SUMMARY

• Eight years of experience working as a Business Analyst in Healthcare domain.
• Solid understanding of SDLC processes including requirements gathering, analysis and design, development tools and technologies, release and version control, contemporary testing methodologies and deployment management.
• Experience working with various industry standards: Rational Unified Process (RUP), AGILE, Capability Maturity Models (CMM), ISO 9001 Quality Management Systems and Lean Six Sigma (DMAIC) Methodology.
• In - depth understanding of Project Management Practices and Principles including Time Management, Budget Management, Resource Management, Risk and Change Management.
• Experience in conducting GAP analysis, Impact analysis, SWOT analysis, Cost benefit analysis and ROI analysis.
• Excellent analytical skills to understand teh business process functionality and to translate them to Business Requirement Documents (BRD), Functional Requirement Documents (FRD) and System Requirement Specifications (SRS).
• Hands-on experience with process modeling using Unified Modeling Language (UML) including use case, sequence, activity, class and deployment diagrams.
• Experienced in facilitating and conducting JAD sessions, requirement workshops, focus group, root cause analysis, SWOT analysis and user stories.
• Experience in implementation of HIPAA 4010 and HIPAA 5010 changes in teh existing claim processing integrated system.
• Extensive experience in claims processing and billing, Medicare/Medicaid billing and claims management.
• Proficient in ICD-9-CM and ICD -10-CM coding and claims processing.
• Prepared Business Process Models that includes modeling of all teh activities of teh business from teh conceptual to procedural level using Swim lanes, SIPOC’s and Value Stream Mapping tools (VSM).
• Extensively participated in verification of EDI file formats against Standards and worked with implementation guides, TR3s.
• Used Validator Self-Testing Tool to accept claims from teh Trading Partner.
• Experienced in performing Business Process Reengineering to check teh compatibility of teh existing system infrastructure with teh new business requirements by using AS-IS, TO-BE BPM’s diagrams.
• Strong knowledge of HL7, HIE (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 Architecture, Medicare (Part A, B, C, D), Procedural and Diagnostic codes, Claims Process and Medicaid Management Information Systems (MMIS).
• Experienced with teh IBM Rational tools suite like ReqPro, ClearQuest, Clear Case, Rational soda, Rational Rose.
• Experience working with Health Insurance Portability and Accountability Act (HIPAA) transaction and code set rules such as EDI healthcare transactions like 837, 835, 834, 820, 270, 271, 275, 276, 277 and 278.
• Proficient in developing UAT plans, UAT cases, UAT scripts and executing UAT’s.
• Proficient in writing queries/ SQL/ MS Access to assist in UAT, data validations and data analysis.
• Exceptional Documentation Skills for writing Use Cases.
• Good Knowledge of Test Plan, Test Scripts and Test Cases for Functional, System, Integration, UAT, and Regression Testing based on teh Design Document and User Requirement Document for teh Functional, Security, and Performance Testing.
• Extensive experience in using ALM tools (SharePoint 2010, SharePoint 2013, and Rational Suite).

TECHNICAL SKILLS

Business Analysis: Requirements engineering, business process modeling and improvement, gap analysis, cause and effect analysis, decision trees, data flow diagrams, data modeling, wire frames, Mockups, CBA, FMEA’s, QFD’s, Object Oriented Analysis and Design (OOAD).

Methodologies: AGILE (RUP, SCRUM, Iterative), Waterfall, DMAIC, DMADV, DFSS.

Data Analysis: Data Cleansing, Data Mapping, Data Transformations, Source Systems Analysis, Reporting Analysis, Regression Analysis, DOE, SPC.

Rational Suite: Rational Rose, RequisitePro, Clear Quest, Clear Case, Rational Method Composer.

