SUMMARY

• Diversified experience as a Senior Business Analyst in Healthcare domain. Strong knowledge of health care insurance, particularly Medicare/Medicaid. Strong Knowledge of ICD - 10/CPT & HIPAA.
• Profound knowledge ofEDI X12standards in healthcare insurance.
• Extensive experience in Business Process Improvement & Re-engineering.
• Skilled in tailoring of comprehensive Business Requirement Documents (BRD).
• Skilled in tailoring of comprehensive System Requirements Specifications (SRS) so as to facilitate the optimal translation of core business priorities into sound technical solutions.
• Strong knowledge of all the phases of Software Development Life Cycle (SDLC).
• Expert knowledge of Agile and Rational Unified Process (RUP) development methodology.
• Knowledge of conducting GAP analysis and traceability matrix.
• Experience in conducting Joint Application Development (JAD) sessions, Q&A sessions, and personal interviews.
• Identify solutions by analyzing outcome of these sessions and proposed alternative tasks.
• In depth experience withrequirementsgathering, analysis, communication managementand extensive familiarity with each phase of the RequirementsLifeCycle, including various methods of elicitation, evaluation of data sources, negotiation, development and documentation of specifications from requirements, and ensuring traceability, validation and verification.
• Comprehensive working knowledge of Unified Modeling Language (UML),, including development and interpretation of Use Case, Class, Object, State, Sequence, Activity and Collaboration diagrams.
• Expertise in producing wireframe templates and design mockups for web applications.
• Expertise in use of Case Complete/RequisitePro in requirements management.
• Expertise in use of Rational Rose in developing Use Case diagrams, Activity diagrams, Class diagrams, Sequence diagrams, and Collaboration diagrams.
• Expertise in HP Quality Center (QC).
• Expertise in managing the User Acceptance Testing (UAT) process based on specifications of end-users or customers.
• Good knowledge of Database relationships, and utilizing Structured Query Language (SQL) through query statements.
• Highly experienced with MS-Word, MS-PowerPoint, MS-Excel, MS-Outlook, MS-Project, and MS-Visio.
• Exceptional interpersonal, communication and writing skills.
• Ability to identify priority issues and determine which issues can be handled within the authority of an Analyst and being able to discern those issues requiring direction from a higher authority.
• Problem solving, creativity, analytical and systems thinking
• Learning approach to understand the business, and the needs of stakeholders.
• Demonstrated leadership ability and team spirit, allowing for remarkable effectiveness as liaison between business and IT concerns.

TECHNICAL SKILLS

Methodologies: Agile, Waterfall, Rational Unified Process (RUP)CASE Tools UML 2.0, RationalRequisite Pro, Rational Rose, Case Complete

Tracking Tools: Quality center, Rational ClearQuest, Rational ClearCase, Rally

Workflow Tools: MS Visio, MS Project, MS PowerPoint, MS Word, MS Excel

Databases: SQL Server 2000(7.0/6.5), Oracle, DB2, Sybase

Languages: SQL, HTML, Java, PL/SQL

Analytical Tools: SAS, SPSS, MS Excel

Operating Systems: Windows (XP/NT/2000)

PROFESSIONAL EXPERIENCE

Confidential, Danville, PA

Senior Business System Analyst

Responsibilities:

• Review organizational process assets, such as methodologies and templates that dictated which deliverables are required.
• Work closely with both internal and external customers/vendors in the development of Requirements.
• Interpret high-level business, compliance requests for complex projects, with little or no background information or foundation.
• Correctly understand and accurately document use cases, requirements, workflow, processes, and business rules required for a clear picture of the business.
• Write business requirements for complex projects, including the definition, scope, objectives, and defining the approach.
• Ensure IT understanding of requested modifications of complex projects, and the accuracy of their technical specification documents.
• Define and document detailed, functional business requirements, including business use cases and process flows (AS-IS/TO-BE) for complex projects.
• Determine testing requirements for complex projects involving cross-functional areas and sub-systems. Collaborated with QA to refine test plan and test scripts.
• Act as a liaison between business and IT concerns during Detailed Design, Build and Integrate Phase of the project.
• Facilitated demo for the business regarding new application developed.
• Upload testing requirements to HPQC and log and track UAT defects in Quality Center.
• Coordinate User Acceptance Testing (UAT) effort with business.
• Coordinate stress testing effort with QA team.
• Supported the development of test plan and test cases to be used in testing based on business requirements, and/or technical specifications.
• Co-ordinate defect process management in Quality Center.
• Conducted mapping of MSA paper application and to be online application for OLC changes. Prepared the final mapping document that maps the information that shall be displayed for MSA application Offline Client.
• Documented system use cases for performing complex calculation for determining number of uncovered months towards calculation of Medicare part D late enrollment penalty.
• Established and defined reporting tool environment, including data mining, report identification, report distribution, ad-hoc report procedures towards development of Enrollment CMS Compliance Metric reports.
• Researched, designed, and implemented the integration of two separate Intranet technology based applications, Approval Screen (Enrollment application) and the outbound document application ‘Client Letter’ Letter Generator. Data modeled and mapped the member enrollment data variables to fields in existing Letter templates to enable developer in creating views for Client Letter application. Supported QA system test cases for testing the data migration from Approval Screen application database to the views/Operational database for generating various types of member enrollment letters.
• Assist technical team in estimating User Stories and assign them to Sprints. Manage sprint backlog items in Rally.
• Solely involved with initial set-up with the vendor (DRX) for Medicare Supplement Files that included populating the internal files in the vendor requested format and validating it with the business before sending out the files through FTP process.
• Assist coordinating and implementing successfully new business Sales & Operation process for Fulfillment and Distribution services with the new vendor.
• Perform gap analysis of certain aspects of EDI transactions for example, HIPAA AAA error codes for 270/271 between health plan and the new trading partner.
• Put together CORE testing requirements that was helpful for preparing test scripts for testing Data content, Connectivity, Soap-wrapper, and AAA error codes for 270/271 and 276/277 Maintain all documentation related to setting up of a new trading partner such as File Transfer Matrix for setting up FTP connectivity and Real-Time HTTP/VPN communications.
• Perform crosswalk of field values for various Provider Portal functionalities displayed on current Health Plan Portal and NaviNet Portal for documentation of product variances.
• QA initial set of Provider Files - Business Entity Files and Rendering Provider Files before letting it out the door to NaviNet.
• Put together comprehensive list of real Test Data for vendors and QA team for testing Provider Portal core functionalities.
• Necessitate the Defect Management process by collaborating the defect resolution with internal QA team and vendor Development team.
• Co-ordinated Single Sign-on (SSO) implementation for various transactions for NaviNet. Identified and documented required parameters for each of these transactions that would be passed in SAML assertion request. Supported Quality test cases for SSO.
• Assist in preparing EDI documentation for internal and external use.
• Update and maintain X12 format 270/271 specifications with trading partner.
• Translate 270/ specifications into readable user specifications for Quality to prepare their test scripts.
• Trouble-shoot EDI issues by performing analyses of EDI transactions and initiate corrective response leading to effective resolution and resulting in 80% user-friendly and robust transactions.
• Proficiently participate in resolving EDI issues in shorter period of time related to health plan and vendor EDI requirements
• Prioritize customer requirements and maintain continuous improvement through customer feedback
• Attended NaviNet EDI Workshop for mapping GHP’s implementation to NaviNet’s recommendations and identify gaps and Decide priority gaps.
• Coordinate post-production 271/276 issues with developers (GHP/axiom), NaviNet & business leading to fixes and retesting. Track post-production issues in Quality Center.

Environment: Agile (NaviNet/Fall Readiness 2014), SDLC-Waterfall (HMO51+), Rally, Case Complete, UML, Quality Center (QC), Web applications, Webserver, Single Sign-on (SSO), TransSend (Axiom mapping software), Command Web - Fulfillment & Distribution services, DRx - Plan Finder, Client Letter, SQL Server Reporting Services (SSRS), EDI 5010 transactions - 270/271; 276/277 & 835, Windows 7, Snagit, MS Project, MS Visio, MS Excel, MS Word.

