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Sr. Business Analyst Resume

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Rochester, MN

SUMMARY

  • A Highly Skilled Business Analyst/ Business Systems Analyst with more than twelve years (12+) of proven track record experience in medium to large - scale IT Web Application Services environment as a business and applications management professional.
  • Expertise in Business Analysis, Business Modeling, Requirements Gathering, Technical Documentation and Software Validation by working in collaboration with Product/Process Owners, Stakeholders, Subject Matter Experts, Architects, Developers, Testers and other team members in the overall enhancement of software product quality. Adept to work in fast and dynamic paced work environment under pressure to prioritize and meet deadlines.
  • Over 10 years of solid work experience in Health Care domain with various Commercial and State health care clients.
  • 5 years experience working in state projects with knowledge in joint federal and state programs (Medicaid, CHIP) and state benefit programs (SNAP, TANF, MABD, 3SQVT, GA/EA, RF/ RU/RA, Crisis Fuel, WIC, EP, LIHEAP).
  • Significant exposure to government-sponsored four-part program (Medicare Part A, B, C and D) and Commercial-based healthcare plans.
  • Solid understanding of Web/Internet (Desktop and Mobile) user experience designs within IT Applications.
  • Sound knowledge of health information and health care services regulatory environment includingHIPAA (Health Insurance Portability and Accountability Act) and ACA (Affordable Care Act).
  • Analysis & compliance experience in EDI conversion project(s) from HIPAA to HIPAA transaction sets.
  • Thorough understanding and hands-on working experience in Process Documentation, Analysis and Implementation for EDI X12 standard transactions like 270/271(Benefits Status Enquiry and Response), 275(Claim Attachment), 276/277(Health Care Claim Status Request and Response), 820(premium payments), 834(Benefit and Enrollment Maintenance), 835(Health Care Claim Payment/Advice) and 837(Health care Claim) and 997/999(Acknowledgments).
  • Exposed to using HL7, ICD-9 and ICD-10, HCPCS and CPT classification coding standards in healthcare systems.
  • Highly skilled EDI Claims Processing and Claims Scrubbing/Clinical Editing related experience in health insurance claims processing applications from Admin/Provider/Payer side.
  • Worked extensively with Member, Provider, Authorizations, Benefits, Premiums, Claims and Pricing functional groups within FACETS, Diamond and NASCO Blue Exchange applications.
  • Worked with the management in improving designs by providing alternative solutions for future processes dealing with claim processing from point of entry to finalizing, claim review identifying claims processing problems like claim adjustments using best practice model and principles.
  • Conducted detailed analysis on migration and conversion ofMember andProviderdata, Group configurations, Premium billing, Benefit set-ups, Fee schedules and Provider pricing functionalities within healthcare domain.
  • Proficient in creating and managing team site, templates and workflows using SharePoint Designer.
  • In-depth knowledgein Software Development Life Cycle (SDLC) methodologies like Agile (SCRUM), Waterfall and Rational Unified Process (RUP).
  • Experience in complete End to End Project life cycle (PLC): System Analysis, Design, Development, Testing, Deployment, and End User Training. Responded proactively to both Business and Project issues and escalated appropriately.
  • Liaison between Business user groups/Business units, Technical system groups/Technology teams and support teams to ensure proper translation of Business Requirements to Software Requirements Specification (SRS).
  • Proven Ability in effectively identifying and capturing complex business needs by developing efficient and detailed Business requirement documents (BRD), Functional requirement documents (FRD) and Non-functional requirement documents (NFRD).
  • Proficient in facilitating Joint Application Development (JAD) sessions, workshops and interviewing Subject Matter Experts (SMEs)/Business user/ End-user/stakeholders and the IT group.
  • Strong problem solving and analytical skills including understanding business processes, functional requirements, non - functional requirements and translating them into solution (system) requirements.
  • Competent in basic conceptual and logical process / data modeling techniques using Business Process Modeling Notation (BPMN) for specifying, constructing, and documenting the system artifacts like Business Process diagrams, Data flow diagrams and Work flow diagrams.
  • Extensive experience in modeling techniques like Unified Modelling Language (UML) and developing/designing diagrams such as Use Case diagrams, Activity diagrams, Class diagrams, and Sequence diagrams to business users and development teams in analysis and design phases of the project utilizing MS Visio and IBM Rational tools.
  • Highly proficient in understanding business problems and transforming these into EPICs/Feature and User stories development/prioritization along with other backlog items (includes but not limited to breaking down the stories, eliciting conversations, facilitating story refinement sessions).
  • Possess sound understanding of DataWarehousing Concepts, Standards and Tools with hands on experience in Data analysis through querying the relational data bases by writing SQL queries and generating reports.
  • Experienced in performing System Testing, End-to-End Testing and User Acceptance Testing.
  • Involved in Alpha and Beta Testing phases of various business applications to check if the system is built to match the business requirements of the organization.
  • Experienced in developing Test scenarios, Test cases and maintaining Traceability Matrices for baseline documents.
  • Assisted in writing efficient and effective Test Plans, Test Strategy, Test Execution, Issue Resolution and Report Generation to assure that project is in compliance with the business requirements.
  • Assisted Test Managers inTest Plan and Test Casewalk-thru for theBusiness and Development teamsto obtain feedback and/or approval Sign-off.
  • Assisted Business users in defining UAT test cases and plans; Established and maintained test cases and test data in Quality Center.
  • Extensively used Project Management Tools like Test Director/HP ALM/Quality Center, Bugzilla and JIRA to document bug tracking, issue tracking, defect tracking and project tracking.
  • Experience in dealing with Multiple projects and Cross-functional teams and ability to coordinate across teams in a large matrix organization environment.
  • Highly motivated team player with excellent Organizational, Interpersonal, Negotiation and Presentation skills.

