SUMMARY:

• Overall 9 + years of experience as Business Analyst in Health Care domain and analysis, design, development and testing of IBM Mainframe applications with complete understanding of Project Methodologies.
• Healthcare Payor Domain expertise: especially in areas such as Claims, Membership/enrollment, Provider/Network Management, Plan/Product, Customer Service.
• Strong knowledge in Medicare, Medicaid, Facets, Claims, Medical Management and Policy Administration.
• Demonstrated strong knowledge of ICD - 9/ICD-10 and HIPAA 4010/5010 transitions in healthcare claims systems.
• Hands on Experience in ICD-10, HIPAA 5010, and EHR implementations and/or optimization projects.
• I am a PAHM (Professional - Academy of Healthcare Management, USA) Certified Professional.
• Experience in analysis, interpretation and reporting using medical or administrative data sets.
• Clear understanding on EDI (flat file renderings - FFRs, HIPAA, X12 transaction knowledge and expertise) Application Developer/Business System Analyst.
• Conducted many Joint Application Developments (JAD) sessions, scrum meetings, walkthroughs, Interviews, Workshops and Rapid Application Development (RAD) sessions with end-user/clients/stake holders and the IT groups.
• Demonstrated knowledge in constructing, interpreting and modifying visual representations such as swim lane based process flows, ERDs, and data dictionaries.
• Strong business acumen, strategic thinking, communication, interpersonal and presentation skills adept at creating, editing, and coordinating extensive communication networks (facilitation of JAD sessions and interviews, written correspondence, reports, implementation requirements, project status reports, oral presentations, e-mails, etc.) to keep executive staff and team members abreast of goals, project status, and resolving issues and conflicts.
• Act as a liaison between business and systems during analysis, Development and testing phases.
• Effective communication skills and received accolades for coordination between globally located teams.
• Worked closely with Business, SMEs and Solution Architects to assess requirements and specification of new applications and re-engineering of existing applications
• Modeling the system using Use Case Models, Analysis Models, Design Models, Implementation Models, authored Use Cases, Use Case Diagrams, Behavior Diagrams (sequence diagrams, collaboration diagrams, activity diagrams) based on UML methodology using MS Visio.
• Conducting User Acceptance Testing (UAT) and familiar with testing tools to design and develop test plans and test scripts.
• Creative and innovative thinker, with excellent communication skills bringing energy, enthusiasm and leadership to problem resolution.

FUNCTIONAL AND TECHNICAL SKILLS:

• Business Analysts in Health Care - Enrolment, Claims and Providers.
• Experience in setting up new Medicaid plans.
• Experience in FACETS software
• S/W Development Life Cycle methodologies.
• Languages - COBOL,XGEN,JCL,VSAM
• Databases - DMSII, DB2, MS Access
• Testing/Tracking Tools - Test Director, Rational Clear Quest
• Development Tools - Easytrieve, Endevour, ISPF, Ergo, Inquiry, Rexx, File aid
• MS Visio, MS Project, Word, Excel, PowerPoint.
• Operating systems - MCP,MVS, Windows XP/NT/7

PROFESSIONAL EXPERIENCE:

Confidential, USA

Sr. Business Analyst

Responsibilities:

• Gathered requirements and prepared business requirement documents (BRD).
• Responsible for translating BRD into functional specifications and test plans. Closely coordinated with both business users and developers for arriving at a mutually acceptable solution.
• Conducted JAD sessions to define the project and to reduce the time frame required to complete deliverables.
• Prepared and presented the process of the ongoing project in a form of Dashboard to the senior management.
• Healthcare Business System Analyst and Developer in projects that constitute PBM, O2C, drug formularies and State & Federal Law implementations.
• Developed and maintained all operational and technical flows using Visio and Power point
• Used MS Office Suite for creating use cases, workflows and sequence diagrams thus defining the Data Process Models
• Defined Use cases from requirements and helped convert them into software specifications
• Maintained Requirement Traceability Matrix (RTM).
• Co-ordinate with the project managers in the preparation of the project plans with any impact due to a change request.
• Identified all the applications and interviewed the application owners to recommend the process improvements.
• Worked on adjudicating the pharmacy claims and Maintaining the claims control system for exception processing claims
• Performed Regression Testing and created test scenarios for User Acceptance Testing (UAT)
• Maintained documents for change request and implemented procedures for testing changes

