SUMMARY

• Result oriented Business Analyst with over 9 years of experience in Business Analysis, business requirements modeling and development of Web Based and Client/Server applications in diverse business domains of Healthcare and Insurance.
• Experienced in Requirement gathering, Business Process Mapping, creating Use Case Documentation, supporting Development and Testing Teams throughout the Software Development Life Cycle (SDLC).
• Thorough understanding of SDLC methodologies including Waterfall, Agile, Scrum, V - Model, RUP.
• Extensive experience in developing and documenting Business Requirement Document (BRD), Functional Requirement Document (FRD), Software Requirement Specification (SRS) and Requirement Traceability Matrix (RTM) across the deliverables of a project.
• Expert in working with SME’s across various department / Business areas during SDLC with strong experience in conducting GAP Analysis, SWOT Analysis, Cost Benefit Analysis, Risk Analysis.
• Analytical skills in understanding the business process (AS-IS and TO-BE), understanding the requirements and translating to System Requirement Specifications.
• Experienced in conducting Joint Application Development (JAD) sessions with SMEs, QA and Technical team.
• Experience working with SMEs from various departments to document Process Flows & Wire Frames.
• Familiar with White-Box/Black-Box testing process such as Regression Testing, System Testing, Performance Testing, Load Testing and Unit Testing.
• Experienced in working with various tools like PeopleSoft, PEGA, Guidewire, Facets and Cognos.
• Excellent knowledge of HIPAA Standards, NCPDP Standards, EDI (Electronic Data Interchange) Transaction syntax like ANSI X12, Implementation and Knowledge of HIPAA code sets, ICD-9, ICD-10 coding and HL7.
• Worked on HIPAA 4010, 5010 EDI 837, 835, 277, 270, 271, NCPDP and ICD-9/ICD-10.
• Knowledge of EMR/EHR, HMO/PPO/POS, Health Care Reform and Patient Protection and Affordable Care Act (PPACA), Medicare (Part A, B, C, D), Medicaid, Medicaid Management Information Systems (MMIS) and Medicaid Information Technology Architecture (MITA)
• Experienced in HIX, Plan Management, Eligibility and Enrollment Process.
• Extensive experience with Business Use Cases, Functional Use Cases, Business Process Models, and Test Cases.
• Extensive experience in process modeling using UML, Flowcharts, Sequence Diagrams, Activity and Diagrams.
• Hands on experience in all phases of DataModeling, Data Transformation, Data Mapping from source to Target Database Schemas, Data Cleansing Procedures.

TECHNICAL SKILLS

Operating Systems: Mac OS, Windows 7/Vista/XP/2000

Statistical Tool: Excel 2007/2010, Access 2003/2007, SPSS

Business Modeling Tools: Blue-print, Rational Rose Enterprise Suite, Rational Requisite Pro, MS Visio, Clear Case, Clear Quest, SharePoint 2007

Database & Server: Oracle, MS SQL server, MS Access, Windows 2000/2003

Project Methodology: Rational Unified Process (RUP), Software Development Life Cycle (SDLC), Agile and Waterfall, SQL, Sybase

Packages: MS Office (Word, Excel, PowerPoint), MS Visio, MS Project

Languages: HTML, DHTML, Visual Basics(VBA)

PROFESSIONAL EXPERIENCE

Confidential, Philadelphia, PA

Sr. Business System Analyst

Responsibilities:

• Collaborated with SMEs and management to understand existing Business Processes, evaluated solutions to business problems.
• Gathered and analyzed requirements and documented them into BRD and FRD.
• Prepared Report Mockups as well as UI Mockups.
• Conducted JAD session and follow up meetings with the SME’s to have better understanding of the requirements.
• Conducted Meeting with ETL developer and Data architect to discuss about the Source data inflow in the Data Warehouse.
• Conducted Source to Target Mapping for “Customer PPO Attribution Report”, “Provider PPO Attribution Report” and “Provider Address File”.
• Conducted JAD Session with Business Lead, ETL Lead and Data Warehouse Lead regarding the creation of Views/Table for BDTC as well the type of data will be loaded to that view.
• Conducted Meeting with Data Research analyst to make sure the data are sync with all the related reports of this project as well all the impacted reports.
• Experienced in working with EDI 837, 835, 277, 270, 271 for HOME, HOST and LOCAL Member
• Involved in designing HOME, HOST and Local Customer Data Schema in the AEDW based on PPO.
• Confirmed Report backend process in BI environment.
• Involved in the process of deciding which filter to be used to get the required data for the reports.
• Conducted critical analysis to determine the Billing month correspond with Attribution Effective month and Expiration month.
• Conducted Meeting with “ Confidential ” associates to discuss about the data structure.
• Participated in Data Mapping process between the data mart and the Source Systems as well as used SQL command for trouble shooting.
• Created Business Process Flow Diagrams to assist the Technical Team.
• Performed AS is and To be analysis and impact of the solution to the business.
• Closely involved with PMO and update the project process.
• Used SharePoint for better document management.
• Experienced to deal with customer interface in different phase of the project.
• Created UI Mockups and User Stories using VISIO and Snagit.
• Experienced to work with AQT (Advanced Query Tool) and Teradata SQL Assistance.
• Strong understanding of PPO, HMO, POS and other customized plans.
• Involved in work with the migration of Data from Mainframe to AEDW.
• Closely involved with test team to prepare test scripts as well doing different kind of testing process as well as worked as UAT coordinator.
• Involved in defect tracking management and used JIRA to create Backlog.
• Created and maintained the Requirements Traceability Matrix (RTM).

Confidential, Baltimore, Maryland

Sr. Business Analyst

Responsibilities:

• Created User Stories, gathered and analyzed requirements and documented them into BRD as well as FRD.
• Created Business Process Workflow Diagrams to assist the technical team in creating the provider portal to allow providers to access patient information conveniently.
• Performed As is and To be analysis and impact of the solution to the business.
• Conducted JAD sessions and requirements gathering sessions with SME’s better understand HIX Functionality under IBM CURAM Platform.
• Closely involved with PMO while implementing the various tools and policies as well as updating the project process.
• Used SharePoint for better document management.
• Involved with development team in Development of GUI (Graphical User Interface)/Customer interface to support HIX portal and assisted them to understand business requirements.
• Experienced to deal with customer interface in different phase of the project.
• Involved in the implementation of Java Message Service to make sure proper communication among different Provider under IBM MQ platform.
• Created Wireframes, User Stories and UI Mockups using Mockup screen and Snagit, maintained Requirement Traceability Matrix (RTM) by using MS Visio based on UML.
• Conducted JAD sessions with the SMEs for the implementation of Health Exchange Business Process with a special focus on Medicaid/Medicare Integrated Eligibility, Plan Management, and SHOP.
• Executed Business Process Maps for Affordable Care Act system implementation.
• Experienced to work with Enterprise Data Warehouse
• Strong understanding of PPO, HMO, POS, CHIP and other customized plans.
• Involved in integration of different software with HIX portal as well as compliance with MMIS system.
• Worked with SME to perform critical information task for EHR/EMR system to integrate with HIX platform.
• Involved in work with the migration of Enterprise Data from legacy system to new system.
• Involved in analyzing different loan options for the citizen of Maryland.
• Interacted with client and the technical team for requirement gathering and translation of Business Requirement to Technical Specifications.
• Closely involved with test team to prepare test scripts as well doing different kind of testing process such as system testing, regression testing, functional testing and stress testing.
• Involved in defect tracking management as well reporting.
• Involved in UAT phase as UAT coordinator as well as preparing the scripts for UAT testing.
• Created and maintained the Requirements Traceability Matrix (RTM).
• Designed and developed Activity Diagrams, Sequence Diagrams, Use Cases and other Process Flow Models using Visio and Rational Rose.
• Participated in Data Mapping process between the data mart and the Source Systems as well as used SQL command for trouble shooting.
• Facilitated Health Insurance Form Filing Requirement Sessions.
• Developed Preliminary Business Object Model for Health Insurance Form Filing, Requirement Document for Health Insurance Form Filing.
• Implemented the Agile Scrum SDLC methodology for gathering requirements by facilitating regular Use Story sessions with SMEs and the technical team.

