SUMMARY

• Business Analyst with 7 years of experience and successful implementations in Healthcare Industry involving in - depth understanding of Business Process Flows.
• Experience in full Software Development Lifecycle (SDLC) from association with end-users for requirements determination, defining the system scope, system analysis, Business Case Development to Rollout, Production, testing, maintenance and documentation.
• Thorough knowledge of Unified Modeling Language (UML), Rational Unified Process (RUP), Waterfall, Rapid Application Development (RAD) methodology and rational tools.
• Strong Knowledgein various domains like Health care, Insurance and Bank Industries.
• Proficiency in transforming business requirements into functional specifications focusing on workflow analysis and design, user interface design, and process flow modeling.
• Lead and organized Requirements gathering sessions and JAD sessions before groups of Subject Matter Experts as needed in order to document decisions regarding future state of business processes.
• Proficient in diverse technology architectures.
• Experienced inHealthcare Pricing/Reimbursement.
• Good knowledge of Health Insurance Plans (Medicare Part A, B, C and D), managed care concepts (Medicaid and Medicare) and experienced in determining the membership eligibility, billing experience within life and disability in health plans with thorough understanding of claim forms and reimbursement forms.
• Proficient in medical terminology and coding outpatient and inpatients diagnosis and procedures using ICD-9, ICD-10 codes.
• Working experience in HIPAAand working knowledge in PIA, EHR and EMR.
• Extensive experience with process modeling using UML, activity Diagrams with partitions and Use Cases, flow charts and sequence diagrams.
• Business writing skills in writing Business requirements document, Use-Case Specifications, Systems Requirements Specification (SRS).
• Experienced in Systems Testing, Integration Testing, and Software Quality Standards, Training, Documentation and implementation in a business environment.
• Experience in conducting SWOT analysis and Facets.
• Experience in writing Test Cases and Test Scripts from the system requirements.
• Ability to rapidly learn new concepts and good experience in handling global projects.
• Can work individually and in a team, posse’s excellent communication and interpersonal skills.
• Competent problem-solver with exceptional negotiation, verbal and written communication skills.
• Proven ability handling multiple projects simultaneously.
• Proven ability working in high pressure and time crunch situation.
• Ability to create and maintain highly efficient environment with all team members and clients with clear understanding of requirements.
• Strong written and verbal communication skills.

TECHNICAL SKILLS

Database: MS Access, Oracle.

Operating System: Windows 95/98/2000/XP.

Methodologies: SDLC, RUP, RAD, Waterfall, SCRUM, Agile, UML, GAP.

Software Languages: SQL, C, C++, HTML.

Modeling Tools: Rational Rose, Rational Requisite, Requisite Pro, MS Visio, Facets.

Testing Tools: Test director, Issue Tracker, Quality Center.

Office Tools: MS Word, MS Power Point, MS Excel, MS Access, MS Outlook.

PROFESSIONAL EXPERIENCE

Confidential, Princeton, NJ

Business Analyst

Responsibilities:

• Responsible for the coordination and completion of projects across various functional areas.
• Provided subject matter expertise in areas including project management, project scope definition, risk identification, project methodology, resource allocation, facilitation, and other areas of expertise based on professional knowledge and background.
• Conducted presentations to management on project updates, project cycle, and expected results.
• Created process flows and conducted walk-through of the process flows for the vendor’s team and the client’s team.
• Successfully executed the BA process such as Entity Relationship diagram, Gap analysis, Process evaluation and SDLC.
• Created UI mockups (prototypes) using Excel and traditional whiteboards.
• Involved in authoring the Project Standards, Project Charter, Project Scope document.
• Migrate the ICD 9 documentation from documents repository to the central share point site.
• Authored System Implementation Documents such as Technical Specifications, which includes creating mockups and screens and functional requirements.
• Developed test requirements by decomposing the functional requirements.
• Performed functional, regression and user acceptance testing on GUI.
• Updated, maintained, and promoted Test Plans, Scripts and cases.
• Designed detailed workflows using MS Visio.
• Design, create and provide training program for the new project members on the SharePoint structure, ICD 9 and the claim processing system.
• Drafted high-level Test Plan with assistance of QA lead to define a roadmap for testing at different phases.
• Assisted QA in generating test scripts and test cases for functional requirement (FR) validation and performed user acceptance testing (UAT) to validate user requirements and expectations.

