SUMMARY

• Qualified professional with over Eight years of extensive experience in the field of Business Analysis, working with the technical staff to implement management and staff's business requirements into the software application in Healthcare Industry.
• Extensive experience with Medicare/Medicaid processing as well as the Claims/Billing.
• Highly motivated team player with excellent communication, presentation and interpersonal skills, always willing to work in challenging and cross - platform environment.
• Experienced as a Business Systems Analyst in using the iterative software development life cycle principles of Rational Unified Process to manage, develop and test distributed client/server, internet and intranet applications on heterogeneous environments.
• Highly proficient in working with users to gather requirements, analyze them and subsequently use the Rational project and design tools to model the requirements.
• In-depth knowledge of creating use cases, functional design specifications, activity diagrams, logical, component and deployment views to extract business process flow.
• Experience with HIPAA 5010, EDI Transaction sets, ICD9/ICD10 conversions.
• Used Query Analyzer, Execution Plan to optimize SQL Queries.
• Experience withHIPAA and CMS Regulatory Compliance and Controls.
• Strong understanding of project life cycle and SDLC methodologies including RUP, RAD, Waterfall and Agile.
• Conducted JAD sessions, created Use Cases, workflows, screen shots and Power Point presentations for the Web Applications.
• Gathered and documented Non-functional requirements.
• Knowledge of healthcare standard Health Level Seven (HL7).
• Conducting requirement gathering sessions, feasibility studies and Impact Analysis and organizing the software requirements in a structured way using Rational RequisitePro to track development.
• Interacting regularly with the development team, creative services, database designer, system administrator and the higher management to meet the deadlines of Project milestones.
• Worked in close co-ordination with the testing team in developing test plan and test cases from functional and business requirements.
• Performed end-to-end UAT.
• Expertise in understanding and supporting the client with Project Planning, Project Definition, Requirements Definition, Analysis, Design, Testing, System documentation and user training.

TECHNICAL SKILLS

UML Tools: MS Visio, Rational Rose

Requirement Mgmt Tools: Requisite Pro, Clear Case/ Clear Quest

Testing Tools: Quality Center, Test Director, Win Runner, QTP, Load Runner

Databases: Oracle, Microsoft SQL Server, DB2, MS Access

Languages: JAVA, J2EE, SQL, PL/SQL, .NET, Java Script, VB Script, C, C++

Web Technologies: HTML,DHTML, CSS, XML

Operating Systems: Windows XP/2003, 7 Server/NT, UNIX

Others / Reporting Tools: Microsoft Office Suite, MS Project, Business Objects, Crystal Reports, Agile, RUP, Waterfall.

PROFESSIONAL EXPERIENCE

Confidential, Miami, FL

Sr. Business Analyst

Responsibilities:

• Interacted with business heads to finalize the Business Requirements for the application.
• Performed the requirement analysis and documented the requirements.
• 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.
• Successfully conducted interview sessionsand worked as liaison between the business and development team.
• Understand the As Is system and develop the To Be system concept and also prepare the System Process Maps.
• Prepared and documented System Requirements and workflows for the functional design document.
• Checked Business Readiness and determined activities of flow.
• Performed System Testingand documented detailed defects.
• Wrote Procedure Manuals and was responsible for continuity preparedness.
• Managed various tests, stored test information, reviewed and analyzedtest results.
• Maintained test cases and defects in Quality Center during the testing lifecycle.

Environment: MS Visio, Quality Center, CIS/mainframe, Java, Smalltalk and on the applications and functions on these and other platforms, e.g. CIS, CALLS, Confidential .com.

Confidential, Lincoln, NE

Sr. Business Analyst

Responsibilities:

• Handled claims in EDI & Paper format 837P, 837I & 837D.
• Extensively worked on Medicaid, Medicare & Health insurance.
• 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.
• Successfully conducted JAD sessions, which helped synchronize the different stakeholders on their objectives and helped the developers to have a clear-cut picture of the project.
• Understand the As Is system and develop the To Be system concept and also prepare the System Process Maps.
• Developed Use cases, Workflow diagram, process maps using Visio.
• Assigned tasks among development team, monitored and tracked progress of project following Agile methodology.
• Responsible for architecting integrated HIPAA, Medicare solutions, Facets.
• Defined Functional Test Cases, documented, Executed test script in Facets system.
• Designed High level design, for New process, integrating with legacy and Facets
• Prepared test plan and test scripts and tested end to end processes.
• Hands on experiences on testing User Interfaces (UI).
• Checked Business Readiness and determined activities of flow.
• Performed Unit Testing and User Acceptance Testing and documented detailed defects.
• Helped in writing Training manuals and helped business with the Training on a one to one session.
• Wrote Procedure Manuals and was responsible for continuity preparedness.
• Managed various tests, stored test information, reviewed and analyzed test results using Rational Rose.
• Conducted presentations of the Q/A test results with analysis to the stakeholders and users and documented modifications and requirements.
• Used Outlook Access for bug tracking during the testing lifecycle/ status update meetings.

