SUMMARY:

• Business Analyst with 6+ years of industry experience in identifying business needs, and determining solutions to business problems for complex software projects including system development component, business process improvement, strategic planning and policy development.
• Experience with full Software Development Life Cycle (SDLC) and project life cycle including Feasibility Analysis, Requirements planning and Management, Application Design and Development, Testing, Implementation and Post - Implementation Validation, and Solution Assessment.
• Documenting and creating Test Plans, Test Objectives and Test Cases. Also involved in maintaining Test Matrix and Traceability Matrix.
• Experience with various methodologies such as Waterfall methodology, Agile (Scrum) and RUP (Rational Unified Process)
• Expert in creating process flows, process maps for AS IS - TO BE process models.
• Proficient in iRise. Worked on E-commerce suite.
• Proficient in Rational Suite including Rational Rose, Requisite Pro, MS Visio, MS Project and MS Access.
• Work on various CMS compliance products based on CMS guidance for Medicare line of business.
• Proficient with application support claims processing, and customer service modules.
• Working knowledge of FACETS.
• Excellent communication skills and proficiency in interacting with the stakeholders, and Subject Matter Experts (SME’s) to get a better understanding of the Business Process.
• Extensive experience with Business Process Management (BPM) system.
• Excellent knowledge of Health Insurance Portability & Accountability Act (HIPAA) standards, Electronic Data Interchange (EDI), and Implementation and knowledge of HIPAA code sets, ICD-9, ICD-10 coding, and HL7.
• Efficient in handling Change Requests by the client.
• Experience in White Box, Black Box, Unit, Functional, Integration, Back End and System Level Load and Stress Testing for many types of applications including web and client server applications.
• Good knowledge and understanding of Medical Management Information System (MMIS)
• Working knowledge and experience with SQL.
• Implementing innovative business processes using new approaches and technology.

TECHNICAL SKILLS:

• Moody's Analytics
• Standard & Poor's
• Crystal Reports
• Rational Unified Process
• UML
• MS Visio
• MS Office (Word
• Excel
• PowerPoint
• Project
• Outlook
• Access)
• MS SQL Server
• Rational Rose
• Rational Requisite Pro
• E-Commerce
• Rational Clear Quest
• Mercury Quality Center
• Broadridge impact
• Thomson one
• Bloomberg
• IDC
• Sungard
• Business Objects
• Cloud computing
• Crystal Reports
• FIX protocol
• Windows NT/ 2000/2003/2007
• Bloomberg AIM.

PROFESSIONAL EXPERIENCE:

Confidential, San Jose, CA

Business Analyst

Responsibilities:

• Conducted user interviews, gathered requirements to create Business Requirement Documentation and other required deliverables.
• Performed Use-Case analysis using UML. Worked on the Flowchart and process diagram along with sequence diagram using Microsoft Visio.
• In depth analysis of Medicare/Medicaid Claims adjudication rules set forth by NCPDP and CMS.
• Interpret and analyze CMS compliance guidance and work with stakeholders to ensure RxClaim is compliant with the CMS rules by working on system enhancements.
• Conducted Claims and HIPAA Compliance Training to run the test cases.
• Developed project plans and managed project scope.
• Created the flow charts and data mapping tables indicating the input files, output datasets, and capacity planning for the data flow to the downstream applications.
• Involved in the Daily Standup Meetings.
• Follow Waterfall method.
• Maintained a good working relationship with departments such as, Research, Clinical Trial, and Regulatory departments and often communicated with them and provided technical support throughout the product development
• Identified and documented issues, risks, gaps and their impact to the project life cycle. Provided recommendations and alternatives.
• Maintained and submitted periodic/monthly status reports to the Program Manager to serve as the team’s assessment of the project and its schedule.
• Provided key input in working with users in defining project and system requirements, UAT requirements.
• Involved in developing Test plan and Test cases based on Use cases and Functional Specifications Documented, reviewed, and verified testing procedures for compliance to Interface Quality Assurance and Development standards and policies

Environment: MS Office Excel, Word, PowerPoint, MS Project, MS Visio, UML, SQL

Confidential, Fairborn, OH

Business Analyst

Responsibilities:

• Successfully defined the scope and business rules of the project, gathered business requirements and documented them textually or using models.
• Worked on MSP/LSP (now BKFS).
• Worked with stakeholders to enhance the system to follow federal compliance requirements for credit score handling.
• Created system reports for loan origination and downstream credit analysis.
• Facilitated JAD sessions and worked with business users through interviews, workshops, and brainstorming sessions.
• Documented Functional Requirements specifications and User Requirements specifications.
• Scheduled meetings with technical personnel to determine technical parameters for EDI and other related processes, including communication, security, and privacy.
• Developed project schedule, scheduled deadlines for project phases, accommodated requirement changes into project timeline and managed project tasks using MS Project.
• Worked as per the Agile development model.
• Conducted daily build validations and report status to Production and QA team.
• Interacted with developers to report software bugs and retested the fixed issues.
• Facilitated User Acceptance Testing and test strategies with developers and testers and participated in manual front-end testing to check all functionalities of different modules.
• Participated in performing detailed non-functional requirements analysis, including usability, reliability, performance, and scalability. Transformed business requirements to technical models.

Environment: UML, SQL, Windows Server 2003, Java, HTML, Agile, Facets, Excel, MS Visio, MS Project, Power Point, Share Point Server, Test Director, Outlook, SQL Server 2005.

Confidential, Chicago, IL

Business System Analyst

Responsibilities:

• Conducted user interviews, gathered requirements to help create Business Requirement Documentation, using MS Word and MS Visio.
• Performed Use-Case analysis using UML. Worked on the Flowchart and process diagram along with sequence diagram using Microsoft Visio.
• In depth analysis of Medicare/Medicaid Claims processes.
• Worked with EDI transaction 837 and 835.
• Conducted Claims and HIPAA Compliance Training to run the test cases.
• Developed project plans and managed project scope.
• Heavily interacted with Data Warehousing team in Metadata Modeling and gathering requirements for product catalogue data load specifications for Data mapping and Data Modeling.
• Created the flow charts and data mapping tables indicating the input files, output datasets, and capacity planning for the data flow to the downstream applications.
• Involved in the Daily Standup Meetings.
• Adopted an iterative and incremental Agile approach.
• Wrote extensive SQL queries to retrieve information from the SQL Database Server.
• Maintained a good working relationship with departments such as, Research, Clinical Trial, and Regulatory departments and often communicated with them and provided technical support throughout the product development
• Identified and documented issues, risks, gaps and their impact to the project life cycle. Provided recommendations and alternatives.
• Maintained and submitted periodic/monthly status reports to the Program Manager to serve as the team’s assessment of the project and its schedule.
• Provided key input in working with users in defining project and system requirements, UAT requirements.
• Involved in developing Test plan and Test cases based on Use cases and Functional Specifications Documented, reviewed, and verified testing procedures for compliance to Interface Quality Assurance and Development standards and policies

Environment: MS Office Excel, Word, PowerPoint, MS Project, MS Visio, UML, SQL, Oracle, SDLC, Windows XP., HTML, PHP, XML.

Confidential, Nashville, TN

Business Analyst

Responsibilities:

• Performed SWOT and Gap analysis for the new functionality requirements
• Worked with HIPPA rules and regulations to draft business rules and claim processes.
• Interacted with the client and the Technical Team for requirement gathering and translation of Business Requirements to Technical specifications.
• Tested different functionality of the application like Medicaid eligibility data, state available funds program, Medicaid claim processing etc.
• Identified and documented the dependencies between the business processes.
• Responsible for testing Medicaid Claims for peach state health plan using MMIS.
• Tested all internal and external file transfer outputs manually and automatically.
• Extensively involved in mapping data from various sources to the target database tables.
• Helped improve the loading process for various external data into Oracle database.
• Well versed with HIPAA, claim adjustments, claim processing from point of entry to finalizing, claim review, identifying claims processing problems, their source and providing alternative solutions using best practice model and principles.
• Involved in preparing project plans and identifying major milestones for each stage as per the SDLC model (RUP Methodology).
• Responsible for teaching sessions for end user to tell how to use tools.
• Used MS Project for various planning and budgeting activities.

Environment: Rational Unified Process (RUP), UML, Dreamweaver, Rational Test Manager, WinRunner, Rational Clear Quest, Windows, MS Office, Rational Rose, HTML, Windows.