Summary:

• Facilitator between Business Systems and Information Technology with over 7 years of various environment experiences in the field of business analysis and project management.
• Over 7 years of experience and advance knowledge of the Systems Development Life Cycle SDLC , and project life cycles like Agile, Rapid Application Development RAD , Extreme Programming XP ,Rational Unified Process RUP
• Experienced in conducting GAP analysis, User Acceptance Testing UAT , SWOT analysis, Risk Analysis and mitigation plan, Cost benefit analysis and ROI analysis.
• Exposure to Healthcare, Insurance and Finance business domains.
• Extensive experience with Business Process Management BPM .
• Have extensive knowledge on Explanation of Benefits EOB , Coordination of Benefits COB , Facets, EMR, EHR, PPACA Obamacare , MMIS, HIX Health Insurance Exchange
• Extensively worked and presented several documents and Use Cases for multiple transactions include 837I, 837P, 835, 276, 277, 270, 271 both inbound and outbound transactions for ongoing industry projects.
• Good knowledge of Health Insurance Plans Medicare Part A, B, C and D , managed care concepts Medicaid and Medicare and experienced in determining the membership eligibility, billing experience within life and disability in health plans.
• A sincere, committed, quick learner, oriented, motivated team player with excellent communication, analytical, leadership, interpersonal and problem solving and management skills. Exceptional Problem Solving and Sound Decision Making capabilities, along with the ability to resolve difficult situations.
• Strong knowledge and working experience of industry standards such as HIPAA, HL7, Six Sigma, and SOX, ICD-9, ICD-10 coding, EDI Electronic data interchange , transaction syntax like ANSI X12
• Participated and actively functioned in Joint Application Development JAD
• Strong Experience in Test Plans development, Test Conditions and Test Cases, test data creation and analysis, interaction with the development team for error detection and correction.
• Hands on implementing Web, Portal, Web-Services and Enterprise Applications using Object Oriented Analysis and Design OOAD Methodology.
• Worked extensively with Dimensional Modeling and Data Migration. Experience in Data Transformation, Data Loading, Data Modeling, Metadata Model, Catalog Creation, Cube Modeling, SDK Development and Performance Tuning.
• Experience in understanding database structures and write SQL/PLSQL.
• Extensive experience in Data Analysis and ETL Techniques for loading high volumes of data and smooth structural flow of the data.
• Worked on System Changed Requests Issue resolution related to Medicare and Medicaid.
• Vast experience in requirement gathering for business and application requirements, business processes, identifying risks, impact analysis, UML modeling, Sequence and Activity Diagrams using Rational Rose and Microsoft Visio.
• Have worked intensively on the PL/SQL for creating and working on the database for multiple projects.
• Adapt at writing Data Mapping Documents, Data Transformation Rules and maintaining Data Dictionary, Data Migration and Interface Requirements Documents.
• Experience in gathering reporting requirements from the business users for Business Intelligence, Data Warehouse application.
• Experience in writing Test Plans, Creating Test Suites, Test Cases/Test Scripts, Defect Tracking.
• In house experience with project management tools like MS-Project, JIRA, Creative Pro Office for status reporting, planning and error tracking and correcting.
• Proficient in working with UML development tools like MS Visio, Eclipse, Enterprise architecture framework, UML2 Tools, and Power Designer etc.
• Extensive management background within varied sectors of the healthcare industry including HMOs , PPOs, Integrated Hospital Systems, Out-Patient Surgery Centers, Dental and Vision

Technical Overview

Professional Experience

Confidential

Sr. Business Analyst

Responsibilities:

• Conducted formal interviews, Live Meetings and JAD sessions with business users and matter experts.
• Designed and developed Use Cases, Activity Diagrams and Sequence Diagrams using UML.
• Involved in Backend Testing to verify data integrity by using T-SQL.
• Documented, identified, organized and tracked the requirements using Rational Requisite Pro.
• Created Data Flow Diagrams DFDs , ER diagrams for data modeling and Web-page mock-ups using MS Visio for acceptance from end users.
• Defined project milestones, schedules, and monitored progress using MS-Project, creative pro office and modified, updated the project scheduled plans as required.
• Analyzed and tested Data Interface needs.
• Worked on System Change Request SCR sent by the clients to change the current work process and work methodology for some pre entered process using IBM Lotus Notes, Microsoft Access and Microsoft SharePoint.
• Worked on IBM Mainframe dealing with different claim types, by adjusting, processing or entering new claims.
• Worked on the maintenance and backend support of pre-existing PBM systems that satisfied multiple external partners client system for their members.
• Worked extensively on both inbound and outbound transactions, creating test cases for multiple transaction types including 837, 835, 276, 277, 270 271
• Worked on changes for HIPAA Transaction from version 4010 to 5010. Documented the detailed business as well as technical requirements to upgrade the current system to 5010 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 837,835, 270, and 271. Transactions and performed gap analysis between the 4010 and 5010.
• Intensive working on the current ICD code conversion from ICD 9 to ICD 10, assisting and leading various teams by complying with already going works in the health care domain and work with the conversion.
• Gap Analysis: Analyzed the client's applications programs to determine the impact of the HIPAA final rule on EDI Transaction Set and Code List implementation and defined the changes to bring the affected systems into HIPAA compliance.
• Worked with FACETS Team for HIPAA Claims Validation and Verification Process Pre-Adjudication .
• Worked intensively on FACETS 4.6.1 for audit trails made on the used account and check and store information related to the HIPPA authorizations.
• Worked on claim adjudication process with different clients applying different adjudication process and methodology.
• Assisted with user testing of systems and maintained quality procedures and ensured appropriate documentation is in place.
• Maintained Requirement Traceability Matrix RTM and Utilized Clear Quest for change requests and defect tracking.
• Claim validation and Pend/Denied Claims Analysis for the Health plans Medicaid programs.
• Worked closely with the technical team to look up for the best possible solution on requirements by keeping business needs and technical constraints in mind.
• Updating, transferring and sharing Files using FTP between Windows and UNIX machines.

