SUMMARY:

• 7+ years of experience, discipline and highly - motivated Business System Analyst, Data analyst and Quality Analyst wif healthcare and Telecommunication domain who hasworked on a wide range of projects.
• An accomplished and fluent communicator wif strong investigation, problem-solving and decision-making skills, combined wif a pragmatic approach and sound business acumen.
• Highly accomplished in fields such as IT noledge specific to Healthcare and has complete noledge of all phases of the software development life cycle (SDLC) gained over working on various projects for different clients.
• me prepare, analyze, and gather business requirements, business processes, mapping and the development of interactive prototypes.Professional Skills:
• Robust experience in writing SQL queries for Data/Business Analysis using Confidential Curam and QA report testing.
• Business Analysis, Supporting Strategy management, Client relations, Business modeling, CRM & Workflow, Test planning MS Office, MS Project, MS Visio, MS Excel.
• Develop workflows dat demonstrate current and proposed business requirements.
• Knowledge and expertise in system design and development required for business process.
• Data Visualization, Migration, Reporting, Cloud Server Computing, ETL Design, Big Data, Hadoop, RDBMS
• Strong noledge of HIPAA standards 4010 & 5010, ICD-9, ICD-10, EDI,HL7, HIX (Health Insurance Exchange), Health Care Reform.
• Develop different EDI healthcare transactions like 837 for submitting claims, 835 for payments, 834 for benefit enrollment, 270,271 for health care benefits and eligibility, 276, 277 for claims status and 278 for transmitting health care service information.
• Proficiency in the child welfare and case management business area,policies and domain noledge in child welfare programs
• Experienced on Claims, Payments, Medicaid, Medicare, Provider, Portal, Billing, and Benefits.
• Extensive experience in performing GAP analysis, SWOT analysis, Cost benefit analysis, Risk analysis.
• Hands on experience in analyzing and documenting Business Requirements Documents (BRD), Functional Requirements Documents, Use Cases and Requirements Traceability Matrix (RTM).
• Broad noledge on Waterfall, RUP and Agile methodologies.
• Incomparable analytical skills in understanding the business process, understanding the functional requirements and translating them to system requirement specifications (SRS).
• Information and understanding in conducting Joint Application Development (JAD) and Rapid Application Development (RAD) sessions. Conducted Requirement Gathering Sessions and interviewed Subject Matter Experts, gatheird detailed functionality aspects of business process and updated the information to the requirements in an easily comprehensible format.
• Broad experience in creating business process flow diagrams, UML (Unified Modeling Language) tools to create Activity, Sequence and Collaboration diagrams.
• Aptitude to construct process models including data dictionaries and volume estimates.
• Experienced in creating Data models, Data designs, data Integration and writing complex SQL queries.
• Understanding service objectives and capturing business requirements through active listening & questioning techniques.
• Keeping abreast of new legislation, company strategy and policy and being able to identify its impact on business projects.
• Experience in creating User Manuals and providing to users.
• Inventive and Aggressive person capable of forming and maintaining positive and productive team environments wif integrative thinking skills.
• Exceptional Problem Solving and Sound Decision Making capabilities, along wif the ability to resolve difficult situations.
• Capable to prepare written proposals, requirements specifications, invitations to tender and solution specifications.
• Able to identify business & systems process improvements from Big Picture to detail level.

TECHNICAL SKILLS:

Languages: SQL, PL\SQL, HiveQL, SAS, R, XML, Java, Python, .Net

Tools: & Environments MS Office, MS Visio, SQL Server SSIS, SSRS, Oracle Developer, Tableau, QlikView, Power BI, SAS EM, ERwin Data Modeler, WebI, SAP Business objects, UDT, Excel, Rational Rose, MS Visio, Visual Paradigm, Omniture Web Analytics, Adobe Site catalyst JIRA, Confluence, MS Visual Studio, Confidential Curams SAS Certified Data Mining and Business Intelligence professional, Google Analytics and AdWords Certified Professional, Certified Microsoft Technology Associate (MTA) in .NET, Advance communicator Silver and Advance Leader Bronze by Toastmasters International

PROFESSIONAL EXPERIENCE

Confidential, Minnetonka, MN

Sr. Business System Analyst

Responsibilities:

• Gatheird requirement through workshops and JAD sessions.
• Developed documents like BRD, FRD, Data specification document, technical specification documents, file transfer document, Data mapping document etc.
• Participated in analysis workshops for ICD 10 Procedure and Diagnosis Codes to make sure they acre coded well for newly added state Medicaid plans.
• Worked on Member grouping, Member Contract, and Provider Contract, Plan benefit, Eligibility for claim processing system.
• Developed Use case diagrams, activity diagram and system design diagrams.
• Managed global administration and support of the Documented based Regulatory Electronic Document Information System (EDMS).
• Facilitated Electronic Data Interchange(EDI) and storage in the ICD-10.
• Worked on HIPAA Transaction Sets 837P and 837I Standards as per the test scenarios.
• Created Test Conditions from business requirement document and functional requirement document.
• Processed Medicaid claims and worked on X12 format of EDI 837 and EDI 835 for Medicaid claims.
• Performed GAP Analysis to make sure dat all requirements were covered by test cases.
• Analyzed extractions, transformations and loading logic across platforms.
• Performed data stage designing, extracting data packages, transforming and loading data packages, stored procedures, process design and implementation.
• Developed SQL scripts for mining medical claim cases which helped in making faster decisions for over 400 healthcare-835, EDI cases
• Designed data flow and mined data for HIPAA/ICD/EDI claim analysis dat helped expedite the process of Medicaid claim processing
• Performed GAP and risk analysis on workflow and business rule models to create project specific action plans for HIPAA implementation
• Worked on EDI 834 to validate new enrollment and dismiss the enrollment.
• Accepted and validated messages in EDI 999 form like accepted, rejected, and accepted wif error.
• Coordinated System and Regression testing schedules and completed the same.
• Ensured the functionality meets business requirements as defined in test results logged in JIRA.
• Developed Test Cases to test the functionality of the system based on the test conditions..
• Analyzed several defects related to Edits & Audits functional area along wif the help of a SME.
• Conducted KT sessions for Member, Provider and Service Authorization.

Environment: MS Office, MS Visio, Windows 7, Citrix, SQL, JIRA, Oracle12c

Confidential, Hartford, CT

Sr. Business System Analyst

Responsibilities:

• Attend weekly dashboard meetings wif the business users and the other stakeholders to plan and track upcoming release activities.
• Attend Use Case reviews and communicate the information wif the team members to maintain transparency for a successful UAT release.
• Assign the change requests in scope of the release and track progress through the planning phase. Develop and ensure adherence to testing standards and best practices.
• Create procedures to ensure adequate coverage of system requirements.
• Manage peer review sessions prior to validation and UAT.
• Manage and facilitate meetings dat include pulse check on Validation and UAT readiness of the environments, build status, defect management and triage process, daily UAT calls to provide daily UAT status to all the stakeholders. Facilitate the Go/No Go decision call at the end of the UAT test cycle.
• Manage Post release activities such as meeting minutes, metrics reports and test summary dat includes the defect analysis for the UAT test cycle.
• Conducted user interviews, gatheird requirements, analyzed and documented business requirements in BRD
• Balanced competing project constraints such as scope, quality, schedule, budget, resources, and risks.
• Coordinated and prepared yearly Strategic Plan, which included medium and long-term goals.
• Track and manage project progress, issues/risks, monthly dashboards and schedule
• Had individual sessions wif the finance, HR and Marketing SME’s to understand the business domain and develop analytical reports. 
• Created Test Scenarios and Test Cases to perform SIT & UAT.
• Reviewed Test results pertaining to the specific desired functionality of the application. Recorded & reported defects& produced daily Test Status Reports.
• Created User stories using JIRA after having sessions wif the SME’S and tan discuss those requirements wif the IT team.
• Used and developed SQL queries to acquire or modify data from SQL database and access database.
• Created System Requirement Specifications (SRS) document entailing business rules, conditions, calculations, triggers, visual representation, type of text (smart text, static text, free text, special formatting, metrics) of various dynamic elements present wifin the reports.
• Conducted meetings to work in coordination wif DBA’s, Developers, Tech Leads and Data Architects to achieve enhanced clarification, consistency and assist in design sessions.
• Followed AGILE methodology, created self-organizing team, induced enhanced communication for quick issue resolution&minimization of change control processes & its impacts. Obtained &recordedBusiness Approvals, Quality Review Approvals, and Architectural Approvals for future s & cross validations.
• Created Business Process Flows (Current State & Future State), Flow Chart diagrams, Data Flow Diagrams, Use Case diagrams, Activity Diagrams using MS Visio.
• Used data mapping for collecting the data and data modeling for storing it in data warehouse using DataStage

Environment: MS Office, Quality Center, SQL Server, MS Project, Server, MS Visio, Unix, SQL, HTML, XML,Windows 7.

