SUMMARY

• 6+ years of extensive experience as a business analyst and QA, with strong experience in Healthcare especially in insurance claim with a solid understanding of Business Process Flows, Case Tools, and Business Analysis.
• Experience working with HIPAA ANSI X12 4010A 270/271, 276/277, 834, 835, 837 for institutional, professional and commercial claims, and up - gradation of ANSI 4010 to ANSI 5010.
• Excellent understanding of ICD 9, ICD 10, HCPCS, and CPT.
• Commanding knowledge of various development methodologies like Waterfall, SDLC, Rational Unified Process, Agile and Scrum.
• Experience in working with QA testing teams, while interacting with business users and gathering user’s requirements to develop necessary Test plans, Test Cases and Test script.
• Extensive experience in gathering Business and Functional Requirements, developing Use Cases, conducting Gap Analysis and preparing Training manuals.
• Experience in developing UML use case diagrams, Work Flow Diagrams using tools like Rational Rose and MS Visio.
• Excellent Business writing skills in creating Business requirement Document (BRD), Use Case Specifications, Functional Specifications, and System Requirements Specifications (SRS).
• Expertise in Rational Unified Process (RUP) methodology, Use Cases, Software Development Life cycle (SDLC) Processes and rational tools used during all four phases of RUP: Inception, Elaboration, Construction and Transition.
• Proficient in Developing and executing Test Plans, performing functional, usability testing and ensuring that the software meets the system Requirement.
• Excellent team player work in conjunction with testing, development and other teams in validation and testing complex scenarios and projects and in the maintenance of Quality Standards in Projects.
• Knowledgeable about preparing RTM documents.
• Proficient in soliciting client Requirements through interviews, workshops, existing system documentation and organizing JAD sessions..
• Knowledge in documentation project related information like test execution procedures, backup plans, new tester training documents, maintaining test logs, release notes etc.
• Writing and Reading data objects i.e. stored procedures, tables, and views, etc. in SQL server.
• Strong Communication and writing skill.

TECHNICAL SKILLS

Modeling Tools: MS Visio, Rational Rose, Enterprise Architect, OminiGraffle.

Methodology: RUP, Agile, Waterfall.

Testing: Quality Center, Test Director, win runner.

Programming Languages: C++, SQL, XML, HTML, and VB.

Platforms: Windows, NT/95/98/2000/XP/Vista/Window 7.

Industry standard: HIPAA, ISO, HL7.

Applications: MS word, MS Excel, MS Access, MS Power point, MS Outlook, Adobe Photoshop.

Other Software: SAS, SPSS.

PROFESSIONAL EXPERIENCE

Confidential, Nashville, TN

Business Analyst

Responsibilities:

• Participated in Business Modeling by understanding the needs of the business, and also documenting Business Use Cases as well as System Use Cases.
• Gathered Requirements and documented the proposed additional extension to the existing HIPAA application.
• Facilitated Joint Application Development (JAD) sessions with the Management, Mainframe and HIPAA team to make sure everyone are in sync with the business requirement processes.
• Worked on HIPAA Transactions 270, 271, 276, 277,834, 835 and 997.
• Involved in HIPAA 5010 gap analysis of ANSI X12 4010 and ICD 10 initiatives.
• Used MS Visio to create Use Cases and Sequence Diagrams.
• Worked on FACET claim processing system.
• Accomplished experience through whole SDLC from requirement analysis till deployment, using highly efficient RUP process of Software development.
• Assisted development team to translate requirements into technical specifications.
• Liaised and Coordinated in resolving EDI mapping issues arising from data transfer process from EWM to ACAS and third party systems.
• Analyzed mandatory and the situational fields and compared with the users manuals for EDI.
• Worked closely with the host (Main frames support person) and helped him understanding the process and in the creation of the match, input and the delete files.
• Created and Maintained the Requirement Traceability Matrix (RTM).
• Initiated Test Plans, developed and executed test cases and scenarios, worked with users to develop specific acceptance criteria and prepare test exhibits.
• Worked on FACET modules such as pricing, payer, eligibility under claims processing system.
• Conducted User Acceptance Testing (UAT) sessions with business users and prepared document for enhancements and bug fixes.
• Used Test Director and Mercury Quality Center to report any bugs found and communicate to the developers and product support team.
• Analyzed and evaluated User Interface Designs, Technical Design Documents and Quality Assurance Test condition the performance of the application from various dimensions.
• Helped create the ‘Business Glossary’ to facilitate efficient understanding of the Business process amongst the other teams

Environment: MS Visio, MS Project, Windows XP, HIPAA, Microsoft Office Suite, Quality center, Rational Unified Process (RUP), UML.

