SUMMARY

• 8 years of industry experience as a Business Analyst with solid understanding of Business Requirements Gathering, Business Process Flow, Business Process Modeling and Business Analysis.
• Worked on Health Insurance Exchange HIX , Health Care Reform PPACA , ICD-10, Medicare/Medicaid, EDI transactions 837,835,270/271,276/277,999
• Worked on industry standard methodologies like Software Development Life Cycle SDLC , Rational Unified Process RUP , CMM Capability Maturity Models , and Capability Maturity Model Integration CMMI and Six Sigma and Rational Tools used during various phases of RUP.
• Excellent team player work in conjunction with testing, development and other teams in validation and testing complex scenarios and projects and in the maintenance of Quality Standards in Projects.
• Adept at implementation of HIPAA 4010 and HIPAA 5010 changes in the existing claim processing integrated system.
• Sound knowledge of HIPAA, HL7, LOINC, ICD9 CM, EDI, HMO, PPO, Medicare, Medicaid, Sarbanes-Oxley Act SOX .
• Experience on bridging the gap between Business/Product department and IT.
• Familiar with current industry standards such as ISO, Six Sigma, and Capability Maturity Model.
• Result oriented, committed and hard working with a quest to learn new technologies and undertake challenging tasks.
• Proficient in Developing and executing Test Plans, performing functional, usability testing and ensuring that the software meets the system Requirement.
• Excellent team player work in conjunction with testing, development and other teams in validation and testing complex scenarios and projects and in the maintenance of Quality Standards in Projects.
• Extensive experience with MS Visio for drawing flow charts and screen mock ups and MS Project for status reporting and planning.

AREAS OF EXPERTISE

P R O F E S S I O N A L E X P E R I E N C E

Confidential

Sr. Business Analyst

Responsibilities:

• Conducted GAP Analysis Data mapping for ICD-9 to ICD-10 implementation as well as also developed RFP for vendor analysis
• Captured detailed BRD/FRD for ICD-10 conducted testing: SIT/UAT: Test-Plan development/Test-Cases development/Test-Data creation etc
• Used IBM Curam for handling eligibility and entitlement requirements, plan management etc.
• Developed BRD for HIX and conducted data mapping as well as developed Use Cases/Activity Diagrams.
• Worked on HIPAA Transactions 270, 271, 276, 277. 837I/P/D and 835R
• Actively involved in Curam product demo's in the organization.
• Conducted ICD9 to ICD10 mapping using GEMS crosswalk file.
• Captured detailed requirements, gap and impact analysis for Health insurance exchange FFM project.
• Followed CMS guidelines for capturing clear and feasible requirements for HIX.
• Identified and document Project constraints and assumption.
• Did Business Modeling by understanding the needs of the business, and also documented Business Use Cases as well as System Use Cases
• Used IBM Curam for streamlining requirements gathering process, design documentation etc related to CHIP, HIX etc.
• Facilitated Joint Application Development JAD sessions with the Management, Mainframe and HIPAA team to make sure everyone are in synchronous with the business requirement processes.
• Used MS Visio to create Use Cases, Activity Diagrams Sequence Diagrams for HIX.
• Prepared Functional Specifications document, solution design documents as per the client need
• Created and Maintained the Requirement Traceability Matrix RTM throughout the project.
• Initiated Test Plans, developed and executed test cases and scenarios, worked with users to develop specific acceptance criteria and prepare test scenarios/test cases.
• Conducted User Acceptance Testing UAT sessions with business users and prepared document for enhancements and bug fixes.

Environment: Rational Rose, Rational Requisite Pro, UML, XML, XSLT, MS Project, MS Visio, MS Office Suite, PL/SQL Developer, HTML, Visual Basic, SQL, Toad, Windows XP, Unix, HIPAA, IBM Curam, Outlook, Test Director, Oracle, Ultra Edit, XML.

Confidential

Sr. Business Analyst

Responsibilities:

• Created and managed project templates, use case project templates, requirement types and traceability relationships in MKS Integrity.
• Mapped EDI 4010 transactions: 837I/P/D, 270/271, 276/277 to HIPAA 5010 as per CMS Mandate did GAP analysis
• Conducted meetings with SME's to understand current business process and performed Gap Analysis to meet future business needs.
• Traced High Level Requirements HLR to Detailed Level Requirements DLR .
• Performed Requirement Analysis and developed Use Cases and Activity Diagrams.
• Worked on the PPACA for various mandates such as Grandfather Rule, Rescissions, D-26, Pre Ex-19, Preventive Care, Operating Rules, and Early Retirees Fund etc.
• Responsible for creating test scenarios, scripting test cases using testing tool and defect management for Policy Management Systems, Payables/Receivables and Claims processing.
• Responsible for integrating with Facets. Designing test scripts for testing of Claims in Development, Integration and production environment.
• Responsible for gathering and documenting Legislative, Business, Functional requirements for all the provisions and their impact on the existing products and systems.
• Developed Systems Specifications document to define the impact of the new requirements on the existing system.
• Developed and managed creation of product documentation to communicate features, benefits, positioning and impacts to different audiences and ensured that documentation deliverables from various groups are produced as needed.
• Created Business Requirement Document BRD , Functional Requirement Specification FRS document, User Requirement Specification URS and Change Request CR document for system application development.
• Wrote test cases and test scripts for SIT/UAT

Environment: Requisite Pro, Rational Rose, XML, Clear Case MS Office, MS-Visio, XML, Java, TOAD, Quality Center, MS Project, SOA.

Confidential

Business System/ Analyst

Responsibilities:

• Followed a structured approach to organize requirements into logical groupings of essential business processes, business rules, and information needs, and ensured that critical requirements are not missed.
• Captured Medicaid specific business requirements and developed BRD's, functional specification document.
• Facilitated collection of Functional Requirements from system users, and prepared Business Requirement documents and have applied the RUP model throughout the entire development and testing process.
• Prepared Logical Process and Data Models that contained set of diagrams and supporting documents containing the essential business elements, detailed definitions, and descriptions of the relationships between the data elements to analyze and document Business Data Requirements.
• Worked on MITA for MMIS upgrade as per the client requirement.
• Did data mapping, cross-walk analysis and GAP analysis for the processes.
• Used Rational Clear Quest to maintain and track the requested enhancements and changes by the stakeholders.
• Followed the UML based methods using MS Visio to create Use Case Diagrams, State Chart Diagrams and Sequence Diagrams.
• Worked closely with the offshore team to convey Technical and Functional specifications.
• Worked on 837I/P/D and 835 transactions as well as devised process flows for Claims Processing System
• Detailed understanding of business functionality and preparing the Functionality Test Plan
• Interacted with Product Manager and Domain Experts to understand various process plans, business process, and functionality in detail.
• Responsible to conduct walkthrough sessions to get Business Sign off for the FRD.
• Meetings with Developers, Team Leads to help them understand the requirements.
• Interacted with the Testing and Development team to resolve and follow up on development issues.

Environment: MS Office Tools, Windows XP, MS Project, Requisite Pro, Rational Rose, Clear Case, MS Power point, MS-SharePoint, MS-Word, MS-Excel, Business Objects, XML