SUMMARY

• 7 years of industry experience as a Sr. Business Analyst with strong healthcare and solid understanding of Business Requirements Gathering, Business Process Flow, Business Process Modeling, Data Modeling, and Business Analysis
• Full understanding of Unified Modeling Language (UML) and SDLC models like Rational Unified Process (RUP), Waterfall, Prototyping and Agile
• Highly proficient in Microsoft Office Suite and Visio
• Good Working Knowledge of HIPAA ICD 10 and HIPAA transaction requirements
• Extensively involved in ICD 10 GAP Analysis, Business Impact and IT System Assessments to remediate the HIPAA ICD 9 to ICD 10 code sets for Health Care Providers
• Medical Claims experience in Process Documentation, Analysis and Implementation in 835/837/834/270/271/277/997 (X12 Standards) processes of Medical Claims Industry from the Provider/Payer side
• Developed ETL architecture for Enterprise level Data warehouses, implemented in INFORMATICA ETL tools
• Strong knowledge and working experience of industry standards such as HIPAA, HL7, six sigma, and ICD - 9, ICD 10 code sets, HIX (Health Insurance Exchange)
• Effectively used ALM (Application Lifecycle Management) for requirement management to track and manage open issues assist in planning for resolution for complex projects
• Working Knowledge of Claims Processing, Insurance Workflow, HMP, PPO, HIPAA, COBRA
• Experience in conducting Joint Application Developments (JAD) sessions walkthrough, Interviews, Workshops for requirement gathering
• Extensive experience in Business Requirements Gathering (Functional, Non-Functional), documented As-Is, To-Be process and performed GAP Analysis
• Proficient in preparing Use Cases by using Unified Modeling Language (UML), used REQUISITEPRO, DOORS Created diagrams such as: Use Case diagrams, Class diagrams, Activity diagrams, Data Flow diagrams and Sequence diagrams
• Extensive experience in Rational Rose and MS Visio for modeling
• Extensively working experience on SharePoint/TEAMSITE and Asp.Net environment
• Involved in User Acceptance Testing and training of end users
• Experience in Maintaining Reference Data Management System and Master Data Management System with Service Oriented Architecture (SOA)
• Exposure to HIPAA Compliance requirements and HL 7 standards
• Experienced with NASCO claim processing system

TECHNICAL SKILLS

Methodologies: Scrum, Waterfall, Agile

Business Analysis: Requirement analysis, Business Rules, Data flow diagram, Flowcharts, Business process modeling & improvement, Functional Requirement analysis, Source to Target mappings, Gap analysis, Cause and effect analysis, Decision tree, BRD, BRS

Business Modeling Tools: Rational Rose, MS Visio, MS Office Studio, Serena Open Project, Enterprise Architect, Adobe Dreamweaver, BALSAMIQ Mockup

Project Management: MS Project, Microsoft Office Suite and SharePoint, Requisite Pro

Requirement Management Tools: Enterprise Architect, Rational Suite (requisite Pro, Clear case, Clear Quest, Rose), Caliber RM, Optional Test 5.1, Rally HP Quality Center

Programming Languages: SQL, UML 2.0

Databases: Microsoft SQL Server 2000, Microsoft SQL Server 2005, Microsoft SQL Server 2008, Oracle 10g, QNXT

Operating System: Windows 98/2000, Windows 7, Windows 8, Windows XP, UNIX

PROFESSIONAL EXPERIENCE

Confidential, Warren, NJ

Senior Business Analyst

Responsibilities:

• Designed and developed project document templates based on the scope and plan for the project
• Gathered Business Requirements, Functional & Nonfunctional requirements by interacting with the internal team, stakeholders, development team, Project Manager and SMEs to have a better idea about the project
• Mapped out timelines, milestones, communication processes, Q&A sessions, MS Excel based query tracking. Communicated with business and other functional stakeholders for all JAD sessions to derive and execute action plans, meeting deadlines and standards
• Identified & documented Software Requirements Specification (SRS) by using UML, created Use Case Diagrams, Sequence Diagrams, Activity Diagram and Dataflow Diagrams with the use of Enterprise Architect
• Performed GAP analysis and responsible for finding out breaks in current process, suggesting new process. Created a well-defined As Is and To Be process for both project roadmaps as well as for final deployment
• Maintained Requirements Traceability Matrix and assisted in creating and reviewing test plan & test cases and conducted User Acceptance Testing (UAT)
• Created document which kept track of Internal/External business rules that project would have to follow due to new Healthcare regulations, developed quality procedures documentation adhering business rules
• Performed Risk analysis of existing strategies and carry out Cost Benefit analysis based on that.
• Experience in extensive sales figure analysis from data mapping to converting the same into final business strategy
• Prepared custom reports and performed SQL query, data analysis and verification on MS Access
• Prepared the UAT Test scripts and uploaded into HP Quality Center. Performed unit testing and UAT and documented test results and defects in Quality Center

Environment: QNXT, Leap frog, Symantec DLP, MS SQL Server 2008, SQL, Rational Requisite ProDreamweaver, MS project, Enterprise Architect, JIRA, MS Office, MS Visio, HP Quality Center.

