SUMMARY:

• More than Seven years of IT experience as a Business Analyst with solid understanding of Business Requirements Gathering, Business Process Flow, Business Process Modeling and Business Analysis.
• Proficient with tools like IBM Rational Suits (Requisite Pro & Rational Rose) and Microsoft Office, Visio, Excel, Power point, and Access.
• Experience in tracking, tracing and administrating requirements using Requisite Pro.
• Skillful in creating UML Diagrams including Use Cases Diagrams, Activity Diagrams, Class Diagrams, Sequence Diagrams using Rational Rose and MS Visio.
• Experience in writing Functional and Technical Specifications on the basis of user requirements. Strong technical knowledge of research and analysis of the existing systems. Experts on evaluating business needs and client’s requirements in technical terms.
• Experience in Evaluating Test Procedures and Making Recommendations, Defining Test Cases, Reviewing and Maintaining Test scripts, Analyzing Bugs, interaction with team members in fixing errors, automated testing and User Acceptance Testing (UAT).
• Experience in Microsoft Project for status reporting, planning, and charts.
• Ability to manage all levels of business user groups, subject matter experts, and developers with great skills in forming and facilitating Joint Application Development (JAD) and Rapid Application Development (RAD) teams.
• Experience in working with GAP Analysis, SWOT Analysis and skillful in working with Claim Processing and SQL.
• Strong knowledge of HL7, HIX (Health Insurance Exchange), EMR/EHR, Health Care Reform and Patient Protection and Affordable Care Act (PPACA) and Facets.
• Extensive knowledge of Healthcare Insurance including Medicaid. Medicaid Information Technology (MITA), Medicare (Part A, B, C, D), Procedural and Diagnostic codes, Claims Process and Medicaid Management Information Systems (MMIS)
• Experience on requirement gathering on Health Insurance Portability and Accountability Act (HIPPA) compliances and analyzing them. Experience in writing several use cases on HIPPA transformation from 40101A to 50101A.
• Experience working with Health Care Client Server Product TRIZETTO FACETS.
• Experience on writing requirements for the conversion from ICD - 9-CM to ICD-10-CM.
• Knowledgeable in writing requirements for the Medicaid and Medicare claims.
• Experience with Medicaid Management Information system (MMIS) and title XIX program.
• Experience in requirement gathering, analyzing, and developing documents for Electronic Data Interchange (EDI) in standard format between trading partners.
• Analyzed facets data like claims, billing to resolve related subject areas issues.
• Wide range experience covering business and functional requirements gathering/analysis, project management, business/process/data modeling, testing, business / data architecture, data-warehousing, system development life cycle and training.
• Excellent performance in organizing, planning, presentation, negotiation & interpersonal skills. Under minimum supervision, I have recommended executives on a variety of business process and risk management services that will help identify, assess, manage, and measure the risk exposure within a variety of operational areas.
• Experienced in performing Business Process Reengineering/Gap Analysis to check the compatibility of the existing system infrastructure with the new business requirements.

TECHNICAL SKILLS:

Process/Tools: MS Office, Visio, Project, Rational Requisite pro, Rose, Clear Case, MS Visio, RSA (Rational Software Architect), Sharepoint

Project Management: MS Project

Languages: C, C++, COBOL, C#

Operating System: Windows XP/Windows Vista/ Windows 7

RDBMS: MS SQL Server, Oracle

Web Tools: Photoshop, Dream Weaver, XML, Balsamiq

Test Tools: Quality Center, Load Runner.

