SUMMARY

• Proficient Business Analyst with 8+ years of experience in Healthcare & Pharmaceutical domain and a Certified Scrum Master.
• Strong project management skills including planning, scheduling, monitoring and budgeting with experience in requirement gathering, gap analysis, risk analysis, effort estimation, capacity etc.
• Strong Knowledge of ICD 9/ICD 10 coding standards along with forward and backward mapping. Good understanding of Medicare, Medicaid claim processing and MMIS for both Inpatients and Outpatients. Strong understanding of PBM for processing and payment of Medicare Part D drug claims.
• Experienced in various versions of ANSI X 12 4010/5010 , worked on EDI (270/271,276/277, 834, 837) transactions and HITSP.
• Knowledge of PPO, HMO, POS environment along with Claim Processing Systems for each. Well versed with Facets, claim adjustments and claim processing, with knowledge of NASCO to give members easy control over their health plans.
• Broad knowledge of HIPAA standards, HL7 framework, SOX Compliances and ACA.
• Good knowledge of EPIC system for managing Electronic medical record (EMR) and electronic Health Record (EHR) system complying with CCD standards and CDA framework. Assisted the Management and Implementation of policies and procedures relating to an employee’s wellness management along with relationship management.
• Good Knowledge in implementation of and expected deliverables of Agile - Scrum (SAFe), Kanban and Waterfall Methodologies including change management throughout the Software Development Life Cycle of the project.
• Facilitated Scrum ceremonies and helped remove impediments and targeted to increase velocity every sprint.
• Created sprint burn down charts and release backlogs for effective management of sprint backlog.
• Interacted with the Stakeholders, End Users to understand and gather stakeholder requirements and create the Business Requirements Document (BRD), Functional Requirement Document (FRD) and System Requirement Specification Document (SRS) and communicate it to the entire team involved.
• Good understanding of OOPS concepts and Object Oriented Analysis and Design (OOAD). Well versed with Business Process Model and Notation (BPMN), and Implemented Unified Modeling Language (UML) to assist in designing of Class Diagram and designing of Use Case Diagrams, Data Flow Diagrams, Activity Diagrams, Sequence Diagram and ER diagrams.
• Conducted JADsession and requirements review meetings with all functional groups and participated in industry events.
• Experienced with Ciboodle CRM software as part of the design, development and implementation process.
• Knowledge of Six Sigma and CMMI techniques for Business process improvement.
• Experienced in ETL and Data Warehousing techniques of extracting data from various OLTP servers and loading the data in transformed format in data warehouses. Good knowledge in using SPSS.
• Well versed with concepts of 3-tier architecture and multi tier architecture, which included UI components, middle tier layer, and data layer.
• Proficient in loosely coupled applications including SOA, web services and web methods.
• Experienced in interacting with quality assurance team and assisting them to make Test Plans and Test Cases. Also helped teams in error handling and discrepancy management.
• Understanding of WTX to process large volumes of data efficiently and aggregate disparate data.
• Good Knowledge of various Modeling tools, ETL tools, BI tools, Project Management tools. Practiced in documentation of the Test Plans, Test Procedures based on data validation for client and server side to do Unit, Integration, Regression, Black box, Performance, Load and User Acceptance Testing (UAT).
• Traced and informed business requirement changes throughout the lifecycle of the project using various tools while maintaining customer needs and maintain a Requirements Traceability matrix (RTM) to keep the stakeholders informed of the progress of the project.
• Expert level skill in VISIO, MS Excel, PowerPoint, Access, Word and MS Project.
• Excellent in written and oral communication, possess analytical and problem resolution skills, leadership skills, and strategic management skills.
• Ability to handle multiple priorities, adapt to changing business needs and handle complex issues.

TECHNICAL SKILLS

Methodologies: Waterfall, RUP, Agile - Scrum

Languages: SQL, HTML, XML, AJAX

Testing Tools: HP Quality Control, HP ALM

Modeling Tools: MS Visio, Rational Rose, ERwin

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

ETL Tools: Informatica, SSIS

Project Management Tools: MS Project, Share point, JIRA, Rally

BI Tools: Tableau, Share Point, IBM-Cognos, Spotfire, SPSS

Healthcare: HIPAA 5010, ICD-10, HL7, HIE, Medicare, Medicaid.

