SUMMARY

• Over 7 years of experience as a Business Analyst with a solid understanding of Business Requirement gathering, Business Process flow, and Business Process Modeling and Analysis.
• Several years of experience and advance knowledge of the Systems Development Life Cycle (SDLC), Waterfall, Spiral, Rapid Application Development (RAD), Extreme Programming (XP), Rational Unified Process (RUP)
• Worked with ICD 9 to ICD 10 upgrade conversion and worked on HIPAA X12 EDI transaction codes such as 270/271(inquiry/response health care benefits), 276/277(Claim status), 834(Benefit enrollment), 835 (Payment/remittance advice/ Explanation of benefits), 837(Health care claim)
• Experience in using tracking tools such as DevTrack, Quality Center, Bugzilla, dashboard and practical experience in defect tracking and Defect Lifecycle.
• Experience in conducting Joint Application Development (JAD) sessions for requirements gathering, analysis and design, and Rapid Application Development (RAD) sessions to congregate early toward a design acceptable to the customer and feasible for the developers.
• Proven track record with handling Change Requests by the Clients.
• Strong knowledge of HL7, HIX (Health Insurance Exchange), EMR/EHR, Health Care Reform and Patient Protection and Affordable Care Act (PPACA) and Facets.
• Extensive knowledge of Healthcare Insurance including Medicaid. Medicaid Information Technology (MITA), Medicare (Part A, B, C, D), Procedural and Diagnostic codes, Claims Process and Medicaid Management Information Systems (MMIS)
• Managed complex business initiatives to balance requirements for functionality, efficiency and quality.
• Developed business requirements by analyzing the As - Is system and designing the To-Be system to stream-line business strategies. Suggested improvements to business processes through better use of existing technology.
• Exceptional Documentation Skills for writing Use Cases and Functional Requirement Documents as well as for creating Use Case diagrams, Activity diagrams, Data Flow Diagrams(DFD), Sequence diagrams, State diagrams, Diagrams based on UML Methodology and business process flow diagrams using MS Visio/Enterprise Architect/Rational Rose.
• Experienced in System Development Life Cycle (SDLC), involved in different phases of development from Information analysis, Data modeling.
• Strong expertise in employing Rational Unified Process (RUP) methodology throughout the SDLC process
• Conducted JAD Sessions, brainstorming sessions to develop an architectural solution that the application meets the business requirements, resolve open issues, and change requests.
• Experienced in performing Business Process Reengineering/Gap Analysis to check the compatibility of the existing system infrastructure with the new business requirements.
• Coordinated with the testing team during the formulation of Test Plan and Test Cases for Functional, System, Integration, UAT and Regression Testing based on the Design Document and User Requirement Document for the Functional and Performance Testing.
• Strengths include quick learner, problem-solving capability, conflict solving, time management skills and ability to lead the teams.

PROFESSIONAL EXPERIENCE

OPERATING SYSTEMS: Windows, UNIX, LINUX

METHODOLOGIES: Rational RUP, RAD, Waterfall (SDLC), Agile, Scrum, Incremental.

CASE TOOLS: Rational RequisitePro, ERWIN, UML

TRACKING TOOLS: QualityCenter, Rational ClearQuest

LANGUAGES: C,C++,HTML,XML,SQL*Plus, SQL,SAP(ABAP)

QA TOOLS: Quality Center, Load Runner, Quick test pro

TOOLS: MS-Project, MS-Excel, MS-Word, MS-PowerPoint, WordPerfect Productivity tools, MS-Visio

DATABASES: MS-SQL Server, ORACLE, MySQL, MS-Access

PROFESSIONAL EXPERIENCE

Confidential, Charlotte, NC

Sr. Business Analyst

Responsibilities:

• Coordinated with Business Owner, Application Vendor, Business Project Teams, Payers and Clearing houses to bring all processes to a level of execution to mitigate any impact to current revenue flow under the HIPAA 5010 compliance requirements.
• Involved in full gap analysis for transaction sets 835 and 837 (I/P) against the documented application on HIPAA 5010 enhancements ensuring the upgraded application included the required changes and additions for 5010 compliance.
• Designed and developed Business Rules document about the Claim Component and HIPAA.
• 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.
• Propose different strategies to implement HIPAA 5010 in the new MMIS system.
• Conducting meeting with the client on a daily basis and reporting on daily progress
• Specifications, Documentation and Construction of systems heavily relied on UML modeling.
• 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.
• Performed the Gap analysis on the earlier systems, generated a detailed Requirements document describing new system architecture through Use Cases and Activity diagrams.
• Designed robust HIPAA 5010 testing and HIPAA 4010 regression SIT and UAT Testing Scripts for the 5010 Project. Scripts were written on an application level and subset by payer resulting in over 600 combined scripts with a maximum of 70 testing scripts steps per script.
• Analyzed the testing results to ensure that the results were in accordance with the Gap Analysis expected results for 5010 compliance.
• Documented workflows and executed comprehensive testing and plans to ensure the new acknowledgement results demonstrated in the 999 and 277CA were properly interpreted and managed to ensure Payer acceptance of the 837 files.
• Took action in the process flow to prevent rejected claims from falling into “limbo”.
• Mitigated claim denial increase through a complete analysis of the application “Claims Scrubber” to ensure 277CA accepted claims would not result in an increase in Denials at the payer adjudication level.
• Validated the receiving A/R applications (up to 12 recipient applications) received the correct split file and the application was able to correctly post the 5010 compliant 835 file.
• Tracked all required resolutions required that were identified as needed from Vendors or Payers based on testing results.
• Identified all risks associated with the project and gave suggestions for mitigating the impact the identified risk posed to the business.

