SUMMARY

• Over 7+ years of proficient experience in teh Business Analysis, Business Modeling, Requirement Gathering, Documenting Requirements (BRDs/FSDs/Use Cases), Design, Development, Implementation and Software Validation.
• Strong business analysis skills and experience in teh Software Development Life Cycle (SDLC) and used methodologies such as Waterfall Model, Rational Unified Process (RUP), Agile Methodology.
• Strong experience in Scrum/Agile methodology and proficient in writing user stories of core business systems.
• Extensive qualifications in all facets of information systems methodology from conceptual design through documentation, implementation, user, quality review, and enhancement.
• Involved in Sprint Planning, Daily Scrum Stand Up, and Sprint Retrospective meetings.
• Expertise in successfully creating diagrams and graphs using Business Process Model and Notation (BPMN) to facilitate an understanding of performance and processes.
• Utilized complicated SQL queries to analyze and validate test databases for data integrity
• Extensive experience in using Microsoft Visio for Proto typing System requirements particularly in creating Activity diagrams and class diagrams and also writing Use cases, Business Process, Work Flows, Process Flows and documentation.
• Hold excellent communication and documentation skills wif good process management and interpersonal skills to gather requirements to bring out quality end product.
• Experienced in performing Gap Analysis to ensure teh compatibility of teh existing system wif teh new business requirements.
• Experienced wif HIPAA 4010 and 5010 EDI healthcare transactions and transition of ICD 9 to ICD 10 codes.
• Extensive experience wif HealthCare transactions Eligibility Request/Response (270/271), Claim Status Request/Response (276/277), Benefit Enrollment (834), Health Care Services Request (278), Payment/Advise (835) and Health Care Claims (837).
• Expertise in broad range of technologies, including business process tools such as Microsoft Project, MS Excel, MS Access, MS Visio, technical assessment tools, Data Warehouse, Data Modeling and Design.
• Adept in writing SQL code in Oracle, MySQL and MS SQL Server wif experience in Data Warehousing.
• Data Mapping and delivering capabilities in teh user friendly GUI.
• Highly logical in developing teh methods and procedures to meet requirements and solve concerns that arise during teh project.
• Strong knowledge in Data Warehouse/Data mart, ODS, OLTP and OLAP implementations teamed wif project scope, Analysis, requirements gathering, data modeling, Effort Estimation, ETL Design, development, System testing, Implementation and production support
• Understanding customer/ client requirement specifications as well as business systems functionality and technicality.
• Carefully worked wif MS Office, MS Excel, MS PowerPoint and MS Visio on multiple projects.
• Conducted User Acceptance Testing (UAT) on newly developed applications.
• Ensured that issues logged into defect and incident reporting and tracking tool (Team Foundation Server) are accurate, complete, and ensure there is no existing ticket on teh same issue.
• Used Quality Center and Rational Clear Quest for any possible error reporting.
• Experienced in writing SQL queries to generate reports.
• Strong communication and interpersonal skills when working wif project managers, subject - matter experts, developers, stakeholders and application end-users to adapt new/existing environment.
• Extensive experience in organizing Joint Application Development (JAD) sessions wif various groups.
• Excellent analytical and problem solving skills wif teh ability to handle multiple tasks TEMPeffectively and quickly master new concepts and subjects.

TECHNICAL SKILLS

Business Methodology: RUP, Scrum, Agile, Waterfall.

Business Modeling Tools: Microsoft Visio, Rational Rose, OpenOffice.

Project Management Software: MS Project.

Requirement Management Tools: HP ALM, JIRRA, TFS.

Testing tools: HP QC, QTP, Requisite Pro, and Rational ClearCase

Database: MS Access, SQL-Server, DB2, Oracle.

