SUMMARY:

• Over 8+ years of expertise and experience in Business Analysis in Health care domain.
• Solid understanding of Business Requirement gathering, Business Process flow, Business Process Modeling and Analysis, design documentation.
• Experienced in all phases of the Software Development Life Cycle (SDLC), Rational unified process (RUP), agile methodology.
• Experienced in conducting Joint Application Development sessions, workshops etc.
• Expertise in Analysis and Review of Software and Business Requirement Documents.
• Experienced in performing Business Process Reengineering/Gap Analysis to check the compatibility of the existing system infrastructure with the new business requirements.
• Managed business initiatives to balance requirements for functionality, efficiency and quality.
• Experienced on Medicaid, TANF, Childcare, HIX, Obama care.
• Excellent knowledge of Health Insurance Portability and Accountability Act (HIPAA) transaction, code set rules such as EDI 837, 270, 271, 276, 277, 834, 835, NCPDP and ICD9 - ICD10.
• Good experience in EC Gateway Architecture i.e. installing EC Gateway, configuring EC Gateway Modules and implementing EC Gateway Communications.
• Excellent knowledge of Health Insurance Portability and Accountability Act (HIPAA) transaction and code set rules such as EDI 837, 270, 271, 276, 277, 834, 835.
• Experienced with tools like ReqPro, Clear-quest, ClearCase, Rational soda, RationalRose.
• Experienced working in Medicare and Medicaid projects.
• Expertise with ISO, Six Sigma, CMM standards.
• Exceptional Documentation Skills for writing Use Cases and Functional Requirement Documents.
• Expertise in creating Use Case diagrams, Activity diagrams, Data Flow Diagrams (DFD), Sequence diagrams, State diagrams based on UML Methodology and business process flow diagrams using MS Visio/Enterprise Architect/Rational Rose.
• Conducted JAD Sessions to develop an architectural solution that the application meets the business requirements, resolve open issues, and change requests.
• Good Knowledge of Test Plan, Test Scripts and Test Cases for Functional, System, Integration, UAT, and Regression Testing based on the Design Document and User Requirement Document for the Functional, Security, and Performance Testing.
• Excellent written and verbal communication.
• Extensive expertise in databases like Oracle, SQL.
• Strengths include quick learner, problem-solving capability, and ability to work as team player and lead the teams and consistently demonstrated ability to achieve tight deadlines.

TECHNICAL SKILLS:

Operating Systems: Win 98/XP/Vista/Windows 7, UNIX, LINUX, Mac.

Languages: C, C++, Java, SQL, HTML, XML, C#, VB, ASP, .Net

Databases: Oracle, MS SQL server, MS Access, IBM DB2, EC Gateway

MS Office: Word, Excel, Access, Power point, Project, Visio, Front Office, Rational Rose, SoDA, Software Modeler, Team Test, Doors, PROLOG, Clearcase, Clearquest, WinRunner, LoadRunner, WebSphere, Business Modeler, HP Quality Centre, Ultra Edit, TOAD and Test Director, MMIS.

Industry Standards: HIPAA, SOX, ISO, Six Sigma, CMM.

WORK EXPERIENCE:

Sr. Business System Analyst

Confidential, Minneapolis, MN

Responsibilities:

• Assured that business objectives and priorities are aligned by collecting business requirements precisely
• Managed and analyzed the project, coordinated between team members and created test plans as per the collected requirements
• Facilitated and actively participated in the interactive sessions with various groups about patient care, including business owners, SMEs and marketing team, for effectively gathering requirements
• Developed Process Model and detailed Business Policies ensuring HIPAA guidelines
• Effectively understand the clinical trial operations and business problems of the pharmaceutical, biotechnology, device and Clinical Research organizations and effectively gather requirements.
• Followed the Agile, methodology for the entire SDLC, documented product requirements in the developmental stage to functional specifications
• Responsible for creating UI mockups using Visio and azure.
• Performed Data Analysis and Data validation by writing complex SQL queries using TOAD against the ORACLE database.
• Created Use case scenarios according to business needs and other UML diagrams to design Use Case Diagrams, Data Flow Diagrams, Activity Diagrams, Sequence Diagram and ER diagrams
• Assure the Traceability of application functional, performance, and security requirements to the business process steps
• Used HP Quality Center to look up defects and issues raised by testing activities.
• Interacted with developers and various members of my team to discuss and resolve defects and their priorities.
• Involved in service-oriented architectures (SOA) suitable for secure, reliable, and high-performance deployment
• Produced and managed documentation on release activities to support problem resolution
• Reviewed and evaluated all the modules of the software before delivery to users to confirm meeting the standard criteria
• Performed basic UAT with the different customers and different business modules.

