SUMMARY:

Sr. Business System Analyst Consultant with 8+ years of diverse experience in Business Modeling, Document Processing, EDI, Mapping, HIPAA regulatory changes and Application Integration, ANSI 4010 / 5010 and ICD 9/10 Code Set System in IT Healthcare domain. I am experienced in gathering Business & Functional Requirements, conducting JAD Sessions, identifying &executing Gap Analysis, producing UML Diagrams & defining Process Flows, Business Documentation for Claims Processing & Claims Adjudication for Medicare and Medicaid and Health Care Reforms. I also worked with different Development &Testing Teams as necessary to produce required deliverables that meet contract quality standards especially for ICD - 10 CM & PCS Code Systems. I am a self-starter with motivation and capable to work independently.

• Specialized in Healthcare, Risk and Compliance Document Management.
• Experienced in GAP analysis of HIPAA 4010 to 5010 with particular attention to qualifier, length and required field and situational rules.
• Verified and documented HIPAA regulator changes found when moving from 4010 to 5010.
• Transaction Mapping Full 4010 - 5010 conversion knowledge for 820, 834, 835, 837 PDI, 276, 277, 270 & 271 transactions.
• Experienced working on web portal projects, creating proto types, wireframes, UI designs etc.
• Excellent knowledge of data warehouse.
• Systematized Claims Processing and Claims Scrubbing in HMO, PPO, Medicaid and Medicare and gathered requirements in Enterprise Healthcare Management (ECHS).
• Revitalized requirement elicitation techniques - conducting user interviews and JAD sessions and managed the requirements using Rational Requisite Pro and Use Case Modeling with all phases of SDLC.
• Executed Business Analysis methodologies and iterative Software Development Life Cycle (SDLC) especially in relation with all the phases of Rational Unified Process (RUP) and Agile Processes.
• Produced and utilized Use Cases, Functional Specifications, User Interface Specifications and Requirements Traceability Matrix to define the changes in client’s systems necessitated by ICD-10 PCS & CM Code Sets.
• ICD-10-CM and ICD-10-PCS Codes and ICD Code Set Mapping.
• Conducted Impact Analysis, Risk Analysis and Risk Mitigation.
• Designed Graphical User Interface using Adobe Photoshop, SQL Queries using MS Access and Oracle.
• On hand experience in implementing changes in HIPAA 4010 to 5010 conversions on SOA (Service Oriented Architecture).
• Synthesized 4010 and 5010 HIPAA implementation guides relate to Claim Testing and Medical Billing.
• Software testing: Writing Test Plans / Test Scripts / Test Cases.
• On hand experience with core PM/BA tools including Microsoft Project 2010 Professional and Outlook, Word, Excel, Visio, Access.
• Substantiated Object Oriented Analysis and Design Representation Techniques in UML using Rational Rose, Dataflow Process Modeling, Analysis & Design with Interaction and Class diagrams.
• Scheduled meetings and reinforced business analysis with developers, system analyst and testers to collaborate rescore allocation and project completion using MS Project.

TECHNICAL SKILLS:

Methodologies: RUP, UML, CMM, SIX SIGMA

Testing Tools: Rational Enterprise Suite, Test Director, Quality Center

Change Management Tools: Rational Clear Quest, Test Director.

Business Modeling Tools: Maestro, Rational Rose, Microsoft Visio.

Version Control Systems: Rational Clear Case.

Project Management: Microsoft Project, Microsoft Office.

Programming Languages: SQL, PL\SQL, Visual Basic, Java, JavaScript, HTML, dBase, Cobol, Fortran, HP Unix and OS390

Web Technologies: Microsoft FrontPage.

PROFESSIONAL EXPERIENCE:

Confidential, Addison, TX

Sr. Integration Clinical Analyst

Responsibilities:

• Identified the business functions and processes, and prepared system scope and objectives based on user needs and industry regulations.
• Defined terms, conducted stakeholder analysis, elicited business needs, conducted business process modeling, and facilitated JAD sessions for various applications.
• Elicited, documented requirements and use cases. Analyzed, validated & prioritized requirements; traced requirements to related project documentation (process models, designs, test scenarios & scripts).
• Worked on High Level Requirements with SME’s, Developers and Stakeholders for different applications.
• Documented the Requirements and circulated them to Business & Technical teams for Signoffs.
• Acted as a client liaison to review priorities and manage the overall client queue.
• Worked on consolidating integration spreadsheet for various applications with developers and SME’s.
• Participated in weekly status meetings to present status and incorporate any digressions from the original scope.
• Captured and documented current “AS IS Process” with respect to applications, Customer Service, Provider department and identified potential changes for the “To Be Process”.
• Worked in GAP analysis to understand the difference between both the billing systems and documented the GAPs in GAP analysis spreadsheet.
• Engaged with clients to understand business processes and determine their specific requirements.

Environment: MS Project, MS Office, MS Visio, ClearQuest, Quality Center, UML, JIRA SQL, SDLC, Agile, Scrum, HTML, Lotus.

