SUMMARY

• Extensive experience spanning over 7 years as a Business Analyst catering various organizations specializing in health care and insurance claims
• Extensive experience in creating/writing BRD (businessRequirement Documents), Gap Analysis, Use Case Diagrams, Activity Diagrams to extractbusiness process flows and workflows.
• Exceptionally well in collecting, understanding, and transmitting thebusiness requirements for the project, and translating them into functional specifications and requirements.
• Integrating the development and quality assurance teams to help them understand the requirements.
• Experience in Prescription Codes, Insurance, Claims, financial Assistance, Billing and Denials.
• Experience in developing and imparting pre and post implementation training, conducting GAP Analysis, User Acceptance Testing (UAT) and SWOT Analysis.
• Possess strong knowledge of healthcare terminology and extensive experience working on healthcare projects.
• Hands on experience working with HIPAA 4010/ transactions such as 837, 835, 834, 278, 270 and 271.
• Revitalized requirement elicitation techniques, conducted user interviews and JAD sessions and managed the requirements using Rational Requisite Pro and Use Case Modeling with all phases of SDLC
• Worked extensively on 5010/ transactions, ICD - 9/ICD-10 codes and good knowledge on EDI.
• Worked on various lines of businesses like PPO, HMO, FEP, High Mark, Enrollment, Medicare and Medicaid claims.
• Expertise in using database applications such as ORACLE, SQL Server and MS Access
• Experienced in Business Analysis, Data Analysis, Requirement Analysis, Business Modeling and Use Case development using UML methodology.
• Expertise in the management of User Request Change, and handle User Conflicts.
• Extensive knowledge in understanding the Risk and control Assessments and ROI.
• Knowledge in evaluating Technical andbusiness needs, analyzing them and providing technical solutions. Provide support for the teams in customizing and implementing the products.
• Skilled in validation and testing complex scenarios to achieve quality of standards in projects.

TECHNICAL SKILLS

Methodologies: SDLC, RUP, UML, RAD, SWOT Waterfall

Testing Tools: Rational Clear Quest, Test Director, Win Runner, Quick test Pro

Change Management Tools: Test Director, Rational Clear Quest

Project Management: MS Office, MS Project, MS PowerPoint

Programming Languages: SQL

Business Modeling Tools: Rational Rose, Microsoft Visio, Smart Draw

PROFESSIONAL EXPERIENCE

Confidential, Deerfield, IL

Responsibilities:

• Procurement of Project Charter and examining in detail the Objectives, Authorization, Management Support, nature and scope, project deliverables, schedule and budgeting.
• Created analysis documents for the BRD and FRD.
• Gather Business requirements by interviewing Subject Matter Experts (SME) and end-users, pharmacists, personal Assistant to Physician, CNA, nurses, other clinical staffs who actually play a role in the Rx filling screen, via JAD session.
• Updating the BRD to the stake holders and the development and QA team by organizing sessions to obtain suggestions and feedback.
• Drafted comparative statements, reports to examine the existing functionalities and present to the stakeholders.
• Created Business Process Workflow Diagrams to enhance the project and for better understanding to the BU through the end user perspective.
• Segregate Business Requirements into high level and low level Use Cases thereby eliminating any possible errors.
• Documented detailed Business Requirements Documents (BRD) and Functional Requirement Documents (FRD) using Rational Requisite Pro.
• Used Rational Test Manager and Rational Clear Case to determine changes.
• Presented the Application Prescription Entry Screen to the Stake holders and board after thoroughly checking all the fields’ functionality.
• Applied Electronic Data Interchange (EDI) codes for verifying Confidential t eligibility and receiving the insurance benefits, Confidential t information, healthcare claim request, and healthcare claim through the new Application/screen.
• Work closely with technical team and QA team to ensure testability of requirements.
• Presented the deliverable ahead of the stipulated projected deadline and walked through the Application with the BU and stake holders.

Environment: MS Office Suite, MS Visio, Rational Requisite Pro. Rational Clear case, Rational Test Manager, Medical Healthcare system.

Confidential, Deerfield, IL.

Responsibilities:

• Lead a team of efficient peers in creating the Notification Screen/Application after procuring the Project Charter from the Stake Holders, BU and Board of Directors for the delivery and refill division.
• Involved in requirements discussions with business units, ensuring all business requirements were satisfactorily met and catered to.
• Gathered user/business requirements by meeting with business users and generated business models and use case analysis.
• Gathered requirements and analyzed them to convert into functional requirements.
• Responsible for creating and reviewing business requirements, functional specifications, project schedules, technical documentation and test plans.
• Conducted JAD sessions to elicit business and system requirements.
• Designed workflow model, prototype model, Collaboration and Sequence Diagrams, Context and Data Flow Diagrams and UI Specs.
• Verified the privacy issues and compliance with the HIPAA Security and Privacy Act.
• Developed test scenarios and participated in system, regression and user acceptance testing.
• Managed requirements and identified inconsistencies with project plans and scenarios.
• Involved in elaborate JAD sessions with Database Management teams to work on a platform where the personal information of the Confidential t could be collaborated and synced.
• Extensively worked with the Developers and QA teams throughout the SDLC to successfully implement the product deliverable.
• Extensive research was conducted with the QA team on the feasibility of the screen and its functionality.
• Validated and tested the application along with the BU, Dev and QA teams.

