PROFESSIONAL SUMMARY:

• Over 8 years of IT experience with US Healthcare Payer experience as Business Analyst while working for various US Healthcare Payer Clients
• Well versed with Requirement gathering, Requirement Management, Use Case writing, Use case diagrams/modeling and other Business Analysis skills/methodologies in general
• Experience in analyzing AS - IS business processes by communicating with Client stake holders at various levels and coming up with TO-BE state along with necessary aids like business process flows, data flows, Gap and Impact analysis
• Played a vital role throughout several project life cycles by understanding and representing stakeholder’s need, documenting, prioritizing and organizing the requirements for IT systems and communicating them to the entire team along with an active role in performing/managing functional testing of the information system being developed
• Experience in project scoping, estimating resource requirement and business case preparation
• Adept in development and documentation of business requirements (BRD), functional specifications (FSD),Test artifacts, Requirement Traceability Metrics and other necessary documents in SDLC phases
• Recognized as a hands-on, pro-active troubleshooter, who can rapidly identify business problems, formulate strategic plans, initiate change and assist to implement new process in challenging and diverse environments
• In-depth understanding of Software Development Life Cycle (SDLC) using Waterfall, Rational Unified Process (RUP) and Agile methodologies
• Experience in design and development of test plans, test case scenarios, test cases and extensive participation in system testing and UAT
• Facilitated and participated in Joint Application Development (JAD) sessions, user workshops, interviews, conference calls and white board sessions to keep executive staff and the team members apprised of goals, project status, and resolving issues.
• Proven ability to co-ordinate a diverse set of Client business users/stake holders to develop cohesive and streamlined requirements, documentation and user acceptance criteria to achieve the project objective on time and in budget
• Designing and executing test plans, test scripts, tracking defects and getting them resolved to ensure that business requirements and functional specifications are tested and fulfilled
• Proficient in MS Office Suite, MS Visio, MS SharePoint, HP Quality Center, HP Service Manager and Application Lifecycle Management (ALM)
• Adept in data analysis, GUI designs, customer management, team management, problem-resolving skills, conflict management skills, people management skills and excellent knowledge of soft skills, writing skills and oral communication.
• AHIP certified US Health Insurance professional with PAHM designation
• Hands on experience in all the Healthcare EDI Transactions (Expertise in 837, 270/271, 276/277, 27,820, 834 and 835) and worked in end to end implementation of HIPAA 5010 program for one of the largest Blues in the US
• Strong understanding of processes and operations of US Health Insurance Industry including current Regulations like Healthcare Reform, Health Insurance Exchanges, HIPAA 5010, and ICD 10 etc

TECHNICAL SKILLS:

Skills/Tools: UML, Rational Requisite Pro, Oracle 8i/9i/10g, SQL Server 2000/2005/2008 , HP Quality Center, HP Service Manager, Application Life cycle Management (ALM),SQL, Mainframe, MS Office Suite 2010/2007/2003 (Excel, Word, PowerPoint, Outlook, Project, Visio), Windows CE/NT/2000/XP, SharePoint 2010 and IBM Data stage (ETL)

PROFESSIONAL EXPERIENCE:

Confidential

Sr. Business Analyst

Responsibilities:

• Gathering and managing Business Requirements, Requirement Elicitation, Gap and Impact Analysis, providing high level design solutions, and delivering System Requirements by closely working with SME’s and Business stakeholders
• Analyzing business requirements and current system behavior and collaborating to create system design specification documents including functional specifications, system use cases, mock-ups, design models, Business process flows, Data flow diagrams
• Actively involved in JAD sessions, Conference calls and Business Interviews.
• Responsible for documenting Use Cases.
• Supporting software implementation and system enhancements
• Preparing software system design and doing system analysis for defect prioritization and fixes
• Prepared test scenarios and participated in functional testing
• Coordinated with the users in performing User Acceptance Testing
• Facilitated Retrospective meetings(After Action Review) with the users after the application went live with the users to discuss what went right and what could have been better

Environment: Mainframes, IBM DB2, CICS, Acclaim, Fineos, SQL Server, Oracle, IBM Data Stage (ETL), HP Quality Center, ALM, HPSM and MS Visio

Confidential

Sr. Business Analyst

Responsibilities:

• Responsible for impact analysis document (Analyzing service requests for ICD 9 to ICD 10)
• Actively involved in JAD sessions, Conference calls and Business Interviews.
• Worked on transactions such as Enrollment, Claims, Medicaid, Medicare, Benefits Affected and HIPAA complaint security issues.
• Responsible for documenting Use Cases from scratch as well as making changes to the existing Use Cases
• Final Business Requirement document that would help IT to perform the necessary changes as approved by the Business area
• Attend, coordinate and lead weekly and ad-hoc project/operational meetings to discuss progress of the deliverables and ensure timely completion
• Assisted Testers in writing Test Cases and Test Plans

Environment: Mainframes, IBM DB2, MS Visio

Confidential

Product Development Business Analyst

Responsibilities:

• Business Requirement Documentation, Mapping EDI fields to common format for 270, 276, 278, 820, 834 and 835 Develop mock screens with user experience team, functional testing and Handling product enhancements requests
• Cascading requirements to the development team and effectively communicate the functionality inherited in all the requirements in an Agile environment
• Managing change requests by analysing the impact, value addition, effort estimates, time frame to achieve functionality wish list facilitating Business Users to take appropriate decision
• Prepare Test Plan, test strategy and test cases for the thorough Functional testing in specified Testing Environment and executing test case as pre-UAT phase
• Preparing data for client demos, participation in product s and product documentation development team on Health insurance business

