SUMMARY:

• 6+ years of industry experience as a Business Analyst with solid understanding of Business Requirements Gathering, Business Process Mapping Evaluating Data Sources, Translating Requirements into functional Specifications and Application Design in Healthcare and Insurance domains.
• Proficient in analyzing and documenting business requirements, assessing current business systems, providing process improvement ideas, liaising with the technology & business team to drive the end - to-end solution implementation
• Working knowledge of implementing software development projects using methodologies such as Waterfall, Rational Unified Process (RUP) and Agile/Scrum.
• Strong Knowledge on claim processing and HIPAA X 12 EDI transactions i.e. Claims inquiry and Response (276/277), Receipt and Verification of claim forms(837), Claim Payment and advice(835), Eligibility inquiry and Response(270/271)
• Knowledge on(Medicaid and Medicare insurance plans) and experienced in determining the membership eligibility, billing experience within life and disability in health plans with thorough understanding of CPT coding, CMS-1500 claim forms and reimbursement forms.
• Excellent Business document writing skills for developing Requirements Document & User Stories.
• Experience in creating Use case diagrams, swimlane diagram, activity diagram and process flow diagram
• In-depth knowledge & experience in gathering, reviewing, analyzing, validating, & mapping business systems, processes & user requirements, documenting them by following organization standards & guidelines.
• Interviewed SMEs and Stakeholders to get a better understanding of client business processes and gather business requirements.
• Experience in facilitating Joint Application Development (JAD) sessions with Business User Groups, IT and cross functional teams
• Work closely with Business teams to visualize & implement future needs.
• Work closely with Functional teams to ensure all requirements are collected, documented & fulfilled.
• Worked with scrum master on Sprint Planning, Sprint Review, Sprint Retrospective & daily stand up meetings in AGILE environment.
• Responsible to Track, Document, Capture, Manage and Communicate the Requirements using Requirement Traceability Matrix (RTM) which helped in controlling numerous artifacts produced by the teams across the deliverable for a project
• Good experience in conducting User Acceptance Testing (UAT) and documentation of Test Cases. Expertise in designing and developing Test Cases and Test Scripts.
• Highly motivated team player with excellent Interpersonal and Customer Relational Skills, Proven Communication, Organizational, Analytical, Presentation Skills

TECHNICAL SKILLS:

Methodologies: Waterfall, Agile/Scrum, RUP,

Utility tools: MS Office Suite, MS project, MS Outlook, Toad,Fidler

Operating systems: Windows, Linux, Mainframe, AS400

Databases: DB2, SQL server, MS Access

Project management/modeling tools: TFS, JIRA, MS Visio, Req Pro,Irise, Erwin

Testing Tools: HP quality center, QTP, clear quest,SOAP UI,

PROFESSIONAL EXPERIENCE:

Confidential

Business system Analyst/Agile scrum

Responsibilities:

• Facilitated requirement gathering sessions with Stakeholders and project team to capture high level scope of the project and establish scope baseline.
• Conducted & lead JAD sessions with business users to capture, negotiate the business needs and elicit requirements.
• Conducted Gap analysis to understand key business process and increase operational efficiency
• Created Product backlog to captures user stories (WBS) and list down the acceptance criteria using Team foundation server (TFS) based on priority.
• Created corresponding tasks in TFS to carry out development and QA activities during sprint.
• Created AS IS and TO BE mock ups and process flow diagrams for various projects as mandatory project deliverable
• Worked with the business SMEs to identify protected health information (PHI) attributes provided by data provider and defined business rules to encrypt identified PHI elements as per HIPAA act.
• Used SQL to query the database and performed data analysis.
• Created Claims Medical, Hospital and Rx claims in AS400 system to set up the test scenario for QA team and business users for UAT testing.
• Analyzed the transactions 837 (Claim for Institutional, Professional and Dental Claims), 835 (Claim Payment), 834 (Enrollment), 270/271 (Member eligibility).
• Worked on EDI Health Care Claim Payment/Advice Transaction Set (835).
• Worked on analyzing and retrieving member’s premium data information from AS400 to create XML file needed to generate new billing statement for the group policies.
• Worked with business SME and IT to redesign the existing billing statement for All Savers policy holders to meet the end users expectations.
• Worked on analyzing and retrieving member ‘eligibility data to create XML files and generate 1095 B/C to comply with IRS letter regulations.
• Worked on enhancement of existing process of retrieving member’s premium/policy information from group roaster.
• Developed and managed the formal Agile Methodology which includes Requirements Management, Agile Manifesto, and Lean Development.
• Conducted user story grooming sessions with Product owners, IT-SME and QA lead to refine the user stories and ensure that backlog remains populated with user stories that are relevant, well define and estimated to a degree appropriate with their priority and in keeping with current understanding of the product and its objective.
• Facilitated kick off sessions with scrum team to give a walkthrough on use stories and acceptance criteria to ensure that team is clear on what needs to be done from the business user perspective and everyone has the information they need to accomplish the tasks during sprint.
• Participated in scrum ceremonies such as Daily stand up, Sprint planning, Sprint review and retrospective meetings.
• Facilitated Daily scrum meeting, conducted sprint retrospective, sprint planning and sprint review meeting and followed up on action items for continuous improvement
• Worked closely with product owners, coordinating product backlog and story estimation
• Participated with the QA team in different phases of testing such as System testing, Functional testing, Regression testing and Integration testing for Quality Analysis.
• Prepared UAT Test cases based on the user defined acceptance criteria.
• Prepared and tracked burn down charts and velocity charts for timely delivery of projects.

