SUMMARY

• Confidential is an accomplished Senior Business Systems Analyst having 7+ years of extensive experience in Business Analysis/Systems Analysis in Healthcare and Insurance Sectors.
• Extensive experience with Medicare/Medicaid processing as well as the Claims/Billing AND Insurance processes.
• Strong knowledge of the Software Development Life Cycle methodologies (phases and gates) like Agile, RUP and Waterfall models
• Excellent knowledge of HIPAA standards, EDI (Electronic data interchange) Transaction syntax like ANSI X12, Implementation and Knowledge of HIPAA code sets, ICD - 9, ICD-10 coding and HL7.
• Experience with Iterative Software Development Life Cycle Process as per Rational Unified Process (RUP), involved in Inception, Elaboration, Construction and Transition phases using rational tools like RequisitePro, ClearCase, ClearQuest during various phases of RUP.
• Extensive experience in Business Requirements Gathering and writing skills with expertise in developing and documenting Business Requirement document (BRD), Functional Requirement Document (FRD),Software Requirement Specification (SRS) across the deliverables of a project.
• Effectively used Rational Requisite Pro to organize, track and change requirements of the system.
• Expertise of UML in visualizing and documenting the artifacts using Use Cases, Use Case Diagrams, Activity diagrams, Class diagrams, Data Flow Diagrams, Business Flow Diagrams, Sequence Diagrams using MS Visio
• Experience in facilitating Joint Application Development (JAD) sessions, Rapid application development (RAD) sessions, conducting user interviews and acting as a liaison between the customers, development team and testing team
• Experience in Project Management, Scheduling, Scoping and Budgetary planning for a project
• Knowledge in the ETL (Extract, Transform and Load) of data into a data ware house/date mart and Business Intelligence (BI) tools like Business Objects Modules (Reporter, Supervisor, Designer, and Web Intelligence).
• Facilitated User Acceptance Testing (UAT) with the stakeholders and the business users as well as trained users to use the system configured.
• Analytical, methodical and resourceful approach to problem solving, identifying root causes and corrective actions to meet short and long-term business, financial and system requirements
• Ability to work with seamlessly with remote and offshore teams in different time zones and continents.

TECHNICAL SKILLS

• Rational Rose
• UML 2.0
• RUP
• OOAD
• MS Visio
• MS Project
• MS - Office
• Oracle - TOAD
• Informatica Business Object
• ETL
• Cognos
• Visual Studio.Net
• Erwin ODBC Visual Source Safe
• C#.Net
• VB.Net
• AS 400
• SQL
• IDMS
• QTP
• IBM WebSphere 5.0
• Power Builder 5 6.5 7
• Sybase SQl Anywhere 5/6 Adaptive Server Anywhere MSSQL 7
• Oracle 6/7.x/8i/9i Cobol
• Source Off-Site
• Round-Table
• Win CVS
• MS Windows NT 4.0/2000 Windows 95/98
• Windows XP

PROFESSIONAL EXPERIENCE

Senior Business Systems Analyst

Confidential, Minneapolis, MN

Responsibilities:

• Testing various change orders of Medicaid applications received from the System Engineer’s
• Regression Testing of Web applications and applications dealing with MEDICAID and MEDICARE Services
• Conducted weekly meetings for deciding the Policies and Procedures to be followed while constructing new sites.
• Conduct complex documentation and user needs analysis. Interface with team and staff to develop HL7 integration
• Assisted JAD sessions to identify the business flows and determine whether any current or proposed systems are impacted by the EDI X12 Transaction, Code set and Identifier aspects of HIPAA.
• Developed the strategy for developing and implementing new EDI (HL7 and X12) interfaces and converting historical clinical and data.
• Reviewed EDI companion guides for all payers to ensure compliance, edit integrity and maintain up-to-date list of payer contacts.
• Performed testing for Medicare, Medicaid and X-Over claims for Medicaid Management Information System (MMIS)
• Developed and implemented the MMIS Third Party Liability (TPL) Subsystem.
• Conducted business-impact assessment and the results were compared with the new HIPAA 5010 standards to determine the current level of compliance and developed an action plan for approval by the project steering committee
• Developed plan for data feeds and data mappings for integration between various systems, including XML, to followICD 10Code set andANSI X12 5010formats.
• Involved in gap analysis and implementation of HIPAA 5010, ICD 10 and Claim Validations
• Conducted Gap Analysis, and Gathered User Requirements by Interviews, user meeting, JAD session, and Requirement Elicitation Sessions.
• Part of the project management team responsible for SWOT analysis.
• Utilized corporation developed Agile SDLC methodology. Used ScrumWork Pro and Microsoft Office software to perform required job functions.
• Responsible for cost estimation and timelines for various Business Intelligence reports.
• Involved in analyzing activities for a variety of major projects including Medicare Plan part D, Coordination of Benefits, New Client Implementations, Consumer driven and regularly scheduled system upgrades.
• Implemented a mechanism to in corporate business-required data which is not in the core Facetssystem.NFE (Non-Facets Elements) proved to be of major business importance in implementing state-customizations and underwriting, needs not encompassed by the Facets system.
• As a consultant, used UML and OO discovery methods to perform discovery for new enterprise wide installation of Trizetto FACETS (both core and extension requirements) using Rational Rose.
• Implemented a mechanism to in corporate business-required data which is not in the core Facets system.NFE (Non-Facets Elements) proved to be of major business importance in implementing state-customizations and underwriting, needs not encompassed by the Facets system.
• Project manager (from Portland) for consolidation of four states Inter-plan Teleprocessing Services (ITS) data, multiple databases and softwareenvironments, into the single Regence data center.
• Extensively interacted with the stakeholders and the IT Department in finalizing the requirements according to the CMS Compliances/Regulations and HIPAA Regulations.
• Assisted to develop the Test Plan, Test Cases and Test Scenarios to be used in testing based on Business Requirements, technical specifications and/or product knowledge.
• Acted as a Business Analyst for the CDS implementation the backbone for data integration among myriad systems, including ERP, CRM, Portal, Workflow Engine, Payroll and related interface
• Prepared graphical depictions of Use Cases, Use Case Diagrams, State Diagrams, Activity Diagrams, Sequence Diagrams, Component Based Diagrams, and Collateral Diagrams and creation of technical design (UI screen) using Microsoft Visio.
• Analyzed trading partner specifications and created EDI mapping guidelines.

Environment: Windows 2000/XP, HL7, Microsoft Office SharePoint 2007, Cognos, Agile, Rational Requisite Pro, MS Office, SQL Server 2005, Cobol, DB2, JAVA, J2EE, MS Project, MS FrontPage 2003, MS Access, EDI

Business Analyst

Confidential, Minneapolis, MN

Responsibilities:

• Understanding and assessment of the current EDI Transactions used
• Understanding and assessment of the current Pharmacy Transactions from an NCPDP 5.1 perspective
• Maintained Traceability matrix throughout the project.
• Created standards / guidelines for business process modeling, Use Cases, Work Flows, Data Dictionary, and Requirements specifications.
• Mentoring end-users on requirements specifications techniques and the software development life cycle.
• Assisted with building the EDI 837(I, D, P), 835, 277-U, 270/271, 276/277, 278, 820 and 834 transactions processing flow from the Trading Partners to the translator to the Mainframe and back to the Trading Partner.
• Schedule meetings with technical personnel to determine technical parameters for EDI and other related processes, including communication, security, and privacy. Create transaction sets requirements, usually with Microsoft Excel, for transactions such as: HIPAA 270/271, 276/277, 835, 837-(I, P, & D), 835 Remittances and others. Resource for UB92 and HCFA1500 billing format, transaction sets requirements, EDI development and Design, X12 protocols through Version 4010 A1 and newer, conversion needs and understanding of legacy EDI formats, such as UB92 Versions 4, 5, 6 and NSF.
• Gathered and analyzed requirement for ICD 9 to ICD 10 changes
• Involved in up-gradation of HIPAA X12 4010 transaction to HIPAA X12 5010 and ICD 9-CM (Clinical modification) to ICD-10-CM/PCS (Clinical modification/procedure coding system) simultaneously.
• Knowledge of industry billing and coding compliance requirements
• Converted the Business Process Requirements (BPR) into System Specification Requirements
• Created various Use Cases and workflow diagrams, sequence diagrams, and Class diagrams using MS Visio and used UML methodology to define the Data Flow Diagrams (DFD)
• Maintained Traceability Matrix in Excel
• Used IBM Rational ClearQuest as Version Control/Change Management Tools
• Created requirements analysis and design phase artifacts using Requisite Pro and MS Visio

