SUMMARY

• 8 + years of diverse experience as Sr. Business Analyst with the expertise in business process analysis, business process modeling, business requirements, database design and strategic planning in Health Care Life insurance, and Financials domain.
• Used ARIS tool for Manufacturing Execution System and Production Management for Shop - floor production of pharmaceutical products.
• Experience working on Business process model and notation(BPMN) like sequence diagrams, UML diagrams and Flow block diagrams using VISIO.
• Worked for a project to customize and integrate a Business Process Management (BPM) solution.
• Comprehensive knowledge and experience in all facets of Software Development Life Cycle (SDLC) with business process models: Waterfall, Agile, and (SCRUM and XP methodologies, including Joint application development (JAD), Joint requirement planning (JRP).
• Proficiency in analyzing and creating Use Case Diagrams, Activity diagrams, Class diagrams and Sequence diagrams using UML methodologies and tools such as MS Visio and Rational Rose.
• Experienced in creating Work Breakdown Structures (WBS), Project Schedules and Project Timelines.
• Familiar on Teradata SQL Assistant (Query man), data load/unload utilities like BTEQ (Import/Export), Fast Load, MultiLoad, T-Pump, Fast Export. Wrote SQL queries for data retrieval, developed reports for business groups.
• Implements SAP and server related software upgrades, supports packs, patches, and license update.
• Strong expertise in Health Insurance Claim process, social services, Medicare, Medicaid and banking.
• Experienced in writing and documenting Business Requirement Documents (BRD), and Functional Requirement Documents (FRD).
• Experience in conducting interviews, Joint Application Development (JAD) sessions and facilitating presentations.
• Worked on integration of SAP SD module with MM & FICO Modules.
• Skilled at reviewing test cases and making sure they are in accordance with requirements, and assist the overall testing process and conducting User Acceptance Testing (UAT).
• Expert in Software Development Life Cycle (SDLC) methodologies like Waterfall, RUP, SAFE Agile/ Scrum.
• Innovative, excellent team player and possesses great MDM data analysis skills.
• Experienced in creating Data Flow Diagrams and Business Flow Diagrams.
• Created Test Plans, Test Cases and Test Scripts and performed manual/ functional testing activities.
• Experience in Risk analysis, Feasibility study, SWOT Analysis and Cost Benefit Analysis.
• Manage and coordinate Testing & Quality Assurance activities for several mortgage originations correspondent applications.
• Implemented agile methodology in the operations, Utilized Agile SCRUM Methodology.
• Excellent knowledge of HIPAA (Health Insurance Portability and Accountability Act) transaction codes such as 270/271 (inquire/response health care benefits), 276/277 (claim status), 470 (benefit codes), 835 (payment or remittance advice), 837 (health care claim) and 834 (benefit enrollment).
• Recorded requirements in the Requirement Traceability Matrix (RTM) defining each technical requirement in detail from areas like: application software, networks, servers, internet and desktop configuration.
• Functional expertise in various SAP HRMS modules like PA, OM, E-Recruiting, ESS/MSS, Talent Management and Time Management.
• In-depth knowledge of Life Insurance, Medicaid and Medicare claims processing along with extensive knowledge on CMS, MITA, MMIS,, Annuity policies, Pharmacy Benefit Management (PBM).
• Participated project scheduling and resource management under the agile process.
• Deployed UML models in different projects by way of activity diagram use case diagrams and sequence diagrams using MS Visio.

TECHNICAL SKILLS

Business Process Modeling Tools: MS Visio, Requisite Pro, Rational Rose, MS Project, SharePoint, BPMN, ARIS Business

Business Analysis Skills: Gap Analysis, SWOT, Risk Analysis, ROI, Cost-Benefit & Impact Analysis, Project Management, Facet analysis, Requirement Gathering

BI Tools: SAP ERP, SAP Business one, SAP Business Object, Tableau(Certified), Power BI, SAP Lumira, SAP Business Objects, SAS, Sales force, JIRA, RUP, HP Quick Test, Business Intelligence Development Studio (SSIS/SSRS), Power BI

Project Management Tools: Microsoft Project, HIPAA, Flow Charts, Observations and Job Shadowing, Joint Application Development (JAD), Rational Unified Process (RUP), Unified Modeling Language (UML), System Development Life Cycle (SDLC), Agile/Scrum

Methodologies: SDLC, RUP, UML, CMM

Programming Languages: Java, C, SQL, HTML, CSS, JavaScript

Database: SQL Server, MS-Access, My SQL, Teradata V13, MDM

Load Testing/ Defect Tracking Tools: Load Runner, Jitter bit, Test Director, Jira Bug Tracking, Scrum, Ant, and Jenkins. Quality center

Operating Systems: UNIX, Linux, Windows

Others: Microsoft Outlook, Version One, Microsoft SharePoint, Managing Use Case Scenarios, Process Flow Diagrams, Mortgage loan structuring, Flow Charts, PowerPoint Presentations, Business requirements document (BRD), Functional specifications document (FSD), Business Rules catalogues, Error Message Catalogues, Traceability Matrices, MS Office (Power Point, Excel, Word etc.), SharePoint, Photoshop, Waterfall, Rational Unified Process (RUP)/Iterative, Rapid Applications Development (RAD), Agile Scrum.

