SUMMARY

• 6+ years of extensive experience as a business analyst and QA, with strong experience in Healthcare especially in insurance claim with a solid understanding of Business Process Flows, Case Tools, and Business Analysis.
• Extensive hands - on and HealthCare management experience in a variety of projects involving the customization, design, development, implementation, and testing of automated systems to support the Medicaid Management Information System (MMIS) as well as day-to-day business operations.
• Experienced in managing various aspects of the software development lifecycle (SDLC) including requirements gathering, design, development, testing, deployment and support
• Facilitated and participated in Joint Application Development (JAD) and Joint Resource Planning (JRP) sessions with management, SMEs, vendors, users and other stakeholders.
• Excellent knowledge of HIPAA standards, EDI (Electronic data interchange) Transaction syntax like ANSI X12, Implementation and Knowledge of HIPAA code sets.
• Excellent understanding of ICD 9, ICD 10, HCPCS, and CPT.
• Experience in developing UML use case diagrams, Work Flow Diagrams using tools like Rational Rose and MS Visio.
• Excellent Business writing skills in creating Business requirement Document (BRD), Use Case Specifications, Functional Specifications, and System Requirements Specifications (SRS).
• Proficient in Developing and executing Test Plans, performing functional, usability testing and ensuring that the software meets the system Requirement.
• Writing and Reading data objects i.e. stored procedures, tables, and views, etc. in SQL server.
• Expertise in object oriented analysis and design (OOAD), unified modeling language (UML), UI development, usage models, layout and wireframes, test cases and user training
• Highly motivated team player with excellent communication, presentation and interpersonal skills, always willing to work in challenging environment.
• Extensive experience in gathering Business and Functional Requirements, developing Use Cases, conducting Gap Analysis and preparing Training manuals.
• In-depth knowledge of creating use cases, functional design specifications, activity diagrams, logical, component and deployment views to extract business process flow.
• Strong understanding of project life cycle and SDLC methodologies likes RUP, Waterfall and Agile.
• Interacting regularly with the development team, creative services, database designer, system administrator and the higher management to meet the deadlines of Project milestones.
• Experience in working with QA testing teams, while interacting with business users and gathering user’s requirements to develop necessary Test plans, Test Cases.
• Performed UAT and exposure to User Certification Testing (UCT) and Operational Readiness Testing (ORT)

TECHNICAL SKILLS

Business Skills: Business Definition Requirements, Business Process Analysis, Gap Analysis Use Case Modeling & Analysis, Business Environment and research Analysis

Tools: MS Visio, Rational Rose, Enterprise Architect, Rational Suite, Rose, Clear Quest, MS Project, MS Access, MS Office Suite, Erwin

Methodology: SDLC, RUP, Agile, Waterfall.

Testing: Quality Center, Test Director, win runner, load runner.

Databases: Oracle 8i/9i; SQL Server 7.0 & 2000; Access 2000, MS SQL Server

Platforms: Windows, NT/95/98/2000/XP/Vista/Window 7.

Applications: MS word, MS Excel, MS Access, MS Power point, MS Outlook

Industry standard: HIPAA, ISO.

Programming Languages: SQL, XML, HTML, HTML/DHTML, VB.Net, SQL, UML

PROFESSIONAL EXPERIENCE

Confidential, MN

Business Analyst

Responsibilities:

