SUMMARY

• Over all 8+ years of professional experience as a Business/Systems Analyst in Healthcare/Insurance Domain.
• Extensive experience using a wide variety of development methodologies, including RUP, SDLC, Agile, Scrum and Waterfall and experience in requirements gathering, analysis and writing system functional specifications including use cases.
• Expertise in using Unified Modeling Language (UML) for developing use cases, activity diagrams, class diagrams, state diagrams, sequence diagrams, and collaboration diagrams for system design, using MS Visio and IBM Rational Rose.
• Several years of experience in using business process models (context and data flow diagrams), Entity Relationship diagrams (ER - Diagrams) as precursors to workflow development, re-engineering, functionality enhancements, migration to new technology and value-addition of existing business solutions.
• Experienced with Object Oriented Analysis and Design (OOAD), client/server environment, web technologies and relational databases.
• Excellent knowledge of HIPAA standards, EDI (Electronic data interchange) Transaction syntax such as ANSI X12, Implementation and Knowledge of HIPAA code sets, ICD-9, ICD-10 coding and HL7.
• Experience in using HP/Mercury Interactive Test Director/Quality Center for gathering requirements, planning and scheduling tests, analyzing results, and managing defects and issues.
• In-depth knowledge of bug-severity analysis, bug-tracking systems and bug-reporting using HP/Mercury Test Director, JIRA and Rational ClearQuest.
• Proven track record in project execution, project coordination, User Acceptance Testing (UAT), end-to-end project delivery, and refinement and enhancements using various iterative models within the stipulated time, resources and cost constraints.
• Possess excellent problem solving and analytical skills coupled with good inter- personal and communication skills.

TECHNICAL SKILLS

Operating Systems: UNIX, Windows 95/98/NT/2000/XP, Linux

Databases: MS-Access, MySQL, SQL Server, Oracle, Teradata, DB2, Sybase, TOAD

Internet: HTML, XML, VBScript, ASP, JavaScript, JSP, J2EE

Automation & Collaboration Tools: Rational Rose, Rational ClearCase, Rational RequisitePro, DOORS, SharePoint, Planview

Business Modeling Tools: MS Visio, Excel, PowerPoint, UML, Agile, Waterfall

Bug Tracking Tools: Mercury TestDirector, Rational ClearQuest, JIRA

Testing Tools: Mercury Interactive Win Runner 7.6/8.0, 7.8/8.0, QuickTestPro 6.5

Standards & Methodologies: Agile, Waterfall, Scrum, RUP, SDLC, HIPAA, Claims, EDI 837/835/834/276/277 , ICD-9 and ICD-10

Utility Tools: MS Office Suite, MS Project, Adobe Photoshop

Data warehousing Tools: Business Objects, Cognos, Rational Robot, Test Director 7.6/8.2, Quality Centre 9.0

Applications: FACETS, SalesForce, NASCO

PROFESSIONAL EXPERIENCE

Confidential, Richmond, VA

Business Analyst

Responsibilities:

• Performed In-Depth analysis of systems and business processes of Medicare Part B as per CMS rules and procedures.
• Gathered requirements for the facets implementation and performed solution analysis.
• Conducted SME interviews, gathered requirements, and analyzed the requirements for the Claim processing system.
• Identified the USER types and roles to prepare a process modeling diagram and Information flow diagram.
• Successfully used Agile/Scrum Method for gathering requirements and facilitated user stories workshop.
• Documented User Stories and facilitated Story Point discussions to analyze the level of effort on project specifications
• Involved in all SDLC stages under Agile process in applications including Requirement Analysis, Implementation, Testing, Deployment and Maintenance.
• Designed and developed Use Case Diagrams for the Facets process modules.
• Developed As-Is document and Gap analysis documents for detailed requirements to meet CMS standards.
• Developed entity diagrams, data interface mapping to map all the possible inputs and outputs.
• Assisted Project with the project plan and conducted status report meeting to finish on the time scheduled.
• Involved in discussions and meetings with implementation team to verify the proposed functionality.
• Traced requirements using traceability matrix and created test cases to test the requirements. Performed UAT testing billing and invoice on facets.

