SUMMARY:

• 10 year’s expertise in Business Analyst and Testing with hands on experience in Healthcare and Insurance Sectors.
• Extensive experience with Medicare/Medicaid processing as well as the Claims/Billing.
• Strong knowledge of the Software Development Life Cycle methodologies (phases and gates) like Agile and Waterfall models
• Excellent knowledge of HIPAA standards, EDI (Electronic data interchange) Transaction syntax like ANSI X12, Implementation and Knowledge of HIPAA code sets, ICD - 9, ICD-10 coding and MMIS.
• Experience with Iterative Software Development Life Cycle Process as per Rational Unified Process (RUP), involved in inception, elaboration, construction & transition phases using rational tools like RequisitePro, ClearCase, ClearQuest during various phases of RUP.
• Extensive experience of EDI 837, 835, 277, 270, 271, NCPDP, 5010, ICD-9 and ICD-10.
• Experience in Medicaid Management Information System (MMIS). Expertise in various subsystems of MMIS- Claims, Provider, Recipient, Procedure Drug and Diagnosis (PDD), Explanation of Benefits (EOB
• Extensive experience in Business Requirements gathering and writing skills with expertise in developing and documenting Business Requirement document (BRD), Functional Requirement Document (FRD),Software Requirement Specification (SRS) across the deliverables of a project.
• Functional experience with concentration on Use Case modeling using UML, Business Process Modeling, Data Modeling, Change Management, Technical Training, Software Development methodologies, QA testing, and Systems Testing of client server and web-based systems.
• Effectively used Rational Requisite Pro to organize, track and change requirements of the system.
• Hands on experience in all facets of User Acceptance Test (UAT): UAT scheduling, walkthrough sessions, UAT test plan and cases, creating data set, user manual, rollout plan, release note, smoke test etc
• Expertise of UML in visualizing and documenting the artifacts using Use Cases, Use Case Diagrams, Activity diagrams, Class diagrams, Data Flow Diagrams, Business Flow Diagrams, Sequence Diagrams using MS Visio
• Experience in facilitating Joint Application Development (JAD) sessions, Rapid application development (RAD) sessions, conducting user interviews and acting as a liaison between the customers, development team and testing team
• Experience in conducting Joint Application Development (JAD) sessions with end-users, expert team, development and QA team for project meetings, walkthroughs and customer interviews.
• Facilitated User Acceptance Testing (UAT) with the stakeholders and the business users as well as trained users to use the system configured.
• Experienced in Office 365, MS Project 2016 and Share Point online to maintain documentation repository.
• Analytical, methodical and resourceful approach to problem solving, identifying root causes and corrective actions to meet short and long-term business, financial and system requirements
• Excellent verbal/written communication skills and strong analytical abilities and can perform well both independently and as a team player

TECHNICAL SKILLS:

Operating System: Windows 7.8.1,10, Web, Win forms, android, iOS

Languages: C, C++,PL/ SQL, T-SQL,HTML, SAS

Software/Database: MS-Access, Oracle PL/SQL, ASP.NET, SQL Server 2008/2012, DB2

MS Office Suite: MS Word, MS Excel, MS PowerPoint, Share Point

Modeling tools: MS-Visio, Rational Rose

Project Management Tools: MS-Project

Methodologies: SDLC,Object Oriented Analysis and Design (OOAD), Rational Unified Process (RUP), Unified Modeling Language(UML), Rapid Application Development (RAD),JAD,SCRUM and Agile.

