SUMMARY

• Overall 8+ years of extensive experience in Business Analysis with hands on experience in integrating business needs into IT solutions with core activities like Requirement Gathering Analysis, GAP Analysis, Designing, Software Development, Implementing, and Software Validation/Testing in healthcare.
• Experienced working on Health Care Reform projects such as Health Insurance Exchange (HIX) and HIPAA Implementation.
• Experience with conducting assessments and impact/gap analysis concerning State Medical Management Information System MMIS.
• Strong institutional knowledge of Medicaid including Medicaid Information Technology Architecture (MITA), and Medicaid Management Information Systems (MMIS)
• Extensive knowledge of Medical Management Information Systems (MMIS), National Provider Identification (NPI), Health Insurance Portability & Accountability Act (HIPAA) standards, Electronic Data Interchange (EDI), Health Level - 7 (HL7), HIX (Health Information Exchange), EMR/EHR, Health Care Reform and Patient Protection and Affordable Care Act (PPACA).
• Experience in Medicare and Medicaid domains of the healthcare systems and industry for inpatients, outpatients, Reimbursement Methodology.
• Experience on Membership, Billing, Claims Payment Processing in relation to HIPAA, EDI, codes 834, 837,835, and 270, 271.
• Knowledge on Confidential, Medicaid, MMIS, HIPAA EDI transactions 278, 820, 834, 835, 837, HL7, HMO, PPO, ANSI X12 Procedural and Diagnosis codes.
• Extensive knowledge working through the Software Development Life Cycle (SDLC) including Requirement Planning and Management, Requirements Elicitation and Requirements Analysis.
• Exposure to data mining, data mapping and data conversion / migration techniques.
• Exposure to creation of Business Requirement Documents (BRDs), Functional Specification Documents (FSDs), Use Case Documents, Acceptance Criteria Documents (ACDs), Business Rules Spreadsheets (BRS) and Requirements Traceability Matrix (RTMs)
• Proficient in relational databases, SQL queries, reporting tool and data analysis.
• Experience with SSAS, SSRS, SSIS, OLAP, OLTP, and T SQL.
• Experienced working with EHR (Electronic health record) and EMR (electronic medical record) team for data requirement.
• Experience in designing Interactive Reports and Data Visualization reports using Power BI and Tableau.
• Successfully conducted interviews, brain storming sessions, group interviews, prototyping, focus group sessions and JAD sessions in order to gather requirements.
• Excellent knowledge of the AS-IS and TO-BE business processes and experience in converting these requirements into technical specifications for preparing test plans.
• Good command over Logical and Physical entity relationship data modeling using Erwin, Oracle Designer and Power Designer.
• Strong working experience in the Data Analysis, Design, Development, Implementation and Testing of Data Warehousing using Data Conversions, Data Extraction, Data Transformation and Data Loading (ETL).
• Extensively worked on Dimensional modeling, Data cleansing and Data Staging of operational sources using ETL processes.
• Experience in Data Transformation, Data Loading, Modeling and Performance Tuning.
• Strong Experience in using different requirement management and testing tools including IBM Rational Requisite Pro, JIRA, HPALM/QC.
• Strong time-management and multi-tasking skills with attention to detail.
• Proficient in relational databases, SQL queries, reporting tool and data analysis.
• Excellent analytical and problem-solving skills in designing, developing and implementing innovative business processes using new approaches and technology.
• Excellent Exposure to OOAD techniques, Struts, Spring, Hibernate, SOA, SOAP, WSDL, Web Services, XML and developing Use Case diagrams (UML)
• Good knowledge of identifying various test scenarios. Holds strong ability to handle multiple tasks and prioritize it.
• Expertise in requirement documentation using Use Cases, User Stories, Page Specs, Mapping Documents and Report Specs in Rational Requirements and other industry standards.
• Proficient in Developing and executing Test Plans, Test Case, Test Scenarios, also performing functional, usability testing and ensuring that the software meets the system Requirement.
• Experience in conducting User Acceptance Testing (UAT) to ensure all the User Requirements were met by the application.

