SUMMARY:

• Successful Lead Business/Systems Analyst with a technical writing background highlighting over 10 years of experience in Business Analysis, SDLC, Agile/Scrum & Six Sigma Methodologies across a wide array of industries.
• Highly experienced with Requirements Gathering, Business Requirements documentation, Functional System Design Documentation, Process modeling with strong writing, scripting, and design/architecture documentation experience.
• Excellent track record of partnering with IT Business Analysts & Project Managers in delivering quality process training to various technical staff and well versed in compliance metrics such as: Sarbanes - Oxley Metrics system as a guide for writing IT and financial procedures for risk assessments.
• Detail Oriented Business Professional with strong communication and leadership abilities. Looking for Permanent/Direct-Hire & International Job Opportunities using my skill set.
• Extensive experience in Healthcare, EHR, EMR, claims and insurance as a Business Analyst with an in depth understanding of Business Requirements Gathering, Evaluating Data Sources, Translating Requirements into Specifications, EDI and Application Design.
• In depth knowledge and understanding about Business Requirement documents, Release procedures, Business Process flow, Design documentation, Use cases, Test Plans, Test scenarios and Test cases.
• Expertise in Analysis and Review of Software and Business Requirement Documents.
• Experienced in performing Business Process Reengineering/Gap Analysis to check the compatibility of the existing system infrastructure with the new business requirements.
• Experience of working with Enterprise governance, risk, and compliance (vendor, IT, enterprise, security, etc…)
• Experience of working in teams dealing with user support of existing BPM process, maintenance and improvement of existing BPM process functionality, development of new BPM functionality.
• Proficient in writing all types of documentation to new BPM functionality.
• Extensive experience in Business Process Reengineering in Health Care Sector especially in FACETS with prime focus on claims adjudication, enrollment and eligibility.
• Extensive experience in Portico and Amisys, AWD, NQ database, NPPES, Attended CRM Training Sessions, Microsoft Office Suite including Advance Excel and Access to Auto load Provider and Practitioner Affiliations.
• Experienced with Medicare (Part A, B, C, D), Medicaid, Medigap/Medisupp and commercial insurances in HIPAA ANSI X12 4010, 5010 formats including 270,271, 276, 277, 835, 820, 837 and 997.
• Experience of working on applications and tools built on open platform with service-oriented architecture.
• Expertise in QNXT solution supporting payer functions across all lines of business and provides comprehensive consumer-directed health capabilities with advanced HSA/HRA.
• Experienced with ICD-9, ICD-10, DRG, CPT, NDC, NCPDP codes and NSF formats for interfaces with clearinghouses.
• Experienced with tools like Rally, HP Quality Center, Putty, IBM Web Sphere, IBM Toolkit, Beyond Compare 2, Eclipse, Notepad++, Edit plus 2.
• Extensive and exceptional skills for writing Test Scenarios and Test Cases.
• Experienced in Defect Tracking and Bug Reporting using tools HP Quality Center.
• Expertise in SOAP and REST concept; very good understanding of SOAP UI, expert in creating XML payloads based on given WSDLs and XSDs.
• Expertise in Analysis of Problem Severity, Defects tracking system, Defects reporting system and Performance Testing and Monitoring 24 x 7 at the production site.
• Working knowledge of DWH including star schema, snow flake schema, slowly changing dimension, facts and dimensions.
• Good communication and customer service skills, Responsible, self-motivated and organized, Excellent written and verbal skills.
• Professional with extensive experience in the development, implementation and integration of strategies within a team oriented environment, utilizing quantitative and qualitative analytical skills.

