SUMMARY

• A results - driven Business Analyst with over 8 years of superior performance in application development projects, implementations and improvements of business processes. Possess large spectrum of experience in dealing with a variety of industries like Healthcare and Finance.
• Implemented complex projects using various SDLC methodologies like Waterfall, Agile, and RUP.
• Expertise in implementing various projects resource management, finance, and new software tools for better management control.
• Experienced in creating and analyzing Business Requirements Documents (BRD), Functional Requirement Documents (FRD), System Requirement Specification (SRS) and Work Breakdown Structure (WBS) and propose changes as per various internal and external requirements gathered for process improvement.
• Traced requirements throughout the development process and verifying adherence using Traceability Matrix (RTM).
• Expertise in creation of Use Case Scenarios, process modeling using Use Case Diagrams, Data Flow Diagrams, Activity diagrams and Sequence Diagrams using MS Visio and Rational Rose.
• Conducted User Acceptance Testing (UAT), Black box, Unit, Functional, Integration, Regression testing and verifying performance, reliability and fault tolerance issues.
• Adjust easily to innovative concepts and tasks. Can undertake difficult mandates and meet tight deadlines.
• Expertise in translating user requirements into Business Requirements and Use Cases.
• Functional and technical knowledge of Medicaid Management Information System (MMIS) implementation.
• Highly proficient in documenting, writing and implementing Functional and Non - Functional Requirements, Risk Analysis.
• Experienced with SDLC models such as Waterfall, Agile/Scrum, RUP, RAD methodology, Synchronize and Stabilize methodology.
• Experienced working in Agile environment by preparing user stories, participating daily stand ups in each agile sprint.
• Advanced analytical and problem-solving skills in designing, developing and implementing innovative business processes using new approaches and technologies.
• Experienced in collecting and transmitting the business requirements for the project and translating them into functional specifications and detailed documentation.
• Experienced facilitator for different types of requirement gathering sessions such as Joint Application Development (JAD), Rapid Application Development (RAD), one-on-one & group interviews.
• Hands on experience with UAT testing in preparing UAT Test plan and assisted in UAT testing.
• Experienced in analyzing methods such as Verification & Validation, GAP analysis, SWOT analysis, Risk analysis, Business Project analysis, Process Flow analysis and Failure analysis.
• Experience in system conversions (Mapping, Migrating, Enhancement) such as HIPAA X12 4010 codes to X12 5010 codes and ICD-9-CM codes to ICD-10-CM & PCS codes in Medicaid, Medicare, Procedural and Diagnostic codes and Claims processes.
• Strong understanding of quality process models like Six Sigma, RUP and CMM. Knowledgeable in creating Design of Experiments (DOE).
• Excellent written and verbal communication skills. Demonstrated team leading and integrative learning skills in many professional and volunteering projects.

TECHNICAL SKILLS

OPERATING SYSTEM: MWindows Server, Windows XP/2000/NT/98,UNIX

TESTING TOOLS: HPQC, Win Runner, Load Runner

FRONT END TOOLS: Adobe Photoshop, MS Excel, MS Office, MS Project

LANGUAGES: C, C+ +, HTML

REQUIREMENT MANAGEMENT: Rational Requisite Pro, Caliber RM

MODELING TOOLS: MS Visio, Rational Rose, Caliber RDM

PROJECT MANAGEMENT TOOLS: MS Project, Share Point 2010, JIRA, Primavera

Business Intelligence: Microstrategy, Tableau

METHODOLOGIES (SDLC): Scrum, Agile, Rational Unified Process (RUP), Waterfall Model

DATABASE: Oracle, MS SQL Server, MS Access

PROFESSIONAL EXPERIENCE

Confidential, San Francisco, CA

Sr Business Analyst/Project Manager

Responsibilities:

• Playing highly visible role in providing executives data insights on KPI and financial and clinical analysis.
• Leading multiple concurrent projects throughout SDLC in Managed Care, Government Contracting and Pricing Medicaid.
• Created BRD, Use Cases, User Stories, Technical Specification documents, Gap and Risk Analysis documents.
• Provide data to guide strategic initiatives and decisions using Business Intelligence tools.
• Utilized knowledge of managed care principals, statistical analysis concepts, and health care data supporting critical business needs
• Developed Summary, Detail and Dashboard reports and management summaries which present data findings in a professional, concise and readable format appropriate for content and audience
• Participated in gaining consensus on guidelines and metric definitions
• Assisted in UAT and QA process for consistent quality review of data and report results.
• Establish and execute Encounter Data Quality Assurance monthly process
• Lead requirements gathering sessions and documented report processes and logic applied in reporting and application development.
• Developed cost of care model development and recommendations to support efficiency and cost savings for finance team.
• Created partnerships with internal resources and leaders to drive the adoption of data-driven decision-making and trained end users.
• Analyzed findings and provides actionable insights and recommendations based on analysis and drilldown.

Environment: MS Project, SQL server2008, Clarizen, Microstrategy, QNXT, Esstte, Agile, Office 365 and SharePoint 2013.

Confidential, Virginia Beach, VA

Business Analyst III/ Project Coordinator

Responsibilities:

• Responsible for gathering project requirements for state and operational reports for Medicaid and Medicare.
• Proposed and Designed Claims Inquiry screen within theMMISand executed Testing Scenarios, Cases & Conditions involving UAT and system testing.
• Acted as SME and product owner for the local health plans to Sand Francisco and covered California transition programs (Affordable Care Act)
• SME expertise on the end to end business flows inFacets
• Good Knowledge in multipleFacetsmodules like Medical Plan, Product Benefit configuration Subscriber/, Claims Processing, ITS claims processing, Billing, Provider Utilization Management & Customer Service
• Preparation of end to end user stories (scenarios) for System Integration validation during the implementation of multiple LOBs inFacets
• Analyzed business processes and perform needs assessments to align CA-MMISinformation technology solutions with DHCS (California Dept. of Healthcare Service) business initiatives
• Interpreted DHCS business needs and translate them into CA-MMISsystem requirements
• Enhancement and Maintenance changes forMMIS subsystems namely Claims and EVS (Electronic Verification System) for the state of California
• Conducted project management responsibilities with contractor to include project task prioritization, preparing schedules and timelines, and developing risk management and contingency plans.
• Facilitating dialogue and collaboration efforts throughout the SDLC between multiple stakeholders.
• Managingbusinessowner and state expectations of report scope and timelines.
• Create Business requirement document, process flow, work flow and systems requirements
• Create use case, test case, and recommendation for functional/system specifications.
• Utilizing root cause analysis to determine effective solutions to development issues
• Created Tableau reports and analysis.
• Defined a change management process to ensure the integrity of the scope and purpose of each report.
• Create source to target data mapping for programming and testing purpose.
• Conduct routine, adhoc and customizable reports, monitor, maintain and troubleshoot systems and delivery/deployment of activities and initiatives related to all Anthem Compliance development programs
• Projects undertaken in Claims processing, Providers, Networks, Medicare, Medicaid and Pharmacy.

Environment: MS Project, SQL server2008, Tableau, JIRA, FACETS, CareCopmass, Agile/Waterfall, Office 365 and SharePoint 2013

Confidential, NYC, NY

Business Analyst

Responsibilities:

• Assisted in identifying project scope, to conform to the regulatory compliance related to X12 837 (I/P) and 835.
• Responsible for soliciting and eliciting requirements for conversions (deadline ).
• Involved in building material and planning material for . Define communication plans and build a project budget for the transition.
• Carried out Risk Assessment, GAP analysis and Impact Analysis for the conversion project.
• Facilitated JAD and JRP sessions with management, development team, users and other stakeholders to refine functional requirements
• Gathered requirements for impacted system and business areas for ICD-10 and their needs to embrace the changes.
• Produced for transaction sets 835 and 837 (I/P) a full gap analysis 4010 vs. 5010 against the documented application 5010 enhancements ensuring the upgraded application included the required changes and additions for 5010 compliancy.
• Prepared the Business requirement Document (BRD) and functional requirement document (FRD), working with Requirements Traceability Matrices (RTM), re-engineering business processes for the enhancement of the existing services.
• Conducted GAP analysis assessment regarding ICD 9 to ICD 10 conversion and business work flows from legacy system to the detailed financial transaction interface
• Used General equivalence Mappings (GEM) to convert ICD 9 to ICD 10.
• Involved in up-gradation of 4010 transaction to 5010 by conducting Impact Analysis and Risk Assessment and worked on the mitigation plan to avoid the risks.
• Identified the impact on the existing services of Business Units, local impact of the transition on the organization and forthcoming challenges and issues related to the transition.
• Used Rational Rose/MS Office Suite for creating use cases, workflows and sequence diagrams according to UML methodology thus defining the Data Process Models.
• Played a key role in project planning activities, User Acceptance Testing (UAT), and implementation of the system enhancements and conversions.
• Conducted Business Process (As Is/To Be) sessions with various department directors and staff to ensure the Testing Plan and Test Approach would meet the identified Business Requirements, and the Program covered all identified new and changed processes.
• Involved in Data Analysis for data mart system for the process of report generation.

Environment: SharePoint, FACETS, MS Project 2000, MS Visio, JIRA, SQL Server 2008

Confidential, Louisville KY

Business Analyst

Responsibilities:

• Assisted in the initial project planning with the management along with project scope, budget, timelines and other parameters.
• Used Rational Rose to assist in engineering and development of Logical, Activity and Component views to better understand the requirements.
• System requirement specification documents, Test Cases and Test plans were extensively reviewed and analyzed.
• Worked on changes for HIPAA Transaction from version .Documented the detailed business as well as technical requirements to upgrade the current system to 5010 transactions.
• Got involved in designing future state processes forHIPAA 5010 transaction processing EDI’s 837,835, 270, and 271.
• Intensive working on the current ICD code conversion from ICD 9 to ICD 10, assisting and leading various teams by complying with already going works in the health care domain and work with the conversion.
• Extensively used Rational Unified Process (RUP) guidelines through the SDLC
• Produced wire frames, UI mockups or functional prototype to demonstrate requirements to Project stakeholders.
• Business Use Cases Models, Use Cases and Vision Document were presented and explained to the development team.
• Developed Class, Activity and Sequence Diagrams and Collaboration diagrams to better visualization of the project by various teams.
• Traceability Matrix was used throughout the project to track changes.

Environment: Rational Unified Process (RUP), UML, Dreamweaver, Rational Test Manager, MS Office, HTML, SharePoint.

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.
• 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 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 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 HIPPA authorizations.
• 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.
• 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

Confidential, Franklin Lakes, NJ

Business Analyst

Responsibilities:

• Conducted interviews, live meetings and JAD sessions with business users and Subject Matter Experts (SME’s) to understand the As-Is system and gather requirements for the To-Be system.
• Analyzed the pre-existing documents to have a better understanding of the present system.
• Incorporated Rational Unified Process (RUP) and analyzed User Business Requirement Document (BRD), Technical Requirement Specification and Functional Requirement Specification (FRS) using Requisite Pro, Rational Rose and MS Visio.
• Did Presentations for Stakeholders explaining the gaps in the system and how the changes would affect different modules w.r.t. Medicare.
• Performed Gap analysis to understand the best way of incorporating the changes in the system with respect to POS.
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams and End to End Scenarios using UML.
• Organized daily scrum calls to keep the team on track and the stakeholders updated.
• Worked on changes regarding new CMS directives and proposed changes to be made in the current system.
• Analyzed Claims adjudication related transactionslike 835, 837, 270, 271, 276 and 277 transactions (both inbound and outbound).
• Worked with Source system Subject Matter Experts (SMEs) to ensure that the extracts are properly mapped.
• Tracked and maintained Stakeholder requested enhancements and changes using Requirement Traceability Matrix (RTM).

Environment: SQL Server, Windows XP, Rational Rose, Rational Requisite Pro, Clear Case, Clear Quest, UML, Rational Suite, MS Visio, MS Project, MS Office (MS Word, MS Excel, MS PowerPoint)