SUMMARY

• Over 8 years of healthcare industry experience as a Business Analyst in identifying business needs and determining solutions to business problems for complex software projects.
• Deep knowledge working through the Software Development Life Cycle including Requirement Planning and Management, Requirements Elicitation and Requirements Analysis.
• Expert in creation of Business Requirement Documents (BRDs), Functional Specification Documents (FSDs), Use Case Documents, Acceptance Criteria Documents (ACDs), Business Rules Spreadsheets (BRS) and Requirements Traceability Matrix.
• Successfully conducted interviews, brainstorming sessions, group interviews, prototyping, focus group sessions and JAD sessions to gather requirements.
• Experienced in all phases of the Software Development Life Cycle (SDLC) Waterfall methodology, SAFe Agile (Version One) methodology (Scrum), Rational unified process (RUP), Rapid Application Development (RAD).
• Excellent knowledge of the AS - IS and TO-BE business processes and experience in converting these requirements into technical specifications.
• Excellent understanding of HIPAA standards, FHIR, Long Term Care (LTC) workflow, EDI (Electronic Data Interchange) syntax of transactions such as ANSI X12, HIPAA code collection implementation and knowledge of health level HL7-CENSUS Message and on technical report type 3 TR3 in healthcare industry.
• Extensive knowledge of Medicaid Management Information Systems (MMIS), National Provider Identification (NPI), Health Insurance Portability & Accountability Act (HIPAA) standards, Electronic Data Interchange (EDI), Health Information Exchange (HIX), EMR/EHR, Health Care Reform and Patient Protection and Affordable Care Act (PPACA).
• Excellent understanding of HIPAA standards, EDI (Electronic Data Interchange) syntax of transactions such as ANSI X12, HIPAA code collection implementation and knowledge and HL7.
• Rigid working knowledge of health care sector claims management, long term care workflow (LTC), HIPAA regulations and 270,271,834, 835,837P EDI transactions specially.
• Designed wire frames, screen mock-ups and Graphical User Interfaces (GUI) for client’s worker portal.
• Professional in the administration and management of a Medicare Prescription Drug Program and Medicare compliance initiatives.
• Knowledge and Experience to Retail Pharmacy, Medicare and Medicaid domains of the healthcare systems and industry for inpatients, outpatients, Reimbursement Methodology.
• Extensively participated in verification of EDI file formats against HIPAA Standards.
• Proficient in relational databases, SQL queries, reporting tool and data analysis.
• Experienced in SQL Server Reporting Service (SSRS), Executing Queries and Running Store Procedures.
• Experience in various programming languages (SQL, XML) and operating hardware and software applications including TOAD, Crystal Reports, Oracle Discoverer, Query Analyzer and SQL Navigator.
• Experience with Microsoft Team Foundation Server (TFS), updating the task and stories on regular basis.
• Strong Experience in using different requirement management and testing tools including IBM Rational Requisite Pro, JIRA, HPALM/QC.
• Experience in analysis, design of APIs in API Connect and API Manager.
• Expert in MS Office products with a concentration in Excel, Access, Visio, and Publisher.
• Excellent Exposure to OOAD techniques, Extensible Markup Language XML and developing Use Case diagrams (UML). Knowledge of Software as a Service (SaaS), Tableau, CSV.
• Proficiency in Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data within the Oracle database. Involved in determining test strategies based on requirements and architecture.
• Followed the RUP based methods by using Visio to create UML Diagrams such as Use Case, Activity and Swim Lane Diagrams.
• Good knowledge of identifying various test scenarios. Holds strong ability to handle multiple tasks and prioritize it.
• Knowledge on system testing while performed on the entire system in the context of a Functional Requirement Specification (FRS) and System Requirement Specification (SRS).
• Strong working experience in the Data Analysis and Testing of Data Warehousing using Data Conversions, Data Extraction, Data Transformation and Data Loading (ETL).
• Hands on experience in User Acceptance Testing (UAT) to ensure all the User Requirements were met by the application.

PROFESSIONAL EXPERIENCE

Confidential - Jersey City, NJ

Senior Business Analyst

Responsibilities:

• Interacted with stakeholders to get a better understanding of clientbusinessprocesses and gathered requirements.
• Documented the Use Cases and prepared the Use Case, Activity, Sequence diagrams and Logical views using MS Visio, MS Office, and Rational Rose for a clear understanding of the requirements by the development team.
• Conducted requirement-gathering sessions with the purpose of creating and defining theBusiness Requirement Document (BRD).
• Conducted JAD sessions, Medicaid meetings, workshops to gather requirements from various stakeholders and SMEs.
• Skilled in gathering business and application requirements, Business Processes, identifying risks, impact analysis, UML modeling, and Sequence and Activity Diagrams using Rational Rose and Microsoft Visio in Clinical and Health Information Management (HIM) processes.
• Performed Gap Analysis to check the compatibility of the existing system infrastructure with the Analyzed the Business Requirements Document (BRD), modified the Master Test Plan and prepared detailed Test Cases for the UAT.
• Planned and documented procedures for data processing and prepared data flow diagrams for the application
• Created Swim Lane Diagrams andbusinesslogic & calculation spreadsheets for variousbusiness processes.
• Extensively worked with HIPPA X12 EDI transaction codes such as 270/271(inquire/response health care benefits), 276/277(Claim-status), 834(Benefit-enrollment), 835(Payment/remittance advice), 837(Health care claim).
• Performed data mapping to define the Source data on 834 Benefit Enrollment and Employer Group File (EGF) EDI Transfers.
• Worked in accordance with theSAFe Agile (Version One)/Scrummethodology for various phases of the business and created business vision, business architecture documents and mock reports.
• Worked closely on 837 I/P transaction code for Health care claims and was involved in Validation of HIPAA for 270/271 (health care benefits and eligibility), 276/277 (Claims Status), 835 (Payment/Remittance advice), 834 (Benefits Enrollment) EDI transactions.
• Met with client groups to determine requirements and goals. Utilized Rational Unified Process (RUP) to configure and develop process, standards, and procedures and create a Business requirement Document.
• Assisted in development of test cases based on functional requirements for claims for EDI and HIPAA Transactions 837/835, 834, 276/277, 270/271 testing.
• Created Process Models for (a) Initial Enrollment, First Billing and Payment and (b) Post Enrollment - Subsequent Recurring Billing and Payment.
• Conducted walkthroughs with the end users and stakeholders to gather the modification requests from the user to upgrade or change the specifications for the product.
• Responsible for architecting integrated HIPAA, Medicare solutions, Facets. Performed the requirement analysis, impact analysis and documented the requirements using Rational Requisite Pro.
• Utilized knowledge of SQL Programming to author over 20 Queries in the HPQC Dashboard.
• Created approach to standardize Excel Reporting using SQL in the HPQC Dashboard.
• Wrote transformations for data conversions into required form based on the client requirement using Teradata ETL processes.
• Incorporated HIPAA standards, EDI (Electronic data interchange), Implementation and Knowledge of HIPAA code sets.
• Involved in requirement gathering phase (Provider, Claim components and HIPAA). Utilized Rational Unified Process (RUP) to configure and develop process, standards, and procedures.
• Manage and lead day-to-day operations of system upgrade to comply with new federal reporting requirements and security protocols including HIPAA.
• Involved in creation of WEB API methods for database operations (CRUD) through EntityFramework.
• Worked closely with the development team in user interface UI screen mockups and UX wireframes
• Conducted Joint Requirements Planning (JRP) sessions with management, SME's (Subject Matter Expertise) users and other stakeholders for open and pending issues to resolve.
• Manage and analyze data communication channel to ensure compliance security requirements in accordance to ISO, HIPAA and PCI guidelines. Coordinated with Project Managers to resolve risk issues and ensure compliance of Security System related to the HIPAA.
• Developed Test Plans and Test Execution Procedure Document based on the Business & Functional Requirement Document and numerous Test Cases and Test Scenarios to cover overall aspect of quality assurance.
• Validated defects and test results generated by the QA team.
• Assisted End User in performing User Acceptance testing and performed testing of the result files created by the development team to verifying whether all the User Requirements were catered to by the development effort.

Confidential, Jacksonville, FL.

Sr. Business Analyst

Responsibilities:

• Conducted multiple JAD sessions between various organizations such as DHS, HHC, DCCA, and OIMT/OIT to elicit system requirements using stakeholder analysis, RACI chart, user stories and prototypes.
• Created BRD, FRD/FSD and SDD for the implementation of functional areas across IF/Notifications and Languages.
• Active member for the policy review to implement the blueprint requirements for Medicaid/MMIS, Medicare, CHIP and Tax Credits benefits per CMS guidelines.
• Compile, validate and report system-wide metrics to attest meaningful use of EHR to the Centers for Medicare and Medicaid Services.
• Gathered analyzed, documented business and technical requirements from both formal and informal sessions and validate the needs of the business stakeholders.
• Responsible to maintain the defect log that traces back to the test cases and to the requirements, involving Agile (Version One) and Scrum methodology.
• Worked on FHIR, HL7 and EDI transactions: X12, 835, and 837 P.I to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
• Intricately involved in Business Process Flow development, Business Process Modeling, and ad hoc Analysis
• Update the existing system with new 834 data allocation for Health Care Reform Health Insurance Exchange (HIX) Population.
• Worked on HIPAA Transactions and Code Sets Standards according to the test scenarios such as 270/271, 276/277,837/835 transactions.
• Collaborated with the front-end design team and back-end team and started converting the staticfiles with the dynamic content with the data is retrieved from the database by the REST API calls.
• Assigned tasks among development team, monitored, and tracked progress of project following Agile (Version One) methodology.
• Experience at writing complex SQL queries and understanding requirements for complex queries and procedures.
• Facilitated Scrum meeting with technical/non-technical team, Accounts updating, data analysis and sharing with XML patterns, SMEs to clarify business rules & solve impediments, rectifying the regulatory issues with SME's and translated Functional requirements into User stories using JIRA.
• Mapped the user requirements with theSaaS solution, identified and documented the gaps, reviewed with the stakeholders to manage their expectation of final solution.
• Performed extensive data modelling to differentiate between the OLTP and Data Warehouse data models
• Worked on complex SQL queries fordataprofiling forDataETLIntegration tool.
• Gathered requirements and modelled the data warehouse and the underlying transactional database
• Activating accounts for users registered through Liferay by waiving the verification items in CRM and setting up licenses per certification and access levels.
• Assisted in configuring the EDI 837, 835, 270/271, 276/277, 278, 820 and 834 transactions processing flow from the Trading Partners to the translator.
• Interacted with the SMEs to gather information about the health care enrollment, eligibility and health care claims processing and created Use cases/FRS traced to use cases.
• Worked extensively on Gap analysis, Root Cause Analysis, and Impact analysis of issues to requirements to meet the gap and redesign of the user interface.
• Involved in mentoring specific projects in application of the new SDLC based on the Agile Unified Process, especially from the project management, requirements, and architecture perspectives.
• Worked on many Change Requests, Parking Lot items, Action Items, Process Flow Diagrams (UML), Pain Points, and Use Cases.
• Understand rules and regulations of HIPAA as imposed during Electronic Data Interchange (EDI).
• Met with relevant stakeholders to obtain EDI contacts for all vendors to communicate testing schedules and ensured project completion.
• Participated in User Acceptance test planning by creating test strategy document, test scenarios and facilitated in execution.

Confidential, Miami, FL

Business Analyst

Responsibilities:

• Work as a BusinessAnalystwhile building US Health Care Public Exchange (HIX) & WEM as well as for respective implementation (MA, KY & CO) carved out of Federal Exchange product.
• Working with UI & UX team to define wireframes and visuals reflecting the PRD requirements.
• Responsible for ensuring HIPAA EDI Trading Partner transactions meet established standards and can be transmitted and processed.
• Prepared Use Case diagrams using IBM Rational Rose tool.
• Converted Business specifications into Business and Functional Specifications.
• Worked on EDI transactions like 834,270/271, 276/277, 835/837 and EDI's. Worked on Use Cases for Batch processing for EDI's.
• Conduct JAD/JRD with Business and SMEs to come up with BRDs.
• Involved in creating effective processes and business strategy to leverage company and SaaS model strengths.
• Responsible for creation of Collaboration Diagrams, Activity Diagram, Project Flow Diagram in MS Visio.
• Extensive Analysis of HIPAA rules to in corporate in the Development of Utility application which are not HIPAA compliant.
• Implemented and managed the formal SDLC implementation using the RUP/ SAFe Agile Methodologies (depending on the client and project).
• Generated Usage Models (i.e., prototyping storyboards, screen mockups, User Interface designs, User stories) based on Agile and SDLC standards.
• Extensively worked with Enterprise Data Warehousing (EDW) Tables and Data Mart Staging Tables.
• Generated Use Case diagrams, Sequence diagrams, Business Objects, Domain Object Model, and Visio to depict process flows and PowerPoint presentations
• Planned, directed, and coordinated the activities of multiple teams utilizing agile methodology best practices (Scrum). Supported product owners to maximize ROI and meet the organizations objectives through Agile. Participate in architecture and design sessions. Involved in coaching, teaching and guiding teams to adopt the Scrum methodology.
• Used Microsoft Test Manager and the Microsoft Team Foundation Server (TFS), and prepared, edited, and reviewed test documentation to efficiently regression test the SERV Suite product, with over 200 cases to validate functionalities before each release
• Involved in creating reports framework with dimensional data models for the data warehouse and worked with the development team on SQL Server 2005 tools like Integrations Services and Analysis Services.
• Extensively used tools such as Rational Rose, Rational Requisite Pro, UML, MS Visio, MS Project, MS Office, MS Access
• Various versions of the documents generated during the project were maintained and managed using Rational ClearCase and performed defect tracking using Rational ClearQuest.