• Managed and leveraged valuable consulting experience in defining important Project Management & QA requirements that involved development using SOA (Service Oriented Architecture)
• Followed the Business Rules, and ensured that HIPAA compliant Rules are followed to display minimum benefit information that the Provider is required to pass on the EDI transactions.
• Managed the privacy and security environments of healthcare data that was governed by HIPAA and other government mandates.
• Wrote Test Cases and performed User Acceptance Testing (UAT), documented the in detail defects using the Defect Tracking report.
• Prepared and delivered Contingency Plan(s) as required.
• Define functional test cases, documented, and executed test scripts in FACET system
• Tracked project schedule and plans with Senior Manager(s), Directors and Officers
• Infrastructure planning for the project, including developing a SharePoint portal
• Advised on best practices in the IT industry for the development of the Requirements definition
• Managed and advised sub-contractors in following industry best practices
• Incorporated Rational Unified Process (RUP) to create BRD Specifications using MS Visio and MS Word.
• Used MS Visio for Process modeling and Business Process flow diagrams.
• Exposure to Human-Computer Interaction (HCI), User Interface (UI) Design and Usability Testing.
• Assisted the PM on various projects throughout the Project Management Life Cycle (PMLC) including Project Charter, Project Plan and Resource allocation.
• Used SDLC (System Development Life Cycle) methodologies like the RUP and the waterfall.
• Monitored and Tracked MS-Project schedules for deviations, gave early warning of schedule and cost variances, implemented change control, and delivered the scope within budget limitations.
• Interviewed subject matter experts to identify and analyze Business Processes, end user behavior and expectations, and potential risks involved.
• Partnered with the internal users to gather, refine and evolve business requirements.
• Translated Business requirements into User Requirements Specifications.
• Translated the User Requirements Specifications into Functional Requirements and captured in Rational Requisite Pro
• Created Traceability Matrix to keep track of user needs, features of the applications and use cases.
• Communicated with the business stake holders on a functional level and with the QA on a technical level.
• Scanned and Reported bugs and re-tested fixed features. Wrote test cases for specific features in the system.
• Verified test cases documented by the QA team pertaining to other features in the system.

Environment: Windows XP professional, MS Office suite, MS Project, UNIX/Oracle Platform, XML, Oracle Application server, VB.net, MS Visio.

Confidential, Rochester, NY

Business Analyst

Responsibilities:

• Participated in Business Modeling by understanding the needs of the business, and also documenting Business Use Cases as well as System Use Cases.
• Gathered Requirements and documented the proposed additional extension to the existing HIPAA application.
• Facilitated Joint Application Development (JAD) sessions with the Management, Mainframe and HIPAA team to make sure everyone are in sync with the business requirement processes.
• Involved in HIPAA 5010 gap analysis of ANSI X12 4010 and ICD 10 initiatives.
• Used MS Visio to create Use Cases and Sequence Diagrams.
• Worked on FACET claim processing system.
• Accomplished experience through whole SDLC from requirement analysis till deployment, using highly efficient RUP process of Software development.
• Assisted development team to translate requirements into technical specifications.
• Liaised and Coordinated in resolving EDI mapping issues arising from data transfer process from EWM to ACAS and third party systems.
• Analyzed mandatory and the situational fields and compared with the users manuals for EDI.
• Worked closely with the host (Main frames support person) and helped him understanding the process and in the creation of the match, input and the delete files.
• Created and Maintained the Requirement Traceability Matrix (RTM).
• Initiated Test Plans, developed and executed test cases and scenarios, worked with users to develop specific acceptance criteria and prepare test exhibits.
• Worked on FACET modules such as pricing, payer, eligibility under claims processing system.
• Conducted User Acceptance Testing (UAT) sessions with business users and prepared document for enhancements and bug fixes.
• Used Test Director and Mercury Quality Center to report any bugs found and communicate to the developers and product support team.
• Analyzed and evaluated User Interface Designs, Technical Design Documents and Quality Assurance Test condition the performance of the application from various dimensions.

Environment: MS Visio, MS Project, Windows XP, HIPAA, Microsoft Office Suite, Quality center, Rational Unified Process (RUP), UML.

