SUMMARY:

• Facilitator between Business Systems and Information Technology with over 8 years of extensive Business Analyst skills - Understanding of Software Development Life Cycle (SDLC), Rational Unified Process (RUP), Agile/Scrum methodology, Unified Modeling Language (UML), Object Oriented Analysis and Design Concepts (OOAD), Business Process Re-engineering (BPR), Test Lifecycle, Data Modeling.
• Extensive experience in writing Business Requirements Documents (BRD), System Requirement Document (SRD), Use Case Specifications, Functional Specifications, Technical Specifications across the Deliverables of a project.
• Good experience in Relationship Database Management System (RDBM).
• Experience in handling Change Management and Release Management.
• Extensive Experience in UML and Process modeling using Use Case Diagrams, Activity Diagrams and Sequence Diagrams.
• Good experience in conducting Joint Application Development (JAD) sessions through interviews and workshops with subject matter experts and business users.
• Good experience with Rational Rose, Rational Requite Pro, Rational Clear Quest, Rational Clear Case, MS Project, MS Visio, Crystal Reports.
• Experienced in conducting GAP analysis, User Acceptance Testing (UAT), Risk Analysis and mitigation plan, Cost benefit analysis and ROI analysis.
• Good Understanding of pharmacy benefit management.
• Well versed with Medicaid Management Information Systems (MMIS), National Provider Identification (NPI) and familiar with Patient Protection and Affordable Care Act (PPACA).
• Experienced in various MS Windows platforms, OS, Office Suite, etc.
• Excellent knowledge of Health Insurance Portability and Accountability Act (HIPAA) transaction, code set rules such as EDI 837, 835, 834, 270, 271, 276, 277 and ICD9-ICD10.
• Extensive knowledge of Medical Management Information Systems (MMIS), Medicaid, Medicare, Procedural and Diagnostic codes and Claims Process
• Strong knowledge of Health Insurance Portability & Accountability Act (HIPAA) standards, Electronic Data Interchange (EDI), Implementation and knowledge of HIPAA code sets, ICD-9, ICD-10 coding,, HL7, HMO, PPO.
• Presented several documents and Use Cases for multiple transactions and worked with ANSI X12 5010 and ANSI X12 4010 including the standards for medical transactions like 837I, 837P, 835, 276, 277, 270, 271(both inbound and outbound) transactions for ongoing industry projects.
• Good knowledge of Health Insurance Plans (Medicare Part A, B, C and D), managed care concepts (Medicaid and Medicare) and experienced in determining the membership eligibility, billing experience within life and disability in health plans. Excellent knowledge of HIPAA standards, EDI (Electronic data interchange), transaction syntax like ANSI X12, Implementation and Knowledge of HIPAA code sets, ICD-9, ICD-10 coding and HL7.
• Experience with Business Process Management.
• Experience in conducting GAP analysis, SWOT analysis and Root Cause Analysis.
• A solid base in gathering and documenting user and business requirement.
• Extensive working and using experience in IBM Curam (HCR and CGIS).
• Expert in writing complex queries using SQL using various tools like Db Visualizer, TOAD etc.
• Trace and inform business requirement changes through the lifecycle of the project using Rational Requisite Pro and Rational Clear Quest while maintaining customer needs and maintain a Requirements Traceability Matrix (RTM) to keep the stakeholders informed of the progress of the project.
• Feasibility studies, Document generation and conducting sessions.
• Strong experience in the creation of Test Plan and Test Cases from the Requirements document.
• Documentation of the Test Plans, Test Cases, Test Scripts, Test Procedures based on the Design Document and User Requirement Document for the Black Box, Functional, Usability and User Acceptance Testing (UAT).
• Adapt at creating, editing and coordinating extensive communication networks (facilitation of joint application design (JAD)) sessions and interviews, implementation requirements, project status reports, project impact analysis, request for estimates, oral presentations and email to keep executive staff and team members apprised of goals, project status, resolving issues and conflicts
• Developed User interfaces, mockups, wireframes for users to relate in the requirements sessions.
• Comprehensive knowledge of the testing lifecycle within web, client server & Mainframe environment.
• Experience working in a team-oriented environment and contributed effectively as a problem-solver. Attention to details and ability to prioritize tasks along with excellent communication, project management and problem solving skills. Analytical, methodical, and resourceful approach to problem solving, identifying root causes and corrective.
• Working knowledge of Bug Reporting Tools like Test Director.
• Expert level skills in MS Office products like MS Word, MS Excel, MS Project, MS Visio, MS PowerPoint and MS SharePoint.
• Use Case development and UML modeling using modeling tools like Rational Rose/MS Visio.
• A motivated, committed, quick learning, detail-oriented team player with good communication, analytical, leadership, interpersonal and problem solving skills.

TECHNICAL SKILLS:

Operating Systems: Windows, UNIX, LINUX, Mac

Languages: SQL, C, C++, Java, XML, C#, VB, ASP, .Net, Assembly, VHDL

Databases: Oracle, MS SQL server, MS Access, IBM DB2

Tools: MS Office: Word, Excel, Access, Power point, Project, Visio, Front Office, Rational Rose, SoDA, Software Modeler, Team Test, Doors, PROLOG, Clearcase, Clear Quest,, Web Sphere, Business Modeler, HP Quality Centre, Ultra Edit, TOAD.

