SUMMARY

• Over 8 years of experience as a Business Analyst in all phases of Software Development Life Cycle with solid understanding of Business Requirement Gathering, Extensive experience working on Agile modeling and SDLC methodology
• Good understanding of health care industry, Claims Management process, Medicaid and Medicare Services and insurance sector
• Areas of professional experience in health insurance, pharmaceutical, and clinical systems includes the analysis of projects, business requirements gathering and business processes for disciplines as: Claim processing, HIPAA X12, EDI transactions and code sets conversion, ICD - 9 to ICD-10 crosswalk strategies; Medicare and Medicaid reimbursement programs, data warehouse and testing.
• Using Facets for various health insurance areas such as enrollment, member, Products and other FACETS related modules
• Experience in testing Facets applications and EDI transactions
• Expertise in creating and maintaining Business requirement document, System Requirement documents. Creating business workflows and processes using Visio.
• Experience working on 4010 and 5010 HIPAA implementation guides relate to Claim Testing and Medical Billing.
• Knowledge of the EDI transaction sets such as 837, 834, 835, 270, 271, 276, 277, 999
• Understanding of HIPAA Standards and Compliance issues, HIPAA Privacy policy, opt in/opt out policy.
• Develop and automate Web Services API testing using Soap UI frameworks
• Extensive experience with Object oriented Analysis and Design using Rational Unified Process (RUP), Waterfall methodology and Agile Modeling
• Requirements gathering in compliance with HIPAA 4010 and 5010 standard.
• Proven ability to analyze complex problems, identify risks and develop effective solutions to improve productivity, reduce cost and track progress through all phases of SDLC
• Executed SQL queries and documented them as part of validating the Business Object reports and for testing purposes
• Designed High level design, for New process, integrating with legacy and Facets
• Facilitating one on one interviews, Joint Requirement Planning (JRP) and Joint Application development (JAD) sessions
• Experience in creating SQL queries to facilitate UAT and perform data validation.
• Experience in methodologies like Agile, Waterfall Model and Data Modeling; Creating Process mapping, Use Cases, Sequence diagrams, Activity diagrams
• Solid understanding of Membership, Claims Processing, Billing, Benefit/Eligibility, Authorization/Referrals, COB, and have experience in HIPAA standards and corresponding EDI transactions.
• Good knowledge of Web Services, SOAP programming, WSDL, XML technologies DTD, SAX and XSLT.
• Facets support systems were used to enable inbound/outbound HIPAA EDI transaction in support of HIPAA 834 transactions.
• Proficient in conducting System Testing, Functionality Testing, Regression Testing, User Acceptance Testing (UAT) and training of users
• Highly skilled in working with Data Warehouse, Data Mining, and ETL tools for loading high volumes of data and a smooth structural flow of the data.
• Expertise in Claims, Subscriber/Member, Plan/Product, Claims, Provider, Commissions and Billing Modules ofFacets.

TECHNICAL SKILLS

Process/Modeling Tools: Agile Methodology, CPT and ICD-9 Coding, FACETS, AMISYS, MS Visio

Testing Tools: Quick Test Pro Rational Requisite Pro, Clear Quest, Clear Case, MS Office Suite GAP Analysis, CICS CMMI, Web Applications Testing,Web services testing using SOAP UI, Oracle CRM On Demand testing

Operating Systems: Windows 7/2000/XP/, UNIX

Reporting Tools: Quality Center, Rational Clear Quest

Languages: SQL,java WSDL,SQL .Net

Methodologies: Agile, JAD, Waterfall, RUP

RDBMS: SQL, Oracle, and MS Access

Utilities/Application: MS Project, MS Visual, MS Office 03/07 (MS-Word, MS-PowerPoint, MS-Excel, MS-Access, MS-Outlook)

PROFESSIONAL EXPERIENCE

Lead Business Analyst

Confidential, Philadelphia, PA

Responsibilities:

• Gathered and documented business requirements for existing and future business systems.
• Acted as a liaison between business staff and technical staff to articulate needs, issues and concerns.
• Lead multiple project teams of technical professionals through all phases of the SDLC using technologies including Oracle, Erwin, Data Stage, Data Warehousing, Web sphere and Cognos.
• Managed Scope and change throughout the SDLC process of the product.
• Performed extensive data modelling to differentiate between the OLTP and Data Warehouse data models
• Defined Functional Test Cases, documented, Executed test script in Facets system.
• Analyzed trading partner specifications and created EDI mapping guidelines.
• Healthcare system implementation including enterprise Electronic Medical Records (EMR) software.
• Involved in mentoring specific projects in application of the new SDLC based on the Agile Scrum and Rational Unified Process, especially from the project management, requirements and architecture perspectives.
• Generated various business process workflows using Visio.
• Created Data Stage jobs to extract, transform and load data into data warehouses from various sources like relational databases, application systems, temp tables, flat files etc.
• Designed and developed use cases, activity diagrams, and sequence diagrams using UML.
• Assisted with building the EDI 837, 835, 270/271, 276/277, 278, 820 and 834 transactions processing flow from the Trading Partners to the translator.
• Converted various SQL statements into stored procedures thereby reducing the Number of database accesses.
• Involved in testing Web services and XML with tool called ‘SOAP UI’
• Co-coordinating with the team to analyze the 834, 835 and 820 EDI Transactions for dual eligibility Project (FTC).
• Worked closely with the Enterprise Data Warehouse team and Business Intelligence Architecture team to understand repository objects that support the business requirement and process.
• The tests also included GUI testing: Testing for validation and display of screens
• Provide healthcare specific operational knowledge to support system design - including workflows charts, diagrams
• Successfully conducted JAD sessions, which helped synchronize the different stakeholders on their objectives and helped the developers to have a clear-cut picture of the project.
• Informatics was used for ETL process and Business Objects are used for Reporting duties.
• Generated weekly and monthly reports and submitted to the Manager for reporting status report and analyzing purpose

Environment: Quality Center, EDI, GEMS, Agile Microsoft Office Professional (Outlook, Word, Excel, Visio, Access, etc.), Microsoft SharePoint 2003, Web services ‘Soap UI, UML, RUP, UAT, db2, Quality Center, SQL, .NET, Clear Case

Sr Business Analyst

Confidential

Responsibilities:

• Gathered Business Requirements from the Subject Matter Experts (SMEs) and documented the requirements in the BRD.
• Expert in ICD 9 - 10Conversion Analysis.
• Documented complex Business requirements and made process flow diagram for the 837, 270/271, 276/277 & 835Remittance transactions as per the implementation for the Medicaid claim processing system enhancement.
• Full knowledge of the Diagnosis and Procedural Code changes for Healthcare Entities like Payers, Employer Groups, and Providers. Worked on ICD 9 codes and gathered future requirements based on ICD 10 codes. Managed creation of sample mappings for the conversion of EDI X12 transactions code sets version and translation of ICD 9 codes into ICD 10 codes.
• Analyzed the impacts of HIPPA 5010 project on inbound 837 claims
• Gathered requirements from the users and analyzed the requirements for RQ System, Facets etc.
• Extensively worked with FACETS Implementation, FACETS Billing, Claim Processing and Subscriber/Member module.
• Gathered and documented functional requirements for testing and verification of HIPAA.
• Web Portal Development - Worked as a Business/Quality Analyst gathering requirements to develop a referral portal.
• Worked on As-Is To-Be analysis of ICD9 to ICD 10 conversion for the new qualifiers used in the 837 claims for the diagnosis and procedure/HCPCS codes.
• Performed manual testing by building 837 claims, converting them into EDI file, uploading them into mainframe region and doing error resolution & testing for 5010 requirements& NPI crosswalk.
• Functionally validated Web Services delivered in SOAP XML format as provided in specification document
• Prepared and documented System Requirements and workflows for the Content Management Application tool.
• Tested 835(payment remittance), 820(payment summary) and 834(enrollment) EDI transactions
• Gathered knowledge on HL7, HIPAA rules and regulations.
• Created process flow diagrams describing provider and member access to the web portals.
• Analyzed and evaluated User Interface Designs, Technical Design Documents and the performance of the application from various dimensions.
• Prepared the Functional requirement for the automation of 834 and 820.
• EDI file testing for checking the HIPAA 5010 (X12) compliance of the inbound 837 claims.
• Conducted JAD sessions, workflow diagrams, UML diagrams, process models, activity diagrams, use cases, for incorporating design changes in the order creation/ management system.
• Assisted in creation of the Functional Design Document from the Business Requirements Document which was used as the reference by the development team while preparing the design and held the responsibility of the required data setup for unit testing.
• 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.
• Used HL7 guidelines and dictionary for defining business rules associated with pre-defined workflows according to business requirements
• Involved in daily scrum meeting to discuss any roadblocks or impediments in the project path.
• Involved in sprint planning session to identify the features and functionalities that should be achieved by the new application.
• Identified various points of integration among the new and existing applications and required integration with other IT components.
• Worked closely with the business team, development team and the quality assurance team to ensure that desired functionalities will be achieved by the application.
• Provided business and technical suggestions and recommendations during the project life cycle.

Environment: MS Visio, Word, Excel, UML, Facets, HIPAA, HL7PowerPoint, web services ‘Soap UI, Rational Requisite.

