SUMMARY

• Innovative and result - oriented Business Analyst professional with over 6.5 years of experience in healthcare projects.
• Flourished in both independent and collaborative work environments with quick learning abilities. Expert communicator, involvinghigh interaction with variety of audiences (PMs, technical specialists, developers, architects, SMEs) from different countries.
• Highly adaptive quality and excellent communication skill helped me gain this experience internationally in US, UK London and Asia.
• Excellent knowledge of Health Insurance Portability & Accountability Act (HIPAA) standards, Electronic Data Interchange (EDI), and Implementation and knowledge of HIPAA code sets and HL7.
• Good understanding of ANSI X12 4010 and X12 5010 versions of HIPAA transaction standards including 837, 835, 834, 820, 270, 271, 276, 277, 278 as well as ICD-9, ICD-10 and CPT code sets.
• Experience in Health Care Industry with exposure to Electronic Medical and Health Records (EMR & EHR)/Automated Health Care Systems.
• Worked on EDI HIPAA Project to convert EDI X12 Healthcare 4010 transactions into 5010 Complaint transactions.
• Also worked using various methodologies such as Waterfall methodology, Agile Software Development, Rapid Application Development (RAD), Joint Application Design (JAD), and Prototyping.
• Experienced in Business writing skills and Technical writing skills in developing Business Case, Scope Document, Business Requirements Document (BRD), Functional Requirements Document (FRD), Non Functional Requirements Documents (NFRD), Use Case Scenarios, Test Plans, Test Cases.
• Created wireframes, mockup screens using MS Visio during elicitation of requirements.
• Proficient in learning new technologies and quickly adapting to new team environments.
• Proficient in the use ofQuality Center and Test Director for Test Planning, Test Designing, Test Analysis, Test Execution, Defect Tracking and Test Evaluation.
• Experience in reviewing Test Procedures, defining Test cases, reviewing and maintaining Test scripts.
• Functional experience with concentration on Use Case Modeling, Business Process Modeling, Data Modeling, Change Management, Rational Unified Process (RUP)methodology and Unified Modeling Language (UML).
• Experience in working with end users and the QA team fordeveloping test cases and test plans.
• Strong time management skills in handling multiple projects and deadlines under minimal supervision.
• Excellent team player to work in conjunction with testers, developers and other team members in validation and testing complex scenarios and projects and in the maintenance of Quality Standards in Projects.
• Expertise in analyzing the “As-Is” systems of the company and providing inputs towards the “To-Be” solution/system and creating activity diagrams using Swim lane.

TECHNICAL SKILLS

Methodology / Techniques: Agile, Waterfall, JAD, RAD,RUP

Project Management: MS Project, MS Office Suite (Excel, Word, PowerPoint, Access)

Databases: Oracle 8i/9i/10g, MS Access, MS SQL Server

Testing / Tracking Tools: Rational Clear Quest, Mercury Test Director 6.x/7.x, Quality Center

QA Tools: Win Runner 7.x, Load Runner 7.x

Change Management Tools: Rational Clear Case.

Data modeling tools: MS VISIO, IRISE, Snagit,Axure

Requirement tools: IBM Rational RequisitePro, UML, Dia

Operating Systems: UNIX, Windows 95/98/NT/2000/XP

PROFESSIONAL EXPERIENCE

Confidential, Woodland Hills, CA

Business Analyst

Responsibilities:

• Utilized SDLC Methodology to configure and develop process, standards and procedures.
• Conducted JAD sessions with business units and stakeholders to define project scope, to identify the business workflows & task analysis and determine whether any current or proposed systems are impacted by the new development efforts.
• Involved in business analysis, coordinating between the team members and creating test plans according to the business requirements.
• Performed GAP analysis for ICD-9 and ICD-10.
• Worked in the analysis of the ICD 9 - ICD 10 codes conversion Project using GEM (general Equivalence mapping) processes and concepts.
• Involved with the business partners to define requirements, determine solution alternatives, and develop high-level designs and estimates.
• Involved in a continuous updating of the artifacts based on the stakeholder/SME feedback.
• Performed the gap analysis between the As-Is and the To-Be system and evaluating the impact of each gap on the existing application.
• Developed test Scripts using Test Director/Quality Center and coordinated with developers to quickly resolve the defects associated with them.
• Coordinated with various IT teams related to back ends for Test Data Setup in UAT environments.
• Designed Test Plans, Scripts after analyzing various scenarios/requirements & performed defect tracking using Test Director & Clear Quest.
• Performed User Acceptance testing & End-to-End testing in interaction with Offshore QA/dev teams for various system releases & pushed them to production.
• Completed Data Mapping for Group and detail Product analysis and report writing
• Analysis and Design of the FACETS data model to ensure optimal system performance and tuning
• Configured facets modules such as Claims, Membership, Billing, Benefit and plan
• Involved in claim adjudication process of facets application
• Responsible for writing the Test Cases and Test Scenarios based on the Functional Specification and technical Specification and documented in Mercury Quality Center.
• Developed SQL queries, functions, stored procedures and triggers to perform the backend testing of the data.

Environment: Windows, MS Office Suite, MS Visio, SharePoint, Quality Center, Rational Unified Process, Rational Suite, Axure.

Confidential, Houston, Texas

Business Analyst

Responsibilities:

• Developed an end-to-end Business reporting process by gathering integrated reporting requirements, designing user reports and finalizing delivery mechanism of ad-hoc reports.
• Provided production and project support for suite of healthcare enterprise products for claims processing, transaction management, business intelligence, care management, utilization management, billing and network management.
• Designed integration solutions in collaboration with EDI clearing houses, pharmacy and carve-out vendors.
• Developed root-cause analysis for multiple user grievances. Made effective changes to the IT delivery process for quicker turn-around times for production tickets.
• Managed knowledge base by coordinating assignments, timelines and resource transition activities.
• Actively encouraged the usage of visual modeling techniques for better project communication. In absence of a thorough quality analysis discipline, encouraged enhanced unit testing and UAT. Built end-to-end traceability schemes between stakeholder requests and final sign-offs.
• Analyzed Business workflows and processes to elicit independent reporting requirements for all possible departments including claims, utilization, accounting, billing and asset management.
• Performed GAP and IMPACT analysis on processes after researching available vendor solutions. Created multiple solution approach documents.
• Attended and scribed multiple best practice, requirements and brain-storming sessions.
• Worked closely with the users to identify product GAPS and communicated them to leadership.

Environment: SQL Server Microsoft Office 2010, MS Visio, XML, XSLT, Web services.

Confidential, Louisville, KY

Business Analyst

Responsibilities:

• Extensively worked to develop Mapping, Business Rules design and testing of EDI 837 (Health Care Claims Transaction), 835 (Remittance Advice for both Institutional and Professional claim).
• Documented the process flow & Business Use Case for the EDI transaction 835, 837 & tagged them in Requisite Pro
• Performed Analysis to check if EDI Type trees for transaction sets 834, 837, 835 are HIPAA Complaint.
• Defined requirements for EDI 834/835/277 transaction sets.
• Gathered requirements from the APCD (All Payer Claims Database)is a database comprised of medical, pharmacy, and dental claims, and information from the member eligibility, provider, and product files encompassing fully-insured, self-insured, Medicare, and Medicaid data.
• Prepare and present Business Requirement Document (BRD), System Requirement Specification (SRS) and Functional Requirement Document (FRD).
• Gathered business requirements through interviewing internal business users, external users who were Brokers, Back office users and Risk analysts, surveys, prototyping, and UI (User Interface).
• Determine user/business/functional requirements. Create vision, scope, and use case documents; business process models, use case diagrams, activity diagrams, and state chart diagrams.
• Experience in leading As-Is and To-Be business process documentation re-engineering efforts across multiple projects.
• Analyze and update old test scripts/cases in Mercury Quality Test Center as per the business requirements.
• Responsible for Requirement gathering, Business Process flow, Business Process Modeling & Analysis.
• Used agile development methods to promote development iterations, teamwork, collaboration and process adaptability and work with the wireframes and storyboard.
• Design and develop Use Cases and UML models using Microsoft Visio.
• Analyze business requirements and segregate them into Use Cases. Created Use case diagrams, activity diagrams, Sequence Diagrams using Rational Rose according to UML methodology.
• Facilitate JAD sessions with management, users and other stakeholders to define the project and to reduce the time frame required to complete deliverables.
• Participated in datamodeling,planning, designing,and implementationof thefinal systemandconducted testing. Produced data mapping and data definition documentation.
• Manage all phases of testing for assigned components ensuring test plans and test cases are completed and business requirements are met.
• Work with development teams investigating and correcting software bugs and deficiencies based on the testing results.
• Support Load Test team by giving them walkthrough of functional flow of application and review testscripts prepared by the team for quality and functionality.