Confidential, Trenton, NJ

Business Analyst

Responsibilities:

• Prepared Business Requirements Documents (BRD) and Functional Requirement Documents (FRD)
• Worked extensively with developing business rules engine enabling the business rules such as referral, prior authorization, eligibility, claims processing and billing essential
• Utilized Agile Software Methodology using Scrum framework. Actively participated in creating the user stories and prioritizing user stories along with tracking of burn up, burn down charts to estimate sprint delivery
• Performed GAP analysis by performing the system analysis between the scheduling systems and documented the gap items
• Facilitated all Aspects of scrum framework, including product backlog, release backlog, sprint planning session, daily scrum meeting, sprint reviews and sprint retrospectives
• Created data mappings to transform the data according to business rules
• Prepared various diagrams by using MS Visio
• Prepared documents for the wireframe and prepared a data dictionary for the same
• Coordinated with the PMO group in defining timelines & schedules for the project
• Managed testing for various functionalities using Quality Center tools
• Worked closely with QA and Developers to clarify/understand functionality, resolve issues and provided feedback to nail down the bugs
• Maintained a close and strong working relationship with teammates and management staff to achieve an expected QA result for the project team

Environment: Agile Scrum, MS Office, MS Visio, MS Project, JIRA, SharePoint, Rally, UML, SQL

Confidential, San Francisco, CA

Senior Business Analyst

Responsibilities:

• Performed the requirement analysis, impact analysis and documented Business Requirements Document (BRD) and Functional Specification Document (FSD) using Rational Requisite Pro
• Prioritized deliverables, identified gaps, tracked defects,defined software requirements, created artifacts for testing and development
• Gathered knowledge on HL7, HIPAA rules and regulations
• Mapped EDItransactions for837: healthcare claims and 835: payment advice transactions
• Administered benefits and provider contracts on a QNXT system accurately analyzing configuration needs for processing claims
• Collaborated efforts with technical staff and subject matter experts to establish the technical vision of product and analyze triple constraint tradeoffs
• Analyzed Business processes, requirements, and data necessary to provide detailed logic for ETL development
• Produced detailed source-to-target mappings for data warehouse/data mart objects
• Created UML diagrams- Use Case Diagrams, Activity Diagrams, Sequence Diagrams and ER Diagrams in MS Visio
• Documented the Traceability Matrix for tracing the Test Cases and requirements related to them
• Conducted GAP Analysis of current state (As-Is) ICD 9 and proposed state (To-Be) ICD 10 situations and represented the same on MS Visio
• Supported development of UAT cycle test scripts, Review User Acceptance Test Plan (UATP) and attended walkthrough
• Recommended changes for system design, methods, procedures, policies and workflows affecting Medicare/Medicaid claims processing in compliance with government compliant processes like HIPAA/ EDI formats and accredited standards like ANSI
• Managed the planning / test process for Medicare Part D Pharmacy Claims (PBM)
• Analyzed, maintained and updated FAQ knowledge base in SharePoint for better data accuracy and better timely data availability

Environment: MS PowerPoint, Requisite Pro, MS Visio, QNXT, Adobe Dreamweaver, MS Excel, MS Access, Oracle, Clear Quest, Waterfall SDLC

Confidential, Santa Ana, CA

Business Analyst

Responsibilities:

• Organized meetings and discussions with client and end users to understand the project requirement
• Initiated JAD sessions and open-ended discussions to identify, clarify and simplify requirements with client and team
• Created WBS, RBS and Gantt charts using Open Source Serena
• Performed Gap Analysis with As Is -To Be Process flow diagrams using MS Visio
• Created and updated the Burn down chart along with the scrum master
• Created wireframe and mockups using BALSAMIQ and Adobe Dreamweaver
• Assisted the scrum master to manage resources and facilitate for the team
• Communicated and collaborated with diverse teams in the organization to understand the products, services, and the culture.
• Gathered the basic requirements from client and end users and discussed them with the team for the first sprint cycle
• Assisted the scrum master to communicate the team's progress on project
• Conducted functionality tests with the team and end users to track defects using QC
• Hands on branding overhaul to drive adoption, usability and consistency
• Automated Business processes management and forms processing through out of the box workflows, SharePoint Designer workflows combined with InfoPath solutions
• Supported cross functional group collaboration sites, secure team collaboration sites, executive blogging, help desk ticketing systems on-boarding and adoption
• Supported a large project management portal that spans several site collections
• Support departmental site owners, end users and other content managers to ensure they have the training, materials and support for optimal use of their respective sites.

Environment: Scrum, HTML, MS Visio, Quality Center, Adobe Dreamweaver, BALSAMIQ, Open Source Serena, MS SharePoint, Oracle, MS Excel

Confidential

Healthcare Business Analyst

Responsibilities:

• Gathering requirements for a data collection and reporting system.
• Researching various topics, scheduling meetings and documenting meeting minutes.
• Analyze patient accounts and clarify any information needed to correctly answer patient’s questions regarding their account.
• Performing application support monitoring system interfaces, generating reports, researching data issues, documenting support requests.
• Performing Business process support reviewing user questions, making data updates, providing one-on-one user training, identifying process improvements.
• Managed multiple Patients Accounts across various platforms.
• Provided good customer service to the patients by proving answers to their question in a timely and courteous manner.

Environment: MS Office, Windows, UML, MS Visio. MS Project, Java