SUMMARY:

• 8+ years of experience in Business Requirements Modeling, Business Process Analysis, and Client/Server applications for enhancing the business processes in diverse business domains of Insurance and Healthcare.
• Certified SCRUM Master with 3 years of working experience in agile SCRUM environment with diverse teams.
• Experience working with managed care plans, Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Point of Service (POS) plans, Coordination of Benefits (COB), Explanation of Benefits (EOB).
• Experience in configuration of claims processing applications, claim adjudication process, claims management process, real time claims adjudication, Electronic Medical Records / Electronic Health Records (EMR/EHR) and Medicaid Management Information System (MMIS), and Medicaid Information Technology System (MITS).
• Good knowledge of COBRA insurance, claim submission process for CMS - 1500 (HCFA-1500) and UB-04 claim forms.
• Have knowledge of HL7 Messaging protocols, HIPAA transaction and code standards and electronic data interchange (EDI) standards like X 12 837, 270, 271, 276, 277, 278, 835, 275 and knowledge of claims encounters process.
• Worked on HIPPA 4010 and ICD 9 systems. Possess implementation knowledge of HIPAA 5010 and ICD -10 initiatives.
• Experience with health care systems: FACETS, Medicare Part A, B, C, D, Medicaid systems, and validating General Equivalency Mappings (GEMs), Technical Report Type 3 (TR3) Implementation Guide, and Companion Guide.
• Experience in SDLC, Agile, Waterfall, Rational Unified Process, and SCRUM software development methodologies.
• Experience in facilitating SCRUM ceremonies like product backlog grooming sessions, sprint planning, daily stand-up, sprint review, and sprint retrospective; Facilitated Product owner on project planning to enhance the ROI.
• Experience in working with self-organizing and cross functional teams, and well-versed with estimation techniques like Planning Poker, T-shirt sizing and Relative Mass valuation and prioritizing methods like MoSCoW, Kano, business value based and walking skeleton. Calculated sprint velocity and capacity; Handled Requirements Churn.
• Experience in Release planning, Acceptance criteria, definition of done, definition of ready, Potentially Shippable Product Increment (PSPI), minimum viable product (MVP), and good understanding of test driven development.
• Good understanding of breaking down of Epics into User stories (INVEST) and User stories into tasks (SMART) using splitting patterns like workflow steps, business rule variation, data variation, interface variation, simple/complex, major effects, operations, defer performance and others. Assisted Product Owner and the team to commit to PBIs.
• Used tools like JIRA and RALLY to create and maintain Product Burn-down chart, Sprint Burn-down/ Burn-up chart.
• Possess skills like Conflict Resolution, Sense Making, Root Cause Analysis, Risk Analysis, Communication Management, problem management, Stakeholders Management and having Servant-Leader leadership skills.
• Proficient at coordinating with stakeholders, vendors, Subject Matter Experts (SMEs), Project Manager (PM) and end users and elicitation of requirements through Joint Application Design (JAD) sessions, Brain storming sessions, interviews, Surveys and questionnaires, prototyping, benchmarking, Requirements workshops, focus groups, document analysis, Joint Application Requirement (JAR) sessions and Rapid Application Development (RAD).
• Skilled in gathering and converting User Requirements into High Level and low level documents (HLD/LLD) like Business Requirements (BRD), Functional Requirement Documents (FRD), Functional Requirement Specifications (FRS) System Requirement Specification (SRS), and visualizing graphical user interface (GUI) using mockup screens.
• Expertise in Gap Analysis, SWOT analysis, risk analysis, cost-benefit analysis, feasibility analysis, and impact analysis.
• Experienced in creating workflow analysis and design, Process re-engineering, process remodeling, Object Modeling Technique (OMT), Object Oriented Analysis (OOA), Unified Modeling Language (UML) diagrams like activity diagrams, sequence diagrams and use case diagrams through MS Visio, What-IF scenario analysis (WISA), To- Be Scenario Analysis, Gap Analysis, User Interface (UI) design, User Experience design (UX), prototypes and wireframes.
• Managing Requirement Traceability Matrix (RTM), Service Level Agreement (SLA) and assisted Project Manager with creating Work Breakdown Structure (WBS), Project proposal and Project charter, Statement of work (SOW).
• Proficient in creating and managing Use Cases, User Stories, Test cases, Test plans, Test reports, Test scripts.
• Skilled at performing User Acceptance Testing (UAT), handling Change Request, and Configuration management.
• Knowledge about different types of testing like Black Box Testing, White Box Testing, System Integration Testing, Alpha Testing, Beta Testing, Stress Testing, Static Testing, Dynamic Testing, Load Testing, Sanity Testing and so forth.
• Strong knowledge of creating conceptual data models, ER diagrams, data mapping, data profiling, data verification, data integrity, ETL process, data normalization, data dictionary, SQL queries for data analysis and data validation.
• Have good understanding of Service Oriented Architecture (SOA), client side validation, server side validation, HTML, CSS, DOM, SAX, XML, XSD, JSON, WSDL, SOAP, REST, web services, API functional testing, and Data Binding.

