SUMMARY

• 8+ years of experience as a Sr. Business Systems Analyst in Various Domains like healthcare, Mortgage, property & casualty with solid understanding of Business Process Modeling, Business Requirements Gathering, Business Process Flow, Systems Analysis, QA and business process Re - engineering.
• Experience in conducting GAP Analysis, in analyzing AS-IS and TO-BE business processes.
• Experience working in all phases of Software Development Life Cycle (SDLC), and using industry standard methodologies like Rational Unified Process (waterfall) and Agile.
• Business Requirements gathered using elicitation Techniques- Interviews, Brainstorming Sessions, Surveys and Questionnaires.
• Proficient in Prototyping Application User Interfaces using wireframes and mock-ups with focused attention to detail in enriching User Experience and User Interaction
• Scrum Master - Agile/Scrum: Ensure vision, goals, and Product Backlog items are clearly identified and communicated.
• Facilitated Scrum meetings/ceremonies-sprint planning, daily standup/scrum, sprint review, and sprint retrospective as needed or requested
• Design, documentation and review of business documents like Business Requirement Document (BRD), Functional Requirement Document (FRD) and System Requirement Specifications (SRS)
• Experience in facilitating Joint Requirement Planning (JRP) sessions with Business User Groups, conducting Joint Application Development (JAD) sessions with IT Groups, SMEs and other project stakeholders
• Competent in creating Unified Modeling Language (UML) diagrams for Business Process Modeling like Use Case Diagrams (UCD),Activity Diagrams (AD),Sequence Diagrams (SD), Data Flow Diagrams (DFD), Flowcharts (FC) and Wireframe Prototypes using MS Visio, Balsamiq.
• Expert in Tracking and Managing the requirements using Requirement Traceability Matrix (RTM)
• Good understanding of Facets, Worked on different modules of Trizetto Facets.
• Extensive knowledge of healthcare standard Health Level Seven (HL7).
• Written SQL queries using winSQL to do data analysis and data validation as per requirements.
• Conducted data mapping, data analysis and wrote complex SQL queries in an EDW environment using TOAD, My SQL, SQL server, Oracle.
• Evaluated Data Sources, Translating Requirements into Specifications and Application Design
• Captured detailed BRD/FRD for ICD-10 & conducted testing: SIT/UAT: Test-Plan development/Test-Cases development/Test-Data creation.
• Basic knowledge of RCM (Revenue Cycle Management) and PMS (Practice Management Software)
• Worked on HIPAA Transactions 270, 271, 276, 277 for CORE certification 834, 835 and 837 for HIPAA 5010project.
• Developed plan for data feed and data mapping for integration between various system, Including XML, to follow ICD 10 code set and ANSI X12 5010 Formats
• Analyzed and tested Trading Partner EDI Proprietary flat files enrolled with MT MMIS for EDI transactions270/271 and 837 D, I & P and sending the Feedback form.
• Worked on Duals, Medicare, Business Operations, Case Management, Claims, Clinical Analytics, Clinical Operations, Compliance, EDI Validations, Finance and Accounting, Healthcare Code, Member Services, Membership and Eligibility, Network Operations Management (OM), OPMR,SOX Auditing, ICD10, Sales, Terms and Conditions, Trainings and Utilization management, Revenue Cycle, EPIC Implementation and EMR Reporting.

TECHNICAL SKILLS

Domain: Healthcare, Mortgage, property and casualty, Web Application enhancement

BPM Tools: MS Visio, Enterprise Architect, Rational Rose, Visual Paradigm

Project Methodologies: Agile Scrum, Waterfall, Waterfall-Scrum

Database: My SQL, Oracle, Toad

Wire framing Tools: Balasmiq, Pencil

Document Creation/Management: MS Office - Word, Excel, Outlook, PowerPoint, MS Project, BRD, FRD, Product backlog, Sprint backlog

Project Management Tools: MS Project

PROFESSIONAL EXPERIENCE

Confidential, Cerritos, CA

Senior Business System Analyst

Responsibilities:

• End to End working experience of Medicare, Medicaid, Duals, Hospice, LTSS, Vision, Dental, Pharmacy and behavioral health benefits projects from Patient/Member Eligibility, Patient/Member Registration to Patient/Member departure.
• Experience with Patient Billing, Payer Compliance, Payer Reporting and Analytics.
• Worked with HIPAA 4010 implementation in designing EDI X12 (837,834,278,270) transaction to the newly implemented Duals System.
• Interviewed the stakeholders to gather high level requirements.
• Responsible for gap analysis in changing old MMIS to new MMIS.
• Performed workflow analysis toward automated disability claims process.
• Experience with Clinical, HL7, EMR and EHR projects.
• Assisted in re-engineering the company's core claims adjudication processing following BABOK standards and extensive use of the BABOK guidelines and practices as commissioned
• Implemented Healthcare Enterprise Core Administration Platforms such as FACETS and Electronic Health Record & Practice Management applications such as NEXTGEN. Also, involved in migrations and customizations of these systems.
• Experience in migration of clinical data from ICD 9 to ICD10.
• Involved in SSAS Cubes design by creating KPI, Actions and Perspective from huge dataset using SQL Server 2008 Analysis Services (SSAS).
• Developed solutions in compliance with the industry models / standards and implementation of Quality Management Systems and HIPPA regulation.
• Develop interfaces to third party system and create business rules and data transfer mappings using XPath, XSLT, and XML.
• Designing and Implementation of XSD schemas using XML Spy Tool keeping reusability in view across the systems.
• Responsible for Change Management Processes (Identify, Analyze, Evaluate, Plan, Implement, Review and Close).
• Clearly understood coding standards required for all Medicare Part D Users transactions involving electronic data interchange (EDI) as provided by department of health and human services and incorporated at every stage of the project wherever found necessary.
• Used and updated all sign of documents on team center and tracked the deadlines of different versions.
• Created SSRS (SQL server Reporting Services) reports from raw data to answer executive management questions on many topics.
• Involved in writing SQL queries to test the mappings and to track the requirements as per the user requirements
• Co-authored functional specifications, business requirements specification (BRS), use-case specifications, and systems requirement specification (SRS) with the business group, and the IT team members.
• Created the Requirements Traceability Matrix (RTM) by mapping the Test Cases to ensure all the Business Requirements are fully covered by the Test Cases
• Validated the following: 837 (Health Care Claims or Encounters), 835 (Health Care Claims payment/ Remittance), 270/271 (Eligibility request/Response), 834 (Enrollment/Dis-enrollment to a health plan).

Environment: MS Visio, MS SQL Server, Team Foundation Server, C#, Visual Studio, Biz talk Server, MS Office Suite, MS Project Professional, MS SharePoint Services, Visual C#, Web Services, XML, XSD, XPATH, Spy 2010, XSLT, EDI X12, Triz0zetto FACETS, Mainframe, DB2.

Confidential, Lincolnshire, IL

Senior Business System Analyst

Responsibilities:

• Involved in preparing Project Scope Document which focused on what were the areas needed to be developed and mentioned the risks, assumption, dependences and limitations of the document.
• Identified various interfacing system of two EMRs and created context diagram and spreadsheet with various information about these interfacing systems to explain Stakeholders about the two EMRs of Confidential .
• Involved in different JAD sessions with stakeholders, system owners, architect and developers to present project scope document and gathered high-level business requirements as well as analyzed the requirements and managed changes using Rational Suite.
• Involved in creating project plan based on available information and release schedule of other system owners.
• Created work package and task lists for completion of different artifacts.
• Developed business process models in RUP to document existing and future business processes as well as created Use Cases, Page Specification and Technical Interface Specification Document.
• Conducted meetings for getting feedback from System Owners and Architects for different artifacts and made correction if needed.
• Developed Activity Diagrams, Logical Diagrams, Physical Diagrams, Sequence Diagrams, Low Level Business Process Flow and Decomposition Diagram for Use Cases.
• Created different Wireframes, Mockups and Prototypes for new web-based business processes by which end users and customers can do their operations.
• Communicated with developers and QAs to collect information about their release schedule and made them understand about various artifacts.
• Managed offshore vendor team who was responsible for development of website and another offshore team who was dealing with all pharmacy claims.
• Developed training materials to train users about new features of the projects.
• Created e-prescription process for Medicare and Medicaid patients and enhanced those processes for claim adjudication.
• Conducted GAP Analysis of ICD-9 to ICD-10 conversions process and got involved in data mapping for conversion.

Environment: RUP, MS Office Suite, Case Completes, MS SQL 2008, HPQC, MS SharePoint, MS Visio 2008, Balsamiq.

