SUMMARY

• Business Analyst with over 6+ years of experience and comprehensive knowledge of the Healthcare domain. Specific experience in Care Management Software, Claims Processing system and data warehousing. Experience in healthcare data collection, data analysis and reporting to procure data from database structures to provide solutions to client requests.
• Strong experience in Project Management, gathering detailed business requirements and creating BRDs and FSDs.
• Possess a deep knowledge of CPT and HCPCS codes and Modifiers and also skilled in designing Business Process Diagrams like Activity diagrams, Data Flow diagrams and Use - Case diagrams using MS Visio and Rational Rose. Analyzed requirements and created Requirement Traceability Matrix using Rational Requisite Pro.
• Heavily involved in various stages of SDLC and familiar with methodologies such as Waterfall and Agile.
• Experienced in conducting requirement gathering sessions like Feasibility studies, Cost-Benefit analysis, GAP and Impact Analysis in organizing the software requirements in a structured environment
• Drafted Requirements Traceability Matrix (RTM) to check the project requirements and to track the documentation and project tasks
• Appraised the AS-IS and TO-BE business processes (GAP analysis) and experienced in converting these requirements into technical specifications for preparing Test plans.
• Experience in conducting Joint Application Development (JAD) sessions and Discovery Workshops for requirements gathering, analysis and design
• Worked on Agile Scrum/Hybrid environment and Waterfall.
• Experienced in creating UML diagrams like Activity, Use case and Sequence diagrams using tools such as Rational Rose and Microsoft Visio
• Experience in Care Management Software, Personalized Care Plans and Referral Management
• Vast experience in dealing with the Claim Processing System adhering to HIPAA compliance, NCCI and CMS guidelines.
• Good understanding of Medicare lines of business; Medicare Advantage Plans, Special Needs Plans
• Well versed with HIPAA, Claim Adjustments, Claim Processing from point of entry to finalizing, claim review, identifying claims processing problems, their source and providing corresponding solutions
• In depth knowledge of ICD-9-CM, ICD-10-CM/PCS structures
• Abstracting medical records with ICD 9, CPT and DRG coding
• Experienced with CPT, HCPCS and Modifier coding
• Knowledge of rules and regulations of HIPAA as imposed during Electronic Data Interchange (EDI) in 4010 and 5010 formats like 837 - Claims and Encounters.
• Excellent knowledge of Health Insurance Portability and Accountability Act (HIPAA) transaction and code set rules such as EDI 837, 270, 271, 276, 277, 834, 835.
• Experienced in Data Warehousing and ETL (Extraction, Transformation and loading) process using different tools such as SSIS and Clover ETL
• Experienced in Data Modeling with good exposure to identify data formats, attributes, dependencies, etc.
• Experience in Reporting Tools like SSRS, Crystal Reports, Zoho Reports and Business Objects
• Proficient knowledge of Data Marts, Operational Data Store (ODS), Star Schema Modeling, Snow-Flake Modeling for Fact and Dimensions
• Familiar with the concepts of project management according to PMBOK and Project Management Lifecycle

TECHNICAL SKILLS

Operating Systems: Windows 98/2000/XP/Vista/7/8

Methodologies: Rational Unified Process (RUP), Agile (SCRUM), Waterfall

Software and Tools: Microsoft Office Suite, Rational Suite, MS Project, MS Visio, JIRA, Rally

Testing Tools: Mercury Quality Center 9.0, HP Quick Test Pro

Database Tools: SQL Server, MS Access

Requirement Gathering tools: Rational Requisite Pro

Reporting Tools: Crystal Reports, Cognos, SSRS

PROFESSIONAL EXPERIENCE

Confidential, Long Beach, CA

Business Process Analyst

Responsibilities:

• Implemented the entire Waterfall methodology of application development with its various workflows, artifacts and activities.
• Held regular JAD sessions with the system architects, developers, database administrators, quality testers during the entire project to assure that the critical as well as the minute details of the project were discussed in order to resolve issues beforehand.
• Led and facilitated daily conference calls with business users, to define end to end business process and depicted the information on flowcharts, workflows and Process documents.
• Implemented GAP analysis to understand the current System, plan a proposed system and did an impact analysis on the proposed systems.
• Documented business and functional requirements and translated them into system requirements using modeling tools, such as requirements documentation templates, use-case analysis, and workflow analysis
• Analyzed and documented existing application processes and workflows using MS Visio to identify processes that required change.
• Analyzed application User Interfaces to determine required updates necessary to fulfill project UI requirements.
• Created the core project Business Requirements Documents (BRD) utilizing Blueprint identifying the project dependencies, constraints and risks.
• Created the core project Functional Requirement Documents (FRD) documenting the high level technical solution, including impacted applications and data fields.
• Identified and established User entitlements impacted by requirements.
• Created and Managed Requirements and Requirements Traceability Matrix (RTM) in Rational Requisite Pro
• Lead coordination of UAT regression testing and wrote test scripts and monitored user testing to ensure end to end testing of future enhancements are functioning as designed

Confidential, Downtown Los Angeles

Sr. Business Analyst

Responsibilities:

• Worked in a Waterfall project delivery environment facilitating Requirement Gathering from business, Requirement Analysis, Functional Point Analysis, Client Interaction, Work Allocation to the team members
• Collected and analyzed the project's business requirements by organizing JAD Sessions, Story boarding workshops and one-one interactions and transferred the same knowledge to the development team
• Interviewed the stakeholders and project sponsors for mapping requirements and analyzing structured & normalized data sets
• Worked as a sole BA on the project and collaborated with the QA team and development team to give them a detailed understanding of the processes.
• Responsible for Providing high level strategic, analytical direction and vision
• Applied proven planning skills to IT improvement and transformation projects, including value proposition, problems, pitfalls, and payback
• Led the database teams to help them transform the data from flat files, excel sheets, pdfs and other databases using ETL (Extract Transform Load) techniques
• Coordinated technology and business issues as well as communicated appropriately with both technology and business experts
• Facilitated requirements prioritization based on business value
• Responsible for creating UI mockups using Visio and azure, wire frames, workflows, use case diagrams, flowcharts, and other analysis-type documentation
• Developed and reviewed test strategy and test plans, and testing activities necessary to assess the quality and completion of system implementations
• Performed Data Analysis and Data validation by writing complex SQL queries
• Provided analytical data to enable management to make informed decisions to drive continuous revenue cycle improvements by realizing gains in operational efficiency, cost savings and member experience
• Owning and managing requirements traceability matrix (RTM), gap analysis and change impact to enable business processes
• Documented STM (Source to Target Mapping) document for detailing data mappings, data transformation logic and business rules.
• Identified various Key Performance Indicators (KPI) for daily, weekly and monthly reporting
• Worked closely with the design, test and product teams to produce quality solutions
• Created, implemented and maintained business dashboard to conduct trend analysis on corporate metrics including detailed drilldowns for every department.

Confidential, Tampa, FL

Business Analyst/Data Analyst

Responsibilities:

• Assisted Project Manager in creating project charter, project plan using Hybrid/Agile methodology for SDLC
• Analyze system needs and integrated requirements to develop a consistent navigation structure
• Created Business & Functional Requirement Document (BRD) and (FRD) and Physical and Logical Data models
• Tracked the requirements and created a Parent-Child relationship and created traceability using Rational Requisite Pro
• Participated in formal Sprint Planning and Review meetings with project teams
• Prepared various UML diagrams like Activity, Use case and Sequence diagrams using tools such as Rational Rose and Microsoft Visio
• Facilitated the resolution of project-related issues, identified risks
• Maintained Salesforce system support and update functions
• Handled Salesforce Help Desk requests
• Worked on Salesforce.com Production, Test and Development environments for various clients.
• Familiar with SFDC MVC architecture, Salesforce.com Sales cloud, Service cloud, Data cloud functionalities.
• Worked on SQL queries in data extraction from Salesforce
• Applied the SQL scripts to the test database and execution of the scripts on the database
• Followed the UML based methods using Rational Rose to create Use case diagrams, Activity diagrams, Sequence diagrams that include functional and non-functional specifications to hand off to development teams
• Worked on deriving the test cases from the Use case
• Created Test Plans, Test strategies and Test cases by interacting with the other Quality Analyst members
• Performed Defect tracking using Rational Clear Quest
• Worked with QA team to test the data quality by writing SQL queries and perform UAT, conducted root cause analysis for UAT environment
• Assisted Project manager to manage the various updates and controlling to ensure on time delivery using MS Project

Confidential, Phoenix, AZ

Business Analyst

Responsibilities:

• Acted as a liaison between business staff and technical staff to articulate needs, issues and concerns.
• Analyzed User Requirement Document, Business Requirement Document (BRD), Technical Requirement Specification and Functional Requirement Specification (FRS).
• Conducted GAP Analysis, SWOT Analysis, Cost Benefit Analysis, Risk Analysis and Impact Analysis.
• Gathered Requirements and documented the proposed additional extension to the existing website
• Facilitated Joint Application Development (JAD) sessions with the Management, HIPAA team and Mainframe team to make sure everyone are in sync with the business requirement processes.
• Collaborated with the stake holders for issue tracking and discussions on the requirements.
• Created Workflow diagrams using Unified Modelling Language (UML), Wireframes and Mock-ups for Prototypes.
• Partnered with the QA teams for test case scenario reviews and sign off.
• Monitored data integrity, modify and maintain databases, as appropriate. Performed data exploration, integration, and retrieval from multi-sourced databases. Developed standardized and ad hoc reports by using internal and external data to profile financial performance
• Schedule and conduct meetings with Client for Requirements gathering, Initial assessment/work estimation.
• Identified and documented data sources needed to fetch and populate required data fields.
• Created data dictionaries for capturing customer information in the required forms
• Worked with the Web team to improve their Interface and facilitated their Annual changes.
• Created Systems specific documents and use cases for the Business requirement documents
• Created wireframes and mockups for the web interface and discussed with UI designer to develop the prototypes for the website.
• Created Requirements document' (System Requirements Specification document) of arte facts produced by Functional Analyst, UI Designer and all Stakeholders.
• Wrote business process flows with user scenarios description (high level sequence diagrams and activity diagrams)
• Reviewed Use Cases and artefacts created by Functional Analysts and consistently provided high quality feedback and support rework/change if required