SUMMARY:

• Information and understanding in conducting Joint Application Development (JAD) and Rapid Application Development (RAD) sessions. Conducted Requirement Gathering Sessions and interviewed Subject Matter Experts, gathered detailed functionality aspects of business process and updated the information to the requirements in an easily comprehensible format.
• Broad experience in creating business process flow diagrams, UML (Unified Modeling Language) tools to create Activity, Sequence and Collaboration diagrams.
• Robust experience in writing SQL queries for Data Analysis and QA report testing.
• Business Analysis, Supporting Strategy management, Client relations, Business modeling, CRM & Workflow, Test planning MS Office, MS Project, MS Visio, MS Excel.
• Develop User interfaces and requirements sessions. Requirements gathering, data modeling, System Architect. Feasibility studies, Scope Documents, Requests for Proposal.
• Worked on requirements emphasizing on Employee Application and Case Worker Portal with customized triggers to send notices via EP Notify in IBM Curam platform.
• Develop workflows that demonstrate current and proposed business requirements.
• Knowledge and expertise in system design and development required for business process.
• Strong knowledge of HIPAA standards 4010 & 5010, ICD - 9, ICD-10, EDI, FACETS, HL7, HMO, PPO, HIX (Health Insurance Exchange), EMR/EHR, Health Care Reform.
• Excellent skills in Business Analysis, OO Analysis, Data Analysis, Requirement Analysis, Business Modeling and Use Case Development using UML methodology.
• Develop different EDI healthcare transactions like 837 for submitting claims, 835 for payments, 834 for benefit enrollment, 270,271 for health care benefits and eligibility, 276, 277 for claims status and 278 for transmitting health care service information.
• Proficiency in the child welfare and case management business area, policies and domain knowledge in child welfare programs
• Experienced on Claims, Payments, Medicaid, Medicare (Part A, B, C and D), Provider, Portal, Billing, and Benefits.
• Extensive knowledge and work experience with Clinical works.
• Extensive experience in performing GAP analysis, SWOT analysis, Cost benefit analysis, Risk analysis.
• Hands on experience in analyzing and documenting Business Requirements Documents (BRD), Functional Requirements Documents, Use Cases and Requirements Traceability Matrix (RTM).
• Well versed with Medicaid Management Information Systems (MMIS), National Provider Identification (NPI) and familiar with Patient Protection and Affordable Care Act (PPACA).
• Broad knowledge on Waterfall, RUP and Agile methodologies.
• Incomparable analytical skills in understanding the business process, understanding the functional requirements and translating them to system requirement specifications (SRS).
• Aptitude to construct process models including data dictionaries and volume estimates.
• Able to test business applications from a business perspective to ensure that all client requirements are incorporated into the design.
• Understanding service objectives and capturing business requirements through active listening & questioning techniques.
• Keeping abreast of new legislation, company strategy and policy and being able to identify its impact on business projects.
• Experience in creating User Manuals and providing training to users.
• Proficient in customizing already existing business practices, workflows, activities and deliverables.
• Inventive and Aggressive person capable of forming and maintaining positive and productive team environments with integrative thinking skills.
• Experience in all phase of SDLC like Requirement Analysis, Implementation and Maintenance, and extensive experience with Agile and SCRUM.
• 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.
• Outstanding communication and presentation skills.
• In depth analysis and working experience in data modeling, data profiling, data warehousing, Metadata Management Services and other data concepts.
• Capable to prepare written proposals, requirements specifications, invitations to tender and solution specifications.
• Able to identify business & systems process improvements from Big Picture to detail level.
• Excellent communication skills to manage and liaise with business and technical consultants to explore business process improvement opportunities.
• Hands on experience of Data manipulation, performance testing on MySQL and MS-Access using SQL scripts.
• Served as a technical & scientific resource to therapeutic area scientists like immunology & neurology, and translated scientific requirements into successful technical solutions and processes,
• Strong knowledge in parallel testing and CR tracing.

TECHNICAL SKILLS:

Business Modeling tools: Rational Rose, Microsoft Visio, UML.

