- 8+ years of professional experience as a Sr. Business System/Quality Assurance/Data Analyst.
- Adequate business knowledge in Health Care (Medicaid & Insurance), Banking & Retail sector.
- Extensive knowledge in Medicaid – specifically in Claims processing, Recipient (eligibility & enrollment), Provider and Prior Authorization sub systems, Banking- Student loan Web Applications, Retail – online shopping web applications.
- Experience in Medicaid – HIPAA EDI 837I, 837P, 837D, 270/271, 277CA, 834 835 transactions with Medicaid Management Information Systems (MMIS).
- Extensive experience in analyzing and requirements gathering and writing system functional specifications including use cases.
- Excellent in developing and evaluating business process models (BPM).
- Proven success as a business analyst through the years, providing a well-balanced understanding of business relationships, requirements, and technical solutions.
- Strong experience in RUP Business Modeling process.
- Expertise in UML (class diagrams, object diagrams, GAP Analysis, use case diagrams, state, sequence, activity diagram, and collaboration diagrams) as a business analysis methodology for application functionality designs using IBM’s Rational Rose.
- Strong experience in conducting User Acceptance Testing (UAT) and documentation of Test Cases. Expertise in designing and developing Test Plans and Test Scripts.
- Excellent in developing and evaluating business process Models.
- Expertise in Software Development Life Cycle (SDLC) include following the RUP/Waterfall/Agile methodologies in defining the business process and acting as a bridge between the Management and the Development teams.
- Design and review of various documents including the Software Requirement Specifications (SRS), Business requirements document (BRD), Use Case Specifications, Functional Specifications (FSD), Systems Design Specification (SDS), Requirement Traceability Matrix (RTM) and testing documents.
- Familiar with ICD 9 to ICD 10 conversion process.
- Familiar with Surveillance and Utilization Review Subsystem (SURS) and Management &Administrative Reporting System (MARS).
- Experienced in Data modeling structures, Data Integration, Source to Target Mapping, Extraction Transformation and Loading (ETL).
- Experience in Data Modeling using Dimensional Data Modeling techniques such as Star Schema, Snowflake Schema.
- Proven success as a business analyst through the years, providing a well-balanced understanding of business relationships, business requirements, and technical solutions.
- Excellent Analytical, methodical, and resourceful approach to problem solving, identifying and documenting root causes and corrective actions to meet short and long term business and system requirements.
- Effective in executing multiple tasks and assignments ahead of schedule. Created and maintained effective budgets.
- Advised management on improvement strategies, Competitive & Profitability Analysis.
Technical / Software Skills:
Operating Systems: UNIX/Linux, Ubuntu, Windows 7, and Mainframes Z/OS.
Databases: Oracle 9i/8i/7.x, DB2 v9.2, Sybase, SQL Server, Informix, and MS Access.
Data Warehouse ETL: Informatica PowerCenter 9.0.1 8.6.1/8.1.1.
Software Quality Assurance: Unit, System, Integration, Migration, Security, Smoke, Ad-hoc, Functional, Regression, UAT, Manual.
QA: Knowledge of Quality Center/Test Director, IBM Rational tools.
BA / BSA Methodology and Tools: SDLC, Waterfall, Agile Methodology, UML
JAD Sessions, Interviewing, Questionnaires, Quality Assurance, Data Flow Diagramming Audit, Compliance and Controls Analysis, Data Mining.
Industry Standards: HIPAA, SOX, CFR 21 Part 11, CFR 21 Part 820, ISO, Six Sigma, CMMI, Rational Unified Process (RUP) Waterfall Capability
Other tools: EDI, Share Point, Clarity v12.0.0, IBM Lotus notes, BI designer, Erwin, MS Visio.
Confidential, Lincoln, NE
IT Senior Business System Analyst
Project I – State-wide Expansion of Managed Care Project - Confidential physical health managed care program will add a new Managed Care Organization (MCO). This project also includes expanding physical health managed care to the remaining 83 counties in Nebraska, transfers the responsibility of PCP assignment from MMIS to the MCOs, adds PAs and NPs as valid PCP types and begins to include new Medicaid populations as mandatory for managed care.
Project II – 837 Encounter Project – Effective January 1, 2014, Confidential begin receiving encounters in industry standard ASC X12 format. It includes electronic 837I and 837P transactions from Confidential Managed Care Organizations (MCOs).
Project III – 837 Dental Encounter Project – Effective July 1, 2015 Confidential will begin receiving dental encounters in industry standard ASC X12 837D format from Confidential Managed Care Organizations (MCOs).
- Under general direction, gather, define and document highly complex business requirements.
- Facilitate meeting discussions between business users, business analysts and technical analysts.
- Document organizational policies and procedures in the context of system requirements.
- Work with technical staff and business users to problem-solve and identify workable solutions.
- Develop work flows that demonstrate current and proposed business requirements.
