Professional Summary:

• 8 yrs of industry experience as a Business Analyst with solid understanding of Business Requirements Gathering, Business Process Flow, Business Process Modeling and Business Analysis.
• Extensive Industry experience in Healthcare -BlueCross, Medicare, Medicaid, and commercial insurances in HIPAA ANSI X12 formats including 270/271, 276/277, 834, 835, and 837 for institutional, professional, and commercial claims.
• Experience in Conversion of HIPAA X12 4010 transactions to X12 5010 transactions and ICD 9 to ICD 10 conversions.
• Experience in facilitating Joint Requirement Planning JRP sessions, Joint Application Development JAD sessions with committee of SME's, business groups, senior management and IT groups to converge early towards a goal acceptable to customer and feasible to designer to complete.
• Thorough understanding and experienced in system development life cycle SDLC development, involved in all phases of development from requirements gathering, business case development and maintenance, defining strategic solutions in business needs.
• Extensive experience with documenting Business Specifications Document BRD , Use Case Specifications and Functional Specifications document FSD , Systems Design Specification SDS , Systems Requirements Specification SRS , Workflows and Unified Modeling Language UML diagrams use case, activity, sequence, collaboration .
• Solid understanding and experience with Business Process Flow and Business Process Modeling and developing ER Process flow diagrams.
• Proficient in creating Use Case diagrams, Sequence Diagrams, Activity Diagrams and other UML based diagrams using MS Visio, Enterprise Architect, and Rational Rose.
• Working Knowledge of Client-server Architecture and Application Servers.
• Facilitated project meetings, reviews, walkthroughs, and customer interviews to gather requirements and relevant information for Business analysis.
• Generated Requirement Traceability Matrices RTM to ensure that all the requirements were met in each phase of the Software Development Life Cycle.
• Experienced in handling Change Management, writing Test Plans and executing Test Cases.
• Experienced as BA/QA analyst in Defect Tracking and extensively involved in User Acceptance Testing UAT .
• Sincere, well-organized, quick learner, self-motivated, team player and achiever.

Technical Skills:

Professional Experience:

Confidential

EDI Business Analyst

Responsibilities:

• Responsible for 837IB Transaction End to End team for CIGNA - Business Operations team handling EDI 277CA 837IB.
• Analyzing and Documenting end client requirements and communicating to the Project Manager Program Director.
• Documenting the Desk level Procedures DLP's for performing End-to-End Control and Balances and the Processes and the sub-process Flows for 837 IB.
• Performing Daily DLP's for 837IB Transaction and researching, identifying, and specifying solutions to problems or escalating the discrepancies in the claim intake volume to the concerned team or leveraged teams within HP example: TPG Trading partner Gateway team .
• Monitoring and creating reports for 837IB Volume tracking, Fallouts, and Aging reports.
• Involved in Root Cause Analysis RCA for fallout claims 837IB in Transaction Manager Tool EDIFECS Tool
• Actively involved in monitoring BAM Business Activity Monitor environment and send any alerts when thresholds have been exceeded.
• Performing Scope/GAP Analysis as well as Preparing Business Requirement Documents and Functional Requirement Documents.
• Working with the Business Operations team, monitoring the overall Business Process flow and also providing feedback to the Project Manager.
• Responsible for coordinating and resolving any technical and business issues related to EDI 837IB.
• Generating multiple reports daily updating the status of Operational flow and updating the senior management in team meetings.
• Experience in designing and building enterprise portal, reports and analytics with professional report building software packages such as Cognos.
• Installation, configuration and deployment of Cognos BI software solutions.
• Maintenance and administration of Cognos BI models, reports and dashboards.
• Work and Assign Incident's to restore normal service operation as quickly as possible, and communicate the resolution to the End User.
• Monitor ticket queue for HPSM Admin team and escalate if any issues.

Environment: MS Windows, EDIFECS Tools, MS Visio, MS Project, MS Office PowerPoint, MS Word, MS EXCEL , Cognos 10, SQL Developer, Oracle

Confidential

Business Analyst

Responsibilities:

• Assisted in identifying project scope, to conform to the regulatory compliance related to X12 837 I/P , 835, 834, 270, 271, etc.
• Responsible for soliciting and eliciting requirements for 4010-5010 conversions.
• Involved in building training material and planning material for 4010-5010.
• Defined communication plans and created a project budget for the transition.
• Carried out Risk Assessment, GAP analysis and Impact Analysis for the 4010-5010-conversion project.
• Involved in one-to-one interview sessions and JAD sessions with stakeholders, SME's and business owners to discuss the scope of the conversion.
• Produced for transaction sets 835 and 837 I/P a full gap analysis 4010 vs. 5010 against the documented application 5010 enhancements ensuring the upgraded application included the required changes and additions for 5010 compliancy.
• Involved in up-gradation of HIPAA X12 4010 transaction to HIPAA X12 5010 by conducting Impact Analysis and Risk Assessment and worked on the mitigation plan to avoid the risks.
• Worked as a liaison among stakeholders both business and IT side in order to elicit, analyze, communicate and validate requirements for changes to business processes.
• Involved in Validation of HIPAA for 837, 270/271, 276/277,835, 834 EDI transactions.
• Prepared UML diagrams Activity diagrams, Sequence Diagrams, Use case diagrams .
• Played a key role in project planning activities, User Acceptance testing, and implementation of the system enhancements and conversions.
• Involved with reviewing defects reported from UAT efforts and analyzed for root cause and took actions based on the findings.
• Conducted Business Process As Is/To Be sessions with various department directors and staff to ensure the Testing Plan and Test Approach would meet the identified Business Requirements, and the Training Program covered all identified new and changed processes.