PROFESSIONAL EXPERIENCE

Confidential, Lansing, MI

Sr. Business Analyst

Responsibilities:

• Interacted closely with the Subject Matter Experts (SME) for gathering, analyzing, and writing business requirements for different functionalities of the web based application.
• Clearly visualized the AS-IS System, participate in the identification, understanding and documentation of business requirements and business rules, and developing requirements for TO-BE System.
• Analyzed facets data like claims, billing to resolve related subject areas issues.
• Created detail business requirements, functional requirements, and layout requirements for reports to be used for higher management.
• Conducted Joint Application Development (JAD) sessions with stakeholders throughout System Development Life Cycle (SDLC) to resolve open issues.
• Created activity diagrams, use case diagrams, sequence diagrams, and class diagrams using UML and Visio to simplify the process for the development team.
• Involved in writing high-level use case narratives using Rational Rose.
• Participated in designing prototypes for development and maintenance processes to explore the feasibility of ideas.
• Enrolled subscribers manually in FACETS.
• Extensively used RUP methodology in all phases of the project.
• Worked on various conversions like ICD-9-CM to ICD-10-CM, Medicaid, and Medicare claims, Electronic Data Interchange (EDI) between trading partners.
• Involved in creating user requirements specifications, functional specification quality assurance plan, product acceptance plan, test plan, and test cases using rational suites.
• Assisted in System Testing and User Acceptance Testing worked with System Test Review team and developers to resolve system test issues and re-test.
• Assisted clients to analyze and write requirements for reducing cost, generating extra revenue and time expensed in improving quality and service, flexibility, and proper use of other available resources by using new automated system.

Environment: Facets, Windows, Visual Basic, VB.Net, HTML, Oracle, Clear Quest, Clear Case, Rational Rose

Confidential, Edinburg, TX

Business Analyst

Responsibilities:

• Understood the AS-IS System, identify and analyze improvements, and developing requirements for TO-BE System.
• Gathered requirement onFACETS EDI 834 Benefit Enrollment and Maintenance subsystems.
• Interacted closely with the Subject Matter Experts (SME), its major stakeholders and business users for the business process modeling, and developed the Business Requirement Document (BRD).
• Played an active and lead role in gathering, analyzing and writing business requirements from SME’s, Stakeholders and end users in Commercial prospective.
• Conducted different form of requirement gathering technique including Web based survey of field agents and used questionnaire as requirement elicitation technique.
• Framed a detailed JAD session agenda and facilitated JAD sessions with the SME’s, process owners & stake holders and collected the meeting minutes from the session.
• Analyzed the Meeting Minutes collected in JAD sessions into Functional Requirements, Non-Functional Requirements and Business Rules.
• Analyzed Functional and Business Requirements for its network, hospital quality ratings, prescription drug costs, and services from A to Z.
• Involved in requirement gathering on modification process of HIPPA 40101A to HIPPA 50101A compliance.
• Gathered requirements for the conversion of ICD-9-CM to ICD-10-CM, Medicaid, and Medicare claims, Electronic Data Interchange (EDI) in standard format between trading partners and wrote several use cases for them.
• Worked on creating clear, concise detailed Functional Requirements Specification (FRS) documents and user documentation in accordance to guidelines and standards of a level where developers can interpret, design and develop the application with minimum guidance.
• Assisted in defining and reviewing the Non-Functional architecture requirements for designing the GUI including security, integration, performance, and quality requirements.
• Represented the requirements in Requirement Traceability Matrix (RTM) using Requisite Pro.
• Identified Use Cases from the Functional Requirement and Created Use Case Narratives along with the functional specifications for each work streams.
• Applied Unified Modeling Language (UML) methodologies to create business process workflow diagrams (Use Case, Activity)
• Project was implemented using the Rational Unified Process (RUP) Methodology to produce artifacts across all its four phases - Inception, Elaboration, Construction and Transition of the Software Development Life Cycle (SDLC).
• Applied Change Management processes to ensure modifications were included and managed within scope of the project.
• Interacted with the developers to explain the proposed changes and understand the system requirements to handle these changes.
• Created test cases for business verification using the acceptance criteria and management inputs to check the functionality of application.
• Collaborated with QA team to create and implement test plan and test cases for User Acceptance Testing (UAT).
• Experience on working with claim processing.
• Experience in using SQL queries to retrieve and validate data.
• Developed User Manuals, Presentations and Training Manuals as per project specifications and timelines.
• Provided regular feedback to the Project Manager of progress made on work products and various milestones reached

Environment: Rational Suite, Oracle, UNIX, UML, MS Project, MS Visio, MS Office, COBOL.

