SUMMARY

• Results - oriented professional with good communications, team building, analysis and problem solving skills including 8 years experience in business analysis, and client relationship management.
• Professional experience in Business Analysis, Software Development Life Cycle: System Analysis, Design, Development, Testing, and Implementation on Business Systems.
• Ability to educe, define, document business user requirements, managing requirements and analyzing requirements, changing requirements and translating requirements and objectives into business/technical requirements based on project scope parameters.
• Responsible for EDI strategies enabling Health Care Providers and Insurance Careers to communicate effectively.
• Involved in gap analysis of healthcare portal applications that are developed in house team and developed gap analysis document, logical and physical design and remediation plan.
• Good Working Knowledge of HIPAA Regulations and Claims Processing.
• Strong experience in Requirements elicitation techniques - conducting user interviews, document analysis, JAD sessions and managing the requirements.
• Created design documents like data flow diagrams, process flow charts using MS VISIO and UML.
• Strong Object Oriented Analysis and Design using UML, Rational Unified Process, RATIONAL ROSE.
• Comprehensive experience in writing Test Plans, Test Cases and Test Scripts using manual and automated testing tools from Rational and Mercury Interactive such as TEST DIRECTOR, WINRUNNER.
• Actively involved in developing, executing and managing User Acceptance Testing (UAT).
• Good hands on experience testing of inquiry screens to support EDI transactions.
• Outstanding communication skills and the ability to work effectively with technical teammates in order to translate business requirements into an effective technical solution and serve as an effective communication channel between the key IT and business contacts.
• Proven ability to grasp any new technology in any software and Healthcare industry.
• Assisted Quality Assurance (QA) team in writing test plans, defining test cases, test scenario and data sets.
• Excellent Leadership qualities with an aptitude for teamwork.
• Built strong relationships with clients and demonstrated commitment to delivery.
• Strong communication, business understanding, critical thinking and analytical skills.
• Highly motivated, organized and target oriented team player who enjoys working with multi-functional team towards a common goal.

TECHNICAL SKILLS

Databases: MS SQL Server 2000, MS ACCESS

Methodologies: Rational Unified Process, Object Oriented Analysis and Design, Unified Modeling Language

Modeling Tools: RATIONAL ROSE, ERWIN 4.0, and MS VISIO

Testing Tools: MERCURY WINRUNNER 7.0, TESTDIRECTOR 6.0

Operating Systems: WINDOWS 98/2000/ME/XP, WINDOWS NT, UNIX

Office Tools: MS WORD, MS EXCEL, MS POWERPOINT, MS PROJECT 2002/2003

Quality Management: HIPAA

PROFESSIONAL EXPERIENCE

Confidential, Thousand Oaks, CA

Business Analyst

Responsibilities:

• The project was on Provider Transactional and Utilization, to focus across all the transactions, Administration, Clinical and Financial across all channels (Web, IVR etc).
• Facilitated JAD sessions with business users of all the levels and development
• Team/technical team to drive out detailed business requirements.
• Created Test Plan, that defines the test environment, phases of testing, entrance and exit criteria into different phases of testing and resources required.
• Prepared the Process flows, Flowcharts and Information Value Chain for the Current state for all the transactions across all channels.
• Defining test cases, creating test scripts, analyzing bugs, interacting with QA / dev teams in fixing errors and User Acceptance Testing (UAT).
• Verified the current state documents by the Business and IT group in the respective meetings.
• Transaction syntax like ANSI X12 4010, Implementation and Knowledge of HIPAA code sets, familiar with ICD-9.
• Arranged JAD sessions with business users and various Users across the department to drive out detailed business requirements.
• Analyzed IT and Process Gaps on the identified Current state for all channels and transactions.
• Recommended the 150+ Opportunities and areas of Improvement, beneficial to the organization.
• Verified the relationship between accounts, contacts, opportunities, and activities.
• Performed thin client testing for the remote users.
• Performed custom tables testing to check if they are resolving the foreign key.
• Manually tested all the interfaces.
• Validated the reports and files according to HIPAA X12 enforced standards.
• Identified Metrics for Future state opportunities/Recommendations.
• Did Value proposition for the recommendations.
• Manually tested the entire application along with the junior testers before the tests were automated
• Involved in HIPAA/EDI Medical Claims Analysis, Design, Implementation and Documentation.
• Prepared the Business case and Business Specifications for the PTU project.
• Prepared Project specification and Scope document
• Identified various dimensions and data fields for DataModelling Phase 1 and 2.

Environment: HIPPA X 12 10, EDI 835, 837. MS Visio, Rational Unified Process (RUP), UML, Use Case Diagrams, Datamodelling TOAD, Activity Diagrams, State Diagram, MS Office, Crystal Reports, Teradata, WebSphere Portal, Test Director, Win Runner, Load Runner.

