SUMMARY

• Over 6+ years’ experience as a Business Analyst in Healthcare industry
• Experienced in analyzing business requirements at different stages of software development life cycle (SDLC) methodologies such as Agile (Scrum), Waterfall
• Expertise in creating prototypes and mock - ups for user interface designs with the use of Axure and MS Visio
• Involved in creating various artifacts like BRD, functional specifications, Use Cases, UML diagrams, data mapping documentation, pre and post RTM, weekly reports
• Conducted Joint Application Development (JAD) sessions and worked with stakeholders and Subject Matter Experts (SMEs)
• Experience in writing SQL queries to generate reports, extract data from Database and for data mapping
• Experience in performing UAT testing, Ad- hoc testing to identify any sort of usability issues
• Developed thorough Use Case Diagram, Activity diagrams based on UML, methodology and business process flow diagrams, Data flow diagrams, state chart diagram using Microsoft Visio
• Excellent knowledge of HIPAA (Health Insurance Portability and Accountability Act) transaction codes such as 270/271 (inquire/response health care benefits), 276/277 (claim status), 470 (benefit codes), 835 (payment or remittance advice), 837 (health care claim) and 834 (benefit enrollment).
• Well versed with HIPAA, Facets claim adjustments, claim processing from point of entry to finalizing, claim review, identifying claims processing problems, their source and providing corresponding solutions.
• Extensively worked with Member/Subscriber and HIPAA Privacy Facets application groups
• Experience working in Medicare and Medicaid projects.
• Analysis done to determine if the system abides by the HIPAA regulations.
• Ability to acclimate new relevant skills with ease in a time sensitive frame.
• Highly motivated, organized and results and detail oriented with excellent interpersonal, communication and presentation skills. Proven capability of adapting to new and fast changing technologies.

TECHNICAL SKILLS

Methodologies: Agile & Waterfall

Tools: Microsoft Office Suite, Microsoft Project, Microsoft Front Page, Microsoft SharePoint, Microsoft SQL Server

Other Tools: JIRA, HP Quality Center

PROFESSIONAL EXPERIENCE

Confidential, NY

Business Analyst

Responsibilities:

• Business Analyst involved in documenting changes to the Benefits Administration, Enrollment Processing and Claims Processing Systems based on the Medicare Plan Changes initiative.
• Gathered Business Requirements from the Subject Matter Experts (SMEs) and documented the requirements in the BRD. Utilized data flow diagrams, use case diagrams and process flow diagrams to represent information provided by the Business Owners.
• Organized meetings and led JAD sessions to ensure legal and compliance deadlines of CMS (Centers for Medicare and Medicaid Services) are met.
• Worked with Business Owners of Market Prominence, the Enrollment Processing System, to ensure that the enrollment process for the new members is updated with changes.
• Provide technical and procedural support forUser Acceptance Testing (UAT)
• Prioritizing and Communicating open issues and project risk/mitigation plans to UAT teams
• Worked with the UAT and QA teams to conduct an assessment and determine how effective UAT and QA guidelines can help the company achieve timely completion of projects.
• Effectively elaborated the current process and gave a clear picture of the proposed process for the projects in the organization.
• Worked with Business Owners and Relationship Managers for Vendors and Delegates, e.g. Davis Vision, Montefiore, HCP, to ensure that Eligibility and File exchanged on daily and weekly basis is updated with the Medicare changes.
• Led the Change Control Process for changes submitted for the BRD once the document was submitted to IT department.
• Worked with Development Team to resolve issues and clarify Business Requirements from the Business Owners.
• 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 track the Business Requirements to the design and testing, keeping track of all requirements in the BRD.

Environment: QCARE, MS Access, ORACLE, ClaimsXten, MS Word, Excel, and PowerPoint.

Confidential, Albany NY

Business Systems Analyst

Responsibilities:

• Conductedone to one meetings with NY-HX to understand the current flow of business and its working conditions.
• WorkedonChangeRequest (CR)that isleading the change control process for changes submitted for the Functional Design Document (FDD) after the document was submitted to NY-HX department.
• Workedwithdevelopingteam toresolving issuesand clarifying business requirements from the NY-HX.
• Effectively elaborated the current process and gavea clear picture of the proposed process for the project and aggressively working towards timely completion of high priority tasks.
• Gathering requirements fromBusiness Owner (NY-State of Health department)for the future state of NY-Home page, various landing pages and other static contents on NY.Gov Portal.
• PreparedAS IS process flow on the current state ofcross-trackfunctionality for better understandingand gathering requirements on same.
• Disposed comments received from NY-HX on Functional Design Document (FDD) by changing the FDD as per recommendations and replying with the same.
• Prepared Comment Log tracker to keep record of changes made to FDD.
• Worked on Master spreadsheet for the static contents required on the NY-State of Health web page.
• Written User storiesto supportFDDs and got approval from Requirements Manager.
• Prepared Test Cases on the FDD to provide developing teamwith walk through of it and FDD for coding.
• Performed Gap analysis by comparing my Master sheet with application by maintaining separate documents.
• Worked on IBM Cognos Navigator of NY State of Health for Oversight Reporting.

