PROFESSIONAL SUMMARY:

• 9+ years of experience in Business Requirements Modeling, Business Process Analysis, Data Analysis , and Client/Server applications for enhancing the business processes in diverse business domains.
• Extensive working experience in agile SCRUM environment with diverse teams.
• Experience in SDLC, Agile, Waterfall, Rational Unified Process, and SCRUM software development methodologies.
• Have knowledge of HL7 Messaging protocols, HIPAA transaction and code standards and electronic data interchange (EDI) standards like X12 837, 270, 271, 276, 277, 278, 835, 275 and knowledge of claims encounters process.
• Experience with health care systems: QNXT, FACETS, Medicare Part A, B, C, D, Medicaid systems, and validating General Equivalency Mappings (GEMs), Technical Report Type 3 (TR3) Implementation Guide, and Companion Guide.
• Extensive experience with Medicare/Medicaid processing as well as the Claims/Billing.
• Experience in working with self - organizing and cross functional teams, and well-versed with estimation techniques like Planning Poker, T-shirt sizing and Relative Mass valuation and prioritizing methods like MoSCoW, Kano, business value based and walking skeleton. Calculated sprint velocity and capacity; Handled Requirements Churn.
• Experience in Release planning, Acceptance criteria, definition of done, definition of ready, Potentially Shippable Product Increment (PSPI), minimum viable product (MVP), and good understanding of test driven development.
• Used tools like JIRA and RALLY to create and maintain Product Burn-down chart, Sprint Burn-down/ Burn-up chart.
• Possess skills like Conflict Resolution, Sense Making, Root Cause Analysis, Risk Analysis, Communication Management, problem management, Stakeholders Management and having Servant-Leader leadership skills.
• Proficient at coordinating with stakeholders, vendors, Subject Matter Experts (SMEs), Project Manager (PM) and end users and elicitation of requirements through Joint Application Design (JAD) sessions, Brain storming sessions, interviews, Surveys and questionnaires, prototyping, benchmarking, Requirements workshops, focus groups, document analysis, Joint Application Requirement (JAR) sessions and Rapid Application Development (RAD).
• Skilled in gathering and converting User Requirements into High Level and low level documents (HLD/LLD) like Business Requirements (BRD), Functional Requirement Documents (FRD), Functional Requirement Specifications (FRS) System Requirement Specification (SRS),and visualizing graphical user interface (GUI) using mockup screens.
• Expertise in Gap Analysis, SWOT analysis, risk analysis, cost-benefit analysis, feasibility analysis, and impact analysis.
• Worked on UAT testing and took signoff from the Commercial line of Property & Casualty business users.
• Experienced in creating workflow analysis and design, Process re-engineering, process remodeling, Object Modeling Technique (OMT), Object Oriented Analysis (OOA),Unified Modeling Language (UML) diagrams like activity diagrams, sequence diagrams and use case diagrams through MS Visio, What-IF scenario analysis (WISA), To- Be Scenario Analysis, Gap Analysis, User Interface (UI) design, User Experience design (UX), prototypes and wireframes.
• Managing Requirement Traceability Matrix (RTM),Service Level Agreement (SLA) and assisted Project Manager with creating Work Breakdown Structure (WBS),Project proposal and Project charter, Statement of work (SOW).
• Proficient in creating and managing Use Cases, User Stories, Test cases, Test plans, Test reports, Test scripts.
• Skilled at performing User Acceptance Testing (UAT), handling Change Request, and Configuration management.
• Strong knowledge of creating conceptual data models, ER diagrams, data mapping, data profiling, data verification, data integrity, ETL process, data normalization, data dictionary, SQL queries for data analysis and data validation.
• Experience working with managed care plans, Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Point of Service (POS) plans, Coordination of Benefits (COB), Explanation of Benefits (EOB).
• Experience in configuration of claims processing applications, claim adjudication process, claims management process, real time claims adjudication, Electronic Medical Records / Electronic Health Records (EMR/EHR) and Medicaid Management Information System (MMIS),and Medicaid Information Technology System (MITS).
• Good knowledge of COBRA insurance, claim submission process for CMS-1500 (HCFA-1500) and UB-04 claim forms.
• Have good understanding of Service Oriented Architecture (SOA), client side validation, server side validation, HTML, CSS, DOM, SAX, XML, XSD, JSON, WSDL, SOAP, REST, web services, API functional testing, and Data Binding.

