SUMMARY:

• 7 years of experience in Business Analysis, Operations Management and Project Management with extensive experience in Software Development Life Cycle methodologies (Agile/Scrum, Waterfall).
• Experienced in Requirement Gathering, Elicitation and Analysis, RFP Development, Change Management, Effort Estimation, Functional Testing, Coordinating Quality Assurance and Client Engagement/Relationship Management.
• Experienced in documenting requirement using Unified Modeling Language (Use Case and Activity Diagrams). Also building business Process Flow, Context Diagrams, Sequence Diagram, Activity Diagrams, Class Diagrams using Rational tools and Microsoft Visio.
• Good knowledge of Revenue Cycle Management, Cash Posting, NPI, NDC, DRG, CPT, NCPDP codes and NSF formats for interfaces & images to clearinghouses/trading partners applications.
• Strong understanding of various PMO techniques used in SDLC such as Rational Unified Process (RUP), Waterfall, Agile and SCRUM with hands on experience in each of them.
• Experienced in interacting with business users to identify their needs, gathering requirements, developing detailed functional specs through JAD sessions, interviews, on site meetings and authoring Business Requirement Documents (BRD), Functional Requirement Document (FRD) and Software Requirement Specification (SRS) across the deliverables of a project.
• Extensive hands on experience in creating RTM, Defect Status Report, Change Request Form, Test Plan and Collaboration Diagram and designing User Interfaces (GUI) and wireframes.
• Strong Knowledge with Iterative approach for Software Development as per Rational Unified Process (RUP). Involved in inception, elaboration, construction & transition phases using rational tools like Requisite Pro, Clear Case, and Clear Quest during various phases of RUP.
• Experienced in SWOT Analysis, Gap Analysis, Impact Analysis, Risk Analysis, and Project Planning. Excellent analytical skills in understanding the business process (AS - IS and TO-BE).
• Exceptional Problem Solving and Sound Decision Making capabilities, along with ability to manage and resolve increasingly complex situations through Root Cause Analysis.
• Extensive knowledge of RDBMS, Web and SQL along with MS SQL administration, SQL Enterprise Manager, Data analysis and reporting.
• Experienced in writing Test Case (manual/automated test cases), Conducting Integration/Regression testing, Black Box/White Box testing, UAT (User Acceptance Testing).
• Strong Subject Matter expertise in Credit Card Industry, Retail/Investment and SOX.
• Experienced in writing Business Requirements Documents (BRD), System Requirement Specifications (SRS), Use Case Modeling and Functional Specifications
• Working experience in Health Insurance Exchange (HIX), Health Information Exchange (HIE) and Encounter Data Processing System (EDPS/RAPS).
• Good knowledge of NASCO system, SCHIP/CHIP, CMS, HMO, PPO, POS and EMTALA.
• 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.
• 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.
• Extensive experience with Unified Modeling Language (UML) and modeling including Business Process Re-engineering.
• Experienced in conducting Joint Application Development (JAD) sessions through interviews and workshops with subject matter experts and business users.
• Extensive experience in conducting full-fledged training programs for new inductions and process trainings.
• Experienced in conducting Business Process Management, GAP analysis, User Acceptance Testing (UAT), Risk Analysis and Mitigation Plan
• 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.
• Extensive knowledge of Patient Protection and Affordable Care Act (PPACA) & Medicaid Information Technology Architecture (MITA).
• Possess a detail-oriented nature with excellent communication, interpersonal and organizational skills. Recognized for being a valued team player with ability to multi-task.
• Strong command in converting client’s non-technical requirements to precise technical representation to the team. Experienced in dealing with cross-functional team environment.

TECHNICAL SKILLS:

Operating Systems: Windows, LINUX

Languages and Platforms: C, C++, Java-J2EE, C#, ASP, .NET

Databases: Oracle 9i, MS SQL server

Tools: Office Word, Excel, Access, Power point, Project, Visio

Test Tools: HP Quality Centre, JMeter, Design: Balsamiq

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

PROFESSIONAL EXPERIENCE:

Confidential, Orlando, FL

Sr. Business Analyst

Responsibilities:

• Gathered requirements by coordinating with external vendor, and internal team.
• Analyzed Gap Analysis of the HIPAA 4010 and HIPAA 5010 processes to identify and validate requirements.
• Coordinated JAD sessions with all the stakeholders to understand the impact of HIPAA 5010 on the existing system.
• Gathered requirements for “Front End” and for “Core Adjudication System” by conducting meetings and brainstorming sessions with end users and Subject Matter Experts (SMEs) and documented them using Requirement Traceability Matrix and later exporting them to HP Quality Center.
• 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.
• Gathered requirements for ICD 10 transition.
• Organized requirements into High level Use Cases and Low level Use Case Specifications and modeled them into UC, Activity and Sequence Diagrams using MS Visio.
• Assisted the QA personnel in the creation of Test Cases using HP Quality Center.
• Analyzed test cases, test scripts, bugs, interacted with QA/ development teams in fixing errors and conducted User Acceptance Test (UAT).
• Practiced Agile/Scrum Development methodology for automation development
• Coordinated and prioritized outstanding defects and enhancement/system requests based on business requirements, allowing sufficient time frame to ensure accuracy and consider deadlines
• Streamlined Claims (837 EDI X12) Migration project by gathering functional specifications in Edifecs
• Daily and weekly status reporting to senior management.

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

Confidential, NYC, NY

Business Analyst

Responsibilities:

• Gathered requirements from stakeholders for provider management and member management.
• Coordinated JAD sessions for Requirement Validation with Dept. of Cleveland clinic to gather requirements for the new MMIS.
• Identified and validated business rules and data elements.
• 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.
• 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.
• Created Business requirement document, Technical specifications, Test Plan and Test cases in the waterfall and Agile methodology.
• 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.
• Analyzed Audit and Change Files of 834, 835, 820, 837 PDI, 270 & 271HIPAA EDI Transactions using MS Word, MS Excel, MS Access and Facets PROD & PPMO
• 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 crosswalk for understanding major changes from ICD-9 to ICD-10 with the help of SME’s.
• Participated in developing test plan, test scripts, and test scenarios and designed user documentation.
• Examine the system design deliverables & validating it against the SLA.
• Maintained and tracked the project plans using MS Project.

Environment: MS Office, MS Visio, Unix, SQL Server, SQL Developer, XML,, Facets, Rational Requisite Pro, Rational Rose.

Confidential, Hartford, CT

Business Analyst

Responsibilities:

• Gathering requirements 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.
• Worked on EDI X 12 transaction set 837 I/P/D, 834,276/277 feeds to allow for change in the claim number
• 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.