Environment: Rational RequisitePro, Rational Clear Case, RUP, UML, HTML, MS Project 2000, MS Visio, TestDirector7.6, MS Office Excel, Word .

Confidential

Business Systems Analyst/ Quality Analyst

Responsibilities:

• Gather requirements and prepared Business Requirement Documents BRD , System Requirement Specification SRS by interviewing Business Users/SME's, Agents, Clients
• Performed analysis and Data Mapping on ICD-9 and ICD-10
• Developed extensive documentation regarding Enhancement of ICD9 to ICD 10 project targeting all the major affected areas such as Claims, Adjudication and Reporting.
• Worked on the testing of ICD-10 by building test cases etc.
• Read and analyzed the federal legislation to update the products as per the mandated provisions of HCR Health Care Reform .
• Interacted with senior business teams and legal firms to gather and analyze requirements for HCR Health Care Reform .
• Conduct Joint Application Development JAD sessions and walk in interview with the business users to gather requirements.
• Work closely with the Business Users, Project Manager, Technical Lead, Business Lead, Computer Programmers and Testers to resolve the work problems related to project specifications
• Develop and maintain Reports, generated directly via MS Excel to perform further Analysis on the data.
• Worked on the test strategy preparation for end-to-end System and Unit testing.
• Analyze the business requirement as per the HIPAA rules and regulations.
• Create mapping/crosswalk documents for mapping data flow between systems.
• Develop Requirements Traceability Matrix between the Requirements and the Test Scripts.
• Extensively used Rational platforms such as Rational Requisite Pro, Rational Quality Manager and Rational Clear Quest for requirements and test case management.
• Conducting User Acceptance Testing UAT and verifying performance, reliability and fault tolerance issues.

Environment: MS Word, MS Visio, MS Excel, SharePoint, UML, SQL, Mercury Quality Center, Rational Requisite Pro, Rational Quality Manager, Rational Clear Quest, BDR.

Confidential

Business Analyst

Responsibilities:

• Gathered requirements from various business areas like Claims, Provider Relations, Enrollment, Finance and Benefits Administration for their updates to the Claim Processing Engine.
• Developed Use Cases using MS Visio, and a detailed project plan with emphasis on deliverables.
• Monitored Change Requests and documented requirements, integrating them with Use Cases.
• Developed and implemented Test Strategies using the Test Director.
• Followed the RUP methodology for the entire Software Development Cycles.
• Assisted the development team during the second and third iteration using the RUP model.
• Involved in project planning, coordination and implemented QA methodology.
• Developed the Requirements Traceability Matrix, prioritized and determined impact of all applications.
• Identified the all applications and interviewed the application owners to recommend the process improvements.
• Provided overall project management to multiple projects successfully completing them on-schedule and on-budget.
• Defect Tracking and Bug Reporting was performed using Test Director

Environment: RUP, Enterprise Architect, Rational Suite Requisite Pro, HP Quality Center, MS Project, MS Visio, MS SharePoint.

Confidential

Business Analyst

Responsibilities:

• Successfully defined the scope and business rules of the project, gathered business requirements and documented them textually or using models.
• Facilitated JAD sessions and worked with business users through interviews, workshops, and brainstorming sessions.
• Researched and understood the claims adjudication and reimbursement systems based on HIPAA X12 4010 standards.
• Exposed to using ICD 9/ANSI/HL7 coding standards in Medicare and Medicaid domains of the healthcare systems and industry for both Inpatients and out patients.
• Documented Functional Requirements specifications and User Requirements specifications.
• Ensured that ICD-9-CM procedure codes used for inpatient services and CPT codes for outpatient and physician services were not outdated.
• Created transaction sets requirements, usually with Microsoft Excel, for transactions such as HIPAA 270/271, 276/277, 835, 837 I, P, D , and others.
• Developed project schedule, scheduled deadlines for project phases, accommodated requirement changes into project timeline and managed project tasks using MS Project.
• Conducted daily build validations and report status to Production and QA team.
• Interacted with developers to report software bugs and retested the fixed issues.
• Participated in performing detailed non-functional requirements analysis, including usability, reliability, performance, and scalability. Transformed business requirements to technical models.

Environment: UML, SQL, HTML, Excel, MS Visio, MS Project, Power Point, Share Point Server, Test Director, Outlook, SQL Server 2005.