SUMMARY

• Over 8+ years of experience in Consulting, Business Analysis, Project Management and experience in SDLC cycle (Waterfall, iterative and Agile): managing scope, tasks and deliverables to client specific requirements
• Certified Professional Scrum Master (PSM) with strong experience in Agile/Scrum framework
• Certified Managed Health Care Professional (MHP) with significant experience in Health Care Sector with prime focus on claims adjudication, COB, provider, appeals, eligibility and prior authorization for Medicaid and Medicare programs. Recent assignments include working with Payer Organizations on corrected claims automation, implementing workflow enhancements, determining COB Carve - Out/ Make-Whole, implementing Single Sign-On in Providers Portal etc.
• Extensive experience in Healthcare/Claimsadjudication with knowledge of industry compliance standards like HIPAA and EDI X12 transactions (834, 837, 835, 270/271, 276/277)
• Excellent understanding of Business Requirements Gathering, Translating Requirements into Specifications and Application Design
• Proficient in Technical and Business writing, Business Process Flow, Business Process Modeling
• Highly proficient in writing User stories, creating Use Cases, Use case diagrams, Workflow Diagrams, Sequence Diagrams, and Class Diagrams etc. Extensively used Rational Rose and MS Visio for UML
• Expert communicator and involved inhigh interaction with variety of audiences (PMs, technical specialists, developers, architects, SMEs)
• Actively used Joint Requirement Planning (JRP) /Joint Application Development (JAD) sessions for requirements gathering and brainstorming ideas
• Highly proficient in preparing Business requirement documents (BRD) and supported in preparing Systems requirement Documents (SRD), Test Plan, User Manual
• Developed /maintained all project communication deliverables including planning list, change request, timeline, scope and requirements
• Experienced in the analysis and design of applications usingOOADtechniques, UML
• Experienced in performing Business Process Reengineering/Gap Analysis to check the compatibility of the existing system infrastructure with the new business requirements
• Expert in broad range of technologies, including business process tools such as Microsoft Project, MS Excel, MS Access, MS PowerPoint, MS Visio (Microsoft Suite) and Rational Suite
• Knowledge of SharePoint and its features and Functionality worked on creating workflows
• Experience in working with end users and the QA team fordeveloping test plans, test coordination, escalation, prioritizing the bugs and user acceptance testing

TECHNICAL SKILLS

• MS SharePoint
• Microsoft Visio
• Windows XP
• Windows Vista
• UNIX
• Win Runner
• Load Runner
• Data Loader
• Clear Quest
• Agile/Scrum
• RUP
• Waterfall
• JAD
• RAD
• Red prairie (WMS)
• Qlikview MS Word
• Excel
• Visio
• Project
• PowerPoint
• Access
• Outlook
• Microsoft SQL Server.

PROFESSIONAL EXPERIENCE

Confidential, Dayton, OH

Business Operations Analyst

Responsibilities:

• Worked with Claims department and acted as a liason between claims team and operations to determine requirements for thousands of claims to automate when it enters Confidential HIPAA Gateway every day from being stuck in XC database.
• Conducted discovery sessions with Business Partner Operations, Provider Life Cycle, and Provider Relations/Health Partner teams and document current & future state process flows to replace Manual Workflow tool with OnBase tool that automate reports on Aging, Volumes, Productivity and trends etc.
• Successfully used Agile/Scrum Method for gathering requirements and facilitated user stories workshop.
• Documented User Stories and facilitated Story Point discussions to analyze the level of effort on project specifications
• Documented clearly and concisely claims adjudication decisions in Claim Notes
• Participated and contributed in daily scrums, Sprint meeting and Sprint review meetings
• Conducted walkthroughs with the different department heads to have a deeper understanding of the requirements.
• Analyzed and documented the business requirements and generated reports for the Manager
• Wrote the software development plan and held meetings with the developers and forwarded Information and documents to them
• Developed flow diagrams for Business process of the company, UI Wireframes and Mockups using Microsoft Visio
• Gathered requirements to automate report generation and document OnBase dashboard requirements
• Functioned as the primary liaison between the business, operations, and technical groups throughout the project cycle
• Worked on different modules in Facets - a product for Healthcare Insurance sector
• Follow up with the end users and developers for user satisfaction and change management if necessary
• Performed extensive Gap analysis to determine the risks and assisted the PM in budget and resource planning
• Assisted and adhered to project work flow process

