SUMMARY

• 7+ years of experience as a Sr. Business Systems Analyst in Healthcare and Retail Industry.
• Strong knowledge of the Software Development Life Cycle methodologies like Agile and Waterfall models.
• Experienced in interacting with business users to identify their needs, gathering requirements and authoring Business Requirement Documents (BRD), Functional Requirement Document (FRD) and Software Requirement Specification (SRS) across the deliverables of a project.
• Experienced in creating HIX ACA requirements, Use cases and process flows.
• Experienced in facilitating Joint Application Development (JAD), Rapid Application Development (RAD) and Joint Requirement Planning (JRP) sessions, interviews, workshops and requirement elicitation sessions with end - users, clients, stakeholders and development team.
• Experienced with Iterative approach for Software Development as per Rational Unified Process (RUP). Involved in inception, elaboration, construction & transition phases using rational tools like Requisite Pro, Clear Case and Clear Quest during various phases of RUP.
• Experienced in Business Analysis, SWOT Analysis, Gap Analysis, Risk Analysis, Disaster Recovery Planning, Testing and Project Planning.
• Built and maintained the Dashboard for the project.
• Extensive knowledge of Medicaid, Medicare, Procedural and Diagnostic codes and Claims Process. Also have worked on FACETS.
• Expertise in EDI and HIPAA Testing Privacy with multiple transactions exposure such as Inbound Claims 837-Institutional, 837-Professional, 837-Dental, 835-Claim Payment/Remittance Advise, 270/271-Eligibility Benefit Inquiry/Response, 276/277-Claim Status Inquiry/Response Transactions and testing in Client Server systems and Mainframe Applications.
• Experience in Conversion of HIPAA X12 4010 codes to X12 5010 codes and ICD 9 codes to ICD 10 codes
• Proficient in creating Sequence Diagrams, Collaboration diagrams, Activity Diagrams, Class Diagrams using Rational tools and Microsoft Visio
• Experienced in handling Change Management
• Experience in Learning Management System
• Experienced in analyzing and documenting business requirements and system functional specifications including Use Cases
• Strong Knowledge of UML, RUP, Rational Tools
• Experienced in writing Test Plans and executing Test Cases
• Skilled in validation and testing complex scenarios for the maintenance of quality standards in projects. Experienced in creating User Manuals and providing training to users.
• Creative and Aggressive person capable of forming and maintaining positive and productive team environments with integrative thinking skills.
• Exceptional Problem Solving and Sound Decision Making capabilities, along with the ability to resolve difficult situations.
• Professional with extensive experience in the development, implementation and integration of strategies within a team oriented environment, utilizing quantitative and qualitative analytical skills.
• Excellent communication and presentation skills.

PROFESSIONAL EXPERIENCE

Confidential, Tampa, FL

Sr. Business System Analyst

Responsibilities:

• Developed a complete approach and project portfolio for ICD in migration of the ICD-9-CM code sets used by medical coders and billers to report health care diagnoses and procedures with ICD-10 code sets.
• Included a complete integration strategy for ICD-10
• Involved in developing the new child onlypediatricQHP compliant dental benefit plans and adult dental insurance products for the IU65 segment on and off exchange.
• Conducted multiple Ops readiness meetings with various lines of business to align withACAand the new market place (Health Exchange)
• Identified internal and external system requirements, design and configuration set-up and documented and delivered Business Requirements Document to the project team.
• Worked as the primary liaison between the business user and the developers throughout project cycle.
• Interacted with the Subject Matter Experts (SME) and stakeholders to get a better understanding of client business processes and gather business requirements.
• Worked on ICD-10 implementation plan including information about entire ICD-10 implementation initiatives, activities, people responsible to complete the tasks and, notably, the deadlines.
• Converted the requirements into Functional Specification Documents, using Requisite Pro.
• Developed Use case, diagrams, flowcharts, sequence diagrams, activity diagrams and user interface models using UML.
• Documented project processes and procedures and version controlled them using Rational Clear Case.
• Designed and developed project document templates based on System Development Life Cycle Methodology (SDLC).
• Ensured good performance of the assigned efforts to the mutual satisfaction of the business partners/sponsors.
• Created Activity Flow Diagrams and Process Flow Diagrams using MS Visio.
• Performed gap analysis and feasibility analysis for the design and architecture of the new application.
• Responsible for managing the documented System Requirements and Requirements Traceability Matrix (RTM).
• Responsible for testing the HIPAA transactions and Code Sets 837(I,P,D) transactions.
• Worked with HIPAA compliant ANSI X12 837 formats for all types of claims.
• Managed change requests and analyzed the impact of change requests on the application with regards to Project Plan, Scope and Schedule.

