PROFESSIONAL SUMMARY:

• Over 7 years of experience as a Business Analyst in Healthcare Domain.
• Strong working knowledge of complete SDLC process and adept at various methodologies like Waterfall, AGILE (SCRUM, XP), and RUP
• Conducted workshops, interviews and discovery sessions with SMEs, Business Users, and End Users to gather requirements for web - based and client-server applications.
• Facilitated and lead JAD sessions to articulate the user requirements to the technical team.
• Liaised between IT and client for requirements and assumption clarification or validation, compromise or agreement mediation, and to close information gaps
• Experience in developing Project Charters, Project Plans, BRDs and FRDs
• Analyzed and translated Business Requirements into High level specifications/Use Cases by employing UML methodologies.
• Experience in creating Mockups and Demos
• Extensively worked on creating UML diagrams like Activity, Class, and Sequence diagrams using analysis and design modeling tools like MS Visio and Rational Rose.
• Strong skills of writing complex SQL Queries using SQL Server /Oracle Databases for Data Validation and Verification.
• Analyzed entity relations for Oracle and SQL Server Databases.
• Working knowledge of QA methodologies.
• Coordinated with QA team to develop Test Plans and Test Cases.
• Experience in organization and coordination of UATs
• Mentored and managed other project team members.
• Good understanding of implementing applications in Homogeneous and Heterogeneous environments.
• Experience in analyzing methods such as Verification & Validation, GAP analysis, SWOT analysis, Risk analysis, Impact analysis, Business Project analysis, Process Flow analysis and Failure analysis.
• Experience in system conversions (Mapping, Migrating, and Enhancement) such as HIPAA X12 4010 codes to X12 5010 (deadline June 30th 2012) codes and ICD-9-CM codes to ICD-10-CM & PCS codes.
• Experience in Medicare, Medicaid, HIX, HIPAA EDI transactions 835,837,270,271,276,277
• Knowledge of HL7 standards.
• Committed team player with an ability to handle multiple projects simultaneously.
• Excellent negotiation and problem solving skills.
• Excellent analytical, decision-making, and organizational skills coupled with good co-ordination and interpersonal skills.
• Excellent written and verbal communication skills. Demonstrated team leading and integrative learning skills in many professional and volunteering projects.
• Strong understanding of quality process models like Six Sigma and CMM.

TECHNICAL SKILLS:

Project Management: MS-Project2010, MS-SharePoint

Project Methodologies: SDLC, Agile, Rational Unified Process (RUP), UML

Business Modeling Tools: Rational Requisite Pro, Microsoft Project, MS Office

Requirement Management Tools: Rational Requisite Pro, Microsoft Project, MS Office

Change/Defect Management Tools: Quality Center, Bugzilla, Rational Clear Quest, Rational Clear Case

Database: Access, My-SQL, SQL Server, MS Access

Scripting Languages: SQL, MS Visual Basic, C++, HTML, XML.

Business Applications: Microsoft Office Suite, MS VISIO, MS Project, SharePoint

PROFESSIONAL EXPERIENCE

Confidential, Chicago, IL

Sr. Business Systems Analyst/ Quality Analyst

Responsibilities:

• Gathered and analyzed the business requirements as per HIPAA rules and regulations.
• Developed Business Requirement Documents (BRD), System Requirement Specification (SRS) by interviewing Business Users and Subject Matter Experts.
• Conducted walk in interviews and Joint Application Development (JAD) sessions with the business users for requirement clarification.
• Developed an extensive report on ICD-9 and ICD-10 comparison
• Analyzed ICD-9 and ICD-10 codes by studying limitations and benefits of ICD-9 and ICD-10 respectively.
• Performed Data Mapping on ICD-9 and ICD-10
• Conducted impact analysis on business areas, policies, processes and systems, and trading partners that may be affected by the transition
• Revised coverage policies for ICD-10 codes
• Conducted cost benefit analysis and determined impact of ICD-10 on reimbursement practices, claims adjudication and reporting
• Developed exhaustive documents GAP and Impact analysis performed.
• Investigated General Equivalence Mappings (GEMs) and reimbursement crosswalks.
• Analyzed GEMS and other mapping tools in the market and created mapping and crosswalk documents for data flow mapping between ICD-9 and ICD-10 codes
• Coordinated with software vendors, billing services, clearinghouses, and providers in regards with Testing and implementation.
• Coordinated review of payment policies and trading partner agreements and revised coverage policies for the ICD-10 codes
• Analyzed the business requirement as per the HIPAA rules and regulations.
• Read and analyzed the regulations to update the products as per the mandated provisions of HCR (Health Care Reform)
• Conducted interviews to gathered requirements for Health Information Exchange
• Analyzed the requirements related to HIX and documented the same.
• Resolved work problems related to project specifications by working closely with the Business Users, Project Manager, Technical Lead, Business Lead, Computer Programmers and Testers
• Developed and maintained Reports, generated directly via MS Access and MS Excel to perform further Analysis on the data
• Developed File Transfer Specification (FTS), Business Requirements Documents (BRD), Interface Requirement Specification (IRS) documents for the project.
• Worked on the test strategy preparation for end-to-end System and Unit testing.
• Developed detailed Test plan, Test Cases, Test scripts for testing the functionality, GUI and security testing.
• Developed Requirements Traceability Matrix between the Requirements and the Test Scripts.
• Extensively used rational platforms such as Rational Requisite Pro, Rational Quality Manager and Rational Clear Quest for requirements and test case management.
• Monitored Functional, Regression and Integration testing.
• Created Data Flow diagrams and User Interface designs.
• Environment:J2EE, MS Word, MS Visio, MS Excel, SharePoint, UML, SQL, Mercury Quality Center, Rational Requisite Pro, Rational Quality Manager, Rational Clear Quest, MS Access

Confidential, Sacramento, CA

Business Analyst

Responsibilities:

• Used Requisite Pro for the Requirement Documents Preparation and Prepared Business Process Models that includes modeling of all the activities of the business - from conceptual to procedural level. Followed top down, leveled technique for building Business Process Models.
• Worked on HIPAA EDI transactions such as 835(medical claim payments), 837(medical claims), 276(claim status), 277(claim status response), 270(eligibility inquiry), 271 (eligibility response)
• Performed Impact analysis for readiness of ICD-10 conversion.
• Produced Gap Analysis documents for HIPAA 5010 and ICD-10.
• Improved the new revenue cycle management and Electronic Medical Record (EMR) for partners.
• Strong Experience in Claims Processing and Claims Scrubbing in HMO, PPO, Medicaid and Medicare.
• Extensive experience in configuring data mapping of files using Edifecs Spec builder.
• Performed Unit Testing and User Acceptance testing and documented detailed results. Provided input (scope, goals, risks, constraints, timelines and interfaces) to PM for project planning and control.
• Created Use Cases, Activity Diagrams, State Chart Diagrams, Sequence Diagrams, and Collaboration Diagrams thus defining the Data Process Model and Business Process Model.
• Met with various HMO, PPO, Medicaid/Medicare Representatives discussing benefits of contracts on behalf of facilities or appeals from denials and compliance issues.
• Worked in mainframe environment and used SQL to query various reporting databases.
• Used SDLC (System Development Life Cycle) methodologies like the RUP and the waterfall.
• Acted as User Acceptance Testing coordinator and monitored business testing and interfaced with the development team regarding defect status and fixes on a daily basis.

