SUMMARY

• Business Analyst with 7 years of experience in teh field Health Care and Information Technology.
• Knowledge of industries standard SDLC methodologies and having extensive experience working on all teh phases of Waterfall, Agile, RAD and RUP including Joint application development (JAD), Joint requirement planning (JRP).
• Experience in conducting GAP Analysis, SWOT Analysis and Cost benefit analysis.
• Strong analytical, and problem - solving skills with particular emphasis on clear, detailed business requirements and functional specifications, as well as reports for management.
• Direct responsibilities include experience with planning, organizing, and change management.
• Team player, result-oriented, fast learner, excellent communication skills with strong research capability, excellent documentation and interpersonal skills.
• Possess excellent Analytical skills and Technical skills in gathering business requirements from business stakeholders and converting them into Functional requirements, Use case document, User Interface Specification, Technical Design Test case document and User manuals.
• Expert in tracing requirements throughout teh development process and verifying adherence Requirement Traceability Matrix (RTM).
• Strong experience in conducting User Acceptance Testing (UAT) and documentation of test cases.
• Excellent business writing skills essential for producing various business documents such as Business Requirements Document (BRD), Functional Requirements Document (FRD), and Non-Functional Requirements Document (NFRD), Business Process Documents, Business Flow Documents, User Training Manuals, User Interface Specifications.
• Created and reviewed Test Procedures, Test plans for quality assurance, analyzing bugs, interacting with team member in fixing errors.
• In-depth noledge of Medicaid and Medicare claims processing along with extensive noledge on CMS, MITA, MMIS, EMR/EHR, Facets, Pharmacy Benefit Management (PBM).
• Deployed UML models in different projects by way of activity diagram, use case diagrams and sequence diagrams using MS Visio.

TECHNICAL SKILLS:

Operating Systems: Windows 2000/XP/Vista/8/8.1

Methodologies: RUP, Waterfall, RAD, Agile Development, SCRUM

Industry Standards: HIPAA, ICD codes, Medicaid and Medicare, Facets.

Requirement Management Tools: Unified Modified Language (UML), IBM Rational Requisite Pro, Version One, Microsoft Visio.

Project Management: Microsoft Office (MS Word, MS Excel, MS PowerPoint, MS Outlook).

PROFESSIONAL EXPERIENCE:

Confidential, Houston TX

Business Analyst

Responsibilities:

• Analyzed existing Business units, Business process, and their Interfaces with their capability through open-ended discussions, brainstorming sessions, and prototyping, prioritizing them and converting them as system requirements dat must be included while developing teh software.
• Interacted with teh Subject Matter Experts (SME’s) to gather information about teh health care enrolment, eligibility, billing and health care claims processing.
• Created documentation for functional and non-functional requirement.
• Gatheird user stories and created product Backlog for teh new system to be implemented.
• Created and maintained teh workflow plans and artifacts Created Business process models and process flow diagrams to meet teh business requirements.
• Worked extensively with GAP Analysis for ICD-9 to ICD-10 and gatheird and validated inventory of applications, interfaces and reports dat are needed for ICD-10 transition.
• Established questionnaires for implementing ICD-10 and worked extensively on identifying need, risk, requirements and concerns of teh hospital in order to comply with ICD-10 transition.
• Experience with full development cycle of a Data Warehouse, including requirements gathering, design, implementation, and maintenance
• Resolved conflicts between development and implementation teams. User Acceptance Testing (UAT) testing was performed to ensure proper compliance of goals was met.
• Followed structured approach of gathering and formalizing business requirements expressed by managers, process owners and operational users of teh information system.
• Logged and resolved defects using JIRA
• Utilized MS Visio to draw use case diagrams and process flow mapping to capture requirements so dat teh development team and stake holders can understand teh business process.
• Coordinated with teh application team and Quality Analysts in teh creation of test plans, User Acceptance Test scripts and Regression test cases (for upgrade).

Environment: MS Office, Microsoft Visio, Agile, Microsoft Project, Microsoft Share Point, UMLJAD, GAP.

Confidential, Oklahoma City, OK

Business System Analyst

Responsibilities:

• Designed Business Requirement Documents (BRD) and Functional Requirement/Specification Documents (FRD)/ (FSD).
• Conducted Request for Information (RFI) and Request for Proposal (RFP) process for vendor products and facilitated Business and Technical teams in Vendor Selection Process.
• Worked intensively with Medicaid claims.
• Facilitated pre-planned meetings, demos and daily stand ups.
• Performed analysis for making system compliant with HIPAA. Involved in making teh Medicaid patient profiles being compliant with teh HIPAA regulations. Managed Patient Profile Transfer (PPT) reports created by data team by verifying teh associated data.
• Interacted with Subject Matter Expert’s (SME’s), Business users, Architects, Data Modelers to gather business process requirements and to translate them into functional specifications.
• Created process workflows, functional specifications and project initiation artifacts.
• Conducted JAD sessions for communicating with all Project stakeholders.
• Prepared data models dat involved a set of diagrams and supporting documents dat contained essential business elements, detailed definitions and descriptions of teh relationships between dat data elements to analyze and document business data requirements.
• Provided technical assistance in identifying, evaluating, and developing systems and procedures dat are cost effective and meet business requirements.
• Also worked with billing and health care claims processing
• Performed User Acceptance Testing (UAT), created test scenarios/plans and developed test cases for testing teh products in order to verify dat client/vendor requirements are incorporated in to teh system design.
• Performed regression testing to ensure teh product integrity.
• Assisted in defining implementation and deployment tasks for teh new platform as per requirement.