TECHNICAL SKILLS:

SDLC Methodologies: Waterfall, Agile (SCRUM, XP), Hybrid (SCRUM-Waterfall)

Operating Systems (OS): Windows XP/8/10/Vista, Linux, Mac OS

Modeling Tools: MS Visio, Mock-up screen, Erwin, Enterprise Architect

Requirement Management Tools: JIRA, Rally

Testing Tools: HP QC, HP ALM

Languages: SQL, HTML, CSS, XML

Reporting Tools: Tableau Desktop, IBM Cognos, Excel,

Architecture: Service Oriented Architecture (SOA), 3 Tier Architecture, N-tier Architecture, Cloud Platform (SaaS)

ETL Tools: Informatica (Power Center), SQL Server Data Tools, Cognos Data manager

Databases: MySQL, IBM DB2, Oracle

SAS Tools: SAS/BASE,, SAS/MACRO, SAS/ODS, SAS/STAT, SAS/GRAPH, SAS/SQL, SAS/ACCESS and SAS/CONNECT

SAS Procedures: MEANS, FREQ, REPORT, SORT, TABULATE, TRANSPOSE, IMPORT, EXPORT, SQL, LOGISTIC, COMPARE, REG, CORR, ANOVA, GLM, GPLOT, GCHART

PROFESSIONAL EXPERIENCE:

Confidential, Fort Worth, TX

Business System Analyst

Responsibilities:

• Submit and gain approval of EDI encounter transactions with State of Texas.
• Worked on QNXT including Claim processing (online and batch adjudication), Case management, Customer service, Member/subscriber administration, Provider network management and reporting.
• Worked on claims, Claim adjudication Membership, Eligibility, Accumulators.
• Responsible for system integration testing of 837 claim files, 834 eligibility files and 270/271 interface files to ensure required interactions are met during the SDLC process.
• Validated Inbound and outbound 837 transactions, including but not limited to the loading and correcting any errors with the process of EDI inbound and outbound files.
• Validated outbound 835 transactions including but not limited with vendor on QNXT mapping and system configuration.
• Business Process Analysis/End User Education/Business Requirements Documentation.
• Validated System configuration, including enrollment, provider and benefits modules.
• Creation of queries and reports to assist Health Plan Operations with the analysis of data relating to claims, members and providers.
• Planned the entire Data Warehousing initiative from requirements gathering, analysis, design, identifying and analyzing the source systems, to data quality, to ETL, and to the end user data access.
• Provided release management strategy checklists and change management techniques.
• Presented and assisted end users for education and training about the new system.
• Generated reports using SQL Server Reporting Services (SSRS), and MS Excel spreadsheets.
• Involved in Source Data Analysis, analysis and design mappings for data extraction.
• Also responsible for Design and Development of SSIS Packages to load the Data from various Databases and Files.
• Design, deploy, and maintain various SSRS Reports in SQL Server.
• Execution of daily, weekly and monthly reports and processes and the creation of ad-hoc reports.
• Broad knowledge of CCHP departmental processes, procedures and data.

Environment:QNXT, RUP, Rational Rose, ASP.NET, Requisite Pro, MS Visio, RUP, MS Project, SQL, Oracle, ETL, SAS, MS Access, MS Excel and MS Word.

Confidential, Baton Rouge, LA

Business Systems Analyst

Responsibilities:

• Implemented SDLC which included Waterfall-SCRUM hybrid agile methodology with requirements, specifications phase and development phase in iterative time boxed sprint cycles, incorporating a rigorous definition of done.
• Gathered functional and non-functional requirements and involved in development and documentation of Business Requirement Document (BRD), and Software Requirements Specification (SRS) using agile methodology.
• Developed implementation guides for Partners EDI X12 transactions such as 834, 835,837,270, 271 and 274.
• Assisted the Project Manager in defining the project plan, project charter, scope, vision, and timelines. Handled requests for proposals (RFP), making presentations to customers, and negotiating project timelines and deliverables.
• Performed Gap Analysis by identifying current technology, policies, procedures, documenting the enhancements for the requirements, and analyzing new HIPAA 5010 compliance and developed an action plan for the migration process.
• Prepared Business Process Models (BPM) and UML diagrams like workflow diagrams, activity diagrams, sequence diagrams, use case diagrams, by using MS Visio, for visual representation to explain various steps involved in business.
• Developed and executed detailed Use Case to describe the functionality of the system including claims transactions.
• Involved in creating and executing test cases, test plans and test scripts for EDI 837 Claims (I & P) Transactions.
• Performed Data mapping to validate and customize Claims daily load into FACETS for processing the transactions.
• Performed Data profiling through careful range and pattern analysis and checked for data integrity by looking for various data anomalies and doing data normalization and data verification using Informatica Data Quality Center.
• Build Data Dictionary for various designers, developers, users, and administration with information on contents, data-type, and data element in various tables, columns and rows, and data modeling through star and snowflake schema.
• Participated in Validating ETL process by creating various simple and complex SQL queries.
• Responsible for the development and implementation of HIPAA EDI Data Mapping artifacts 270, 271, 274, 276, 277, 820, 834, 835, 837 and 5010.
• Performed User Acceptance Testing for the ANSI X12 Version 5010 / EDI transactions (HIPAA) for Claims Status and Eligibility (270, 271, 276, 277, 834, 837P, 837I, 837D, 835 remittances and NCPDP Claims).
• Developed HL7 messaging for bi-directional case and disease report exchange, in HTML and XML formats, in accordance with HL7 specifications.
• Developed XSD Schemas and wrote XML test files for backwards compatibility testing.
• Created test cases for the premium calculations and Claims limits and deductibles (Claims calculations).
• Wrote SQL queries to match the results with the actual BI report.
• For User Acceptance Testing (UAT) created ad hoc BI reports using Tableau

Environment: Waterfall- SCRUM hybrid methodology, Version one, MS Visio, Informatica, Altova map force, Enterprise Architect, MySQL, Tableau, Excel.

Confidential, NYC, NY

Business Systems Analyst

Responsibilities:

• Implemented SDLC, agile (SCRUM) methodology for the developing life cycle and followed the standards process in the application and elicited requirements from Business users and stakeholders by interacting with them and asking them detailed questions, and through JAD sessions, Focus Groups, Brainstorming, Prototyping and carefully recording and documenting the requirements in a format easily understood and reviewed by both business and technical people.
• As a SCRUM expert, I facilitated SCRUM ceremonies like Backlog Grooming sessions, Sprint planning meeting, Daily Stand-Up Meeting, Sprint Review, and Sprint Retrospective meetings, acting as a service leader to guide the team.
• Proficient in writing and prioritizing User Stories using INVEST in Product Backlog along with the Product Owner as per business and Technical needs using prioritizing techniques like business value based and technical value based.
• Facilitated breaking down EPICs into User stories and estimation of User Stories using estimation techniques like Planning Poker in Backlog grooming sessions, assisting the team to clarify ambiguity in estimating the user stories.
• Efficiently handled team and organizational impediments thereby fostering an environment for efficient team work.
• Used JIRA for issue tracking, User Story management and requirement traceability and created, managed, tracked and analyzed sprint Burn Down Chart and Product Burn Down chart to estimate sprint velocity, Development team’s capacity and release planning respectively, to improve and maximize value while focusing to achieve the Sprint Goal.
• Maintained SCRUM Task Board and did issue tracking through prioritizing and managing the defects using JIRA.
• Ensured that the team is following coding standards and is adhering to Definition of done to avoid/reduce technical debt and focused on resolving and shielding the team from impediments to keep them working in a group flow.
• Conducted Impact Analysis and Gap Analysis to derive and document requirements for Web based Claim Processing System (CPS) and identified AS-IS and TO-BE business processes based on which created business process models.
• Identified gaps between current policies and procedures and new HIPAA 5010 compliance, to check the compatibility of the existing system capabilities with the new requirements and developed an action plan for the migration process.
• Implemented Test Driven Development (TDD) to ensure quality of application is maintained through SDLC.
• Developed Mockup screens and wireframes using UI components such as Radio Buttons, Down lists, Check Boxes, and Data Entry Fields for web based custom dashboard of the CPS application for Business Users and Stakeholders.
• Worked with Front end and UI developers and Created HTML and CSS files using HTML5 and CSS3 for web based custom dashboard, and ensured that the client side validation and server side validation were implemented.
• Created XSD schemas and verified XML files based on XSD schemas. Assisted testers with validating XML requests.
• Developed HL7 messaging for patient EMR in text and XML formats, in accordance with HL7specifications and performed functional (API) testing and worked with QA team in reviewing and executing test plans and test cases.
• Created Data mapping documents between various data elements, XML files, flat files, excel files, HIPAA EDI files X12 837, 270, 271, 276, 277, 278, 835, 275, and 5010 and web services, to perform verification and validation.
• The process included importing claims into Facets that had been adjudicated and setting them in a "PAY" status so that a payment cycle could be run to create checks on Facets.
• Defined Data Maps to validate and customize Claims daily load into FACETS for processing the transactions.
• Reviewed Stored Procedures for reports and wrote test SQL queries for Joins, Unions, Group By functions against the source system (SQL Server) to match the results with the actual report against the Data mart (Oracle 10g).

