SUMMARY:

• Total of 9 yrs. and over 6 years of professional experience as Business Analyst with expertise in Software Development Life Cycle (SDLC) and project lifecycle recently in HealthCare & Insurance Environment.
• Comprehensive knowledge of Waterfall, RUP, Agile and SCRUM methodologies.
• Organized many Joint Application Developments (JAD) sessions, scrum meetings, walkthroughs, Interviews, Workshops and Rapid Application Development (RAD) sessions with end - user/clients/stake holders and the IT group.
• Good working exposer to HIPAA 4010, 5010 Platform. Good working knowledge of HIPAA ICD10 and HIPAA transaction requirements.
• Experience in healthcare environment with extensive working knowledge of provider and payer system configuration, use, and data exchanges (EDI).
• Efficient in all areas of claims insurance/healthcare, including: CMS, HMO, POS, ASO, PPO, EPO, Commercial Managed Care; Medicare Advantage; Indemnity; Medicaid Plans, Division of Financial Responsibility and Coordination of Benefits Methodology.
• Experienced in Enterprise Integration, Systems, Architecture and Business Process Integrations that includes Service Oriented Architecture (SOA) and B2B solutions.
• Manage all aspects of the client medical billing practices for the entire life cycle.
• Electronic claims knowledge includes ANSI ASC X12 HIPAA compliant formats of 837P, 837I, 835, 834, 270/271, 276/277 & 997.
• Knowledge of CMS and Medicare Secondary Payer regulations, medical billing, CPT and ICD-9 coding.
• Participated in successful large scale efforts in migrating medical procedure codes from ICD9 codes to the newer ICD10 codes to meet new government regulations from the BA prospective.
• Good understanding of industry standards such as HIPAA, CMM, Six Sigma, SOX, ISO.
• Extensive exposure to Rational Unified Process (RUP) methodology including UML. Experience with User Acceptance Testing (UAT) and release skill sets.
• Developed Use Case diagrams, Sequence diagrams, State diagrams and Activity diagrams using UML to make users and developers understand the system.
• Documentation: Wrote BRD, PRD, FRD, use cases, test scenarios, test cases for testing the functional and non-functional aspects
• Created and maintained Narrative Use Cases (Business Use Cases, System Use Cases) and modeled Use Case Diagrams, Activity Diagrams, Data Flow Diagrams using MS Visio.
• User training on the changes being released and conducting post production activities like getting feedback from users. In case of any issues - doing root cause analysis, prioritizing tasks with business users.
• Experienced in Business Analysis, SWOT Analysis, Gap Analysis, Risk Analysis, Disaster Recovery Planning, Testing and Project Planning.
• Experience writing SQL queries and optimizing SQL queries. (inner and outer joins)
• Experience with Data Analysis, Data Mapping and Dimensional Modeling experience in decision support systems (data marts) using Star Schema.
• Excellent communication and presentation skills with experience in the development, implementation and integration strategies within a team oriented environment, utilizing quantitative and qualitative analytical skills.

TECHNICAL SKILLS:

Platform: Windows XP/Vista/7/2003, UNIX

SDLC Methodologies: Agile/Scrum, RUP, Waterfall

Programming language: Java, HTML, SQL

Industry Standards: UML, OOAD, RUP, CMMI, Six Sigma, HIPAA

Data Base: Oracle 11g/10g/9i, SQL Server 2005/2008, DB2,MS Access

Modeling tools: MS Visio, Requisite Pro

Testing Tools: Quality Center (Test Director), Rational Rose

Reposting Tools: Cognos 9, Crystal Reports

Other tools: Microsoft Office Suite (Excel, Word, PowerPoint), MS Project, Rational Rose, CA Clarity, Lotus Notes

PROFESSIONAL EXPERIENCE:

Confidential, Windsor, CT

Business Analyst

Responsibilities:

• Elicited requirements from Subject Matter Experts (SMEs) interviews and documented them as per the needs and requirements of the project and prepared PRDs, BRDs and FRDs for the enhancement of the existing services.
• Created Statement of Work (SOW) document for various capabilities in the Initial Requirements Gathering Phase.
• Managed all the requirements in Requisite Pro, making requirements available to all team members.
• Analyzed the functional details of various modules in mainframe and did the GAP Analysis with the new system.
• Involved with all the phases of Software Development Life Cycle (SDLC) and utilized Rational Unified Process (RUP) to configure and develop processes, standards and procedures.
• Produced RACI charts outlining all stakeholders and project team members assigning responsibility, accountability etc.
• Reviewed claims processing procedures and made recommendations for business process improvements.
• Built benefit plans for all lines of business and conducted unit systems integration and regression testing of those plans.
• Part of Business Process Reengineering Support Team of 6 personnel that leveraged Lean Six Sigma, Change Management and other Continuous Process Improvement methodologies to improve Claim Processing Cycle.
• Work closely with Underwriting and other internal departments to coordinate medical and dental responses to RFPs.
• Used Requirement Traceability Matrix (RTM) to verify that the current requirements are being met and to aid in the creation of a Request for Proposal (RFP), various deliverable documents and project activities.
• Assist in the definition and maintenance of the standards of project management and process within the Claims-Technology- PMO through effective facilitation, tracking, reporting and training.
• Performed research and trouble-shooting for claims transactions or software issues for CMS Change Requests and Medicare Secondary Payer (MSP) claim adjudication processes.
• Validated data at the Backend to ensure that all the Claims related data has been loaded as per the Standards.
• Good knowledge of medical billing codes such as ICD-9, Revenue, HCPCS and CPT codes that are used on the UB04 and CMS1500 claim forms and various systems and applications for claims adjudication. Assist and troubleshoot daily medical billing/contract issues on a more technical level.
• Monitor daily processing of medical billing data on a daily basis to proactively identify potential client service issues related to Managed care, Medicare, Medicaid, Tricare and Workers Compensation contracts/claims.
• Trained customers on how to build benefit plans and use the claims modules of the claims processing software program.
• Provided Cigna’s CRM support for all system users, escalating technical issues to IT department when necessary.
• Conducted JAD/JAR sessions with business units and stakeholders to define project scope, to identify the business flows and determine whether any current or proposed systems are impacted by the new development efforts
• Created workflow diagrams, UML diagrams, process models, activity diagrams, use cases, swim lanes, for incorporating design changes in the order creation/ management system.
• Developed complex SQL queries using joins, sub queries to test data tables against the source and target and to validate data and verifying referential integrity.
• Coordinated the upgrade of Transaction Sets 837P, 835 and 834 to HIPAA compliance, Support CIGNA's ability to intake both 4010 and 5010 compliant claim transactions.
• Used MS SharePoint as a central repository for all project documentation and the communication of project information.
• Managed project schedules utilizing project management software tool, MS Project for the development and deployment of IT systems.
• Utilized Agile Methodology to configure and develop process, standards and procedures
• Reviewed and validated all code changes that were found during QA and UAT testing.
• Created traceability view between Use Cases, Test Cases, and System design to assist the program with all acceptance testing phases.
• Identify, Analyze, Track and Report defects and errors using Mercury Quality Center
• Monitored and managed Project progress using MS-Project.
• Manage production support issues and monitor that they are resolved efficiently and closed on time.

Environment: RUP, HIPAA, EDI,MS Office Suite (Excel, Word, PowerPoint), Requisite Pro, Rational Rose, MS Project, Window XP/7, MS Visio, Oracle 11g/10g, PL/SQL, UML, JAD, Requisite Pro, SharePoint 2010, CA Clarity, UAT, Agile, Quality Center, Lotus Notes

Confidential, Chicago, IL

Business Analyst

Responsibilities:

• Gathered information by interviewing subject matter experts (SMEs) and other key members from the business teams regarding their requirements and produced Business Requirement Documentation (BRDs) and Product Requirement Documents (PRDs).
• Created Process flows, CRS and BRM documents for ICD claims workgroup(i.e. Claim Submission, Claim Adjudication, Post Adjudication and Claims review)
• Responsible for providing Status reports, Action items, Risk, issues and daily meeting agenda to PM.
• Conducted JAD/JAR sessions with management, SME, vendors, users and other stakeholders for open and pending issues.
• Planned and defined Use Cases, Use Case Scenario and Use Case Narrative using the UML (Unified Modeling Language) methodologies.
• Worked extensively on ICD Claims processing system to upgrade ICD 9 Diagnosis and procedure code to ICD 10
• Used MS Visio for creating UML Diagrams; Use Case Diagrams, Activity Diagrams, and Sequence Diagrams.
• Interacted with group of SMEs on daily basis to prepare and update the functional requirements documents, prepared Non-functional requirement documents (SRS)
• Conducted and documented session for the preparation of logical design documents and physical design documentation
• Provided training sessions on Quality center to the team Business Analysts.
• Executed several SQL queries in DB2 as part of backend testing and involved in data validation and verifying data-integrity and also to check the data flow between different Systems.
• Developed tables, Views, Stored Procedures and Triggers using SQL Scripting.
• Loaded business requirement, generated reports for business team in to the Quality center, monitoring Quality center for ICD 10 to make sure all requirements are uploaded correctly and ready for testing team.
• Implement procedural and process controls to the change management process utilizing SDLC frameworks and methodologies.
• Used MS Project for creating project schedules, distributing resources and managing budgets.
• Participated in documentation of Requirement traceability matrix (RTM) and performed Gap analysis.
• Work with other business units such as the Configuration, Claims, and Provider Relation to facilitate completion.
• Business Process Reengineering: Identify all the processes in an organization and prioritize them in order of redesign urgency.
• Identified and analyzed techniques that can be used in a business process improvement (BPI) situation.
• Analyze installation and administration documentation for SOA-based claims software.
• Produced all requisite documentation from Business and Functional requirements to UAT Specifications as well as implementation documentation following IIBA guidelines.
• Publish and maintain documents on the SharePoint site.
• Provided production support for troubleshooting issues and problems.

