Summary

• 6+ years of extensive experience as a business analyst and QA, with strong experience in Healthcare especially in insurance claim with a solid understanding of Business Process Flows, Case Tools, and Business Analysis.
• Experience working with HIPAA ANSI X12 4010A 270/271, 276/277, 834, 835, 837 for institutional, professional and commercial claims, and up-gradation of ANSI 4010 to ANSI 5010.
• Excellent understanding of ICD 9, HCPCS, and CPT.
• Commanding knowledge of various development methodologies like Waterfall, SDLC, Rational Unified Process, Agile and Scrum.
• Experience in working with QA testing teams, while interacting with business users and gathering user's requirements to develop necessary Test plans, Test Cases and Test script.
• Extensive experience in gathering Business and Functional Requirements, developing Use Cases, conducting Gap Analysis and preparing Training manuals.
• Experience in developing UML use case diagrams, Work Flow Diagrams using tools like Rational Rose and MS Visio.
• Excellent Business writing skills in creating Business requirement Document (BRD), Use Case Specifications, Functional Specifications, and System Requirements Specifications (SRS).
• Expertise in Rational Unified Process (RUP) methodology, Use Cases, Software Development Life cycle (SDLC) Processes and rational tools used during all four phases of RUP: Inception, Elaboration, Construction and Transition.
• Proficient in Developing and executing Test Plans, performing functional, usability testing and ensuring that the software meets the system Requirement.
• Excellent team player work in conjunction with testing, development and other teams in validation and testing complex scenarios and projects and in the maintenance of Quality Standards in Projects.
• Knowledgeable about preparing RTM documents.
• Proficient in soliciting client Requirements through interviews, workshops, existing system documentation and organizing JAD sessions.
• Knowledge in documentation project related information like test execution procedures, backup plans, new tester training documents, maintaining test logs, release notes etc.
• Writing and Reading data objects i.e. stored procedures, tables, and views, etc. in SQL server.
• Strong Communication and writing skill.

Skill Sets:

Modeling Tools: MS Visio, Rational rose, Enterprise Architect, OminiGraffle.
Methodology: RUP, Agile, Waterfall.
Testing: Quality Center, Test Director, win runner.
Programming Languages: C++, SQL, XML, HTML, and VB.
Platforms: Windows, NT/95/98/2000/XP/Vista/Window 7.
Industry standard: HIPAA, ISO, HL7.
Applications: MS word, Excel, MSAccess, Power point, MS Outlook, Adobe Photoshop.
Other Software: SAS, SPSS.

Experience:

Client: Confidential, Mason, OH April '11 - Present
Business Analyst
This Project is about to implement the Automated Adjudication System, which deals with different phases of claim process such as Intake Phase, Adjudication Phase and Reporting Phase. Implementation of ACAS (Automated Claim Adjudication System) must have to comply with HIPAA Rules and Regulation of privacy and security. Implementation of ACAS to generate automated Claim Submission, Processing and creating a report.

Roles & Responsibilities

• Participated in Business Modeling by understanding the needs of the business, and also documenting Business Use Cases as well as System Use Cases.
• Gathered Requirements and documented the proposed additional extension to the existing HIPAA application.
• Facilitated Joint Application Development (JAD) sessions with the Management, Mainframe and HIPAA team to make sure everyone are in sync with the business requirement processes.
• Worked on HIPAA Transactions 270, 271, 276, 277,834, 835 and 997.
• Involved in HIPAA 5010 gap analysis of ANSI X12 4010
• Used MS Visio to create Use Cases and Sequence Diagrams.
• Accomplished experience through whole SDLC from requirement analysis till deployment, using highly efficient RUP process of Software development.
• Assisted development team to translate requirements into technical specifications.
• Liaised and Coordinated in resolving EDI mapping issues arising from data transfer process from EWM to ACAS and third party systems.
• Analyzed mandatory and the situational fields and compared with the users manuals for EDI.
• Worked closely with the host (Main frames support person) and helped him understanding the process and in the creation of the match, input and the delete files.
• Created and Maintained the Requirement Traceability Matrix (RTM).
• Initiated Test Plans, developed and executed test cases and scenarios, worked with users to develop specific acceptance criteria and prepare test exhibits.
• Conducted User Acceptance Testing (UAT) sessions with business users and prepared document for enhancements and bug fixes.
• Used Test Director and Mercury Quality Center to report any bugs found and communicate to the developers and product support team.
• Analyzed and evaluated User Interface Designs, Technical Design Documents and Quality Assurance Test condition the performance of the application from various dimensions.
• Helped create the 'Business Glossary' to facilitate efficient understanding of the Business process amongst the other teams

Environment: MS Visio, MS Project, Windows XP, HIPAA, Microsoft Office Suite, Quality center, Rational Unified Process (RUP), Clear Case, UML.

Confidential, Owings Mills, Maryland June '09 - January'11
Business Analyst
Confidential, is an American Healthcare company provides consumers directed healthcare products, including medical, pharmacy, dental, behavioral health, group life, long-term care and disability plans, and medical management capabilities. The project was to design an automated underwriting business function, consumer portal-interface for online enrollment, e-health, e-Vendors-Broker sites that route business to CareFirst through their websites, Billing and enrollment for Approval/Declines of applications.

