SUMMARY

• Over 7 years of experience inHealthCare Insurance (Medicaid and Medicare Claims) andPharmaceutical based Industries as a Business Analyst.
• Strong experiencein documenting theBusiness Requirements Document (BRD), developing theUAT Plan, maintainingtheTraceability Matrix and assisting inPost implementationactivities.
• Extensive experience in working in SDLC for Various methodologies included RUP, Agile, and other internal methodologies.
• Expert in translating business requirements & user expectations into detailed Functional Requirements Specifications (FRS) by employing Unified Modeling Language (UML)
• Highly experienced in performingFeasibility Studies,Impact analysis,GAP analysis and Risk Analysis.
• Expertise in creatingUse Cases, Use Case Diagrams,ClassDiagrams, Sequence Flows usingMS Visioand UML concepts.
• A great deal of experience with insurance administration systems included Actuarial, Policy Application, Eligibility, Enrollment, Underwriting, Claims, Billing, and Payments.
• Hands on experience on working with claims automation tool FACETS 4.51.
• Strong testing experience in HIPAA X - 12 EDI Insurance/Health Series (INS) such as 270/271, 274, 276/277, 278, 820, 834, 835, 837, and Version 5010 of this transactions.
• Hands on experience with SQL server reporting services and other Business Intelligence tools such as Cognos and Informatica
• Web Portal Development - worked in the development of a web portal used by providers and members to view referral information.
• Extensive experience in working withhealthcare claims, HIX, HL7 scripts, EHR, use of ICD - 9 diagnosis codes, CPT, Claims, Provider, Enrollment, finance, benefits and Vendor ManagementBusiness Areas.
• Good understanding of HIPAA 5010 and ICD -10 initiatives.
• Sound knowledge of the Medicare Fee for Parts A, B, C & D claims processing system.
• Knowledge of ICH guidelines, GCP, GLP, 21 CFR part 11, part 312, part 314, Regulatory affairs, and FDA guidelines.
• Defect Management/ Bug Fixing - Fully involved in the process ofdefect identificationand resolution using tools likeTest Director, Clear Quest and Quality Center.
• Good experience in conductingUser Acceptance Testing (UAT)and documentation of Test Cases.
• Organized professional with excellent oral and written communication skills, excellent presentation, interpersonal skills, problem solving skills, fast learner and also adept quickly new technology with ability to take new roles in minimum time and little training.

TECHNICAL SKILLS

• HIPAA ANSI X 12 4010-5010
• CMMI
• Six Sigma
• MMIS
• SDLC
• RUP
• Agile Methodology
• Cognos
• Informatica
• CPT and ICD-9 Coding
• ICD10
• 21 CFR 312
• 21 CFR 820
• HCPCS Codes
• Modifiers
• FACETS
• AMISYS
• NASCO
• ANSI X12
• Rational Rose
• Requisite Pro
• MicrosoftVisio
• INKSCAPE
• Mumps
• SAS
• SAS/SQL
• .NET
• Cobol
• Microsoft Project
• Microsoft Office
• Erwin
• Clinical Data Management Systems ARGUS
• Crystal Report
• Rational Quality Center
• MS SQL Server-2005/2008
• MS-Access
• MS Windows 7/98/XP.

PROFESSIONAL EXPERIENCE

Confidential, Port Washington,NY

Sr. Business Analyst

Responsibilities:

• Agile methodology was used throughout the project, with daily status report, queries and updates on the Scrum master.
• Conducted JAD sessions, Meetings, Teleconferences to gather business requirements from various Stake Holders and SME’S.
• Performed GAP analysis by the performing the system analysis between the scheduling systems and documented the gap items.
• Prepared the Business Requirement Specifications, System Requirement Specification, Interface documents, Architecture Specification and documented the environment setup for various environments. (Development, QA, UAT, Implementation, Testing and Production).
• Worked on the developing business rules engine enabling the business rules such as referral, prior authorization, eligibility, claims processing and billing.
• Mapped the business process flows required for processing the claims in the business rules engine.
• Assisted in the project involving the conversion of HIPPA 4010 to 5010.
• Validated the process flow for the HIE for the point of care project.
• Coordinated with the team in preparing the scripts for HL7 along with integration of LIMS with EHR.
• Worked extensively with the XML files for analyzing and handling various billing formats from various agencies which included the standard 837P along with ICD 9 codes, HCPCS codes.
• Performed the UAT testing and validated the claims processing system using the test data.
• Written SQL queries for data analysis,
• Created Database Design, Entity-Relationship Modeling, Dimension Modeling & Star Schema also used MS excel for data mining, data cleansing, data mapping, and data dictionary and data analysis.
• Developed and maintained requirement traceability matrix.
• Created data mapping documents for various ETL processes.
• Prepared various Activity diagrams, Sequence diagrams, Swim lane diagrams using MS VISIO, INKSCAPE tools.
• Prepared Test Cases and Use Cases to demonstrate the interaction of the user with the system along with the various preconditions and the end results.
• Prepared documents for the wireframe and prepared a data dictionary for the same.
• Prepared various Service oriented Architecture for diagrams for various systems in SANDATA.
• Prepared architecture document for the system, also documented the environment setup for the system.
• Managed testing for various functionalities using JIRA and quality center tools.

Confidential, Danville, PA

Sr. Business Analyst

Responsibilities:

• Gathered requirements and documented the proposed processes to the existing system.
• Modules included: Medical Claims Processing files and HIPPA guidelines adherence across the company.
• Enhanced applicationsassociated withClaim Numbersso that duplicate Claim Numbers could be eliminated in the system.
• Worked extensively with the medical units of Geisinger (wellness program) to update thePatient profile, Sales Administration processes (hospital integration) while maintaining the HIX integration.
• Performed GAP analysis assessed the as-is processes through user interviews, data collection and analysis, design and evaluation of to-be process solutions.
• Worked on FACETS 4.51 software for adjudicating and processing the claims, as well as worked on EPIC software for maintaining the EHR.
• Claim Transactions and Billing Transactions - Created flows for adequate matching of Claims.Performed data mapping by matching the billing fileandEDI claim filerecord claims received from Medicare and Medicaid agencies.
• Duplicated Claim Number Project - Enhanced three different applications - EDI Feedsand Patient Screen Appto remove duplicate claim numbers.
• Worked with XML files for project involvingDanville Systemsto create Drug Cards and validated the process for Part D (Prescription Drugs).
• Validated the following: 837 (Health Care Claims or Encounters), 835 (Health Care Claims payment/ Remittance), 270/271 (Eligibility request/Response), 834 (Enrollment / Dis-enrollment to a health plan) for Part B and Part D of Medicare health claims.
• Validated the codes for the billing process which included ICD 9, CPT codes and various modifiers where applicable in compliance with HIPPA 4010.
• Created Test File to be sent to theDrug Card Vendorsfor approval. Worked on a Paid without prejudice project for various States.
• Worked with PL/PL/SQL queries using MS Access for data manipulations.
• Assisted QA manager to develop test plan and test case
• User Acceptance Testing (UAT) - Performed UAT tests usingthe Usability Testing Toolusing the Observer and the Manager Mode.
• Testing -DevelopedTest ScriptsusingTest Director/Quality Centerand coordinated with developers to quickly resolve the defects associated with them.
• Participated insystem testing and user acceptance testingworked with System Test Review team and developers to resolve system test issues and re-test.
• Facilitated Change Control Board and Governance Board meetings and acted as a liaison between parties impacted by the change requests
• Helped create the'Business Glossary'to facilitate efficient understanding of the business process amongst the other teams.

