EXECUTIVE SUMMARY:

• Accomplished Business Analysis and Quality Analysis professional in Healthcare domain with exceptional ability t execute and manage IT project for developing, implementation and maintenance.
• Extensive working knowledge and experience in US Health Insurance of HIPAA 4010-5010 EDI X12-837, 270/271 and 835 , CAQH ACA , Compliance issues, ICD9, ICD10 and Claims Adjudication process.
• Experienced in Electronic Medical Record EMR , EPIC.
• Experienced in Online Patient Tracker OPT application implementation and Database Enhancement projects.
• Encompassing knowledge of Software Development Cycle SDLC and quality control methodologies such as Waterfall, Agile Scrum.
• Strong knowledge of Business Intelligence, Data Warehousing, Data Translation, and Analytics concepts with expertise in grasping transaction flows and process management.
• Skillful in performing Gap Analysis SWOT analysis, GAP analysis and Risk Analysis and creating BRD Business requirement Document , FRD Functional Specification Document and UAT Documents.
• In-depth understanding of IIBA-Business Analysis Body of Knowledge BABOK .
• Extraordinary communicator and a skilled presenter.
• Complete understanding of Use Case diagrams like Class Diagram, Collaborative Diagram, Sequence Diagram
• Expertise in broad range of technologies, including business process tools such as Microsoft Project, MS Access, MS Visio, MS PowerPoint, MS Word
• Exceptional presentation skills including verbal and written skills, and flexibility in adapting t new relevant information and changes.
• Proven track record of creating and transforming business requirement int functional requirements and non-functional requirements.

Technical Skills

• Diagramming Techniques UML Use case, Activity Diagram, Basic Process, Dataflow Diagram
• Software Development SDLC, Waterfall, Agile, Scrum
• Database EPIC, Oracle, MS Access, MS SQL Server, DB2
• Data Analysis Tool MS Excel, MS Access, TOAD, Oracle Developer
• Office Automation MS Project, MS Word, MS Excel, MS PowerPoint, Outlook,
• Programming Language Write SQL, Read - COBOL, C, C , PLSQL, SQL,
• OS Unix, Mac, Windows, Linux

PROFESSIONAL EXPERIENCE

Confidential

Sr. Business Analyst/Quality Analyst - Medicaid Management Information System MMIS

• Exclusively worked for the claim adjudication system. Supported the implementation of 'Unbundling the Mental Health Providers' s that the individual provider with specific specialty could be identified and therefore their claim could be individually processed and paid. In this project all the mental health providers were consireded for all the institutions that were affiliated with the State of Texas MMIS.
• Conducted interview sessions with users and different levels of management s as t extract requirements t understand the functional specifications of the AS IS system.
• Did the GAP and IMPACT analysis t design the T BE system.
• Responsible for the execution for the project life cycle SDLC , including requirements gathering, design, testing, implementation and documentation, as required.
• Facilitated smooth completion of project by providing insurance subject matter expertise t the team and utilizing subject matter know-how for quality assurance purposes.
• Gathered and documented business requirements in order t describe the business needs in terms of the main deliverables.
• Actively involved in creating/updating Work Breakdown Structure WBS , preparing deliverable tasks in the project plan.
• Provided issue resolution recommendations by ensuring that there is regular and effective communications of issues and corrective actions between teams.
• Identified Actors, Activities, Artifacts and Workflows and developed use case diagrams.
• Assisted clients during UAT Environment.
• Performed Requirement Analysis and developed Use Cases, Activity Diagrams using Rational Rose.
• Completed the documentation of Claims Scenarios for the source system.
• Helped in designing and implementing deployment process, and thus maintaining the application in post deployment process.

