PROFESSIONAL EXPERIENCE:

• 7 years of experience as a Business Analyst in healthcare domain.
• Created numerous SDLC artifacts such as Business Requirements Documents (BRD), Functional Requirements Documents (FRD), Requirements Traceability Matrix (RTM), Business Use Case documents, System Use Case documents, GAP analysis documents, etc. Strong experience in various SDLC methodologies like Waterfall, Agile.
• Worked closely with IT personnel and business partners to identify and maximize opportunities to improve products services and program business processes.
• Experience in managing product backlog, follow agile process to identify new items, review details, estimate work and prioritize.
• Gathered, documented existing system processes and data in order to perform gap analysis between client’s specifications of the desired system and the existing system.
• Participated in Scrum, scrum of scrums and other design related meetings.
• Assisted in creation of user stories and acceptance tests in AGM and got those approves from product owner.
• Facilitated JAD sessions between the stakeholders, Subject Matter Experts (SMEs) and the IT team.
• Created numerous UML diagrams such as Use Case diagrams, Activity diagrams, Sequence diagrams, State Machine diagrams, Business Process Flow diagrams and Entity Relationship Diagrams (ERD).
• Experience in using MS Visio for preparing process flow charts and creating data models.
• Well versed with HIPAA, claim adjustments, claim processing from point of entry to finalizing, claim review, identifying claims processing problems, their source and providing corresponding solutions.
• Acted as project team member to combine a local and national claims processing system into one single platform.
• Experience in working independently and prioritizing tasks and workload efficiently.
• Strong knowledge of RDBMS and proficient in creating SQL queries in SQL Server databases.
• Conducted user acceptance testing and data validation of web applications used to present benefit information.
• Strong experience in healthcare domain - Claims Processing, Benefit Administration, EDIs (837, 835, 834, 270, 271, 276, 277), ICD 9, ICD 10, Membership system, Provider Information system, Revenue Cycle Management (RCM).
• Researched, defined and analyzed changes to both state and federal laws affecting the Medicaid Management Information System (MMIS).
• Coordinated and facilitated work sessions with Medicare Operations users to define project scope and requirements and managed project expectations.
• Strong knowledge on ANSI X12 standard and experience in implementing HIPAA 4010/5010 conversion.

TECHNICAL SKILLS

RDBMS: MS Access, SQL server

Project Tracking tool: HP QC/ALM, JIRA (6.2), Rational, RequisitePro

UML: MS Visio, Rational Rose, MS Access.

Page Mockups: Axure (8.0.0.3311 )

MS Office Suite: Project, Visio, Excel, Word, PowerPoint, Sharepoint (15.0.4659.1001 )

Web Technologies: HTML, XML

Methodology: Agile(Scrum), Waterfall

Operating System: Windows Vista\XP\7\8\10, Linux, Unix

Testing tools: Quality Center, Quick Test Pro (QTP), Rational Clear Quest

PROFESSIONAL EXPERIENCE

Confidential, Chicago

Business/System Analyst

Responsibilities:

• Facilitated sessions to collect User Requirements and business Requirements
• Business/User/Functional/Technical Requirement Specification using MS Project, MS Word and MS Visio that provided appropriate scope of work for technical team to develop prototype of the overall system
• Created Use Cases, various UML Diagrams and Data Flow Diagrams to determine the data flow via various systems
• Proposed the change and reengineering of the 'AS IS' business processes into the 'TO BE' process flow
• Involved in the day-to-day implementation of the Agile methodology of application development with its various work flows, artifacts and activities.
• Gathered requirements from the administrative staff and business rules for determining member eligibility and successfully converted them into functional requirements for the developments team.
• Responsible for resource planning, cost benefit analysis and risk analysis and present the same to senior management.
• Created web Page mock ups for clients using wireframes.
• Developed and maintained the Requirement Traceability Matrix (RTM) for the project deliverables using Rational Requirements Composer
• Analyzed if the system abides HIPAA regulations as portal displays member's private information.
• Reviewed and approve technical recommendations related to software and hardware proposals from technical team.
• Participated in leading and executing user acceptance test scripts.
• Assisted BI developer to build and maintain SQL queries for data extraction and analysis
• Assisted in designing test plans, test scenarios and test cases for integration, regression and UAT to improve overall quality of the Application.

