SUMMARY

• 7+ years of experience as a Business Analyst in IT industry with solid understanding of Business Requirements Gathering, Translating Requirements into Specifications & Application Design. 
• Proficient in Conducting AS - IS, To-Be analysis and suggest Business Process Flow, Business Process Modeling Notations (BPMN), Business Analysis and testing various methodologies.
• Developed Request for Proposal RFP(S), Statement of Work (SOW) to find solution and partners.
• Prepared solution options, risk identification, and financial analyses such as cost/benefit, ROI, buy/build, etc.
• In depth knowledge Agile/Scrum, Waterfall methodology, Use Cases, Software Development Life Cycle (SDLC) processes.
• Conducted Daily Scrum meeting, Planning Sessions, Backlog updates, User Stories updates, Continuous Integration, Continuous Testing
• Documentation in the form of Artifacts and Specs. Creation of industry standard documents such as BRDs, FSDs, User Stories and Use Case specs.
• Experienced in Scrum Practices like User Stories, Story Slicing, Backlog Grooming, Release Planning, Sprint Planning, Sprint Review and Sprint Retrospective.
• Experience in developing Business Requirement Document (BRD) and Functional Requirement Documents (FRD).
• Experience in facilitating Joint Requirement Planning (JRP) sessions with Business User Groups, conducting Joint Application Development (JAD) sessions with IT Groups and Conflict Management with Project team members. 
• Competent in Creating Unified Modeling Language (UML) diagrams such as Use Case Diagrams, Activity Diagrams, Class Diagrams and Sequence Diagrams. 
• Facilitated Change Management (CM) across entire process from Project conceptualization to Testing through Project Delivery, Software Development and Implementation Management in diverse Business and Technical Environments. 
• Possess good knowledge Medicare, Medicaid and regulatory standards such as HIPAA, X12, HL7 .
• Strong Technical writing skills for Validation Deliverables such as Quality Assurance Plan (QAP), Validation Strategy Document, Requirement Specifications, Design Specifications, Standard Operating Procedures (SOP), Traceability Matrix (RTM), Qualification Protocols (IQ, OQ, PQ) and Validation Summary Report.
• Extensive knowledge of Medicaid, Medicare, Procedural and Diagnostic codes and Claims Process.
• Strong knowledge of Health Insurance Portability & Accountability Act (HIPAA) standards, Electronic Data Interchange (EDI),transaction syntax like ANSI X12, Implementation and knowledge of HIPAA code sets, ICD-9, ICD-10 coding, HL7, HMO, PPO .
• Excellent knowledge of FACETS .
• Presented several documents and Use Cases for multiple transactions and worked with ANSI X12 5010 including the standards for medical transactions like 837I, 837P, 835, 276, 277, 270, 271 (both inbound and outbound) transactions for ongoing industry projects.
• Well versed with Medicaid Management Information Systems (MMIS), National Provider Identification (NPI) and familiar with Patient Protection and Affordable Care Act (PPACA), Health benefits Exchange.
• Strong knowledge of SQL, data analysis and data validation using SQL, QlikView, Tableau, or SAS.
• Extensive experience in creating and maintaining source to target Data mapping documents.
• Excellent understanding and expertise in writing complex SQL queries to perform back-end testing. 
• Strong expertise in Data analysis, Data mapping, Data modeling and development of Databases for business applications in client/server applications.
• Proficient on designing and implementing basic SQL queries for QA testing and report / data validation using Oracle, SQL Server and DB2.
• Involved in Test Planning, Test Preparation, Test Execution, Issue Resolution and Report Generation to assure that all aspects of a Project are in Compliance with the Business Requirements.
• Strong experience in conducting User Acceptance Testing (UAT) and documentation of Test Cases. Expertise in designing and developing Test Plans and Test Scripts.
• Providing Training/Knowledge Transfer to the end users.

TECHNICAL SKILLS

OPERATING SYSTEM: Windows Server, Windows, UNIX, Linux, MAC, MS-DOS

TESTING TOOLS: HPQC, Load Runner, Quick Test pro

FRONT - END TOOLS: Adobe Photoshop, MS Excel, MS Office, MS Project

LANGUAGES: C, C+ +, HTML, XML, UML,

REQUIREMENT MANAGEMENT: Rational Requisite Pro, Caliber RM

MODELING TOOLS: MS Visio, Rational Rose, Caliber RDM

PROJECTMANAGEMENT TOOLS: MS Project, Share Point 2010, JIRA, Confluence, Primavera

BUG TRACKING TOOLS: Rational Clear Quest, Rational Clear Case

METHODOLOGIES (SDLC): Scrum, Agile, Rational Unified Process (RUP), Waterfall Model

