PROFESSIONAL SUMMARY

• Business Analyst with excellent communication skills with around 8 years of hands-on experience primarily in Healthcare Industry.
• A hard-working team player with extensive knowledge of Unified Modeling Language UML , Software Development Life Cycle SDLC , Object Oriented Analysis and Design OOAD , Business Process Re-engineering BPR , Testing Lifecycle, Data Modeling, Service Oriented Architecture SOA , GAP analysis, risk analysis, cost-benefit analysis, conducting Joint Application Development Sessions JAD and various methodologies including Waterfall, Agile and SCRUM, Prototyping and Rational Unified Process RUP .
• Adept in various tools including Rational Rose, Rational Requisite Pro, Rational Clear Quest, MS Visio, MS Project.
• Extensive Scrum and Agile experience, user Stories including blending Agile practices with existing processes as well as gaining executive and organizational support for transitions to Agile practices
• Skillfully documented Business Requirements, Use Case Specification, Functional and Non-Functional specification, UML diagrams including Use Case diagram, Activity diagram, Class diagram, Sequence diagram, Data Flow diagram DFD , Entity-Relationship diagram ERD , Requirement Traceability Matrix RTM , Change-Version Control, Training and User Manuals.
• Good conceptual understanding of Data Warehousing. Proven experience in complete project life cycle - Design, Development, Maintenance and Documentation of Enterprise Data Warehouse, Data Marts, and Operational Data Stores ODS
• Experience with HIPAA ANSI X12 4010/5010 transaction sets: 270/271, 276/277, 820, 834, 835, 837 Professional Institutional claims
• Worked on Agile methodology in almost all the projects
• Extensive knowledge of HMO Medical Management Information Systems MMIS , Health Insurance Portability and Accountability Act HIPAA standards, Electronic Data Interchange EDI and implementation of HIPAA code sets, ICD-9, ICD-10 and HL7.
• Extensive knowledge of Pharmacy Benefit Management PBM working environment and Medicaid and Medicare Part A,B,C,D including processing Retail pharmacy claims, FACETS, Direct claims and Mail-Order Pharmacy claims. Also, extensive knowledge of PBM's Drug Management Lists DML .
• Experience in White Box, Black Box, Functional Integration Testing.
• Working experience with PL/SQL, SQL, HTML and MS Access.

TECHNICAL SKILLS

PROFESSIONAL EXPERIENCE

Confidential

Role: Business Data Analyst

The Investment Management Information System IMIS , an Oracle-based Data warehouse system with a front-end reporting tool OBIEE for investment reconciliation, reporting and analysis of a number of different assets mortgages, real estate, agriculture, policy loans, fixed maturities, etc. . The main goal of this project is to consolidate all assets into a single system for accounting and reporting which is easy to load and reconcile, contains all asset detail at the same level, and will serve as the source for accurate and flexible reporting for all users within the Investment Accounting Group.

Responsibilities:

• Worked with the core team to gather business requirements from multiple stakeholders, accounting, operations and management groups - and reconciled conflicts by conducting Joint Application Development JAD sessions based on the project scope.
• Analyzed Business Requirements and segregated them into high and low level Use Cases and Activity Diagrams using MS Visio.
• Performed GAP analysis involving the current state and proposed state.
• Worked closely with other BAs and ETL Leads/Managers and was responsible to perform detailed data requirements analysis and create design specifications and operational documentation.
• Provided the ETL team with the Data mapping document and assisted them to create the mappings.
• Worked closely with the architects, database administrators and technical team during Data Mapping and Data Integration
• Involved with Analysis of reference data from Accounting Systems and Investment Accounting Groups.
• Analyzed and presented the Business with information on data anomalies, issues, input errors, field value ranges, data patterns, referential integrity gaps and the level of record incompleteness that is in the source systems.
• Organized meetings with the SMEs and Data Owners to walk through the findings and determine the cleansing process.
• Participated in various sessions with Business to understand the business rules and to come up with naming conventions to standardize the data.
• Played a key role in the user acceptance testing UAT , and implementation of system.
• Extensively used SQL scripts/queries for data verification and Validation at the backend.

Confidential

Role: Scrum BA / Agile Coach

Confidential is a leading pharmacy benefit manager PBM , with the nation's largest mail order pharmacy operations. Through advanced pharmacy, Confidential improves the health and lowers the total cost of care for clients and their members. Working directly with drug manufacturers and a nationwide network of retail pharmacies, Confidential provides flexible options backed by quality customer service.The project involved Modifying the Point of Sale application to ensure the removal of special drugs from being dispensed from pure play pharmacies and all retail pharmacies depending on the clients and the list of drugs.The Project was meant to allow AWP pricing for one client and a different price basis for another client, decided to Create a Pricing rule station within the existing application that would efficiently allow alternate methods of claims pricing based on client and NDC set-ups combined. The new system additions would allow client set ups to designate pricing options at the appropriate client level and would allow pricing options support varied pricing by service channel, drug type, and specific drug list.