TECHNICAL SKILLS

Business Intelligence Tools: IBM Cognos ReportNet(CRN), MicroStrategy, QlikView, Microsoft BI tools, Crystal Reports

Business Modeling Tools: Rational System Architect, Rational Rose, Requisite Pro, Microsoft Visio 2007/2010, Microsoft SharePoint Designer 2007/2010

Change Management Tools: Rational Quality Manager, Rational Clear Quest

Relational Databases: MS Access, Oracle 9i/10g, SQL Server 2000

Operating Systems: Microsoft Windows 2000/XP/Server2003/R2/Vista/Server2008/R2/2012/R2/7

Programming/Query Languages: SQL, PL/SQL, HTML, XML

Project Management Tools: Clarity PPM, Microsoft Project, JIRA 4.3, HP Agile Manager, HP Requirements Management, Team Foundation Server (TFS), Confluence KM, Microsoft Office Suite 2003/2007/2010

Testing Tools: HP Quality Center Enterprise v9.2/v10.0/v11.0, HP Business Process Testing, Bugzilla 3.2, Win Runner, QTP, Mercury Test Director v8.0

Version Control Tools: Rational Clear Case 7.1.2/7.1.2.2/8.0 , Microsoft VSS 2005, PVCS

Wireframe Tools: Axure RP Pro 5.6, SnagIt 11.2.1

PROFESSIONAL EXPERIENCE

Confidential, Rochester, MN

Sr. Business Analyst

Responsibilities:

  • Gathered business requirements while documenting to build user stories for a web based/cloud-based content management solution using agile methodologies.
  • Collaborated and Communicated consistently with Business and Development teams and synthesize cross-functional input in a team/collaborative environment.
  • Documented Business Process Flows using Microsoft Visio and validated with Subject Matter Experts (SMEs) for accuracy and completeness.
  • Elicited and documented business requirements by conducting workshops, formal-informal sessions, and design review sessions with Product Manager and Stakeholders to translate business objectives into measurable functional requirements.
  • Performed GAP Analysis to check the compatibility of the existing requirements with the new business requirements and determined traceability and dependability between the requirements.
  • Actively participated in Scrum events/ceremonies like Daily Scrum, Sprint/Iteration Planning, Sprint/Iteration Review, Sprint/Iteration Retrospective and Grooming sessions.
  • Collaborated with Application designers, Application architects, Developers and Quality Analysts to define detailed technical requirements and technical solutions.
  • Extensively used Excel to write Epics/Themes and ensure they have business value and story points for sprint backlog.
  • Created user stories that can be delivered for a team of developers in meeting the small piece of business value that a team can deliver in iteration.
  • Proficiently helped and guided the development teams in organizing requirements by translating large and complex user stories into simplified versions for execution.
  • Answered questions to Clarify requirements along with performing Enhancements during the estimation process.
  • Extensive use of Microsoft Team Foundation Server (TFS) repository that lets distributed teams collaborate and share requirements, understand their relationship to tests, and evaluate linked defect in a single shared repository.
  • Extensively worked with the Development and SQA team to resolve issues on demand basis.
  • Documented the errors to report back to Development (developers) team identified during System testing.
  • Involved in identifying defects, re-creation of defects by testing modules of the product and interacted with SQA team to see that the defect got resolved by retesting the defect and closing the defect.
  • Interacted with business to communicate and obtain sign-off on the fixed defects that are ready to test in both System testing and UAT.
  • Exclusively worked in SharePoint to manage the content generated during the project and utilized to improve daily business.
  • Assisted Project Manager in day-to-day project leadership and decision making on critical project issues as they pertain to project scope, value, schedule, budget, methodology and resources at project, functional and task levels.
  • Participated in Daily Scrum/Stand-up meeting to update the team(s) on status of upcoming user stories.

