PROFESSIONAL SUMMARY

• 8 years of experience as a Sr. Business Analyst in Healthcare Industries.
• Strong knowledge of the Software Development Life Cycle methodologies like Agile and Waterfall models.
• Experienced in interacting with business users to identify their needs, gathering requirements and authoring Business Requirement Documents BRD , Functional Requirement Document FRD and Software Requirement Specification SRS across the deliverables of a project.
• Experienced in creating HIX ACA requirements, Use cases and process flows.
• Experienced in facilitating Joint Application Development JAD , Rapid Application Development RAD and Joint Requirement Planning JRP sessions, interviews, workshops and requirement elicitation sessions with end-users, clients, stakeholders and development team.
• Experienced with Iterative approach for Software Development as per Rational Unified Process RUP . Involved in inception, elaboration, construction transition phases using rational tools like Requisite Pro, Clear Case and Clear Quest during various phases of RUP.
• Experienced in Business Analysis, SWOT Analysis, Gap Analysis, Risk Analysis, Disaster Recovery Planning, Testing and Project Planning.
• Worked as a business system analyst BSA to maintain the relationships between Business People and Programmers
• Built and maintained the Dashboard for the project.
• Extensive knowledge of Medicaid, Medicare, Procedural and Diagnostic codes and ClaimsProcess. Also have worked on FACETS.
• Expertise in EDI and HIPAA Testing Privacy with multiple transactions exposure such as Inbound Claims 837-Institutional, 837-Professional, 837-Dental, 835-Claim Payment/Remittance Advise, 270/271-Eligibility Benefit Inquiry/Response, 276/277-Claim Status Inquiry/Response Transactions and testing in Client Server systems and Mainframe Applications.
• Experience in Conversion of HIPAA X12 4010 codes to X12 5010 codesand ICD 9 codes to ICD 10 codes
• Proficient in creating Sequence Diagrams, Collaboration diagrams, Activity Diagrams, Class Diagrams using Rational tools and Microsoft Visio
• Experienced in handling Change Management
• Experience in Learning Management System
• Experienced in analyzing and documenting business requirements and system functional specifications including Use Cases
• Strong Knowledge of UML, RUP, Rational Tools
• Experienced in writing Test Plans and executing Test Cases
• Skilled in validation and testing complex scenarios for the maintenance of quality standards in projects. Also worked on CDR portals.
• Experienced in creating User Manuals and providing training to users.
• Creative and Aggressive person capable of forming and maintaining positive and productive team environments with integrative thinking skills.
• Exceptional Problem Solving and Sound Decision Making capabilities, along with the ability to resolve difficult situations.
• Professional with extensive experience in the development, implementation and integration of strategies within a team oriented environment, utilizing quantitative and qualitative analytical skills.
• Excellent communication and presentation skills.

TECHNICAL SKILLS

• Business Skills: Business Process Analysis Design, Requirement Gathering, Use Case Modeling, JAD/JRP Sessions, Gap Analysis and Impact Analysis.
• Methodology: RUP, Agile, OOAD and Waterfall.
• Languages: C, C , SQL, PL/SQL, HTML and XML.
• Management Tools: Rational Rose, Requisite Pro, Clear Quest, Clear Case, Serena Team Track and MS Visio.
• Testing Tools: HP Quality Center, Win Runner, Load Runner and TOAD.
• Data Modeling Tools: ERwin, Informatica 7.1.1/6.5
• Database: Oracle 8i/9i/10g, DB2, MS SQL Server.
• Operating Systems: UNIX, Windows 95/2000/NT/XP, and MS-DOS.
• Microsoft tools: MS Office 2003 Word, Excel, Power Point, Outlook , MS SharePoint, MS Visio, MS Project, MS Access and MS FrontPage.

