SUMMARY OF QUALIFICATIONS:

• Over 8 years of IT and Management experience in Software Development Life Cycle (SDLC) and Project Life Cycle working as Business Analyst mainly in Healthcare sector.
• ­Extensive experience in interviewing Business users & subject matter expert providing recommendations to resolve issues for various business/technical groups & defining strategic solutions to business problems in a multiple project environment.
• Competent skills in developing detailed functional specs through JAD sessions, interviews with clients and business users, onsite meetings with business users & development team.
• Experience with PMO techniques such as Rational Unified Process (RUP), RAD, Agile(scrum meetings, user stories, sprints), Waterfall life cycle.
• Conducted Financial Business Case Analysis, Cost Benefit Analysis, ROI, Gap Analysis, Risk Analysis, SWOT Analysis, Feasibility Analysis, Impact analysis, Requirement Analysis, and then organized review meetings with various Stakeholders and the end users aimed towards finalizing the Software Requirement Specifications.
• Adept at using Gap Analysis techniques to gain a clear understanding of the AS IS of the system and additionally derive new user scenarios to understand the potential TO BE system
• Extensive experience with analyzing business processes and documenting them using MS Visio, MS PowerPoint, MS Excel and MS Project.
• Experience in development of business modeling including the use of BPMN, BOM (Business Object Models/TOM (Technical Object Models), Process Flow Diagram, Use Case Diagram, Activity Diagram, and Sequence Diagram by using UML methodology.
• ­Analysis & Design (Use Case, Sequence and Activity diagrams).
• ­Experience in documentation: BRD (Business Requirement Document), FRD (Functional Requirement Document) and Non-functional Requirement Document (NFRD).
• Used SQL to test various reports and ETL load jobs in development, QA and production.
• ­Writing (manual/automated test cases) and Conducting (Integration testing, Regression testing) UAT (user acceptance tests) test cases.
• ­Working experience in a cross-functional team environment/different geographical locations teams.
• ­Well versed in translating business requirements and user expectations into detailed specifications employing Unified Modeling Language (UML) diagrams using MS Visio and Rational Rose.
• Sound knowledge of HIPAA, HL7, ICD9 CM, ICD10, EDI, HMO, PPO, Medicare, Medicaid.
• Experience in Conversion of HIPAA X12 4010 codes to X12 5010 codes and ICD 9 to ICD 10 codes.
• Experienced with the NASCO MembersEdge System (both MembersEdge Client and MembersEdge Web Client) for Enrollment, Account Implementation, Billing and Accounts Receivable.

AREAS OF EXPERTISE:

Business Re-engineering, Business Continuity plan, System Architecture, Problem Solving, Strategic Partnering, Strategic Planning, Application Design, Information Security, EDI (Electronic Data Interchange), Data Mining, Leadership, Project Management, Medicaid/Medicare.

TECHNICAL QUALIFICATIONS:

Operating Systems: Windows 9x/XP/7, UNIX, Solaris, Linux

Programming Languages: PL/SQL, C/C++, Visual Basic, .NET

Packages: Rational Complete Suite, MS Office, MS Visio, MS Project, MS Share Point, Rally Software for Agile, SAS.

Testing Tools: Rational Quality Manager, Rational Functional Tester, Rational Performance Tester, Mercury Test Director, QTP, Rational Tools and Test Complete

EXPERIENCE:

Confidential, Rye, NY

Sr. Business Analyst

Confidential the company for women, is a leading global beauty company, with $10 billion in annual revenue. As one of the world's largest direct sellers, Confidential is sold through more than 6 million active independent Confidential Sales Representatives. The project was to make available a SharePoint repository to store all fulfillment documents generated for direct representatives, for the purpose of reuse, and it should provide inbound and outbound services to store and retrieve the documents.

The other project I worked on was an electronic leave processing system using Sharepoint, and Active Directory.

Responsibilities:

• Organized one-on-one and group sessions with stakeholders to elicit requirements
• Acquired knowledge of day-to-day business operations to create current state and future state process flows using MS Visio.
• Documented business processes and developed functional requirements
• Created Process maps, and collaborated with the technology delivery team during requirements, wireframes, mockup phases
• Produced Data mapping and data definition documentation.
• Developed UAT test cases, and conducted UAT testing
• Developed Training Manuals, Job aids and coordinated with Knowledge Management teams to prepare for the User Training sessions.

