SUMMARY OF EXPERTISE:

• Sr. Business Analyst with 8 years industry experience in data modelling, software requirement analysis, process modelling, process flow and quality assurance skills using different methodologies, mainly OOA, OOAD and UML
• Experience in Medicaid Management Information System MMIS . Expertise in various subsystems of MMIS- Claims, Provider, Recipient, Procedure Drug and Diagnosis PDD , Explanation of Benefits EOB .
• Expertise in the EPIC Medical software application EMR, HER as it relates to hospital workflows and setting up the infrastructure for a software implementation in a clinic environment.
• Strong knowledge of Project management skills includes time estimation, task identification, and scope management.
• Extensive hands-on and HealthCare management experience in a variety of projects involving the customization, design, development, implementation, and testing of automated systems to support the Medical Management Information System MMIS as well as day-to-day business operations.
• Extensive knowledge of all phases of the software development life cycle SDLC and the iterative Rational Unified Process RUP
• Organized many Joint Application Developments JAD sessions and Joint Requirement Planning sessions JRP , walkthrough, Interviews, Workshops and Rapid Application Development RAD sessions with end-user/clients/stake holders and the IT group.
• Worked effectively with physicians, nurses, and engineers to solve problems related to EMR, EPM, and ICS to make software more user-friendly to staff and doctors.
• Strong experience in Claims, enrolment, eligibility verification for members and providers, benefits setup, and backend payment cycle in facets.
• Hard-core experience involving Business Process Re-Engineering, Software Re-Engineering using RUP methodology and ERP Systems Implementation and Continuous Improvement techniques.
• Used knowledge of Health Care Information Systems Electronic Medical Records EMR model to develop proposed workflow in MS Visio.
• Strong understanding of project life cycle and SDLC methodologies including RUP, RAD, Waterfall and Agile.
• 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.
• Tested HIPAA regulations in Facets HIPAA privacy module.
• Healthcare system implementation including enterprise Electronic Medical Records EMR software.
• Conducting requirement gathering sessions, feasibility studies and Impact Analysis and organizing the software requirements in a structured way using Rational RequisitePro to track development.
• Professional experience in business analysis, operations management and development, design, documentation and testing.
• Proficient in creating Risk Analysis documents, Risk Management Plan, User Requirement Specification, Functional Requirement Specification and Business Process Flows.
• Proficient in using UML in behavioural, structural and architectural modelling in creating Use Case, State, Activity, Class and Sequence diagrams using Rational Rose.
• Designed, test, and customized EMR templates, documents and crystal reports.
• Experience in conducting Joint Application Development JAD sessions and White Board Sessions with end-users, Subject Matter Expert SMEs team, Architects and design group development and QA team for project meetings, walkthroughs and customer interviews commensurate with excellent communication skills.
• Well versed in project management tool MS Project for status reporting, planning and resource allocation.
• Successful as a team player to work in conjunction with other DBA's, testers, developers and other team members in validation and testing complex scenarios and projects and in the maintenance of Quality Standards in Projects especially with Test Director.

PROFESSIONAL EXPERIENCE

• Proven experience in all aspects of Business Analysis, Requirements Gathering, GAP Analysis, QA/Testing, Business Process Re-Engineering Scoping, As-Is Study, Recommendations and Implementation , Data Modeling, Data analysis
• Excellent facilitation skills in conducting walkthroughs, surveys, questionnaires, interviews, brainstorming sessions and JAD sessions with Stakeholders, Business partners and end users
• Experienced in documenting Business Requirements Documents BRD , Functional Requirement Documents FRD , Test Strategy and Test data preparation, Coordinating User Acceptance Testing UAT , Preparing Manuals and Training Business Users
• Collaborative skills within team and throughout organization to bring together desired results
• Proven ability to influence outcomes by clearly articulating needs and demonstrating benefits to gain buy-in

TECHNICAL SKILLS:

• Business Tools: Rational Suite Requisite Pro, Rose, Clear Quest, Clear Case , MS Visio, MS Project, MS Access, MS Office Suite, Visual Paradigm, Doors Erwin Data Modeller 4x, Business Object Crystal Reports
• Business Skills: Business Definition Requirements, Business Process Analysis, Gap Analysis, Use Case Modelling Analysis, Business Environment and Market Research Analysis.
• Methodologies: RUP, OOAD, UML Business/Data Modeling
• Testing Tools: Win Runner, Load Runner, Test Director, Quick Test Pro, PR Tracker
• Operating Systems: Windows 7/8, Mac OS X, DOS, UNIX, Linux
• Databases: Oracle 8i/9i SQL Server 7.0 2000 Access 2000, MS SQL Server, DB2
• Languages: UML, C, C , HTML, Java, SQL, PL/SQL, ASP.NET