Roles & Responsibilities:

• Interacted with clients to gather all requirements to formulate business specifications and translate those into application functionally, decide when to advocate and when to compromise to arrive at a mutually acceptable solution.
• Documented workflows and results of business analysis and obtain sign-off from client on specifications.
• Worked at different stages of Software Development Life Cycle (SDLC) with business users, developers, and stakeholders.
• Performed GAP Analysis by identifying existing technologies, documenting the enhancements to meet the end - state requirements.
• Experienced RUP's development cycle with four consecutive Phases - Inception, Elaboration, Construction and Transition.
• Assisted the technical team in translating application functionality into application architecture and the production of a system functionality document.
• Responsible for the design and execution of test plans to ensure that business requirements and functional specifications are tested and fulfilled.
• Created Requirements Traceability Matrix (RTM) from functional specifications.
• Complete understanding of the long term business objectives and suggest technical strategies to meet those objectives.
• Participated actively in assembling the JAD team and in conducting the weekly sessions from requirements gathering phase to the sign-off of the application.
• Correlated Requirement to test script in Test Director.
• Corrected and Updated the Requirement Traceability Matrix after completion of the UAT testing phase.
• Created a complete test bed for Users Acceptance Testing (UAT) in Test Director 8.0.
• Design specifications and Test Cases usages for the HIPAA 837i, 270/271, 276/277, 835, 824, 275 and others.
• Used HIPAA regulations to prevent the changes made to the insured rates.
• Verified the functionalities of the application manually.
• Documented Test Plans that contains test scripts, test cases, test data and expected results for the Users Acceptance testing.

Environment: Requisite Pro, RUP, UML, Rational Rose, JAD, MS-Office 2003, MS-Project, MS Visio.

Confidential, New York, NY October '08 - May '09
Business Analyst
Confidential, is an innovative leader in the health and well-being industry serving approximately 65 million Americans. The project dealt with enhancements to the Healthcare Payment EDI transaction set to generate a payer level containing payer specific information. Implementation of the Automated Clearing House Origination software to generate NACHA compliant files that adhere to all NACHA standard entry class codes at a multi payer level to further penetrate the provider market with electronic payments and statements.

Roles & Responsibilities:

• Gathered Business Requirements, interacted with the Users, Designers, Developers, Project Manager, and SMEs to get a better understanding of the business processes, and analyzed and optimized the process.
• Actively involved in the entire Software Development Life Cycle (SDLC) Process.
• Created reports containing all the information regarding the publishers, distributors and retailers using crystal reports.
• Facilitated demonstration of a major ACH software systems and performed evaluations with a group of experts to select a package that best suits the need of the business.
• Extensively worked with HIPAA transactions such as 835-claim payment/advice.
• Developed Traceability Matrix for maintaining/updating current and new system requirement using MS Excel.
• Researched/Analyzed the various steps in claim processing lifecycle and then wrote the Business Requirement Document and Functional Requirement Document in such a way that developers could construct the system to identify and monitor the riskier claims.
• Worked with electronic claim clearing house like Web MD and automated clearing house (ACH) for electronic payment, remittance data processing and services.
• Created the User Requirement Specifications and helped convert them to Functional Requirements, and assisted the developers with System Requirement Specifications.
• Responsible for ensuring data integrity and coordinating effort with testing and implementation responsible for the development and execution of test plans.

Environment: MS Office tools, MS Project, MS Visio, UML, RUP, Windows, National Requisite Pro, and SQL Server.

Confidential, Hyderabad, India May'06 - June '08
Business Analyst
Confidential, Record is designed to create a paperless office with features designed for physicians and consultants build on HIPAA compliance. Quick and easy access to patient records through secure web access makes it possible to provide better care for patients. This web-based application has Medicare and Medicaid claims features. Records are electronically stored in database.

Roles & Responsibilities:

• Analyzed, documented and managed all project requirements and changes to requirements throughout the software development life cycle through Rational Doors.
• Analyzed customer needs and existing functions in the area of HIPAA transactions to determine feasibility and requirements.
• Documented Functional/Technical data flow of 4010 HIPAA transaction to determine feasibility and requirements.
• Prepared and created Test Cases/Test Data according to Business Requirements.
• Created Statement of Work (SOW) document for various capabilities in the Initial Requirements Gathering Phase.
• Strong Documentation experience that required converting business needs to technical documents.
• Documented and reviewed high level and detailed requirements in Business Requirement Document (BRD).
• Created Use Cases and Use Case description/narratives based on the Requirements list.
• Experienced in using Microsoft Share Point to centrally store, manage and access business artifacts across all platforms.
• Created activity diagrams in UML using Rational Rose and also involved in creating the Business Process Models.
• Coordinated activities involved in QA and User Acceptance Testing.
• Actively involved in reporting project updates, managing project resources, conflict resolution and maintaining project deadline.
• Communicated with business/technology leadership for overall project/program office milestone.
• Monitor the production environment and proactively prioritize, communicate, and resolve EDI process or system issues.

Environment: Rational Rose, Agile, Rational Requisite Pro, Rational Clear Case, MS Project, Crystal Report, PL/SQL.

Education:

B.COM