PROFESSIONAL SUMMARY:

• Possess7+ years of IT and Management experience in Software Development and Project Life Cycle working as Business Analyst mainly in Healthcare sector.
• In depth Knowledge of various SDLC methodologies like Waterfall, RUP and Agile models.
• Experienced in Business analysis, Risk analysis, GAP analysis, Project Management.
• Experienced with Iterative approach for Software Development as per Rational Unified Process (RUP). Involved in inception, elaboration, construction and transition phases.
• Experienced in facilitating Joint Application Development (JAD), Rapid Application Development (RAD), interviews, workshops, and requirement elicitation sessions with end - users, clients, stakeholders and development team.
• Broad knowledge of DCG benefit, DRG system. Good knowledge of ETG/MEG system.
• Broad knowledge of HIPAA Standards (Title I & Title II),Medicare, Medicaid, PPO, HMO, POS, diagnostic codes and claims process.
• In depth experience in HIPAA ANSI X-12 EDI series such as 270/271, 276/277, 278, 834, 835, 837 and version 5010 of this transaction.HL7, ICD9/ICD10 and 4010/5010 versions.
• Extensive experience in interacting with stakeholders, gathering Requirements and creating Business Requirement Documents (BRD), analyzing and Creating Use Cases, Use Case Diagrams, Activity diagrams, Business Flow Diagrams.
• Strong experience in Data Analysis, data warehousing and QA testing.
• Excellent analytical skills in understanding the business process (AS-ISversusTO-BE), understanding the functional requirements and translating them to system requirement specifications.
• Experience creating Traceability matrix to better manage the requirement gathering process and keeping track of the milestones.
• Excellent Knowledge of Industry standards such as Six Sigma, ISO 9000 and CMM levels.
• Expert in writing SQL queries, Stored Procedures & ETL to extract and load data from multiple source on to data mart. Designed complex dataflow tasks to integrate, transform and load the data from different sources.
• Professional with extensive experience in the development, implementation and integration of strategies within a team oriented environment, utilizing quantitative and qualitative analytical skills.
• Self-starter, quick learner with excellent communication skills to perform well both independently and as a team player.

TECHNICAL SKILLS:

Methodologies: RUP, Agile, Waterfall

Project Management: MS Project, Primavera, SharePoint

Requirements Management: Requisite Pro

Change Management Tools: Rational Clear Case

Operating Systems: Windows 95/98/NT/2000/03/XP, MAC OS, LINUX, UNIX

Databases/RDBMS: Oracle 8.x/9.x,10.x, DB2, MS SQL Server, MS Access, Teradata

Business Modeling Tools: MS Visio, MS PowerPoint, Enterprise Architect, Rational Rose

Business Intelligence Tools: COGNOS 8, Report Net

Documentation Tools: MS Word, MS Excel, Rational SoDA

Reporting Tools: Crystal Reports

Automated Test/Bug Tracking Tools: Win Runner 7.6, Quick Test Professional 8.0, Load Runner 7.x, 8.0, Test Director 8.0, Quality Center 9.0, Clear Quest, PVCS, SQA Administrator, SOAP UI.

PROFESSIONAL EXPERIENCE

 BUSINESS ANALYST

RESPONSIBILITIES:

• Functioned as the primary link between business line, operations and the technical areas throughout the project.
• Facilitated JAD sessions, user meetings, interviews and Requirement Elicitation Sessions to extract business requirements and to confirm that those requirements are in alignment with up gradation of existing system to 5010.
• Conducted meetings to gather requirements from Business Managers, Supervisors, stakeholders, Data Governance Team and subject matter experts to gain knowledge about needs of the system.
• Extensive use of MS Project to maintain record of recommendations, communications, activities, schedules and to monitor progress of project in real time.
• Worked on HIPAA ANSI X-12 EDI series such as 270/271, 837Pand version 5010 of this transaction.
• Conducted GAP analysis to identify and document gaps between existing 4010 compliant system and proposed 5010 compliant system.
• Thorough use of UML and MS Visio to develop Use Cases, Activity Diagrams, Sequence Diagrams.
• Identified, researched, investigated, analyzed and documented business processes and use case scenarios.
• Designed strategy for up gradation of system and implementing user interfaces to be 5010 compliant.
• Ensured that project followed Business Rules and was compliant with HIPAA rules to display minimum benefit information.
• Created Traceability matrix to manage the functional requirement to ensure all the requirements were implemented.
• Prepared Business Process Reengineering (BPR) documents by interacting with SMEs.
• Executed SQL queries to test the database for records that detect and submit functional acknowledgement and remittance advice in the claims application.
• Worked with Designers to create data warehouses and/or reporting solutions using Informatica /ETL.
• Dealt with Data mostly during the Staging phase.
• Performed data analysis by mapping source to target data and Joining tables including various clinical and provider data.
• Applied various business rules during the data profiling and continued on Business rule validation.
• Interacted effectively with internal and external parties and worked closely with project manager in handling the whole and project.