Environment: Windows, MS Office (MS Word, MS Excel, MS PowerPoint, MS Visio), MS Access, MS Project, Rational Rose, Community Manager, BPML, SQL, Clear Case, Agile

Confidential, Albuquerque, NM

Sr. Business Systems Analyst

Responsibilities:

• Interacted with stakeholders to get a better understanding of client business processes and gathered requirement
• Collaborated with business analysis team members in understanding existing business processes and requirement management process.
• Followed a structured approach to organize requirements into logical groupings of essential business processes, business rules, and information needs, and insured that critical requirements were not missed
• Planned the meetings by providing advanced meeting Agendas and previous minutes
• Kept record of the meeting minutes and action items
• Worked closely on 834 transaction code for Benefit Enrollment and was involved in Validation of HIPAA for 834 EDI transactions
• Ensured clear communication via Activity Diagrams, Workflows, Use case Diagrams, Swim lanes
• Identified the Gaps and conducted GAP analysis
• Conducted working sessions to gather and document high level business requirements and detailed level business requirements for different business units impacted by ICD 10 such as EDI Claims Intake, Claims Adjudication, Medical Management- Utilization Management, Case management and Provider Reimbursement- Provider Payment
• Conducted Product Review on various aspects of the business documents that were submitted by clients, to see the progress of the project.
• Worked on the consolidation of the Oversight Checklist area based on the Product Review to identify the process of the business and identify the gap to provide feedback to the client.
• Worked as a secondary lead on Requirement Management, Data Management and System and Acceptance Testing to help the lead of the designated areas to accomplish the task.
• Prepared Weekly and Monthly Report with the guidance of Project Manager to be submitted to the client.
• Maintained the Daily Meeting Log to keep track of the Meetings attended and assuring that a Meeting worksheet has been submitted
• Designed use cases and activity diagrams for the processes highlighted specifically by the business.
• Facilitated JADs for requirement walkthrough, identification of nonfunctional requirements from system users and updated business requirements that provided appropriate scope of work for technical team to develop prototype and overall system.
• Identified and recognized opportunities to resolve problems related to EDI transactions
• Mapped the test scenarios to business requirements as part of creating traceability matrix
• Verified the Business Scenarios on new builds to allow extended testing by the QA team
• Attended various meetings with the NMHIX, Get Insured, CMS and Public Consulting Group (CMS).
• Attended a two day Final Design Review Meeting with NMHIX, PCG, CMS, Deloitte, HSD (Human Services Department) to see the progress of the project.
• Monitor daily EDI activities such as transmission verification, troubleshooting, analysis, problem solving, exception handling, and re-processing as necessary to ensure reliable and successful operations
• Ensured that the Project SharePoint site is up-to-date and versioning of the documents are clearly maintained
• Maintained a high level of documentation in respect to requirement gathering, keeping track of the product evaluation documents and any agenda received from the meeting or any progress status of the project.
• Recommended controls by identifying, gathering, analyzing and documenting business and functional requirements for EDI applications; writing improved procedures

Environment: MS Project, MS Visio, MS Word, MS Excel, MS PowerPoint, MS SharePoint, JIRA, Windows XP, HIPAA

Confidential, Tampa, Fl

Senior Business Analyst

Responsibilities:

• Elicited and documented business requirements, perform data and transaction mapping, completed a GAP analysis and documented the impact of the migration from HIPAA 4010 to HIPAA 5010 on current business processes and applications.
• Designed functional specifications for HIPAA 5010 transactions 837 (Dental, Professional, Institutional), 835 (Remittance), and 834 (Enrollment and Benefit Maintenance).
• Worked with SQL queries for data manipulation and reports generation and assisted data analyst in data mart design and prototyping.
• Designed and validated the source target mappings and performed data mapping, and data modeling.
• Performed gap analysis between the 4010 and 5010.
• Implemented HIPAA/ EDI X 12 4010/5010 healthcare-related file formats including 834/835, 837, 270/271, 276/ 277, 278, 999 for acknowledgements
• Used SQL queries to filter data within the database tables, and to pull data from various databases.
• Involved in creating and maintaining Use Cases andmodeledUse Case Diagrams, Activity Diagrams, and Data Flow Diagrams using MS Visio.
• Tracked the adaptive RUP structure for the whole Project life cycle (PLC).
• Involved with the QA team to conceptualize, establishand developtest approaches and schemes for unit testing, integration and functional testing, load and usability testing according to the requirements.