Environment: - SDLC, RUP, Rational Requisite Pro, Share point, MS Visio, MS Office, HTML, SQL, Oracle Clinical Database, Windows XP

Confidential, Minneapolis, MN

Business Analyst

Responsibilities:

• Involved in preparing the project scope and objectives.
• Prepared business requirements documents by conducting client group interviews, focused groups, workshops and online surveys.
• Prepared and maintained the Requirement Traceability Matrix (RTM) to record the business, functional and non-functional requirement.
• Prepared business requirement document (BRD) and functional requirement document (FRD) to provide details of each business and functional requirement, development and implementation plan of these requirements, timelines, owners, etc.
• Prepared the efforts and cost estimation of the project and worked towards obtaining approvals from all the stakeholders.
• Participated in prioritize the requirements to better manage the project.
• Performed comparative analysis and gap analysis to meet HIPAA standards.
• Ensured that the CPT codes requirements are thoroughly understood by all the stakeholders to in corporate appropriate changes in the recording system.
• Prepared use case diagrams and description documentation based on the analysis, and obtained approvals from the clients.
• Prepared activity diagrams and sequence diagrams on MS Visio to better understand the flow of activities along with the timelines of each actor.
• Used Rapid Application Development (RAD) model to in corporate all required features as per the HIPAA guidelines in the patient’s ID.
• Coordinated with project stakeholders to track the progress of the project, update status and lead review meeting to ensure that schedules and deliverables are met.
• Coordinated and controlled change request for the clients by conducting impact and cost analysis, prioritizing and mitigating changes.
• Prepared change request form to provide details of the changes requests, and obtained approvals from the appropriate stakeholders.
• Prepared test plan and test cases.
• Supported the testing team during the testing stage by conducting user acceptance testing (UAT)

Environment: - UML, RAD, Rational Requisite Pro, MS Visio, MS Office, MS Outlook,MS Projects, Issue Tracker, Windows XP

Confidential, Atlanta, GA

Business Analyst

Responsibilities:

• Gathered business requirements by driving user-group meetings and working with various global, cross-functional and virtual teams.
• Responsible for business system analysis of customizing the product with SDLC.
• Responsible for handlingdata manipulation, mapping, and basic database tasks.
• Responsible for understanding current processes and tools and experience in reviewing and analyzing documentation.
• Developing requirements with compliance with HIPAA.
• Worked Extensively on mapping the ICD-9 codes ICD-10 codes for the existing DHHS system.
• Experience in working in the Application development.
• Experienced in working with technical Writing teams and ensures the delivery of a high quality software application.
• Used Visio to model the process using UML to create behavioral and structural diagrams.
• Experience in Facilitating organizational change strategy development and objective setting with a cross-functional group ofBusiness/Statestakeholders.
• Experience in Insurance Claims process procedures and knowledge of basicadjudicationand Insurance business rules.
• Developed medical claims business workflows andworked extensively on adjudication systems.
• Responsible for working on the document mandating that all covered health care providers and health care plans as described in the document begin using a single, assigned National Provider Identifier.
• Responsible for developing Front end edits for claimsadjudication.
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, UML and Business Process Modeling.
• Developed business process models in RUP to document existing and future business processes.

Environment: UML, RUP, SDLC, Rational Requisite Pro, SharePoint,MS Visio, MS Office, MS Project, MS Access, SQL Server, Windows 2000/XP

Confidential, Swedesboro, NJ

Business Analyst

Responsibilities:

• Analyzed the existing explanation of benefits and understanding its shortcomings.
• ArrangedJAD sessions with the employees to understand their needs.
• Conducted detailed walkthrough of Business requirement and functional requirement.
• Developed Project Plan around RAD (Rapid Application Development) and gap analysis.
• Chalked out the scope, timeframe, risk analysis, cost and maintenance procedure.
• Researched and established the points of improvement in the software and the possible implementation of security standards.
• Microsoft Visio was used to create various documents such as Use Cases and Activity Diagrams.
• Used Microsoft project to develop the project plan.
• Played the key role in planning, developing, implementing and User accepted testing and maintenance.

Environment: - Agile Methodology, RAD, MS Visio, MS Office, SQL, Windows 2000/XP

Confidential, Pittsburg, PA

Business Analyst

Responsibilities:

• Actively participated in Focused session to gather requirement and documented them modeling UI Diagrams.
• Involved creating various Documents like Business requirement, Functional, System and testing documents.
• Wrote Statements of Work, Business Specification Documents, Test Plans and Test Reports.
• Extensively coordinated in assessing the risk for 5010 HIPAA documented them as per request.
• Worked with software engineers and business units, assisted in formulating and defining system scope and objectives through research and fact-finding, combined with a basic understanding of business systems and industry requirements.
• Extensive GAP analysis was done to bridge gap between “As-is” state to convert to “To-be state or Future state”.
• Responding to member eligibility or group questions & verifying enrollment status.
• Worked with various types of member correspondence.
• Deep data diving for Reconciling eligibility discrepancies, analyzing transactional data & submitting retroactive eligibility changes.
• Worked with Inventory control of member and group transactions.
• Defined and documented business and system processes.
• Defined and communicated work direction to the various developers.
• Facilitated UAT with the stakeholders and the business users.
• Recognized scope limitations and raised potential scope issues, while designing best systems approach.

Environment: Agile, Facet,Rational Requisite Pro, Rational Rose,MS Visio, MS Project, MS Access, SQL.