Responsibilities: -

• Developed detailed work flow document and Process flow diagrams.
• Interacted with cross-functional teams for collection of detailed business requirements.
• Analyzed Business Requirements and segregated them into high and low level Use Cases, Activity Diagrams and Sequence Diagrams using MS Visio.
• Gathered user requirements by interviewing focus groups and brainstorming with SMEs, Business users and Product owners. Created targeted questionnaires for SMEs to refine requirements and translated into business rules
• Ensured that functional team understands requirements to implement the Pure Play Optimization Rules Station.
• Reviewed and revised a comprehensive list of Retail and Pure play Pharmacies, to include them in the rules Station, with the help of the SME.
• Worked in coordination with the Legal standards department to incorporate mandatory and specific State laws, related to sale and distribution of Specialty drugs, in to the Rules Station.
• Conducted Gap Analysis to determine ways that allow AWP pricing for one client and a different price basis for another client.
• Conducted Business process study to establish link between BA front-end tool, File Management review/approval process, and creation of back-end rules in Average Manufacturing Pricing System.
• Worked on their software product development methodology and implemented RUP Rational Unified Process .
• Used AGILE methodology and worked in short SPRINTS to achieve goals.
• Participated in SCRUMS and discussed the open issues and statues.
• Participated in Agile Planning Sessions and assumed the Product Owner role for the agile initiative.
• Developed the Epics and Themes for the Scrum Project
• Devised and prioritized the Product Backlog by conducting requirement churning sessions with various Business / Product Teams.
• Created and explained the User Stories to the Scrum Team and helped them design the Tasks.
• Designed acceptance criteria for validating the output of each Sprint.
• Reviewed Team Velocity on a frequent basis and advised Scrum Master at various stages.
• Participated in Sprint Planning and Sprint review meetings for Finalizing the Sprint Backlogs and Verifying the sprint outputs respectively
• Created Release Tracking Document in order to track the necessary changes.
• Participated in Business Demonstrations and Decisions for the Release of the Sprint Output to Production.

Confidential

Role: Business Systems Analyst

The project involved development and update to the current electronic transaction application and Forms from current ICD9 version to the new updated ICD10 version. The goal of the project was to develop the application as per HIPAA 5010 standard and to support ICD10 update to enable UHG to add, manage and terminate members via multiple channels, specifically paper, web, EDI, and phone. The project also involved working with a third-party vendor to develop the enrolment engine as per EDI standard.

Responsibilities:

• Conducted JAD sessions to gather and document business requirements
• Translated business requirements BRD to technical staff to ensure the requirements are incorporated into system design by preparing following documents: Functional Document Specifications FDS and System Requirement Inventory SRI
• Identify Member, Provider, Coverage, Medicare, and Medicaid
• Firsthand knowledge of HIPAA claims processing.
• Responsible for resolving and/or driving the resolution to issues and risks through evaluation of differing opinions to negotiate resolution and priority.
• Developed Activity Diagrams, Use Case Diagrams, and Workflow Diagrams using Microsoft Visio.
• Provided support during Integration testing and UAT
• Reviewed and executed feature test cases and ensured that feature testing validated the business technical requirements for system implementation
• Involved in HIPAA/ EDI Medical Claim analysis, design, implementation and documentation.
• Participated in ICD 9 to ICD 10 codes mapping sessions as well as statusmeetings and provided comments and suggestions on challenges faced with the outsourced medical coding partner company
• Worked on the knowledge of HIPAA and EDI 837, 835, 997.
• Maintained documents on SharePoint to facilitate seamless interaction with multiple teams with different document repositories.
• Interfaced between users and diverse teams and was involved in application development to enhance understanding of business and IT processes.
• Hands on experience in all facets of User Acceptance Test: UAT scheduling, walkthrough sessions, UAT test plan and cases, creating data set, user manual, rollout plan, release note, smoke test etc
• Worked with team to stay abreast with new process and render it more effective.
• Succeeded in creating alternate strategies to ensure development was completed as required.
• Maintained proper communication with the developers ensuring that the modifications and requirements were addressed and also monitored these revisions.

Confidential

Role: Business Analyst

Confidential new web portal system PEP, LTSS Long Term service and support Provider enrollment, automating validation for claims/encounters, PCCM Enhancements, CMS interfaces and Medicaid Advantage Testing.

