SUMMARY

• Over 6 years of experience in identifying the user requirements Functional and Non-Functional, capturing AS IS and TO BE business processes.
• Proficient in creating BRD Business Requirement Document , FRD Functional Requirement Document , PDD Project/ Product Definition Document , SRS System Requirement Specification , Requirement Traceability Matrix RTM , and Change Management Documents.
• Experience in constructing Application Architecture Work Objects System Application Flow, User Interface Validations, and System Interface Validations.
• Created Business Processes, Reports, Screen Layouts, Wireframes, and Prototypes.
• Strong knowledge of the Software Development Life Cycle SDLC and software methodologies like Waterfall, Agile, Scrum, and Rational Unified Process RUP .
• Proficient in analyzing and creating Use Cases and Use Case Diagrams, Activity diagrams, Class diagrams and Sequence diagrams, Business Processes, Business workflow Diagrams, and Data Flow Diagrams.
• Extensive experience on project management tools, processes methodologies.
• Competent in conducting Joint Requirement Planning JRP sessions, Joint Application Development JAD sessions with a committee of Subject Matter Experts SME's senior management and IT groups
• Expertise in Data Migration and Conversion and analyze data from multiple source systems.
• Adept in creating and reviewing the Test Procedures, Test cases, and Test scripts.
• Identified defects and coordinated with team members to fix the errors.
• Conversant in Manual testing Graphical User Interface GUI Testing, Field Validation Testing, and Functionality Testing of User Interface UI and Web Applications, Functional testing, Navigational testing, web services testing XML and WSDL files , back-end testing and User Acceptance Testing UAT .
• Supported the end user by documenting the user guides and training materials.
• Experience in conducting GAP analysis, ROI analysis, SWOT analysis and, Cost benefit analysis

TECHNICAL SKILLS

PROESSIONAL EXPERIENCE

Confidential

Sr. Business Analyst

Confidential is one of the nation's leading health care providers, offering a seamless array of acute, primary, tertiary, quaternary and preventive care backed by excellence in research and education. The main deliverable of this assignment was to develop an integrated solution to provide quality health care, optimized process flows, and increased patient flows to the clinic and providing exceptional and consistent patient experiences across all services provided. Worked on HIPAA Claims Processing HIPAA 837 Billing Payment Transactions . Worked with trading partners and automated the process of the payments. Responsibilities: Interacted closely with the Business users along with the administration and management to gather business requirements and analyze the functionalities to be incorporated into the system Worked on HIPAA 5010 transaction requirements and analyzed and tested HIPAA formats Analyzed processes in medical coding and transition from ICD 9 TO ICD 10 Worked with BA and UAT tasks involving FACETS application and claims processing Attended demo sessions to understand existing system functionalities Arranged interviews with all the stakeholders to review and understand the gathered business requirements Performing Impact analysis for readiness of ICD 10 conversion. Document system functionality through artifacts including use cases, use diagrams and process charts Set up JAD sessions with project manager and stake holders for a detailed analyses and better understanding of the impact in projects Developed current and future business processes and use case documents in compliance with HIPAA policies and procedures using MS Visio Worked with EMR and helped in developing professional as well as hospital claim and their solutions Performed criteria table updates to determine the billing needs send to the insurance companies using MS access tables as a tool Tested HIPAA EDI Transactions 837/835 using Claredi The system process flows were streamlined and process efficiency increased by 50 The EMR system which was built in to the process was in full effect throughout all the functionalities performed AS400: Trained in functions of Order Management, Accounting, Customer Information Management, and Interfacing The new billing system application reduced medical errors and performed more efficiently Coordinated with system architects and developers to convert business requirements into system requirements Conducted meetings to document Change Requests for new requirements Prepared the project status reports and represented the BA team in the PMO meetings Working with the business and various technology departments, and acting as a liaison between the underwriters and application developers to provide production support for the National Pricing Solution web based application Interacting with National Pricing Staff Underwriting, Actuarial Sales/AM on daily basis with regards to how the NPS application functions, troubleshooting incidents/issues for Users and completing defect and enhancement requests on daily basis Performing system administrator duties i.e. adding/removing users to system Extracting data from databases and preparing reports for auditing/SOX compliance purposes Traveling throughout regional offices to provide support and training to end users as an SME Subject Matter Expert in Claims processing management, mentored trained entry levels

Confidential

Business System Analyst

This project is for enhancing portal build for automated reporting. Information Management system has direct interface with the hospital management. The claims and insurance details are processed at the health care facility for preferred insurance company and providing them in EHS - Environmental health and safety system. Project is implemented in accordance with the HIPAA guidelines in Facets platform.

