SUMMARY

• Business Analyst with 8 years of industry experience in identifying business needs, and determining solutions to business problems for complex software projects including system development component, business process improvement, strategic planning and policy development.
• Experience in creating and organizing deliverables in a secure retrievable area: such as BRD Business Requirement Document , FRD Functional Requirement Document logical design, SRS System Requirement Specification and Change Management Documents.
• Experience with full Software Development Life Cycle SDLC and project life cycle including Feasibility Analysis, Requirements planning and Management, Application Design and Development, Testing, Implementation and Post-Implementation Validation, and Solution Assessment.
• Documenting and creating Test Plans, Test Objectives and Test Cases. Also involved in maintaining Test Matrix and Traceability Matrix.
• Strong knowledge of Object Oriented Analysis and Design OOAD using Unified Modeling Language UML , Rational Unified Process RUP , CMM
• Also worked using various methodologies such as Waterfall methodology, Agile Software Development, Rapid Application Development RAD , Joint Application Design JAD , and Prototyping.
• Experienced in Business writing skills and Technical writing skills in developing Business Case, Scope Document, Business Requirements Document BRD , Functional Requirements Document FRD , Non Functional Requirements Documents NFRD , Use Case Scenarios, Test Plans, Test Cases, AS-IS and TO-BE workflows.
• Proficient in Rational Suite including Rational Rose, Requisite Pro, MS Visio, MS Project and MS Access.
• Also proficient with application support claims processing, and customer service modules in Facets.
• Excellent communication skills and proficiency in interacting with the stakeholders, and Subject Matter Experts SME's to get a better understanding of the Business Process.
• Extensive experience with Business Process Management BPM system.
• Excellent knowledge of Health Insurance Portability Accountability Act HIPAA standards, Electronic Data Interchange EDI , and Implementation and knowledge of HIPAA code sets, ICD-9, ICD-10 coding, and HL7.
• Efficient in handling Change Requests by the client.
• Experience in White Box, Black Box, Unit, Functional, Integration, Back End and System Level Load and Stress Testing for many types of applications including web and client server applications.
• Good knowledge and understanding of Confidentiall Management Information System MMIS
• Working knowledge and experience with SQL/PL SQL, HTML, and MS Access
• Excellent analytical and problem solving skills in designing, developing, and implementing innovative business processes using new approaches and technology.

AREAS OF EXPERTISE

P R O F E S S I O N A L E X P E R I E N C E

Confidential

Sr.BusinessAnalyst

Confidential refers to a group of companies held by a non-profit, tax exempt holding company called Confidential Holding Company. Its family of businesses includes Confidential Health Plans, Confidential Health Plans of Wisconsin, Confidential Insurance Company, Confidential Self-Insured and Confidential Health Management, LLC, as well as the Confidential Foundation and the Confidential Research Institute.I was working on implementing the Patient Protection and Affordable Care Act PPACA signed into law by President Barrack Obama on March 23, 2010. With PPACA, all private and non-profit insurers, including Horizon, beginning 2014, are required to modify their health insurance plans according to the Act and put up the subsidized plans on Health Insurance Exchanges with other insurers making it a one-stop shop for the customers looking to purchase insurance coverage. I was assigned to 3 different projects namely, OS Upgrade deployment, changes/modifications to the 834 Enrollment from FFE/FFM and 820 Payment Process reporting. Some of my common duties are:

Job Responsibilities

Generated the new 820 reports for the Finance department giving a detailed breakdown of all payments made by CMS at the Program level and at the subscriber level. Worked with Actuarial department and design new healthcare QHPs including changes to existing certificates and riders for the HMO plan for Blue Cross. Updates to existing riders to add/reduce benefits for eligible group health insurance plans. Developed mapping documents for incoming 834 files from the Exchange and analyze the differences between the current 834 process and the future 834 enrollment processes. Analyzed upgrades needed in NASCO to support the incoming Health Insurance Exchange HIX Analyzed the existing Broker Commission System and automate the new Broker Administrative fee for brokers obtaining Individual and Group Businesses. Analyzed the existing 820 reports and modify them based on the changes resulting from HIX. Analyzed current business processes and systems to provide business process improvement ideas. Gathered requirements and develop detailed documentation related to systems requirements and conceptual solutions. Coordinated with the testing center while testing built products. Worked independently within guidelines, provides analytical support to a specific group of customers on business application, infrastructure and technology related activities Provided guidance, assistance, coordination and follow-up on complex problems and ensure a resolution workedwith application developers to support applications and customer requests. Used MS SharePoint for Project Management tasks like baseline, change request, project plan, resource assignment and other project related activities. Prepared risk identification, and financial analyses such as cost/benefit, ROI, buy/build, etc. Wrote detailed description of user needs, program functions, and steps required to develop or modify computer programs Worked with IT and business project teams to understand reporting and data warehousing requirements and propose solutions Utilized knowledge of relational database concepts, and client-server concepts to help upgrade the systems and data conversion for newer systems.

Confidential

Buisness Analyst

Confidential is the largest provider of health care coverage in Confidential, serving more than half of the state's population. Insures and/or administers claims for about 510,000 people .In 2013 income was 1,195,644,000 and also the claims incurred totaled I was involved in BCBS health services Web Application, which provides the quality level of Health services for customers. The web site and the supporting system are developed to provide Online insurance services to their customers and Agents. The insurance Application involves quotation tool and also enables the customer to complete the transaction after selecting the insurance plan, pricing, location details etc. Also agents are allowed to quote or complete the application online on behalf of the customer. This includes Health insurance, Policy and Claim Service modules.

