SUMMARY:

• 8+ years of experience as a Business Analyst in Healthcare Industries.
• Strong knowledge of the Software Development Life Cycle methodologies like Agile and Waterfall models.
• Experienced in interacting with business users to identify their needs, gathering requirements and authoring Business Requirement Documents (BRD), Functional Requirement Document (FRD) and Software Requirement Specification (SRS) across the deliverables of a project.
• 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 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.
• Experienced in Business Analysis, SWOT Analysis, Gap Analysis, Risk Analysis, Disaster Recovery Planning, Testing and Project Planning.
• Worked as a business system analyst(BSA) to maintain the relationships between Business People and Programmers
• Extensive knowledge of Medicaid, Medicare, Procedural and Diagnostic codes and Claims Process. Also have worked on FACETS.
• 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
• Proficient in creating Sequence Diagrams, Collaboration diagrams, Activity Diagrams, Class Diagrams using Rational tools and Microsoft Visio
• Experienced in handling Change Management
• Experience in Learning Management System
• Experienced in analyzing and documenting business requirements and system functional specifications including Use Cases
• Strong Knowledge of UML, RUP, Rational Tools
• Experienced in writing Test Plans and executing Test Cases
• Skilled in validation and testing complex scenarios for the maintenance of quality standards in projects. Also worked on CDR portals.
• 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.
• Professional with extensive experience in the development, implementation and integration of strategies within a team oriented environment, utilizing quantitative and qualitative analytical skills.
• Excellent communication and presentation skills.

TECHNICAL SKILLS:

Business Skills: Business Process Analysis & Design, Requirement Gathering, Use Case Modeling, JAD/JRP Sessions, Gap Analysis and Impact Analysis.

Methodology: RUP, Agile, OOAD and Waterfall.

Languages: C, C++, SQL, PL/SQL, HTML and XML.

Management Tools: Rational Rose, Requisite Pro, Clear Quest, Clear Case, Serena Team Track and MS Visio.

Testing Tools: HP Quality Center, Win Runner, Load Runner and TOAD.

Data Modeling Tools: ERwin, Informatica 7.1.1/6.5

Database: Oracle 8i/9i/10g, DB2, MS SQL Server.

Operating Systems: UNIX, Windows 95/2000/NT/XP, and MS-DOS.

Microsoft tools: MS Office 2003 (Word, Excel, Power Point, Outlook), MS SharePoint, MS Visio, MS Project, MS Access and MS FrontPage.

PROFESSIONAL EXPERIENCE:

Confidential, MN

Business System Analyst

Responsibilities:

• Worked as a key BSA on the Benefits track of Claims Migration.
• Created Detail Functional Requirements document, Use Case Specification document, Activity Diagram to convert BCBSMN benefit to the NASCO BeneFACT system. Reviewed various documents with NASCO as well as with other vendors.
• Created end to end process flows for Benefit Coding, Use cases for Staffware & Report specifications for the reports.
• Worked with the Benefit Analyst and SME's in order to verify new groups benefit eligibility.
• Documenting the Benefits Conversion which was intended to provide detail process associated with the conversion and migration of BCBSMN Benefit data to NASCO’s Benefit systems. We were using the PEGA rule engine.
• Created Use cases & flows explaining how BPM will get the answer set ID for the triggered VPE & BPM will search for BLID’s on converted active VPE’s by answer set ID.
• Also captured the requirements of BPM to call BCI & BRMS for the Benefit string header information.
• Captured requirements and worked with BCBSMN SMEs, NASCO SMEs and Solution Architect in alignment process.
• Participated in NASCO BeneFACT Training.
• Created File Transfer Specification (FTS) to automate the extract, translate, and load process of the BCBSMN data (Provider Specialty, National Place of Service) into the NASCO Plan Flex table.
• Worked with IT team in encrypting the conversion files to NASCO & decrypted the files coming back from NASCO
• Strong technical knowledge of the FACETS system, more specifically the Subscriber/Member application.
• Worked with BCBSMN and NASCO SMEs to map the Benefit Variables.
• Captured Action Items, Issues, Risks and Dependencies during the JAD Sessions and coordinated with Lead and PM to manage and resolve.
• Reviewed and analyzed current reports, reviewed reports with NASCO, finalized matching reports and captured requirements for new reports for Actuarial, EDI and Benefits track.
• Understood and captured criteria to create new Benefit String and BLID.
• Actively participated on creating Conversion strategy from existing Star System to NASCO NPS System.
• Analyzed and captured existing reports for BCBS Host Plan
• Implemented Traceability Matrix and Business Requirement Specification Document verified the functionality coverage.

