Professional Summary:

• A resourceful and dynamic Senior Business Analyst with more than 7 years of diverse IT experience in Health Insurance, Pharmaceutical and Hospital domains.
• Worked closely with various stakeholders, SMEs and staff to understand and document Business, Functional and Software requirements.
• Possess excellent Analytical skills and Technical skills in gathering business requirements from business stakeholders and converting them into Functional requirements, Use case document, Test case document and User manuals.
• Functional experience in Claim life Cycle and Health Care Payer/Provider domain along with various line of health insurance system like PPO, HMO, POS and CHIP.
• Expertise in interviewing stakeholders by learning organizational culture and stakeholder psychology. Skilled at performing SWOT Analysis, Gap analysis, Root Cause analysis, Impact analysis and Cost benefit analysis.
• Hands on experience with HL7 and Facets.
• Adept enhanced knowledge of industries' standard SDLC methodologies and having extensive experience working on all the phases of Waterfall, Agile, RAD and RUP including Joint application development JAD , Joint requirement planning JRP.
• In-depth knowledge of Medicaid and Medicare claims processing along with extensive knowledge on CMSO, MITA, MMIS, Electronic Medical Health Record EMR/EHR and Pharmacy Benefit Management PBM .
• Worked on healthcare standards such as HIPAA 4010, 5010, ICD-9 and ICD-10, HIX and EDI Transactions 270,271,277,820,834,835,837 .

Technical Summary:

Professional Experience:

Confidential

Senior Business Analyst

• Performed role of liaison between the business units, technology teams and support teams.
• Worked on Agile methodology, with excellent use of product backlog review meetings, sprint backlog meetings, sprint review meetings.
• Elicited the current system to create the user story with As is process followed To be document from FAMIS to MEDES.
• ICD Interface Control Document was created during MEDES implementation.
• Critically evaluated information with the help of SWOT analysis, Impact analysis, Gap analysis and brainstorming.
• Gathered from multiple sources, reconcile conflicts, decompose high-level information into details, abstract up from low-level information to a general understanding, and distinguish user requests from the underlying true needs.
• Utilized JIRA tool towards software development process and for connecting people, system and respective tools which made process of gathering content more fluent.
• Developed and implemented guide for EDIx12 transactions such as 834,835,837,270 and 271 in the claims processing system in accordance with HIPAA compliancy.
• Elicited requirements using JAD sessions, requirements workshops, surveys, site visits, traceability matrix and workflow analysis
• Collaborated with developers and SMEs subject matter experts to establish the technical vision, and analyze tradeoffs between usability and performance needs.
• Prepared the test case scenarios with all details for Main path, data to be tested and exceptions to ensure that Testing team can test the requirements in documented scenarios.

Environment: RUP, UML, Microsoft Office Word, PowerPoint, JIRA, SharePoint, MS-Project

Confidential

Business Analyst

• Created Use cases, Use Case Diagram, Business flow diagram, Work and Navigation flow diagram using Unified modeling language UML .
• Wrote and maintained Business Requirements Documents BRD and Functional Requirements Documents FRD defining new systems operations for the project using Rational Requisite Pro.
• Interacted with the Business Users to get a better understanding of client business processes and Business Requirements.
• implemented.
• Subsections where existing customer's information was updated, waterfall methodology was
• Adopted agile and waterfall methodologies where first part was Agile methodology while in
• Worked as business liaison with developers, business users and QA team to ensure that all the business goals are met.
• Created Use Cases, and developed detailed Use Case Diagrams and Sequence diagrams describing how actions are to be carried out using MS Visio.
• Completed test cases and scripts for frontend and backend applications and dealt with the EDI transaction-835 claims payments which deal the payment from payer to provider.
• Conducted User Acceptance Testing UAT and verified performance, reliability.
• 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.
• Responsible for conducting a gap/impact analysis to ensure HIPAA Compliances required by CMS for the years 2012 and 2013.
• Organized many Joint Application developments JAD and Joint Requirement Planning sessions JRP , Interviews, workshops and requirement Elicitation sessions, Rapid Application Development RAD sessions and JAM session with end-user/clients/stake holders and the development group.
• Responsible for experience on analysis of GAP analysis between current HIPAA 4010 and HIPAA 5010 requirements.

Confidential

Business Analyst

• Assessed new electronic medical record management system and performed GAP analysis. Tracked and maintained stakeholder's requests with excellent use of Requirement traceability matrix RTM
• Successfully created Business requirement documents and functional specification documents for the new system to be implemented.
• Utilized the Rational Unified Process RUP methodology of iterative software development. Conducted JAD sessions to gather key business requirements KBR and participated in the development of project plans and key business processes assessment.
• Extensively involved in the implementation of New Electronic Medical Health Record EMHR system and verified that new system is compliant with HIPAA. Verified newly added functionalities of EMR/EHR System like clinical data repository and drug database.
• Worked extensively with GAP Analysis for ICD-9 to ICD-10 and gathered and validated inventory of applications that are needed for ICD-10 transition.
• Established questionnaires for implementing ICD-10 and worked extensively on identifying needs, assessing risks and HIPPA concerns of the hospital in order to comply with ICD-10 transition.
• Handled the change management requests from technical team, documented project change request PCR and updated them accordingly. Utilized MS Visio to draw Use case diagrams and Process flow mapping to capture the requirements so that the development team and stake holders can understand the business process.

Environment: RUP, UML, MS Visio, MS Excel, MS word, JAD, GAP, PCR, JIRA, SQL

Confidential

Business Analyst

• Participated in meetings with developers, Project managers and Quality analysts to discuss business requirements, test planning, resource utilization and defect tracking.
• Utilized Rational unified process to create BRD and FRD.
• Worked with cross functional business teams and stored project artifacts using MS SharePoint.
• Developed business requirement and specification documents as well as high-level project plan and translated business requirements into Process models and Use cases using MS Visio.
• Conducted JAD sessions with stakeholders throughout SDLC to resolve open issues.
• Implemented Environmental Health and Safety System EHSS in claims processing system in order to prevent incidents that might result from abnormal operating conditions.
• Worked with the management for improving and giving new ideas for designing future process of the HIPAA format dealing with EDI Transactions on Facets platform.
• Processed EDI test files and verified system is able to validate certified and non-certified trading partners. Created detailed level test scenarios on HIPAA Compliance testing.
• Reviewed relational database design of the application and conducted multiple SQL querying.
• Reviewed Test scripts, Test scenarios and performed UAT of the application.