Confidential - Bethesda, MD

Business Analyst

Responsibilities:

• Interacted with stakeholders and gathered requirements as per thebusinessneeds.
• Implemented RUP methodology for iterative and incremental development of the system.
• Worked on Required Traceability Matrix (RTM) in Rational Requisite Pro for traceability of requirements through test cases
• Successfully conducted JAD sessions, which helped synchronize the different stakeholders on their objectives and helped the developers to have a clear-cut picture of the project.
• Was involved in the planning of the RUP iterations and documenting of the artifacts throughout the various phases of the development process.
• Reviewed the user requirements in SOX context and validated the SOX compliance.
• Writing stored procedures, triggers, cursors, and views to improve the quality of application, and manage mission-critical information using T-SQL.
• Involved in system requirement analysis and conceptual design of the CURAM implemented Web application.
• Created Business Requirement Document (BRD), Functional Requirement Specification (FRS) document, and Traceability Matrix document for system application development
• Conducted GAP analysis by understanding the AS-IS system and the TO-BE system requirements by having discussions with the SME's.
• Conducted live JAR &JAD sessions with SMEs, and all the placeholders to develop High Level Requirement and then formalized those requirements to Detailed Level Requirements.
• Facilitate project meetings deriving User requirements, creating use cases and user stories, and working as liaison between Business and Technical teams.
• Elicited business requirements and business needs as part of an Agile Scrum team
• Facilitate the Change Authorization Group (CAG) meeting, calendar approved changes and communicate with our stakeholders
• Prepared Test Cases (manual/automated) and Conducted Tests (Integration testing, Regression testing), Black Box/White Box testing, UAT (User Acceptance Testing).
• Used Quality Center and ALM for defect tracking and reporting.
• Compiled the Vision Document and composed detailed Use Case Specification Documents in Rational Requisite Pro.
• Used UML to perform Use-Case analysis to capture the dynamic aspect of the application.
• Ensured the accuracy and consistency of the data during the data loading process.
• Developed State Diagrams, Activity diagrams and Class Diagrams in MS Visio using UML for various modules of the project.
• Created Process Flow Charts,BusinessRequirements Documents, Functional Specification Documents.
• Was involved in managing the Daily Standup meetings and ensured that quality standards were enforced as per the build-release schedule.
• Developed Test Plan and Test cases based on the Use cases and Functional specifications and performed manual testing of the functionality of the application by inserting varying data on different test runs.
• Developed Flowchart and process diagram using Microsoft Visio.
• Was in regular contact withBusinesspartners on the status of issues, action plans and timeframe for resolution throughout the development cycle.

Confidential, Seattle, WA

Business Analyst

Responsibilities:

• Conducted working sessions to gather and document detailed and high-level business requirements for different business units impacted FACETS, Utilization Management, Case management and Provider Reimbursement/Provider Payment.
• Involved in managing the risk adjustment process for Medicare advantage plans throughout the RAPS to EDPS (Encounter Data Processing System) transition.
• Designed wire frames, screen mock-ups and Graphical User Interfaces (GUI) for client’s worker portal.
• Prepared use cases and data flow diagrams in Rational Jazz, MS Visio, and MS Word to analyze the impact of diagnosis codes embedded in different systems and applications.
• Contacted SMEs to collect and finalize all system and business process requirements for incorporating changes to existing Medicaid Management Information System (MMIS).
• Prepared and maintained requirements traceability matrix (RTM) throughout the project lifecycle.
• Worked closely with project manager and team leads to coordinate resources and document cost estimates throughout the project.
• Worked with PBMs to monitor prescription safety across several pharmacy networks and reviewed formularies. Worked on pharmacy claims processing and facilitated reconciliation.
• Coordinated with Business Project Teams, Business Owner, Application Vendor, Payers, and Clearinghouses to bring all processes to a level of execution to mitigate any impact to current revenue flow
• Performed Accounts Receivable Data entry with specific involvement in Cash Posting and closely interacted with Revenue Cycle Management team.
• Worked closely on 837 I/P transaction code for Health care claims and was involved in Validation of HIPAA for 270/271 (health care benefits and eligibility), 276/277 (Claims Status), 835 (Payment/Remittance advice), 834 (Benefits Enrollment) EDI transactions.
• Designed and developed Business Rules document about the Claim Component and HIPAA.
• Created business workflows on the claims module for the client to get a better understanding of the software and prepared a detailed BRD including all functional and non-functional requirements.
• Performed the Gap analyses of the earlier systems, generated a detailed Requirements document describing new system architecture through Use Cases and Activity diagrams. Specifications, Documentation and Construction of systems heavily relied on UML.
• Tracked all required resolutions that were identified as needed from Vendors or Payers based on testing results.
• Identified all risks associated with the project and gave suggestions for mitigating the impact the identified risk