Professional summary

• 7 years of experience as a Business Systems Analyst with strong knowledge in Health Care Industry.
• Extensive experience with Business Analysis, Rational Unified Process Methodologies and Software Development Life Cycle SDLC Methodologies.
• Developed detailed Requirements specifications through JAD sessions, interviews, on site meetings with business users IT team.
• Proficient in creating and transforming business requirements into functional requirements by using Use cases diagrams, Activity diagram, Class diagrams, Sequence diagrams, Test Cases, Test Plans.
• Strong experience with analyzing business processes and documenting them using MS Visio, MS Powerpoint, MS Excel, MS Project.
• Documented Traceability to ensure all the features for the project has been captured and mapped back to the requirements in the BRD.
• Worked on different EDI healthcare transactions like 837-Institutional, 837-Professional, 835-Claim Payment/Remittance Advise, 270/271-Eligibility Benefit Inquiry/Response, 276/277-Claim Status Inquiry/Response Transactions.
• Detail understanding of ICD 9/ANSI/HL7 to ICD 10/ANSI/HL7 coding standards in Medicare and Medicaid domains of the healthcare industry.
• Proficient in business requirements gathering and writing including the EDI transactions from 4010 to 5010.
• Well Versed on HIPAA regulations and requirements.
• Experienced in working with HL7 Standards.
• Skilled in Interviews, Joint Application Development Sessions JAD , Focus sessions for requirements gathering, analysis and design with stakeholders, SME's, Developers and system architects.
• Experience with claims process and adjudication in the Medicare, and Medicaid.
• Experienced in performing manual testing.
• Excellent communication and analytical skills with problem solving capabilities to interface with stakeholders, business representatives and development teams.
• Quick learner, reliable and confident working independently as well as in a team.
• Exceptional track record for meeting deadlines and submitting deliverables on time.
• Highly motivated team leader with excellent communication, presentation and inter-personal skills, always willing to work in challenging environments.

Education details

Bachelor of Science in Accounting

Technical Skills

Professional Experience

Confidential

Sr. Business Analyst

Responsibilities

• Gathered requirements, conducted meetings and prepared requirement document in initial part of the project.
• Acted as Point of Contact POC for all major critical and high priority tickets providing leadership and facilitation of CIRT critical incident response team exercises.
• Arranged, assigned, adjusted and monitored shifts to have enough coverage during the shift.
• Ensured all issue owners follow ticket guidelines and provides clear action plan to resolve particular issues with dates.
• Worked with Facilitators, SME, Tech Lead, BAT to ensure the issues are moving in correct direction.
• Interacted with PA Ops, Eligibility team, POS team, RNM team, release management, QA, DBA and IW teams to resolve outside dependencies. Setup meetings/discussions as necessary.
• Published ticket priorities for the day based on its criticality and nature of ticket to prioritize the issues and resolve it accordingly.
• Provide regular status reports regarding tickets to management on critical, high and medium issues.
• Coordinate escalation and resolution of major service issues.
• Report promptly to management, critical issues every 2 hour, high issues every 4 hour and medium issues every 8 hour until resolution.
• Investigated about resolved ticket and worked with team members to identify the root cause of an issue and resolution details to provide to senior leadership.
• Ensure that SLAs are met in timely manner. Provide detailed findings and status on all issues in every shift and updated in the SharePoint log.
• Provide 24x7 Production Support on first two weeks of January.
• Provided reject report from IW everyday for tiers 11 and 13 to upper management.
• Ability to work in a fast-paced environment, handling multiple priorities.
• Ability to work in a team.

Environment: Claims Research tool, Teradata, CBM, Mainframe, esd, SharePoint

Confidential

Sr. Business System Analyst

Responsibilities:

• Involved in up-gradation of 4010 transaction to 5010 by conducting Impact Analysis and Risk Assessment and worked on the mitigation plan to avoid the risks.
• Produced for transaction sets 835 and 837 I/P a full gap analysis 4010 vs. 5010 against the documented application 5010 enhancements ensuring the upgraded application included the required changes and additions for 5010 compliancy.
• Involved in one-to-one interview sessions and JAD sessions with stakeholders, SME's and business owners to discuss the scope of the conversion.
• Carried out Risk Assessment, GAP analysis and Impact Analysis for the 4010-5010-conversion project.
• Responsible for soliciting and eliciting requirements for 4010-5010 conversions.
• Assisted in identifying project scope, to conform to the regulatory compliance related to X12 837 I/P and 835.
• Tracking and addressing the problems on timely manner encountered on Acknowledgement 997, Claim Status Inquiry/Response 276/277, Remittance Advice 835, Eligibility Inquiry/Response 270/271, Prior Authorization 278 claims.
• Worked as a liaison among stakeholders both business and IT side in order to elicit, analyze, communicate and validate requirements for changes to business processes.
• Involved in creating Reports and Documents like Requirements Documents, and Management Plan, Issue/Alternatives documents, Project Summary and Plans with formats like PDF, HTML, Excel and Word.
• Prepared UML diagrams Activity diagrams, Sequence Diagrams, Use case diagrams for Extensions.
• Identified the master file changes and builds needed to enable the 5010 format to be utilized.
• Conducted Business Process As Is/To Be sessions with various department directors and staff to ensure the Testing Plan and Test Approach would meet the identified Business Requirements, and the Training Program covered all identified new and changed processes.
• Gathered requirements for impacted system and business areas for ICD-10 and their needs to embrace the changes.

Environment: MS-Office, MS Word, Quality Center, MS Access, MS Sharepoint, UAT, HTML, XML, Java Script, Java, ASP.

Confidential

Sr. Business System Analyst

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.
• Conducted Risk analysis and developed mitigation plans.
• Conducted Impact analysis when there is any change in the requirements and updated the Business Requirements Document BRD and Systems Requirements Specification SRS .
• Facilitated meetings with the technical team and client team to analyze the current process and gather requirements for the proposed process.
• Used detailed knowledge of the application features and functionality to assess the scope of the business needs throughout the analysis and completion of enhancement specification.
• Conducted Business Impact Assessment and the results were compared with the EHR standards to determine the current level of compliance and developed an action plan for approval by the project steering committee.
• 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 for the EHR and HIPAA compliance.
• Involved in the analysis of HIPAA compliance and EDI transaction sets and actively participated in the designing of the EDI transactions using the new HIPAA 5010 utilizing the ICD-10 codes.
• Involved in the transitioning of the ICD-9-CMto ICD-10-CM/PCS codes.
• Proposed strategies to implement HIPAA 4010 in the new MMIS system eventually move to HIPAA 5010.Facilitate HIPAA integration and applied ANSI ASC X12 standards for 837 P, I, D , 270/271, 276/277, 278, and 835 transactions.
• Documented the process flow Business Use Case for the EDI transaction 835, 837 tagged them in RequisiteProDesigning Functional Specifications for the target physical database.
• Facilitated JAD sessions for Requirement Validation with Dept. Of Health Human Services DHHS to gather requirements for the new MMIS.
• Analyzed different data crosswalks, complicated logic look ups required by different fields for the source to target transformations.
• Analyzed EDI X12 data elements captured by the existing system to validate it against the data elements required for new system.
• Developed and maintained a requirements work plan and assessed the performance metrics of the team members.
• Worked with legacy team in developing BRD for multiple system change requests and participated in system testing.
• Developed UAT test cases associated with the functional requirements.
• Maintained a bi-weekly status report for the requirements team and incorporated the same to the PMO status reports send to CMS.
• Participated in developing test plan, test scripts, and test scenarios and designed user documentation.

Environment: UML, Windows, Mainframe, SQL, Microsoft Office, Test Director, Rational Unified Process RUP , MS Access, HTML, XML, Java Script, Java, ASP, DB2.

Confidential

Sr. Business Systems Analyst

Responsibilities:

• Acted as a liaison between business and development team.
• Gathered Business Requirements from the SMEs and documented it in the BRD and createdService Level Agreements SLA for 5010.
• Used Agile Methodology to configure and develop process, standards and proceduresFacilitated and managed JAD sessions with various stakeholders, development QA team and prepared Business Requirement Documents, and Functional Specification Documents.
• Responsible for the full HIPAA compliance lifecycle from gap analysis, mapping, implementation and testing for Medicaid Claims.
• Attended daily SCRUM and guided QA and Developer regarding the defects, Technical Specification Documents and Mapping Documents.
• Prepared Data flow diagram, sequence diagrams and business process models that would comply with ICD-10.
• Responsible for the full HIPAA compliance lifecycle from gap analysis, mapping, implementation and testing for processing of Medicare/Medicaid Claims.
• Gained experience on Claims Billing, Claims, Payment Processing in relation to HIPAA, EDI 4010 codes 834, 835, 837.
• Proficient in gap analysis and impact analysis for the new Medicare PPO product.
• Documented test plan, test cases and test summary to ensure the desired application functionality.
• Analyzed functional test cases to confirm the expected outcome and behavior.
• Executed SQL queries to test the database for records that detect and submit functional acknowledgement and remittance advice in the claims application.
• Prioritized outstanding defects and system problems, ensuring accuracy and deadlines were met.
• Maintained the Traceability Matrix table to uniquely trace the identified business requirements to general design to testing as proof that requirements requested have been developed into a solution and that it has been tested and tracked.