TECHNICAL SKILLS:

SDLC Methodologies: Waterfall, Agile (SCRUM, XP), Hybrid (SCRUM-Waterfall)

Operating Systems (OS): Windows XP/8/10/Vista, Linux, Mac OS

Modeling Tools: MS Visio, Mock-up screen, Erwin, Enterprise Architect

Requirement Management Tools: Rational Requirements Composer, Rational Team Concert, JIRA, Rally

Testing Tools: HP QC, HP ALM

Languages: SQL, HTML, CSS, XML

Reporting Tools: Tableau Desktop, IBM Cognos

Architecture: Service Oriented Architecture (SOA), 3 Tier Architecture, N-tier Architecture, Cloud Platform (SaaS)

ETL Tools: Informatica (Power Center), SQL Server Data Tools, Cognos Data manager

Databases: MySQL, IBM DB2, Oracle

PROFESSIONAL EXPERIENCE:

Confidential, Hartford, CT

Business Analyst

Responsibilities:

• Elicited and captured business requirements and technical requirements and documented them in Business Requirement Document (BRD) and Software Requirements Specification (SRS) document using elicitation techniques like JAD sessions, interviews, questionnaire, among others using waterfall-scrum hybrid methodology.
• Based on the high-level business needs, captured high level requirements common for all the domains like plan sponsor, member, provider and claim and then gathered detailed requirements individual to the respective domains.
• Performed Gap Analysis by identifying dependencies between various domains, analyzing current technology and applications, and determining the discrepancies and deficiency between the current and future state.
• Collaborated with onsite, off-shore and collocated teams, and with vendor team resources located in different geographical locations across different time zones to identify the best approach for accomplishing the solution.
• Assisted in successfully implementing and validating the single sign on (SSO) process for members in the Aetna Navigator application, so that when member accesses the link they will be directed to the vendor tool dashboard.
• Validated the claims in Automated Claims Adjudication System (ACAS) coming through the EDI Gateway (GW) application and analyzed the claim extracts to verify the claim accumulator information like annuals and deductibles, and other sensitive claim information like SSN, Subscriber ID and member ID which need to be supplied to the vendor.
• Prepared business process flow diagrams, activity diagrams, and use case diagrams for illustrating the process and flow of information between various applications to different stakeholders.
• Designed GUI and mockup screens to analyze and demonstrate to the stakeholders where the links to the vendor based tool be located, how the end results would look like, and how the member experience could be enhanced.
• Assisted in performing cost benefit analysis in conjunction with the architecture and development teams regarding usage of available APIs and services to pull in data from existing applications versus building new APIs, and using mostly batch files for making available provider data to the external vendor.
• Analyzed XML documents and XSD Schemas to validate data attributes and coordinated with architecture team to identify the best approach to make available the data elements on a real-time basis, required by the vendor.
• Developed elaborate use cases explaining interaction between user and system context, and system to system context, to demonstrate dependencies between the plan, member, provider and claim domain to facilitate design discussions with architecture team, and to illustrate member interaction with the vendor based tool.
• Maintained Open Items and Action Items log, and Team Task Tracker log for monitoring and tracking team progress, assign accountability to the related stakeholders, and document open items that needed to be resolved.
• Created and maintained requirements traceability matrix to keep track of the requirements corresponding with the business needs and link them to the test cases.
• Created data mapping documents, to analyze, map, and define the data elements, between source and target systems and identify missing fields from the source system by analyzing the claim extracts and identify the best approach to compensate for the missing fields, and determine if they can be pulled from existing applications.
• Worked closely with architecture team to identify the best approach for making available the data elements to the vendor which included- leveraging existing APIs, invoking a call to use web services and delivering the data attributes through SAML technology which uses XML format, to the vendor.
• Assisted QA team in documenting test plans, test cases, test scripts, and master test strategy for the claim, provider, member and plan sponsor information made available to the vendor.
• Assisted with User Acceptance Testing to validate if the system functionality has been accomplished based on the expectations and needs of the end user.
• Collaborated with agile teams for the member and plan sponsor areas and assisted the agile BAs in grooming sessions and documenting the Epics, user stories, acceptance criteria based on the high-level requirements.

