SUMMARY

• 9+ years of professional experience as a Business Analyst in Healthcare Domain with solid understanding of Business analysis, Requirements Gathering, Translating Requirements into Specifications, Project management, Application Design, data mapping/modeling, and Testing.
• Extensively worked on analysis & compliance of ICD 9 to ICD 10 and HIPAA (Health Insurance Portability and Accountability Act) 4010 and 5010 EDI transactions.
• Experience with Medicare, Medicaid and commercial insurances in HIPAA ANSI X12 formats including 270/271,276/277,820, 835, 837, 997
• Proficient in authoring Business Requirement Document, Narrative Use Cases, creating Use Case diagrams, Sequence Diagrams, Activity Diagrams and other UML based diagrams using MS Visio, Rational Rose.
• Experience working in a matrix environment, enhancing UI applications, creating data sets, extracting and synthesizing data, conducting and interpreting quantitative and qualitative analyses.
• Extensive knowledge about the various types of health insurance programs such as: Medicaid, Medicare (Part A, B, C and D), PPO (Preferred provider organization), HMO (Health maintenance organization), Medical Management Information SystemsMMIS
• Experience with claims process and adjudication in the Medicare, Medicaid & Private Insurance Sectors
• Also worked using various methodologies such as Agile Software Development, Rapid Application Development (RAD), Joint Application Design (JAD) and Prototyping.
• Expertise in Business Modeling and UML Diagrams (Use Case Diagrams, Activity Diagrams, Sequence Diagrams) using MS Visio and Rational Rose.
• Strong knowledge of Business Intelligence, Data Warehousing, Data Modeling and Analytics concepts with expertise in grasping transaction flows and process management
• Expertise in Healthcare Data warehousing and BI tools (SQL server Reporting/Analytical tools)
• Expertise in reviewing Test Procedures, creating Test plans, defining System & Integration Test Cases, executing Test Cases, Test Data reviewing and maintaining and executing detailed Test scripts for User Acceptance Testing (UAT), analyzing bugs, interacting with team members in fixing.
• Excellent Written and oral communication skills with ability to articulate requirements, process flows and relationships.

TECHNICAL SKILLS

Methodologies: OOAD, RUP, UML, SDLC, JAD, CMM, RAD, Agile, SCRUM.

Tools: MS Office 365, TOAD, Visio, Adobe Acrobat Suite, SharePoint, Rational Rose, Requisite - Pro, Clear case, Quick Test Professional, AXURE, Balsamiq, JIRA, BUGTRAC, DB visualizer

Quality Management: Test Director, Quality Center, Load runner.

Reporting Tools: Business Objects, MS Excel, Crystal reports, Cognos

Other Tools: Clarity, EMC Documentum, eRoom

PROFESSIONAL EXPERIENCE

Confidential, Minnesota

Business Analyst, Scrum Master

Responsibilities:

• Gathered requirements to calculate participant health score based on total cholesterol, HDL, Triglycerides, resting heart rate and various other biometric parameters.
• Created LOINC/SNOMED Vocabulary Mapping for Lab data that was sent to Medivo to get physician approvals.
• Translated business needs into system design and requirements
• Worked with total Health sales team and operational team to improve the Salesforce application used to sell the MyHealth Check products to clients
• Interacted with Subject Matter Experts (SMEs) and stakeholders to get a better understanding of client business processes and gather business requirements.
• Developed plans to make the portal compliant with PPACA requirement of giving reasonable alternative to employee with low health score.
• Developed Data flow diagrams using Microsoft Visio.
• Created User stories to capture requirements in JIRA and developed various Software Specification Documents(SRS) and Business Requirement Documents(BRDs) in Office 365.
• Conducted brainstorming sessions with stakeholders, solutions architects and developers using innovative techniques such as ‘Human centered Design Thinking’ and ‘Lateral Thinking’
• Worked with a diverse team of product owners, UX designers and Web developers to analyze existing software (Web and mobile) for usability and accessibility issues and provide recommendations for improvement.
• Conducted Daily Stand-ups, Backlog grooming, Sprint Planning and Sprint Retrospective meetings.
• Helped the team in understanding SCRUM concepts such as Velocity points vs Capacity Points, burndown charts and other concepts as a Scrum Master
• Recommended design for creating high-impact User pages focusing on company’s branding.
• Created Mock-ups and wireframes to capture requirements using Axure and Balsamiq.
• Conducted JAD sessions to develop architectural solution that application meets the business requirements, resolve open issues, and change requirements
• Helped in the development of an Enterprise wide Data Dictionary Document which included representational definition for data elements and semantics

Environment: Agile, SQL Server, MS Project, MS Visio, Java, XML, Windows XP, MS Office 365

