SUMMARY:

• Over All 9+ years of experience as a Business Analyst / Business System Analyst with extensive knowledge and experience across complete Systems Development Life Cycle (SDLC) stages in the fields of HealthCare domain.
• Excellent experience using and implementing Agile process and preparing business artifacts Business Requirements Documents (BRDs), System Requirement Specifications (SRS), System Design Specification (SDS), functional specifications, defining project test plan and change request.
• SQL skills with solid understanding of Databases, Data Warehouse, Data Modeling, Business process design, application systems analysis, object oriented analysis.
• Experienced cross functional professional across technology areas and operations focusing primarily on business requirements gathering and analysis, technical writing, functional requirements gathering and analysis.
• Experience on web services like SOAP UI and WSDL elements and knowledge in SOA.
• Participated in numerous walkthrough and requirement review meetings, attended knowledge transfer and brainstorming sessions to understand and exchange necessary information regarding the projects.
• Experience creating Traceability matrix to better manage the requirement gathering process and keeping track of the milestones.
• Created Data flow, Activity, Sequence diagrams in UML using tools like Rational Rose and MS Visio, also involved in creating Business Process Model and Notation (BPMN).
• Extensive knowledge and experience of HIPAA EDI X12 834, 837,835, 270/271, 276/277, 278 transactions.
• Extensive knowledge of Medicaid Management Information Systems (MMIS), and National Provider Identification (NPI).
• Developed test scenarios and implemented test plans for system testing and user acceptance testing.
• Delivered projects on time by working on MS Project, MS Visio, MS Word, MS PowerPoint, and MS SharePoint.
• Participated in the designing test plans, test scripts for software development.
• Developed tables and views using SQL scripting.
• Strong experience performing Functionality and Regression testing during the various Phases of the development lifecycle.
• Conducted requirement analysis techniques such as Business Process Automation, Business Process Improvement, and Business Process Re - engineering.
• Using project management tools like MS-Project for status reporting and planning.

TECHNICAL SKILLS:

Methodologies: Rational Unified Process (RUP), Agile, Waterfall

Requirements Management Tools: Rational Requisite Pro, Rational Rose, MS VisioTesting Tools Quality Center, ALM, Jira, SoapUI Pro.

Microsoft Technologies: MS Project, Access, Visio, Excel, Word, Outlook, PowerPoint, Microsoft Office 2007, 2010, Microsoft Project.

Languages/Standards: SQL, XML, HTTP, HIPAA 4010/5010, ICD9/10, ANSI X12, CPT, CMS form.

PROFESSIONAL SKILLS:

Confidential, New York, NY

Sr. Technical Analyst

Responsibilities:

• Extracted the Business Requirements from the Business Users and documented it for the developers following the HIPAA guidelines by conducting JAD sessions and Interviews.
• Initiated with a comparison report of migration of 4010 to 5010. 270 Eligibility, coverage and benefit inquiry (V4010X092A1) Vs. 270 (V5010X279)
• Responsible in design and development of the API (IPA) to be used in the service layers of the application.
• Worked on different modules of Facets such as Members/subscriber, commissions, provider, billing and plan.
• Managed and developed EDI specifications, for data feeds and mappings for integration between various systems, to follow ANSIX124010 formats including 270, 271, 276, 277, 834, 835 and 837, to meet HIPAA requirements set forth by the federal government and Deep understanding of enterprise data warehouses.
• Configured the Data mapping between Oracle and SQL Server 2005 and Tested Performance & Accuracy related queries under SQL Server
• Worked with providers and Medicare or Medicaid entities to validate EDI transaction sets or Internet portals. This includes HIPAA 4010; 837, 835, and others. Provided healthcare provider problem resolution.
• Completed several HIPAA 4010 and 5010 Projects, included Medicaid and Commercial entities. Projects include claims and enrollment testing as well as NPI and medical coding and ICD-9 EDI testing.
• Worked in an Agile environment, with an ability to accommodate and test the newly proposed changes at any point of time during the release
• Involved in impact analysis of HIPAA 5010 835 and 837P transaction sets on different systems.
• Worked with FACETS Team for HIPAA Claims Validation and Verification Process.
• Worked on requirements of the 835, 276, 277, 837, and HIPAA transaction across the enterprise.
• Met with the Provider and Trading Partners to ensure that HIPAA transactions pass the EDI gateway and interpret technical difficulties into simple language.
• Participated in Daily Agile Scrum, bi-weekly Sprint Planning/Review and Retrospective meetings with Account Manager, Project managers, Scrum Master, Business Analysts, developers and QA Team.
• Worked on web service requirements documentation using API/REST services
• Involved in Service Oriented Architecture (SOA) of the claims processing system.
• Worked on developing the business requirement and use cases for FACETS batch process, automating the billing entities and commission process.
• Expert in the ETL (Extract, Transform and Load) of data into a data ware house/date mart and Business Intelligence
• Converted various SQL statements into stored procedures thereby reducing the Number of database accesses.
• Troubleshoot any problems found within FACETS and when testing the SQL data database while validating the business rule.