Confidential

Responsibilities:

• Elicited and captured business requirements and technical requirements and documented them in Business Requirement Document (BRD) and Software Requirements Specification (SRS) document using waterfall-scrum hybrid methodology.
• Assisted in determining the frequency of the claims extract that needed to be sent to the FEHBP and non- FEHBP suppliers and worked closely with the development team to determine the controls that needed to be applied to the claim extracts to filter out data specific to FEHBP and non- FEHBP suppliers.
• Coordinated with the development team and identified the source system for pharmacy claim information which had to be sent to the vendor called Wageworks and identified the field names, table names which they were mapped to and the internal and external tables where they were housed.
• Functioned as a liaison and actively coordinated with resources from dependent projects within the program, to consider the possibility of using an already existing Enterprise Data Warehouse(EDW) as opposed to using a newly created application called Federal Repository Data Mart (FRDM) as it would be a more cost-effective alternative to create pharmacy claim extracts for the vendor from already existing applications.
• Created data mapping document to verify the source of the pharmacy claim data elements in the pharmacy output file layout, that is being sent to the vendor Wageworks.
• Coordinated with the development team and documented the necessary data elements for pharmacy extracts that need to be added to the external tables of the data warehouse.
• Assisted the Project Manager in handling the project plan, project scope, vision, timelines and the dependencies of this project with other federal projects at the program level.
• Developed Use Cases to describe the functionality and purpose of the federal plan migration to various stakeholders.
• Assisted the QA team in executing test cases, test plans and test scripts for the requirements captured for the migration of the federal plan related data.
• Created requirement traceability matrix and project traceability matrix to identify the dependencies of the current project with other projects within the program and to link the high-level business needs to the requirements.

Environment:: Waterfall- SCRUM hybrid methodology, Rational Requirements Composer (RRC), Rational Team Concert (RTC), Clear Quest, Clear Case, MS Visio 2010, Informatica 8.5, Altova map force, COBOL, Share Point, MS outlook 2013, MS office Suite 2013 (Word, Excel, Power point), MySQL, tableau 7.0.

Confidential, Baton Rouge, LA

Business Systems Analyst

Responsibilities:

• Implemented SDLC which included Waterfall-SCRUM hybrid agile methodology with requirements, specifications phase and development phase in iterative time boxed sprint cycles, incorporating a rigorous definition of done.
• Gathered functional and non-functional requirements and involved in development and documentation of Business Requirement Document (BRD), and Software Requirements Specification (SRS) using agile methodology.
• Developed implementation guides for Partners EDI X12 transactions such as 834, 835,837,270, 271 and 27 4.
• Assisted the Project Manager in defining the project plan, project charter, scope, vision, and timelines. Handled requests for proposals (RFP), making presentations to customers, and negotiating project timelines and deliverables.
• Performed Gap Analysis by identifying current technology, policies, procedures, documenting the enhancements for the requirements, and analyzing new HIPAA 5010 compliance and developed an action plan for the migration process.
• Prepared Business Process Models (BPM) and UML diagrams like workflow diagrams, activity diagrams, sequence diagrams, use case diagrams, by using MS Visio, for visual representation to explain various steps involved in business.
• Developed and executed detailed Use Case to describe the functionality of the system including claims transactions.
• Involved in creating and executing test cases, test plans and test scripts for EDI 837 Claims (I & P) Transactions.
• Performed Data mapping to validate and customize Claims daily load into FACETS for processing the transactions.
• Performed Data profiling through careful range and pattern analysis and checked for data integrity by looking for various data anomalies and doing data normalization and data verification using Informatica Data Quality Center.
• Build Data Dictionary for various designers, developers, users, and administration with information on contents, data-type, and data element in various tables, columns and rows, and data modelling through star and snowflake schema.
• Participated in Validating ETL process by creating various simple and complex SQL queries.
• Responsible for the development and implementation of HIPAA EDI Data Mapping artifacts 270, 271, 274, 276, 277, 820, 834, 835, 837 and 5010.
• Performed User Acceptance Testing for the ANSI X 12 Version 50 10 / EDI transactions (HIPAA) for Claims Status and Eligibility (270, 271, 276, 277, 834, 837P, 837I, 837D, 835 remittances and NCPDP Claims).
• Developed HL7 messaging for bi-directional case and disease report exchange, in HTML and XML formats, in accordance with HL7 specifications.
• Developed XSD Schemas and wrote XML test files for backwards compatibility testing.
• Created test cases for the premium calculations and Claims limits and deductibles (Claims calculations).
• Wrote SQL queries to match the results with the actual BI report.
• For User Acceptance Testing (UAT) created ad hoc BI reports using Tableau version 7.0

Environment:: Waterfall- SCRUM hybrid methodology, Version one, MS Visio 2010, Informatica 8.5, Altova map force, Enterprise architect, MySQL, tableau 7.0.