Confidential, Madison, WI

Sr. Business System Analyst

Responsibilities:

• Implemented RUP methodology for iterative and incremental development of the system.
• Involved in the creation of the Mockups and Use Cases for MACD quotes and Orders using MS Visio.
• Coordinated wif the stakeholders and project key personnel to gather functional and non-functional requirements during JAD sessions.
• Recorded requirements in the Requirement Traceability Matrix (RTM) defining each technical requirement in detail from areas like: main hardware, application software, networks, servers, internet and desktop configuration.
• Planned RUP iterations and documented the artifacts throughout the various phases of the development process.
• Propose strategies to implement HIPAA 4010 to HIPAA 5010 changes in the System.
• Developed an implementation guide for Partners for HIPAA 5010EDI X12 transactions such as 837 (medical claims), 835 (medical claim payments), 270 (eligibility inquiry), 271 (eligibility response), 276 (claim status), 277 (claim status response), 820 (enrollment), and 834 (premium payments).
• Studied the existing business process and created AS-IS workflow to illustrate the existing system.
• Prepared Logical Process and Data Models dat contained set of diagrams and supporting documents containing the essential business elements, detailed definitions, and descriptions of the relationships between the data elements to analyze and document Business Data Requirements.
• Compiled the Vision Document and composed detailed Specification Documents in Rational RequisitePro.
• Created UML class diagrams, use case diagrams and sequence diagrams to view the system from different perspectives.
• Incorporated stakeholder feedback throughout project lifecycle to ensure project quality and customer satisfaction.
• Created Technical documentation for the project using tools like Visio, Word, etc.
• Used MS Project for managing schedules, resources and collaboration.
• Produced complete data mappings and data conversion documents needed for the Claims application.
• Performed Functional and GUI Testing to ensure dat the user acceptance criteria are met.
• Co-coordinated the UAT wif the SME’s to make sure dat all the Business Requirements are addressed in the application.
• Formed detailed UAT and QA test plans, managed system testing and preserving testing documentation.

Environment: MS Office, MS Project, MS Visio, SQL, Oracle, Test Director, Rational Unified Process (RUP), Rational Suite (RequisitePro, ClearQuest),Business Objects, Windows XP.

Confidential, Tampa, FL

Sr. Business Analyst

Responsibilities:

• Analyzed current business process flow by understanding preset business rules and conditions.
• Conducted formal interviews, Live Meetings and JAD sessions wif business users and SME’s.
• Designed and developed Use Cases, Activity Diagrams and Sequence Diagrams using UML.
• Involved in Backend Testing to verify data integrity by using SQL.
• Created Data Flow Diagrams (DFDs), ER diagrams for data modeling and Web-page mock-ups using MS Visio for acceptance from end users.
• Defined project milestones, schedules, and monitored progress using MS-Project and updated plans as required.
• Analyzed and tested Data Interface needs wif external systems.
• Analyzed, manipulated and updated the Database using SQL.
• Wrote multiple Test-Cases (unit, compliance, integration) for multiple transactions including837, 835, 276, 277 transactions.
• Conducted Gap Analysis to analyze the client’s applications programs to determine the impact of the HIPAA final rule on EDI Transaction Set and Code List implementation and defined the changes to bring the affected systems into HIPAA compliance.
• Assisted wif user testing of systems and maintained quality procedures and ensured appropriate documentation is in place.
• Maintained Requirement Traceability Matrix (RTM) and Utilize ClearQuest for change requests and defect tracking.
• Conducted claims validation and Pend/Denied Claims Analysis for the Health plans Medicaid programs.
• Worked closely wif the technical team to look up for the best possible solution on requirements by keeping business needs and technical constraints in mind.
• Updated, transferred and shared files using FTP between Windows and UNIX machines.

Environment: UML, MS Word, Rational RequisitePro, Rational ClearQuest, Quality Center, SQL, FTP