Confidential, Alpharetta, GA

Sr. Business Analyst

Responsibilities:

• Interviewed business users, SMEs, Trading Partner asking detailed questions to gather business requirements, wants, and needs concerning the project and carefully recorded the requirements in a format that can be understood by both business and technical teams.
• Created business workflows on the claims module for the client to get a better understanding of the software and prepared a detailed BRD including all functional and non-functional requirements
• Use Rational Tools like Rational ReqPro for requirement management, Rational Clear Quest for defects, Rational Test Manager for Test Cases and Rational Rose for Use Cases to track, analyze and document system requirements and defects.
• Gathered and validated inventory of applications, interfaces, and reports that will need to be modified to comply with ICD-10 requirements
• Performing GAP analysis of business rules, business and system process flows, user administration and requirements to document the current as-is processes and the future to-be processes.
• Conducted working sessions to gather and document high level business requirements and detailed level business requirements for different business units impacted by ICD 10 such as EDI Claims Intake, Medical Management- Utilization Management, Case management and Provider Reimbursement- Provider Payment.
• Conducting JAD sessions with business stakeholders to reach a decision on changing strategies regarding the way business will be conducted on the new platform
• Wrote Use Cases, prepared use case diagrams (using Rational Rose) and followed Rational Unified Process at every stage of the process.
• Worked closely on 834 transaction code for Benefit Enrollment and was involved in Validation of HIPAA for 837, 270/271, 276/277,835, 834 EDI transactions
• Designed and developed Business Rules Document about the Claim Component and HIPPA
• Work with QA Team to develop test strategies and test scenarios. Also help clarify specific requirements to System Tester/s to help develop test cases.
• Prepared and maintained requirements traceability matrix (RTM) throughout the project lifecycle
• Conduct unit testing and system testing to ensure the product meets all the requirements specified for the end user.
• Developing test strategies, test scenarios and test cases.
• Used UML for Specifications, Documentation and Construction of systems
• Executing and reviewing test runs.
• Responsible to provide day to day status of projects and communicate the project schedules, open issues, and project risk/mitigation plans to all the impacted teams.
• Had good exposure on scripting on Visual Studio (automation testion tool)

Environment: MS Project, MS Access, MS Excel, MS Word, Jira, MS Power Point, Rational Requisite Pro, Clear Case, Clear Quest, RUP

Confidential, Nashville, TN

Sr. Business Analyst/Quality Analyst

Responsibilities:

• Gather Business Requirements from the Business users, Subject Matter Experts (SMEs) and document the requirements in the BRD.
• Utilized data flow diagrams, use case diagrams and process flow diagrams to represent information provided by the Business Owners.
• HIPAA 4010 - 5010 Conversion Analysis - Involved in the documentation of HIPAA 5010 changes to EDI 837, 834, 835, 276, 277 Transactions.
• Conducted JAD sessions to help decide the best solution for the Clients and maintained the Meeting Agendas and Minutes.
• Did gap analysis for HIPAA 4010 837P and 835 transactions and HIPAA 5010 837P and 835 transactions.
• Creating Mapping documents for translating 837(I/P) to internal XML format and vice versa.
• Completed Data Mapping for Group and detail Product analysis and report writing.
• Developed Data Mapping and Crosswalk documents.
• Did data analysis, created data mapping and data interface documents and kept the documents updated with changes in requirements and functional specifications.
• Prepared Test Data for the UAT as per the specifications of the FRD.
• Written multiple Use Cases for multiple transactions include 837I, 837P, 835, 276, 277, 270, 271(both inbound and outbound) transactions.
• Maintained Requirement Traceability Matrix (RTM).
• Developed Use Case and UML modeling using modeling tools like Rational Rose/MS Visio.
• Identified and fixed edit and mapping issues in the cross paths (4010-5010/5010-4010 ).
• Interaction with the payers and submitters for 5010 UAT certification.
• Analyzed payer/submitter specific 4010 claim editing to migrate it to 5010 claim editing system Identify and document transition issues from 4010 to 5010 format.
• Analyzed EDI ANSI X12 file mapping and reported in analysis spreadsheet. Performed validation of 837 (P, I, D) & 835 format files according to the EDIFECS engine. Management of Patient Profile Transfer (PPT) reports created by data team by verifying the associated data
• Helped testers to create Test scenarios and test cases for testing the migration of EDI 4010 to 5010 and the processing of member enrollment and benefits, batch jobs corresponding to the claims (837) and real time transactions like 270/271/276/277 .

Environment: Sybase, Agile, DB2, .NET, MS Office Tools, MS Visio, IBM Process Modeler, Jira, Windows XP, Mercury Quality Center.