PROFESSIONAL EXPERIENCE

Confidential - VA

Lead Business Analyst

Responsibilities:

• Followed a structured approach to organize requirements into logical groupings of essential business processes, business rules, and information needs, and ensured that critical requirements are not missed.
• Directly Involved in writing Test plans, Test cases and responsible for executing teh Test Scripts.
• Responsible for designing, developing test plans use cases and executing test scripts.
• Performed Smoke, Integration, functional, Regression, and system testing.
• Interacted wif Business users and Technical team in providing clear solutions to requirements.
• Involved in testing HIPAA EDI Transactions and mainly focused on PA and Eligibility Transactions.
• Worked Extensively wif Inbound837 me and 837 P, 835s(Out bounds)claims processing systems
• UsedSharePointto store document and version control.
• Well versed wif Claim processing from point to point.
• Involved extensively in testing of teh application both manually as well as using teh required tools
• Created complex SQL queries using SQL editor.
• Worked on teh Data Warehouse team analyzing data files that had to be compiled from disparate non-production sources and readied them for production. Tasks included: comparing data to requirements documentation, creation of data layouts and data dictionary.
• Created product documentation, including online help, printed user manual, and materials
• Conducted and automated teh ETL operations to Extract data from multiple data sources, transform inconsistent and missing data to consistent and reliable data and finally load it into teh Multi-dimensional data warehouse
• Participated in teh design of teh 276/277 Claims Status transaction, createEDI map(s), and added some project leadership thru-out teh project by working closely wif teh Business Analysts and Project Manager.
• Analyzing and Testing the837(Institutional/ProfessionalInbound/Outbound),834Inbound,835Outbound,997Acknowledgement Inbound and Outbound EDI Transactions.
• Designed and developed Data warehouse, Data marts, star schemas, fact table, Dimension tables, Slowly Changing Dimension, Staging areas, Operational Data Store.
• Checked teh data flow through teh frontend to backend and used SQL Queries and UNIX commands to extract teh data from teh database. Strong Knowledge of MS Office Suite (including Excel and Word).
• Created mapping documents and technical analysis on Paper Claims, Medicaid Claims likeUB04, andHCFA.
• Involved working wif HIPPA-EDI ANSI X12 Transaction Code sets EDI 834, 835 and EDI 837.
• Involved in Testing (271, 277, 820, 834, 835 & 837) Transactions.
• Using SQL Query generated reports.
• Extensive experience in ETL processes in extracting data from Operational and Legacy Systems to Data Warehouse using Informatics.
• Used SQL tools like TOAD to run SQL queries to view and validate teh data loaded into teh warehouse.
• Generated on-demand and scheduled reports for business analysis or management decision using SQL Server
• Organized and facilitated meetings wif teh management and development teams.
• Performed extensive task which include Data Quality Analysis, Data lineage and Data Standardization data structures, data base design, data warehouses, business.
• Executed teh SQL queries in Oracle.
• Used SQL tools like TOAD to run SQL queries to view and validate teh data loaded into teh warehouse.
• Performed extensive task which include Data Quality Analysis, Data lineage and Data Standardization data structures, data base design, data warehouses, business.
• Involved in backend testing wif SQL, check teh data integrity and referential integrity
• Performed UAT, regression testing on EDI 835 and formats in Facets.
• Responsible for writing SQL Queries to find out that teh data is correctly populated in each field.
• Conducted requirement-gathering sessions wif teh purpose of creating and defining teh Business Requirement Document (BRD) and teh Functional Requirement Document (FRD) using Rational Requisite Pro.

Confidential

Sr. Business System Analyst

Responsibilities:

• Creating test plans and tested teh EDI transactions including 270,276,277, 835, 837I and 837P.
• Testing Authorizations for Claims.
• Updating ticketing software wif results.
• Tested LIS-LEP Enhancement for HEALTH suite system
• Tested MIM (McKesson Integration Module) Claim Check integration enhancement wif HEALTHsuite
• Tested NACHA files and Batch Eligibility Query (BEQ) Request and Response files for CMS
• Tested BEQ (Batch Eligibility Query) Request/Response files to obtain eligibility information for Medicare from CM Experience in extracting, transforming and loading (ETL) data from spreadsheets, database tables and other sources using Microsoft SSIS and Informatica.
• Provided project planning, milestones, and deliverables for implementation of document management system using MS Project.
• Tested teh interface between Member360/EEM 360 and HEALTHsuite enhancement
• Testing EDI inbound and Outbound Mapping
• Developed schemas for extraction, transaction, and loading (ETL) to expedite data integration between systems
• Prepared technical specifications to develop Informatica ETL mappings to load data into various tables confirming to teh business rules.
• Strong MS Project experience to manage project schedules analysis and reporting.
• Decoded XML results to validate test results
• Checking conflicts and installing teh COBOL scripts into Test Environment
• Setting up teh properties
• Create and run SQL queries for database validation
• Testing teh Medicaid Provider Number Status Enhancement.
• Extensively involved in UAT support for their execution and Defect Triage
• Creating several Test Cases and Test Conditions for testing various Claims,, and Billing and Provider reports
• Performed complex ad hoc SQL queries from BAs in Teradata SQL Assistant.
• Extensively tested different versions of RA (Remittance Advice) and EOB (Explanation of Benefits) both paper and XML
• Migrated SSIS packages and SSRS reports.
• Wrote test script for Members benefits verification
• Wrote SQL statement for to extract providers, claims and member information for validation
• Wrote test scripts for Mercato products testing
• Monitored teh progress of projects using MS Project and took appropriate action to ensure that they keep up wif teh schedule.
• Strong knowledge in Java/J2EE, Web Services, WSDL, MainFrame, etc
• Wrote configuration scripts for Plan, product and benefits
• Wrote configuration scripts Customer Fee schedules
• Wrote test scripts for claims processing
• Wrote test scripts for SIT testing
• Wrote test scripts for ICD10
• Wrote test scripts for DOD member enrollment and claims processing
• Wrote test scripts for EASYGroup paying out-of-network Medicare claims and standardizing contract management practices for hospitals and physicians.

Confidential, Dublin, OH

Business Analyst

Responsibilities:

• Worked as a liaison between teh business client and development team for teh in compliance wif HIPAA standards.
• Identified teh business functions and processes, and prepared system scope and objectives based on user needs and industry regulations.
• Defined terms, conducted stakeholder analysis, elicited business needs, conducted business process modeling, and facilitated JAD sessions. Elicited, documented requirements and use cases. Analyzed, validated & prioritized requirements; traced requirements to related project documentation (process models, designs, test scenarios & scripts).
• Gathered business requirements for teh Claims Business Area and updating EDI Transactions like EDI 837, 835, 276 and 277.
• Responsible for architecting integrated HIPAA, Medicare solutions, Facets.
• Documented teh Requirements and circulated them to Business & Technical teams for Signoffs.
• Participated and led daily stand-up meetings in line wif Agile Scrum methodology.
• Created User Interface for displaying various information related to providers and claims (Billing, Payments and Invoicing) using FACETS.
• Helped business users to reconcile reports generated from Data Warehouse wif reports from legacy systems, and validate teh data before and after teh migration/integration.
• Prepared documents such as Project Scope, Project Vision, Project Success, Business Requirements, Functional Specification, Data Warehouse Process Flow (SQL queries & Crystal Reports) using MS Office (Word, Excel, Visio) and dashboards
• Created 837 me & 837 P claims using macro enabled claim spreadsheets.
• Order Process Management - Designed techniques to implement a new Billing and Inventory Management Tool to better track teh expanding business' products.
• Processed EDI 837P, 837I, 834 and 837D transactions, verified 837 transactions were converted correctly to XML file format and verified teh claims data loaded to Facets for further processing.
• Used SOAP UI tool to send request and verify teh response back from services. Created a new project using SoapUI and run request wif input XML to receive a response XML for teh request sent.
• Raise defects as found during manual test via SOAP UI and test script.
• Prepared test cases and data for testing teh application developed using various mobile technologies for application web testing using SOAP UI.
• Worked on analysis of FACETS claims processing system and gathered requirements to comply wif HIPAA.
• Conduct JAD sessions to gather and document requirements that enhance a wide range of functionalities including claims processing, eligibility and enrollment, provider networks, and electronic data interchange for our Facets core application.
• Identified testing scenarios and defined Test Cases for detailed functional testing and UAT.
• Facilitated claims processing while passing 837 claims for a compliance check and running through load processing.
• Created SQL statements to work wifin teh functional document and ran teh results against teh facets system to ensure teh correctness of teh data
• Worked wif ANSI X12 HIPAA EDI Transactions 270, 271, 276, 277, 837, 835 and 997
• Created and maintained data mapping document(s) in to teh HIPAA transactions: 270/271, 276/277, 837, and 835.
• Prepared all documents necessary for knowledge transfer such as ETL strategy, ETL development standards, ETL processes, etc.
• Performed manual Back-End testing on teh application by writing complex SQL queries.
• Experienced in writing complex SQL queries for data validation for both ETL and BI testing. Wrote SQL queries for data validation.
• Developed a Schedule and identified project milestones.
• Reported project progress to teh team, senior management and all stakeholders periodically.
• Performed testing of teh health benefit claims receiving and processing system to ensure that teh system adheres to project standards, performance criteria, and functional specifications
• Identified risk and project impact and performed risk assessment and mitigation.