Environment: Agile (Scrum), Knowledge Content Management System (KCMS), Team Foundation Server 2105 (TFS), MS Visio 2007, MS Office Suite 2013, Windows 7

Confidential, Williston, VT

Sr. Business Analyst

Responsibilities:

  • Worked with IT architects and project managers on an enterprise basis to ensure successful design, development and implementation of new and improved IT programs.
  • Coordinate multi-business platform change projects with analysts from other business departments for analyzing and designing new business solutions.
  • Developed flow diagrams for Business process, UI Wireframes and Mockups using Microsoft Visio along with creating and maintaining data mapping documents.
  • Provided GAP analysis of the discoveries to the stakeholders for approval and discussion along with assisting the Project Manager in budget and resource planning.
  • Elicit business rules and data elements for analysis and interpretation into future state business processes.
  • Extensively worked with functional SME’s on Vermont programs like SNAP also called 3SquaresVT and TANF called Reach Up documenting ‘As-Is’ mapping processes and applying EBC approach for the ‘To-Be’ future state.
  • Track and Manage the Requirements using Requirement Traceability Matrix (RTM) that controls numerous artifacts produced by the teams across the deliverables for a project.
  • Facilitate internal solution discussions and analysis with Enterprise Business Process Owner/SME during workshop sessions to assess current capabilities and define ‘As-Is’ and ‘To-Be’ business processes to define gaps or new product functionality.
  • Identified areas for business improvement by reducing operating costs and improving efficiencies for MABD, CHIP, GA/EA, Crisis Fuel, WIC, EP, LIHEAP, Fuel Assistance, and Phone Assistance state programs along with their respective ‘Appeals’, ‘complaints’, ‘Fair Hearings’ and ‘Grievances’ process in accordance with CMS guidelines to reach their business goals through modeling new business processes and customized solutions to accommodate budget and build in scalability.
  • Worked closely with functional SME’s by scheduling and leading regular Elicitation Meetings/Interviews/Workshops to assess future capabilities and define ‘to-be’ business processes using UML.
  • Provided agendas and captured action items, issues, and key decisions made during workshops and distributed the documented meeting minutes to attendees using a link from project team site in SharePoint.
  • Written and managed BRD's, requirement specifications/use cases, user scenarios, screen flows/ content requirements and Visio flows/activity diagrams in natural language according to standards.
  • Managed all Healthcare and Non-Healthcare related business rules that drive eligibility assessments for AHS programs.
  • Managed cross-project dependencies i.e. co-ordinate and collaborate with various project resources to ensure all system design requirements are incorporated into the project and successfully implemented.
  • Work under direction of BA Manager /Project Manager for assigned projects to provide daily/weekly status reports reflecting work completed during the previous week, and work activities targeted in the following week.

Environment: Waterfall, MS Visio 2013, MS Office Suite 2010/2013/360 , ACCESS Advanced Computer Controlled Essential Services Software, Windows 7

Confidential, Austin, TX

Business Systems Analyst

Responsibilities:

  • Conducted detailed and comprehensive Business Analysis by working with the line of business (LOB) and/or business users to identify the system and proposed enhancements.
  • Gathered requirements by facilitating meetings, arranged JAD sessions, face to face meetings, Tele and Web conferences.
  • Performed analysis on existing systems, recommended enhancements, and implemented strategies to streamline current processes using HP Application Lifecycle Management (ALM) BPM practice.
  • Extensive use of HP Agile Manager (AM) Software during the course of the project for sprint planning, daily meetings and sprint retrospective for defining, managing, and tracking software requirements in collaboration between distributed teams.
  • Heavily used Business process modeling to streamline the existing processes, responsible for creating and updating technical and training documentation for theCalWINapplication.
  • Similar process modeling was done for claim processing as well, removing the pain points & bottlenecks in claim mapping, member identification & uniquely identifying that member, claim adjudication, removing duplicate claims, etc. Through these restructuring, system performance was highly improved.
  • Worked with Subject Matter Experts (SMEs) and the PMO to create and/or update existing documentation, and document management and version control in a collaborative environment within MS SharePoint.
  • Extensive use of HP Requirements Management (RM) shared repository that lets distributed teams collaborate and share requirements, understand their relationship to tests, and evaluate linked defect in a single shared repository.
  • Extensive use of HP Business Process Testing (BPT) software into the process of defining business-driven testing use cases and process flows and using them to increase the accuracy of tests for the testers.
  • Assisted the Project Manager in setting realistic project expectations and in evaluating the impact of changes on the project plans accordingly and conducted project related presentations.
  • Worked closely and performed hand-off sessions with QA testers from SIT/UAT environment and ensuring that appropriate documentation like Test Plan and Test Cases are based on the functional specifications.
  • Involved in testing process like bug reporting, analyzing the test results, tracking the progress of system testing, and provide daily status to Test Manager for defect Meetings.
  • Participated in review sessions on regular basis with QA, development teams and provided regular status updates to the QA Lead on high priority issues.
  • Extensive use of HP Application Lifecycle Management (ALM) that brings together key data on requirements, test execution, and defect management to report defects and track repair throughout the application management process to make it easy for project managers to spot their most pressing problems across the application lifecycle.

