SUMMARY

• Over 7 years of experience in IT Business Analysis - gathering, analyzing and accurately documenting software requirements.
• Profound insight into performing BA duties in several phases of Waterfall, Agile SCRUM and RUP software development life cycle (SDLC).
• In-depth knowledge of gap analysis framework to identify AS-IS processes of claims transactions of 4010/4010A standard and TO-BE processes (ICD-10-CM and ICD-10-PCS compliance requirements) of 5010 standard.
• Experience in EDI and HIPAA Testing Privacy with multiple transactions exposure such as 837 for submitting claims, 835 for payments, 834 for benefit enrollment, and 820 for premium payments to insurance products, 270, 271 for healthcare benefits and eligibility, 276, 277 for claims status and 278 for transmitting health care service information.
• Experience in FACETS support system to inbound/outbound HIPAA EDI transaction in support of HIPAA 834,835, 837,270/271 transactions.
• Good understanding of HIPAA 5010 and ICD -10 initiatives and Worked on healthcare standards such as HIPPA 4010, CPT and ICD and epic software.
• Experience in creating different artifacts such as Product Scope Document, WBS, RBS, Gantt charts, Business Requirements Documents (BRD), User Stories, Use cases, Functional Requirement Specifications (FRS) and Traceability Matrix & Reports.
• Experience in Object Oriented Analysis and Design techniques with UML using, Use Case Diagrams, Activity Diagrams, Process flow diagrams, class diagram and Sequence Diagrams.
• Experience in facilitating Joint Requirement Planning (JRP) sessions with Business User Groups, conducting Joint Application Development (JAD) sessions with IT Groups and Conflict Management with Project team members.
• Experience in conducting SWOT analysis, Cost - benefit / ROI analysis, Risk analysis.
• Hands on experience in developing an ETL lifecycle to support enterprise-wide data processing projects (i.e., Enterprise Data Warehouse).
• Good working experience in Dynamics CRM implementation.
• Deep knowledge on Dynamics CRM, SQL Server, Microsoft workflow processes.
• Solid understanding of MDM (Master Data Management) and requirements pertaining to data deduplication, data matching, data scrubbing, data cleansing wrt a UCM implementation plan.
• Experience in Conversion of HIPAA X12 4010 codes to X12 5010 codes.
• Proficient in medical and pharmaceutical terminology and coding outpatient and inpatients diagnosis and procedures using ICD-9, ICD-10 and CPT codes.
• Experience in working with Electronic Medical Records (EMR) and Electronic Health Records (EHR).
• Experience in conducting User Acceptance Testing (UAT)
• Experience in Quality Assurance testing, using automated tools, manual testing and Experience in Sanity testing, Integration testing, Functional testing, System testing, Compatibility testing, Retesting, Regression Testing, Performance testing.
• Experience in conducting training sessions for modified and new processes. Experience in developing training materials, Training documents and User Guides, for new technology and process improvements. Provided training to users and user managers.

TECHNICAL SKILLS

Healthcare Transaction Management Tools: Edifecs (Xengine, HTM, Specbuilder)

Methodologies: Waterfall, RUP, and Agile (Scrum), JAD.

Languages: UML, SQL, HTML, XML, JavaScript’s

Business Modeling Tools: MS Visio, UML, Rational Rose, Enterprise architect, MS Visio.

Web developing technologies: Macromedia, Adobe Dreamweaver MX, Balsemiq, Snagit.

Databases: MySQL, MS-Access, Oracle

Testing Suite: Quality Center, WinRunner, Test Director.