Confidential, Rye Brook, NY

Business System Analyst

Responsibilities:

• Aided in the collection of User Requirements and Business Requirements to create the Business Requirement Documentation (BRDs), using MS Word and MS Visio that provided appropriate scope of work for technical team to develop prototype and overall system.
• Incorporated and implemented all the HIPAA standards, Electronic Data Interchange (EDI 835,837,270,271) transaction syntax like ANSI X12, ICD-9, ICD-10 coding and HL7.
• Worked on designing Crystal reports and integrating them into Sharepoint. Also worked on NASCO framework.
• Conducted AS-IS and TO-BE analysis and assisted in developed process models and systems integration structure.
• Worked for audit trails of FACETS 4.6.1and also porting of the system from 4.6.1 to 4.7.1
• Guiding LMS stakeholder teams in delivering a new online learning platform that will serve employees. Configuring the overall design of the Moodle 2 site including the various add-on components
• Worked in Microfocus COBOL as an intermediate. Also worked on Meta Data cataloging.
• Involved in the analysis of HIPAA compliance and EDI transaction sets and actively participated in the designing of the EDI transactions using the new HIPAA 5010 version also including the use of ICD-10 codes, conversion of ICD9 codes to ICD 10 codes.
• Migrated documents from shared drives to SharePoint environment
• Conducted and facilitated Joint Application Development (JAD) sessions to reduce time spent in moving information between stakeholders and team members.
• Wrote test cases and test plans for the related and assigned scripts according to the test strategies defined in the project and testing team guidelines in Quality center.
• Conducted the AS-IS and TO-BE analysis of the business process using GAP analysis.
• Recommended corrective actions, if necessary, along with the progress against Development/Action Plan routinely to the Project Manager.
• Tracked and maintained Stakeholder requested enhancements and changes using Requirement Traceability Matrix (RTM).
• Identified critical areas of business risk and modified business processes to reduce risk by using the Risk-Management Process.
• Knowledge of the complete EDI format used in electronic documentation which was part of the knowledge transfer program to the vendors as per the requirements.
• Worked with Source system Subject Matter Expert (SME) to ensure that the extracts are properly mapped. Used SQL for data mapping and querying.
• As part of the data mapping procedures, assisted in writing requirement document for ETL - Data Extraction, Data Analysis and Loading process of collected data.
• Involved in various types of Audits and the Financials involved through different stages.
• Gained Compliance audit experience due to exposure to the legal/audit consulting groups.

Environment: MS Office, Quality Center, SQL Server, Facets 4.21, MS Project, Server, MS Visio, Unix, J2ee, Java, XML, Mainframes and Rational ClearQuest, ClearCase, Windows XP

Confidential, Salem, OR

Sr. Business Analyst

Responsibilities:

• Gathered requirements from stakeholders for provider management and member management.
• Identified and validated business rules and data elements.
• Developed the stakeholder list and created stakeholder assessment matrix to prioritize them. Also worked as a BSA to maintain the relationship between business people and the Programmers
• Developed and maintained a requirements work plan and assessed the performance metrics of the team members.
• 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.
• Conducted Impact analysis when there is any change in the requirements and updated the Business Requirements Document (BRD) and Systems Requirements Specification (SRS).
• Worked on Microfocus cobol as an intermediate.
• Propose strategies to implement HIPAA 5010 in the new MMIS system.
• Developed the User Interface (UI) prototypes to capture and validate requirements and spike solutions to the current problem.
• Experience in converting this type of data from state partner receipt, through uploading to the FACETS application, via the MMS application.
• Partnered with LMS vendor to request and schedule new features, system enhancements, and bug fixes. Provided LMS vendor with Functional Specifications and System Requirements documents.
• Designing Functional Specifications for the target physical database.
• Facilitated JAD sessions for Requirement Validation with Dept. of Health & Human Services (DHHS) to gather requirements for the new MMIS.
• 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.
• Analyze different data cross-walks, complicated logic & look ups required by different fields for the source to target transformations.
• Analyze EDI - X12 data elements captured by the existing system to validate it against the data elements required for new system.
• Participated in developing test plan, test scripts, and test scenarios and designed user documentation.
• Worked with legacy team in developing BRD for multiple system change requests and participated in system testing.
• Worked with the deployment team for reversion of the member portal.
• 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.
• Examine the system design deliverables & validating it against the Request for Proposal (RFP).

