SUMMARY

• Business Analysis Professional with more than 6+ years of experience in the areas of Business Analysis, Project Management, Strategic Planning for Business Intelligence (BI), Data Warehousing, Business Process Modeling, Business Process Improvement, Business Process Reengineering, Design, Development, and Testing.
• Strong experience in working in SDLC for various methodologies included RUP, Agile, and other internal methodologies.
• Strong experience with developing Use Cases, Test Cases and Traceability Matrix.
• Strong experience in working as liaison between Marketing, Customer Care, Finance, IT development, Clinical Trial Management Systems, Regulatory Submissions, Accounting, Claims, Billing and Field Sales Professionals.
• Strong experience with insurance administration systems included Actuarial, Policy Application, Eligibility, Enrollment, Underwriting, Claims, Billing, and Payments.
• Expert in translating business requirements & user expectations into detailed Functional Requirements Specifications (FRS) by employing Unified Modeling Language (UML).
• Synthesize User Interface and Business Process Requirements and translate it into the Business Requirement Document (BRD), to be used as input to the functional design specifications.
• Expert in Developing Software Requirements Specifications (SRS) with detailed Business Rules from FRS or from Business Requirements Document.
• Strong experience in facilitating UAT with the stakeholders and the business users.
• Diverse experience in Insurance Claims, Healthcare and Pharmacy organization as a Business Analyst including payer/agent operations and complete understanding of Business Process Flows and Case Tools.
• Strong experience of working with Medicare and Medicaid insurance data, Medicare parts A, B, C & D, and Insurance Claims.
• Excellent in creating Sequence Diagrams, Collaboration diagrams, Activity Diagrams, and Class Diagrams.
• Strong Testing Experience in HIPAA X - 12 EDI (Insurance/Health Series (INS) such as 270/271, 274, 276/277, 278, 820, 834, 835, 837, and Version 5010.
• Strong knowledge of current industry standards, such as HIPAA, CAQH, 21 CFR part 11, 21 CFR part 820, cGMP, CAPA.
• Sound knowledge and experience of ICD-9 & ICD-10 codes.

TECHNICAL SKILLS

Methodologies: RUP, UML, SDLC, CMM, Waterfall, Agile.

Testing Tools: Rational Enterprise Suite, Mercury Test Director, WinRunner, Load Runner

Business Modeling Tools: Rational Rose, DOORS, Microsoft Visio, Erwin

Version Control Systems: Rational Clear Case, PVCS, Documentation

Project Management: MS Project, Requisite Pro, Rational Soda, MS Excel

Management Tool: Rational Clear Quest, Mercury Test Director

Programming Languages: SQL, PL\SQL, Visual Basic, HTML, C, C++

Databases: MS Access, SQL Server, Oracle 9i,10g, DB2

Operating Systems: Windows 95/98/NT/2000/XP/Vista, UNIX, MS Dos, Mac OS

Reporting Tool: Microsoft Front Page, Macromedia Dreamweaver 8, Microsoft Office (Word, Excel, PowerPoint), MS Project, Lotus Notes SAP Business Objects

PROFESSIONAL EXPERIENCE

Business Analyst

Confidential, Chicago, IL

Responsibilities:

• Adhered to HIPAA for health insurance & Medicare claims, responsibility included from functional requirement specification to testing the claims for HIPAA-compliant format and also to ensure all NCPDP formatting standards.
• Reviewed and implemented the change requests from CMS (Center for Medicare Services).
• Analyzed Healthcare transaction flow for HIPAA Healthcare Transactions like 834, 835, 270, 271, 276, 277, and 278.
• Requirements specification for Indemnity Healthcare plans and Indemnity Payer.
• Performed Requirements Gathering and Analysis, discussed with SME (Subject Matter Experts), and ensured that contributors and all key stakeholders were motivated to complete assigned tasks.
• Facilitated Joint Application Development (JAD) Sessions for communicating and managing expectations. Managed the Requirements (Business as well as System requirements), performed requirements analysis along with the creation of Use Case Scenarios. Modeling of the business and application using Rational Unified Processing (RUP) and Unified Modeling Language (UML).
• Created Process Work Flows and responsible for preparing Business Requirement Document (BRD), Software Requirement Specifications (SRS), and Functional Specification Document (FSD).
• Researched and helped resolve data inquiries by utilizing SQL queries via Toad.
• Participated in developing test plans and test procedure templates and guidelines to be used by the project team with detailed screen layouts with regards to various types of corporate actions.
• Performed Defect Tracking using Rational ClearQuest.
• Worked with QA team to design test plan and test cases for User Acceptance Testing (UAT)