Confidential - Albany, NY

Business Analyst, Project Lead

Responsibilities:

• Facilitated and lead meetings to gather information and requirements, and presented information, analyses and recommendations for various in-house applications including Radiation Permit Processing, Business Licensing and Child lead applications.
• Gathered, organized and documented analysis of information such as cost/benefit, advantages/disadvantages, feasibility studies and project approaches.
• Effectively served as Project Lead for coordinating the efforts of three major state agencies in the integration of various incident management systems.
• Made recommendations to optimize user experience and behavior by designing new Web pages/redesigning existing pages to follow child notes chronologically
• Managed Requirement Document, Test Plans and Project charters in SharePoint Online.
• Develop forms, applications, and workflows within SharePoint using InfoPath and SharePoint designer
• User interface design, front-end web development & branding of SharePoint sites
• Analyzed the current state of the Electronic Health and Inspection permitting system (EHIPS) which generates permits and conducts inspections on various State regulated Businesses such as restaurants, children’s camp, water supply etc. and came up with an AS-IS application document.
• Conducted meetings with over 40 County and District officials EHIPS users to extract requirements and understand problems in their day to day processing.
• Acted as a joint facilitator in JAD sessions that were conducted to gather requirements
• Worked with secondary teams to give requirements for a customer facing application for Businesses to apply for permits.
• Analyzed several third party tools (Acela, CDP, and GOVPILOT) to assess the viability of these products and to understand the pros, cons, impacts and risks associated with replacing and/or integrating existing system with a new system.
• Created a TO-BE document to recommend changes to the system and ways to improve several aspects of the system including business rules, efficiency, ease of navigation and reports.
• Created various use-case diagrams and documents, process workflow diagrams, system-mapping diagrams and wireframe diagrams for the new recommended application.
• Conducted FIT-GAP analysis of the current and desired state based on the AS-IS and TO-BE diagram.
• Assist individuals in maximizing the potential of Sharepoint as it relates to their job function
• Document SharePoint configurations and architectures.
• Gather requirements for developing an Office 365 License Assignment tool that dynamically finds the available licenses within an Office 365 tenant, allowing the administrator to pick and choose which licenses to assign to specific users/customers.
• Generated numerous Business Requirement Documents & Functional requirements specification documents for the State Child Lead system which tracks all children that have high lead levels.
• Created Business rules and Business requirement document to combine the two radiation applications into one central system.
• Created Mock-ups and Prototypes of the new centralized radiation system using PENCIL, VISIO and AXURE.
• Generated various reports such as project status reports, requirements coverage, defects trends and application quality coverage using HP ALM
• Used HP ALM to identify, manage and track defects and enforce the resolution for various defect fixes.
• Generated reports and analyzed data needed to improve matching process (children to their residence county) using TOAD for Data analysis.
• Worked with technical teams to come up with a GEO-CODING Algorithm.
• Communicated with Project managers, Directors of Environmental Health and various Section chiefs to communicate project scope, project changes and various improvements and recommendations.

Environment: Agile, SQL Server, MS Project, MS Office 365, MS Visio, SharePoint, Oracle, Sybase, Power Builder.

Confidential - Columbus, OH

Business Analyst

Responsibilities:

• Responsible for developing high level business along with functional requirements pertaining to different aspects of the State Wide Billing of Mental Health hospitals project including but not limited to Client Eligibility, Client Enrollment, Client Financial and Client Bills
• Acted as a liaison between Business Area Subject Matter Experts (SMEs) & development team throughout all phases of SDLC; starting from Inception to Transition Phase Agile methodology (Hybrid with Waterfall)
• Generated numerous Business Requirement Documents & Functional requirements specification documents, Use cases, system flow and work flow diagrams.
• Worked with the Fiscal Supervisor Subject Matter Expert (SME) and Users to ensure that all the requirements for system change are covered.
• Extracted and refined user requirements by conducting requirement sessions, facilitating meetings & interview with Business Units and Technical Supports & Development team, identifying the business flows and process flows, conducting detailed and comprehensive business, functional & system analysis to determine High Level and Low Level artifacts & deliverable.
• Testing of HL7 Message Validation and sending of ADT Messages like ADT A01, ADT A04 and ADT A08.
• Developed business and detailed functional requirements related to changes to be made to the new system screens, including use cases for Medicare (PART A, PART B, PART C and PART D), Medicaid, Veteran’s Affairs, Worker’s Compensation and Confidential toFinancial.
• Worked with the State Medicaid system MITS to change flow of Medicaid data and decommissioning legacy RMF (Recipient Master File)
• Created new screen layouts and identified locations for new fields being added and existing fields which are being moved.
• Developed Test Plans and Test Execution Procedure Document based on the Business & Functional
• Designed and distributed the Medicare Secondary Payer (MSP) questionnaire, impact of business changes to legacy systems and several other forms using Adobe Acrobat fillable forms and MS Excel.
• 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.
• Worked with Team Leads, Technical staff and key users to identify track and manage project issues as they arise.
• Worked on creating Data Mapping Matrix using the 270/271 Companion guide to identify Confidential t data from 270/271 transaction.
• Developed work flows that demonstrate current and proposed business requirements.
• Responsible for implementation and coordination of system testing - Certify for the regression testing of the renewal cycles, batch jobs and various screens in the mainframe system
• Created tickets to log in defects and assigned defects to development team in the BUGTRAC system.