Office Automation: Microsoft Office Suite, Outlook

Management Tools: MS Project, Quality Centre, Open source SERENA

Operating System: Mac OS, Windows 97/2000/XP/Vista/7

PROFESSIONAL EXPERIENCE

Confidential, Columbus, OH

Business Analyst

Responsibilities:

• Developed the scope and vision documents that defined the primary goals, objectives and scope of the project.
• Designed and worked on successfully developing web applications that allow independent sales agents and underwriters for quoting, rating, processing and tracking applications.
• Developed the integrated development life cycle by integrating Rational Requisite Pro, Rational Quality Manager and Rational Requirements Composer (RRC) with Rational Team Concert.
• Involved in generating Test cases for property and casualty Insurances for Different Levels of Business.
• Created screen-mockups using iRise to review the requirements and provide feedback on the screen design. Also, used Microsoft Paint to create ad-hoc screen mock-up to review with the users.
• Responsible for Data Manipulation and Data Validation using SQL queries in a MS SQL Server 2008 environment
• Prepared business requirements Documents (BRD) and got sign off to be used by the developers.
• Designed and developed Use Cases, Activity Diagrams, and Sequence Diagrams using Unified Modeling Language (UML), and with Rational Rose. used the BPMN to GAP Analysis to bridge the gap between business processes.
• Created prototypes of the GUI environment using iRise to be used by the developers during the design phase.
• Document, analyze and define the user and system requirements and use Rational Requisite Pro to manage the requirements.
• Developed detail class diagrams and sequence diagrams using Rational Rose.
• Developed as-is and to-be business processes using BPMN standards.
• Identified and establish scope and parameters of requirements analysis in order to define impact, outcome criteria, and measure-taking actions through interface analysis, prototyping and JRP/JAD sessions with Focus group.
• Documented business requirements for system issues and enhancements using Rational Requisite Pro.
• Worked with the development team during the Design, Build and Test phase of system projects to clarify business requirements as required.
• Used MS Project to manage schedules, deadlines and resources and collaborate on the project.
• Acted as a liaison to the Training team to facilitate them to deploy the training.
• Worked with the Policy and Procedure team as required to define new/updated policies and procedures.
• Provided post production support/analysis and assisted in performing User Acceptance Testing (UAT), performance testing and validated test plans.

Environment: Rational Rose, Rational Requisite Pro, Rational Clear Quest, SharePoint, HTML, MS Project, MS Office, Macromedia Flash, M.S. Visio, M.S. Project, Dreamweaver, J2EE, SQL

Confidential, Overland Park, Kansas.

Business Analyst

Responsibilities:

• Maintained and monitored project progress and status through MS Project.
• Used HIPAA 4010 transactions to support the analysis of current business processes and work with management to improve and implement enterprise solutions to ensure compliance and got involved in designing future state processes for HIPAA 5010 transaction processing EDI’s 837,835, 270, and 271.
• Analyzed HIPAA 5010 related to 837,835, 270, and 271. Transactions and performed gap analysis between the 4010 and 5010.
• Extracted the business requirements from the stakeholders keeping in mind their need for the application and documented them using Rational ReqPro.
• Implemented the entire Rational Unified Process (RUP) methodology of application development with its various workflows, artifacts and activities.
• Analyzed business requirements, tested high level and low level Use Cases and Activity Diagrams / State Chart Diagrams using Rational Rose, thus defining the Data Process Models.
• Conducted the FRS and URS reviews and walkthroughs with designers, developers and stakeholders. Also conducted feasibility and adaptability study.
• Developed the business anomalies workarounds and described them in documentation and presented the matter to the upper management for review.
• Developed non-functional requirements and documented them as Business Rules, Quality attributes and constraint documents.
• Responsible for GAP analysis of ICD9-ICD10.
• Involved with ICD10 implementation testing.
• Involved in Facets Configuration to make sure all information will be sent without any error.
• Effective communication made possible between the developers and the end-clients to guarantee that development efforts were within the scope of the project and the development was as expected.
• Attended Facet’s training and discussion session.
• Held regular JAD meetings with the system architects, developers, database developers, quality testers during the entire project to assure that the critical as well as the minute details of the project were discussed and issues were resolved beforehand.
• Facilitated smooth transition of the project from the project environment to the live environment.
• Worked with QA lead in validating Test Plan and Test Scenarios.
• Executed test scripts in different cycles to get the perfection and logged defects in defect tab of Quality center.
• Used HP Quality Center for tracking Defects and tracing requirement functionality performances.
• Executed test cases manually. Compared and analyzed actual with expected results and reported all deviations to the appropriate individual(s) for resolution.
• Involved in automation testing using QTP.
• Involved in performance testing using Load runner.
• Assisted Business User during deployment in formulating User Acceptance Testing (UAT) for customized application and getting confirmation for product Release

Environment: MS Project, SQL, Rational Unified Process (RUP), Rational Requisite Pro, Rational Rose, Microsoft Visio, QTP, HP Quality centre, Load Runner, Rational Clear Quest, Windows, MS Office, XML, TOAD, Ultra Edit.

