SUMMARY

• Over 8 years of professional experience as a Business Analysis with hands on experience in Requirement Gathering & Analysis and complete understanding of Project Cycle Management (SDLC) in Healthcare/Insurance domain.
• Expertise in Waterfall and Scrum Agile methodologies, business process redesign, interacting with business, understanding user requirements and articulating them into User Requirements Specifications.
• Extensive experience leading and facilitating Joint application development (JAD) sessions among stakeholders, SME’s and technical team to gather high level requirements, creating project plans, schedules and managing changes.
• Excellent Business writing skills in creating Business requirement document (BRD), Use case specifications, Functional specifications and System requirements specifications (SRS), Requirement traceability matrix (RTM) and Change request documents.
• Expertise in designing business models, Use cases, Activity diagrams, Process flow diagrams and Unified modeling language (UML) using MS Visio and Rational rose.
• Excellent knowledge of User acceptance testing (UAT), Smoke testing, Regression testing Performance testing and Functional testing.
• Expertise in MS Project, Excel, Word, PowerPoint, Visio, clear quest, HPQC, JIRA, MS SharePoint and requisite - pro.
• Experience writing SQL queries in Oracle, MySQL server databases.
• Strong knowledge of Data Modeling, Data Warehousing and Data Mapping.
• Strong knowledge of OLTP/OLAP System, E-R modeling and schemas like Star schema and Snowflake schema used in relational, dimensional and multidimensional data modeling.
• Strong knowledge of HL7, HIX (Health Insurance Exchange), EMR/EHR, Plan Management, eligibility and enrollment process application.
• Knowledge of Explanation of Benefits (EOB) and Explanation of Payments (EOP).
• Extensive knowledge of Healthcare Insurance, Medicaid Information Technology (MITA), Medicare (Part A, B, C, D), Procedural and Diagnostic codes, Claims process and Medicaid management information systems (MMIS).
• Experienced in provider and payer systems, including Electronic medical records (EMR) and revenue including Medicare and Medicaid projects.
• Experience working with HIPAA ANSI X12 4010A 270/271, 276/277, 834, 835, 837 for institutional, professional and commercial claims, and up-gradation of ANSI 4010 to ANSI 5010.
• Excellent understanding of ICD 9, ICD 10, HCPCS and CPT.
• Managed complex business initiatives to balance requirements for functionality, efficiency and quality.
• Strong project management skills and breaking down complex issues identify solutions and communicate these to the development and management teams.

TECHNICAL SKILLS

ff Packages: MS Office, MS Visio, MS Project

MS Office Tools: MS Word, Outlook, Excel, Access, and PowerPoint, MS SharePoint

Tools: Share point, Rally, Clear case, Clear Quest, Rational Rose, Requisite Pro, HP Quality Center, Java Script, SQL, HTML Desktop, OLTP/OLAP, ETL Process, E-R Model.

Database: Oracle 10g-11g, MySQL, MS Access.

Operating Systems: Linux, HP UNIX, Windows and MAC.

Methodologies: Agile, SCRUM, Rational Unified Process (RUP), Waterfall Model.

Business Documentation Skills: BRD, FRD, User Stories, Use Case Specifications, Functional and Non-functional Specification, System Requirement Specification, UML Diagrams Use case, Class and Sequence, Traceability Matrix, Project Estimate, System and Acceptance, Test Plan Review.

PROFESSIONAL EXPERIENCE:

Confidential, FL

Sr Business System Analyst

Responsibilities:

• Worked as client dedicated Business Analyst, responsible for gathering requirements from client ( Confidential Inc.) and documented Business requirement document (BRD).
• Facilitated JAD sessions with both internal and client teams to get a better understanding of On & OFF Exchange business processes.
• Conducted sessions with development and technical teams to document solution/functional requirements.
• Attended Daily scrum calls, Sprint planning and review sessions in order to achieve efficient work progress.
• Developed and maintained Market movement matrix, reporting members/policies.
• Generated ad-hoc SQL queries to fetch data from main Database to develop and analyze reports of migrating members.
• Designed and developed Activity Diagrams, Sequence Diagrams, Use Cases and other Process Flow Models using Visio.
• Worked as production and testing support, performing daily testing validation of 834 files to analyze and understand the impacts of migration.
• Actively interacted with other corporate departments, including executive, legal and recon and regulatory.
• Participated in developing test plan, test scripts, and test scenarios and designed user documentation.
• Managed change requests from business users and web developers and conducted sessions to resolve conflicts.