Environment: Agile, MS Office, SQL Server, MS Project, MS Visio, Unix, J2ee, Java, XML, Mainframes, Windows XP

Confidential - Lincoln, NE

Business Analyst

Responsibilities:

• Acted as a liaison between Business Area Subject Matter Experts (SMEs) & development team throughout all phases of SDLC; starting from Inception to Transition phase of Rational Unified Process (RUP) methodology
• Updated data processes, data reporting, data collection tools and other processes such as problem lists, writing orders, referrals according to ICD-10 code set.
• Ensured that ICD-9-CM procedure codes used for services and CPT codes were not outdated
• Contributed in ICD-10 Awareness Training Management Plan, created evaluation tool, and survey questions
• Reviewed state documents (policies, manuals, business processes, systems documents, banners, bulletins) from various divisions. Analyzed and performed quality assurance to determine areas impacted by ICD-9 related data
• Generated numerous Business Requirement Documents & Functional requirements specification documents, Use cases, system flow and work flow diagrams.
• Worked with the Managed Care Subject Matter Expert (SME) and Users to ensure that all the requirements for system change are covered.
• Developed business and detailed functional requirements related to changes to be made to the claim entry screens, including Practitioner, Crossover Practitioner, Dental and Hospital Claim Entry Screens.
• Developed business and functional requirements for the National Provider Identifier (NPI) Crosswalk and Crossover Claims Crosswalk solution.
• 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.
• 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.

Environment: Agile, MS Office, SQL Server, MS Project, MS Visio, Unix, J2ee, Java, XML, Windows XP

Confidential - Long Beach, CA

Project Business Analyst

Responsibilities:

• Reviewed, analyzed & created BRD’s identified Functional Requirements & Non Functional Requirements using Rational Requisite Pro.
• Conducted GAP analysis & identified loop, segment, field additions/deletions, error conditions changes between As-Is process & To-Be process.
• Assisted in highlighting key aspects required for vendor solutions - HIPAA translators & testing tools & created vendor statement of work document.
• Identified & conducted mapping process for output from 5010 to proprietary UB92 & NSF formats for legacy payer systems.
• Captured key payer systems & HIPAA repository data flow issues & risks.
• Conducted Claim Adjudication (check for payer edits & rules), analyzed and identified any errors to generate 834.
• Conducted Gap Analysis & identified specific ICD 10 requirements & participated in development sessions capturing ERD diagrams, Workflows & Communication diagrams.
• Created Project Plan using MS Project identifying key resource constraints, deadlines & dependencies. Documented & created weekly project status reports.
• Created Current Process Flow (as-is process) & Future Process Flow (to-be process) using MS Visio.
• Created Use Cases, Activity Diagrams, System Context Diagrams entailing grandfathering process, preexisting condition exclusions, dependent coverage age increase & other required provisions.
• Used Ultra Edit Professional to format ANSI X12 EDI 837I,P,D files, identified & changed duplicates, changed loops, elements & segments, wrapped & unwrapped files.
• Used Ultra Compare Professional to do 3-way comparison among ANSI X12 EDI 837I,P,D files
• Logged defects using Rational Clear Quest & produced defect status reports to ensure quality standards

Environment: Mainframes, DB2, Rational Requisite Pro, Rational Clear Quest, Rational Test Manager, Oracle 10g, UML, MS Office, IBM Lotus Notes, Windows XP.