Confidential

Sr. Business Analyst

• Implementation on X12 4010 and 5010 standard transactions such as
• 270/271 Eligibility Transaction Processing
• 276/277 Claims Inquiry Transaction Processing
• 837I/837P Claims Submission Processing
• 278 Service Authorization Processing
• 835 Remittance Advice Processing
• NCPDP standard transactions
• Identified Use Cases from the requirements. Created UML Diagrams including Use Cases Diagrams, Activity Diagrams/State Chart Diagrams, Sequence Diagrams, Collaboration Diagrams and Deployment Diagrams, Data Flow Diagrams (DFDs), ER Diagrams and Web Page Mock-Ups using Rational Rose and MS-Visio thus defining the Business Process Model and Data Process Model.
• Conducted JAD sessions for effective discussion between stakeholders and gathered business requirements.
• Communicated and interacted on a regular basis with the project manager and development team during different stages of the product life cycle
• Communicate with design, development and test team using MS exchange Messaging and Defect Tracking System.
• Ensured that all the artifacts are in compliance with corporate SDLC Policies and guidelines,
• Prepared BRD and converted into functional specifications using requirement management tool
• Created UML diagrams such as use case diagrams, and sequence diagrams
• Designed Data Flow Diagrams (DFD’s) and Entity Relationship Diagrams (ERD’s) using modeling tools.
• Prepared Business Process Models that depicted modeling of all the activities of the business from the conceptual to procedural level.
• Used the Unified Change Management (UCM) tool, Rational Clear Quest, to maintain and track the Stakeholders requested enhancements and changes.
• Used prototypes to demonstrate and verify the behavior of the system
• Provide technical and procedural support for User Acceptance Testing (UAT)

Confidential

Sr. Business Analyst/Project Lead

• Gathered requirements and prepared BRD, FRD, UseCases, Non- Functional requirements through JAD and brain storming sessions.
• Planned sessions with Business, SMEs and required stakeholders to confirm business requirements.
• Identify the various files (Daily Transaction File, Customer File, and Non-Financial Activity File) and reports created by the current Variable Annuity System with the help of VAS management team.
• Defined Use cases from requirements and helped convert them into software specifications.
• Aided management in standardizing UI used to create copies of files for users of dependent systems.
• Maintained Requirement Traceability Matrix (RTM).
• Used Rational Unified Process (RUP) as the Software Method. Analyzed and optimized the process, Prepared Business Requirement Document and converted them to functional and technical specification using the rational requisite pro.
• Tracking changes to Files and Reports that result from other projects in the program.
• Provide technical and procedural support for User Acceptance Testing (UAT).
• Maintained documents for change request and implemented procedures for testing changes.
• Involve in discussions with solution and process designers to help them understand the requirements and prepare robust solution and process design.
• Preparing Project Plan and tracking the deliverable
• Assigning the projects and responsibilities to the team members and monitoring the progress
• Present regular project status updates to senior management.
• Track external dependencies and alert customers of issues on missing external dependencies.
• Review of work packages for impacted applications and review of offshore deliverable
• Process Improvement initiatives. Automated tool for data correction

 Confidential

Business Analyst

• Broad range of experience working on different types of project like App development, Business Intelligence Workflow etc.
• Extensive scripting done in HP Quick Test Pro to automate Regression Testing.
• Planned sessions with Business, SMEs and required stakeholders to confirm business requirements,
• Defined Use cases from requirements and helped convert them into software specifications
• Maintained Requirement Traceability Matrix (RTM).
• Provide technical and procedural support for User Acceptance Testing (UAT)
• Maintained documents for change request and implemented procedures for testing changes
• Involve in discussions with solution and process designers to help them understand the requirements and prepare robust solution and process design.

Confidential

Business System Analyst/ Developer COSMOS

• Understand the requirements and perform Gap Analysis.
• Assisted in technology selection for the application, based on Cost-Effectiveness and Quality with an eye towards the future.
• Understand the high level design and Prepare low level design document with pseudo code.
• Developed / performed coding on applications that involve major health care implementations.
• Prepare unit test plan, system integration test cases and perform unit testing and system testing.
• Conducted Onshore-Offshore coordination calls for triage/status meetings.