SUMMARY

• Over 7 years of experience as Business Analyst with expertise in Joint Application Development, Business Process Analyses, Requirements gathering and management of documentation, Software Analysis and Modeling of client/server based applications with strong understanding of software development life cycle in diverse business domains of PBM/Healthcare/Insurance and IT Industries.
• Efficient in eliciting, prioritizing and documenting business requirements.
• Excellent writing and analytical skills in preparing business requirements (Utilizing Use Cases), system requirements, system design, functional specifications and defining project plans.
• Expertise in Gap Analysis, analysis of Error handling and AS - IS and TO-BE Process flow diagrams.
• Experienced in all development methodologies such as Waterfall, RUP, RAD, Agile (SCRUM).
• Very well experienced in conducting GAP, SWOT and PESTLE analysis
• Expertise in Health Care X12 ASC EDI Inbound and Outbound Transactions and their equivalent TR3s (Technical Report Type 3).
• Hands on experience working with HIPAA Transactions such as 837I & P, 835, 834.
• Worked on various lines of businesses HMO, PPO, POS, ASO, Medicare and Medicaid claims.
• Good knowledge about healthcare reimbursement policies, procedures and Centers for Medicare and Medicaid Services (CMS) rules and guidelines.
• Experienced in Medicare and state Medicaid claims, MMIS applications, benefit plans, claims cycle and adjudication process.
• Experienced in Electronic Data Interchange (EDI) and implementation of HIPAA code sets, ICD-9, ICD-10.
• Served as Lead Business Analyst on business rules, adjudication process and waiver programs.
• Served as a primary contact for PBM related inquiries and also responsible for coordinating and facilitating prompt response to all pharmacy benefit related queries & questions
• Participated in internal and customer meetings to clarify requirements, formulate design approaches and confirm that they meet the business needs.
• Extensive experience in analyzing and creating Use Cases, Use Case Diagrams, Data Flow Diagrams, Business Flow Diagrams, Navigational Flow Diagrams, Wireframes and Sequence Diagrams.
• Served as a liaison between business users and IT developers’ team and worked closely with Subject Matter Experts (SMEs) to help in creating Project Requirement Documents (PRDs), Functional Specification Documents (FSD) and use cases.
• Coded and executed SQL queries to validate data loads (counts of rows and sums of key columns).
• Served Healthcare, Pharmacy, Auto/Real estate Insurance, Petrochemical, Retail, Consumer Product and Manufacturing Industries.
• Participated in innovation by learning to identify, presented alternative solutions to solve business needs and articulated the pros and cons of the various approaches.
• Experienced in gathering and documenting business requirements through interviews, seminars and translating guidelines set by Centers for Medicare and Medicaid Services (CMS).
• Strong experience in bug tracking using tracking tools such as Test Director and Quality Center
• Proficient at working as an individual contributor and as a team leader/player.
• Experienced in managing various aspects of the Software Development Lifecycle (SDLC) including requirements gathering, design, development, testing, deployment, UAT and support
• Proficient in M.S Office (Visio, PowerPoint, Excel, Access).
• Involved in project management activities including preparing the timelines, submitting project status reports to senior management.

TECHNICAL SKILLS

AUTOMATED TESTING TOOLS: WinRunner, LoadRunner, Test Director

GUI TOOLS: MS Excel, MS Office, MS Project, Adobe Photoshop

LANGUAGES: C++, MLASP.NET 3.0/3.5, HTML/DHTML

REQUIREMENT MANAGEMENT: Rational Requisite Pro 6.5, Enterprise Architect 10, Caliber RM, Rally

MODELING TOOLS: MS Visio, Rational Rose, Caliber RM

CUSTOMER RELATIONSHIP MANAGEMENT: Microsoft dynamics CRM, Siebel CRM

PROJECT MANAGEMENT TOOLS: MS Project, SharePoint, HP Quality Center

DEFECT TRACKING TOOLS/CHANGE MGT. TOOLS: Rational Clear Quest, Rally, Bugzilla, MS TFS

METHODOLOGIES: Scrum, Agile, Rational Unified Process (RUP), Waterfall Model

DATABASE: Oracle, MS SQL Server, MS Access, MS Excel

PROFESSIONAL EXPERIENCE

Confidential, Blue Bell, PA

Sr. Business Analyst

Responsibilities:

• Analyzed Business Requirement Specifications (BRS) and Functional Requirement Specifications (FRS) to understand business rules of application.
• Created “As-Is Business Models” to understand the existing claim settlement process flow through interacting with SMEs, Underwriters, Actuaries and Finance Department.
• Expertise in Gap Analysis, analysis of Error handling and AS-IS and TO-BE Process flow diagrams.
• Assisted QA team in creating ICD-10 implementation Test plans and Test Scenarios.
• Responsible for getting the sign-offs for BRDs and FRDs.
• Expertise shown in mapping ICD - 9 and ICD - 10 codes for the existing DHHS system.
• Experienced worked in Gap analysis of ICD - 9 and ICD - 10 and analyzed the impacted systems.
• Analyzed associated business rules for providers and Insurance carriers including Medicare and Medicaid.
• Worked extensively with Medicare and Medicaid claims for transactions.
• Responsible for Reconciliation of Data and document the process flow to handle it.
• Conducted HIPAA 4010A1 to 5010 upgrade JAD sessions and documented the outcomes on QNXT and FACETS platforms.
• Experienced in Claims processing, Claims Adjudication, health care EDI transaction between payer and provider, error handling/remediation and data profiling
• Experienced in claims processing, error handling/remediation and data profiling.
• Worked with Healthcare Insurance providers to discuss the third party liability requirements for the Medicaid Management Information System (MMIS) application.
• Experienced in project management with HIPAA, X12 transactions 837I/P, 835, 820, queries, testing and SQL statements.
• Helped in performing Regression Testing to ensure the product integrity and also reviewing Test Specifications, Test cases and performed Manual Testing.
• Analyzed the results, generated reports and tracked the defects using Test Director and Quality Center.