Environment: Waterfall, MS Visio, Axure, HP ALM, MS excel, HP Quality Center, MS Project, and MS Office 2013 (Word, Excel, Power Point, Outlook)

Confidential New Jersey

Business Analyst

Responsibilities:

• Conducted JAD sessions with business units and stakeholders to define project scope, to identify the business flows and determine whether any current or proposed systems are impacted by the new development efforts.
• Prepared the Business Requirement Document (BRD) and Functional Requirement Document (FRD) for the enhancement of the existing services.
• Generated requirements from the business stakeholders and SME's using various requirement gathering techniques.
• Expert Knowledge in various Payer Fee Schedules and Provider Fee Schedules for Medicare and Medicaid.
• Involved in Facets implementation, involved in end-to-end testing of Facets Billing, Claim Processing, and Subscriber/Member Module.
• Elicited requirements to be able to generate the tools and info needed to process the ICD-10.
• Experience working in ANSI x12 EDI transaction.
• Worked on coordination of benefits (COB) in a claim processing.
• Performing analysis in Membership and billing data from Facets.
• Involved in the analysis on conversion of Claims and Members files from legacy systems into Facets and to its downward systems.
• Involved in Facets billing module mainly in Back - End system process for membership's enrollment info to downstream system
• Used to execute test cases for several transactions such as 837, 835.
• Experience in working with a Provider portal for claims where the rendering providers provide claims for the service rendered.
• Conducted User Acceptance Testing (UAT) and documenting the UAT issue log.
• Participated in the configuration of the billing module that includes fee rate, premium rate, and invoices.
• Extensively worked on any requirement upgrade and/or change request while doing UAT.
• Created User Acceptance Test checklist (Scope, entrance criteria, test case, test scripts, test execution, test data, defect management, test results, UAT test exit criteria)
• Wrote test cases in Quality Center derived from the design documents and generated a Traceability Matrix for testing purposes. Used Quality Center to record documenting information useful in debugging process, evaluating test data.
• Worked closely with development team to ensure the application performance, stability, and to ensure the application completes the whole end-to-end process.

Environment: Waterfall, Requisite Pro, Rational Rose, Axure, SQL, XML, Sharepoint, Quick Test Pro (QTP), MS Word, MS Excel.

Confidential Chicago, IL

Business Analyst/Data Analyst

Responsibilities:

• Worked exclusively with businessusers and Stakeholders to elicit requirements and create Epics, Features and User Stories.
• Utilized extensive EHR/EMR knowledge to recommended solutions to the technical team and served as liaison between departments for data related requirements.
• Conducted Gap Analysis to show the current state and proposed functionalities of the new system.
• Researched current challenges and trends in the Confidential t management space and bought information and recommendations back to leadership for consideration.
• Assisted the doctors/clinical staff with the generation of all necessary reports regarding the Confidential t.
• Extensively used AGILE methodology's best practices during the project.
• Used JIRA to track the User Stories from start to completion and manage the sprints.
• Assisted the Scrum Master in conducting AGILE ceremonies like Sprint Review and Sprint Retrospective.
• Worked closely with the Product Owner to prioritize the user requirements during and after each sprint.
• Oversaw SQL queries to make sure data was in the appropriate format to ensure compliance with regulations for electronic data and records.
• Reviewed test cases with the QA team and ensured that the test cases covered all scenarios of the requirements.
• Provided training for a variety of audiences including leadership and front line staff.
• Conducted UAT and obtained signoffs/approvals from the stakeholders.
• Acted as User Acceptance Testing coordinator and monitored businesstesting and interfaced with the development team regarding defect status and fixes on a daily basis.

Environment: JIRA, SQL Server, Requisite Pro, Rational Rose Windows XP Professional, MS Access 2000, MS Excel, UML, Agile/Scrum, MS Office suite, MS Visio 2003, Microsoft Word, Project, PowerPoint, Visio.

Junior Business Analyst

Confidential

Responsibilities:

• Conducted JAD sessions for activity diagrams and workflow diagrams for incorporating design changes in the screens of the system
• Analysis and Design of existing transaction sets, and modification of these transaction sets to ensure HIPAA compliance.
• Successfully used Agile/Scrum Method for gathering requirements and facilitated user stories workshop.
• Documented User Stories and facilitated Story Point discussions to analyze the level of effort on project specifications.
• Participate in Daily Agile Scrum "Stand-up", Biweekly Sprint Planning and Retrospective Sessions and update the team on status of upcoming User Stories.
• Performed data analysis, created data mapping and data interface documents and kept the documents updated with changes in requirements and functional specifications.
• Applied a structured change management approach and methodology for the people side of change caused by the respective projects and change efforts.
• Worked on developing the business requirements and use cases for automating the billing entity and commission process.
• Created UI mock up and functional specification.
• Involved in impact analysis of HIPAA and 837 transaction sets on different systems
• Performed SQL queries including retrieves data, tables, joins, extract, creates, and analyzes to presents reports and data crosswalk from database.
• Perform excel functions and formulas including Vlookups, Conditions, concatenate, substring and other formulas for data analysis.
• Created mapping table for the Transactions accepted by the Sybase translator move into an Interface Database for 837 transactions.
• Coordinated with data architects and ETL team to understand/drill down on the data mart requirements.
• Designed strategy for up gradation of system and implementing User interfaces (UI) to be 5010 compliant.

Environment: Agile, SQL, ETL, MS Excel, MS Word, SharePoint, HP-Quality Center, MS Office, MS Visio.