Environment: Agile (SCRUM), HP Agile Manager, HP BPT, HP RM, HP Application Lifecycle Management v11 Quality Center Edition, MS Office Suite 2010, Windows Server 2012 R2

Confidential, Columbus, OH

Business Analyst

Responsibilities:

  • Successfully implemented Agile/Scrum methodology for gathering requirements, and facilitate user stories workshop, Story Point discussions including documenting User Stories to analyze the level of effort on project specifications.
  • Facilitate JAD sessions with project SME’s to gather the Business enhancement requests for PE Portal.
  • Written functional design requirements for the Self Citizen Portal that allows qualified entities to access and log in to the PE portal.
  • Written functional design requirements for the Benefit Management System to include PE programs, Add PE Rules, Add PE Forms, and New PE Batch Job.
  • Worked with project teams to ensure that the Security Console will be responsible for ensuring the functionality is compatible to meet PE requirements.
  • Worked with SME’s to document PE requirements for Children, Hospitals and Pregnant Women in the Accenture Self Service Portal (ACSSP).
  • Worked with SME’s to document automated enhancement to ABMS processes for the QE to process a PE application in the Accenture Benefit Management System (ABMS) in case of fall out.
  • Extensively worked with project teams to document and compare the project requirements Vs. CMS mandates and adhere to ACA guidelines.
  • Collaborated with Project teams to work in creating the Business Process for new PE Portal.
  • Created screen mock-ups for the new enhanced PE design for Self Citizen and ABMS portals.
  • Extensively used SnagIt windows screen capture and Axure interactive wireframe software and mockup tools to create new screen mock-ups for Self-Citizen Portal and ABMS portals.
  • Worked to capture changing screen details and subsequent requirements for the corresponding screen mock-ups.
  • Worked closely with the project teams to see if the desired Functionality of the new PE portal is achieved.
  • Worked with the Rational Requisite Pro tool to upload the business requirements and trace with future testing scenarios.
  • Assisted in testing efforts by using IBM Rational Quality Manager for the script execution and IBM ClearQuest for logging defects based on the standards for product test.
  • Assisted project management in identifying the scope, dependencies, risks and milestones for the new enhanced application.

Environment: Agile (SCRUM), Rational Requisite Pro 7.1.2, Rational Jazz Team Server (RQM) 2.0.1.1, Rational Clear Quest 7.1.2.0, SnagIt 11.2.1, Axure RP Pro 5.6, MS Visio 10, MS Office Suite 2010, Windows 7 Enterprise

Confidential, Sacramento, CA

Business Analyst

Responsibilities:

  • Written functional design requirements for the Exchange Home Page that allows users to easily access and log in to the Employer, Individual/Employee, Admin, Carrier and Navigator/Broker portals.
  • Written functional design requirements for the Individual/Employee Portal that enables individuals seeking coverage to determine eligibility for various programs and enroll in coverage.
  • Written functional design requirements for the Individual Account Maintenance page that allows users to view and manage their account information, submit payments, send inquiries and complaints, and terminate coverage.
  • Written functional design requirements for the Admin Portal that enables users to carry out necessary administrative tasks associated with AHBX processes and requirements.
  • Written functional design requirements for the Carrier Portal that enable users to manage their accounts and related processes in the AHBX.
  • Written functional requirements for the Navigator/Assister Portal that enables users to manage their accounts and related processes in the AHBX.
  • Written functional requirements for the Broker/Agent Portal that enables users to manage their accounts and related processes in the AHBX.
  • Written Billing Engine requirements specific to AHBX product that is provided through portlet/Citrix enabled Open-cIS, the Accenture Billing Engine asset.
  • Worked closely with CalHEERS ( Confidential, Eligibility and Retention System) to create product and project specific Federal Data Services Hub (DSH) functional documents provided by CMS.
  • Worked with Third Party Plug In (currently GetInsured.com) for Enrollment and Shop and Compare features.
  • Created Business Processes to include in FRD for Employer Initial Eligibility Application, Verify Data on Employer Eligibility Application, Determine Employer Eligibility, Collect/Update Employee Roster, Complete Employer Enrollment, Update Employer Information, Appeal SHOP Eligibility Decision, Renew Employer Participation and Terminate Employer Participation.
  • Written use cases for Eligible new employer, Ineligible new employer, Appeal submission, Annual renewal, Employer Maintenance for the product.
  • Created Interface functional design documents for Plan selection and get the premium and contribution rates as AHBX (Accenture Health Benefit Exchange) interfaces with GI (Get Insured) system.
  • Created Interface functional design documents for managing the Billing and Financial Management services as AHBX (Accenture Health Benefit Exchange) interfaces with ABE (Open-cIs) system.
  • Involved in UI enhancement and made Wireframes and Screen Mockups/Definitions and Dependencies using Excel.
  • Worked closely with CalHEERS Functional Leads during the system design activities.
  • Requirements Elicitation - Identifying opportunities to implement SharePoint functionality based on business challenges rather than technical requirements.
  • Responsible for meeting with internal departmental clients in order to gather information and requirements for SharePoint projects and present them with recommended and proposed solutions.
  • Utilized SharePoint and SharePoint Designer to create and manage team site, templates and workflows.
  • Created robust and reusable workflows with Visio 2010 using extensible workflow opportunities in SharePoint Designer 2010 and ensuring that SharePoint acts as a ‘hub’ for all related business activities.
  • Responsible for organizing the Quality Analyst (QA) walkthrough to explain proposed changes along with coordinating and performing Quality Review Feedback.
  • Worked closely with Application developers to make sure system developed is in sync with business requirements.
  • Extensively worked with Rational Requisite Pro tool including uploading the business requirements.
  • Maintained Error log for all the defects identified and worked continuously with the developers to resolve the same.
  • Provided assistance to Release Manager in the identification, scoping, estimation, scheduling, monitoring and delivery of various application deliverables.

