- Sr. Business Systems Analyst with 7+ years of industry experience in identifying business needs, and determining solutions to business problems for complex software projects including system development component, business process improvement, strategic planning and policy development in Healthcare sector
- Experience in creating and organizing deliverables in a secure retrievable area: such as BRD (Business Requirement Document), FRD (Functional Requirement Document), PDD (Project/ Product Definition Document), SRS (System Requirement Specification) and Change Management Documents.
- Experience with full Software Development Life Cycle (SDLC) and project life cycle including Feasibility Analysis, Requirements planning and Management, Application Design and Development, Testing, Implementation and Post - Implementation Validation, and Solution Assessment.
- Good knowledge of Business Intelligence, Data Warehousing and Business Architecture.
- Extensive experience in Medicare (Part D/PBM) and Medicaid.
- Good knowledge and understanding of Medical Management Information System (MMIS)
- Documenting and creating Test Plans, Test Objectives and Test Cases. Also involved in maintaining Test Matrix and Traceability Matrix.
- Strong knowledge of Object Oriented Analysis and Design (OOAD) using Unified Modeling Language (UML), Rational Unified Process (RUP), Capability Maturity model (CMM), Six Sigma (DMAIC) .
- Also worked using various methodologies such as Waterfall methodology, Agile Software Development, Joint Application Design (JAD), and Prototyping.
- Experienced in Business writing skills and Technical writing skills in developing Business Case, Scope Document, Use Case Scenarios, Test Plans, Test Cases, AS-IS and TO-BE workflows.
- Proficient in Rational Suite including Rational Rose, Requisite Pro, MS Visio, MS Project and MS Access.
- Broad knowledge of Medicare, Medicaid, PPO, HMO, POS, diagnostic codes, and claims process, EDMS (electronic data management system).
- Excellent knowledge of Health Insurance Portability & Accountability Act (HIPAA) standards, Electronic Data Interchange (EDI), and Implementation and knowledge of HIPAA code sets, ICD-9, ICD-10 coding, and HL7.
- Understand rules and regulations of HIPAA as imposed during Various Electronic Data
- Interchange (EDI) transactions- 837 - Claims and Encounters, 834 - Benefit Enrollment and
- Excellent communication skills and proficiency in interacting with the stakeholders, and Subject Matter Experts (SME’s) to get a better understanding of the Business Process.
- Extensive experience with Business Process Management (BPM) system.
- Good knowledge of PPACA ( Patient Protection and Affordable Care Act) and HIX.
- Efficient in handling Change Requests by the client.
- Experience in User Acceptane testing, White Box, Black Box, Unit, Functional, Integration, Back End and System Level Load and Stress Testing for many types of applications including web and client server applications.
- Working knowledge and experience with SQL/PL SQL, HTML, and MS Access
- Excellent analytical and problem solving skills in designing, developing, and implementing innovative business processes using new approaches and technology.
- Microsoft Tools MS Project, Visio, Excel, Word, Outlook, PowerPoint, MS Excel, SharePoint
- Requirements Management Tools Rational Requisite Pro, Rational Rose, MS Visio, Share Point.
- Operating System Windows 2000/7/XP, DOS, Unix
- Business Skills Business Process Analysis & Design, Process Improvement and Implementation assessment, Requirement Gathering, Use Case Modeling, JAD/JRP Sessions, Gap Analysis, Impact Analysis.
- Languages/Standards SQL, JAVA, XML, HTTP, HIPPA 4010/5010, ICD9/10, ANSIX12, CPT, CMS form, Six Sigma.
- Methodologies Rational Unified Process (RUP), Agile, Waterfall, Rapid Application Development (RAD)
- Other Tools Axure, Magic Draw, Informatica, Cognos, Visual Basic, Mainframe.
Confidential, Waukesha, WI
Sr. Business Systems Analyst
- Gathered requirements for impacted system and business areas for ICD-10 and their needs to embrace the changes.
- Compiled the Vision Document and composed detailed Use Case Specification Documents in Rational RequisitePro.
- Used UML to perform Use-Case analysis to capture the dynamic aspect of the application.
- Interacted with stakeholders and gathered requirements as per the business needs.
- Adhered to existing change management procedures. Recommended improvements to existing procedures.
- Facilitated Joint Application Development (JAD) sessions with all IT groups for communicating & managing expectations and to discuss various means for integrations with current system using an adoption through execution strategy and to collaborate resource allocation and project completion.
- Developed high level Design and Development Recommendations and prepared ICD-09 to ICD-10 Code (Diagnosis and Procedure) Mapping documents.
- Created activity diagrams and sequence diagrams to analyze the requirements and recommend solutions. Involved in creating use case diagrams activity diagrams and state diagram using enterprise architect.
