SUMMARY

Seeking a role as a Business System Analyst to gather, analyze and document business requirements to deliver a successful IT project by working as a liaison between business users and technical area.

PROFESSIONAL SUMMARY:

• Experienced with Business System Analysis activity throughout the project lifecycle with strong knowledge of software development methodologies.
• Experienced in creating business analysis artifacts such as Impact analysis, Requirement management plan, Business requirement document BRD , UML diagrams, Functional specification documents FRD .
• Experienced in assisting BA team for SDLC implementation and peer review business artifacts for requirement definition management RDM .
• Experienced in creating Test Plan, Test cases and details test scripts with test data to execute requirements testing. Also created Requirement Traceability Matrix RTM for tracking requirements.
• Actively involved in performing GAP analysis. And conducting User Acceptance Test UAT .
• Experienced in healthcare domain with Healthcare reform Affordable Care Act, ACA , HIPAA 4010 to 5010 enhancement , ICD9 to ICD10 conversion and EDI transactions. Worked on Healthcare mandate implementation projects such as ACA and HIPAA as a business systems analyst.
• Experienced in EDI and HIPAA Testing Privacy with multiple transactions exposure such as Inbound 834 Membership Enrollment, 837 Institutional, 837 Professional, 837 Dental, FEP claims 835 claim Payment/Remittance Advise, 270/271 Eligibility Benefit Inquiry/Response, 276/277 Claim Status Inquiry/Response Transactions and testing in Client Server systems and Mainframe Applications.
• Highly analytical and detailed oriented approach in developing the methods and measures to meet requirements and solve any issues that arise during the project. Also experienced with SOA service oriented architecture approaches.
• Experienced in preparing user guides desk procedures for business users.
• Experienced in using requirement management and defect tracking tools such as HP Quality Center, Application Lifecycle Management ALM , Rational requisite pro and MS Access for small scale project work .
• Experience in writing SQL queries using various tools like MS MySQL and Teradata.

TECHNICAL SKILLS:

• Methodologies: Waterfall,RUP, UML, Agile
• Requirement Tracking: Rational Requisite Pro, Quality Center, MS Access, HP ALM
• Change Management Tools: Rational Clear Quest, Test Director, Clarity
• Operating Systems: MS Windows NT/98/2000/XP, UNIX
• Databases: Oracle, MS Access, MySQL
• MS Office Tools: MS Word, Excel, MS Project, MS Outlook, MS Access, SharePoint
• UML Diagram Tools: Rational Rose, Microsoft Visio.

PROFESSIONAL EXPERIENCE:

Confidential

Sr. Business System Analyst

Responsibilities:

• Worked as a Sr. Business System Analyst during project execution phase for internal company systems enhancement and supporting migration activities for new platform migrating to OSCAR system required daily interactions with Highmark SMEs .
• Worked as Sr. Business Systems Analyst on multiple projects such as Claims processing system migration migration to new platform , implementing healthcare mandate projects such as out-of-pocket maximum for ACA Affordable Care Act mandate and enhancing company's front-end applications.
• Performed Impact analysis to identify all the business areas and systems impacted to create an Impact Analysis document.
• Interacted with the business stakeholders and subject matter experts to understand the high-level requirements and scope items based on Impact analysis.
• Created Requirements Management Plan RMP to understand the work effort required for gathering business needs and conveying a timeline to project manager for completing requirements gathering.
• Scheduled and lead the requirements elicitation sessions JAD sessions with multiple business areas, individual business area, learning curve knowledge gain sessions, conference calls .
• Documented business and functional requirements by preparing business requirements document BRD .
• Utilized MS Visio to layout business process BPMN to illustrate interaction of different business area. Also incorporated UML language for as-is and to-be system process flows and use cases.
• Provided input during the development and testing phase giving input in various artifacts such as functional design document FRD
• Prepared requirements traceability matrix RTM and requirements import spreadsheet for importing the requirements into HP ALM Quality Center for testing phase.
• Utilized HP ALM for writing Test Cases for the requirements and performed defect tracking throughout the testing execution. Performed manual testing by executing the test cases using the test data positive testing, negative testing, end to end testing .
• Led the User Acceptance Testing UAT sessions with key business users to explain the new developed functionalities.
• Maintained effective communications with third party administrators Pharmacy Benefits Management, Davis Vision , FEPOC and BCBSA for documenting business and functional requirements.
• Created and maintained Issues list in excel throughout the project lifecycle. Also used Excel to create Pivot tables, dropdowns menus and other data validation features for business information to be exported in sales systems IBC Benefit Update System .
• Assisted BA program manager in conducting requirements definition management RDM workshop for SDLC implementation.
• Implemented maintained document repository on Clarity for all project artifacts for throughout the project life cycle responsible for having for structured documentation on Clarity as per project needs . Utilized Clarity for requesting a particular task for BA activities and entered allocated time for assisting project Manager for budget tracking.
• Utilized Microsoft SharePoint to maintain Business Analysis Team artifact templates, team calendar for all the shared artifacts and activities requiring group approach.
• Participated in weekly project status meeting for providing details on hour-allocations, task timeline status and documentation completion for project manager to help track project timeline using Clarity and MS Project.
• Gathered business and system requirements for Service Oriented Architecture SOA for reducing redundant system/application features.
• Involved with informatics EDW area to capture data requirement, preparing data mapping documents and give input for data flow diagrams. Also assisted technical team for ETL work-effort for data requirements specify business rules for source to target data population using Teradata for SQL .