Confidential, Pittsburgh, PA

Business Analyst

Responsibilities:

• Conducted meetings with Data Architects, Data Modelers and MS SQL Reporters to determine the feasibility of the related data.
• Extensively involved in requirement gathering and design meetings with Integrated Product Team (IPT) Business / Lead users to understand requirements for configuring / test System Workflows.
• Worked extensively with HIE,HL7, EHR along with assisting in hospital integration for data received from the trials site.
• Worked with FDA guidelines, ICH-GCP guidelines including 21 CFR part 11 and 21 CFR part 312 required for clinical trials data.
• Successfully conducted numerous Joint Application Development (JAD) Sessions with various stakeholders at different phases of the Software Development Life Cycle (SDLC)
• Conducted feasibility study to identify if the business system can be created within the limited time, budget and resources.
• Performed GAP Analysis to identify areas of improvement for the business process.
• Developed, compiled and updated the Requirement Traceability Matrix (RTM) during all phases of the software lifecycle.
• Worked in with Requirement Analyst for documenting / revising, User Requirements, User Interface Requirements, Migration Requirements, Software Requirements Specification, and Product Retirement Requirements and Requirements Traceability Matrix.
• Worked with Technical Writer and Senior System Analyst to prepare User Manuals, System Administrator, Facility Administrator and B HQ Administrator Manuals.
• Created data mapping document to load data from XML files to SQL table.
• Provided Training to Business Users, Test Team, and Product Specialists
• Attained IPT meetings and meetings with management and lead business users from various regions
• Involved in Prototyping of the application and Gap Analysis
• Worked with Senior Requirement Analyst to understand the User Requirements
• Reviewed / revised Use Case Document
• Prepared User Acceptance Testing (UAT) Protocol from Use Cases encompassing basic and alternate flows
• Wrote Test Cases and Procedures for User Acceptance Testing
• Tracked documents through all stages of lifecycle coordinate activities with authors, reviewers and approvers to promote document flow through the system.
• Execute distribution workflow phase for new and revised documents.
• Authored and reviewed technical documentation for multiple CFR Part regulated business units within company.

Confidential, Omaha, Nebraska

Business Analyst

Responsibilities:

• Conducted detailed and comprehensiveBusiness Analysis by working with end users and other stake holders to identify the system, operational requirements, and proposed enhancements.
• Validated the business process flow for the claims processing which included hospital claims(Part A, B) and prescription drug claims (Part D) for Nebraska state.
• Facilitated Joint Application Development (JAD) sessions with all IT group members for communicating & managingexpectations and to discuss various means for integrations with current system using an adoption through execution strategy.
• Conducted Gap Analysis on the AS-IS and TO-BE business processes and technology; and identified potential pitfalls, risks, and issues.
• Mitigated risks and developed contingency plans for risk management
• Identified all necessary Business and System Use Cases from requirements, created UML diagrams including Use Case Diagrams, Activity Diagrams, and Sequence diagrams using Microsoft Visio.
• Understood the Business Logic, User Requirements and test-objectives to develop Test plans, Test cases, Use Case Scenarios.
• Involved in comprehensive testing of the system to check it satisfies functional specifications.
• Responsible for checking the benefit set and adjudication of claims.
• Created High Level Test Scenarios, Test Cases and Test Scripts for Data Hub requirements as described in RSD (Requirement Specification Documents) and DSD (DesignSpecification Documents) as well as HIPAA.
• Gathered Data Hub requirements and responsible for creating test cases and test scripts under Quality Center Test Plan and Test Lab modules.
• Worked with ICD 9 codes, CPT codes required for processing the claims required in compliance with HIPPA 4010.
• DevelopedTest ScriptsusingTest Directorand coordinated with developers to quickly resolve the defects associated with them.
• Analyzed and evaluatedUser Interface Designs, Technical Design Documents and Quality Assurance Test Conditionsthe performance of the application from various dimensions.
• Documented theUAT Planfor the project and worked with the UAT Team to ensure every acceptance criteria for the requirements has been included in the UAT task plan.
• Data Hub testing scope includes testing the Data Hub requirements, documenting and testing source system records, change requests and assist SMEs with validation of daily error files.
• Verified and validated all the build or release related issues and resolve then through discussion with business analysts with the users approval.

