SUMMARY:

• 8+ years of experience as a Business System Analyst in Healthcare industry.
• Strong knowledge of the Software Development Life Cycle models like Agile and Waterfall software development methodology.
• Experience in interacting with business users to identify business needs, gathering requirements and documenting requirements in Business Requirement Documents (BRD), Functional Requirement Document (FRD) and Software Requirement Specification (SRS) across the project as various deliverables.
• Experienced with Iterative approach for Software Development as per Rational Unified Process(RUP). Involved in inception, elaboration, construction & transition phases using rational tools like Requisite Pro, Clear Case and Clear Quest during various phases of RUP.
• Experienced in interacting with business users to identify their needs, gathering requirements and authoring Business Requirement Documents (BRD), Functional Requirement Document (FRD) and Software Requirement Specification (SRS) across the deliverables of a project.
• Experienced in facilitating Joint Application Development (JAD), Rapid Application Development (RAD) and Joint Requirement Planning (JRP) sessions, interviews, workshops and requirement elicitation sessions with end - users, clients, stakeholders and development team.
• Created Requirements Traceability Matrix (RTM) to keep the stakeholders informed of the progress of the project.
• Experienced in Business Analysis, SWOT Analysis, Gap Analysis, Risk Analysis, Disaster Recovery Planning, Testing and Project Planning.
• Extensive knowledge of Medicaid, Medicare, MMIS, Procedural and Diagnostic codes and Claims Process.
• Expertise in EDI and HIPAA Testing Privacy with multiple transactions exposure such as Inbound Claims837-Institutional, 837-Professional, 837-Dental, 835-Claim Payment/Remittance Advise, 270/271-Eligibility Benefit Inquiry/Response, 276/277-Claim Status Inquiry/Response Transactions and testing in Client Server systems and Mainframe Applications
• Experience in Conversion of HIPAA X124010 codes to X12 5010codes and ICD 9 codes to ICD 10 codes
• Good indulgent of HIX, HL7
• Experienced in analyzing and documenting business requirements and system functional specifications including Use Cases
• Strong Knowledge of UML, RUP, Rational Tools
• Proficient in creating Sequence Diagrams, Collaboration diagrams, Activity Diagrams, Class Diagrams using Rational tools and Microsoft Visio
• Experienced in handling Change Management
• Strong knowledge of Business Process Modeling, Business Intelligence and Business Architecture.
• Experienced in writing Test Plans and executing Test Cases
• Skilled in validation and testing complex scenarios for the maintenance of quality standards in projects
• Experienced in creating User Manuals and providing training to users.
• Professional with extensive experience in the development, implementation and integration of strategies within a team oriented environment, utilizing quantitative and qualitative analytical skills.
• Excellent communication and presentation skills.

TECHNICAL SKILLS:

Languages: SQL, Java, Visual Basic, C++, JavaScript, .Net

Tools: Quality Center, QTP, MS Office

Database: MS SQL Server 2005/2000,MS Access, Oracle

Business Analysis: SDLC, Critical Thinking, Decision Making Strategy, Analytical thinking, Use Case Analysis, Requirement Analysis.

Documentation Tools: MS Project 2000

Operating Systems: Windows 2000/2003/2007/XPPROFESSIONAL ACCOMPLISHMENTS:

PROFESSIONAL EXPERIENCE

Confidential, IL

Business Systems Analyst

Responsibilities:

• Coordinated with Business Owner, Application Vendor, Business Project Teams, Payers and Clearing houses to bring all processes to a level of execution to mitigate any impact to current revenue flow under the HIPAA 5010 compliance requirements.
• Produced a full gap analysis for transaction sets 835 and 837 (I/P) against the documented application on HIPAA 5010 enhancements ensuring the upgraded application included the required changes and additions for 5010 compliance.
• Conducted JAD sessions for communicating with all the project directors and stakeholders. Created process workflows, functional specifications and project initiation artifacts.
• Created business workflows on the claims module for the client to get a better understanding of the software and prepared a detailed BRD including all functional and non functional requirements.
• Designed and developed Business Rules document about the Claim Component and HIPAA.
• Created business workflows on the claims module for the client to get a better understanding of the software and prepared a detailed BRD including all functional and non functional requirements.
• Propose different strategies to implement HIPAA 4010 in the new MMIS system.
• Conducting meeting with the client on a daily basis and reporting on daily progress
• Specifications, Documentation and Construction of systems heavily relied on UML modeling.
• Worked closely on 834 transaction code for Benefit Enrollment and was involved in Validation of HIPAA for 837, 270/271, 276/277,835, 834 EDI transactions.
• Performed the Gap analysis on the earlier systems, generated a detailed Requirements document describing new system architecture through Use Cases and Activity diagrams.
• Worked with Source system Subject Matter Expert (SME) to ensure that the extracts are properly mapped. Used SQL for data mapping and querying.
• Designed robust HIPAA 5010 testing and HIPAA 4010 regression SIT and UAT Testing Scripts for the 5010 Project. Scripts were written on an application level and subset by payer resulting in over 600 combined scripts with a maximum of 70 testing scripts steps per script.
• Documented workflows and executed comprehensive testing and training plans to ensure the new acknowledgement results demonstrated in the 999 and 277CA were properly interpreted and managed to ensure Payer acceptance of the 837 files.
• Took action in the process flow to prevent rejected claims from falling into “limbo”.