- Prioritize the individual work load that involves multiple project assignments and deadlines.
- Create and execute test cases, test scripts, data sets and user procedures.
- Ensure testing results correspond to the business user’s expectations.
- Work with management team, technical staff and key users to identify, track and manage project issues
- Provide business user support, including training, help and instructions.
Environment: Mainframes Z/OS, DB2 v 9.2, IBM Lotus Notes, Clarity v12.0.0, Share Point 2010, .Net, Microsoft Office, Visio and Access
Confidential, Nashville, TN
Sr. Business System/Quality Analyst
The application developed leverages Department of social services of Tennessee to manage the different functional areas of Medicaid Management. This also included the development of new products or software for the Medicare Part- D including claims entries, claim processing, AVRS (Automated voice recording system), and e-billing via Internet etc.
- Performed Gap Analysis to check the compatibility of the existing system infrastructure with the new business requirements.
- Participated in JAD sessions to ensure appropriate scope management for MMIS.
- Followed solely RUP methodologies during the course of the project.
- Accumulated system requirements from various departments through surveys and interviews.
- Responsible for special projects, external audits, evaluations and process improvements in support of governance initiatives while working on MMIS application.
- Worked on Medicaid Recipient processing including specialized knowledge of Recipient processing, Portals, and Enrollment Subsystems of MMIS.
- Involved in prioritizing the defects and writing business requirements to resolve them.
- Conducted JAD sessions with management, SME, vendors, users and other stakeholders for open and pending issues.
- Planned and defined system requirements to Wire Frames with Use Case, Use Case Scenario and Use Case Narrative using the UML (Unified Modeling Language) methodologies.
- Created Use Cases and other Process Flow Models were designed for MMIS using Visio and Rational Rose.
- Followed the UML based methods using Rational Software Modeler/MS Visio to create: Use Cases, Activity Diagrams / State Chart Diagrams, Sequence Diagrams, and Collaboration Diagrams.
- Created and managed project templates, use case project templates, requirement types and traceability relationships in Requisite Pro.
- Developed Systems Specifications document to define the impact of the new requirements on the existing system.
- Involved in performance measurement of ongoing data collection to determine if a program is implementing activities and achieving objectives.
- Performed functional, integration, regression, system, and acceptance testing.
- Designed the test cases using Quality Center.
- Involved in reviewing test plans and test cases and ensuring test cases reflect user needs. Also responsible for conducting user training and user acceptance testing to ensure and verify system is designed according to user needs.
- Conducted review sessions on regular basis with QA and development teams for preparing status, delivery report and client reporting for MMIS testing.
- Suggested measures and recommendations to improve the current application performance.
Environment: SQL Server 2000, Windows, Oracle, Clarity, UML, MS Office, MS Visio, Quality center.
Confidential, Madison, MS
Business Analyst Senior
Pulse (Platform for Unified Loan Support in Education)
Pulse Application provides a single platform for Confidential, Confidential for Private Education Loans. It provides functionality necessary to generate and support operational efficiencies and application effectiveness required to meet the private credit volume growth.
- Created business process flows, use cases, information modeling, data mapping and gathered business requirements
- Conducted JAD Sessions as a Facilitator to gather requirements from the group
- Created a project intake proposal and plan
- Created a change management plan for the project
- Interacted and coordinated with end users & management to identify business system needs
- Worked closely with vendors to figure out the best methodology for different work streams of the project
- Performed Gap Analysis for new functionality requirements, as well as prioritized them based on actual business needs so as to align them with the product release roadmap
- Developed test plans, test cases and test scripts based on the functional specifications
- Maintained Test Matrix, Traceability matrix, prepared and maintained the requirements traceability matrix (RTM)
- Created BRD for all the different work streams in the project
- Used Test Director for error reporting and communicating between developers, product support and test team members
- Conducted functional walkthroughs and get sign offs
- Has knowledge of Enterprise Analysis, Requirements Planning & Management, Requirement elicitation, Requirements communication, Requirements Analysis & documentation and solution Assessment & validation
- Performed User Acceptance Testing (UAT) sessions, and supervised the development of User Manuals for customers
Environment: Test Director, Oracle 9i, SQL Server, .NET, HTML, MS Office Suite, Kofax Asscent Capture , Infragistics Test Advantage
Confidential, Dallas, TX
Confidential The project is involved in enhancing the web application of the Confidential shopping portal. The enhancements are adding new buttons, drop downs, banners, changing the online shopping functionality, look & feel and shopping cart.
- Created work flow diagrams for the online shopping functionality
- Created Business & System requirements for the enhancements
- Conducted business JAD sessions with clients
- Created test plan, test cases and use cases for the business users
- Conducted UAT sessions with business users
- Worked closely with developers, senior management, Business users, clients in order to finalize the requirements
Environment: .NET, JAVA, HTML, MS Office Suite, Test Director, SQL server