Confidential, NYC, NY

Business Systems Analyst / SCRUM Master

Responsibilities:

• Implemented SDLC, agile (SCRUM) methodology for the developing life cycle and followed the standards process in the application and elicited requirements from Business users and stakeholders by interacting with them and asking them detailed questions, and through JAD sessions, Focus Groups, Brainstorming, Prototyping and carefully recording and documenting the requirements in a format easily understood and reviewed by both business and technical people.
• As a SCRUM Master, I facilitated SCRUM ceremonies like Backlog Grooming sessions, Sprint planning meeting, Daily Stand-Up Meeting, Sprint Review, and Sprint Retrospective meetings, acting as a service leader to guide the team.
• Proficient in writing and prioritizing User Stories using INVEST in Product Backlog along with the Product Owner as per business and Technical needs using prioritizing techniques like business value based and technical value based.
• Facilitated breaking down EPICs into User stories and estimation of User Stories using estimation techniques like Planning Poker in Backlog grooming sessions, assisting the team to clarify ambiguity in estimating the user stories.
• Efficiently handled team and organizational impediments thereby fostering an environment for efficient team work.
• Used JIRA for issue tracking, User Story management and requirement traceability and created, managed, tracked and analyzed sprint Burn Down Chart and Product Burn Down chart to estimate sprint velocity, Development team’s capacity and release planning respectively, to improve and maximize value while focusing to achieve the Sprint Goal.
• Maintained SCRUM Task Board and did issue tracking through prioritizing and managing the defects using JIRA.
• Ensured that the team is following coding standards and is adhering to Definition of done to avoid/reduce technical debt and focused on resolving and shielding the team from impediments to keep them working in a group flow.
• Conducted Impact Analysis and Gap Analysis to derive and document requirements for Web based Claim Processing System (CPS) and identified AS-IS and TO-BE business processes based on which created business process models.
• Identified gaps between current policies and procedures and new HIPAA 5010 compliance, to check the compatibility of the existing system capabilities with the new requirements and developed an action plan for the migration process.
• Implemented Test Driven Development (TDD) to ensure quality of application is maintained through SDLC.
• Developed Mockup screens and wireframes using UI components such as Radio Buttons, Down lists, Check Boxes, and Data Entry Fields for web based custom dashboard of the CPS application for Business Users and Stakeholders.
• Worked with Front end and UI developers and Created HTML and CSS files using HTML5 and CSS3 for web based custom dashboard, and ensured that the client side validation and server side validation were implemented.
• Created XSD schemas and verified XML files based on XSD schemas. Assisted testers with validating XML requests.
• Developed HL7 messaging for patient EMR in text and XML formats, in accordance with HL7 specifications and performed functional (API) testing and worked with QA team in reviewing and executing test plans and test cases.
• Created Data mapping documents between various data elements, XML files, flat files, excel files, HIPAA EDI files X 12 837, 270, 271, 276, 277, 278, 835, 275, and 5010 and web services, to perform verification and validation.
• Defined Data Maps to validate and customize Claims daily load into FACETS for processing the transactions.
• Reviewed Stored Procedures for reports and wrote test SQL queries for Joins, Unions, Group By functions against the source system (SQL Server) to match the results with the actual report against the Data mart (Oracle 10g).

Environment:: SCRUM Methodology, JIRA 5.0, JAVA, Eclipse 4.3, MS Visio 2013, UML, Apache, AWS, AMI, Amazon EC2, HP ALM v11, Oracle 10g, Tableau 9.0, Altova XML spy, SOAP UI PRO, MS outlook 2013, MS office Suite 2013 (Excel, Word, Power point).

