SUMMARY

• 6+ years of IT experience as a Business Analyst in deployment of web - based, Client-Server applications, developing business processes and system solutions in Health Care Insurance Industries and labs for various projects from conceptualization to implementation.
• Expertise in all the phases of the Software Development Life Cycle (SDLC), Agile Development methodology, Waterfall Development Methodology.
• Experienced in conducting JAD, focus group and brainstorming sessions, reviews, and walkthroughs and customer interviews for business processes.
• Excellent technical writing skills to create Business Requirements Document (BRD),Functional Requirements Document (FRD), Use Cases Reports, Gap Analysis Report and change management Process.
• Strong process modeling using UML (Use Cases, Sequence Diagrams, Activity Diagrams, etc.)
• Strong Analytical and Problem Solving skills, Multi-Tasking abilities, with proven experience in utilizing people and process knowledge to assist enterprises in making critical decision.
• Ability to Elicit, Analyze, gather and document Business Requirements in compliance with HIPPA.
• Proficient in performing Gap Analysis, by evaluating the key differences between the As-Is and the T0-Be system and identifying the key requirements for System Engineering.
• Strong Requirement Traceability Matrix mapping.
• Strong in writing SQL queriessuch as left join, right join, inner join, outer join, constraints and reporting the results to the business team.
• Worked with Project Manager to review time line and schedule for the implementation and discussing the milestone.
• Excellent Team player to work in conjunction with testers (QA), developers and other team members in validation and testing of complex project scenarios and in the maintenance of Quality Standards of projects.
• Ability to think outside of the box and worked extensively with offshore development team.
• Prepared an analysis of costs and benefits so that management can decide if computer upgrades are financially worthwhile
• Fluent in a broad range of technologies, including business process tools such as MS Word, Excel, Access, Visio, and Rational Tools.
• Experienced in using various tools like RequisitePro and MS Office for requirement gathering, Quality Centre and Clear Quest for Defect Management/Defect Tracking, MS-Visio for UML Diagrams, MS Outlook, and SharePoint for information sharing, Axure for prototyping.
• Hands on experience in the complete Quality Assurance (QA) life cycle from Requirements Gathering and Documentations to developing Test Plan, Test Cases,Traceability matrices and conducting User Acceptance Testing (UAT).
• Excellent track record for meeting deadlines and submitting deliverables on time.
• Extensive knowledge of Medicaid, Medicare,Medicaid Management Information Systems,Procedural and Diagnostic codes, Claims Process, Health information Exchange (HIX), HIPAA EDI transactions (834, 835, 837), transactions adjudication applications especially FACETS and conversion of HIPAA X12 4010 codes to X12 5010 codesand ICD 9 codes to ICD 10 codes.

TECHNICAL SKILLS

Project Methodologies: Rational Unified Process (RUP), Waterfall, Agile, Spiral, SCRUM

Business Modeling Tools: Rational Rose, MS Visio, Rational Clear Case

Requirement Management Tools: Rational Requisite Pro, Axure

Defect Tracking Tools: Rational Clear Quest, Quick Test Professional, HP Quality Center, ALM

RDBMS: SQL Server, Oracle 10g/9i/8i, MS Access.

Business Applications: MS Access, MS Office Suite, MS SharePoint, FACETS

Version Control Systems: Rational Clear Case

Operating System: Windows NT/2000/2003/XP/Vista, Windows 7, Windows 8

PROFESSIONAL EXPERIENCE

Confidential, San Francisco, CA

Sr. Business Analyst

Responsibilities:

• Performed Requirements Gathering and Analysis by facilitating JAD session, interviewed the SME (Subject Matter Experts), and ensured that contributors and all key stakeholders were motivated to complete assigned tasks.
• Manage the Business Requirements, performed requirements analysis along with the creation of Use Case Scenarios. Modeling of the business and application using UML.
• Performed Gap analysis to by evaluating the key differences between the As-Is and the T0-Be system
• Translated and transferred requirements from Business Requirements Document (BRD) to Functional Requirement Document (FRD).
• Designed Activity, Sequence and Process Flow Diagrams using MS Visio to simplify and elaborate certain selection criteria and filter conditions.
• UpgradedICD 9-CM (Clinical modification) to ICD-10-CM/PCS (Clinical modification/procedure coding system).
• Analyzed and worked with HIPAA specific EDI transactions for claims submission (837) and Claim Payment (835).
• Ensured that application was created and maintained in a manner that supports the departmental, user and overall business objectives in coordination with other system vendor products.
• Experienced with Trizetto Facets System implementation, Claims and Benefits configuration involving HIPAA EDI 837 (i,p,d).
• Worked as liaison between software developers and users of EMR systems to create better electronic medical record systems.
• Coordinated, managed, and lead technical support for new products, software, upgrades, or equipment.
• Configured systems for optimal end user support, including disaster recovery and scheduled downtime plans.
• Gained experience in working with offshore development team.
• Performed UAT testing and Black box testing.

Environment: MS SQL 2010, Windows NT 5.1, UML 2.4.1, MS Visio 2010, MS Office 2010, Trizetto Facets 4.7, SharePoint 2010, Rational Tools.