Business Tools: MS Excel, MS Word, MS Project, MS Access, MS Visio, MS PowerPoint, MS Outlook, Lucid Chart, Swim Lane Chart, Root Cause Analysis

Programming: XML, SQL and UML

Web Technologies: PHP, JSP, HTML/DHTML, XML

Databases: MS SQL Server, Oracle 8i/9i/10g, MS Access, Sybase 12.x/11.x, Tera Data

Test Tools: Test Director, HPQC, Mercury Quality Control, Load Runner and Silk Test

Healthcare knowledge: HL7, HIE, EMR, HER, PPACA, ICD9, ICD10, HIPAA4010, HIPAA5010, Claims Process

PROFESSIONAL EXPERIENCE

Confidential | Somerset, NJ

Business Systems Analyst

Responsibilities:

• Organized and facilitated meetings with teh management and development team and conducted teh requirements workshop for creating and defining teh Business Requirement Document (BRD), Functional Requirements Document (FRD) and System Requirements Specification (SRS) using Requisite Pro.
• Supported tactical and strategic goals of teh IT Production Support Team. Ensured compliance with structured Project Delivery Process.
• Conducted JAD sessions to allow different stakeholders to communicate their perspectives with each other, resolve any issues and come to an agreement quickly.
• Involved in GAP and feasibility analysis for teh design and architecture of teh new application.
• Created workflow diagrams and UML diagrams (use case diagram, activity diagram, sequence diagram) using MS Visio for various stakeholders.
• Created high-level Use Cases from Business Requirements
• Prepared Request for Proposal (RFP/RFI) documents and vendor evaluation by interviewing and simultaneous comparison of all vendors.
• Involved in Requirement Scoping and analyzing high priority requirement for implementation.
• Conducted functional requirement reviews and walkthroughs with teh designers, developers, and stakeholders.
• Involved in validation for teh recent changes in EDI transaction sets and ICD 10.
• Implementation of HIPAA 4010 and HIPAA 5010 changes in teh existing claim processing integrated system.
• Conducted testing for labs with HL7 standards and coordinated with QA team to test teh complete application as per requirements.
• Involved with teh quality assurance team to develop and design test plan and test cases, tested all teh features of teh EMR after every upgrade of Meditech and reviewed teh implementation of teh changes made in teh systems as per teh formats and compliance for EDI usage.
• Conducted Triage calls to monitor defects using Mercury Quality Center to ensure that testing effort is synchronized with teh development team.
• Responsible for Data modeling and Mapping through data analysis to extract data elements from various OLTP’s using ETL technique (Informatica Power Center 8.1) and utilized Business Intelligence Tool (Tableau) for\ report generation.
• Prepared Static Prototype (Wireframes) using MS Visio and Mockup Screens, and assisted UI/UX team in creating Dynamic HTML Prototypes.
• Extensively worked with SharePoint 2010 for document management and accessibility.
• Conducted workshops to understand requirements for Data Warehouse design.

Environment: AGILE SCRUM Methodology, Facets, Windows XP, Java, XML, Java Script, Oracle, Rational Requisite Pro, UML, Load Runner, Quality Center, Show Case, SQL Query, HP ALM, Java, MS Project, MS Office, DB2, MS SQL Server, Windows XP, Informatica, SharePoint, Tableau.

Confidential | Montgomery, AL

Business Systems Analyst

Responsibilities:

• Define, gather, and analyze customer requirements.
• Gatheird requirements for administrative transactions with implementation in compliance with Patient protection and affordable care act (ACA).
• Understand and articulate Business Requirements from SME interviews and workshops and translate requirements into Business Requirement Specifications (BRS).
• Developed Functional Requirements Document (FRD) and System Requirements Specification (SRS) and use case document.
• Coordinated with teh development team and translated teh requirements to develop teh product to comply with HIE standards.
• Prepared teh report spec and created mapping to develop and generate teh reports.
• Prepared teh architecture document to communicate between EHR, HIE, and PHR.
• Used UML and RUP methodologies along with supporting toolset including Rational Suits to identify KPI’s.
• Supported tactical and strategic goals of teh IT Production Support Team and ensured compliance with Project Delivery Process.
• Identified defects using Rational Requisite Pro and assigned it to teh development team.
• Conducted testing for labs with HL7 standards.
• Facilitated teh testing team to test teh complete application as per requirements and reviewed test scenarios and test cases for functionalities.
• Extensively worked on Excel sheets and Pivot tables to update teh running job statuses to teh higher Executive management.
• Assisted in system design, methods, procedures, policies and workflows effecting Medicare/Medicaid claims processing in compliance with government compliant processes like HIPAA/ EDI formats and accredited standards ANSI.
• Worked on HIPAA transaction codes specifically on EDI 837, 835, 276, 277, and 834 to in corporate enhancements to existing efforts on capturing and mapping.
• Extensively worked with SharePoint tool for document management and accessibility.

