SUMMARY

• Over Eight years of expertise as a Business Analyst in Financial and Health Care Domains
• Excellent work experience in the Insurance service Industry with in - depth knowledge in Claims processing of Medicare/Medicaid plans
• EDI/HIPAA health information and health care services regulatory environment working knowledge and compliance experience
• In depth knowledge and experience in Defining and Gathering requirements and translating them to technical requirements
• Hands on work experience with the Healthcare Insurance Industry in concern to Medicare/Medicaid claims
• Good understanding of HHS mandated changesto be implemented HIPAA 5010 and ICD10.
• Strong business analysis skills and an understanding of the Software Development Life Cycle (SDLC) utilizing Rational Unified Process (RUP)
• Excellent skills in writing Business requirements document (BRD), Use case specifications, Functional specifications document (FRD), systems design specification, workflow and diagramming skills for drawing UML diagrams such as Activity diagrams, Class diagrams and Sequence diagrams, Dataflow diagrams, Requirement Tractability Matrix
• Facilitated UAT with Stake holders and Business users
• Adept in Using MS Outlook, MS Share Point, MS Access, MS Visio and MS Excel
• Proficient in using ICD 9/CPT/DRG/ANSI/HL7 coding standards in Medicare and Medicaid domains of the healthcare systems and industry for both Inpatients and outpatients
• Knowledge and experience of conducting and using JAD/RAD sessions
• Strong Documentation and Report generation skill and experience by Use Case approach
• Strong quantitative and analytical skills with hands-on experience in Financial and statistical analysis
• Compliance knowledge through projects and meetings with Legal/Audit groups
• Excellent Communication skills with ability and willingness to work towards the business and technical requirements of clients and users
• Exceptional Flexibility and ability to work independently and in a team
• Acted as liaison between management and development team for requirements

TECHNICAL SKILLS

Applications: MS Excel, MS Access, MS Share point, EDI Docs

Testing Tools: HP Quality Center

Business Tools: MS Visio and MS Project

Date Base: MS Access, Oracle 8i/9i/10g

Operating Systems& programming languages: Windows XP/2000, UNIX, .NET, Java, & SQL,PL/SQL

Web Technologies: HTML, XML, Web Portal, Web logic

PROFESSIONAL EXPERIENCE

Confidential, MD

Business Analyst

Responsibilities:

• Responsible for interacting with client for requirements gathering, analyzing requirements, and creating detailed specifications.
• Analyzed plan requirements and then contributed further defining the plan requirements with their Project Manager.
• Observed the compliance of the requirements with federal and state government regulations Medicaid, Medicare, and accreditation body requirements.
• Ensured that the MMIS upgrades are able to handle the new HIPAA transactions.
• Met with business users and stakeholders to understand the customer requirements through surveys, interviews (group and one-on-one) along with JAD sessions.
• Involved in understanding the current business process, defining scope of the project along with position statement.
• Responsible for creating business work flows and processes and creating management reports based on the analysis.
• Troubleshoot any problems found within application and when testing against the database while validating against business rules.
• Assisted with the mapping ofthe "to-be" processes insuring that these processes are aligned with theMITAmaturity model.
• Researched EDI claims and claims adjustments data to determine root causes of data errors.
• Worked with Development Team to generate EDI HIPAA 837, 820, 834, 270, 271, 276, 277 Transaction Set using Companion Guides.
• Developed requirements specification and process diagrams including context, dataflow diagrams.
• Worked on the implementation and process automation for Electronic Data Interchange.
• Created front-end prototypes as deliverables and projected the end-delivery modules as part of the efforts towards joint application development.
• Developed Use Case diagrams by analyzing the business process followed by Class diagrams, Activity diagrams and Collaboration diagrams in UML.
• Used MS-Visio for model diagrams and Rational Rose for UML class modeling and Visual modeling.
• Coordinated and attended meetings to review these specifications with the Quality Assurance Manager, Business Systems Analysts, RUP Engineers, Project Manager & others on the team.
• Worked closely with the development team to communicate client requirements.