PROFESSIONAL EXPERIENCE:

Confidential, Los Angeles, CA

Sr. Business System Analyst

• Worked with users, subject matter experts (SME), Developer, Testers, etc. to enhance the functionality of the Information System and data quality.
• Created Functional Requirements and Technical design specification documents that cover the business problem and technical (Data/BI) solutions to enhance the overall functionality of the system.
• Data Analysis/Profiling to discover the underlying data bugs, anomalies, design issues, data modeling issues, etc. And propose data/database solutions to improve the data quality of the MISIS (My Integrated student information system).
• Worked with developers (onsite and offshore) of managed services team- Infosys to understand the current design and design solution to accommodate the new business requirements with least impact to the business users.
• Implement data solutions to solve business problems and fulfill business requirements for the MISIS (My integrated student information systems).
• Worked with implementation partner Microsoft on sketches to develop FARs (Feature acceptance report) and BSRs (Build-Stabilize-Release).
• Created screen, report, interface, API technical documentation for MiSiS application.
• Created Testing documents (test strategy/test plan/..) and testing the technical solutions before deployment.
• Report data integrity issues to the development & QA teams and manage the timely deployment of the resolution.
• Interpreted and analyzed MiSiS site metrics by using web analytics tools such as google analytics.
• Well versed with SQL queries against SQL Server and Oracle to identify underlying issues.
• Created and maintained sites, sites collections and applications.
• Frequently worked in Office 365, SharePoint online and MS Project 2016 for documentation and project management.
• Developed and maintained sites, document libraries, enterprise lists, web parts and wikis.
• Planned and created SharePoint 2007 and SharePoint 2010 Workflows.
• Investigate data quality issues reported by users of the Data Warehouse/Information System and manage it to resolution.
• Document business requirements, technical specifications and implementation of various ETL standards in the mappings.
• Assigning and tracking bugs and enhancements on TFS.
• Created mapping and specifications for data loads to MiSiS from other systems like IODS, Welligent.
• Analyze root cause for bugs and present to PMO team.

Environment: SQL,PL-SQL, Data Quality, ETL, SSIS, SSRS, TFS (Team Foundation Server), Visual Studio 2013, SQL Server Management Studio, Share Point

Confidential, Franklin, WI

Sr. Business/Data Analyst- Care Management

• Developed a story board for WY-CQS end-to-end business model.
• Responsible for defining the scope and implementing business rules of the project, gathering business requirements and documentation.
• Worked on Agile methodology for iterative process for MedCompass application-case management development.
• Analyzed Business Requirements and segregated them into high level and low level Use Cases, Activity Diagrams / State Chart Diagrams using Rational Rose according to UML methodology thus defining the Data Process Models.
• Developed a checklist for Smoke testing of MedCompass application in Pre-Dev environment.
• Developed Provider Portal manual from MedCompass application vendor Assure Care.
• Created business requirements and converted them into detailed use case, report specifications and nonfunctional requirements.
• Developed reports interactive dashboards and internal procedures
• Supported multiple internal levels of management in the evaluation of initiatives
• Maximized effectiveness of analysis programming and reporting.
• Developed Test Plans and Test Cases according to Business Requirements. Wrote SQL queries/joins for Oracle database and prepared test data. Tracked gap status, Worked in JIRA to update Use Case and Gap status and track cross-functional dependency for reporting purpose.
• Created data models and data flow diagrams for the AS-IS and To-BE process.
• Utilization Management for patient’s ER visits.
• Testing of Provider Portal for different functionalities.
• Maintained and updated issue tracker for the CQS for defects in the MedCompass application
• Worked on MedCompass application to resolve defects.
• Analysis of the new requests specified by the end users for the future releases and discussion with the functional and technical teams.
• Smoke testing of MedCompass application 2.0/2.1/2.2/2.3 versions.

Environment: Data Quality, DB2, .Net, Cloud, SQL server, Microsoft Office, Team Foundation Server

Confidential, El Segundo, CA

Sr. Business Analyst - Claims/Provider

• Analyzed trading partner specifications and created EDI mapping guidelines
• Gathering and reviewing the business requirements and working with Development and QA team for gaps found during the review.
• Performed GAP analysis of 4010 and 5010 EDI transaction using implementation guide to identify the changes in the segments and data elements.
• Analyzed business requirements and functional specifications for testing the application.
• Consolidated data in cross functional environment from multiple data sources to create ad hoc reports to support large group proposals.
• Developed test plan to give a detailed approach of the testing that will be performed on the projects.
• Implemented physician-profiling capabilities utilizing epidemiological methods, comparative data on physician practice patterns, assessing dimensions of cost, utilization of services and quality of care and patient care management.
• Understanding the business requirements and developed Test scenarios and test cases as per process flows, business rules.
• Worked on solving the errors of EDI 834 load to Facets through MMIS.
• Conducted reviews of test efforts, scenarios, plans, and results to obtain sign off and approval from claims services department.
• Triggering pending claims, copying claims from Production to Test Environment and putting them through daily and weekly cycles.

