SUMMARY

• 6+ years of experience in as business analyst, business requirements modeling and development of Web Based, and Client/Server applications in diverse business domains of Healthcare/insurance and Service Industry Sectors.
• Expert communicator and facilitator with great interpersonal skills - effective in interactions with business and technology professionals as well as executive management
• Experienced in managing various aspects of the software development lifecycle (SDLC) including requirements gathering, design, development, testing, deployment and support
• Wide-ranging experience in managing artifacts in methodologies such as Waterfall, RUP, Agile (SCRUM)
• Facilitated and participated in Joint Application Development (JAD) and Joint Resource Planning (JRP) sessions with management, SMEs, vendors, users and other stakeholders.
• Excellent knowledge of HIPAA standards, EDI (Electronic data interchange) Transaction syntax like ANSI X12, Implementation and Knowledge of HIPAA code sets, ICD-9, ICD-10.
• Experience with data mappings including ANSI 4010A1 835, 837I, P, 276/277, 278, 270, 997, 850, 834 for institutional, professional, and commercial.
• Strong Experience in Medicaid and Medicare claims and reimbursements, Health insurance plans like Indemnity plans, Managed Care plans (HMO, PPO & POS)
• Serve as a SME for PBM functional questions for client’s clients as well as internal team members.
• Comprehensive knowledge on Waterfall, RUP and Agile methodologies
• Experience in HIM (Health Insurance Management), to manage the administrative, financial and clinical aspects of a hospital and also encompasses paper-based information processing as well as data processing machines.
• Excellent in analyzing and documenting Business Requirements Documents (BRD), Functional Requirements Documents, Use Cases and Requirements Traceability Matrix
• Extensive experience in developing and creating Screen Mockups, conducting Gap Analysis and Impact Analysis, Cost Benefit Analysis & prepared solution Memo, Decision Memo.
• Involved in Test Planning, Test Preparation, Test Execution, Issue Resolution and Report Generation to assure that all aspects of a Project are in Compliance with the Business Requirements.
• Strong experience in conducting User Acceptance Testing (UAT) and documentation of Test Cases. Expertise in designing and developing Test Plans and Test Scripts.

TECHNICAL SKILLS

Languages: SQL, UML, ASP .net, C#, Java

Methodologies: Rapid Action Development (RAD), Joint Application Development (JAD), Rational Unified Process (RUP), Unified Modeling Language (UML), System Development Life Cycle (SDLC), Service Oriented Architecture (SOA), Waterfall, Agile, Six Sigma and CMM

Testing: Quick Test Pro (QTP), Test Director, Mercury Quality Center, Bugzilla, HPQC, SQL, SPSS

Database: MS SQL Server 2005/2000 Oracle 8i/9i/10g/11i, MS Access

Operating Systems: Windows XP/2000/98/95/Vista, Windows NT, windows 7, UNIX, Linux, Mainframe, MAC

Documentation Tools: MS - Office Suite (Word/Excel/Power Point).

Business modeling Tools: Rational Rose, Requisite Pro, MS Visio, MS Project, Clear Quest, Adobe Photoshop

Requirements: MS Office, Visio, JAD, Workshop, MS Project, MS Office, Visio, Req Pro, Rose, MS Paint, dream weaver, Photoshop.

Application Software: MS Office suite (MS Word, MS Excel, MS PowerPoint), MS Project, SQL Tool, MS Visio

Requirements/Application Management Tools: IBM Rational Requisite Pro, MS Visio, MS Office Suit, MS-Project, Share Point

QA Methodologies: Functional, Integration, System testing, Regression, Acceptance, Test Automation, Negative, Boundary, Agile

Networking: TCP IP, FTP, HTTP, Internet, Intranet

PROFESSIONAL EXPERIENCE

Confidential, Franklin, NJ

Sr. Business System Analyst

Responsibilities:

• Worked on HIPAA 4010 & 5010 ANSI X12, EDI series (Insurance/Health Series) (INS) such as 270/271, 276/277, 278, 834, 835, 837.
• Maintained the insurance record of customers through EDI (ANSI ASC X12 standards) for better privacy and security, compliant with HIPPA regulations.
• Responsible for coordinating test data preparation, validating data and ensuring testing cycle is completed with necessary test scenarios reviewed.
• Identified and documented issues, risk and gaps, their descriptions, their impact and provided recommendation and alternatives to develop the application to meet the user requirements
• Worked in a team to develop use cases for their newly added application layout and understood all the business processes related to newly added layout and designed use cases that helped developers to build application
• Interacting with the developers on resolving the reported bugs and various technical issues
• Involved in UAT to confirm that the system under test meets the user needs and provides confidence in its use
• UML diagrams such as activity and use case diagram were used to document the requirements and ensure creation of high level business requirements documentation.
• Worked cross functionally with developers, QA and project managers to make sure each the data could address their needs
• Performed verification tests to validate integrity of data

Environment: Agile-scrum, MS Access, MS Word, MS Excel, MS Project, MS Visio, Lotus Notes, SPSS Analysis.