Responsibilities:

Implemented business optimization projects that reduced the cost, improved efficiency and quality. Involved in monthly business reviews with the program/project managers and management teams. Involved in tracking business goals, performance and status across the projects. Developed Business Requirement Documents BRD and Functional Requirements Document resulting from JAD sessions and translated requirements to development teams. Developed Implementation Plan. Having cross functional review where in required for setup. Participated in ICD9 to ICD 10 codes mapping sessions. Designed Use Cases, Use Case diagrams, Sequence diagrams in UML methodology using MS Visio. Well versed with HIPAA, Facets System, claim adjustments, claim processing from point of entry to finalizing, claim review, identifying claims processing problems, their source and providing corresponding solutions. Tracked Business requirement traceability matrix RTM Assisted the QA team, by testing web applications using Quality Center. Defined Functional Test Cases, documented, Executed test script in Facets system. Maintained a good working relationship with departments such as, Research, Clinical Trial, and Regulatory departments and often communicated with them and provided technical support throughout the product development. Worked with the management for improving and giving new ideas for designing future processes of the HIPPA transactions dealing out with EDI'S 271, 276 and 270, 470, 835, 837, 834, HIPAA 4010, 5010, claim adjustments, claim processing from point of entry to finalizing, claim review, identifying claims processing problems, their source and providing alternative solutions using best practice model and principles and also well versed with ICD10, Facets Liaised and Coordinated in resolving EDI mapping issues arising from the third party systems. Customized an off the shelf supplemental Billing software that generated HIPAA compliant claims. Design specifications and Test Case usages for the HIPAA 837, 270/271, 276/277, 835, 824, 275 and others. Responsible for updating monthly status to the Project Manager.

Environment: UML, Facets, MS Visio, MS Office, MS SharePoint

Confidential

Business Analyst

Confidential provides customers with expertise, benefits, and services that seek to improve their well-being. My role as a Business Analyst comprised developing fully automated, real-time claims processing system for complete, on-line mediation of medical, dental, vision, and disability claims Confidential guidelines. The system allowed the efficient and timely management of all relevant data- clinical, financial, and administrative throughout the organization enabling the sharing of information between subsystems. Responsibilities: Analyzed Business Requirements, developing tracking and enhancing them into functional requirements using Rational Requisite Pro as a requirements tool. User Acceptance Testing UAT - Carried out UAT activities associated with each project and presented the results to the Business Stakeholders. Worked on HIPAA transaction codes specifically on EDI 837, 835 and 834 to incorporate enhancements to existing efforts on capturing and mapping, member enrollment and eligibility and contribution data respectively received at the Plan level from the State. Documented the meeting minutes from the JAD's and stored the artifacts in the appropriate place holders in PDS and SharePoint for both the teams to review. Worked in GAP analysis to understand the difference between both the billing systems and documented the GAPs in GAP analysis spreadsheet. Used UML and RUP best practice methodologies along with supporting toolset including Mercury Test Director, Caliber RM and StarTeam for overall development framework Documented the business requirements into functional requirements document. Gathered the requirements and transformed them into high-level Process-Flow Diagram using PowerPoint. Created a task plan for the team identifying the key deliverables and the respective deadlines. Created the ETL requirements to load the data into TeraData. Analyzed the business requirement as per the HIPAA rules and regulations. Involved in preparing Test Plans based on User Requirements Document URD and prepared the Test Cases using Test Director/HP Quality Center. Created mapping/crosswalk documents for mapping data flow between systems.

Environment: Windows XP Professional, Mercury Test Director, Oracle, MS Access 2000, MS Excel, RUP, Oracle, UML, Rational Rose, Requisite Pro, TOAD, Rational Clear Quest 2002, MS Office suite, MS Visio, Informatica.