SUMMARY

• Skilled professional with proven track record of over 7+ years as a Business Analyst and have hands on experience in Healthcare Industry.
• Experienced in conducting Joint Application Development (JAD) sessions for requirements gathering, analysis, design, development, testing and Rapid Application Development (RAD).
• Have experience working on all the phases of Agile/Waterfall software development life cycle (SDLC).
• Managed all phases of SDLC with comprehensive knowledge of business requirements analysis, use case modeling, and use case specification.
• Hands on experience working with HIPAA 4010/5010 x12 transactions such as 837, 835, 834, 278, 270 and 271. Worked extensively on gap analysis and data mapping of ICD - 9 and ICD-10 codes using GEM's.
• Extensive Experience working with the Affordable Care Act (ACA).
• Good knowledge of HIX, Health Insurance Plans (Medicare Part A, B, C and D), managed care concepts (Medicaid and Medicare) and experienced in determining the membership eligibility, billing experience within life and disability in health plans.
• Have worked on systems integration testing, Regression testing, Functional testing and User Acceptance Testing (UAT).
• Skilled in Gap analysis, SWOT analysis, Risk analysis.
• Experienced with SharePoint operations to share documents and information with the team members for the development of the application.
• Experienced in business Modeling and Use Case development using UML methodology. Created process flow diagram, system diagram, sequence diagrams and data flow diagrams by using MS VISIO.
• Good Knowledge of SQL and FACET.

TECHNICAL SKILLS

• MS Project
• SQL
• Requirement Traceability Matrix (RTM)
• JAD
• Windows OS
• MS Office
• MS Word
• MS Excel
• MS PowerPoint
• MS Visio
• JIRA
• Share Point
• HP ALM/ Quality Center
• SQL Server .

PROFESSIONAL EXPERIENCE

Confidential

Business Analyst

Responsibilities:

• Facilitated requirements gathering sessions with the clients and refined the requirements.
• Involved in all aspects of projects, including documentation of project needs, analysis/ research of needs and possible solutions, documenting and updating business requirements and working with project members to execute the test plan, recommending preferred solutions, and implementing the recommendations.
• Gap Analysis for the functionality, usability and performance of the existing website/portal.
• Involved in analysis of existing documentations to get the possible solutions.
• Created test cases on portal and extracted the data from DDE to check different functionality of the web portal.
• Created process flow diagram by using MS VISIO.
• Conducted highly interactive requirement gathering sessions with projects stakeholders such as users, QA analysts, and project management team for identifying and resolving issues.
• Involved in writing the business logics in order to populate the placemat (Reporting spreadsheet) for the counts from the production environment to the state.
• Created test cases on different scenarios to check if the coding is correct based on the business logics for the extraction of the count from production Environment.

Confidential

Responsibilities:

• Prepared PPT Slides for E&E (eligibility and enrollment) tower with all the information incorporated with OPTUM work and how OPTUM deals with CMS, QSSI, ACCENTURE, OPERA and MIDAS; to give an overview to the vendor.
• Prepared PDD (Process Description Documents) for transition purpose.
• Created the process flow chart diagrams by using Visio to present the process to the vendor.
• Attended and scheduled meetings with CMS, QSSI and the vendor and scribed the meetings.
• Assisted the tower leads of E&E (Eligibility and Enrollment), OC (Office Communication), SLS (Scalable Logical System), EPDS and FM (Financial Management) with all the documentation as per the need.
• Helped the Tower lead with the shadowing and the reverse shadowing in transition process.
• Track down the records of the meetings and the transition process.
• Responsible for updating the tracker accordingly on the share point and the documents related to the transition process as well.
• Used SharePoint to share all the documents and information with the team.

Confidential, WI

Business Analyst

Responsibilities:

• Analysis and documentation of existing processes dat display products on the portals (UI) .
• Conducted JAD session to gather requirement
• Involved in the meeting with the development team related to the defects.
• Identification and documentation of areas dat will be impacted on the portals and the downstream processes with respect to the changes.
• Worked extensively with ACA Escalated Case Resolution team and developed processes to efficiently handle the incoming case volumes from the exchange.
• Requirements Elicitation, Requirements Analysis and Requirements Gathering to propose the changes dat needs to be made on the impacted areas.
• Created of Functional Requirement Documents for the changes dat needs to be made on the portals and the underlying applications.
• Presented progress reports to clients in order to keep them current on the project status.
• Coordinated with the application's teams to support and manage the overall process as an ongoing activity.
• Coordinated with the Development, Testing and Release Management teams to support and manage smooth implementation of the changes.
• Developed Use case, diagrams, flowcharts, sequence diagrams, activity diagrams.