Environment: MS Office (MS Word, MS Excel, MS PowerPoint, MS Visio), MS-Project, Windows, Clear Quest, Medical Health systems.

Confidential, Pittsburg, PA

Responsibilities:

• Understanding the Project details with the Business Users, stake Holders and the PM.
• Gathered data and relevant information pertaining to the subject matter and conducted questions and query sessions regarding the deliverable in question.
• Gathered Business Requirements and Functional Requirements relevant to the new application.
• Conducted detail JAD sessions with SME, Dev and QA teams upon completion of each phase of Business requirements.
• Designed different work flow diagrams and flow charts to project & decipher the advancement of the project.
• Designed Collaboration and sequential diagrams to help understand the progress.
• Interfaced with internal clients and technical vendors on new feature requirements and conducted a thorough analysis of the system features to assist project team with implementation of new features according to HIPPA Rules.
• Extensive work done on ICD 9 and ICD 10 as this was the transition phase of the change of codes.
• Organized Meetings and quick updates checks with peers and the Dev teams to check the feasibility of the time management.
• Collaborated and incorporated all the different modules and information about various insurance providers and brought them under one single process screen.
• Responsible for organizing team event for BRD and FRD discussions; and organizing client’s events with different insurance providers for updates on policy.
• Contracted with the HCFA (Health Care Financing Administration)/ Medicare Centers and Medicaid Services for norms and regulations to be followed.
• Reviewed and processed medical health claims for Self-Insured Groups including verification of coverage and adjudication of claims.
• Updated the system and submitted reports to support and populate ICD10 codes on claims.
• Examined reports and similar insurance claims or precedents to determine extent of insurance coverage.
• Responsible for scheduling weekly meetings with different users and documenting meeting minutes.
• Developed risk assessments, generate recommendations for process improvements, prepare written reports, and written/oral presentations.

Environment: Windows, Clear Quest, Microsoft Office, Excel, PowerPoint, Word, MS Visio), MS-Project, Medical Health systems.

Confidential, Bolingbrook, IL

Responsibilities:

• Interacted with board of directors, understood their business and medical center processes and gathered requirements for business definition.
• Involved throughout the System Development Life Cycle (SDLC) and performed a primary liaison between the Medical Center and the technical areas.
• Created Planning documents involving Claims, insurance and finance sectors.
• Responsible to interact and liaison with Business/Hospital teams and other technical teams to facilitate joint application development (JAD) sessions and document the business requirements.
• Conducted JAD sessions with Business Users and SMEs to identify and gather various functional and non-functional requirements.
• Gathered Business Requirements and Functional Requirements relevant to the application and made the teams understand the project flow.
• Sessions with the claims and finance teams to furnish the BRD in compliance with HIPPA and PHI norms.
• JAD sessions with the finance, billing, claims and denials teams resulted in integration of all business documents on a single platform. Created data, functional and quality requirements.
• Integrated PHI from various sources like insurance, billing, claims, Confidential t database using Rational Requisite Pro.
• Developed Traceability Matrix to trace each requirement to test cases.
• Worked with management to create and communicate critical information to the user community via email and discussion boards.
• Tested the system and applications for compliance with the HIPAA and EDI.
• Work with Business user in understanding billing guidelines with respect to standards of ICD 9 Coding.

Environment: HTML, XML, MS Visio, MS Excel, MS SQL, Rational Requisite Pro, UML, Rational Unified Process, SQL, Medical Health Systems.

Confidential, Boston, MA

Responsibilities:

• Implemented an integrated RUP solution with complete line of traceability for all the artifacts of web development projects.
• Followed a structured approach for gathering and formalizing business requirements expressed by managers, process owners and operational users of the information system.
• Prepared functional and non-functional requirements.
• Involved in requirement gathering including interviews, and meetings with stakeholders, SMEs and created requirement specification artifact.
• Responsible for preparation of functional specification and supplementary requirement document.
• Conducted JAD sessions, prepared Prototype, documented workflow processes and studied business process workflow diagrams.
• Created Use-Case Models using Rational Rose to depict Actors and Use-Cases in various Business Processes.
• Responsible for creation of Prototypes; evaluation of development and technology options and feasibility analysis.
• Prepared Business Process Models that includes modeling of all the activities of the business from the conceptual to procedural level. Followed top down, leveled technique for building Business Process Models.
• Worked with UI team to create the User Interface screenshots to be presented to the Business. Worked with change management tool.
• Responsible in timely completion of project tasks and deliverables with a high degree of quality by prioritizing tasks appropriately and communicating issues directly with the project manager.
• Prepared Test plans and Test procedures based on RUP methodology.
• Used Rational Clear Case, and Configuration Management tool, to maintain different builds of the application with descriptions about all changes and versions.
• After successful development and testing of the application, participated in product release and deployment to end-user.

Environment: MS Office (MS Word, MS Excel, MS PowerPoint, MS Visio), MS-Project, Windows 2000, SWOT analysis, Clear Case, Clear Quest.