Summary

• More than 6 years of experience as a Business Analyst working with all the phases of SDLC.
• Worked closely with various project stakeholders, SMEs, and staffs to understand the business requirements, functional requirements, and design specification for the new application along with re-engineering the existing one.
• Researched, created, reviewed, and revised requirement documents and use cases.
• Experienced in the analysis and design of application using OOAD techniques, UML and design patterns.
• Hands on experience with IBM rational software integrated tools like requisite pro, rational rose for requirements management and analysis use case development, business and data modeling.
• In depth knowledge of RUP' s iterative software development life cycle process at all stages.
• Good knowledge on Agile, Waterfall methodologies of software development life cycle.
• Performing gap analysis, SWOT analysis, risk analysis, and cost/benefit analysis.
• Responsible for JAD facilitator.
• Modeling the system using use case diagram, activity diagram, sequence diagram, state diagram, and class diagram.
• Good understanding on EDI transactions (270, 271, 810, 850, 834, 835, 837),HIPAA gateway, ICD9 and ICD10, HIPAA 4010 and 5010.
• Good knowledge on different modules of Facets (member, provider, claim etc.), QNXT, NDC and DRG codes.
• Conducting User Acceptance Test (UAT) and verifying performance, reliability and Fault tolerance issues.
• Reliable, responsible, hardworking and good team player.

Technical Skills

Requirements Management tools: Requisite Pro, ClearCase, ClearQuest
Modeling tool: Rational Rose, UML, MS Visio
Utilities: MS Office, MS Project, MS FrontPage
Methodologies: SDLC, RUP, SWOT, Cost/Benefit, Agile, Waterfall
Database: MS Access, MS SQL Server 2000, Oracle 9i
Testing tools: WinRunner, Quicktest Pro, Loadrunner,
Testdirector
Operating System: Windows98/XP/ NT/ 2000, DOS, UNIX
Data Modeling: E-R Diagrams, Data Flow Diagrams, Data Dictionary, Data mapping
Languages: C/C++, UML, HTML, VB Script
Reporting Tools: Cognos 8 Report Net, Microsoft Reporting Services, and Crystal Reports

Education

Bachelors in Information Technology

Professional Experience

Position: Sr Business Analyst
Confidential,
Period: OCT 2010- Present
Environment: Windows 98/2000, XML, SQL Server, ODBC, Web Logic, UNIX, Rational Requisite Pro, ClearCase, Rational Rose, ClearQuest, UML, MS Visio, and MS Project, EDI ANSI X12/HIPAA, Facets 4.3/4.7

Description: Unicare offer health plans that are unavailable elsewhere with unlimited prescription drug coverage, hospital cost coverage, low out of pocket premiums and worldwide coverage, all without the complexity of most other health plans. The project was aimed to support and process various health Insurances claims (HMOS and PPOS, Medicare, Medicaid, Medical) without any hassle and effective tool for the end users for renewal and status on their application and to provide WebMD health on line source for well-being. Reviewed HIPAA 270/271, 276, 277, 835, 837 standards for the process and products developed. Effectively used facets for integrated claims management, adjudication and mapping, migration conducted for new authorization in Facets.

Responsibilities:

• Studied and assessed the clients/patients systems and business processes. (HIPAA and SOX requirements).
• Established business analysis methodology after assessing the corporate and HIPAA compliance procedures.
• Packages designed to support HIPAA requirements for claims such as CPT or HCPCS coding codes, ICD-9, ICD-10 coding.
• Participated in the walkthroughs and meetings specifically for Claims and Membership modules in FACETS.
• Experience working in Claims, and Member/Subscriber module of FACETS.
• Clearly understood coding standards for all transactions involving electronic data interchange (270/271,837/835) between the clients with their users which includes the use of unique health identifiers for the insurers before proceeding to address health insurance claims processing life cycle.
• Worked closely with the SME in Claims Logging, Claims Pre-pricing and ClaimsProcessing application of the Claims module.
• Addressed all aspects of the claims processing life cycle.
• Performed GAP analysis of 4010 and 5010 EDI transaction using implementation guide.
• Conducted user interviews, gathered, analyzed and documented business requirements (BRD) based on the analysis of business process, work flow model, existing use cases and work flows.
• Designed and developed Use Cases, Activity Diagrams and Sequence Diagrams.
• Played a key role in the planning, User Accepted testing and implementation of system enhancements and conversions.
• Developed and maintained all operational and technical flows using Visio and Power Point.
• Aid in work flow analysis and process design.
• Organized weekly Project Status and Task Review meetings,
• Provided key input in working with users in defining project and system requirements and advantages of using WebMD environments.
• Conducted Unit testing for all the queries developed through concepts like group, sub query, joins, primary key and foreign key constraints.

Position: Business Analyst
Confidential,
Period: OCT 2008- AUG 2010
Environment: EDI ANSI X12/HIPAA, MediStat, Mercator, MS Office, MS Project, Rational Rose, TestDirector, Windows NT/XP.

Description: Towers Perrin, one of the world\'s leading professional service firms. Healthcare consulting is one of the important and profitable aspects of the company. The main aim of the project was to provide an expertise in healthcare cost for the mid-market companies and analyzing the healthcare programs, how they are working and where they can have the greatest potential improvements in cost and how it can be implemented.

