SUMMARY

• 7 years of experience as a Business Analyst with extensive knowledge and experience in the Systems Development Life Cycle (SDLC), in the fields of HealthCare and Insurance.
• EDI applications to process Health Care transactions as per the HIPAA guidelines.
• Experience in X12 4010 A1, 5010 and ICD 10 codes.
• Worked on 5010 implementation of EDI transactions 834, 835,837, 277, 278.
• Extensive experience in facilitating user group meetings and gathering system requirements for web application development using Rational Requisite Pro and Rational Clear Case.
• Expertise in project planning, project design, creating functional specifications and data flow diagrams.
• Experience using and implementing Rational Unified Process methodology (RUP).
• Highly analytical in developing the methods and measures to meet requirements and solve any issues that arise during the project.
• Performed planning and development of test plans, test cases and test scenario to meet product’s business requirements.
• Experience facilitating JAD (Joint Application Design) sessions and maintenance of Test Matrix and Requirements Traceability Matrix.
• Optimum use of documentation to avoid any form of miscommunication or misinterpretation during the entire software development process.
• Worked on implementation of Medicaid Management information.
• Experience in creating and maintaining the requirements definition documents that included business requirements and functional requirements.
• Experience in developing Use Case diagrams, Sequence diagrams, State Chart diagrams, and Class diagrams.
• Strong experience performing functionality and regression testing during the various phases of the development lifecycle.
• Exposure in creating and analyzing data flow diagrams, and Entity Relationship diagrams.
• Extensive use of UML/RUP for modeling views in Microsoft Visio.
• Strong knowledge of project management skills such as time estimation, task identification, and scope management.
• Experience in customer / client interaction, deep understanding of business systems functionality and technicality.
• Conducted requirement analysis techniques such as Business Process Automation, Business Process Improvement, and Business Process Re - engineering.
• Implemented and experienced in various QA methodologies.
• Formulated numerous Test Plans and Test Cases by coordinating with respective individuals.
• Conducted User Acceptance Testing (UAT).

TECHNICAL SKILLS

Methodologies: SDLC, RUP, UML, Agile, Waterfall

Business Modeling Tools: Microsoft Visio, Rational Rose

Platforms: Windows

Testing tools: Test Director, Mercury Quality Center

Change Management Tools: Rational Clear Quest

Office Tools: MS Project, MS Office, MS Visio

Version Control Systems: Rational Clear Case

Database: MS SQL Server, MS Access, and Oracle

PROFESSIONAL EXPERIENCE

Confidential, Colorado Springs, CO

Business System Analyst

Responsibilities:

• Involved in preparing “BRD” Business requirement Documents for 5010.
• Prepared “FSD” functional specification document for 5010 from 4010A1.
• Performed the detail comparison between 4010A and 5010 to identify differences across loops.
• Responsible for the integration of STOMP with ClaimsManager (ACE) and validating the X12, PI & XML files for clinical accuracy and mapping to IMF File format with the help of simple object access protocol.
• Validating the Claims Manager rules for their accuracy which enables providers and hospitals to only pay clean claims.
• Responsible to setup provider information so that Print Image files will be processed correctly and triggered against CM Rules.
• Validate the crosswalks of taxonomy codes with specialty given by CMS and uploads them to all the three environments of ACE - Test, Staging & Production.
• Responsible to update CM knowledgebase given by CMS, every quarter on all the environments.
• Performed the detailed business analysis across line of business (LOB), transaction types.
• Worked on EDI 835 & 837 as per HIPAA guidelines.
• Conducted “JAD” sessions to understand requirements in detail and performed “GAP” analysis.
• Involved in the data movement between systems and validating the business requirements.
• Followed the SCRUM methodology for the entire “SDLC”.
• Worked in testing the Professional, Institutional Claims processing and adjudication.
• Conducted walkthroughs and defect meetings periodically to assess the status of the testing process and discuss areas of criticality.
• Tested data to check HIPAA implementation.
• Extensively involved in Database testing by writing SQL queries.
• Used SQL Developer to execute Queries.

Environment: Agile SCRUM, RallyDev, Claredi, XML, Oracle, TOAD, SQL Developer, Quality Center, Windows XP, MS Word, Excel, PowerPoint, Visio & Rational Suite.

