SUMMARY

• 9 years of experience in Business Requirements Modeling, Business Process Analysis, and Business Process Reengineering for enhancing the business processes in diverse business domains of Insurance, Healthcare and IT.
• Certified SCRUM Master with experience working in agile SCRUM environment with diverse cross functional teams.
• Experience working with managed care plans, Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Point of Service (POS) plans, Coordination of Benefits (COB), Explanation of Benefits (EOB).
• Experience in configuration of claims processing applications, claim adjudication process, claims management process, real time claims adjudication, Electronic Medical Records / Electronic Health Records (EMR/EHR) and Medicaid Management Information System (MMIS), and Medicaid Information Technology System (MITS).
• Good knowledge of COBRA insurance, claim submission process for CMS - 1500 (HCFA-1500) and UB-04 claim forms.
• Have knowledge of HL7 Messaging protocols, HIPAA transaction and code standards and electronic data interchange (EDI) standards like X12 837, 270, 271, 276, 277, 278, 835, 275 and knowledge of claims encounters process.
• Worked on HIPPA 4010 and ICD 9 systems. Possess implementation knowledge of HIPAA 5010 and ICD -10 initiatives.
• Experience with health care systems: FACETS, Medicare Part A, B, C, D, Medicaid systems, and validating General Equivalency Mappings (GEMs), Technical Report Type 3 (TR3) Implementation Guide, and Companion Guide.
• Experience in SDLC, Agile, Waterfall, Rational Unified Process, and SCRUM software development methodologies.
• Proficient at coordinating with stakeholders, vendors, Subject Matter Experts (SMEs), Project Manager (PM) and end users and elicitation of requirements through Joint Application Design (JAD) sessions, Brain storming sessions, interviews, Surveys and questionnaires, prototyping, benchmarking, Requirements workshops, focus groups, document analysis, Joint Application Requirement (JAR) sessions and Rapid Application Development (RAD).
• Skilled in gathering and converting User Requirements into High Level and low-level documents (HLD/LLD) like Business Requirements Document (BRD), Functional Specification Document (FSD), System Requirement Specification (SRS), creating process flows, and visualizing graphical user interface (GUI) using mockup screens.
• Possess skills like Conflict Resolution, Sense Making, Root Cause Analysis, Risk Analysis, Communication Management, problem management, Stakeholders Management and having Servant-Leader leadership skills.
• Expertise in Gap Analysis, SWOT analysis, risk analysis, cost-benefit analysis, feasibility analysis, and impact analysis.
• Experienced in creating workflow analysis and design, Process re-engineering, process remodeling, Object Modeling Technique (OMT), Object Oriented Analysis (OOA), Unified Modeling Language (UML) diagrams like activity diagrams, sequence diagrams and use case diagrams through MS Visio, What-IF scenario analysis (WISA), To- Be Scenario Analysis, Gap Analysis, User Interface (UI) design, User Experience design (UX), prototypes and wireframes.
• Managing Requirement Traceability Matrix (RTM), Service Level Agreement (SLA) and assisted Project Manager with creating Work Breakdown Structure (WBS), Project proposal and Project charter, Statement of work (SOW).
• Proficient in creating and managing Use Cases, Test cases, Test plans, Test summary reports, and Test scripts.
• Knowledge about different types of testing like Black Box Testing, White Box Testing, System Integration Testing, Alpha Testing, Beta Testing, Stress Testing, Static Testing, Dynamic Testing, Load Testing, and Regression Testing.
• Skilled at performing User Acceptance Testing (UAT), handling Change Request, and Configuration management.
• Strong knowledge of creating conceptual data models, ER diagrams, data mapping, data profiling, data verification, data integrity, ETL process, data normalization, data dictionary, SQL queries for data analysis and data validation.
• Have good understanding of Service Oriented Architecture (SOA), client side validation, server side validation, HTML, CSS, DOM, SAX, XML, XSD, JSON, WSDL, SOAP, REST, web services, API functional testing, and Data Binding.
• Experience in facilitating SCRUM ceremonies like product backlog grooming sessions, sprint planning, daily stand-up, sprint review, and sprint retrospective; Coordinated with Product owner on project planning to enhance the ROI.
• Experience in working with self-organizing and cross functional teams, and well-versed with estimation techniques like Planning Poker, T-shirt sizing and Relative Mass valuation and prioritizing methods like MoSCoW, Kano, business value based and walking skeleton. Calculated sprint velocity and capacity; Handled Requirements Churn.
• Experience in Release planning, Acceptance criteria, definition of done, definition of ready, Potentially Shippable Product Increment (PSPI), minimum viable product (MVP), and good understanding of test driven development.
• Good understanding of breaking down of Epics into User stories (INVEST) and User stories into tasks (SMART) using splitting patterns like workflow steps, business rule variation, data variation, interface variation, simple/complex, major effects, operations, defer performance and others. Assisted Product Owner and the team to commit to PBIs.
• Used tools like JIRA and RALLY to create and maintain Product Burn-down chart, Sprint Burn-down/ Burn-up chart.

