SUMMARY

• 8 plus years of experience as a Business Analyst with solid IT experience. Excellent communication, leadership, problem solving, and organizational skills; extensive experience in working and coordinating with team members and senior management staff.
• Thorough knowledge about ICD 9, ICD 10, HIPAA transactions, Medicare and Medicaid claims.
• Experience working on HIPAA Transactions for enquiry and response (270/271), claim status request and response (276/277), benefit enrollment and maintenance (834), claim payment/advice (835), and professional, institutional, dental claims (837) for HIPAA 5010 projects.
• Experienced in conducting Joint application development (JAD) sessions.
• Experience in SDLC methodologies such as Agile, Waterfall and in developing different phases of Software Development Life Cycle (SDLC) using the Rational Unified Process (RUP)
• Experience in analyzing and documenting business requirements using Business Requirements Document (BRD), Requirement Traceability Matrix (RTM), Functional Specification Document and other project deliverables.
• Excellent skills in performing analysis of EDI ANSI X12 file mapping and reporting in the analyses
• Experience in using the UML based methods through Rational rose to create Use Cases, Activity diagrams, Sequence diagrams, Collaboration diagrams, which included both Functional and Non - Functional specifications.
• Experience working on AS-IS and TO-BE processes.
• Worked on projects requiring creating sequence diagrams, activity diagrams, collaboration diagrams, class diagrams, task diagrams, flow charts, and use cases and created process flow, workflow, and data flow diagrams
• Experience working with on Data Mapping and Data Extracting Strategies for data migration.
• Experience in using EDI, SQL, FACETS, MS Visio, Rational Rose, Requisite Pro, UML
• Experience working on MMIS, Medicaid Management Information Systems in modules like Claims, Billing, Membership, Capitation, Customer service, membership management, provider management, advanced Healthcare management, provider agreement management.
• Proficient in using FACETS
• Experience documenting training and procedural documents and assisted in training the End Users for navigating through the enhanced system.
• Proficient in risk analysis using SWOT, Cost benefit, GAP, and ROI analyses.
• Experienced and proficient in performing and facilitating User Acceptance Testing (UAT) sessions with business users and conducted documentation for enhancements and fixing bugs.
• Experience using MS office and MS Visio for documentation and presentation purposes
• Worked on EMR and EHR, EPIC and Cerner.
• Good understanding of Trizetto Facets, HL7, Medicare, Medicaid, Medicare Part D, HMO and PPO.
• Performed Use-Case analysis using UML to capture the dynamic aspect of the application.
• UML was further used for specifying, constructing and documenting the software system using Rational Rose.
• Liaison with customers business unit managers, stakeholders and functional subject matter experts (SME).
• Created project charter, scope and schedule. Maintained project documents such as the risk management plan, action item list, project benefits list, monthly updates and review with the project manager at regular time intervals.

TECHNICAL SKILLS

Methodologies: Agile, Scrum, RUP, Waterfall

Front-End Tools: MS Excel, MS Office, MS Project, Adobe Photoshop, Macintosh Macromedia Flash, Mac

Testing Tools: Testing Tools: Quality Care, Load Runner, Quick Test pro

Bug Tracking Tools: Rational Clear Case, Jira, TFS

Modeling Tools: Rational Rose, MS Visio, Caliber RM

Project Management Tools: MS Visio, MS Project, Share Point 2010, Primavera

Languages: UML, XML, HTML, SQL

Databases: SQL Server, ORACLE, MS Access

Web Technologies: HTML, MS SharePoint.

PROFESSIONAL EXPERIENCE

Confidential, Dallas, TX

Sr. Business Analyst

Responsibilities:

• Developed test plans and test cases and the High Level Project Requirements (HLR) for a very large project.
• Modified and used Project Templates to gather the requirements and carry on the project.
• Facilitated the requirement gathering work sessions with stakeholders, SME's and Business owners to understand and in corporate the potential requirements in the BRD.
• Developed detailed Functional Requirements Document (FRD) based on the BRD, incorporating business process flow diagram, activity diagram, sequence diagram, state diagram, flow charts, use cases and use case diagrams.
• Built use case scenarios, workflow scenarios, designed new process flows with project team from the requirement documents to create use case diagrams and use case documents.
• Managed content of website by gathering information and integrating data from other departments.
• Coordinated the project team for JAD and BRD Sessions.
• Created 837(P, I, D) claims, and maintained data mapping documents in reference to HIPAA transactions primarily 837(P, I, D), 835,276/277 and 278.
• Expertise in documenting Business requirement document (BRD), Functional and Non-functional requirements, Requirement Traceability matrix (RTM), Use case Specifications and the complete System Requirement Specifications (SRS)
• Worked on 837 and 835 projects, including syntax and business rules for X12 HIPAA 5010 validation for loops, segments, elements, qualifiers and code sets.
• Use of Microsoft Outlook to communicate and gather vendor information. Attend Kick Off meeting for Black Friday Holiday Readiness project.
• Performed System testing, Regression testing and UAT for several claim types and test scenarios.
• Recorded retention stored in Knowledge Link. Ad Hoc reporting, Admin for MS Project, Excel dbase and pivot tables, Clarity and MS Project Server Admin duties.
• Documented FRS (Functional Requirement Specifications) and assisted Systems analyst to come up with SRS (System Requirement Specifications).
• Created business process models using MS Visio.
• Assured that all Artifacts are in compliance with corporate AGILE Policies and guidelines.
• Created a Key Indicator Report to monitor customer activity and associated risks.
• Assisted the SQA team to write the Test plan and Test cases.
• Followed a structured approach to organize requirements into logical groupings of essential business processes, business rules, information needs and insured that critical requirements are not missed.
• Coordinated activities between business unit and technical staff, developed new methods, policies, and procedures to meet the business needs.
• Analyzed requirements and created BRD, Use case, Process flows, Use case diagrams using MS Visio.
• Analyzed and translated business requirements into system specifications utilizing UML and RUP methodology.
• Participated in Requirement Analysis / Project Development & Test Planning meetings.
• Involved in developing test plan and test cases based on use cases and functional specifications.
• Prepared Functional Design Specifications (FRS) employing Use case scenarios, sequence diagrams, DFDs and class diagrams.
• Identified and clearly defined functional issues and supported IT development staff throughout the design, development, unit testing, and implementation phases of the software development life cycle.
• Documented the Requirement Traceability Matrix for tracing the Test Cases and requirements.
• Documented and assisted the QA Team with the Test Plan.
• Developed Data Conversion Strategy using ETL functions for converting data from the existing site to the new site.
• Assisted Project Manager to complete the project approval process.

Environment: HIPAA, Oracle, SQL, QTP, Caliber, BlueStar, Dynamics Mainframe, Lotus, MS Office, MS-Visio, Rational Suite (Rose, Requisite Pro), Dreamweaver, Rational Unified Process (RUP), Windows NT/XP/2000, MS-Project, MS-Office Suite.

Confidential, Rockville, MD

Sr. Business Analyst

Responsibilities:

• Analyzed and documented the differences between 4010 and 5010 formats for all segments, elements, and loops of 837-I and 837-P using GAP analysis.
• Worked with a team on 820 transactions in order to keep the Managed Care Plans updated about the premium payment data.
• Conducted and facilitated several JAD sessions with the SMEs from other feeder systems in order to derive a detailed analysis and a better estimation of the effect of projects on each other. A few sessions were targeted for functional requirement walkthroughs for all the projects that could have an impact.
• Assisted in designing and development of Sequence Diagrams, Use Cases, Activity Diagrams, OOD using UML
• Gathered information about CMS data from Research Data Assistance Center (ResDAC) for training purposes.
• Worked on MMIS and MITA modules.
• Worked with team members from projects in the process of deciding if modules need to be implemented independently, or together.
• Prepared several Business Requirement Documents (BRDs) and translated them into functional specifications and test plans.
• Functional knowledge of Medicaid Management Information System (MMIS).
• Created business requirement documents for the impacting projects
• Updated data in Oracle database using MS Access, and performed SQL query, in addition to data analysis and verification.
• Performed User Acceptance Testing (UAT) for several web based and database related applications.
• Assisted in creating UAT plans for several test cases in each project to make sure that the system runs smoothly following its update
• Analyzed and aided the BA team to understand the Medicare Claims Synthetic Public Use Files (SynPUFs)
• Gathered requirements from the users in operations group and performed data mapping for the applications, along with confirming and vacillating the requirements during BA testing.
• Documentation and Analysis of business and system requirements for the clients and Property and casualty modules
• Conducted workflows, screen shots and Power Point presentations for the Web Applications.
• Provided data modelling support for numerous strategic application development projects.
• Conducted review of test results and coordinated with testing and development team to correct the issues, if any.
• Worked with the QA team during the designing phase of the Test Plan and Test Cases for User Acceptance testing.
• Created Bordereau reports every month for the reinsurance broker.
• Worked with the Risk Assessment team for several projects.
• Responsible for documentation and delivering Functional Specification Documents to the project managers.
• Updated several MS Access tables and worked extensively with MS Excel and MS access
• Processed and followed through timelines for project delivery, and managed resources
• Additional job responsibilities such as managing schedules, deadlines and resource.
• Communicating with the developers for resolving the reported bugs and various other technical issues.

