SUMMARY OF EXPERIENCE:

• Actively seeking a key role with an organization in need of a qualified individual with efficient business analysis skills and professional knowledge in setting goals, coordinating and developing operations for any project.
• Analytical, creative and goal oriented professional with significant years of experience in providing:
• Committed and result oriented professional with over 8 years of experience as Business Analyst in
• Healthcare and Insurance Industry.
• Worked closely with project stakeholders, SMEs, and development team to understand the
• requirements and specifications for new applications.
• Experienced in Software Development Life Cycle SDLC methodologies Traditional Waterfall
• Model and iterative approach to software development as per Agile methodology and Rational

Unified Process RUP .

• Experienced in and have good knowledge of ITIL standards and its components.
• Proven excellence in analyzing business processes, eliciting requirements, defining business needs,
• and translating to business and technical specifications documents.
• Experienced in performing Gap Analysis, Impact Analysis, SWOT Analysis, Feasibility analysis
• and Risk analysis.
• Skilled in translating business requirements and user expectations into detailed specifications
• employing designing techniques like OOAD and Unified Modeling Language UML .
• Sound proficiency in analyzing and creating, Use Case diagrams, Sequence diagrams, Activity
• diagrams, Data flow diagrams, Business flow diagrams, Wire frames using MS Visio.
• Hands on experience with IBM Rational tools like Requisite Pro, Rational Rose for managing
• requirements and analyzing Use Case development.
• Proven experience in SFDC implementations.
• Recurrently conducted Joint Application Development JAD sessions with end-users, SMEs' and
• development team for project meetings, walkthroughs and customer interviews.
• Solid understanding of database tables and created SQL queries.
• Knowledge of Data Warehousing Concepts and Extraction, Transform and loading ETL Processes.
• Worked with the Business teams including Information Security and Risk Operations teams to
• imbibe the applicable regulations in terms of Data Privacy.
• Adept in conducting User Acceptance Testing and verifying performance, reliability and fault
• tolerance issues. Also familiar with testing tools to design and develop test plans and test scripts.
• Knowledge of health care services regulatory environment including HIPAA, MMIS,Medicaid/Medicare, and EDI.
• Experience working with various subsystems within MMIS such as Third Party Liabilty TPL ,
• Service Authorization SA , member functionality, provider functionality, etc.
• Experienced in Working in Six Sigma and CMMI at project levels
• Experience of ICD 9 and ICD 10, and various HIPAA 4010/5010 formats.
• Creative and aggressive self-starter with ability to handle ambiguity, Able to communicate effectively
• with Cross Functional Teams at all levels, capable of delivering solutions under high pressure.

Domain Knowledge Skills: Healthcare and Insurance Industry

Documentation Skills: Use Case Scenarios, Process Flow Diagrams, Flow Charts, PowerPoint Presentations, Business requirements document BRD , Functional specifications document PRD, FSD , Business Rules catalogues, Error Message Catalogues, Traceability Matrices, Test plans, Test cases, Test Scenarios, Query/Issue logs etc, Technical Documentation.

TECHNICAL SKILLS:

PROFESSIONAL EXPERIENCE

Confidential

Sr. Business Analyst

Project Description: Confidential is a licensed Health Maintenance Organization that has been serving western Confidential. HNE serves more than 100,000 members and 5,000 employers across the Confidential

Project 1 Implementation of EDI Enrollment

The project with HNE involved working in the Enrollment group to develop a new enrollment system as per HIPAA 5010 standards. The goal of the project was to enable HNE to add, manage and terminate members via multiple channels, specifically through EDI. The project also involved working with a third-party vendor to develop the enrollment engine as per EDI standard.

Project 2 Implementation Assessment of ICD - 9 to ICD -10

The scope of the project was to assess and gather high-level requirement for implementing of ICD-10. The goal of the project was to define the roadmap for implementation, analyze various applications within the organization in order to migrate from ICD-9 to ICD-10.

Roles Responsibilities:

• Interfaced with, and interviewed, cross-functional stakeholders to generate requirements.
• Leveraged agile Scrum methodology for portal development.
• Prepared Data mapping document for EDI 834 to health New England's internal format.
• Gathered high level requirements from the business, created user stories, and prioritize the backlog with project manager
• Collaborated with development team through iteration and attended every Scrum meeting to represent
• product team.
• Enabled product-centric testing and facilitated QA team's understanding of acceptance criteria and
• test scenarios.
• Developed Activity Diagrams, Use Case Diagrams, and Workflow Diagrams using Microsoft Visio.
• Accountable for extensive User Acceptance Testing.
• Maintained documents on SharePoint, Wiki and Jive to facilitate seamless interaction with multiple
• teams.
• Interfaced between users and diverse teams and was involved in application development to enhance
• understanding of business and IT processes.
• Worked with team to stay abreast with new process and render it more effective.
• Utilized technical writing skills to create effective documentation and training materials.
• Performed a baseline assessment and related interfaces, existing service level agreements, policies,
• and operational business procedures for readiness to comply with ICD-10 requirements
• Identified risks, problems, requirements and concerns in order to comply with ICD-10 changes by
• conducting interviews
• Actively worked on Data analysis and Report analysis with respect to ICD-10 impact.
• Collected the information related to ongoing application upgrade. Studied their impact on ICD-10
• implementation.

Confidential

Sr. Business Analyst

Description

Confidential . has supported the Department of Health, Confidential Claims and Eligibility efforts. Provides business support for benefit accumulator and claims processing system, NASCO. The core data is in MMIS Legacy system and can handle the processing of different Claims within POS in MVS Site D and AIX Box. The MMIS can handle the HIPAA EDI transactions such as 835, 837 P, D, I 276, 277, 278. The Inbound and Outbound is run through JCL in batch mode

Project 2: Document Management System

Confidential is all set to be retired in a phased manner and replace with Document Document Management System using Enterprise Imaging Architecture. The project also involved the migration of all the document data 25 million documents from the FileNET system's database to an external database.

Responsibilities:

• Responsible for defining the scope and implementing business rules of the project, gathering business
• requirements and documentation.
• Responsible for writing Functional Requirement Specifications FRS and User Requirement
• Specification URS .
• Created Test Plan, Test Cases and Test Scripts with respect to Test plan
• Analyzed Business Requirements and segregated them into high level and low level Use Cases,
• Activity Diagrams / State Chart Diagrams using Rational Rose according to UML methodology thus
• defining the Data Process Models.
• Captured document governance requirements
• Understand the As Is system and develop the To Be system concept and also prepare the System
• Process Maps.
• Effectively used NASCO system.
• Worked with NASCO teams to get current work flow for detailed business process.
• Created and managed project templates, Use Case project templates, requirement types and
• traceability relationships in Requisite Pro.
• Conduct Requirements Gathering sessions with the use of Content Data Modeling.
• Defined Functional Test Cases, documented, executed test script in Facets system.
• Captured for the Workflow, Versioning and Metadata requirements for the Document Management
• System
• Successfully conducted JAD sessions, which helped synchronize the different stakeholders on their
• objectives and helped the developers to have a clear-cut picture of the project.
• Conducted presentations of the Q/A test results with analysis to the stakeholders and users and
• documented modifications and requirements.
• Coordinating and Developing QA activities.
• Developed business process models in RUP to document existing and future business processes.
• Assigned tasks among development team, monitored and tracked progress of project following Agile
• methodology.
• Conducted user interviews, gathered Requirements, analyzed the Requirements and managed changes
• using Rational Suite.
• Prepared for GAP Analysis identified and documented improving areas to meet capital requirement
• regulations.
• Created Process Flow diagrams, Use Case Diagrams, Class Diagrams and Interaction Diagrams using
• Microsoft Visio and Rational Rose.
• Wrote Test Cases and performed User Acceptance Testing, documented the in detail defects using the
• Defect Tracking report.
• Used Test Case distribution and development reports to track the progress of test case planning,
• implementation and execution results.
• Wrote PL/SQL statement and stored procedures in Oracle for extracting as well as writing data.
• Prepared logical data models in the form of Business Context diagram to include various entities and
• attributes in order to facilitate the design of Data model in the form of ER Diagrams. Studied current
• information structures and data models of the current databases to better understand the design of
• target data source.
• Maintained proper communication with the developers ensuring that the modifications and
• requirements were addressed and also monitored these revisions.
• Involved in compatibility testing with other software programs, hardware, Operating systems and
• network environments.

Confidential

Sr. Business Analyst

Project Description: Confidential is a company providing customers with benefits, expertise and service that improves the health, well-being and productivity. As a BA, I was involved in developing fully automated, real-time claims processing system for complete, on-line mediation of medical, dental, vision, and disability claims and encounters as per HIPAA guidelines. System allowed the efficient and timely management of all relevant data clinical, financial, and administrative throughout the organization enabling the sharing of information between subsystems.

Technologies: Windows NT/2000, MS SQL Server, Rational Unified Process RUP , CMM, UML, Rational Rose RequisitePro, Mercury Quality Center TestDirector, Clear Quest, MS Office Tools, MS Outlook, Java.