Industry Standards: HIPAA, SOX, ISO, Six Sigma, CMM

PROFESSIONAL EXPERIENCE:

Confidential, Baton Rouge, LA

Business Systems Analyst

Responsibilities:

• Gathered requirements by conducting meetings and brainstorming sessions with end users and Subject Matter Experts (SMEs) and documented them using Requisite Pro.
• Propose strategies to implement HIPAA 4010 in the new MMIS system & eventually move to HIPAA 5010.
• Prepared Business Requirement Documents (BRDs) after the collection of Functional Requirements from System Users that provided appropriate scope of work for technical team to develop prototype and overall system.
• Support the new Affordable Care Act (ACA) Branded Prescription Drug (BPD) initiative as the key Business Analyst.
• Acted as a liaison between the Managed Care Organizations (MCOs)/Medicaid providers and the development team in gathering requirements.
• Gathered requirements and modeled the data warehouse and the underlying transactional database.
• Performed Gap Analysis of the processes to identify and validate requirements.
• Identified/documented data sources and transformation rules required populating and maintaining data warehouse content.
• 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).
• Organized requirements into High level Use Cases and Low level Use Case Specifications and modeled them into UC, Activity and Sequence Diagrams using Rational Rose and MS Visio.
• Created Business requirement document (BRD), Functional Requirement Specification (FRS), Technical Requirement Specification for application development following the Agile methodology.
• Apply UML notations and methodology in developing models that accurately represent the business process and workflows and clearly communicate them to the stakeholders.
• Conducted JAD sessions involving the management, development and user teams for clarifying requirements and facilitating better communication.
• Analyzed the laws and regulations (HIPAA, HL7) before implementing the electronic medical record software
• Worked on interface requirements for the Patient Appointment feature in the system that allowed the user to check the Doctor's availability & their schedule before finalizing the patient's appointment.
• Gathered requirements to allow feature that allowed the user to capture notes in the quick notes section where any important points related to the appointment could be entered & viewed.
• Identified, researched, investigated, analyzed, defined and documented business processes and Use Case Scenarios.
• Worked on a solution to establish a system that COB teams can use to maintain accurate TPL coverage information in the client’s Medicaid Management Information System (MMIS) to trigger appropriate cost-avoidance and recovery activities.
• Documented & validated the requirements for Patient Care Module which includes the IPD & OPD modules. The main components of IPD & OPD modules were Patient Appointments & Hospital visit history. These modules also included prescription & medication details as well as patient Admission details.
• Created data requirements to extract data from Curam and Connecture and exact sources for reports.
• Performed testing on application Renewals to determine case is renewed and program determination given as per IBM Curam rules engine.
• Involved in data modeling process for designing the data warehouse.
• Analyzed and prepared Risk Analysis and Impact Analysis reports.
• Coordinated and prioritized outstanding defects and enhancement/system requests based on business requirements, allowing sufficient time frame to ensure accuracy and consider deadlines
• Reviewed Test Plans developed by the testing team for testing the application.
• Assisted the QA personnel in the creation of Test Cases using Rational Test Manager.
• Involved in performing version control and defect tracking activities using Rational Clear Case and Rational Clear Quest.

Environment: UML, MS Visio, MS Project, Ms Office, C++, Java, SQL, RDBMS, XML, Windows

Confidential, Buffalo, NY

Sr. Business Analyst

Responsibilities:

• Gathered requirements from stakeholders for provider management and member management.
• Identified and validated business rules and data elements.
• Propose strategies to implement HIPAA 4010 in the new Medicaid (MMIS) system & eventually move to HIPAA 5010.
• Created 837(P, I, D) claims, and maintained data mapping documents in reference to HIPAA transactions primarily 837(P, I, D), 835, 270/271, 276/277 and 278.
• 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.
• Analyze EDI - X12 data elements captured by the existing system to validate it against the data elements required for new system.
• Worked with legacy team in developing BRD for multiple system change requests and participated in system testing.
• Worked within project team to identify and interpret state Medicaid policies as applicable to customer defined algorithm research as well as assist with internal development of new healthcare analytics.
• Conducted Impact analysis when there is any change in the requirements and updated the Business Requirements Document (BRD) and Systems Requirements Specification (SRS).
• Facilitated meetings with the technical team and client team to analyze the current process and gather requirements for the proposed process.
• Created functional requirement specification documents such as UML diagram, use case diagram, scenarios, activity diagrams and mapping.
• Developed the User Interface (UI) prototypes to capture and validate requirements and spike solutions to the current problem.
• Analyzed requirements for developing a cross-walk for understanding major changes from ICD-9 to ICD-10 with the help of SME’s.
• Used code sets such as HIPAA code sets, ICD-9, ICD-10 coding and HL7 - Health Level Seven International (HL7) HL7 provides standards for interoperability that improve care delivery, optimize workflow, reduce ambiguity and enhance knowledge transfer among all of our stakeholders, including healthcare providers, patients etc
• Facilitated JAD sessions for Requirement Validation with Dept. of Cleveland clinic to gather requirements for the new MMIS.
• Participated in developing test plan, test scripts, and test scenarios and designed user documentation.
• Used RUP methodology for the entire SDLC.
• Performed GAP analysis to identify the AS-IS a process and TO-BE processes required to achieve the targeted goal
• Examine the system design deliverables & validating it against the SLA.
• Developed UAT test cases associated with the functional requirements.

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

Confidential, Little Rock, AR

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 HIPAA compliance regulatory document to safe guard patient information.
• Analyzed and studied the technical, structural and data content changes for EDI transaction sets 834 (Enrollment and Maintain ace), 837 (Professional, Institutional and Dental Claims) and 835 (Claim Payment/Advice).
• Implemented RUP methodology for iterative and incremental development of the system.
• Performed GAP analysis to identify AS-IS a process EDI transaction set 834,837 and 835 of 4010A and TO-BE processes of HIPAA standard and based on that developed Business Requirement Documents.
• 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 risk 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.
• Involved in training and quality of the overall workflow process.
• 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.