Environment: RUP, Rational RequisitePro, Rational Soda, Rational Rose, Rational Clear Case, Rational Clear quest, Java, MS VISIO, MS Project, Oracle, HTML, WINDOWS

Confidential, Richmond, VA

Business Analyst

Responsibilities:

• Gathered requirements from Business Managers, Supervisors, stakeholders, Data Governance Team and the subject matter experts through meetings to understand needs of the system.
• Used the guidelines and artifacts of the Rational Unified Process (RUP) to strategize the Implementation of Rational Unified Process effort in different iterations and phases (Inception, Elaboration, Construction and Transition) of the Systems Life Cycle methodologies. Prepared various artifacts for all the phases of RUP.
• Led JAD sessions with stakeholders to analyze system needs and integrate requirement to develop a consistent navigation structure
• 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.
• Involved in gap analysis in changing old MMIS and testing new MMIS.
• Involved in up-gradation of HIPAA X12 4010 transaction to HIPAA X12 5010
• Responsible for business analysis, requirement specifications, project planning and identifying the resources and implementation of the project.
• Performed the Gap analyses of the earlier systems, generated a detailed Requirements document describing new system architecture through Use Cases and Activity diagrams.
• Worked with the QA (Quality Assurance) team for designing Test Plan and Test Cases for the User Acceptance testing- Defined test cases, creating test scripts, analyzing bugs, interacting with QA / development teams in fixing errors and User Acceptance Testing (UAT).
• Created functional flow diagrams, context diagrams and other high level diagrams for documenting the functionality of separate modules using MS-Visio and UML.
• Implemented Traceability Matrix and Business Requirement Specification Document verified the functionality coverage.
• Used MS Project to maintain the project schedule and track its status.
• Responsibilities involved interface with end-users, obtaining approval, identifying information, procedures and decision flows, evaluating existing procedures, methods and technical documentation.

Environment: UML, RUP, MS-SharePoint, MS-Project 2000, MS-VISIO, CMMI, testDirector7.6, WinRunner7, windows 2000,EDI, HIPAA compliances.

Confidential, New York City, NY

Business Analyst

Responsibilities:

• Worked according to the activities/roles laid down in each phase of software development life cycle created using Rational Unified Process.
• Involved in HIPAA/EDI Medical Claims Analysis, Design, Implementation and Documentation.
• Involved in preparing the Test Scenarios for Health Care Claim Payment/Advice.
• Analyzed and documented the system specifications, Business requirements and detail design of the software for full understanding of the business and used Requisite Pro for the requirement tracking and analyzing.
• Performed requirements analysis and design using Rational Rose and Requisite Pro.
• Conducted JAD sessions for communicating with all the project directors and stakeholders. Created process workflows, functional specifications and project initiation artifacts.
• Analyzed, documented and managed all project requirements and change to requirements throughout the software development lifecycle using Requisite Pro.
• Created full life cycle documentation from product requirements in the developmental stage to functional specifications for the completed modules of application components.
• Created Use-Cases, Sequence and Collaboration Diagrams to demonstrate software architecture and interaction of system components before prototyping. Used Rational Rose, Requisite-Pro for requirement traceability.
• Involved in GAP analysis around the identification of business rules, business and system process flows, user administration, requirements and assumptions.
• Developed test cases and scripts based on business requirements for the GUI, functional, User Acceptance & System Back-end testing.
• Worked closely with QA and Developers to clarify/understand functionality, resolve issues and provided feedback to nail down the bugs.
• Maintained a close and strong working relationship with teammates and management staff to achieve an expected QA result for the project team.
• Reviewed and evaluated all the modules of the software before delivery to user’s to confirm its meeting the standard criteria.

Environment: Windows XP/NT, UNIX, C++, Java, HTML, XML, Java Script, Oracle, Rational Requisite Pro, UML, Load Runner, Quality Center

Confidential, Cleveland, Ohio

Business Analyst

Responsibilities:

• Created complete test cases of varying complexity, executing tests, measuring expected and actual results, and reported status ensuring accurate coverage of requirements
• Set up test requirements, developed test plans, and documented manual test cases using TestDirector requirements module.
• Assisted staff by sitting with patients, answering call lights, obtaining funeral arrangement information from families and delivering/restocking supplies.
• Managed all types of functional change requests in the ‘patient’ module of the application, including defects, enhancements, issues and documentation changes with a flexible workflow process using TestDirector
• Verified the software and applications according to the requirement specifications (SRS) and generated detailed test coverage reports and graphs twice a week
• Worked closely on documentation in regards to GMP and traced it through various procedures to ensure quality and avoid contamination.
• Used documented for content management.
• Involved in validation of HIPAA 834, 270/271 EDI transaction codes.
• Developed the Project using the Iterative RUP model. The Project was streamlined through all phases of the Rational Unified Processes (RUP) model starting from Inception through Transition. Used a Functional Decomposition strategy to divide system into sub-systems.
• Designed message formats, queues, legacy systems interfaces, and worked with the business users through interviews and Joint Application Development (JAD) sessions. Created front-end prototypes as deliverables and projected the end-delivery modules.
• Prepared requirement specification, functionality trace matrix, quality assurance plan and designed test cases. Communicated with business, technology leadership for overall project/program office milestones.
• Evaluated application testing results and recorded the discrepancies using TestDirector to track, analyze and report on them.
• Used TestDirector as a repository for Test Cases and Test Scripts. Responsible for monitoring the defect tracking process and generating customized reports using TestDirector. Interfaced with developers to resolve the bugs following the bug life cycle policy.

Environment: TestDirector, Rational RUP, UML, Quick Test Pro, SQL Server, MS-Project, MS Visio, HIPAA compliances.