PROFESSIONAL EXPERIENCE

Confidential, San Francisco, CA

Sr. Business Analyst

Responsibilities:

• Interacted with stakeholders to get a better understanding of clientbusinessprocesses and gathered requirements.
• Documented the Use Cases and prepared the Use Case, Activity, Sequence diagrams and Logical views using MS Visio, MS Office and Rational Rose for a clear understanding of the requirements by the development team.
• Conducted requirement-gathering sessions with the purpose of creating and defining theBusiness Requirement Document (BRD)
• Created Swim Lane Diagrams andbusinesslogic & calculation spreadsheets for variousbusiness processes.
• Performed data mapping to define the Source data on 834 Benefit Enrollment and Employer Group File (EGF) EDI Transfers.
• Create and maintain Use Cases, visual models including activity diagrams, logical Business process models, and sequence diagrams using UML.
• Associated with full HIPAA Compliance life-cycle from gap analysis, mapping, implementation and testing for processing of Medicare, Medicaid and Tri-care claims.
• Experience in understanding of HIPAA X12 EDI transaction 834 for enrollment and eligibility, X12 EDI transaction 820 for Payment Order/Remittance Advice, Acknowledgement transactions 999 and TA1.
• Worked on Transaction-835 claims payments and remittance advice, which deals the payment from payer to provider.
• Involved in HIPAA EDI transactions such as 270, 271, 837 (P, D, I), 276, 277, 834, 820, 278, 999/TA1, and 277 CA.
• Assisted JAD sessions to identify thebusinessflows and determine whether any current or proposed systems are impacted by the EDI X12 Transaction, Code set and Identifier aspects of HIPAA
• Gained experience on Quality Center, Microsoft Outlook, Lotus Notes, Microsoft Word, Microsoft Excel, Microsoft SharePoint, Microsoft Visio, Microsoft Access and Clarity.
• Analyzing the ETL process created in Informatica, developed SQL queries and tables which replicated the ETL, and compared the SQL results with the Informatica tables
• Worked with HIPAA rules and regulations to draftbusinessrules and claim processes
• Transformed project data requirements into project data models.
• Wrote SQL queries for each Test case and executed in SQL Plus to validate the data between Enterprise Data Warehousing and Data Mart Staging Tables.
• Involved in Data mapping specifications to create and execute detailed system test plans. The data mapping specifies what data will be extracted from an internal data warehouse, transformed and sent to an external entity.
• Extraction of test data from tables and loading of data into SQL tables.
• Well versed with HIPAA, claim adjustments, claim processing from point of entry to finalizing, claim review, identifying claims processing problems, their source and providing alternative solutions using best practice model and principles.
• Created new screen layouts and identified locations for new fields being added and existing fields which are being moved.
• Developed business and functional requirements for the National Provider Identifier (NPI) Crosswalk and Crossover Claims Crosswalk solution.
• Was responsible for Documenting and analyzing of code defects raised by clients between releases using IBM Rational Clear Quest web software and the routing of issues to appropriate teams.
• Involved in analysis and design with team members to make Use Case diagrams, Sequence diagrams using UML/Visio to depict process flows and PowerPoint presentations.
• Involved in creating automated Test Scripts representing various Transactions, Documenting the Load Testing Process and Methodology. Created meaningful reports for analysis and integrated the Performance Testing in the SDLC.
• Analyzed the Business Requirements Document (BRD), modified the Master Test Plan and prepared detailed Test Cases for the UAT.
• Attended User story grooming sessions and created user stories in JIRA in the backlog. Gathered, documented and communicated Business requirements from stakeholders for projects that required Business Analysis support.
• Created Power BI and Tableau Dashboards with filters, KPIs using calculated key figures and parameters.
• Developed Test Plans and Test Execution Procedure Document based on the Business & Functional Requirement Document and numerous Test Cases and Test Scenarios to cover overall aspect of quality assurance.
• Successfully tested all the test conditions, documented the defects and discussed with technical analysts the discrepancies between expected and actual results for the test conditions.
• Conducted knowledge transfer sessions which were used to make the users and other teams aware of all the changes being made in the system as part of various projects.
• Assisted End User in performing User Acceptance testing and performed testing of the end result files created by the development team to verifying whether all the User Requirements were catered to by the development effort.