Environment:M.S Word, Excel, PowerPoint, Clarity, MS SharePoint, MySQL, MS Visio, HP ALM QC V11.0 , Java, Teradata

Confidential

Sr. Business System Analyst

The Nebraska Medicaid initiated a MMIS HIPAA 5010 Implementation project for making the Medicaid claim processing system compliant with the HIPAA 5010 regulations by enhancing from the current 4010 legacy system.

The ICD-9 to ICD-10 conversion Project is also undertaken for making the system compliant for the ICD-10 CM PCS codes from the current ICD9 codes VOL I, II, III .

Responsibilities:

• Analyzed the impacts of HIPPA 5010 project on inbound 837 claims.
• Performed Gap Analysis for 5010 enhancement using the TR3 implementation guides, Washington Publications and side-by-side HIPAA 4010 to 5010 guides provided by CMS Center for Medicare Medicaid Services .
• Gathered, defined and documented complex business requirements for NPI crosswalk.
• Review and understand the claims process and complex requirements for the enhancement of the current system created under the Requirement Specification Documents after conducting interviews with End Users, JAD Sessions and analyzed their current systems.
• Prepared General System Design Documents that demonstrate current and proposed/solution business design and changes to the current Legacy System.
• Documented complex Business requirements and made process flow diagram for the 837, 270/271, 276/277 835Remittance transactions as per the 4010 to 5010 implementation for the Medicaidclaim processing system enhancement.
• Worked on Data Mapping documents explaining flow of data from one-to-another table for the system enhancement purpose required by HIPAA 5010 implementation.
• Facilitate and participate in the meeting and discussions held with the business users, Business analysts and Technical analysts.
• Maintained effective communication with technical team and business users to problem-solve and identify workable solutions.
• Maintained Requirements Traceability Matrix RTM throughout the testing phase.
• Updated Companion Guides for the business users as per 5010 enhancement .
• Performed User Acceptance Test UAT for business users to explain Mainframe CICS screens for claim processing.
• Answer questions and inquiries about system functionality and provide user support, including training, help and instructions for the Trading Partner Application used by Nebraska Medicaid.
• Worked on As-Is To-Be analysis of ICD9 to ICD 10 conversion for the new qualifiers used in the 837 claims for the diagnosis and procedure/HCPCS codes.
• Performed manual testing by building 837 claims, converting them into EDI file, uploading them into mainframe region and doing error resolution testing for 5010 requirements NPI crosswalk.
• Written test cases, test scenarios, test scripts and prepared test data to conduct the manual testing of EDI files and the mainframe screens.
• EDI file testing for checking the HIPAA 5010 X12 compliance of the inbound 837 claims.

Confidential

Acting Business System Lead

• DEERS Data match project was simultaneous to the HIPAA 5010 implementation project in which DEERS is a part of Department of Defense which performs a data match for every eligible subscriber of NE Medicaid for checking their eligibility with Tricare, a government payer for the eligible military personnel and their family members. NE Medicaid DEERS converted the traditional data match process to proprietary 270/271 X12 electronic transactions.
• Followed Agile SCRUM methodology to lead the 6 people team right from the beginning of the project and reported to Project Manager on periodic basis 2 week sprint cycle .
• Involved in telephonic interview sessions for gathering requirements user stories . Also conducted daily SCRUM meetings and weekly status meeting for following up on the project tasks to be done in timely manner.
• Performed Gap Analysis and Side-by-Side mapping as per the client's submission/companion guide and prepared solution process diagrams.
• Worked on Test Cases, Scripting and preparing the Test Data. Performed a manual EDI testing for the compliance check and data validation.
• Conducted UAT session with the legacy business users of NE Medicaid for every 30 day release.

Environment:IBM Mainframe,PowerPoint, Excel, Word,Visio,SybaseHIPAA X12 translator, MS Access RTM Test Cases , Lotus Notes, Clarity.

