Summary:

• 6+ years of extensive experience as a business analyst and QA, with strong experience in Healthcare especially in insurance claim with a solid understanding of Business Process Flows, Case Tools, and Business Analysis.
• 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 Medicaid Management Information System (MMIS) as well as day-to-day business operations.
• Experienced in managing various aspects of the software development lifecycle (SDLC) including requirements gathering, design, development, testing, deployment and support
• Facilitated and participated in Joint Application Development (JAD) and Joint Resource Planning (JRP) sessions with management, SMEs, vendors, users and other stakeholders.
• Excellent knowledge of HIPAA standards, EDI (Electronic data interchange) Transaction syntax like ANSI X12, Implementation and Knowledge of HIPAA code sets.
• Excellent understanding of ICD 9, ICD 10, HCPCS, and CPT.
• Experience in developing UML use case diagrams, Work Flow Diagrams using tools like Rational Rose and MS Visio.
• Excellent Business writing skills in creating Business requirement Document (BRD), Use Case Specifications, Functional Specifications, and System Requirements Specifications (SRS).
• Proficient in Developing and executing Test Plans, performing functional, usability testing and ensuring that the software meets the system Requirement.
• Writing and Reading data objects i.e. stored procedures, tables, and views, etc. in SQL server.
• Expertise in object oriented analysis and design (OOAD), unified modeling language (UML), UI development, usage models, layout and wireframes, test cases and user training
• Highly motivated team player with excellent communication, presentation and interpersonal skills, always willing to work in challenging environment.
• Extensive experience in gathering Business and Functional Requirements, developing Use Cases, conducting Gap Analysis and preparing Training manuals.
• In-depth knowledge of creating use cases, functional design specifications, activity diagrams, logical, component and deployment views to extract business process flow.
• Strong understanding of project life cycle and SDLC methodologies likes RUP, Waterfall and Agile.
• Interacting regularly with the development team, creative services, database designer, system administrator and the higher management to meet the deadlines of Project milestones.
• Experience in working with QA testing teams, while interacting with business users and gathering user’s requirements to develop necessary Test plans, Test Cases.
• Performed UAT and exposure to User Certification Testing (UCT) and Operational Readiness Testing (ORT)

Technical Skill:

Business Skills: Business Definition Requirements, Business Process Analysis, Gap Analysis  Use Case Modeling & Analysis, Business Environment and research Analysis
Tools: MS Visio, Rational Rose, Enterprise Architect, Rational Suite, Rose, Clear  Quest, MS Project, MS Access, MS Office Suite, Erwin
Methodology: SDLC, RUP, Agile, Waterfall.
Testing: Quality Center, Test Director, win runner, load runner.
Databases: Oracle 8i/9i; SQL Server 7.0 & 2000; Access 2000, MS SQL Server 
Platforms: Windows, NT/95/98/2000/XP/Vista/Window 7. 
Applications: MS word, MS Excel, MS Access, MS Power point, MS Outlook
Industry standard: HIPAA, ISO.
Programming Languages: SQL, XML, HTML, HTML/DHTML, VB.Net, SQL, UML

Professional Experience:

Confidential, Rochester, MN
Business Analyst June 2011-till date

Confidential provides comprehensive diagnosis and treatment in virtually all medical and surgical specialties. As a Business Analyst I performed pivotal role in multiple projects & handling three releases at the same time. Release 1 & 2 was web-based service application developed for streamlining office workflow processes involved in Electronic Data Interchange (EDI) transactions and benefits in claims management cycle based on HIPAA Guidelines. Release three was based on reporting the policy premium. There were seven reports, which were generated in Brio portal.

Responsibilities:

• Managed and leveraged valuable consulting experience in defining important Project Management & QA requirements that involved development using SOA (Service Oriented Architecture)
• Followed the Business Rules, and ensured that HIPAA compliant Rules are followed to display minimum benefit information that the Provider is required to pass on the EDI transactions.
• Managed the privacy and security environments of healthcare data that was governed by HIPAA and other government mandates.
• Wrote Test Cases and performed User Acceptance Testing (UAT), documented the in detail defects using the Defect Tracking report.
• Prepared and delivered Contingency Plan(s) as required.
• Define functional test cases, documented, and executed test scripts in FACET system
• Tracked project schedule and plans with Senior Manager(s), Directors and Officers
• Infrastructure planning for the project, including developing a SharePoint portal
• Advised on best practices in the IT industry for the development of the Requirements definition
• Managed and advised sub-contractors in following industry best practices
• Incorporated Rational Unified Process (RUP) to create BRD Specifications using MS Visio and MS Word.
• Used MS Visio for Process modeling and Business Process flow diagrams.
• Exposure to Human-Computer Interaction (HCI), User Interface (UI) Design and Usability Testing.
• Assisted the PM on various projects throughout the Project Management Life Cycle (PMLC) including Project Charter, Project Plan and Resource allocation.
• Used SDLC (System Development Life Cycle) methodologies like the RUP and the waterfall.
• Monitored and Tracked MS-Project schedules for deviations, gave early warning of schedule and cost variances, implemented change control, and delivered the scope within budget limitations.
• Interviewed subject matter experts to identify and analyze Business Processes, end user behavior and expectations, and potential risks involved.
• Partnered with the internal users to gather, refine and evolve business requirements.
• Translated Business requirements into User Requirements Specifications.
• Translated the User Requirements Specifications into Functional Requirements and captured in Rational Requisite Pro
• Created Traceability Matrix to keep track of user needs, features of the applications and use cases. Communicated with the business stake holders on a functional level and with the QA on a technical level.
• Scanned and Reported bugs and re-tested fixed features. Wrote test cases for specific features in the system. Verified test cases documented by the QA team pertaining to other features in the system.

Environment: Windows XP professional, MS Office suite, MS Project, UNIX/Oracle Platform, XML, Oracle Application server, VB.net, MS Visio.

Confidential, Nashville TN
Business Analyst Jan 2010-May 2011

This Project is about to implement the Automated Adjudication System, which deals with different phases of claim process such as Intake Phase, Adjudication Phase and Reporting Phase. Implementation of ACAS (Automated Claim Adjudication System) must have to comply with HIPAA Rules and Regulation of privacy and security. Implementation of ACAS to generate automated Claim Submission, Processing and creating a report.

Responsibilities:

• Participated in Business Modeling by understanding the needs of the business, and also documenting Business Use Cases as well as System Use Cases.
• Gathered Requirements and documented the proposed additional extension to the existing HIPAA application.
• Facilitated Joint Application Development (JAD) sessions with the Management, Mainframe and HIPAA team to make sure everyone are in sync with the business requirement processes.
• Involved in HIPAA 5010 gap analysis of ANSI X12 4010 and ICD 10 initiatives.
• Used MS Visio to create Use Cases and Sequence Diagrams.
• Worked on FACET claim processing system.
• Accomplished experience through whole SDLC from requirement analysis till deployment, using highly efficient RUP process of Software development.
• Assisted development team to translate requirements into technical specifications.
• Liaised and Coordinated in resolving EDI mapping issues arising from data transfer process from EWM to ACAS and third party systems.
• Analyzed mandatory and the situational fields and compared with the users manuals for EDI.
• Worked closely with the host (Main frames support person) and helped him understanding the process and in the creation of the match, input and the delete files.
• Created and Maintained the Requirement Traceability Matrix (RTM).
• Initiated Test Plans, developed and executed test cases and scenarios, worked with users to develop specific acceptance criteria and prepare test exhibits.
• Worked on FACET modules such as pricing, payer, eligibility under claims processing system.
• Conducted User Acceptance Testing (UAT) sessions with business users and prepared document for enhancements and bug fixes.
• Used Test Director and Mercury Quality Center to report any bugs found and communicate to the developers and product support team.
• Analyzed and evaluated User Interface Designs, Technical Design Documents and Quality Assurance Test condition the performance of the application from various dimensions.

Environment: MS Visio, MS Project, Windows XP, HIPAA, Microsoft Office Suite, Quality center, Rational Unified Process (RUP), UML.

Confidential, Farmington hills, MI
Business Analyst May 2009- April 2010 

The project dealt with enhancements to the Healthcare Payment EDI transaction set to generate a payer level containing payer specific information. Implementation of the Automated Clearing House Origination software to generate NACHA compliant files that adhere to all NACHA standard entry class codes at a multi payer level to further penetrate the provider market with electronic payments and statements.