- Involved in the planning of the sprint sessions and documenting of the artifacts throughout the various phases of the development process.
- Ensured the accuracy and consistency of the data during the data loading process.
- While working with various members at the management level to understand the business process and decision models, was also involved in Compiling the Vision Document and composing detailed Use Case Specification Documents in Rational RequisitePro.
- Actively worked on Data analysis and Report analysis with respect to ICD-10 impact.
- Involved in managing the Daily Standup meetings and also ensured that quality standards were enforced as per the build-release schedule.
- Conducted GAP analysis by understanding the AS-IS system and the TO-BE system requirements by having discussions with the SME’s.
- Documented Requirement Traceability Matrix in Microsoft Excel for traceability of requirements through test cases.
- Developed Flowchart and process diagram using Microsoft Visio.
- Was in regular contact with Business partners on the status of issues, action plans and timeframe for resolution throughout the development cycle.
- Performed User acceptance testing (UAT)
- Responsible for defect tracking and reporting using Quality Center.
- Organized meetings to discuss outstanding issues with QA team and developers.
Environment: Rational RequisitePro, UML, Agile, Microsoft Office (Project, Publisher, Excel, Word, PowerPoint and Visio), Project Manager, PHP, Facets, Issue Tracker, BI Applications, MS Outlook, SDLC, Oracle 10g, Quality Center.
Business Systems Analyst
- Gathered Business Requirements from all the stakeholders and interacting with the providers, managers, developers to develop the business Processes.
- Extensively developed project documentation, process flow documents, formal proposals, RFQ’s and RFP’s. Formulated methodologies and developed SDLC phases, strategies, time & cost estimates with milestones for each phase.
- Prepared Business Requirement Documents (BRD's) and Functional Requirement Documents (FRD's) from System Users that provided appropriate scope of work for technical team to develop prototype and overall system.
- Conducted Risk Analysis and Impact analysis whenever there is any change in the business requirement and continually updating the business requirement document.
- Conducted JAD sessions and ultimately reducing the time spent in moving all the information from stakeholders and other team members.
- Perform GAP analysis in order to identify the changes in 837, 270/271, 275, 276/277, 834 and 835 transactions being proposed in the upgrade from HIPAA 4010 to HIPAA 5010.
- Complete understood the business process to determine the needs of the business.
- Assisted in the meetings with the technical team as well as the clients regularly to assess the current process and how it could be changed in making a better proposed process.
- Provide various strategies to implement HIPAA 4010 in the new MMIS system and ultimately move to HIPAA 5010.
- Performed six-sigma process during the project to eliminate any defects in the process.
- Develop spike requirements solution for all the current problems and UI prototypes for capturing the requirements.
- Helped in developing test cases such as test plans and test scenarios.
- Utilize Agile Methodology and build different phases of software developmental cycle.
- Actively involved in designing EDI transactions using the new HIPAA 5010 version and ICD -10 codes and analyzing HIPAA compliance and EDI transaction.
- Recommending actions against the action plans during the ongoing progress of the project to the project manager.
- Involved in designing and developing Data Models and Data Marts that support the Business Intelligence Data Warehouse.
- Assisted Project Manager in creation of project management plans to manage timely delivery using MS project.
- Created Requirement Tractability Matrix (RTM) to track and maintain stakeholders requested requirements and changes.
- Involved in creating test plans and test specifications as per business requirements.
- Participated in the bug review meetings.
Environment: MS Project, Agile, Requirement Traceability Matrix (RTM), Rational Rose Test, JAD,, MS Visio, Windows OS, MS Office, SharePoint, ETL, Server, Quality Center, SQL Sever
Confidential, Davenport, IA
Sr. Business Systems Analyst
- Analyzed the Business Modules and their impact on the current system.
- Performed requirement gathering & analysis by actively soliciting, analyzing customer requirements
- Created BRD and FRD to be used by IT Team after conducting Interviews with End Users, JAD Sessions and analyzed their current systems.
- Created Use Cases, Use Case Models, Work Flows, and System Specification Document Using Agile Methodology.
- Used Component business modeling for improving strategic planning and efficiency.
- Assisted with building EDI 837(I, D, P), 835, 270/271 transactions processing flow from the Trading Partners to the translator to the Mainframe and back to the Trading Partner.
- Developed plan for data feeds and data mappings for integration between various systems, including XML, to follow ICD 10 Code set and ANSI X12 HIPAA 5010 formats.
- Identified AS-IS processes of claims transactions of 4010/4010A standard and TO-BE processes (ICD-10-CM and ICD-10-PCS compliance requirements) of 5010 standard using the gap analysis and develop actions to fill those gaps.
