Summary:

An accomplished Business Analyst skilled in achieving efficiency and increasing revenue in the health care industry. Experienced in gathering user requirements and converting them into system specifications throughout the software development life cycle projects.Business process improvement and data analysis expert.Exceptional analytical, planning and implementation capabilities.

• Over 8 years of experience working as a Business Analyst on multiple domains like insurance, pharmaceutical and healthcare industries.
• Extensive experience working on various phases in the Software development lifecycle SDLC of the project.
• Highly skilled and experienced in utilizing Agile methodologies in SDLC, including Scrum and RUP.
• Worked on various service oriented, client/server and web based applications.
• Extensive knowledge and experience in the Health Insurance and HealthCare industry including expertise in Medicaid, Medicaid Information Technology Architecture, Medicare Part A, B, C, D , Procedural and Diagnostic codes, Claims Process and Medicaid Management Information Systems MMIS ,ACO, PPO, HMO.
• In-depth understanding of Project Management Practices and Principles including Time Management, Budget Management, Resource Management, Risk Management and Change Management.
• Excellent knowledge of HIPAA Health Insurance Portability and Accountability Act transaction codes such as 270/271 inquire/response health care benefits , 276/277 claim status , 835 payment or remittance advice , 837 I, P, D health care claim and 834 benefit enrollment .
• Experience with HIPAA 4010 and 5010 health care transactions, and transition from ICD-9 to ICD-10 codes.
• Strong knowledge of HL7, HIE Health Insurance Exchange , EMR/EHR, Health Care Reform and Patient Protection and Affordable Care Act PPACA and Facets.
• Experience with HEDIS Healthcare Effectiveness Data and Information Set for benchmarking managed care effectiveness and evaluating provider payer relationships.
• Excellent analytical skills to understand the business process functionality and transform business requirements document BRD into software requirement specification SRS and designing business models using use case model, analysis model, activity diagrams, sequence diagrams in Rational Rose and MS Visio.
• Extensive experience in creating As-Is and To-Be process models, conducting Gap Analysis to understand areas of improvement and analyzing the risks involved through SWOT, Value Stream Mapping, Cost-Benefit Analysis, Decision Tree analysis and Fish-Bone analysis.
• Experience in leading successful JAD session for performing gap analysis, deriving functional/non-functional requirements and document decisions on the future state of the systems and processes
• Excellent knowledge of Business Process Modeling and Process Re-engineering.
• Hands-on experience with process modeling using Unified Modeling Language UML including Use-Case diagrams, Sequence diagrams, Collaboration diagrams, Activity diagrams and Class diagrams.
• Strong experience in conducting User Acceptance Testing UAT and reviewing Test Procedures and creating Test Cases. Manual testing of GUI, Field Validation Client-side, Server-side and database
• Highly experienced in tracing requirements throughout the development process and verifying adherence to Requirement Traceability Matrix RTM .
• Comprehensive experience and knowledge in using Data Modeling and Business Intelligence tools OBIEE, IBM Cognos, SAS 9.2, TABLEAU DESKTOP 8.2, MS Visio, UML, SQL SSRS, SSIS, SSAS , and Data Warehousing.
• Extensive experience in using ALM tools MSSharePoint2007, SharePoint 2010, SharePoint 2013, and Rational Suite .
• Ability to organize, document and track changes and defects using tools like MS Project, Rational Clear Quest and archive change request in Clear Case.
• Experience working with business users, SME's, offshore teams and senior management.
• Sound and confident decision making capabilities coupled with impeccable communication and interpersonal skills.
• Belief in team work, dedication, and professional ethics within the working environment.

Technical Skills

Professional Experience

Confidential is a leading provider of diagnostic imaging products and medical informatics solutions. The Synapse RIS Radiology Information System offers the advantages of Teleradiology to physicians from a single platform solution. Orders can be generated from a DICOM image as well as from HL7 or through web-based remote order entry. The captured patient data is to be utilized effectively and efficiently with the help of data warehousing and business intelligence. The project team is to utilize ETL to extract, transform, load and integrate the data with multiple servers.

Roles and Responsibilities:

• Actively Involved in understanding the As-Is Current State of project with SME Subject Matter Experts , and dev team.
• Conducted interviews with the Business Owners BO to understand the To-Be Future state process. Conducted Gap Analysis by conducting several JAD Sessions with business users, system architects and development teams to identify potential opportunities of improvement and recommended them to the BO.
• Created BRD andgenerated a unique WBS for the project by incorporating principles of Waterfall for project planning and requirement gathering phases as well as Agile Scrum Framework during design, development and test phases
• Analyzed the risks involved in standardizing the data processing system through SWOT and Cost-Benefit Analysis in Microsoft Office Environment.
• Acted as a Scrum Master, documented sprint backlogs, organized and conducted sprint planning sessions, daily scrum meetings. Created sprint burn down charts and release backlogs for effective Project Management.
• Conducted Feasibility Analysis and Product backlog planning with the Product Manager and PM team and helped create the Product backlog with help of user stories collected through requirements gathering and gap analysis.
• Utilized SharePoint 2013 as an administrator for document management, version control and creating team dashboards on the team site.
• Conducted workshops to understand requirements for Data Warehouse design. Conducted client side validation to study ETL Extract Transform and Load operations on database.
• Integrated thePicture Archiving and Communicating system PACSs with heterogeneous information systems like hospital information system HIS and radiologic information system RIS
• Implemented therecognized industrial standards in image and data format, i.e., DICOM and HL7.
• Utilized Informatica to ETL data for business intelligence and reporting.
• Conducted interviews, JAD sessions with the Business Corporate team, Predictive analytics team to understand the reporting and integration functionalities of SAS Predictive Modeling and Tableau Data Modeling, Visualization and BI and created the FRD.
• Created Process Flow diagrams, Use case diagrams, Sequence diagrams UML using MS-Visio.
• Performed UAT based on Requirements Documentand prepared the Test Cases using Quality Center.

Environment:GScript, JavaScript, Java, Eclipse, Oracle DB, SQL, Informatica, SAS, Tableau Desktop 8.2, HP Quality Center, Lean Standard Work, MS Visio, MS Access, MS Project, MS Excel, MS PowerPoint, MS Word, MS Outlook, SharePoint 2013.

The project involved maintenance of the HIPAA Health Connect system which is used for keeping Electronic Health Records of HIPAA. Also involved in its sub-systems like EDI transaction codes 835 and 837 health care aims at improving safety in the health care industry using modern day technology.

Roles and Responsibilities:

• Participated in user meetings, gathered business requirements specifications for the Data Warehouse design.
• Helped to develop use cases, project plans and manage scope.
• Involved in the meeting with Business Process Owners, SME Subject Matter Experts and store users for Requirement gathering in Definition Stage.
• Worked on HIPAA 4010 and 5010 / ICD 9, version for all EDI transactions.
• Manage Scope and change requests throughout the SDLC process.
• Claim Transactions and Billing Transactions created flows for adequate matching of claims. Performed data mapping by matching the billing file and EDI claim file record claims received from Medicare and Medicaid agencies.
• Validated 837 Healthcare Claims , 835 Healthcare Claims payment/ Remittance , 270/271 Eligibility request/Response , 834 Enrollment /Disenrollment to health plan for Part B and Part A of Medicare health claims.
• Validated codes for billing process which included ICD-9, CPT codes and various modifiers where applicable in compliance with HIPAA 5010.
• Deployed HL7 codes for machine to machine communication including ADT, ORM and ORU messages.
• Responsible for writing Functional Requirement Specifications FRS .
• Created workflow diagrams to better demonstrate the processes adopted in the EDI group and accounting groups of the company.
• Created new and modified existing reports using the Actuate Developer Workbench and integrated it with Siebel.
• Analyzed Business Requirements and segregated them into high level and low level Use Cases, Activity Diagrams/State Chart Diagrams UML .
• Created Process Flow diagrams, Use case diagrams UML using MS-Visio
• Prepared Test Strategy, Test Plan, and Gap Report
• Performed UAT based on Requirements Document and prepared the Test Cases using Quality Center.
• Maintained Traceability Matrix in Excel.

Environment: Quality Center, MS Project 2004, MS excel, MS Word, MS Visio, MS .NET, AJAX, MS SQL, MS FrontPage, MS Power Point.

Confidential has built a growing portfolio of medical practice software solutions to support business goals and deliver the highest quality of health care possible. The project was to implement Practice Management software that allowed the providers to automate tasks like patient management, appointment scheduling and recalls, accounts receivable management and collections, reporting, and filing claims through integrated EDI X12 transaction sets in compliance with HIPAA standards.

Roles and Responsibilities:

• Conducted JAD sessions with SME, Sr. Architect and BO to understand the Functional, Non-Functional Data and GUI requirements of the project.
• Extensively interacted with the stakeholders and the IT Department in finalizing the requirements according to the CMS Compliances/Regulations and HIPAA Regulations.
• Involved in Requirement Scoping, RFP documenting and analyzing high priority requirement for implementation Created BRD, FRD and use case documents.
• Incorporated UI and UX requirements from FRD by creating GUI mock-ups using MS Visio.
• Implemented AGILE RUP methodology for the SDLC and identified workflows in the four phases of the RUP. Organized and reviewed Backlogs brought in by the stakeholders to be used in the project.
• Used Rational Requisite Pro to manage the requirement and keep the Traceability Matrix.
• Prepared logical data model in the form of Business Context diagram to include various entities and attributes in order to facilitate the design of Data model in the form of ER Diagrams.
• Conducted Joint Application Development JAD and Rapid Application Development RAD sessions for communicating and managing expectations.
• Involved in HIPPA assessment and HIPAA X12 EDI transaction 835, 837, and 270/271 mapping and identified changes that needed to be done to comply with HIPAA regulations.
• Involved in Gap and Feasibility Analysis for the design and architecture of the new application.
• Worked with HIPPA compliant ANSI X12 837 formats for all the types of claims.
• Gathered the business requirements for Medicare Part D and managed the requirements using Rational Requisite Pro.
• Executed SQL queries to test the database for records that detect and submit functional acknowledgement and remittance advice in the claims application.
• Prepared test cases, test script and coordinated with the QA team for testing and interacted with the developers to report and track bugs using Test Manager.
• Involved in GUI Design sessions with Usability Team Browser compatibility and navigation were tested manually.
• Managed the change request and analyzed the impact of the change request on the application in regards to Project Plan, Scope, and Schedule.