Environment: RUP, Waterfall, MS Office 2007(Excel, Word, PowerPoint), Requisite Pro, MS Visio, DB2, SQL Server 2005, Quality Center (HPQC), NASCO, Microsoft Project, SharePoint 2010, Windows XP.

Confidential, Long Beach, CA

Business Analyst

Responsibilities:

• Interact and interviewed business stakeholders, SMEs, end-users, developers, system architects, testers, and technical writers to gather all business and functional requirements for Phase II of the CEMS Enhancement Project.
• Analyzed business requirements and created BRD (Business Requirement Documentation) and Product Requirement Documents (PRD).
• Performed multiple outsourcing tasks including time and materials documentation for outsourcing projects; writing RFPs to software vendors, developing web-page prototypes using MS FrontPage and software evaluation.
• Developed use cases and wireframes for the project using OOAD concepts.
• Developed, documented, and implemented policies & procedures across the board to meet service level agreement associated training plans for user administration, and appropriate use.
• Used JAD/JAR sessions in gathering business requirements from various users and stakeholders to understand the needs of the business.
• Created UI Storyboards, Mockup Reports, Use Cases, Data Flow Diagrams (DFDs) and power point presentations.
• Gather data through interview, survey, and on-site observation, working with staff from bureaus, institutions, and outside agencies.
• Conduct studies for a variety of business and procedural problem areas.
• Documented current state, and defined future state, and prepared gap analysis.
• Used MS Visio for creating UML Diagrams; Use Case Diagrams, Activity Diagrams, and Sequence Diagrams.
• Facilitated data mapping between mainframe (DB2) and client/server (Oracle) repositories on UNIX.
• Generated SQL queries to validate various reports, loads and extract processes.
• Performed Impact Analysis after implementing the change management processes.
• Maintained documents on SharePoint to facilitate seamless interaction with multiple teams with different document repositories.
• Performed manual, black box, component and regression testing throughout the Software Development Life Cycle (SDLC).
• Worked as technical writer and supported developers, testers to author end-user documentation.
• Worked with clients directly in assistance with UAT issues and defects.
• Used the RTM (Requirement Traceability Matrix) to track the requirements in each phase of the project.
• Produced reports using Business Objects and Crystal Reports.
• Provided production support testing for upcoming and current releases.

Environment: RUP, MS Office Suite (Excel, Word, PowerPoint), PL/SQL, Oracle 9i, DB2, PL/SQL, CA Clarity PPM, Window XP, Unix,/Linux, MS Visio, UML, JAD, Crystal Reports, Cognos, SharePoint 2007, Dreamweaver, UAT, Citrix, Photoshop

Confidential, Portland, OR

Business Analyst

Responsibilities:

• Coordinated with brand management, information services team, creative agencies, site production team and international site management to deliver engaging and on-time content for consumer interactive website
• With business stakeholders, defined image requirements and standards with all teams from product developers, photography, digital creation and configurator development team to create consistent product presentation.
• Worked on Storyboarding, Rational Unified Process (RUP), UML, Gap Analysis and conducted JAD Sessions.
• Work with factories, liaison offices, and logistics partners to evaluate and refine production and shipment process to increase efficiencies in delivery timeframes
• Performed global production management on website content to define resource requirements, timelines and budget to deliver on site redesign.
• Used MS Visio for creating UML Diagrams; Use Case Diagrams, Activity Diagrams, and Sequence Diagrams.
• Ensured Traceability and Quality Assurance (QA) for requirements through the SDLC and across the team.
• Utilize SQL queries to capture extensive data for analysis. Resolve issues related to web development, system improvements, and end-user training.
• Played a key role in the testing at the UAT, SAT and CAT levels having possessed SME knowledge of the business processes involved.
• Provided production support.

Environment: MS Office Suite (Excel, Word, PowerPoint), MySQL, MS Access, HTML, Javascript, Dreamweaver, Window XP, MS Visio, UML, JAD, RUP, Trackwise, Mindjet Mind Manager

Confidential

Design Engineer

Responsibilities:

• Tracked the defects in legacy reports as per account managers and end users. Compared the results and tracked the differences in Excel
• Managed workload, schedules and coordinated status review meetings with project managers, business managers and team members.
• Involved in weekly, monthly closing activity. MIS for accounting purpose at Regional & Head office. Experienced on module implementation, program testing, and report generation and inventory management.
• Customize price determination process with necessary condition types, condition table, access sequence & schema group.
• Inventory management: Managing materials stock by quantity, by value, goods issue, Stocks movement documentation.
• Developed Gap Remediation Document which identified risks and provided potential solutions.
• Configured Subcontracting & consignment process.
• Creation of service master, service PO & service entry sheet.
• Stock transfer orders for transfer of materials from plant to plant.

Environment: MS Office Suite (Excel, Word, PowerPoint), Window XP, PVCS, ERP