Confidential, New York

Business System Analyst

Responsibilities:

• Worked in an agile development environment fractioning out the functionalities of Electronic Medical Record (EMR) and Practice Management and Billing Software.
• Worked independently without any upfront documentation to follow.
• Gathered Business requirements by interviewing Subject Matter Experts (SME) and end-users, nurses and physicians.
• Assisted in recognizing the weaknesses in the existing functionality of Electronic Medical Record (EMR) System besides adding additional functionalities.
• Developed comparative statements, reports to examine the existing functionalities.
• Provided the solution to enhance the existing functionalities.
• Documented detailed Business Requirements Documents and Functional Specification Documents using Rational Requisite Pro.
• Created UML diagrams with the help of Rational Rose to understand the process flow.
• Conducted JAD sessions periodically in order to resolve any issues in requirements, development or testing.
• Followed a structured approach to organize requirements into logical groupings of essential ambulatory practice processes and billing software, and ensured that the critical requirements are met.
• Used Electronic Data Interchange (EDI) codes for verifying patient eligibility for receiving the insurance benefits, patient information, health care claim request, and healthcare claim.
• Coordinated periodic meetings between the user group and development team at various phases of software development.
• Provided inputs and guidelines to the testing team in accordance with test plan writing, and traceability matrix.
• Used Rational ClearCase to track and fix bugs.
• Participated in coordinated team effort in User Acceptance Testing.

Environment: Agile, SQL Server, SQL, Requisite Pro, MS Project, Rational Rose, Rational ClearCase, UML, Webserver, Windows XP, MS Word, MS Visio, MS Excel.

Confidential, San Francisco, CA

Business Analyst

Responsibilities:

• Interviewed business experts including participating provider and referral coordinator to gather the business requirements.
• Analyzed Technical Design Documents (TDD) of existing Electronic Medical Record to understand the site for integrating the new system.
• Documented Business Requirements Documents and Functional Specification Documents for various required functionalities of the eReferral System.
• Used SQL queries to access database before writing use cases to understand different field names and character specifications.
• Developed use cases, activity diagrams, and sequence diagrams using MS Visio.
• Conducted highly interactive JAD sessions with project stakeholders to review the requirements and identify the solutions.
• Ensured consensus between Line of Business and IT Teams.
• Developed new documentation, participated in development of departmental procedures and implementation policies.
• Assured that the system privacy and security is in compliance with HIPAA.
• Collaborated with QA team to refine test plans and test cases.
• Participated in User Acceptance Testing (UAT).
• Used Quality Center (QC) to track and report bugs.
• Designed reports and presentations according to department guidelines.
• Prepared training manuals for employees.

Environment: Rational Unified Process (RUP), DB2, SQL, UML, Quality Center (QC), Windows XP, Webserver, MS Project, MS Word, MS Visio, MS Excel

Confidential, New York, NY

Business Analyst

Responsibilities:

• Interacted with department heads, managers, business customers, and business sponsors to gather requirements.
• Communicated with personnel across departments for verification, research, processing, and audit to conduct a thorough analysis of the existing process.
• Documented Business Requirement Documents (BRD) using Agile method.
• Conducted Joint Application Development (JAD) sessions to review requirements.
• Ensured consensus between business and IT teams.
• Used SQL queries to access database before writing use cases to understand different field names and character specifications.
• Developed use cases, activity diagrams, and sequence diagrams using Rational Rose.
• Ensured detailed and up-to-date features are included.
• Collaborated with QA team to refine test plans and test cases.
• Conducted Gap Analysis and traceability matrix to verify the solution meets the business requirements.

Environment: Agile, Sybase, SQL, Requisite Pro, Rational ClearQuest, Rational Rose, UML, Webserver, Windows XP, MS Project, MS Word, MS Visio, MS Excel