PROFESSIONAL SUMMARY

• Over 9 years of extensive experience as a Business Analyst/Business System Analyst in Healthcare using IT Business Analytics, Modeling expertise, and SDLC.
• Experience in working in all phases of project life cycle. Proficient in different SDLC methodologies such as Agile trained in Rally and MS Version one , Waterfall, RAD and RUP.
• Expertise in gathering business requirements and conducting workshops and JAD sessions involving company employees and end users.
• In depth knowledge of health care basics including Medicare/Medicaid, HIPAA 4010-5010, ICD9 and ICD10, and EDI Transactions.
• Excellent work experience in creating Project Plans, BRDs, FRDs, Use Cases, Activity Diagram, Requirement Traceability Matrix and Test Plans.
• Experienced in ensuring quality, budget and timeliness of the project.
• Good communicator, coordinator and organizer.
• Proficient in interacting with the Technical Teams and Developers and converting business needs to technical specs for their understanding.
• Very creative, self-motivated, flexible, knowledgeable, hardworking, patient and detail oriented person.
• Have strong interpersonal skills with ability to resolve issues. Analytical, methodical, and resourceful approach to problem solving, identifying root causes and corrective actions to meet short and long-term business, financial, and system requirements.
• Experience in project planning, management and project plan development in Microsoft project.
• Capable of writing basic SQL queries.
• Experienced in executing test plans, test cases, test results analysis with the testing team and reporting defect management and test status matrices.
• Experience in planning, documenting and conducting User Acceptance Testing for software application.
• Excellent communication and presentation skills.
• Experience working with business users as well as senior management.

TECHNICAL SKILLS

PROFESSIONAL EXPERIENCE

Confidential

Sr. Business Analyst

The project was to develop a Claim Management Application on Optum Cloud to improve the amount of information UHG proactively shares with providers including line-by-line payment explanations including contract information, payment policy, medical policy, Explanation of Benefits EOB and payment records.

Responsibilities:

• Responsible for gathering and developing business requirements, writing user stories, documentation and test plans.
• Used Agile methodology with extensive training in Rally tool. Conducted sprint planning and sprint review meetings.
• Conducted every day scrum calls and review of developed product.
• Responsible for planning sprints for application development. Grooming, developing and assigning planned epics and user stories for new sprint.
• Closely involved with software development team in assigning tasks and understanding technical needs and providing documentation.
• Co-ordinated with Business and development team to convey business needs and end user sentiments.
• Follow HIPAA compliance and other security issues to safe guard patient information.
• Performed Mapping, Gap analysis and feasibility studies for web service call response and UI display.
• Developed PRDs, SRDS and traceability matrices
• Developed and maintained flow diagrams for understanding the newly developed application. .
• Involved in writing and reviewing test cases during application development based on user stories. Used Quality center as a testing tool.
• Created User acceptance testing UAT plan and detail documentation for the Claim Management application.

Environment Agile trained in RALLY , .NET, MS Project, MS SharePoint, MS Excel, MS PowerPoint, MS Visio, WebEx, SQL, MS Access.

Confidential

Sr. Business System Analyst

The project was to provide web based revenue cycle automation and management solution to its clients on demand basis. The main objective of the application will be to maintain patient related information and account receivable to increase collection from insurance companies. HIPAA compliance was needed in all processes from tracking medical claims, sending it to the insurance company and follow up and closing of the claims.

Responsibilities:

• Responsible for developing and reviewing business requirements, functional specifications, project schedules, documentation and test plans.
• Closely interacted with designers and software developers to understand application functionality, navigational flow and updated them about end-user sentiments.
• Collecting information from various insurance companies to be able to develop an application for checking the outstanding balance.
• Bridging gap between the Business needs and the Technical solutions.
• Used RUP methodology to satisfy business needs.
• Defining the Business Process Model and Data Process Model.
• Follow HIPAA compliance to safe guard patient information.
• Coordinated with Project Managers to resolve risk issues and ensure compliance with HIPAA standards.
• Performed Gap analysis and feasibility studies.
• Managed and developed EDI specification, gap analysis and applications structures for data feeds and mappings for integration between various systems to follow ANSI X12 4010 formats including:
• 270/271: Eligibility/Benefit Inquiry and Information.
• 276/277: Claim Status Request and Response.
• 834: Benefit Enrollments.
• 835: Remittance Advice.
• 837: Claims and Encounter.
• Developed use cases, and traceability matrices to better assist software development.
• Developed training material for understanding the newly developed application.
• Wrote technical documentation for root cause analysis on customer support issues.
• Part of the team assisting in documentation such as proposal writing, evaluation criteria, proposal approval, design document, project plan, project scheduling and project report.
• Prepared and presented monthly collection reports.
• Involved in training and quality of the overall workflow process.
• Creating and analyzing numerous clients' reports for various financial requirements
• Led both internal peer review and external reviews of use case specifications and in the process clarifying the critical requirements.
• Met with business teams as well as test teams to review the requirements as outlined in the use cases.
• Involved in developing test plans, test conditions and test cases to be used in testing based on business requirements using Quality center.
• Created and maintained the Requirement Traceability Matrix between the requirements and other products such as design documents and test plans.
• Familiar with User acceptance testing UAT , System testing, Integration testing and Regression Testing.