Platforms Tools: MMIS, X12, HP Quality Center, Windows XP, MS Office, MS Visio

Confidential

Lead Business System Analyst

• Supported multiple projects of HIPPA 5010, ICD10 and CAQH Council for Affordable Quality Healthcare projects. The deliverables prepared were doing Gap Analysis, writing Business Requirement Analysis and Functional Requirement Analysis Documents. Als supported the testing.
• Worked as a liaison among stakeholders in order t elicit, analyze, communicate and validate requirements for changes t business processes, policies and information systems.
• Prepared Business requirement and Functional requirements document for the various screens impacted by ICD 9 t 10.
• Prepared BRD and Test documents for CAQH ACA .
• Performed HIPPA 4010 t 5010 GAP analysis, requirement and testing for several EDI X12 transactions like 837I/P, 270/271 and 835.
• Prepared scope assessment documents and high level requirement document for 270 and 276 transaction.
• Met with SMEs and business users and defined the scope of the project, gathered business requirements, and conducted gap analysis
• Created Business Requirement Documents BRDs , Use-Case Narratives including business process workflow diagrams and Requirements Traceability based on any of the projects need.
• Lead Facilitated numerous meetings t help answer any question on requirements during Design, Development, Testing and Implementation phase.
• Organized interviews, brainstorming and JAD sessions with stake holders, business users, technical teams, testing team t analyze and validate the business requirements, system life cycle and explained the key performance indicators and documented the specifications.
• Used HP Quality Center for maintaining the Requirements, Test Plan Test Cases , Test Lab and Defects.
• Prepared Test scenarios based on the real Business scenarios obtain from the end user for both internal testing as well as external testing for implementation readiness.
• Written Test Cases after analyzing the Business Requirement Documents and Design Documents in Quality Center.
• Provided training and support of new function updates t Vendors/Partners.
• Act as interface between technical and business users t prepare business and technical requirement document.

Platforms Tools: 4010, 5010, 837, ICD 9, ICD10, X12, HP Quality Center, Windows XP, MS Office, MS Visio

Confidential

Sr. Business System Analyst

• Up-gradation of database for all the record of the patients and customers. Merging of several different data marts and building a new database. Managing claims processing system plus managing the goverrment funding t support Medicare and Medicaid through the internal software system within the company. Successful implementation Medicaid Management Information System MMIS
• Gathered Business Requirements through brainstorming sessions, JAD sessions, interviews and others.
• Acts as liaison between clients and development. Facilitates sessions t bring business requirements and functionality int SAP system development and enhancement.
• Experience working with Electronic Data Interchange EDI concepts with messaging formats such as ANSI/X12 and EDIFACT
• Created screen-mockups using irises t review the requirements and provide feedback on the screen design.
• Documented and tracked requirements in Mercury Quality Center.
• Developed data conversion programs for membership, claims, and benefit accumulator data - converted thirteen corporate acquisitions. Developed data field mappings. Provided programming and support for claims processing functions and auto-adjudication.
• Used MS-Visi for flow-charting, process model and architectural design of the application.
• Analyzed and translated business requirements int system specifications utilizing UML and RUP methodology.
• Worked on EDI transaction 835 t identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
• Incorporated HIPAA standards, EDI Electronic data interchange , transaction syntax like ANSI X10
• Developed straightforward DBMS queries, knowledge of HL7 and xml interface messaging.
• Assisted in monitoring ancillary data transactions and addressed problems with HL7 messages.
• Analyzed, Documented and authored Business Requirement Document BRD , functional requirements documents FRD and System Requirement Documentation, using UML methodologies
• Acted as a liaison between the development team, QA team and the Business team and resolved any conflicts due t change in requirements.
• Drafted and reviewed test scripts and delegated/performed testing.
• Prepared UAT Materials, including the UAT Process, UAT Test document which would include step-by step process for UAT as well as all the tests that would cover all requirements.
• Interacted with the users and logged any defects, enhancements from the UAT.

Platforms Tools: Windows XP, MS Excel, Word, Case wise Corporate Modeler, Agile/Scrum, XML, LDAP, Visio, power point, SQL, PL/SQL, DB2.

