SUMMARY:

• 7 years of experience as a Sr. Business Systems Analyst with strong knowledge in the Health Care and Insurance Industry.
• Strong knowledge of the Software Development Life Cycle methodologies like Agile and Waterfall models.
• Extensive knowledge of Health Care Reform.
• In - depth knowledge of RUP (Rational Unified Process) methodology and its application to health care industry process management.
• Worked on different EDI health care transactions like 834-Benefit Enrollment and Maintenance, 837-Institutional, 837-Professional, 837-Dental, 835-Claim Payment/Remittance Advise, 270/271-Eligibility Benefit Inquiry/Response, 276/277-Claim Status Inquiry/Response Transactions.
• Extensive knowledge of HL-7, EHR, Medicaid, Medicare, Procedural and Diagnostic codes and Claims Process.
• Experience in Conversion of HIPAA X12 4010 codes to X12 5010 codes and ICD 9 codes to ICD 10 codes.
• Experience in interacting with business users to identify their needs and gathering Business and Functional Requirements, developing Project Plan, Business Requirement document, Functional specification document, Test Plans, Conducting Gap Analysis and Impact Analysis, preparing manuals and knowledge transfer manuals.
• Data flow analysis using use cases, data flow diagrams, sequence diagrams, activity diagrams and class diagrams.
• Experienced in facilitating Joint Application Development (JAD), Rapid Application Development (RAD) sessions, interviews, workshops and requirement elicitation sessions with end-users, clients, stakeholders and development team.
• Experienced in using UML and tools like Rational Rose, Visio, and Requisite Pro.
• Excellent knowledge on industry standards such as Six Sigma, CMM and Electronic Health Record.
• Good experience in creatingWireframes / UI Designusing MS Visio, Axure, SnagIt and Paint.
• Well versed with FACETS, claim adjustments, claim processing from point of entry to finalizing, claim review, identifying claims processing problems, their source and providing corresponding solutions.
• Experience creating Traceability matrix to better manage the requirement gathering process and
• Capable of writing SQL queries for the retrieval and management of data
• Good Understanding of RDBMS, OOPS (Object Oriented) concepts, Data Modeling, Data Mapping and Data Warehousing.
• Experience in working with Microsoft Office Suite (Word, Excel, Power Point, Access, Visio, and Project) for documentation, analysis and presentation.
• Strong knowledge of Business Process Modeling, Business Intelligence and Business Architecture.
• Experienced in writing Test Plans and executing Test Cases
• Good organization & time management skills.
• Proven track record of delivering projects (quality documents/ deliverables) on time.

TECHNICAL SKILLS:

CORE BUSINESS COMPETENCIES: Information Technology EFT IVR (Interactive Voice Response) HIPAA EDI ICD Change Management SIT (System Integration Testing) JAD Session User Acceptance Testing (UAT) Data Migration Gap Analysis Visual User Interface Production Support GUI Test Plans and Test Cases Agile, RUP, SDLC, and Waterfall Methodologies Requirements Gathering AS-IS and TO-BE Business Processes

TECHNOLOGIES & TOOLS: SQL UML XML Microsoft Project Microsoft Visio Microsoft Office (Word, Excel, Access, PowerPoint) Rational Modeler SharePoint Clear Case Rational Rose Business Objects UI Crystal Reports Plan View HP Quality Center IBM Rational Clear Quest Requisite Pro RQM (Rational Quality Manager) Scope Tracking across all Phases

PROFESSIONAL EXPERIENCE:

Confidential, Tampa, FL

Sr. Business Systems Analyst

Responsibilities:

• Conducted weekly meetings for deciding the Policies and Procedures to be followed while constructing new sites.
• Performed the requirement analysis, impact analysis and documented the requirements using Rational Requisite Pro.
• 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.
• Developed plan for data feeds and data mappings for integration between various systems, including XML, to follow ICD10 Code set and ANSI X12 5010 formats.
• Worked in a close coordination with the ICD9/10 conversion SME to ensure the requirements for conversion met the guidelines.
• Thoroughly studied the difference between the Procedure and Diagnostic Codes in the ICD 9 format versus the codes in the ICD 10 format.
• Worked on EDI 834 mapping from X12 to XML.
• Worked on member enrollment processing and member enrollment module.
• Worked with FACETS team for HIPAA Claims validation and verification process (Pre-Adjudication).
• Worked on homegrown enrollment processor and rating module for APTC and CSR calculations.
• Documented use cases, BRDs, Functional documentation & requirements traceability matrix.
• Performed Gap Analysis to check the compatibility of the existing system infrastructure with the new business requirements.
• Extensively worked withSMEto better understand the existing claim process.
• Created story board using ms power point for executives from previously developed business process and executing the projects within mix methodology Agile/Scrum Project Management.
• Used Query Analyzer, Execution Plans to optimize SQL Queries.
• Interacted with client and the Technical Team for requirement gathering and translation of Business Requirement to Technical specifications.
• Performed research on Member, Provider, Claims, Authorization, Appeals and Grievancesdatafrom FACETS back end and front end application system for reporting purposes.
• Conducted interviews, meetings and JAD sessions during the process of Requirement Gathering.
• Planned and documented procedures for data processing and prepared data flow diagrams for the application.
• Analyzed and translated business requirements into system specifications utilizing UML and RUP methodology.
• Broad Knowledge in reviewing Test Procedures, creating Test plans and detailed test plans for UAT, Test scenario,defining Test cases, both System & Integration and executed many test cases Test Data reviewing and maintaining and executing detailed Test scripts for UAT, analyzing bugs, interacting with team members in fixing errors and User Acceptance Testing (UAT) and also assisted in post - Production support. Worked on Black Box and White Box Testing.