Roles Responsibilities:

• Extensively involved in implementation of effective requirements practices, including gathering User
• Requirements, and analyzing User Requirement Document URD , and functional specification
• document FSD , use and continuous improvement of a requirement gathering processes.
• Applied RUP methodology with its various workflows, artifacts and activities to manage life cycle
• from Inception to Transition phase.
• Acted as liaison between external clients and SMEs to generate and standardize product requirements
• specification documents such as URS/FRS/Use Cases.
• Employed UML methodology in creating UML Diagrams such as Use Cases, Sequence Diagrams,
• State Diagrams, Activity Diagrams and business process and workflows.
• Was engaged in applying CMM standards which provided guidance for improving organization's
• processes and the ability to manage the development, acquisition, and maintenance of products or
• services Cigna was providing to its clients.
• Assisted JAD sessions to identify the business flows and determine whether any current or proposed
• systems are impacted by the EDI X12 Transaction, Code set and Identifier aspects of HIPAA.
• Involved in GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims.
• Worked on EDI transactions: 270, 271, 835, and 837 P.I.D to identify key data set elements for
• designated record set.
• Involved in designing determined 3-tier architecture for the claim processing system. Assisted team
• lead in developing Requirements Traceability Matrix RTM to trace the relationship between
• business and functional requirements to test cases. Prepared and executed different Test Cases and
• Test Scripts.
• Involved in conducting Functionality testing, Integration testing, Regression testing and User
• Acceptance testing UAT . Provided analysis and insight to QA Team in defects and bugs tracking.

Confidential

Sr. Business Analyst

ACS provides a full range of outsourcing services and solutions to Businesses, Government, and Industry leaders, both large and small.

Project Description: The project involved customizing ACS COTS product MMIS Medicaid Management Information Systems for the state of New Hampshire. The main focus of the project was to automate the Medicaid eligibility processes using the criteria provide by the state. The application also helps in tracking the Third Party Liability and County Billing claims.

Roles Responsibilities:

• Adapted RUP methodology for the software development life cycle.
• Understood and defined various elements and objects used in Healthcare Medicaid management
• information systems MMIS COTS Product like County Billing, Third Party Liability Insurance
• Claims, and Miscellaneous .
• Gathered and developed Business Requirements for enhancements and Technology requests forms for
• sizing and planning the Healthcare Medicaid application for the state of New Hampshire.
• Worked with Healthcare Insurance providers to discuss the Third Party Liability requirements for the
• Medicaid MMIS application.
• Created the process flow and Swim lane diagrams to integrate the Third Party Liability Insurance
• claims and County Billing claims to the MMIS application.
• Worked with New Hampshire County's to determine the Billing ratios for providing the Medicaid
• services to the beneficiaries.
• Facilitated JAD sessions by formulating and defining systems scope and objectives through research
• and fact-finding combined with understanding of business systems, business unit requirements, and
• industry requirements.
• Liaison for business units to analyze business and user needs, documenting requirements, and
• revising existing system logic difficulties as necessary.
• Performed Data Analysis to see the variation in the as is system and to be system.
• Conducted GAP Analysis, and created Business Rules and Error Message catalogue for the new
• version of MMIS.
• Created Traceability Matrix using IBM Requisite Web to trace the Business Rules and Error
• Messages to the Business and Functional Requirements.
• Developed User stories and Acceptance Criteria for technical team to provide detail descriptions of
• the Healthcare Medicaid modules.
• Worked closely with the offshore Technical and Testing team to make sure all the requirements were
• met and the functionality was developed as per the Business Requirements.

Confidential

Business Analyst

• Confidential Company serves full range of managed healthcare, life and disability insurance products and services. This current system only provides complete information regarding benefits about various product lines and product offered by the company.
• Confidential was looking for a system that could automatically calculate the policy rating. The new systems were designed to increase productivity, and reduce costs.

Roles Responsibilities:

• Used Rational Unified Process RUP methodologies and Unified Modeling Language UML .
• Involved in writing use cases and other design documents like Sequence Diagrams, Class Diagrams,
• and Activity Diagrams for better understanding of the system using MS Visio.
• Conducted JAD sessions to develop business solution that application meets the business
• requirements, resolve open issues, and change requirements.
• Conducted interviews with key business users to collect requirement and business process
• information.
• Documented Functional Requirements for business level components, user interface, and system
• security.
• Defined Core Business Rules and Core Business Validations for the entire application.
• Analyzed the technical specifications and business requirements.
• Developed business requirement specification documents, business process models in RUP to
• document existing and future business processes.
• Documented and delivered Functional Specification Document to the project team.
• Involved in benchmarking activities to identify best practices.