Confidential, La Crosse, WI

Business Analyst

Responsibilities:

• Conducted sessions with the Stakeholders and Subject Matter Experts (SME) to elicit requirements necessary for the analysis and documentation of the hospital’s process.
• Analyzed existing process and its relationship with other processes and departments
• Reviewed, analyzed and gathered the hospital’s business and user needs. Understand, evaluate, and communicate data integration options to appropriate parties.
• Studied the business and technical needs and conducted the Gap analysis of “As-Is” and “To-Be” scenarios and generated Scope documents.
• Conducted JAD sessions, Focus groups and individual interviews to facilitate elicitation with regards to analysis, specifications, and design of the relevant business processes and systems.
• Responsible for defining, documenting and publishing Functional Specifications, Non Functional Specifications and BRD-Business Requirements Documents.
• Worked with IT/QA/BA for functional specifications document and modified it with changing requirements.
• Followed the Agile methodology to manage change controls for documented and helped the team to design and optimize the change control process.
• Interacted with stakeholders to identify, analyze, and document data sources. Created Data Flow/ ER diagrams based on Use Cases using MS Visio.
• Participated in Team Meetings and led the team to discuss and resolve issues relevant to the project’s development (team oriented) and reporting to the Project Manager.
• Helped the testing team and involved in the User Acceptance Testing (UAT).
• Monitored and prepared Progress Reports for Project Manager. Handled problems and provided solutions relevant to the project’s development.
• Communicated and coordinated with the Project manager, as well as business and technical stakeholders from initial phase to implementation of the project.

Environment: Windows, MS Office, MS Word, MS Excel, MS Power Point, MS Visio, UML, SQL.

Confidential, Boston, Massachusetts

Business Analyst

Responsibilities:

• Worked with Business users and Product group to identify various data elements that were required for risk assessment and reporting.
• Worked with Source System Developers, SMEs, Data Administrators, Data Integration team members to determine the data transformation method and required ETL tools for data transfer.
• Worked closely with the SME’s and Risk Professionals to identify elements that contributes to default risk.
• Interacted with Business Users to understand the business rules involved in assessing counterparty diversification and data rules applied to trigger alert for credit ratings or exposure.
• Presented system prototypes to the business stakeholders during JAD sessions.
• Presented business solution document walk-through to the Business, Product and Developer to help them understand the future state of the system.
• Provided project status to project owners in weekly meetings and kept track of project using MS Project 2000 for status reporting and project planning.
• Created current and future process models by using MS Visio and identified existing gaps that required to be addressed.
• Documented requirement change requests and technical change request for stakeholders for any requirement or technical changes that came up after business solution document sign-off.
• Tracked stakeholder’s requests for system enhancements and changes using Unified Change Management tool (UCM) such as Rational Clear-Quest.
• Performed root cause analysis on bug list with Quality Analyst and Developers and suggested enhancements to the existed application.

Environment: MS Visio, Rational Clear Quest, MS Office.

Confidential, Orange County, CA

Business Analyst

Responsibilities:

• Conducted business users’ interviews gathered and analyzed requirements. Conducted Knowledge Sharing sessions.
• Documented project processes and procedures. Conducted JAD sessions for better understanding and refining of requirements in coordination with multiple teams.
• Knowledge of business processes in Capital Market Infrastructure Entities.
• Identified Risks, documented business processes, conducted GAP analysis, experienced with fixed income security.
• Translated business requirements into Design Document for functional coding. Developed Use cases and Activity Diagrams in Rational Rose.
• Worked on Wire frames during the Elaboration Phase. Identified /documented data sources and transformation rules required to populate and maintain data warehouse content.
• Participated and contributed in discussions about parameters for reporting capabilities
• Scheduled meetings with developers, SA’s (System Analyst) and testers to collaborate resource allocation and project completion.
• Suggested measures and recommendations to Marketing Department to improve the visibility of the new Portal.
• Prepared Mock Up screens in MS Visio and created presentations for the Business Users in PowerPoint.
• Assisted with user testing of systems, developing and maintaining quality procedures, and ensuring that appropriate documentation is in place.
• Involved in requirement analysis, designing test plan, identifying test conditions.
• Involved in monitoring process flows and created Business Process Verification Plans, conducted and wrote user test check list manual for UAT Phase.
• Conducted User Acceptance Testing (UAT).

Environment: HP Quality Center, Rational Requisite Pro, Rational Clear Case, MS-Excel, MS-Visio, Windows 2003, SQL Server.