SUMMARY:

• Over Seven years’ of experience in all phases of SDLC (Software Development Life Cycle) as Sr. Business Analyst.
• Experience in conducting Joint Application Development (JAD) sessions for requirements gathering, analysis, design and Rapid Application Development (RAD) sessions.
• Assisted in user acceptance testing (UAT) of the system.
• Documented Requirement Traceability Matrix in Requisite Pro, Test Director and MS - Excel for traceability of requirements through use cases.
• Strong functional expertise in the Healthcare Payer Area - Membership claims, benefits, eligibility, ICD10, HIPAA, and CMS HCPCS Exposure to Health Care Industry standards like HIPAA / PHI and data format like EDI, XML, and HL7 Interface Implementation.
• Broad knowledge of 837 EDI file creation using flat files includes detailed experience working on Pro-EDI and 837 formatter tool.
• Developed EDI files for 837I, 837P and 837DME for CMS submission.
• In-depth Understanding of Payer plan sponsor and the EDI transactions like 837, 835, 834.
• SME for EDPS return files 999, 277, MAO 001, MAO 002 and MAO 004 etc.
• Extensive knowledge of EDPS errors which includes 254, 19, 255, 465 etc., in addition to that RAPS Errors 450, 451, 455, 400, 500 etc.
• Expert on US Health Care Industry, Electronic Data Interchange (EDI), Health Level 7(HL7) and Health Insurance Portability and Accountability Act (HIPAA).
• Developing functional specifications for business process refinement and automation, conducting feasibility studies, analyzing scope and vision of the project.
• Excellent knowledge of Medicare, Medicaid, and MMIS (Medicare Management Information System)
• Good knowledge of Business Process Modeling and Business Process Re-Engineering and experience with SWOT analysis.
• Proficient in data analytics, data modeling and data integration with complete expertise over different ETL tools.
• Expert in iterative software development life cycle AGILE with experience in SPRINT planning, SCRUM meetings, and story board management.
• Extensive experience with process modeling using Unified Modeling Language (UML), use case diagrams, including the business workflow using Rational Suite, Rational Rose and MS Visio.
• Experience in working with Work Breakdown Structure (WBS), in project management and systems engineering.
• Assisted teams in creating different SSIS packages to automate processes in different Control Flow and Data Flows.
• Strong Subject Matter expertise (SME) in Healthcare, ARMS Medical Billing Information System, Market Research, Risk Management, Product Development, Banking, Risk Analysis, Asset Management- risks and returns.
• Experience in conducting GAP analysis, User Acceptance Testing (UAT), SWOT analysis, Cost benefit analysis and ROI analysis.

TECHNICAL SKILLS:

Project Management: JIRA, MS Project, Rally, Blueprint

EDI Tools: Pro-EDI, 837 Formatter

Business Process Automation: SSIS, Talend, SAS

Requirement Management: Rational Requisite pro, UML, Microsoft Project, JIRA, Microsoft SharePoint

Modeling & Designing Tools: MS Visio, SnagIt

Business Analysis Structure: Agile/Waterfall/Scrum/SAFe/JAD/RAD/BPM

Testing Tools: Quick Test Pro, Load Runner, Win runner, HP Mercury Quality Center

ETL Tools: Informatica, Talend, SSIS, SPSS

Databases tools: Oracle9i/10g/SQL/SQL Server/Microsoft Access/Toad for SQL, SAS, Essbase, SSIS, SPSS

Reporting Tool: Tableau, Jasper Soft, Cognos, Crystal Reports, BRIO Query, SSRS

Communications: MS Outlook, Lotus Notes, TCP/IP, and MS NetMeeting/Chat

Operating Systems: windows, Mac OS, Linux

Languages: VB, SQL, XML, UML, ASP

PROFESSIONAL EXPERIENCE:

Confidential

Sr. Business Analyst

Responsibilities:

• Lead extensive research on un-submitted and invalid claims worth of $80 million and achieved remarkable goal by generating revenue of $99 million and got acknowledged by Bravo award.
• Produced BRDs and FRDs for RAPS and EDPS process to automate return file management process and achieved accomplished efficiency in saving processing time by 95%.
• Enhanced business intelligence and data analytics using SQL, Talend, SSIS, Tableau, ETL and SSRS to improve reporting process for audit team, finance team, and higher management.
• Streamlined process of data enrichment, modeling, and management & warehousing.
• Performed GAP analysis to draft roadmap for business undertakings.
• Analyzed existing Business units, Business process, System/ Application and their Interfaces through KT session, open-ended discussions, brainstorming sessions, prototyping etc., which helped in designing business process restructure and automation.
• Conducted KT session and developed Job Aids for different RAPS and EDPS claim file generation process for other team member reference purpose and to help in audit.
• Developed claim submission and return tracking structure using SQL and SSIS packages used to automate reconciliation report, served to top management in status meetings.
• Extensive knowledge of Pro-EDI tool and generated EDI file for EDPS submission to CMS.
• Configuration of SFTP for claim files submission and receiving flat files from clients.
• Took initiative to develop 837 formatter to replace Pro-EDI tool, legacy tool used to generate 837 EDI Claim file submitted to CMS.
• Assisted with budget management, team goal planning, team building etc.
• Processed EDPS return files including 999, 277, MAO 001, MAO 002 and MAO 004.
• Performed UAT on 837 formatter and validate all the features and process.
• On boarded 837 Formatter in production environment and with the efficiency of 95% time saving in file conversion.
• Dealt with ICD 10 encryption to verify and confirm the validity of the incoming claims and documented.
• Streamlined OPTUM EDPS claim generation and submission process with achievement of 99% acceptance rate.
• Functioned as a CMS point of contact for whole RAPS and EDPS claim submission process, which include tracking all claim submission, return file management, regulatory documentation distribution, maintaining clear communication etc.
• Reorganized SQL scripts to generate claims which helped reducing query running time by 80%.
• Examined errors claims in RAPS and EDPS process and worked on its correction and submitting them followed by 70% acceptance rate.
• Worked on RAPS Errors which includes 450, 451, 455, 400, 500 etc., and EDPS errors which includes 254, 19, 255, 465 etc.
• Created department structure diagram & process diagram which helped in pointing out bottleneck in the process.
• Improved TFS (Team Foundation Server) functionality by designing efficient hub of documents related to process, SQL scripts, SSIS packages, UAT planning, test cases etc.
• Developed submission schedule for Jan 16 and 17 sweep time submission of 14 & 15 DOS to maintain effective file tracking and generate ad hoc reports.
• Schedule meetings with vendors regarding testing of data transfers (SFTP) Secure File Transfer Protocol
• Document QA process on SFTP connectivity between OPTUM and vendors
• Wrote production manuals for inbound and outbound files transfer through SFTP
• Helped new team members with on boarding process, required system access, providing system knowledge and sharing documentation.
• Efficaciously finished and meet the entire deadline in sweep time which includes claim submission of all DOS 2014 as this was the last chance to get everything submitted to CMS.

Business Analyst

Responsibilities:

• Managed project and was involved in resource management.
• Co-ordinated with documenting processes used agile methodology to write the Business Requirements documents and designed Functional specifications.
• Served as a liaison between the internal/external business community and the IT organization in order to provide technical solutions to meet user needs.
• Participated in design review meetings and translated the requirements to the developers and guided the team when issues related to business requirements arose.
• Worked with Associates and understood the business rules, systems and integrated them into the requirements document and assisted in generation of test cases and test data.
• Created workflows, data model diagrams, and other industry standard documents to represent client’s business processes.
• Conducted JAD sessions between the business users, Developers, testers & Subject Matter Experts to resolve bottlenecks.
• Used HL7 guidelines and dictionary for defining business rules associated with pre-defined workflows according to business requirements.
• Played important role into creation of CRUD (Create, Read, Update and Delete) Metric to make analysis and better understand data flows between different systems
• Conducted Risk Analysis to identify the risks associated with developing the patches, and formulated a Mitigation Plan to eliminate or reduce risks of high severity and any major effects.
• Played an active role in performing of Gap Analysis and its documentation.
• Designed and implemented SSIS packages to translate data from operational systems.
• Work closely with the application development and design team onsite and offshore to resolve technical issues and interact with them to ensure overall quality of the project.
• Met with client to present future functionality of the application, gather information from them to know about their need and send this information to test manager.
• Worked closely with the application development and design and testing team to resolve technical issues and interacted with them to ensure overall quality of the software
• Responsible for creating & maintaining Requirement Traceability Matrix in order to track the development and QA process .
• Interacted closely with QA to finalize the Test strategies and maintained quality assurance using HP Quality Center .
• Provided production support pre-production and post- production issue management and defect tracking .