Confidential, Indianapolis, IN

Business Analyst

Responsibilities:

• Worked exclusively on the SAFEi9 re-write process.
• Conducted workflow, process diagram and GAP analysis by identifying existing technologies, documenting the enhancements to meet the end state requirements.
• Wrote user requirements specification (URS) and Functional requirements specification (FRS) Documents as per the Business requirements and process flow.
• Analyzed system performance and initiated process improvement measures for mainframe and Web based applications.
• Responsible for communicating with multiple teams to integrate their applications into the FADV web portal
• Managed their Change Requests (CR's) and Service Request (SR's) after integration and during Maintenance phase
• Work with core team members (usability consultants, web designers, developers) to design and implement new features for the FADV web portal.
• Worked on following applications Business Objects, Enterprise Architect, Toad, PlanView (project management), Microsoft Suite (Word, Excel, PowerPoint, Visio, Access, Project).
• Part of a highly Agile development team with daily standup meetings and regular requirement analysis/documentation.
• Conducted JAD sessions to allow different stakeholders to communicate their perspectives, resolve issues and reach agreements.
• Identified all necessary UML Business Use Cases from requirements, including Use Cases Diagrams, Class Diagrams, State Diagrams, ER diagrams, Sequence diagrams using MS Visio.
• Conducted user interviews, gathered and analyzed Business requirements.
• Helped prepare Use cases, version description documents (VDD) for weekly/monthly deployments into DEV and UAT environments to follow up with Developers and Testers.
• Worked closely with DEV and QA team on daily basis to convert business requirements into User Stories and JIRA Tickets.
• Worked closely with the Portal OPS team to handle incoming requests and translate them into requirements for Dev team
• Conducted weekly meetings with the DEV team to discuss the user stories for that sprint and helped estimate LOE's (Level of Effort).
• Communicate and document system changes to business models.
• Used SalesForce for generation of various forms of Interactive Reports.
• Performed SQL Queries and PL/SQL stored procedures on the database to extract and prepare test data.
• Acting as the interface and a single point of contact with the customer for his security related, technical issues and for the entire documentations and the written as well as the verbal correspondence
• Documented Test Plans that contains test scripts, test cases, test data and expected results for the User Acceptance testing.

Confidential, NY

Business Analyst

Responsibilities:

• Extensively interacted with the stakeholders and the IT Department in finalizing the requirements according to the CMS Compliances/Regulations and HIPAA Regulations.
• Prepared graphical depictions of Use Cases, Use Case Diagrams, State Diagrams, Activity Diagrams, Sequence Diagrams, Component Based Diagrams, and Collateral Diagrams and creation of technical design (UI screen) using Microsoft Visio.
• Analyzed trading partner specifications and created EDI mapping guidelines.
• Conducted Gap Analysis, and Gathered User Requirements by Interviews, user meeting, JAD session, and Requirement Elicitation Sessions.
• Utilized corporation developed Agile SDLC methodology.
• Testing various change orders of Medicaid applications received from the System Engineers.
• Conducted weekly meetings for deciding the Policies and Procedures to be followed while constructing new sites.
• Conducted complex documentation and user needs analysis. Interface with team and staff to develop HL7 integration.
• Conducted business-impact assessment and the results were compared with the new HIPAA 5010 standards to determine the current level of compliance and developed an action plan for approval by the project steering committee.
• Developed plan for data feeds and data mappings for integration between various systems, including XML, to follow ICD 10 Code set and ANSI X12 5010 formats.
• Created Use Cases for NASCO claims processing system.
• Involved in gap analysis and implementation of HIPAA 5010, ICD 10 and Claim Validations.
• Involved in analyzing activities for a variety of major projects including Medicare Plan part D, Coordination of Benefits, New Client Implementations, Consumer driven and regularly scheduled system upgrades.

Confidential, Milwaukee, WI

Systems Analyst

Responsibilities:

• Worked with the account managers, managements, and report requestors to gather requirements, get report requests.
• Analyzed legacy system documentation, file and record formats, system flow charts and other information to develop a comprehensive depiction of the existing environment as it relates to HIPAA rulings.
• Worked with the SMEs from the business area, Access Recertification & Reporting team to get their requirements for improving, streamlining and automating the data pulls
• Assisted JAD sessions to identify the business flows and determine whether the EDI X12 Transaction, Code set and Identifier aspects of HIPAA, impacts any current or proposed systems.
• Introduced Agile and RUP methodologies to reflect liquid nature of front-office improving time-to-market.
• Wrote Business Requirements, analyzed them and tested them.
• Worked on client server environment and tools such as SQL Loader, UNIX shell scripts and TOAD.
• Worked on EDI transactions: 4010, 270, 271, 834, 835, and 837 (P.I.D) to identify key data set elements for designated record set. Interact with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
• Assured that all Artifacts are in compliance with corporate Agile Policies and guidelines.
• Performed Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data.
• Used Test Director and Mercury Quality Center for updating the status of all the Test Cases & Test Scripts that are executed during testing process.
• Create and maintain requirements, test cases and defects in Mercury Quality Center
• Responsible to import the parts of the existing reports using Business Objects Live Office to develop the required reports in Microsoft Excel and Word.
• Wrote BRD, FRD, use cases, test scenarios, test cases for testing the functional and non-functional aspects of both ETL jobs and Reporting jobs.
• Wrote PL/SQL statement and stored procedures in Oracle for extracting as well as writing data.
• Extracted data from Oracle database with MS Access, and performed SQL query, data analysis and verification.
• Experienced in automating standardized reporting by integrating corporate data export tools (e.g.,CognosReportnet) and Microsoft Office tools (e.g. MS Visual Basic, MS Access, and MS Excel) seamlessly into scheduled, hands-free reporting solutions

