SUMMARY

• Over 8 years of Business Analysis experience with in - depth knowledge of business processes in health care, banking and financial industries
• Proficient in Requirement Management, including gathering, analyzing, detailing and tracking requirements
• Expertise in Quality Assurance to fulfill requirements for product and service.
• Extensive knowledge and experience in Change Management. Helped organizations go through mission changes, strategic changes, operational changes and technological changes.
• Experienced in documenting requirement using Unified Modeling Language (Use Case and Activity Diagrams). Also building business Process Flow, Context Diagrams, Sequence Diagram, Activity Diagrams, Class Diagrams using Rational tools and Microsoft Visio
• Strong understanding of various SDLC methodologies such as RUP, Waterfall and Agile with hands on experience in all of them
• Experienced in interacting with business users to identify their needs, gathering requirements and authoring Business Requirement Documents (BRD), Functional Requirement Document (FRD) and Software Requirement Specification (SRS) across the deliverable of a project
• Strong Knowledge with Iterative approach for Software Development as per Rational Unified Process (RUP). Involved in inception, elaboration, construction & transition phases using rational tools like Requisite Pro, Clear Case, and Clear Quest during various phases of RUP
• Experienced in SWOT Analysis, Gap Analysis, Impact Analysis, Risk Analysis, and Project Planning
• Extensive knowledge of Medicaid, Medicare, Procedural and Diagnostic codes and Claims Process
• Good understanding of Data Reconciliation, MDM, MMIS and MITA.
• Exceptional Problem Solving and Sound Decision Making capabilities, along with the ability to resolve difficult situations
• Possess a detail-oriented nature with excellent communication, interpersonal skills, and recognized for being a valued team player
• Outstanding organizational skills including ability to multi-task, prioritize and manage increasingly complex issues.
• Good understanding of using testing tools, such as QTP and Test Director and performing a variety of software testing including User Acceptance, Performance, Load, Stress, Sanity, Parallel, Black Box, Grey Box, White Box, Positive, and Negative Testing
• Well experienced in working on MS Word, MS PowerPoint, MS Excel, MS Visio and MS Project
• Excellent verbal, written, interpersonal and communication skills with strong analytical abilities to perform well both independently and as a team player
• Proficient in working with project management tools like MS Project for status reporting and planning.
• Experience in Conversion of HIPAA X12 4010 codes to X12 5010 codes and ICD 9 codes to ICD 10 codes
• Extensive experience in claims processing and billing, Medicare/Medicaid billing and claims management including Medicare (Part A, B, C, D), /Medicaid, Trizetto Facets, MMIS (Medicaid Management Information System), HL7, HIX (Health Insurance Exchange).
• Knowledge of HIPAA and various transaction codes like 270/271 (inquiry/health care benefits), 276/277 (Claim Status), 834 (Benefit Enrollment), 837 (Health Care Claim), 835 (Payment/Explanation of benefits), 820, PPACA (Health Care Reform and patient Protection and Affordable Care act).

TECHNICAL SKILLS

Operating Systems: Windows 95/98/NT/XP/Vista and Windows 7

Languages: C, Java, SQL, UML

Database: Oracle 8i/9i/10g/11i, MS Access

Methodologies: Rapid Action Development (RAD), Joint Application Development (JAD), Rational Unified Process (RUP), Unified Modeling Language (UML), System Development Life Cycle (SDLC), Agile, Six Sigma and CMM

Documentation Tools: MS - Office Suite (Word/Excel/Power Point).

Business modeling Tools: Rational Rose, Requisite Pro, MS Visio, MS Project, Clear Quest, Adobe Photoshop

Testing: Quick Test Pro (QTP), Mercury Quality Center-ALM, Bugzilla

PROFESSIONAL EXPERIENCE

Confidential, WI

Sr. Business Analyst

Responsibilities:

• Interacted with the Business users, SME’s, Developers, PMs and QA teams to better understand the business processes and application knowledge.
• Responsible for gap analysis in changing old MMIS and Involved in testing new MMIS.
• Developed BRD for new MMIS system and conducted data mapping as well as developed Use Cases/Activity Diagrams.
• Met with Supervisors and business users and defined the scope of the project, gathered business requirements, and conducted gap analysis.
• Participated in ICD 9 to ICD 10 codes conversion requirement gathering sessions and created high level business requirement document.
• Gathered and prepared BRD for the Crosswalk Query Tool.
• Prepared product backlog working with product owner and other SME.
• Facilitated daily stand ups and managed task board with user stories and board.
• Defined ICD-9 to ICD-10 mapping process using GEMs (General Equivalency Mapping) crosswalk file.
• Analyzed HIPAA 5010 related to 820, 834, 837,835, 270, and 271. Transactions and performed gap analysis between the 4010 and 5010.
• Created Preliminary mapping between ICD-9 and ICD-10 codes.
• Extracted data from several databases to create a master list of the ICD-9 and ICD-10 codes.
• Created Business Requirement Documents (BRDs), Use-Case Narratives including business process workflow diagrams and Requirements Traceability based on any of the projects need.
• Conducted Requirements Walk-Thru Sessions and resolved all issues/findings.
• Lead & Facilitated numerous meetings to help answer any question on requirements during Design, Development, Testing and Implementation phase.
• Developed business requirement updates while working with different concerned authorities to define priorities concerning business requirements.
• Organized brainstorming and JAD sessions with stake holders, business users, technical teams, testing team to analyze and validate the business requirements, system life cycle and explained the key performance indicators and documented the specifications.
• Checked claim processing while passing 837 claims for compliance check and running through load processing.
• Coordinated closely with Business Intelligence Architecture team and Enterprise Data Warehouse team to understand repository objects that support the business requirement.

