SUMMARY

• 8+ years’ experience as Business Analyst/System Analyst/EDI Analyst professional with proven abilities in leveraging technology to achieve business - driven objectives, manage competing priorities, solve complex problems, and define requirements to bridge the information gap between non-technical and technical staff.
• Proven ability to define requirements and Test strategies to major projects like EDI upgrade, ACA, ICD10, conducting Trading Partner Testing (Provider Testing), Medicaid, and Medicare membership, Performing SIT and supporting UAT efforts for various business groups/ LOB’s.
• Experience in all phases of software development life cycle (SDLC), Optimized waterfall, Agile, Scrum including Requirement gathering and documentation, Use Case Documentation, Business Case Study/Analysis and user stories.
• Experience in developing and writing functional business requirement, Scope documents, Gap and Risk analysis documents,
• Expertise in generating various reports to assist with validating Reconciliation reports for claims and also Daily Outstanding Reports
• Experience in working on multi-channel cross-platform web applications, supporting implementation of new and existing products, ensuring requirements delivery on budget, time and quality for the agreed upon scope.
• Experience in Software Quality Assurance with excellent understanding of Software Testing Life Cycle (STLC), Change Control management, Defect Tracking, and reporting.
• Experience in conducting JAD sessions for project definition involving analyzing requirements, creating user interface (UI) prototypes.
• Excellent knowledge of Health Insurance Portability and Accountability Act (HIPAA) transaction and code set rules such as EDI 837,834,835.
• Extensive knowledge, and experience on Medicaid, and Medicare Part A, Part B, Part C, and Part D, and Medicare advantage plans.
• Experience in implementation ofHIPAA 4010andHIPAA 5010changes in the existing claim processing integrated system.
• Good understanding of ICD 9, ICD 10, HCPCS, and CPT.
• Highly experienced with requirements gathering, planning, organizing, and Change Management.
• Experience with Rational Tools including Rational Requisite Pro, Rational Rose.
• Extensive exposure to SDLC Methodologies like Rational Unified Process (RUP) Agile, Waterfall, Spiral.
• Experienced in GAP Analysis, Traceability Matrices, SWOT and Cost Benefit Analysis.
• Experience with User Acceptance Testing (UAT), Unit Testing, application testing, integration testing, Black box testing.
• Designed and implemented basic SQL queries for QA testing and report / data validation.
• Experience with PL/SQL and MS Access database and MS office.
• Developed Process flows, use case diagrams, class diagrams, sequence diagrams, collaboration diagrams, state diagrams and activity diagrams using UML to make users and developers understand the system.
• Practical understanding of the Data modeling (Dimensional & Relational) concepts like Star-Schema Modeling, Snowflake Schema Modeling, Fact and Dimension tables.
• Experience in extracting, transforming and loading (ETL) data from spreadsheets, database tables and other sources using Datastage.
• Understanding the Business Architecture and Business Processes of technology network like insurance, banking, finance, and investment industry.

TECHNICAL SKILLS

Process/Model Tools: MS Word, Excel, PowerPoint, Visio, Toad, Agile Methodology, Scrum, Rational Unified Process (RUP), Rational Rose, Rational RequisitePro, Rational Clear Case, UML, Use Case Diagrams, Sequence Diagrams, Excel VBA, Activity Diagrams, MS Office, Google Analytics.

Reporting Tools: Crystal Reports, OBIE.

Test Tools: ALM (Application Lifecycle Management), Bugzilla, Jira

Operating System: Unix, Windows NT/2000, Windows XP, IBM Mainframe

Languages and tools: C programming, IBM mainframes, DataStage.

Databases: Oracle, SQL Server 2000, 2005, 9g, 10g, My SQL.

PROFESSIONAL EXPERIENCE

Confidential, Chicago, IL

Business Analyst

Responsibilities:

• Engage business stakeholders to gather software requirements/business rules, and ensure alignment with development teams.
• Translate Business needs into functional requirements, use cases, user stories, workflow/process diagrams.
• Identify system and data requirements for the project and engage appropriate stakeholders to ensure those needs are met.
• Support all levels of testing including functional, regression, user acceptance, system integration and performance to verify the client’s needs are met.
• Identify risks related to requirements implementation and ensure project management is kept up to date on assigned tasks, issues, risks and key decisions.
• Facilitate meetings to discuss complex situations with business stakeholders and external vendors and explore potential solutions.
• Monitor and report defects, review open issues with stakeholders to set priority and ensure speedy resolution.
• Prepare presentations for business, give demo to sales and marketing team for assigned products.
• Participate actively in focus groups and process improvement meetings.

Confidential, Chicago, IL

SDO Tech Business Analyst

Responsibilities:

• Responsible for making and maintaining necessary changes for claims finalization tasks using Blue-chip (core enrollment and adjudication system).
• Responsible for cost containmentfor investigating the eligibility of Institutional in Confidential t hospital stays and specific Institutional out Confidential t diagnostic procedures
• Develop business analysis using requirements such as scope, processes, and risks assessment.
• Worked on Healthcare experience management rules cleanup and DCDD updates.
• Establish requirements with using ALM to ensure it is written for the business needs.
• Gathered requirements from Business Partners, Business Managers, Stakeholders, and SME’s.
• Conducted Joint Application Development (JAD) sessions with stakeholders.
• Involved in walkthroughs and meetings with development team to discuss related issues.
• Maintained Requirement Traceability Matrix (RTM).
• Involved in the creation and maintenance of the Workflow plans and artifacts.
• Modified existing workflow to accommodate change request from the client.
• Updated Impact and Trace Matrix.
• Participated in functional and technical reviews.
• Worked with QA team to design test strategy and test cases for User Acceptance Testing (UAT).
• Resolve and process different types of claim audits.

