SUMMARY

• 7+ years of IT experience as a Business Analyst in business consulting and application development with excellent skills in process implementation, client interfacing, requirement gathering, user support, problem solving, and documentation.
• Strong understanding of various SDLC methodologies such as RUP, Waterfall and Agile with hands on experience in all of them.
• Strong at writing requirements in Waterfall and Agile style.
• Experienced in working with the offshore teams.
• Proficient in identifying, documenting and analyzing Business Requirements Specifications (BRS), System Design Specifications (SDS) and Software Requirement Specification (SRS).
• Extensive knowledge of Medicaid, Medicare, Procedural and Diagnostic codes, Claims Process, Health information Exchange (HIE), Electronic Health Record (EHR) and Electronic Medical Record (EMR).
• Experienced in gathering requirements for HIPPA (Health Insurance Portability and Accountability Act) EDI (Electronic Data Interchange) Transactions 820, 834, 835, 837 (I, P and D), 270, 271, 276, 277, 278, 997 and 999 in various phases of implementation.
• Experience in conversion of HIPAA ANSI (ASC) - X12 4010 codes to ANSI (ASC) - X12 5010 codes and International Classification of Diseases (ICD) 9 codes to ICD 10 codes.
• Strong knowledge of Facets and actively involved in end-to-end implementation of Facets Billing, Enrollment, Claim Processing and Subscriber/Member module.
• Good knowledge of Lab Results and HEDIS (Healthcare Effectiveness Data and Information Set).
• Strong Experience with HL7 CDA (Clinical Document Architecture), HL7 file formats, and compliance/SNIP level HIPAA validations.
• Proficient in soliciting requirements, creating architectural diagrams, data model, and driving project through execution.
• Good knowledge of Informatica, SQL Server, Teradata and B2B tools (Informatica B2B, Axway, IBM Sterling).
• Proficient in Requirement Engineering Process, including gathering, analyzing, detailing and tracking requirements.
• Experience in interacting with stakeholders like business clients, end users, vendors, SDLC team, configuration manager and production team to identify information needs and initiate process change.
• Expertise in creating various artifacts like BRDs, Functional Specs, Used Cases, UML Diagrams, Data Mapping Documents, Test Plans and Test Strategies, pre and post RTMs and Status Weekly Reports etc.
• Strong visual modeling and Business Process Modeling (BPM) skills using Rational Unified Process (RUP) with tools like Rational Rose, and MS Visio.
• Expertise in using various tools like RequisitePro and MS Office for requirement gathering, Quality Centre and Clear Quest for Defect Management/Defect Tracking, MS-Visio for UML Diagrams, MS Outlook, IBM Lotus Notes and SharePoint for information sharing.
• Excellent analytical, organizational, communication and documentation skills along with good project management skill to gather requirements to bring out the quality product.
• Excellent written and oral communication skills with the ability to communicate appropriately in business and technical situations at all levels of project management.
• Effectively used various elicitation techniques to gather requirements like JAD sessions, brainstorming, prototyping, one and one sessions, workshops, surveys, interviews and conferences.
• Proficient in using TFS in managing the defect lifecycle.
• Hands on experience in the complete Quality Assurance (QA) life cycle from Requirements Gathering and Documentations to developing Test Plan, Test Cases, Traceability matrices and conducting User Acceptance Testing (UAT) for QA Testing.
• Hands on experience with SQL database, SSIS (SQL Server Integration Services), ETL (Extract, transform, load) and ODBC (Open Database Connectivity) connections.
• Hands on experience with SQL in writing joins, triggers, tables, user defined functions, views, indexes, and relational database models and data integrity.
• Strong experience with database structures, table layouts and Data Mapping.
• Strong experience with Contact Center.
• Proficient with data integrations and integration patterns to help identify data requirements for source to target systems.
• Worked with PMO (Project Management Office) to review time line and schedule for the implementation and discussing the milestone.
• Experienced in working with middleware, SOA, Web Services, EAI (Enterprise Application Integration) and Enterprise Integration.
• Excellent analytical, organizational, communication and documentation skills along with good process management skill to gather requirements to bring out the quality product.
• Motivated self-starter, good team member with exceptional team building, leadership, and interpersonal skills to resolve issues.
• Thorough knowledge of Eligibility and membership Affairs for Medicare and Medicaid. Also knowledge of HIPAA, ANSI (ASC) - X12, and HL7 standards, and Medicaid provider best practices.
• Experienced with Medicare and Healthcare Insurance; as well as Medical Standards (HIPAA and HL7).

