SUMMARY

• Professional with 7 years of experience as a Business Analyst in Healthcare, Banking and Customer Relationship Management
• Experience in Healthcare Application Facets in different modules like Claims, Memebrship and Provider.
• Experience in Finance/Mortgage industry,Customer Support and HR payroll system.
• Extensive experience and knowledge on all stages of the Software Development Life Cycle (SDLC)
• Experience and knowledge in Business Intelligence tool Tableau, can develop data visualizations in worksheets and dashboards.
• Well versed in using Tableau Desktop and Tableau server.
• Well versed in writing SQL queries, together with inner and outer Join commands for data analysis and retrieval.
• Knowledge and experienced on Health Insurance Portability & Accountability Act (HIPAA 4010 and HIPAA 5010), Affordable Care Act (ACA), Six Sigma Standard, International Statistical Classification of Diseases and Related Health Problems, 9th Revision and 10th Revision (ICD - 9 and ICD-10), Current Procedural Terminology(CPT).
• Proficient in Medicaid, Medicare (Part A, B, C, and D), Procedural and Diagnostic codes, and Claims Process.
• Experienced working with Claim Transactions such as 837 P/I/D - medical claims, 835 - Health Care Claim Payment/Advice, 270 - Eligibility, Coverage or Benefit inquiry, 271 - Eligibility, Coverage or Benefit response, 276 - Claim status request, 277 - claim status response, 820 - Payment Order/Remittance Advice, and 834 - Benefit Enrollment and Maintenance.
• Strong understanding on Electronic Data Interchange(EDI), both in 4010 and 5010 formats
• Extensive experience in organizing and facilitating joint application development (JAD) sessions, interviews and workshops with user(s), subject matter experts (SME’s), and business stakeholders.
• Proficient in producing Business Requirement Documents (BRD), Functional Requirement Document (FRD) and Software Requirement Specification (SRS) across the deliverables of a project.
• Expertise on website Wireframes and Business Process Modeling Notations with excellent skills on Use Case, Activity, Sequence, Data-Flow diagrams using Unified Modeling Language (UML), in MS Visio and Rational Rose.
• Well versed in Relationship Database Management System (RDBMS).
• Strong knowledge and experience with HIPAA EDI transactions such as 835, 837 (P, D, I) 276, 277 etc
• Adapt with running large scale meetings, gathering/writing requirements, scheduling meeting and presenting deliverables.
• Hands on experience in up-gradation and configuration of HIPAA 5010, FACETS systems.
• Skilled user in Clear Quest for defect tracking, bug reporting tools like Test Director and Quality Center.
• Experienced in handling Change Management and Release Management.
• Proficient in handling functional and non-functional requirements with exceptional understanding and skill set in writing Test Scenarios, Test Conditions, Test Cases, and Test Scripts.
• Possess understanding and experience in using Rational Requisite Pro to trace and update business requirements throughout the lifecycle of a project and keep stakeholders informed about the progress of the project utilizing Requirement Traceability Matrix (RTM).
• Experience in writing requirements and generating Software Requirement Specification (SRS) in requirements management
• Energetic and creative. Dynamic team player with integrative thinking skills.
• Excellent problem solving, conflict managing, decision making, and leadership skills.
• Excellent analytical, written, communication, presentation and interpersonal skills

TECHNICAL SKILLS

Project Methodologies: RUP, SDLC, Agile Methodology

Business Modeling: Rational Rose, MS Visio, MS Project

Requirement Management Tools: Test Director(Quality Center), Rational Requisite Pro, Clear Quest,SoapUI

Programming Languages: C++,SQL, PL/SQL, UML, HTML, VB Script

Defect Tracking Tools: Rational Clear Quest and Mercury Test Director

RDBMS/ Database: MS SQL, MS Access, Oracle

Operating Systems: Windows 2000/XP/ME/VISTA, LINUX, UNIX

Project Management Tools: MS Office Suite, MS Project, MS SharePoint

PROFESSIONAL EXPERIENCE

Confidential, MI

Business Analyst

Responsibilities:

• Performed extensive GAP Analysis in order to understand the As-Is and To-Be conditions and determine the feasibility of the new project with the existing system.
• Carried out User Acceptance Testing and extensively used SQL to perform Backend Testing in order to verify data integrity.
• Interacted with the QA team to performed Unit and Integration .
• Worked with Trizetto to resolve the issues identified at analysis state while building the Custom components for Claim life cycle.
• Updated, analyzed, and manipulated the SQL database.
• Collected, documented, organized, and tracked the business requirements using Rational RequisitePro.
• Made business requirements document, change requests, and use cases available to all teams using Rally and MS Visio.
• Developed business flow diagrams, activity diagrams, and interaction diagrams so that the development team and other stakeholders could understand the business process clearly.
• Maintained project milestones, schedules, and project progress using MS Project.
• Held presentations and participated in walkthroughs with the development team and the QA team to help them understand the requirements and formulate test plans and test scripts.
• Maintained Requirement Traceability Matrix (RTM) to check whether the requirements of the system was met accordingly and to produce RFPs.
• Performed claim validations and Pend/Denied claims analysis for the Health plans Medicaid programs.

Environment: UML, MS Word, Rational RequisitePro, Rational ClearQuest, Quality Center, SQL, FTP, TelNet, Facets, Microsoft SharePoint

Confidential, Urbandale, IA

Business Analyst

Responsibilities:

• Determined how the changes in HIPAA-5010 impacted the current business operations, defined and developed business and technical requirements within and across transactions.
• Performed Gap Analysis to identify AS-IS processes of claims transactions of 4010/4010A standard and TO-BE processes of 5010 standard.
• Worked extensively with the users, development team and different levels of management to clarify/understand functionalities and ensure that the developers clearly understood the business requirements that the system was designed to fulfill.
• Using Rational Rose, the business requirements were segregated into high level and low level Use Cases, Activity Diagrams.
• Designed and developed state diagrams, activity diagrams and class diagrams in MS Visio for various modules of the project.
• Gained a clear understanding of the claims adjudication and reimbursement systems based on HIPAA X12 5010 standards
• Interacted with the QA team to develop Test plan and Test cases based on Use cases and Functional Specifications.
• Conducted Claims and HIPAA Compliance Training in order to run the test cases.
• Helped requirement documentation for Data Extraction, Data Transformation, and Loading processes as a part of data mapping procedures.
• Assisted in writing test scripts and verifying test results to fulfill business requirements.
• Directly involved in process improvement plans and implementing business change, creating and managing Project templates, Use Case project templates, requirement types and traceability relationships in Requisite Pro.
• Maintained a Traceability Matrix to ensure that all Functional Requirements were addressed at the Use Case Level as well as the Test Case Level.
• Assisted in EDI 835/837/270/271 transactions of medical claims/underwriting for support and point of reference for the providers in business issues.
• Performed Unit and Integration Testing and implemented Alpha Test in order to confirm the functionality of recent conversion.

Environment: MS Office, Quality Center, SQL Server, Facets, MS Project, Server, MS Visio, Unix, SQL, HTML, Java, XML, Mainframes and Rational ClearQuest, ClearCase, Windows XP

Confidential, CA

Business Analyst

Responsibilities:

• Reviewed and analyzed business requirements and interacted with the business users to resolve conflicts.
• Performed initial functional and business analysis to determine scope and document review for the technical team.
• Constructed data lineage information on usability and conceptualized data applications in a program-level scenario, highlighting the happy or base flow and probable exceptions.
• Constructed, developed, and deployed ACH Money Transfer documentation for Overseas Business Unit, created functional and technical specifications (mid-level), highlighting chief actors, process flows, and exception errors.
• Worked with various Overseas Funds Transfer Applications.
• Interacted with Offshore development team, and incorporated the analysis and requirements in the final detailed design documentation.
• Reviewed and provided critical document feedback to team members, communicated document analyses to team lead and stake holders.
• Chaired and participated in project conferences for coordinating group efforts leading to the development and testing phase.
• Used MS Project to develop project schedules and tasks.
• Participated in developing Use Cases, activity and sequence diagrams to define the functionality scope of the applications during walkthroughs and JAD sessions.