Confidential, Lansing, MI

Business Analyst

Responsibilities:

• Involved in requirements gathering sessions with SME’s (Subject Matter Experts), Business Analysts and Architects to understand requirements in terms of business.
• Played a major role in collecting, documenting, blueprinting and managing business requirements.
• Actively worked on Business requirement analysis and Data analysis.
• Worked at different stages of Software Development Life Cycle (SDLC) with business users, developers, and stakeholders.
• Worked on business process from taking a requirement from a systems record to a centralized database.
• Gathered requirements from the clients and developed crosswalks for 277/288, 834, 835, 837 P/I claims.
• Developed test cases based on the crosswalks and compliance guidelines for 277/288, 834, 835, 837 Professional, Institutional and Dental claims and for 270/271 eligibility benefit inquiry and response
• Generated test data using X12 generator for transactions 277/288, 834, 835, 837P/I/D.
• Conducted Gap Researched and understood the claims adjudication and reimbursement systems based on HIPAA X12 4010 standards.
• Ensured that ICD-9-CM procedure codes used for inpatient services and CPT codes for outpatient and physician services were not outdated
• Designed and developed Use Cases, Activity Diagrams and Sequence Diagrams using MS Visio.
• Participated in Forward Mapping and Backward Mapping analysis of ICD 9 - ICD 10.
• Participated in the JAD sessions along with the technical team members and clients to elicit requirements for HIPPA migration process.
• Actively worked with quality control teams to develop test plans and test cases.
• Developed tables, Views, Stored Procedures and Triggers using SQL Scripting.
• Established Inner Join, Outer Join and created Indexes whenever necessary.
• Writing Standard SQL queries and optimizing SQL Queries
• Responsible to meet the information demands of our business users by delivering timely, accurate, meaningful and standardized data and reporting.
• Developed test scenarios and implemented test plans for system test and user acceptance test (UAT).

Confidential, New York, NY

Business Analyst

Responsibilities:

• Gathered Business Requirements, interacted with the Users, Designers, Developers, Project Manager, and SMEs to get a better understanding of the business processes, and analyzed and optimized the process.
• Actively involved in the entire Software Development Life Cycle (SDLC) Process.
• Created reports containing all the information regarding the publishers, distributors and retailers using crystal reports.
• Facilitated demonstration of a major ACH software systems and performed evaluations with a group of experts to select a package that best suits the need of the business.
• Extensively worked with HIPAA transactions such as 835-claim payment/advice.
• Developed Traceability Matrix for maintaining/updating current and new system requirement using MS Excel.
• Researched/Analyzed the various steps in claim processing lifecycle and then wrote the Business Requirement Document and Functional Requirement Document in such a way that developers could construct the system to identify and monitor the riskier claims.
• Worked with electronic claim clearing house like Web MD and automated clearing house (ACH) for electronic payment, remittance data processing and services.
• Created the User Requirement Specifications and helped convert them to Functional Requirements, and assisted the developers with System Requirement Specifications.
• Responsible for ensuring data integrity and coordinating effort with testing and implementation responsible for the development and execution of test plans.

Environment: MS Office tools, MS Project, MS Visio, UML, RUP, Windows, National Requisite Pro, and SQL Server.

Confidential

Business Analyst

Responsibilities:

• Analyzed, documented and managed all project requirements and changes to requirements throughout the software development life cycle through Rational Doors.
• Analyzed customer needs and existing functions in the area of HIPAA transactions to determine feasibility and requirements.
• Documented Functional/Technical data flow of 4010 HIPAA transaction to determine feasibility and requirements.
• Prepared and created Test Cases/Test Data according to Business Requirements.
• Created Statement of Work (SOW) document for various capabilities in the Initial Requirements Gathering Phase.
• Strong Documentation experience that required converting business needs to technical documents.
• Documented and reviewed high level and detailed requirements in Business Requirement Document (BRD).
• Created Use Cases and Use Case description/narratives based on the Requirements list.
• Experienced in using Microsoft Share Point to centrally store, manage and access business artifacts across all platforms.
• Created activity diagrams in UML using Rational Rose and also involved in creating the Business Process Models.
• Coordinated activities involved in QA and User Acceptance Testing.
• Actively involved in reporting project updates, managing project resources, conflict resolution and maintaining project deadline.
• Communicated with business/technology leadership for overall project/program office milestone.
• Monitor the production environment and proactively prioritize, communicate, and resolve EDI process or system issues.

Environment: Rational Rose, Agile, Rational Requisite Pro, Rational Clear Case, MS Project, SQL.