SUMMARY

• 7 years of experience in the Healthcare, Manufacturing and Operations; Business consulting experience in all the stages of SDLC including Requirements Gathering, Analysis, Design, Architecture, Development, Integration, Implementation, Administration, Enhancement, Testing, Production Support and Customer Liaison and Training.
• Excellent knowledge of Patient Protection and Affordability Care Act (PPACA), HL7, Health Insurance Exchange (HIX), EMR/EHR.
• Solid expertise to analyze and synthesize results from Joint Application Development (JAD) and in Rapid Application Development (RAD), design solutions that are acceptable to the customer and feasible for the developers.
• Experience in using methodologies such as UML (Unified Modelling Language), OOAD (Object Oriented Analysis and Design) and APM (Agile Project Management).
• Expertise in Rational Unified Process (RUP), Rational Requisite Pro, Rational Clear Quest, Microsoft Project, Rational Rose and MS Visio for business process modelling and designing data flow diagrams (DFD).
• Proven skills in conducting GAP analysis, User Acceptance Testing (UAT), SWOT analysis, Cost Benefit analysis, ROI Analysis, Requirement Traceability Matrix (RTM), Rational Unified Process (RUP) and SCRUM methodology.
• Preparing graphical depictions of use cases including State Diagrams, Activity Diagrams, Sequence Diagrams, Use Case Diagrams, and Component - Based Diagrams, Collateral Diagrams, including the Business Workflow Chart.
• Very good understanding of Relational Database, Object Oriented Programming, Data Modelling, Data Mapping and Data-warehousing; Excellent skills in data analysis, impact analysis, risks analysis
• Creating Functional specification Documents (FSD), AS-IS and TO-BE workflows, Test Plans and Test Cases.
• Experience in transformation of HIPAA 4010 to HIPAA 5010 in the existing claims processing integrated system; Medicare and Medicaid projects; Changing to and testing of new MMIS;
• Excellent knowledge of HIPAA X12 EDI transaction codes such as 270/271 (Inquiry/Response Healthcare Benefits), 276/277 (Claim status), 834 (Benefit enrollment), 835 (Payment/remittance advice/ Explanation of benefits), 837 (Health care claim).
• Knowledge of ICD-9-CM and ICD -10-CM coding and claims processing; Managing Test Director for the test team, SQL, Oracle EBS R12, Supply chain analysis.
• Worked extensively on B2B applications and B2C applications in transaction processing and E-commerce applications.
• Excellent Analytical, Interpersonal, Communication and Presentation skills.

PROFESSIONAL EXPERIENCE

Confidential, Seattle, Washington

Senior Business Analyst

Responsibilities:

• Created Business Requirement Document (BRD) by aiding in the collection of the User Requirements and Business Requirements; Provided appropriate scope of work for the technical team to develop the prototype.
• Incorporated and implemented HIPAA standards, Electronic Data Interchange (EDI 835, 837, 270, 271), transaction syntaxes such as ANSI X12, ICD-9, ICD-10 coding and HL-7.
• Conducted AS-IS and TO-BE analysis and assisted in developing process models and system integration structure; Conducted business process analysis using GAP analysis.
• Extensively involved in the analysis of HIPAA compliance and EDI transaction sets and actively participated in designing the EDI transactions using the new HIPAA 5010 version including the ICD-10 codes.
• Facilitated Joint Application Development (JAD) sessions to speed up information flow among the stakeholders as well as the project team.
• Test cases and test plans preparation according to the test strategies defined in the project guidelines.
• Developed a very effective tracking system using Requirement Traceability Matrix (RTM) to track and maintain stakeholder requests for enhancements and changes during the project life cycle.
• Identified critical areas of the business risks, modified business processes to manage and reduce risk using Risk Management Process.
• Handled the knowledge transfer of EDI format used in electronic documentation to vendors as per the requirements.
• Worked with Subject Matter Expert (SME) to ensure the extracts are properly mapped; Used SQL for mapping and querying; Assisted in creating requirement document for ETL - Data Extraction, Data Analysis and Data uploading process.
• Involved extensively in various types of Audits in different stages; Gained Compliance Audit experience through exposure to different legal and audit consulting groups.

Environment: MS Office, Quality Center, SQL Server, Facets 4.21, MS Project, Server, MS Visio, Unix, J2ee, Java, XML, Mainframes and Rational ClearQuest, ClearCase, Windows XP

Confidential, Frederick, MD

Senior Business Analyst

Responsibilities:

• Facilitating interactive sessions with stakeholders to facilitate a smooth understanding of Project scope and feasibility.
• Conducting JAD sessions with members of Business and Technology teams to research and identify the Requirements and investigate their impact.
• Develop the Business Requirements Specifications document ensuring consistency with Sarbanes Oxley considerations.
• Preparing Use Case Diagrams, Workflow Diagrams and Entity Relationship Diagrams using MS Visio to define the business process.
• Identifying the Data elements and Attributes and preparing a Conceptual Data Model.
• Preparing Screen Mockups and Demo presentations for the application.
• Defining and building prototypes for necessary reports to provide the management a measure of success for each Life Stage/ Value as it pertains to the participant’s experience.
• Interacting with the Technical developers and preparing the Functional Specifications document and participating in Technical design walk-throughs to ensure they meet stakeholders’ expectations.
• Working closely with Project Manager and Technical Lead to identify, research and drive issues and risks to resolution.
• Interfacing effectively with external Vendors to ensure the Technical solution meets the Stakeholders’ expectations.
• Interacting with Testing team to create Testing plans and System and Functional tests cases and assisting with executing the same.
• Conducting UAT and obtaining Business sign-off.
• Developing Training material and Conducting Training session for end users.
• Performing Analysis & Estimation of Enhancement requests and implementing effective Change Management strategy.
• Communicating frequently with all team members and stakeholders and following up when required to ensure project timelines are met and to ensure project success.

