Summary of Qualifications:

• Facilitator between Business Systems and Information Technology with more than 8 years of various environment experiences in the field of business analysis.
• Several years of experience and advance knowledge of the Systems Development Life Cycle SDLC , and project life cycles like Agile, Extreme Programming XP ,Rational Unified Process RUP
• Strong knowledge and working experience of industry standards such as HIPAA, Six Sigma, and SOX, ICD-9, ICD-10 coding, EDI Electronic data interchange , transaction syntax like ANSI X12
• Participated and actively functioned in Joint Application Development JAD
• Strong Experience in Test Plans development, Test Conditions and Test Cases, test data creation and analysis, interaction with the development team for error detection and correction.
• Understanding the Business Intelligence concept using set of methodologies, processes, architectures, and technologies that transform raw data into meaningful and useful information used to enable more effective strategic, tactical, and operational insights and decision-making.
• Worked on System Changed Requests Issue resolution related to Medicare and Medicaid.
• Vast experience in requirement gathering for business and application requirements, business processes, identifying risks, impact analysis, UML modeling, Sequence and Activity Diagrams using Rational Rose and Microsoft Visio.
• Adept at writing Data Mapping Documents, Data Transformation Rules and maintaining Data Dictionary, Data Migration.
• Proficient in working with UML development tools like MS Visio,Eclipse, Enterprise architecture framework, UML2 Tools, and Power Designer etc.
• Experienced in conducting GAP analysis, User Acceptance Testing UAT , SWOT analysis, Risk Analysis and mitigation plan, Cost benefit analysis and ROI analysis.
• Exposure to Healthcare, Insurance and Finance business domains.
• Extensively worked and presented several documents and Use Cases for multiple transactions include 837I, 837P, 835, 276, 277, 270, 271 both inbound and outbound transactions for ongoing industry projects.

Experience

Confidential

Claims Business Systems Analyst-

• Confidential Worked on testing new member benefits, products, and system enhancements that resulted from the implementation of HIX. Worked on enhancing SSPT system by adding a new window where diagnosis codes could be imported from internal code repository and promoted to Diamond claims processing system and maintenance.
• Reviewed, analyzed, and evaluated business systems for end user needs, including documenting requirements and creating process workflows.
• Coordinated with business owners and BCBS-FL departments to determine project requirements.
• Responsible for leading JAD sessions with Subject Matter Expert, stakeholders, project manager, developers, and end-users to identify requirements.
• Created FRS and system requirement documents, along with diagrams ERD .
• Identified gaps between features when data was being mapped from old system to new system, analyzed issues and provided solutions
• Wrote SQL queries to pull data from the database in Unit and Test stage, and also for UAT.
• Wrote and managed all of the business and functional requirements of the new applications, as well as the added features for the older application, in Rational RequisitePro.
• Analyzed functional requirements segregated them into use case specifications and created use case diagrams using MS Visio, according to UML methodology.
• Performed static, functional and end-to-end testing.
• Used HP Quality Center / ALM 11.0.0 to create and execute test scripts.
• Worked on ICD-10 claims processing and tested the functionalities of the Single Source Pricing Tool SSPT .
• Trained team on functionality testing for SSPT and DMT.
• Single point of contact for establishment, configuration and tracking all projects throughout the lifecycle in 'Project Server' PMO Tool .
• Worked with the local claims processing system, utilizing Diamond, Mojo, Availity, GAP, APT, SSPT, DMT and other pricing tools.
• Gathered requirements for health claims system for Professional and Institutional, ICD 9 and 10, and pharmacy claims.
• Tested member benefits for HIX products, including SHOP, Small Group / Large Group, and New / Existing.

Confidential

Sr. Business Systems Analyst

• Project - Updated the existing FACETS Claims Processing System to handle a large number of claims with little change to the system framework, to comply with HIPAA 5010. Old system data was mapped to the new system to route claims out to Gateway Systems, which belonged to different payers.
• Worked on processing P, D and I claims in FACETS and gathered requirements for integrating them into the FACETS backend claims processing system.
• Worked with trading partners, clients, management, technical and non-technical personnel to create Use Cases and system validation artifacts.
• Created business rules and testing to implement HIPAA 5010 in the new system.
• Analyzed 837 and 835 EDI files including syntax and business rules for X12 HIPAA 4010 and 5010 validation for loops, segments, elements, qualifiers and code sets.
• Tested claims, enrollment, NPI, medical coding, and performed ICD-10 EDI testing.
• Used Clarity to validate HIPAA EDI files. Documented errors and artifacts demonstrating success.
• Coordinated with third party vendor for claims testing.
• Managed defects and reviewed reports exported from HP QualityCenter, SAP BO and SAP DW.
• Scheduled conferences with SMEs, reporting and ETL teams to clear doubts from QA professionals.
• PerformedUAT for HIPAA 4010 and 5010 projects including HIPAA requirements and compliance mandates.

