SUMMARY

• Over 7 years of Business Analyst experience in Health care.
• Experienced in performing Business Process Reengineering/Gap Analysis to check the compatibility of the existing system infrastructure with the new business requirements.
• Managed complex business initiatives to balance requirements for functionality, efficiency and quality.
• Excellent knowledge of Health Insurance Portability and Accountability Act (HIPAA) transaction and code set rules such as EDI 837,270,271,276,277,834,835.
• Experienced with Rational tools like ReqPro, Clear quest, Clear Case, Rational soda, Rational Rose.
• Expertise in handling issues and getting it solved in a quick and efficient manner.
• Experienced working in Medicare and Medicaid projects.
• Solid understanding of Business Requirement gathering, Business Process flow, Business Process Modeling and Analysis, design documentation.
• Experienced in all phases of the Software Development Life Cycle (SDLC), Rational unified process (RUP), agile methodology.
• Exceptional Documentation Skills for writing Use Cases and Functional Requirement Documents.
• Experienced in conducting Joint Application Development JAD sessions, workshops etc.
• Expertise in Analysis and Review of Software and Business Requirement Documents.
• Experience in implementation of HIPAA 4010in existing claim processing integrated system.
• Extensive experience in claims processing and billing, Medicare/Medicaid billing and claims management.
• Proficient inICD - 9-CMand ICD -10-CMcoding and claims processing
• Prepared Business Process Models that includes modeling of all the activities of the business from the conceptual to procedural level. Followed top down, leveled technique for building Business Process Models.
• Extensively participated in verification of EDI file formats against Standards.
• EDI healthcare experience working with implementation guides.
• Proficient in developing UAT plans, UAT cases, UAT scripts and executing UAT.
• Proficient in writing queries/ SQL/ MS Access to assist in UAT, data validations and data analysis.
• Experience using Rational Rose, and MS Visio for business process modeling and designing data flow diagrams.
• Expertise in creating Use Case diagrams, Activity diagrams, Data Flow Diagrams (DFD), Sequence diagrams, State diagrams based on UML Methodology and business process flow diagrams using MS Visio/Enterprise Architect/Rational Rose.
• Good Knowledge of Test Plan, Test Scripts and Test Cases for Functional, System, Integration, UATand Regression Testing basedon the Design Document and User Requirement Document for the Functional, Security, and Performance Testing.
• Experience with ISO, Six Sigma, and CMM standards.
• Excellent written and verbal communication.
• Experience in databases like Oracle, SQL.
• Strengths include quick learner, problem-solving capability, and ability to work as team player and lead the teams.
• Consistently demonstrated ability to achieve tight deadlines.

TECHNICAL SKILLS

Operating Systems: Windows, UNIX, LINUX, Mac.

Languages: Java, SQL, HTML, XML, C#, VB, ASP, .Net

Databases: Oracle, MS SQL server, MS Access, IBM DB2

Tools: MS Office: Word, Excel, Access, Power point, Project, Visio, Front Office

Industry Standards: HIPAA, SOX, ISO, Six Sigma, CMM.

PROFESSIONAL EXPERIENCE

Confidential, Seattle, WA

Sr. Business Analyst

Responsibilities:

• Gathered Business Requirements from all the stakeholders and interacting with the providers, managers, developers to develop the business Processes.
• Conducted Risk Analysis and Impact analysis whenever there is any change in the business requirement and continually updating the business requirement document.
• Conduction JAD sessions and ultimately reducing the time spent in moving all the information from stakeholders and other team members.
• Complete understanding the business process to determine the needs of the business.
• Assisted in the meetings with the technical team as well as the clients regularly to assess the current process and how it could be changed in making a better proposed process.
• Provide various strategies to implement HIPAA 4010 in the new MMIS system and ultimately move to HIPAA 5010.
• Performed six-sigma process during the project to eliminate any defects in the process.
• Conducted the gap analysis and analyze various gaps and develop actions to fill those gaps.
• Develop spike requirements solution for all the current problems and UI prototypes for capturing the requirements.
• Helped in developing test cases such as test plans and test scenarios.
• Utilize Rational Unified Process (RUP) and build different phases of software developmental cycle.
• Actively involved in designing EDI transactions using the new HIPAA 5010 version and ICD -10 codes and analyzing HIPAA compliance and EDI transaction.
• Recommending actions against the action plans during the ongoing progress of the project to the project manager.
• Knowledge of the software system and the programs.
• Creation of project management plans to manage timely delivery using MS project.
• Performed Requirement Tractability Matrix (RTM) to track and maintain stakeholders requested requirements and changes.
• Instrumental in capturing the requirements from the clients and publishing them into a requirements document.