Environment: Java, J2EE technology, Windows, UNIX / Oracle Platform, MS Visio, RUP, UAT, Rational Rose, Rational Clear Quest, Rational Clear Case, Rational requisite pro, rational test manager.

Confidential, Charlotte, NC

Business Analyst

Responsibilities:

• Conducted analysis studies that serve as input to the strategic planning, goal setting, and approach to achieving the goals.
• Involved in gap analysis workshops to facilitate the proper requirements strategy and defined existing business process (BPM-Business Process Modeling) and identified the gap (Gap Analysis) between the existing & improved business process.
• Worked closely with Business Users to gather and understand requirements for streamlining the Claims Processing System. Prepared business requirements documents (BRD) and functional requirements (FRD).
• Involved in claims and records data mapping and data modeling with technical teams.
• Explained the solution model, analyzed functional requirements, prepared Use cases, defined user profiles, defined supplementary requirements, defined assumptions and prepared traceability matrix and validated requirements.
• Conducted joint application development (JAD) sessions by convening project sponsors, end-user representatives, SME. Also, used brain storming, document analysis, and user task analysis for various reporting types like CLUE (Comprehensive loss underwriting exchange, Change Report, Claim Count, Claim summaries).
• Interacted with the SMEs and stakeholders to get a better understanding of client business processes and gather business requirements.
• Prepared and maintained Requirement Trace ability Matrix (RTM) in Rational Req Pro.
• Assisted in locking bugs, in order to meet specific requirements and deadlines for successful execution of the project.
• Created Business Intelligence reporting, Performed analysis data/report integration & provided functional specification to development team for better understanding of business process and data.
• Createduse cases, process flow models, data flow diagrams and logical flow diagramsusingUMLfor various integrations.
• Gathered requirements from the end-users and acted as a liaison between the end-users and the development team and QA team.
• CreatedQAandUATtest strategies,including regressionandintegrationtesting, wrote test scripts,end-to-end testingscenarios and test plans, managed testing, defect reporting and change requests
• Followed the Agile methodology during the entire SDLC.
• Assured that all artifacts are in compliance with corporate SDLC policies and guidelines.

Environment: Visual Basic, Oracle, MS-Project, MS-Visio Windows 2000 Server, Windows, Rational Tools, Agile, HP Quality Center, Dot Net Framework, Java.

Confidential, Portland, OR

Business Analyst

Responsibilities:

• Gather requirements by conducting meetings and brainstorming sessions with end users and SME and document them using Requisite Pro - the documentation tool offered by Rational.
• Gathered requirements and modeled the data warehouse and the underlying transactional database
• Perform Gap Analysis of the processes to identify and validate requirements.
• Identified/documented data sources and transformation rules required populating and maintaining data warehouse content.
• Used Test Director as bug tracking and reporting tool and followed up with development team to verify bug fixes, and update bug status
• Responsible for Query optimization and performance tuning using tools like SQL Server Profiler, Database Engine Tuning Advisor for SQL queries and Stored Procedures.
• Planned the UAT testing, test plans, test cases and worked with the business users for UAT test execution & assisted in developing the training documentation.
• Coordinate with the business customer for the BAT and mitigate risks
• Acquisition Operations will be responsible for analyzing many areas of the business, including but not limited to: receipts routing, planning, receiving, buying, shipping, inventory management, grading, item number creation and purchase order management
• Having a common order management system to eliminate shadowing of trades from different system.
• Served as expert in the functional use of hybris, its various administrative cockpits and b2b and b2c accelerators.
• Provided training to end users and involved in conducting UAT sessions to gain user confidence and approval.
• Worked in mainframe environment and used SQL to query various reporting databases.
• Used MS Visio for Process modeling, Process mapping and Business Process flow diagrams.
• Assured that all Artifacts are in compliance with corporate AGILE Policies and guidelines.
• Involved in all phases of SDLC including Requirement Gathering, Process Mapping, Analysis & Design, Development and Testing.

Environment: PL/SQL, SQL Server, XML, Windows, Internet Explorer, Web Logic, Hybris, Rational Req. pro, clear case, Rational Rose, Clear Quest, UML, UAT, MS Word, MS Excel, MS Access, Ms Visio, and Ms Project