Environment: Agile (SCRUM), Get Insured, Microsoft .Net, MS SharePoint Designer 2010, Rational Requisite Pro 7.1.2, HP Quality Center 10, MS Office Suite 2010, Windows 7 Enterprise

Confidential, Des Moines, IA

EDI Analyst

Responsibilities:

  • Worked extensively in Agile scrum development methodology by dividing the application into iterations to create BUR (Business user Requirements) and business Process flows using MS Visio.
  • Facilitate the initial Kick-Off sessions with SME’s, and team managers for gathering the action items needed to come up with the business requirements.
  • Defined Business Requirements for Medicaid functionality to meet state specific needs and also develop Business use cases to support the same.
  • Worked elaborately to define new Business Process Flows, to cater them to existing Medicaid functionality for both EDI and different modules within the QC (Quantum Choice) tool.
  • Conducted various Business/Stakeholder User Reviews to check for any missing functionality throughout the analysis and elaboration phases of the requirements gathering sessions.
  • Improved the Business Requirements as and when needed to match the Worker Portal functionality.
  • Well versed with HIPAA X12 EDI guides and written requirements for APHP’s Portal and EDI Gateway to send and/or receive the 834 transactions and its configurability within QDS. The BRD documents contained all the X12 Transaction Loops and Segments Table which defines elements that are only required as per state Medicaid rules to be accepted into QDS and/or those that must be available for processing within QC for all the 834, 835, 837 I/P/D, (270/271) and (276/277) inbound and outbound transactions.
  • EDI 275: Defined requirements for APHP’s Portal and EDI Gateway use of the 275 transactions and its configurability within QDS, and Accenture’s intended use with the 837 and 278 transactions. The BRD document also contains the X12 275 Transaction Loops and Segments Table which defines elements that are only required as per state Medicaid rules to be accepted into QDS and/or those that must be available for processing within QC.
  • Identified Specific loop/segment information for X12 transactions which may be optional information on standard transaction set but needed for Medicaid implementation.
  • Performed stakeholder interviews, researched policy and procedure documentation and technical systems specifications to determine where and how ICD-9 codes are currently used within the MMIS and other applications.
  • Involved in providing education about the ICD-10 codes and 5010 standards, its requirements, complexity and accuracy to the management and performed impact analysis on applications for deadliness of ICD-10 conversion.
  • Used GAP analysis framework to identify ‘As-Is’ processes of claims transactions of HIPAA X 12 4010/4010 A standard and ‘To-Be’ processes (ICD-10-CM and ICD-10-PCS compliance requirements) of 5010 standards.
  • Performed extensive research on functional areas (Authorization and Referral, Capitation and Premium Billing) where specific enhancements are needed for Medicaid implementation and wrote business requirements as Gaps were identified to build this functionality in Plexis base products since they can be applicable for commercial health care.
  • Written detailed FRD for Prior Authorizations/Referrals functionality to support the following high-level and additional specifications like validation criteria and frequency support.
  • Written detailed FRD for Capitation functionality to support the high-level and additional specifications like Provider PMPM and MCO payments, capitation rate adjustments and history tracking, additional rate assignment criteria on a HealthCare account involving Managed Care sub-system.
  • Written FRD for Premiums functionality to support the high-level and additional specifications like Premium payment criteria and override rules, including Medicare Buy-in premiums.

Environment: Agile (SCRUM), Quantum Choice 11.3, MS Visio 10, MS Office Suite 2010, Windows 7 Enterprise

Confidential, Phoenix, AZ

Business Analyst

Responsibilities:

  • Involved in daily scrum/standup meetings to produce artifacts- product backlog, sprint backlog along with documenting the meeting minutes and send them out to the participants for confirmation.
  • Facilitate JAD sessions with Product management, SME’s, and Customer operations to gather business enhancement requests.
  • Prepared and conducted Requirements and Design Review sessions with product managers and business users.
  • Gather and document existing end-to-end business process maps and business context diagram using System Architect to streamline activities and maintain business efficiency resulting in increased productivity.
  • Used System Architect to document data flow of the ‘As-Is’ process and ‘To-Be’ process (GAP).
  • Created functional design document and assisted SharePoint Administrator with upgrade and transition to SharePoint 2010 from SharePoint 2007.
  • Worked extensively with Information Technology (IT) personal to understand the system and gather Technical information needed for the documents.
  • Worked extensively with Confidential t Studies Team and Customer Operations Team to analyze, gather and document the business process enhancements required as per business rules.
  • Created Requirement Traceability Matrix (RTM) to validate and track the client requirements, test cases and the defects.
  • Worked with Product management to confirm the scope of the document on process enhancements/ modification requests.
  • Extensively worked with data architects and technical leads to gather Non- Functional requirements (ex: database schemas) and confirm data dictionary during design as agreed earlier during initial phases of the project.
  • Wrote Business use cases in Excel once the business requirements are signed-off for validation.
  • Participated in Test Plan meetings for providing the breakdown of activities from testing perspective and assist Test Lead in documenting the Test Plan.
  • Analysed Business Requirements from Black Box testing perspective; reviewed Test Strategy, Traceability Matrices and Test Plan to ensure that test cases reflect user needs for functional, performance, usability and security requirements.
  • Worked extensively with Test manager in confirming the various testing activities that needs to be handled from business perspective like preparing Business use cases, track Test Cases etc.
  • Served effectively as main point of contact for development team for clarifications of requirements and conducted integration testing as needed.
  • Assisted developers in bug tracking, Issue tracking and project tracking as they are traced to business requirements by using JIRA defect tracking tool.
  • Worked closely with Testers to Create, Triage and Resolve bugs and make sure test results are in sync with business requirements.
  • Conducted UAT sessions with stakeholders and business users and got system approvals (sign-off) during go-live.
  • Trained users with regards to what SharePoint workflows are and how to best implement them.
  • Provided end user support for SharePoint helpdesk tickets.

Environment: Agile (SCRUM), IBM Rational System Architect 11.1, JIRA 4.3, Confluence Knowledge Management, Microsoft .Net, MOSS 2007/2010, MS Office Suite 2010, Windows 7 Enterprise

Confidential, Tampa, FL

Business/Data Analyst

Responsibilities:

  • Incorporated Scrum framework to create Software Requirement Specifications (SRS) and Business Process Modeling Language (BPML) to create business Process Workflows.
  • Facilitated JAD sessions with management, SME’s, and stakeholders for open, pending and critical issues.
  • Gathered existing End-to-End business workflows, reviewed and prioritized requirements in Requirement review sessions along with clarifying business requirements that occur internally within the team.
  • Performed GAP Analysis to identify the missing business requirements for Enrollment, Billing and Claims modules along with writing Business use cases for new/improved functionality.
  • Participated in business meetings/interviews with Business user groups to analyze and redesign Claims, Group & Member Enrollment process Enhancements and modification requests issues.
  • Actively analyzed current business processes (Claims, Recipient eligibility and Enrollment etc.) and worked with management to improve and implement enterprise solutions to ensure compliance.
  • Analyzed and implemented opportunities for improvement to the core processing that affects claims payment performance and increase provider satisfaction.
  • Configured Enrollment Data for ID card and Validated the incoming/outgoing data from EDI (834), (837I), (835), (270/271), (276/277) interfaces to administer HIPAA privacy rights for Claims EDI files.
  • Correspond with staff to analyze current ICD-9 usage i.e. Elicited information from key staff to determine where and how ICD-9 conversion will need to be performed for written documentation, processes, procedures and IT systems.
  • Created high level MS Visio process flow diagrams to clearly display where ICD-9 conversion would take place.
  • Worked with Clinical Systems customer support to test the proper transmission of messages.
  • Wrote Use Case Specifications according to the business requirements using Rational Requisite Pro.
  • Responsible for maintaining Requirement Traceability Matrix (RTM) to make sure test plan is written for all the requirements.
  • Executed SQL Queries using various DDL and DML statements in Query analyzer to do database test.
  • Identified Use Cases from the gathered requirements and prepared a comprehensive use case specifications document for HIPAA 834, 835, 837I, 270/271 and 276/277 transactions and responsible for maintaining all requirements in HP Quality Center as they are traced to Business use cases.
  • Participated and contributed in Daily Scrum, Sprint Planning, Sprint Review and Sprint Retrospective meetings.
  • Responsible for coordinating and performing functional and data-related testing.
  • Provided a thorough knowledge transfer of the project to the QA team prior to their test plan and test case preparation.
  • Communicated between the development and testing teams to ensure each requirement has adequate test coverage along with evaluating and updating existing test cases and create new tests to achieve comprehensive test coverage.
  • Used HP Quality Center to analyze the defect reports and work closely with Application developers for resolution.
  • Assisted the team lead with daily QA tasks like maintain and track all defects are logged and resolved in HP Quality Center.
  • Participated in various meetings like defect Review, defect resolution, release and QA status meetings.
  • Developed Test Summary Reports and participated in GO / NO-GO meeting.
  • Participated in daily status meetings to provide status updates briefing the progress of execution.
  • Functioned as a mentor for junior developers and provided assistance when needed.