Environment: RUP, Facets, MS Visio, ASP, C#.Net, API, JAVA/J2EE, Web application,SQL, Agile, PL/SQL, Oracle 8i, SQL server 2000, Agile, Requisite Pro, SQL Server, SDLC, Rational Rose and MS Office Suite.XP Professional.

Confidential, Bloomfield, CT

Business Systems Analyst

Responsibilities:

• Interfaced with and interviewed cross-functional stakeholders to generate requirements
• Worked in an AGILE development environment using MS Visual Studio platform in support of program and project management staff with story lifecycle management.
• Used Agile testing methodology for achieving deadlines in UAT testing.
• Worked on projects following Waterfall Methodology, Agile Framework (SCRUM), and Hybrid models based on client needs.
• Strong experience in Extraction, Transformation and Loading (ETL) data from various sources into Data Warehouses.
• Created SQL Queries using Oracle, SQL Server in validating data into Data Warehouse/ETL applications.
• Supported EDI (x12); concentrated on 270/271 (eligibility, coverage and benefits); experience with the 837 (claim); ensured data was formatted correctly and researched errors; validated data was accurate by comparing it to source system
• Prepared data mapping document for EDI834 to Confidential Health internal format
• Gathered high-level requirements from business, created user stories, and prioritized backlog with project manager.
• Performed Smoke (Sanity) testing, Functional testing, SIT, UAT and End to End Testing of API, GUI, Web Applications and Web services.
• Collaborated with development team through iteration and attended every Scrum meeting to represent product team
• Enabled product-centric testing and facilitated QA team's understanding of acceptance criteria and test scenarios
• Developed Activity Diagrams, Use Case Diagrams, and Workflow Diagrams using Microsoft Visio
• Accountable for extensive User Acceptance Testing (UAT)
• Interfaced between users and diverse teams and was involved in application development to enhance understanding of both business and IT processes
• Developed and maintained reports using relational databases as data sources for internal and external client reporting.
• Key liaison between business unit and development groups in a Service Oriented Architecture (SOA) environment.
• Utilized technical writing skills to create effective documentation and training materials
• Performed a baseline assessment and related interfaces, existing service level agreements, policies, and operational business procedures for readiness to comply with ICD-10 requirements
• Identified risks, problems, requirements and concerns to comply with ICD-10 changes by conducting interviews
• Actively worked on Data analysis and Report analysis with respect to ICD-10 impact
• Responsible for defining scope and implementing business rules of project, gathering business requirements and documentation.
• Responsible for writing Functional Requirement Specifications(FRS) and User Requirement Specification(URS).
• Executed SQL statements to check if the data integrity has been maintained.
• Analyzed Business Requirements and segregated them into high-level and low-level Use Cases, Activity Diagrams, State Chart Diagrams using UML methodology; clearly defined Data Process Models

Environment:: Rational Requisite Pro, RDBMS, Microsoft Office, MS Visio, Agile, ALM, XML, Rational Rose, Oracle, Microsoft Outlook, MS SharePoint, Facets.

Confidential, Owings Mills, MD

Business Systems Analyst

Responsibilities:

• Provided technical writing support in documenting, editing, and formatting of technical documents such as Requirements Specifications, Functional Requirements Documents (FRDs), Communications Plans, System Design Documents (SDDs), Standards Operating Procedures (SOPs), and Test Plans following System Development Lifecycle.
• Strong experience with Scrum/Agile methodology and well versed in writing user stories.
• Prepare AS IS process flow on the current state business process and identified the gaps for future TO BE state for better understanding and gathered requirements on same.
• Performed Gap Analysis on current business process, identify pain points and recommend efficient and effective solution for better future process.
• Collaborated with functional areas of the business to ensure alignment and scope of practice based on need for completion of project.
• Validating the data passed to downstream systems by using data management.
• Worked with Data Extraction, Transformation and Loading (ETL).
• Tested HIPAA Transactions and Code Sets Standards according to the test scenarios such as 270/271, 276/277, 837/835 transactions.
• Oversaw the development, implementation and ongoing maintenance of HIPAA 837(claims), 834 (enrollment), 835 (remittance), 276/277 (claims status enquiry and response), (278 (referral authorization) EDI transactions as required to ensure quality claims.
• Worked with FACETS to understand, verify and validate claim adjudication process.
• Participated in the JAD sessions along with team members and to elicit requirements.
• Created business use-cases, flow diagrams and validated business rules and data elements for Claims process and adjustment application.
• Worked with flat file database and execute queries to extract required data.
• Prepared weekly reports to inform upper management of any potential improvement gaps in business process.
• Prepared the Business Workflow using MS-Visio with input, output, and Pre and Post conditions.
• Actively participated in business reengineering and activities including process improvement plans.
• Communicated with business/technology leadership for overall project/program office milestones.
• Gathered business requirements, interact with users, managers and SME’s to get better understanding of the process and analyze and optimize the process.
• Created and maintained complete development plans that include requirements engineering, Use Case modeling, risk assessment and mitigation, internal and external workflow.

Environment:: Agile, MS Access, Outlook, FACETS, NASCO, HP ALM, SQL, Java, MS Visio, MS SharePoint, MS Office Suite .

Confidential, Southfield, MI

Business Systems Analyst

Responsibilities:

• Interacting with client’s team SME’s and key users to understand their business processes and solution management within timelines.
• Lead JAR sessions with internal/external business and IT partners
• Prepare detailed system requirements, specifications and documents and provide consultative services through all phases of the System Development Life Cycle
• Elicit and prepare detailed system requirements through conducting JAR/JAD sessions, interpreting business requirements and working with business partners and development teams
• Undertaking Quick Gap Analysis; current / future business process analysis, generating documents of future business process and validating same from the company.
• Assists users in data retrieval from system
• Prepare requirement specifications such as Use cases and System requirement specifications and Supplementary specifications
• Conceptualizing and developing functional specifications across different business areas such as Claims, Membership, PBM etc.
• Develop policies, procedures, forms, workflows and other organizational tools to implement and manage data reporting and mining
• Worked on Member Management, Eligibility, Claims and Billing modules within FACETS.
• Followed Workgroup for Facets Electronic Data Interchange standards for testing that need to comply with the HIPAA guidelines.
• Troubleshoot and resolve software problems, including user access and component configuration
• Develop and produce physical design of databases based upon logical data models by employing program and business requirements and analysis
• Involved in project planning, coordination and QA methodology in the implementation of the Facets in the EDI transaction of the claims module.
• Provide analyst support during all phases of the Software Development Life Cycle including development and testing (unit/system) phases
• Experience in GUI, Functional and web testing both with manual testing using tools as Quality Center.
• Used ClearCase to keep different versions of the documents and ClearQuest to report bugs or defect
• Used Rational RequisitePro as requirement gathering tool.
• Design and review of various documents including the Software Requirement Specifications (SRS), including USE Cases, Business requirements document (BRD), Use Case Specifications, Functional Specifications (FSD), Systems Design Specification (SDS), Requirement Traceability Matrix (RTM) and testing documents
• Analyzed and tested various Common Eligibility Outbound Interface Process and other Inbound/Outbound FACETS interfaces.
• Training the development and testing team on Healthcare domain and Facets.

Environment: Facets, Windows, Quality Center, MS Project, EDI Gateway, Rational Enterprise Suite (Rose, RequisitePro, ClearCase, Clear Quest), SQL, TL-SQL, PL/SQL, SQL Server, Oracle.

Confidential, Topeka, KS

Business Analyst

RESPONSIBILITIES:

• As Business analyst I involve in developing and documenting Product Test Plans, using Agile/Scrum Methodology for Software Development Life cycle.
• Developed detailed BRDs and DFDs using various modeling tools and developed databases based on the system model following the techniques in Agile.
• Trained the team on JIRA tool for Agile/ Scrum Methodologies.
• Facilitated various meaningful scrum meetings
• Helped create the 'Business Glossary' to facilitate efficient understanding of the business process amongst the other teams. Assisted in creation of the Functional Design Document from the Business Requirements Document which was used as the reference by the development team while preparing the design and held the responsibility of the required data setup for unit testing.
• Performed end-to-end System Integration testing which covered the entire business process flow from the initial point of sales through to all the downstream systems and XML output files, including apps/interfaces.
• Responsible for creating Mockup screens using Wireframes for Mobile and Web Portal.
• Worked on creating UI and process flow for new mobile application for member portal.
• Implemented automated COB processing of Medicare claims into Facets
• Created and maintained requirement documents for Facets for the different modules like Billing, Member enrollment and Claim adjudication.
• Performed numerous data extraction requests using SQL scripts to prepare ad hoc reports
• Strong experience in conducting Functional Testing, Regression Testing, User Acceptance Testing (UAT), and System Integration testing (SIT).
• Performed numerous data extraction requests using SQL scripts to prepare ad hoc reports
• Provided the required test data for the developers in order to fix the defects
• Monitored EDI Eligibility/Inquiry/Response (270/271) transactions via reports generated by the developers.
• Worked on solving the errors of EDI 834 load to Facets through MMS.
• Checked the data flow through the frontend to backend and used SQL Queries to extract the data from the database.
• Involved in writing extensive SQL Queries for back end testing oracle database.
• Retrieved files using SQL statements and UNIX commands.
• Created and maintained SQL Queries for back-end testing.
• Performed manual back-end testing using PL/SQL to connect to an Oracle 9i database.
• Established and maintained test cases and test data in ALM.
• Tested the ETL process for both before data validation and after data validation process.
• Tested the messages published by ETL tool and data loaded into various databases.
• Assisted in writing efficient and effective Test Strategy, System Testing, End-to-End Test and User Acceptance Test Plan.
• Logged the defects in ALM and maintained track of the defect throughout its life cycle
• Participated in QA team meeting and defect tracking meetings.

Environment: Windows XP, SQL Server, Clear Quest, Facets, MS Office, MS Visio, .Net, SDLC, Agile.

Confidential, Bethesda, MD

Business Analyst/ System Analyst

Responsibilities:

• Followed the Agile methodology during the entire SDLC.
• Under general direction, gathered, defined and documented highly complex business requirements for NPI crosswalk.
• Reviewed and understood the claims process and complex requirements for the enhancement of the current system created under the Requirement Specification Documents after conducting interviews with End Users, JAD Sessions and analyzed their current systems.
• Conducted JAD/RAD sessions and elicited customer requirements by organizing interviews with internal/external stakeholders and subject matter experts (SMEs) to create subject specific questionnaires for clinical trials.
• Involved in identifying and studying the Facets system data and conducting field by field analysis of Facets system for the attribute mapping purpose.
• Analyzed the data in the Facets source system to map into the correct field and attribute in the target storage.
• Writing the General System Design Documents that demonstrate current and proposed/solution business design and changes to the current Legacy System.
• Created test scenarios for Functional Testing of Web Services.
• 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.
• Worked out to get the correct count on number of Members, their Eligibility status and their Demographic information to set Groups/Subgroups/Subscribers/Members accurately in Facets.
• Developed business case, objectives, cost analysis and budget for implementation clinical and financial business systems.
• Extensive experience in XML Web Services, XML, XSD, XSLT and Design Pattern.
• Worked with user to define user acceptance test cases. Involved in UAT testing (User Acceptance Testing) and Implementation.
• Assisted JAD sessions to identify the business flows and determine whether any current or proposed systems are impacted by the EDI X12 Transaction, Code set and Identifier aspects of HIPAA.
• 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.
• Identifying the requirements for accommodating HIPAA 4010 standards for EDI X12 transactions and capture these requirements for mapping purposes.
• Analysis and Design of existing EDI transaction sets, and modification of these transaction sets to ensure HIPAA compliance.
• Analyzed EDI -X12 data elements captured by the existing system to validate it against the data elements required for new system.
• Worked with EDI Team for 837, 835, 834, 820, 270, 271 transactions.
• Documented complex Business requirements and made process flow diagram for the 837, 270/271, 276/277 & 835 Remittance transactions.
• Facilitate and participate in the meeting and discussions held with the business users, Business analysts and Technical analysts.
• Incorporated HIPAA standards, EDI (Electronic data interchange), Implementation and Knowledge of HIPAA code sets.
• Answer questions and inquiries about system functionality and provide user support, including training, help and instructions for the Trading Partner Application used by Nebraska Medicaid.

Environment: Windows, Oracle, UML, Requisite Pro, Clear Case 2002, Agile, Rational Clear Quest, MS Office suite, MS Visio, MS Access.