TECHNICAL SKILLS

SDLC Methodologies: Waterfall, Agile (SCRUM, XP), Hybrid (SCRUM-Waterfall), Rational Unified Process(RUP), SAFe, XP, Kanban

Operating Systems (OS): Windows XP/8/10/Vista, Linux, Mac OS

Modeling Tools: MS Visio, Rational Rose, Mock-up screens, Erwin, Enterprise Architect

Requirement Management Tools: JIRA, Rally, Version One, Rational Requisite Pro, Rational Requisite Composer, Rational Team Concert

Collaboration Tools: SharePoint, Confluence

Testing Tools: HP QC, HP ALM, Selenium, Load Runner

Languages: SQL, HTML, CSS, XML, JSON, Java, J2EE, JavaScript

Reporting Tools: Tableau Desktop, IBM Cognos, Power BI

Architecture: Service Oriented Architecture (SOA), 3 Tier Architecture, N-tier Architecture, Cloud Platform (SaaS)

Data Warehousing: ER Modeling, Dimension Modelling, Data Marts, OLTP, OLAP, Data Profiling, Data Mapping, Data Mining, Data Validation, Star schema, Snowflake Schema

ETL Tools: Informatica (Power Center), SQL Server Data Tools, Cognos Data manager

Databases: MySQL, IBM DB2, Oracle

PROFESSIONAL EXPERIENCE

Confidential, Hartford, CT

Business Systems Analyst

Responsibilities:

• Implemented SDLC which included Waterfall-SCRUM hybrid agile methodology with requirements specifications phase and development phase in iterative time boxed sprint cycles, incorporating a rigorous definition of done.
• Gathered functional and non-functional requirements and involved in development and documentation of Business Requirement Document (BRD), and Software Requirements Specification (SRS) using various elicitation techniques.
• Assisted in creating implementation guides for various EDI X12 transactions such as 834, 835,837,270, 271 and 274.
• Assisted the Project Manager in defining the project plan, project charter, scope, vision, and timelines. Handled requests for proposals (RFP), making presentations to customers, and negotiating project timelines and deliverables.
• Performed Gap Analysis by identifying current technology, policies, procedures, documenting the enhancements for the requirements, and analyzing new HIPAA 5010 compliance and developed an action plan for the migration process.
• Prepared Business Process Models (BPM) and UML diagrams like workflow diagrams, activity diagrams, sequence diagrams, use case diagrams, by using MS Visio, for visual representation to explain various steps involved in business.
• Developed elaborate use cases explaining interaction between user and system context, and system to system context, to demonstrate dependencies between various applications in the plan, member, provider and claims domain to illustrate the functionality of the systems to various business stakeholders and technical teams.
• Involved in creating and executing test cases, test plans and test scripts for EDI 837 Claims (I & P) Transactions.
• Performed Data mapping to validate and customize Claims daily load into FACETS for processing the transactions.
• Performed Data profiling through careful range and pattern analysis and checked for data integrity by looking for various data anomalies and doing data normalization and data verification using Informatica Data Quality Center.
• Built Data Dictionary for various designers, developers, users, and administration with information on contents, data-type, and data element in various tables, columns and rows, and data modelling through star and snowflake schema.
• Participated in Validating ETL process by creating various simple and complex SQL queries.
• Responsible for the development and implementation of HIPAA EDI Data Mapping artifacts for various claims related transactions like 270, 271, 274, 276, 277, 820, 834, 835, and 837.
• Performed User Acceptance Testing for the ANSI X12 Version 5010 / EDI transactions (HIPAA) for Claims Status and Adjudication process involving 270, 271, 276, 277, 834, 837P, 837I, 837D, 835 remittances and NCPDP Claims.
• Validated HL7 messaging protocols for bi-directional case and disease report exchange, in HTML and XML formats, in accordance with HL7 specifications for electronic communication of Confidential t health information.
• Developed XSD Schemas and wrote XML test files for backwards compatibility testing.
• Created test cases for the premium calculations and Claims limits and deductibles (Claims calculations).
• Wrote SQL queries to match the results with the actual BI report for various analytics purposes.
• For User Acceptance Testing (UAT) created ad hoc BI reports using Tableau version 7.0

