SUMMARY

• Over 7+ years of experience as a Sr. Business Analyst in Healthcare Industries.
• Strong Knowledge of UML, RUP, Rational Tools.
• Proficient in creating Sequence Diagrams, Collaboration diagrams, Activity Diagrams, Class Diagrams using Rational tools and Microsoft Visio.
• Good understanding of Relationship Database Management System (RDBMS).
• Experienced writing queries in SQL blocks.
• Experienced in handling Change Management and Release Management.
• Experienced in conducting GAP analysis, User Acceptance Testing (UAT), SWOT analysis, Risk Analysis and mitigation plan, Cost benefit analysis and ROI analysis.
• Strong knowledge of Business Process Modeling, Business Intelligence and Business Architecture.
• Strong knowledge of the Software Development Life Cycle methodologies like Agile and Waterfall models.
• Experienced in interacting with business users to identify their needs, gathering requirements and authoring Business Requirement Documents (BRD), Functional Requirement Document (FRD) and Software Requirement Specification (SRS) across the deliverables of a project.
• Experienced in facilitating Joint Application Development (JAD), Rapid Application Development (RAD) and Joint Requirement Planning (JRP) sessions, interviews, workshops and requirement elicitation sessions with end - users, clients, stakeholders and development team.
• Experienced with Iterative approach for Software Development as per Rational Unified Process (RUP). Involved in inception, elaboration, construction & transition phases using rational tools like Requisite Pro, Clear Case and Clear Quest during various phases of RUP.
• Worked as a business system analyst(BSA) to maintain the relationships between Business People and Programmers
• Built and maintained the Dashboard for the project.
• Extensive knowledge of Medicaid, Medicare, Procedural and Diagnostic codes and ClaimsProcess. Also have worked on FACETS.
• Experience in EDI automated first-pass claim adjudication, requiring thorough understanding of claim processing, both front and backend operations.
• Experience with ANSI X12N translations that are HIPAA mandated (837, 835, 270/271, 276/277).
• Facilitated interviews, workshops, JAD sessions and requirement elicitation sessions with the management, SMEs, Business User Groups and the IT Groups.
• Extensive experience with health insurance claims, enrollment, eligibility verification for members and providers, Web portal enhancements, and backend payment cycle.
• Knowledge of Data Warehouse life cycle, Data Mart design concept.
• Sound Knowledge of Medicaid Management information System (MMIS), PPO, EMR/EHR, CMS, HMO, HL7 standards and HIX (Health Insurance Exchange).
• Extensively worked on some phases of data warehousing and business intelligence projects like data mining, data cleansing, data modeling for data mart, ETL, Indexing, data updating plan, data presentation to business users, auditing, backup and recovery.

TECHNICAL SKILLS

Business Skills: Business Process Analysis & Design, Requirement Gathering, Use Case Modeling, JAD/JRP Sessions, Gap Analysis and Impact Analysis.

Methodology: RUP, Agile, OOAD and Waterfall.

Languages: C, C++, SQL, PL/SQL, HTML and XML.

Management Tools: Rational Rose, Requisite Pro, Clear Quest, Clear Case, Serena Team Track and MS Visio.

Testing Tools: HP Quality Center, Win Runner, Load Runner and TOAD.

Data Modeling Tools: ERwin, Informatica 7.1.1/6.5

Database: Oracle 8i/9i/10g, DB2, MS SQL Server.

Operating Systems: UNIX, Windows 95/2000/NT/XP, and MS-DOS.

Microsoft tools: MS Office 2003 (Word, Excel, Power Point, Outlook), MS SharePoint, MS Visio, MS Project, MS Access and MS FrontPage.P

PROFESSIONAL EXPERIENCE

Confidential, Minneapolis, MN

Business Analyst

Responsibilities:

• Worked on improving the monitoring process and identifying /documenting problems or faults.
• Worked on profile dashboard (Birthday, Pre registry, Mobile Program, Student Deals, etc). Also worked on account information like username and password.
• Ensured all artifacts complied with corporate SDLC Policies and guidelines.
• Conducted interviews with clients to analyze their data.
• Performed GAP analysis of business rules, business and system process flows, user administration, and requirements. Ensured POS PCI compliance requirements were met.
• Developed use case with UML for new product functionality.
• Analyzed Ad hoc reports with SQL, daily and weekly report generation and maintenance procedures to create requirements and deliver to vendors.
• Gathered requirements and translated the business details into the Functional Specification Documents that described the different types of processes.
• Identifying faults so as to perform solution analysis on the failed component in the shortest time possible. This leads to reduction in customer impact, diagnostic time or downtime in general and, therefore, increased system availability.
• Coordinate workshops and brain storming sessions.
• Created and managed requirements throughout the project using CALIBER RM.
• Analyzed and Documented Sales transaction data.
• Created application supporting documents including Non-Functional Requirements, user manuals, training material etc.
• Document all Data Mapping and transformation processes in the Functional Design documents based on the business requirements.
• Worked as a bridge with business and functional owner during risk engineering sessions and high-level review sessions to derive and execute action plans, meeting deadlines and standards.
• Analyzed the data flow by looking up different APIs. Had a different API for each system/service to see if the data has reached the specific system
• Used Axure for web designing and documentation. Analyzed the current wireframe and created requirements, BRD’s etc.
• Prepared PPT and presented sales data to finance, payment, inbound and outbound teams.
• Analyzed and Research store activities of Cashier and Guest Service Team Leader (GSTL) to make the POS system work accordingly.
• Developed Business Process Flow diagram for more than 200 functionalities for retail sale transaction, promotion, payment, and guest experience and cashier activities.
• Updated System Change Request (SCR) forms for Product Data Management (PDM).
• Worked Closely with Technical team to explain current systems process and future system plans.
• Assisted Developers with Detailed Design Document and Application Transition Document.
• Worked closely with testing team to provide scenarios of sales transaction
• Prepared Test cases/Scenarios for the product during the Testing Phase
• Traced test cases and functional specifications to SSRs and BPRs using HP Quality Center.
• Conducted User Acceptance testing (UAT) and worked with users and vendor who build the system.
• Facilitate Defect triage meetings and prioritized outstanding defects, system problems, ensuring accuracy and deadlines were met.

Environment: Agile, MS Word, MS Excel, MS PowerPoint, MS Visio, MS Project, Windows 2007, Share Point, Oracle, SQL Server Management Studio, .NET Framework 3.5, Visual Studio 2010, IIS 6.0, SQL Server 2005, CaliberRM, HP Quality Center, Data station, XML, C#

Confidential, Indianapolis, IN

Sr. Business Systems Analyst

Responsibilities:

• Implemented and incorporated all the HIPAA standards, Electronic Data Interchange (EDI 834, 835, 837) transaction syntax like ANSI X12.
• Used JIRA for tracking bugs and issues.
• Worked in creating requirements for ICD 9 to ICD 10
• Involved in Requirement Modeling which helped in increasing the workflow.
• Worked on Electronic Enrollment Requirements Document to get big brands like Whole Foods, Chipotle, Hewett Confidential, etc enrolled in the system.
• Collected the data from DeCare Dental’s System and sent it to WellPoint’s system on a weekly basis.
• Created File Transfer Specification (FTS) to automate the extract, translate, and load process of DeCare’s data.
• Wrote Business Requirement Documents for EFT and ERA web app.
• Actively participated in the Open Enrollment phase and gained hands on experience with EDI 834 files.
• Captured requirements and worked with WellPoint’s SMEs and Solution Architects in alignment process.
• Captured Action Items, Issues, Risks and Dependencies during the JAD Sessions and coordinated with Lead and PM to manage and resolve.
• Performed UAT for both EFT and ERA functionalities.
• Worked closely with Trizetto (TRZ) (Facets 4.8 to 4.9) by submitting BRD’s and getting their feedback and updating the BRD’s accordingly.
• Reviewed and analyzed current reports, finalized matching reports and captured requirements for new reports for Actuarial and EDI track.
• Created Detailed Functional Requirements documents, Use Case Specification documents and Activity Diagrams.
• Initiated review of various systems to identify the business processes, services and functions that may be leveraged for the Health Care Exchange.
• UsedSQL queriesfor the arrangement of customerdata.Created and maintained end-to-enddata mapping and data conversion spreadsheet.
• Worked on facets 4.0.1 version to create and implement the systems implementation requirements.
• Experience in Conversion of HIPAA X12 4010 codes to X12 5010 codes and ICD 9 codes to ICD 10 codes.
• Worked with leadership and team to ensure tracking and reporting needs are executed.
• Made sure that we are in compliance with HCR guidelines.
• Work as a member of a virtual development team where members of the team were physically located in different parts of the world.
• Implemented Traceability Matrix and Business Requirement Specification Documents and also verified the functionality coverage.
• Used agile systems and strategies to provide quick and feasible solutions, based on agile system, to the organization.
• Ensured a smooth handoff of artifacts/deliverables and knowledge transfer to as part of project close-out.