Environment: HTML, XML, LoadRunner, SharePoint, Contact Center, Rational Suite, UML, SQL/PLSQL, SQL Server 2008, Rational tools, MS Visio, MS-Project, MS Word, MS Excel, MS PowerPoint, HP QC, Rational Rose, Axure RP Pro 6.5.

Confidential, Long Beach, CA

Sr. Business Analyst

Responsibilities:

• Worked with stakeholders to understand and document business requirements.
• Worked on gathering and analyzing Business and System Functional Requirements for understanding and translating these needs into Business Requirement Specification (BRS) and System Requirement Specification (SRS) documents.
• Created and managed Use Cases, requirements and created use case stories to capture exact needs and requirements of end users.
• Created site maps followed my content hierarchy in order to get a graphical view of the final product.
• Created Technical and Functional documents to define interface between SIEBEL and ECICS applications.
• Facilitated Joint Application Development (JAD) Sessions and weekly client and team meetings.
• Interacted with the Subject Matter Experts (SME) and stake holders to get a better understanding of client business process and gather business requirements.
• Worked on wireframes for designing the software and blue prints (sitemaps) for designing the final software.
• Responsible for maintaining and updating project documentation and tracking with HP Quality center.
• Conducted User Acceptance Testing to ensure that the system is as per the business and technical requirements.
• Created RTM (Requirement Traceability Matrix) and Managed CRs (Change Requests).

Environment: MS Visio, Rational tools, SharePoint, UML, MS Word, MS Excel, MS PowerPoint, SQL/PLSQL, SQL Server 2005, SIEBEL CRM 7.8, Axure RP Pro and HP (Mercury) Test Director.

Confidential, Dublin, OH

Business Analyst

Responsibilities:

• Worked with operations and IT stake holders to build functional requirement documentation for all systems in scope.
• Led client facilitation meetings to gather Interface and Business Process Requirements from Subject Matter Experts (SME’s).
• Gathered business requirements from SMEs and drafted Business Requirement Documents (BRD).
• Created user stories and use cases for analyzing and gathering requirement for effective project management. Also made sure that all deadlines were met and delivered in time.
• Involved in Business Process Management (BPM) activities like process design, process monitoring and process execution.
• Provided support to the Pharmacy Benefit Management (PBM) Team coordinating responses to benefit related questions and identifies issues of an urgent nature requiring immediate supervisor's attention.
• Served as primary contact for pharmacies relative to benefit related Team Tracks, questions and inquiries.
• Managed requirements with Rational Requisite Pro and crated Traceability Matrix.
• Reported bugs to development team using Mercury Test Director.
• Created and monitored a training strategy and work plan for user acceptance testing (UAT) training and also designed wireframes

Environment: HTML, XML, MS Project, Load Runner, Agile Method, SharePoint, Contact Center, MS Office Suite, Rational Requisite Pro, UML, Microsoft Visio, SQL/PLSQL, SQL Server 2005.

Confidential, Hialeah, FL

Business Analyst

Responsibilities:

• Understand and articulate business requirements from user interviews and then convert requirements into technical specification.
• Derived Functional Requirement Specifications (FRS) based on User Requirement Specification (URS).
• Analyzed business requirement and segregated them into high level and low level Use Cases, Activity and Sequence using Rational Rose according to UML methodology.
• Implemented RUP and followed iterative process for Use Case driven processes of requirement documentation and their deployment and also created a Traceability Matrix.
• Verified the Business Scenarios on new builds to allow extended testing by QA team.

Environment: MS Visio/Word/Project/Excel, SharePoint, MS PowerPoint, HP Quality Center, Rational Rose, Axure RP Pro.

Confidential

Business Analyst

Responsibilities:

• Worked with Team leaders, identified and analyzed the given information, procedures and decision flows.
• Evaluated existing procedure and methods.
• Worked on MS Word and MS Visio for analyzing, managing and documenting requirements.
• Analyzed and collected business requirements, identified system interfaces and created the Required Specification Documents.
• Prepared Process Flow diagrams, Activity diagrams and Use Case diagrams using MS Visio.
• Analyzed requirement document by identify ambiguous, incomplete & incorrect requirements
• Helped in developing attribute matrix and functionality Traceability Matrix.
• Followed PMI standards throughout the project life cycle.

Environment: MS Visio, MS Project, UML, Rational Requisite Pro, SQL, Oracle, Java and MS Office Suite