Confidential, San Diego, CA

Sr. Business Analyst

Responsibilities:

• Active member for the policy review to implement the blueprint requirements for Medicaid/MMIS, Medicare, CHIP and Tax Credits benefits per CMS guidelines.
• Created BRD, FRD/FSD and SDD for the implementation of functional areas across IF/Notifications and Languages.
• Conducted multiple JAD sessions between various organizations such as DHS, HHC, DCCA, and OIMT/OIT to elicit system requirements using stakeholder analysis, RACI chart, user stories and prototypes.
• Responsible to maintain the defect log that traces back to the test cases and also to the requirements, involving Agile and Scrum methodology.
• Update the existing system with new 834 data allocation for Health Care Reform Health Insurance Exchange (HIX) Population
• Reviewed 834 companion guide (OHS of Health EDI 834 companion guide 1.2) and other documents to complete the data gap between the existing and new data elements.
• Assisted with building the EDI 837, 835, 270/271, 276/277, 278, 820 and 834 transactions processing flow from the Trading Partners to the translator.
• Involved in developing Schemas of EDI x12 Claims (837) and Eligibility forms in XML.
• Converted the XML files into X12 and X12 to XML files on GIS for sending and receiving the EDI files.
• Also worked on multiple 837s and multiple Eligibility (270/271) and healthcare claim status (276/2
• Involved in developing, testing, modifying and managing the EDI (x12 standard) maps using B2B mapping tool.
• Performed extensive data modelling to differentiate between the OLTP and Data Warehouse data models
• Gathered requirements and modelled the data warehouse and the underlying transactional database
• Primary liaison between the development team and thebusinessowner to understand and implement the amendment and modification required through change request or work request.
• Responsible for creating Dashboards, Reports, Memos, RTMs, Defect reports, usingBusiness Objects (BO) and SQL for CMS and other organizations.
• Extensive use of JIRA and Confluence to track user stories.
• Responsible for data analysis to support the marketing and outreach planning.
• Analysis of customer request/complains/suggestion to proposebusinessopportunity and sustainability to the executives by creating SOWs across various functional areas.
• Performed quality assurance checks. Regularly developed Power BI and Tableau Reports as per the Need.
• Created wireframes and GUI for the website design encompassing the industrial standard of UX deigns to manage the existing and new applicants. Responsible to triage defects/data issues/deficiencies from OneGate portal to SIEBEL, triage through SOA and transaction log.
• Responsible to maintain the defect log that traces back to the test cases and also to the requirements, involving Agile and Scrum methodology.
• Involved in project planning, coordination and QA methodology in the implementation of the Facets in the EDI transaction of the claim’s module.
• Responsible to triage the SOA logs for troubleshoot and root cause analysis for case-by-case analysis.
• Interacted with the SMEs to gather information about the health care enrollment, eligibility and health care claims processing and created Use cases/FRS traced to use cases.
• Worked extensively on Gap analysis, Root Cause Analysis and Impact analysis of issues to requirements to meet the gap and redesign of the user interface.
• Involved in mentoring specific projects in application of the new SDLC based on the Agile Unified Process, especially from the project management, requirements and architecture perspectives.
• Worked on many Change Requests, Parking Lot items, Action Items, Process Flow Diagrams (UML), Pain Points, and Use Cases.