PROFESSIONAL EXPERIENCE

Sr. Business Analyst

Confidential, Pleasanton, CA

Responsibilities:

• Prepared the Functional Specification Document FSD and Software Requirement Specifications SRS as per SEI-CMM standards.
• Business Analyst responsibilities for creation and maintenance ARIS business process flows, documentation of user role separation of duties, and program test execution.
• Proficient in creating Business Process Diagram using Business Process Modeling Notation (BPMN) and developing Use Cases and Activity diagrams using Unified Modeling Language (UML) by MS Visio, and Aris Express.
• Used Aris Express and MS Visio to model the business process diagram and UML to create use case diagrams, activity diagrams
• Conducted the JAD Sessions with stakeholders and developers to have a clear picture of a project.
• Created Process Flow diagrams, Use Case Diagrams, Class Diagrams and Interaction Diagrams using Microsoft Visio and Rational BPMN.
• Managed and built relationships with clients to build the EDI benefit enrolment file feed.
• Maintain SQL, Oracle and SAP HANA as backend for SAP system.
• Performed tasks like test cases, identifying defects, mockups, quality reporting, data cleansing and data quality.
• Worked on Facets Data Tables like (MEES, MEME, BLEI, MESU, BLDF etc ;) and created audit reports using queries.
• Requirement gathering from Inception and creating RTM, Functional Specification Documents and Data Mapping Analysis for System Integrations.
• Design and implement Data Quality mappings for bringing data into MDM Hub from the internal source systems (SAP, SFDC, etc.) and External source systems.
• Utilized agile software development methodology SCRUM as a lightweight process we used to manage and control software and product development.
• Implementing network standards and procedures as they relate to SAP systems.
• Developed UAT and System Integration Testing (SIT) plan, facilitated UAT and SIT testers as well as Triage defects per iodization and solutions.
• Responsible for conversion of data in Data Mapping and writing transformation rules.
• Excellent knowledge of HIPAA (Health Insurance Portability and Accountability Act) transaction codes such as 270/271 (inquire/response health care benefits), 276/277 (claim status), 470 (benefit codes), 835 (payment or remittance advice), 837 (health care claim) and 834 (benefit enrolment).
• Participated in daily Agile Scrum, Sprint Planning and Retrospective Sessions and update the team on status of upcoming User Stories for the a project of changing the client's software maintenance structure of their various software products.
• Assisted in configuring dash boards and reports using Power BI.
• Have experience on HL7 Messaging Standard which is the workhorse of data exchange in healthcare.
• Used Spark Enterprise Architect for CLT Business rules management.
• Facilitated Joint Requirement Planning (JRP) sessions with Business User Groups, along with conducting Joint Application Development (JAD) sessions with IT Groups and Conflict Management with Project team members.
• Clarify, communicate and document requests for change requests from As-Is to To-Be process and coordinate with the testing and development team.
• Experience with developing User Stories throughout the Agile Lifecycle as well as created UML diagrams such as Use Case, Activity, ER diagram and Chart diagrams with MS Visio.
• Manually loaded data in FACETS and have good knowledge of Facets Business rules.
• Created UAT test plan (for AP & e Banking modules) that included test approach, test security, development & execution of complex use case user acceptance test scripts, scheduling of testing efforts, defect tracking for regression, training considerations.
• Designing storyboard, process flow diagrams and visual presentations in MS Visio.
• Ensured all technical artifacts complied with corporate SDLC Policies and guidelines with Power Bi tools.

Environment: Mainframe system, XML, WSDL, Oracle 12, SharePoint, Version One, SOA, CA Rally, Rational Requisite Pro, SOAP, Power BI, UI, REST, TOAD, SAP, MS Visio, MDM tools.

Sr. Business Analyst & Data Analyst

Confidential, MA

Responsibilities:

• Analysis of complex MMIS System database design, reports and system processes. Supported the implementation and enhancement of Statewide MMIS, Web portal, and integration.
• Responsible for gathering requirements, data mapping, gap analysis, and process flow and activity diagrams in changing old MMIS and Involved in testing new MMIS.
• Responsible for Medicaid Claims Resolution/Reimbursement for peach state health plan using MMIS.
• Managed automation of reports from Access to SSRS by creating complex stored procedures, scheduling SQL agent jobs, using PowerBI, designing reports in SSRS, and deploying to report server.
• Managed projects to improve client's financial performance, internal processes and procedures. Employed MS Project to plan and track progress for clients' projects.
• Tested the changes for the front-end screens in FACETS related to Membership, Benefit and Plan modules.
• Performed SAP hybris cross-training and managed integrations among SAP HR, SAP Financial and SAP Materials Management/Production Planning related functions.
• Knowledge and Experience on Membership, Billing, Claims Payment Processing in relation to HIPAA, EDI 4010, 834, 837,835, and 270, 271.
• Created Bar charts, Pie charts, Drill down reports and parameterized reports using SSRS.
• Participated and lead JAD sessions on a regular basis and presented both informational and persuasive presentations.
• Working knowledge in ICD 9 ANSI Health codes/HL7 in the claims environment for inpatients and outpatients; reviewed the implementation of the changes made in the systems as per the formats and compliance for EDI usage.
• Worked on HIPAA Standard/EDI standard transactions: 270, 271, 276, 277, 278, 834, 835, and 837 (P.I.D), 997 and 999 to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrolment hence analysing and documenting related business processes.
• Served as Senior Consultant responsible for designing, developing, and testing, documenting and delivering technology solutions for Microsoft Dynamics ERP, Management Reporter, Crystal Reports, and SQL Server including customizations and alterations to existing applications.
• Studied existing business process and created AS-IS workflow to illustrate the existing system.
• Responsible for the full HIPAA compliance lifecycle from gap analysis, mapping, implementation, and testing for Medicaid Claims.
• Generated periodic reports based on the statistical analysis of the data from various time frame and division using SQL Server Reporting Services (SSRS).

Environment: Scrum, MS Visio, RALLY, SOAP UI, MS OFFICE, Power BI, HP ALM, VMWare, Horizon Client, Scrum, UML, HP Quality Centre, SAP, Win Runner, Rational Clear Quest, Windows, MS Office, XML, TOAD, Ultra Edit, Rational Rose, agile, Rally, SQL, TFS, JIRA

Business Analyst

Confidential, Columbus, OH

Responsibilities:

• Worked with Infection control for a safe environment where risks for infection are identified and minimized for patients, employees, and visitor’s healthcare sites.
• Practiced Agile/Scrum Development methodology for automation development.
• Extensive experience on First Data Merchant Services (FDMS) payment gateway.
• Coded tables, documented procedures and trained analysts in use of RPS for 4 annuity products.
• Developed, executed test plans for web interface automating exchanges on Vantage system.
• Preparation of user-stories for team estimation activity (grooming), user story decomposition, transfer a brief description of user-story into more detailed requirements of task for developers.
• Ensure all facets of payroll are planned and completed within the necessary time frame.
• Function analysis for new product Gap analysis between current and desired functionality Create development documentation in Confluence (according to UML).
• Create business-process diagrams using MS Visio (according to BPMN).
• Supported new business and post issue departments through documenting and reporting issues to CSC, testing suggested solutions for Vantage and RPS.
• Integrated Test Director into BA / QA processes to link requirements to testing and reporting for Vantage & RPS enhancements and support issues.
• Involved in the reconfiguration of FACETS in functional areas, including Membership, Claims, Provider, Enrollment, and Service Modules.
• Coordinated QA work for RPS system software upgrade.
• Our Scrum team readjusted the business process and combined functionality of three different systems in one, which helped to simplify and reduce the time for account opening.

Environment: RUP, SQL Server, Jira, PL SQL, agile, Oracle 12, Epic, Onbase, SharePoint, HP Quality center and ALM, Rational Requisite Pro, Hadoop, MS Access, Excel.

Business Analyst

Confidential

Responsibilities:

• Designed a new matrix covering all the conceptual parameters of the new system.
• Extensive knowledge on relevant cross-industry data and messaging standard organizations and HIPPA/EDI industry-specific organizations to maintain a point of view as to the current applicability and risks associated in implementing standards or new technologies to client environment.
• Created class diagrams, use case diagrams and sequence diagrams to view the system from different perspectives.
• Got involved in designing future state processes for HIPAA 5010 transaction processing EDI's 837,835, 270, and 271.
• Used Microsoft Visio to document Use Cases, ad-hoc reports Activity Diagrams/State Chart Diagrams, Sequence Diagrams, Collaboration Diagrams.

Business Analyst

Confidential

Responsibilities:

• Served as a liaison between the internal and external business community (Claims, Billing, Membership, Payments, Capitation, Customer service, membership management, provider management, advanced Healthcare management, provider agreement management) and the project team.
• The system performs all the functions of medical billing cycle such updating new and existing patient records, auto posting of the charges and payments to the patient records and submission of claims to the medical insurance Carrier.
• Provided business requirements with in an Agile Software development SCRUM Framework.
• Enrolment Resolution and Reconciliation process for health insurance exchanges.
• Responsible for troubleshooting and resolving errors in 834 and 820. Transactions for health insurance exchanges and performing root cause analysis.
• Determined business requirements and business workflows from legacy system to the detailed financial transaction interface.

Business Analyst

Confidential

Responsibilities:

• Experience working with user to analyze the requirements.
• Experience in creating clients report and delivering reports (ad-hoc and automated) in a timely manner.
• Organized meetings, documented action items and minutes; presented summarizations to the peers and communicated with clients, regarding issues.
• Created Business Requirement Documents and Functional Requirement Documents.
• Conducted status update meetings weekly, to review the progress of the project.
• Coordinated in developing test scenarios, test cases and implemented test plan with QA team.