Environment: MS Project, Requirement Traceability Matrix (RTM), Rational Rose Test, JAD, RUP, MS Visio, Windows OS, MS Office, SharePoint, Server, Quality Center, SQL Sever.

Confidential, New York, NY

Business Analyst

Responsibilities:

• Propose strategies to implement HIPAA 4010 in the new MMIS system.
• Involved in the creation of the Mockupsusing Balsamiq and Use Cases using MS Visio.
• Documented business requirements, and communicated these requirements with the development team for design and implementation of business solutions.
• Worked with Business Analysis team to prepare a detailed Business Requirement Document.
• Analyzed Business Requirements to develop Functional and detail Design Specifications of the application.
• Conducted Requirement Gathering Sessions with the stakeholders.
• Interacted with the project team to help define the Business and System Objectives, confirmation of scope, identify constraints and the measures of success for the system to be developed.
• Conducted the JAD sessions, daily meetings, brainstorming sessions to solve the problems and enhance the workflow.
• Assisted in building a Business analysis process model using Rational Rose and Visio.
• Gathered Functional Requirements from users and the management. Coordinated all the requirements in team based environment.
• Acted as liaison between the senior management and different teams with effective presentations.
• Experience in Rational Rose & HP Quality Centre
• Monitored change requests and documented requirements, integrating them withUse Clear Cases.
• Incorporated stakeholder feedback throughout project lifecycle to ensure project quality and customer satisfaction.
• Did Technical documentation for the project using tools like Visio, Word, etc.
• Used MS Project for managing schedules, resources and collaboration.

Environment: MS Office, SQL, MS Project, MS Visio, UNIX, XML and Windows.

Confidential, New Brunswick, New Jersey

Business Analyst

Responsibilities:

• Implemented RUP methodology for iterative and incremental development of the system.
• Planned RUP iterations and documented the artifacts throughout the various phases of the development process.
• Produced complete data mappings and data conversion documents needed for the enhancement
• Compiled the Vision Document and composed detailed Use Case Specification Documents in Rational RequisitePro.
• Created UML class diagrams, use case diagrams and sequence diagrams to view the system from different perspectives.
• Performed Functional and GUI Testing to ensure that the user acceptance criteria are met.
• Co-coordinated the UAT with the SME’s to make sure that all the Business Requirements are addressed in the application.
• Formed detailed UAT and QA test plans, managed system testing and preserving testing documentation.
• Developed strategic partnerships with the business unit to develop a solid knowledgebase of the business line, including the business plan, products and processes.
• Provided key project inputs by working with users in defining the project and system requirements.
• Assisted Test Lead, Testers understanding business process and help them successful completion of Unit Testing, Integration Testing and Requirements Testing.
• Played a key role in the planning, testing, and implementing system enhancements and conversions.

Environment: MS Office, MS Project, MS Visio, SQL, Oracle, Test Director, Rational Unified Process (RUP), Rational Suite (RequisitePro, ClearQuest, ClearPro),Business Objects, Windows XP

Confidential, Nashville, TN

Business Analyst

Responsibilities:

• Gathered Requirements from various Business Areas like Claims, Provider Relations, Enrollment, Finance and Benefits Administration for their updates to the Claim Processing Engine.
• Developed Use Cases using MS Visio, and a detailed project plan with emphasis on deliverables.
• Monitored Change Requests and documented requirements, integrating them with Use Cases.
• Developed and Implemented Test Strategies using the Test Director.
• Assisted QA team in testing phase by creating Test Plans and Test Cases documents.
• Followed the RUP methodology for the entire Software Development Cycles.
• Assisted the development team during the second and third iteration using the RUP model.
• Checked the data flow through the front end to backend and used SQL queries to extract the data from the database.
• Involved in project planning, coordination and implemented QA methodology.
• Developed the Requirements Traceability Matrix, prioritized and determined Impact of all applications.
• Identified the all applications and interviewed the application owners to recommend the process improvements.
• Provided overall project management to multiple projects successfully completing them on-schedule and on-budget.
• Defect Tracking and Bug Reporting was performed.

Environment: Oracle, SQL, PL/SQL, ASP.NET, Rational Requisite Pro, Microsoft Visio, HTML.