Environment: Agile(SCRUM), Rational Requisite Pro, HP Quality Center 9.2, Clarity, QlikView, MS Visio 10, MS Office Suite 2010, Windows 7 Enterprise

Confidential, Baltimore, MD

Business Systems Analyst

Responsibilities:

  • Worked with Provider SME’s to gather detail business requirements from requirements gathering sessions that is essential for the system or application to meet the business objective. Requirements once agreed upon are tracked throughout the life cycle of the project.
  • Performed Feasibility Analysis, GAP Analysis and formulate system strategies to determine the exact changes that need to be made to the adjustment system.
  • Analysis of member benefits including regulatory requirements to develop and implement Member Benefit and Provider Reimbursement solutions within the core processing, clinical edit and prospective payment systems.
  • Served as a liaison between the internal and external business community (Claims, Billing, Membership, Capitation, Customer service, membership management, provider management, advanced Healthcare management, provider agreement management) and the project team.
  • Extensive use of UML for designing Activity diagrams and Data flow diagrams using MS Visio.
  • Provider Networks - Worked for a project involving addition of providers in the CPF (Provider) file that is sent to clients.
  • Provider Contracts - Gathered requirements for the Providers and Contracts Team and participated in enhancements of their individual Provider and Contract Mgmt Systems.
  • Made sure HIPAA guidelines are being adhered and worked on EDI X12 transactions sets 834 Enrollments, 270/271 Eligibility Inquiry/Response, 276/277 Claim Status Inquiry/Response to allow for change in the claim number.
  • Created Data Mapping document to migrate the data from existing system to the New System (Enhanced).
  • Wrote and presented Functional Requirement Documents (FRD) for the technology team for every complex pharmacy Medicare Med D, commercial or a group claim that needed a change in the Adjustment system.
  • Analyzed Medicare and Pharmacy claims to ensure that process and procedures are followed in accordance to scope of the health plan and work with development teams to ensure that proposed design meets business specifications and enterprise quality standards.
  • Worked on different types of letters from Enrollment and Claims Modules like Membership letters, Authorization letters, Billing letters, Contract generation letters, EOB (final letter) etc.
  • Executed SQL queries to access data from a central SQL database system to match the claims processing data coming in from various pharmacies.
  • Acted as a resource in identifying and analyzing how the upgraded system carries out the business functions (questionable functions, inconsistencies in application functions, outputs, online screens, and content) for both development and QA teams and assisted in ensuring the timely and effective implementation.
  • Reviewed and corrected Test Cases stored in Excel and PVCS tracker.
  • Prepared defect summary reports and provided daily status to Test Manager on defect reports and test coverage for further action.
  • Responsible for maintaining the defects in HP Quality Center and follow up with developers for open defects along with closing defects as they are fixed.

Environment: RUP, UML 2.0, Facets, Oracle 9i, TOAD 9.5, HP Quality Center 9.2, MicroStrategy 8.0, MS Visio 2007, MS Office Suite 2007, PVCS 6.8, Windows Server 2008/Windows Server 2008 R2

Confidential, Louisville, KY

Business Systems Analyst

Responsibilities:

  • Responsible for documenting Model processes, Information flows and Data stores using BPMN.
  • Implemented Rational Unified Process (RUP) in terms of disciplines and phases, each consisting of one or more iterations. Analyzed, documented, and managed all project Requirements and changes to requirements throughout the software development Lifecycle (SDLC).
  • Conducted JAD sessions with the management, end-users and stakeholders for open and pending issues to develop and document detailed requirements for benefit enrollment and COB.
  • Developed all three Software Requirement Specification (SRS) documents (The requirements for this project are subdivided into three separate Software Requirement Specification (SRS) documents, one for each release of the project).
  • Extensively interacted with both user group and development team to develop Activity diagrams using Microsoft Visio.
  • Identified use cases from the gathered requirements and prepared a comprehensive Use Case Specifications document for inbound and outbound HIPAA transactions.
  • Managed and developed EDI specifications, GAP analysis, and applications structures for data feeds and mappings for integration between various systems, including XML, to follow ICD-9 Code set, ANSI X12 4010 formats including (270/271, 276/277, 834, 835, and 837) to meet and exceed HIPAA requirements set forth by the federal government.
  • Performed analysis of the Benefit Coding conversion processes, to in corporate effective dating of member benefits into the COTS claims processing system on a Sybase DBMS and loading this data to the Data Warehouse on an oracle DBMS.
  • Identified and documented Data Sources and Transformation Rules required for populating and maintaining data warehouse content.
  • Participated and conducted testing by developing simple to complex SQL queries along with writing Data Mapping Documents, Data Transformation Rules and maintaining Data Dictionary.
  • Analyzed various resource files being used to generate the report and documented data mapping and data source interface documents to assist the development team.
  • Managed all content in the e-Room EMC Documentum (Content Management System) and kept it running smoothly by managing its settings and membership and controlling access to the items it contains.
  • Maintained various versions of the documents generated during the project in Share Point.
  • Assisted testing team during creation of Test Plan along with writing test scenarios and test cases.
  • Logged high level defects in Clear Quest and conducted status checkpoint meetings with the development teams.
  • Co-ordinate with business users in system testing and UAT to validate the functionality and obtain sign-off.