Environment: MS Office, MS Visio, Microsoft SharePoint, Rational Team Concert (RTC), IBM Cognos Connection and IBM Lotus

Confidential, Tampa FL

BusinessSystems Analyst

Responsibilities:

• Studied thebusinessgoals that were reflected in the requirements.
• Facilitated all aspects of the scrum framework, including sprint planning sessions, backlog grooming sessions, daily scrums, product demos, sprint reviews and sprint retrospectives
• Supported and consulted product owner in developing, maintaining and grooming product backlog.
• Configured GUI maps for the standard and custom objects.
• Maintained the capacity plan, iteration board, sprint backlog, velocity charts and burn down charts
• Identified and removed impediments to the success of the sprint by working with every single team member
• Communicated dependencies and potential risks to the completion of the sprints including resources, costs and systems.
• Conducted JAD sessions, workflow diagrams, UML diagrams, process models, activity diagrams, use cases, for incorporating design changes in the order creation/ management system.
• Workedwith Source system Subject Matter Experts (SMEs) to ensure that the extracts are properly mapped. Used SQL for data mapping and querying.
• Tracked and maintained Stakeholder requested enhancements and changes using Requirement Traceability Matrix (RTM).
• Identified Actors, Activities, Artifacts and Workflows and developed use case diagrams using Rational Rose.
• Analyzed SQL queries that were used by the testing team to validate the data in the back-end
• Gathered documents regarding HIPAA compliance, Local County and state compliance regulations.
• Executed test scripts to conduct UAT and System testing using Win Runner.
• Performed Front-End and Functionality testing using Manually
• Participated in Weekly meeting and discussed modification request with management team

Environment: SQL, UNIX, Java, Microsoft Visio, MS Access.

Confidential

BusinessAnalyst

Responsibilities:

• Part of the team for migration of HIPAA - EDI X12 4010 series to 5010 series for EDI Transaction code sets:837 - Claim and encounters
• Performed GAP analysis of 4010 and 5010 EDI transaction using implementation guide to identify the changes in the segments and data elements.
• Developed Incident documents and portrayed the as-Is reporting structures versus To-be Reporting needs for data integrity and accuracy.
• Prepared and performed to Client and Internal staff as a result of system changes.
• Worked on analysis of FACETS claims processing system and to gathered requirements to comply with HIPAA 5010 requirements
• Documented theBusinessRequirements Document (BRD) and the Functional Specification Document (FSD).
• Identified Actors, Activities, Artifacts and Workflows and developed use case diagrams using Rational Rose.
• Analyzed SQL queries that were used by the testing team to validate the data in the back-end Oracle Database.
• Created Use Cases using UML and managed the entire functional requirements life cycle using Rational Unified Process, Requisite Pro.
• Produced clear user manuals & guides for User Acceptance Testing (UAT) and deployment for end-clients with step-by-step instructions and appropriate GUI screenshots.
• Generated the sequence, state chart, and activity diagrams to enable understanding and representation of thebusinessprocesses for ease of software system development in Rational Unified Process (RUP) methodologies using Rational Rose.
• Created use cases specifications, use case diagrams, swim lane diagrams, component diagram and context diagrams to define the workflow and segregate high-level and low-level requirements using MS Visio.
• Conducted and Participated JAD sessions to gain consensus on various issues related to the project. Acted as a facilitator on different occasions.
• Held regular meetings with theBusinessusers and SME’Sto priorities thebusinessRequirements.
• Worked with issues coming from, Cross, Operational tables in the Oracle Database and Updating the tables per the requirements using Oracle SQL

Environment: Rational Suite, Requisite Pro, Rational Rose,FACETS, SQL, UNIX, Java, File-Aid, ClearCase, Clear Quest, Microsoft Visio, MS Access.

Confidential, Bronx, NY

Jr. Business Analyst

Responsibilities:

• Performed GAP analysis as pertains to management and claims processing to evaluate the adaptability of the new application with the existing process
• Gathered and prioritized requirements using 1 to 1 interviews, job shadowing, brainstorming & developing questionnaires
• Translated business requirements into functional specifications and documented the work processes and information flows of the organization
• Created detailed use cases, use case diagrams, and activity diagrams using MS Visio
• Conducted requirement feasibility analysis with the developers to ensure the project was in scope with the timeline defined in the project plan
• Created data structures by using SQL
• Developed SQLs for Extracting data from database and built data structures, reports
• Designed and developed various Ad hoc, Daily, Weekly, Monthly and year-end reports for the Business Analyst using SQL, MS Excel, MS Access
• Understood EMEVS, the NY state's electronic Medicaid eligibility verification system & the Medicaid & Medicare intermediary along with their roles in claim processing
• Produced Activity diagrams with defined swim lanes as part of claims process analysis
• Used HIPAA Gateway to comply with HIPAA standards (270/271, 276/277 & 837) for EDI transactions
• Coordinated with the developers and IT architects to design the interface of the new system according to the X12 (270, 276, 278, 834, 837 (I,P,D) and 820) standards
• Took part in the meeting held for the analysis of migration to HIPAA 5010 from 4010 and migration of ICD9 codes to ICD10
• Participated in all phases of the Facets Extended Enterprise administrative system implementation to include the planning, designing, building, validation, testing, and Go-live support phases
• Created detailed use cases, use case diagrams, and activity diagrams using MS Visio
• Led and managed the User Acceptance Testing (UAT) for the implementation of Facets Extended Enterprise administrative system with emphasis on ensuring that the HIPAA regulation are met across all the modules
• Conducted requirement feasibility analysis with the developers to ensure the project was in scope with the timeline defined in the project plan
• Involved with various aspects of the project's needs such as the logging, tracking, and resolution of issues, current state workflow assessments, assist with integration and script testing, downtime activities/testing
• Clarified to claims personnel the new Affinity payments and Explanation for payments (EOPs) for same claim processing cycle
• Conducted user pertaining to old and new Affinity Provider ID appearing on documents providers receive from Affinity (mainly occur with EOPs, capitation rosters, PCP rosters, provider directory listings and some system generated letters)

Environment: Facets, Oracle, DB2, Crystal Report, MS Project, MS Office suite, SQL, SQL Server, Rational Suite, Citrix, MS SharePoint