OBJECTIVE:

• To become a potential asset for company in order to contribute the best traits in field of business analysis; as mediator, connector and ambassador with, in - depth knowledge and profound experience towards ultimate outcome.

SUMMARY

• A seasoned Business Analyst with 7+ years experience working in Healthcare domain.
• Expert in Business Analysis, Business Process Analysis, Requirements gathering, management of documentation, and Software Analysis applications.
• Strong ability to understand operational aspects and manage projects from a business perspective with the ability to conceptualize innovative solutions.
• Successful execution of multiple projects from Inception to Implementation phase.
• Extensive knowledge of various SDLC methodologies such as Agile (Scrum), RUP (Rational Unified Process), RAD (Rapid Application Development) and Waterfall.
• Skilled in writing Business Requirements Document (BRD) and Functional Requirements Document (FRD).
• Worked closely with various stakeholders, SMEs and staff to understand and document Business and Functional requirements.
• Strong knowledge of project management tools, approaches, methodologies and processes that help implement the Change Management, Content Management and Configuration Management effectively.
• Proficient in analyzing and creating Use-Cases, Process Flow Diagram using MS Visio and IBM's Rational Rose Tools.
• Extensive experience in conducting Gap analysis, SWOT analysis and Impact analysis.
• Good understanding of EDI formats HL72.3 and HL7v3.
• Professional knowledge of HIPAA 4010/5010x12 transactions which include 270/271, 275, 276/277, 834, 835, and 837.
• Experience of working on ICD-9 and ICD-10.
• Professional understanding of various Health Insurance plans such as HMO, PPO, POS, ASO, Medicare and Medicaid claims.
• Adept in learning new Business Analysis trends and quickly adapting to new environment.
• Team player, result-oriented, fast learner, excellent communication skills with strong research capability, excellent documentation and interpersonal skills.

TECHNICAL SKILLS

Operating System: Windows 95/98/2000/7/8 ; Mac OS X

Methodologies: Waterfall, Agile, RUP, RAD and JAD

Programming Languages: SQL

Business Modeling Tools: MS Visio, Rational Rose

MS Office Suite: MS Word, MS Excel, MS PowerPoint, MS Outlook

Testing Tools: Rational Requisite Pro, HP Quality Center

PROFESSIONAL EXPERIENCE

Confidential, NYC

Sr. Business System Analyst

Responsibilities:

• Worked as a liaison among stakeholders in order to elicit, analyze, communicate and validate requirements for changes to business processes, policies and information systems.
• Interacted with the Business users, SME’s, Developers, PMs and QA teams to better understand the business processes and application knowledge.
• Contributed in implementation of transition in accordance with HIPAA standards.
• Performed Gap Analysis for HIPAA 5010.
• Met with Supervisors and business users and defined the scope of the project, gathered business requirements, and conducted gap analysis.
• Incorporated changes in the change management document and updated it to the QA lead and Developer lead
• Was involved in the documentation of extraction, of the data from various tables in the Data warehouse.
• Wrote BRD’s for 834(member Eligibility), Provider files and Claims tracking system, Use-Case Narratives including business process workflow diagrams and Requirements Traceability based on any of the projects need.
• Worked on Business requirement for payer information in geographical area and contact payers to facilitate contracting.
• Worked on billing operations for specialty care, hospital care, filing claims, posting charges and payments, collections, transcription and payer contracting/credentialing
• Documented and gathered Functional specifications for 837 (claims),834(member Eligibility), 278 (Authorizations) and 270/271 (Eligibility and Benefit Response)
• Conducted Requirements Walk-Thru JAD Sessions and resolved all issues/findings.
• Successfully received Sign-Offs after resolving all open questions.
• Lead daily team meeting and co-ordinate with different cross-functional teams, offshore as well as onshore.
• Lead & Facilitated numerous meetings to help answer any question on requirements during Design, Development, Testing and Implementation phase.
• Worked on Payer Provider credentialing, contracting, billing and claims issues.
• Communicated with all the key stakeholders, business teams, contributors, operations and technical experts to ensure help and involvement in completing the assigned task.
• Developed business requirement updates while working with different concerned authorities to define priorities concerning business requirement.
• Organized brainstorming and JAD sessions with stake holders, business users, technical teams, testing team to analyze and validate the business requirements, system life cycle and explained the key performance indicators (KPIs) and documented the specifications.
• Created test cases, test scenarios and participated with QA team in testing of the functionality of the application by inserting varying data on different test runs.
• Helped QA team in creating the test plans and test cases for 834(member Eligibility)
• Created Use Case diagrams by analyzing the business process followed by Activity diagrams using MS-Visio and participate in production of HIPAA 5010 EDI Test data.
• Developed use case Designed process flow diagrams using MS-Visio and also Business Context Diagrams
• Coordinated with users in doing UAT and conducted UAT testing.

Environment: Agile/ Scrum, MS Office ( MS Word, MS Excel, MS PowerPoint, MS Outlook, MS Visio), SQL Server, Rational Rose.

Confidential, Houston

Senior Business Analyst

Responsibilities:

• Utilized RUP iterations and documented the artifacts throughout the various phases.
• Understood the AS-IS and TO-BE business (current and future flow) and developed BRD and FRD.
• Created RTM-Excel to ensure the full coverage. Developed Traceability Matrix. Used MS SharePoint to manage the repository of requirement for traceability and version control.
• Facilitated JAD session with the SME, process owners, stake holders, technical team and identified various action items and enhancements to be implemented in current Medicare processing system.
• Recommended changes for system design, policies and workflow affecting Medicare/ Medicaid Claims processing system in compliance with current HIPAA regulations.
• Successfully utilized Medicare Prescription Drug Plan (Medicare Part D) claims and gained extensive knowledge on Pharmacy Benefit Management (PBM)
• Developed an implementation guide for EDIx12 transactions such as 834,835,837,270 and 271 in the claims processing system in accordance with current HIPAA regulation.
• Adopted MMIS (Medicaid Management Information System) for insurance claims filling and patient information and gained good understanding of MITA (Medicaid Information Technology Architecture).
• Conducted brainstorming sessions to analyze provider contracts, medical policies and medical management rules for transition of ICD-10 Codes. Collected the information of ongoing ICD-10 upgrade process and performed the Impact analysis to identify problems, risks, concerns associated with the ICD-10 implementation.
• Prepared Process flow diagrams and Use Cases for easy interpretation of system functionality

Environment: RUP, UML, JAD, SharePoint, MS-Office MS-Project, Facets.

Confidential, Louisville, Kentucky

Business Analyst

Responsibilities:

• Participated in meetings with developers, Project managers and Quality analysts to discuss business requirements, test planning, resource utilization and defect tracking.
• UtilizedRational unified processto create BRD and FRD.
• Worked with cross functional business teams and stored project artifacts using MS SharePoint.
• Developed business requirement and specification documents as well as high-level project plan and translated business requirements into Process models and Use cases using MS Visio.
• Conducted JAD sessions with stakeholders throughout SDLC to resolve open issues.
• Implemented Environmental Health and Safety System (EHSS) in claims processing system in order to prevent incidents that might result from abnormal operating conditions.
• Worked with the management for improving and giving new ideas for designing future process of the HIPAA format dealing with EDI Transactions on Facets platform.
• Processed EDI test files and verified system is able to validate certified and non-certified trading partners. Created detailed level test scenarios on HIPAA Compliance testing.
• Reviewed relational database design of the application and conducted multiple SQL querying.
• Reviewed Test scripts, Test scenarios and performed UAT of the application.

Environment: RUP, UML, MS Office, MS Project, Test Director, Clear Quest Facets.