Confidential, Parsippany, NJ

Business Analyst

Responsibilities:

• Performed Gap analysis, requirements gathering and for enhancements to existing systems and processes.
• Worked with Investigator Brochures, NDA periodic Reports, PSUR, and e-CTD.
• Worked with Regulatory Report Authoring & Publishing management Systems (e.g. Dossier, Liquent Insight etc) and Documentum in compliance with FDA guidelines.
• Worked with the Documentum Query Language and Documentum wrapper.
• Prepared use case models based on Business Requirement documentation gathered through interaction with users and the stakeholders.
• Assisted in maintaining the EHR and the health record interchange for clinical trial image management system, as well as assisted in HL7.
• Implemented RUP, which included requirements, specifications, design and analysis.
• Created and maintained the Requirements Traceability Matrix (RTM).
• Assisted in data modeling, mapping the fields for the reports along with generation of periodic reports using cognos.
• Worked with the Project Manager on various Project Management activities like keeping track of Project Status, Deadlines, Environment Request, and Compliance Issues.
• Ensured Use-Cases were consistent and covered all aspects of the Requirements document.
• Identified and analyzed the data requirements for the various site teams and made sure that the required data is available in the testing environment.
• Worked directly with software engineers to ensure clear communications on requirements and defect reports.
• Designed and developed scenarios based on business requirements.
• Involved in Functional System Testing, Integration Testing, Regression Testing, and User Acceptance Test before releasing the application.
• Validated the scripts to make sure they have been executed correctly and meets the scenario description.
• Involved in project status meetings, QA review meeting, and System Test meeting.

Confidential, NY, NY

Business Analyst

Responsibilities:

• Understanding the current business process, defining scope of the project along with vision statement.
• Work with Project Managers, Development Managers, and other Business Intelligence Analysts to develop and implement DataMart solutions for the Enterprise using Micro strategy tools.
• Applied Unified Modeling Language (UML) methodologies to design Use Case Diagrams, Activity Diagrams and Sequence Diagrams in Rational Rose.
• Managed the HIPAA EDI transactions for Medicare/Medicaid claims setting such as 835, 837 (P, D, I) 276, 277, 278.
• Established RUP (Rational Unified Process) methodology and provided assistance in developing Use cases and project plans.
• Designed the business requirement collection approach based on the project scope and SDLC methodology.
• Created use-case scenarios and storyboards in MS Word and MS PowerPoint for better visualization of the application and managed them using Rational Requisite Pro.
• Resolved issues and improve the process to ensure a stable and accurate solution.
• Used MS Visio for Process modeling and Business Process flow diagrams.
• Created UML notations for Object Oriented Design and Documentation.
• Developed Use Case diagrams, business flow diagrams, Activity/State diagrams and Sequence diagramsso that developers and other stakeholders can understand the business process.
• Validated business rules and all artifacts with users, approval and sign off.
• Analyzed data, logical data modeling, created class diagrams and ER diagrams in Rose for designing databases.
• Created test plans and scripts, facilitated user acceptance testing and tested strategies with developers and testing team.
• Designed and created Excel sheets to provide market analysis charts.

Confidential

Associate Business Analyst

Responsibilities:

• Involved in writing theBusiness Requirements for different functionalitiesof the web based application, including creation of an account online.
• Diligent in writing the Data Dictionary for different processes and their file layouts
• Mentored the effort to develop artifacts with an emphasis on the Rational Suite including: Vision, User requirements specifications, Functional specification quality assurance plan, product Acceptance plan, and test plan, test case.
• Wrote high-level use case and generatedUMLuse case diagrams using Rational Rose.
• Designed prototypes for development and maintenance processes to explore the feasibility of ideas.
• Participated inJADworkshops, refined prototypes and use cases.
• Wrote requirements management plan document using Rational Requisite Pro.
• Extensively used RUPmethodology in all phases of the project.
• UsedClear Case and Clear Questfor data management and defect tracking.
• Assisted insystem testing and user acceptance testingworked with System Test Review team and developers to resolve system test issues and re-test.
• Developed timelines for project delivery, and managed projects and resources to successful completion.
• Assisted in development of training materials for new technology and process improvement.