PROFESSIONAL EXPERIENCE:

Confidential, Reston VA

Sr. Business Analyst

Responsibilities:

• Gathered detailed business and technical requirements and participated in the definitions of business rules and data standards.
• Created process for producing user stories and conducting backlog grooming for Agile/Scrum Development.
• Involved in FACETS Implementation, end to end analysis of FACETS Subscriber/Member, Plan/Product, Provider, Claims and commissions and Billing modules.
• Facilitated functional requirement gathering from system users and prepared business requirement documents (BRD).
• Created Business Process Mapping Diagrams and Documentation for the process improvement recommendations.
• Followed the Continuous improvement techniques like 5S and Lean and participate in Six Sigma activities.
• Used MS-Visio for flow-charting, Use- Case process model and architectural design of the application
• Implemented the Rational Unified Process (RUP) methodology guidelines with its various workflows and artifacts in Requirements Management and Development.
• Gathered and documented functional requirements and use cases for automation of operational and administrative business processes.
• Provided overall project management to multiple projects successfully completing them on-schedule and on-budget.
• Documented the “AS-IS” Business Workflows adhering to UML standards. Conducted JAD sessions to define requirements and finalize the Functional Requirement Document (FRD)
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, OOD (Object oriented Design) using UML and Visio.
• Worked on different EDI healthcare transactions like 834-Benefit Enrollment and Maintenance and 820-Payment Order/Remittance Advice.
• Interfaced with team leaders, identify and analyze the given information, procedures and decision flows, evaluated existing procedures, methods and technical documentation. Communicated with executives, managers and other stakeholders regarding project scope
• Responsible for business process analysis that includes requirements facilitation, definition & analysis, alternatives, software selection, prototyping, business process design and mapping.
• Maintained a Traceability Matrix to ensure that all functional requirements are addressed at the use case level as well as the test case level
• Involved in identifying use cases, actors and writing use case narratives. Created use case diagrams and activity diagrams using MS Visio
• Conducted meetings and JAD sessions for project definition, resource identifications and deliverable prototype identification
• Interfaced with developers, analysts, customers and project managers to discuss requirements and recommended solutions, to help resolve issues.
• Lead the User Acceptance Testing efforts to verifying that the developed reports meets the requirements
• Involved in developing the test strategy and helped in developing QA Test plans for Functional, Integration and System Testing.

Environment: Quality Center ALM, Facets, Excel, Outlook, MS Office, MS Project, project management, Rational Rose, Rational Requisite Pro, UML.

Confidential, Woodland Hills, CA

Sr. Business Analyst

Responsibilities:

• Created Vision, Scope, and Use Case documents, Business Process Models, System Models depicting software architecture and interaction of system components.
• In my dual role as Project Manager/Business Analyst, I am responsible for all aspects of project management, including the development and management of the system requirements.
• Converted business requirement into functional requirements.
• Involved in Enrollment transaction and Payment transaction.
• Prepared detailed business specifications for development of systems.
• Responsible for architecting integrated HIPAA, Medicare solutions, Facets.
• Provided services to the Center for Medicaid and Medicare Services (CMS) for the Affordable Care Act (ACA), assisting with the software implementation of the Federal Health Insurance Exchange.
• I have also had the opportunity to assist both Medicare and Medicaid programs with their NCPDP Standard use and modification request. Documented Medicare claims processing.
• Responsible for membership analytics, billing and enrollment, medical capitations, medical expense projections, risk pool development, and for developing and analyzing other claims projects.
• Functioned as the liaison between Eligibility Medicare Operations and internal cross-functional partners including Product, Finance, Communication Fulfillment, Vendor Management, and other Client Services Teams
• Responsible for identifying HIPAA 837 claim XML historical Hospital claim data to assist in the development of impact analysis and trending analysis.
• Managed SDLC on several large projects developments such as Enterprise Data warehouse, Dimensional Data Mart, and IBM HPDM model from Waterfall to Agile process.
• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims.
• Performed Business Process Mapping and performed AS IS and TO BE analysis.
• Involved in creating Project Management Documentation, followed PMBOK Standards.
• Track project related data/issues and report it to project management. Regular collaboration with PMO on project management, project delivery, process governance implementation, operational risk assessment; facilitated Vision workshops and JAD sessions.
• Involved in developing Business Requirement Document, System Requirement Specification document for application development.
• Maintained Requirement Traceability Matrix, Change Requests. Coordinated work plans between project manager and stakeholders using MS Project.
• Followed the UML based methods using MS Visio to create Use Case Diagrams, State Chart Diagrams and Sequence Diagrams.
• Coordinated Joint Application Development (JAD), Interview sessions with stakeholders throughout SDLC to resolve open issues.
• Worked with QA team to get technical designs developed by application and database developers validated against functional specifications.
• Wrote Business Requirements Documents (BRD) and Functional Requirements Specifications (FRS) documents.
• Facilitated meetings with product, compliance, operations, vendor and technology stakeholders to define, review and obtain sign-off for Scope Document.
• Defined Use Cases and Process flows for new functionality and documented them in Business Requirements Document
• Conducted Walkthroughs and User Acceptance Tests (UAT) and worked closely with the UAT personnel to both ensure that their needs are met.
• Communicated requirements through visually modeled UML diagrams to both management and development teams.