Environment: MS Office Suite, MMIS, POS, GEMS, Document Analyzer, Sharepoint, XML

Business Analyst

Confidential, NYC, NY

Responsibilities:

• Responsible for creating and reviewing business requirements, functional specifications, project schedules, documentation and test plans.
• Closely interacted with designers and software developers to understand application functionality, navigational flow and updated them about end-user sentiments
• Coordinated with Project Managers to resolve risk issues and ensure compliance of Security System-Related to the HIPAA.
• Perform analysis on 837, 270/271, ANSI-X12N etc. HIPPA code sets.
• Perform EDI activities that comply with government reporting requirements and standard.
• Working with management to establish, document and maintain EDI procedures by identifying errors and taking corrective action, reconciling EDI transactions through coordination of information with internal and external customers, Accounting Department, IT Department and external vendors to maintain EDI integrity.
• Overseeing and maintaining the EDI Inquiry Problem database including the evaluation of problems or issues through to resolution.
• Conducting regular audits of EDI transactions to determine accuracy and areas for improvement and maintaining EDI maps and business rules for HIPAA validation software.
• Further analysis of the requirements was performed using Rational Rose through the use of sequence, Entity relationship diagram and class diagrams.
• Led both internal peer review and external reviews of use case specifications and in the process clarifying the finer details of the requirements.
• Assisted in tailoring the views and applets for accounts, Opportunities, Contacts, etc, as per the client requirements.
• Met with business teams as well as test teams to review the requirements as outlined in the use cases.
• Involved in developing test plans, test conditions and test cases to be used in testing based on business requirements using Quality center.
• Created and maintained the Requirement Traceability Matrix between the requirements and other products such as design documents and test plans.
• Familiar with User acceptance testing (UAT), System testing, Integration testing. Validated and helped verify defects to weed out cosmetic problems and keep the project on schedule.

Environment: OO Modeling, Web Sphere, Rational RequisitePro, Rational Rose, Rational SoDA, RUP, UML, Load Runner, MS-Project, MS Visio, Java, MS Office, Windows XP.

Junior Business Analyst/Systems Analyst

Confidential, New York City, NY

Responsibilities:

• Interacted with business heads to finalize the Business Requirements for the application.
• Performed the requirement analysis and documented the requirements using Rational Requisite Pro.
• Used the requirement attributes (priority, effort, and risk) as the basis for negotiating the inclusion of the requirement, to manage the scope of the system efficiently.
• Involved in creating sample mappings for the conversion ofEDI X12transactions code sets version and translation ofICD 9codes intoICD 10codes.
• Involved with the coders in evaluation of CPT and ICD-9 codes to ensure that the diagnosis meets medical necessity for the specific CPT code.
• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims. Worked on EDI transactions: 270, 271, 834, 835, and 837 (P.I.D) to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
• Involved in mentoring specific projects in application of the new SDLC based on the Agile Unified Process, especially from the project management, requirements and architecture perspectives.
• Developed and managed project teams (both internal and outsourced) in accordance with standards and processes, tracked work plans, issues, risks, dependencies, staffing needs, deliverables and milestones.Teams delivered results to corporate standards and exceeded stakeholder requirements.
• Managed time, cost and quality issues from identification through resolution, validation and verification QA, plus change and implementation management.
• Conformed to PMO project approaches and standards (RUP, Agile), metrics, a
• As a consultant, used UML and OO discovery methods to perform discovery for new enterprise wide installation of Trizetto FACETS (both core and extension requirements) using Rational Rose.
• Performed due diligence on requirements tool purchase, arranged comparison demos, facilitated cross-sectional agreement, negotiated the purchase of Borlands Caliber, and arranged for third party professional in-house requirements training of the cross-functional staff.
• Produced full spectrum of specifications including business and functional requirement sets
• As Content Analyst, worked with customers on data mapping and migration
• Began the overlay of a RUP-like process within development - designed, promulgated iterative processes
• Represent Operations Team as Client Liaison for Medicare Part D Plan.
• Provided clear and concise documentation regarding requirements management plans, Functional Requirements, supplemental Requirements, Test Plans and Test Cases.
• Conducted Joint Application Development (JAD) sessions with IT groups. Identified the Key Changes, and participated in Stakeholder Management to communicate effectively with them
• Implemented Data Modeling standards, including element-naming conventions.
• Used SDLC (System Development Life Cycle) methodologies like the RUP and the waterfall.
• Understand the As Is system and develop the To Be system concept and also prepare the System Process Maps.
• Developed extensive experience in eligibility and benefits calculation for state, federal and local services such as Medicare and Medicaid.
• Design, development, implementation and roll-out of Microstrategy Business Intelligence applications.
• Performed Requirement Gathering & Analysis by actively soliciting, analysing and negotiating customer requirements and prepared the requirements specification document for the application using MS Word.
• Review requirements and understand technical recommendations and constraints, and develop comprehensive and accurate functional specifications; Data Mapping, and process flows.
• Created and managed project templates, Use Case project templates, requirement types and traceability relationships in Requisite Pro.
• Followed the UML based methods using Microsoft Visio to create: Use Cases Diagrams, Activity Diagrams, State Chart Diagrams, Sequence Diagrams and Collaboration Diagrams.

Environment: Rational Rose and Requisite Pro, MS Visio, MS Office, MS Project, Agile, UML, XML, Windows XP, NT/2000, HTML, Cobol, DB2, SQL Server 2000, JAVA

Junior Business Analyst

Confidential

Responsibilities:

• Met with client groups to determine requirements and goals. Utilized Rational Unified Process (RUP) to configure and develop process, standards, and procedures and create a Business requirement Document.
• Created new database objects like Tables, Procedures, Functions, Indexes and Views using T-SQL in Development and Production environment for SQL Server 2000.
• Designed and development of test cases based on functional requirements for Institutional and Professional claims for EDI and HIPAA Transactions 837/835, 834, 276/277, 270/271 testing.
• Experience in EDI automated first-pass claim adjudication, requiring thorough understanding of claim processing, both front and backend operations
• Created Process Work flows, Functional Specifications documents and documented system requirements.
• Performed all necessary programming, testing and documentation for COBOL, DB2 batch programs and sub-routines.
• Conducted interviews, meetings and JAD sessions during the process of Requirement Gathering.
• Extensive involved in Conducting Market Research, Feasibility Studies, Data Analyses, System Analyses, Gap Analyses, and Risks Analyses.
• Develop detailed unit test plans and scripts and conducted rigorous testing per requirements and assisted in data mapping.
• Provided configuration expertise for global configuration strategy and development and worked with multiple conversion/implementation teams.
• Managed several different teams of configuration analysts responsible for system configuration, including product design and loading, benefit conversions, and reporting.
• Provide implementation assessment, strategy, and mentoring services for Rational Rose, UML and RUP.
• Interacted with various cross-functional teams on building business use cases, and understanding expenses and revenue stream. Performed extensive Requirement analysis and developed use cases and workflows.
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, and OOD
• Worked with Quality Control Teams to develop Test Plan and Test Cases.
• Interaction with the developers to report and correct bugs.
• Developed Test Plans and Test Cases according to Business Requirements.