Confidential

Business Analyst

For more than a decade, AmeriHealth has led the way in bringing quality, affordable health care to more than 265,000 people in New Jersey, Delaware, and Pennsylvania. I was involved in a project to upgrade the EDI system in compliance with new ASC X12 standards and HIPAA. This upgrade was undertaken to covert the current 4010 version of payment remittance transaction 835 to the new 5010 version. I was also involved in requirements gathering for conversion of 837 P/ I, 27x.

Responsibilities:

• Performed gap impact analysis and prepared a communication plan requirements schedule to gathered requirements for the different products line of business .
• Maintained daily communications with third party vendors with conference calls and email.
• Worked on EDI X12 transactions, HIPAA standard transaction codes including 837, 835, 270, 271, 276, 277 and performed analysis and testing of such transactions.
• Conducted Business Analysis on 4010, data mapping and testing 837 and 835 transactions.
• Interacted with one of their important Client, provider Yale for the usability and current challenges that are faced usability point of view.
• Documented all the changes for the enhancements and recommended changes.
• Involved in enhancements of HIPAA 4010 to HIPAA 5010 eligibility and verification transactions. Also involved in Automation of Secondary claims.
• Worked on the Dental and Professional Claims and Design of the real time transaction.
• Created screen mockups and wireframes for prototype for the front end application of the different products using MS visio .
• Participated in analyzing Data Model Design and Data flow from various sources to target mapping.
• Analyzed system requirements and developed detailed Test Plan for System Testing.
• Written SQL queries select statement for testing Reports specific requirements.
• Involved in working on the EDI Transactions 835, 837 and Request Response, 270, 271 HIPAA upgrade from 4010A to 5010.

Environment: M.S Word, Excel, PowerPoint, Clarity, MySQL, MS Visio, Quality Center, Ultra Edit

Confidential

Business Analyst

Texas Medicaid and Healthcare partnership- Texas State developed New MMIS system for centralizing the all-Healthcare related transactions all over the state. The New MMIS project is a large IT project replacing the Medicaid claims payment system. Participated in all aspects of testing the New MMIS Primary responsibilities is to ensure that the system functions as designed, meets the requirements of the business community and conforms to all applicable Federal and state laws. Worked on the claims and provider modules of the New MMIS system

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.
• 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.
• 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.
• Conducted integration testing and regression testing with developers in development and QA, also conducted user acceptance testing with UAT team. Safety reporting on system-based projects, acted as a liaison, writing documentation and increased project coordination.
• 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
• Performed automated testing in QTP.
• Created BPR charts for AS IS and TO BE processes of different business functionalities.

Environment: Oracle, Quality Center, HTML, MS Office, Visio

Confidential

Business Analyst

CDPHP is the largest Health Maintenance organization in New York. There are nine different regions and a single common website linking all the regions. CDPHP is a consortium of three distinct groups of entities: the Kaiser Foundation Health Plan, Inc and its regional operating organizations, Kaiser Foundation Hospitals, and the Permanente Medical Groups.

Responsibilities:

• Performed Requirements Gathering and Analysis, interviewed the SME Subject Matter Experts , and ensured that contributors and all key stakeholders were motivated to complete assigned tasks.
• Facilitated Joint Application Development JAD Sessions for communicating and managing expectations.
• Use HIPAA transactions to interface with Third-Party Administrators TPA also various proprietary file interfaces for TPAs not supporting HIPAA transactions.
• Develop health and welfare fund and/or TPA to administer all member benefits and payment.
• Design Plans to pay provider based on specific reimbursement arrangement.
• Manage the Requirements Business as well as System requirements , performed requirements analysis along with the creation of Use Case Scenarios. Modeling of the business and application using Rational Unified Processing RUP and Unified Modeling Language UML .
• Responsible for Documentation in each phase of RUP Methodology, Risk Assessment, and Validation Verification process.
• Created Process Work Flows, Functional Specifications, and responsible for preparing Functional Specification Document FSD .
• Performed Gap Analysis to identify the deficiencies of the current system and to identify the requirements for the proposed system.
• Support Internal and external auditors for department audit.
• Performed Defect Tracking and Change Control Procedures using Quality Center and Configuration Management and Version Control using Rational Clear Case.
• Participated in developing test plans and test procedure templates and guidelines to be used by the project team with detailed screen layouts with regards to various types of corporate actions.
• Was involved in Functional System Testing, Integration Testing, Regression Testing, and User Acceptance Test using the test cases given by the client before releasing the application.
• Involved in the development of Test Plans, Test Cases and Expected Results, and coordinated the tests with the QA team to verify implementation of new features and enhancements.
• Provided assistance in other concurrent projects, especially in Regression Testing, in order for the team to gain time, before the clients could proceed to the system's User Acceptance Testing UAT
• Effectively logged and managed defects found during project system testing, and successfully interacted with the offshore development team to provide input for system fixes.

Environment:M.S Word, Excel, PowerPoint, SQL, MS Visio, Rational Tools, MS Access.