SUMMARY

• Over 7 years of Business Analysis experience with in-depth knowledge of business processes primarily in health care.
• Proficient in Requirement Management, including gathering, analyzing, detailing and tracking requirements.
• Experienced in documenting requirement using Unified Modeling Language Use Case and Activity Diagrams . Also in building Business Process Flow, Context Diagrams, Sequence Diagram, Activity Diagrams and Class Diagrams using Rational Rose and Microsoft Visio.
• Strong understanding of various SDLC methodologies such as RUP, Waterfall and Agile with hands on experience in all of them.
• Experienced in interacting with business users to identify their needs, gathering requirements and authoring Business Requirement Documents BRD , Functional Requirement Documents FRD , Software Requirement Specifications SRS , Requirement Traceability Matrix RTM , Wire Frames, User manuals, Data Dictionary and Test Plan across the deliverables of a project.
• Strong Knowledge with Iterative approach for Software Development as per Rational Unified Process RUP . Involved in inception, elaboration, construction transition phases using rational tools like Requisite Pro, Clear Case, Axure and Clear Quest during various phases of RUP.
• Experienced in SWOT Analysis, Gap Analysis, Impact Analysis, Risk Analysis, and Project Planning.
• Extensive knowledge of Medicaid, Medicare Part A, B, C and D .
• Through understanding and hands on experience of Claims adjudication systems.
• Experience in HL7, conversion of HIPAA 4010 codes to HIPAA 5010 codes, ICD-9 codes to ICD-10 codes, Procedural and Diagnostic codes.
• Extensive experience with EDI X12 transactions like 270 eligibility enquiry , 271 eligibility response , 276 claims status , 277 claims status response , 820 enrollment , 834 premium payments , 835 medical claims payment and 837 medical claims .
• Exceptional Problem Solving and Sound Decision Making capabilities, along with the ability to resolve difficult situations.
• Possess a detail-oriented nature with excellent communication, interpersonal skills, and recognized for being a valued team player.
• Outstanding organizational skills including ability to multi-task prioritize and manage increasingly complex issues.

AREAS OF EXPERTISE

• Business Skills: Business Process Analysis Design, Gap Analysis, Impact Analysis, JAD/JRP Sessions Requirement Gathering, and Use Case Modeling.
• Methodologies: Agile, RUP, and Waterfall.
• Languages: C, C , SQL, PL/SQL, HTML and XML.
• Management Tools: Clear Quest, Clear Case, MS Visio, Rational Rose, and Requisite Pro.
• Testing Tools: HP Quality Center, Win Runner.
• Database: DB2, MS SQL Server.
• Operating Systems: Windows Vista, Windows 95/2000/XP/7, and MS-DOS.
• Microsoft tools: MS Office Suite Word, Excel, Power Point, Outlook , MS SharePoint, MS Visio, MS Project, and MS FrontPage.

PROFESSIONAL PROFILE

Confidential

Sr. Business Analyst

The project was to understand the Medicare Claims Adjudication System, end to end, to fill the gaps in the system and incorporate the new CMS directives, HIPAA standards and Electronic Data Interchange EDI . Also implemented HL7.

Responsibilities

• Conducted interviews, live meetings and JAD sessions with business users and Subject Matter Experts SME's to understand the As-Is system and gather requirements for the To-Be system.
• Analyzed the pre-existing documents to have a better understanding of the present system.
• Incorporated Rational Unified Process RUP and analyzed User Business Requirement Document BRD , Technical Requirement Specification TRS and Functional Requirement Specification FRS using Requisite Pro, Rational Rose and MS Visio.
• Did Presentations for Stakeholders explaining the gaps in the system and how the changes would affect different modules w.r.t. Medicare.
• 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.
• Performed Analysis of ICD 9 Procedure and Diagnosis Codes in accordance with ICD 10 CM and ICD 10 PCS Conversion Compliances
• Organized daily scrum calls to keep the team on track and the stakeholders updated.
• Documented, organized and tracked the requirements using Rational Requisite Pro.
• Worked on changes regarding new CMS directives and proposed changes to be made in the current system.
• Analyzed Claims adjudication related transactions like 835, 837, 270, 271, 276 and 277 transactions both inbound and outbound .
• Involved with implementation with HL7 standards.
• Worked with source system Subject Matter Experts SMEs to ensure that the extracts are properly mapped.
• Tracked and maintained Stakeholder requested enhancements and changes using Requirement Traceability Matrix RTM .
• Integrated Requisite Pro with Rational Rose to provide all teams visibility and maintain tractability among requirements, use cases and change requests.
• Assisted in writing test case scenarios for regression testing and end-to-end testing.
• Assisted with user testing of systems and maintained quality procedures and ensured appropriate documentation is in place.
• Assist end users and IT staff in the use of data to satisfy informational and reporting requirements and implementing and using SQL and DBMS.