Environment: UML, MS Word, MS Share Point, MS Access, IBM Lotus Notes, IBM Main Frame, Rational RequisitePro, Rational ClearQuest, Quality Center, SQL, FTP.

Confidential, Pleasanton, CA

Business System Analyst

Responsibilities:

• Worked with internal team to build out of a high level roadmap and time line to achieve compliance.
• Contributed in implementation of transition in accordance with HIPAA standards.
• Analyzed various inbound and outbound interfaces to determine the impact of HIPAA 5010 and NPI
• Ran reports using Excel and Access to compare and verify data.
• Conducted Business Requirements walkthrough with the business owners as well as the Technical Stakeholders.
• Analysis and Design of HIPAA X12 834 and 820 EDI Transactions for Health Insurance Exchange (HIX)
• Change Control Process - Led the Change Control Process for changes submitted for the BRD once the document was submitted to IT department.
• Documented the UAT Plan for the project and worked with the UAT Team to ensure every acceptance criteria for the requirements has been included in the UAT task plan
• Maintained the Traceability Matrix table to uniquely trace the identified business requirements to general design to testing as proof that requirements requested have been developed into a solution and that it has been tested and tracked.
• Worked cross functionally with developers, QA and project managers to make sure each the data could address their needs
• Developed documents and implemented appropriate policies and procedures related to patient accounting, including follow-up on all patient accounts receivables
• Actively participated in and monitored the accounts receivable management activities, including collection efforts, to insure their effectiveness
• Ensured all audits are conducted and are on time. These included and are not limited to denial audits, co-pay audits, patient collection audits, staff accuracy audits

Environment: Rational Requisite Pro, Rational Rose, Rational ClearQuest, Rational TestManager, RUP, UML, SQL, MS Office, MS-Project, MS Visio

Confidential, Milwaukee, WI

Business Analyst

Responsibilities:

• Conducted formal interviews, Live Meetings and JAD sessions with business users and matter experts.
• Designed and developed Use Cases, Activity Diagrams and Sequence Diagrams using UML.
• Involved in Backend Testing to verify data integrity by using T-SQL.
• Documented, identified, organized and tracked the requirements using Rational RequisitePro.
• Created Data Flow Diagrams (DFDs), ER diagrams for data modeling and Web-page mock-ups using MS Visio for acceptance from end users.
• Defined project milestones, schedules, and monitored progress using MS-Project, creative pro office and modified, updated the project scheduled plans as required.
• Analyzed and tested Data Interface needs.
• Conducted Asset Management, Risk Analysis of the Requirements and Traceability focus areas of the various projects and worked with the project team to help them identify the high-risk areas.
• Worked extensively on both inbound and outbound transactions, creating test cases for multiple transaction types including 820, 834, 837, 835, 276, 277
• Worked on new Pharmacy Benefit Management System Medical Claim Data feed, Data Dictionary layout and definition, Eligibility files and various File Transfer Specifications
• Gap Analysis: Analyzed the client’s applications programs to determine the impact of the HIPAA X12 final rule on EDI Transaction Set and Code List implementation and defined the changes to bring the affected systems into HIPAA compliance.
• Worked with FACETS Team for HIPAA Claims Validation and Verification Process (Pre-Adjudication).
• Worked intensively on FACETS for audit trails made on the used account and check and store information related to the HIPAA authorizations.
• Worked with FACETS to port the system from 4.6.1 to 4.7.1 and check the system responds equally fast and also is complying with the standards of the institution all the time.
• Assisted with user testing of systems and maintained quality procedures and ensured appropriate documentation is in place.
• Maintained Requirement Traceability Matrix (RTM) and Utilized ClearQuest for change requests and defect tracking.
• Claim validation and Pend/Denied Claims Analysis for the Health plans Medicaid programs.
• Worked closely with the technical team to look up for the best possible solution on requirements by keeping business needs and technical constraints in mind.
• Updating, transferring and sharing Files using FTP between Windows and UNIX machines.

Environment: UML, MS Word, Rational RequisitePro, Rational ClearQuest, Quality Center, SQL, FTP, TelNet