Responsibilities:

• Implemented SDLC from requirement analysis through deployment, using RUP Methodology.
• Conducted JAD sessions to allow different stakeholders to communicate their perspective with each other, resolve any issues and come to an agreement quickly.
• Interacted with business users of Facets claim processing system and gathered the gaps faced by them in the existing applications.
• Working on Medicaid and Medicare for clients.
• Documented Software Requirements Specifications SRS , Use case documents and System Design Documents and communicated them with IT teams.
• Involved in requirements gathering and preparing the technical system design and System Design analysis of the flow of EDI transaction sets 835, 837,997.
• Created Work Package, Development Case and Sign off Requests.
• Managed system requirements and requirements traceability matrix RTM , and Scenarios using Requisite Pro.
• Created mapping documents and technical analysis on Paper Claims, Medicaid Claims
• Used Rational Software Architect to carry out business modeling and created use case diagrams, and activity diagrams, worked on change management process.
• Implemented the HIPAA privacy and Security regulations to enhance the capabilities of the systems to process new products
• Involved in writing of SQL queries in SQL Navigator and performed data analysis on gathered data.
• Reported defects via the HP Quality Center tool to the developer.
• Supported business during UAT testing to research issues with the new functionality and log defects.
• Well versed with HIPAA, claims adjustments, claims processing from point of entry to finalizing, claim review, identify claims processing problems, their source and providing alternative solutions using best practice model and Principles.

Role: Business Analyst

Assurant solution is one of the leading providers of health insurance services. The ADA Ramp up project is to implement a centralized billing system that maximizes automation. The Web system performs all the functions of billing process such as billing customers, updating accounts receivable and getting transaction summary.

Responsibilities:

• Waterfall SDLC methodology was followed throughout software development cycle.
• Coordination with onsite, offsite and offshore teams during the project implementation period for development and testing activities.
• Coordinated extensive JAD sessions with Design, Development, DBA's and SME's to tree down the business requirements into Functional requirements Technical .
• Performed GAP analysis and analyzed system effectiveness in meeting the requirement.
• Extensive Requirement illustration and documentation was performed and any changes were controlled by Change control board CCB .
• Worked with FACETS Team for HIPAA Claims Validation and Verification Process Pre-Adjudication .
• Worked intensively on FACETS for audit trails made on the used account and check and store information related to the HIPPA authorizations.
• Worked with FACETS to port the system from and check the system responds equally fast and also is complying with the standards of the institution all the time.
• Developed Use Case Models, Activity Flow, Business process flow, Sequence and well documented for future reference
• Implemented Claims adjudication module facets online with EMR/EHR in compliance with HIPPA approved transactions such as claim filing 837 , Claim Remittance 835 , and Health plan Eligibility 270/271 .
• Involved in daily scrum meetings and implemented Agile methodology
• Executed various SQL queries to perform data validation and check data integrity.
• Assisted QA team in creating Test plans, Test Scenario and Test Cases for smoke, Functional, system integration and regression testing.
• Conducted UAT testing with the Business end-users and Developed Training Manuel/Guide for performing claim remittance 835 , claim status 276/277 , and health Plan eligibility 270/271 transactions.
• Defect process management was performed with QA and Developers to resolve defects.

Confidential

Role: Jr. Business Analyst /

Confidential is one of the nation's leading diversified health care benefits companies, serving approximately 36.1 million people with information and resources to help them make better informed decisions about their health care. Project Project was a web-enabled application and it involved developing an online Health Insurance Medicare application which allows customers to apply for it, check the status of their application, calculates an estimate of the payments as per the customer's credit history. Provides the users with secure access and helps to increase the efficiency and the quality of services provided by the company during developing web application. Responsibilities

• Interfaced between Business Users and the different teams involved in the application development for better understanding of the business and IT processes.
• Conducted JAD sessions for requirement gathering, and analysis.
• Conducted GAP Analysis and formulated the TO-BE features based on the business requirements.
• Responsible for the delivery of Business Requirements Documents BRD and Functional Requirements Documents FRD .
• Analyzed system requirements and created Use Case Diagrams, Activity Diagrams using Rational Rose.
• Responsible for continuous process improvement and for identifying and maintaining a clear and measurable Development Process that is deployable throughout the enterprise.
• Created scenarios for User Acceptance Testing and conducted UAT.
• Involved in documenting defects and responding to IT in defect clarifications and resolution.
• Designed and implemented test scenarios for the application.
• Extensively used SQL scripts/queries for data verification and validation.
• Gathered user requirements and directed developers for practical deliverables.
• Worked with the full SDLC, elicit, analyze and define requirements.
• Conducted JAD sessions with the clients to identify the requirements.
• Worked with the software architects / developers to ensure that the applications conform to customer requirements.
• Used Rational Unified Process RUP for streamlining the team's development activities.
• Followed the UML based methods using Rational Rose to create: Use Cases, Activity Diagrams/State Chart Diagrams, Sequence Diagrams, and Collaboration Diagrams.
• Participated Testing and Evaluation of projects at established integration points to assess progress and identify key functionality issues.
• Tracked UAT issues/bugs and prepared reports.