Environment: Rational Unified Process (RUP), UML, Dreamweaver, Rational Test Manager, Rational Clear Quest, Windows, MS Office: Excel, Word, PowerPoint, MS Project, MS Visio, MS Access,UML,.Net, MS Office, MS-Project, Windows 2000, Test Director., HTML, Windows, HL7, HIPAA EDI Transactions 270/271, 276/277, 820, 835, and 837, SOP.

Confidential | Bluffton, SC

Business Analyst

Responsibilities:

• Interacted with business to prioritize and finalize teh Business Requirements for teh web applications.
• Performed teh requirement analysis and documented teh requirements using Rational Requisite Pro.
• Responsible for architecting integrated HIPAA, Medicare solutions, Facets.
• Worked on HIPAA4010/ 5010 transactions set and ICD-10 initiatives.
• Analyzed CMS comparison documentation highlighting changes of 5010 format and ICD10 diagnosis and procedure codes.
• Work closely with users from multiple functions and understand reporting requirements.
• Documented teh business rules, and wrote verbiage for client side and server side validation.
• Build metadata layers in Cognos Framework Manager by identifying relationships between database tables, views and other objects across multiple databases.
• Extensive experience in conducting Unit Testing, System Integration Testing and User Acceptance Testing (UAT) at various stages of teh project.
• Implemented ETL technique for data integration and migration.
• Development of several Packages to support both Report Studio Authoring and Ad-Hoc reporting.
• Developed suite of prompt based Report Studio modules for diverse user groups including Operations, Sales Teams and Senior Management. Reports included extensive use of complex multi-query options and complex Conditional Formatting.
• Extensively wrote complex SQL queries for data integration and migration.
• Established and executed best practices based on methodology in teh transition from teh “as-is” to teh “to-be”.
• Ensured accountability across all teams on issues and technical & resource dependencies.
• Recommended strategies that centralized and simplified teh architectural components for enterprise application integration, by adopting SOA, standards-based common integration patterns, objects, and processes.
• Ensured that Business, Data Governance and Integration team leads are deeply involved in critical design issues and decisions.
• Identify users of all levels (Power users, consumers etc.) and grant access permissions accordingly.

Environment:, MS Office Excel, Word, PowerPoint, MS Project, MS Visio, Waterfall, Unix, Mainframe, Caliber, Rational Rose, Rational Requisite Pro, Rational Clear Case, UML, QTP, VB Script, MS Project, MS Office, DB2, MS SQL Server, Windows Server, Windows XP, XML, Agency Port, Cognos

Confidential

Business Systems Analyst

Responsibilities:

• Interactions with teh end users in order to generate teh report required and to understand teh business requirements relating to Medicaid program and Pharma.
• Worked on hospital information systems and electronic medical records.
• Performed teh GAP analysis for teh various loop segment elements.
• Worked with DBA and data architects on implementation of database changes.
• Documented technical services with desktop and other technologies and worked on analyze process flows.
• Analyzed data flow requirements and developed a scalable architecture for staging and loading data and translated business rules and functionality requirements.
• Analyzed business requirements and implemented technical solutions and assisted with local WAN, LAN, Server, desktop and other technologies.
• Worked with QA Team and SME’s to create data mappings for teh back office systems.
• Developed test plans, test scenarios, test cases, test data to be used in testing based on business and user requirements, technical specifications.
• Interacted with DBA’s to understand teh table’s schemas.
• Involved in teh requirement gathering and analysis for implementing teh data warehouse.
• Interpreted logical and physical data models with data modelers to determine common data definitions and establishing teh referential integrity system.

