SUMMARY

• Over 8 years of experience as Business Analyst in the Healthcare Industry with expertise in Affordable Care Act (ACA), HL - 7, EDI Transactions (834, 835, 837), HIPAA, MMIS, Medicare and Medicaid.
• Excellent communication skills, writing skills as well as presentation skills. Experience working with business users as well as senior management.
• Solid understanding of all phases of Software Development Life Cycle (SDLC) methodology (such as requirement, analysis, design, data modeling, business process modeling, implementation and deployment).
• In-depth knowledge of Rational Unified Process (RUP); risk engineering, data modeling and mapping, and design using UML (Unified Modeling Language), Rational Rose and Visio.
• Good knowledge of Oracle and SQL.
• Excellent knowledge of HIPAA (Health Insurance Portability and Accountability Act) transaction codes such as 270/271 (inquire/response health care benefits), 276/277 (claim status), 470 (benefit codes), 835 (payment or remittance advice), 837 (health care claim) and 834 (benefit enrollment).
• Conducted successful projects with the help of teams to achieve deadlines timely and proficiently.
• Experience in User Acceptance Testing, Smoke Testing, Regression Testing Performance Testing and Functional Testing.
• Experience in conducting SWOT Analysis, Cost Benefit and ROI Analysis.
• In-depth experience in financial analysis, financial modeling, Research, Accounting, and good knowledge of Assets, Liabilities, Equities, Fixed Income and Taxation.
• Strong expertise in Health Insurance Claim process, social services, Medicaid and banking.
• Extensive experience in conducting Joint Application Development (JAD) sessions for project definition involving analyzing requirements, creating prototypes, user interface, database schema and system design.
• Well versed with HIPAA, Facets claim adjustments, claim processing from point of entry to finalizing, claim review, identifying claims processing problems, their source and providing corresponding solutions.
• Extensive experience in gathering Business/Functional user requirements, creating Use Cases as per user requirements, developing/designing diagrams such as Activity, Class, and or Sequence diagrams, and in addition to creating Business Requirements Document (BRD).
• Organized, goal-oriented, self-starter, and ability to master new technologies, manage multiple tasks while following through from start to completion.
• Good in requirement gathering including Joint Application Development (JAD) and requirement analysis.
• Analysis done to determine if the system abides by the HIPAA regulations.

TECHNICAL SKILLS

Databases: MS SQL, MS Access, Oracle

Languages: SQL, Visual Basic

Methodologies: SDLC, RUP, UML, CMM

Testing Tools: Test Director, Quality Center

Operating Systems: Windows 95/98/2000/XP/Vista/NT

Project Management: MS Office Suite (Microsoft Word, Microsoft PowerPoint, Microsoft Excel), MS Project

Change Management: Rational Clear Quest

Business Modeling Tools: MS Visio, Rational Rose

PROFESSIONAL EXPERIENCE

Confidential, St. Louis, MO

Senior Business Systems Analyst

Responsibilities:

• Designed Test Plans and Test Cases for User Acceptance testing (UAT) with the help of QA teams.
• Utilized RUP to configure and develop process, standards and procedures.
• Interfaced with business users to prepare and update Business Process Requirements for the new release of Healthcare tools.
• Prioritized outstanding defects and systems problems, ensuring accuracy and deadlines were met.
• In depth knowledge of Medicare/Medicaid Claims processes from Admin/Provider/Payer side which were later part of the training program to vendors.
• Performed GAP analysis of business rules, business and system flows, user administration and requirements.
• Tracked and maintained Stakeholder requested enhancements and changes using Requirement Traceability Matrix (RTM).
• Used the Rational Unified Process (RUP) to develop the different phases of Software Development Life Cycle (SDLC).
• Prepared Business process models; used Visio to create use case diagrams.
• Designed mockup and wireframes to communicate visual data flow to the end users.
• Developed use cases, activity diagrams and sequence diagrams for a clear understanding of the vision document.
• Recommended corrective actions, if necessary, along with the progress against Development/Action Plan routinely to the Project Manager.
• Administered and coordinated User Acceptance Testing and obtain final system acceptance sign-off with the help of Program Manager.
• Conducted Risk Engineering to derive and execute action plans on time.
• Conducted Joint Application Development (JAD) sessions with stakeholders throughout SDLC to resolve open issues.
• Wrote SQL Queries in MS Access to sort data and analyze the large set of data during project life cycle.
• Used Rational Clear Quest for defects and bug testing.