Confidential, Salem, OR

Sr. Business System Analyst

Responsibilities:

• Gathered requirements from stakeholders for provider management and member management.
• Identified and validated business rules and data elements.
• Developed the stakeholder list and created stakeholder assessment matrix to prioritize them. Also worked as a BSA to maintain the relationship between businesspeople and the Programmers
• Developed and maintained a requirements work plan and assessed the performance metrics of the team members.
• Modeled the ‘as-is’ process flow and the ‘to-be’ process flow and analyzed the gap and developed the action steps to fill the gaps.
• Conducted Risk analysis and developed mitigation plans.
• Conducted Impact analysis when there is any change in the requirements and updated the Business Requirements Document (BRD) and Systems Requirements Specification (SRS).
• Propose strategies to implement HIPAA 5010 in the new MMIS system.
• Developed the User Interface (UI) prototypes to capture and validate requirements and spike solutions to the current problem.
• Designing Functional Specifications for the target physical database.
• Facilitated JAD sessions for Requirement Validation with Dept. of Health & Human Services (DHHS) to gather requirements for the new MMIS.
• Developed UAT test cases associated with the functional requirements.
• Maintained a bi-weekly status report for the requirements team and incorporated the same to the PMO status reports send to CMS.
• Analyze different data cross-walks, complicated logic & look ups required by different fields for the source to target transformations.
• Analyze EDI - X12 data elements captured by the existing system to validate it against the data elements required for new system.
• Participated in developing test plan, test scripts, and test scenarios and designed user documentation.
• Worked with legacy team in developing BRD for multiple system change requests and participated in system testing.
• Used Microsoft SharePoint as the version tracking tool for managing the requirements documentation.
• Create monthly/weekly status reports to update the project schedules & deliverable plan.
• Examine the system design deliverables & validating it against the Request for Proposal (RFP).

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

Confidential, Dublin, OH

Business Analyst

Responsibilities:

• Analyzed Business Requirements, developing tracking and enhancing them into functional requirements using Rational Requisite Pro as a requirements tool.
• User Acceptance Testing (UAT) - Carried out UAT activities associated with each project and presented the results to the Business Stakeholders.
• Worked on HIPAA transaction codes specifically on EDI 837, 835 and 834 to incorporate enhancements to existing efforts on capturing and mapping, member enrollment and eligibility and contribution data respectively received at the Plan level from the State.
• Documented the meeting minutes from the JAD’s and stored the artifacts in the appropriate place holders in PDS and SharePoint for both the teams to review.
• Worked in GAP analysis to understand the difference between both the billing systems and documented the GAPs in GAP analysis spreadsheet.
• Used UML and RUP best practice methodologies along with supporting toolset including Mercury Test Director, Caliber RM and StarTeam for overall development framework
• Documented the business requirements into functional requirements document.
• Gathered the requirements and transformed them into high-level Process-Flow Diagram using PowerPoint.
• Created a task plan for the team identifying the key deliverables and the respective deadlines.
• Created the ETL requirements to load the data into TeraData.
• Analyzed the business requirement as per the HIPAA rules and regulations.
• Involved in preparing Test Plans based on User Requirements Document (URD) and prepared the Test Cases using Test Director/HP Quality Center.
• Created mapping/crosswalk documents for mapping data flow between systems.

Environment: Windows XP Professional, Mercury Test Director, Oracle, MS Access 2000, MS Excel, RUP, Oracle, UML, Rational Rose, Requisite Pro, TOAD, Rational Clear Quest 2002, MS Office suite, MS Visio, Informatica

Confidential, MO

Business Analyst/Tester

Responsibilities:

• Performed the requirement analysis, impact analysis and documented the requirements using Rational Requisite Pro.
• Documented the server farm requirements and requirements related to security within Share Point and using Windows Active Directory.
• Followed a systematic approach to eliciting, organizing, and documenting requirements of the system.
• Reviewed the Joint Requirement Documents (JRD) with the cross functional team to analyze the High Level Requirements.
• Experience in EDI automated first-pass claim adjudication, requiring thorough understanding of claim processing, both front and backend operations.
• Managed the team of consultants responsible for developing on-demand Medicaid Management System reports.
• Developed Business Requirement Document (BRD).
• Worked on Functional Requirement Document (FRD).
• Designed the online screens and reports for the Medicaid Online Electronic Claims Submission System.
• 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.
• Interacted with client and the Technical Team for requirement gathering and translation of Business Requirement to Technical specifications.
• Conducted interviews, meetings and JAD sessions during the process of Requirement Gathering.
• Planned and documented procedures for data processing and prepared data flow diagrams for the application.
• Identified/documented data sources and transformation rules required to populate and maintain data warehouse content.
• Developed Requirements Tractability Matrix (RTM) using MS excel to trace each software design requirement to test case.
• Analyzed and translated business requirements into system specifications utilizing UML and RUP methodology
• Participated in the development of the data modeling methodology to be used in the project.

Environment: Windows 2000/XP, Microsoft Office SharePoint, Cobol, Cognos, Rational Requisite Pro, MS Office, MS Project, MS FrontPage, MS Access, EDI