SUMMARY

• 8+ years of experience as a Business Analyst with IT knowledge specific to Confidential and have Complete knowledge on all phases of the Software Development Life Cycle (SDLC) gained over working on various project for different Clients
• Strong Experience in Medicaid and Medicare claims and reimbursements, Health insurance plans like Indemnity plans, Managed Care plans (HMO, PPO & POS)
• Strong knowledge on HIPAA standards 4010 & 5010, ICD - 9,ICD-10, HL7, CMS, EDI, EMR, Medicaid Management Information System (MMIS), FACETS and NASCO
• Worked on different EDI healthcare transactions like 837 for submitting claims, 835 for payments, 834 for benefit enrollment, 270,271 for Confidential benefits and eligibility, 276, 277 for claims status and 278 for transmitting Confidential service information
• Experienced in performing GAP analysis, SWOT analysis, Cost benefit analysis, Risk analysis
• Hands on experience in analyzing and documenting Business Requirements Documents (BRD), Functional Requirements Documents, Use Cases and Requirements Traceability Matrix
• Comprehensive knowledge on Waterfall, RUP and Agile methodologies.
• Excellent analytical skills in understanding the business process (AS-IS and TO-BE), understanding the functional requirements and translating them to system requirement specifications
• Experienced in conducting Joint Application Development (JAD) and Rapid Application Development (RAD) sessions. Conducted Requirement Gathering Sessions and interviewed Subject Matter Experts, gathered detailed functionality aspects of business process and updated the information to the requirements in an easily comprehensible format
• Extensive experience in creating business process flow diagrams, UML (Unified Modeling Language) tools to create Activity, Sequence, Use Case, Class, and Collaboration diagrams
• Good understanding of testing tools, such as QTP and Test Director and performing a variety of software testing including User Acceptance, Performance, Load, Stress, Sanity, Parallel, Black Box, Grey Box, White Box, Positive, and Negative Testing
• Well experienced in working on MS Word, MS PowerPoint, MS Excel, MS Visio and MS Project
• Excellent verbal, written, interpersonal and communication skills with strong analytical abilities to perform well both independently and as a team player

TECHNICAL SKILLS

Operating Systems: Windows 95/98/NT/XP/Vista and Windows 7

Languages: Java, SQL, UML

Database: Oracle 8i/9i/10g/11i, MS Access

Methodologies: Rapid Action Development (RAD), Joint Application Development (JAD), Rational Unified Process (RUP), Unified Modeling Language (UML), System Development Life Cycle (SDLC), Agile, Six Sigma and CMM

Documentation Tools: MS - Office Suite (Word/Excel/Power Point).

Business modeling Tools: Rational Rose, Requisite Pro, MS Visio, MS Project, Clear Quest, Adobe Photoshop

Testing: Quick Test Pro (QTP), Test Director, Mercury Quality Center, Bugzilla, HPQC

PROFESSIONAL EXPERIENCE

Confidential, Buffalo, NY

Business Analyst

Responsibilities:

• Worked on HIPAA 4010 & 5010 ANSI X12, EDI series (Insurance/Health Series) (INS) such as 270/271, 276/277, 278, 834, 835, 837
• Worked on insurance data related to Medicare, Medicaid claims and reimbursement and other Insurance claims
• Worked on HL7 to provide framework to carry out transfer of electronic healthcare information
• Analyzed the detailed user needs, gathered requirements during inception phase, documented and delivered Functional Specification Documents (FSD) and assisted architecture analysis and design using UML and Rational tools
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams using UML and Visio
• Identified, researched, investigated, analyzed, documented business processes and use case scenarios
• Performed gap analysis to identify and document the gaps between the existing system 4010 and new 5010 compliant system
• Functioned as a liaison between the business line, operations and the technical areas throughout the project cycle
• Participated in JAD sessions, product presentations and conducted interview sessions to collect information
• Used SQL queries for the retrieval and management of data
• Assisted the QA team in developing the test plan, test conditions and test cases to be used in testing based on business requirements, technical specifications and/or product knowledge
• Used Test Director with QA team for testing
• Interfaced with Subject matter experts to prepare the Business Process Re engineering (BPR) documents for the ongoing project
• Assisted in the development of training materials for new technology and process improvements
• Ability to interact effectively with the internal and the external parties
• Worked closely with the project manager in handling the whole project

Environment: RUP, ANSI X12- EDI, Rational Enterprise Suite (Rose, Requisite Pro, Clear Quest), Microsoft Office Suite (Word, Excel, Power Point, Visio, Project),Sharepoint, Informatica, Windows XP, SQL, Test Director, Oracle 10g, Toad.