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

Confidential, Dallas Texas

Business Analyst

Responsibilities:

• Requirements gathering from various insurance companies to develop a system to check for the outstanding balance from various accounts using highly efficient RUP process of software development.
• 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.
• Ensured that the claims processing is strictly under the HIPPA compliance regulatory document to safe guard patient information.
• 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 root cause 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.
• Developed and implemented plans to bring down the Accounts Receivables aging days.
• Involved in training and quality of the overall workflow process.
• Creating and analyzing numerous clients’ reports for various financial requirements.
• 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

Confidential, Dublin, OH

Business Analyst

Responsibilities:

• Analyzed Business Requirements, developing tracking and enhancing them into functional requirements using Rational Requisite Pro as a requirements tool.
• User Acceptance Testing (UAT) - Carried out UAT activities associated with each project and presented the results to the Business Stakeholders.
• Worked on HIPAA transaction codes specifically on EDI 837, 835 and 834 to in corporate enhancements to existing efforts on capturing and mapping, member enrollment and eligibility and contribution data respectively received at the Plan level from the State.
• Documented the meeting minutes from the JAD’s and stored the artifacts in the appropriate place holders in PDS and SharePoint for both the teams to review.
• Worked in GAP analysis to understand the difference between both the billing systems and documented the GAPs in GAP analysis spreadsheet.
• Used UML and RUP best practice methodologies along with supporting toolset including Mercury Test Director, Caliber RM and StarTeam for overall development framework
• Documented the business requirements into functional requirements document.
• Gathered the requirements and transformed them into high-level Process-Flow Diagram using PowerPoint.
• Created a task plan for the team identifying the key deliverables and the respective deadlines.
• Created the ETL requirements to load the data into TeraData.
• Analyzed the business requirement as per the HIPAA rules and regulations.
• Involved in preparing Test Plans based on User Requirements Document (URD) and prepared the Test Cases using Test Director/HP Quality Center.
• Created mapping/crosswalk documents for mapping data flow between systems.

Environment: Windows XP Professional, Mercury Test Director, Oracle, MS Access 2000, MS Excel, RUP, Oracle, UML, Rational Rose, Requisite Pro, TOAD, Rational Clear Quest 2002, MS Office suite, MS Visio, Informatica

Confidential, Nashville, TN

Business Analyst

Responsibilities:

• Gathered Requirements from various Business Areas like Claims, Provider Relations, Enrollment, Finance and Benefits Administration for their updates to the Claim Processing Engine.
• Developed Use Cases using MS Visio, and a detailed project plan with emphasis on deliverables.
• Monitored Change Requests and documented requirements, integrating them with Use Cases.
• Developed and Implemented Test Strategies using the Test Director.
• Assisted QA team in testing phase by creating Test Plans and Test Cases documents.
• Followed the RUP methodology for the entire Software Development Cycles.
• Assisted the development team during the second and third iteration using the RUP model.
• Checked the data flow through the front end to backend and used SQL queries to extract the data from the database.
• Involved in project planning, coordination and implemented QA methodology.
• Developed the Requirements Traceability Matrix, prioritized and determined Impact of all applications.
• Identified the all applications and interviewed the application owners to recommend the process improvements.
• Provided overall project management to multiple projects successfully completing them on-schedule and on-budget.
• Defect Tracking and Bug Reporting was performed using Test Director

Environment: Oracle 8i, SQL, PL/SQL, ASP.NET, Rational Requisite Pro, Microsoft Visio, HTML.