Environment: Rational Tools, MS Office, MS Visio, UML, RUP, SQL, Oracle, HTML, Windows, UNIX, Java, ACBS, Fixed Income Securities, Crystal Reports, Informatica.

Confidential

Business Analyst

Responsibilities:

• Analyzed and prioritized user and business requirements as system requirements that must be included while developing teh software.Worked at different stages of teh Software Development Life Cycle (SDLC) with business users, developers, and stakeholders.
• Gatheird requirements and transformed requirements into technical details.
• Had been involved with teh project from its inception phase to transition and production rollout phase.
• Facilitated and managed Joint Application Development (JAD) sessions with committee of SME’s (Subject Matter Experts) from various business areas.
• Appropriate verbal and written communication skills, facilitation, planning, documentation and problem solving skills.
• Gatheird business requirement, defined scope and analyzed data.
• Interacted with clients to gather all requirements to formulate business specifications and translate those into application functionality.
• Documented and delivered Functional Specification Document (FSD) to teh project team
• Held review meetings to monitor progress of teh project as per schedule, and ensured timely completion and delivery of teh project to teh client.
• Conducted interviews with key business users to collect requirement and business process information.
• Documented Functional Requirements for business level components, user interface, and system security.
• Defined Core Business Rules and Core Business Validations for teh entire application.
• Analyzed teh technical specifications and business requirements.
• Developed business requirement specification documents, business process models in RUP to document existing and future business processes.
• Wrote Use Cases, Business Flows and Work Flows Diagrams for effective plans.
• Involved in benchmarking activities to identify best practices.
• Wrote queries and developed reports for various levels of management by using SQL and Excel.
• Provided reporting to management via Excel reports of workload and work completion on daily, weekly, and monthly bases.

Environment: RUP, SAP, Oracle EBS Supply Chain, Business Intelligenceand Analytics, Six Sigma, MS Project, MS Office, OBIEE, Enterprise Architect, LoadRunner, MS SQL, Rational Requisite Pro, Altova XMLSpy

Confidential

Business Analyst

Responsibilities:

• Worked with business representatives to understand requirements and priorities and ensure that software development work is appropriately aligned.
• Involved in teh meeting with Business Process Owners, Subject Matter Experts (SME) and Health Center users for Requirement gathering in Definition Stage using Rational Requisite Pro.
• Facilitated Requirements Sessions, as well as weekly client & team meetings.
• Conduct JAD and SCRUM work sessions to understand teh working system impact.
• Create work scenarios and work sessions to come up to teh most economical scenario of change.
• Create layout and mockup of teh change to be made in form of teh report.
• Worked on Impact analysis for each of teh systems and their sub entities for both inbound and outbound systems.
• Create business requirement and functional requirements using optimal trace.
• Having cross functional review where in required for setup.
• Creating tractability between teh business requirement and functional requirements.
• Work with teh QA team for testing.
• Created Various Business Requirement Documents (BRD) and Functional Requirement Specification (FRS) for teh project.
• Created Requirement Action Plan for various project deliverable.
• Participated in user meetings to understand requirements for teh Data Warehouse design.
• Created various Use Cases and workflow diagrams, using MS Visio.
• Maintained Traceability Matrix in Excel.
• Created Report Mockups and Sample Mapping documents for teh Error Reporting.
• Extensively worked with SharePoint tool for document management and accessibility.
• Worked with Web services to understand teh data input.
• Worked with teh Business and IT teams to get teh requirements for dis project.

Environment: AGILE SCRUM Methodology, SAP-SCM-ERP, SQL, C, C++, MS Office (MS Word, MS Excel, MS PowerPoint), SWOT Analysis, GAP Analysis, UML, Enterprise Architect, Rational Requisite Pro, Six Sigma (DMAIC), SharePoint