Environment: MS Access, MS Excel, MS Visio, Test Manager, MS Project, Rational requisite Pro, HTML, Oracle.

Confidential manufactures animal vaccines such as bacterial vaccines HS haemorrhagic Septicemia vaccine , BQ Blackquarter vaccine and Viral Vaccines Rabies Vaccine and Foot and Mouth Disease Vaccine . They required defining the IT infrastructure for their latest R D division which was intended to transition from their legacy practice of manual documentation to a more flexible and less labor intensive online portfolio.

Roles and Responsibilities:

• Involved in the meeting with Business Process Owners and Subject Matter Experts SME for Requirement gathering in Definition Stage using Rational Requisite Pro.
• Conduct JAD and SCRUM work sessions to understand the working system impact.
• Createdwork scenarios and work sessions to come up to the most economical scenario of change.
• Createdlayout and mockup of the change to be made in form of the report.
• Worked on Impact analysis for each of the systems and their sub entities for both inbound and outbound systems.
• Created Various Business Requirement Documents BRD and Functional Requirement Specification FRS for the project using Rational Requisite Pro.
• Created Requirement Action Plan for various project deliverable.
• Created SQL queries CRUD Operations for extracting and updating data as required by the Dev team.
• Participated in user meetings to understand requirements for the Data Warehouse design.
• Created various Use Cases and workflow diagrams, using MS Visio.
• Maintained Traceability Matrix in Excel.
• Created Report Mockups and Sample Mapping documents for the Error Reporting.
• Extensively worked with SharePoint 2007 MOSS tool for document management and accessibility.

Environment: HTML 4, Apache Tomcat Webserver, Java, Oracle DB, SQL, HP Quality Center, MS Visio, MS Access, MS Project, MS Excel, MS PowerPoint, MS Word, MS Outlook, SharePoint 2007.

Confidential required the integration of compliance standards ICS in to the present processes to take care of current and future regulatory norms. The task was to build a technology framework to integrate these standards in to the present processes and help design a new and improved functional system.

Roles and Responsibilities:

• Aided the project manager in developing a vision document for the project.
• Created the SRS document using existing artifacts and inputs from the SMEs, Sr. Architect and the Dev team.
• Performed Gap Analysis by identifying the shortcomings in the current systems and areas where compliance is a must.
• Utilized SharePoint for collaborating with the team on project artifacts and for communicating the project status and deadlines.
• Utilized Waterfall Methodology for the development of the application.
• Created UML and information flow diagrams using MS Visio.
• Assisted the Dev Team in unit testing and the product manager in end-user acceptance testing.

Environment: SQL, Java Script, Java, DB2, COBOL, VSAM, JCL, CICS, zOS, MS Visio, MS Access, MS Excel, MS PowerPoint, MS Word, MS Outlook, SharePoint

Confidential is one of the leading and fastest growing super specialty care and multi-organ transplantation hospital. Their present system of managing the care coordination online, though effective, was based on old technology platform. They were unable to leverage total advantage of the effective online application. The task was to retain the functionality and logic of the system and rebuild it on the new technology platform.

Roles and Responsibilities:

• Provided key project inputs by working with users in defining the project and system requirements.
• Reviewed business process, and functional requirements.
• Worked on hospital data processing for improving database for storing user files.
• Analyzed business needs, created and developed new functionality to meet real time data integration that facilitated decision.
• Involved in detailing project mission, data process flow diagrams, and timelines.
• Worked with SQL queries for data manipulations.
• Assisted in building a business analysis process model using Rational Rose, Requisite Pro and Visio.
• Designed and developed Use Cases, Activity Diagrams and Sequence Diagrams.
• Assisted in process modeling conducted and participated in JAD sessions with system users helped with design walkthroughs with stakeholders for base lining architecture.
• Assisted Test Lead, Testers understanding business process and help them successful completion of Unit Testing, Integration Testing.

Environment: Oracle 9i, Rational Rose, Requisite Pro, MS Visio, RUP, MS Project, SQL, MS Access, MS Excel and MS Word.