Environment: Rational Rose, Rational Requisite Pro, UML,XML, XSLT, MS Project, MS Visio, MS Office Suite, PL/SQL Developer, HTML, Visual Basic, SQL, Toad, Windows XP, Unix, HIPAA, Outlook

Confidential, Rye Brook, Ny

Senior Business Analyst

Responsibilities:

• Worked as a key BSA on the Benefits track of Claims Migration.
• Created Detail Functional Requirements document, Use Case Specification document, Activity Diagram to convert UACNY benefit to the NASCO BeneFACT system. Reviewed various documents with NASCO as well as with other vendors.
• Created end to end process flows for Benefit Coding, Use cases for Staffware& Report specifications for the reports.
• Worked with the Benefit Analyst and SME's in order to verify new groups benefit eligibility.
• Documenting the Benefits Conversion which was intended to provide detail process associated with the conversion and migration of UACNY Benefit data to NASCO’s Benefit systems. We were using the PEGA rule engine.
• Created Use cases & flows explaining how BPM will get the answer set ID for the triggered VPE& BPM will search for BLID’s on converted active VPE’s by answer set ID.
• Also captured the requirements of BPM to call BCI & BRMS for the Benefit string header information.
• Worked closely on PBM requirements that were dependent on Benefits for the Claims.Also created flows and use case description.
• Created the dashboard for the project and updated it weekly.
• Extensive design, development and testing experience with InformaticaPowerCenter.
• Knowledge of Data Warehouse life cycle, Data Mart design concept.
• Performed unit testing, point-to-point testing and integration testing to confirm ETL code integrity.
• Captured requirements and worked with UACNY SMEs, NASCO SMEs and Solution Architect in alignment process.
• Worked in creating detail requirements, BRD’s for PPO, POS, CMS, EMTALA and HMO
• Participated in NASCO BeneFACT Training.
• Created File Transfer Specification (FTS) to automate the extract, translate, and load process of the UACNY data (Provider Specialty, National Place of Service) into the NASCO Plan Flex table.
• Worked with IT team in encrypting the conversion files to NASCO &decrypted the files coming back from NASCO
• Strong technical knowledge of the FACETS system, more specifically the Subscriber/Member application.
• Experience in Conversion of HIPAA X12 4010 codes to X12 5010 codes and ICD 9 codes to ICD 10 codes
• Worked with UACNY and NASCO SMEs to map the Benefit Variables.
• Captured Action Items, Issues, Risks and Dependencies during the JAD Sessions and coordinated with Lead and PM to manage and resolve.
• Reviewed and analyzed current reports, reviewed reports with NASCO, finalized matching reports and captured requirements for new reports for Actuarial, EDI and Benefits track.
• Understood and captured criteria to create new Benefit String and BLID.
• Actively participated on creating Conversion strategy from existing Star System to NASCO NPS System.
• Analyzed and captured existing reports for UACNY Host Plan
• Implemented Traceability Matrix and Business Requirement Specification Document verified the functionality coverage.

Environment: MS SQL, C++, Windows XP, Rational Rose, Rational Requisite Pro, Clear Case, UML, Rational Suite, Business Objects, MS Visio, MS Project, MS Excel

Confidential, Hartford, CT

Business Analyst

Responsibilities:

• Gathered requirements from Business Managers, Supervisors, stakeholders, Data Governance Team and the subject matter experts through meetings to understand needs of the system.
• Completed a Business and Technical Requirement Document (BTRD).
• Analyzed the laws and regulations (HIPAA, HL7) before implementing the electronic medical record software.
• Developed current and ‘to be’ business processes and use case documents in compliance with HIPAA policies and procedures using MS Visio.
• Involved with project management team in developing project plan.
• Written business flow and work flow diagrams to develop software.
• Involved in Blackbox testing using decision testing and use case testing.
• Created Use case diagrams, Activity,Sequence and Collaboration diagrams using UML.
• Worked directly with quality resources to ensure testing activities are in line with the defined business requirements.
• Defined Quality Assurance Checklist using Oracle Service Contract.
• Coordinated with QA and user acceptance testing.
• Maintained a record of recommendations, communications, activities, and schedules to monitor the progress of project in real time using MS Project.
• Interacted with Subject Matter Experts (SME) and end users and established a business analysis around AGILE methodology.
• Intensively involved in project testing efforts by doing Integration Testing, Regression Testing and by helping UAT team in User Acceptance Testing.
• Effectively communicated user acceptance test (UAT) results between users and development team and provided recommendations for Application change requests (ACR).
• Dealt with HIPAA transactions.
• Documented various key elements of HIPAAcompliance and made sure that they are understood by the development teams. Test cases written for the project were HIPAA complaint.
• Worked on Application Change Request(ACR) by Creating HLR, DBR for the ACR and working with developer to develop the functionality, and working with UAT team for testing within the time and budget
• Worked with EDI Mercator team for data mapping.
• Worked with Claims, enrollment, eligibility verification for members and providers, benefits setup, and backend payment cycle in Facets.
• Understood EMR capabilities, Created User manual, and provided one-on-one training to end users.

Environment: UML, MS Word, Rational RequisitePro, Rational ClearQuest, Quality Center, SQL, FTP, TelNet