Responsibilities:

• Gathered Business Requirements, interacted with the Users, Designers, Developers, Project Manager, and SMEs to get a better understanding of the business processes, and analyzed and optimized the process.
• Actively involved in the entire Software Development Life Cycle (SDLC) Process.
• Created reports containing all the information regarding the publishers, distributors and retailers using crystal reports.
• Facilitated demonstration of a major ACH software systems and performed evaluations with a group of experts to select a package that best suits the need of the business.
• Extensively worked with HIPAA transactions such as 835-claim payment/advice.
• Developed Traceability Matrix for maintaining/updating current and new system requirement using MS Excel.
• Researched/Analyzed the various steps in claim processing lifecycle and then wrote the Business Requirement Document and Functional Requirement Document in such a way that developers could construct the system to identify and monitor the riskier claims.
• Worked with electronic claim clearing house like Web MD and automated clearing house (ACH) for electronic payment, remittance data processing and services.
• Created the User Requirement Specifications and helped convert them to Functional Requirements, and assisted the developers with System Requirement Specifications.
• Responsible for ensuring data integrity and coordinating effort with testing and implementation responsible for the development and execution of test plans.

Environment: MS Office tools, MS Project, MS Visio, UML, RUP, Windows, National Requisite Pro, and SQL Server.

Confidential, Canton, MI 
Business System Analyst June 2008-April 2009 

Electronic Health Record is designed to create a paperless office with features designed for physicians and consultants build on HIPAA compliance. Quick and easy access to patient records through secure web access makes it possible to provide better care for patients. This web-based application has Medicare and Medicaid claims features. Records are electronically stored in database.

Responsibilities:

• Analyzed, documented and managed all project requirements and changes to requirements throughout the software development life cycle through Rational Doors.
• Analyzed customer needs and existing functions in the area of HIPAA transactions to determine feasibility and requirements.
• Documented Functional/Technical data flow of 4010 HIPAA transaction to determine feasibility and requirements.
• Prepared and created Test Cases/Test Data according to Business Requirements.
• Created Statement of Work (SOW) document for various capabilities in the Initial Requirements Gathering Phase.
• Strong Documentation experience that required converting business needs to technical documents.
• Performed gap analysis as pertains enrollment, membership management, Commissions, Finance and claims processing; relating for instance to Provider IDs use on plan communications; remittance advice statements; explanation of payments (EOP); and Member ID cards; and healthcare providers use of the assigned Affinity Provider ID number(s) for use in claims submission and plan inquiries.
• Participated in all phases of the Facets Extended Enterprise(TM) administrative system implementation including the planning, designing/building/validation (DBV), testing, and Go-live support phases
• Documented and reviewed high level and detailed requirements in Business Requirement Document.
• Created Use Cases and Use Case description/narratives based on the Requirements list.
• Experienced in using Microsoft Share Point to centrally store, manage and access business artifacts across all platforms.
• Created activity diagrams in UML using Rational Rose and also involved in creating the Business Process Models.
• Coordinated activities involved in QA and User Acceptance Testing.
• Actively involved in reporting project updates, managing project resources, conflict resolution and maintaining project deadline.
• Communicated with business/technology leadership for overall project/program office milestone.
• Monitor the production environment and proactively prioritize, communicate, and resolve EDI process or system issues.

Environment: Rational Rose, Agile, Rational Requisite Pro, Quality center, MS Project, SQL.

Confidential June-2006-May-2008 
Business Analyst

Confidential care based project for Healthcare industry. A web application was reengineered to make it compliant with the EDI standards. Integration of this web applicationwith the third party administrator’s applications (TPA) was achieved. The developed application is complaint with the HIPAA standards.

Responsibilities:

• Identified the project’s stakeholders during initial meetings for the purposes of understanding the requirements.
• Prepared project plan and allocated resources working with Business analysis team and development team.
• Conducted user interviews, gathered requirements, analyzed the requirements by using Rational Rose,Visio and Requisite pro - RUP
• Created Use Case Diagrams, Activity Diagrams, Sequence Diagrams and ER Diagrams in MS Visio.
• Conducted Functional Testing, Joint Functional Testing and UAT, documented and reported user feedbacks to management team.
• Assisted the PM on various projects throughout the Project Management Life Cycle (PMLC) including Project Charter, Project Plan and Resource allocation.
• Managed and updated daily project status using MS Project
• Mapped the entire process chain for which the system was being implemented, and created the Work Breakdown Structure to help facilitate in managing the projects better.
• Used RUP methodology and Unified Modeling Language (UML) to design, document, and manage requirements throughout lifecycle of the project.
• Transformed the business requirements maintained in the Requisite Pro into Functional Requirements and prepared the Functional Requirement Document (FRD)
• Assisted development team in Preparing collaboration diagrams, sequence diagrams and UML notations for detailed analysis of business objects.
• Created test plan for QA and Usability testers
• Responsible for managing the documented system requirements and Requirements Traceability Matrix.

Environment: MS Office 2003, MS Project, XML, MS Visio 2000, Rational Clear Quest 2003, Win Runner, Load Runner.