Professional Summary:

• Experienced as a Sr. Business System Analyst for 7 years with proficiency in Business Process Engineering and Software Development Life Cycle including analysis, design, testing and implementation of software applications in Healthcare domain.
• Excellent team player work in conjunction with testing, development and other teams in validation and testing complex scenarios and projects and in the maintenance of Quality Standards in Projects.
• Experienced in interacting with business users to identify their needs, gathering requirements and authoring Business Requirement Documents BRD , General system Design GSD , Functional Requirement Document FRD and Software Requirement Specification SRS across the deliverables of a project.
• In-Depth Knowledge in facilitating Joint Application Development JAD , Rapid Application Development RAD and Joint Requirement Planning JRP sessions, interviews, workshops and requirement elicitation sessions with end-users, clients, stakeholders and development team.
• Strong Knowledge with Iterative approach for Software Development as per Rational Unified Process RUP and Agile approach. Involved in inception, elaboration, construction transition phases using rational tools like Requisite Pro, Clear Case and Clear Quest during various phases of RUP.
• Experienced in Business Analysis, SWOT Analysis, Gap Analysis, Risk Analysis, Disaster Recovery Planning, Testing and Project Planning.
• Extensive knowledge of Medicaid MMIS , Medicare, Procedural and Diagnostic codes and Claims Process.
• Expertise in EDI and HIPAA Testing Privacy with multiple transactions exposure such as Inbound Claims 837-Institutional, 837-Professional, 837-Dental, 835-Claim Payment/Remittance Advise, 270/271-Eligibility Benefit Inquiry/Response, 276/277-Claim Status Inquiry/Response, EDI 834-Enrollment and 820-Payment order and remittance advice.
• Experience in Conversion of HIPAA X12 4010 codes to X12 5010 codes and ICD 9 codes to ICD 10 codes
• Gathered requirements for ICD 10 Codes pertaining to Other Payer Liability OPL , Federal Employee Program FEP , Enterprise Code Management system ECM , Claims Processing System Diamond , Maintenance Process.
• Proficient in creating Sequence Diagrams, Collaboration diagrams, Activity Diagrams, Class Diagrams using Rational tools and Microsoft Visio
• Experienced in handling Change Management
• Experienced in writing Test Plans and executing Test Cases
• Experience with healthcare reform HCR and healthcare payer systems.
• Proficient in Developing and executing Test Plans, Test Scripts, performing functional, usability testing and ensuring that the software meets the system Requirement.

Technical Skills:

Professional Experiences:

Confidential

Role: Sr. Business System Analyst

• Description: This Project was about to implement the Automated Adjudication System, Which deals with different phase of claim process such as Intake Phase, Adjudication Phase and Reporting Phase. Implementation of ACAS Automated Claim Adjudication System must have to comply with HIPAA 5010 Rules and Regulation of privacy and security. Implementation of ACAS to generate automated Claim Submission, Processing and creating a report.
• Another project involved helping the department in Implementing ICD9-ICD10 changes in the system.

Responsibilities:

• Participated in Business Modeling by understanding the needs of the business, and also documenting Business Use Cases as well as System Use Cases
• Develop the supporting plans such as scope, cost, risk, schedule, quality, resource, security deliverables, procurement and change management plans.
• Facilitated Joint Application Development JAD sessions with the Management, Mainframe and HIPAA team to make sure everyone are in synchronous with the business requirement processes.
• Worked on HIPAA Transactions 270, 271, 834, 835 and 837 for HIPAA 5010 MMIS project.
• Involved in HIPAA 5010 gap analysis of ANSI X12 4010 for MMIS system.
• Developed plan for data feed and data mapping for integration between various system, Including XML, to follow ICD 10 code set and ANSI X12 5010 Formats
• Produced Gap Analysis documents for HIPAA 5010 and ICD-10.
• Prepared UAT Materials UAT Test Cases to include various steps involved for UAT and to have proper coverage of requirements
• Checked eligibility and validated Benefit Enrollment EDI 834 of Members.
• Extensively gathered business requirements for ICD -10 Groupings/classes pertaining to the maintenance process, ICD -10 Business rules remediation process, Other Payer Liability OPL , Claims Processing system Diamond .
• Gathered High Level Deliverables for ICD -10 Remediation of Configuration Rules to comply with ICD mandate , to regroup with sequential ICD- 10 Codes
• Gathered detailed requirements OPL tables to convert, capture and/or map the current ICD 9 diagnosis and procedure codes to the new ICD -10 diagnosis and procedure codes.
• Define project goals, objectives and success criteria.
• Worked on up gradation of different modules of MMIS like claim processing, Provider and Recipients.
• Worked on ANSI X 12 formats of EDI 835 and EDI 837 to check new ICD 10 code.
• Identified and document Project constraints and assumption.
• Used MS Visio to create Use Cases and Sequence Diagrams for changes in MMIS.
• Assisted development team to translate requirements into technical specifications.
• Created and Maintained the Requirement Traceability Matrix RTM .
• Initiated Test Plans, developed and executed test cases and scenarios, worked with users to develop specific acceptance criteria and prepare test exhibits.
• Involved in MMIS new functionality testing so wrote test plan, test script and test cases for it.
• Conducted User Acceptance Testing UAT sessions with business users and prepared document for enhancements and bug fixes.

Environment: HP Quality Center 10.0, Caliber RM, MMIS, MS Office, Windows XP, Windows Vista, MS Visio, HP SharePoint, MS Project, MS Visio, SQL, SOA Infra, XML, RUP.