Confidential, Kansas City, Missouri

Business System Analyst

Responsibilities:

• Conducted workshops to gather requirements from site and internal Subject Matter Experts(SMEs).
• Conducted meetings with SMEs of various departments to understand their requirements and help the design and development team to modify the PeopleSoft in accordance to satisfy SMEs need.
• Acted as a liaison between stakeholders: system users, clients and managers, who have a business problem and software development team to gather requirements.
• Conducted JAD session to elicit requirements for various attributes of PeopleSoft with SMEs, PMO, Design and Development Team.
• Understanding the business process (AS-IS and TO-BE), understanding the requirements and translating to System Requirement Specifications.
• Involved in implementation of PeopleSoft in claim process, claim history, claim status.
• Involved in centralizing claim information through PeopleSoft.
• Participated in meetings to have better understanding of PeopleSoft in connecting the different departments of the organization especially with finance and accounts department in accordance with accounts payable/accounts receivable and expense principle.
• Involved in customization of PeopleSoft for Asset Management, Cash Management, service procurement as well as General ledger.
• Involved in updating project plans and also ensured the project documents were uploaded on SharePoint and submitted to PMO for final review.
• Worked with Approval Workflow Engine (AWE) to keep track on transaction event, transaction approval process, email templates etc.
• Involved with Data team to extract data from Data Warehouse and generate report.
• Involved in report generation through SQL statement.
• Involved in integration Peoplesoft with Enterprise Data Warehouse.
• Created use case diagrams usingUMLdiagram module inMS Visio.
• Defined functional and non-functional requirements to Use Case narrative using the UML diagrams
• Created Requirement Traceability Matrix (RTM) to trace requirements and manage Change Requests.
• Designed and developed Activity Diagrams, Sequence Diagrams, Use Cases and other Process Flow Models using Visio.
• Used SharePoint for proper document management including document upload and download.
• Prepared the Process flows, Activity Diagram, Business Requirement Documents.
• Involved in dealing with the Customer Interface, Data and different functionalities of PeopleSoft.
• Closely worked with QA on organizing Test Plans and training rollout, preparing Test Cases and UAT scripts, actively participated in testing to ensure successful implementation and project sign-off.

Confidential, Alexendria, Virginia

Business Analyst

Responsibilities:

• Participated in daily Scrum meeting with the Project team and change management team to discuss the requirement updates, change requests, tasks and assign/re-assign man hours on a daily basis.
• Used Requisite Pro for the Requirement Document Preparation and Prepared Business Process Models (BPM) that includes modeling of all the activities of the business from the conceptual to procedural level.
• Performed requirement analysis, impact analysis, Cost analysis and documented the requirements using Rational Requisite Pro with respect to CMS requirement.
• Documented user stories and modeled use case diagrams by utilizing MS Visio.
• Performed Gap assessment between current transaction and the HIPAA 5010 Migration requirements.
• Conducted user interviews and JAD Sessions with end users, stake holders and developers to gather functional and non-functional requirements of the system, and creation of User Stories.
• Prepared graphical depictions of Use Cases, Use Case Diagrams, State Diagrams, Activity Diagrams, Sequence Diagrams, Component Based Diagrams, and Collateral Diagrams and creation of technical design (UI screen) using Microsoft Visio.
• Assisted in developing the Test Plan, Test Cases and Test Scenarios to be used in testing based on Business Requirements, technical specifications and/or product knowledge.
• Worked on Facets in complaint with HIPAA EDI transactions such as 835, 837, 276, 277, 278, 270, 271, 834, and 820.
• Involved in remediation of the legacy MMIS to meet the minimal functionality necessary to electronically send, receive and process the HIPAA 5010 complaint standard transactions and implement of NPI components.
• Involved in process flow analysis of EHR incentive programs to note the potential inaccuracies in using MMIS.
• Understanding of the complete Claims process in compliance with Facets.
• Conducted Claim/Encounter Management, Claim Data Collection, Claim Quality Check, and filtered claims for Risk Adjustment.
• Developed plan for data feeds and data mappings for integration between various systems, including XML, to followICD 10Code set andANSI X12 5010formats.
• Involved in gap analysis and implementation of HIPAA 5010, ICD 10 and Claim Validations.
• Used General Equivalence Mappings (GEM) to convert ICD-9 to ICD-10.
• Interacted with various HMO, PPO, Medicaid/Medicare Representatives discussing benefits of contracts on behalf of facilities or appeals from denials and compliance issues.
• Involved in User Acceptance Testing (UAT) and assisted in developing the test plans, test scenarios, test cases and test data to be used in testing based on business requirements, technical specifications and product knowledge.
• Used MS SQL to query various record and information tracking database.