Business Analyst

Confidential

Responsibilities:

• Coordinate with Project Managers, ETL Developer, Business Objects team, QA Testers and work on defects
• Gather and analyze requirements for development write code in ETL Informatica tool
• Analysis of the defects related to the reports and various EDI transactions within the HP system
• JAD sessions were done with business and business requirements were gathered before working on requirements document as a BA from Enterprise data warehouse team.
• Create and maintain the Business Requirement Documents for the defects (Defect Resolution Document)Act as a liaison between the ETL developers, QA tester and SME
• UsedFACETSAnalytics for fast and easy retrieval, display and grouping of information for performing queries and generating reports.
• Developed test plans, test scripts and use cases for testing of workflow automation tool in conjunction with business users and IT development staff.
• Working with the application and Business Analyst team to develop requirements
• Translating process/technical solutions for business during defect analysis
• Help in preparing the training material of the providers and insurance companies using the software supporting ICD 10.
• Indicator field (electronic standard code) was added and moved to the enterprise data warehouse to be stored on the claim line table
• Utilized survey assessment results of ICD-10 to create listing constraints, processes, projects and systems, applications and vendor software to be impacted by the ICD-10 Conversion Project.
• Worked With HIPAA compliant ANSI X12 837 formats for both professional claims and institutional claims.
• Analyzed the mainframe reports for member/eligibility/claims and mapped the fields withFACETSbatch jobs and reports.
• Created process workflows and designed end-user screens based on Use Cases.
• Working through the phases of SDLC using the Agile methodology
• Reviewed ETL and Business Objects defects and proposed fix for defects as per the scheduled timeframe
• Strong hold on Data Warehouse with ETL process and domain knowledge of Claim processing, Group Insurance (GI),Plan Sponsor, Member, Product, Provider, Lab Results,
• Worked on defect related to EDI 837, 835, 277 and 999 transactions
• Implemented the data driven frame in SOAP UI and Tested various functions in web services with different sets of data.
• Worked on new requirements (Change Request) and modifications on various reports that were determined as critical by the Client.
• Worked with Waterfall methodology during the beginning of the project then transitioned to Agile methodology
• Involved in the transition of the reporting team, provided necessary Knowledge Transfer sessions to the Cognizant Solution Team for the takeover

Environment: Informatica, Toad for SQL Developer, Agile, SharePoint Waterfall, Oracle, MS Office tools, Facets, HP Quality Center, web services ‘Soap UI, Windows, MS Project, Data warehouse, Mainframe

Business Analyst

Confidential

Responsibilities:

• Involved in gathering requirements as per the consensus meetings between Confidential and providers.
• Worked on the EDI 834-file load to Facets through MMS (Membership maintenance sub-system)
• Developed Use Case diagrams and process flow diagrams using Rational Rose and MS Visio.
• Actively prioritized and managed requirements throughout SDLC with all key stakeholders
• Developed functional requirements and a proposed data warehouse strategy for supporting employee compensation and compliance reporting/analytics.
• Negotiated and managed multiple priorities, project plans, time frames and trade-offs while ensuring the clinical and administrative staff understood the final results of the projects, sharing detailed vision of cost-benefit analysis.
• Worked on solving the errors of EDI 834 load to Facets through MMS.
• Provide input to estimates for project management and change management activities through analysis of requirements effort, resources, and technology.
• Worked on EDI 834, 835,837 as per HIPPA guidelines.
• Performed the detail comparison between 4010A and 5010 especially in regard to EDI 837.
• Helped with data modeling and defining the conceptual and logical model of the data warehouse.
• U created Use cases, activity diagrams and drafted UML diagrams using the Rational Rose.
• Written requirements following SDLC methodology, converted them to User Stories in order to follow agile development.
• Updated the requirements and prepared comprehensive Business Requirements Document (BRD) that provided the appropriate scope for the users and management to make appropriate decisions.
• Played a key role in planning UAT and implementation of system enhancements and data migration and conversions.

Environment: Microsoft Visio, Windows XP, Facets, MS Office, SharePoint Rational Requisite, Rational Rose, Quality Center, SQL .Java

Business/Quality Analyst

Confidential, Eagan MN

Responsibilities:

• Studied the CMS regulation for reporting requirements.
• Attended HIPAA training
• Work closely with Business Owners and Stakeholders to outline Business Requirements.
• Work with System analyst and IS teams to understand the flow of data.
• Reviewed and analyzed data from various sources.
• Identified gaps and performed gap analysis with respect to CMS requirements
• Created Mapping Documents, Report Mockups and modified existing report mockups as to CMS requirements and finalized for development
• Prepared UML diagrams including Use cases, Sequence Diagrams, and Activity Diagrams
• Provide technical expertise as an early engagement to different modules and enhancements to access impacts and define scope.
• Formulated logical statements of business requirements researched and evaluated alternative solutions and recommend the most efficient solution for system design.
• Review requirements and understand technical recommendations and constraints, and develop comprehensive and accurate functional specifications; Data Mapping, and process flows.
• Work with Compliance and Regulatory operations to follow and monitor different IT process bound by CMS Regulations.

Environment: Windows XP, Business Objects, MS Excel, Word, Visio, power point, SQL, DB2, SAS database