Environment: MS Project, SQL, Rational Unified Process (RUP), Rational Requisite Pro, Rational Rose, Clear Quest, Microsoft Visio, Windows Vista/XP, MS Visio, ETL, SQL, DB2, Office Suite (Word, Excel, Power Point).

BUSINESS ANALYST

RESPONSIBILITIES:

• Addressed the changes made to the Medicare program and created requirements mapping to that of the system requirements.
• Gathered and documented business requirements from SMEs, user groups and vendors via workshops, interviews and surveys.
• Worked in close collaboration with the Project Manager and business users to gather, analyze and document the functional requirements for the project. 
• Worked in Healthcare Claims Administration - Healthcare Claims Processing (837/835) includes facility claims and professional claims. Worked with FACETS Team for HIPAA Claims Validation and Verification Process (Pre-Adjudication).
• Facilitated and managed meeting sessions with committee of SME's from various business areas including Benefits Administration, Health Claims Group, HIPAA Administration, Health Policy and Program Evaluation Team and Data Management Group.
• Created Functional specifications for the 834 enrolment files with their changed benefits in the Medicare program.
• Gathered and documented requirements for Pharmacy benefit managers (PBMs) for health insurance carriers.
• Submitted change requests and worked with change request records in Clear quest.
• Participated in entering, tracking system defects in Rational Clear quest.
• Involved in Configuration Management, Requirement management and analysis.
• Provide technical and procedural support for User Acceptance Testing(UAT).

Environment: Trizetto Facets 4.1, 4.7, Rational Requisite Pro, ClearCase, MS Visio, MS Project, SQL, Windows 2000, MS Office.

BUSINESS ANALYST

RESPONSIBILITIES:

• Created business process workflow diagrams (Activity diagrams) in Rational Rose.
• Worked with the business users to define business requirements and analyze the possible technical solutions.
• Performed extensive data analysis and data integrity testing for loading and validation of the data set output.
• Gathered user and business requirements through discussions, brainstorming, interacting with corporate to understand the business requirement.
• Reviewed the user perspective use cases to determine the functionality that had been incorporated on the web application.
• Functioned effortlessly and efficiently, as a liaison between four work streams and its task leads, SMEs, QA team, and management group. Actively participated in Joint Meetings with the various teams involved in the development process.
• Reviewed the test cases that detailed the functionality to be tested in various UIs.
• Performed the User Acceptance Testing(UAT) of the functionality and involved in defect management process using Track Record (TR).
• Interacted with the SME’s and stakeholders to get a better understanding of client business processes and gather business requirements.
• Facilitated JAD and JAR sessions with management, development team, users and other stakeholders to refine functional requirements.
• Redefined existing Business Processes and preparing To-Be Processes using MS Visio.
• Developed Traceability Matrix for maintaining/updating current and new system requirements using MS Excel.
• Created and managed Use Case project templates.
• Creating test plans utilizing the customer request documents for identifying specific business requirements to be created and maintained numerous automated functional regression tests from the ground up and delivered on time working within an Agile (SCRUM) process.
• Implementing Software Quality Assurance (SQA) development policies, procedures, SDLC and testing methodologies.

Environment: JAD, MS Visio, Windows 2000/2003,RUP, Rational RequisitePro, Rational Rose, Oracle, SQL, PL/SQL, MS Office, Load Runner, UAT

BUSINESS ANALYST

Responsibilities:

• Gathering requirements from Current Account Group, Saving Group, Mortgage Group, Tax Group, identifying functional requirements and documenting them into a Business Requirement Document (BRD).
• Created Narrative Use Cases, Use Case diagrams, Work flow diagrams, flow diagrams using MS Visio.
• Worked with Business Owners, IT Group, QA Team to scope and prioritize development releases.
• Prioritized project efforts, developed Project plans, Process flows, Use Cases and System requirement specification and analyzed the Business requirements and the site specifications.
• Documented Detailed Business Requirements for Automated Management, Automated Financial Reporting and Automated Process Notifications to relevant departments.
• Analyzed System and Functional Specification documents for the Web System.
• Worked on writing functional specification for reporting module that handled credit and consumer risk management services. Object Oriented Analysis and Design (OOAD).
• Extensive interactions with the client and the management teams to understand the requirements and report the status of the testing efforts on their applications.

Environment:Oracle9i, UNIX, SQL, Clarify, MS Office, UML, Visio,, QTP, UAT, Sub Queries