Environment: .Net, Windows 8.1 Touch, Cloud, SQL server, Microsoft Office

Confidential, Lincoln, NE

Sr. Business Analyst

Responsibilities:

• Met with client groups to determine requirements and goals. Utilized Rational Unified Process (RUP) to configure and develop process, standards, and procedures and create a Business Requirement Document.
• Responsible for preparing Software Requirement Specification (SRS) and documenting them.
• Analyzed, designed, and coded several online subsystems for the Medicaid System.
• Created Process Work flows, Functional Specifications documents and documented system requirements.
• Worked with MMIS subsystems on Member area, Claims Processing Subsystem, Recipient Subsystem and Provider Subsystem.
• Provide implementation assessment, strategy, and mentoring services for Rational Rose, UML and RUP.
• Interacted with various cross-functional teams on building business use cases, and understanding expenses and revenue stream.
• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, and implementation for processing of Claims.
• Configured Member Data via EAI tools for ID card and HIPAA Gateway for claims EDI files.
• In the MMIS Provider Subsystem worked on provider data, enroll new providers, and update providers’ files.
• Working with clients to better understand their needs and present solutions using structured SDLC approach.
• Collaborated with the QA team for developing scenarios for validation and testing.
• Developed the systems implementation project management plan with milestones and steps from procurement of vendors to project implementation and maintenance.
• Interacted with client and the Technical Team for requirement gathering and translation of Business Requirement to Technical specifications.
• Analysis of the new requests specified by the end users for the future releases and discussion with the functional and technical teams.
• Communicated changes to requirements promptly and precisely to all personnel involved.
• Identified and clearly defined functional issues and support IT development staff throughout the design, development, unit testing, and implementation phases of the software development life cycle.
• Analyzed and translated business requirements into system specifications.

Environment: SQL, SQL Server Management Studio, Share Point

Confidential, Atlanta, GA

Business Analyst

• Analyzed user requirement documents (URD), software requirement specification document (SRS) and prepared System test plan by dividing the application into manageable units.
• Involved in writing Detailed Test Plan for the Application under Test (AUT).
• Enhanced the Test Cases by analyzing the Specification Documents.
• Developed, implemented and executed test methodologies and plans to ensure software product quality as per the RUP methodology.
• Worked with MMIS team to provide project oversight for the initiation and planning phases of federally mandated project.
• Designing & Implementation of a new Underwriting System for the new Individual Line of Business catering to MMIS
• Worked on the conversion to 5010 transaction standards, ICD-10 code sets, and an integrated program eligibility system (for Medicaid, food stamps and more).
• Assisted DCH is taking further steps to streamline the provider enrollment process with a single application for Medicaid and the various care management organizations.
• Interacted with the Subject Matter Experts (SMEs) and stakeholders, gathering business requirements to get a better understanding of client’s business processes.
• Used UML, for gathering requirements, created Use Case Diagrams, and Use Case Specification document (USD).
• Used Unified Modeling Language (UML) for process modeling and use cases.
• Worked with Implementation of the Medicaid Modified Adjusted Gross Income changes and New Integrated Eligibility System.
• Worked on MMIS for Real-time processing of claims where providers can submit their claims and follow up immediately if they're being paid.
• Wrote HIPAA Companion Guides for 834 Enrollments, 270/271 Eligibility Inquiry/ Response & 820 - Health Plan premium payments for MMIS

Environment: DB2, .Net, Cloud, SQL server, Microsoft Office