DATABASE: Oracle, MS SQL Server, MS Access

PROFESSIONAL EXPERIENCE

Sr. Business Analyst

Responsibilities:

• Conducted Joint Requirements planning sessions (JRP) as a facilitator to gather requirements from the Business User and conducted many Joint Application Development (JAD) and Joint Application Management (JAM) and conducted many Rapid application development (RAD) sessions.
• Documented business functionality requirements in User Stories.
• Collaborate with the Product Owner on project/roadmap planning, facilitated daily stand-up meetings, reviews, retrospectives, sprint and release planning, demos and other Scrum-related meetings.
• Coordinated cross-functional process development and identified opportunities and improve process.
• Developed As-Is and To-Be Business Process Models for complex processes by analyzing the current processes, and gathering information from SME's.
• Continuously monitored the business process using the (BPMN) tools like Appian.
• Arranged sprint grooming, planning, daily scrum, sprint demo, and sprint retrospectives.
• Managed the product backlog with user stories through progressive refinement applying business prioritization, solution approach, and technical delivery considerations.
• Conducted walk through sessions to discuss certain issues with stakeholders, architectures and design & development teams and also performed GAP Analysis.
• Involved in all phases of software development life cycle (SDLC) in agile framework.
• Used MS-Visio for Flow-Charting, Use- Case process model and Architectural design of the application.
• Managed requirements and use cases with the help of Enterprise Architect.
• Used SQL, Toad, Data Warehousing and Data Cleansing for the arrangement of customer data. 
• Queried database using Web focus and acted as a Liaison between end users and the data team (Business Intelligence Competency team).
• Familiar with Data Warehousing, relational database concepts, and client-server concepts.
• Performed analysis and data manipulation of source data from SQL Server and other data structures to support the business organization; these departments include planning, evaluation, programs, and administration. 
• Implemented the HIPAA privacy and security regulations to enhance the capabilities of the systems to process new products.
• Participated in the review, creation and updating of HIPAA compliant security policies, procedures and controls
• Design, analyze and performed Integration and wrote System requirements on different leading health care software’s such as FACETS.
• Involved in Claims adjustment process in the Payer System
• Handled Sensitive Personal Identity Information (PII)
• Documented all the aspects of Systems validation lifecycle in accordance with the FDA regulations, including Validation Plan and Protocol, Installation Qualification (IQ) Specifications, Operation Qualification (OQ) Specifications, Performance Qualification (PQ) Specification.
• Managed product backlog within JIRA.
• Tracked UAT issues/bugs and prepared reports.
• Regularly interacted with the Testing team for executing the Test Plans, providing Test Data, creating Test Cases, and resolving issues upon detection of bugs and collecting the Test Metrics.
• Assisted QA team with User Acceptance Testing, develop and maintain quality procedures ensuring that appropriate documentation is in place.

Environment: MS Office, SQL, MS Project, MS Visio, Unix, XML, Windows, HP Load runner, HP Quality Center.  

Sr. Business Analyst

Responsibilities:

• Developed, implemented, and conducted the statistical analyses of Client Engagement Surveys.
• Oversaw the completion of multiple client survey projects at one time.
• Managed the Data Warehouse, which included managing up to six external contractors, training and developing, coordinating activities, and developing efficient protocols for incoming client paper surveys
• Consulted with clients pertaining to best practices in survey development, analysis, and action planning Served as the main liaison between Business users and Development staff to ensure that all requirements are completed as per the schedule; communicating business requirement changes to the business users.
• Created project plan, track project deliverables and created flow charts using MS Visio.
• Provided effective project management by presenting project status to the project core team and third party vendor on weekly basis using MS PowerPoint in conjunction with the project manager.
• Developed and maintained project issues and risk log, and reported the same to senior management on weekly basis.
• Worked to develop the Requirement Traceability Matrix (RTM) for future references and audit purpose
• Mainly worked on different mainframe screens like Provider Eligibility, Recipient Eligibility, Claims data entry UB04.
• Created and maintained an online project document repository using SharePoint
• Worked on the electronic Claims creations in HIPAA file viewer.
• Developed Standard Operating Procedures (SOPs), User Training Materials, User Access guides, online help, end user guides and FAQ’s for customer service and Claims operations and Claims imaging/OCR end users.
• Configuration management process for controlling document revisions.
• Managed financial forecasting of existing and portfolio projects with respect to budgets, resources, and direct and indirect costs.
• Project managed separate research projects including development of a research instrument.
• Responsible for budgets, project documentation, and presentations to customers.
• Managed vendor relationships with Business teams

Environment: MS SharePoint, MS office, MS Visio, JIRA, MMIS.