Confidential, Virginia Beach, VA

Business Analyst

Responsibilities:

• Gathered functional requirements based on data and workflow analysis. Performed the requirement analysis according to different maturity levels of CMMI specifications
• Conducted JAD sessions for gathering requirements by communicating with the Project directors and stakeholders; created process workflows and project initiation artifacts
• Worked for maintaining dual eligibilities for members with Medicaid and Medicare with support of the Medicaid Management Information System (MMIS)
• Maintained the insurance record of customers through EDI(ANSI ASC X12 standards) for better privacy and security, compliant with HIPPA regulations
• Performed Gap Analysis for conversion ICD 9 - ICD 10 listed the differences between the both and possible implications on software at practice
• Documented Business Requirement Document (BRD) and Functional Requirement document (FRD) and uses cases
• Analyzed, documented and managed all project requirements and change to requirements throughout the software development lifecycle
• Developed UML diagrams such as use case and activity diagrams
• Developed test cases based on business requirements for the Functional and User Acceptance modes on a simultaneous project by its pharmacy benefit managers
• Also assisted the QA team, by testing web applications using Quality Center

Environment: HIPAA,EDI,Data Analysis,JAD sessions, Sharepoint,Rational Requisite Pro, Use cases, Test cases, Quality Center, UML, BRD, SRS, MS Share Point, MS Office

Confidential, Raleigh, NC

Business Analyst

Responsibilities:

• Conducted user interviews, gathered requirements, analyzed the requirements and managed change requirements by implementing change management methodology
• Contracted with the HCFA ( Confidential Financing Administration)/ Medicare Centers and Medicaid Services to provide quick, easy, and affordable access to the Confidential service of their choice
• Improvised HL7 for the exchange, integration, sharing, and retrieval of electronic health information
• Worked with the UI developer to implement UI and create enhancements to optimize user experience
• Prioritized system impact analysis for web portal experience development
• Identified and documented issues, risk and gaps, their descriptions, their impact and provided recommendation and alternatives to develop the application to meet the user requirements
• Worked in a team to develop use cases for their newly added application layout and understood all the business processes related to newly added layout and designed use cases that helped developers to build application
• Interacting with the developers on resolving the reported bugs and various technical issues
• Involved in UAT to confirm that the system under test meets the user needs and provides confidence in its use
• Performed verification tests to validate the data integrity
• UML diagrams such as activity and use case diagram were used to document the requirements and ensure creation of high level business requirements documentation.
• Worked cross functionally with developers, QA and project managers to make sure each the data could address their needs
• Performed verification tests to validate sure integrity of data
• Developed documents and implemented appropriate policies and procedures related to patient accounting, including follow-up on all patient accounts receivable .Actively participated in and monitored the accounts receivable management activities

Environment: Agile, Rally, MS.Visio07, SQL Server 2008, MS Office Suite, HP Quality Center Automation tool

Confidential

Business Analyst

Responsibilities:

• Communicated with Confidential Business Users to identify needs, defined project scope, and detail functional and non-functional requirements
• Conducted JAD sessions for gathering requirements by communicating with the Project directors and stakeholders, created process workflows and project initiation artifacts
• Worked onBusiness Process Management (BPM) and implemented process management principles
• Reviewed documents/templates to create BRD and implemented the RUP process
• UML diagrams such as activity and use case diagram were used to document the requirements and ensure creation of high level business requirements documentation
• Performed Data Analysis using a variety of statistical analysis
• Worked on the Flowchart and Process diagrams using MS Visio, Created use Cases and test cases
• Held and attended presentations and meetings to coordinate efforts among all the groups, leading the inception phase
• Assisted Confidential Client business in forming creative alliances with centers of excellence to obtain and develop lead compounds and technologies