Professional Summary:

• Approximately 7 years of professional experience as a Business Analyst in Healthcare Insurance Industry equipped with self-motivational approaches and leadership qualities to co-ordinate with the cross functional teams.
• Comprehensive understanding of HIPAA Standards 4010 5010 and Compliance issues, Medicare, Medicaid, Medical Management, Utilization Management, Provider, ICD9, ICD10, CPT/HCPCS, HCR HealthCare Reform .
• Detailed knowledge of claim adjudication process within a Healthcare payer and interaction with different hospitals.
• Well familiar with Claim Processing in Healthcare Industry with wide knowledge of various standards including X12, Accredited Standard Committee ASC and American National standard Institutes ANSI .
• Justified track record of creating and transforming business requirement into functional requirements and non functional requirements.
• Exceptional presentation skills including verbal and written skills, and flexibility in adapting to new relevant information and changes.
• Can easily adopt organizational culture.
• Skilled at time management, decision making and problem solving.
• Have worked with Claim Adjudication softwares such as NASCO and FACETS.
• Excellent written and verbal communication skills with a results-oriented attitude.
• Extensive experience in Software Development Life Cycle SDLC , application design- development, system testing and quality control methodologies such as Waterfall, Agile RUP.
• Proficient in creating BRD Business requirement Document , TRD Technical Requirement Document , FSD Functional Specification Document and UAT Documents, Use Case Narratives, User Stories Use Case Diagram.
• Led many JAD Joint Applications Development , RAD Rapid Application development and JRP Joint Requirement Planning Sessions .
• Experience in User Interface Design and Process improvement Tools and techniques.
• Exceptional understanding of Business Processing Logic.
• Extensive hands on experience with Requirement Management Tools such as RequisitePro, ClearCase, and ClearQuest CaliberRM.

Business Analysis Skills:

• Comprehensive understanding of Health and Insurance Industry.
• Business Requirement Gathering Functional non- functional .
• Skilled at performing GAP Analysis, Risk Analysis, Cost/ Benefit Analysis, Impact Analysis along with Good Knowledge of process workflow tools and techniques.
• Documents: BRD, FSD, UAT, User Manual, Training Material, SRS documents, test cases, scope and vision.
• JAD, JRP Joint Requirement Planning Sessions and RAD Rapid Application Development Sessions.
• BPAD-- Business Process Research and Reengineering, Analysis Documentations.
• Experience in Healthcare Pricing / Reimbursement with Trizetto NetworX Pricer.
• Experience in PNO Provider Network Operation Application for better provider information management and better end-to-end provider network operation.
• User Interface Design.
• Process improvement methodologies: Process Mapping, Process Flowcharting, Matrix Analysis, Bar Charts, Brainstorming, and Histogram.
• Problem Solving and Analysis with DRIVE: Define, Review, Identify, Verify, Execute.
• Experience in Clinical Data Management System CDMS Paper based and Electronic CDMS.
• Experience in Clinical Trials Management System.

Technical Expertise:

• Operating Systems: MS Windows 98/2000/XP/VISTA/7/MAC.
• Project Methodologies: SDLC, Agile, RAD, RUP.
• Business Modelling Tools: MS Visio, Rational Rose, UML.
• Adobe Photoshop, Flash Business Objects.
• Project Management: Microsoft Project, Microsoft Office.
• Requirement Management Tools: Requisite Pro, ClearCase, ClearQuest, CaliberRM, and SharePoint-Foundation/ Eneterprice edition.
• Reporting Tools: Rational SODA, Crystal Reports.
• Claim Adjudication Softwares : NASCO and FACETS, Claim Vantage Suite.
• Customized Health Benefits and Cliam Processing Software-HEALTHsuite .
• Automated Claim Pricing and Provider Network Management Software : Trizetto NetworX Pricer
• Documentation Tools: MS word, MS Excel.
• Testing Tools: Win Runner, Load Runner, Quick Test-Pro, SilkPerformer, Test Director, and Mercury Quality Center.
• Strong SQL knowledge.
• Live Meeting Tools: Breeze, Go Meeting, WebEx
• RDBMS Relational Database Management System : Oracle 9i DB2 v8.1.
• DBI's Distributed Database Performance Optimization Tool: Brother-Eagle

