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Sr. Business Analyst Resume

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New York, NY

SUMMARY

  • 6.5 years of diverse experience as a Business Analyst in developing and implementing innovative business processes.
  • In - depth knowledge and experience in full SDLC with RUP, agile and waterfall methodologies.
  • Excellent knowledge of claim processing and EDI transactions, code sets and EDI Implementation guides in Healthcare industry.
  • Expertise in creating the companion guides on various EDI transactions.
  • Specialize in HIPAA 5010 implementation including GAP analysis
  • Clear understanding of ICD-9-CM and ICD-10-CM/PCS
  • Well versed with ANSI X12, EDIFACT EDI and HL7 standards.
  • Expertise in mapping of EDI transactions using Map force, Specbuilder.
  • Verification of EDI transaction syntax to ensure HIPAA compliance.
  • Well versed with HIPAA, claim adjustments, claim processing from point of entry to finalizing, claim review, identifying claims processing problems, their source and providing corresponding solutions.
  • Exceptional ability to maintain and build client relationships with business owners to identify, prioritize and document business requirements.
  • Proficient in all phases of Requirement Management, including gathering, analyzing, detailing, and tracking requirements.
  • Expertise in creating prototypes and mock-ups for user interface designs.
  • Experience in Business Requirement and System Specifications Analysis.
  • Specialized in creating UML Diagrams like Use Case, Activity and data flow diagrams using Rational Rose and MS-Visio and consistently translate business requirement into IT solutions.
  • Functional experience in health Care Industry with vast knowledge on Medicare and Medicaid.
  • Extensive knowledge of reporting tools such as SQL and ACCESS for underlying database tables and resolve data issues.

TECHNICAL SKILLS

Microsoft Technologies: Microsoft Project, Visio, Excel, Word, Outlook, Power point

Requirements Test Management: Rational Requisite Pro & Rational Test Manager

Defect Tracking Tools: HP Mercury Quality Center, Rational ClearQuest

Languages/Standards: SQL, HIPPA 5010, ICD9, ICD10, XML, ANSIX12

Methodologies: Rational Unified Process (RUP), Agile, Waterfall

PROFESSIONAL EXPERIENCE

Confidential - New York, NY

Sr. Business Analyst

Responsibilities:

  • Used the mapping tools to map 4010 and 5010 transactions along with ICD 9 and ICD 10 codes, and validated the HIPAA Syntax.
  • Developed Incident documents and portrayed the As-Is reporting structures versus To-be Reporting needs for data integrity and accuracy.
  • Identified the scope, business objective and documented the functional requirements for each release.
  • Directly involved in process improvement Plans and implementing business change.
  • Produced clear user manuals & training guides for User Acceptance Testing (UAT) and deployment for end-clients with step-by-step instructions and appropriate GUI screenshots.
  • Interacted with the development team on regular basis to ensure and balance practicalities with innovative and efficient business systems solutions
  • Created Change Notification Requests (CNRs) for report modifications, Table updates and Internal processes.
  • Created use cases specifications, use case diagrams, swim lane diagrams, component diagram and context diagrams to define the workflow and segregate high-level and low-level requirements using MS Visio.
  • Experience in Forward Mapping and Backward Mapping analysis of ICD 9 - ICD 10 Conversion for CM (Diagnosis Codes) and PCS (Procedure Codes).
  • Created Mapping document for ICD 10 impacted process and created mapping document to capture for AS IS and To Be process after ICD 10 code implementation.
  • Clear understanding of Facets, utilized 4.51 versions.
  • Conducted and Participated JAD sessions to gain consensus on various issues related to the project. Acted as a facilitator on different occasions.
  • Held regular meetings with the Business users and SME’S to priorities the business Requirements.
  • Facilitated the resolution of project-related issues, identified risks, and mitigation steps to manage risk using PLSQL in RDBMS.
  • Conducted walkthroughs and code reviews with developers, project managers and stakeholders and users to comprehend business work flow of applications.

Environment: Windows 7, SQL Server 2005/2008, Oracle 10g, Microsoft Visio 2007, Microsoft Office suite, Rapid SQL 7.1.1, FACETS 4.71.