Confidential - Houston, TX

Business Analyst

Responsibilities:

• Implemented RUP methodology for iterative and incremental development of the system.
• Researched and understood the claims adjudication and reimbursement systems based on HIPAA X12 4010 standards
• Performed gap analysis to identify AS-IS processes of claims transactions of HIPAA 4010/4010A standard and TO-BE processes of HIPAA 5010 standard
• Conducted Claims and HIPAA Compliance Training to run the test cases.
• Was involved in managing of Medicare Part-D Claims processes from Admin/Provider/Payer side which were later part of the training program to providers.
• Assisted in writing requirement document for ETL - Data Extraction, Data Analysis and Loading process of collected data as a part of data mapping procedures.
• Helped review and edit test scripts, certify test results and fulfilled business requirements.
• Designed and developed on the State Diagrams, Activity diagrams and Class Diagrams in MS Visio using UML for various modules of the project.
• Assisted in X 12 transactions 835/837/270/271 of medical claims/underwriting for support and point of reference for the providers in business issues.
• Analyzed business Requirements, performed gap analysis and segregated them into high level and low level Use Cases, Activity Diagrams using Rational Rose.
• Developed Test plan and Test cases based on Use cases and Functional Specifications.

Environment: MS Office, Quality Center, SQL Server, Facets, MS Project, Server, MS Visio, Unix, SQL, HTML, Java, XML, Mainframes and Rational ClearQuest, ClearCase, Windows XP.

Confidential -Louisville, KY

Business Systems Analyst

Responsibilities:

• Analyzed, documented, and managed all project requirements and changes to requirements throughout the software development lifecycle.
• Created the architecture flow, rating modules structure and the database structure of the Optional Supplemental Benefits (OSB) which was used by the downstream systems
• Responsible for the team status meetings, reporting and updating reports in the eRoom Documentum
• Developed all the required documents (SRS, Design Document, Use cases, Data Flow diagram, Test Plan, Test Cases, UAT testing template etc.) using MS Visio and MS Office
• Developed the design specification, testing information (use cases), installation instructions, and user documentation which provided end-to-end IT Service Management based on ITIL
• Responsible for scheduling meetings, one on one sessions and facilitating System testing and UAT with all systems and business partners
• Prioritized defects, Service desk tickets and enhancement requests from business partners
• Assisted in transition from ICD 9 Code set to ICD 10 code set and also documented the draft
• Documented the workflow structure of creating the questions for the benefits, approving the benefits and rates from CMS, enrolling customers and groups to the benefits, billing cycles, claims and information printed on the ID cards
• Responsible for implementation and coordination of the automated testing tool - Certify for the regression testing of the renewal cycles, batch jobs and various screens in the mainframe system

Environment: MS Office, SQL Server, MS Project, MS Visio, Unix, J2ee, Java, XML, Mainframes, Windows XP.

Confidential - Marietta, GA

Business Analyst / Data Analyst

Responsibilities:

• Gathered requirements from stakeholders for provider management and member management.
• Identified and validated business rules and data elements.
• Modeled the ‘AS-IS’ process flow and the ‘TO-BE’ process flow and analyzed the gap and developed the action steps to fill the gaps.
• Conducted Risk analysis and developed mitigation plans.
• Involved in requirement gathering of clinical health record
• Conducted Impact analysis when there is any change in the requirements and updated the Business Requirements Document (BRD) and Systems Requirements Specification (SRS).
• Facilitated meetings with the technical team and client team to analyze the current process and gather requirements for the proposed process.
• Designing Functional Specifications for the target physical database.
• Analyze EDI - X12 data elements captured by the existing system to validate it against the data elements required for new system.
• Participated in developing test plan, test scripts, and test scenarios and designed user documentation.
• Worked with legacy team in developing BRD for multiple system change requests and participated in system testing.
• Developed UAT test cases associated with the functional requirements.
• Used Microsoft SharePoint as the version-tracking tool for managing the requirements documentation.

Environment: MS Office, Agile, Windows 2000, .NET, MS Visio, MS SharePoint, TFS, MS Project, MS Visio, SQL, Oracle, SOA, HTML.

Confidential, Portland, OR

Business Systems Analyst

Responsibilities:

• Performed SWOT and Gap analysis for the new functionality requirements
• Worked with HIPAA rules and regulations to draft business rules and claim processes.
• Interacted with the client and the Technical Team for requirement gathering and translation of Business Requirements to Technical specifications.
• Identified and documented the dependencies between the business processes.
• 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.
• Data modeling using UML.
• Involved in preparing project plans and identifying major milestones for each stage as per the SDLC model (RUP Methodology).
• Documented Requirement Traceability Matrix in Requisite Pro for traceability of requirements.
• Scheduled meetings with developers, system analyst’s (SA) and testers to identify resource allocation and project completion using MS Project.
• Performed Smoke Testing to ensure that the compiled software components of the Applications adhere to Project Standards, Performance Criteria and Functional specifications to ensure feasibility of testing effort.

Environment: Rational Unified Process (RUP), UML, Dreamweaver, Rational Clear Quest, Windows, MS Office, MS Project, MS Visio, HTML