Confidential, Pleasanton, CA

Business System Analyst

Responsibilities:

• Gathered Business requirement and converted in to Functional requirement document.
• Helped business leaders understand business requirements and performing gap analysis relative to industry standards and future directions for strategic initiatives.
• Validated the following: 837 (Health Care Claims or Encounters), 835 (Health Care Claims payment/ Remittance), 270/271 (Eligibility request/Response), 834 (Enrollment/Dis-enrollment to a health plan).
• Extensively worked on EDI 834 transaction set and Experience in 835, 270/271, 276/277, & 997 processes of medical claims/underwriting for support and point of reference for the vendor in business issues.
• Identified, Evaluated and recommend solution alternatives analysis.
• Worked with development organizations to ensure successful implementations of designed solution.
• Prepared, Presented, and collaborate on all required deliverables of the technical team.
• Documented high level technical design to enable the integration and implementation of the solution.
• Responsible for understanding the strategic direction, priorities and needs of business leaders.
• Create and maintain templates, schedules, estimates and models.
• Create and maintain technical documentation for architecture, systems, vendor solutions and strategy.
• Coordinated with other project managers and staff to identify cross-project dependencies.
• Coordinated activities of multiple vendors and SME’s and assist in developing Service level Agreement.
• Established and sustained strong ongoing relationship with KP-IT and business partner.
• Determined cost factor involved in integration process of third party vendors.
• Create and identified USE Case from the business requirement.
• Create and maintained Software Architecture Document and Logical Solution Design.
• Organized JAD Sessions to resolve issues and conflicts, and to arrive at quick agreements regarding the system architecture design.
• Participated in various meetings and discussed enhancement and modification request issues.
• Actively participated in enhancement meetings. Involved in the meeting with Business process owners, SME (subject matter experts) and Marketing Team for Requirements gathering in definition stage.
• Worked with the project manager for planning and organizing the project activities, and in communicating with other business center managers and stakeholders of the project.
• Used MS Project for status reporting and planning.
• Involved in Deep Dive analysis of implementing new functionality in the Cost Estimation Engine.
• Heavily worked with various group to identify their need to determine different level of integration.
• Interacted extensively with the third party vendor and the management teams to understand the requirements and to report the status of the assessment effort to the audience.

Environment: Diamond, Xcelys, MS project, UML, MS Visio, Agile, Windows XP, MS-Office Suite, Cognos Report, Share Point.

Confidential, San Diego, CA

Business Analyst

Responsibilities:

• Developed and executed strategic initiatives and programs to enhance existing Medicare claims processing functions in support of corporate initiatives and requirements.
• Recommended changes for system design, methods, procedures, policies and workflows affecting Medicare/Medicaid claims processing in compliance with government compliant processes like HIPAA/ EDI formats and accredited standards like ANSI.
• Worked on ICD 9 ANSI Health codes/HL7 in the claims environment for inpatients and outpatients; reviewed the implementation of the changes made in the systems as per the formats and compliance for EDI usage.
• Participated in development, testing and implementation of new and or revised system enhancements to ensure effective and efficient Medicare claims processing.
• Provided guidance in the investigation and final disposition of complex claim matters from Executive/Senior Management through JAD sessions for analysis and design.
• Used the RUP methodology and related processes for software re-engineering process.
• Monitored claims inventory, cycle time processing and work quality to assure conformity with corporate objectives and departmental goals.
• Produced management reports using COGNOS relative to inventory, productivity, accuracy and cycle time and maintained team leave documents and artifacts in web based MS Share point
• Maintained regular interaction with all Metro Plus departments relative to Medicare policies, procedures and regulatory requirements and maintained ad hoc reports using MS Access.
• Reviewed new contract business requirements relative to benefits and Medicare claims processing.
• Converted business needs to technical documents. Wrote USE cases and prepared the Business Requirements Documents for various requirements collected from the business users.
• Used MS Visio and UML for generating class diagrams and activity diagrams.
• Conducted special projects /studies; participates in various work groups upon request
• Involved in Data Analysis for the data warehouse and data mart system for the process of report generation of the data.
• Wrote requirement document for Data Extraction, Data Analysis and Loading (ETL) process of collected data as a part of data mapping procedures.
• Used SQL queries for defining such requirements
• Performed UAT testing with client and supported all phases of testing with QA team and managers.
• Summarized audit reports for clients and teams regarding policies and procedures
• Participated in various types of Audits regarding claims and its Financials.