Confidential, California

Sr. Business Analyst

Responsibilities:

  • Involved in gathering the requirements that were critical to the business process flow and using those requirements for the Business Requirements Document (BRD), for the implementation of the NPI in EDI X12 transactions as mandated by the Federal Regulation.
  • Conducted JAD sessions with Subject Matter Experts (SME’s) to obtain domain level information, interviewing and asking detailed questions and carefully recording the requirements in a format that can be reviewed an understood by both business and technical team.
  • Performed GAP analysis of 4010 and 5010 EDI transaction using implementation guide to identify the changes in the segments and data elements.
  • Maintained a daily meeting with the Business and the NPI team on task order approval, increased and decrease frequency of the meetings as per the progress of the task.
  • Followed a structured approach to organize requirements into logical groupings of essential business processes, business rules, and information needs, and insures that critical requirements are not missed.
  • Involved in GAP analysis both at the time of requirement gathering and later after development with the Testing team to identify areas and possible scenarios that might have been overlooked.
  • Facilitated collection of functional requirements from system users and preparation of functional specification documents that provided appropriate scope of work for technical team to develop prototype and overall system.
  • Additional responsibilities included mapping the requirements in Caliber to the Test Cases and Scenarios in Quality Center.
  • Involved in identifying dummy data for the testing scenarios for the QA team
  • Used MS Access to create a time tracking tool for QA resources. This included estimations as well as actual worked hours on enhancements.
  • Assigning defects detected by the Test Team to the relevant developers and escalating issues when and where required.

Environment: MS Project, MS Visio, MS Excel, Facets, MS Word, MS Access, Rational Requisite Pro, Crystal, HP Quality Center, SQL

Confidential, Atlanta, GA

Business Analyst

Responsibilities:

  • Facilitated JAD sessions, which focused on the definition of business requirements associated with Confidential ’s claims process.
  • Created Use Cases that defined the role of users who receive claims, users who process claims, and users who adjudicate claims. Used MS Visio to develop UML diagrams
  • Used Rational Requisite Pro for gathering and documenting requirements from business users.
  • Determined eligibility benefits for customers with EDI Health Care Eligibility/Benefit Inquiry (270).
  • Worked on EDI Health Care Claim Payment/Advice Transaction Set (835) to make payments, send an explanation of benefits (EOB) remittance from a health insurer to a health care provider.
  • Authored data flow diagrams, sequence diagrams, and business process models that describe how the EDI Health Care Claim Transaction set (837) is used to submit health care billing information and encounter.
  • Acted as a liaison by working closely with the development and testing team for achieving milestones.
  • Collected test metrics weekly from the Clear Quest in RUP suite database that reflected the current status of the test execution and the state of the defects.
  • Used Rational Clear Case for managing the version changes across all stages of the SDLC
  • Worked with the technical architect to design security, interaction, and interface of the application. Also worked with architects to create logical and physical data models.
  • EDI Health Care Claim Status Request (276) was used as part of the implementation by Confidential to request a status of a health care claim.
  • Performed manual testing of the functional items by checking a summary of all claims entered and submitted.

Environment: Rational Unified Process (RUP), Rational Clear Quest, Rational Clear Case, Rational Requisite Pro, MS-Visio, ANSIX12

Confidential

Jr. Business Analyst

Responsibilities:

  • Interacted closely with the Subject matter experts (SME) for the functional requirements gathering.
  • Facilitated JAD sessions, conducted interviews, Q and A sessions with business users to solicit business requirements relative to proposed functionality and created Functional and Non-functional requirements.
  • Worked closely with the development team to clarify and understand functionality, resolve issues and provided feedback from the UML diagrams.
  • Analyzed, collected and prepared user requirements, definitions, scope and expectations for deliverable plans and delivered system documents, processes, diagrams.
  • Defined business processes, identified gaps, evaluated requirements and change requests, managed scope and transferred knowledge.
  • Developed and managed all the work plans, acted as the key client contact, handled all kinds of scheduling, ran all status meetings and compiled various reports.

Environment: UML, Use Case Analysis, MS Visio, Enterprise Architect, MS Office

Confidential

Jr. Business Analyst

Responsibilities:

  • Coordinating all aspects of projects such as initiation, planning, scheduling, task assignment and tracking, status reporting and risk management.
  • Facilitated team meetings to coordinate activities for project schedules, presented deliverables to the management, conducted JAD sessions to elicit requirements.
  • Managed requirements to minimize scope issues. Understand all system requirements and provide feedback, collected requirements from customers, users and prioritized them.
  • Involved in walkthroughs and meetings with development team to discuss related issues.
  • Involved in the creation and maintenance of the Workflow plans and artifacts.
  • Prepared Business Process Models that includes modeling of all the activities of the business from the conceptual to procedural level.
  • Examined, analyzed and modeled Use Case Model cases based on RUP methodology.
  • Coordinated with the QA team in creating test cases and conducted UAT.
  • Wrote clear, concise detailed system requirements specification (SRS) documents and user documentation in accordance with the guidelines and standards of a level where developers can interpret, design and develop the application with minimum guidance.
  • Worked closely with Project manager/Senior Analysts in handling the whole project.

Environment: UML, Use Case Analysis, MS Visio, Enterprise Architect, MS Office

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