Environment: Waterfall- SCRUM hybrid methodology, MS Visio 2010, Informatica 8.5, Altova map force, Enterprise architect, Rational Requirements Composer (RRC), Rational Team Concert (RTC), Clear Quest, Clear Case, MS Visio 2010, Informatica 8.5, Altova map force, COBOL, Share Point, MS outlook 2013, MS office Suite 2013 (Word, Excel, Power point), MySQL, Javascript, jQuery, JAVA, J2EE, Tableau 7.0.

Confidential, Baton Rouge, LA

Business Systems Analyst

Responsibilities:

• Analyzed the Business Need and Business Case for the project to understand the needs of the various stakeholders.
• Involved in business process reengineering (BPR) by conducting business process modelling, SWOT analysis, impact analysis, and performed GAP analysis to analyze the gap between As-Is business process and the To-Be scenarios.
• Created artifacts like Business Requirement Document (BRD) to in corporate high-level business requirements, and Software Requirements Specification (SRS) containing functional, non-functional, GUI and Data requirements.
• Created Mock-Ups and Wireframes of User Interface components for client verification using Balsamiq.
• Developed Use Cases, Activity Diagrams and Sequence Diagrams for a clear understanding of the project vision.
• Prepared Business process models; used Visio to create process flow diagrams for mapping the logical workflows.
• Created Requirement Traceability Matrix (RTM) and interacted with QA team to ensure quality of software.
• Used Informatica Power center for the ETL process to map the code sets according to the implementation & Companion guides and used GEMs for forward mapping and backward mapping of the ICD-9 and ICD-10 codes.
• Assisted ETL Developers and Data Analyst in all stages of development processes including extraction, transformation, and loading (ETL) data from various applications to minimize redundancy and anomalies in data.
• Created data mapping documents, to analyze, map, and define the data elements, between source and target systems and analyze the various tables in the applications in the database which housed the data elements.
• Analyzed the API documentation to illustrate applications connectivity, and created user manuals explaining system interactions through SOAP, REST, XML, JSON, WSDL, etc. at the Service Oriented Architecture (SOA) level.
• Validated business scenarios on new builds to enable extensive testing by the QA team and assisted the testing team to expedite Regression Testing and User Acceptance Testing, to meet the production date deadlines.
• Validated various components and error scenarios in the FACETS system occurring during the claims adjudication process related to different HIPAA ANSI X12 EDI transactions such as 834, 835,837,270, 271, 276, 277 and 278.
• Facilitated face-to-face and conference meetings with the team and the business to review business requirements related to automating the claims processing system and also error resolution for batch and real-time transactions.
• Provided insights into issues in the automated claim review process and assisted in the easy correlation and real-time monitoring of events across all layers and components of the claim processing cycle through data analytics.
• Generated rapid & automated regulatory compliance verification reports by analyzing the systems generated data.
• Ensured all applications were tested rigorously for functionality and were adequately controlled in production.
• Involved in creation of User Acceptance Test cases and plans, defect tracking, defect management, creating reports, dashboards, creating graphical and statistical representations of claims data for analytics purposes.
• Coordinated with the backend team associated with the application server which was built using C, C++ & Python and the front-end UI team working on the web browser which was built using AJAX, CSS, HTML & java script.
• Assisted the QA/QC team in creating Test plans, Test cases, Test Scripts and Test scenarios using HP ALM & HP QC.
• Developed wireframes and coordinated with UX team to convert them into prototypes and visual design.

Environment: Waterfall- SCRUM hybrid methodology, MS Visio 2010, Informatica 8.5, Altova map force, Enterprise architect, MySQL, Balsamiq, HP ALM, HP QC, Tableau 7.0.

