SUMMARY:

• 7+ years of industry experience as a Business Analyst with solid understanding of Business Requirements Gathering, Business Process Flow, Business Process Modeling and Business Analysis.
• Excellent knowledge and deep understanding of industry standard methodologies like Software Development Life Cycle (SDLC), Iterative Software Development Life Cycle Process as per Rational Unified Process (RUP), CMM (Capability Maturity Models), Market Prominence’s automated solution, Capability Maturity Model Integration (CMMI) and Six Sigma and Rational Tools used during various phases of RUP such as Inception, Elaboration, Construction and Transition.
• Excellent team player work in conjunction with testing, development and other teams in validation and testing complex scenarios and projects and in the maintenance of Quality Standards in Projects.
• Worked on Health Care Reform (PPACA), ICD - 10, Medicare/Medicaid, EDI transactions (837,835,270/271,276/277,999)
• Excellent track record for meeting deadlines and submitting deliverables on time.
• Adept at implementation of HIPAA 4010 and HIPAA 5010 changes in the existing claim processing integrated system.
• Sound knowledge of HIPAA, HL7, ICD9 CM, NDC, CPT4, EDI, ASTM, DICOM,HMO, PPO, Medicare, Medicaid, Sarbanes-Oxley Act (SOX), ACORD, SOPs (Standard operating Procedures) and forms, GMP’s terms and Practices.
• Experience on bridging the gap between Business/Product department and IT.
• Experience in assisting technical team in different phases of SDLC such as Design, Development and Quality Assurance.
• Experience in working with QA testing teams, while interacting with business users and gathering user’s requirements to develop necessary Test plans, Test Cases and Test script.
• Adept at reducing development costs and providing traceability of projects.
• Familiar with current industry standards such as ISO, Six Sigma, and Capability Maturity Model.
• Experience withhealthcare reform (HCR)and healthcare payer systems.
• Result oriented, committed and hard working with a quest to learn new technologies and undertake challenging tasks.
• Proficient in Developing and executing Test Plans, performing functional, usability testing and ensuring that the software meets the system Requirement.
• Excellent team player work in conjunction with testing, development and other teams in validation and testing complex scenarios and projects and in the maintenance of Quality Standards in Projects.
• Extensive experience with MS Visio for drawing flow charts and screen mock ups and MS Project for status reporting and planning.
• Experienced working in Medicare and Medicaid projects.

TECHNICAL SKILLS

Methodologies: Agile, Waterfall, RUP, UML, SDLC, Scrum, RUP, BPEL, BPMN

Change Management Tools: Rational Clear Quest, Rational Clear Case.

Business Modeling & Versioning Tools: MS VISIO, Visual Paradigm, Rational Rose; Rational Requisite Pro, Rational Clear Case

MS Office: MS Project, MS Word, MS Excel, MS PowerPoint, MS Access

Programming Languages: Structured Query Language (SQL).

Operating System: Windows NT/98/2000/XP.

Databases: Access, Oracle, Teradata, DB2, MS SQL Server

Other known tools: Informatica, Load Runner, Win Runner, Crystal Ball, Core, Caliber

OLAP Tools: Business Objects XI, Cognos

Testing tools: Rational Robot, Rational Clear Quest Test Manager, HP Quality Center, Quick Test Professional, LoadRunner, WinRunner.

Apps & Web servers: Apache web server, Tomcat, Web logic 8.1, IIS

PROFESSIONAL EXPERIENCE:

Confidential, Baton Rouge, LA

Senior Business Analyst

Responsibilities:

• Responsible for gathering and documenting Legislative, Business, Functional requirements for all the provisions and their impact on the existing products and systems.
• Responsible for integrating with Facets. Designing test scripts for testing of Claims in Development, Integration and production environment.
• Participated in the CORE (Committee on Operating Rules for Information Exchange) compliance process for the company.
• Responsible for creating test scenarios, scripting test cases using testing tool and defect management for Policy Management Systems, Payables/Receivables and Claims processing.
• Worked on the PPACA for various mandates such as Grandfather Rule, Rescissions, D-26, Pre Ex-19, Preventive Care, Operating Rules, and Early Retirees Fund etc.
• Wrote test cases and test scripts for the User Acceptance Testing.
• Performed Requirement Analysis and developed Use Cases and Activity Diagrams.
• Traced High Level Requirements (HLR) to Detailed Level Requirements (DLR).
• Conducted meetings with SME's to understand current business process and performed Gap Analysis to meet future business needs.
• Created and managed project templates, use case project templates, requirement types and traceability relationships in MKS Integrity.
• Developed Systems Specifications document to define the impact of the new requirements on the existing system.
• Developed and managed creation of product documentation to communicate features, benefits, positioning and impacts to different audiences and ensured that documentation deliverables from various groups are produced as needed.
• Created Business Requirement Document (BRD), Functional Requirement Specification (FRS) document, User Requirement Specification (URS) and Change Request (CR) document for system application development.