Confidential, SLC-Utah

Business system analyst/UAT tester

Responsibilities:

• Performed GAP Analysis to analyze the current system and worked with internal users to help define system requirements.
• Analyzed and prioritized user and business requirements as system requirements that must be included while developing the software.
• Served as a liaison between the business team and the technical team by identifying, understanding, and documenting their needs
• Worked closely with product owners to write user stories and define the acceptance criteria.
• Facilitated and participated in Bi-weekly estimation meeting to provide high level estimate (story points) on user stories committed for forthcoming sprint.
• Facilitated Backlog grooming, sprint planning and retrospective meetings.
• Created relationships in Requirement Traceability Matrix linking User stories to Functional requirements and Functional Requirements to Systems Requirements.
• Communicated project progress to the stake holders and product owners through burn down charts.
• Performed requirements gathering from the business users of the system while adhering to SDLC (Software Development Life Cycle) industry best practices.
• Developed UI screens using Irise prototype tool and presented to the business users.
• Collaborated in building a business analysis process model using MS Visio and Rational requisite Pro.
• Provided clear and concise documentation regarding requirements management plans, Functional Requirements, supplemental Requirements and Test Cases.
• Involved in creation and execution of manual test cases in HP quality center and automated Test Cases in QTP and analyzed the Test Results.
• Tested the application manually by executing Test Cases in Quality Center prior to Automation and Involved in automated testing
• Performed functional testing with the development team as well as User Acceptance Testing and Regression Testing of the application using Quality center and Jira for prioritizing defects and assigned it to the developer to fix the bugs.

Environment: MS Office Suite, MS Visio, Agile, Oracle, SQL, Quality Center, Requisite Pro, Java Script, Project Management, QTP, Jira, irise

Confidential, Phoenix-AZ

Business system a nalyst/QA Tester

• Interviewed SMEs and Stakeholders to get a better understanding of client business processes and gather business requirements
• Created use case scenarios and documented work flow and business process using MS Visio.
• Gathered and documented business requirements for existing and future business systems.
• Analyzed and tested various Common Eligibility Outbound Interface Process and other Inbound/ Outbound Facets interfaces.
• Acted as a liaison between business staff and technical staff to articulate needs, issues and concerns.
• Analyzed current MMIS and EDI claims and documented the requirements to implement new MMIS automated system.
• Defined Functional Test Cases documented and executed manually using quality center.
• Analyzed trading partner specifications and created EDI mapping guidelines.
• Responsible for Data Manipulation and Data Validation using SQL queries in a MS SQL Server.
• Helped with building ICD 9 to ICD 10 crosswalk map by grouping thousands of codes and ranges in Clinical, Benefits, Financial, Medical policy waves.
• Working within a growing environment of X 12 4010/5010 HIPAA Transaction Processing 837 I, 835, 834, 8270, 271, 276, 277, 278, EDI, Privacy, Security, and Medicaid.
• Reviewed EDI companion guides for all payers to ensure compliance, edit integrity and maintain up-to-date list of payer contacts.
• Written test cases, test scenarios, and prepared test data to conduct the manual testing of EDI files and the mainframe screens.
• Involved in creation and execution of manual test cases in HP quality center and automated Test Cases in QTP and analyzed the Test Results.
• Tested the application manually by executing Test Cases in Quality Centre prior to Automation and Involved in automated testing
• Performed functional testing with the development team as well as User Acceptance Testing and Regression Testing of the application using Quality center and Jira for prioritizing defects and assigned it to the developer to fix the bugs

Environment: MS Office Suite, MS Visio, Agile, Quality Center, Jira, Rational clear quest.

