SUMMARY

• More than 8 years of experience as a Business/Data/Systems Analyst with clients in domains of Health Services, Financial Services, Consumer Goods and Services, and Information Technology with few of the most renowned organizations
• Excellent Business Analysis skills and extensive experience writing Use Case Requirements, Requirement gathering, Request For Proposal (RFP)/ Request for Information (RFI)
• Strong foundation in conducting review meetings for scope document sign - offs with stakeholders involved in project planning, project monitoring and control
• Implementation of ICD 10 codes in United States system transferring from ICD 9 codes system.
• Knowledge of implementing iterative Software Development Life Cycle (SDLC) using Rational Unified Process (RUP), Agile, Waterfall & Scrum
• Experienced in creating Business Requirement Document (BRD), functional requirements document (FRD) and Technical Requirements Document (TRD) with GUI design and non-functional documents
• Good knowledge of Electronic Health Record (EHR) and Electronic Medical Record (EMR)
• Extensive experience in claims processing and billing, Medicare/Medicaid billing and claims management.
• Strong understanding of Business Process Management, Business Process Reengineering, Business Process Modeling, Business Analysis, System Analysis and System Architecture
• Led JAD sessions with stakeholders to analyze system needs and integrate requirements
• Created current costs - time - scope analysis, robust financial planning, forecasting, modeling and reporting documentation to facilitate executive-level decision making
• Experience in SQL queries to extract data from various database for data analysis and generating reports per the formal specified Subjects Matter Experts (SME’s)
• Experience in creating Logical Data Models, Data Mappings, Data Dictionaries and Meta Data Specifications
• Knowledge of HIPAA and various transaction codes like 270/271 (inquiry/health care benefits), 276/277 (Claim Status), 834 (Benefit Enrollment), 837 (Health Care Claim), 835 (Payment/Explanation of benefits) PPACA (Health Care Reform and patient Protection and Affordable Care act).
• Experience in Uploading ERA data files into the Oracle database for the analysis and produced slices and dices of the data for specific data analysis purpose and ERP POC to auto-post claim payments.
• Good working experience with QA activities starting from Test Plan preparation, Test case writing / review, Test case execution, bug verification / triage & reporting, expertise in UAT region
• Experience in creating and maintaining Requirements Traceability Matrix (RTM) and Interface Specifications Document (ISD) and Go-Live Requirements Summary Documents.
• Highly motivated and organized leader with excellent client relationship, listening, communication, and delivery skills

TECHNICAL SKILLS

Operating System: Windows-NT/XP, DOS, Vista/7, Mac OSX.

Languages: C, C++, Java Script, J2EE, SQL, HTML, XML, WML, ASP, VB Script, .Net.

Tools: MS Project, MS Excel, MS Visio, Rational Suite (Rational Rose, Rational Requisite Pro, Rational ClearCase, UML, Lotus Notes, Microsoft Power-point, Team Track, JIRA, Crystal Reports, SSRS, Cognos, Business Objects.

Database: SQL, MS-Access, Oracle, Sybase, Teradata.

Methodologies: Joint Application Development (JAD), Agile Software Development, Spiral, Rational Unified Process (RUP), Rapid Application Development (RAD), Unified Modeling Language (UML), System Development Life Cycle (SDLC), Waterfall Model.

PROFESSIONAL EXPERIENCE

Confidential, Pittsburgh, PA

EDI Developer / Business Systems Analyst

RESPONSIBILITIES:

• Design and Development the convert processing of EDI 835 transaction from ANSI 5010 to internal file format to support ScriptMED ERP RA auto-post implementation.
• Used C/C++ based, XML, Redix AnyToEDI Developer to extract outbound ANSI 837 Claims data during clients' migration to a new EDI provider
• Design and Development loading scripts for the Electronic Remittance Advise (ERA) in SQL* Loader for processing of the ERA into ERP, data RA auto-post module needs for processing.
• Transitioned 70+ payers to a new EDI services provider from payer enrollments to initial 837 claims test analysis.
• During design and development stages acted as the liaison and lead between Trading Partners, Implementation Steering Comity, and the development team.
• Design and Development creation xml’s for 30 Trading Partners from Pharmacy Scripts flat files and NCPDP standards using Redix 7.5 Translator.
• Used C/C++ based, XML, Redix AnyToAny Developer to transform inbound E-Referral data during clients' ( Confidential . ) internal pharmacy application upgrade
• Aided in the development of scripting and automation in Linux Red Hat 6.5 to translate Pharmacy Scripts, and NCPDP Script Transfers.
• During design and development stages acted as the liaison between ERP provider and users to ensure Pharmacy Scripts are loaded and are functioning properly.
• As a liaison between the stakeholders I’ve created flows, project scope and plans, HD&FD, BRDs, and CRs.
• Aided in the design and development of Exception handling to generate default responses based on users and business advice.
• Provided guidance and technical support to Unit testing, System Testing, Systems Integration Testing and Partner plan testing during respective implementation cycle.

Environment: UML, RUP, MS-SharePoint, MS-Project, MS-Visio, Redix Any-to-Any Translator, Linux Red Hat 5.4, Oracle 12c Database, SQL *Loader 12c, SQL Developer, Toad 9.7, VM Ware, Script MED 6.1, TestDirector7.6, WinRunner7,EDI 5010, HIPAA compliances, Quality Center.