Confidential, Collegeville, PA

Business System Analyst

Responsibilities:

• Worked with the clinical managers to document the current processes.
• Gathered and documented BRD, FRS, and URS during user interviews.
• Facilitated brainstorming sessions to understand data capture, data management, and data validation functionalities in clinical trials.
• Worked on Accounts Payable, Payment Generation and Integration with Lawson.
• To position Sterling with the capability of supporting the anticipated growth of existing and new business products and services, this project was initiated to address the deficiencies with the current core Sterling Health Plan, Group and TPA administration system.
• Deliver a complete set of Business Requirements focused on claims processing, Benefit administration, member management and Customer Service.
• Deliver platform related specifications such as security, performance, and capacity, Standard code sets such as ICD-9, HIPAA EDI, CPT and DRG etc.
• Elicit, analyze, specify, and validate the business needs of project stakeholders. This Includes interviewing stakeholders and gathering and compiling user requirements.
• Responsible for meeting with report users and stakeholders to understand the problem domain, gathered customer requirements through surveys, interviews (group and one-on-one) along with JAD sessions. Manage and track the status of requirements throughout the project lifecycle; enforce and redefine as necessary and leveraging these processes.
• Prepare and deliver recommendations or alternatives for improving processes in operating systems across the organization.

Environment: SDLC, Waterfall, MS Visio, UML, UNIX, Rational Requisite Pro, Microsoft Share Point, SQL, MS Office suite (MS Word, MS Excel, MS PowerPoint), Share Point

Confidential

Business Analyst

Responsibilities:

• Acted as an interface with different stakeholders of the project.
• Defined Business Rules by interacting with stakeholders and users through Surveys & Brainstorming.
• Developed a vision plan that defined the primary goals and objectives of the project.
• Conducted Joint Application Development (JAD) sessions.
• Performed Gap Analysis, conducted walkthroughs and acted as a liaison between the business users, stakeholders and the team to perform requirements, quality and risk analysis.
• Involved extensively in the inception phase for understanding the Scope of the Project, feasibility of the implementation and define the risk factors involved in the project.
• Gathered business requirements through sessions and analysis by interviewing users and Subject Matter Experts (SME).
• Analyzed business/system requirements using requirement arbitrage and assigned appropriate priorities.
• Documented AS-IS and TO-BE analysis, and conducted process evaluations and write recommendations based on the analysis.
• Applied Unified Modeling Language (UML) notations and methodology in developing models that accurately represent the business process and workflows to effectively communicate them to the stakeholders.
• Got system approvals by conducting UAT sessions.

Environment: Windows 2000/NT, MS Visio, Rational Requisite Pro, MS Power Point, MS- WORD, MS Access, MS Excel, UML, Waterfall.

Confidential

Business Analyst

Responsibilities:

• Performed feasibility and adaptability study to identify the business critical areas from requirement perspective.
• Elicited business needs, conducted business process modeling work and facilitated work sessions (JAD), to analyze, validate and prioritize requirements.
• Documented detailed Business Requirements Documents (BRD), Technical Requirement Specifications (TRS) and Functional Requirements Specification (FRS).
• Worked as a liaison between clinical staff and the technical developers.
• Closely interacted with designers and software developers to discuss application functionality, navigational flow and updated them about end-user sentiments.
• Coordinated work on XML based Electronic Common Technical Document (E-CTD) application and electronic Case Report Form (E-CRF) application. The application will help in validating electronic regulatory submissions and will enable content contained with the documents to be searchable and achievable.
• Conducted JAD sessions to allow stakeholders with different backgrounds to communicate their perspectives with each other and resolve issues.
• Worked with QA team to design test plan and test cases for User Acceptance Testing (UAT) and Back End Testing.
• Created Traceability matrix between requirements and test cases.

Environment: User Acceptance Testing (UAT), Rational Unified Process (RUP), Rational Clear Quest, Joint Application Development (JAD), MS Access, Windows, MS Office.