Confidential, Farmington hills, MI

Business Analyst

Responsibilities:

• Gathered Business Requirements, interacted with the Users, Designers, Developers, Project Manager, and SMEs to get a better understanding of the business processes, and analyzed and optimized the process.
• Actively involved in the entire Software Development Life Cycle (SDLC) Process.
• Created reports containing all the information regarding the publishers, distributors and retailers using crystal reports.
• Facilitated demonstration of a major ACH software systems and performed evaluations with a group of experts to select a package that best suits the need of the business.
• Extensively worked with HIPAA transactions such as 835-claim payment/advice.
• Developed Traceability Matrix for maintaining/updating current and new system requirement using MS Excel.
• Researched/Analyzed the various steps in claim processing lifecycle and then wrote the Business Requirement Document and Functional Requirement Document in such a way that developers could construct the system to identify and monitor the riskier claims.
• Worked with electronic claim clearing house like Web MD and automated clearing house (ACH) for electronic payment, remittance data processing and services.
• Created the User Requirement Specifications and helped convert them to Functional Requirements, and assisted the developers with System Requirement Specifications.
• Responsible for ensuring data integrity and coordinating effort with testing and implementation responsible for the development and execution of test plans.

Environment: MS Office tools, MS Project, MS Visio, UML, RUP, Windows, National Requisite Pro, and SQL Server.

Confidential, Canton, MI

Business System Analyst

Responsibilities:

• Analyzed, documented and managed all project requirements and changes to requirements throughout the software development life cycle through Rational Doors.
• Analyzed customer needs and existing functions in the area of HIPAA transactions to determine feasibility and requirements.
• Documented Functional/Technical data flow of 4010 HIPAA transaction to determine feasibility and requirements.
• Prepared and created Test Cases/Test Data according to Business Requirements.
• Created Statement of Work (SOW) document for various capabilities in the Initial Requirements Gathering Phase.
• Strong Documentation experience that required converting business needs to technical documents.
• Performed gap analysis as pertains enrollment, membership management, Commissions, Finance and claims processing; relating for instance to Provider IDs use on plan communications; remittance advice statements; explanation of payments (EOP); and Member ID cards; and healthcare providers use of the assigned Affinity Provider ID number(s) for use in claims submission and plan inquiries.
• Participated in all phases of the Facets Extended Enterprise(TM) administrative system implementation including the planning, designing/building/validation (DBV), testing, and Go-live support phases
• Documented and reviewed high level and detailed requirements in Business Requirement Document.
• Created Use Cases and Use Case description/narratives based on the Requirements list.
• Experienced in using Microsoft Share Point to centrally store, manage and access business artifacts across all platforms.
• Created activity diagrams in UML using Rational Rose and also involved in creating the Business Process Models.
• Coordinated activities involved in QA and User Acceptance Testing.
• Actively involved in reporting project updates, managing project resources, conflict resolution and maintaining project deadline.
• Communicated with business/technology leadership for overall project/program office milestone.
• Monitor the production environment and proactively prioritize, communicate, and resolve EDI process or system issues.

Environment: Rational Rose, Agile, Rational Requisite Pro, Quality center, MS Project, SQL.

Confidential

Business Analyst

Responsibilities:

• Identified the project’s stakeholders during initial meetings for the purposes of understanding the requirements.
• Prepared project plan and allocated resources working with Business analysis team and development team.
• Conducted user interviews, gathered requirements, analyzed the requirements by using Rational Rose, Visio and Requisite pro - RUP
• Created Use Case Diagrams, Activity Diagrams, Sequence Diagrams and ER Diagrams in MS Visio.
• Conducted Functional Testing, Joint Functional Testing and UAT, documented and reported user feedbacks to management team.
• Assisted the PM on various projects throughout the Project Management Life Cycle (PMLC) including Project Charter, Project Plan and Resource allocation.
• Managed and updated daily project status using MS Project
• Mapped the entire process chain for which the system was being implemented, and created the Work Breakdown Structure to help facilitate in managing the projects better.
• Used RUP methodology and Unified Modeling Language (UML) to design, document, and manage requirements throughout lifecycle of the project.
• Transformed the business requirements maintained in the Requisite Pro into Functional Requirements and prepared the Functional Requirement Document (FRD)
• Assisted development team in Preparing collaboration diagrams, sequence diagrams and UML notations for detailed analysis of business objects.
• Created test plan for QA and Usability testers
• Responsible for managing the documented system requirements and Requirements Traceability Matrix.

Environment: MS Office 2003, MS Project, XML, MS Visio 2000, Rational Clear Quest 2003, Win Runner, Load Runner.