Environment: MS Project, MS Office, Facets, Rational Suite, project management, MS Visio, RequisitePro, ClearQuest, RUP, UML.

Confidential, Reston, VA

Lead Business Analyst / Data Analyst

Responsibilities:

• Attended the client meeting and give presentations to the clients on the Work flow process that will be followed. Identify opportunities for different business efficiencies and give detailed report to the client.
• Define work flow -related metrics to be collected and reported.
• Defined Oracle DB design, validation, and migration activities, in addition to supporting APEX reporting requirements, and ETL development and transformation tasks. Worked on the Data Model Changes with the Data warehouse Architect

  Work on the current AS-IS functionality of the system and create a current process work flow consisting of Preconditions, Main workflows, additional workflows, CRUD actions, Inputs Outputs, interfaces/relations, triggers, Post conditions, Exceptional handling, messages requirements met .

• Categorized the business needs based on the comments in the website and change the comments into understandable business needs.
• Created the road maps for the project using the MS office.
• Worked with multiple development teams and software projects. Verify end-user documentation and training materials.
• Developed process for defect recording and tracking and monitor process compliance.
• Managing and facilitating multiple workgroups in requirements gathering activities, plan, manage, track, and communicate project progress, manage client expectations, and coordinate with numerous other development activities contributing to a highly visible data warehouse of national importance is requisite.
• Co-authored business requirements documents with the business users. Extracted, discussed, and refined business requirements from business users and team members.
• Attended the Testing PAT kickoff 'CMMI ML3 Owners' meeting as the company needs to get upgraded to CMMI Level 3.
• Developed the test process workflows, Test Strategy, Test Plan, Test Scenarios, Test cases, Test Schedule, RTM Documents, Test Status,
• Measurement Documents for CMMI developing documentation for using the Team Forge
• Schedule meetings with technical personnel to determine technical parameters for EDI and other related processes, including communication, security, and privacy. Create transaction sets requirements, usually with Microsoft Excel, for transactions such as: HIPAA 270/271 (Eligibility), 276/277 (Claims Status Request/ Response), 278/278, 820, 834 (Benefit Enrollment and Maintenance), 835, 837 (Claims) - (I, P, &D), 835 Remittances and others.
• Resource for UB04 and CMS1500 billing formats, transaction sets requirements, EDI development and Design, X12 protocols through Version 4010 and Errata; conversion needs and understanding of legacy EDI formats.
• Documented Business/Functional Requirements Documentations, Data Mappings/Transformations, and Informatica sessions as per the business requirement.
• Assessed the quality of agency data against the data specifications, business rules, requirements
• Identified data quality issues, including inaccuracies, duplication, errors, inconsistencies in data, impact of the data quality issues identified, and document them in a formal report
• Involved working on different set of layers of Business Intelligence Infrastructure.
• Create Physical Data Mapping document and Logical Data Requirements document to add/update new tables in the existing data model.
• Tested Complex ETL Mappings and Sessions based on business user requirements and business rules to load data from source flat files and RDBMS tables to target tables
• Assisted the PM on various projects throughout the Project Management Life Cycle (PMLC) including Project Charter, Project Plan and Resource allocation.
• Performed Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data
• Worked on designing the data structure in SQL Server 2005 and implemented to design 3 database based on the requirement for Dashboard
• Analyzed and translated business requirements into system specifications utilizing UML and Agile methodology.
