SUMMARY

• 5+ years of experience working as a Business Analyst in Healthcare domain.
• Experienced in business requirement gathering from various stakeholders by understanding business goals and priorities through JAD sessions with teams, stakeholders and end users.
• Good knowledge of performing GAP analysis on existing system and suggest solutions for a new system based on business needs.
• Extensive knowledge of creating BRDs, FRDs, and SRSs. Hands - on experience with MS Visio and use case diagrams for creating data flow/process flow diagrams such as flowcharts, activity charts, sequence diagrams
• Performed User Acceptance Tests and other testing procedures when required.
• Experience in using Agile and water fall methodologies and working knowledge in all areas of project life cycle in a structured change management environment.
• Good subject knowledge in insurance, pharmacy and health care sectors.
• Good knowledge on various insurance products and plans like Endowment Insurance Products, Term Insurance Products and Unit Linked Insurance Plans, Health Insurance, Life Insurance Products
• Expertise in ICD-9 to ICD-10 Conversion.
• Medical Claims experience in Process Documentation, Analysis and Implementation in 835/837/ 834/270/271/277/997 (X12 Standards) processes of Medical Claims Industry from the Provider/Payer side.
• Worked on healthcare standards such as HIPPA 4010, 5010, ICD-9 ICD 10.
• Demonstrated ability to work both in independent and team-oriented environments with well-developed organizational skills, excellent interpersonal and communication skills, solving and delivering solutions under high stress environment.
• Strong experience in documenting test cases, requirements and working with requirements traceability matrix.
• Good knowledge of HIPPA compliance life cycle, insurance regulations and HIPPA 5010 transaction standards.
• Extensive use of BABOK guidelines and practices in Life sciences.
• Proven record of high accuracy in designing and building healthcare benefits on the clinical trial management system.
• Effective in executing multiple tasks and assignments ahead of schedule.

TECHNICAL SKILLS

Microsoft Technologies: MS Project, MS Word, MS Visio, MS Power point, MS Excel, SharePoint, MS Access

Methodologies: Waterfall, Agile

Languages/Standards: SQL, PLSQL, ICD9, ICD10, HIPPA 5010

Requirements test management: Rational Rose, Requisite Pro & Rational test manager

Testing Automation Tools: Quick Test Professional, Rational Robot

Defect Tracking Tools: HP ALM, JIRA

Operating systems: MS Windows, Mac OS X.

Quality Management: Concepts and Tools of Quality Management Test Director and load Runner, Six Sigma Techniques

PROFESSIONAL EXPERIENCE

Confidential, PA

Business Analyst

Responsibilities:

• Gathered Business Requirements. Interacted with the Users, Designers and Developers, Project Manager to get a better understanding of the Business Processes.
• Responsible for the full HIPAA compliance lifecycle from gap analysis, mapping, implementation and testing for Tenn Care processing of Medicaid Claims.
• Liaison between the Business needs (business users and sponsor) and the Technical solutions (development and testing staff), ensuring technical solutions satisfied business requirements.
• Performed Web Page Mock-Ups using MS Visio and thus defining the Business Process Model and Data Process Model.
• Experienced in Agile software development cycle methodology.
• Developed gap analysis document, logical and physical design and remediation plan for State.
• Responsible for mapping documents, creation of test plan, test scenarios, test cases for unit, system and system integration testing.
• Worked with business owners, content staff, IT and other stakeholders in creating a content management solution for managing the information in the supplier portal using WebSphere Application Server.
• Created Project management plans for managing on time delivery using MS Project along with writing test cases, unit and systems integration test plans in Win Runner and used Load Runner to check if application works fine with load.
• Creating and analysing numerous clients’ reports for various financial requirements.
• Documenting workflow and results of analysis for the aging accounts.

Environment: Modeling, Rational Requisite Pro, Rational Rose, UML, Load Runner, MS-Project, MS Visio, Java, MS Office, Windows XP

Confidential, NJ

Business Analyst

Responsibilities:

• Part of the team for migration of HIPAA - EDI X12 4010 series to 5010 series for EDI Transaction code sets:
• 835 - Claim payment/Advice
• 837 - Claim and encounters
• 834 - Benefit enrollment and maintenance
• 270/271 - Eligibility benefit inquiry and response
• 6 - Claim request for additional information and response
• Performed GAP analysis of 4010 and 5010 EDI transaction using implementation guide to identify the changes in the segments and data elements.
• Used the mapping tools to map 4010 and 5010 transactions along with ICD 9 and ICD 10 codes, and validated the HIPAA Syntax.
• Developed Incident documents and portrayed the As-Is reporting structures versus To-be Reporting needs for data integrity and accuracy.
• Identified the scope, business objective and documented the functional requirements for each release.
• Directly involved in process improvement Plans and implementing business change.
• Produced clear user manuals & training guides for User Acceptance Testing (UAT)
• Utilize SharePoint and Excel as necessary to work through daily inventory assignments.
• Interacted with the development team on regular basis to ensure and balance practicalities with innovative and efficient business systems solutions.
• Created use cases specifications and use case 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.
• Facilitated the resolution of project-related issues, identified risks, and mitigation steps to manage risk using PLSQL in RDBMS.
• Analyzed business processes, requirements, and data necessary to provide detailed logic.
• Extensive experience in translating business requirements and user expectations into detailed specifications by using various Text formats & Unified Modeling Language (UML).
• Collaborated efforts with technical staff and subject matter experts to establish the technical vision of product and analyze triple constraint tradeoffs.

Environment: MS Access, MS Visio, MS Project, MS Office, HTML, SQL, MS Access, Windows XP, HP ALM

Confidential

Jr. Business Analyst

Responsibilities:

• Gathered user/business requirements by meeting with business users and generated business models and use case analysis.
• Prepared the Software Specification Document for the application based on business user information.
• Created use case document to elaborate user experience taking into account the business objective.
• Converted Business Requirements to the Functional Specification to develop an architectural solution that the application meets the business requirements, resolve open issues, and change requests.
• Assisted in on-going process improvement efforts to ensure Test Planning, Execution, and Reporting is effective, efficient, standardized, coordinated, and integrated.
• Assisted the Senior Business Analyst in writing Functional Requirement Specifications (FRS) and User Requirement Specification (URS).
• Conducted JAD Sessions periodically with various stakeholders at various phases of the Software Development Life Cycle (SDLC) to discuss open issues and resolve them.
• Feature identification, defining and documenting business requirements and priorities.
• Critically evaluated the information gathered from multiple sources during requirements and analysis and responsible for tracking, tracing and managing requirements using Requisite Pro.
• Developed Test Plans and Test Cases according to Business Requirements.
• Interacted with development team for communicating the requirements and use cases.
• Involved in generation and execution of SQL queries.

Environment: s: MS Visio, MS Office, SQL, PowerPoint, MS Word, MS EXCEL, Windows.