Environment: RUP, Rational Rose, PL/SQL, HTML, MS Office, MS Visio, EDI, Requisite Pro, Rational Clear Quest, Rational Clear Case, UML, MS Office.

Confidential

Jr. Business Analyst

Responsibilities:

• Gathered Business Requirements. Interacted with the Users, Designers and Developers, Project Manager and SME’s to get a better understanding of the Business Processes, and Analyzed and Optimized the process.
• Prepared Business Requirement Document and then converted business requirements into Functional Requirements Specification and Technical Specification using Rational RequisitePro.
• Identified Use Cases from the requirements. Created UML Diagrams including Use Cases Diagrams, Activity Diagrams/State Chart Diagrams, Sequence Diagrams, Collaboration Diagrams and Deployment Diagrams, Data Flow Diagrams (DFDs), ER Diagrams and Web Page Mock-Ups using Rational Rose and MS Visio and thus defining the Business Process Model and Data Process Model.
• Assisted in selecting the technology for the application based on Cost-Effectiveness and Quality with an eye towards the future.
• Prepared Functional and Behavioral document that describe the detail design of the application
• Used the Unified Change Management (UCM) tool, Rational ClearQuest to maintain and track the stakeholders requested enhancements and changes.

Environment: Rational Suite (RUP, UML with Rational Rose, Rational RequisitePro, ClearQuest, ClearCase), MS Visio, Visual Basic, MS Access, Microsoft Windows.

Confidential

Data Analyst/Business Analyst

Responsibilities:

• Involved in understanding Logical and Physical Data model using Erwin Tool.
• Involved in rebuild testing of the BI Reports from Cognos to Crystal Reports.
• Writing complex SQL queries for data validation for verifying the ETL Mapping Rules.
• Performed Metadata Analysis by Data Profiling and acted as a data steward in maintaining the quality metrics on a continuous basis. Conducted Data Migration and Data Cleansing.
• Responsible for creating different sessions and workflows to load the data to Data Warehouse using Informatica Workflow Manager.
• Actively involved in data warehouse and mart design sessions for both Logical and Physical design.
• Used Master Data Management (MDM) technology, tools to create and maintain consistent and accurate lists of Master.
• Responsible for Import and Export databases between Microsoft Access, Microsoft Excel, Text, or SQL.
• Extensively tested the reports for data accuracy and universe related errors.
• Used SQL tools to run SQL queries and validate the data loaded in to the target tables.
• Validated the data of reports by writing SQL queries in PL/SQL Developer against ODS.
• Involved in user training sessions and assisting in UAT (User Acceptance Testing).
• Wrote data conversion and data migration scripts for ETL process
• Transferred data from flat files, Excel spreadsheets and heterogeneous data to and from SQL Server using DTS and also used BCP and Bulk Insert.
• Created Test input requirements and prepared the test data for Data Driven testing.
• Created ETL execution scripts for automating jobs.
• Involved in extensive DATA validation using SQL queries and back-end testing
• Used workflow manager for session management, database connection management and scheduling of jobs.

Environment: SQLServer 2000/2005, TOAD, Crystal Reports, Oracle 9i, PL/SQL, IBM DB2, Microsoft Visio, MS Excel, Windows.