Confidential, Aurora, CO

Sr. Business Analyst

Responsibilities:

• Created documents that incorporated both the technical and functional details.
• Involved in creating documents and diagrams for Membership Enrollment according to the HIPAA 834 Compliance Standards for Membership Enrollment.
• Analyzed forward mapping and backward mapping for HIPAA 4010 and HIPAA 5010 standards for EDI 834 transactions and prepared gap analysis document.
• Worked with Vendors like RR Donnelly to ensure printing of ID cards is scheduled on time for the new and existing members.
• Worked with Top down Systems, a vendor specialized in automated letter generation, to convert manual letter generation to automated generation of the Membership Enrollment Letters.
• Maintained the Traceability Matrix table to track the Business Requirements to the design and testing, keeping track of all requirements in the BRD.
• Wrote complex SQL queries to extract and validate the data from the Facets database.
• Designed Activity and Diagrams using MS Visio to simplify and elaborate certain selection criteria and filter conditions.
• Extensively worked with Member/Subscriber and performed member enrollment process, group invoicing, payment, accounts receivable, and reconciliation.
• Documented requirements using Use Case (UC) analysis for the development team. Also, stored the documentation in a common SharePoint Repository for version control.
• Maintained open and clear communication with the team on change requests.
• Review, back up, and update systems regularly, documenting changes and system operation.
• Compiled, analyzed, and evaluated data from multiple sources to provide decision-making information
• Documented the UAT Plan for the project and worked with the UAT Team to ensure every acceptance criteria for the requirements has been included in the UAT task plan.
• Worked with user to define user acceptance test cases. Involved in Black box testing for the system and involved in manually testing the application from the backend to carry out data validation

Environment: Microsoft Office 2007, Oracle 10g, HP Quality Center 9.0, UML 2.3.1, MS Office 2007, MS Visio 2007, MS SQL Server 2008, Trizetto Facets 4.7, SharePoint 3.0

Confidential, Richmond, VA

Business Analyst

Responsibilities:

• Performed Requirements Gathering and Analysis, interviewed the SME (Subject Matter Experts), and ensured that contributors and all key stakeholders were motivated to complete assigned tasks.
• Facilitated Joint Application Development (JAD) Sessions for communicating and managing expectations and gathered requirements.
• Created the Business Requirements, performed requirements analysis along with the creation of Use Case Scenarios and modeling of the business and application using Unified Modeling Language (UML).
• Performed Gap analysisto understand the differences between existing system and proposed system.
• Worked with Business Owners to ensure that Eligibility and Membership File exchanged on daily and weekly basis is updated with the Medicare changes.
• Ensured that application was created and maintained in a manner that supports the departmental, user and overall business objectives in coordination with other system vendor products.
• Experience in working and conducting requirement engineering process and Business process Analysis.
• Translated and transferred requirements from Business Requirements Document (BRD) to Functional Requirement Document (FRD).
• Designed Activity, Sequence and Process Flow Diagrams using MS Visio to simplify and elaborate member selection criteria.
• Enabled successful implementation and usage of the File Transfer Protocol for the extract submission to the corresponding vendor.
• Experience with Trizetto Facets System especially with the Managed Care Credit policies.
• Experienced with Trizetto Facets System membership enrollment involving HIPAA EDI 834.
• Was involved in discovering defects in the system using Mercury Quality Center andUser Acceptance Test using the test cases given by the client before releasing the application.

Environment: Facets 4.7, Microsoft Office 2007, Oracle 9i, HP Quality Center 9.0, UML 2.3.1, MS Visio 2007, MS SQL Server 8.0, MS SharePoint 2.0, Trizetto facets 4.7.

Confidential, Burlington, NC

Business Analyst

Responsibilities:

• Analyzed, designed, and implemented web applications for Risk Managers to assess insurance applications
• Responsible for the functional study and analysis of the business requirements, UML diagrams, flow charts, business process and designing data elements
• Presented to large groups to review all analysis, ad-hoc reports and made suggestions for new processes that would benefit the organization
• Responsible for streamlining business processes through analysis, design, and documentation of new processes and applications including risk assessments and mitigations, and creation of process flows (VISIO flow design) and change enabling quality controls
• 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
• Created UML Diagrams including Use Cases Diagrams, Activity Diagrams,web page Mock-Ups using Axure and MS Visio, and defined Business Process Model.
• Involved in gathering requirements about Provider Implementation and Claim Submitting Details about specific Providers
• Conducted JAD sessions to understand the unique high level diagram and broke them into detailed functional requirements.
• Involved in customizing a third party commercial health information platform called MS HealthVault and integrating it with in house membership data management software “Beacon”.

Environment: Rational Tools, MS Visio 2003, SQL Server 8.0, Windows XP, MS Office 2003, SharePoint2.0, Oracle 9i.

Confidential, Austin, TX

Business Analyst

Responsibilities:

• Prepared the business requirement document (BRD) and Functional Requirements Documents (FRD) for the enhancement of the existing services.
• Set up Provider's Access to the System. (Security Setup).
• Worked on Technical design documentation (TDD) of the claims processing system.
• Performed task estimations and documentation of procedures.
• Acted as a liaison, writing documentation and increased project coordination and to avoid any gaps in understanding or implementation of requirements.
• Did impact analysis for changing requirements and coordinated with business users for prioritizing the testing/release of the changes.
• Created Gap Analysis for As Is and To Be processes of different business functionalities.
• Maintained a very close interaction between business users and developers to avoid any gaps in understanding or implementation of requirements.
• Did data analysis, created data mappingand kept the documents updated with changes in requirements and functional specifications.
• Conducted integration testing and regression testing with developers in development and QA, also conducted user acceptance testing with UAT team.
• Safety reporting on Involved in gathering requirements and designing of web portal of New MMIS system

Environment: SQL Server 8.0, MS Visio 2003,MS Office 2003, SharePoint 2.0, UML 2.1.1, Oracle 8i.