PROFESSIONAL ACCOMPLISHMENTS:

Confidential

Role: Sr. Business Analyst

Responsibilities:

• Converted the Business Requirements BRD into Technical Requirements TRD for the IT Department.
• Performed GAP Analysis, walkthroughs and acted as liaison between the business users, stakeholders and the team to perform requirements, quality and risk analysis.
• Healthcare system implementation including enterprise Electronic Medical Records EMR software.
• Contributed to writing technical proposals to bid on IV V, QA, and system testing contracts for business development purposes.
• Maintained and tracked Stake holder's requested enhancements and changes using Requirement Traceability Matrix RTM .
• Documented and reported the progress to the Management on an ongoing basis.
• Designed IVR application for delivery notification of customers shipping information via out going phone calls, including carrier name, tracking info also allowing an escape to customer service use a follow the sun timing program as to deliver the info at an appropriate time.
• Responsible for all facets of testing unit, component integration, system integration and user acceptance testing quality assurance.
• Involved in mentoring specific projects in application of the new SDLC based on the Agile Unified Process, especially from the project management, requirements and architecture perspectives.
• Used knowledge of Health Care Information Systems EMR model to develop proposed workflow in MS Visio.
• Participated in creating Facets data model.
• Developed Business Intelligence reports using Business Objects BO tool to report updated data to various stakeholders.
• Experience in Health Care Industry with exposure to Electronic Medical and Health Records EMR EHR /Automated Health Care Systems. Experience in ICD 9 coding, and Healthcare Claims Process ANSI 837.
• Organized and facilitated meetings like JAD sessions with the management and development teams.
• Extensive knowledge of Electronic Medical Records EMR and Electronic Health Records EHR .
• Analyzed if the system abides HIPAA regulations as portal displays members private information.
• Reviewed and approve technical recommendations related to software and hardware proposals RFP .Also written Request for proposal RFP for getting new MMIS system.
• Authored progress and completion reports which were then submitted to project management on a weekly basis in MS project.
• Involved in testing the Business Objects Reports as a part of Unit Testing.
• Responsible for integrating with Facets, Designing test scripts for testing of Claims in Development, Integration and production environment.
• Created detailed design of the system with the project team including class diagrams, activity diagrams and sequence and collaboration diagram.
• Worked on Facets, HIPAA 5010, EDI 837 I,P,D, 835, 999, Medicare, Medicaid, wrote test cases using Quality Center.
• Analyzed and prioritized user and business requirements as system requirements that were included while developing the software.
• Conducted JAD Sessions with Management, SME Subject Matter Expertise , users and other stakeholders for open and pending issues to develop specifications.
• Prepared BRD Business Requirement Documents supporting documents containing essential business elements, detailed definitions descriptions of the relationships to analyze business data requirements.
• Generated Use Case Diagrams, Sequence Diagrams, Business objects, Activity Diagram, ER Diagrams, Domain Object Model using MS Visio to demonstrate business flows and Power Point Presentations.
• Worked closely with Project Managers of different groups to define timelines schedules for the project.
• Hand-on experience working in Healthcare Claims Administration Processing 837/835 including facility claims and professional claims.
• Maintained Requirement Traceability Matrix RTM to keep stakeholders informed of the progress of the project.
• Understand rules and regulations of HIPAA as imposed during Electronic Data Interchange EDI .

Environment: Rational Enterprise Suite, Microsoft Office Suite Word, Excel, Power Point, Visio, Project , Windows, SQL.

Confidential

Role: Business Analyst

Responsibilities:

• Defined a complete set of metrics report requirements including a framework that will meet the needs of regional and national business leaders
• Provided analytical data to enable management to make informed decisions to drive continuous revenue cycle improvements by realizing gains in operational efficiency, cost savings and member experience
• Expertise in project management i.e. project scoping, planning, estimating, scheduling, organizing, directing, controlling, budgeting and drafting remedy procedures.
• Performed Analysis on NextGens EPM/EMR application.
• Worked with stakeholders on process improvement projects designed to improve results, and will lead business process re-engineering efforts.
• Worked with the business/functional unit to assist in the development, documentation, and analysis of functional and technical requirements within FACETS.
• Produced/presented IV V/QA Reports to the Clients/Technical Review Board TRB for review/approval.
• Experience in Claims Processing per Medicaid Management Information Systems MMIS 42 CFR 433.
• Expertise in the EPIC Medical software application EMR .
• Established questionnaires and resource leveling required for implementing HIPAA 5010 and upgrading ICD-9 diagnosis codes to ICD-10 codes
• Coordinating meetings between Hospital, EMR and practice Interface IT team.
• Created and conducted statewide HIPAA 5010 and ICD-10 awareness program for all IDS staff in the client.
• Assisted the Technical team with Formal Integration Testing of Imany Government Pricing. Created Testing Inventory report, Test Scripts and developed Formal Integration Test Cases. Also, assisted the technical team with parallel testing by being onsite with client as well as providing remote assistance.
• Worked on the EDI 834-file load to Facets through MMS Membership maintenance sub-system
• Assigned tasks among development team, monitored and tracked progress of project following Agile methodology.
• Interacted with client and the Technical Team for requirement gathering and translation of Business Requirement to Technical specifications.
• EMR Electronic Medical Records Handling and supporting the external customers on easy claims process knowledge.
• Conducted interviews, meetings and JAD sessions during the process of Requirement Gathering.
• Used the DataStage Designer to develop processes for extracting, cleansing, transforms, integrating and loading data into data warehouse database.
• Extensive experience in XML data validation for secure transmission to EMR.
• Co-mentored team with PM in establishing war room environment and agile tasking approach.
• Identified and drafted the calculations used for various regions, using their source SQL's for standardization purpose.
• Performed Requirement Analysis and developed Use Cases, Activity Diagrams using Rational Rose.
• Acted as a Subject Matter Expert on Application knowledge for preparing training presentation, Quick Reference Guides and assisting with any issues/questions that arose from training
• Involved in interactions with Subject Matter Expert, Project Manager, Developers, and the end-users in more than one JAD sessions. MS Project proved useful in coordinating activities with project manager and various other team.
• Performed GAP analysis for the modules in production, conducted feasibility study and performed impact analysis for proposed enhancements.
• Coordinated JAD session with system analysts, development team, project manager for application development and Pre-validation specifications

Environment: Windows 7, Oracle, PL/SQL, MS-Project, MS-Office Suite, MS Visio, Rational Requisite Pro, UML, Clear Case, Clear Quest, MS Visual Source Safe

Confidential

Role: Business Analyst

Responsibilities:

• Collected and documented business processes as well as business rules.
• Provided key input in working with users in defining project and system requirements.
• Well versed in project management tool MS Project for status reporting, planning and resource allocation.
• Translated the business needs into functional requirements and communicated the same to the business users, to baseline the initial high-level requirements.
• Understanding of health insurance products Medicare, Medicaid, Claims, Adjudication, HIPPA regulations, Underwriting, EDI etc
• A strong emphasis on developing and producing daily, weekly, monthly reports for different departments, especially the Regulatory Department was practiced and documented in EDMS Electronic Document Management System.
• Mapped process flow assess as-is processes through user interviews, data collection and analysis, design and evaluation of to-be process solutions.
• Recorded retention stored in Knowledge Link. Ad Hoc reporting, Admin for MS Project 2003, Excel dbase and pivot tables, Clarity and MS Project Server Admin duties.
• Documented FRS Functional Requirement Specifications and assisted Systems analyst to come up with SRS System Requirement Specifications .
• Created business process models using MS Visio.
• Involved in risk analysis in identifying and documenting business controls in the various business processes in question.
• Interacted with the Help Desk team to investigate and resolve production issues.
• Prepared documents with Traceability matrix, and Change Request form
• Prepared reports from data warehouse.
• Created Use Case Diagrams and Data Flow Diagrams to provide the development team with a better view of the requirements
• Involved in walkthroughs and meetings with development team to discuss related issues.
• Collected Business requirements BRD from Business owners for applications

Environment: Requisite Pro, Rational Rose, Agile, MS Project, MS FrontPage 2003, Agile/Scrum,,PL/SQL,facets 4.31.HTML, MS Office, MS Visio, MS Access, EDI, UML.

Confidential

Role: QA Analyst

Responsibilities:

• Performed Regression, Systems, end-to-end testing to maintain the quality of the application.
• Reviewed and created test scripts and executed test cases.
• Helped with building ICD-9 to ICD-10 crosswalk map by grouping thousands of codes and ranges in Clinical, Benefits, Financial, Medical policy waves.
• Used Quality Center for Requirements Documentation, Test Plan, Execution and Bug Tracking.
• Performed data validation, field verification and data display.
• Produced bug reports based on priority and severity of the problem.
• Attended bug tracking and problem escalation meetings.
• Interact with developers and business analyst.
• Performed batch jobs to upload all the patient opportunities to Rx Connect from different sources Like EOMS, RXDW.

Environment: Quality Center, Java, UNIX, Windows XP, SQL, XML, Oracle, Team Track