Environment - MS Word, MS Power Point, MS Access, MS Excel, MS Visio, MS Projects, HTML, MS SQL Server 2000, SDLC.

Confidential

Sr.Business Analyst

Involved in the Latitude server application Latitude which was designed to provide the foundation for the various other solution components needed to extend a viable remote monitoring service to physicians and patients with implanted heart devices and external sensors. Remote patient management is a key application for future health care solution.

Responsibilities:

• Conducted meetings with the business users to understand the current process
• Conducted one to one sessions with system administrators, system access request teams, HR assistants in documenting the current process
• Identified and documented management approval workflow for provisioning.
• Co-ordinated between developers and test engineers to conduct FDA regulated subsystem verification of Regulated Server Application for remote patient monitoring product of Boston Scientific
• Creating Sub System Testing Strategy documents, creating test plan based on sub system requirements. It included creating training materials for tester's of the system, remote patient management system using in-depth knowledge of different parts of the system.
• Gathered the roles across the enterprise and prepared the segregation of the duties SoD for the roles with the help of the Id Governance group
• Gathered the information about all the resources to be provisioned and deprovisioned and the rules for the same and document it
• Prepared formats for compliance reports
• Collaborated with identity governance department for deciding the intervals for periodic auditing and attestations
• Worked on the business process high level diagrams to illustrate the current manual workflow
• Conducted various meetings with the service providers to understand how the single sign on can be integrated into the company
• Worked on the Business Requirements documents to represent the future proposed diagrams to show how the different workflows can be triggered
• Worked on documenting the attributes for different use cases
• Worked on illustrating the workflow process for request approvals.

Environment: Agile ,.NET, MS Project, MS SharePoint, MS Excel, MS PowerPoint, MS Visio, WebEx, SQL, MS Access.

Confidential

Business Analyst

Mississippi Division of Medicaid's Management Information System MMIS, controlled by ACS had to comply with the CMS mandated Health Insurance Portability and Accountability Act HIPAA requirements. Purpose of the project was to analyze system impact and perform GAP between current HIPAA 4010 and compliance HIPAA 5010 for state Medicaid Management Information System.

Responsibilities:

• Actively worked on Business requirement gathering, analysis and Data analysis
• Created Business Rule Comparison BRC documents and Side-By-Side SBS comparison documents using 4010 / 5010 implementation guides for X12 transactions i.e. 837 I, P, D , 834, 835, 276,277,270, 271
• Created BRCs of EDI inbound and outbound transactions and mapped the provided data
• Extensively involved in HIPAA 5010 User Acceptance Testing UAT . Defined and maintained Test Cases for EDI transactions.
• Worked with multiple clearinghouses to ensure smooth transition to 5010 standard for their day-to-day EDI X12 transactions.
• Manually read through the loops, segments and elements of individual test files from clearing houses using Notepad and compared them to Implementation Guide/ Companion Guide to ensure that they met 5010 standards. If errors were found on these, the same were communicated back to the clearinghouse and asked them to resubmit the file after making necessary changes.
• Used HP Quality Center for error reporting and communicating between developers, product support and test team members
• Worked on various subsystems within the MMIS including but not limited to Recipient Payer, EDI etc
• Used MS Share point for sharing documents, calendars and other data between users in different locations.

Environment: MS SharePoint, Quality Center, MS Office.

Confidential

Business Analyst

Patient's information, history about disease and medication is collected and stored in the CMR Health Information Management/Enterprise Document Management System. I worked on enhancements and fixes to the Claim Engine with the various Business Owners.

Responsibilities:

• Analyzed the business functionality of CMS.
• Development of business rules and testing for HIPAA compliance certification of healthcare standard.
• Recommended tactic to implement HIPAA 4010/5010 in the new system.
• Managed various levels of Projects in accordance to SDLC standards, worked with project lead/PM for various central build and regional build projects.
• Worked in agile/scrum methodology for better and rapid delivery of the business solutions. Suggested planning features one sprint ahead of the implementation in the Sprint Retrospective in order to achieve maximum utilization of resources and comfortable and thoroughly tested deliveries.
• Development of standard documentation package Requirements, Specification, Design, Operations and Quality Testing Plans
• Working Experience in Electronic Submissions in standard format.
• Performed GAP Analysis to derive requirements for existing systems enhancements.
• Interacted with the Subject Matter Experts SMEs and stakeholders, gathering business requirements to get a better understanding of client's business processes.
• Gathered business requirements and drafted Business Requirement Document BRD .
• Used UML for gathering requirements, created Use Case Diagrams, and Use Case Specification document.
• Prepared test plan and test cases using Test Manager based on the function specifications.

Environment: Windows, Microsoft Office Suite, MS Visio, UML, SQL, Activity diagrams, Test Director, CMS.

