Summary:

• Over 5 years of experience with Business IT Systems and Quality Assurance in Healthcare domain. Experience in analyzing the business process, identifying and proposing the solutions for an effective customer experience and establishing products in the newer markets.
• Excellent skills in gathering business requirements, facilitating Joint Application Development JAD sessions, Rapid application development RAD sessions, developing Process Flows, creating Use Cases, Business Requirements Document BRD and Functional Requirement Specification FRS , System Development Life Cycle SDLC .
• Extensive knowledge of Medicaid, Medicare, Procedural and Diagnostic codes and Claims Process.
• Strong knowledge on HIPAA standards, EDI transactions and 4010/5010 versions.
• Worked on different EDI healthcare transactions like 837 for submitting claims, 835 for payments, 270,271 for health care benefits and eligibility, 276, 277 for claims status and 278 for transmitting health care service information.
• Familiar with ICD 9- CM, ICD 10-CM structures and Impact Analysis caused due to migration to ICD 10 on the key business process and key application system like claim processing, payments, reporting in health insurance companies.
• Extensive experience with Requirement Traceability Matrix RTM to map requirements to use case, design and test cases.
• Extensive experience in organizing and facilitating joint application development JAD sessions through interviews and workshops with user s , subject matter experts SMEs , and business stakeholders.
• Strong background working with clients, designers, and programmers to identify requirements, provide cost analysis, assist with creating user interfaces, and develop implementation timelines.
• In depth knowledge of UML and proficient in creating Sequence Diagrams, Collaboration diagrams, Activity Diagrams, Class Diagrams using Rational Rose and Microsoft Visio.
• Experienced in conducting GAP analysis, User Acceptance Testing UAT , SWOT analysis, Risk Analysis and mitigation plan.
• Experienced in creating User Manuals and providing training to users.
• Team oriented with excellent communication and inter-personnel skills to quickly learn new concepts. Skilled at assessing client needs, working in a group, and presenting / training / supporting end users.

Technical Skills:

• Standards Methodologies: HIPAA, EDI, CMM, SDLC, RUP, Agile, CMS forms
• Operating Systems: Win 95/98/NT/2000/XP, OS-390
• Tools: HP Test Center, QA UI, SIT UI, Production UI, Rational ClearQuest
• Business Modeling Tools: Rational Rose, Microsoft Visio.
• Version Control Systems: Rational Clear Case
• Project Management: MS Project, Microsoft Office, SharePoint, Lotus Notes
• Programming Language: COBOL, SQL, HTML
• Testing Tools: Rational Suite, Test Director,
• Quality Management: ISO 9000, PMBOK

Professional Experience:

CONFIDENTIAL

Business Analyst

• Project Scope: Pharmaceutical Rebate Contract Management and Billing System Re-engineering
• Blue Cross Blue Shield BCBS is North Carolina's largest health insurer. The goal of the project was to replace the legacy AS400 application with a web based application that houses a decision engine, which allows the users to enter all contractual terms for every pharmaceutical company as well as build a classification tree and an exception tree. The system also performs predictive modeling, which in turn allows the users to negotiate better terms on the rebate contract with pharmaceutical companies.

Responsibilities:

• Participated in the identification, definition and documentation of current business process including the customer service model and how the processing of payments and updates to corporate card features happen in the As-Is world
• Participated in Joint Application Development JAD sessions by convening project sponsors, end-user representatives, development team members, subject-matter experts, technical personnel, and different stakeholders to communicate their perspectives with each other, resolve any issues and come to consensus.
• Identified Use Cases and wrote Use Case Narratives.
• Worked closely with the development team to help them understand Use Case Narratives.
• Conducted requirement workshops among all project stakeholders to verify and validate the business requirements
• Handled the development of business requirement documents BRD resulting from JAD sessions.
• Gathered Business Requirements from users and used Enterprise Architect for documenting the requirements.
• Involved in maintaining Requirements Traceability Matrix RTM .
• Participated in identifying opportunities and parameters for business process improvements.
• Used the guidelines and artifacts of the Rational Unified Process RUP to release multiple iterations of the deliverable over the span of the project lifecycle propounded early development and base lining of a robust executable architecture.
• Created Use Case Diagrams and Activity Diagrams using Enterprise Architect
• Assisted QA department to write and execute Test plans and Test Cases

Environment: Enterprise Architect, Microsoft Office Suites MS Word, PowerPoint, Access, Excel, Outlook, Project, Visio , RUP, Windows, Microsoft SQL Server 2000 2005 , UML.

Confidential

Sr. Business Analyst

Project Scope: Integrating to FACETS 4.51

Leon Medical Centers Health Plans, Inc. was established to meet the needs of Medicare patients of Leon Medical Centers. A project at Leon Medical Center Health Plans involved integrating the newer version FACETS 4.51 with the existing system. I worked as a business analyst to work closely with project team to identify user's business requirements, interpret complex business needs and translate them into system requirements, write business specifications and forward to technical staff for system integration.

