SUMMARY:

• Over 8+ years of experience as highly skilled Business Analyst on large time boxed projects with strong domain knowledge in Healthcare and Pharmaceutical industries.
• Extensive experience in Software Development Cycle (SDLC), application design, development, system testing and quality control methodologies such as Waterfall, Agile & RUP.
• Having expertise in ICD - CM CM/PCS Conversion, legacy claim processing systems, EDI Transactions, Financial neutrality (Organization wide) and prior authorization submission processes.
• Working expertise in Project Development Life cycle (PDLC), Business Process Modeling (BPM), Software Development Methodologies including Rational Unified Process (RUP), Waterfall, and Agile.
• Actively used Unit Sessions, Joint Application Development (JAD) and Rapid Application Development (RAD) sessions with Business users, SME's and Stake holders alike in gathering requirements, collating and analysing them to identify the real business need and facilitating the development of a customized solution which delivers maximum cost and usability benefit to the client and company.
• Extensive knowledge and working experience in converting business requirements into UML diagrams (Use Case Diagram, Class Diagram, Sequence Diagram, Collaboration Diagram, Streamline process flow diagrams) using Rational Rose and MS Visio and also managing and tracking those requirements.
• Extensive experience in producing documents like Business Requirements Documents (BRD), Functional Requirement Specifications (FRS), Software Requirement Specifications (SRS), Request for Proposals (RFP), Requirements Traceability Matrix (RTM).
• Experience in developing and imparting pre and post implementation training, conducting GAP Analysis, User Acceptance Testing (UAT), SWOT Analysis, Cost Benefit Analysis and ROI analysis.
• Knowledge in Business Intelligence, Business Architecture and Data Warehousing including Data Analysis and Data Mapping.
• Extensive experience on Excel, Word, PowerPoint, MS Project, MS Visio, Rational Suite and SQL.

WORK EXPERIENCE:

Sr. Business Analyst

Confidential, Tampa, Florida

Responsibilities:

• Gathered analyzed, documented business and technical requirements from both formal and informal sessions and validated the needs of the business stakeholders.
• Created Functional Requirement Specification for Informatics team for the development of client driven reports for a new product (Utilization Management).
• Defined process to send/receive the letter generation for the third party vendor.
• Created Functional Requirement Specification for the enhancement of the existing Health Assessments.
• Conducted and facilitated Test Cases/UAT for CareConnect Application.
• Conducted user interviews and documented business and functional requirements.
• Queried database using SQL for backend testing.
• Used JIRA Application for defect management and Product enhancement.
• Performed Requirement Analysis and developed Use Cases, Activity Diagrams using Rational Rose.
• Completed the documentation of Claims Scenarios for the source system.
• Analyzed the existing claims process and specific business rules logic applied in the ACP model.
• Created High Level Design document for the new process, integrated with legacy and Facets.
• Created Use Case scenarios and documented work flow and business process.
• Facilitated meeting with the Clients to extract business requirements
• Identified documented data sources and transformation rules required for populating and maintaining data warehouse content.
• Responsible for creating test scenarios, scripting test cases using testing tool and defect management for Policy Management Systems, Payables/Receivables and Claims processing.
• Served as conduit for managing system requirements between the business and the software development team

Sr. Business Analyst

Confidential, Toledo, Ohio

Responsibilities:

• Developed the High Level Project Requirements (HLR) for a very large project.
• Modified and used Project Templates to gather the requirements and carry on the project.
• Facilitated the requirement gathering work sessions with stakeholders, SME's and Business owners to understand and in corporate the potential requirements in the BRD.
• Coordinated the project team for JAD and BRD Sessions.
• Contributed in implementation of transitions in accordance with HIPAA standards.
• 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.
• Worked on 837 and 835 projects, including syntax and business rules for X12 HIPAA validation for loops, segments, elements, qualifiers and code sets.
• Performed System testing, Regression testing and UAT for several claim types and test scenarios.
• Compared and validated 5010 system test results with 4010 results for the same test scenarios.
• Created X12's for 4010 and 5010 standards to meet test scenarios.
• Followed a structured approach to organize requirements into logical groupings of essential business processes, business rules, information needs and insured that critical requirements are not missed.
• Frequently resolved the issues with EDIFECS and ACTTNow, primarily the generation of 997, 999, 824, 277CA reports.
• Coordinated activities between business unit and technical staff, developed new methods, policies, and procedures to meet the business needs.
• Analyzed and translated business requirements into system specifications utilizing UML and RUP methodology.
• Prepared Functional Design Specifications (FRS) employing Use case scenarios, sequence diagrams, DFDs and class diagrams.
• Identified and clearly defined functional issues and supported IT development staff throughout the design, development, unit testing, and implementation phases of the software development life cycle.
• Documented the Requirement Traceability Matrix for tracing the Test Cases and requirements.
• Documented and assisted the QA Team with the Test Plan.
• Developed Data Conversion Strategy using ETL functions for converting data from the existing site to the new site.
• Assisted Project Manager to complete the project approval process

Business Analyst

Confidential, Miami, Florida

Responsibilities:

• Conducted System Analysis & Design along with Business Continuity and Crises Management
• Authored blueprint of all Functional Requirement Specifications (FRS) and Business Level Specifications (BLS) including job profiles using UML with department collaboration and sequencing diagrams
• Conducted SME's meetings for requirements gathering, created analysis/functional specifications. Performed the requirement analysis and documented the requirements in the Business Requirement Document (BRD).
• Gathered the new processes requested by the stakeholders and listed a summary of all new reports that need to be produced.
• Conducted JAD sessions with multi location team and authored Use Cases and Use Case diagrams
• Captured business requirements using Rational Rose methodology
• Prepared Data Flow Diagrams (DFDs) and Sequence diagrams
• Utilized UML notations to document activity, deployment and workflow diagrams in Visio
• Led in-house team of 10 persons for enhancing existing functionality of the product and to manage the Sales, and Purchases company's operation
• Conducted User Acceptance Testing (UAT)
• Suggested recommendations for Integrating systems and Business Process optimization, by eliminating redundancies and reducing cycle time
• Preparation of documentation and Training of all staff members along with hiring new members.

Business Analyst

Confidential, King of Prussia, PA

Responsibilities:

• Create and maintain numerous audit tools within SharePoint that allow our department to collect, organize, and report audit results.
• Created, update, and maintain the numerous internal sub-sites in both SharePoint 2007 and SharePoint 2011, including updating content, managing permissions, and troubleshooting issues. Also developed, modified, and supported several SharePoint based workflows.
• Selected to be responsible for the 2011 Provider Incentive program that determined the individual bonuses each care provider within the entire organization received.
• Assist the new Care Management Department by creating and implementing several new processes; including but not limited to creating benchmarking and productivity tracking and reporting, creating a PTO approval process and assigning staff coverage, and completely restructuring the insurance review and authorization request process.
• Coordinate with the Project Management team to gather and disseminate educational materials to all of the care providers in preparation for the hospital wide roll out of the new ICD-10 coding process.
• Work with the DSS team and various clinical departments to create custom reports and dashboards for a various departmental needs.
• Use advance Excel functions to create a host of custom and interactive reports to identify problems with our inpatient reimbursement process.
• Communicate with several clinical departments to analyze the existing business processes and discuss the problems at hand and opportunities to overcome them.