Confidential, Albany, NY

Business Analyst

Responsibilities:

• Involved in preparing “BRD” Business requirement Documents for 5010.
• Prepared “FSD” functional specification document for 5010 from 4010A.
• Performed the detail comparison between 4010A and 5010 to identify differences across loop Structures.
• Performed the detailed business analysis across line of business (LOB), transaction types.
• Worked on Facets 4.51.
• Worked on EDI 834, 835,837 as per HIPAA guidelines.
• Conducted “JAD” sessions to understand detail requirements and performed “GAP” analysis.
• Involved in the data movement between systems and validating the business requirements.
• Followed the RUP methodology for the entire “SDLC”.
• Performed data mapping from supplemental file to database by using “CDMA”.
• Created Interfaces.
• Actively participated in status report meetings and interacted with developers to discuss the technical issues.
• Performed “UAT” for 5010 and ICD 10 codes.
• Worked in testing the Professional, Institutional Claims processing and adjudication and validate data with facets.
• Conducted walkthroughs and defect meetings periodically to assess the status of the testing process and discuss areas of criticality.
• Tested data to check HIPAA implementation.
• Extensively involved in Database testing by writing SQL queries.
• Used SQL Developer to execute Queries.

Environment: Facets 4.51, Windows, MS Office, Clarity, Clear Quest, CDMA, Oracle, SQL Developer

Confidential - Reston, VA

Business Analyst

Responsibilities:

• Created documents that incorporated both the technical and functional details.
• Involved in standardizing the documents to meet the HIPAA Compliance Standards.
• Attended Joint Application Mapping (JAM) Sessions with my team to map the business needs.
• Used requirement elicitation techniques such as JAD Sessions and Document Analysis to gather information regarding the application from the SME and the BizTalk developers.
• Maintained open and clear communication with the team on change requests.
• Performed requirements gathering for healthcare analysis and created reports for EDS’s Medicaid Clients
• Worked on Medicare and Medicaid Data, Medicare Subsidy, Medicare parts A, B, C & D for giving more customized system use for the client.
• Worked on insurance data related to Medicare, Medicaid, Medicare Subsidy and Insurance claims.
• Involved in weekly status meetings for updates.
• Ensured that all Entrance and Exit criteria were properly met.
• Hosted all the documents in Share Point and assigned them to the requisite individuals for review along with using Share Point as a document management tool.
• Created UI Documents as supporting documents for the Business Requirements Documents.
• Involved in Data Flow/Business Process Diagrams to illustrate the flow, input and output of data.

Environment: MS Office 2007, MS Visio 2003, MS BizTalk Server 2004, Internet Explorer, MS Visual Studio .NET, MS SQL Server

Confidential, WI

Business Analyst

Responsibilities:

• Performed business analysis and project management, coordinating between the team members, addressing budget issues and creating test plans according to the business requirements.
• Worked with the project manager for planning and organizing the project activities, and in communicating with other business center mangers and stakeholders of the project.
• Interacted with the business partners to define requirements, determine solution alternatives, and develop high-level designs and estimates.
• Defined and documented the vision and scope of the project.
• Met with various groups, including business owners, SME’s (subject matter experts) and marketing team, for requirements gathering in definition Stage.
• Gathered requirements, developed Process Model and detailed Business Policies.
• Designed Use Cases using UML and managed the entire functional requirements life cycle using RUP.
• Managed multiple vendors in the project (Issue & Risk management and timely project deliverables).
• Followed the RUP methodology for the entire SDLC.
• Conducted Gap Analysis for the system considering As-is and To-be features.
• Responsible for writing and implementation of the test plan, and various test cases.
• Initiated, proposed and implemented critical analytical and technical turnkey solutions extensively increasing the quantitative and qualitative value of the application.
• Provided overall project management to multiple projects successfully completing them on-schedule and on-budget.
• Build and managed a cohesive team to meet deliverables per project / track assigned.
• Provided customer support as required to meet service level agreements.
• Prepared the Business Workflow using MS-Visio with input, output, Pre and Post conditions.
• Utilized technical flow charts, Network Diagrams and Gantt Charts to effectively map and manage critical paths and bottlenecks in conjunction with Project Tracking Reports and Project Data Sheets for Senior Management.
• Enhanced test cases and scripts by adding the required functionality as per the new business requirements.
• Defect Tracking and Bug Reporting was performed using Test Director.
• Worked with the clients on the final signing process in the User Acceptance stages.

Environment: Rational Requisite Pro, Rational ClearQuest, MS Visio, MS Project, Windows, Oracle, UML, RUP, SDLC, Mercury Test Director