Confidential, Denver, CO

Business Analyst

Responsibilities:

• Conducted Interviews and facilitated JAD sessions with SME's, Management, development team, users and other stakeholders to understand the business requirements refine functional requirements.
• Gathered and created BRD Business Requirement Document, performed cost-benefit analysis with Project Manager.
• Used Requisite Pro for the Requirement Document Preparation and Prepared Business Process Models BPM that includes modelling of all the activities of the business from the conceptual to procedural level.
• Performed Transactional/encounter processing, and reviewed claims creation using Axiom Transcend.
• Performed detailed analysis for the functional areas that will be impacted by implementation of ICD-10 codes
• Identified gaps and performed GAP analysis, cost analysis with respect to CMS requirements and conducted Impact Analysis and prepared an Implementation and Recommendations Report communicated to the stakeholders.
• Created FRD Functional Requirement Document based on the signed-off business requirements.
• Created Use case models, analysis models, implementation models, authored use cases, use case diagram, behaviour diagrams sequence diagrams, activity diagrams based on UML methodology using Rational Software Modeller and MS Visio.
• Handled Regression testing for various scenarios and logged the bugs in JIRA.
• Created and maintained a RTM Requirement Traceability Matrix to see if all the requirements are being captured and are being worked on, throughout the project lifecycle.
• Worked on HIPAA EDI transactions such as 835, 837, 276, 277, 278, 270, 271, 834, and 820.
• Authored Companion Guide to support all the information needed to process HIPAA transactions.
• Managed all the Change Requests Document that came in through after signoff and maintained all the artifacts on SharePoint.
• Involved in designing and developing Data Models and Data Marts that support the Business Intelligence Data Warehouse and Streamlined the Restatement Financial Data Warehouse access review Process.
• Interacted with various HMO, PPO, Medicaid/Medicare Representatives discussing benefits of contracts on behalf of facilities or appeals from denials and compliance issues.
• Extreme involvement in production and development phase to report out to the stakeholders about the current status of the project.
• Worked closely with business power users to create reports/dashboards using Power BI and Tableau.
• Performed Unit Testing and User Acceptance testing and documented detailed results creating test plans and scripts, tested strategies with developers and testing team for Validation and Provided input scope, goals, risks, constraints, timelines and interfaces to PM for project planning and control.
• Implemented SDLC, which included requirements specifications, design, analysis and testing. Followed RUP methodology with Agile/SCRUM.
• Organized daily scrum calls to keep the team on track and the stakeholders updated.
• Worked with the software development team for testing codes and used PL/SQL to query various reporting databases.
• Reproduced, verified and validated issues documented in a defect tracking system and writing tractability matrices based on use cases and business requirements BRDs performed the requirement analysis and documented the requirements using Rational Requisite Pro.
• Worked with the compliance and audit team to make sure we were following correct HIPAA. Guidelines/protocols throughout the project lifecycle.
• Involved in SWOT analysis of project plan.

Confidential, Mclean, VA

Business Analyst

Responsibilities:

• Knowledge of Medicaid Management Information Systems (MMIS), National Provider Identification (NPI), Electronic Data Interchange (EDI), Health Level -7 (HL7), HIX (Health Information Exchange), EMR/EHR, Health Care Reform and Patient Protection and Affordable Care Act (PPACA).
• Created relationship with the Project team, Project Management Office, customer interfacing including Line of Business and Interface Partners to discuss the as Is system and develop the to Be system concept after client interviewing.
• Successfully conducted workshops and JAD sessions, which helped synchronize the different stakeholders, SMEs on their objectives and helped the developers to have a clear-cut picture of the project.
• Worked on Member Management, Eligibility, Claims, and Provider modules within FACETS.
• Performed Gap analysis designed new process flow, documented the business process, various business scenarios and activities of the business from the conceptual to procedural level.
• Formulated and defined systems scope and objectives through research, data mining, analytics and fact-finding.
• Proficient in creating Business Requirements Document (BRD), Functional Specifications Document (FSD/FRD) and Systems Requirements Specifications (SRS).
• Interacted with the developers for resolving the bugs reported in JIRA and various technical issues related to the requirements.
• Prepared Use Case Document, assisted testing teams with Test Plans, Test Cases and Test Scenarios, conducted User Acceptance Testing (UAT), and managed defects using defect-tracking systems.
• Expert in Gathering Requirements and document, track, manage and communicate requirements using Requirements Traceability Matrix (RTM).
• Developed data visualizations and dashboards using Power BI and Tableau.
• Worked on Structured Query Language (SQL) for data manipulation and retrieval.
• Created wireframes, developed a prototype of the Graphical User Interface (GUI), demonstrated to the stakeholders and business users, and took feedback from them using Rational Rose.
• Helped in data analysis, data mapping, source and target data analysis, transformations and validations.
• Designed and developed UML diagrams- Use Cases, Activity Diagrams, Entity Diagrams, Sequence Diagrams, Visio and Business Process Modelling.
• Managing and tracking requirements changes while communicating project status to business stakeholders throughout the Software Development Life Cycle (SDLC).
• Worked with QA team to design test plans and cases for User Accepted Testing (UAT).
• Performed analysis and translated business needs to create high-quality Business Requirements and Functional Specifications documentation within specified time frames to solve moderately complex problems (multiple interfaces with other systems within a business unit) considering all impacted components from an end-to-end perspective.

Confidential, San Francisco, CA

Business Analyst

Responsibilities:

• Gathered requirements and use case scenarios for all HIPAA X12 transactions to be upgraded to a new platform for compliance, validation and routing that included process flows
• Worked on profiling the data for understanding the data and ETL specification document.
• Understanding the specifications for Data Warehouse ETL Processes and interacting with the data analysts and the end users for informational requirements.
• Obtains, analyzes, and appraises evidentiary data as a basis for an informed objective opinion on the adequacy and effectiveness of internal control systems, propriety of accounting records, and efficiency of operational activities and ensuring all test cases are in line with the business.
• Prepare the Audit Risk Analysis to document the planning process and establish the audit scope and risk evaluation for assigned audit areas and testing.
• Met with various HMO, PPO, Medicaid/Medicare, and Tricare Representatives discussing benefits of contracts on behalf of facilities or appeals from denials and compliance issues
• Creating and implementing test plan and scenarios to match business requirements, design and transactions claim submissions, verification of Health plan Eligibility, Claim status and their corresponding formats.
• Prepares and reviews audit reports expressing opinions on the adequacy and effectiveness of internal control systems, and efficiency of operational activities.
• Prepares and delivers periodic performance evaluations for specific audit projects of assigned staff based on the results analyzed from the users.
• Utilized corporation developed Agile SDLC methodology. Used Scrum Work Pro and Microsoft Office software to perform required job functions.
• Stored and executed test data in Quality Centre ALM.
• Manage closure of defects and bugs by regular follow-ups and ensure that the adjustments are completed timely and accurately.
• Performs or directs special projects as requested, including research on audit techniques and accounting issues.
• Performed defect tracking with ALM for the bugs in the application that included documentation, tracking and re-validating defects that helped developers to track the problem and resolve the technical issues.
• Prepare documentation to support my findings as well as to provide full information to the responsible party on why an error was cited on them or when the test case failed to meet its requirements.
• Creates work requests in the IBM Clear Quest system for enhancements to the Audit system.
• Prepares Business Requirements for enhancements to the Audit system.
• Worked on completing "TRIAGE" on the duplicate entries as part of QA audit.
• Updated Score card details in the Duplicate entries.
• Identified the duplicates on National and non-National entries.
• Marked the groups based on the no of employee and grouped them according to size.
• Repeated entries were identified (True duplicates) and ensured they were not audited.
• Participates in the complete system development life cycle by actively engaging in requirements gathering, design reviews, and user testing.
• Fully involved in UAT testing phase to support client.