SUMMARY

• 8+ years of industry experience as a Sr. Business Analyst with solid understanding of Business Requirements Gathering, BusinessProcess Flow, Business Process Modeling and Business Analysis
• Experience in coordinating on various healthcare systems implementations by interfacing closely with vendors, technical teams andclinical users
• Demonstrated success in managing business requirements, process and workflow analysis, development of functional specifications and documentation, development and testing of interfaces, testing of applications, deployment and implementation, training, and post implementation support of healthcare systems
• Sound knowledge of Health Care Reform Act, PatientProtection and Affordable Care Act (PPACA), Health Insurance Exchange (HIX),HIPAA, ICD9/10, EDI, HMO, PPO, Medicare and Medicaid.
• Proficient in conducting JAD sessions with management, SME’s, vendors, users and other stakeholders
• Experience in HIPAA EDI transactions 837I/P/D, 835, 270, 271, 276, 277, 278, 997/999
• Excellent Business writing skills in developing Business Requirements Document (BRD), Use Case Specifications, Functional Specifications Document (FSD), Workflows and Project Plan
• Participate and contribute to lessons learned sessions and prepare the documents Logged and reviewed Defects, documented the whole Bug life cycle using Quality Centre.
• Strong communicator and creative problem - solver skilled at analyzing business needs and transforming them into technical designs, applying technical skills and business knowledge to achieve sound results

TECHNICAL SKILLS

Project Management: Project planning; Process improvement, resources and timeline;PMBOK Methodology

Methodologies: Agile, Waterfall, RUP, UML, SDLC, Scrum

Change Management Tools: Rational Clear Quest, Rational Clear Case

Business Modeling & Versioning Tools: MS Visio, Visual Paradigm, Rational Rose; Rational Requisite Pro, Rational Clear Case

MS Office: MS Project, MS Word, MS Excel, MS Power Point, MS Access

Programming Languages: Structured Query Language (SQL)

Operating Systems: Windows NT/98/2000/XP/7

Databases: MS Access, Oracle 8i/9i/10g, MS SQL Server 7.0/2000

OLAP Tools: Business Objects XI, Cognos

Testing & Defect Management Tools: Rational clear quest, HP Quality Center, HP ALM

PROFESSIONAL EXPERIENCE

Confidential, Atlanta, GA

Lead Business Analyst

Responsibilities:

• Gathered high level requirements and developed scope of the project.
• 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.
• Documented the server farm requirements and requirements related to security within Share Point and using Windows Active Directory.
• Followed a systematic approach to eliciting, organizing, and documenting requirements of the system.
• Reviewed the Joint Requirement Documents (JRD) with the cross functional team to analyze the High Level Requirements.
• 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
• Followed the standards of PMO which included getting approvals for SOX Compliance at various Gates.
• Prepared Functional Design Specifications employing Use case scenarios, and DFD's.
• Identified and clearly defined functional issues and supported IT development staff throughout the design, development, and implementation phases of the software development life cycle.
• Documented Test Cases and assisted the QA Team with the Test Plan.
• Documented the Traceability Matrix for tracing the Test Cases and requirements related to them.
• Developed Data Conversion Strategy for converting data from the existing site to the new site.
• Prepared Demo on SharePoint for various Business to get new approvals like the Therapist and Nursing divisions.
• Designed workflows and allocated permissions within SharePoint.
• Performed User Acceptance testing and documented detailed results.
• Provided input (scope, goals, risks, constraints, timelines and interfaces) to PM for project planning and control.

Environment: Windows 7, Microsoft Office SharePoint 2010, Rational Requisite Pro, MS Office, SQL Server, MS Project, MS Access, UML

Confidential, Baltimore, MD

Sr. Business Analyst

Responsibilities:

• Interacted with stakeholders to get a better understanding of client business processes and gathered requirements.
• Involved profoundly in the GAP Analysis of Employer Rosters, Employee and Employer Application Fields focusing on changesrequired in existing COTS products to meet client business needs.
• Conducted requirement gathering sessions with the purpose of creating and defining the Business Requirement Document (BRD).
• Created Swim Lane Diagrams and business logic and calculation spreadsheets for various business processes.
• Performed data mapping to define the Source data on 834 Benefit Enrollment and Employer Group File (EGF) EDI Transfers.
• Created Process Models for (a) Initial Enrollment, First Billing and Payment and (b) Post Enrollment - Subsequent Recurring Billingand Payment.
• Collaborated with vendors (CURAM, CONNECTURE and PWC) in order to ensure smooth transition of requirements from State toVendors.
• Involved in Small Business Health Option Plans (SHOP) activities across vendors -
• CURAM - Emphasis on Employee Application and Case Worker Portal with customized triggers to send notices via EP Notify.
• CONNECTURE - Emphasis on Quality Health Plan (QHP) Presentment, Employer Application and Enrollment, DEED Interfacing for Employer Eligibility Determination, Group Plan Administration and Employee Enrollment with customizedtriggers to send notices.
• Integration Layer Activities - EGF, 834, Enrollment State Administration, etc.
• Worked on streamlining SharePoint to meet project policies and processes.
• Performed Data Mapping for State Administration Enrollment Management function to define the data elements, their source and readonly/editable parameters.
• Documented and Analyzed impact upstream and downstream when change in editable data elements in State AdministrationEnrollment Management function is recorded.
• Documented the “Configure Billing Cycle” scenarios and billing rules for the employer.
• Mapped Employer Subscription Service with Enrollment data from CONNECTURE and identified gaps.
• As the processes and methodology moved from waterfall towards agile, wrote requirements in form of User Stories and AcceptanceCriteria Documentation.