Environment: Windows, MS Office 2013 (MS Word, Advance MS Excel, MS PowerPoint, MS Visio), MS Access, MS Project, Apache Subversion, Erwin, SSIS, Rational Rose, MySQL, Clear Case, Requisite Pro

Business Analyst

Responsibilities:

• Conducted Joint Application Development (JAD) sessions and walk in interview with the business users to gather requirements.
• Did impact analysis for changing requirements and coordinated with business users and Project Manager for prioritizing the testing/release of the changes through CAB.
• Work as part of an Agile team to solve problems and deliver projects in a fast paced environment
• Helped creating Reports for Claims processing, Provider and Member.
• Prepared the Business requirement Document for the enhancement of the existing services. Wrote TRD for the requirements and RTM for testing and defect tracking .
• Modeled the AS-IS system and performed GAP Analysis for the existing system in order to map it to the TO-BE system .
• Worked on improvement of Claims Reimbursement User Interface for a better experience and in corporate changes as per HIPAA guidelines using the gap analysis.
• Assisting business users in defining UAT test cases and plans ; Established and maintained test cases and test data in Quality Center .
• Coordinated with the QA Team for testing activities across multiple systems and managed Conversion test execution.
• Helps in conducting User Acceptance Testing (UAT), and System Integration testing (SIT) and SWOT analysis .
• Performed GAP Analysis for HIPAA 5010 transactions and Performed Analysis of ICD 9 Procedure and Diagnosis Codes in accordance with ICD 10 CM and ICD 10 PCS Conversion Compliances
• Provided SQL queries to developer as source queries to identify the data provided logic to assign.
• Responsible for providing the Data Mapping document and rewrite of the SQL queries from As-Is To-Be and validating the data through SQL .
• Lead through UAT procedure and also conducted training sessions for the end users along with the necessary documentation
• Created test plan and facilitated its implementation, create Test cases and assisted manual testing
• Worked closely with the testing team to discuss the functionality and fix any defects found in the Crystal reports created
• Used SharePoint to ensure all team members have easy access to all the documents created

Environment: Blueprint, Rational Rose, Rational Requisite Pro and UML, Rational Clear Quest, SQL, Microsoft Visio, Test Director, HP Quality Center, Crystal reports, MS SharePoint, MS Project, ER-Win, MS Office.

Business Analyst

Responsibilities:

• Thoroughly studied the incumbent systems to get an understanding of the processes and the functional workflow in order to analyze and initiate the project.
• Defined vision and scope of the project and transformed them into documents to better analyze and understand the rationale for the application.
• Facilitated Gap analysis to get a hold of the new business model and to extract additional functionalities that would be incorporated into the module.
• Worked closely with claim system processing to in corporate claim approval/denial and claim reimbursement and evaluated the claim system with which the data would be interfaced for the user.
• Conducted JAD sessions for clarity and gathered requirements through brainstorming sessions with the stakeholders and SMEs and with the help of rational requisite pro, prioritized these requirements.
• Documented Business Requirement Documents and use case specification documents and came across various functional requirements through UML diagrams with the help of activity, use case and specification diagrams.
• Aggressively participated in the design process along with the architect in attaining technical requirements to provide technical expertise to the developers for the development phase of the application.
• Developed reports using Crystal Reports and SSRS .
• Dealt with ICD 9 encryption to verify and confirm the validity of the incoming claims and documented them by saving it in the database.
• Helped streamline the 276/277 transaction in order to enable easier and faster exchange of information between the payer and the provider.
• Assisted QA team by reviewing test cases and test protocols for verifying the requirements to ensure complete coverage of all functional and technical requirements. Used Requirement Traceability Matrix to conduct thorough testing and verification.
• Managed offshore teams in different geographical places.
• Designed SSIS Packages to transfer data from flat files to SQL Server using Business Intelligence Development Studio.
• Provided training to the end users, conducted Regression testing and User acceptance testing sessions to gain user approval and feedback.

Environment: Windows, MS Office 2010 (MS Word, MS Excel, MS PowerPoint, MS Visio), MS Access, SSIS, MS Project, Rational Rose, MySQL, Crystal Reports, SSRS, Clear Case, Requisite Pro