Responsibilities:

• Participated and organized requirement gathering sessions with the stakeholders to elicit and analyze requirements.
• Assisted in preparing Scope Document by analyzing - various business domains interdependencies, end to end business processes of claims adjudication, various business domains scope statement, current business process flows and current system documentations.
• Worked with all Facets Provider of software development from requirements gathering to testing, configuration and international deployment.
• Followed Workgroup for Facets Electronic Data Interchange standards for testing that need to comply with the HIPAA guidelines.
• Involved in project planning, coordination and QA methodology in the implementation of the Facets in the EDI transaction of the claims module.
• Coordinated and worked with Project Manager to prepare Project Plan in MS Project for Process Claim Domain.
• Executed complex integrated systems planning and solution alternative analysis and design.
• Executed business process analysis As-Is system To-Be systems perform gap analysis.
• Worked on the EDI 834-file load to Facets through MMS Membership maintenance sub-system .
• Worked on solving the errors of EDI 834 load to Facets through MMS.
• Created keyword files to have member data bulk loaded into the FACETS system through the MMS batch
• Experience in developing, validating and implementing SAS programs and produce derived datasets for analysis and generating documenting tables, listings and graphs for clinical study reports.
• Deeply involved being a part of the solution delivery life cycle of enterprise solutions, including software and vendor selection, package implementation, and vendor management.
• Organized and participated in JAD sessions with the system architect, SMEs project sponsor for a faster effective system development.
• Developed solutions in compliance with the industry models / standards and implementation of Quality Management Systems HIPPA regulation.
• Experienced creating design documentation related to system specifications including user interfaces, security support and control, performance requirements and data conversion.
• Created use cases specifications, use case diagrams, swim lane diagrams to define the workflow and segregate high-level and low-level requirements using MS Visio.
• Created and documented test plans and test cases in the project.
• Analysis of the data using SAS retrieving data MS Excel Sheets.
• Formed a bridge between project manager and different teams with effective presentations.
• Involved in Integration Testing, and User Acceptance Test UAT using the test cases.
• Interacted with other teams through walkthroughs, meetings, etc. to resolve various issues.
• Validated the scripts to verify they have been executed and meet the scenario description.
• Involved in project status meetings, QA review meeting, and System Test meeting.
• Prepared test cases and test scripts for the User Acceptance testing.

Environment: Windows 2008/XP, UNIX, Oracle 9i, Quality Center, Quick Test Pro, SAS, HIPAA Standards, FACETS 4.51, MS Visio, MS Project, SharePoint

Confidential

Business Analyst

Project Scope: Re-engineering of a Web Application according to HIPAA standards

United Health Group is a diversified Health Care company. A web application was reengineered to make it compliant with the EDI standards. Integration of this web application with the third party administrator's application TPA was achieved. The developed application is complaint with the HIPAA standards.

Responsibilities:

• Gather requirements by conducting meetings and brainstorming sessions with end users and Subject Matter Experts SMEs and document them using Requisite Pro.
• Prepared Business Requirement Documents BRDs after the collection of Functional Requirements from System Users that provided appropriate scope of work for technical team to develop prototype and overall system.
• Gathered requirements and modeled the data warehouse and the underlying transactional database
• Performed Gap Analysis of the processes to identify and validate requirements.
• Responsible for architecting integrated HIPAA, Medicare solutions, Facets.
• Identified/documented data sources and transformation rules required populating and maintaining data warehouse content.
• Defined and analyzed test cases, test scripts, bugs, interacted with QA/ development teams in fixing errors and conducted User Acceptance Test UAT .
• Organized requirements into High level Use Cases and Low level Use Case Specifications and modeled them into UC, Activity and Sequence Diagrams using Rational Rose and MS Visio.
• Created Business requirement document BRD , Functional FRS , Technical requirement specification for application development
• Apply UML notations and methodology in developing models that accurately represent the business process and workflows and clearly communicate them to the stakeholders.
• Conducted JAD sessions involving the management, development and user teams for clarifying requirements and facilitating better communication.
• Maintained benchmark controls to policies, company standards and contracts, performed vendor sourcing, pricing and contract negotiation, performed procurement, ensured compliance with service/joint interest contracts.
• Coordinated and prioritized outstanding defects and enhancement/system requests based on business requirements, allowing sufficient time frame to ensure accuracy and consider deadlines
• Assured that all Artifacts are in compliance with corporate SDLC Policies and guidelines.
• Reviewed Test Plans developed by the testing team for testing the application.
• Assisted the QA personnel in the creation of Test Cases using Rational Test Manager.
• Involved in performing version control and defect tracking activities using Rational ClearCase and Rational ClearQuest

Environment: PL/SQL, SQL Server, XML, Windows 95/98/2000, ODBC, Internet Explorer and Netscape, Web Logic, UNIX, Rational Req. pro, Clear Case, Rational Rose, Clear Quest, UML, MS Visio, and MS Project