Confidential, Newark, NJ

Sr. Business Analyst

Horizon Blue Cross Blue Shield of New Jersey , headquartered in Newark, New Jersey is the only licensed Blue Cross and Blue Shield Association plan in New Jersey, providing health insurance coverage to over 3.2 million people throughout all of North, Central, and South Jersey. The project involves migrating from NMS to MembersEdge. ‘MembersEdge is NASCO’s fully integrated membership and billing solution that simplifies the servicing of large group, small group and individual accounts through process automation. It supports all enrollment, billing, payment reconciliation, financial reporting and claims eligibility functions’. I worked as a Change Management BA, and was involved in process improvement, process mapping and documentation in the Enrollment, Account Implementation and Billing Domain. I have worked on EDI transaction 834 (Benefit Enrollment and Maintenance ) and 820 (Payment Order/Remittance Advice). I was also involved with the EBPP (Electronic Bill Presentment & Payment) Project, which would make it possible for HBCBS to offer customers the option to make electronic payments.

Responsibilities:

• Using MS Word & Visio, created AS-IS and TO-BE business process flow diagrams for Account Implementation , Member Enrollment & Bill Payment/Accounts Receivable , and integrated process flow diagrams to show end-to-end business model and business process mapping exercise including swim lanes.
• Performed analysis to identify the needs of the business based on HCR and CMS guidance for On-Exchange Business for Individual and SHOP group.
• Performed gap analysis for billing domain between NMS & the new system and identified alternative solutions options to fill the gaps.
• Organized workshops with NASCO and Business SMEs and developed detailed process flow and work flow documents for Enrollment, Account Setup, Billing and AR, Treasury on both MembersEdge Client and MembersEdge Web Client.
• Used NASCO Members Edge MO (Model Office) Test Environment to create Test profiles (and profiles for training) for Members enrolled in Platinum, Gold, Silver & Bronze Metallic level EPO/PPO Plans.
• Coordinated with ORT (Operational Readiness Team) and KM (Knowledge Management) to test the work flow documents in Model Office, or UAT environment.
• Collaborated with IT and/or NASCO to resolve issues that Business came across in Model Office or Production.
• Worked with Business SME’s and Instructional Design to develop training curriculum for Account Implementation, Enrollment, Billing and A/R and Treasury teams, and reviewed final training materials developed by ISD.
• Participated in weekly sessions to discuss the CMS guidance for Individual Consumer and SHOP group for Exchange Business and how it affected Enrollment and Billing and what actions needed to be taken to remain in compliance.
• Created Business Terms Glossary for MembersEdge in adherence to the corporate business terms glossary
• Facilitated sessions and documented the topics that needed training materials for the internal associates.

Confidential, Minnetonka, MN

Sr. Business Analyst

Confidential serves millions of people worldwide. It is known as a health and related benefits company. The main objective of the project was to design an Electronics Claims Processing (ECP) system to accept the ICD-10 electronic claims coming from the various providers (doctors and hospitals) and process them. System also incorporates the health insurance products, which help their employees to choose and calculate their benefits. The project was also to make the service providers HIPAA compliant and to integrate them into one system.

The project was specifically related to upgrading HIPAA X12 4010 transaction to X12 5010 and ICD 9-CM to ICD 10-CM/ PCS simultaneously. I have worked on EDI transaction 837 and 270/271 (HIPAA Eligibility Transaction). The scope of the project includes the implementation of several interfaces and processes, enhancement and support of the existing claims system and electronic data interfaces to accommodate the upcoming 5010 EDI changes

Responsibilities:

• Assisted Project manager and led the efforts to identify best approach for gathering requirements and estimated project size using UCP analysis.
• ICD-10 remediation in alignment with GEM Mapping, Reimbursement Mapping, and Forward/Backward Crosswalk concepts.
• Performed Reviews and Audits for internal and external activities for the existing system at UHG Health care and prepare activity/process flow using MS Visio.
• Prepared process flow/activity diagram for existing system using MS Visio and re-engineer the design based on business requirements.
• Identifying the requirements for accommodating HIPAA 4010 and 5010 standards for EDI X12 transactions as well as ICD 9-CM to ICD 10-CM/ PCS
• Gathered Business Requirements, created Functional Requirements Document (FRD) and analyzed data/workflows, defined the scope, financial projections and cost/benefit analysis; progressed from Problem Statement to well-documented designs. Prepared user guidelines for easy access of the application.
• Provide benefit analysis in context with current ICD-9 codes and recommendation about the ICD-10 codes to be included.
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, and Business Process Modeling.
• Conducted JAD sessions to get SME’s input on how to implement the application for Group Disability Claims.
• Gathered Business requirements for Integration points and mapped them with Functional requirements. Extensively used MS Excel during the course of the project.
• Created sample Wire frames to make system better understood by Business and technical teams.
• Performed GAP analysis to identify the gap between the optimized allocation and integration of the inputs, and the current level of allocation.
• Using MS Word & Visio, created AS-IS and TO-BE business process flow diagrams, Integrate process flow diagrams to show end-to-end business model and business process mapping exercise including swim lanes.