Environment: Scrum and Waterfall Methodologies, Quality Center, MS Visio, MS Excel, UNIX & SQL Database Server, Web gateway tool, Macros requirement template, EDI notepad, Win.scp.

Confidential, Neptune, NJ

Lead Business Analyst

Responsibilities:

• Involved in defining scope of the project along with vision statement using Agile and Waterfall Methodologies.
• Worked as a primary liaison between the business, SME’s and the technical areas throughout the project cycle.
• Performed Gap Analysis to check the compatibility of the existing system infrastructure with the new business requirements.
• Facilitated JAD sessions with stakeholders and SMEs to gather requirements, create the Business Requirement Document (BRD) and the Functional Requirement Document (FRD).
• Attended Daily scrum calls, Sprint planning and review sessions in order to achieve efficient work progress.
• Conducted one-on-one sessions with business users to gather data warehouse requirements.
• Developed normalized Logical and Physical database models as well as worked on use cases diagrams for Data mapping and Data marts.
• Wrote the requirements for ETL mapping.
• Organized and conducted meetings, briefings, demonstrations, and JAD sessions.
• Worked with Database Administrators, Business Analysts and Content Developers to conduct design reviews and validate the developed models.
• Created data models and data flow diagrams for the to-be process.
• Working with developer, mainframe and backend system support team to understand existing and future implementations.
• Involved in identifying Functional and Non-Functional requirements and created the functional system design document (FSD).
• Conducted User Acceptance Testing (UAT) and verified performance, reliability and fault tolerance issues.
• Generated ad-hoc SQL queries using joins, database connections and transformation rules to fetch data from legacy DB2 and SQL Server database systems
• Interacted with the developers and defined the needs to update the design of the Graphical User Interface.
• Actively interacted with other corporate departments, including executive, legal and information services.

Environment: Scrum and Waterfall Methodologies, Rally software, Quality Center, MS Visio, MS Excel, OMS Oracle, UNIX & SQL Database Server, Rational Rose.

Confidential, Stony Brook, NY

Sr. Business Analyst

Responsibilities:

• Followed waterfall and agile methodologies.
• Involved in all phases of SDLC from requirement gathering, designing, and development/testing.
• Facilitated JAD sessions with stakeholders and SMEs to get a better understanding of HIX business processes.
• Interacted with client and the Technical Team for requirement gathering and translation of Business Requirement to Technical specifications.
• Gathered requirements to document the Business requirement document (BRD), Functional requirement document (FRD) and also created business processes, business flows.
• Designed and developed Activity Diagrams, Sequence Diagrams, Use Cases and other Process Flow Models using Visio and Rational Rose.
• Execute business process maps for Affordable Care Act system implementation.
• Managed the Change management process to document change controls, justifications for the changes, impact analysis and approvals.
• Developed, maintained and published project plan & scheduled project deliverables using Clarity resource database as well as MS Project.
• Extensively involved in the modeling and development of Reporting Data Warehousing System.
• Research, Review and update clients and Independent Verification and Validation edits for approval.
• Formulate Test strategies, Test plans and test data and execute test scripts.
• Create User Manualsfor the HIX System for Training and Communications Team Design notices.
• Maintain accurate documentation in all internal systems and their integration pointsand define technical solutions.
• Environment: Scrum and Waterfall Methodologies, Rally software, Quality Center, MS Visio, MS Excel, OMS Oracle, SQL, Java, Oracle, Load Runner, MS Project, MS Office, Rational Requisite Pro, Rational Rose, Clear Quest.

Confidential, Philadelphia, PA

Business System Analyst

Responsibilities:

• Involved in defining scope of the project along with vision statement using Agile and Waterfall Methodologies.
• Performed the GAP analysis, to understand the gap between the 4010 and 5010 conversions.
• Worked as a primary liaison between the business line, operations, and the technical areas throughout the project cycle.
• Created Business requirement document (BRD), Functional requirement document (FRD), User stories and Product backlog.
• Attended daily scrum meetings and sprint planning sessions to determine documentation requirements and deadlines.
• Responsible for doing the gap analysis for the interfacing system.
• Involved in 835,837 files validations at Claim level, Line level, Service level and Transaction level
• Coordinated updates with client's staff and implement efficiencies in documentation maintenance.
• Worked with ANSI X12 5010 as well as 4010 including medical transactions such as 837 (medical claims), 835 (medical claim payments), 270/271(enquiry and response) and 820 (enrollment.)
• Extracted and maintainedSASdata sets from the raw data created by the data management group.
• FacilitatedICD9-ICD10conversion requirement gathering session and created high level Business Required Document.
• Extensively used SQL queries and procedures for data validation in both source system and target system.
• Involved inforward mappingfromICD 9toICD 10andbackward mappingfromICD 10-ICD 9throughGEM.
• Created Use Cases diagrams, Data Flow diagramsandUser Interface design diagrams.
• Participated in developing test plan, test scripts, and test scenarios and designed user documentation.
• ConductedUser Acceptance Testing (UAT)and verified performance, reliability and fault tolerance issues Participated in weekly status meetings to present status and incorporate any digressions from the original scope.
• Analyzed the“As is”and“To be”system documents to show the current and proposed functionalities of the system using MS Visio.

Environment: Scrum and Waterfall Methodologies, Rally software, HPQC, MS Visio, MS Excel, OMS Oracle, UNIX & SQL Database Server, Rational Rose, JIRA.

Confidential, Oklahoma City, OK

Business Systems Analyst

Responsibilities:

• Used SDLC (System Development Life Cycle) methodologies like the Agile and Waterfall.
• Gathered requirements from stakeholders for provider management and member management.
• Developed the stakeholder list and created stakeholder assessment matrix to prioritize them.
• Conducted Risk analysis and developed mitigation plans.
• Developed Gap Assessment and Impact Analysis Roadmap, Implementation Advanced Planning Document (IAPD) and developed the action steps to fill the gaps for the HIPAA compliance.
• Facilitated JAD sessions for Requirement Validation with Dept. Of Health & Human Services (DHHS) to gather requirements for the newMMIS.
• Conducted interviews sessions with SME’s and different divisions of state dept.
• Gathered all documents divided into different areas Policies, state plans, Manuals, Business Process, Systems and Interface.
• Developed documentation processes and supported project groups with creation Visio diagrams, spreadsheets, and other documentation.
• Performed detailed analysis for the following functional areas that is going to be impacted by ICD-10 codes.
• Used detailed knowledge of the application features and functionality to assess the scope of thebusinessneeds throughout the analysis and completion of enhancement specification.
• Conducted Business Process (As Is/To Be) sessions with various department directors and staff to ensure the Testing Plan and Test Approach would meet the identified Business Requirements, and the Training Program covered all identified new and changed processes.
• Proposed strategies to implement HIPAA 4010 in the newMMISsystem and eventually move to HIPAA 5010.
• Facilitate HIPAA integration and applied ANSI ASC X12 standards for 837 (I, P, D), 270/271, 276/277, 278, and 835 and 837 transactions.
• Created and maintain requirement traceability matrix (RTM).
• Analyzed different data crosswalks, complicated logic and lookups required by different fields for the source to target transformations.
• Involved in designing and developing Data Models and Data Marts that support the Business Intelligence Data Warehouse.
• Analyzed EDI X12 data elements captured by the existing system to validate it against the data elements required for new system.
• Worked with legacy team in developing BRD for multiple system change requests and participated in system testing.

Environment: Scrum and Waterfall Methodologies, Rally software, JIRA, MS Visio, MS Excel, OMS Oracle, UNIX & SQL Database Server, Rational Rose

Confidential, NJ

Business Analyst

Responsibilities:

• Involved in planning of development work using Agile Software Development.
• GatheredBusinessrequirements from the stakeholders, SME’s and documented the requirements in theBRD.
• Developed FRD (Functional requirement Document) for data architecture and communicated with the SME’s.
• Designed Mapping document, which is a guideline to ETL Coding.
• Created artifacts such as Use Cases, Activity Diagrams, Swim lanes Diagrams and Sequence Diagrams using UML/Visio.
• Created Use case and Activity diagrams using MS Visio to give web developers a better idea of the application design.
• Managed change requests from business users and web developers and conducted JAD sessions to resolve conflicts between keys users and web developers.
• Created several stored procedures for data profiling purposes to get a good understanding of duplications and anomalies already exist in the source databases.
• Created roles and file groups to authorize customers to access certain resources of database.
• Generated reports weekly and monthly to an online management interface using SRS.
• Created UAT testing status reports to present to upper management.

Environment: Scrum and Waterfall Methodologies, Rally software, JIRA, MS Visio, MS Excel, Oracle database, UNIX & SQL Database Server, Rational Rose.