TECHNICAL SKILLS

Project Methodologies: Rational Unified Process (RUP), Waterfall, Agile, Spiral, Scrum

Business Process Modeling Tools: Rational Rose, MS Visio, Axure

Requirement Management Tools: Rational Requisite Pro

Project Management Tools: MS Project

Defect Tracking Tools: Rational Clear Quest, Quick Test Professional, Quality Center, (Application Lifecycle Management) ALM 11

Databases: Oracle, MS SQL Server, IBM DB2

Languages: Visual Basic, Java, XML, SQL

Front - End Tools: MS Office Suite(Word, Access, Excel, Outlook, PowerPoint, SharePoint) - Advanced Skills

Claim Processing Tool: Facets 4.8

Version Control Systems: Rational Clear Case

Operating System: Windows, MAC OS, UNIX/Linux

PROFESSIONAL EXPERIENCE

Confidential, Long Beach, CA

Business Systems Analyst

Responsibilities:

• Conducted ITIL assessments and gap analysis based on customers' goals.
• Created Business Analysis risk analysis to make sure project is on track and what factors can affect the timeline of the project.
• Manage and share all formal and information project deliverables in SharePoint under project specific site.
• Created new templates for the Business Analysis team to use on various projects.
• Applied and shared best practices with the Business Analysis team for them to apply it on several projects within the firm.
• Conducted JAD sessions with Subject MatterExperts (SME's).
• Did Presentations making Stakeholders understand how the changes wouldaffect different modules w.r.t. Medicare and Medicaid.
• Designed and developed Use Cases, Activity Diagrams and Sequence Diagrams using UML.
• Conducted User Acceptance Testing (UAT) prior to and after implementation phase.
• Worked on conversion from ICD-9 to ICD-10 with respect to the claims related to Medicare (Part A, Part B, Part C, Part D).
• Tracked and maintained Stakeholder requested enhancements and changes using Requirement Traceability Matrix (RTM).
• Part of the team for migration of HIPAA - EDI ANSI (ASC) - X12 4010 series to ANSI (ASC) - X12 5010 series for EDI Transaction code sets: 820, 834, 835, and 837 (I, P and D).
• Performed GAP analysis of 4010 and 5010 EDI transactions 270, 271, 276, 277 and 999 using implementation guide to identify the changes in the segments and data elements.
• Completed a review ofexisting documentation for orders, referrals and reports and compared it to the clinical detailsneeded forICD-10.
• Involved withICD-10implementation testing.
• Assisted in writing test case scenarios and performed Claims Unit testing, Regression testing, Integration testing and Compliance testing.
• Extensively worked on Facets, the claim processing tool used in the project.
• Involved in configuration of Facets Subscriber/Member Application group.
• Analyzed the member/eligibility information on claim to that in Facets.
• Worked on Facets to efficiently execute core administrative functions, including claims processing, premium billing and customer service.
• Worked with SME close to analyze the Claim Adjudication Process setup in Facets.
• Implemented automated COB (Coordination of Benefits) processing of Medicare claims into Facets.
• Worked with Claims, enrollment, eligibility, benefits verification for members and providers, benefits setup, and backend payment cycle in Facets.
• Analyzed the change detection process on Facets database tables to capture the daily changes done by Users through Online Facets Application.
• Done Business Process Modeling for representing processes of an enterprise, so that the current process may be analyzed or improved.
• Created Business Process Modelling workflows for projects using Microsoft Visio.
• Worked on ETL (Extract, transform, load) -based design.
• Responsible for development/implementation of systems project or cross functional teams focused on the delivery of the Electronic Health Record or any systems associated with the EHR.
• Conducted training sessions on EHR application and suites.
• Working with respect to EHR towards standardization in methodology, performing testing and implementation and build, error proofing, and data integrity and LEAN methods.
• Performed SQL Backup and Restore tasks on Various SQL Servers.
• Ensured different internal & external systems exchanged data according to the specification to transform data from enterprise data warehouse to SQL Server & load data to fact tables.
• Deployed Reports for Internal, Departmental & Executive Reporting based on the requirements using SQL Server Reporting Services.
• Involved in migration of various objects like, stored procedures, tables, views from various data source to SQL Server.
• Work with stake holders / product owners under Agile - Scrum methodology to prioritize the User Stories for Sprint.
• Allowed the User Stories under Agile - Scrum methodology into the Sprint based on team velocity and individual capacity.
• Coached and mentored 5 Agile teams containing a total of 54 team members.
• Motivated the team under Agile - Scrum methodology to come up with quality shippable product and meet the product goals.
• Worked with Product owners under Agile - Scrum methodology on artifacts Such as Product Backlog, Spring Backlog, Sprint burn up / Burn-down, and Release Burn up / Burn-down.
• Set up and maintain the Scrum Board for Project tracking in JIRA.
• Decomposed Epics into user stories and created category hierarchy for the backlog.
• Performed bug checking, requirements management using JIRA and Grasshoppers.
• Created and Managed User Stories in Epics, Themes and Sprints also calculated velocity and Story-points in TFS.
• Assisted in monitoring ancillary data transactions and addressed problems with HL7 messages.
• Performed manual testing, including validation/smoke testing of HL7 interface messages on each new build before delivering to the quality assurance team.