PROFESSIONAL EXPERIENCE

Confidential

Senior Business Analyst PMO

• Environment: Process Documentation, MS Word, SharePoint, MS Visio, Windows 7, MS Excel

Responsibilities

• Responsible for creating process documents to make sure Project Managers are able to understand their responsibilities towards the project.
• Responsible for creating Forecast Travel Meeting Expense form , which will be used to forecast Travel Meeting Expenses for the program.
• Responsible for creating Actual Travel Meeting Expense form , which will be used to determine the Actuals and will be then used in CBA.
• Responsible for creating CBA process that will help the team to understand their responsibilities towards CBA updates.
• Also worked inEDI and HIPAA Testing Privacy with multiple transactions exposure such as Inbound Claims 837-Institutional, 837-Professional, 837-Dental, 835-Claim Payment/Remittance Advise
• Responsible for creating Contractor Time Expense system using SharePoint, which will provide a Time entry system to the contractors. This will be tracking system for the program to track hours and expenses incurred by the contractors.
• Responsible for creating a High Level CCT PMO process flow.
• Responsible to elicit, analyze, validate, specify, verify, and manage the real needs of the Initiatives.
• Responsible for understanding and analyzing PMO requirements, developing improved business processes and supporting documentation, maintaining schedules as well as risks and issue management.
• Responsible for creating IRAAD process to make sure the program understands their responsibilities towards IRAAD items.
• Responsible for creating a standardize document for creating process flows which will be followed by the entire program to create process flows.
• Responsible for creating Staffing process document.

Confidential

Senior Business Analyst

Confidential is a health care project which helps the State to meet the requirements to afford the care act by allowing the users of the state to shop and compare health insurance and determine eligibility. This project is building a website where users will have instant, easy access to coverage options. In addition, it is collaborating with community partners and insurance agents/brokers to create a customer service network that will provide one-to-one assistance.

Environment: MS Project, Requirement Traceability Matrix RTM , Rational Rose Test, JAD, RUP, MS Visio, Windows OS, MS Office, SharePoint, Server, Quality Center, SQL Sever.

• Worked on capturing and mapping, member enrollment and eligibility and contribution data.
• Create/Validate HIX ACArequirements with the SME's.
• Create requirements for the HIX ACA website for users to have instant easy access to coverage options.
• Create requirements and process flows for SHOP and map the requirements in Enterprise Architect.
• Create process flows for Eligibility
• Facilitate requirements gathering sessions.
• Act as primary liaison between project business staff and technical staff.
• Responsible for gaining a detailed understanding of components of the business and translating that knowledge into the requirements for systems or processes.
• Evaluate and recommend enhancements to application efficiency and reliability.
• Perform administrative functions, such as time reporting and project status reporting.
• Model business process diagrams, swim lane diagrams and use cases using Sparx Enterprise Architect UML modeling software.
• Create user acceptance tests.

Confidential

Senior Business System Analyst

Confidential is an innovative healthcare provider who promotes a wider, more economical and timely availability of health services for the people Confidential and to the healthcare industry. BCBSKC and BCBSNC are working together for TOPAZ for this project so as to enhance their functionalities in FACETS.

Environment: UML, MS Word, MS Visio, MS Project, Rational RequisitePro, Rational ClearQuest, Quality Center, SQL, FTP, TelNet

Responsibilities

• Worked as a key BSA on Workflow on Customer domain.
• Created Use Cases that enables multiple functionalities of FACETS.
• Worked closely with Trizetto TRZ by submitting BRD's and getting their feedback and updating the BRD's accordingly.
• Created process flows for workflow on how work can be automatically assigned, reassigned etc on FACETS.
• Created BRD's on Member 360
• Created Use cases on Customer dev for FACETS.
• Captured Action Items, Issues, Risks and Dependencies during the JAD Sessions and coordinated with Lead and PM to manage and resolve.
• Modeled the 'as-is' process flow and the 'to-be' process flow and analyzed the gap and developed the action steps to fill the gaps.
• Created and updated dashboard for the project.
• Worked on the traceability of the requirements.
• Created Change reports for the project every week for all the domains.

Confidential

Senior Business System Analyst

Confidential is an innovative healthcare provider who promotes a wider, more economical and timely availability of health services for the people of Minnesota and to the healthcare industry. Blue Cross Blue had to renovate or replace its claims system to maintain compliance with federal and state mandates, and to enable new business functionality to meet marketplace demands. The purpose of this project was to renovate its in-house system with a third party commercial solution that would provide better than equivalent functionality over the in-house system , at a reduced cost. As a result of this, the entire claims adjudication had to be migrated to two commercial companies. Government Programs has chosen to move to a Business Process Outsourcing BPO model using TMG as their vendor. Commercial Markets has chosen to move to a hosted system NASCO for their Blue Cross and CCS business including FEP.