Environment: SQL Server, Windows XP, Rational Rose, Rational Requisite Pro, Clear Case, Clear Quest, UML, Rational Suite, MS Visio, MS Project, MS Office MS Word, MS Excel, MS PowerPoint .

CONFIDENTIAL

Business Analyst

The HIPAA-EDI Health Insurance Portability and Accountability Act / Electronic Data Interchange project involved the validation and testing of the various HIPAA transactions in HL7/EDI X12 formats in order to simplify the way business was conducted with group customers and members. Utilized Facets software to store, send and receive enrollment, billing and health care claims according to HIPAA 4010.

Responsibilities

• Extensively involved in implementation of effective requirements practices, including gathering User Requirements, and analyzing User Requirement Document URD , and Functional Specification Document FSD , use and continuous improvement of requirement gathering processes.
• Interacted with the SME's to gather information about the Medicaid billing and claims processing and checked if the processed floe is up to date or not.
• Applied RUP methodology with its various workflows, artifacts and activities to manage life cycle from Inception to Transition phase.
• Acted as liaison between external clients and SME's to generate and standardize product requirements specification documents such as URS/FRS/Use Cases.
• Employed UML methodology in creating UML Diagrams such as Use Cases, Sequence Diagrams, and State Diagrams, Activity Diagrams and business process and workflows.
• Was engaged in applying CMS directives that provide guidance for improving organization's processes.
• Organized JAD sessions to identify the business flows and determine whether any current or proposed system enhancements are impacting the preexisting processes or other related systems for processing of Medicaid Claims.
• Assisted team lead in developing Requirements Traceability Matrix RTM to trace the relationship between business and functional requirements to test cases. Prepared and executed different Test Cases and Test Scripts.
• Worked on Medicare, Medicaid insurance, HIPAA 4010, health care regulations and CMS terminology.
• Tested the system and applications for compliance with the HIPAA 5010, HL7.
• Managed the project related content on Microsoft SharePoint server.
• Worked with Facets software for maintaining data about the enrollment, billing and health care claims management and to store, send, receive HIPPA transactions and facilitate the administration of HIPAA privacy rights.
• Worked closely with the ETL data warehouse and BI teams while developing data marts, data models and while reporting and data mapping.
• Validated and wrote SQL queries, prepared dashboards and performed data analysis. Interacted with the QA team to develop test plans and test cases.
• Involved in conducting Functional Testing, Integration Testing, Regression Testing and User Acceptance Testing UAT . Provided analysis and insight to QA Team from a business perspective.

Environment / Tools: Facets Managed Care 4.3.1, Caliber RM, MS Access, Excel Visio, SQL, Oracle, HP Quality center, Clear Case.

CONFIDENTIAL

Business Analyst

CONFIDENTIAL is a leader in improving the health of low-income individuals and communities. The company's Child Health Plus program was top-ranked in the CONFIDENTIALCity and Long CONFIDENTIALand ranked best on Long Island among all Medicaid plans. The project was to build an Enterprise SOA service-oriented architecture based system and was developed on the Microsoft .NET Platform. The new Claims Processing MMIS Medicaid Management Information System replaced the old legacy system and automated all the business areas. As a Business Analyst, I was involved with drafting the migration plan for the Claims Processing data which needed to be migrated from the Mainframe to the SQL Server environment. I was also involved with the HIPAA 5010compliance for the new MMIS system.

Responsibilities:

• Gathered requirements from stakeholders for provider management and member management.
• Identified and validated business rules and data elements.
• Developed the stakeholder list and created stakeholder assessment matrix to prioritize them.
• Identified and documented different modules of the system to be affected by the shift.
• Developed and maintained a requirements work plan and assessed the performance metrics of the team members.
• Performed Analysis of ICD 9 Procedure and Diagnosis Codes in accordance with ICD 10 CM and ICD 10 PCS Conversion Compliances
• Modeled the 'as-is' process flow and the 'to-be' process flow and analyzed the gap and developed the action steps to fill the gaps.
• Proposed strategies to implement HIPAA 4010 in the new MMIS system eventually move to HIPAA 5010 and worked on HL7.
• Conducted Risk analysis and developed mitigation plans.
• Translated the business needs into system requirements, communicating with the business on a non-technical level, and with the System Analyst on a more technical level.
• Conducted Impact analysis when there is any change in the requirements and updated the Business Requirements Document BRD Functional Specification Document FSD and Systems Requirements Specification SRS .
• Analyze EDI X12 data elements captured by the existing system to validate it against the data elements required for new system.
• Facilitated meetings with the technical team and client team to analyze the current process and gather requirements for the proposed process.
• Developed the User Interface UI prototypes to capture and validate requirements and spike solutions to the current problem.
• Designing Functional Specifications for the target physical database.
• Helped the developer team understand the needs of the business environment using the programming terminology.
• Developed UAT test cases associated with the functional requirements.
• Conducted User Acceptance Testing UAT with the help of Test Director.
• Assist the PM in setting realistic project expectations and in evaluating the impact of changes on the organization and plans accordingly.
• Developed test scenarios and implemented test plan, providing key input in working with users in defining project and system requirements.
• Conducted project related presentations.
• Analyze different data crosswalks, complicated logic look ups required by different fields for the source to target transformations.
• Participated in developing test plan, test scripts, and test scenarios and designed user documentation.
• Worked with legacy team in developing BRD for multiple system change requests and participated in system testing.
• Used Microsoft SharePoint as the version-tracking tool for managing the requirements documentation.
• Examine the system design deliverables validating it against the Request for Proposal RFP .