Confidential, Madison, WI

Business Analyst / SCRUM Master

Responsibilities:

• Functioned as the primary liaison between the business line, operations, and the technical areas.
• Performed Gap Analysis to understand the AS-IS and TO-BE state of the project.
• Assisted the Project Manager (PM) with the Project Plan using MS Project.
• Conducted focus groups and interviews with end users such as dentists and physicians to understand additional functionalities deemed critical on top of the mandated functionalities in hospital’s EMR System.
• Performed technology Impact for change Request and submitted it to the Change Control Board.
• Organized JAD sessions and shared calendar with tech leads to facilitate JAD sessions using MS Outlook.
• Created Workflow documents, UML diagrams, activity and sequence flow diagrams using Erwin.
• Created conceptual Data models and ER diagrams showing relationships between various data entities using Erwin. Also created BRDs, FRDs, FRSs, SRSs and use cases.
• Utilized Current Medicaid Information Technology System (MITS) Provider subsystem data map and the Department of IT data map to create crosswalk documents.
• Used Data mapping documents to Analyze source and target database, analyze data integrity, and identify areas of improvement.
• Developed and implemented Structured Query Language (SQL) queries for data integrity testing.
• As a SCRUM Master used RALLY created artifacts like burn down charts and User stories.
• Facilitated daily stand up meetings and demo sessions using Agile principles and practices.
• Wrote user stories (INVEST) in JIRA, and Planning Poker and Relative mass valuation method to estimate user stories. Managed Requirement churn and helped to define acceptance criteria.
• Used techniques like MoSCoW and KANO approach to prioritize backlog Items.
• Developed Requirements Traceability Matrix (RTM) to trace software design requirements to test cases.
• Performed manual testing and User Acceptance Testing for the web based custom dashboard

Environment:: Waterfall-SCRUM hybrid, HP ALM v11, Oracle 10g, IBM Cognos, MS Visio 2010, JIRA, Outlook 2010, MS Office suite 2010 (Excel, Word, PowerPoint), N-tier Architecture.

Confidential, Louisville, KY

Business Analyst

Responsibilities:

• Articulated and presented business analysis results clearly and concisely to programming staff and senior management.
• Acted as a liaison between business Domain Experts and Technical Team to develop high quality system.
• Lead remediation of encounters through periodic workgroup meetings between business, development, and market office. Created BRD and FRD.
• Developed Requirements Traceability Matrix (RTM) to be used in software development and QA testing.
• Performed Gap Analysis between ICD 9 and ICD 10.
• Involved in Forward Mapping from ICD 9 to ICD 10 and backward mapping from ICD 10 to ICD 9.
• Perform Gap Analysis to upgrade HIPAA 4010 to 5010; prepared solution document and project plan.
• Created Uses cases, UML diagrams, activity, and sequence diagrams.
• Handled Change requests and conducted impact analysis (Business and Technical).
• Worked on the EDI 834 file load to Facet. Participated in creating Data models.
• Worked with business users to document current end to end work flow processes and collaborated with users in identifying, defining, and documenting process improvement options and alternatives, as directed by business needs. Supported Quality Assurance by using HP AL. Participated in UAT and manual testing.
• Identified various attributes for fact and dimension tables in constellation, star, and snowflake schemas.
• Checked the ETL process by generating various SQL queries.
• Gave proper input for metadata registry based on Business users’ and stakeholders’ requirements.
• Identified required information fields and developed data dictionary.
• Worked with business users to define and document business rules.
• Participated in training users on application software.

Environment:: Waterfall methodology, MS project 2010, HP ALM V11, Oracle 10g, IBM Cognos, MS outlook 2010, Erwin, SQL, General Equivalence Mapping, MS Visio, MS Office Suite 2010 (Excel, Word, PowerPoint), MS Outlook 2010.

Confidential

Business Analyst

Responsibilities:

• Documented business requirements, and communicated these requirements with the development team for design and implementation of business solutions.
• Worked with Business Analysis team to prepare a detailed Business Requirement document (BRD) and System Requirement Document (SRS).
• Analyzed Business Requirements to develop functional and detail design specifications.
• Conducted Requirement Gathering Sessions with the stakeholders. Incorporated stakeholder feedback throughout the project lifecycle to ensure project quality and customer satisfaction.
• Interacted with the project team to help define the Business and System Objectives, confirmation of scope, identify constraints and the measures of success for the system to be developed.
• Conducted the JAD sessions, daily meetings, brainstorming sessions to solve the problems and enhance the workflow. Assisted in building a business analysis process model.
• Monitored change requests and documented requirements, integrating them with Use Cases.

Environment:: MS Visio, Mock-up screens, wireframes, My SQL Workbench 5.0, My SQL 5.0, MS office suite 2007.

Confidential

Dental Surgeon/ Project coordinator

Responsibilities:

• Managed and coordinated with physicians working in department of dentistry in-patient and out-patient department. Involved in daily operations and quality initiatives in the department.
• Analyzed and maintained statistical performance and patient satisfaction data to identify trends in service delivery. Reduced turnaround time for discharged third party insurance patients by 30 minutes.
• Designed patient and family survey tools to evaluate experience and identify areas of improvement