  Mitigated claim denial increase through a complete analysis of the application “Claims Scrubber” to ensure 277CA accepted claims would not result in an increase in Denials at the payer adjudication level.

• Validated the receiving A/R applications (up to 12 recipient applications) received the correct split file and the application was able to correctly post the 5010 compliant 835 file.
• Tracked all required resolutions required that were identified as needed from Vendors or Payers based on testing results.
• Identified all risks associated with the project and gave suggestions for mitigating the impact the identified risk posed to the business.

Environment: Agile, Rational Requisite Pro, Rational Soda, Rational Rose, SQL, Rational Clear Case, Rational Clear quest, Java, MS VISIO, MS Project, Oracle, HTML, WINDOWS

Confidential, Overland Park, KS

Sr. Business System Analyst /Ecommerce Portal Consultant

Responsibilities:

• Developed BRD and FRD for illustrating storefront experience for individual users, broker and Medicare segment users
• Prepare use case documents and utilized MS Visio to create UML diagrams including use case, activity and class diagrams to extract business process flows and workflows, thereby assisting development and quality assurance teams in understanding the requirements.
• Participated in JAD sessions for requirement, feasibility and risk analysis with various stakeholders, including designers, developers, QA and management to identify critical and high risk areas of the application.
• Created Statement of Work (SOW) and project execution plan for entire developmentand testing phase which included multiple iterations
• Involved in one-to-one interview sessions and JAD sessions with stakeholders, SME’s and business owners to discuss the scope of the conversion.
• Worked on gathering requirements for creating the Medicarewebsite.
• Responsible for working with technical architects to create demos to demonstrate IBM WebSphere Commerce configurable storefronts. This included demonstrating features such as promotions management, catalog management, user registration andshopping cart
• Along with client SMEs, developed the product catalog hierarchy for 20+ medical and dental plans for multiple user segments. The product catalog hierarchy was later used to demonstrate the catalog management features of IBM WebSphere Commerce
• Develop Web Access Management (WAM) requirements to integrate user roles with secured authentication services.
• Worked with User Interface (UI) team from Cognizant and client to develop wireframes and HTML prototypes of new web portal
• Documented the Traceability Matrix for tracing the Test Cases and requirements related to them.
• Develop Non-Functional requirements (NFR) along with client SMEs to ensure coverage of requirements such as browser support, load testing and other mandatory US Government norms specific for healthcare industry
• Analyzing feasibility and Risk to identify the business critical and high-risk areas of the application.
• Worked as a liaison between business users and developers to submit requirements and changes, clarify questions and issues.
• Worked on team environment to finalize use cases to develop functional and detail design specifications of the application.

Environment:Rational Rose, Rational Requisite Pro, SQL,UML,MS Project, MS Visio, MS Office Suite, SharePoint, PL/SQL Developer, HTML,Java, .Net, Visual Basic,Toad, Windows XP, Unix, Outlook, Test Director.

Confidential, Detroit, MI

Sr. Business System Analyst

Roles and responsibilities:-

• Conducted brainstorming and JAD sessions with stakeholders and end-users for requirement analysis and documented the same.
• Documented business requirements, and communicated these requirements to the development team for the design and implementation of business solutions.
• Created EDI documents for EDI maps to generate requirement documents, and logical design documents for EDI transactions and code sets.
• 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.
• Worked on HIPAA ANSI X-12 EDI 837 transaction and version 5010 of this transaction.
• Performed GAP and Impact Analysis for ICD 10 changes.
• Developed, implemented and executed test methodologies and plans to ensure software product quality as per the Rational Unified Process (RUP) methodology. Test some of the Extensions in Facets application manually.
• Analyzed, coordinated, documented and managed project processes and procedures and its changes throughout the software development lifecycle.
• Involved in creating sample mappings for the conversion of EDI X12 transactions code sets version 4010 to 5010 and translation of ICD 9 codes into ICD 10 codes.
• Performed Requirements Analysis and traceability using Quality Center and MS Word.
• Involved in writing test plans, defining test cases, test scenarios and data sets; analyzed bugs and interacted with development team in fixing the errors.
• Established questionnaires required for implementing and upgrading ICD-9 diagnosis codes to ICD-10 codes.
• Worked with Subject Matter Experts (SME), project team members (business and technical), to define technology application for the business and system requirements. Also worked with the QA Team Lead to develop QA standards and ensured compliance with all regulatory requirements.
• Developed several MS Excel spreadsheets and applications to automate manual calculations and optimize reporting structure.
• Participated in Logical design and ETL processes development discussion.
• Also involved in analysis for the conversion of ICD-9 to ICD-10 and also worked with the Data management team for data mapping and data analysis.
• Created Gantt charts and project charters, and followed the Software Development Life Cycle (SDLC)methodology to complete projects on time and within budget.