Professional Experience

Confidential

Sr. Business Analyst

Responsibilities:

• Worked as a liaison among stakeholders in order to elicit, analyze, communicate and validate requirements for changes to business processes, policies and information systems.
• Interacted with the Business users, SME's, Developers, PMs and ETQA teams to better understand the business processes and application knowledge.
• Met with Supervisors and business users and defined the scope of the project, gathered business requirements, and conducted gap analysis.
• Created Business Requirement Documents BRDs , Use-Case Narratives including business process workflow diagrams and Requirements Traceability based on any of the projects need.
• Conducted Requirements Walk-Thru Sessions and resolved all issues/findings.
• Successfully received Sign-Offs by utilizing ClearQuest tool for all projects on time after resolving all open questions.U
• Led facilitated numerous meetings to help answer any questions on requirements during Design, Development, Testing and Implementation phase.
• Identified and analyzed the key parameters of proposed business plan.
• Communicated with all the key stakeholders, business teams, contributors, operations and technical experts to ensure help and involvement in completing the assigned task.
• Developed business requirement updates while working with different concerned authorities to define priorities concerning business requirement.
• Organized brainstorming and JAD sessions with stake holders, business users, technical teams, testing team to analyze and validate the business requirements, system life cycle and explained the key performance indicators and documented the specifications.
• Performed deep analysis of systems and business processes of Medicare Part A, B and D as CMS standards.
• Created 837 I, P D claims, also created and maintained data mapping documents in reference to HIPAA transactions: 270/271, 276/277, 835 837 I, P D.
• Planned and documented NPI Crosswalk procedure including NT Z into the provider data base.
• Checked claim processing while passing 837 claims for compliance check and running through load processing.
• Designed and developed Data Model and Data Marts that support Business Intelligence Data Warehouse.
• Performed workflow analysis toward automated disability claim process.
• Conducted requirement sessions and translated that requirement into use cases and GUI wireframes.
• Coordinated closely with Business Intelligence Architecture team and Enterprise Data Warehouse team to understand repository objects that support the business requirement.
• Coordinated with users in doing UAT and developed Manuel testing, executed test script and conducted UAT testing.
• Performed Lotus notes server maintainenance and troubleshooting on the UNIX server.

Confidential

Business Analyst

Responsibilities:

• Facilitated smooth completion of project by providing insurance subject matter expertise to the team and utilizing subject matter know-how for quality assurance purposes.
• Responsible for the execution of the project life cycle SDLC , including requirements gathering, design, testing, implementation and documentation as required.
• Developed and maintained a work plans for system projects.
• Conducted interview sessions with users and different levels of management so as to extract requirements and to develop use cases and functional specifications.
• Drove the definition of customer business requirements by analyzing and documenting business rules, source to target mapping, business processes, process flows, and procurement documents developed gap analysis when/where required.
• Assisted clients during UAT Environment.
• Provided issue resolution recommendations to project managers for each project. Ensured that there was regular and effective communication of issues and corrective actions between teams.
• Implemented data access, storage and validation routines on the database server using structured Query Language SQL .
• Organized and conducted extensive JAD sessions with users to identify and understand requirements.
• Worked on Change Requests and was a part of CCB Change Control Board .
• Was responsible for doing the gap analysis for the interfacing system.
• Developed customer deliverables, including Detailed Specification Documents, Call flow document and General system design documents.
• Coordinated with the different teams distributed at different geographic locations for various releases.
• Identified Actors, Activities, Artifacts and Workflows and developed use case diagrams.
• Developed and maintains Business and Use Cases.
• Involved in overall development of the projects including status reports, client presentations, risk analysis and mitigation, defining milestone deliverables and defining critical success factors.
• Coordinated with Reporting team for developing report prototypes.
• Facilitated requirements gathering activities, including meeting with users to discuss System Task Requests STRs , Enhancements, and Project Assessment Quotations PAQs requirements.
• Performed SWOT Analysis- Strength, Weakness, Opportunities, Threat Gap Analysis Risk Analysis Impact Analysis.
• Assisted in deletion of defects and bugs, in order to meet specific requirements and deadlines for successful execution of the project.
• Performed testing on Medicaid Client Server claims processing system, Medicaid MCO/MCC and MMIS and converted EDI X12 transaction codes set version 4010 to 5010.
• Initiated test plans, develop and execute test cases and scenarios worked with users to develop specific acceptance criteria and prepare test exhibits.