Confidential, Lincoln, NE

Sr. Business Systems Analyst

The project was contributed to the early phase into conversion of ICD-9 to ICD-10 compliant with HIPAA 5010. (HIPAA) require that all health insurance payers in the United States comply with the EDI standards for health care as established by the Secretary of Health and Human Services. The Addenda version of the ANSI ASC X12 837/835 transaction set was selected as the HIPAA-mandated format for electronic enrollment and disenrollment in a Health Plan. Along with that also managed claims processing for the entire enterprise of EDI X12 837/835 (I/P/D). Implementation of National Provider Identifier (NPI) compliance for NE-DHHS Medicaid Management Information Systems (MMIS) under HIPAA 5010 Project. Legacy system is currently in place with mainframe systems for the backend. Analysis is done on identifying impacted systems, reports, interfaces, screens and policies due to NPI crosswalk implementation.

Responsibilities:

• Implementing National Provider Identifier (NPI)
• Compliance for NE-DHHS Medicaid Management Information Systems (MMIS) under HIPAA 5010 Project
• Legacy system is currently in place with mainframe systems for the backend
• Involved in HIPAA EDI transactions such as 835, 837 (P, D, I), 276/277.
• Performing business process and systems analysis with a focus on data, analysis models and diagrams in support of building out current state and future state views.
• Conducted JAD sessions with management, vendors and other stakeholders for open, pending and critical issues
• Gap analysis and structured walkthrough of workflow with users to identify and fill the gap after the merger
• Helped redefine existing practices, methods, and formats used in creating source to target mapping documentation, and documented several source to target data flows.
• Produced data mapping and data definition documentation. Interacted with ETL programmers, database administrators, project managers and business managers
• Documented/Updated business requirements and RTM using Rational Requisite Pro.
• Planned and defined system requirements to Use Case, Use Case Scenario and Use Narrative using the Business Process Modeling Notation (BPMN) methodologies
• Played a major role in Unit testing, System testing both functionally and manually by writing test cases and validating them
• Interacted with the data warehouse team and the management to develop the application
• Assigned problems to appropriate software development team for fixes
• Responsible for updating Project plan as needed and updating project schedule and tasks using MS Project.

Confidential, Deerfield, IL

Business Analyst

Confidential is one of the health insurers in the United States. A web application was reengineered to make it compliant with the EDI standards. Integration of this web application with the third party administrators’ applications (TPA) was achieved. The developed application is complaint with the HIPAA standards.

Responsibilities:

• Involved in the analysis of the existing credit card processing system, mapping phase according to functionality and data conversion procedure.
• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims.
• Followed solely RUP methodologies during the course of the project.
• Upgraded the existing Test Scripts and created new scripts for client application to be able to work for new versions and patches, which improved product quality.
• Provider inquiry about the status of Remittance Vouchers (RVs). This involved checking the MMIS provider subsystem and checked the setup of their Remit Media.
• Created Data Stage jobs to extract, transform and load data into data warehouses from various sources like relational databases, application systems, temp tables, flat files etc.
• Accumulated system requirements from various departments through surveys and interviews.
• Performed Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data
• Conducted JAD sessions with management, SME, vendors, users and other stakeholders for open and pending issues.
• Created Use Case Diagrams, Activity Diagrams, Sequence Diagrams and ER Diagrams in MS Visio.
• Assisted in the development, design and implementation of new relational or multi-dimensional databases, including the analysis of user needs.
• Created and managed project templates, Use Case project templates, requirement types and traceability relationships in Requisite Pro.
• Involved in writing the detailed Test Plan using Mercury Quality Center, after analyzing business requirements and software/functional requirement artifacts.
• Worked extensively with MS Excel and MS Access.
• Suggested measures and recommendations to improve the current application performance.