Environment: Waterfall, UAT, GAD (Gap Analysis Document), Microsoft Office Professional (Outlook, Word, Excel, Visio)

Confidential, CT

Business Analyst

Responsibilities:

• Provided support to full development life cycle, testing, training and implementation.
• Communicated any requested changes to project scope and coordinates needs with Supervisor / Project Manager.
• Performed analysis on 834, 835, 837 P, D & I, 270, 271 Audit Files, Change Files and recorded changes.
• Used EDIFECS analyzer & Data Migrator for HIPAA validation.
• Performed word compares and database compares for 834 Enrollment Files, 835, 837 Change & Audit Files.
• Created extension in claim processing with respect to Claim processing module in member details, plan names and benefits were upgraded using FACETS 4.8 which displayed newly structured payment plans for Medicare members.
• Balanced payment options and plans using Network X Pricer and workflow in Facets 4.8.
• Demonstrated a high level of competency in utilizing data analysis and query tools such as MS Access, SQL, and MS Excel in order to identify root-cause issues, create new processes, or enhance teh development of FACETSsystem changes in FACETS & Service Oriented Architecture (SOA) Configuration Team.
• Responsible for creating test files and testing it’s functionality
• Followed teh mapping documents and HIPAA implementation guides for HIPAA Transaction Mapping.
• Created test plan, project plan, test strategy, test cases, test procedures, test matrix and defect strategy detailing scope, resource assignments, schedules etc. for teh Functional Automation Testing and Performed Security Testing to test against any unauthorized access in Web Application. Created test files for different scenarios for audit and change files.
• Performed and executed integrity testing, requirement testing, balance testing, situational testing, code set testing, line of business testing, vendor / trading partner testing according to HIPAA compliance with EDI transaction as a means of communication.
• Created teh trace-ability matrix and different types ofreports& graphsforeach stage of testing.
• Supported system testing, user acceptance testing (UAT), and operational readiness testing as required.
• Performed regression, integration and functional Testing along with Manual and Automated Testing.
• Worked with testing manager to review test case scenarios and facilitate completeness of test coverage requirements.

Environment: Agile, UML, SQL, MS office, Black Box and White Box Testing.

Confidential, Milwaukee, WI

Business Analyst

Responsibilities:

• Involved in interview sessions with end-users to gather information about business processes.
• Actively worked on Business requirement gathering, analysis and Data Analysis.
• Conducted kick-off meetings and developed various strategies to distribute teh work in team.
• Created “As-Is Business Models” to understand teh existing claim settlement process flow through interacting with SMEs, underwriters and Finance department and created “To-Be” Business Models.
• Worked extensively on GAP analysis of 4010 and 5010 using ‘Tracer’ tool.
• Reviewed documents (policies, manuals, business processes, systems documents, banners, bulletins) from various divisions. Analyzed and performed Impact Analysis to determine areas impacted by HIPAA 5010 and ICD-10 related data.
• Developed and maintained teh product backlog with tracking teh progress pertaining to all teh user stories.
• Performed analysis of systems and business processes of Medicare Part D as per CMS rules and procedures. Mapped ICD codes and prepared final result summary documents with reports.
• Designed and developed use cases, activity diagrams and sequence diagrams.
• Reviewed test specifications, test cases and performed manual testing.
• Performed User Acceptance Testing (UAT), developed test logs and opened/closed as and when teh issue is fixed and quality checked with teh assumed company data with all teh possible Test Scenarios.

Environment: Agile, UML, SQL, MS Office, MS-Project, Test Director, MS Visio.

Confidential, New York, NY

Business Analyst

Responsibilities:

• Studied teh documents in place and interviewed user groups to gather requirements and prepared Business Requirement Documents (BRD) and Functional Specifications Document (FSD).
• Prioritized requirement deliverables documented in requirement document to meet teh crucial deadlines to complete teh project according to schedule.
• Designed teh navigation flow and user interface for teh full-featured reporting functionality.
• Developed UML Diagrams such as use case diagram, activity diagram, class diagram, and sequence diagram to interact with developers.
• Created workflow diagrams, swim lanes, process flow, and reviewed test cases, test plans and test scripts.
• Facilitated Joint Application Development (JAD) sessions, Joint Requirement Planning (JRP) sessions, workshops and requirement elicitation sessions with teh Business Stakeholders, Subject Matter Expert’s.

Environment: MS Office Suite (Word, PowerPoint, Excel), MS Visio, UML, Share point

Confidential

Business Analyst

Responsibilities:

• Documented Business and Functional Requirements.
• Participated for teh creation ofbusiness process workflow diagramswith Stakeholders.
• UtilizedRational Unified Process (RUP)to configure and develop process, standards and procedures to create Business requirement Document (BRD).
• ConductedGAP analysisof teh different reports dat are being presented to clients to accommodate their requirements for teh new enhancements.
• Created artifacts such asuse cases, activity diagrams, and sequence diagramsusing MS Visio.
• Understand teh various stages of aclaim life cycleand utilize teh noledge in meeting client goals.
• ConductedJADsessions during teh various stages of upgrading teh matching system and discuss teh current system preference.

Environment: Waterfall methodology, Designed Use Cases, Use Case diagrams, Activity diagrams, Sequence diagrams in UML methodology using MS Visio.