Confidential, Hartford, CT

Business Analyst

Responsibilities:

• Interacted withstakeholdersto get a better understanding of clientbusiness processesandgathered requirements.
• Conducted requirement gatheringsessions with the purpose of creating and defining theBusiness Requirement Document(BRD) and theFunctional Requirement Document(FRD).
• DevelopedUseCasesfor each of the Service Types for each of the application - Inpatient, Outpatient.
• Responsible for the UAT testing of the ICD 9 to ICD 10 Diagnostic and Procedure codes while reviewing the information to ensure accuracy.
• Developed (UAT) User Acceptance Testingplan to guide a select group of key end-users in testing the user interface and functionality of the application.
• ConductedFields Mappingby explaining each column name in the backend database tables..
• Develop Test analysis report fromQuality Centerafter test execution.
• DevelopedUAT Test Casesto cover overall quality assurance testing.
• ConductedJAD sessionsto allow different stakeholders to communicate their perspectives with each other,resolveanyissuesand come to an agreement quickly.
• ClarifiedQA team issues and reviewed test plansdeveloped by QA team to ensure dat allrequirementshave been in scope and tested accordingly.
• ExecutedSQL queriesto test the databasefor records for functional acknowledgement and remittance advice in the claims application in FACET

Confidential, MN

Business Analyst

Responsibilities:

• Analyzed and Designed of HIPAA X12 834 EDI Transactions for Health Insurance Exchange (HIX) .
• Created Test Case and Test Scenario based on X12 834 E2E Functional Testing.
• Created Process Flow Charts, Business Requirements Documents, and FunctionalSpecification Documents.
• Facilitated requirements gathering sessions.
• Acted as primary liaison between project business staff and technical staff.
• Responsible for gaining a detailed understanding of components of the business and translating dat knowledge into the requirements for systems or processes.
• Used SOAPUI tool for Web-service Testing (Send X12 834, Receive 999 / TA1's).
• Designed process flows of EDI Transactions (Portal -->HIX --> Carriers) using MS Visio 2010.
• Created 834, Transport Layer Specification and Master Mapping Document (MMD) stating loops and segments.
• Generated, Edit and Analyze EDI X12 transactions using Oracle Spec builder 6.6.1 powered by Edifecs.
• Very good understanding of ORACLE B2B Health Care Adapters (HIPAA EDI X12 834 )
• Workedon SOA Web Service testing, watching HBE Enroll Web Service and Carriers Enroll Web Service interaction, using SOAPUI to test web service request and response between to ends..

Confidential, Dallas, Texas

Jr. Business Analyst

Responsibilities:

• Worked with the SMEs (Subject Matter Experts), IT managers, software architects to identify the key changes pertaining to HIPAA, and participated in Health Management to communicate effectively with them.
• Performed Requirement Gathering & Analysis by actively soliciting, analysing and negotiating customer requirements and prepared the requirements specification document for the application using MS Word.
• Produced Gap Analysis documents for HIPAA 5010.
• Conducted weekly meetings for deciding the Policies and Procedures to be followed while constructing new sites.
• Performed the requirement analysis, impact analysis and documented the requirements using Rational Requisite Pro.
• Identified opportunities for business process improvement through various meetings with business users and developers and initiated efforts to make improvements.
• Worked on project life cycle and SDLC methodology of Agile.
• Developed the project plan with assistance from the management, and included provisions for project scope changes and issues and initiated efforts to make improvements.
• Worked with Designers to create data warehouses and/or reporting solutions using ETL.
• Conducted project kick off meetings with team members to explain roles / responsibilities, relationships with other groups, deliverables, timelines, assignments and status reporting.
• Extensive use of Excel to create Functional Specification Documents & Templates
• Prepare presentation slides in MS Project for JAD sessions and to track progress.

Confidential, New York City, NY

Jr. Business Analyst

Responsibilities:

• Analyzed and documented the system specifications, Business requirements and detail design of the software for full understanding of the business .
• Conducted JAD sessions for communicating with all the project directors and stakeholders. Created process workflows, functional specifications and project initiation artifacts.
• Managed all project requirements and change to requirements throughout the software development lifecycle using Requisite Pro.
• Created full life cycle documentation from product requirements in the developmental stage to functional specifications for the completed modules of application components.
• Created Use-Cases, Sequence and Collaboration Diagrams to demonstrate software architecture and interaction of system components before prototyping. Used Rational Rose, Requisite-Pro for requirement traceability.
• Managed GAP analysis around the identification of business rules, business and system process flows, user administration, requirements and assumptions.
• Developed test cases and scripts based on business requirements for the GUI, functional, User Acceptance & System Back-end testing.
• Worked closely with QA and Developers to clarify/understand functionality, resolve issues and provided feedback to nail down the bugs.
• Reviewed and evaluated all the modules of the software before delivery to user’s to confirm its meeting the standard criteria.