Environment:-SQL Server, Agile, MS Projec

Confidential

Business Systems Analyst

Responsibilities:

• Conducted GAP Analysis for current Medicaid Management Information System (MMIS) and federal mandate HIPAA 5010 / ICD-10.
• Aided Valuable Information’s in the collection of User Requirements and Business Requirements to create the Business Requirement Documentation (BRDs), using MS Word and MS Visio that provided appropriate scope of work for technical team to develop prototype and overall system.
• Assessed HIPAA 5010 requirements by creating Side By Side 4010-5010 Business Rule Comparison documents for State specific Interface Record Layers (IRL) using ASC X12 Standards 5010 implementation guide for all transaction.
• Briefed System Analysts about the changed/added/deleted Business Rules for HIPAA 5010 and project details.
• Analyzed System Impact including MMIS Tables, Windows, Reports and Interfaces to external entities.
• Conducted and facilitated Joint Application Development (JAD) sessions to reduce time spent in moving information between stakeholders and team members.
• Facilitate meetings with stakeholders and Subject Matter Experts (SME) to evaluate "As Is" processes, identify gaps and craft the "To Be" processes.
• Create Requirements Traceability Matrix (RTM) to trace Business Requirements to Functional Requirement and perform gap analysis in order to meet business needs.
• AnalyzedMedicaid Eligibility Determination System for Children’s Health Insurance Program (CHIP) and enrolment transaction 834 submitted to program administrator for HIPAA 5010.
• Worked closely with the Data Modeling Team to design the new data warehouse and database structure and co-relate the legacy and the new data warehouse structure.
• Prepared Use Case Analysis by documenting UML Use Case Diagrams to describe the interaction among various systems and actors.
• Conducted User Acceptance Test (UAT).
• Provided End-User training and managed workshops.
• Analyzed HIPAA 5010 impact on external data warehouse and data warehouse extract process and mapping of MMIS database and data warehouse.

Environment: UML, RUP, MS-SharePoint, MS-Project 2000, MS-VISIO, CMMI, TestDirector7.6, WinRunner7,windows 2000,EDI, HIPAA compliances.

Confidential, Charlotte, NC

Business Analyst

Responsibilities:

• Conducted analysis studies that serve as input to the strategic planning, goal setting, and approach to achieving the goals.
• Involved in gap analysis workshops to facilitate the proper requirements strategy and defined existing business process (BPM-Business Process Modeling) and identified the gap (Gap Analysis) between the existing & improved business process.
• Worked closely with Business Users to gather and understand requirements for streamlining the Claims Processing System. Prepared business requirements documents (BRD) and functional requirements (FRD).
• Involved in claims and records data mapping and data modeling with technical teams.
• Explained the solution model, analyzed functional requirements, prepared Use cases, defined user profiles, defined supplementary requirements, defined assumptions and prepared traceability matrix and validated requirements.
• Conducted joint application development (JAD) sessions by convening project sponsors, end-user representatives, SME. Also, used brain storming, document analysis, and user task analysis for various reporting types like CLUE (Comprehensive loss underwriting exchange, Change Report, Claim Count, Claim summaries).
• Interacted with the SMEs and stakeholders to get a better understanding of client business processes and gather business requirements.
• Prepared and maintained Requirement Trace ability Matrix (RTM) in Rational ReqPro.
• Assisted in locking bugs, in order to meet specific requirements and deadlines for successful execution of the project.
• Created Business Intelligence reporting, Performed analysis data/report integration & provided functional specification to development team for better understanding of business process and data.
• Createduse cases, process flow models, data flow diagrams and logical flow diagramsusingUMLfor various integrations.
• Gathered requirements from the end-users and acted as a liaison between the end-users and the development team and QA team.
• CreatedQAandUATtest strategies,including regressionandintegrationtesting, wrote test scripts,end-to-end testingscenarios and test plans, managed testing, defect reporting and change requests
• Followed the Agile methodology during the entire SDLC.
• Assured that all artifacts are in compliance with corporate SDLC policies and guidelines.

Environment: Visual Basic, Oracle, MS-Project, MS-Visio Windows 2000 Server, Windows, Rational Tools, Agile, HP Quality Center, Dot Net Framework, Java.