Business Analyst

Confidential, Franklin, TN

Responsibilities:

• Created EC Gateway process scripts that automatically run maps created in the EC Map product for processing EDI as well as proprietary data formats.
• Performed SWOT and Gap analysis for the new functionality requirements
• Worked with HIPPA rules and regulations to draft business rules and claim processes.
• Interacted with the client and the Technical Team for requirement gathering and translation of Business Requirements to Technical specifications.
• Conducted JAD sessions.
• Involved in processing Medicare stand-alone plan part D and Part C managed care plans.
• Proficient in healthcare EDI systems and electronic claim transaction technology.
• Used HIPAA 4010 transactions to support the analysis of current business processes and work with management to improve and implement enterprise solutions to ensure compliance and got involved in designing future state processes for HIPAA 5010 transaction processing EDI's 837, 835.
• Analyzed HIPAA 5010 related to 837, 835, 834. Transactions and performed gap analysis between the 4010 and 5010.
• Hosted the application online using Microsoft share point excluding some functionality those were developed to use by employees only.
• Identified and documented the dependencies between the business processes.
• Documented the Use Cases and prepared the Use Case, Activity, Sequence diagrams and Logical views using MS Visio, MS Office and Rational Rose for a clear understanding of the requirements by the development team.
• Data modeling using UML.
• Working with Medicare operational management to monitor, trend, and report on operational metrics such as timeliness, workload, and staff trending, customer satisfaction, and other key measures to facilitate performance excellence.
• Create and maintain Use Cases, visual models including activity diagrams, logical Business process models, and sequence diagrams using UML.
• Well versed with HIPAA, claimadjustments, claim processing from point of entry to finalizing, claim review, identifying claims processing problems, their source and providing alternative solutions using best practice model and principles.
• Involved in preparing project plans and identifying major milestones for each stage as per the SDLC model (RUP Methodology)
• Implemented the HIPAA privacy and security regulations to enhance the capabilities of the systems to process new products.
• Responsible for teaching sessions for end user to tell how to use tools.
• Used MS Project for various planning and budgeting activities.
• Used Quality Center to upload, execute and run script to compare and verify two outputs.

Business Analyst

Confidential, Tampa, FL

Responsibilities:

• Gathered Business Requirements. Interacted with the Users, Designers and Developers, Project Manager to get a better understanding of the Business Processes.
• Responsible for the full HIPAA compliance lifecycle from gap analysis, mapping, implementation and testing for Well Care processing of Medicaid Claims.
• Responsible for gap analysis in changing old MMIS and Involved in testing new MMIS.
• Developed gap analysis document, logical and physical design and remediation plan for State.
• Responsible for mapping documents, creation of test plan, test scenarios, test cases for unit, system and system integration testing.
• Worked with business owners, content staff, IT and other stakeholders in creating a content management solution for managing the information in the supplier portal using Web Sphere Application Server.
• Built and customized SoDA for Word templates and extract information from information sources such as RequisitePro and Rose, and created a highly automated system for handling approvals, exceptions and priorities.
• Used the Rational Unified Process (RUP) to build the different phases of Software development life cycle
• Created Project management plans for managing on time delivery using MS Project along with writing test cases, unit and systems integration test plans in Win Runner and used Load Runner to check if application works fine with load.

Business Analyst

Confidential, New York

Responsibilities:

• Served my Team in an Agile/Scrum software development environment, empowering the Team to self-organize using agile principles
• Analyzed and documented the system specifications, Business requirements and detail design of the software for full understanding of the business and used Requisite Pro for the requirement tracking and analyzing.
• Worked with various IT functional areas as well as regularly interacted with hospital personnel such as Clinical Informatics, hospital IT management, clinicians, physicians and senior management
• Performed requirements analysis and design using Rational Rose and Requisite Pro.
• Conducted JADsessions for communicating with all the project directors and stakeholders. Created process workflows, functional specifications and project initiation artifacts.
• Analyzed, documented and managed all project requirements and change to requirements throughout the software development lifecycle using Requisite Pro.
• Created Use-Cases, Sequence and Collaboration Diagrams to demonstrate software architecture and interaction of system components before prototyping. Used Rational Rose, Requisite-Pro for requirement traceability.
• Responsible for data management, data modeling.
• Responsible for data mapping from xml to facets
• Involved in GAP analysis around the identification of business rules, business and system process flows, user administration, requirements and assumptions.
• Developed test cases and scripts based on business requirements for the GUI, functional, User Acceptance & System Back-end testing.
• Worked closely with QA and Developers to clarify/understand functionality, resolve issues and provided feedback to nail down the bugs.
• Trained and acted as point of contact for new employees.
• Involved in White Box Testing of the Java Code with developer in Unit Testing phase.
• Reviewed and evaluated all the modules of the software before delivery to user's to confirm its meeting the standard criteria.
• Interacted with developers & various members of my team to discuss and resolve defects and their priorities.