Environment: SCRUM Methodology, JIRA 5.0, JAVA, Eclipse 4.3, MS Visio 2013, UML, Apache, AWS, AMI, Amazon EC2, HP ALM v11, Oracle 10g, Tableau 9.0, Altova XML spy, SOAP UI PRO, MS outlook 2013, MS office Suite (Excel, Word, Power point).

Confidential, Lincoln, NE

Business Systems Analyst

Responsibilities:

• Worked as a liaison between the business client and development team for the implementation of 4010 to 5010 transition in compliance with HIPAA standards.
• Involved in the HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Health Insurance Claims. Worked on HIPAA Standard/EDI standard transactions: 270, 271, 276, 277, 278, 834, 835, and 837 (P.I.D) to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
• Worked on document approval and submission system on COTS application for pharmaceutical regulatory submission system.
• Identified the business functions and processes, and prepared system scope and objectives based on user needs and industry regulations.
• Defined terms, conducted stakeholder analysis, elicited business needs, conducted business process modeling, and facilitated JAD sessions. Elicited, documented requirements and use cases. Analyzed, validated & prioritized requirements; traced requirements to related project documentation (process models, designs, test scenarios & scripts).
• Documented the Requirements and circulated them to Business & Technical teams for Signoffs.
• Coordinated with the developer and testers for transition of EDI X12 4010 series to 5010 series. Maintained traceability through updates to the Requirement Traceability Matrix (RTM) using Requisite Pro.
• Identified testing scenarios and defined Test Cases for detailed functional testing.
• Developed a Schedule and identified project milestones.
• Analyzed business scenarios to track possible business outcomes for the functions which could be incorporated into more detailed test scripts.
• Reported project progress to the team, senior management and all stakeholders periodically.
• Identified risk and project impact and performed risk assessment and mitigation.

Environment: SQL, MS Word, Excel, Access, Oracle, DB2, Lotus Notes, File Viewer, Web Client, Clear Quest, Requisite Pro, GEM, MS Visio, SharePoint.

Confidential, Los Angeles, CA

Business Analyst

Responsibilities:

• Coordinated IT projects and ensures company resources are utilized appropriately.
• Compiled project status reports, coordinates project schedules, manages project meetings, and identifies and resolves technical problems.
• Identified and analyzes systems requirements and defines project scope, requirements, and deliverables.
• Coordinated project activities and ensures all project phases are documented appropriately
• Conducted Requirements Clarification Sessions with concerned project members to clarify requirements.
• Worked on Policy Submissions, Policy Changes, Policy Renewals, Rewrites and Reinstatements Functionalities
• Scheduled and conducted JAD (Joint Application Development) sessions for analyzing and documenting requirements.
• Used the guidelines and artifacts of the Rational Unified Process (RUP) to strategize the Implementation of Rational Unified Process effort in different iterations and phases of the Software Development Life Cycle.
• Carried out AS-IS and TO-BE Analysis to showcase the improvements in business processes.
• Worked as an interface between the users and the different teams involved in the application development for better understanding of the business and IT processes.
• Followed the UML based Methods using Rational Rose to create Activity Diagrams, Sequence Diagrams, and Collaboration Diagrams.
• Used Requisite pro to input all the data elements, Use cases, and UI specifications.
• Prepared Business Process Models that includes modeling of all the activities of the business from the conceptual to procedural view.
• Aided management in standardizing web applications by preparing GUI standards and recommending alternative strategic solutions incorporated in a phased and iterative manner.
• Involved in project status meetings, QA review meeting, and Defect Status Meeting.
• Prepared Test Strategy and Test plan documents.
• Worked for multiple Sprints in Agile Methodology.
• Written Test conditions based on Requirements.
• Created positive and negative Functional Integration test cases by analyzing requirements and test conditions.
• Worked on Test Data Setup, created data as per test case requirements.
• Interacted with Business Partners in Reviews and User Acceptance Testing.
• Created and Reporting Bugs, involved in every phase of Bug Life Cycle.
• Escalation of Critical problems / issues during Testing and reporting them in JIRA.
• Prepared Final Test reports containing test steps and snapshots of execution