Environment: PEGA, BeneFACT, RUP, Use Case Documentation, MS Office, Quality Center, Informatica, SQL Server, Facets 4.5.1,ETL Tools: Informatica PowerCenter/PowerMart 8.6/7.2/6.2/5.1 ,MS Project, Server, MS Visio, Unix, XML, Mainframes and Rational ClearQuest, ClearCase, Windows XP, MS Excel

Responsibilities:

• Worked as a key BSA on the Benefits track of Claims Migration.
• Created Detail Functional Requirements document, Use Case Specification document, Activity Diagram to convert BCBSMN benefit to the NASCO BeneFACT system. Reviewed various documents with NASCO as well as with other vendors.
• Created end to end process flows for Benefit Coding, Use cases for Staffware Report specifications for the reports.
• Worked with the Benefit Analyst and SME's in order to verify new groups benefit eligibility.
• Documenting the Benefits Conversion which was intended to provide detail process associated with the conversion and migration of BCBSMN Benefit data to NASCO's Benefit systems. We were using the PEGA rule engine.
• Created Use cases flows explaining how BPM will get the answer set ID for the triggered VPE BPM will search for BLID's on converted active VPE's by answer set ID.
• Also captured the requirements of BPM to call BCI BRMS for the Benefit string header information.
• Worked closely on PBM requirements that were dependent on Benefits for the Claims.Also created flows and use case description.
• Created the dashboard for the project and updated it weekly.
• Extensive design, development and testing experience with Informatica PowerCenter.
• Knowledge of Data Warehouse life cycle, Data Mart design concept.
• Performed unit testing, point-to-point testing and integration testing to confirm ETL code integrity.
• Captured requirements and worked with BCBSMN SMEs, NASCO SMEs and Solution Architect in alignment process.
• Participated in NASCO BeneFACT Training.
• Created File Transfer Specification FTS to automate the extract, translate, and load process of the BCBSMN data Provider Specialty, National Place of Service into the NASCO Plan Flex table.
• Worked with IT team in encrypting the conversion files to NASCO decrypted the files coming back from NASCO
• Strong technical knowledge of the FACETS system, more specifically the Subscriber/Member application.
• Worked with BCBSMN and NASCO SMEs to map the Benefit Variables.
• Captured Action Items, Issues, Risks and Dependencies during the JAD Sessions and coordinated with Lead and PM to manage and resolve.
• Reviewed and analyzed current reports, reviewed reports with NASCO, finalized matching reports and captured requirements for new reports for Actuarial, EDI and Benefits track.
• Understood and captured criteria to create new Benefit String and BLID.
• Actively participated on creating Conversion strategy from existing Star System to NASCO NPS System.
• Analyzed and captured existing reports for BCBS Host Plan
• Implemented Traceability Matrix and Business Requirement Specification Document verified the functionality coverage.

Confidential

Senior Business System Analyst

Confidential together with its subsidiaries, provides health insurance and managed care products and services primarily to the senior population in the Confidential. This project involved enhancing the current legacy system to implement HIPPA 5010 changes. Also functionalities were designed to accommodate subscriptions in a single plan on customer's specific needs for their dependents like maternity benefits for spouse, pediatric benefits for the child and various therapy services which were not part of the system before. So if the subscriber enrolled under a particular plan, these benefits could be assigned to the dependents in a single plan. Earlier if the subscriber needed to add few of these particular benefits, he would need to enroll under multiple plans for these benefits.

Environment: MS Office, Quality Center, SQL Server, Facets 4.21, MS Project, Server, MS Visio, Unix, J2ee, Java, XML, Mainframes and Rational ClearQuest, ClearCase, Windows XP

Responsibilities:

• Aided in the collection of User Requirements and Business Requirements to create the Business Requirement Documentation BRDs , using MS Word and MS Visio that provided appropriate scope of work for technical team to develop prototype and overall system.
• Incorporated and implemented all the HIPAA standards, Electronic Data Interchange EDI 835,837,270,271 transaction syntax like ANSI X12, ICD-9, ICD-10coding and HL7.
• Worked in FACETS data model.
• Conducted HIPAA 834 data mapping and interpretation, as well as the conversion of this type of data from state partner receipt, through uploading to the facets application, via the MMS application.
• Develop, test and maintain ETL procedures employing both ETL tools and custom PL/SQL
• Worked on designing Crystal reports and integrating them into Sharepoint. Also worked on NASCO framework.
• Managing and manipulating the pharmacy data PBM and putting down requirements around it.
• Conducted AS-IS and TO-BE analysis and assisted in developed process models and systems integration structure.
• Worked for audit trails of FACETS 4.6.1and also porting of the system from 4.6.1 to 4.7.1
• Guiding LMS stakeholder teams in delivering a new online learning platform that will serve employees. Configuring the overall design of the Moodle 2 site including the various add-on components
• Worked in Microfocus COBOL as an intermediate. Also worked on Meta Data cataloging.
• Involved in the analysis of HIPAA compliance and EDI transaction sets and actively participated in the designing of the EDI transactions using the new HIPAA 5010 version also including the use of ICD-10 codes, conversion of ICD9 codes to ICD 10 codes.
• Migrated documents from shared drives to SharePoint environment
• Conducted and facilitated Joint Application Development JAD sessions to reduce time spent in moving information between stakeholders and team members.
• Wrote test cases and test plans for the related and assigned scripts according to the test strategies defined in the project and testing team guidelines in Quality center.
• Conducted the AS-IS and TO-BE analysis of the business process using GAP analysis.
• Recommended corrective actions, if necessary, along with the progress against Development/Action Plan routinely to the Project Manager.
• Tracked and maintained Stakeholder requested enhancements and changes using Requirement Traceability Matrix RTM .
• Identified critical areas of business risk and modified business processes to reduce risk by using the Risk-Management Process.
• Knowledge of the complete EDI format used in electronic documentation which was part of the knowledge transfer program to the vendors as per the requirements.
• Worked with Source system Subject Matter Expert SME to ensure that the extracts are properly mapped. Used SQL for data mapping and querying.
• As part of the data mapping procedures, assisted in writing requirement document for ETL - Data Extraction, Data Analysis and Loading process of collected data.
• Involved in various types of Audits and the Financials involved through different stages.
• Gained Compliance audit experience due to exposure to the legal/audit consulting groups.

Confidential

Senior Business Analyst

Confidential provides health care coverage to low-income Oregonians through programs administered by the Division of Medical Assistance Programs DMAP . Currently, more than 380,000 people each month receive health care coverage through the Oregon Health Plan. The project aims at building an Enterprise SOA service-oriented architecture based system that will be developed on the Microsoft .NET Platform. The new Claims Processing MMIS Medicaid Management Information System will replace the old legacy system and will automate all the business areas with minimum human intervention. As a Business Analyst, I was involved with drafting the migration plan for the Claims processing data which needed to be migrated from the Mainframe to the SQL Server environment. I was also involved with the HIPAA 5010 compliance for the new MMIS system

Environment: MS Office, Windows 2000, .NET, MS Visio, MS SharePoint, TFS, MS Project, MS Visio, SQL, Oracle, SOA, HTML.

Responsibilities:

• Gathered requirements from stakeholders for provider management and member management.
• Identified and validatedbusiness rules and data elements.
• Developed the stakeholder list and created stakeholder assessment matrix to prioritize them. Also worked as a BSA to maintain the relationship between businesspeople and the Programmers
• Developed and maintained a requirements work plan and assessed the performance metrics of the team members.
• Modeled the 'as-is' process flow and the 'to-be' process flow and analyzed the gap and developed the action steps to fill the gaps.
• Conducted Risk analysis and developed mitigation plans.
• Conducted Impact analysis when there is any change in the requirements and updated the Business Requirements Document BRD and Systems Requirements Specification SRS .
• Worked on Microfocus cobol as an intermediate.
• Propose strategies to implement HIPAA 5010 in the new MMIS system.
• Developed the User Interface UI prototypes to capture and validate requirements and spike solutions to the current problem.
• Experience in converting this type of data from state partner receipt, through uploading to the FACETS application, via the MMS application.
• Experience of the FACETS Subscriber/Member backend database structure, and the ability to query information in support of requirements definition
• Partnered with LMS vendor to request and schedule new features, system enhancements, and bug fixes. Provided LMS vendor with Functional Specifications and System Requirements documents.
• Designing Functional Specifications for the target physical database.
• Facilitated JAD sessions for Requirement Validation with Dept. of Health Human Services DHHS to gather requirements for the new MMIS.
• Developed UAT test cases associated with the functional requirements.
• Maintained a bi-weekly status report for the requirements team and incorporated the same to the PMOstatus reports send to CMS.
• Analyze different data cross-walks, complicated logic look ups required by different fields for the source to target transformations.
• Analyze EDI X12 data elements captured by the existing system to validate it against the data elements required for new system.
• Participated in developing test plan, test scripts, and test scenarios and designed user documentation.
• Worked with legacy team in developing BRD for multiple system change requests and participated in system testing.
• Worked with the deployment team for reversion of the member portal.
• Used Microsoft SharePoint as the version tracking tool for managing the requirements documentation.
• Create monthly/weekly status reports to update the project schedules deliverable plan.
• Examine the system design deliverables validating it against the Request for Proposal RFP .