Confidential

Business Analyst

• Claims Management and Reconciliation CMR . Patient's information, history about disease and medication is collected and stored in the CMR Health Information Management/Enterprise Document Management System. I worked for enhancements to this application with the various Business Owners. Responsibilities:
• Gathered Requirements from various Business Areas like Claims, Provider Relations, Enrollment, Finance and Benefits Administration for their updates to the Claim Processing Engine.
• Developed Use Cases using MS Visio, and a detailed project plan with emphasis on deliverables.
• Monitored Change Requests and documented requirements, integrating them with Use Cases.
• Developed and Implemented Test Strategies using the Test Director.
• Assisted QA team in testing phase by creating Test Plans and Test Cases documents.
• Followed the Scrum methodology and created product backlog for making enhancements to the system.
• Decomposed the product backlog into release backlog for each sprint and assigned priority to each of them.
• Checked the data flow through the front end to backend and used SQL queries to extract the data from the database.
• Developed the Requirements Traceability Matrix, prioritized and determined Impact of all applications.
• Identified all the applications and interviewed the application owners to recommend the process improvements.
• Defect Tracking and Bug Reporting was performed using Test Director.

Environment: Quality Center, SQL, MS Office, Visio, Test Director.

Confidential

Business Analyst

Responsibilities:

• Elicited, Analyzed, Documented and Validated Requirements for Sales and Operational Planning SOP .
• Implemented and Configured SAP Forecasting - SOP using Flexible Planning
• Designed customized Flexible Planning solution using self-defined information structure, Planning Hierarchies and Product Groups.
• Designed customized Sales planning and Production planning tables with macros.
• Evaluated and configured Forecasting Models in SAP based on actual data.
• Designed Events, Transfer Profiles and Rough Cut Capacity Profiles.
• Created Functional Specifications for Conversion of historical data from Oracle into SAP.
• Integrated SOP process to Lean Manufacturing solution in Production Planning module.
• Configured Demand Management for lean manufacturing process by consumption of Planned Independent Requirements by Customer Requirements/Purchase Requisitions.
• Created Functional Specifications for creation of master data for SOP.
• Collaborated with CRM, SD MM Teams in integrating IPO process with SOP Production Planning.
• Worked with the master data team in setting key logistics fields of article master relevant to SOP/PP.
• Prepared unit test plans for SOP and conducted unit testing for production planning functions.
• Prepared configuration documents and Business Process Procedure BPP .
• Involved in preparation of integration test plan and documentation of test plan procedures.

Environment: SAP Retail Industry Solution IS-Retail ECC 6.0

Confidential

Sr. Business Analyst

Responsibilities:

• Responsible for requirement and design documentation review, identification of Customer Management software anomalies and test results, customer interaction and IT management.
• Managed all the requirements and change requests and made updated requirements available to all team members involved in the project.
• Conducted GAP analysis in understanding how the upgraded system carries out the business functions
• Checked the data flow through the front end to backend and used SQL queries to extract the data from the database.
• Developed the Requirements Traceability Matrix, prioritized and determined Impact of all applications.
• Worked closely with Developers and User Representatives, participated in the product design process including specifications, end-user reviews and application walk-through
• Developed business use cases in most instances, worked extensively on Rational Requisite Pro in gathering user Requirements, manage Workflows and elicit Communication plans
• Generated Use Case diagrams using MS Visio to depict process flows, timelines and cost-benefit models
• Worked with development and testing teams to approach timely release objectives, patch releases and provided assistance during deployment
• Interacted with Development and QA Team to ensure overall quality and scalability of the software

Environment: XML 1.0, HTML, Oracle 10g, MS Office, MS Project, MS Visio, UML2.2.

Confidential

Business Analyst

Responsibilities:

• Used Test Director to invoke the scripts, initially performed the baseline testing, organized all the scripts systematically and generated reports
• Interacted with Development and QA Team to ensure overall quality and scalability of the software
• Held several JAD sessions with SME's from various domains across the multi - national space
• Developed over 30 system flows documenting more than 200 different business processes across various domains
• Prepared Business Process Models that includes modeling of all the activities of the business from the conceptual to procedural level
• Organized Joint Application Development JAD sessions as a facilitator and moderator to gather requirements
• Facilitated business requirements gathering sessions with the client, and manage the creation of Use Cases/Activity Diagrams and Functional Specifications using Microsoft Visio.
• Involved in business analysis of the existing tools and configuring new feature set up
• Jointly managed project resource allocations, planning and status updates to senior management
• Led weekly Project team meetings to discuss project status and resolve issues
• Initiated and managed cross training sessions between onsite and offsite team members for outsourced projects
• Worked together with the Development team and the Project Coordination Team to ensure that clients' business needs have been met
• Helped enhance and convert existing Visio workflow diagrams.
• Created reading material for better analysis and explanation of system flows.

Environment: Windows XP/2000, MS office suite, MS Visio, Power Point, MS SQL Server, MS Project