PROFESSIONAL SUMMARY:

• Expert in all phases of Requirement Management, including gathering, analyzing, tracking requirements and quality assurance.
• Worked closely with project managers, SMEs, and staff to understand and brief the requirements and specifications for new applications along with re-engineering the existing applications.
• Strong understanding of various SDLC methodologies such as RUP, Waterfall and Agile with hands on experience in all of them.
• Experienced in writing and preparing business requirements documents (BRDs), system requirements specifications (SRS), system design specification (SDS), functional specifications, defining project plan and change request.
• Conducted JAD sessions, Gap analysis, and prioritized requirements using interviews, document analysis, and requirements workshops.
• Experienced in documenting requirement using Unified Modeling Language (Use Case and Activity Diagrams) and building business Process Flow Charts.
• Expert in organizing and managing all phases of the application testing process using Mercury Quality Center.
• Strong understanding of test plans, test cases, test scripts and defects tracking/reporting.
• Extensive knowledge of SQL queries and back end system integration testing.
• Conducted User Acceptance Testing (UAT) and verification of performance, reliability and fault tolerance issues for web based and client/server applications.
• Strong understanding of Functional, Integration, System, and Regression testing.
• Experienced in various Healthcare areas like Enrollment, Benefits, Claims, Medicare, and implementation of HIPAA key EDI (ANSI X12) transactions.
• Involved in HIPAA gateway transactions 997/999 and converting HIPAA 4010 messages into HIPAA 5010.
• Well versed experience in all EDI transactions like 834, 837 P, 835, 27x and conversion of 4010 to 5010.
• Dealt with the complexity of migrating from the ICD-9 set of diagnostic codes to ICD-10.
• Excellent communication and writing skills and adept at facilitating walkthrough and training sessions.

TOOLS AND TECHNOLOGIES:

• Methodologies: RUP, Agile, Waterfall
• Requirement management tools: Rational RequisitePro, Enterprise Architect
• Project management tools: MS Project
• Business Modeling: Rational Rose, MS Visio
• Defect tracking: MQC, TestDirector, Rational ClearQuest/ClearCase
• Web technologies/languages: SQL, C++, Java, VB-scripts, XML, XSLT, web services, SOA, HTML, CSS, .NET, TSL, ODBC, OLTP, FTP
• Front-End tools: Microsoft Excel, Access, Front Page, Flash, SharePoint
• Database: MS SQL Server, MS Access, Oracle, IBM DB2, SQL*Plus, SQL *Loader, Toad 7.6
• Operation system/platform: MS Windows 2003/XP/2000/NT, AS/400, UNIX, Sun Solaris, IBM AIX, Apache HTTP Server, IIS

EXPERIENCE:

Confidential, Maryland, MD May '11- Present
Business Analyst/Data Analyst
Project Description:
Participated in company-wide design, development, testing, and implementation transition from a legacy system to Xcelys enterprise solution. Adhered to strict compliance, policies/regulations configured Facets modules such as Claims, Membership, Benefit and plan. Part of the project was to migrate all application functionality and convert data from a mainframe-based system to an open systems environment. I was also assigned to do Up-gradation from HIPAA X12 4010 transaction to HIPAA X12 5010 and ICD 9-CM (Clinical modification) to ICD-10-CM/PCS (Clinical modification/procedure coding system)and data mapping simultaneously.
Responsibilities:

• Worked with a cross functional and diverse team of business users and developers to enable accurate communication of requirements and ensure consensus.
• Analyzed data and created reports using SQL queries for all issued Action Items. Performed the Gap Analysis to find the existing gap between the HIPAA 4010 and HIPAA 5010 EDI transactions.
• Developed Data Mapping and Crosswalk documents.
• Involved in preparing several Use Cases, Business Process Flows, and Activity Diagrams using Microsoft Visio.
• Worked on requirements of the 835 HIPAA projects, 276/277, 278, 837, and HIPAA EDI Transactions across enterprise.
• Initiated with a comparison report of migration of 4010 to 5010. 270 Eligibility, Coverage or Benefit Inquiry (V4010X092A1) vs. 270 Eligibility, Coverage or Benefit Inquiry (V5010X279), 278 Prior Authorizations.
• Tested the ANSI X12 Version 4010 / EDI transactions (HIPAA) like 270, 271, 276, 277, 278 837P, 837I, 837D, 835 remittances)
• Used General equivalence Mappings (GEM) to convert ICD 9 to ICD 10.
• Worked on the existing mainframe system to understand the code written in COBOL, documented the system requirements from the COBOL code and came up with Use Cases from the analysis.
• Wrote Test scenarios and test cases for testing the migration of EDI 4010 to 5010 and the processing of member enrollment and benefits, batch jobs corresponding to the claims (837) and real time transactions like 270/271/276/277.
• Worked with multiple teams and coordinated with them to do various releases. Involved in forward mapping from ICD 9 to ICD10 and backward mapping from ICD10 to ICD9 using General equivalence Mappings (GEM).
• Performed Gap Analysis for HIPAA 4010 837P and 835 transactions and HIPAA 5010 837P and 835 transactions.
• Involved in impact analysis of HIPAA 5010 835 and 837P transaction sets on different systems.
• Re-engineering and capturing of EDI transactions with legacy systems [Enrollment -834, Eligibility Transaction (270/271), Claims (837), Claim Status Request and Response (276/277), Remittance (835)].
• Performed Migration and Validation per SDLC standards. Interacted with the Test Team and reviewed Test Plans and Cases.
• Assisted in Regression Test, System Test, and UAT.
• Worked with the business/functional unit to assist in the development, documentation, and analysis of functional and technical requirements within FACETS.

