SUMMARY

• Healthcare Business Analyst with more than 7 years of experience in HealthCare, Finance, Pharmacy, Insurance Industries.
• Expertise in documenting the Business Requirements Document (BRD), generating the UAT Plan, maintaining the Traceability Matrix and assisting in Post Implementation activities.
• Expert in creating Use Cases, Use Case Diagrams, Class Diagrams, Sequence Flows using MS Visio and UML concepts for EDI 837, EDI 835, POA (Present On Admission No), COB (coordination of benefits)
• Experience in business requirements gathering and writing EDI. Versed on HIPAA regulations and requirements. Experienced in HIPAA Transactions 270/271, 278, 837, 835, 834, 820, 276/277 & ICD9/10; 4010/5010.
• Performed GAP analysis between 4010A1 and I, P, D and risk analysis of existing system and evaluated benefits of new system.
• Worked on preparation of Companion Guide for EDI 837 I, P, D and EDI 835 D according to HIPAA 4010A1 and 5010 guidelines.
• Web Portal Development - worked in the development of a web portal used by providers and members to view referral information.
• Created Use Cases and Process Flow diagrams for the Referral Web Portal. Analyzed current and future processes for the portal.
• Knowledge and expertise in working with Claims, Provider, Enrollment, Finance, Benefits and Vendor Management Business Areas.
• Worked on ETL during Data Conversion Requirement and Perform SLA.
• Experience in analyzing test plans and test cases and navigating through the test lab.
• Defect Management / Bug Fixing - Fully involved in the process of defect identification and resolution using tools like Quality Center.
• Maintained the Traceability Matrix table to track the Business Requirements to the design to the testing keeping track of all requirements in the BRD.
• Change Control Process - Led the Change Control Process for changes submitted for the BRD once the document was submitted to IT department.
• Experience in conducting User Acceptance Testing (UAT) and documentation of Test Cases.

TECHNICAL SKILLS

Standards & Methodologies: HIPAA, Six Sigma, SDLC, RUP, Waterfall, Agile Methodology, HL7

Business Modeling Tools: UML, Microsoft Visio, Enterprise Architect, SnagIt

Programming Skills: SQL

Project Management: Microsoft Project, Microsoft Office

Databases: MS SQL Server, MS-Access.

Environment: MS Windows 95/98/XP, MS Windows Server 2000

Testing Tools: Quality center

PROFESSIONAL EXPERIENCE

Confidential

Sr Business System Analyst

Responsibilities:

• Work closely with Project stakeholders, SMEs, and staff to understand the requirements and specifications for new applications along with re-engineering the existing applications.
• Deliver a complete set of Business Requirements focused on claims processing, Benefit administration, member management and Customer Service.
• Elicit, analyze, specify, and validate the business needs of project stakeholders. This includes interviewing stakeholders and gathering and compiling user requirements.
• Prepared High level scope documents, business requirement document and technical specification document.
• Created User manual guide for various applications to report issues and incidents and conducted Web ex demo sessions to all the users for various application for Incident Service Management.
• Performed Gap Analysis of business rules, business and system process flows, user administration and requirement
• Developed Use Case with UML for new product functionality, workflow, screen mock-ups and conversion requirements.
• Change Control Process - Led the Change Control Process in Clear quest for changes submitted for the BRD once the document was submitted to IT department.
• Conducted JAD sessions with the management, users and other stakeholders for open and pending issues to develop specifications
• Worked with QA team to design Test Cases for UAT and conducted Traceability Matrix and SLAs.
• Seek flexible, globally applicable system solutions to client requirements (HIPAA compliancy)
• Conducted Impact Analysis for transforming existing system into newer system.
• Validated Technical designs created by IT developers against functional requirements

Environment: DB2, LDAP, MOM Server, Java, html, SnagIt 9.0, MS Visio, Word, Excel, PowerPoint, Access, SQL, RUP, IBM Rational ClearQuest, and IBM Lotus Notes.

Confidential

Business Analyst

Responsibilities:

• Gathered Business Requirements from the Subject Matter Experts (SMEs) and documented the requirements in the BRD and creating Service Level Agreements (SLA) for 5010.
• Ensured all artifacts compiled with HIPAA 5010 policies and guidelines.
• Worked on EDI 834, 835,837 as per HIPAA guidelines.
• Assisted in process modeling, conducted and participated in JAD sessions with system users and stakeholders for base lining architecture.
• Performed the detail comparison between 4010A and 5010 to identify differences across loop structures.
• Knowledge and experience on Claims Billing, Claims, Payment Processing in relation to HIPAA, EDI 4010 codes 834, 835, 837.
• Prioritized outstanding defects and system problems, ensuring accuracy and deadlines were met.
• Performed User Acceptance Test (UAT) for 5010 and ICD 10 codes.
• Coordinated work plans between project manager and client.
• Created Business Requirement Documents and Technical Requirement Documents for 5010 from 4010A as a result of meetings with the Business Areas. Obtained business sign offs on the documents after reviewing the final documents with them.
• Performed Gap Analysis of business rules, business and system process flows, user administration and requirement for HIPAA 4010 and 5010.
• Developed Use Case with UML for new product functionality, workflow, screen mock-ups and conversion requirements.
• Prioritized business and system problems analyzed legislation and conducted Impact Analysis.
• Change Control Process - Led the Change Control Process for changes submitted for the BRD once the document was submitted to IT department.
• Documented the UAT Plan for the project and worked with the UAT Team to ensure every acceptance criteria for the requirements has been included in the UAT task plan.
• Maintained the Traceability Matrix table to uniquely trace the identified business requirements to general design to testing as proof that requirements requested have been developed into a solution and that it has been tested and tracked.