Environment: User Acceptance Testing (UAT), Rational Unified Process (RUP), Rational Clear Quest, Joint Application Development (JAD), MS Access, Windows, Rational Test Manager, MS Office, Requirement Traceability Matrix (RTM).

Confidential, Cambridge, MA

Business Analyst

Responsibilities:

• Implemented the SDLC for the developing life cycle and followed the standards process in the application.
• Translated business requirements into functional requirements and approaches for developers.
• Provided management support to the off-shore End to End integration/ Regression Test Team.
• Workflow documentation and comprehensive training to the healthcare clients.
• Analyzed corporate healthcare business processes to develop customized solutions.
• Interacted with healthcare clients to gather requirements, objectives, and input and output requirements.
• Developed test cases and scripts for front end testing.
• Performed execution of test cases manually to verify expected results.
• Ensured the accuracy and consistency of the data during the data loading process.
• Developed Use case, Functional, Object diagrams using Rational Rose.
• Responsible for architecting integrated HIPAA, Medicare solutions, Facets.
• Was involved in managing the Daily Standup meetings and also ensured that quality standards were enforced as per the build-release schedule.
• Developed a detailed test plan and test cases to cover all the requirements.
• Used rational Rose to create UML diagrams such as use case, activity, sequence, class and component diagrams.
• Developed Flowchart and process diagram using Microsoft Visio.
• Analyzed data architecture, documented and delivered data mapping, performed risk analysis.
• Frequently communicated with developers to resolve technical issues.

Environment: SQL, Test Director, MS Office, UML, Rational Rose, Windows XP.

Confidential, Louisville, KY

Business Analyst

Responsibilities:

• Prepared the Functional Specification Document (FSD) and Software Requirement Specifications (SRS) as per SEI CMM standards.
• Conducted the JAD Sessions with stakeholders and developers to have a clear picture of a project.
• Implemented RUP (Rational Unified Process) methodology for iterative and incremental development of the system.
• Worked on improvement of Claims Reimbursement User Interface for a better experience and in corporate changes as per HIPAA guidelines using the gap analysis.
• Wrote SQL scripts for creating performance evaluation reports.
• Developed test cases and test plans on the basis of requirements and also did manual testing of the functionality of the application to ensure that the application is able to handle a lot of data.
• Used UML to create use case diagrams, sequence diagrams and activity diagrams.
• Performed Backend testing by using PL/SQL queries to test the integrity of the application.
• Developed flowchart and process diagram using MS Visio.
• Conducted interviews with clients to analyze their data and gather requirements.
• Clarified QA team issues and reviewed test plans and test scripts developed by development team and QA team to make sure all requirements have been covered in scripts and tested properly.
• Was in regular contact with Business partners on the status of issues, action plans and timeframe for resolution throughout the development cycle.
• Identified bugs during the test phase and reported them using HP Quality Center.
• Maintained Traceability Matrix throughout the project.
• Used the Rational Unified Process (RUP) to build the different phases of Software Development Life Cycle (SDLC).

Environment: RUP, SQL, MS Visio, MS Office, UML, Windows XP, Rational test Manger.

Confidential, San Diego, CA

Business Analyst

Responsibilities:

• Fully responsible for understanding business logic and designing requirements, assisting other business analysts in generating
• Functional Requirement specifications (FRS) and User Requirements Specifications (URS) and communication with the developers.
• Developed use cases, workflow, screen mock-ups and conversion requirements.
• Coordinated work plans between project manager and client using MS Project.
• Helped in reviewing and editing of the test scripts.
• Followed UML based methods using Rational Rose to develop use cases and activity diagrams; assisted developers in creating sequence diagrams and collaboration diagrams.
• Reviewed business process, URS, and functional requirements.
• Assisted in process modeling; conducted and participated in JAD sessions with system users; helped with design walkthroughs with stakeholders for base lining architecture.
• Created and tested scripts for the premium calculations and claim limits and deductible.
• Involved in detailing project mission, data process flow diagrams, and timelines.
• Developed Test plans and Test cases according to business requirements with the help of Mercury Test Director.
• Used Rational Clear Quest for handling change requests.
• Participated in automated regression and Non-functional test plans.
• Provided assistance in building EDIs 270, 271, 276, 277, 470, 835, 837 and 834 transactions.
• Maintained Requirement Traceability matrix throughout the project.

Environment: RUP, Rational Requisite Pro, Rational Clear Quest, MS Office, Visio, Project, Windows XP, UML, SQL.