• Creating Test Plan and Test cases using Mercury Quality center
• Performed Gap analysis and implemented updates for the Data Warehousing Application.
• Reviewing the defects and Reporting the Defects through Quality Center.
• Assisted in the designing and development Quality Assurance standard and processes to all levels of project team.
• Utilized corporation developed Agile SDLC methodology. Used Scrum Work Pro and Microsoft Office software to perform required job functions.
• Comfortable in several modules of Amisys Advance, including Benefit Configuration, Reference and Controls, and setup of authorization tables.
• Experienced resource within my department and the health plan as a whole on questions of Amisys Advance use and benefit design.
• Provided expertise in strategic planning, business process modelling, business process analysis, object-oriented analysis & design, use case modelling, use case analysis, component-based development, and quality assurance.
• Prepared Business Process Models that includes modelling of all the activities of the business from the conceptual to procedural level. Followed top down, levelled technique for building Business Process Models.
• Worked closely with CTO in writing Stored Procedures in MS Access and MS SQL for structure consistency.
• Created Use-Case Models using Rational Rose to depict Actors and Use-Cases in various Business Processes and identification of Basic/Alternative flows and definition of preconditions and post conditions of the system.
• Worked with the UI team to create the User Interface screenshots to be presented to the Business.
• Performed Gap analysis for the modules in production, conducted feasibility study and performed impact analysis for proposed enhancements.
• 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
• Experience in creating UNIX scripts for file transfer and file manipulation.
• Provided key input in working with System’s architect to baseline System Performance, identified expected Bottlenecks and set Load and Stress Targets.
• Created product documentation, including online help, user manual and training materials

Confidential, Rockville, MD

Lead Business Analyst

Responsibilities:

• Worked with various teams and business stakeholders including testers, developers, business and technical team members.
• Understood and captured business goals and high level functional concepts of the project and business process engineering; WEB software testing; and product ownership
• Captured success criteria and desired milestones from business perspective and work with finance teams.
• Conducted and participated in review sessions on regular basis with the business teams, SME's and other stake holders.
• Participated in working sessions to clarify requirements o Provide and obtain resolutions for outstanding questions around requested functionality and/or creative designs
• Led, co-ordinated and controlled the data management process and information collection activities associated with creation, deletion and changes to supply chain data ensuring all departments submit the data as per required time frames
• Standardized and simplified ways of working ensuring a consistent approach to data management.
• Create, implement and lead monthly KPI/dashboard reporting, daily and weekly reporting as required on data accuracy within the JDE Systems across the supply chain
• Analyzed the source data, Coordinated with Data Warehouse team in developing Relational Model. Understand and translate business needs into data models supporting long-term solutions.
• Performed Business Process Reengineering/Gap Analysis to check the compatibility of the existing system infrastructure with the new business requirements, BPM process, maintenance and improvement of existing BPM process functionality, development of new BPM functionality
• Involved in writing test cases, test plans and participated in user acceptance testing (UAT)
• Used Quality Center for bug tracking, reporting and report generation for the test cases
• Performed backend testing to check the system data integrity for insert, update, delete and retrieve transactions by writing

Confidential, Phoenix, AZ

Business Analyst

Responsibilities:

• Met with business partners to understand business needs
• Contributed to overall solution design, responsible for build and test of applications
• Conducted root cause analysis and complex performance tuning
• Worked within Portico and Amisys, AWD, NQ database, NPPES, Attended CRM Training Sessions, Microsoft Office Suite including Advance Excel and Access to Auto load Provider and Practitioner Affiliations.
• Assisted in the conversion of a state health plan from AMISYS Version 4 to Version 6 in 2013.
• Setup and updated fee schedules in both the AMISYS and DST Pricer systems for state health plans
• Acted as a subject matter expert for the Encounters system, regarding business area content, processes and procedures.
• Contributed to the entire implementation process including driving the definition of improvements based on business need and architectural improvements
• Conducted root cause analysis and advanced performance tuning for complex business processes and functionality
• Liaised with production readiness assessments and deployments teams.
• Documented Encounters core business processes and establish best practices. Document the business requirements and map them to Encounters functional specifications.
• Developed standard and custom reports to meet the reporting requirements for Encounters management and staff.
• Developed user guides and training manuals to ensure successful implementation and ongoing support for the business.
• Extensively used Excel; Charting, pivots, VBA/macros and ability to recognize patterns
• Worked on Medicare (Part A, B, C, D), Medicaid, Medigap/Medisupp and commercial insurances in HIPAA ANSI X12 4010, 5010 formats including 270,271, 276, 277, 835, 820, 837 and 997.

Confidential, Sacramento CA

Business Analyst

Responsibilities:

• Analyzed the business rules for the international user subscription and impact of localization.
• Involved in attending Scrum meetings and coordinating with business analysts and developers to convert Sprints to testable requirements.
• Reviewed and built test scenarios based on the Project Test Strategy plan document according to the IT strategy of our company to ensure timely delivery.
• Wrote Test Cases to cover all the requirements. Manually tested each unit and module of the application and verified against expected results.
• Test data entry into SOA application in the test environment for creating groups, subscribers and family members.
• Performed Claims validation in new application which includes claims pending status & member status.
• Managed the privacy and security environments of healthcare data that was governed by HIPAA and other government mandates.
• Prepares financial and data analyses as directed. Analyzes claims, lags and reserves data as directed.
• Healthcare data and expertise in extracting and reporting on healthcare trends, claims, membership, and pharmacy claims.
• Researched, compiled and analyzed appropriate and relevant data and make recommendations.

Confidential, Denver, CO

Business Analyst

Responsibilities:

• Managed logistics pipeline sing planning software JDE between supplier and customer through manipulating and analyzing raw data from numerous sources
• Controlled logistics process and develop strategies to ensure timely delivery and customer satisfaction
• Examined effectiveness of strategies by weighing the trade-off between speed of delivery and cost of transportation
• Educated and consult with customers to increase service, meet expectations, and encourage developing markets through open communications and by developing trusting relationships
• Initiated, led and participated in cross-functional, cross-business initiatives
• Interacted with different Med Vendors to clearly identify the problem and the obstacles that the problem presents
• Conducted Gap Analysis by brainstorming with Project managers, IT lead and Business users to get the low level “To Be”/ proposed environment
• Recommended a new SharePoint site collection. Design concepts, site planning, meetings, Q&A sessions, developed project plan
• Used Business Objects functionalities like applying breaks on reports, Slice and Dice to create the Cross-tab and Master Detail reports
• Researched, investigated, analyzed, defined and documented business needs and processes
• Rebuilt intranet sites to consolidate multiple site collections into one and support ticket system to avoid excessive complexity and poor design
• Tested accumulators, members and limits using soap ui and performed GUI testing on AGATE front end
• Assisted in identifying trends or changes in procedures which may result in improvements to the current processes and reported this to management team
• Conducted weekly meetings with MED Vendors to go over the existing issues and plan out a resolution process for the recent ones
• Involved in developing Project plan, Process flows as a guidelines for Issue resolution
• Participated in discussions about Federal Mental Health Parity
• Conducted weekly walk-through of the test scenarios with the PMs, team leads and IT
• Developed major workflow process to resolve outstanding accumulator issues as part of core focus group
• Participated in defect reporting and validation of resolutions