PROFESSIONAL SUMMARY

• Over 6 years of comprehensive experience as a Business Analyst in Healthcare and Retail E-Commerce industry.
• Proficient in business process engineering and software development life cycle methodologies such as Waterfall, RUP and Agile including analysis, design, development, testing and implementation of software.
• Experienced in facilitating JAD sessions, Scrum sessions, Requirement elicitation sessions, Interviews and Focus Groups.
• Skilled in translating business objectives into prioritized functional requirements and recommending feasible solutions to the business problems.
• Authored multiple Business Requirement Documents BRD , Functional Requirement Documents FSD , Project Requirement Documents PRD , and Functional Specification Documents FSD .
• Extensive knowledge of Object Oriented Analysis and UML Design using Rational Rose, CaliberRM, and MS Visio to create Use Case Diagrams, Activity Diagrams, Swim Lane Diagrams, Sequence Diagrams, Process Flow Diagrams, Data Flow Diagrams, Wireframe Diagrams, and Entity Relationship Diagrams.
• Ability to write SQL queries to extract data from production and Business Intelligence databases.
• Prepared presentations, reports, tables, graphs, and observations to present clinical/consult/claims data or results.
• Experienced working in a Managed Care and government health programs e.g. Medicare/Medicaid .
• Extensive knowledge of healthcare claims processing including EDI transactions 820, 835, 837, 270/271, 276/277, and 998/999 , HIPPA 4010/5010, and ICD-10 implementation.
• Experienced in developing Test Cases, Test Scripts, UAT Plan and Test Plans based on both business and system requirements.
• Possess very good organizational and communication skills, with the ability to multi-task and deal with shifting priorities.

COMPUTER SKILLS

Confidential

Sr. Business Analyst

The project was to upgrade their proprietary claims platform to be compliant with ICD-10. Project also involved mapping EDI transactions for multiple inbound transactions from trading partners.

Responsibilities:

• Performed root cause analysis on denial claims for rejections based on new ICD-10 adjudication.
• Performed impact analysis for readiness of ICD-10 conversion and dual processing to continue run out of ICD-9 claims.
• Worked closely with adjudication department to research complex claims inquires that would require customized communication responses for auto-adjudication failures.
• Conducted JAD sessions with business and IT to highlight impacts of ICD-10 transition and obtain detailed requirements to finalize business requirement document BRD .
• Researched reporting department impacts of ICD-10 by conducting detailed SQL queries on test and production claim records.
• Created GAP analysis and mapping documents for 837I and 837P to ensure that all existing information was being submitted.
• Led meetings as the project SME with work-stream owners of different functional areas such as Claims, Benefit and Provider Configuration, Member Enrollment, Special Populations to engage them in procedural support for User Acceptance Testing UAT .
• Prioritized and Communicated open issues and project risk/mitigation plans to UAT teams.
• Worked closely with QA Team to prepare detailed test cases by analyzing technical requirements and ensuring requirements traceability using HP Quality Center.

Environment: Waterfall, MS Office, SharePoint, Quality Center, DB2 and MS Visio

Confidential

Sr. Business Analyst

The project was to upgrade the system from HIPAA 4010 to 5010 standards which included the NCPDP conversion for drug claims. The project goal also included receiving, documenting and processing the claims including eligibility verification involving changes in policies, rules regulations due to the business necessities.

Responsibilities:

• Utilized Waterfall Methodology to configure and develop process, standards and procedures.
• Conducted requirement sessions, workflow diagrams, UML diagrams, process models, activity diagrams, use cases for incorporating design changes in the order creation/ management system.
• Actively participated on creating Migration strategy from existing PDE Microsoft Access files to Gold Data Repository.
• Clearly understood coding standards required for all Medicare Part D Users transactions involving electronic data interchange as provided by department of health and human services and incorporated at every stages of the project wherever found necessary.
• Prepared the Business Requirement Document BRD and Functional Requirement Document FRD for the enhancement of the existing services.
• Analysis and Design of existing transaction sets, and modification of these transaction sets to ensure HIPAA compliance.
• Conducted data analysis, created data mapping and data interface documents to aid in documenting requirements and functional specifications.
• Involved in forward mapping EDI transactions from 4010 to 5010 and backward mapping from 5010 to 4010.
• Attended meetings with QA and Developer to discuss defects, bug fixes and testing updates
• Provided Production support and post-production support/explained the changes to the business users/did one on one sessions/one to many sessions to make the business uses aware of the system changes.

Environment: Waterfall, MS Visio, MS Office, HPQC, PeopleSoft and SharePoint

Confidential

Business Analyst

The project was to enhance the product detail pages on the e-Commerce site including search and product information to improve site navigation.

Responsibilities:

• Facilitated JAD sessions with team leads and development team to determine high level functionality and to determine system level requirements.
• Drafted Requirements Documentation Scope Document, Use Cases, Business Requirement Documents BRDs , Functional Requirement Documents FRDs and User Interface Documents.
• Worked with web designers to create HTML screen prototypes and wire frames.
• Participated in requirement walkthroughs with offshore development team before development started and with QA team before test scripts were written.
• Worked on gathering requirements by analyzing the existing system and holding meetings with various SMEs and technical architects for the business application using RequisitePro.
• Conducted JAD sessions to resolve the conflict arising from ambiguous requirements.
• Created the process flows, Use Cases and Use Case Diagrams, Activity Diagrams using MS Visio.
• Involved in Reviews of Test Cases/Scripts and track them to closure.
• Responsible for defects tracking and reviewing them with the QA team using Quality Center.