Confidential

Role: Sr. Regulatory System Analyst/ Project Coordinator

The project involved Trizetto heading the IT solution for Blue plans. Project was involved working on the design and configuration changes as per the PPACA Patient protection and Affordable Care Act in the current healthcare plans.

Responsibilities:

• Actively involved through the successful Implementation phase of HIPAA 5010 Project.
• Involved in HIPAA EDI transactions such as 835, 837 P, D, I 276, 277, 278.
• Involved in up-gradation of HIPAA X12 4010 transaction to HIPAA X12 5010 and ICD 9-CM Clinical modification to ICD-10-CM/PCS Clinical modification/procedure coding system simultaneously
• Produced Gap Analysis documents for HIPAA 5010 and ICD-10.
• Responsible for creating test scenarios, scripting test cases using testing tool and defect management for Policy Management Systems, Payables/Receivables and Claims processing.
• Responsible for gathering and documenting Legislative, Business, Functional requirements for all the provisions and their impact on the existing products and systems.
• Created UML diagrams for Medicare new system implementation.
• Created handlers for checking eligibility of Medicare costumers.
• Wrote test cases and test scripts for the User Acceptance Testing.
• Performed Requirement Analysis and developed Use Cases and Activity Diagrams.
• Traced High Level Requirements HLR to Detailed Level Requirements DLR .
• Conducted meetings with SME's to understand current business process and performed Gap Analysis to meet future business needs.
• Responsible for integrating with Facets. Designing test scripts for testing of Claims in Development, Integration and production environment.
• Tested and validated claims processed by Facets.
• Developed Systems Specifications document to define the impact of the new requirements on the existing system.
• Developed and managed creation of product documentation to communicate features, benefits, positioning and impacts to different audiences and ensured that documentation deliverables from various groups are produced as needed.
• Assisted client IT department in reviewing current QNXT configuration, advising on HIX configuration, advising on regression testing, and leading HIX testing.
• Attended the training sessions to make sure that I have an understanding of all the modules in QNXT for example: Members, Providers, Claims, Utilization Management, Finance, Underwriting etc.
• Experienced with QNXT configuration and billing to membership processing.
• Created Business Requirement Document BRD , Functional Requirement Specification FRS document, User Requirement Specification URS and Change Request CR document for system application development.

Environment: HTML, QNXT,Windows 2000, Rational Requisite Pro, RUP, Facets, MS Visio, MS Excel, MS Word, MS Office, UML, SQL, HIPAA, MS Access.

Confidential

Role: Sr. Business Analyst

Description: This project involved the implementation of a web based portal for billing departments, claims submission and other major enhancements to claims system.

Responsibilities:

• Developed Functional Requirement Scenarios and Use Cased based on business needs.
• Involved in gathering Data Mapping Requirements from Technical Team.
• Worked with Business user to define Functional Requirements and Business Process Flows.
• Developed Business Requirement Document BRD and Use Case Document UCD using Microsoft Office.
• Worked with data migration and file mapping for various EDI transactions.
• Enhanced the Provider/Patient verification criteria using additional parameters based on the information retrieved from the EDI 837 I/P transaction files.
• Translated the EDI X12 data into XML format for initial transformation/migration.
• Reloaded multiple business rules from the Legacy System into the new system.
• Worked on various Business and technical documents including the Requirements and Specifications.
• Worked on Child Support Obligations and benefits and prepared process flows and data flow diagrams.
• Wrote test plan, test cases for testing Medicare system.
• Coordinated with the developer's team to make sure the systems are running efficiently.
• Prepared reports, and submitted it to higher authority.
• Actively participated in Change Board Meeting for any changes in the business requirements.
• Updated BRD based on Change Request and manage Change Request Document using Microsoft Office.
• Used Quality Center to import all Defined Requirements from Microsoft Word.
• Worked with Quality Analyst to ensure the validation of the system.
• Documented all the development work submitted to the client in a report format.

Environment:- Agile, UML, Windows, SQL, Microsoft Office, HTML, XML, Java Script, Java, HTML, MS Access, Oracle, QC.

Confidential

Role: Business Analyst

Description: Duties included building various applications for physicians, clearinghouses, billing services, and hospitals who submit or receive electronic claim data. Duties include working with the Web Based systems, Desktop Applications and other Clinical Applications.

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.
• Developed prototype of a new mobile information processing application and performed walkthroughs of the prototype with end users to better understand user needs.
• Coordinated with the offshore UI designer to prepare the prototype for the application.
• Facilitated collection of Functional Requirements from system users, and prepared Business Requirement documents and have applied the RUP model throughout the entire development and testing process.
• Prepared Logical Process and Data Models that contained set of diagrams and supporting documents containing the essential business elements, detailed definitions, and descriptions of the relationships between the data elements to analyze and document Business Data Requirements.
• Used Rational Clear Quest to maintain and track the requested enhancements and changes by the stakeholders.
• Followed the UML based methods using MS Visio to create Use Case Diagrams, State Chart Diagrams and Sequence Diagrams.
• Worked closely with the offshore team to convey Technical and Functional specifications.
• Detailed understanding of business functionality and preparing the Functionality Test Plan
• Interacted with Product Manager and Domain Experts to understand various process plans, business process, and functionality in detail.
• Responsible to conduct walkthrough sessions to get Business Sign off for the FRD.
• Meetings with Developers, Team Leads to help them understand the requirements.
• Interacted with the Testing and Development team to resolve and follow up on development issues.

Environment :- MS Word: Excel, Visio, UML, RUP, SQL, Java, Windows XP.