SUMMARY

• Over 6 years of experience working as a Business Analyst in the Industry.
• Strong knowledge of SDLC methodologies like RUP (Rational Unified Process), RAD (Rapid Application Development), Waterfall, Scrum and Agile.
• Extensive experience in Unified Modeling Language (UML) diagrams (Use Case, Activity, Sequence) using Rational Rose and MS Visio.
• Trace and inform business requirement changes through the lifecycle of the project using Rational Requisite Pro while maintaining customer needs and maintain a Requirements Traceability Matrix (RTM) to keep the stakeholders informed of the progress of the project.
• Analyzed and synthesized results from Joint Application Development (JAD) sessions and transformed those into Business Requirement Document (BRD).
• Strong experience in the creation of Test Plan, Test Cases, Test Scripts and Test Procedures based on the Design Document and User Requirement Document for the Black Box, Functional, Usability and User Acceptance Testing (UAT).
• Experience in performing GAP analysis, SWOT analysis, SMART Analysis, Cost Benefit analysis and ROI Analysis.
• A solid background in gathering and documenting User and Business requirements, creating Business Process Flows, Use Cases and Use Case Diagrams.
• Expert in writing complex queries using SQL for AdHoc Report Generation and Research Analysis.
• Experience using QUINTIQ.
• Proficient in transforming Business requirements into detailed Functional Requirement Specifications Document (FRD) and Use Case Narratives.
• Excellent knowledge of Health Insurance Portability & Accountability Act (HIPAA) standards, Electronic Data Interchange (EDI), HL7 and ICD - 9 to ICD-10 coding.
• Worked with (ACS) X12 5010 and (ASC) X12 4010A including the various Claims Transactions such as: 837 (submit medical claims), 835 (medical claim payments), 270 (benefit/eligibility inquiry), 271 (benefit/eligibility response), 276 (claim status request), 277 (claim status notification), 820 (premium payments), and 834 (enrollment).
• Extensive knowledge on the various health insurance programs such as: Medicaid, Medicare (Part A, B, C and D), PPO (Preferred provider organization), HMO (Health maintenance organization), and POS (Point Of Service).
• Knowledge of MMIS (Medicaid Management Information System), HIX (Health Insurance Exchange), EMR (Electronic Medical Record), EHR (Electronic Health Record) and healthcare reforms like the Patient Protection and Affordable Care Act (PPACA), Emergency Medical Treatment and Active Labor Act (EMTALA)
• Working knowledge of Bug Reporting Tools like Test Director and Quality Center.
• Experience in working with Project Managers, Project Sponsors and Service Managers to support project administration and manage the scope.
• Expert level skills in MS Office products like MS Word, MS Excel, MS Project, MS Visio and MS PowerPoint.
• Excellent Team Building, Project management, interpersonal and communication skills.

TECHNICAL SKILLS

Business Methodologies: RUP, RAD, Agile, JAD, GAP Analysis, SWOT Analysis, SMART Analysis, Brainstorming

Business Modeling: UML, Rational Rose, MS Visio 2010, Balsamiq

Requirement Analysis: Rational Requisite Pro, Rational DOORS

Databases: Oracle, SQL Server, MS Access, IBM DB2, Optim Query, SQL Developer, Cognos

Project Management: Lotus Notes, HP Service Manager, CMMI Level, Sigma6, MS Office Suite, MS Project

Operating Systems and Languages: Linux, Unix, Windows XP, C/C++, Java, J2EE, Spring, Hibernate, XML, SQL

Testing & Defect Tracking Tools: Toad, Bugzilla, Quality Center

PROFESSIONAL EXPERIENCE

Business Analyst

Confidential - Pittsburgh, PA

Responsibilities:

• Worked with Business community, Stakeholders, SME’s and Systems to define business requirements and analyze the functional requirements.
• Implemented RUP methodology for iterative and incremental development of the system.
• Facilitated JAD sessions with management, users and other stakeholders to define the project scope and requirements as well as to reduce the time frame required to complete deliverables.
• Conducted extensive R&D and impact analysis on all the areas affected due to ICD-9 to ICD10 transformation.
• Performed GAP analysis to identify AS-IS processes of claims transactions of (ASC) X12 4010A standard and TO-BE processes of (ASC) X12 5010 standard.
• Prepared and presented Business Requirement Document (BRD), and Architectural Decision Document (ADD) and involved in sign-off process.
• Managed day-to-day project activities and coordinate tasks with other teams through the SCRUM meetings.
• Analyzed high-level business requirements to create Use Cases and Use case diagrams using Rational Rose according to UML methodology.
• Created Screen mock-ups to elicit new requirements and align them around project scope using HTML and MS Visio.
• Data mapping, logical data modeling, used SQL queries to filter data within the IBM DB2 database tables.
• Designed Functional Specifications for the target physical database.
• Developed and validated Test scenarios/scripts and Defect Tracking with Quality Center and TRAC. Also developed Test plans and Test cases based on Use cases and Functional Specifications.
• Used Qunitiq to help solve supply chain issues and help match solutions based on requirement. Used Quintiq for daily scheduling and strategic planning to provide an overview on company’s complex supply chain.
• Provided support for User Acceptance Testing with UAT plans and resolving any issues with the users, performed UAT and developed different testing strategies for Black Box and Load testing.
• Worked on multiple 837s and multiple Eligibility (270/271) and healthcare claim status (276/277). Create EOB systems (835).
• Conducted SMART analysis and Facilitated Joint Application Development (JAD) sessions to resolve issues.
• Adopted AGILE methodology throughout the project.
• Responsible for managing the System Requirements and Requirements Traceability Matrix using Rational Requisite Pro.
• Worked on mapping of ICD9-ICD10
• Reported progress against Development/Action Plan routinely to the Program Manager and leadership with recommendations for corrective actions, where necessary.

Environment: - MS Office, Quality Center, MS Project, MS Visio, IBM DB2, Rational Requisite Pro, Rational Rose, Windows XP, Rational Clearcase, Quintiq, Rational ClearQuest, Rational DOORS, IBM Optim Query, WinSQL, MS SQL, Oracle SQL.

Business Analyst

Confidential - Phoenix, AZ

Responsibilities:

• Evaluated EDI transaction sets 276/277 (Claim Status Request/Response) and 270/271 (Benefit Inquiry/Response).
• Analyzed and studied the technical, structural and data content changes for EDI transaction sets 834 (Enrollment and Maintainace), 837 (Professional, Institutional and Dental Claims) and 835 (Claim Payment/Advice).
• Implemented RUP methodology for iterative and incremental development of the system.
• Performed GAP analysis to identify AS-IS process EDI transaction set 834,837 and 835 of 4010A
• Met with users and stakeholders to understand the problem domain, gathered customer requirements through interviews (group and one-on-one) and JAD sessions.
• Helped develop use cases, project plans and to manage project scope.
• Assisted in building the business analysis process model using Rational Rose.
• 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.
• Worked extensively with RUP methodology and Rational Suite Analyst Studio using Rational Rose, and Rational Requisite Pro
• Performed analysis of business rules, business and system process flows, user administration, and requirements
• Assisted in User Acceptance Testing (UAT). Conducted meetings to resolve UAT defects.
• Designed and developed Use Cases using UML and Business Process Modeling.
• Used MS-Visio for flow-charting, process model and architectural design of the application.
• Designed and developed project document templates based on SDLC methodology

Environment: - MS Office, Test Director, MS Project, MS Visio, Unix, Oracle, Toad, Rational Requisite Pro, Rational Rose