Environment: MS Office, SQL Server, ETL, FACETS, Agile, MS Project, MS FrontPage, HP ALM, MS Access, EDI, Microsoft Excel, Microsoft Word, Microsoft Power Point, Visio.

Confidential, CO

Business Systems Analyst

Responsibilities:

• Conducted and lead JAD sessions with Business, Stakeholders, Development lead, users to understand the requirements and refine functional requirements.
• Analyzed and synthesized JAD output and proposed further meetings, conducted interviews for better solutions.
• Gathered and created BRD (Business Requirement Document), performed cost-benefit analysis with Project Manager.
• Used Requisite Pro for the Requirement Document Preparation and Prepared Business Process Models (BPM) that includes modeling of all the activities of the business from the conceptual to procedural level.
• Performed detailed analysis for the functional areas that will be impacted by implementation of ICD-10 codes with GEM
• Identified gaps and performed GAP analysis, cost analysis with respect to CMS requirements and conducted Impact Analysis and prepared an Implementation and Recommendations Report communicated to the stakeholders.
• Created FRD (Functional Requirement Document) based on the signed-off business requirements.
• Created Use case models, analysis models, implementation models, authored use cases, use case diagram, behavior diagrams (sequence diagrams, activity diagrams) based on UML methodology using Rational Software Modeler and MS Visio.
• Created and maintained a RTM (Requirement Traceability Matrix) to see if all the requirements are being captured and are being worked on, throughout the project lifecycle.
• Worked on HIPAA EDI transactions such as 835, 837, 276, 277, 278, 270, 271, 834, 820.
• Managed all the Change Requests Document that came in through after signoff and maintained all the artifacts on SharePoint.
• Arranged meetings with the IT team to configure Data Mapping Document facilitating the conversion from ICD-9-CM codes to ICD-10-CM/PCS codes to ensure that both the application and Health Record comply with new regulations.
• Analyzed the impact of ICD-10-CM/PCS coding system and identified General Equivalence Mappings (GEM) to facilitate the conversion from ICD-9-CM codes to ICD-10-CM/PCS codes validating that both the application and Health Record comply with new regulations.
• Interacted with various HMO, PPO, Medicaid/Medicare Representatives discussing benefits of contracts on behalf of facilities or appeals from denials and compliance issues.
• Extreme involvement in production and development phase to report out to the stakeholders about the current status of the project.
• Recommended necessary changes to the existing data model, to be able to maintain raw history claims and processed claims data for reconciliation.
• Performed Unit Testing and User Acceptance testing and documented detailed results creating test plans and scripts, tested strategies with developers and testing team for Validation and Provided input (scope, goals, risks, constraints, timelines and interfaces) to PM for project planning and control.
• Reproduced, verified and validated issues documented in a defect tracking system and writing tractability matrices based on use cases and business requirements (BRDs) performed the requirement analysis and documented the requirements using Rational Requisite Pro.
• Worked with the compliance and audit team to make sure we were following correct HIPAA. guidelines/protocols throughout the project lifecycle.

Environment: Java, Agile, Rational Requisite Pro,UML Use Cases,SQL Server, ETL, Rational Rose, XML, Use Case Documentation, Clear Case, Clear quest, HP Quality center, EDI, SharePoint, MS Access, MS Excel.

Confidential, Minneapolis, MN

Business Systems Analyst

Responsibilities:

• Extensive experience in waterfall & agile methodologies throughout the lifecycle. Hands on experience in leading, facilitating and conducting Joint Application Development (JAD) sessions among user community, stakeholders and technical management, creating project plans and schedules and managing changes.
• Analysis and synthesizing results from JAD, proposed alternative tasks and transformed those into BRD.
• Expertise in preparing various artifacts like BRD (Business Requirement document), FRD (Functional Requirement Document), MRD (Market Requirement Document) SRS (System Requirement Specification) etc.,
• Actively involved in created the targeted questionnaire and Knowledge Base for SMEs and Business users for elaborating requirements.
• Experience in conducting GAP analysis, User Acceptance Testing (UAT), SWOT analysis, Cost Benefit analysis, ROI analysis and Requirement Traceability Matrix (RTM).
• Preparing graphical depictions of use cases including State Diagrams, Activity Diagrams, Sequence Diagrams, Use Case Diagrams, Component Based Diagrams, Collateral Diagrams including Business Workflow Chart and System Workflows.
• Strong skills performing Data analysis, impact analysis, risks analysis, writing test cases for User Acceptance Testing, Gather Functional and Data requirements, analyzed workflows and created use cases, requirement specifications, report specifications, Data requirements, Data mapping and data flow diagrams.
• Identified UI requirements, createdWireframes,PrototypesandUI specification.
• Prepared RTM, designed and developed Use Cases and UML models using MS Visio.
• Design test cases for business requirements using Selenium suite.
• Execute testing with various strategies for function, system, UI, and regression testing
• Enter and manage defects for the application to ensure application meets stakeholder criteria.
• Provided data modeling and migration data and developed user interface.
• Ensure the system interfaces well with legacy back-end systems via cross-environment testing and ensure application is ADA Section 508 compliant
• Prepared data to be used for performance testing and worked with performance testing team to ensure all tests are executed correctly.
• Collaborate with other BAs to split up testing responsibilities and confirm application defect entries.
• Involved in testing the legacy system to ensure existing functionality still works while the Portal application interfaces with it.
• Perform queries in portal back-end database and legacy system database to ensure data is correctly stored using SQL Developer

Environment: JAD, MS Office, SQL, ETL, Oracle, Windows, Rational Requisite Pro, Axure, HP ALM (Quality Center), MS SharePoint.

Confidential, Overland Park, KS

Business Systems Analyst

Responsibilities:

• Worked on changes for HIPAA Transaction and proposed changes to be made in the current system for an easy transition from version .
• Conducted Joint Application Development (JAD) process with Stakeholders to analyze deliverables and system constraints.
• Responsible for the full HIPAA compliance lifecycle from gap analysis, mapping, implementation and testing for processing of Medicare/Medicaid Claims.
• Performed Gap analysis for better understanding of transition from HIPAA 4010 to HIPAA 5010.
• Created Use Cases diagram and Activity diagram to depict the interaction between the various actors and the system in Rational Rose for the Business Use Case and System Use Case.
• Documented, organized and tracked the requirements using Rational Requisite Pro.
• Documented the detailed business as well as technical requirements to upgrade the current system to 5010 transactions.
• Involved in designing future state processes for HIPAA 5010 transaction processing EDI’s 837,835, 270, and 271.
• Analyzed HIPAA 5010 related to 835, 837, 270, 271, 276, 277 and 278 transactions (both inbound and outbound) and performed gap analysis between the 4010 and 5010.
• Worked with Source system Subject Matter Experts (SMEs) to ensure that the extracts are properly mapped. Used SQL for data mapping and querying.
• Tracked and maintained Stakeholder requested enhancements and changes using Requirement Traceability Matrix (RTM).
• Incorporated Rational Unified Process (RUP) and analyzed User Business Requirement Document (BRD), Technical Requirement Specification and Functional Requirement Specification (FRS) using Requisite Pro, Rational Rose and MS Visio.
• Completed a review of existing documentation for orders, referrals and reports and compared it to the clinical details needed for HIPAA 5010.
• Worked with technical experts to prepare test case scenarios for unit testing, integration testing, user acceptance testing and compliance testing.
• Developed ETL logic to transfer data from systems to the Data warehouse environment using the available ETL code and tool set for implementation.
• All data modeling and user interfaces were prototyped using Microsoft Visio
• Assisted with user testing of systems and maintained quality procedures and ensured appropriate documentation is in place.
• Integrated Requisite Pro with Rational Rose to provide all teams visibility and maintain tractability among requirements, use cases and change requests.

Environment: SQL Server, .NET, Windows XP, Rational Rose, Rational Requisite Pro, Clear Case, Clear Quest, UML, Rational Suite, Java, MS Visio, MS Project, MS Office (MS Word, MS Excel, MS PowerPoint), MS Access, XML

Confidential, Greenwich, CT

Business Analyst

Responsibilities:

• Involved in interactions with Subject Matter Expert, Project Manager, Developers, and the end-users in more than one JAD sessions. MS Project proved useful in coordinating activities with project manager and various other teams.
• Designed and developed UML Use Cases, Activity Diagrams, Sequence Diagrams.
• Created UML use cases and use case diagrams using Rational Rose.
• Created traceability matrix for maintaining/updating system requirements using MS Excel.
• Gathered product requirements in order to describe the business needs in terms of the main deliverables or products that are created.
• Talked to the end users to create the process requirements and to properly explain the flow of future data modules to the design and development team.
• Kept a watchful eye on the changes along with maintaining a constant communication with the developers.
• Provided clear and concise documentation regarding requirements management plans, functional requirements, supplemental requirements, test plans and test cases.

Environment: Windows, UNIX, JAVA, ETL, Rational Requisite Pro, UML, Rational Rose, RUP, MS Project, MS Excel