PROFESSIONAL EXPERIENCE

Confidential - Philadelphia, PA

Senior Business Analyst

Responsibilities:

• Conducted JAD sessions and Participated in the development of project plans, assessing business processes.
• Extensively involved in data modeling and worked with business users and IT to develop system solutions.
• Analysis for making system compliant with HIPAA and ACA standards.
• Involved in making the Medicare and Medicaid patient profiles being compliant with the HIPAA regulations.
• Managed patient profile transfer (PPT) reports in the epic modules and transferred data by verifying the associated data.
• Designed and implemented AD-hoc SQL queries to extract data from different databases for timely reporting, Data Analysis and Validation.
• Involved in interpreting the data, analyzing the results using statistical tool (SPSS) and provide ongoing reports.
• Understand and translate the business functionality into Epic system configuration and workflow validations.
• Used BPMN to display Business and process flows for the project. Organized requirements into high level Use Cases and low level Use Case Specifications and modeled them into UC, Activity and Sequence Diagrams using MS Visio.
• Worked extensively on GAP analysis and participated in the mapping of ICD-9 CM TO ICD-10 using SSIS. Highly experienced in documenting business requirements.
• Assisted the team implementation and consulting initiatives to enhance patient care, increase operational efficiency, and ensure regulatory compliance using Epic Willow system.
• Acquire data from primary or secondary data sources and maintain databases/data systems
• Facilitated the Scrum meetings and solved impediments affecting the team performance. Used JIRA to keep all the team members updated on all aspects/priorities during sprint cycles.
• Managed the IAM for practice management features and performed User Acceptance Testing (UAT) and documentation of test cases for Identity and access management.
• Worked in the Ciboodle environment with colleagues and across teams to design and implement service calls to/from front end and back end applications for customer order processing, billing, identity management and fulfillment transactions.
• Attended daily defect Scrum meeting in order to identify the defects encountered in the current release and worked with the development team for resolution. Assisted other projects following Kanban with the expected deliverables.
• Identified the business flows and determined whether any current or proposed systems are impacted by the EDI X12 Transactions, Code set and Identifier aspects of HIPAA.
• Helped in Implementing policies and procedures relating to an employee’s wellness management.
• Used Use Case diagrams during analysis to capture the requirements diagrams and Sequence diagrams so that the development team and other stakeholders can understand the business process.

Environment: Agile-Scrum, MS Office Suite, MS Access, UML, MS Visio, SQL, SSIS, JIRA, Tableau, Ciboodle.

Confidential -San Francisco, CA

Senior Business Systems Analyst

Responsibilities:

• Gathered functional and non-functional requirements in collaboration with end clients and internal project managers and created the BRD, FRD and SRS
• Provided qualitative and quantitative data analysis and reporting of patterns, insights and trends to decision makers. Provided feasibility analysis for the project.
• Conducted presentations to management on project updates, project cycle, and expected results.
• Created process flows and conducted walk-through of the process flows for the vendor’s team and the client’s team.
• Successfully executed the BA process such as Entity Relationship diagram, Gap analysis, and Process evaluation.
• Created lucid UI mockups, wireframes emphasizing on the UI components and detailed workflows using MS Visio.
• Acted as a PM by authoring the Project Standards, Project Charter artifact, defining Project Scope and maintaining the triple constraints.
• Defined data elements of the reports, data mapping, and report layout with Cognos 8 BI Suite like Query Studio and Report Studio.
• Analyzed the existing reports of the reporting system in the database. Checked the consistency of the data after ETL process using SQL queries.
• Created custom views in Cognos Power Play Transformer model for IAM to limit access to information in a cube to members of a given user class.
• Involved with overlooking of Clinical Supply Chain Management for extracting patient and volunteer information from various geographic locations and generating reports based on the outcomes.
• Worked on clinical study reports and clinical protocols, also suggested corrective actions for clinical applications.
• Developed test requirements by decomposing the functional requirements.
• Documented all the project change request documents (PCR) and updated them accordingly.
• Assisted testing teams in functional, regression, black box and user acceptance testing along with error handling management.
• Drafted high-level Test Plan with assistance of QA lead to define a roadmap for testing at different phases.
• Assisted QA in generating test scripts and test cases for client side and server side validation and performed user acceptance testing (UAT) to validate user requirements and expectations.

Environment: Waterfall, MS Visio, MS Access, HP ALM, SharePoint, HTML, SQL, Toad, Oracle Clinical Database, IBM Cognos

Confidential -Newark, NJ

Senior Business Analyst/Scrum Master

Responsibilities:

• Collaborated with the SME and interviewed the stakeholders to understand the As-Is and To-Be state of the project
• Conducted several JAD sessions and requirement workshops with the system architects, business users and development team to perform GAP Analysis
• Created detailed business scenarios and writing master use cases, which covered step-by-step process of interaction between user and system.
• Worked with Facets application to improve critical business processes by reducing manual errors and administrative costs using AMISYS.
• Extensively used SQL scripts/queries for data verification and Toad for object comparison at the backend. Worked to regulate flexibility of the application’s features during development to help in customization of the product onsite at the client organization.
• Implemented Ciboodle while working with business partners and technical architecture team to design and implement effective workflow for call center transactions; analyzed business process to design efficient processing and implement accordingly.
• Acquired data from primary or secondary data sources and maintain databases/data systems.
• Developed Business Flow diagrams applying BPMN techniques, Entity Relationship diagrams and Sequence diagrams using MS Visio so development team and other stakeholders could understand business process
• Created wireframes usingAxure based on collaboration with use cases and Visio flows.
• Created a WBS for the project by integrating the features of both Waterfall and Agile Scrum Framework.
• Involved in implementation of SAFe environment, change control and change management and ensured that changes during the project lifecycle are introduced in a coordinated manner.
• Used Rally to keep all the team members updated on all aspects/priorities and user stories during sprint cycles.
• Utilized SharePoint tool effective document management and creating dashboards for the team
• Conducted workshops to understand requirements for Data Warehouse design. Conducted client side validation to study ETL (Extract Transform and Load) operations on database.
• Utilized Informatica to ETL data for business intelligence and reporting. Used Tableau as the reporting tool.
• Participated in mapping documents for transferring data from source to target.
• Assisted QA team in conducting User Acceptance Testing (UAT) and documentation of test cases.
• Organized, documented and tracked changes and defects in HP QC
• Expertise in interacting with the client and the IT Department and thus acted as a facilitator between both the parties