Confidential

Sr. Business Analyst

• It is the main hospital of the Parkland Health Hospital System and serves as Dallas County's public hospital. Parkland has the distinction of delivering more infants under one roof than any other hospital in the nation, averaging 15-16,000 deliveries per year. It has eleven prenatal clinics and employs 80 doctors training t become obstetricians-gynecologists and 45 nurse-midwives. Parkland created one of the first high-risk antenatal units in the nation and had the first neonatal intensive care unit in North Texas.
• The project was based on EPIC STORK Implementation CPOE / Clinical Documentation. EPIC STORK organizes the complete course of obstetric care and supports the unique documentation workflow of Labor and Delivery.
• Involved in requirement gathering of the operational components of large-scale STORK implementation with the use of JAD sessions with emphasis on the technical aspects of informational planning, process executions, resource identification and deployment.
• Actively participate in steering committee that would accept or decline milestones necessary for departmental and facility endurance structure within the Epic system for STORK.
• Involved in extensive Subject Matter Expert interviews, needs assessments, work flow mapping and conceptual integration of facility t software for full STORK curriculum content creation.
• Documented function a specifications for multiple LOBS Lines of Business in migrating additional interface systems t the EPIC electronic medical records system. L D Devices, OBIX fetal monitoring system, etc.
• Worked within compliance of DMHO, HIPAA, SOSA, JCAHO, EMTALA and various other regulatory agencies and mandates in order t meet the standards.
• Created use-case scenarios and storyboards in MS Word and MS PowerPoint for better visualization of the application and managed them using Rational Requisite Pro.
• Resolved issues and improve the process t ensure a stable and accurate solution.
• Created UML notations for Object Oriented Design and Documentation.
• Used MS Visi for Process modeling and Business Process flow diagrams.
• Developed Use Case diagrams, business flow diagrams, Activity/State diagrams and Sequence diagrams s that developers and other stakeholders can understand the business process.
• Validated business rules and all artifacts with users, approval and sign off.
• Created test plans and scripts, facilitated user acceptance testing and tested strategies with developers and testing team.

Platforms Tools: Rational Unified Process RUP , MS Office, MS Visio, MS Project, SQL, Rational Requisite Pro, Rational Test Manager, Rational Clear Quest.

Confidential

Business Analyst/SME

• The Project designed an Intranet-based application called OPT Online Patient Tracker , which provides a centralized access t all the necessary resources in the hospital for Physicians, Nurses and other employees in the hospital. For the User's the Interface was a web-based one where they can schedule their appointments, search for Physicians, their bills and many more. This application helps the authorized administrators in the hospital t update the patient records.
• Studied the CMS regulation for reporting requirements.
• Directed the clinical trial data capture and worldwide data collection systems for various therapeutic areas.
• Developed business case, objectives, cost analysis and budget for implementation clinical and financial business systems.
• Involved in creating business processes and modeling diagrams using Rational Unified Process RUP .
• Designed a claim processing system for the healthcare management client system. It allowed the user t inexpensively capture information regarding patient, summary of medical history, symptoms ICD-9 codes , and treatment CPT .
• Prepared an analysis report based on the COTS evaluation.
• Consolidated the analysis of multiple business lines after the COTS evaluation.
• Work closely with Business Owners and Stakeholders t outline Business Requirements.
• Work with System analyst and IS teams t understand the flow of data.
• Reviewed and analyzed data from various sources.
• Participated as a core team member of a Clinical Development initiative t create an architectural business end-to-end solution for clinical trials as a standard for all remote data capturing clinical trials.
• Identified gaps and performed gap analysis with respect t CMS requirements
• Created Mapping Documents, Report Mockups and modified existing report mockups as t CMS requirements and finalized for development.
• Provide technical expertise as an early engagement t different modules and enhancements t access impacts and define scope.
• Identify Member, Provider, Coverage, Medicare, and Medicaid.
• Created SAS programs that are used for data validation, statistical report generation and program validation and automated the Edit Check programs using Macros
• Used SAS t create output files in different formats including PDF and RTF
• Formulated logical statements of business requirements researched and evaluated alternative solutions and recommend the most efficient solution for system design.
• Review requirements and understand technical recommendations and constraints, and develop comprehensive and accurate functional specifications Data Mapping, and process flows.
• Used Test Director and Mercury Quality Center for updating the status of all the Test Cases Test Scripts that are executed during testing process.
• Work with Compliance and Regulatory operations t follow and monitor different IT process bound by CMS Regulations.

Platforms Tools: Windows XP, Business Objects, Framework, MS Excel, Word, Case wise Corporate Modeler, Java, XML, LDAP, Visio, PowerPoint, Blue print requirement center, SQL, PL/SQl, DB2, SAS database.

Confidential

Clinical Data Manager

Confidential

Project Manager - Clinical Research

Confidential

Clinical Research Associate

Confidential

Residency in Anesthesiology