Environment: MS Visio (vs.10), Rational Rose (vs.7), MS Project, UML, Windows XP, Mainframe, SQL Server, Truven

Confidential, Tampa, FL

Sr. Business Analyst

Responsibilities:

• Conducted weekly meetings for deciding the Policies and Procedures to be followed while constructing new sites.
• Performed the requirement analysis, impact analysis and documented the requirements using Rational Requisite Pro.
• Developed plan for data feeds and data mappings for integration between various systems, including XML, to follow ICD10 Code set and ANSI X12 5010 formats.
• Worked in a close coordination with the ICD9/10 conversion SME to ensure the requirements for conversion met the guidelines.
• Thoroughly studied the difference between the Procedure and Diagnostic Codes in the ICD 9 format versus the codes in the ICD 10 format.
• Was responsible for data mapping of HL7 messages into relational database.
• Documented the server farm requirements and requirements related to security within Share Point and using Windows Active Directory.
• Documented use cases, BRDs, Functional documentation & requirements traceability matrix.
• Performed Gap Analysis to check the compatibility of the existing system infrastructure with the new business requirements.
• Created story board using ms power point for executives from previously developed business process and executing the projects within mix methodology Agile/Scrum Project Management
• Used Query Analyzer, Execution Plan to optimize SQL Queries.
• Meticulously assessed data from various sources and generated conceptual and logical database designs using ERwin data modeling tool.
• Interacted with client and the Technical Team for requirement gathering and translation of Business Requirement to Technical specifications.
• Conducted interviews, meetings and JAD sessions during the process of Requirement Gathering.
• Planned and documented procedures for data processing and prepared data flow diagrams for the application.
• Analyzed and translated business requirements into system specifications utilizing UML and RUP methodology
• Analyzed trading partner specifications and created EDI mapping guidelines.
• Participated in the UAT process.

Environment: MS Office, SQL Server, Agile, MS Project, MS FrontPage 2003, MS Access, EDI, Documentum2.0., Microsoft Excel, Microsoft Word, Microsoft Power Point, Visio.

Confidential, Minneapolis, MN

Business Analyst

Responsibilities:

• Conducted JAD Sessions to develop an architectural solution that the application meets the business requirements, resolve open issues, and change requests.
• COBOL was used as a front-end application and DB2 as a back end.
• Established a Business Analysis methodology around the Rational Unified Process.
• Interaction with underwriters to understand multiple data points. Prepared data flow diagrams using MS Visio for better clarity and to ensure documented process.
• 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.
• Ensured that all Lines of Business specifications were consistent in form and function to the Diamond Base System.
• Provide implementation assessment, strategy, and mentoring services for MS Visio, UML and RUP.
• Installed, authored, and managed reports using SQL Server Reporting Services.
• Developed project plans and managed project scope.
• Gather requirements by conducting meetings and brainstorming sessions with end users and SME and document them using Requisite Pro - the documentation tool offered by Rational.
• Worked extensively with MS Excel and MS access.
• Defining test cases, creating test scripts, analyzing bugs, interacting with QA / dev teams in fixing errors, SIT and UAT.
• Created the SQL scripts for demonstrating the prototypes and for verifying the result sets.
• Teamed up with both internal and external software development groups to provide functional requirements specifications in form ofuse cases, business process flows, and prototypes and management reporting requirements.
• Ensured that project/requirement(s) are properly tracked and documented as per Project Manager’s needs.
• Involved in project management using MS Project.
• Designedand implementedaweb service to support the outsourcing of clinical trial disclosure.
• Performed extensive Requirement analysis and developed use cases and workflows.
• Performed usability analysis and testing including user interface design throughout the development life cycle, provided Client meetings, Artifacts and end-user training on application usage and General IT knowledge.
• Worked with Siebel users and coordinated with the teams involved in testing the user interface and backend testing.
• Worked on Business Intelligence tool like Requisite Pro for BRD and Informatica for ETL and data mapping with Data warehouse team closely for the development of the SDLC.
• Developed business requirement specification documents as well as high-level project plan.
• Responsible for all risk assessment and management activities including business continuity, disaster recovery planning and physical and information security.
• Followed top down, leveled technique for building Business Process Models.

Environment: SQL Server, Oracle, Rose, MS Word, MS Excel, MS Visio, LoadRunner, WinRunner

Confidential, New York

Business Analyst

Responsibilities:

• Responsible for defining the scope and implementing business rules of the project, gathering business requirements and documentation.
• Responsible for writing Functional Requirement Specifications (FRS) and User Requirement Specification (URS).
• Analyzed Business Requirements and segregated them into high level and low level Use Cases, Activity Diagrams / State Chart Diagrams using Rational Rose according to UML methodology thus defining the Data Process Models.
• Developed straightforward DBMS queries, knowledge of HL7 and xml interface messaging.
• Assisted in monitoring ancillary data transactions and addressed problems with HL7 messages.
• Designed a claim processing system for the healthcare management client system. It allowed the user to inexpensively capture information regarding patient, summary of medical history, symptoms (ICD-9 codes), and treatment (CPT).
• 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.
• 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.
• Responsible for architecting integrated HIPAA, Medicare solutions, Facets.
• Identified Member, Provider, Coverage, Medicare, and Medicaid.
• Involved in Service Oriented Architecture (SOA) of the claims processing system.
• Performed extensive requirement analysis including Data analysis.
• Defined Functional Test Cases, documented, Executed test script in Facets system.
• Conducted presentations of the Q/A test results with analysis to the stakeholders and users and documented modifications and requirements.
• Coordinating and Developing QA activities.
• Assigned tasks among development team, monitored and tracked progress of project following Agile methodology.
• Wrote Test Cases and performed User Acceptance Testing, documented the in detail defects using the Defect Tracking report.
• Wrote PL/SQL statement and stored procedures in Oracle for extracting as well as writing data.
• Carried out defect tracking using Clear Quest.
• Maintained proper communication with the developers ensuring that the modifications and requirements were addressed and also monitored these revisions.
• Involved in compatibility testing with other software programs, hardware, Operating systems and network environments.

Environment: Requisite Pro, Rational Rose, HTML, MS Office, MS Visio, EDI, Rational Clear Quest, Rational Clear Case, UML,RUP, Microsoft Excel, Microsoft Word, Microsoft Power Point, Visio.