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

Confidential

Business Analyst

Responsibilities:

• Writing the detailed user needs, Gathered requirements during inception phase, documented and delivered functional specification documents, and assisted architecture analysis and design using UML and Rational tools.
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, andOOD Object Oriented Design using UML and Visio.
• Identified, researched, investigated, analyzed, defined and documented business process and Use Case scenarios.
• Conduct workflow, process diagram and GAP analysis to derive requirements for existing systems enhancements.
• Worked on insurance data related to Medicare, Medicaid, and Insurance claims.
• Worked on HL7 to provide framework to carry out transfer of electronic healthcare information.
• Helped manage risk analysis and mitigation plans, status reports, and client presentations prepared business process models, defined milestone deliverables, and established critical success factors.
• Functioned as the primary liaison between the business line, operations, and the technical areas throughout the project cycle.
• Formulating the systems of project to parallel the business strategies.
• Analyzed research on operational procedures and methods and recommended changes for improvement with an emphasis on automation and efficiency.
• Wrote SQL queries in MS Access for data manipulations.
• Assist with user testing of systems, developing and maintaining quality procedures, and ensuring that appropriate documentation is in place.
• Develop the test plan, test conditions and test cases to be used in testing based on business requirements, technical specifications and/or product knowledge.
• Used Test Director with QA team for testing.
• Interfaced with SME's to prepare BPR documents for ongoing projects.

Environment: RUP, MS Project, ANSI X12 EDI, Rational Rose, HP Service Desk, MS Visio, MS Word, MS Excel, Medicare, Medicaid, Rational Requisite Pro, SQL.

Confidential

Business Analyst

Responsibilities:

• Gathered requirements and communicated product roadmap by engaging key customers.
• Worked together with stakeholders to get a better understanding of client business processes and gathered requirements.
• Involved in creating Business Flow Diagrams, Dataflow diagrams, UML Activity diagrams and USE cases diagrams using MS Visio.
• Involved working with different HIPPA-EDI ANSI X12 Transaction Code sets.
• Organized JAD sessions for documenting AS-IS and TO-BE scenarios for Electronic Health Records project.
• Organized and facilitated meetings with the management and development teams.
• Tracked stakeholder requested enhancements and changes using Requirement Traceability Matrix RTM .
• Used agile methodology during entire SDLC.
• Worked on EDI transactions: 270, 271, 276, 277, 834, 835, and 837 P.I.D to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
• Translated the business needs and objectives on how to respond to coverage inquiries from both internal and external sources into requirements. Organized benefits structure to ensure accurate claims processing.
• Defined test cases, created test scripts and interacted with QA / development teams in identifying and resolving errors and in User Acceptance Testing UAT .
• Worked on complex business problems, analyzing and evaluating current business methods and procedures for improvements.
• Mentoring end-users on requirements specifications techniques and the software development life cycle SDLC .
• Involved in creating requirements that comply with HIPAA, HL7, and ANSI X12 format regulations to protect the privacy of the employee insured under any policy.

Environment:Requisite Pro, Rational Rose, Mainframe, ClearCase, Clear Quest, MS Visio, MS Access, MS office, MS excel, MS word.

Confidential

Business Analyst

Responsibilities:

• Involved in development documentation of Software Requirements Specification SRS and using Rational Rose.
• Handled requests for proposals, making presentations to customers, and negotiating project timelines and deliverables.
• Created different Traceability views to maintain the Traceability of the requirements.
• A major part of the responsibility included interacting with the users and business relationship managers and implementing changes on the database in order to ensure approval.
• Implemented SDLC which included requirements, specifications, design, analysis and testing utilizing RUP methodology.
• Involved in GUI Testing, Unit Testing, System Testing, Integration Testing, Regression Testing , performance Testing.
• Performed Gap Analysis to check the compatibility of the existing system infrastructure.

Environment: MS-Office, MS Word, UAT.