Confidential, Richmond, VA

Business Systems Analyst

Responsibilities:

• Studied existing business application and processes, current source system, collected end user requirements and suggested the improvised business process model
• Analyzed the “As is” and “To be” system documents to show the current and proposed functionalities of the system using MS VISIO.
• Worked with providers and Medicare or Medicaid entities to validate EDI transaction sets or Internet portals.
• This includes HIPAA 4010; 837, 835, 270/271, and others. Provided healthcare provider problem resolution.
• Completed several HIPAA 4010 and 5010 Projects, included Medicaid and Commercial entities.
• Projects include claims and enrollment testing as well as NPI and medical coding and ICD-9 EDI testing.
• Determined eligibility benefits for customers with EDI Health Care Eligibility/Benefit Inquiry (270)
• Gap Analysis of client requirements, generated workflow process, flow charts and relevant artifacts
• Involved in defining and documenting the vision and scope of the warehousing project
• Utilized the knowledge of Facets system to perform the data warehousing of facets system data into Teradata
• Worked with ACES claims data for claims subject area, Enrollment and billing data for membership subject area
• Conducting business validations covering the following deliverables: Facets Providers, Facets Claims and Facets Membership areas
• Involved in the development of Business and Technical Requirements Document (BTRD) and Business System Design (BSD) document for the project.
• Involved in identifying and studying the ACES and Facets system data and field by field analysis of Facets system for the attribute mapping purpose
• Analyzed the data in the Facets source system to map into the correct field and attribute in the target storage
• Conducted interviews with management team and other stakeholders
• Conducted and participated in the JAD session with the SMEs and project team members
• Worked as a liaison between the business and technical side to convey the business needs to the system architects
• Participated in weekly status meetings to present status and in corporate any digressions from the original scope
• Designed Use Cases using UML and managed the entire functional requirements life cycle using SDLC
• Created and managed project templates, Use Case project templates, requirement types and traceability relationships in Requisite Pro
• Carried out a thorough target data model assessment and risk analysis
• Involved in cross-functional teams, developing new ways to boost efficiency and delivering results in a fast changing environment to achieve company goals
• Participated in the walkthroughs and meetings specifically for Claims and Membership modules
• Coordinate with Development and Business team to develop high level Business and Technical documents
• Worked with the clients on the verification process for the requirement phase documents
• Implemented Standardized process throughout the software Development Life Cycle (SDLC)

Environment: Windows XP, Unix, ACES, Facets, Rational Requisite Pro, MS Office, MS Visio, UML, COBOL, Informatica, IBM classic event publisher, Teradata, DB2, IMS, SDLC

Confidential, Portland, OR

Business Analyst

Responsibilities:

• Interacted with stakeholders to understand the high level business needs, conducted focus group sessions to understand low level requirements.
• Performed functional requirements gathering for health and health insurance information technology, specifically with Eligibility and/or Enrollment systems.
• Involved in GAP analysis of HIPAA 4010 and 5010 standards for EDI transactions.
• Implemented a mechanism to in corporate business-required data which is not in the core Facets system.
• Created high-level Use Cases from Business Requirements and created UML diagrams like Use Case scenarios and Activity diagrams using MS-Visio.
• Developed a (UAT) User Acceptance Testing plan to guide a select group of key end-users in testing the user interface and functionality of the application.
• Provided inputs to develop and modify systems to meet new requirements and develops business specifications to support these modifications.
• Organized JAD sessions, used techniques like mind mapping, brainstorming to elicit requirements.
• Updated all the documents onto SharePoint & kept the team well informed.
• Maintained flat files, crosswalk documents.
• Used HP QC to maintain test resources, test plan and Requirement Traceability matrix.
• Used MS- project to create Work Breakdown Structure and conduct Critical Path Analysis.