Professional Summary

• Overall 7 years of industry experience as a Business Analyst, specialized in Medicaid, Healthcare System, Healthcare Claims Processing and Information Technology.
• In depth knowledge of Healthcare Institutional, Professional and Pharma Claims Data Elements, X12 EDI Transaction Sets such as 837, 270/271, and 276/277 for 4010, 5010 industry standard and ICD 9 and ICD 10 code sets and qualifiers.
• Extensive experience with full spectrum of Business Analysis Approaches from plan driven Waterfall to change driven Agile, Scrum, XP, RUP and wide range of application development from Web Based Applications to Enterprise Solutions.
• Extensive experience in gathering Business and Functional Requirements, developing Use Cases, conducting GAP Analysis and Impact Analysis, modeling Businesses Processes, QA Testing, and preparing Training manuals and Knowledge Transfer manuals.
• Through understanding of different phase and artifacts Deliverables of Software Development Life Cycle SDLC .
• Expertise in different requirement modeling techniques such as, Unified Modeling Language UML - Use cases Diagrams, Activity Diagrams, Business Process Models, prototypes and wireframe diagrams.
• Hands on experience with different requirements elicitation techniques such as, brainstorming, interview, job shadow, focus group and structured walkthrough.
• Have experience in preparing and executing Test cases, Test plans for functional, regression and User Acceptance Testing.
• Excellent interpersonal skills with proven ability to develop strong relationships within the organization in order to coordinate project operations.
• Strong time management skills in handling multiple projects and deadlines under minimal supervision.
• Strong leadership skills that facilitate mediators and conflict resolution at levels of project management group.

Technical Skills

Professional Experience

Responsibilities:

• Gathered and administrated business requirement from different bureaus, analyzed and allocated impacted areas into various interim groups, established communication channel with sister agencies
• Identified and amended agency's impacted policy changes that includes agency rules, provider handbooks, agency statutes, proprietary and CMS forms, agency's website update, annual reports, provider notices and bulletins
• Engaged in Hospital Rate Reform projected where identified impacted functional areas like mainframe screens, Hospital Edits. Updated provider rates, tested screen functionality
• Grouped inpatient and outpatient claims and evaluated 3M grouper output rates for over 54 line and HRR projects
• Prepared and typed paper claims for testing in ICD-10, tested forms using internal scanner
• Worked with encounter data, conducted business and system requirement for FFS to MCO conversion
• Prepared test data for ICD-10 and HRR projects, created and modified X12's 837i and P , validated frond end and back end outcome of EDI files
• Developed GAP analysis document, accumulated Business Requirement and Functional Requirement Document for various screens and edits impacted by ICD-10 implementation.
• Conducted Joint Requirement Gathering session along with the product team to capture ICD-9 to ICD-10 Code conversion rules.
• Used GEMs General Equivalency Mapping crosswalk file for ICD-9 to ICD-10.
• Conducted Business Requirements walkthrough with the business owners as well as the Technical Stakeholders for ICD-10.

Environment: HIPAA X12-MEDI, 3M Grouper, MMIS, Mainframe, blue zone, Microsoft SharePoint, Teradata SQL assistant, Bi-Query, Ultra Edit, EDI Notepad, MS Visio, System Architect, MS Project,

MS Access MS Word, MS Excel.

Responsibilities:

• Conducted impact assessment sessions along with the project team to identify functional area like screen, Database, hospital EDITS impacted by ICD- 10 and 5010 implementation project.
• Conducted Planning sessions with Project Team, Sponsor, SMEs, and developers to build high level project scope for ICD10 and 5010.
• Validated requirements for business processes, policies and information systems impacted by ICD-10.
• Prepare GAP analysis document, Business Requirement and Functional Requirement Document for various screen and edits impacted by ICD-10 implementation.
• Conducted Joint Requirement Gathering session along with the product team to capture ICD-9 to ICD-10 Code conversion rules.
• Prepared 5010 GAP Documents for 270/271 transactions set along with the Business and Technical SMEs.
• Used GEMs General Equivalency Mapping crosswalk file for ICD-9 to ICD-10.
• Conducted Business Requirements walkthrough with the business owners as well as the Technical Stakeholders for ICD-10.
• Conducted requirement elicitation session to capture business requirements, functions/system specifications and non-functional requirements.
• Documented the UAT Plan for the project and worked with the UAT Team to ensure every acceptance criteria for the requirements has been included in the UAT task plan.
• Prepared Traceability Matrix to establish forward and backward traceability between scope, requirements, test cases, user acceptance test cases.
• Performed testing for Claim or eligibility file coming through FTP and Web application.
• Involved in trading partner testing during 5010 dual use phase and production support post implementation.
• On calls with the providers/trading partners to resolve any issues they are facing when submitting claims through the Web-Application or through FTP.

