meeting sessions with the SMEs to review business requirement
• Developed Use Case UML modeling using modeling tools like Rational Rose/MS Visio
• Experience and skilled in creating and analyzing Data flow diagrams, Entity Relationship diagrams, and Logical Data Flow Diagrams
• Expertise in Data Modeling, Data Analysis, Requirement Analysis and Business Modeling
• Proficient in UAT user acceptance testing , Functionality Testing, Unit testing, System Testing, Integration Testing and Regression Testing
• Conducted GAP analysis so as to analyze the variance between the system capabilities and business requirements

SKILLS

EXPERIENCE

Confidential

Project Lead / Business Analyst

• Accenture, one of the largest consulting firms provides services to various clients. I am currently working in the Government Programs Division of Express Scripts. HCR Health Care Reform is a new business line that requires changes to all applications/systems to support and to ensure client compliance with State/Federal regulations. Health Care Reform regulations require client specific reporting. In order to assist our clients, we will need to provide them reporting which will include different levels of pharmacy data to be submitted to CMS as well as provide them informational reporting to be used in the administration of the Health Care Exchange benefit.
• 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.
• Responsible for creating and updating the Business Needs and Test Scenarios BNTS document.
• Conducted meetings with various stakeholders to gather requirements High Level Business and Functional Needs for creating the BNTS.
• Conducted structured walk through and JAR sessions for creating the Detailed Level Requirements DLR and Detailed Level Design DLD .
• Responsible for post-production monitoring and validation of all code enhancements and set up changes in support of Government Programs Group.
• Collaborated with Business Systems Analysis Specialist team members to monitor the business project portfolio in an effort to identify synergies between projects.
• Conducted weekly meetings to update on the status of the project and to discuss on any prior issues.
• Responsible for reviewing and approving the IT QA test plans and detailed test cases.
• Assessed QA performance Retrieved and analyzed QA information to identify root causes of performance gaps and other QA problems.
• Designed quality regulations and evaluations based on monitoring of data flow.
• Set and verified standards of quality and testing procedures Reviewed and modified quality assurance programs and tested performance according to user's specific requests and data inputs.
• Administered the company privacy policy regarding data.
• Acted as a TAG Technology Alignment Group lead for IMS Issue Management System issues assigned and worked in liaison between the IT team working on the issue, and the Issue Owner s on the business side.
• Ensured that the systems are functioning as expected and member's claims are being processed correctly.
• Conducted GAP analysis in understanding how the upgraded system carries out the business functions and assists in ensuring the timely and effective implementation.
• Interacted with the top management and business users on daily basis with regards to how the application functions, troubleshooting incidents/issues for Users and completing defect and enhancement requests on daily basis.
• Designed and developed all Use Cases and UML models.
• Involved in drawing process flow diagrams and work flow diagrams in all phases of the SDLC.
• Involved in preparing Software Requirement Specifications SRS and User Interface Design.
• Conducted functional walkthroughs, User Acceptance Testing UAT .

Environment: MS Visio, MS Office Suite, MS Project, Rational Clear Case, Rational Requisite Pro, Test Director, Rational Tool, eSD Maintenance, eSD Production, Claims Research Tool POS, RUMBA, CBM, PEGA Adjustments front end tool , IW and SQL Teradata

Business Systems Analyst Confidential

• Baylor Health Care systems established over 100 years ago, works to improve the community by reinvesting all profits, after expenses, to improving the health of the North Texas community. This project is Web- based application which enables actions like registering new policy holders on the internet directly and incorporating complete details of the customer.
• Defined scope of the project and developed a vision plan that defined the primary goals and objectives of the project.
• Worked with Rational Unified Process right from the initiation to transition phase.
• Gathered and analyzed business requirements for inbound and outbound files, managing all requirements using Rational Requisite Pro RRP .
• Conducted brain storming sessions to analyze provider contracts, provider reimbursement, benefit rules, medical policies and medical management rules to see the impact of ICD 10 diagnosis codes.
• Conducted working sessions to gather and document high level business requirements and detailed level business requirements for different business units impacted by ICD10 such as EDI Claims Intake, FACETS- Claims Adjudication, Medical Management-Utilization Management, Case management and Provider Reimbursement- Provider Payment.
• Organized impacted systems into high, medium and low impact to help business analyze the level of effort for remediation activities and ease resource allocation work
• Analyzed Healthcare transaction flow for HIPAA Healthcare Transactions like 834, 835, 270, 271, 276, 277, and 278.
• Conducted Impact analysis gap analysis and assisted in Risk-Management analysis.
• Designed and developed all Use Cases and UML models.
• Developed business requirement specification documents as well as high-level project plan.
• Experience in gap analysis, data mapping and manually tested the interfaces and functionalities.

Environment: Rational Rose, Rational Clear Case, Rational Requisite Pro, Test Director, Rational Tool, MS Visio, MS Office Suite, MS Project, Oracle 10g, SQL loader.