Environment: UML, RUP, Microsoft Office Suite, Microsoft Visio, Unix, Documentum, Windows NT/XP, Oracle, SQL, SQL Server, Sybase, VBScript, C#,DOORS, C++, NET, ASP.NET, COBOL, JCL, Business Objects.

Confidential, VA

Business Analyst

Responsibilities:

• Performed requirement analysis by gathering both functional and non functional requirements based on interactions with Stakeholders. Performed user interviews and JAD sessions.
• Worked closely with Project Leaders to confirm alignment of the requirements management plan with the overall project management plan.
• Assessed the impact of requirement changes to the overall solution and project.
• Prepared Business Requirement Document (BRD) and used Requisite Pro to manage, analyze, and convert business requirements into functional specifications.
• Interacted with Onsite Project managment team and created filter criteria like customer ID, security name, CUSIP to retrieve and manage project information.
• Developed UML Use Cases for the system and prepared a detailed work flow diagram exhibiting the entire process of the Proliance system.
• Worked closely with QA team in designing test plans, test scenarios and test cases for integration, regression and user acceptance testing.
• Represented functional and non functional requirements of Custom UI in requirement traceability matrix using Requisite Pro.

Environment: Windows 7, IIS 7.5, .NET 4.0, Visual Studio 2012, ASP.NET MVC, HTML5, Web APIs, Requisite Pro

Confidential, Cincinnati, OH

Business Analyst

Responsibilities:

• Extensively gathered requirements from all users, experts and laymen to understand the current functionality and assess the needs of the users using Waterfall methodology. 
• Participated in JAD sessions to develop an architectural solution that the application meets the business requirements.
• Converted Business Requirements to Functional Specifications.
• Participated in Business and data modeling by understanding the needs of the business users and documenting the Business Use Cases and System Use Cases.
• Analyzed the problem domain, specified features, and established baseline architecture, developed project plan. 
• Reviewed quality with respect to requirements based on reliability, functionality, & performance. 
• Perform all business analysis tasks that pertains to mortgage (business requirements documents, technical specs, testing including planning, monitoring, establishing test scenarios, scripts and associated data, conversion/migration including planning, mapping of data, integrity management, utilization of regression tools, issues management and tools, reconciliations and tools. 
• Documented, tracked and monitored systems development and functionality using MS Share Point, Excel and Power Point. 
• Maintained RTM to make sure that all the scope items had been fulfilled and there was no scope creep. 
• Involved in preparing Test cases/Test Plans
• Knowledge in coordinating and communicating between Developers, QA Teams, Management, QA and project leads and stakeholders to keep them informed at all the times about the development and the open issues. Perform training administration and organizations (reach out to vendors for cost estimates, select vendor based on requirements, update internal tracking systems. 
• Reviewed the business test cases with the business users.
• Conducted User Acceptance Testing.
• Worked with team to design, plan and implement operational workflows. 
• Executed SQL to ensure data is populated into correct table and data integrity is maintained. 

Environment: Windows XP, SharePoint, Web logic, TOAD, Java Script, Rational Rose, MS Visio, MS Project.

Confidential, Atlanta, GA

Global Fares/Pricing Analyst

Responsibilities:

• Determined most appropriate fare for complex international itineraries and forwarded pricing to travel agents using the Lanyon Easyview System via various airline computer systems. 
• Provided over-the-phone assistance to frontline representatives regarding international fare rule interpretations and manual fare storage.
• Helped resolve customer problems and supported all company and department initiatives, including SkyTeam member airlines. 
• In-depth ticketing experience facilitated transactions and ensured quality service and timely turnover for all agents resulting in seamless experience for customers and higher revenues. 
• Completed several special job assignments abroad assisting in marketing, sales and training capacities
• Participated in numerous automation and business process improvement projects. 

Environment: Waterfall, MS Visio, MS Word, MS Excel, SQL, MS Access, MS Project, MS SharePoint, HPQC.