Environment: RUP, Windows XP, MS Suite, Requisite Pro, SharePoint and HPQC.

Confidential

Business Analyst

• The Scope of the project was to identify the plan codes that have been exposed to the juvenile tobacco compliance issues and offer refunds to policy holders who have passed the age of majority and mail future lower Cost of Insurance COI rates for insured juveniles. Responsibilities:
• Facilitated joint requirements planning sessions with the business unit to gather requirements and conduct requirements sign-offs.
• Created User Stories that were prioritized through analysis of project-critical milestones and then developed as per the agreed iterations and sprint backlogs, in collaboration with Cross-functional teams.
• Managed JAD session with the Project Managers, developers, SMEs and testers for the project to ensure understanding and implementation of critical success factors.
• Involved with Technical Team to design and deploy Web Services/ Service Oriented Architecture for communication between application servers to save cost, and maintain reusability of the code components.
• Created a traceability matrix from business requirements of a 3rd party vendor.
• Extracted data thru SQL queries for data validation.
• Collaborated with DB team in data mapping, field mapping, data integration and data warehousing
• Collaborated with the QA team in the development of Test Cases for UAT, SIT, and system testing for creating the Test Plan and evaluate Acceptance Criteria thru consultations with SMEs.

Environment: Agile, CaliberRM, MS Office, MS Project, Visio, SharePoint and HPQC

Confidential

Business Analyst

Confidential is the premier direct seller of high quality kitchen tools. The project aimed at re-deploying the web portal with new enhancements also integrated various internal systems, processes, and SOPs with it to achieve a higher level of efficiency in assuring a rich, satisfying experience for external, as well as internal users.

Responsibilities:

• Assisted the Program Manager in defining, documenting, and implementing success milestones for the Project's critical path, and target-dates for the complete SDLC.
• Analyzed and mapped the As-Is business processes, compare them to the To-Be state, thereby defining the GAP, and then create the new Process flow diagrams, which would result into the desired data-flow.
• Gathered requirements and created a data mapping document.
• Coordinated between teams to clarify GAP's, and find resolutions conflicting issues by investigating and highlighting the discrepancies when found.
• Drafted Use Cases when needed for the functionalities under test, in collaboration with the Business SMEs.
• Created UAT Test scenarios, UAT Test Scripts and monitored the results for any bugs and assisted developers with next steps.
• Actively helped the UAT Business lead in conducting smooth and successfully completed UAT.

Environment: Agile, JIRA, Java, SQL, Quality Center, MS Project and MS Office.

Confidential

Business Analyst

The project's main purpose was to increase the efficiency and throughput on payments from carries. In addition the scope was expanded to improve the tracking processes for medical claims submitted to the carriers.

Responsibilities:

• Conducted GAP Analysis to understand the reason for delays in submitting claims to the carriers and documented findings.
• Heavily involved in authoring the Project Standards, Project Charter and Project Scope documents.
• Organized requirement gathering sessions with stakeholders to get a better understanding of claims processes and gathered requirements to create the Business Requirement Document BRD .
• Conducted user interviews to analyze the requirements and managed changes by implementing a formal change management methodology using SharePoint.
• Created current and future state Process flow diagram using MS Visio and conducted walk-through sessions of the process flows with the vendor and client to validate them.
• Tracked stakeholder requested enhancements and maintained changes using Requirement Traceability Matrix RTM .
• Assisted the project manager in developing and updating timelines for project delivery, implementing milestones, managing risks, issue and resources for successful completion of the entire project by using MS Project.
• Continually interacted with the business and technical teams to ensure consistency in ideas and other work processes related to the project.
• Coordinated and performed UAT User Acceptance Testing to assess if the system could support day-to-day business and user scenarios and ensure the system was sufficient and correct for business usage.

Environment: Waterfall, MS Visio, MS Share Point, MS Office, Oracle Database and QTP.

Confidential

Business Analyst

Project was to enhance the functionality of ecommerce website for Green Mountain Coffee Roasters which would enable the customers to apply discount coupons for the purchases done in various currencies.

Responsibilities

• Gathered high level business requirements from Subject Matter Expert's located in USA, Europe, Asia and Canada and documented those requirements through JAD sessions, surveys, face to face interviews and conference calls.
• Extensively utilized wireframe diagrams, data flow diagrams, use case diagrams and process flow diagrams to represent information provided by the business owners.
• Led the Change Control Process for changes submitted for the BRD after initial sign off with all the stakeholders.
• Maintained the Traceability Matrix to uniquely trace the identified business requirements from general design to testing.
• Performed accurate and efficient data testing and maintained information on bugs using a defect tracking log.
• Worked with the UAT and QA teams to conduct an assessment and determine how effective UAT and QA guidelines could help the company achieve timely completion of projects.

Environment: RUP, Word Excel, PowerPoint, Rational Rose, RequisitePro, SQL and Oracle.