Confidential

Sr. Business System Analyst

• Project:In the project of Confidential, a departmental site for the Heart Vascular Center was designed and developed. The project team needed to insure that the new departmental site is in compliance with client's EMR system, which they newly purchased according to HITECH Bill.
• Coordinated and conducted system requirements walkthroughs/sessions JADs with business Owner/stakeholders/SMEs as well as design/development teams.
• Analysis of key business requirements and assisted in the development of BRD.
• Managed and maintained Requirements Traceability Matrix RTM .
• Created activity diagrams and sequence diagrams and other UML diagrams.
• Analysis for making system compliant with HIPAA, involved in making Medicare patient profiles being compliant with the HIPAA regulations.
• The elicitation of the requirements for a replacement MMIS.
• Error handling using MySQL queries in Oracle.
• Worked with business area SMEs/analysts to develop and finalize test plans/use cases.
• Receiving and managing and modeling EDI data.
• Worked on EDI transactions 270/271 276/277.
• Developed Test Plans for the Business users and QA team and recorded the user observation about the testing and release.

Confidential

Business Systems Analyst

• Project:This project aimed at developing software for auto-adjudication of claims process to improve the efficiency in processing claims.
• Defined project milestones and schedules, and monitored progress using MS Project and Creative Pro Office. Modified and updated the project schedules and plans as required.
• Used MS Visio to create Data Flow Diagrams DFDs , ER Diagrams for data modeling, and Web-page mock-ups for acceptance from end users.
• Conducted risk analysis of the requirements and traceability focus areas of the various projects and worked with the project team to help them identify the high-risk areas.
• Worked on both inbound and outbound transactions, creating test cases for multiple transaction types including 837, 835, 276, 277, 270 271.
• Worked on changes for HIPAA Transactions from version 4010 to 5010. Documented the detailed business and technical requirements to upgrade the current system to 5010.
• Designed future state processes for HIPAA 5010 transaction processing EDIs 837,835, 270, and 271.
• Analyzed HIPAA 5010 related to 837,835, 270, and 271 transactions and performed gap analysis between the 4010 and 5010.
• Gap Analysis: Analyzed the client's applications programs to determine the impact of the HIPAA final rule on EDI Transaction Set and Code List implementation and defined the changes to bring the affected systems into HIPAA compliance.

Confidential

Sr. Business Analyst

• Project: The project was on American Express Bank which Integrated On-Line Transaction Processing System IOTPS which includes mortgage loan processing application.
• Effectively communicate project expectations, project goals and scope to the team.
• Facilitated team meetings to coordinate activities for project schedules, presented deliverables to the management, conducted to elicit requirements.
• Define, prioritize, and track requirements throughout the project lifecycle, software development teams are able to respond rapidly to ever-changing requirements without risking the project success.
• Perform analysis on project scope parameters gap analysis, usability, cost /benefit etc.
• Conducted JAD sessions with SMEs, system architects, technical teams and other stakeholders for open and pending issues
• Responsible for managing the documented system requirements and mapped using MS Excel for Requirements Traceability Matrix
• Worked with developers in design/development activities in converting SSRS reports into the SQL database and manage all the electronic records in the system.
• Managed requirements to minimize scope issues. Understand all systems requirements within deliverable and provide feedback, collected requirements from customers, users and prioritized them.

Confidential Business Analyst

• Project: To improve pharmaceutical manufacturing, R D, clinical trial management, document management, laboratory information management system LIMS and research performance by controlling and tracking all aspects of clinical trial, production and research, promoting best practice and capturing critical data for compliance, quality control and process improvement.
• Participated in all phases of software development life cycle in RUP framework.
• Prioritized business requirements, policies, calculation methods, business processes, and business rules according Six Sigma methodology and documented.
• Conducted interviews with over fifty subject matter experts including laboratory scientists, manufacturing engineers and executives .
• Worked in an RUP environment for elicitation and representation of requirements and in modified management.
• Conducted walkthrough sessions for Business Requirement Document BRD and use cases to discuss issues with stakeholders, architecture, design and development teams, and also performed GAP Analysis.
• Partnered with clients/peers/scientists/technical groups to perform quality reviews on business requirements in order to verify that the requirements accomplished the demands of the end users.
• Facilitated Joint Requirements Planning Sessions JRP to gather requirements from the business users and conducted many JAD and RAD sessions.
• Assisted in the execution of essential validation protocols and other IT testing and documentation content, processes and procedures associated with implementing enterprise applications.
• Created user manuals, presentations and training manuals.

Confidential

Business Analyst

• Served as liaison with QA and Developers to understand functionality, resolve issues, nail down bugs and resolve them provided feedback and fine-tuning for the entire development process.
• Prepared business requirement document and then converted the business requirements into technical specification using Rational RequisitePro.
• Created UML Diagrams including Use Case, Activity / State Chart, Sequence, Collaboration and Deployment, Data Flow Diagrams DFDs , ER Diagrams and Web Page Mock-Ups using Rational Rose and MS Visio, thus defining the Business Process Model and Data Process Model.