SUMMARY

• Qualified professional with over 8+ years of extensive experience in the field of Business Analysis, working with the technical staff to implement management and staff's business requirements into the software application in Healthcare Industry
• Well versed with current healthcare industry standards such as CMS, MMA, EDI X12 standard Transaction sets (834, 835, 837, 820, 270/271 and 276/277) HHS, SOX and FDA.
• Experience in Agile / Scrum methodology in writing user stories/epics and acceptance criteria using JIRA.
• Expertise in working with ETL process Extract, Transform and Load of data into a data warehouse.
• Experience in Medicare and Medicaid domains of the healthcare systems and industry for inpatients, outpatients, Reimbursement Methodology and Medicaid Management Information System (MMIS).
• Expertise in Claims Processing and Claims Scrubbing in HMO, PPO, Medicaid and Medicare.
• Solid understanding of Business Requirement gathering, Business Process flow, Business Process Modeling and Analysis, design documentation.
• Extensive experience in retrieving HIX and data validation using SQL queries like Joins, Views, Sub queries and Aggregate functions like max, min, sum and average with good understanding of Stored Procedures, Functions and Triggers.
• Skilled in Data Warehousing implementation including OLTP, Data Marts, ODS, Staging, Data sources, Normalization and Dimension tables, Data Profiling, Data Integration, Data Migration, Data Organization, Data Conversion, Data Quality and Data Modeling concepts like conceptual model and logical model.
• Proficient in developing and executing Test plans, performing functional, usability testing and ensuring that the software meets the system requirements.
• Experience in Claims, Claims Intake Process, Claims Adjudication Process and Claims scrubbing in HMO, PPO, Medicaid and Medicare
• Experience with TriZetto’s Facets Application Groups: Claims Processing, Guided Benefit Configuration, Medical Plan, Provider, Subscriber/Member, and Utilization Management.
• Experience in creation of complex project plans and business plans as applicable.
• Well - versed with leading industry tools like Jira, Version1, Caliber, MS Visio, MS Word, MS Excel and MS PowerPoint to develop various project deliverables
• Handled multiple projects involving multiple team sizes, involved in Clinical Trial using SCRUM development methodology, establishment of recommendation of new firm wide coding and testing standards.
• Experience in HIPAA assessment and HIPAA X12 EDI transaction (820, 834) mapping and identified changes that needed to be done to comply with HIPAA regulations and HL7 compliant.
• Skilled in eliciting user demands and converting them into visualizing models as well as ensuring that the business goal is met throughout the project life cycle.
• Hands on experience on AWS services including EC2, VPC, S3,RDS,Kenesis,Auto scaling configurations.
• Adequate Knowledge in Test Plan, Test Scripts and Test Cases for Functional, System, Integration, UAT, and Regression Testing based on the Design Document and User Requirement Document for the Functional, Security, and Performance Testing.
• In depth knowledge GAP Analysis, Impact Analysis, SWOT analysis, Cost Benefit Analysis and Risk Analysis.
• Experience in testing Facets applications and EDI transactions
• Extensive expertise in databases like Oracle, SQL, Regulatory compliance Analysis and Risk management.

PROFESSIONAL EXPERIENCE

Sr. Business Analyst

Confidential - Arlington, VA

Responsibilities:

• Facilitated the SCRUM ceremonies like Sprint planning meeting, Daily Stand-Up Meeting, Sprint Review, and Sprint Retrospective meetings.
• Involved in the implementation of agile SCRUM methodology for increasing the security and integration of customer specific software of healthcare related data.
• Elicited requirements from Business users and stakeholders by interacting with them and asking them detailed questions and carefully recording the requirements in a format easily understood and reviewed by both business and technical people.
• Actively involved in the building an Information Security Risk Assessment (ISRA) for the secure exchange of health insurance data as part of the Affordable Care Act (ACA).
• Involved in writing test cases for integrated testing which were based on traceable requirements.
• Co-ordinated in using the Medicaid Information Technology Architecture (MITA) framework which followed Service Oriented Architecture of the Enterprise Bus Architecture to carry out data management using XML standards, message management using HL7 and service co-ordination.
• Processed information for regulatory compliance (i.e,statutory flings,proof insurance,certificates)
• Reviewed documents relating to inquires by the confidential regarding regulatory compliance issues of a certain investments bank and bank subsidiary,relating to regulatory capital treatment of variable interest entity VIE assets.
• Worked on Data sharing, data mapping, Target mapping and data loading.
• Used JIRA for issue tracking, User Story management and requirement traceability and created, managed, tracked and analysed Sprint Burn down Chart and Product Burn Down chart to estimate sprint velocity, Development team’s capacity and release planning respectively. Maintained SCRUM Task Board for project.
• Efficiently handled team and organizational impediments as a Scrum Master by fostering a conducive environment for efficient team work.
• Assisted in testing the changes for the front-end screens in FACETS related to following modules, test the FACETS batches membership, Billing, Provider.
• Examined, analysed and model Test plans, Use Case Model cases & Test procedures based on Agile methodology.
• Executed the test cases and test scenarios using HP Quality centre QC
• Designed the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims.
• Managed IT Audit implementing best practices and meeting Regulatory compliance needs and provided Audit reports.
• Involved in developing SQL queries and tables which replicated the ETL, and compared the SQL results with the Informatica tables.
• Executed SQL queries and optimizing them in Oracle, SQL Server, MS Access and Teradata.
• Performed HL7 standards analysis and documented the enhancements to meet the end state requirements.
• Involved in developing the test strategy and helped in developing the QA test plans for functional, integration and system training.
• Updated Procedural Documents for the Business Risk Management Department
• Worked with AWS Cloud platform and its features which includesEC2, VPC, RDS, EBS, S3, CloudWatch, Cloud Trail, CloudFormation and Autoscaling etc.
• Conducted project related Presentations periodically to the management and end users during various phases of Software Development Life Cycle SDLC.
• Managed requirements from Global Business & Risk Management users.
• Managed testing for various functionalities using Quality Centre tools.
• Performed Analysis on Data mapping between different data models
• Created UML-based feasibility studies and Use Case Models to communicate those ideas to the develop
• Involved in developing the Test Cases for unit testing, prepared spreadsheet for testing criteria, including regression, positive and negative testing, process flow testing and screenshot for test results to complete expected and actual results.
• Prepared Business Requirements BRD and Use Cases for the FSI initiative to deliver a global strategic adjustment service across the CFO organization, to support all Finance adjustment activities for Product Control and Financial Accounting functions.
• Worked with Senior Business Users in Market &Credit Risk Management, Prime Brokerage, Auditing/Compliance, and Back & Middle Office to prioritize and secure Budgeting for Projects and Day - to-Day Support.
• Mitigated existing workflow issues and provide technical support for issues with SharePoint and Nintex workflow.
• Analyzed and Propose strategic process development solutions and document workflows to improve an intranet solution for on-time product delivery process.
• Created and assessed current and future process models for the purposes of creating common understanding and uncovering process issues Identified business logic and prepared Business Process Modelling diagrams, Use Case Scenarios, Use Case Stories and describe the requirements with relevant UML Diagrams and facilitate data validation.
• Gathered site owner requirements and converts to migration plans, jobs and workflow recreation
• Recreated workflows in Power Automate and Established Intranet solutions for workflows and forms

Business analyst

Confidential - Detroit, MI

Responsibilities:

• Designed and documented Business Process Re-engineering, Business Process Modelling, Historical Data Reports Analysis accompanied by conducting and facilitating elicitation sessions such as survey/questionnaires, Interviews sessions, Focus group sessions, Requirement workshops, Interface analysis and Document analysis with internal as well as external stakeholders
• Identified business logic and prepared Business Process Modeling diagrams, Use Case Scenarios, Use Case Stories and describe the requirements with relevant UML Diagrams and facilitate data validation.
• Maintained Traceability Matrix in Excel and improved data collection quality using Six Sigma.
• Collaborated with the QA testing team to develop the test plan, test conditions and test cases to be used in testing based on business requirements, technical specifications and/or product knowledge
• Participated in using the Agile Methodologies on projects utilizing full Systems Development Lifecycle (SDLC), while using MS SharePoint for storing project documents.
• Identified/documented data sources and transformation rules required populating and maintaining data warehouse content.
• Used FACETS Analytics for fast and easy retrieval, display and grouping of information for performing queries and generating reports.
• Conducted Presentations periodically to the management and end users during various phases of Software Development Life Cycle SDLC.
• Worked on improvement of Claims Reimbursement User Interface for a better experience and in corporate changes as per HIPAA guidelines using the gap analysis.
• Involved in developing test cases and scripts based on business requirements for the GUI, functional, User Acceptance & System Back-end testing.
• Worked closely with QA and Developers to understand functionality, resolve issues and provided feedback to nail down the bugs.
• Involved in UML-based feasibility studies and Use Case Models to communicate those ideas to the developers.
• Managed requirements to minimize scope issues. Understand all systems requirements within deliverable and provide feedback, collected requirements from customers, users and prioritized them.
• Followed the UML based methods using Microsoft Visio to create Use Cases Diagrams, Activity Diagrams, and Sequence Diagrams.
• Prioritized outstanding defects and system problems, ensuring accuracy and deadlines were met. Identified and participated in resolution of business system issues.
• Wrote clear, concise detailed system requirements specification documents and user documentation in accordance to guidelines and standards of a level where developers can interpret, design and develop the application with minimum guidance.
• Managed Regulatory compliance implementation with OWASP and HIPAA.
• Liaised with IT team to ensure that Functional Specification Documents, prototyping and GUI designs would be in line with business expectations, as well as strategic target delivery for the FSI initiative
• Working closely on emergency application processing and coordinating with vendors till the time the corporate cards are delivered to the card members.
• Used Rational Rose to visually determine the proper structure, key elements and optimal design for database
• Worked with Rational Clear quest for defect management
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, OOD using UML.
• Participated in various stages of data and requirement analysis for project needs.
• Interfaced with the client as part of the Requirements Engineering team to finalize the project scope.
• Facilitated JAD Sessions and gathered Business Requirements
• Worked closely with Sr. Business Analysts and Project Manager in developing Use Cases and project plans and managed changes to the scope of the project.
• Gathered user and business requirements through open-ended discussions, brainstorming sessions and role-playing.
• Translated the Business needs into system Requirements, communicating with the Business on a broader scale and with an in-depth view.
• Gathered requirements and facilitated DCO sessions to capture the business objectives for the Omni application.
• Used Agile methodology and utilized Software Development Life Cycle (SDLC) to configure and develop process, standards procedures.
• Performed financial and business analysis, cost-benefit and risk management in support of capital planning for investments.
• Used AWS command line client and management console to interact withAWSresources andAPIs.
• Created business requirement documents and integrated the requirements and underlying platform functionality.
• Produced metrics which provide management insight into the requirements process, to include, status, size, volatility, quality, effort, etc.- Visio, Rational Tools, Traceability Matrixes.
• Partnered with continuous product engineering teams on investigating systemic issues.
• Created and executed SQL queries to find clues on what may be causing the opportunity.
• Participated in the Logical and Physical Design sessions and developed Design Documents.
• Played key role in defining test automation procedure and standards, creating Win Runner and Quick Test Professional scripts for all the modules, which reduced the regression cycle drastically and improved the testing efforts for daily builds.
• Worked with Quality Control Teams to develop Test Plan and Test Cases.
• Worked on User Manuals, and Training Manuals as per Project Specifications and timelines.
• Participated and provided signoff based on User Acceptance Testing results.
• Created Power Automate workflows and Power App Forms

Business analyst

Confidential - New York City, NY

Responsibilities:

• Worked with QA team to design & implement Test plans, Test cases and performed Black-box Testing, System Testing, Integration Testing, Regression Testing, User Acceptance Testing (UAT), Load/Stress Testing & Performance Testing
• Incorporated stakeholder feedback throughout project lifecycle to ensure project quality and customer satisfaction.
• Worked with HIPPA rules and regulations to draft business rules and claim processes.
• Interacted with the client and the Technical Team for requirement gathering and translation of Business Requirements to Technical specifications.
• Worked on designing and implementing Xerox automation workflow tools to significantly reduce throughput times by automating and consolidating manual processes at client sites (mostly Medicaid/Medicare claims, crossover claims, MMIS).
• Performed Gap Analysis and Expedite Nintex Forms/Workflows produced by off-boarding consultancy
• Utilized Agile software methodology using scrum frame work.
• Manages and lead Regulatory compliance analysis, mapping and monitoring.
• Involved in managing testing for various test functionalities using quality centre tool
• Created UML-based feasibility studies and use case models to communicate those ideas to the developers
• Wrote SQL scripts for creating performance evaluation reports
• Performed backend testing by using PL/SQL queries to test the integrity of the application
• Developed use cases and activity diagrams and analysed business requirements.
• Extensively interacted with stakeholders and IT department in finalizing requirements according to CMS compliances/regulations and HIPAA regulations
• Worked on HIPAA compliance life cycle, HIPAA insurance regulations and claims processing.
• Facilitated test plan/test case walk-throughs for the Business and Development teams to obtain feedback and/or approval sign-off.
• Played key role in implementation of integrated RUP solution with complete line of traceability for all the artifacts of projects.
• Worked withCredit Risk Management such as Treasury Bonds, Junk bonds And Over the counter Derivatives (OTC) and Vanilla swaps to hedge foreign currency riskand future and forward contract risk, counter party risk.
• Responsible for Project Planning, Tracking, Risk management, Resource Management, coordinating tasks and Creating/Updating Status Report with TIC.
• Conducted UAT, documented and reported user feedbacks to management team, and developed training materials for different end users and assisted in users training for the new system.
• Developed flowchart and process diagram using MS Visio.
• Extensively used tools such as Rational Rose, Rational Requisite Pro, UML, MS Visio, MS Project, MS Office and MS Access to Analyze and corporate healthcare business processes to develop customized solutions
• Performed Backend testing by using PL/SQL queries to test the integrity of the application was in regular contact with Business partners on the status of issues, action plans and timeframe for resolution throughout the development cycle.

Business analyst

Confidential - Minneapolis, MN

Responsibilities:

• Involved in the User Acceptance testing UAT to check the reliability for end users.
• Worked on requirements of the 835, 276, 277, 837, and HIPAA transaction across the enterprise.
• Examined and analysed Test plans, Use Case Model cases & Test procedures based on RUP methodology.
• Performed felid-by-field mapping of interface between parent EMR system and downstream system
• Worked on Healthcare system implementation including enterprise Electronic Medical Records (EMR) and Electronic Health Records (EHR) software.
• Conducted user interviews and documented business and functional requirements.
• Assisted quality assurance team to functional-test the new HL7 interfaces always keeping in mind HL7 and HIPAA guidelines, and coordinated user acceptance testing using derived test data.
• Conducted project related Presentations periodically to the management and end users during various phases of Software Development Life Cycle SDLC.
• Performed Gap Analysis of the processes to identify and validate requirements.
• Involved in testing phase right from the unit testing to the user Acceptance testing.
• 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 system
• Performed HL7 standards analysis and documented the enhancements to meet the end state requirements.
• Involved in design and Implementation of the XSD schemas using XML Spy Tool keeping reusability in view across the system.
• Worked with Data Services team to create reports and extracts in SAP Web Intelligence rich client for Controllers, Loans, Private Banking, Treasury, Compliance and Risk Management.
• Involved in audit space through onsite evaluations, offsite financial analysis and surveillance. This includes regulatory compliance to ensure that they have in place the appropriate risk identification and risk management processes for CCAR analysis in capital planning that involves planned capital actions in supervisory scenarios and capital action assumptions required in stress testing rules.
• Worked onAWS Elastic Beanstalkto deploy, monitor, and scale an application, created newEC2 instance in AWS, allocate volumes and giving Provisionals usingIAM
• Created and managed project templates, use case templates, requirement types and tractability matrix in Requisite Pro.
• Extensively worked with Workflow analysis to create BA and other project artifacts. SharePoint workflow projects.
• Led cross team interviews to gather requirements and documented workflow analysis.
• Build Platform features, user stories, and maintain backlog with priorities, using Rally and JIRA platforms.
• Comprehensively worked with requirement gathering for Enterprise reporting system using Requisite Pro.
• Designed and developed all Use Cases and UML models using Rational.
• Developed Sequence Diagrams, OOD using UML.
• Involved heavily in testing of the tool, end-to-end testing and validation of data
• Worked on SQL for data analysis.