SUMMARY

• Senior Business Analyst with 9+ years of industry wide experience in the various domain like Healthcare, Insurance and Mortgage with solid understanding of Business Requirement elicitation techniques, BusinessRequirements Gathering, Business Process Flow and Business Process Modeling.
• Comprehensive knowledge of software development methodologies such as Waterfall, RAD, RUP and AGILE SCRUM.
• Adept at preparing Business requirements documents (BRDs), Functional requirements documents(FRDs), defining project plans and delivering project reports
• Expertise in Project Planning, Project Design, creating functional specifications and data flow diagrams.
• Lead and worked with teams to examine and solvebusinessproblems by accurately analyzing the needs of clients and helping them achieve improved quality and value for their customers, strong leadership and mentoring skills, and highly proficient organizational and computer skills
• In depth knowledge of RUP's Iterative Software Development Life Cycle (SDLC) process, Agile Software Development and Waterfall models
• Experience in developing Test Plans, Test Scenarios and Test Cases based on functional requirements.
• Experience with health care systems: QNXT, 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.
• In - depth knowledge of Healthcare organization operations including outsourced operations, Health Insurance, HIPAA, and Medicaid/MMIS, including MITA.
• Mentored other team members on the development & support of HL7 interfaces for clinical applications.
• Knowledge of HL7 and/or X12 standards, segments and fields required
• Strong background of analysis of HL7 and / or X12 workflow documentation
• Significant Epic EMR work experience, tasked with building, implementing and supporting the Epic application from both the end user (clinical) and technical perspectives.
• Solid Epic experience that includes participation in all phases of EMR implementation; project planning, workflow analysis, design, build, validate (DBV), “go-Live” training delivery, on-site support, and post go-live optimization.
• Extensively worked with different X12 Hierarchical Levels (HL structures) in various inbound claim/inquiry-response transactions (837 P/I/D, 270/271, 276/277).
• Involved in testing HIPAA Database, which incorporates all the HIPAA (Health Insurance Portability and Accountability Act) transaction sets
• Worked on development and implementation of policies, procedures and QA methodologies
• Gathered requirements to check HIPPA- eligible & participation check for individual coverage.
• Technical and business knowledge in multiple disciplines/processes.
• Strong understanding of HIPAA Transactions & Code Sets Standards like (820- Premium Payment for enrolled health plan members, 834- Enrolment /Disenrollment to a health plan, 835, 837 ...etc.)
• Strong understanding ofMortgagebanking, Credit Approval System, MBS, SOX and Basel accords and Investment banking (Stock exchange, Fixed income, Stocks/bonds, equities, options/futures, trading operations, mutual funds etc.)
• Experienced in working with SMEs from variousbusinessareas related to Loan origination, loan Processing, underwriting, closing, post closing, Loan Monitoring/servicing
• Knowledge of Mortgage Loan Origination, Servicing, Closing, Loss Mitigation, Loan Modification, Appraisal, Credit, Income and Title functionalities.
• Skilled at performing GAP analysis, Financial Analysis, User Acceptance Testing (UAT), SWOT analysis, Cost benefit analysis and ROI analysis.
• Plan, Design and implement application database code objects, such as tables, stored procedures, user defined functions, triggers, SQL, packages, cursor & schedulers etc. in windows environment.
• SQL query optimization and tuning by choosing proper access plan.
• Build SQL scripts, indexes and complex queries for analysis, extraction & creation of data on client server.
• Experience in executing Test Cases to test the application functionality against the requirements manually.
• Excellent skills inBusinessAnalysis, OO Analysis, Data Analysis, Requirement Analysis, BusinessModeling and Use Case Development using UML methodology, Project Management Methodologies include RUP, SDLC, and Waterfall
• Excellent communication and presentation skills. Experience working withbusinessuser as well as senior management

TECHNICAL SKILLS

Methodologies: Agile, Waterfall

Requirement management tools: QC, Rally Dev, Jira

Project management tools: MS Project, Sharepoint, Visio

Business Modeling: MS Visio

Defect tracking: Rallydev, Jira

Web technologies/languages: SQL, HTML, Java, XML

Front-End tools: Microsoft Excel, Word, Power Point

Database: MS SQL Server, Oracle, Access

Applications: Facets, QNXT

PROFESSIONAL EXPERIENCE

Confidential, Carrollton, TX

Business Analyst / Project Coordinator

Responsibilities:

• Responsible for system integration testing of 837 claim files, 834 eligibility files and 270/271 interface files to ensure required interactions are met during the SDLC process.
• Experience with care operational workflows, clinical data and standards.
• Worked on EDI transactions: 270, 271, 834, 835, and 837 (P.I.D) to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrolment hence analyzing and documenting related business processes.
• Performed gap analysis of claims and enrolment business process for changes from SSN identifier to USI (Unique Subscriber Identifier) affecting for HIPAA EDI X12 transactions 837, 834, 276/277, 270/271, 278, 835 and 820.
• Created specifications for EDI HL7 (A28, A31, ADT) and X12 (837/835) transactions that were transmitted between Claims Editor and Legacy Billing application and external Payers.
• Worked with data migration and file mapping for various EDI transactions. Enhanced the Provider/ Confidential t verification criteria using additional parameters based on the information retrieved from the EDI 837 I/P transaction files.
• Translated the EDI X12 data into XML format for initial transformation/migration.
• Facilitated functional requirement gathering from system users and prepared business requirement documents (BRD).
• Created Business Process Mapping Diagrams and Documentation for the process improvement recommendations.
• Used MS-Visio for flow-charting, Use- Case process model and architectural design of the application.
• Implemented the Rational Unified Process (RUP) methodology guidelines with its various workflows and artifacts in Requirements Management and Development.
• Gathered and documented functional requirements and use cases for automation of operational and administrative business processes.
• Provided overall project management to multiple projects successfully completing them on-schedule and on-budget.
• Documented the "AS-IS" Business Workflows adhering to UML standards. Conducted JAD sessions to define requirements and finalize the Functional Requirement Document (FRD).
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, OOD (Object oriented Design) using UML and Visio.
• Interfaced with team leaders, identify and analyze the given information, procedures and decision flows, evaluated existing procedures, methods and technical documentation. Communicated with executives, managers and other stakeholders regarding project scope.
• Responsible for business process analysis that includes requirements facilitation, definition & analysis, alternatives, software selection, prototyping, business process design and mapping.
• Maintained a Traceability Matrix to ensure that all functional requirements are addressed at the use case level as well as the test case level.
• Involved in identifying use cases, actors and writing use case narratives. Created use case diagrams and activity diagrams using MS Visio.
• Conducted meetings and JAD sessions for project definition, resource identifications and deliverable prototype identification.
• Interfaced with developers, analysts, customers and project managers to discuss requirements and recommended solutions, to help resolve issues.
• Led the User Acceptance Testing efforts to verify that the developed reports meet the requirements.
• Involved in developing the test strategy and helped in developing QA Test plans for Functional, Integration and System Testing.

Environment: Quality Center, Excel, Outlook, MS Office, MS Project, SQL, Rational Rose, Rational Requisite Pro, RUP, UML.

Confidential, El Paso, TX

SME / Business Analyst

Responsibilities:

• Submit and gain approval of EDI encounter transactions with State of Texas
• Worked on QNXT including Claim processing (online and batch adjudication), Case management, Customer service, Member/subscriber administration, Provider network management and reporting.
• Worked on claims, Claim adjudication Membership, Eligibility, Accumulators.
• Responsible for system integration testing of 837 claim files, 834 eligibility files and 270/271 interface files to ensure required interactions are met during the SDLC process.
• Gathering Requirements from business, created BTRDs, BRDs, TDD and supported technical and testing team. Prepared Business Process Analysis/End User Education/Business Requirements Documentation.
• Validated System configuration, including enrollment, provider and benefits modules
• Creation of queries and reports to assist Health Plan Operations with the analysis of data relating to claims, members and providers.
• Execution of daily, weekly and monthly reports and processes and the creation of ad-hoc reports.
• Broad knowledge of CCHP departmental processes, procedures and data.

Environment: QNXT, RUP, Rational Rose, Requisite Pro, MS Visio, RUP, MS Project, SQL, Oracle, MS Access, MS Excel and MS Word.