Confidential

Business Analyst/Data Analyst

• Interviewed Business Users to gather Requirements and analyzed the feasibility of their needs by coordinating with the project manager and technical lead.
• Write user stories and maintain product backlog to commit and development the functionalities during sprint period.
• Worked on a Data Conversion project that involved converting claims in the Legacy Claims Systems into Guide wire Claim Center and Contact Center.
• Performed Business Process Mapping and performed AS IS and TO BE analysis
• Collected business requirements to set rules for proper data transfer from Data Source to Data Target in Data Mapping
• Involved in creating a sample policy in target system and then retrieved the target XML using XML Notepad and then retrieved the target xpaths for fields assigned for mapping.
• Created sample policy in source system and retrieved source XML and retrieved the source x paths. Once we retrieved the source and target xpaths. We logged these in to mapping specification tool and also write transform rules where ever it required.
• Provide back end testing for data validation using SQL Queries.
• Created an Intranet based application to be used by the field agents of the company to enter the data of customers. Prior to this application development, field agents were using a mainframe based application.
• Created relationships in Requirement Traceability Matrix linking Business Requirements to Functional requirements and Functional Requirements to Systems Requirements
• Analyzed the business and functional requirements of the application and developed detailed test cases in Quality Center.
• Conducted Functional Walkthrough, User Acceptance Testing (UAT), and Tested the final application for Usability testing to verify whether all the User Requirements were catered to by the application.
• Involved in Entire Defect life cycle by prioritizing defects and assigned it to the developer to fix the bugs and tested again to verify the Defects and endured the end product is Bugs free using Rational clear quest.

Environment: MS Office Suite, MS Visio, waterfall, MS access, SQL Server Quality Center, Requisite Pro, QTP, Rational clear quest., Toad data analysis

Confidential, Baltimore, MD

Business /System Analyst

• Interviewed Business Users to gather Requirements and analyzed the feasibility of their needs by coordinating with the project manager and technical lead.
• Prepared Business Requirement Documents (BRD’s) after the collection of Functional Requirements from System Users who provided appropriate scope of work for technical team to develop prototype and overall system.
• Collaborated in building a business analysis process flow using Rational Rose and MS Visio.
• Analyzed and prioritized user and business requirements as system requirements that must be included while developing the software.
• Develop Logical and Physical data models that capture current state/future state data elements and data flows using Erwin
• Led and conducted JAD sessions for requirements gathering, analysis and design of the system.
• Use Cases and other Process Flow Models were designed using MS Visio and Rational Rose.
• Created relationships in Requirement Traceability Matrix through linking Business Requirements to Functional requirements and Functional Requirements to Systems Requirements.
• Responsible for scheduling meetings with users, SMEs and stakeholders to identify problems, resolve issues and improve the process to ensure a stable and accurate solution
• 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.
• Created the test scripts and manual test cases in Quality Center and linked the test requirements to the test plan and individual test sets.
• Assisted in Entire Defect life cycle by prioritizing defects and assigned it to the developer to fix the bugs and tested again to verify the Defects and endured the end product is Bugs free using Jira bug tracking tool.

Environment: MS Office Suite, MS Visio, waterfall, DB2, Quality Center, Requisite Pro, Rational clear quest, Erwin.

Confidential

Business Analyst

Responsibilities:

• Created Business Requirement Document (BRD), Functional Requirement Specification (FRS) document, User Requirement Specification (URS) and Change Request (CR) document for system application development.
• Analyzed and prioritized user and business requirements as system requirements that must be included while developing the software
• Responsible for scheduling meetings with users, SMEs and stakeholders to identify problems.
• I was also part of company's people Management project The core of the project is the data management system of the company. Everyone having permission can easily see-update the Microsoft document in their own office application or on web browser.
• Served as a liaison between the business team and the technical team by identifying, understanding, and documenting their needs
• Created relationships in Requirement Traceability Matrix linking Business Requirements to Functional requirements and Functional Requirements to Systems Requirements.
• Interacted with users for verifying User Requirements, managing Change Control Process, updating existing Documentation
• Worked with SQL queries using MS Access for data manipulations.
• Involved in DATA validation using SQL queries and back-end testing.
• Documented requirements associated change requests with requirements and connected requirements with Use cases.
• Involved in reviewing test plans and test cases and ensuring test cases reflect user needs. Also responsible user acceptance testing to ensure and verify system is designed according to user needs.
• Tested the application manually by executing Test Cases in Quality Center.
• Assisted in Entire Defect life cycle by prioritizing defects and assigned it to the developer to fix the bugs and tested again to verify the Defects and endured the end product is Bugs free using Rational clear quest

Environment: MS Office Suite, MS Visio, Agile, MS access, SQL, Quality Center, Requisite Pro, Java Script, Rational clear quest.