SUMMARY:

• 7 + years of experience as a Business Analyst in Health Care domain.
• Strong knowledge of the Software Development Life Cycle methodologies like Agile and Waterfall models.
• Experienced with Iterative approach for Software Development as per Rational Unified Process (RUP). Involved in inception, elaboration, construction & transition phases using rational tools like Requisite Pro, Clear Case and Clear Quest during various phases of RUP.
• Design and review of various documents including the Software Requirement Specifications (SRS), Business requirements document (BRD), Use Case Specifications, Functional Specifications (FSD), Systems Design Specification (SDS), Requirement Traceability Matrix (RTM) and testing documents.
• Proficient in creating Sequence Diagrams, Collaboration diagrams, Activity Diagrams, Class Diagrams using Rational tools and Microsoft Visio
• Professional with extensive experience in the development, implementation and integration of strategies within a team oriented environment, utilizing quantitative and qualitative analytical skills.
• Experienced in Business Analysis, SWOT Analysis, Gap Analysis, Risk Analysis, Disaster Recovery Planning, Testing and Project Planning.
• Strong knowledge of managed care payer requirements and procedures.
• Extensive knowledge of Medicaid, Medicare, Procedural and Diagnostic codes and Claims Process.
• Expertise in EDI and HIPAA Testing Privacy with multiple transactions exposure such as Inbound Claims 837 - Institutional, 837-Professional, 837-Dental, 835-Claim Payment/Remittance Advise, 270/271-Eligibility Benefit Inquiry/Response, 276/277-Claim Status Inquiry/Response Transactions and testing in Client Server systems and Mainframe Applications
• Experience in Conversion of HIPAA X12 4010 codes to X12 5010 codes and ICD 9 codes to ICD 10 codes
• Good understanding of Trading partner management for 4010 and 5010 files.
• Experienced in facilitating Joint Application Development (JAD), Rapid Application Development (RAD) and Joint Requirement Planning (JRP) sessions, interviews, workshops and requirement elicitation sessions with end-users, clients, stakeholders and development team
• Experienced in analyzing and documenting business requirements and system functional specifications including Use Cases
• Solid understanding of Rational Unified Process (RUP) using Rational Rose, Requisite Pro, Unified Modeling Language (UML).
• Experienced in handling Change Management
• Strong knowledge of Business Process Modeling, Business Intelligence and Business Architecture.
• Experienced in writing Test Plans and executing Test Cases
• Skilled in validation and testing complex scenarios for the maintenance of quality standards in projects
• Experienced in creating User Manuals and providing training to users.
• Creative and Aggressive person capable of forming and maintaining positive and productive team environments with integrative thinking skills.
• Exceptional Problem Solving and Sound Decision Making capabilities, along with the ability to resolve difficult situations.
• Creative and aggressive self-starter with integrative thinking skills, capable of communicating creative ideas through graphical analysis charts and statistical data display.

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

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

Industry Standards: HIPAA, SOX, ISO, Six Sigma, CMM, HL7.

PROFESSIONAL EXPERIENCE:

Confidential, Rye Brook, NY

Business Analyst

Responsibilities:

• Coordinated with the stakeholders and project key personnel to gather functional and non-functional requirements during JAD sessions.
• Studied the existing business process and created AS-IS workflow to illustrate the existing system.
• Created Business Requirement Document (BRD), Functional Requirement Specification (FRS) document, User Requirement Specification (URS) and Change Request (CR) document for system application development.
• Responsible for the full HIPAA compliance lifecycle from gap analysis, mapping, implementation and testing for Medicaid Claims.
• Gathered and analyzed requirement for HIPAA 5010 and ICD 10 changes.
• Analyzed and documented the changes in the compliance rules for adverse action redesign.
• Involved in up-gradation of HIPAA X12 4010 transaction to HIPAA X12 5010.
• Analyzed CMS comparison documentation highlighting changes of ICD10 diagnosis and procedure codes.
• Worked on different EDI scenarios for batch processing.
• Worked on EDI transactions: 270, 271, 834 and 820 to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
• Ensure day-to-day EDI transmission, Reject tracking and Reconciliation. 
• Run EDI Reconciliation reports daily and document in MS Excel.
• Was responsible for data mapping of HL7 messages into relational database.
• Assisted in monitoring ancillary data transactions and addressed problems with HL7 messages.
• 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.
• Integrated Requisite Pro to provide all teams visibility and maintain tractability among requirements, use cases and change requests.
• Created Use cases, Activity, Sequence and Collaboration diagrams
• Maintained and monitored project progress and status through MS Project.
• Worked extensively with the users and with different levels of management to identify requirements, use cases and to develop functional specifications.
• Managed all the requirements, making requirements available to all team members.
• Created requirements analysis and design phase artifacts using Requisite Pro and MS Visio. .
• Syndicated with various cross-functional teams for building business use cases.
• Conducted Asset Management, Risk Analysis of the Requirements and Traceability focus areas of the various projects and worked with the project team to help them identify the high-risk areas.
• Data mapping, logical data modeling, used SQL queries to filter data within the Oracle and Sybase.
• Responsible for co-coordinating business meetings and generating monthly status reports etc.
• Assisted QA team with Test Plans and executing Test Cases .

Environment: MS SQL, Windows XP, Requisite Pro, Clear Case, UML, Business Objects, MS Visio, MS Project, MS Excel

Confidential, Revere, Massachusetts

Sr. Business Analyst

Responsibilities:

• Involved with the project from its inception phase to transition and production rollout phase.
• Have provided projects with pre-project planning expertise; high-level and detailed project definition, as well as acted as the primary liaison between IT and Business Partner(s) on a daily and project basis.
• Have followed project management principles to develop project plans in order to deliver the project product.
• Worked closely with the Business Partners and IT teams to mentor and share their specialized knowledge base
• Arranged JAD sessions with business users and development team to drive out detailed business requirements.
• Developed and maintained a requirements work plan and assessed the performance metrics of the team members.
• Responsible for claim processing in MMIS.
• Served as a liaison between the internal and external business community (Claims, Billing, Membership, Capitation, Customer service, membership management, provider management, advanced Healthcare management, provider agreement management) and the project team.
• Facilitated JAD sessions for Requirement Validation and requirement gathering for the new MMIS.
• Analyze EDI - X12 data elements captured by the existing system to validate it against the data elements required for new system.
• Conducted Impact analysis when there is any change in the requirements and updated the Business Requirements Document (BRD) and Systems Requirements Specification (SRS).
• Participated in developing test plan, test scripts, and test scenarios and designed user documentation.
• Modeled the ‘as-is’ process flow and the ‘to-be’ process flow and analyzed the gap and developed the action steps to fill the gaps.
• Conducted Risk analysis and developed mitigation plans.
• Facilitated meetings with the technical team and client team to analyze the current process and gather requirements for the proposed process.
• Defining test cases, creating test scripts, analyzing bugs, interacting with QA / dev teams in fixing errors and User Acceptance Testing (UAT).
• Prepared the Test plans and Test cases to successful perform the system integration testing, functional testing.
• Designing Functional Specifications for the target physical database.
• Developed UAT test cases associated with the functional requirements.
• Maintained a bi-weekly status report for the requirements team and incorporated the same to the PMO status reports send to CMS.
• Used Microsoft SharePoint as the version tracking tool for managing the requirements documentation.
• Create monthly/weekly status reports to update the project schedules & deliverable plan.
• Actively involved in updating internal processes (submit claims, check eligibility), updating data collection and data reporting.
• Defects and bug testing by using Rational Clear-Quest, Configuration management and Version control with Clear-Case.

Environment: MS Office, Windows 2000, .NET, MS Visio, MS SharePoint, TFS, MS Project, MS Visio, SQL, Oracle, SOA, HTML.