Environment: Windows, Rational Rose, Rational Requisite Pro, Clear Case, Clear Quest, UML, Rational Suite, MS Visio, MS Access, MS Excel, Oracle, HTML

CONFIDENTIAL

Business Analyst

Life Time is part of, a premier provider of specialized insurance products and related services in CONFIDENTIAL and selected worldwide markets. It is the brand name for a family of health insurance products focused on providing a variety of affordable plan choices to consumers. The portfolio of health care products includes major medical, supplemental and fixed-benefit plans for individuals, families and small employers. The project was to incorporate the changes proposed in HIPAA 5010 and upgrading the current system from HIPAA 4010 to HIPAA 5010 converting ICD-9 to ICD-10 so that the system is in accordance with the new standards mandated by Health Insurance Portability and Accountability Act HIPAA . Also, had to integrate the Medicare Part A, Part B, Part C and Part D data all in one single system for a smooth flow through the claims processing system.

Responsibilities

• Conducted JAD sessions with Subject Matter Experts SME's .
• Interacted directly with marketing directors, Drug safety, Health Care practitioners and Oncology Consultants to ensure compliance with industry regulations.
• Incorporated Rational Unified Process RUP and analyzed User Business Requirement Document BRD , Technical Requirement Specification and Functional Requirement Specification FRS using Requisite Pro, Rational Rose and MS Visio.
• Did Presentations making Stakeholders understand how the changes would affect different modules w.r.t. Medicare and Medicaid.
• Performed Gap analysis for better understanding of transition from HIPAA 4010 to HIPAA 5010.
• Worked in the analysis of the ICD 9 - 10 codes
• Revised HCFA-1500 and MCS-1500 forms with stakeholders.
• Designed and developed Use Cases, Activity Diagrams and Sequence Diagrams using UML.
• Documented, organized and tracked the requirements using Rational Requisite Pro.
• Worked on changes for HIPAA Transaction and proposed changes to be made in the current system for an easy transition from version 4010 to 5010.
• Documented the detailed business as well as technical requirements to upgrade the current system to5010 transactions.
• Got involved in designing future state processes for HIPAA 5010 transaction processing EDI's 837,835, 270, and 271.
• Analyzed HIPAA 5010 related to 835, 837, 270, 271, 276 and 277 transactions both inbound and outbound and performed gap analysis between the 4010 and 5010.
• Worked on ICD conversion from 9 to 10 with respect to the claims related to Medicare Part A, Part B, Part C and Part D .
• Worked with 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 .
• Integrated Requisite Pro with Rational Rose to provide all teams visibility and maintain tractability among requirements, use cases and change requests.
• Completed a review of existing documentation for orders, referrals and reports and compared it to the clinical details needed for ICD-10.
• Assisted in writing test case scenarios for unit testing, integration testing and compliance testing.
• Involved with ICD10 implementation testing.
• Assisted with user testing of systems and maintained quality procedures and ensured appropriate documentation is in place.
• Assist end users and IT staff in the use of data to satisfy informational and reporting requirements and implementing and using SQL and DBMS.

Environment: SQL Server, Windows XP, Rational Rose, Rational Requisite Pro, Clear Case, Clear Quest, UML, Rational Suite, MS Visio, MS Project, MS Office MS Word, MS Excel, MS PowerPoint , MS Access, XML

CONFIDENTIAL

Business Analyst

CONFIDENTIAL is a world leader in the research and development of products to protect and improve health and well-being. The company has core businesses in pharmaceuticals, vaccines, consumer health, generics and eye care. The scope of the project involved the enhancement of Laboratory Information Management Systems LIMS . The LIMS application used to keep track of the various tests that were being performed in the laboratory. There were different laboratories across the country where different types of tests were performed and this system used to keep a track of all the tests that were ordered by the Client.