Business Analyst

Responsibilities:

• Involved in requirements gathering sessions with SME’s (Subject Matter Experts), Business Analysts and Architects to understand requirements in terms of business.
• Played a major role in collecting, documenting, blueprinting and managing business requirements.
• Actively worked on Business requirement analysis and Data analysis pertaining to various areas of Facets.
• Worked at different stages of Software Development Life Cycle (SDLC) with business users, developers, and stakeholders.
• Worked on business process from taking a requirement from a system record to a centralized database.
• Gathered requirements and developed crosswalks for270/271, 834, 837 P/I claim.
• Employed Revenue Cycle Management (RCM) to imply in healthcare delivery.
• Developed test cases based on the crosswalks and compliance guidelines for 834, 837 Professional, Institutional and Dental claims and for 270/271 eligibility benefit inquiry and response
• Involved in various aspects of QNXT lifecycle.
• Constantly in touch with business to work on policies in place to modify them on timely basis.
• Generated test data using X12 generator for transactions 277/288, 834, 835, 837P/I/D.
• Designed and developed Use Cases, Activity Diagrams and Sequence Diagrams using MS Visio.
• Participated in Forward and Backward Mapping analysis of ICD 9 - ICD 10using GEM provided by CMS.
• Designed and analysis of HIPAA 5010 related to 837,835, 834 transactions and formulated General Equivalence Mapping (GEM) documentation between ICD-9 and ICD-10, and vice-versa for the modules in production, conducted feasibility study and performed impact analysis for proposed enhancements
• Actively worked with quality control teams to develop test plans and test cases.
• Developed tables, Views, Stored Procedures and Triggers using SQL Scripting.
• Established Inner Join, Outer Join and created Indexes whenever necessary.
• Writing Standard SQL queries and optimizing SQL Queries
• Responsible to meet the information demands of our business users by delivering timely, accurate, meaningful and standardized data and reporting.
• Developed test scenarios and implemented test plans for system test and user acceptance test (UAT).

Environment: SQL, UML, MS Project, SQL Server, MS Visio

Business Analyst

Responsibilities:

• Gathered business requirements by driving user-group meetings and working with various global, cross-functional and virtual teams.
• Successfully conducted JAD sessions, which helped synchronize the different stakeholders on their objectives and helped the developers to have a clear-cut picture of the project.
• 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, 270, and 271.
• Responsible for GAP analysis of ICD9-ICD10.
• Involved in Mapping Disease codes from ICD system to EHR.
• Validated all health data in EHR as per HIPAA 5010.
• Involved in testing Diseases codes and health information in EHR.
• Helped in improving EHR as per customer service perspective and developed user guide for our customer support team.
• Involved with ICD10 implementation testing.
• Responsible for business system analysis of customizing the BPS Risk Management product with involvement through the whole SDLC
• Consulted with healthcare insurance company to develop conversion specifications for other insurance Coordination of Benefits (including Medicare).
• Performed Unit Testing and User Acceptance Testing and documented detailed defects.
• Developed Test Cases to validate the requirements and documented the Traceability Matrix for Test Cases and Requirements
• Conducted presentations of the Q/A test results with analysis to the stakeholders and users and documented modifications and requirements
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, OOAD using UML and Business Process Modeling.
• Developed business process models in RUP to document existing and future business processes.
• Created Business Requirement Document (BRD), Functional Requirement Specification (FRS) document, User Requirement Specification (URS) and Change Request (CR) document for system application development.
• Provided management support to the off-shore End to End Integration / Regression Test Team
• Prepared UAT Materials UAT Test Cases to include various steps involved for UAT and to have proper coverage of requirements

Environment: Windows XP Professional, Oracle9i, MS Excel, RUP, Oracle, UML, Rational Rose, Requisite Pro, MS Office suite, XML, MS Visio 2003, HP Quality centre.

Jr. Business Analyst

Responsibilities:

• Liaison between the Business needs (business users and sponsor) and the Technical solutions (development and testing staff), ensuring technical solutions satisfied business requirements.
• Web Page Mock-Ups using MS Visio and thus defining the Business Process Model and Data Process Model.
• Experienced in RUP software development cycle methodology with four consecutive phases - Inception, Elaboration, Construction and Transition.
• Authored Business and Functional requirements with supporting diagram, use cases, traceability matrices, and training manuals for Provider Portal web-based application.
• Developed training material and trained the users on newly developed application.
• Analyzed and wrote technical documentation for risk analysis on customer support issues.
• Part of the team assisting in documentation involved in this project such as RFP, proposal, evaluation criteria, proposal approval, design document, project plan, project scheduling, project report, release document.
• Prepared and presented monthly collection reports.
• Involved in training and quality of the overall workflow process.
• Documenting workflow and results of analysis for the aging accounts.

Environment: RUP, Rational Requisite Pro, UML Use Cases, VB.NET, SQL Server, Rational Rose, XML, Use Case Documentation.