PROFESSIONAL SUMMARY

• 10 years of in - depth knowledge and diverse Business and Systems Analysis experience dealing varied business processes in Healthcare Insurance, Pharmaceutical and Hospital domain.
• Proficient in different software development life cycle (SDLC) methodologies such as Waterfall, RUP, AGILE/Scrum and Prototype models.
• Broad knowledge in healthcare insurance domain including system conversions (Mapping, Migrating, Enhancement) such asHIPAA X124010codes to X125010codesandICD-9-CMcodes toICD-10-CM &PCScodesinMedicaid,Medicare,Procedural and Diagnostic codesandClaims processes.
• Expertise in HIPAA ANSI X12 EDI transaction codes such as 270/271(inquire/response health care benefits), 276/277,278,834,835(Payment/remittance advice), 837(Health care claim) and version 5010 of this transaction.
• Experience in gathering requirements and writing specifications like Business Requirements Document (BRD), Use Case Realization Document, Functional and Non-Functional Requirements Specifications.
• Experienced working with Agile methodology, creating user stories, participating in iterations for completion of projects and conducted daily Scrum/Stand-up meetings to track the progress of the team on a day to day basis.
• Hands on experience with UAT testing in preparing UAT Test plan and assisted in UAT testing.
• Strong experience in Data Analysis, data warehousing and Quality Assurance testing to fulfill requirements for product and service.
• Excellent analytical skills in understanding business process (AS-IS) and (TO-BE), understanding functional requirements and translating them to system requirement specifications.
• Experienced in writing SQL queries, Stored Procedures & ETL to extract and load data from multiple source on to data mart. Designed complex dataflow tasks to integrate, transform and load the data from different sources.

TECHNICAL SKILLS

Project Management: MS-Project, Primavera, MS-SharePoint

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

Business Modeling Tools: MS Visio, MS PowerPoint, Enterprise Architect, Rational Rose

Requirement Management Tools: Rational Requisite Pro,HP Application Life Cycle (ALM)

Defect Tracking Tools: JIRA, Rational Clear Quest,HP-ALM, Quality Center, Test Director

PROFESSIONAL EXPERIENCE

Confidential, VA

Team Lead/Sr. Business Systems Analyst

Key Responsibilities:

• Led a team of up to 26 analysts at a time depending on where we were in the life cycle of the project
• Worked directly with manager and senior management in identifying roadblocks which are holding analysts back from proceeding with case work
• Triaged cases to determine how to classify each case from start/end date, APTC amount, Premium amount, Multiple, Missing 1095 and Original 1095
• Implemented CMS directives which were given to Cognosante by documenting SOP’s (standard operating procedure and DOU’s (document of understanding) project wide for all Team Lead’s and analysts to use
• Mentored and trained incoming analysts on what expectations will be asked of them before they joined their respective teams
• Monitored extracted data which would be used to compare the consumer claim to the data on the federal marketplace to determine whether the claim is viable or not

Confidential, Boston, MA

Sr. Business Systems Analyst

Key Responsibilities:

• As a Senior Business Analyst, I communicated directly with MassHealth (Business) to determine their expectations and needs.Produced and presented updates for senior management as well as our Business subject matter experts throughout the projects lifecycle.
• Attended knowledge transfer sessions with CGI to get comprehension on what they were working on before, during and after the system crashed.
• Updated Junior Business Analysts on scope of project and worked closely with them in completing critical tasks assigned to them such as but not limited to reporting, data mapping, traceability matrix, and work related to UAT and Environmental testing.
• Documented Business requirements using BRD’s (Business Requirement Document), DOU’s (Document of Understanding) and ICD (Interchange Control Document) and worked with our IT department on translating into technical requirements.
• Using MS-SharePoint, uploaded my documents for evaluation, updates and eventual signoffs from senior management.
• Using JAD sessions, whiteboard sessions, conference calls and WebEx, discussed solutions for numerous issues associated with Application Intake, Notices, Program Determination and MMIS.
• Worked directly with Quality Assurance team from our outside vendor used for testing, QSSI, in running various scenarios which real life users would run into during user experience and validated test cases and test scenarios.
• Worked on defect management using JIRA initially which was a CGI system and ultimately ALM which is the system now being used by Optum and MassHealth.
• Created a detailed Transaction Plan for the next Senior Business Analyst to use as a reference before rolling off of the project.

Confidential, NJ

Sr. Business Systems Analyst

Key Responsibilities:

• Worked on the claims domain and was in charge of communicating between Horizon-BCBSNJ and the various vendors that Horizon-BCBSNJ worked with.
• External Vendors included Davis Vision (vision), Labcorp (lab work), Caremark (pharmacy), HearRX (hearing), CareCore (imaging), Magellen (mental health), and Scion (dental).
• Worked on reviewing and compliance of the 837 claim files and Medical claims associated with the State of NJ.
• Gathered the needed requirements to facilitate the transfer and to document them in the BRD.
• Responsible for UAT testing with close coordination between Businesses and QA teams.
• Worked closely with the IT side and communicating these requirements to them so then they can in turn use these to document the TRD
• Assisted on another project which had to do with the employment of the new CASS ID which was originally supposed to be implemented on December 1st, 2013 but has been postponed by the State to an unknown date.