- Involved in understanding the business logic, designing requirements, communicating them to the developers, generating documentation, designing use cases, creating various diagrams like State Diagrams, Sequence Diagrams as part of project.
- Maintained Traceability matrix throughout the project.
- Created standards / guidelines for business process modeling, Use Cases, Work Flows, Data Dictionary, and requirements specifications.
- Mentoring end-users on requirements specifications techniques and the software development life cycle.
- Schedule meetings with technical personnel to determine technical parameters for EDI and other related processes, including communication, security, and privacy.
- Created transaction sets requirements, usually with Microsoft Excel, for transactions such as: HIPAA 270/271, 276/277, 835, 837-(I, P, &D), 835 Remittances and others. Resource for UB92 and HCFA1500 billing formats; transaction sets requirements, EDI development and Design, X12 protocols through Version 4010A1 and newer, conversion needs and understanding of legacy EDI formats, such as UB92 Versions 4, 5, 6 and NSF.
- Analyzed requirements and formulated a Test Plan for testing the functionality, navigation, and integration testing of the application.
- Bug Reporting & Tracking the status in HP QC.
Environment: UML, SQL, Windows Server, Java, HTML, Agile, Facets, Excel, MS Visio, MS Project, Power Point, Share Point Server, Quality Center, Outlook, SQL Server.
Confidential , San Francisco, CA
Business Systems Analyst
- Assisted in identifying the end users of the system and interviewed them in meetings and workshops.
- Met with client groups to determine User Requirements and System Goals. Coordinated work plan between project manager and client using Microsoft Project.
- Planned and defined system requirements to Wire Frame with Use Case, Use Case Scenario and Use Case Narrative using the UML (Unified Modeling Language) methodologies.
- Created and updated Issue, Risk, Assumption, Action and Dependency Document (IRAAD) identifying the risks to the project due to its severe dependencies on internal blocks and external vendors or entities. Also provided mitigation plans for the risks and issues identified.
- Assisted in interviewing SME, asking detailed questions and carefully recording the requirements in a format that can be reviewed and understood by both business and technical people.
- Participated in JAD sessions to develop architectural solution that met application with the business requirements, resolved open issues, and changed requirements. Participated in walkthroughs and review meetings with Business Analysts & Development team.
- Involved in developing techniques for requirement gathering including interviews, brainstorms and meetings with stakeholders.
- Developed flow diagrams for Business process of the company using Microsoft Visio.
- Followed up with the end users and developers for user satisfaction and change management.
- Developed Use Case Modeling using Rational Unified Process (RUP) for preparing Functional Requirements documents.
- Functioned as the primary liaison between the business, operations, and technical groups throughout the project cycle.
- Developed business process models in RUP to document existing and future business processes.
Environment: Rational Rose, RUP, UML, Rational ClearCase, SQL Server, HTML, MS Visio, MS Office, Oracle, Windows NT
Confidential, Portsmouth, NH
- Developed and pruned the artifact repository and templates.
- Conducted JAD sessions with extensive involvement from Business, Development, Testing teams, Architects, SME’s (Subject Matter Experts) and Managers of various Business Units.
- Instrumental in writing the Business and System Vision documents, Business and System Use Cases, Supplementary Specifications and extracting Stakeholder requirements.
- Responsible for rating multi-line policies. Manual rated Property, Liability, Auto and Workers Compensation policies. Conducted training classes for Auto and Workers compensation rating.
- Supported full traceability among all artifacts throughout the software development life cycle.
- Practice agile methodology, lead sprints and prioritize line items based on key business initiatives.
- Realized Use Cases and their corresponding activity flows with complete entity relationship, recording all flows in Rational Rose and using Clear Case for Version Control. Generated reports for the realized Use Cases in Rational Rose, using Rational SoDA for Word.
- Extracted the Business Requirements during various sessions with business leads and tagged all requirements in RequisitePro, tracing them all the way to the stakeholder requirements.
- Designed conceptual and specification methodology using Object oriented analysis and design (OOAD) methodologies based on UML (Unified Modeling Language).
- Extensively involved in integrating existing models for various LOB’s (Lines of Business) and highlighting issues due to abstraction of Use Cases from Process Flows.
- Extensively involved in performing Gap Analysis in the upgrade of the existing Claims Processing system and highlighting related issues.
- Co-ordination with multiple teams and integration architects, in performing analysis for issues regarding speed and stability.
- Interfaced with Artifacts and Solutions delivery teams to provide input for planning a Web-based Architecture.
- Extensively involved in performing the SIT (System Integration Testing) and UAT (User Acceptance Testing) testing of new system.
Environment: Rational Analyst Suite (Requisite Pro, Rose, Clear Case, Clear Quest), Agile, PVCS, MS Word, MS-Outlook, Excel.