Confidential

Business Analyst

Confidential is a provider of innovative revenue cycle automation and outsourcing solutions to the healthcare industry. Azima has combined best of breed software, rigorous business processes, and highly skilled reimbursement specialists to create the most advanced array of revenue cycle automation and management solutions in healthcare. Azima provides its client partners with access to these solutions via the Internet on an as-needed, pay-as-they-go basis. The main purpose of this project was to maintain patient related information and help Account Receivable Team to increase the collection from insurance companies. Also, help in the tracking a medical claim, sending it to the insurance companies, follow up and closing of the claim as per HIPAA compliance.

Environment: RUP, Rational Requisite Pro, UML Use Cases, VB.NET, SQL Server, Rational Rose, XML, Use Case Documentation

Responsibilities:

• Requirements gathering from various insurance companies to develop a system to check for the outstanding balance from various accounts using highly efficient RUP process of software development.
• Liaison between the Business needs business users and sponsor and the Technical solutions development and testing staff , ensuring technical solutions satisfied business requirements.
• Web Page Mock-Ups using MS Visio and thus defining the Business Process Model and Data Process Model.
• Experienced in RUP software development cycle methodology with four consecutive phases - Inception, Elaboration, Construction and Transition.
• Ensured that the claims processing is strictly under the HIPPA compliance regulatory document to safe guard patient information.
• Authored Business and Functional requirements with supporting diagram, use cases, traceability matrices, and training manuals for Provider Portal web-based application.
• Developed training material and trained the users on newly developed application.
• Analyzed and wrote technical documentation for root cause analysis on customer support issues.
• Part of the team assisting in documentation involved in this project such as RFP, proposal, evaluation criteria, proposal approval, design document, project plan, project scheduling, project report, release document.
• Prepared and presented monthly collection reports.
• Developed and implemented plans to bring down the Accounts Receivables aging days.
• Involved in training and quality of the overall workflow process.
• Creating and analyzing numerous clients' reports for various financial requirements.
• Documenting workflow and results of analysis for the aging accounts.

Confidential

Business Analyst

Confidential customers with expertise, benefits, and services that seek to improve their well being. My role as a Business Analyst comprised developing fully automated, real-time claims processing system for complete, on-line mediation of medical, dental, vision, and disability claims following HIPAA guidelines. The 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.

Environment: Windows XP Professional, Mercury Test Director, Oracle, MS Access 2000, MS Excel, RUP, Oracle, UML, Rational Rose, Requisite Pro, TOAD, Rational Clear Quest 2002, MS Office suite, MS Visio, Informatica

Responsibilities:

• Analyzed BusinessRequirements, developing tracking and enhancing them into functional requirements using Rational Requisite Pro as a requirements tool.
• User Acceptance Testing UAT Carried out UAT activities associated with each project and presented the results to the Business Stakeholders.
• Worked on HIPAA transaction codes specifically on EDI 837, 835 and 834 to incorporate enhancements to existing efforts on capturing and mapping, member enrollment and eligibility and contribution data respectively received at the Plan level from the State.
• Documented the meeting minutes from the JAD's and stored the artifacts in the appropriate place holders in PDS and SharePoint for both the teams to review.
• Worked in GAP analysis to understand the difference between both the billing systems and documented the GAPs in GAP analysis spreadsheet.
• Used UML and RUP best practice methodologies along with supporting toolset including Mercury Test Director, Caliber RM and StarTeam for overall development framework
• Documented the business requirements into functional requirements document.
• Gathered the requirements and transformed them into high-level Process-Flow Diagram using PowerPoint.
• Created a task plan for the team identifying the key deliverables and the respective deadlines.
• Created the ETL requirements to load the data into TeraData.
• Analyzed the business requirement as per the HIPAA rules and regulations.
• Involved in preparing Test Plans based on User Requirements Document URD and prepared the Test Cases using Test Director/HP Quality Center.
• Created mapping/crosswalk documents for mapping data flow between systems.