Responsibilities

• Developed and maintained business relations, prioritizing project requests based on a basic knowledge of research and laboratory science, for effective and efficient project execution.
• Conducted scientific process analyses, facilitating lab process modeling, reviewing and understanding business requirements.
• Served as a direct point of communication with business partners, with Lab Systems Support, and with in-house developer staff and/or various vendors and contract developers in order to provide technical assistance during the development, testing and deployment processes.
• Utilized RUP methodology to configure and develop process, standards and procedures.
• Created use case documents, use case diagrams, sequence diagrams, process flows and other business analysis documents for the needs of the project.
• Responsible for creating FDA regulation 21 CFR Part 11 compliance assessment checklist for electronic records.
• Documented various artifacts as per the FDA 21 CFR Part 11considerations as well as Good Manufacturing Practices GMP and Good Clinical Practices GCP .
• Interacting with developing team and QA team for functional specification and test plan.
• Created, managed, shared and collaborated all business documents and contents.
• Assisted Project Manager with the creation and maintenance of project related control documentation such as project charters, scope documents, tracking logs.
• Assisted the QA team in analysis, validation and testing.
• Involved in UAT testing of the application after the application was tested by the QA team.
• Worked with E2B data elements according to the standards determined by the ICH Electronic Standards in an XML Format.

Environment: SQL Server, Windows XP, Rational Rose, Rational Requisite Pro, Clear Case, Clear Quest, UML, Rational Suite, MS Visio, MS Project, MS Excel, XML.

CONFIDENTIAL

Business Analyst

Project PCCP was launched to design an efficient Property and Casualty Claims Processing system that would be integrated with an existing Customer Relationship Management CRM program. The system provided a common customer view across agents, call centers and claims. In addition, it allowed for the transfer of business from independent agency management systems.

Responsibilities

• Facilitated JAD Joint Application Development sessions to identify business rules and requirements and then documented them in a format that can be reviewed and understood by both business people and technical people for P C business domain areas.
• Worked with Underwriting and Insurance rating team Corporate and Field to create detailed requirement documents to ensure accurate business requirements that allow Configuration.
• Assisted insurance QA Analyst with the test cases based on the gathered requirements and analyzed the existing property and casualty claims processing system.
• Developed the feature lists, functional requirements, non-functional requirements, use cases, and domain models for business domain application features.
• Led the P C insurance best practice and process to define the appropriate static and dynamic views of P C business domains using UML and other software development tools.
• Used Visio to carry out the business modeling and object modeling effort to develop the information business architecture and workflow diagrams for the application for rapid and controlled Web Application development.
• Participated in the analysis of User Interface Design efforts participated in design sessions, documented and validated recommendations.
• Assisted in systems and business process support within the Enterprise business Solutions Department. Maintain test data files and monitor system configuration to ensure data integrity review data loaded and processed to identify gaps and data anomalies.
• Analyzed Requirements and created Use Cases, Use Case Diagrams, Activity Diagrams using Visio. Tested the final application for Usability testing to verify whether all the User Requirements were catered to by the application.
• Use core product for P C configuration tool to implement carrier specific insurance product structures, rules, rating elements, and coverage.
• Trained clients in the use of product definition tools and serve as a resource throughout the project implementationProcess.

Environment: MS Project, MS Access, MS Visio, MS Excel, MS Word, MS Power Point, Rational Requisite Pro, Clear Case, Clear Quest.

CONFIDENTIAL

Business Analyst

The CONFIDENTIAL was launched to design an interface of different legacy systems mortgage, credit etc. with the core banking solution at the bank. The system provided a framework to ensure data consistency and reporting across the different operating units starting from the client transaction till the account was balanced. In addition, it supported reports with business analysis on types of customers and their spending patterns extracted from their data warehouse.

Responsibilities

• Worked with their business interface team to define requirements and translate them into technical specifications.
• Did impact analysis on existing reports to fit changes while ensuring regulatory compliance.
• Worked with the project manager and QA teams to do UAT to ensure that all requirements were tested effectively before being put into production.

Environment: MS Office MS Word, MS Excel, MS PowerPoint , MS Access, XML.

CONFIDENTIAL

Data Analyst

The work involved developing a system for their internal IT department to manage different government tenders in the Brazilian market place. The project was to keep internal candidate data e.g. certifications , project profiles from similar projects executed in the past and win-loss data analysis based on technical and financial weightages ready for use in the tenders.

Responsibilities

Worked with their business interface team to define requirements and translate them into technical specifications.

Environment: MS Office MS Word, MS Excel, MS PowerPoint , MS Access, XML, SQL.