Confidential, Charlotte, NC

Business System Analyst

Responsibilities:

• Met with stakeholders and users to review / manage expectations and identify opportunities to improve ROI.
• Proactively prepared RASCI Charts and Cross-Functional Flowcharts using MS Excel 2003 and MS VISIO 2003 respectively.
• Used Agile Software Development process viz. Scrum, as this was a time bound project.
• Facilitated JAD sessions with end users, development and QA teams.
• Authored Business Requirements Document BRD with project teams. Extracted, discussed, and refined business requirements from business users and SME's.
• Prepared Use cases and Activity flow diagrams and Work flow diagrams, considering the scope of the project with MS VISIO 2003.
• Assisted in creating wireframes for web interface with the GUI design team. Moreover, I also authored functional requirements documents FRD by interacting with development team for improving client's legacy system.
• Conducted status report meetings with the business and the IT team on a weekly basis, as the most important aspect of the project was Data Mapping.
• Assisted project managers with the development of project schedules. Developed requirements and preliminary design for client applications. Performed analysis and design projects using systems development methodology. Worked with all levels of client staff in solution definition.
• Assisted the development team in preparation of the CRUD Matrix.
• Exposed to SQL queries while churning out relevant information from company's database.
• Assisted in system and user acceptance testing (UAT), free-trial demos, performed client presentations.
• Submitted change requests and worked with change request records in Clear Quest.
• Participated in entering and tracking system defects in Rational Clear Quest.

Confidential, Charlotte, NC

Business System Analyst

Responsibilities:

• Gathered requirements, defined specifications by interviewing the business user group. Used Agile as software method.
• Brainstorm with Senior Management to define a common framework for providing the standardized business functionality using reusable components and Interact with the Technical Architecture team to discuss and evaluate the various technical options and provide recommendations to senior management.
• Developing the Proto type and preparing the process flow diagram.
• Supported and managed RUP Methodology.
• Formulated and documented business requirements using CaliberRM to support new product initiatives that support strategic plan and customer initiatives.
• Lead cross-functional teams to implement strategies.
• Works in partnership with Project Team, Functional Team Leads and functional end-users to identify and document business process improvement opportunities and complete the definition of requirements for system design, implementation & training.
• Conducted JAD with SME for property and casualty insurance process details and requirements. Used User Cases and Used Stories to define the functions and workflow. Interacted with Technical teams in developing requirements for the enhancement of Property and casualty Insurance process.
• Established Test data that accurately represents conditions necessary to meet application testing and certification requirements.
• Wrote business rules for migrating from legacy system to web-based application.
• Worked on extensive analysis and research based on existing customers.
• Facilitated user interview sessions with a committee of SME's of Home Equity Loans Group and Mortgage Loan Acquisition Groups, Los (Loan Origination System), Loss Mitigation in understanding and documenting their business Process and user requirements.
• Preparing the SDD (Story Definition Document) for the Loan Origination System.
• Responsible for creating UML modeling plans, use cases, process flows, and business requirements documentation using Visio, CaliberRM and Star Team.
• Configured the development of Quality Control (QC) and User Acceptance Test (UAT) activities.
• Coordinated work plan between project manager and client with Microsoft Project; implemented and managed migration process; scheduled and tracked progress for team members of project through completion.
• Met with business stakeholders to gain consensus on new product functionality.
• Conducted Data analysis, Trend analysis and Gap analysis of business processes and requirements and identified technology enabled improvements.
• Prepared closing packages and requested funding for settlement.
• Performed Post Closing audits and delivery of files to secondary marketing investors.
• Utilized existing internal processes and improved those same processes for software problem identification, escalation, resolution and facilitated project team meetings. Continually reviewed and revised project processes to ensure accurate and timely results. Led JAD Sessions with end user community ensuring that the software addressed all business needs.

Environment: MS Visio, Agile Methodology, CaliberRM, SQL Navigator, Oracle, SQL Server, CMM

Confidential, Chicago, IL

Junior Business Analyst

Responsibilities:

• Worked exclusively withBusinessusers and Stakeholders to elicit requirements and create Epics, Features and User Stories.
• Utilized extensive EHR/EMR knowledge to recommended solutions to the technical team and served as liaison between departments for data related requirements.
• Conducted Gap Analysis to show the current state and proposed functionalities of the new system.
• Researched current challenges and trends in the Patient management space and bought information and recommendations back to leadership for consideration.
• Assisted the doctors/clinical staff with the generation of all necessary reports regarding the patient.
• Extensively used AGILE methodology's best practices during the project.
• Used JIRA to track the User Stories from start to completion and manage the sprints.
• Assisted the Scrum Master in conducting AGILE ceremonies like Sprint Review and Sprint Retrospective.
• Worked closely with the Product Owner to prioritize the user requirements during and after each sprint
• Reviewed test cases with the QA team and ensured that the test cases covered all scenarios of the requirements.
• Provided training for a variety of audiences including leadership and front line staff.
• Conducted UAT and obtained signoffs/approvals from the stakeholders.
• Acted as User Acceptance Testing coordinator and monitoredbusinesstesting and interfaced with the development team regarding defect status and fixes daily.