Confidential, NYC, NY

Business Systems Analyst / SCRUM Master

Responsibilities:

• Implemented SDLC, agile (SCRUM) methodology for the developing life cycle and followed the standards process in the application and elicited requirements from Business users and stakeholders by interacting with them and asking them detailed questions, and through JAD sessions, Focus Groups, Brainstorming, Prototyping and carefully recording and documenting the requirements in a format easily understood and reviewed by both business and technical people.
• As a SCRUM Master, I facilitated SCRUM ceremonies like Backlog Grooming sessions, Sprint planning meeting, Daily Stand-Up Meeting, Sprint Review, and Sprint Retrospective meetings, acting as a service leader to guide the team.
• Proficient in writing and prioritizing User Stories using INVEST in Product Backlog along with the Product Owner as per business and Technical needs using prioritizing techniques like business value based and technical value based.
• Facilitated breaking down EPICs into User stories and estimation of User Stories using estimation techniques like Planning Poker in Backlog grooming sessions, assisting the team to clarify ambiguity in estimating the user stories.
• Efficiently handled team and organizational impediments thereby fostering an environment for efficient team work.
• Used JIRA for issue tracking, User Story management and requirement traceability and created, managed, tracked and analyzed sprint Burn Down Chart and Product Burn Down chart to estimate sprint velocity, Development team’s capacity and release planning respectively, to improve and maximize value while focusing to achieve the Sprint Goal.
• Maintained SCRUM Task Board and did issue tracking through prioritizing and managing the defects using JIRA.
• Ensured that the team is following coding standards and is adhering to Definition of done to avoid/reduce technical debt and focused on resolving and shielding the team from impediments to keep them working in a group flow.
• Conducted Impact Analysis and Gap Analysis to derive and document requirements for Web based Claim Processing System (CPS) and identified AS-IS and TO-BE business processes based on which created business process models.
• Identified gaps between current policies and procedures and new HIPAA 5010 compliance, to check the compatibility of the existing system capabilities with the new requirements and developed an action plan for the migration process.
• Implemented Test Driven Development (TDD) to ensure quality of application is maintained through SDLC.
• Developed Mockup screens and wireframes using UI components such as Radio Buttons, Down lists, Check Boxes, and Data Entry Fields for web based custom dashboard of the CPS application for Business Users and Stakeholders.
• Worked with Front end and UI developers and Created HTML and CSS files using HTML5 and CSS3 for web based custom dashboard, and ensured that the client side validation and server side validation were implemented.
• Created XSD schemas and verified XML files based on XSD schemas. Assisted testers with validating XML requests.
• Developed HL7 messaging for Confidential t EMR in text and XML formats, in accordance with HL7 specifications and performed functional (API) testing and worked with QA team in reviewing and executing test plans and test cases.
• Created Data mapping documents between various data elements, XML files, flat files, excel files, HIPAA EDI files X12 837, 270, 271, 276, 277, 278, 835, 275, and 5010 and web services, to perform verification and validation.
• Defined Data Maps to validate and customize Claims daily load into FACETS for processing the transactions.
• Reviewed Stored Procedures for reports and wrote test SQL queries for Joins, Unions, Group By functions against the source system (SQL Server) to match the results with the actual report against the Data mart (Oracle 10g).

Environment: SCRUM Methodology, JIRA 5.0, JAVA, Eclipse 4.3, MS Visio 2013, UML, Apache, AWS, AMI, Amazon EC2, HP ALM v11, Oracle 10g, Tableau 9.0, Altova XML spy, SOAP UI PRO, MS outlook 2013, MS office Suite 2013 (Excel, Word, Power point).

Confidential, Madison, WI

Business Analyst / SCRUM Master

Responsibilities:

• Functioned as the primary liaison between the business line, operations, and the technical areas.
• Performed Gap Analysis to understand the AS-IS and TO-BE state of the project.
• Assisted the Project Manager (PM) with the Project Plan using MS Project.
• Conducted focus groups and interviews with end users such as dentists and physicians to understand additional functionalities deemed critical on top of the mandated functionalities in hospital’s EMR System.
• Performed technology Impact for change Request and submitted it to the Change Control Board.
• Organized JAD sessions and shared calendar with tech leads to facilitate JAD sessions using MS Outlook.
• Created Workflow documents, UML diagrams, activity and sequence flow diagrams using Erwin.
• Created conceptual Data models and ER diagrams showing relationships between various data entities using Erwin. Also created BRDs, FRDs, FRSs, SRSs and use cases.
• Utilized Current Medicaid Information Technology System (MITS) Provider subsystem data map and the Department of IT data map to create crosswalk documents.
• Used Data mapping documents to Analyze source and target database, analyze data integrity, and identify areas of improvement.
• Developed and implemented Structured Query Language (SQL) queries for data integrity testing.
• As a SCRUM Master used RALLY created artifacts like burn down charts and User stories.
• Facilitated daily stand up meetings and demo sessions using Agile principles and practices.
• Wrote user stories (INVEST) in JIRA, and Planning Poker and Relative mass valuation method to estimate user stories. Managed Requirement churn and helped to define acceptance criteria.
• Used techniques like MoSCoW and KANO approach to prioritize backlog Items.
• Developed Requirements Traceability Matrix (RTM) to trace software design requirements to test cases.
• Performed manual testing and User Acceptance Testing for the web based custom dashboard

Environment: Waterfall-SCRUM hybrid, HP ALM v11, Oracle 10g, IBM Cognos, MS Visio 2010, JIRA, Outlook 2010, MS Office suite 2010 (Excel, Word, PowerPoint), N-tier Architecture.