Environment: HIPAA 4010/5010, EDI 837, 835, 834, ICD 9 CM & ICD 10 CM, MS Visio, Word, Excel, PowerPoint, SQL.

Confidential

Business Analyst

Responsibilities:

• Gather requirements and document the proposed processes to the existing system. Modules included: Claims Processing Files and HIPAA Guidelines adherence across the company.
• Validated technical designs created by IT developers against functional specifications.
• Claim Transactions and Billing Transactions - Created flows for adequate matching of Claims. Matched Billing File and EDI Claim File records upon receipt.
• Conducted risk engineering to derive and execute action plans on time.
• Prepared business process models, used Visio to create Use case diagrams and conducted Impact Analysis.
• Performed GAP and risk analysis of existing system and evaluated benefits of new system.
• Conducted UAT, worked with QA team to design Test cases.
• Testing - worked with QA team and analyzed Test Scripts using Test Director/Quality Center, maintained Traceability Matrix and coordinated with developers to quickly resolve the defects associated with them.
• Conducted JAD sessions with the management, users and other stakeholders for open and pending issues to develop specifications.
• Analyzed and evaluated User Interface Designs, Technical Design Documents and Quality Assurance Test Conditions the performance of the application from various dimensions.
• Updated System Change Request (SCR) forms and applied change request and versions.

Environment: HIPAA 4010/ 5010, EDI 837, 835, 276, 277, 270, 271, MS Visio, Word, Excel, PowerPoint, Enterprise Architect, SQL.

Confidential

Health Analyst

Responsibilities:

• I was involved in dental and medical software which are key to health administration.
• Dealt with various insurance companies to work for dental claims, billing and payments through software.
• Gather requirements and document the proposed processes to the existing system. Modules included: Claims Processing Files and HIPAA Guidelines adherence across the company.
• Enhanced applications associated with Claim Numbers so that duplicate Claim Numbers could be allowed in the system. Updated the Electronic Claims, EDI 835 D, Confidential t Screen and Sales Administration processes.
• Was involved in the ICD 9 CM Diagnosis and Procedural Code changes for Healthcare Entities like Payers, Employer Groups and Providers.
• Claim Transactions and Billing Transactions - Created flows for adequate matching of Claims. Matched Billing File and EDI Claim File 10A1 records upon receipt.
• Deliver a complete set of Business Requirements focused on claims processing, Benefit administration, member management and Customer Service.
• Deliver platform related specifications such as security, performance, and capacity, Standard code sets such as ICD-9, HIPAA and DRG etc.
• Documented Gap Analysis on EDI 837 D.

Environment: HIPAA 4010/ 5010, EDI 837D, 835D, 270, 271, 277, 276, MS Office Tools, UML, Ms Visio, Quality Center.

Confidential

Business Analyst

Responsibilities:

• Deliver a complete set of Business Requirements focused on claims processing, Benefit administration, member management and Customer Service.
• Deliver platform related specifications such as security, performance, and capacity, Standard code sets such as ICD-9, HIPAA and DRG etc.
• Elicit, analyze, specify, and validate the business needs of project stakeholders. This includes interviewing stakeholders and gathering and compiling user requirements.
• Met with report users and stakeholders to understand the problem domain, gathered customer requirements through surveys, interviews (group and one-on-one) along with JAD sessions
• Manage and track the status of requirements throughout the project lifecycle; enforce and redefine as necessary and leveraging these processes.
• Liaised with business and functional owner during risk engineering and high level review sessions to derive and execute action plans, meeting deadlines and standards.
• Conducted UAT, GAP Analysis and Impact Analysis for transforming existing system into newer system.
• Created Use Case documents, define Use Case diagrams and Activity diagrams.
• Validated Technical designs created by IT developers against functional requirements and perform Service Level Agreement (SLA) and Extraction Transformation And Load (ETL)
• Verifying Test Cases from Uses Cases and creating Traceability Matrix.

Environment: MS Office Tools, UML, Ms Visio, Windows XP, MS Project 2003, Sharepoint.

Confidential, New Jersey

Business Requirements Consultant

Responsibilities:

• Analyze client’s data and provide technical support to new client installations.
• Gathered business requirements, documented and delivered functional specification documents and assisted architecture analysis and design using UML tools.
• Conducted Joint Application Development (JAD) sessions with stakeholders throughout SDLC to resolve open issues.
• Define and document client requirements for installations and manage requirements with changes.
• Seek flexible, globally applicable system solutions to client requirements (HIPAA compliancy)
• Created vision, scope and Use Case documents, business process models, Use Case diagrams, Activity diagrams.
• Performed GAP and Risk Analysis of existing system and evaluated benefits of new system.
• Applied change request, versions and addendums.
• Worked with QA team to design Test Cases for UAT and conducted Traceability Matrix and SLAs.
• Collaborative work with Account Managers to proactively design programs to address market demands.
• Analyze claim files, after client installation, to ensure processing accuracy.
• Work with client to develop test scenarios, organize and coordinate testing and review testing results
• Adopt new Healthcare Level 7 (HL7) interface rules and help customer understand when needed

Environment: HIPAA 4010, EDI, MS Office Tools, UML, Ms Visio, Quality Center.