Confidential, Franklin Lakes, NJ

Business Analyst

Responsibilities:

• Attended Reliability meetings to escalate any high risk issues to the senior management for immediate attention.
• Key participant on a team responsible for migrating jobs (over 10k) running on a Legacy Platform to a New Platform. The New platform provided more visibility job monitoring and issue resolution.
• Led the initiative on migrating legacy job submission tool to web based which was responsible for processing 100+ data loads for client delivery. Responsible for providing all the requirements and testing and served as the operations lead for testing and certifying all the migrated jobs.
• Worked with analytics and development teams in integrating a third-party processing and presentation tool into our production environment. As a result, the sales team was able to sign up 50+ clients to use this presentation tool. Recipient of the best product documentation award
• Created SOP's wherever necessary to ensure proper training is given to the Customer Service Representatives.
• Worked on closing the production tickets using Remedy.
• Proficient in dealing with Medicare and Medicaid requirements to meet the CMS standards.
• Created Business requirements and discussed the impact with the cross-functional teams using JAD sessions.
• Maintained traceability to ensure all the Business Requirements are transformed into the Functional Requirements.
• Held Peer reviews within the team so everyone is aware of the changes and avoid any duplicate work effort and thus minimize cost over-runs due to rework and scope creep.
• Reviewed Technical Specification Documents (TSD) and made sure all the functional requirements are traced back to the construction level and provided sign-offs.
• Coordinated with the Data Support Team to provide data both to Dev and QA teams.
• Reviewed the Integration Results (Unit Test) and provide sign-off before the code can be moved from Integration to QA Environment.
• Reviewed Quality Test Cases (QTC's) and Quality Test Outputs (QTO's) with the QA team and provided sign-offs
• Tracked the defects using Clear Quest and held daily meetings to ensure their closure and to avoid jeopardizing the timelines.

Environment: SQL, MS Word, Excel, Access, Clear Quest, Requisite Pro, GEM, MS Visio, JIRA, SharePoint.

Confidential, Carrollton TX

Business Analyst

Responsibilities:

• Worked and acted as a liaison betweenbusinessusers, all internal IT staff, program managers and clients to elicit and documentbusiness, functional and non-functional requirements using agile methodology.
• Worked on multiple projects at a time and successfully handling the deployment dates.
• Interacted with Pharmaceutical and Healthcare clients and working on enhancement of the healthcare projects.
• Involved in HIPAA/EDI Medical Claims Analysis, Design, Implementation and Documentation.
• Involved in preparing the Test Scenarios for Health Care Claim Payment/Advice.
• Developing specifications, diagrams and flowcharts to assist the process.
• Assisting with the documentation and reporting of defects, errors and issues.
• Assisting and providing support during User Acceptance Test and Deployment phase.
• Helped in controlling and coordinating release scope, coordinating change requests and change tracking.
• Helped in developing and maintaining team processes, procedures, and templates to continuously improve release quality and deployment schedule.
• Wrote test plans and test cases for the projects.
• Acted as a Project manager whenever the project demanded.

Environment: Windows, MS Office (MS Word, MS Excel, MS PowerPoint, MS Visio), MS Access, Agile, SQL and SharePoint.

Confidential, Portland, OR

Business Analyst

Responsibilities:

• Conducted weekly meetings for deciding the Policies and Procedures to be followed while constructing new sites.
• Conducted complex documentation and user needs analysis. Interface with team and staff to develop HL7 integration.
• Assisted JAD sessions to identify the business flows and determine whether any current or proposed systems are impacted by the EDI X12 Transaction, Code set and Identifier aspects of HIPAA.
• Developed the strategy for developing and implementing new EDI (HL7 and X12) interfaces and converting historical clinical and data.
• Used Team Foundation Server (TFS) and MTM for defect tracking and maintaining test cases.
• Reviewed EDI companion guides for all payers to ensure compliance, edit integrity and maintain up-to-date list of payer contacts.
• Performed testing for Medicare, Medicaid and X-Over claims for Medicaid Management Information System (MMIS).
• Developed and implemented the MMIS Third Party Liability (TPL) Subsystem.
• Conducted business-impact assessment and the results were compared with the new HIPAA 5010 standards to determine the current level of compliance and developed an action plan for approval by the project steering committee.
• Developed plan for data feeds and data mappings for integration between various systems, including XML, to follow ICD 10 Code set and ANSI X12 5010 formats.
• Involved in gap analysis and implementation of HIPAA 5010, ICD 10 and Claim Validations.
• Conducted Gap Analysis, and Gathered User Requirements by Interviews, user meeting, JAD session, and Requirement Elicitation Sessions.
• Worked on CRM (Customer Relationship Management) project to implement Microsoft Dynamics.
• Worked with the Marketing Management/team members to understanding their needs and requirements in regards to picking the right CRM system.
• Part of the project management team responsible for SWOT analysis.
• Used Scrum Work Pro and Microsoft Office software to perform required job functions and prepare Product back log and sprint back log and conduct all the meetings and discuss and help scrum master.
• Involved in mapping data from SWIFT securities reporting messages.
• Responsible for cost estimation and timelines for various Business Intelligence reports.
• Involved in analyzing activities for a variety of major projects including Medicare Plan part D, Coordination of Benefits, New Client Implementations, Consumer driven and regularly scheduled system upgrades.
• Used UML and OO discovery methods to perform discovery for new enterprise wide installation of Trizetto FACETS (both core and extension requirements) using Rational Rose.
• Implemented a mechanism to in corporate business-required data which is not in the core Facets system. NFE (Non-Facets Elements) proved to be of major business importance in implementing state-customizations and underwriting, needs not encompassed by the Facets system.
• Extensively interacted with the stakeholders and the IT Department in finalizing the requirements according to the CMS Compliances/Regulations and HIPAA Regulations.
• Assisted to develop the Test Cases and Test Scenarios to be used in testing based on Business Requirements, technical specifications and/or product knowledge.
• Prepared graphical depictions of User stories, Use Case Diagrams, State Diagrams, Activity Diagrams, Sequence Diagrams, Component Based Diagrams, and Collateral Diagrams and creation of technical design (UI screen) using Microsoft Visio.

Environment: SQL, HP Quality Center, Agile, ALM, Windows XP, MS Excel, MS word, VM ware.

Confidential, Owing Mills, MD

Business System Analyst/QA Analyst

Responsibilities:

• Responsible for the development and implementation of HIPAA EDI Data Mapping artifacts 270, 271, 274, 276, 277, 820, 834, 835, 837.
• Performed User Acceptance Testing for the ANSI X12 Version 5010 / EDI transactions (HIPAA) for Claims Status and Eligibility (270, 271, 276, 277, 834, 837P, 837I, 837D, 835 remittances and NCPDP Claims).
• Developed HL7 messaging for bi-directional case and disease report exchange, in HTML and XML formats, in accordance with HL7 specifications.
• 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.
• Worked as a liaison between the business client and development team for the implementation 5010 transition in compliance with HIPAA standards.
• Involved in analyzing and understanding Business Epics.
• Clarifying requirements which are not clear with Business Analyst.
• Collecting test data for requirements to perform testing.
• Analyze requirements to ensure testability, report gaps and discrepancies.
• Creating and executing test cases for GUI, Sanity, Smoke, Functional and Regression testing.
• Performed Peer review for testing related documents Test cases, Test Plan and Release summary document
• Executing test cases and log defects in JIRA.
• Retest the scenarios post defect fix.
• Adding scenarios, test data and screen shots used for testing to Test Ready User Stories in JIRA.
• Prepared and present weekly status reports to management
• Played active role during daily scrum meeting and task planning as part of agile methodology
• Interacted with offshore team to share & provide required information on planned work items for the sprint.
• Internal review of user stories with management for scenarios/test data/screen shots prior demo.
• Participated in Sprint Demo sessions with business.
• Involved in giving KT to the new member of the team.
• Performed Integration testing of ACMP application.
• Well versed with Microsoft SharePoint to manage project related documents.
• Involved in writing complex queries in SQL Server.
• Involved in Functional Design review meetings.
• Participated in daily offshore & onsite meetings on daily task assignments.
• Involved in Sprint retrospective meetings scheduled at the end of each sprint.
• Coordinated with team members to share work items based on the priority and completed in timely manner
• Maintained good relationship with in the team and was active team member
• Involved in UAT & SIT Concerns meetings.
• Involved in Planning & Product Backlog Grooming User Stories with Business Analyst and Team members.
• Participated in Defect Triage call to discuss open defects and Defect clarifications.
• Maintained Defect/Issues/Observations Tracking sheet.