Environment: Grails framework (Open source) SQL Server, Oracle, HP Quality Center and MS Visio

Confidential

Business Analyst

Responsibilities:

• Understanding the current manual system with the help of high level requirements, client meetings and other discussions
• Conducting requirement gathering sessions and documenting requirement in the client provided template and getting sign off
• Translating the functional requirement into use case language and process flow to assist technical team to come up with required architecture
• Performing impact analysis of all the integrated system as a result of changes in required database
• Identifying database requirement for every kind of input for the development of GIC database
• Acting as SPOC for all the functional queries from development and testing team and getting all the ambiguities resolved by having discussion with Client
• Preparing Process and Data flow diagram which in turn would be used as an input to the creation of functional architecture
• Preparation of Requirement Traceability Metrics, Test scenarios and test cases

Environment: BizTalk, FACETS, SQL server, SSRS. MS Share point Portal and MS Visio

Confidential

Business Analyst

Responsibilities:

• Use case document Creation, Process and Data flow Diagrams creation and other functional design documents creation
• Responsible for creation of work breakdown structure from functional perspective for 270/271, 276/277, 837 P, I and D EDI transactions
• Developing expertise in understanding Transactions code sets for all the 9 EDI X12 Healthcare Transactions and drawing test scenarios and test cases for the respective transactions sets
• Preparing Ambiguity Matrix based on the BRDs to get the clarified requirements from the Customer SMEs
• SPOC for all the functional queries of Development team at offshore and getting them resolved with Customer SMEs from the respective areas
• All types of BizTalk 2009 HIPAA 5010 Schema mapping and Common Claim format (Canonical format) mapping review. Expert in XML - EDI Mapping, EDI, XML- Facets XC format mapping etc
• Designed and imparted a comprehensive sessions of 28 hours covering Customer’s LOBs, Business process flows and EDI transaction structures from TR3s detailing segments, loops and element and the logical relationship among them
• Performing comprehensive BA activities for making Proprietary Provider Portal of the Client as 5010 Compliant
• Requirement Documents Creation, Requirement Traceability Metrics, Test scenarios and test cases review

Environment: BizTalk, Asp .net, C# and MS Visio

Confidential

Business Analyst

Responsibilities:

• Single point of contact for the Confidential product development and marketing activities
• Competition analysis and target customer profiling
• Understanding the Requirements translating into solution needs
• Responsible for end-to-end RFX activities and Proposal Development
• Developing the product collaterals like presentations, videos, brochure, Confidential, flyers
• Designing and updating the website content for the company website specific to the service offering

Confidential

Responsibilities:

• Developed the business case based on the market gap analysis
• Gathering the requirements
• Prepared use cases and activity diagrams
• Requirement and functional specification documentation
• Assisting the programmers to understand the various business processes
• Preparation of Functional test cases
• Developed marketing collaterals

Environment: Java, SQL Server, Oracle, MS SharePoint Portal HP Quality Center BPMN and MS Visio

Confidential

Responsibilities:

• Requirement Analysis and developed the Business Requirement document
• High Level design documentation and developed the process flow for understating the Business “AS - IS” and “TO - BE” understanding and Identifying constraints, boundary, assumptions, risks
• Generated the Functional Specification Document
• Involved in the preparation of Project plan, user acceptance testing
• Defining Rules using the ICD and CPTS for identification of Chronic Population
• Writing the rules and documenting the specifications as per requirements of client
• Business Test scenarios documentation and perform Validation of Processing logics at Micro and Macro level

Environment: Java, SQL Server, Oracle, HP Quality Center BPMN and MS Visio

Confidential

Business Analyst

Responsibilities:

• Responsible for imparting domain knowledge on HIPAA X12 transactions and how it is used as HIPAA 837 transactions
• Supporting project team in validating 837 Transactions by providing them with better understanding of the business terms used in X12 transactions
• Clarifying business terms mentioned in HIPAA implementation guide to help project team map the same with the technical fields in the middle ware schema
• Responsible for verifying mapping documents
• Making the team understand the Loop structure and how various information come under respective Loops
• Instrumental in developing POC for transaction format conversion from HIPAA for X12 837 P to commence with
• Coordinated with Technical Architecture team and imparted EDI X12 structure knowledge at all the stages of HIPAA POC development

Environment: Facets, Crystal reports, Asp .net

Confidential

Presales Consultant / Business Analyst

Responsibilities:

• Responsible for creation and enhancement of Insurance domain Service Offering binders
• Dissemination of Service Offering across the relationship units.
• Instrumental in creation of POCs as competency demonstrator for Customers.
• Responsible for conceptualizing the application with regard to POC, gathering requirements for the same and coordinating with development and functional testing team.
• Created “Straight through Processing” POC pertaining to New Business.
• Creating work products on Health Insurance service offerings based on BASETM that is Confidential ’s proprietary Business Analysis Framework
• Providing response to RFP’s and RFI’s.
• Creating high impact presentations on subject matter for Business development teams
• Authoring approach note for current industry trends like ICD 10 and HIPPA 5010, Health Benefit Exchanges, Health reforms etc
• Preparation of Study Material for Confidential Health Insurance Practice) and Instrumental in developing content for advanced Confidential 102
• Collateral Authoring like Case studies, Thought papers, Confidential
• Responsible for Knowledge Management activities and enhancing domain knowledge capability of the practice