Environment: RUP Methodology, Rational Requisite Pro, MS Visio, Rational Rose, Rational Clear Case, Rational Clear Quest, SQL Server

Confidential, Franklin Lakes, NJ

Sr. Business Analyst

Responsibilities:

• Conducted interviews, live meetings and JAD sessions with business users and Subject Matter Experts (SME’s) to understand the As-Is system and gather requirements for the To-Be system.
• Analyzed the pre-existing documents to have a better understanding of the present system.
• Incorporated Rational Unified Process (RUP) and analyzed User Business Requirement Document (BRD), Technical Requirement Specification and Functional Requirement Specification (FRS) using Requisite Pro, Rational Rose and MS Visio.
• Presented to Stakeholders explaining the gaps in the system and how the changes would affect different modules with respect to Medicare.
• Performed Gap analysis to understand the best way of incorporating the changes in the system with respect to POS
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams and End to End Scenarios using UML.
• Organized daily scrum calls to keep the team on track and the stakeholders updated.
• Documented, organized and tracked the requirements using Rational Requisite Pro.
• Worked on changes regarding new CMS directives and proposed changes to be made in the current system.
• Analyzed Claims adjudication related transactionslike 835, 837, 270, 271, 276 and 277 transactions (both inbound and outbound).
• Worked with Source system Subject Matter Experts (SMEs) to ensure that the extracts are properly mapped.
• Tracked and maintained Stakeholder requested enhancements and changes using Requirement Traceability Matrix (RTM).
• Integrated Requisite Pro with Rational Rose to provide all teams’ visibility and maintained tractability among requirements, use cases and change requests.
• Assisted in writing test case scenarios for regression testing and end-to-end testing.
• Involved withMedicaidclaims testing.
• Assisted with user testing of systems and maintained quality procedures and ensured appropriate documentation is in place.
• Assisted end users and IT staff in the use of data to satisfy informational and reporting requirements and in implementation and usage of SQL and DBMS.

Environment: SQL Server, Rational Rose, Rational Requisite Pro, Rational Clear Case, Rational Clear Quest, UML, Rational Suite, MS Visio, MS Project, MS Office

Confidential, Overland Park, Kansas

Business Analyst

Responsibilities:

• Maintained and monitored project progress and status through MS Project.
• Used HIPAA transactions to support the analysisof current business processes and work with management to improve and implement enterprise solutions to ensure compliance and got involved in designing future state processes forHIPAA transaction processing EDI’s 837,835, 270, and 271.
• Experienced in an outsourced healthcare insurance operations environment and understanding of MECT and MITA.
• Extracted the business requirements from the stakeholders keeping in mind their need for the application and documented them using Rational Requisite Pro.
• Implemented the entire Rational Unified Process (RUP) methodology of application development with its various workflows, artifacts and activities.
• Analyzed business requirements, tested high level and low level Use Cases and Activity Diagrams / State Chart Diagrams using Rational Rose, thus defining the Data Process Models.
• Conducted the FRS and URS reviews and walkthroughs with designers, developers and stakeholders. Also conducted feasibility and adaptability study.
• Developed the business anomalies workarounds and described them in documentation and presented the matter to the upper management for review.
• Developed non-functional requirements and documented them as Business Rules, Quality attributes and constraint documents.
• Involved in Facets Configuration to make sure all information will be sent without any error.
• Effective communication made possible between the developers and the end-clients to guarantee that development efforts were within the scope of the project and the development was as expected.
• Held regular JAD meetings with the system architects, developers, database developers, quality testers during the entire project to assure that the critical as well as the minute details of the project were discussed and issues were resolved beforehand.
• Facilitated smooth transition of the project from the project environment to the live environment.
• Worked with QA lead in validating Test Plan and Test Scenarios.
• Executed test scripts in different cycles to get the perfection and logged defects in defect tab of Quality center.
• Used HP Quality Center for tracking Defects and tracing requirement functionality performances.
• Executed test cases manually. Compared and analyzed actual with expected results and reported all deviations to the appropriate individual(s) for resolution.
• Involved in automation testing using QTP.
• Involved in performance testing using Load runner.
• Assisted Business User during deployment in formulating User Acceptance Testing (UAT) for customized application and getting confirmation for product Release

Environment: MS Project, SQL, Rational Requisite Pro, Rational Rose, MS Visio, QTP, HP Quality centre, Load Runner, Rational Clear Quest, MS Office, XML, TOAD, Ultra Edit.