Environment: SQL, HP Quality Center, Agile, ALM, Windows XP, MS Excel, MS word, VM ware.

Confidential, Oklahoma, OK

Jr. Business Analyst

Responsibilities:

• Obtained a detailed knowledge of business process involved in the project environment.
• Gathered requirements from Business Partners.
• Established Business Analysis methodology using Agile Extreme Programming to create Architecture and Interaction models.
• Interacted with numerous internal groups and formed productive and positive working relationships with staff with varying technical and business backgrounds and skill levels across the organization.
• Used business process modeling techniques for reengineering.
• Conducted Gap Analysis to show the current and proposed functionalities of the system.
• Generated reports using business objects.
• Extensively involved in JAD sessions to converge early towards a design acceptable to the customer and feasible for the developers.
• Involved in the back office operations using data from Bloomberg.
• Generated advanced reports related company's performance that would help the business users in managing their portfolio.
• Helped the business users in portfolio management by giving additional information such as; beta value, target price and performance charts for the last five years.
• Created artefacts and defined milestones and iterations plan for inception and elaboration phases.
• Assisted in testing the application whether all the user requirements were catered to by the application.
• Reviewed loan applications and analyzed data required to process loan documents and performed validation to ensure loan documents are transmitted to appropriate departments.
• Created Test Plans and Test Cases for GUI and database testing by analyzing the Business requirements specification document.
• Involved in preparing a simple and detailed User manual for the application for intended users.
• Expertise knowledge of pricing and selling of stocks, bonds, securities, investment assets.
• Developed database triggers, procedures and functions to monitor the business functionality and needs.

Environment: Windows, SQL, Microsoft Office tools, Business Objects, Rational Requisite Pro, Rational Clear Case, UML, Office 365,Compliance Calibrator, Open pages, Informatica Power Centre, DOORS

Confidential, Roanoke, VA

Claim Analyst

Responsibilities:

• Identified processes for developing and documenting detailed business requirements. Data was collected from end-users, and analysts.
• Created Use-Cases and Requirements documents to document business needs.
• Requirements were gathered through interactions and meetings and periodic walkthroughs with loan analysts, credit analysts and other potential users of the application.
• Conducted Use-Case reviews and identified gaps, leading to improvements/enhancements in the same.
• Created and maintained the Requirements Traceability Matrix (RTM).
• Worked on Guidewire, extensively worked on Guidewire Policy center & Guidewire Claim Center
• Used GuideWire software to track the claims of the policyholders.
• Guidewire was specifically used by the team to implement the enhancement to expedite the claim process for unregistered users
• Used Guidewire to upgrade the current Claim system to track the claim of the policyholders and third party applications
• Involved with the testing team to check the augmentations done previously using Guidewire.
• Ensured Use-Cases were consistent and covered all aspects of the Requirements document.
• Maintained documents and the effect of proposed changes on the project schedule and costs.
• Used Rational Clear Quest for bug reporting.
• Documented the Use Cases and Activity diagram worked on COTS Integration and Application Architecture design. Created and maintained workflow plans and business process flows using MS Visio 2013.
• Worked directly with software engineers to ensure clear communications on requirements and defect reports.
• Designed and developed scenarios based on business requirements.
• Developed requirements integrating E-R diagrams and designed the testing process flows.
• Followed the RUP methodology for the entire SDLC.
• Used the guidelines and artifacts of the Rational Unified Process (RUP) to strategize the implementation of Rational Unified Process effort in different iterations and phases (Inception, Elaboration, Construction and Transition) of the Software Development Life Cycle.
• Interacting with other teams through walkthroughs, teleconferences, meetings, etc. to resolve various issues.
• Validated the scripts to make sure they have been executed correctly and meets the scenario description.

Environment: Windows2000, Rational Rose, Guidewire, Rational Unified Process, Rational Clear Quest, Oracle, and Microsoft Project 2000.