Business Analyst NaviNet, Confidential

• The project was to develop a Provider Desktop module for the EHR Electronic Health Record System with the objective to improve productivity and patient care. It serves as a central dashboard for providers to access crucial information such as Patient appointments, Clinical results and Electronic lab orders. The project was implemented securing patient privacy and health information conforming to HIPAA standards and guidelines. The purpose of this system was to have a Paperless Medical Record and instant retrieval of data and laboratory records by the doctors. The system was designed to track the flow of patients through the clinic.
• Attended demo sessions to understand existing system functionalities
• Arranged interviews with all the stakeholders to review and understand the gathered business requirements
• Conducted structured walk through and JAD sessions for consensus on baseline.
• Coordinated with system architects and developers to convert business requirements into system requirements
• Conducted meetings to document Change Requests for new requirements
• Analyzed business requirements and segregated them into Use Cases.
• Created Use case diagrams and documented Use case specifications
• Maintained various versions of the documents generated during the project using Rational Clear Case
• Was responsible for creating and updating project schedule and managing resources and timeline using MS Project
• Prepared the project status reports and represented the BA team in the PMO meetings
• Participated in UAT along with the development testing teams
• Gathered requirements from collection, claims, Billing, and insurance appeal departments

Environment: Windows 7, MS Office Tools 2010, MS Project 2010, Windows Server 2003, Microsoft SQL Server 2008, MS Visio 2010, Rational Requisite Pro

Confidential Business Analyst

• Confidential, which dates back to 1888, is one of the region's largest not-for-profit health care providers, serving the people of Delaware as well as neighboring areas of Maryland, Pennsylvania and New Jersey.
• Involved in Business Process Reengineering BPR - analyzed existing business processes and implemented new improved processes
• Created Use cases diagrams using Microsoft Visio
• Involved in technical designing to develop blueprints
• Conducted requirement gathering using focus groups, document analysis, interviews, prototyping and authoring blueprints
• Involved in designing of the system with the system architecture and the development team, implementing technology based solutions
• Conducted the initial study of Health Care Management to collect customers' information like data about existing systems at customer site, specific customer requirements
• Designed and implemented basic SQL queries for QA testing and report / data validation
• Authored and monitored progress reports on a weekly basis
• Developed Sequence Diagrams, Activity Diagrams
• Conducted JAD sessions between the end users and the development team
• Performed User Acceptance Testing UAT and reporting the bugs to the development team

Environment: Rational Rose7.0, JAD, UML, Microsoft Office Visio, Microsoft Office Project 2010, UAT, SQL Server 2005, MS Access, Windows Server 2003, Mercury Quality Center, Visual studio 2005, Power Center.

Confidential Business Analyst

• The project involved customizing and enhancing CVS Caremark's web based prescription-tracking site. CVS Caremark is a market leader in mail order pharmacy, retail pharmacy, specialty pharmacy, and retail clinics.
• Responsible for requirement and design documentation review, identification of Customer Management software anomalies and test results, customer interaction and IT management
• Managed all the requirements and change requests and made updated requirements available to all team members involved in the project
• Worked extensively through Agile development methodology by dividing the application into iterations and working on each iteration through full SDLC
• Conducted GAP analysis in understanding how the upgraded system carries out the business functions and assists in ensuring the timely and effective implementation
• Conducted feasibility study and performed impact analysis for proposed enhancements
• Worked closely with Developers and User Representatives, participated in the product design process including specifications, end-user reviews and application walk-through
• Developed business use cases in most instances, worked extensively on Rational Requisite Pro in gathering user Requirements, manage Workflows and elicit Communication plans
• Generated Use Case diagrams using MS Visio to depict process flows, timelines and cost-benefit models
• Interacted with Development and QA Team to ensure overall quality and scalability of the software

Environment: HTML, Oracle 10g, MS Office, MS Project 2010, MS Visio, UML2.2.

Business Analyst, Confidential

• Confidential operates as a pharmaceutical company. It focuses on formulations, active pharmaceutical ingredients and intermediates, generic drugs, critical care products, biotechnology products, custom pharmaceutical services, and drug discovery.
• As a Business Analyst, I was involved with drafting the migration plan for the Claims Processing data that needed to be migrated from the Oracle to the SQL Server environment. I was also involved with the HIPAA 5010 compliance for the new MMIS Medicaid Management Information System system.
• Interviewed clients to gather business requirements and provided input on possible non-technical solutions.
• Developed project schedules, timelines, status, system schematics and process work flows using MS Project.
• Studied existing documentation and for certain components performed Business Process Re-engineering.
• Conducted Joint Application Development JAD session to expedite requirements gathering.
• Prepared Functional Requirements Specifications from the Business Requirement Document.
• Extensive experience in writing Technical specifications using MS Word.
• Created UML diagrams such as Use Case Diagrams, Activity Diagrams, and State Chart Diagram using MS Visio and Rational Rose to define the Business Process.
• Performed extensive requirement analysis and gap analysis.
• Developed business requirement specification documents as well as high-level project plan.
• Worked on multiple modules like Life Insurance, Annuities and Retirements and Investment Services.
• Comprehensively worked with requirement gathering using Requisite Pro.
• Established a business Analysis methodology around the RUP Rational Unified Process .
• Assisted in the QA testing by providing the detailed functional aspects of the system
• Worked on validating the data in MS Excel before being fed into the applications.
• Wrote SQL queries to conduct Data Validation tests and Data Integrity tests.

Environment: Java, Web logic, Oracle, SQL, Quality Center, Windows, MS Office, MS Visio, Rational Requisite Pro