Environment: Agile/Scrum, MS Visio, MS Office, Trizetto Facets 520R2, OnBase 15

Confidential, Tampa, FL

Sr. Business Analyst

Responsibilities:

• Interacted with the software development team and executive team to liaison the business requirements to ensure that the application under development confines to the business requirement.
• Involved in UI enhancement and made Wireframes and Screen Mockups/Definitions and Dependencies using Excel
• Performed analysis and reporting of marketing and operational data. Develop and monitor web metrics.
• Interacted directly and assisted Stakeholders, SMEs and Development team to allow compliance with successful implementation of project within time and cost.
• Worked as an Interface between the end users and the different teams involved in the application development for the better understanding of the business and IT processes.
• Followed a structured approach to organize requirements into logical groupings of essential Functional Requirements, Non Functional Requirements, Interface Requirements and Report Requirements andensured that critical requirements are not missed.
• Documented Use Cases, Algorithms, Test Plans, test data and expected results for the Integration, Functional Performance, and User Acceptance Testing.
• Analyzed and modeled the system using Functional Hierarchy Diagram and Process Development Diagram.
• Responsible for defining the scope of the project, gathering business requirements and documenting them textually or within models.
• Interviewed business area experts and SMEs asking detailed questions and carefully recording the requirements and performed data analysis.
• Conducted JAD sessions to develop architectural solution that application meets the business requirements, resolve open issues, and change requirements.
• Documented Test Plans and prepare of Requirements Traceability Matrixes (RTM) that contains test scripts, test cases, test data and expected results for the User Acceptance testing.
• Developed the test plan, test conditions and test cases to be used in testing based on business requirements, technical specifications and/or product knowledge.

Environment: MS Project, MS Excel, Oracle, MS Visio, AS/400, MS Word, Rational Requisite PRO, MS Excel, Calibre RM, Agile.

Confidential, Dublin, OH

Sr. Business Analyst

Responsibilities:

• Analyzed client requirements and prepared Analysis documents
• Interacted with the Consultants to review requirements and clarified queries with respect to the requirements.
• Facilitated JAD/JAR sessions with SME / business users to gather and document requirements.
• Organized and Conducted reviews and Inspections with SME’s on the requirements
• Documented project related artifacts and forwarded them for Onsite review and stored them in the Project database.
• Assigned tasks to the team keeping in mind the complexity and priority of the tasks.
• Organized and conducted training sessions to keep the team well versed with respect to Domain knowledge.
• Reviewed tasks and provided required inputs and ideas with the team.
• Provided tasks based on reports to the Manager and evaluated team SLA (Service Level Agreements) on weekly and monthly basis
• Managed and motivated the team and raised the environment high in order to achieve maximum efficiency and productivity.
• Facilitated team meetings and reviews.
• Provided project leadership to the development team, schedule control, status reporting, client/project team coordination and quality assurance.
• Provided service specific expertise for Data, Foundation specifications.
• Conducted reviews and Hand off to Configuration Analyst.
• Initiated discharging basic project management/project Coordination responsibilities
• Documented project related artifacts and forwarded them for Onsite review and store them in the Project database.
• Assigned tasks to the team members keeping in mind the complexity and priority of the tasks.

Environment: IBM Mainframe, DB2,CICS, SAS, Microsoft Office, VB Script, .Net, MS SharePoint, .MS Visio.

Confidential, Atlanta, GA

Business Ops Analyst

Responsibilities:

• Facilitated Working sessions, articulated requirements, make recommendations for process andbusinessflows, develop consensus on requirements, performed analysis of requirements, by developing use cases, andcollaborating with users to reduce project risk and to increase quality.
• Independently analyzed and defined solutions for complexbusinesssituations that will include all aspects of life and healthbusinessincluding Actuarial, Underwriting, Valuations, Reinsurance Administration and Technical Accounting.
• Produced functional specifications and lead weekly meetings with developers and business units to discuss outstanding technical issues and deadlines that had to be met, used RequisitePro for gathering the requirements, Clear Quest to track the business process and Rational Rose to create UML Diagrams.
• Conducted Joint Application Development (JAD) process with Stakeholders to analyze deliverables and system constraints.
• Developed test plans, test cases for Quality Assurance and developed root-cause analysis reports, ensured proper placement of business controls, re-engineered business processes, implemented performance measures, presented project presentations to executive management, provided user training, and performed a variety of ad-hoc project.
• Managed project risk management and business process analysis reviews over the implementation of different applications.