Confidential, West Palm Beach, FL

Business Analyst

Responsibilities:

• Used Requisite Pro for the Requirement Documents Preparation and Prepared Business Process Models that includes modeling of all the activities of the business from the conceptual to procedural level. Followed top down, leveled technique for building Business Process Models.
• Responsible for processing Medicare claims and COB claims.
• Responsible for checking Medicare eligibility and verifying claim payment.
• Medical Claims experience in Process Documentation, Analysis and Implementations in 835/837, 270, 276/277processes or Medical Claims Industry from the Provider/Payer side
• Conducted JAD sessions to define the project and to reduce the time frame required to complete deliverables.
• Gathered requirement for HIPAA 4010-HIPAA 5010 and ICD9-10 conversion.
• Analyze HIPAA 4010 -HIPAA5010 changes.
• Met with various HMO, PPO, Medicaid/Medicare Representatives discussing benefits of contracts on behalf of facilities or appeals from denials and compliance issues
• Developed and maintained all operational and technical flows using Visio and Power point.
• Used Rational Rose/MS Office Suite for creating use cases, workflows and sequence diagrams according to UML methodology thus defining the Data Process Models.
• Created Use Cases / Activity Diagrams / State Chart Diagrams, Sequence Diagrams, and Collaboration Diagrams thus defining the Data Process Model and Business Process Model.
• Written multiple Use Cases and test cases for multiple transactions include 837, 835, 270, 271, 276, 277
• Involved in preparing the Test Scenarios for Health Care Claim Payment/Advice.
• Aided in workflow analysis and process design.
• Analyze business requirements from Black Box testing perspective, business process and system architecture/design.
• Design, build and test maps to translate X.12 EDI to and from transaction formats such as EDIFACT, SAP IDOC, and various proprietary formats.
• Maintained Requirement Traceability Matrix (RTM).
• Performed Regression Testing and created test scenarios for User Acceptance Testing (UAT).
• Maintained documents for change request and implemented procedures for testing changes
• Defined program and project goals, objectives, products, services, constraints, assumptions, risks and facilitated processes by working with the project team, sponsor, and stakeholders to baseline the scope of the work and enable development of the plan.
• Used SDLC (System Development Life Cycle) methodologies like the RUP and the waterfall.
• Developed business process models in RUP to document existing and future business processes
• Performed SWOT and Gap analysis for the new functionality requirements by identifying existing technologies, documenting the enhancements to meet the end state requirements.
• Responsible for architecting integrated HIPAA, Medicare solutions, Facets.
• Involved in generation and execution of SQL queries

Environment: Rational Unified Process (RUP), UML, Rational Test Manager, Rational Clear Quest, Windows, MS Office, HTML, Windows 2003

Confidential ., Tampa, FL

Business Analyst

Responsibilities:

• Gathered Business Requirements through brainstorming sessions on global calls.
• Conducted JAD sessions with Subject Matter Experts to obtain domain level information.
• Involved in converting the User requirements into business requirements, functional requirements and technical requirements and also created business process modes from the requirement specification. Managed requirement using Rational Requisite-Pro.
• Have worked on projects in claims department of Claims Re-pricing, Claims Processing.
• Managed the project as Business Analyst to implement Automation Underwriting.
• Involved in resolving and documenting issues related to these EDI transactions including 271 transactions using Test Director
• Presented and conducted functional requirement reviews and walkthroughs with the designers, developers, and stakeholders.
• Worked with HIPAA compliant ANSI X12 270 formats for both professional claims and institutional claims.
• Analyzed forms and successfully crosswalk details to corresponding ANSI X12 formats
• Managed all the requirements in Requisite-Pro, creating a Requirements Matrix and making requirements available to all team members and also urge communication and collaboration among team members.
• Analyzed and synthesized results from Joint Application Development (JAD).
• Strong experience in RUP and waterfall Business Modeling process, complete UML artifacts related to Business Modeling and Requirements using MS Visio.
• Have good experience of using Rational Requisite Pro, Rational Clearquest and Rational Clearcase.
• Deep understanding of Various Software development life cycle (SDLC) aspects such as Requirement Analysis, Design, Development, Testing and Deployment.
• Ability to create read and comprehend process-level and system-level documents including functional specifications, project scoping, project planning and GAP analysis.
• Worked on Test Cases and Test Plans using Different Testing Methodology like Functional, Regression, Integration, and User Acceptance testing (UAT).

Environment: Rational Unified Process (RUP), UML, Dream weaver, Rational Test Manager, Win-Runner, Rational Clear Quest, Windows, MS Office, HTML, Windows.