Environment: RUP, UML, Rational Requisite Pro, Rational Rose, Rational ClearQuest, MS Visio, TOAD.

Business Analyst

Confidential, East Hanover, NJ

Responsibilities:

• Performed Gap analysis, requirements gathering and enhancements to existing systems and processes.
• Prepared use case models based on Business Requirement documentation gathered through interaction with users and stakeholders.
• Implemented RUP, which included requirements, specifications, design, analysis.
• Created and maintained the Requirements Traceability Matrix (RTM).
• Worked with the Project Manager on various Project Management activities like keeping track of Project Status, Deadlines, Environment Request, and Compliance Issues.
• Designing and plan BI solutions with SQL.
• Ensured use cases were consistent and covered all aspects of the Requirements document.
• Identified and analyzed the data requirements for the various site teams and made sure that the required data is available in the testing environment.
• Worked directly with software engineers to ensure clear communications on requirements and defect reports.
• Designed and developed scenarios based on business requirements.
• Involved in Functional System Testing, Integration Testing, Regression Testing, and User Acceptance Test before releasing the application.
• Validated the scripts to make sure they have been executed correctly and met the scenario description.
• Involved in project status meetings, QA review meeting, and System Test meeting.

Environment: Rational Requisite Pro, MS Visio, Load Runner, Win Runner, ORACLE, Windows NT.

Business Analyst

Confidential, Tampa, FL

Responsibilities:

• Involved in framing the Technical Specification of the Enterprise structure, interacting closely with the end users and take repeated documented feedback.
• Documented the current process, suggested future state process improvement, identified bottlenecks, and modeled current and future state processes using Rational Rose.
• Reviewed and analyzed the business requirements document to derive the functional specifications document and assisted in the preparation of System Requirement Specifications.
• Documented the detailed Technical Specification for future reference.
• Developed and executed real world lending scenarios based on client’s business requirements to ensure functional/non functional integrity.
• Implemented the entire Rational Unified Process (RUP) methodology of application development with its various workflows, artifacts and activities.
• Developed Use Cases using UML based on the needs of Business Users.
• Used MS Office suite (Word, Excel, Access, Visio, Power Point, Outlook, and Project) for project tracking, documentation, and presentation.
• Collected and documented business processes as well as business rules.
• Participated in the identification, understanding, and documentation of business requirements, including the applications capable of supporting those requirements.
• Identified, organized, and documented the changing requirements of the project.
• Conducted end user training sessions (125 + users) for exercising full use of the application.

Environment: Windows 2000, IBM Rational Suite (IBM Rational Requisite Pro, IBM Clear Case) Oracle 9i, SQL.

Junior Business Analyst

Confidential

Responsibilities:

• Developed/Communicated/Documented overall project plan using MS Visio.
• Involved in interviewing business area experts, asking detailed questions and carefully recording the requirements in the format so that it can be reviewed and understood by both business and technical people.
• Gathered user and business requirements through interviews, surveys, prototyping and observing from account managers and User Interface of the existing system.
• Prepared businessprocess models which include modeling of all activities of the business from conceptual to procedural level.
• Used brainstorming and storyboarding techniques to derive ideas from the stakeholders.
• Developed non-functional requirements and documented them as Business Rules, Quality attributes, constraints documents.
• Utilized RUP to configure and develop process, standards, and procedures.
• Also involved in feasibility analysis of the project.
• Validated technical designs created by IT developers against functional specifications.
• Created reports for business analysis purposes using SQL, MS Excel and MS Access.

Environment: RUP, UML, Rational Requisite Pro, Rational Rose, Rational ClearQuest, MS Visio.