Responsibilities:

• Involved in gathering and documenting the requirements that were critical to the business process and using those requirements to design application software using a Use Case approach.
• Interviewing several business area experts, asking detail questions and carefully recording the requirements in a format that can be reviewed and understood by both business people and technical team.
• Conducted Functional Requirement reviews and walkthroughs with the designers, developers and stakeholders.
• Created and maintained the Product Backlog.
• Participated in and at times conducted the daily scrum.
• Interviewed business users to gather business wants and needs around project ideas and translate them into business and technical requirements.
• Reviewed each iteration deliverables with the Product owner and Scrum Master.
• Understanding of HIPAA compliant ANSI X12 837 formats for both professional and institutional claims.
• 276/277 Claim Status Request / Response
• 277/275 - Claim Request for additional Information and Response
• 270/271 - Eligibility Benefit Inquiry and Response
• 835 - Claim Payment/Advice
• 834 Benefit Enrollment and Maintenance
• 837 Claims and Encounters
• Helped developers with the following list of HIPAA-EDI Transaction Code sets:
• Matched the requirements for programs such as Confidentialre and Confidentialid which are part of the Social Security Act.
• Worked With HIPAA compliant ANSI X12 837 formats for both professional claims and institutional claims.
• Interacted with clients and end users in order to understand the process and gather User Requirements.
• Analyzed forms and successfully crosswalk details to corresponding ANSI X12 formats.
• Conducted UAT and User Trainings.

Environment Agile, MS Visio, MS Word, MS Excel, MS PowerPoint, MS Outlook, UML, html, SQL, MS Access.

Confidential

Business Analyst

Confidential provides health care coverage to low-income Oregonians through programs administered by the Division of Confidential Assistance Programs DMAP . Currently, more than 380,000 people each month receive health care coverage through the Oregon Health Plan. The project aims at building an Enterprise SOA Service-Oriented Architecture based system that will be developed on the Microsoft .NET Platform. The new Confidential will replace the old legacy system and will automate all the business areas with minimum human intervention. As a Business Analyst, I was involved with drafting the migration plan for the Claims Processing data which needed to be migrated from the Mainframe to the SQL Server environment. I was also involved with the HIPAA 5010 compliance for the new MMIS system.

Responsibilities:

• Gathered requirements from stakeholders for provider management and member management.
• Analyzed EDI X12 data elements captured by the existing system to validate it against the data elements required for new system.
• Proposed strategies to implement HIPAA 5010 in the new MMIS system.
• Analyzed different data cross-walks, complicated logic look ups required by different fields for the source to target transformations.
• Facilitated JAD sessions for Requirement Validation with Dept. of Health Human Services DHHS to gather requirements for the new MMIS.
• Identified and validated business rules and data elements.
• Developed the stakeholder list and created stakeholder assessment matrix to prioritize them.
• Developed and maintained a requirements work plan and assessed the performance metrics of the team members.
• Maintained a bi-weekly status report for the requirements team and incorporated the same to the PMO status reports send to CMS.
• Modeled the 'as-is' process flow and the 'to-be' process flow and analyzed the gap and developed the action steps to fill the gaps.
• Conducted risk analysis and developed mitigation plans.
• Conducted impact analysis when there is any change in the requirements and updated the Business Requirements Document BRD and Systems Requirements Specification SRS .
• Participated in developing test plan, test scripts, and test scenarios and designed user documentation.
• Worked with legacy team in developing BRD for multiple system change requests and participated in system testing.
• Used Microsoft SharePoint as the version tracking tool for managing the requirements documentation.
• Developed the User Interface UI prototypes to capture and validate requirements and spike solutions to the current problem.
• Designed Functional Specifications for the target physical database.
• Developed UAT test cases associated with the functional requirements.
• Create monthly/weekly status reports to update the project schedules deliverable plan.
• Examined the system design deliverables validating it against the Request for Proposal RFP .

Environment: MS Office, Windows 2000, .NET, MS Visio, MS SharePoint, TFS, MS Project, MS Visio, SQL, Oracle, SOA, HTML

Confidential

Role: Business Analyst

Confidential 90 of the top 100 FORTUNE 500 Confidential is a leading global provider of insurance, annuities and employee benefit programs. Through its subsidiaries and affiliates, Confidential.The project that I was involved with focused on the development of the ECF Electronic Claim Filing application. ECF has replaced the existing legacy system built on DB2 database.

Job Responsibilities:

• Coordinated Regression Testing and created test scenarios for User Acceptance Testing UAT .
• Developed queries using SQL to automate the weekly and monthly Meds Update Reports and FCO reports.
• Created product documentation, printed user manual and training materials.
• Analyzed business needs, created and developed new functionality to meet real time data integration that facilitated decision-making.
• Use Case development and UML modeling using modeling tools like Rational Rose/MS Visio.
• Maintained Requirement Traceability Matrix RTM .
• Written multiple Use Cases for multiple transactions include 837I, 837P, 835, 276, 277, 270, 271 both inbound and outbound transactions.
• Involved in preparing the Test Scenarios for Health Care Claim Payment/Advice.
• Involved in HIPAA/EDI Confidentiall Claims Analysis, Design, Implementation and Documentation.
• Defined Use cases from requirements and helped convert them into software specifications.
• Used Rational Rose/MS Office Suite for creating use cases, workflows and sequence diagrams according to UML methodology thus defining the Data Process Models.
• Conducted JAD sessions to define the project and to reduce the time frame required to complete deliverables.
• Responsible for translating BRD into functional specifications and test plans. Closely coordinated with both business users and developers for arriving at a mutually acceptable solution.
• Gathered requirements and prepared business requirement documents BRD .
• Maintained documents for change request and implemented procedures for testing changes.