Responsibilities:

• Conducted one on one telephonic and face to face interview with the end users (the healthcare professionals) of the doctor-centric portal to research their areas of interest so as to be able to identify key challenges, define project scope deliverables and ultimately developing the application features for their benefit.
• Interacted with the Subject Matter Experts (SMEs) and stakeholders, gathering business requirements to get a better understanding of client\'s business processes.
• Used UML, for gathering requirements, created Use Case Diagrams, and Use Case Specification document (USD).
• Responsible for researching and documenting existing system features and capabilities and documented findings in user guide for the purpose of various stakeholders and team members in the project to understand the features and functionality of the application accurately.
• Cleaning of incomplete, inconsistent and noisy data to form a more organized data warehouse to ensure consistency in coding and naming. Organizing this data in terms of various major subjects to provide a simple and a concise view around the entities.
• Used Unified Modeling Language (UML) for process modeling and use cases.
• Dealing with EDI transactions like 270,271,834,837 and 835.
• Involved in forward mapping form ICD 9 to ICD 10 and backward mapping from ICD 10 to ICD 9.
• Generated daily, weekly, and monthly reports using MS OFFICE Tools and submitted to the Team Leads and Manager for reporting, status reporting and analyzing purpose.
• Developed gap analysis document (4010 to 5010, ICD-9 to ICD-10), logical and physical design and remediation plan.
• Functioned as a liaison and advocate between the technical teams and the business teams and end users and taught other members of the team business and functional rules and business concepts.
• Captured, communicated, managed system requirements and Maintained requirement tractability to keep team members up to date with the latest requirements and changes if any.
• Responsible for training and testing of transactions.
• Analyzed existing procedures and reported to management to improve productivity
• Interacted with various cross-functional teams on budgeting, forecasting, building business use cases, and understanding expenses and revenue stream.
• Tested the system manually and using automated tools.
• Involved in creation of test plan, test scenarios, test cases for unit, system and system integration testing.
• Performed Integration testing, Regression Testing, Functional Testing, System Testing and Load Testing.
• Execution of test scripts using WINRUNNER, TESTDIRECTOR.
• Investigated faults within the application and interacted with the development team to resolve technical issues.

Position: Business Analyst
Confidential,
Period: March 2007- Sep 2008
Environment: Windows 98/2000,XML, SQL Server, MS Visio, Requisite Pro, Rational Rose, UML, DB2 Mainframe, RUP, ClearQuest, ClearCase.

Description: The project involved launching a New Web Application using XML Web Services designed to simplify core business functionality. It is leader in the e-prescribing movement. IScribe, provides with generic formulary coverage and alternative information, prescribe with core business functionality, assisting the physician in selecting the most effective medication for their patients. Physicians can use the electronic prescribing tools to write prescriptions for all of their patients, regardless of the patient' s prescription benefit coverage.

Responsibilities:

• Gathered requirements through a series of interview sessions and group meetings with the identified users and developers. Involved in documenting Business process Model and process Overview.
• Performed Gap Analysis, prepared project plan and solution documents and coordinated with multiple teams ( Developers, QA, Vendors) both internal and external, to ensure delivery of the project on time.
• Actively involved in gathering high level system requirements needed to implement the new operating platform for claims processing. Constructed a draft version of the Business Requirements Document for both 837 Inbound) and 835 (Outbound) transactions.
• Conducted meetings/interviews and JAD sessions with stakeholders to collect business requirements.
• Developed Use Cases, Logical Views and Activity Diagrams using Rational Requisite Pro.
• Translate data mapping, business requirements and functional requirements into system requirements.
• Used Rational Unified Process (RUP) methodology and Rational Rose for developing the use case diagrams for Requirement Management using Rational Requisite Pro.
• Assesses the flaws in the existing as-is system and made clear recommendations of Business process improvements and BPR, incorporated them in the future to-be system design.
• Responsible for creating and maintaining Requirement Traceability Matrix in order to track the development and QA process.
• Performing Functional and GUI testing on various screens to assure user acceptance criteria is met.
• Extensively used SQL scripts/queries for data verification at the backend.
• Interfaced with business users to prepare and update Business Process Requirements (BPR) and Software Systems Requirements (SSR). Traced test cases and functional specifications to SSR and BPR.
• Got exposure to NASCO.

Position: Business Analyst
Confidential, OK
Period: April 2006- Feb 2007
Environment: Agile, MS Project, MS Visio, MS Word, MS Excel, MS PowerPoint, QualityCenter 9.2, IBM DB2, Rational ClearQuest, Toad, Caliber RM.

Description: The Payless Supply Chain project included restructuring the entire supply chain from production order to shipping & delivery and order management. The new system was set up in a way that product creation and supply chain groups could work together to address critical dependencies between processes like demand, supply, tooling and warehousing

Responsibilities:

• Worked with Project Manager in activities such as project planning, budgeting, scheduling and costing and used MS Project extensively as a part of these activities.
• Elicited business requirements through interviewing internal business users and external users.
• Extracted, discussed and refined business requirements from business users and team members by conducting Joint Application Design (JAD) sessions.
• Performed GAP Analysis between the current website with respect to all the new enhancements.
• Involved in writing use cases for the requirements assigned and created the requirement traceability matrix to make sure all the documents are prepared.
• Enhanced feeds after cost-Benefit analysis amongst vendors to upstream and downstream systems.
• Transported data to various delivery points such as data marts or data warehouses.
• Involved in developing test strategies, test planning, test execution and defect management for the entire enterprise integration team and used Quality Center to achieve it.
• Managed scope and change throughout the life cycle of the system.
• Reviewed use cases authored by the offshore development teams.
• Updated the SOP (Standard Operating Procedure) according to the enhancements made on the old system.