Confidential, Louisville, KY

Business Analyst

Responsibilities:

• Responsible for creating and reviewing business requirements, functional specifications, project schedules, technical documentation and test plans to meet user needs
• Gathered user/business requirements by meeting with business users and generated business models and use case analysis
• Responsible for defining the scope of the project, gathering business requirements, doing gap analysis and documenting them textually or within models
• Interfaced with internal clients and technical vendors on new feature requirements and conducted a thorough analysis of the system features to assist project team with implementation of new features.
• Conducted individual and group (JAD) sessions with business and technical units. Gathered requirements by interacting with the stakeholders by interviewing them, by preparing questionnaires and getting feedback which helped in developing application according to HIPAA Rules.
• Exposure to HIPAA Compliance requirements. Considered HIPAA rules while data validation and testing
• Designed/Implemented the performance testing environment for SQL Reporting Services using the SQL Tracer
• Contracted with the Medicare Centers and Medicaid Services (CMS) to provide quick, easy, and affordable access to the health care service of their choice

Confidential, Lincoln, Rhode Island

Business Consultant

Confidential is one among the oldest mutual insurers in the United States. They provide Auto, Home and Life Insurance. Amica’s Web Portal incorporates a wide range of features for policyholders and new customers. I worked with an application that was taking care of Online Account Services that included Billing Application, Checking the bill history, Changing customer profile, Ordering auto insurance ID cards and Modifying the load provider details.

Responsibilities:

• Identified and documented business requirements from clients while translating them into system specifications.
• Analyzed existing and planned business processes, documented workflows and created functional specs for development.
• Extensively used SQL for creating and deleting tables and for generating Project Progression Reports.
• Coordinated meetings with business clients and various IT teams including developers and testers to discuss defects and gather new requirements.
• Rational Unified Process (RUP) was used in the system development methodology.
• Conducted Root Cause Analysis (RCA) during the Inception and Elaboration Phases of RUP as well as conducted Process and System based RCA.
• Used Rational Requisite Pro to actively organize, maintain and keep track of user requirements.
• Analyzed and segregated business requirements into high level and low level Use Cases, using MS Visio.
• Software Development Life Cycle steps were followed in the application development process.
• Communicated the project status to clients bi-weekly, highlighted changes made in requirements and gathered new requirements.
• Identified and created Use Case diagrams and business process workflow diagrams including Activity diagrams and Sequence diagrams from the requirements.
• Proficient at retrieving and monitoring data and information with the use of SQL.
• Heavily involved in working with the offshore region while acting as a liaison and communicating the status of reports and process flow documents between the local and offshore teams.
• Helped develop timelines for Project Delivery, Deployment Schedules and User Training Modules.
• Reviewed and evaluated all software modules before delivery to confirm meeting standard criteria.
• Used detailed knowledge of application features, architectures and functions to assess scope and impact of business needs throughout analysis and through the completion of all enhancement specifications.
• Identified and recorded production issues through the use of Issue Logger tracking sheet.
• Organized regular conferences with management and testers for discussing issue resolution and cost impact.

Confidential

Business Analyst

The objective of the project was to upgrade available services so as to provide a comprehensive range of online banking services to their clients. The new services were to provide online functionality like account information and balances, bill payments, fund transfers, deposits, and recurring payments and check management.

Responsibilities:

• Responsible for gathering requirements and specifications, project planning and identifying the resources and implementation of the project.
• Implemented and followed the Waterfall methodologies throughout the SDLC while working with multi-functional teams in gathering and analyzing the business requirements and convert it to FRS and created business process models from the requirement specification.
• Facilitated Joint Application Development (JAD) sessions, conducted surveys, and interviews to identify business rules and end-user's requirements and then documented it in a whitepaper that can be reviewed and understood by both business people and technical people.
• Attended daily SCRUM and guided QA and IT Developer regarding the defects.
• Performed the analysis of the earlier systems, generated a detailed requirements document describing new system architecture through use cases diagrams and activity diagrams using MS Visio.
• Authored data flow diagrams, sequence diagrams and business process models.
• Developed a logical Integration model detailing the flow of information through the various components, including definition of external and internal message contents.
• Conducted requirement workshops among all project stakeholders to verify and validate the business requirements in UI designs.
• Participated in the daily status meetings to discuss defects with developers, users and the product managers.
• Supported the Program Manager in balancing project goals and business needs.
• Worked in management information system department on reporting compliance, security and privacy issues.
• Provided status updates on progress including percent tested, percent of tests blocked, percent of tests remaining.
• Facilitated and managed meeting sessions with key personals from various business areas including financial executives, regional directors and contract management teams.