Environment: Rational Requisite Pro, MS-Visio, RUP, UML, Oracle 8i, SQL, PL/SQL, MS Office, MS-Project, Windows 2000.

Confidential

Business System Analyst

Responsibilities:

• Interacted with Business Unit members for gathering data, information and requirements related to business analysis in the clinical and regulatory area of pharmaceuticals.
• Gained intermediate and advanced knowledge of the industry best practices in UK market, document management systems, regulatory submissions creation, review & approval, and publishing.
• Participated in the entire life cycle of projects related with initial situational analysis GAP analysis, change management, operation design procedures, overall project scoping and QA testing procedures
• Utilized UML methodologies and Requisite Pro tool to design, document, and manage requirements Gathered requirements.
• Document and established traceability between the Business requirements, Use Cases, Business Rules, Activity diagrams and Test Scenarios.
• Document and defined the functionalities of the new system based on business needs to integrate with Employer and Member data from the system, imaging and workflow components.
• Developed, derived and clarified specifications for system related projects to ensure business unit needs are identified, communicated to ensure technical programmers understand the functional requirements of the business unit.
• Confers periodically with both business unit and technical developers throughout the SDLC lifecycle of assigned projects to track progress.
• Performed User Acceptance Testing.
• Documented Business Rules surrounding the complex calculations for the service credit eligibility.

Environment: SQL, Oracle, Rational Rose, MS Word, MS Excel, MS Visio, Test Director, Win XP, MS Project.

Confidential

Business System Analyst

Responsibilities:

• Involved in business analysis, coordinating between the team members and creating test plans according to the business requirements.
• Facilitated JAD sessions to collect requirements from system users and prepared business requirement that provided appropriate scope of work for technical team to develop prototype and overall system.
• Involved in gathering, documenting and verifying business requirements.
• Worked with the project manager for planning and organizing the project activities, and in communicating with other business mangers and stakeholders of the project.
• Involved with the business partners to define requirements, determine solution alternatives, and develop high-level designs and estimates.
• Defined and documented the vision and scope of the project.
• Co-ordinated JAD sessions with business owners, SMEs (Subject Matter Experts) and marketing team, for requirements gathering in definition Stage.
• Created the Business Requirements Document with its key components including Use Cases, Functional Requirements Document and Gap Analysis.
• Prepared the Business Workflow Diagrams using MS-Visio.
• Worked with the clients on the final signing process in the User Acceptance stages.
• Development of Project Scope, Objective and Operational Vision.
• Responsible for business requirements management, project delivery on time and within scope of business requirements.
• Understand existing technology, budget constraints and infrastructure.
• Conducted structured documentation plan, and created prototypes for the To-Be system. Derived business requirements from JAD sessions with the Stakeholders and the Subject Matter Experts.
• Developed test scenarios, test cases for testing the functional requirement.
• Enhanced test cases and scripts by adding the required functionality as per the new business requirements.
• Worked closely with QA and Developers to clarify/understand functionality and resolve issues.

Environment: MS Office Suite, MS Visio, SQL, Rational Suite, Windows XP.