Environment: Waterfall, Agile Scrum, MS Visio, HP QC, Rally, Informatica, Tableau, MS Access, SharePoint, SPSS, Ciboodle

Confidential -New York, NY

Business Systems Analyst

Responsibilities:

• Supported tactical and strategic goals of the IT Production Support Team. Ensured compliance with structured Project Delivery Process.
• Extensively gathered Business/Functional requirements, created Use Cases, designed UML diagrams such as Activity, Class, and Sequence diagrams, in addition to creating Business Artifacts
• Created “As is” and “To Be” diagram and Swimlane Diagrams in order to understand the current system and conducted GAP analysis to accomplish the end system needs.
• Conducted JAD sessions in order to understand the business process and sent the Minutes of Meetings to the attendees.
• Worked on organizations data processing for improving database for storing user files.
• Performed user acceptance testing (UAT) to validate user requirements and expectations.
• Created UI screens to illustrate the requirements and aligned them around the project scope using MS Visio.
• Updated the existing system with new 834, 835, 837 data allocation for Health Care Reform Health Insurance Exchange (HIX) Population
• Extensively used SQL scripts/queries for data verification at the backend. Worked to regulate flexibility of the application’s features during development to help in customization of the product onsite at the client organization
• Well versed with HIPAA, Facets, claim adjustments, claim processing from point of entry to finalizing, claim reviewing, identifying claims processing problems, their source and providing corresponding solutions.
• Involved in implementation of HIPAA EDI Transactions (834, 835, 837) and facilitated Electronic Data Interchange.
• Performed analysis for HIPAA 4010 transactions and used EDI tools to verify mapping to X12 format and checked for defects.

Environment: MS SharePoint, UML, SQL, MS Office suite, Agile Scrum, MS Visio, MS Project, Informatica, Teradata

Confidential

Business Analyst

Responsibilities:

• Analyzed and optimized the existing business processes using the conceptual modeling methods and documented the business process. Conducted requirement workshops with key business users to make them understand the project scope and deliverables and to check the feasibility of the project.
• Created the Functional Requirement Document (FRD) and System Requirement Specification Document (SRS).
• Analyzed and translated business requirements into system specifications utilizing UML diagrams.
• Conducted walkthrough session with business end users, stakeholders, SME, project manager to discuss and resolve various issues.
• Extensively worked on Data Analysis and created tables comprising the aspects of Disintegration, Hardness, Friability and Dimensional analysis etc.
• Responsibilities involved importing, cleaning, transforming and validating data with the purpose of understanding or making decisions.
• Assisted architect in selection of PK, CK and SK for developing of star schema. Involved in development of fact tables and establishing relationships using dimension modeling as basis for designing data warehouse.
• Created Use case diagrams and activity diagrams using UML for designer and developer to describe whole scenarios using ERwin.
• Data validation, analysis and generating accurate reports for different testing of pharmaceutical drugs.
• Trained business end users for new functionality of application.

Environment: MS Access, MS Excel, MS Word, Agile, Requisite Pro, MS Project, MS Visio, Outlook, Microsoft Visual studio.

Confidential

Junior Business Analyst

Responsibilities:

• Participated for the creation ofBusiness Process Workflow Diagramswith Stakeholders.
• Conducted meetings with business users andSMEsto identify and gather various functional and non-functional requirements.
• UtilizedRational Unified Process (RUP)to configure and develop process, standards, and procedures to create a Business requirement Document (BRD) and SRS.
• ConductedGAP analysisof the different reports that are being presented to clients to accommodate their requirements for the new enhancements.
• Created artifacts such asUse Cases and Sequence Diagramsusing MS Visio.
• Understand the various stages of claim life cycle and utilize the knowledge in meeting client’s goals. ConductedJADsessions during the various stages of upgrading the matching system and discuss the current systempreference.
• Developed Requirements Tractability Matrix (RTM) using MS excel to trace each software design requirement to test case.

Environment: RUP, Agile, UML, MS Visio, MS Excel, SharePoint, SQL