PROFESSIONAL SUMMARY:

• 7+ years of Experience as a Business Analyst/Business System Analyst with extensive knowledge and experience across the project life cycle in Systems Development Life Cycle (SDLC) in the fields of Healthcare industry.
• Profound Knowledge of Rational Unified Process (h) methodology, Use Cases, Object Oriented Analysis and Design (OOAD).
• Solid understanding of Business Requirement gathering, Business Process flow, Business Process Modelling and Business Analysis.
• Extensive experience in creating, executing and data extraction using SQL queries.
• Experience in facilitating Joint Application Development (JAD) sessions with IT Groups and Conflict Management with Project team members.
• Expertise in identifying, developing interface and process specifications, documenting them in Business Requirement Documents (BRD), creating Functional Requirements Specifications (FRS), System Requirement Specification document(SRS), and Change Request Specification(CRS).
• Extensively worked on the various types of Business Requirements Elicitation, Process Modelling, Gap analysis, and development of Functional Specifications
• Experience in development of Process Flow Diagram, Use Case Diagram, Activity Diagram, and Sequence Diagram by using UML methodology using tools such as Rational Rose and MS Visio.
• Extensive experience in developing Use Cases, creating Screen Mock - ups, conducting Gap Analysis, SWOT analysis, and Cost Benefit Analysis.
• Good Knowledge about the added and deleted functions, and changes in different sections of the affected EDI transactions834, 820, 270/271, 278, 837(I, D, P), 276/277, 835 as per the HIPAA 5010.
• Experience in HIPAA ASC X12 transactions. Good Knowledge and understanding of HIPAA 4010. Experience in working with GAP Analysis between HIPAA 4010 and HIPAA 5010.
• Worked on Data migration, Facets version upgrades
• Good Knowledge on cross walking ICD-9-CM to ICD-10-CM/PCS “forward mapping” & ICD-10-CM/PCS to ICD-9-CM “backward”.
• Expert in Tracking and Managing the Requirements using Requirement Traceability Matrix (RTM) that controls numerous artefacts produced by the teams across the deliverables for a project.
• Involved in Test Planning, Test Preparation, Test Execution and 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.
• Expertise in the preparation of ETL Test Plan, Test case Design, Progress Reports and Traceability matrix, responsibilities in preparation and review of Test Cases.
• Data extraction, Data Migration and Data conversion using ETL tools from application front-end with Oracle databases and data warehouse.
• Worked in cross functional and geographically dispersed team environments.
• 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, good understanding of team management.
• Excellent Communication skills with ability and willingness to work towards the business and technical requirements of clients and users.

WORK EXPERIENCE:

Confidential, Charlotte, NC

Sr. Business Systems Analyst

Responsibilities:

• Gathered Business Requirements from the Subject Matter Experts (SMEs) and documented the requirements in the BRD. Utilized data flow diagrams, use case diagrams and process flow diagrams to represent information provided by the Business Owners.
• Worked with scrum master to break the requirements into user’s stories and sprints.
• Closely worked with data analysist team in defining sources and content for the data ware house component. Work on the integration of data from various sources, created comprehensive data mapping and dataflow diagrams.
• Actively participated in weekly meetings and ad hocks meetings with PM, stakeholders and delivery mangers throughout the life cycle to identify and track project issues and risks.
• Performed Analysis of ICD 9 Codes in accordance with ICD 10 CM and ICD 10 PCS Conversion Compliances.
• Organized meetings and led JAD sessions to ensure legal and compliance deadlines of CMS (Centers for Medicare and Medicaid Services) are met.
• Read and analyzed the federal legislation to update the products as per the mandated provisions of HCR (Health Care Reform).
• Created and maintained Service Level Agreements (SLA’s) and wrote business rules pertaining to the HIX project.
• Created use cases diagrams and business process workflows using Visio
• Implemented various EDI transactions like enrollment (834) and premium payment (820) to support HIPPA transaction set.
• Got a great exposure to Electronic Medical and Health Records (EMR & EHR)/Automated Health Care Systems.
• Worked with the UAT and QA teams to conduct an assessment and determine how effective UAT and QA guidelines can help the company achieve timely completion of projects.
• Effectively elaborated the Current process and gave a clear picture of the proposed process for the projects in the organization. Worked aggressively towards timely completion of High Priority Tasks.
• Participation in a HP Quality Center for System Integration Testing support and help finalizing defects.
• Led the Change Control Process for changes submitted for the BRD once the document was submitted to IT department.
• Worked with IT to resolve issues and clarify Business Requirements from the Business Owners.
• Wrote test cases, test script and test plan for testing.
• Documented the UAT Test Plan for the project and worked with the UAT team to ensure every acceptance criteria for the requirements that has been included in the UAT task plan.
• Maintained the Traceability Matrix table to uniquely trace the identified business requirements from general design to testing as proof that requirements requested have been developed into a solution and that it has been tested and tracked.