Confidential - New York, NY

Business Analyst

Responsibilities:

• Followed a structured approach to organize requirements into logical groupings of essential business processes, business rules, and information needs, and ensured that critical requirements are not missed.
• Followed teh UML based methods using MS Visio to create Use Case Diagrams, State Chart Diagrams and Sequence Diagrams
• Worked on FACETS claims processing, payment adjustments, claims inquiry, benefits,
• Enhanced test cases and scripts by adding teh required functionality as per teh new business requirements.
• Was responsible for Defect Tracking and Bug Reporting, which was performed in HP Quality Center.
• Verified data outputs and transformations between systems remained true and were not compromised as systems were integrated.
• Developed process flows diagrams, DFD in accordance wif Medicare and Medicaid rules and regulations pertaining to teh Facets configuration and evaluated teh impact of proposed changes.
• Responsible fortestingMedicaidClaims using MMIS.
• Prepared detailed reports and presentations using SQL and MS Access
• Participated in various meetings and discussed enhancements and modifications request to resolve issues and expand capability of teh systems.
• Identify and documented data sources and transformation rules required to populate and maintain data warehouse content.
• Interacted wif stakeholders to get a better understanding of client business processes and gathered requirements.
• Wrote complex SQL queries to perform teh backend testing of teh Oracle database using PL/SQL developer and UNIX shell commands
• Experience in conducting scrum meetings and sprint planning.
• Executed PL/SQL statements to check if teh data integrity TEMPhas been maintained.
• Collaborating wif business partners and cross-functional teams and supporting system documentation.
• Enrolled members and provider in teh Facets system.
• Created and modified queries utilizing Facets data tables.
• Responsible for checking member eligibility, provider enrollment, member enrollment for Medicaid and Medicare claims.
• Designed and developed Data warehouse, Data marts, star schemas, fact table, Dimension tables, Slowly Changing Dimension, Staging areas, Operational Data Store.
• Extensively used SQL statements to query teh Oracle Database for Data Validation and Data Integrity.
• Performed manual back-end testing using PL/SQL to connect to an Oracle 9i database on a UNIX server
• Experience wif COB (coordination of benefits) application wif in facets, testing of claims status for selected subscribers.
• Involved working wif HIPPA-EDI ANSI X12 Transaction Code sets EDI 834, 835 and EDI 837.
• Involved in Testing (271, 277, 820, 834, 835 & 837) Transactions.
• Generated on-demand and scheduled reports for business analysis or management decision using SQL Server
• Organized and facilitated meetings wif teh management and development teams.
• Performed UAT, regression testing on EDI 835 and formats in Facets.
• Conducted requirement gathering sessions wif teh purpose of creating and defining teh Business Requirement Document (BRD) and teh Functional Requirement Document (FRD) using Rational Requisite Pro.