Confidential

Business Analyst

Responsibilities:

• Served as a liaison between business team and project team by defining business requirements and business rules.
• Involved in writing business requirements by identifying and analyzing their business needs and business process flow.
• Created detail user/business/functional requirements as well as vision, scope, and use case documents.
• Created business process model by creating activity diagrams, use case diagram, sequence diagram, collaboration diagrams, class diagrams and state chart diagram.
• Translated the business needs into system requirements, communicating with the business users on a non-technical level, and with the system analyst on a more technical level.
• Collaborated with the development architect and management team to develop both high level and detailed application architecture to meet the business needs.
• Involved in process modeling, reviewing and writing functional specifications and technical specification for different functionalities of the Web based application, including online access to the system by their employer health plan.
• Involved to assist other fellow business analysts to gather business requirements, business needs of the client, and colleting business rules, analyzing and documenting them.
• Conducted JAD sessions and collected the meeting minutes from the sessions.
• Analyzed and documented the meeting minutes collected in JAD sessions and converted them into functional and non-functional requirements as well as Business Rules.
• Involved in requirement gathering and documenting on modification process of HIPPA 40101A to HIPPA 50101A compliance.
• Involved in writing use cases for Medicaid and Medicare claims as well as Medicare prescription Drug plan and Medicare Advantage Plan claims.
• Created and wrote quality assurance plan, test plan and test case using Rational suites.
• Project was implemented using the Rational Unified Process (RUP) Methodology to produce artifacts across all its four phases- Inception, Elaboration, Construction and Transition of Software Development Life Cycle (SDLC).
• Used Clear Case and Clear Quest for data management and defect tracking and helped the database team to identify requirements.
• Assisted in System Testing and User Acceptance Testing worked with system test review team and developers to resolve system test issues and re-test.

Environment: Windows, Java, DHTML, HTML, Oracle, Clear Quest, Clear Case, Rational Rose

Confidential, Fort Worth, TX

Business Analyst/Quality Analyst

Roles & Responsibilities:

• Interacted as a liaison between end users, stakeholders, development team, test team and management involved in the application development and document reviews.
• Understood the Process Flow in manufacturing environment and gather, identify, analyze, and document requirements including the applications that are capable of supporting those requirements.
• Clearly familiarized with IS-System, identify and analyze improvements, and develop requirements for the TO-BE System in production environment.
• Collaborated with end users to identify defects, analyze them and write requirements to how to correct them as well as wrote requirement for the process flow.
• Created activity diagrams, sequence diagrams, collaboration diagrams and use case diagrams using the Unified Modeling Language (UML) and Microsoft Visio.
• Closely interacted with developing team to create test strategy preparation, test plan development, test case creation, test execution, and bug tracking.
• Created Requirement Traceability Matrix (RTM) to track the defects by using Requisite pro and analyzing the repeated defects.
• Conducted Root Cause Analysis to avoid repeated defects.
• Wrote test procedures, define test cases, review and maintain test scripts, analyze bugs, interaction with team members in fixing errors.
• Analyzed business requirements, software requirement specifications to create test plan and test cases for manual and automated testing.
• Conducted manual and automated testing procedures including black box, white box, functional, GUI, system, regression, integration, user acceptance and performance.
• Used Rational Unified Process (RUP) methodology for the project development life cycle.
• Used clear case and clear quest for data management and defect tracking.
• Involved in Creating Automation Test Scripts using Quick Test Pro (QTP).
• Created product acceptance criteria for the defected product and document them.
• Assisted in System Testing and User Acceptance Testing worked with system test review team and developers to resolve system test issues and re-test.
• Reviewed development plans, quality assurance test plans and user documents to ensure correct interpretation of original specifications.

Environment: Rational Rose, Rational Requisite Pro, Rational Clear Case, Rational Clear Quest, HP Quick Test Pro, QualityCenter, Load Runner, HTML,XML, Java Scripts, VB Scripts, SQL Server, Oracle,MS Power Point, MS Visio, Windows, Linux.