Environment: UML, Windows, SQL, Microsoft Office, HP / Quality Center, Agile, MS Access, MS SharePoint, HTML, XML, Java, ASP, DB2.

Confidential, Overland park, KS

Sr. Business Systems Analyst/ EDI Analyst

Responsibilities:

• Conducted, facilitated, lead JAD (joint application development) sessions with business, development leads, technical team and other stake holders to understand the business requirements.
• Analyzed and synthesized JAD output and conducted further meetings and interviews to propose better solutions.
• Expertise in data mapping of the various EDI transactions (270/271, 276/277 and 835) with business and trading partners.
• Coordinating with other Service Providers and creating RTM (Requirement Traceability Metrix) for the requirement.
• Facilitate and initiate meetings with other Application Service Groups to make sure that all eligibility and benefits are sent with the right deductible to the providers and other trading partners.
• Analyzed data and conducted GAP ANALYSIS to find the gap between the current state and "to-be state" & create Logical diagram for current and future state using MS Visio.
• Worked on provider information management of PPO, POS and HMO networks including large institutional networks as well as small providers.
• Extensive use of Business Process Modeling Notations & Data flow diagrams to represent the flow of data from external entities into the system.
• Creating test strategy document, finalizing dates for all the test deliverables including System testing and integration testing.
• Work closely with Business and trading partners and drive them through all the Waterfall Phase from Designing, Testing to Release Phase.
• Work with the clearinghouses, and gateway providers to schedule monthly eligible member list.
• Test the environment to have a successful transaction.
• Analyze and document non-functional system requirements.
• Responsible for entering the test cases on HP Quality Center (QC).

Environment: MS Office Suite (Word, Excel, Power Point, Visio, Project, Access, Share Point), Facets, ETL, Agile, BizTalk, Quality Center, SQL, XML.

Confidential, Bismarck, ND

System Analyst

Responsibilities:

• Gathered Business Requirements from all the stakeholders and interacting with the providers, managers, developers to develop the business Processes.
• Conducted Risk Analysis and Impact analysis whenever there is any change in the business requirement and proposed solutions while continually updating the business requirement document.
• Conduction JAD sessions and ultimately reducing the time spent in moving all the information from stakeholders and other team members.
• Created and updated data mapping document(s) with reference to the source for 270/271 (Eligibility & Benefit Inquiry & Response), 276/277 ( Claim Status Inquiry & Response) and 837 (Health Care Claim).
• Assisted in the meetings with the technical team as well as the clients regularly to assess the current process and how it could be changed in making a better proposed process.
• Provide various strategies to implement HIPAA 4010 in the new MMIS system and ultimately move to HIPAA 5010.
• Performed six-sigma process during the project to eliminate any defects in the process.
• Conducted the gap analysis and analyze various gaps and develop actions to fill those gaps.
• Develop spike requirements solution for all the current problems and UI prototypes for capturing the requirements.
• Helped in developing test cases such as test plans and test scenarios.
• Utilize Rational Unified Process (RUP) and build different phases of software developmental cycle.
• Actively involved in designing EDI transactions using the new HIPAA 5010 version and ICD -10 codes and analyzing IPAA compliance and EDI transaction.
• Recommending actions against the action plans during the ongoing progress of the project to the project manager.
• Knowledge of the software system and the programs.
• Identification of changes in the existing North Dakota Electronic Disease surveillance system to adopt ELR implementation through GAP analysis.
• Created architectural styles such as application architecture, enterprise architecture, and service-oriented architecture with the help of Service - Oriented modelling (SOA).
• Creation of project management plans to manage timely delivery using MS project.
• Performed Requirement Tractability Matrix (RTM) to track and maintain stakeholders requested requirements and changes.
• Instrumental in capturing the requirements from the clients and publishing them into a requirements document.