• Created and updated test cases according to the new HIPAA 5010 standards for Transactions 837 P, 270/271's.
• Worked extensively in validating theX12 EDI 837P, 270/271's transactions to check for HIPAA Compliance through compliance checker tool called Sybase.
• Prepared User Acceptance test plan UAT and depending on that created a test scenario document, test cases and test data.

Environment: HIPAA X12, MMIS, Sybase, Ultra Edit, MS Visio, System Architect, MS Word, MS Excel.

Responsibilities:

• Primary role is to lead JAD session to capture the requirements from state client and prepare the transaction and reporting functional design document and then translate in to detail design document.
• Responsible for getting sign off on BUR, FD from client and handling change approval process.
• Responsible to elicit, analyze, validate, specify, verify, and manage the needs of the project stakeholders.
• Communicate the Gap process Analysis with the stakeholders and feed that into the requirements traceability matrix.
• Used agile methodology to execute complete software development lifecycle SDLC solutions, including requirements gathering, test planning and execution, design, development, and deployment for clients.
• Worked alongside with cross functional teams in order to establish comprehensive business and functional requirements and then translating those requirements into software design specifications using various notations of UML for designing and documenting the detailed business and functional requirements.
• Used Visio for Business Use Case Diagrams and Business process mapping. Developed use cases for claim front end, back end, inbound and outbound business process and file processing.
• Prepared data mapping document for developers to generate several reports.
• Run SQL queries to pull and analyze the data as per the reporting requirements.
• Worked on EDI to transfer of data between organizations by electronic means.
• Interacted closely with QA team in different phases of testing such as System testing, Functional testing, Regression testing and Integration testing for Quality Analysis using Quality Center and resolving the issue assigned on JIRA.
• Closely working and supporting operational, developers, QA and UAT teams.
• Worked in Visio and UML for Business Process Mapping, designing applications and use cases.
• Worked with SharePoint for storing project documentation.

Environment- NCPDP, HIPAA, EDI, Oracle11g, Quality center, JIRA, RUP, UML, MS Office, MS Visio, MS Excel, SharePoint

Responsibilities:

• Communicate the Gap process Analysis w/ the stakeholders and feed that into the requirements traceability matrix.
• Work on designing processes sub-processes confirming it against the functional requirements by following the Agile methodology.
• Created X12 flowcharts for Business Requirement Documents BRD based on the requirements and EDI standards.
• Managed and designed data in accordance to SOA Service Oriented Architecture and designed and developed Use Cases, Activity Diagrams, Sequence Diagrams using UML
• Worked on EDI to transfer of data between organizations by electronic means.
• Used Agile methodology to write the Business Requirements documents and designed Functional specifications for the target physical database.
• Created and maintained required technical GSM documentation including architecture, support and communication plans, work instructions and processes.
• Tracked Business requirement traceability matrix RTM and handled scope creeps.
• Worked toward claim processing such as Claim Adjudication and Claim Reimbursement.
• Designed Use Cases, Use Case diagrams, Class diagrams, Activity diagrams, Sequence diagrams in UML methodology using MS Visio.

Environment: SQL Server 2005, MS Visio, MS Project, MS Office, AS/400, EDI, SOA, UML.

Responsibilities:

• Participated in all phases of Software Development Life Cycle SDLC , from requirement elicitation to design, development, testing and implementation phase.
• Held regular meetings with the SME'S to priorities the business Requirements and Participated in the training sessions to get to know the HIPAA standards and procedures.
• Conducted interviews with the users by preparing questionnaires and getting feedback.
• Conducted walkthroughs with developers, project managers, stakeholders and users to comprehend business work flow of applications.
• Participated in meetings, Updated requirement document as per business user feedback and change in functionality of the application.
• Participated in developing test plans and test procedure templates and guidelines using Test Manager to be used by the project team with detailed screen layouts with regards to various types of corporate actions.
• Analyzed the business and functional requirements of the application and developed detailed test plans, test cases for functional and regression testing.
• Coordinated and prioritized outstanding defects and enhancement/system requests based on business requirements, allowing sufficient time frame to ensure accuracy and consider deadlines.

Environment: GEBS,EDI X12,Test Manager, MS Outlook, MS Word, MS Excel

Responsibilities:

• Participated and conducted in Joint Application Development JAD sessions, facilitated meetings, captured meeting minutes.
• Conducted requirement elicitation session to capture and confirm business requirements, functional requirements and non-functional requirements.
• Designed and developed use cases, activity diagrams, and sequence diagrams to support architectural development.
• Assisted in building a business analysis process model using Rational Rose.
• Collaborated with the Project Manager to organize training material and write user manuals.
• Created prototypes for the web-based form.

Environment: HTML, RUP, Rational Rose, Visual Basic, MS FrontPage, Windows 98, MS Word, MS Excel.