Confidential, CT

Sr. Business Systems Analyst

Key Responsibilities:

• Participated innumerousHealthcare presales initiative forEHR applications, HIPAA 4010-HIPAA 5010 and ICD9 - ICD10 conversions.
• Researched andcomprehendedtheclaimsadjudication and reimbursement systems based onHIPAA X12 4010standards.
• Helped the organization go through the HIPAA 4010 to 5010 transition smoothly by using differentChange Management methodologies.
• UsedAgilemethodology for Claim intake process and contributed in daily standups, user stories in each Agile sprint.
• Specified inEDI837/835transactions, whichEDI837transaction wasused either as a one-way transaction, or as a two-way“inquiry/response”type of transaction.
• Created businessuse-cases, flow diagramsand validated business rules and data elements for EOBand adjustments application.
• Took partindeveloping test plan, test scripts, and developedUAT test casesassociated with thefunctional requirements.
• CreatedBusiness Information Rules MatrixforClaimsregression automation capturing various products and capabilities for the MEDICARE-D business.

Confidential, Paul, MN

Business Systems Analyst

Key Responsibilities:

• Gathered requirements by conducted meetings with CMA/MNSDOH counter parts for different modules like Security, Business Intelligence Portal, Metadata and Infrastructure
• Performed administration for IBM Rational Requisite Pro and used it extensively for loading stakeholder requirements, business requirements, functional and design specifications and used Rational Clear Quest for defect tracking
• Given formal training for administration and using of Clear Case and Clear Quest and participated and provided suggestions in implementing Clear Quest on an enterprise scale for managing projects related to CMA.
• Prepared UML activity, collaboration and sequence diagrams for detailed analysis of business objects using the Rational Unified Process (RUP)
• Created Use Cases (Business and SystemUse Cases) and modeled Use Case Diagrams, Data mapping, Activity Diagrams, Business Flow Diagrams, Data Flow Diagrams for the defining the functionality for MDW modules like Business Intelligence, Data Delivery, ETL, Security and Metadata
• Worked on conversion and on-going data loads from Teradata to Oracle. Was involved in writing SQL scripts in both Teradata and Oracle to perform validation of data on conversion and on-going loads.
• Established traceability between Business requirements, functional, design and test specifications in order to ensure the completeness of system and testing efforts
• Dealt with Medicare/Healthcare Payers and Providers and processing of Paid Claims, Denied Claims, Shopper Claims (for Fraud detection) and county based member claims.
• Performed a major role in the accomplishment of three major deliverables - Requirement Definition Deliverable (RDD), Functional Specification Deliverable (FSD) and the Technical Design Deliverable (TDD) to MNSDOH
• Defined and designed the Data and Application security matrix spreadsheet which spans through different organizations in MNSDOH and describes their capability of accessing specific applications and data elements in the Medicaid Data Warehouse

Confidential, FL

Business Analyst

Key Responsibilities:

• Documented business requirements, and communicated these requirements to the development team for the design and implementation of business solutions.
• Core activities involved creating/updating Work Breakdown Structure (WBS), preparing deliverable tasks in the project plan
• Developed business requirement updates while working with different user groups to define priorities concerning project development.
• Conducted brainstorming and JAD sessions with stakeholders and end-users for requirement analysis and documented the same.
• Experience working with Claims adjudication system for incoming claims processing, Includes EDI Gateway, Data Mapping, Data Migrator (Member Validation), EPBS (Provider validation).
• Used UML during requirements gathering and created Use Case Models and Use Case Diagrams for the purpose of stakeholders in the project to help them understand the workflow of the system associated with the requirements.
• Analyzed, coordinated, documented and managed project requirements, project processes and procedures and its changes throughout the software development lifecycle.
• Performed Requirements Analysis and traceability using Test Director and MS Word.
• Maintain PeopleSoft systems by performing PeopleSoft required system updates and maintenance ona periodic basis.

Confidential, OH

Business Analyst

Key Responsibilities:

• Developed thorough Functional Requirements Document (FRD) by applying analytical questioning and critical reasoning to business user requirements.
• Documentation of test plan, test cases and test summary to confirm the credibility of application functionality.
• Conducted focused interview sessions with SMEs, project stake holders and Business users so as to obtain maximum details of requirements and involved in documenting business Requirements Documents.
• Conducted interview sessions with SME’s and different application owners so as to ensure the credibility of GAP analysis.
• Ensured credibility and accuracy of business specifications by carrying out brainstorming sessions, development meetings and other collaborative efforts.
• Detailed knowledge of business process to help determine the user needs.
• Acted as a liaison between stakeholders and software development team to gather requirements
• Interviewed client employees for all three projects: Investments, Research and Trading to gather information, understand the users need, define requirements and develop specifications.
• Facilitated (JAD) Joint Application Development sessions to identify business rules and requirements and then documented them in a format that can be reviewed and understood by both business personnel and technical personnel.
• Analyzed gaps for training purposes between existing application and after integration of the new one.
• Mentored and guided junior Business Analysts
• Assisted in the development of quality assurance artifacts including: Quality Assurance Plan, Test Plan and Test Cases