Confidential, Radnor, PA

Business Analyst

Responsibilities:

• I gathered the requirements for MDS 3.0 project by arranging one on one session with the clinicians and the development team and prepared the functional specifications for the conversion from MDS 2.0 to MDS 3.0 file submission process.
• Defining test cases, creating test scripts, analyzing bugs, interacting with QA / dev teams in fixing errors and User Acceptance Testing (UAT).
• Prepared the specification document for the MDS file submission Green light report to provide the user the percentage of expected file submission over a given time period.
• Attended the meetings with the clinicians and the CMO to gather the requirements for the MDS 3.0 RADAR reports.
• Prepared the mock-up screens for the new RADAR reports and worked on the crosswalk document between the clinical consideration and Focus reports.
• Conducted JAD sessions between the end users and the development team.
• Analyzed and synthesized results from Joint Application Development (JAD).
• Worked on Sub-Modules Like, PA, Benefits, Time Management and Payroll for the company.
• I worked on adding a new feature to the existing RADAR reports called Off-cycle assessments.
• I came up with the process flow for Off-cycle assessments using Visio.
• Designed the new screens for Off-cycle assessments using Publisher.
• Arranged project status weekly meetings with the Clinicians and business users.
• Attended daily Scrum meetings with the development team.
• Worked on Test Cases and Test Plans using Different Testing Methodology like Functional, Regression, Integration, and User Acceptance testing (UAT).

Environment: MS Visio, RUP, UML, Use Case Diagrams, Activity Diagrams, State Diagram, MS Office, Crystal Reports, Publisher, Visio and Agile/Scrum, Test Director.

Confidential, Dallas, TX

Sr. Business Analyst

Responsibilities:

• Determined user/business/functional requirements. Created vision, scope, and use case documents; business process models, use case diagrams, activity diagrams, and state chart diagrams.
• Utilized RUP to configure and develop process, standards, and procedures.
• Performed GAP and Risk analysis of existing system and evaluated benefits of new system.
• Conducted Joint Application Development (JAD) sessions with stakeholders throughout SDLC to resolve open issues.
• Validated technical designs created by IT developers against functional specifications.
• Worked with QA team to design test plan and test cases for User Acceptance Testing (UAT).
• Coordinated work plans between project manager and client using MS Project.
• Conducted Joint Application Development (JAD) sessions with IT groups. Identified the Key Changes, and participated in Stakeholder Management to communicate effectively with them
• Developed Functional Specification Document and Supplementary Specification (non-functional) Document.
• Participated in the Logical and Physical Design sessions and developed Design Documents.
• Worked with developers.
• Designed and implemented basic SQL queries for QA Testing and Report / Data Validation.
• Partnered with the Technical Areas in the research and resolution of System and User Acceptance Testing.
• Worked with Quality Control Teams to develop Test Plan and Test Cases.
• Develop User Manuals, and Training Manuals as per Project Specifications and timelines.

Environment: Microsoft Office Suite, MS Visio, Windows XP, DreamWeaver, SQL, PLSQL, XML, VB, ASP, Crystal Reports, Adobe Photoshop, Mercury TestDirector, UAT, WinRunner, LoadRunner

Confidential, Orange County, CA

Health Analyst

Responsibilities:

• I was involved in dental and medical software, which are key to health administration.
• Dealt with various insurance companies to work for dental claims, billing and payments through software.
• Gather requirements and document the proposed processes to the existing system.
• Modules included: Claims Processing Files and HIPAA Guidelines adherence across the company.
• Enhanced applications associated with Claim Numbers so that duplicate Claim Numbers could be allowed in the system.
• Updated the Electronic Claims, EDI 835 D, Patient Screen and Sales Administration processes.
• Was involved in the ICD 9 CM Diagnosis and Procedural Code changes for Healthcare Entities like Payers, Employer Groups and Providers.
• Claim Transactions and Billing Transactions - Created flows for adequate matching of Claims. Matched Billing File and EDI Claim File 10A1 records upon receipt.
• Deliver a complete set of Business Requirements focused on claims processing, Benefit administration, member management and Customer Service.
• Deliver platform related specifications such as security, performance, and capacity, Standard code sets such as ICD-9, HIPAA and DRG etc.
• Documented Gap Analysis on EDI 837 D.

Environment: HIPAA 4010/ 5010, EDI 837D, 835D, 270, 271, 277, 276, MS Office Tools, UML, Ms Visio, Quality Center.

Confidential

Business Analyst

Responsibilities:

• Studied the current business systems.
• Interacted with the stakeholders by interviewing them, by preparing questionnaire and getting feedback.
• Conducted JAD sessions to allow different stakeholders to communicate their perspectives with each other, resolve any issues and come to an agreement quickly.
• Gathered requirements for linking the card payment system to the centralized payment system.
• Used Requisite Pro to document requirements, associated change requests with requirements and connected requirements with Use cases.
• Created use case scenarios and documents work flow and business process.
• Prepared the UML Use Cases using Rational Rose.