Methodologies: RUP, UML, Six Sigma, CMM, OOA,OOD

Programming Languages: SQL, PL/SQL, Java, J2EE, HTML, C, UNIX and LINUX

Project Management: Microsoft Project, Microsoft Word

Change Management Tools: Test Director

Version Control Systems: CVS, PVCS

Databases: Oracle (SQLPLUS, XQuery)

Web Technology: Microsoft FrontPage, HTML, CSS,XML, DTD/XSD

Build Tools: Ant, Maven

IDE tools: Eclipse, JCreator, NetBeans

WORK EXPERIENCE:

Confidential, El Segundo, CA

Sr. Business Analyst

Responsibilities:

• Gathered requirement through workshops and JAD sessions.
• Developed documents like BRD, FRD, Data specification document, technical specification documents, file transfer document, Data mapping document etc.
• Participated in analysis workshops for ICD 9 Procedure and Diagnosis Codes in accordance with ICD 10 CM and ICD 10 PCS Conversion Compliances.
• Developed Use case diagrams, activity diagram and system design diagrams.
• Validated CPT, HCPC, ICD 9 code sets from Data Flat files to support configured benefit plan building.
• Managed global administration and support of the Documented based Regulatory Electronic Document Information System (EDMS).
• Facilitated Electronic Data Interchange (EDI) and storage in the ICD-10.
• Worked on HIPAA Transaction Sets 837P and 837I Standards according to the test scenarios.
• Created Test Conditions from business requirement document and functional requirement document.
• Processed Medicaid claims and worked on X12 format of EDI 837 and EDI 835 for Medicaid claims.
• Accessed Diagnosis Master File and Crosswalk Mapping file to use ICD Diagnosis and Surgical Procedure Codes.
• Performed GAP Analysis to make sure that all requirements were covered by test cases.
• Prepared and submitted weekly test status reports to QA Lead.
• Used SQL, Data Warehousing and Data Cleansing for the arrangement of customer data.
• Analyzed the System Impact including MMIS Tables, Windows, Reports and Interfaces on external entities.
• Worked on EDI 834 to validate new enrollment and dismiss the enrollment.
• Accepted and validated messages in EDI 999 form like accepted, rejected, and accepted with error.
• Coordinated System and Regression testing schedules and completed the same.
• Ensured the functionality meets business requirements as defined in test results logged in RQM.
• Developed Test Cases to test the functionality of the system based on the test conditions.
• Worked with Facets team for HIPAA Claims validation and verification process (Pre-Adjudication).
• Conducted claim validation and end/denied claims analysis for the health plans Medicaid programs.
• Extensively used Rational Quality Manager to monitor the progress of assignment of testing activities and Reported executed results.
• Logged the defects in Clear Quest tool, assigned the right severity level and managed the defects through it.
• Performed parallel testing comparing unmatched fields from the ND MMIS Enterprise subsystem and the Legacy subsystem and analyzing why the fields were unmatched by looking up unmatched reasons on the Enterprise subsystem and business rules.
• Performed CR tracing by matching the use cases related to the CR’s, CTC’s, Test Plan, Test Case idsto the location on the Final DSD using Rational Clear Quest.
• Involved in fixing System testing issues and UAT issues.
• Analyzed several defects related to Edits & Audits functional area along with the help of a SME.
• Conducted KT sessions for Member, Provider and Service Authorization.

Environment: MS Office, Rational Clear Quest, Oracle database, Windows, Environment, Citrix.

Confidential, Baton Rogue, LA

Business Systems Analyst

Responsibilities:

• 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.
• Conducted meetings to work in coordination with DBA’s, Developers, Tech Leads and Data Architects to achieve enhanced clarification, consistency and assist in design sessions.
• Propose strategies to implement HIPAA 4010 in the new MMIS system & eventually move to HIPAA 5010.
• Followed AGILE methodology, created self-organizing team, induced enhanced communication for quick issue resolution & minimization of change control processes & its impacts. Obtained & recorded Business Approvals, Quality Review Approvals, and Architectural Approvals for future references & cross validations.
• Played a key resource as Business Analyst, Systems Analyst & Data Analyst during the entire SDLC phases of the project.
• Conducted meetings with business/ corporate editor to capture information and create Large & Small Group Renewal Package Mockups (reports) in Power Point.
• Make changes for HIPAA 277, 278, 835, 837 may also be receiving an (ORU) HL7 message.
• Defined and analyzed test cases, test scripts, bugs, interacted with QA/ development teams in fixing errors and conducted User Acceptance Test (UAT).
• Involved in analysis and risk assessment of EDI transaction sets based on a 834 companion guide
• Analyzed, documented and managed all EDI requirements and changes to requirements throughout the software development lifecycle
• Completed HIPAA X12N EDI QA testing of 834 Enrollment transactions for Employer Health Plans. Utilized CLAREDI testing/certification software
• Developed a System Test Plan for the 834 Enrollment transaction - Inbound / Outbound (included test scenarios, test cases and test scripts). Utilized Extol EDI mapping translator
• Developed detailed understanding of Health plan Enrollment and Maintenance (ANSI X12 834) file specifications under HIPAA framework
• Used Facets to receive 834 inbound files and processing of the files across different modules in the application
• Created Logical/physical Data Model in ERwin and have worked on loading the tables in the Data Warehouse
• Identified, researched, investigated, analyzed, defined and documented business processes and Use Case Scenarios.
• Worked on Analyzing defects in Quality center for HIPAA 5010 EDI 837 and 835(Payment and remittance).
• Validated Backward and forward mapping for ICD9-ICD10 and logged when I found bug in it.
• Performed walkthroughs of the prototype with end users to better understand user needs.
• Led policy changes or implementation of new child welfare programs into current business operations in field or central offices
• Worked with the developers to make sure that the mapping for the transition from the ICD-9 code sets to ICD-10 code sets was implemented properly and also made sure that the new ICD-10 code sets were compliant with the new 5010 standards.
• Wrote policy or procedure handbooks/manuals for use in a child welfare business operations
• Conducted GAP analysis of the transition from HIPAA 4010 to 5010 EDI 835(Payment and remittance) and 837 focusing on how current transactions and system was going to be effected by the new 5010 compliance.
• Followed a structured approach to organize requirements into logical groupings of essential business processes, business rules, and information needs, and ensured that critical requirements are not missed.
• Conducted user interviews, attended JAD (Joint Application Development) sessions, created agendas and documented analysis in requirement gathering
• Excellent in writing Agile User Stories.
• Created and managed project templates, use case templates, requirement types and traceability relationships
• Performed Gap analysis on EDI - X12 data elements captured by the existing against the new system
• Conducted Business Process Services and Workflow Analysis in the eRoom EMC Documentum (Content Management System)
• Reviewed errors and EDI transaction reports and analyzed information for trends
• Updated and maintained all reports for different errors and EDI transactions related to the inbound 834 files
• Verified and validated data model with changes to business rules related with ANSI file feed
• Worked on different EDI scenarios for batch processing
• Analyzed and reviewed existing practices, methods, and formats to create Source-to-Target mapping documentation and documented several Source-to-Target data flows
• Participated in data modelling; planning, designing, implementation of the data warehouse (ETL) and conducted testing
• Tracked requirements in a RTM capturing Req ID, BRD Number, BRD high level description, BRD grouping id, SRS id, Design element, Implementation Module, System Test Case id, UAT Test Scenario, Deployment Module, Comments.
• Created Business Process Flows (Current State & Future State), Flow Chart diagrams, Data Flow Diagrams, Use Case diagrams, Activity Diagrams using MS Visio.
• Wrote test cases and executed them for ICD9-ICD10 and HIPAA 4010-HIPAA 5010.
• Created Test Scenarios and Test Cases to perform SIT & UAT.
• Reviewed Test results pertaining to the specific desired functionality of the application. Recorded & reported defects& produced daily Test Status Reports.

Environment: MS Office, Quality Center, SQL Server, Facets, MS Project, Server, MS Visio, Unix, SQL, HTML, Java, XML, Rational Clear Quest, Windows.

Confidential, Madison, WI

Business System Analyst

Responsibilities:

• Implemented RUP methodology for iterative and incremental development of the system.
• Involved in the creation of the Mockups and Use Cases for MACD quotes and Orders using MS Visio.
• Coordinated with the stakeholders and project key personnel to gather functional and non-functional requirements during JAD sessions.
• Recorded requirements in the Requirement Traceability Matrix (RTM) defining each technical requirement in detail from areas like: main hardware, application software, networks, servers, internet and desktop configuration.
• Planned RUP iterations and documented the artifacts throughout the various phases of the development process.
• Propose strategies to implement HIPAA 4010 to HIPAA 5010 changes in the System.
• Developed an implementation guide for Partners for HIPAA 5010EDI X12 transactions such as 837 (medical claims), 835 (medical claim payments), 270 (eligibility inquiry), 271 (eligibility response), 276 (claim status), 277 (claim status response), 820 (enrollment), and 834 (premium payments).
• Studied the existing business process and created AS-IS workflow to illustrate the existing system.
• Prepared Logical Process and Data Models that contained set of diagrams and supporting documents containing the essential business elements, detailed definitions, and descriptions of the relationships between the data elements to analyze and document Business Data Requirements.
• Compiled the Vision Document and composed detailed Specification Documents in Rational RequisitePro.
• Created UML class diagrams, use case diagrams and sequence diagrams to view the system from different perspectives.
• Incorporated stakeholder feedback throughout project lifecycle to ensure project quality and customer satisfaction.
• Created Technical documentation for the project using tools like Visio, Word, etc.
• Used MS Project for managing schedules, resources and collaboration.
• Produced complete data mappings and data conversion documents needed for the Claims application.
• Performed Functional and GUI Testing to ensure that the user acceptance criteria are met.
• Co-coordinated the UAT with the SME’s to make sure that all the Business Requirements are addressed in the application.
• Formed detailed UAT and QA test plans, managed system testing and preserving testing documentation.