Confidential, Huntsville, AL

Business Analyst/Systems Analyst

Responsibilities:

• Gathered requirements, organized team meetings requirements from business users such as insurance policy managers, generated business process models, & use-case models, and created business requirements document (BRD) & functional requirements document (FRD).
• Wrote Test Cases in MS Excel for user registration, access to training material, and activity login, reviewed the test cases and finalized.
• Performed monthly and quarterly audits for some of the accounts using MS Access.
• Extracted the data from SQL Server, Oracle, Files, and Access into Data warehouse.
• Personally responsible for attaining HIPAA EDI validation from Medicare, Medicaid, and other payers or government carriers.
• Work included complete business cycle management and hands-on production as well.Create EDI Testing process, documentation, and performance matrices.
• Maintained business requirements, use cases, Functional Requirement Specifications, and business rules in DOORS and linked them to UAT test cases in Quality Center.
• Involved in creating business processes and modeling diagrams using Rational Unified Process (RUP).
• Created use case scenarios and documented work flow and business process using Rational Rose.
• Designed DataStage ETL jobs for extracting data from heterogeneous source systems, transform and finally load into the Data Marts.
• Involved in creation and execution of manual test cases in Mercury Test Director and automated Test Cases in QTP and analyzed the Test Results.
• Maintained test notes and requirement using DOORS.
• Developed UNIX Shell scripts to automate repetitive database processes.
• Involved with all the phases of Software Development Life Cycle (SDLC) methodologies throughout the project life cycle.
• Served as conduit for managing system requirements between the business and the software development team.
• Queried database using SQL for backend testing.

Confidential, Cleveland, OH

Business Analyst/Systems Analyst

Responsibilities:

• Gathered requirements and perform Gap Analysis of the processes to identify and validate requirements.
• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims.
• Communicated and interacted with the Project Manager, worked from large data pulls to breakdown the actions based on standard operating procedures and develop functional requirements.
• Created EDI documents for EDI maps to generate requirement documents and Project Charter, and logical design documents for EDI transactions and code sets.
• Extensively worked with Teradata, Oracle, Mainframes, and Microsoft Business Intelligence tools.
• Converted the systems database from Sybase to oracle & vice versa.
• Prepared (BRDs) after the collection of Functional Requirements from System Users that provided appropriate scope of work for technical team to develop prototype and overall system and maintained requirements in DOORS.
• Established documentation for Agile methodology for implementation with a very water-fall-centric development team.
• Worked closely with the Enterprise Data Warehouse team and Business Intelligence Architecture team to understand repository objects that support the business requirement and process.
• Analyzed data for migration from TcSE to Rational DOORS using Integrator.
• Develop and maintain sales reporting using in MS Excel queries, SQL in Teradata, and MS Access.
• Performed criteria table updates to determine the billing needs send to the insurance companies using MS access tables as a tool.
• Responsible for cost estimation and timelines for various Business Intelligence reports.
• Established traceability matrix using Rational Requisite Pro to trace completeness of requirements in different SDLC stages.

Confidential, Greenwood Village, CO

Data Analyst/Business Analyst

Responsibilities:

• Gathered Business Requirements interacting with the Agents, Medicare Users, Business Users and SMEs.
• Utilized and improved my understanding of HIPAA transaction codes specifically on 834 and 820 to in corporate EDI X12 - 4010 enhancements to existing efforts.
• Create export and XML processes for Lotus Notes. Create EDI Export and Import processes and work with EDI Trading Partners, Payers or Vendors
• Created AS IS and TO BE documents to show the current and proposed functionalities of the system.
• Facilitate Joint Application Development (JAD), sessions to identify business rules and requirements and then documented them for inter and intra departmental review.
• Accomplished experience from requirement analysis till deployment, using highly efficient Agile Methodology process of software development.
• Analyzed the business requirement as per the HIPAA rules and regulations.
• Adhered data transition of the enrollment process, COB, Claim Status and Eligibility as per the EDI standard 834, 837, 277 and 271.
• Documented high-level Use Cases and derived detailed low-level System Use Cases and Functional Designs from it.
• Developed Traceability Matrix between the Use Cases and the Test Scripts.
• Follow a structured approach to organize requirements into logical groupings of essential business processes, business rules, and information needs, and ensures that critical requirements are not missed.
• Closely monitored development team to make sure, the software application fits within the architecture and has the required behaviors.
• Developed detailed Test plan, Test Cases, Test scripts for testing the functionality and GUI