Confidential, Louisville, KY

Business Analyst

Responsibilities:

• Articulated and presented business analysis results clearly and concisely to programming staff and senior management.
• Acted as a liaison between business Domain Experts and Technical Team to develop high quality system.
• Lead remediation of encounters through periodic workgroup meetings between business, development, and market office. Created BRD and FRD.
• Developed Requirements Traceability Matrix (RTM) to be used in software development and QA testing.
• Performed Gap Analysis between ICD 9 and ICD 10.
• Involved in Forward Mapping from ICD 9 to ICD 10 and backward mapping from ICD 10 to ICD 9.
• Perform Gap Analysis to upgrade HIPAA ; prepared solution document and project plan.
• Created Uses cases, UML diagrams, activity, and sequence diagrams.
• Handled Change requests and conducted impact analysis (Business and Technical).
• Worked on the EDI 834 file load to Facet. Participated in creating Data models.
• Worked with business users to document current end to end work flow processes and collaborated with users in identifying, defining, and documenting process improvement options and alternatives, as directed by business needs. Supported Quality Assurance by using HP AL. Participated in UAT and manual testing.
• Identified various attributes for fact and dimension tables in constellation, star, and snowflake schemas.
• Checked the ETL process by generating various SQL queries.
• Gave proper input for metadata registry based on Business users’ and stakeholders’ requirements.
• Identified required information fields and developed data dictionary.
• Worked with business users to define and document business rules.
• Participated in training users on application software.

Environment: Waterfall methodology, MS project 2010, HP ALM V11, Oracle 10g, IBM Cognos, MS outlook 2010, Erwin, SQL, General Equivalence Mapping, MS Visio, MS Office Suite 2010 (Excel, Word, PowerPoint), MS Outlook 2010.

Confidential

Business Analyst

Responsibilities:

• Documented business requirements, and communicated these requirements with the development team for design and implementation of business solutions.
• Worked with Business Analysis team to prepare a detailed Business Requirement document (BRD) and System Requirement Document (SRS).
• Analyzed Business Requirements to develop functional and detail design specifications.
• Conducted Requirement Gathering Sessions with the stakeholders. Incorporated stakeholder feedback throughout the project lifecycle to ensure project quality and customer satisfaction.
• Interacted with the project team to help define the Business and System Objectives, confirmation of scope, identify constraints and the measures of success for the system to be developed.
• Conducted the JAD sessions, daily meetings, brainstorming sessions to solve the problems and enhance the workflow. Assisted in building a business analysis process model.
• Monitored change requests and documented requirements, integrating them with Use Cases.

Environment: MS Visio, Mock-up screens, wireframes, My SQL Workbench 5.0, My SQL 5.0, MS office suite 2007.

Confidential

Dental Surgeon/ Project coordinator - EMR

Responsibilities:

• Managed and coordinated with physicians working in department of dentistry in- Confidential t and out- Confidential t department. Involved in daily operations and quality initiatives in the department.
• Analyzed and maintained statistical performance and Confidential t satisfaction data to identify trends in service delivery. Reduced turnaround time for discharged third party insurance Confidential ts by 30 minutes.
• Designed Confidential t and family survey tools to evaluate experience and identify areas of improvement
• Elicited Requirements by interviewing various stakeholders and business users like hospital administration department employees, billing department employees, physicians, and other healthcare workers. Conducted GAP Analysis of current state (As-Is) and proposed state (To-Be) situations.
• Created BRD and FSD based on business requirement of the stakeholders. Prepared workflow diagrams, designed process flows. Performed Data analysis and validation of BI reports using SAS.
• Performed Change Management by handling change requests and getting the approval from the Change Review Board (CRB). Participated in making conceptual data models and data mapping.
• Participated in performing data profiling and checking for integrity of the data by using SQL queries.

Environment: MS Visio, MS office suite 2007, MySQL 5.0, Erwin, General Equivalence Mapping