Environment: Microsoft Office, Tomcat, JBoss, Windows XP, Business Objects, Toad, MS Visio, Oracle, HTML

Confidential, Chicago, Illinois

Business Analyst

Responsibilities:

• Developed proposed HIPAA 5010 transaction processing design for EDI’s 837 and 835, analyzed HIPAA 5010 compliance related to 837, 835 and 834.
• Implemented an integrated RUP solution with complete line of traceability for all the artifacts of web development projects
• Assisted in creating the Workflow plans, ICD-9-CM and ICD-10-CM coding and claims processing.
• Conducted GAP analysis of the current business process including modeling of business activities from conceptual to procedural level using top-down approach.
• Analyzed and identified possible pitfalls using SWOT analysis and to foolproof implementation of the project.
• Proposed strategies to implement HIPAA 4010 in the new MMIS and eventually transform to HIPAA 5010
• Examined, analyzed and created Test Plan, Use Case Model and Test Procedures based on RUP methodology.
• Conducted Feasibility Study and Impact Analysis for the proposed enhancements and managed the enhancements and changes using the Requirement Traceability Matrix (RTM).
• Determined the proper structure, key elements and optimal design for the database using Rational Rose.

Environment: Microsoft Office( MS Word, MS Excel, MS PowerPoint, MS Visio, MS Access),Rational Requisite, RUP, XML, VB.NET, Oracle, RUP, UML, SQL, Test Director.

Confidential, Lansing, Michigan

Business Analyst

Responsibilities:

• Developed the stakeholder list, created a stakeholder assessment matrix, gathered requirements from stakeholders for provider management and member management.
• Identified and validated business rules and data elements; Developed and maintained a requirements work plan and assessed the performance metrics of the team members.
• Modeled the ‘AS-IS’ and the ‘TO-BE’ process flow and analyzed the gap; Developed and initiated the action plan steps to fill in the gaps.
• Conducted Risk analysis and developed mitigation plans; Conducted Impact analysis when there is any change in the requirements and updated the Business Requirements Document (BRD) and Systems Requirements Specification (SRS).
• Facilitated meetings with the technical team and client team to analyze the current process and gather requirements for the proposed process.
• Proposed strategies to implement HIPAA 4010 in the new MMIS system.
• Developed the User Interface (UI) prototypes to capture and validate requirements and spike solutions to the current problem.
• Designed Functional Specifications for the target physical database.
• Facilitated JAD sessions for Requirement Validation with Dept. of Health & Human Services (DHHS) to gather requirements for the new MMIS.
• Developed UAT test cases associated with the functional requirements.
• Maintained a bi-weekly status report for the requirements team and incorporated the same to the PMO status reports send to CMS.
• Analyze EDI - X12 data elements captured by the existing system to validate it against the data elements required for new system.
• Participated in developing test plan, test scripts, and test scenarios and designed user documentation.
• Worked with legacy team in developing BRD for multiple system change requests and participated in system testing.
• Used Microsoft SharePoint as the version-tracking tool for managing the requirements documentation.
• Create monthly/weekly status reports to update the project schedules & deliverable plan.
• Examine the system design deliverables & validating it against the Request for Proposal (RFP).

Environment: MS Office, Windows 2000, .NET, MS Visio, MS SharePoint, TFS, MS Project, MS Visio, SQL, Oracle, SOA, HTML

Confidential, Nashville, Tennesse

Business Analyst

Responsibilities:

• Interacted and coordinated with stakeholders and key project personnel to gather the functional and non-functional requirements during JAD sessions. Analyzed the current business process, created AS-IS work flow chart to illustrate the current system.
• Created Business Requirement Document (BRD) by gathering user requirements and business requirements.
• Developed Requirement Traceability Matrix (RTM) to define each technical requirement and to track stakeholder requested enhancements and changes..
• Responsible for 100% HIPAA compliance by conducting GAP analysis, mapping, implementation and testing of Medicaid claims.
• Instrumental in assisting the project manager in creating the business case and project plan.
• Acted as a liaison between the internal and external business community such as customer service, membership management, advance healthcare management, provider agreement management and the project team.
• Analyzed the current business process - claims, recipient eligibility, enrollment etc. and worked with management to improve and implement enterprise solutions to ensure highest compliance rate; Ensured IT and business representatives are properly aligned by understanding the data requirements and priorities.
• Created Use Cases, Activity diagram, Sequence diagram, Collaboration diagram that include functional and non-functional specifications by using UML based Rational Rose.
• Extensively involved in updating internal processes data collection and data reporting; Used Rational Clear-Quest, Configuration management and Version control with Clear-Case to test for any defects and bugs.

Environment: RUP, MS Office, Windows XP, MS Visio, UML, Rational Test Manager, Ultra Edit