Confidential, San Francisco, CA

Sr. Business Systems Analyst

RESPONSIBILITIES:

• Gathered requirements from Business Owners, stakeholders, Data Governance Team and the subject matter experts through meetings to understand needs of the system.
• Used the guidelines and artifacts of the Rational Unified Process (RUP) to strategize the Implementation of Rational Unified Process effort in different iterations and phases (Inception, Elaboration, Construction and Transition) of the Systems Life Cycle methodologies. Prepared various artifacts for all the phases of RUP.
• Led JAD sessions with stakeholders to analyze system needs and integrate requirement to develop a consistent navigation structure
• Created business workflows on the claims module for the client to get a better understanding of the software and prepared a detailed BRD including all functional and non-functional requirements.
• Used documentum to store and manage documents in a single repository using a secure web based system.
• Conducted brainstorming sessions to analyze provider contracts, provider reimbursement, benefit rules, medical policies and medical management rules to see the impact of ICD 10 diagnosis codes.
• Gathered and validated inventory of applications, interfaces, and reports that will need to be modified to comply with ICD-10 requirements.
• Worked with different teams such as HIPAA 4010 to identify any project dependencies or initiatives competing against ICD 10 schedules.
• Involved in up-gradation of HIPAA X12 4010 transaction to HIPAA X12 5010
• Responsible for business analysis, requirement specifications, project planning and identifying the resources and implementation of the project.
• Performed the Gap analyses of the earlier systems, generated a detailed Requirements document describing new system architecture through Use Cases and Activity diagrams.
• Created functional flow diagrams, context diagrams and other high level diagrams for documenting the functionality of separate modules using MS-Visio and UML.
• Implemented Traceability Matrix and Business Requirement Specification Document verified the functionality coverage.
• Involved in Validation of HIPAA for 837, 270/271, 276/277,835, 834 EDI transactions. Worked with the QA (Quality Assurance) team for designing Test Plan and Test Cases for the User Acceptance testing - Defined test cases, creating test scripts, analyzing bugs, interacting with QA / development teams in fixing errors and User Acceptance Testing (UAT).
• Used MS Project to maintain the project schedule and track projects status.
• Interfaced with end-users, obtaining approval, identifying information, procedures and decision flows, evaluating existing procedures, methods and technical documentation.
• Process all submit table and RFI’s to share file folder using Adobe PDF and logged all hard copies to file.
• Created ANSI X12 HIPAA Transactions Implementation documentation for end-client ( Confidential )

Environment: UML, RUP, MS-SharePoint, MS-Project 2000, MS-Visio, CMMI, TestDirector7.6, WinRunner7, windows, EDI, HIPAA compliances, Quality Center.

Confidential, Temple, TX

Business Analyst

RESPONSIBILITIES:

• Participated in the recording and analysis the business requirements for the COB project
• Managed Requirements in accordance with the MEDICARE and MEDICAID policies.
• Performed GAP analysis to identify AS-IS process and TO-BE process.
• Developed and maintained Requirement Traceability Matrix (RTM) including both functional and non-functional requirement
• Designed Business Requirement Document (BRD), and Functional Requirement Document (FRD) to help aid the development team.
• Participated in creating the project plan, which included information including project activities, anchors, efforts, etc. and tracked the developments of the project
• Designed the activity diagram and sequence diagram to enhance the clarity of the situation to all stakeholders of the project on the flow of operations of the system and timelines of each actors involved in the project
• Used Agile model to ensure that all the requirements are met at the completion of the project
• Prepared use case diagrams and use case description by studying the requirements and discussing them with the subject matter experts (SME) and users
• Ensure that the ICD-9-CM diagnosis and procedure codes & CPT codes requirements are appropriately incorporated in the COB systems.
• Managed change requests by conducting impact analysis, and formulate the implementation plan
• Prepared change request form to provide description of the change requests, the results of the impact analysis, workarounds, if changes are not feasible, and the additional efforts required.
• Collaborated with all stakeholders of the projects to update them about the progress of the project, reviewed the developments, discuss change requests, and obtained approvals

Environment: - MS Projects, MS Visio, MS Word, MS Excel, MS PowerPoint, MS Outlook, UML, Windows 2000, SQL, Rational Rose.

Confidential, Raleigh, NC

Business Data Analyst

RESPONSIBILITIES:

• Facilitated Joint Requirement Planning (JRP) sessions with SME’s in understanding the Requirements pertaining to Loan Origination to Loan Processing.
• Worked with AGILE methodology.
• Extracted the Business Requirements from the end users keeping in mind their need for the application and prepared Business Requirement Documents (BRD) using Rational RequisitePro.
• Reviewed Design Documents, Requirements Analysis Specifications with Project Lead, Business Owners and the Technical Lead
• Performed Data Mapping
• Modeled the As Is and To Be business models using Casewise Modeller
• Created and managed Project Templates, Use Case Project Templates, Requirement Types and Traceability Relationships in RequisitePro.
• Involved in creating automated Test Scripts representing various Transactions, Documenting the Load Testing Process and Methodology.
• Created meaningful reports for analysis and integrated the Performance Testing in the SDLC.
• Developed and managed Project Plans and Schedules. Manage d resolution of Project issues and conflicts.
• Conducted Functional Walkthroughs, User Acceptance Testing (UAT), and supervised the development of User Manuals for customers.
• Worked as a User/Customer advocate and negotiated with user as well as with developers and management staff to resolve any requirement conflict to bridge the Gaps between IT and Business.
• Various versions of the documents generated during the project were maintained and managed using Rational Clear Case and performed defect tracking using Rational Clear Quest.
• Tested the final application for Usability testing to verify whether all the User.

Environment: Rational Enterprise Suite (Rose, RequisitePro, Clear Case, Clear Quest), Casewise modeler, IBM Web Sphere, XML, Java, Unix, C++, J2EE, JSP, Oracle, DB2, Sybase, SQL Server Reports, Win Runner, Load Runner, Quick Test Pro.