Environment: MS Office, MS Excel, MS Visio, MS Project, Rational Clear Quest, Rational Clear Case, PL/SQL, JAVA.

Confidential, Milwaukee, WI

Business Analyst

Responsibilities:

• Schedule meetings with technical personnel to determine technical parameters for EDI and other related processes, including communication, security, and privacy.Create transaction sets requirements, usually with Microsoft Excel, for transactions such as: HIPAA 270/271, 276/277, 278/278, 820, 834, 271U, 835, 837-(I, P, &D), 835 Remittances and others.
• Determine workflow processes, best practices and security requirements of shared patient data including HIPAA and HL-7 and ANSI X12 4010transactions such as (270/271, 276/277, 835).
• Involved in testing claim (270/271, 837, 997, 276,277, 835) to make sure application is transferring data accordingly.
• Worked extensively on Inbound transaction set 834(Benefit Enrollment & Maintenance), Claims Adjudication NSF/EDI (837), Remittance (835), Claims Status (276/277).
• Coordinated with teams within the project to collect the high level estimates and release requirements.
• Experienced in web services concepts and support utilities, related database utilities. Demonstrated understanding and experience with SQL Queries.
• Participated in detail data analysis of both data elements requested by the business and data source for the data warehouse initiative.
• In support of the development and maintenance role, helped data warehousing service of the company to document and publish training and transition materials for internal staffs.
• Interacted with SME’s to gather system requirements for building the new Trading Platform.
• Assisted the business team in Business Case Modeling, Use Case Modeling using Rational Unified Process for preparingFunctional Requirementsdocuments.
• Given project sizing for various releases of the project to senior management.
• Coordinated the process for users, which analyzed their current business practices, user, needs, and then used that information to define functional requirements andRequest for Proposal(RFP) for a new system.
• Organized weekly Project Status and Task Review meetings.
• Created PowerPoint presentations and project updates usingMS Projectfor management review.
• PerformedSWOTandGAPanalysis for new functionality requirements as well as prioritized them based on actual business needs.
• FacilitatedJADsessions and conducted peer review meetings periodically to keep track of projects milestones.
• Identified opportunities to use customer data to develop customer strategies and improve business performance.
• Undertook project risk management and business process analysis review of the implementation of different stages of the applications.
• Worked closely with QA team to identify the test scenarios and test cases.
• Collaborated with the QA team to ensure adequate testing of software, maintained quality procedures, and ensured that appropriate documentation is in place.
• Assist with User Acceptance Testing of systems (UAT), developing and maintaining quality procedures, and ensuring that appropriate documentation is in place.
• Worked on developing the Implementation plan for the entire Enterprise Integration Team supporting multiple enterprise wide applications during Conversion time-period and supported all the Enterprise applications for a smooth transition from the old to the new system.

Environment: Windows XP/2000, Rational Suite (Rational Rose, Rational Requisite Pro, Rational Clear Quest), Oracle, SQL, PL/SQL Mercury Quality Test Center 10.0, MS Project, MS Office Suite (Word, Excel, Access, Power Point, Outlook).

Confidential, Woodland Hill, CA

Business Systems Analyst

Responsibilities:

• Interacted with the software development team and executive team to liaison the business requirements to ensure that the application under development confines to the business requirement.
• Served as a liaison between the business and technical team.
• Performed analysis and reporting of marketing and operational data. Develop and monitor web metrics.
• Interacted directly and assisted project manager and team members to allow compliance with successful implementation of project within time and cost.
• Managed project risk management and business process analysis reviews over the implementation of different applications.
• Worked with Oracle databases to create data objects necessary to analyze and report findings, including tables, functions, stored procedures, views, and indexes.

Environment: Microsoft Office Suite, MS Visio2003, MS Project2003, MS Excel2003, JSP, Windows XP, Solaris, Requisite