Environment: MS-Project, Visio, .Net, JIRA, Grasshopper, Rational Rose, Requisite Pro, SQL, Clear Quest, QC, QTP, ANSI (ASC) - X12 - EDI, Oracle, Facets 4.8, Agile, TFS 2012.

Confidential, Clayton, MS

Business Systems Analyst

Responsibilities:

• Assisted Project Manager in planning the project time-line and scheduled various project deliverable dates according to the various phases of the project.
• Developed and maintain the integrated Master Project Plan for cross-functional teams and outside vendors assigned to the project.
• Developed WCF Services to encapsulate business logic components to be used in a distributed environment and exposed them through SOAP and XML.
• Prepared Project reports for management and assisted the project manager in the development of weekly and monthly status reports, policies, and procedures.
• Have strong experience in requirements gathering by conducting interviews with end users.
• Actively worked on Data analysis and Report analysis with respect to ICD-10 impact.
• Performed Gap analysis for better understanding of transaction from HIPAA 4010 to HIPAA 5010insideTrizetto QNXT different modules.
• Analyzed System flows of various department of the hospital.
• Identified risks, problems, requirements and concerns of the Hospital in order to comply with ICD-10 changes.
• Highly involved in understanding of department workflows and process flowswith respect to applications.
• Re-Organized the collected data and prepared documentation for implementation.
• Performed impact analysis on applications for deadliness of ICD-10 conversion.
• Got involved in designing future state processes forHIPAA 5010transaction processing EDI820, 834, 835 and 999.
• Analyzed HIPAA 5010 related toEDI 837 (I, P and D), 270, 271, 276 and 277 transactions (both inboundand outbound) and performed gap analysis between the 4010 and 5010.
• Join tables by employing SQL INNER JOIN, INTERSECT, UNION ALL and UNION syntax.
• Created various SQL Schema, Triggers, views, index/keys and stored procedures along with compiling them in SQL server and troubleshoot errors.
• Responsible for installation of SQL Server, database design, and create schema objects like tables, views and indexes.
• Designed and created SQL Databases tables, indexes, and views, User Defined Functions, Stored Procedures and Triggers based on user requirements.
• Participated in Agile Planning Sessions and assumed the Product Owner role for the Agile initiative.
• Created and explained the User Stories to the Scrum Team under Agile - Scrum methodology and helped them design the Tasks.
• Designed acceptance criteria under Agile - Scrum methodology for validating the output of each Sprint.
• Reviewed Team Velocity under Agile - Scrum methodology on a frequent basis and advised Scrum Master at various stages.
• Participated in Sprint Planning and Sprint review meetings under Agile - Scrum methodology for finalizing the Sprint Backlogs and Verifying the Sprint outputs respectively.
• Responsible to meet the information demands of ourbusinessusers by delivering timely, accurate, meaningful and standardized data and reporting.
• Help the product owners to come up with set of User stories for better understanding for estimate and development.
• Conduct User Story estimation meetings on epic level as well as story level.
• Manage iterations using JIRA/ Grasshopper plugins for Agile Sprint management.
• Create Epics, Stories and sub-tasks.
• Mapped the collected data with the existing data provided by the hospital departments.
• Experience in working and conducting requirement engineering process and Business process Modelling.
• Used Microsoft Word, Excel, Access, Project and Visio as working tools.
• Analyzed existing reports in order to respond to Change Requests (CR) coming from client side in the form of new business requirements.
• Assisted the QA team and worked on Quality Center.
• Interacted with developers to report software bugs and re-tested the fixed issues.
• Metthe deadlines and scheduled day to day meeting sessions.

Environment: Java, SQL, Windows XP, MS Project, RUP, JIRA, .Net, Grasshopper, Rational Rose, Requisite Pro, UML, MS Visio, Waterfall.

Confidential, Atlanta, GA

Business Analyst

Responsibilities:

• Utilized Rational Unified Process (RUP) to configure and develop process, standards and procedures.
• Prepared the Business Requirement Document (BRD) and System Requirement Document (SRD).
• Facilitated Provider Enrollment, Setting up Provider profile & Trading Partner Agreement.
• Set up Provider's Access to the System. (Security Setup).
• Helped creating Provider Reports i.e. Financial, Claims processing.
• Prepared the Business requirement Document for the enhancement of the existing services.
• Wrote FRDs for the defects and enhancements and got approval from business for the developers.
• Worked on Technical Design Documentation (TDD) of the claims processing system.
• Performed task estimations and documentation of procedures.
• Designed, prepared and implemented test cases for system testing as well as for User Acceptance testing.
• Involved in the testing of web portal of New MMIS system.
• Analyzed and documented system release/deployment issues according to version management, backward compatibility, load balancing of components in production environment.
• Did impact analysis for changing requirements and coordinated with business users for prioritizing the testing/release of the changes.
• Maintained a very close interaction between business users and developers to avoid any gaps in understanding or implementation of requirements.
• Did data analysis, created data mapping and data interface documents and kept the documents updated with changes in requirements and functional specifications.
• Performed Risk Analysis based on defect severity and priority.
• Tested User Interface inconsistency and application functionality.
• Developed Reports and Graphs to present the Stress Test results to the management.
• Created BPR charts for AS IS and TO BE processes of different business functionalities.