Environment: UML, MS Word, MS Share Point, MS Access, IBM Lotus Notes, IBM Main Frame, Rational RequisitePro, Quality Center, SQL, FTP.

Confidential

Business Analyst

Roles and Responsibilities:

• Conducted requirement gathering sessions with the Information Technology team.
• Attended JAD sessions for Requirement Validation to gather requirements for the new MMIS.
• Developed Use Cases, Activity diagrams and Sequence diagrams from the requirements based on the UML methodologies using MS-Visio.
• Involved in the design and development of User Interfaces UI using HTML, JavaScript and JSP.
• Held periodical meetings with the Development team to gather information on the progress and resolve project issues.
• Used Microsoft SharePoint as the version tracking tool for managing the requirements documentation.
• Performed an analysis of requirements so that they are in compliance with
• Requirement Traceability Matrix RTM was maintained through RequisitePro to keep the timelines and milestones in check.
• Helped the testing team in carrying out manual testing and also assisted in writing test cases and a Test Plan.
• Tested the final application for Usability testing to verify whether all the User Requirements were catered to by the application.
• Bugs that would enhance the usability of the application were logged using Rational ClearQuest.
• Interacting with the developers on resolving the reported bugs and various technical issues.
• Tested the features and functions based on priority using Rational Quality Manager.
• Involved in preparing a simple and detailed User manual for the application, for an intended novice user.

Environment: Rational RequisitePro, Rational Rose, UML, MS-Project, MS Visio, Java, MS Office, Windows XP, Microsoft SharePoint, RQ

Confidential

Business Analyst

Responsibilities:

• Drove the requirement-gathering phase Provider, Claim components and HIPAA .
• Conducted joint discussion sessions with business users, stakeholders to understand the requirements in more detail
• Conducted workflow, process diagram and gap analysis to derive requirements for existing systems enhancements
• Work with business representatives to understand data marts requirements and priorities and ensure that IT work is appropriately aligned
• Interaction with the business user and the IT team for understanding the requirements.
• Responsible for creating business work flows and processes and creating management reports based on the analysis.
• Used the Rational Unified Process RUP to build the different phases of Software development life cycle.
• Developed this application for management to analyze the market trends, behavior, habits etc by collecting relevant data at various point and organizing the data into appropriate data warehouses and data marts the processing the data into various statistical reports ad-hoc/canned for strategic management decision making by utilizing SAS
• Applying the SQL scripts to the test database and execution of the scripts on the database
• Studied Oracle 11i data elements and provide a mapping from the existing legacy system.
• Worked with ANSI X12 4010 including medical transactions such as 837 medical claims , 835 medical claim payments , 270 eligibility inquiry , 271 eligibility response , 276 claim status , 277 claims status response , 820 enrollment .
• Incorporated HIPAA standards, EDI Electronic data interchange , transaction syntax like ANSI X12
• Worked on Medicaid and other claims processing division of the company.
• Followed the UML based methods using Rational rose to create use cases, activity diagram, sequence diagram, collaboration diagram that include functional and non-functional specifications to hand off to development teams.
• Data mapping, logical data modeling, used SQL queries to filter data within the Oracle database tables.
• Created and tested Scripts for the premium calculations and Claims limits and deductibles Claims calculations .
• Developed Base line scripts for testing the future releases of the application
• Came up with test cases for various reports on the data marts and identified that the test case documents are updated timely.
• Clarified QA team issues and reviewed test plans and test scripts developed by development team and QA team to make sure all requirements have been covered in scripts and tested properly.
• Maintained Test Matrix with the test results obtained.

Environment: Windows XP/NT, UNIX, C , Java, HTML, XML, Java Script, Oracle, Rational Requisite Pro, UML