Environment: MS Project, MS Visio, MS Word, MS Excel, MS PowerPoint, MS SharePoint, JIRA, Windows XP, HIPAA

Confidential, Baltimore, MD

Business Analyst

Responsibilities:

• Analyzed existing reports and defined business requirements and business process flows.
• Conducted JAD sessions with PM, SMEs; facilitated interviews with end users and hospital administrators to collect business requirements.
• Built a business process model using Microsoft Visio.
• Gathered detailed business and technical requirements and participated in the definitions of business rules and data standards.
• Facilitated SME interviews and assisted in identifying and analyzing the possible technical solutions.
• Performed requirement analysis, went through use cases according to the flow of the patient data and rules of security sharing.
• Conducted manual and user acceptance testing with the development and QA team.
• Participated in all phases of the development life cycle for assigned projects and coordinated business issues resolution throughout each project.
• Maintained proper communication with the developers ensuring that the modifications and requirements were rightly addressed & revisions were monitored.
• Validated business rules and all artifacts with users for approval and sign off.

Environment: MS Office- Excel, Word, PowerPoint, MS Project, MS Visio, UML, SQL, Oracle, Rational Unified Process (RUP), Rational Suite Requisite Pro, SharePoint, Windows XP

Confidential, Newark, NJ

Business Analyst

Responsibilities:

• Involved in Business Analysis forInbound and Outbound Transactions.
• Provided day-to- dayEDItranslator support.
• Served as primary point of contact to bring new trading partner onboard.
• Tested HIPAA Transactions and Code Sets Standards such as 837/835, 270/271, 276/277 transactions.
• Created maps & layouts forHIPAAas imposed duringElectronic Data Interchange (EDI):837 - Claims and Encounters,834 - Benefit Enrollment and Maintenance,835- Claim Payment/Advice,270/271- Eligibility Benefit Inquiry and Response,277/275 - Claim Request for additional Information and Response,276/277 - Claim Status Request / Response.
• Analyzed and identified gaps/issues in claims, encounters and remittance advice process flow.
• ConvertedX12data to XML (using DI)and verify the data by performing schema validations.
• CreatedUse Case Diagrams and Test Casesfor federal employee program.
• Gathered and documented doctor company'sbusinessrequirements and developed, entered and verified test cases.
• RenderedX12 Syntax Integrated Testing, Balancing Testing, Code Testing, Specialty Testing and Trading Partner SpecificTestingwhen environment is upgraded.
• Performed re-testing in order to verify resolution of defects.
• Collaborated withproject team, project leads, and project managersand fostered with them to review plans, systems testing and overalltesting of software.
• Provided support during the integration and UAT.

Environment: MS Project, MS Visio, MS Word, MS Excel, MS PowerPoint, MS SharePoint, Rational Requisite Pro, Oracle 11i, SQL, Toad, Windows XP, HP Quality Center, UML, HIPAA

Confidential

Business Analyst

Responsibilities:

• Full-fledged interactions and co-ordination with more than 70 odd project stakeholders from Confidential business and IT.
• Planned and developed migration scripts for validating data between source and target systems.
• Prepared data mapping document from Source Systems to destination source system and defined the Business rules to populate the data.
• Created reports on plan, participant and fund level information using OMNI script as part of business validations.
• Prepared test plan documentation, including functional lists and test cases from Business Specifications/Requirement documents.
• Responsible for reporting, researching and debugging problems found as a result of data migration.
• Coordinated the development and testing efforts between the onsite and offshore teams to accomplish a 24X7 development and testing schedule.
• Identified critical defects in the data migration upfront and communicated it to the development team.
• Raised and addressed defects in HP-Quality Center and tracked defects for closure.
• Conducted Knowledge Sharing sessions with the Development team and testing team to provide functional aspect of the project and provide the Business rules.

Environment: MS Project, MS Visio, MS Word, MS Excel, MS PowerPoint, Oracle, SQL Server, SQL, Windows XP, Quality Center, MS SharePoint