Environment: RUP, UML 2.0/1, Rational Requisite Pro, Rational Clear Quest 7.0, EMC Documentum e Room, Community Manager, Mainframe, Oracle 9i, ReportNet 1.1, MS Visio 2007, MS Office Suite 2007, Mercury Quality Center 8.5, Windows Vista

Confidential, Indianapolis, IN

Business Systems Analyst

Responsibilities:

  • Used guidelines and artifacts of Rational Unified Process (RUP) to strategize the Implementation of RUP effort in different iterations and phases of the SDLC.
  • Worked with Project manager to identify best approach for gathering requirements and estimated project size using Use Case Points (UCP) analysis.
  • Worked as an Interface between the end users and different teams involved in the application development for better understanding of the business and IT Processes.
  • Gathered requirements and documented the proposed processes to the existing system. Modules included: Claims Processing Files, Mismatch Flows (Current and Proposed) and HIPAA Guidelines adherence across the company.
  • Enhanced applications associated with Claim Numbers so that duplicate Claim Numbers could not be allowed in the system. Updated the Electronic Claims, Confidential t Screen and Sales Administration processes.
  • Responsible for claim adjudication likeMedicare claims, Professional and Institutional claims.
  • Claim Transactions and Billing Transactions - Created flows for adequate matching of Claims, Matched Billing File and EDI Claim File records upon receipt.
  • Duplicate Claim Number Project - Enhanced three different applications - EDI Feeds, IFX and Confidential t Screen App to not allow duplicate claim numbers to exist in the database.
  • Identified all necessary Business use cases from requirements and followed the UML based methods to create Use Case Diagrams, Sequence Diagrams using Microsoft Visio.
  • Created Test File to be sent to the Drug Card Vendors for approval.
  • Created complex and sophisticated reports that had drilldown, slice and dice features using Cognos Report Net.
  • Correlated current business process to scope the future business process in developing test scenarios for application testers.
  • Worked extensively in developing UAT Test Plan, test scenarios and test cases.
  • Worked extensively in Mercury Test director to track defects and assign to concerned developers.
  • Effectively communicated UAT test results between users and development team and provided recommendations for change control requests (CCR).
  • Assisted user training sessions with developing training documentation like end user SOP documents.

Environment: RUP, UML 2.0, NASCO Blue Exchange, Oracle 9i, Requisite Pro, MS Visio, Visual Source Safe, Mercury Test Director 6.0, MS Office Suite 2007, Cognos Impromptu 6.0, Windows Server 2003/ Windows Server 2003 R2

Confidential

Technical Writer/Communicator

Responsibilities:

  • Gathered business needs from the End Users/Customers/Business and documented High-level requirements in the business needs document.
  • Analyzed business needs, existing systems logic difficulties and revised/developed new functionality as needed.
  • Written Technical papers, gathered Technical requirements and compiled them to help in system design.
  • Created Data Flow Diagrams, ER diagrams, Activity diagrams, Sequence diagrams and Use Case diagrams for database modeling, Web-page mock-ups, and development team using MS Visio for acceptance from analysts, surveyors and customers during initial analysis and construction phase activity.
  • Documented the user requirements into Functional Requirements Document (FRD) and Non-Functional Requirements Document (NFRD) for the development team to better understand the application requirements, manage changes to those specifications and validate technical designs created by IT developers against functional specifications.
  • Played a substantial role in the business and functional requirements gathering, in an effort to develop a practical technology solution for automating sales methodology.
  • Study and analysis of the mapping document indicating the source tables, columns, data types, transformations required, business rules to be applied, target tables, columns and data types.
  • Extracted data using SQL from multiple sources which include relational sources and flat files for data sourcing and data integrity.
  • Performed use case analysis using UML, which provided the framework for potential use case deliverables along with documentation and development of use cases.
  • Acted as a resource in understanding how the upgraded system carries out the business functions between the development and QA teams in ensuring timely and effective implementation.
  • Worked with the QA team and reviewed Test Plan and test scripts for proper implementation.
  • Participated in various meetings and discussed Enhancement and Modification Request issues including creating new enhancements through Change Control.
  • Developed and maintained the Issue/Defect matrix and provided the status reports to the project team members during the defect resolution meetings.
  • Helped in creating the business glossary for efficient understanding of the business processes amongst the other teams.
  • Created documentation (SOPs) that facilitated training Help Desk/CSR staff in using the system effectively.

Environment: Waterfall, UML 1.5, MS Visio, Rational Enterprise Suite, MS Office Suite 2003, Mercury Test Director, Windows XP/Server 2003

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