Environment: Rational RequisitePro, Rational Rose, RUP, UML, Load, MS-Project, MS Visio, Java, MS Office, Windows XP

Confidential, Cleveland, OH

Business Analyst

Responsibilities:

• Congregated requirements from different levels of management, stakeholders, and SMEs through JAD sessions and Live meetings.
• Incorporated AGILE methodology to establish a business analysis by interacting SMEs and end users.
• Completed a Business and Technical Requirement Document (BTRD).
• Developed Use Case documents using MS Visio of As-Is and To-be business.
• Designed and developed business flow and work flow diagrams to develop the software.
• Created Use case diagrams, Activity, Sequence and Collaboration diagrams using UML.
• Participated in walkthroughs with the development team and QA team, to help them understand the requirements and help them formulate the test plans and test scripts on EDI 834 benefit enrollment.
• Involved in verifying EDI 834 raw data from different portals such as fax, websites or email.
• Experienced in Blackbox testing using decision testing and use case testing.
• Defined Quality Assurance Checklist using Oracle Service Contract.
• Utilized MS Project to maintained a record of recommendations, communications, activities, schedules in order to monitor the progress of project in real time.
• Intensively involved in project testing efforts by doing Integration Testing, Regression Testing and by helping UAT team in User Acceptance Testing.
• Maintained traceability of requirements through to the testing phase; created and executed test cases; coordinated with testing teams during QA and UAT testing activities.
• Presented documentation on key elements of HIPAA compliance to ensure the development teams were on track.
• Worked with Claims, enrollment, eligibility verification for members and providers, benefits setup, and backend payment cycle in Facets.
• Created User manuals and provided one-on-one training to end users.

Environment: Agile methodology, MS Visio, MS Project, UML, WinRunner, MS Office, Microsoft SharePoint

Confidential, Troy, MI

Business Analyst

Responsibilities:

• Created a test schedule to conform to the confines of the Project Schedule and also deliver value to client.
• Shopped and procured automated testing tools facilitating Program Policy and Standards and compliance; support repeatable testing procedures.
• Developed project delivery schedule, managed projects and identified resources to successful completion
• Managed Project Management staff, Quality Assurance and Technical Writing staff.
• Managed open enrollment technical projects for 20,000.
• Acquired comprehensive knowledge of Banking activities and operating processes
• Collected and documented business processes as well as business rules.
• Participated in the identification, understanding, and documentation of business requirements, including the applications capable of supporting those requirements.
• Translated the business needs into system requirements, communicating with the business on a non-technical level, and with the System Analyst on a more technical level.
• Collaborated with development architect and the business to develop both high-level and detailed application architecture to meet the business needs.
• Documented and delivered Functional Specification Document to the project team.
• Performed GAP Analysis and conducted User Acceptance Testing (UAT).
• Developed test scenarios and implemented test plan. Providing key input in working with users in defining project and system requirements.
• Conducted project related presentations.

Environment: Rational Rose, MS PowerPoint, Test Director, Rational Requisite Pro, RUP, UML, Rational ClearCase

Confidential

Business Analyst

Responsibilities:

• Gathered requirements and prepared business requirement documents (BRD).
• Responsible for translating BRD into functional specifications and test plans.
• Closely coordinated with both business users and developers for arriving at a mutually acceptable solution.
• Conducted JAD sessions to define the project and to reduce the time frame required to complete deliverables.
• Involved in business and technical to develop business requirements for implementation
• Developed and maintained all operational and technical flows using Visio and Power point
• Used Rational Rose/MS Office Suite for creating use cases, workflows and sequence diagrams according to UML methodology thus defining the Data Process Models
• Defined Use cases from requirements and helped convert them into software specifications
• Involved in developing and executing test scripts, test cases, data sets and user procedures
• Aided in workflow analysis and process design
• Analyze business requirements from Black Box Testing perspective, business process and system architecture/design
• Maintained Requirement Traceability Matrix (RTM).
• Performed Regression Testing and created test scenarios for User Acceptance Testing (UAT)
• Used MS Office Tools (Word, Excel, Outlook), MS Visio, MS Access, Lotus Notes and Clarity
• Maintained documents for change request and implemented procedures for testing changes.

Environment: Rational Rose, RequisitePro, Test Manager, Clear Quest, RUP, MS Visio, MS Project