Confidential, Columbus, Ohio

Business Analyst

Responsibilities:

• Collaborated with SMEs and management to understand existing Business Processes, evaluated solutions to business problems/bottlenecks and finding automatic methods to increase efficiency and productivity.
• Used Rational Unified Process (RUP)/UML to make an Object Oriented model for the application and used modeling tools like UML/Rational Rose for creating the Use Cases, Class Diagrams, Sequence Diagrams etc.
• Conducted Joint Application Development (JAD) sessions with stakeholders throughout SDLC to resolve open issues.
• Involved in the implementation of PEGA in various stages of the process.
• Involved in Customer Interface for making it understandable to the client.
• Involved with the Claim Processing of various EDI transaction in PEGA system.
• Conducted Claim/Encounter Management, Claim Data Collection, Claim Quality Check, and filtered claims for Risk Adjustment.
• Actively engaged with various partners from the client team to monitor and control the risk associated with changing scope.
• Involved in dealing with different Function, Data of legacy system.
• Involved in the implementation of HIPAA 5010 as well as ICD 10 in compliant with PEGA system.
• Developed Data Flow Diagrams, illustrating the flow of data from the Legacy Systems into the Application Database Tables, along with checkpoints for testing / verification.
• Analyzed user requirements, attended the Change Request meetings to document and notify the changes that are implemented/ or needed to be implemented and also make space for scenarios to test the implemented procedures.

Confidential, Lansing, Michigan

Business Analyst

Responsibilities:

• Maintained the Functional Gap spreadsheet and was responsible for tracking the progress of all Gaps.
• Created and Reviewed Business Requirements, Functional Specifications, Project Schedules, Documentations and Test plans.
• Responsible for elaborating Billing Center configuration user stories such as Invoicing rules, Delinquencies, Policy Cancellation, Automated disbursements, Policy Rewrites, Policy Reinstatements, Billing Parameters, Fees, and Payment distribution rules.
• Conducted User Interviews and JAD sessions with end users, stake holders and developers to gather functional and nonfunctional requirements pertaining to Loan Origination to loan Processing
• Worked with thebusinessusers and product owners to modify/add requirements to address multiple enhancements that are needed to fix any issues with previously implemented functionality in Billing Center
• Prepared Business workflow models, Workflows & analyzed the process which needed customization based on Waterfall methodology.
• Developed UML Use Case diagrams for faster and more efficient communication with stakeholders, by utilizing MS Visio.
• Ensured that the current project requirements were being met by using Requirement Traceability Matrix (RTM).
• Created Use case and Activity diagrams using MS Visio to give web developers a better idea of the application design.
• Assisted the QA team in creation of Test Cases and tests implementations.
• Frequently performed QA testing in the QA environment to assist QA in meeting testing deadline.
• Analyzed business lines on a macro level utilizing multiple information sources (primary and secondary) to provide actionable consumer and business insights.
• Create process flowcharts for various issues in Billing Center functionality and help perform gap analysis