Environment: Windows XP, SQL, MS-Visio, Rational Rose, Requisite Pro, Clear Quest, UML, Axure, Java, Agile.

Confidential, New York City, NY

Business Analyst

Responsibilities:

• Facilitated Joint Application Development (JAD) Sessions for communicating and managing expectations.
• Performed Gap analysis and assessed risks of the project.
• Gathered Requirements through interviews and JAD sessions with business owners.
• Analyzed and worked with HIPAA specific EDI transactions for claims, member enrollment, billing transactions. Worked specifically with 270, 271, 276, 277 and 999.
• Observed extensive troubleshooting for the failures in mapping systems for outbound claim payment transactions (835).
• Involved in up gradation of HIPAA ANSI (ASC) - X12 4010 transactions to HIPAA ANSI (ASC) - X12 5010.
• Ensured that application was created and maintained in a manner that supports the departmental, user and overall business objectives in coordination with other system vendor products.
• Performed System Integration and Regression Testing for the Microsoft BizTalk 2002 applications. These are developed to perform Electronic Data Interchange (EDI) translation from ANSI (ASC) (American National Standards Committee) ASC(Accredited Standards Committee) ANSI (ASC) - X12 layout to MMIS fixed-width record format.
• Worked as liaison between software developers and users of Electronic Medical Record (EMR) systems to create better electronic medical record systems.
• Involved in creating mappings for the conversion ofEDI ANSI (ASC) - X12 transactions 820, 834, 835 and 837 (I, P and D) code sets version .
• Worked on changes for HIPAA Transactionand proposed changes to be made in the current system for an easy transaction from version .
• Documented the detailedbusinessas well as technical requirements to upgrade the current system to 5010 transactions.
• Created test scenarios for EMR systems executed those tests cases and evaluated the results.
• Translated and transferred requirements from Business Requirements Document (BRD) to Functional Requirements Document (FRD).
• Designed Activity, Sequence and Process Flow Diagrams using MS Visio to simplify and elaborate certain selection criteria and filter conditions.
• Extensively worked with HIPAA Privacy Facets application groups.
• Enabled successful implementation and usage of the FTP(File Transfer Protocol) for the extract submission to the corresponding vendor.
• Was involved in User Acceptance Test using the test cases given by the client before releasing the application.
• Worked with the Project Manager on various Project Management activities like keeping track of Project Status, Deadlines, Environment Request, and Compliance Issues.

Environment: Rational Requisite Pro, Rational Clear Quest, MS Visio, SQL, MS Project, Java, Windows XP, Oracle, Axure, Facets, Waterfall.

Confidential, Long Island, NY

Business Analyst

Responsibilities:

• Performed GAP analysis of 4010 and 5010 EDI transactions 837 (I, P and D), 270, 271, 276 and 277 using implementation guide to identify the changes in the segments and data elements.
• Developed Incident documents and portrayed the as-Is reporting structures versus To-be Reporting needs for data integrity and accuracy.
• Identified the scope, business objective and documented the functional requirements for each release.
• Worked on analysis of Facets claims processing system and to gathered requirements to comply with HIPAA 5010 requirements.
• Directly involved in process improvement Plans and implementing business change.
• Documented the Business Requirements Document (BRD) and the Functional Specification Document (FSD).
• Coordinated with the different teams distributed at different geographic locations for various releases.
• Identified Actors, Activities, Artifacts and Workflows and developed use case diagrams using Rational Rose.
• Prepared and performed training to Client and Internal staff as a result of system changes.
• Produced clear user manuals & training guides for User Acceptance Testing (UAT) and deployment for end-clients with step-by-step instructions and appropriate GUI screenshots.
• Interacted with the development team on regular basis to ensure and balance practicalities with innovative and efficient business systems solutions.
• Conducted and Participated JAD sessions to gain consensus on various issues related to the project. Acted as a facilitator on different occasions.
• Held regular meetings with the Business users and SME’S to priorities the business Requirements.
• Conducted walkthroughs and code reviews with developers, project managers and stakeholders and users to comprehend business workflow of applications.

Environment: Rational Requisite Pro, Clear Quest, UML, MS Visio, Axure, Quality Center, SQL, MS Office, Java, Facets, Waterfall.