Environment: BlueChip, CLAIMS GUI, PREMIER, Agile, Waterfall, ALM, ARIS, JIRA, SharePoint, Super Scrubber, Splunk, UML, Use Case Analysis, MS Visio, MS Project, MS Office, One Note, BAM.

Confidential, Chicago, IL

Business Analyst / Quality Analyst

Responsibilities:

• Worked with TMG (External vendors), and internal user teams to fix membership for Medicaid and Medicare members.
• Worked on gathering requirements to automate the process of co-ordination of benefits.
• Planned and prioritized user stories for a 2 week Sprint with Product Owner.
• Facilitated daily Stand up meetings, and worked on resolving Impediments.
• Create provider testing documentation and checked patterns in data submitted by providers that have completed their own internal testing.
• Log and track provider testing issues and risks in ALM. Provided instructions to claims examiners when test claims may be adjudicated
• Created provider test summary report every month as a part of deliverables to key stakeholders.
• Assisted in designing policies and procedures to protect the privacy of Electronic Protected Health Information to ensure data integrity as per HIPAA guidelines
• Involved profoundly in theGAP Analysisof thetransitionfromHIPAA and Impact Analysis focusing on how current transactions and system was going to be effected by the new5010compliance.
• Analyze EDI data elements captured by the existing system to validate it against the data elements required for new system.
• Conducted GAP analysis and assessed the status of the organization to determine the scope of the application
• Designed and developed Use case diagrams, Activity diagrams, and Sequence diagrams using UML
• Reviewed detailed test cases with in-depth description of each test scenario of the system according to HIPAA guidelines.
• Facilitated JAD sessions with stake holders, developers, systems analyst and testers to collaborate resource allocation and project completion using MS Project.
• Collected and documented business processes as well as business rules. Conducted meetings and workshops to discuss high level requirements and developed User Requirement specification Document (URD).

Environment: Agile methodology, Windows, MS Office, Rational Requisite Pro, IBM Mainframes, EDIFECS,HIPAA, UML, SQL, SWOT analysis, JIRA,, Sprints.

Confidential

Business Analyst/ Quality Analyst

Responsibilities:

• Responsible for Coordinating deployments to various test environments (UAT, SIT (Pre production and Production support environments)
• Responsible for designing and supporting the Claim adjudication process Testing for ICD10 upgrade, and for Retail claims.
• Responsible for Smoke Testing to ensure environment is ready for various releases supporting UAT for 837 - ICD 10 upgrade
• Responsible for Testing of EDI 837I/P claims transactions
• Responsible for testing EDI 27XI - Inquiry Transactions
• Tested 834 and 820 Transactions
• Responsible for ICD10 Testing for multiple applications during 5010 upgrade and also during the 2014 hold on ICD-10
• Tested ACA/ HCR/ Obamacare Issuer Portal and Memberships and products
• Responsible for coordinating efforts across multiple test environments
• Responsible for Testing of 835 - Remittance transactions
• Hosted meetings to discuss various CR’s with the development, BA’s and Business along with the test team to better understand the requirements
• Hosted JAD sessions for all FACETS refresh’s
• Responsible for publishing multiple (Daily/ Weekly) reports (Progress, 4-BOX, Daily Trend reports, etc) throughout the testing cycles
• Created test strategy for various E2E activities involving business and IT
• Closely monitored SLA’s on production tickets and also for testing defects
• Documented Key learning’s from each release and discussed with all project teams and assigned each item to the appropriate team for improvement
• Set up a process to create a business process after each release to help new resources
• Hosted various meetings/ Working sessions with the business when there are limited Business requirements or when the requirements are constantly changing

Environment: Agile methodology, JIRA, Facets 4.7, UNIX, Oracle 10G, TOAD, EDIFECS, Mainframes, XML,HP Quality Center 11.0, MS-Project, MS-Office

Confidential, Dayton, Ohio

Business Analyst

Responsibilities:

• Conducted JAD sessions for evolving the requirement list into functions and business rules.
• Participated in daily scrum meetings to effectively communicate the progress and road blocks in order to deal with the constantly changing requirements by presenting views to document and upgrade these changes in the process flow.
• Performed Data mapping, logical data modelling, created class diagrams and ER diagrams and used SQL queries to filter data.
• Maintained and documented current and to-be CRM process flows.
• Identify business rules for data migration and Perform data administration through data models and metadata.
• Identified, researched, investigated, analysed, defined and documented business processes and Use Case Scenarios.
• Determined and documented the As-Is and the To-Be (future) business process flows using MS Visio and maintained the requirement traceability.
• Performed extensive Requirement Analysis including data analysis and gap analysis
• Functioned as the primary liaison between the business line, operations, and the technical areas throughout the project cycle.
• Participated in developing test plan, test scripts, and test scenarios and designed user documentation.

Environment: Waterfall methodology, Windows, MS Office (MS Word, MS Excel, MS PowerPoint, MS SharePoint, MS Access, MS Visio), Oracle, UML, SQL, SWOT analysis, GAP Analysis, Quality Center.