Environment: MS Office, MS Project, MS Visio, SQL, Oracle, Test Director, Rational Unified Process (RUP), Rational Suite (RequisitePro, ClearQuest, ClearPro), Business Objects, Windows.

Confidential, Tampa, FL

Senior Business Analyst

Responsibilities:

• Analyzed current business process flow by understanding preset business rules and conditions.
• Conducted formal interviews, Live Meetings and JAD sessions with business users and SME’s.
• Designed and developed Use Cases, Activity Diagrams and Sequence Diagrams using UML .
• Involved in Backend Testing to verify data integrity by using SQL.
• Created Data Flow Diagrams (DFDs), ER diagrams for data modeling and Web-page mock-ups using MS Visio for acceptance from end users.
• Defined project milestones, schedules, and monitored progress using MS-Project and updated plans as required.
• Analyzed and tested Data Interface needs with external systems.
• Analyzed, manipulated and updated the Database using SQL.
• Wrote multiple Test-Cases (unit, compliance, integration) for multiple transactions including837, 835, 276, 277, 270 271 transactions.
• Conducted Gap Analysis to analyze the client’s applications programs to determine the impact of the HIPAA final rule on EDI Transaction Set and Code List implementation and defined the changes to bring the affected systems into HIPAA compliance.
• Worked with FACETS Team for HIPAA Claims Validation and Verification Process (Pre-Adjudication).
• Assisted with user testing of systems and maintained quality procedures and ensured appropriate documentation is in place.
• Maintained Requirement Traceability Matrix ( RTM ) and Utilize ClearQuest for change requests and defect tracking.
• Conducted claims validation and Pend/Denied Claims Analysis for the Health plans Medicaid programs.
• Worked closely with the technical team to look up for the best possible solution on requirements by keeping business needs and technical constraints in mind.
• Updated, transferred and shared files using FTP between Windows and UNIX machines.

Environment: UML, MS Word, Rational RequisitePro, Rational ClearQuest, Quality Center, SQL, FTP, TelNet

Confidential, New York, NY

Business Analyst

Responsibilities:

• Conducted user interviews, gathered requirements, analyzed the requirements and managed change requirements by implementing change management methodology.
• Contracted with the HCFA (Health Care Financing Administration)/ Medicare Centers and Medicaid Services to provide quick, easy, and affordable access to the health care service of their choice.
• Improvised HL7 for the exchange, integration, sharing, and retrieval of electronic health information.
• Worked with the UI developer to implement UI and create enhancements to optimize user experience.
• Prioritized system impact analysis for web portal experience development.
• Identified and documented issues, risk and gaps, their descriptions, their impact and provided recommendation and alternatives to develop the application to meet the user requirements.
• Worked in a team to develop use cases for their newly added application layout and understood all the business processes related to newly added layout and designed use cases that helped developers to build application.
• Interacted with the developers on resolving the reported bugs and various technical issues.
• Involved in UAT to confirm that the system under test meets the user needs and provides confidence in its use.
• Performed verification tests to validate the data integrity.
• UML diagrams such as activity and use case diagram were used to document the requirements and ensure creation of high level business requirements documentation.
• Worked cross functionally with developers, QA and project managers to make sure each data could address their needs.
• Performed verification tests to validate sure integrity of data.
• Developed documents and implemented appropriate policies and procedures related to patient accounting, including follow-up on all patient accounts receivable. Actively participated in and monitored the accounts receivable management activities.

Environment: Agile, Rally, MS. Visio, SQL Server, MS Office Suite, HP Quality Center Automation tool