Confidential

Business Analyst

Responsibilities:

• Assisted in deletion of defects and bugs, in order to meet specific requirements and deadlines for successful execution of the project.
• Assured that all artifacts are in compliance with corporate SDLC policies and guidelines.
• Assisted System Architects and Quality Assurance Analysts in creation of various tests.
• Helped in designing and implementing deployment process, and thus maintaining the application in post deployment process.
• Functioned effortlessly and efficiently, as a liaison between four work streams and its task leads, SMEs, development team, and management group. Actively participated in Joint Meetings with the various teams involved in the development process.
• Facilitated meetings with Subject Matter Experts SMEs to create the process requirements, process improvements and to proper explain the development team the flow of future data modules.
• Gathered and documented business requirements in order to describe the business needs in terms of the main deliverables.
• Involved in feasibility analysis and risk analysis of the project.
• Created Use Cases to identify automated processes and the actors vendors, systems involved in the project to ensure reliable results of implemented business/functional needs.
• Actively involved in creating/updating Work Breakdown Structure WBS , preparing deliverable tasks in the project plan.
• Created Activity Diagram, detailed Data Flow Diagrams, Use Cases, and business process flowcharts for the As-Is and To-Be process.
• Prepared Business Workflow models and process diagrams depicting how business processes are accomplished.
• Held meetings with users and stakeholders to identify problems, resolve issues and improve the process to ensure a stable and accurate solution.
• Analyzed data to generate information about clients and their attributes, and drafted a data requirements document.
• Gathered business and system requirements from various departments like accounting, Fund Management, Legal and Human Resource through focus groups, surveys, interviews, and JAD sessions.
• Reached out to vendors for clarification of data.
• Coordinated UAT of the product with Business Users.

Confidential

Business Analyst

Responsibilities:

• Coordinated UAT of the product with Business Users.
• Obtained business requirements from business users and stakeholders using JAD sessions, brain storming sessions, focus groups and personal interviews to get a better understanding of the client's business process.
• Worked with the business to document and develop formulas for the calculation of premiums and losses statistics in the marts eg. Written Premium, Earned Premium, Unearned Premium
• Elicited, documented, modelled, validated and prioritized functional and non-functional requirements using interviews, data analysis, and different modelling tools.
• Actively involved in preparing and writing the business requirement documents, functional requirement documents and data mapping documentation.
• Performed in depth data analysis identifying data issues in legacy system and worked with business to develop resolutions to those issues.
• Used MS Project for status reporting and planning.
• Utilized MS Visio for designing Use Case Diagrams, Activity Diagrams and Sequence Diagrams, after accessing the status and scope of the project and understanding the business processes.
• Analyzed the as-is and to-be state of the project and performed Gap analysis, Impact analysis and SWOT analysis.
• Created data mapping documents for the movement of data from production databases to the warehouse and from the warehouse to the policy and claims marts.
• Used the guidelines and artifacts of the SCRUM methodology for project implementation and development.
• Assisted System Architects and Quality Assurance Analysts in creation of various tests.
• Assured that all artifacts are in compliance with corporate SDLC policies and guidelines.
• Assisted in deletion of defects and bugs, in order to meet specific requirements and deadlines for successful execution of the project.
• Worked as an SME for identifying the scope of End-to-End testing with different teams.

Confidential

Business Analyst

Responsibilities:

• Mapped to the automated system from existing manual system.
• Researched and analyzed the claim business system.
• Explored all aspects of claim processing life cycle, from its inception to its closure.
• Authored Business Requirement and coordinated JAD sessions with SMEs, business officials and technical teams.
• Generated use-case diagrams using UML.
• Involved with the Software Quality Assurance SQA Team to develop test plans.