Environment: Requisite Pro, Rational Rose, XML, Clear Case MS Office, MS-Visio, XML, TOAD, Quality Center, MS Project, SOA.

Confidential, Mount Laurel NJ

Sr. Business Analyst

Responsibilities:

• Participated in the initial Impact Analysis (ICD-10) for all the critical functions, i.e., & Enrollment, Claims Processing, Utilization Management, Medical Policy, Reporting, Vendor Management, etc.
• Worked with internal team to build out of a high level roadmap and time line to achieve compliance.
• Performed impact analysis on 5010 upgrades and ICD-10 conversions.
• Participated in ICD 9 to ICD 10 codes conversion requirement gathering sessions and created high level business requirement document.
• Prepared product backlog working with product owner and other SME.
• Prioritize user stories and assigned to different sprints.
• Facilitated daily stand ups and managed task board with user stories and board.
• Prepared and tracked burn down charts and velocity charts for timely delivery of projects.
• Prepared 5010 GAP documents involved with 837 and 835 transactions in collaboration with other team members.
• Defined ICD-9 to ICD-10 mapping process using GEMs (General Equivalency Mapping) crosswalk file.
• Created custom mapping between ICD-9 and ICD-10 codes.
• Extracted data from several databases to create a master list of the ICD-9 codes.
• Ran reports using Excel and Business Objects to compare and verify data.
• Conducted Business Requirements walkthrough with the business owners as well as the Technical Stakeholders.
• Change Control Process - Led the Change Control Process for changes submitted for the BRD once the document was submitted to IT department.
• Documented the UAT Plan for the project and worked with the UAT Team to ensure every acceptance criteria for the requirements has been included in the UAT task plan
• Maintained the Traceability Matrix table to uniquely trace the identified business requirements to general design to testing as proof that requirements requested have been developed into a solution and that it has been tested and tracked.

Environment: Agile, MS Visio, Word, Excel, PowerPoint, SQL, SharePoint 2010, MS Project.

Confidential, Glen Allen, VA

Business System/ Analyst

Responsibilities:

• Acted as primary liaison between the Business unite and development team department; performed analysis, review, and estimation of client requests; prepared and reviewed system requirements, and client documentation; prepared and executed detailed test plans.
• Prepared questionnaire and conducted personal user interviews to gather requirements.
• Prepared business requirement (BRD) and functional requirement documents (FRD) using Rational Requisite Pro.
• Developed test cases and participated in QA and UAT testing.
• Worked with outsourced team to resolve application issues.
• Provided to users and resolved day to day issues.
• Prepared user manual and guide.
• Conducted user in cross functional departments.
• Developed standard operating procedures for IT tasks.
• Maintained, analyzed and resolved IT issue log.
• On the basis of customer feedback analyzed the report and identified vital areas to fix.
• Provided data for reporting to internal pharmaceutical research groups and sales for enhancement purposes.
• Created use case with UML for product functionality.

Environment: MS Office Tools, Windows, MS Project, Requisite Pro, Rational Rose, Clear Case, MS-SharePoint, MS-Word, MS-Excel, Business Objects, XML

Confidential, Chicago, IL

Business System Analyst

Responsibilities:

• Followed a structured approach to organize requirements into logical groupings of essential business processes, business rules, and information needs, and ensured that critical requirements are not missed.
• Developed prototype of a new mobile information processing application and performed walkthroughs of the prototype with end users to better understand user needs.
• Coordinated with the offshore UI designer to prepare the prototype for the application.
• Facilitated collection of Functional Requirements from system users, and prepared Business Requirement documents and have applied the RUP model throughout the entire development and testing process.
• Prepared Logical Process and Data Models that 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.
• Used Rational Clear Quest to maintain and track the requested enhancements and changes by the stakeholders.
• Followed the UML based methods using MS Visio to create Use Case Diagrams, State Chart Diagrams and Sequence Diagrams.
• Worked closely with the offshore team to convey Technical and Functional specifications.
• Detailed understanding of business functionality and preparing the Functionality Test Plan
• Interacted with Product Manager and Domain Experts to understand various process plans, business process, and functionality in detail.
• Responsible to conduct walkthrough sessions to get Business Sign off for the FRD.
• Meetings with Developers, Team Leads to help them understand the requirements.
• Interacted with the Testing and Development team to resolve and follow up on development issues.

Environment: MS Office Tools, Windows XP, MS Project, Requisite Pro, Rational Rose, Clear Case, MS Power point, MS-SharePoint, MS-Word, MS-Excel, Business Objects, XML