Environment: MS Project, Requirement Traceability Matrix (RTM), Rational Rose Test, JAD, RUP, MS Visio, Windows OS, MS Office, SharePoint, Server, Quality Center, ETL, FACETS, SQL Server.

Confidential, Tampa, FL

Business Systems Analyst/Data Analyst

Responsibilities:

• Assisted project manager to prepare business document, project schedules, resource allocation, project duration and cost by using MS Project.
• Facilitated sessions with senior agency staff to identify the business flows and determined whether any current or proposed systems are impacted by the EDI X12 Transaction Code Sets and Identifier aspects of HIPAA.
• Produced reports through Impact Analysis on system, data, technology, providers and clearing houses, enabling recommendations and best practices for becoming HIPAA compliant.
• Involved in developing Project Plan, detailing the tasks and effort required to achieve HIPAA compliance.
• Validated the following: 837 (Health Care Claims or Encounters), 835 (Health Care Claims payment/ Remittance), 270/271 (Eligibility request/Response), 834 (Enrollment/Dis-enrollment to a health plan)
• Communicated Project Requirements, Business Issues, Solutions and made recommendations.
• Created Wire Frame and Swim Lanes using MS Visio
• Monitored the UML based methods to create: Use Cases, Activity Diagrams, and Swim lanes
• Created use case diagram, Process Flow Diagram (PFD), Data Flow Diagrams (DFD), various different type of wireframes Setup meetings with Quality Analysts and Development teams/vendors to clarify questions on the requirement documents.
• Created System Requirement Specifications (SRS) document entailing business rules, conditions, calculations, triggers, visual representation, type of text (smart text, static text, free text, special formatting, metrics) of various dynamic elements present within the reports.
• Created Report Mock-ups.
• Coordinate with client and manage their business needs. Developing the Proto type and preparing the Process flow diagram using iRise.
• Gathered user and business requirements through interviews, surveys, prototyping and observing from portfolio managers and UI (User Interface)
• Coordinated with different team in order to develop the web service.
• Working directly with Project managers, Business Team, Technical team, QA Team to analyze and eliminate errors.
• Involved in all phases of system development including requirement gathering and analysis, Designing, Development, Testing, Implementation, deployment, maintenance.
• Worked with relational database models, schemas & Entity-Relationship Diagrams (ERMs) to create technical/system design documents
• Carry out SQL queries to analyze the data in collaboration with DB team during data mapping, warehousing, normalization, and meta-data analysis for Medicare
• Involved in coordinating with the database design team, using SQL to Query databases and providing inputs in finalizing the data model, report layouts.
• Gathering Requirements from business, created BTRDs, BRDs, TDD and supported technical and testing team.
• Documenting all system changes and request for changes (RFC) for user access using change management forms.
• Used MS Excel to create test cases and import the data to Quality Center.

Environment: Rational Requisite Pro, Data Warehouse, RUP, Microsoft Project, MS Excel, MS Word, Power Point, Clear Quest, Quality Center.