Environment: Microsoft SharePoint, MS Visio, MS Office, HP Quality Center 10.0, Toad for Oracle, Team Track, AGILE methodology, DB2

Confidential, Bronx, NY Jan 2010 - April 2011
Business Analyst/Data Analyst Affinity Health Plan is an independent, non-profit managed care plan that serves the needs of over 210,000 residents of the New York Area and provides healthcare coverage through its family health plus, Medicare & Medicaid programs.
Affinity Health Plan implemented Facets Enterprise administrative system, a new core system built by TriZetto, with updated technology to allow for more efficient claims processing, membership enrollment and provider data maintenance & getting access to customer records. X12 EDI and HIPAA standards were followed thorough the project.
Responsibilities:

• Assisted the project manager in the creation of the project charter & vision document during the inception phase of the project
• Performed GAP analysis as pertains to membership management and claims processing to evaluate the adaptability of the new application with the existing process
• Understood EMEVS, the NY state's electronic Medicaid eligibility verification system & the Medicaid & Medicare intermediary along with their roles in claim processing
• Produced Activity diagrams with defined swim lanes as part of claims process analysis
• Involved in gathering and prioritizing requirements using 1 to 1 interviews, job shadowing, brainstorming & developing questionnaires
• Translated business requirements into functional specifications and documented the work processes and information flows of the organization
• Used TriZetto HIPAA Gateway to comply with HIPAA standards (270/271, 276/277 & 837) for EDI transactions
• Coordinated with the developers and IT architects to design the interface of the new system according to the X12 (270, 276, 278, 834, 837 (I,P,D) and 820) standards
• Contributed in the build and design of organizational Wiki that provided comprehensive knowledge of workflows, policies and procedures, patient care objectives, regulatory requirements, and industry best practices for membership management
• Took part in the meeting held for the analysis of migration to HIPAA 5010 from 4010 and migration of ICD9 codes to ICD10.
• Owner of the business rules document which documented the business rules across different systems.
• Participated in all phases of the Facets Extended Enterprise administrative system implementation to include the planning, designing, building, validation, testing, and Go-live support phases
• Involved with various aspects of the project's needs such as the logging, tracking, and resolution of issues, current state workflow assessments, assist with integration and script testing, downtime activities/testing
• Created detailed use cases, use case diagrams, and activity diagrams using MS Visio
• Led and managed the User Acceptance Testing (UAT) for the implementation of Facets Extended Enterprise administrative system with emphasis on ensuring that the HIPAA regulation are met across all the modules
• Conducted requirement feasibility analysis with the developers to ensure the project was in scope with the timeline defined in the project plan
• Created test plan, test data and conducted manual testing to validate functionality and performed regression testing
• Clarified to claims personnel the new Affinity payments and Explanation for payments (EOPs) for same claim processing cycle
• Designed and implemented complex SQL queries for QA testing and data validation
• Conducted user training pertaining to old and new Affinity Provider ID appearing on documents providers receive from Affinity (mainly occur with EOPs, capitation rosters, PCP membership rosters, provider directory listings and some system generated letters)

Environment: Facets, Oracle, MS Project, MS Office suite, SQL, SQL Server, Rational Suite, Citrix, MS SharePoint.

Confidential, Lincoln, NE Aug 2008 - Dec 2009
Business Analyst
DHHS provides payment and Primary Care Case Management administration duties to the State of Nebraska. It is dedicated to helping low income families, children and elderly people to improve their health, well-being and security. As a Business Analyst for the Business System Delivery (BSD) team, I was involved in providing support through the entire lifecycle for multiple projects involving web service and user interface development, covering Provider, Claims and Reimbursement Processing domains.
Responsibilities:

• Facilitated JAD sessions to collect requirements from system users and prepared business requirement that provided appropriate scope of work for technical team to develop prototype and overall system.
• Identified processes for developing and documenting detailed business requirements. Data was collected from end-users, and analysts.
• Implemented systematic approach (BPR) to redesign of business processes.
• Through Business Process Re-engineering designed the cost effective and competitive business processes possible.
• Worked on the HIPAA 4010 conversions and worked on the EDI 834, 837, 835 and 278 files and validated the functionality according to the new HIPAA 4010 changes.
• Worked on the EDI 834 inbound and 834 outbound data movement with our trading partners.
• Conducted process mapping to identify current As-Is business processes and To-Be road map for reengineering the products.
• Created Use-Cases and Requirements documents to document business needs.
• Requirements were gathered through interactions and meetings and periodic walkthroughs with loan analysts, credit analysts and other potential users of the application.
• Conducted Use-Case reviews and identified gaps, leading to improvements/enhancements in the same.
• Created and maintained the Requirements Traceability Matrix (RTM).
• Worked with the Project Manager on -various Project Management activities like keeping track of Project Status, Deadlines, Environment Request, and Compliance Issues.
• Ensured Use-Cases were consistent and covered all aspects of the Requirements document.
• Refined the requirements (use-cases) and Business Process Models to detailed level appropriate for technical analysis and system design.
• Was responsible for tracking issues that are detected and updating the status of existing issues based on the daily meetings with the off-shore team.
• Identified and analyzed the data requirements for the various site teams and made sure that the required data is available in the testing environment.
• Assisted in the data conversion and data mapping of the legacy data to new data base.
• Worked directly with software engineers to ensure clear communications on requirements and defect reports.
• Developed requirements integrating E-R diagrams and designed the testing process flows.
• Followed the RUP methodology for the entire SDLC.
• Was involved in Functional System Testing, Integration Testing, Regression Testing, and User Acceptance Test using the test cases given by the client before releasing the application.
• Used the guidelines and artifacts of the Rational Unified Process (RUP) to strategize the implementation of Rational Unified Process effort in different iterations and phases (Inception, Elaboration, Construction and Transition) of the Software Development Life Cycle.
• Interacting with other teams through walkthroughs, teleconferences, meetings, etc. to resolve various issues.
• Validated the scripts to make sure they have been executed correctly and meets the scenario description.
• Wrote test cases and test scripts for the User Acceptance testing.

Environment: SQL, MS Word, Excel, EDI, SQL, ACCESS, Lotus Notes, File Viewer, Web Client, Quality Center, MS Visio, SharePoint.

Confidential, Richardson, TX April 2006 - July2008
Data Analyst
The primary goal of the project is to extract common services such as Eligibility, Formulary, Drug Maintenance, etc. out of the disparate systems and host them independently to facilitate economy of operations, isolation of common business services from core adjudication transaction processing and externalize the data in a way that can be consumed by other external applications within the Organization. This will enable common services, tools and interfaces that can improve client experience and drive consistency regardless of which adjudication engine is used.
Responsibilities:

• Gathered analyzed, documented business and technical requirements from both formal and informal sessions and validate the needs of the business stakeholders.
• Performed Data mapping on the extracted data, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data.
• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Health Insurance Claims. Worked on HIPAA Standard/EDI standard transactions: 270, 271, 276, 277, 278, 834, 835, and 837 (P.I.D), 997 and 999 to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
• Designed and developed Use Cases and Use Case scenarios, Activity Diagrams, Sequence Diagrams, High Level and Low Level Process Flow Diagrams, OOAD using UML and Business Process Modeling.
• Responsible for creating test case scenarios, creating test data plan and writing test scripts for the UAT using testing tool and defect management for Policy Management Systems, Payables/Receivables and Claims processing.
• Conducted surveys, interviews, and JRP, JAR and JAD sessions and translated them into system Requirements. Suggested measures and recommendations to improve the current application performance of the system.
• Assisted the team members to develop Service Oriented Architecture (SOA), and data warehouse system (EDW) to utilize data mining for data analysis.
• Responsible for preparing Business Requirement Document (BRD), Functional Requirement Document (FRD) and then translating into functional specifications and test plans. Closely coordinated with both business users and developers for arriving at a mutually acceptable solution.
• Performed Gap Analysis in every phase and stages to check the compatibility of the existing system infrastructure with the new business requirements.
• Interacted with DBA for the process of data extraction, data transformation, data load, data integration and conversion processes using business intelligence tools on the Benefit Plan functionality.
• Worked with PM to prepare Project charter, Project plans, daily, weekly and monthly team deliverables for each phase, drafting WBS and RBS systematically using MS Project.
• Served as a Peer review member to verify, validate and modify necessary changes made considering technical and business aspects, in the deliverable documents and thereby uploading it on SharePoint. Consolidated individual Statistical Summary from the team deliverables, various reports, jobs, files and Inventory documents to present it in weekly status meetings.
• Lead requirements analysis and inspection, ensuring that requirement statements and business rules are complete, consistent, concise, comprehensible, traceable, feasible, unambiguous, and verifiable, and that they conform to standards.
• Facilitated various brainstorming, requirement gathering sessions, and provided training on HIPAA Compliance, HIPAA Standard transactions and current version of X12 HIPAA 4010A1.
• Managed requirements traceability information and tracked requirements status throughout the project. Also managed changes to baseline requirements through effective application of change control processes and change management tools.
• Proposed and came up with the RAID document to identify the Risks, Assumptions, Issues and Dependencies involved with every tasks assigned.
• Provided highly complex analytical support through the analysis and interpretation of data in support of cross-functional business operations.
• Developed budget tools and templates, and prepared and analyzed highly complex financial and budget reports for management review.

Environment: RUP, COBOL, IBM AS/400, CICS, Citrix, DB2, MS Excel, MS Word, MS Access, MS Project, MS Visio.