SUMMARY:

• Results - oriented professional with good communications, Project Management, Claims Processing, team building, analysis, BPM and User Acceptance Testing (UAT), problem solving skills including 8+ years experience in business analysis, and client relationship management
• Worked with PM's on transmission test setups and production healthcare 834 Enrollment processes
• Professional experience in Business Analysis, Software Development Life Cycle (SDLC): System Analysis, Design, Development, Testing, and Implementation on Business Systems
• Having strong knowledge of the Software and Project Management life cycles within a formal methodology process / PMLC
• Familiar with HIPAA EDI transactions such as 835, 834, 837 (P, D, I) 276, 277, 278 etc
• Having strong “AS IS” and “TO BE” processes experience
• Expertise in Project Management i.e. Project Scoping, Planning, Estimating, Scheduling, Organizing, Directing, Controlling, Budgeting and Drafting Remedy Procedures
• Having good knowledge on Care Management
• Technical experience in using IBM BPM (Teamwork's Lombardi) and IBM Integration Designer (IID) tools. Hands on experience with WLE 7.2, IBM BPM 7.5, 8.0 and 8.5
• Worked with NASCO teams to get current work flow for detailed business process
• Ability to educe, define, document business user requirements, managing requirements and analyzing requirements, changing requirements and translating requirements and objectives into business/technical requirements based on project scope parameters.
• Responsible for EDI strategies enabling Health Care Providers and Insurance Careers to communicate effectively.
• Involved in gap analysis of healthcare portal applications that are developed in house team and developed gap analysis document, logical and physical design and remediation plan
• Experience in designing and development of business processes using IBM BPM including process analysis, process modeling, Web services, REST services, Coaches, Coach views, Business Objects, Decisions, UCA's, Exception Handling, Tracking Points, Ajax services and Task routing
• Good Working Knowledge of HIPAA Regulations and Claims Processing.
• Strong experience in Requirements elicitation techniques - conducting user interviews, document analysis, JAD sessions and managing the requirements
• Established IBM BPM best practices and guidelines throughout the organization and also mentored the new team members on BPM tool
• Provided overall project management, monitoring development team progress, delivering feedback and support as necessary to resolve technical issues and maintain project delivery timelines
• Created design documents like data flow diagrams, process flow charts using MS VISIO and UML.
• Strong Object Oriented Analysis and Design using UML, Rational Unified Process, RATIONAL ROSE.
• Efficient in MS Project/MS Excel for planning/status reporting/writing test scenarios.
• Extensive knowledge of all phases of the software development life cycle (SDLC) and the iterative Rational Unified Process (RUP)
• Actively involved in developing, executing and managing User Acceptance Testing (UAT).
• Good hands on experience testing of inquiry screens to support EDI transactions.
• Built strong relationships with clients and demonstrated commitment to delivery.
• Strong communication, business understanding, critical thinking and analytical skills.
• Highly motivated, organized and target oriented team player who enjoys working with multi-functional team towards a common goal.

TECHNICAL SKILLS:

• OOAD (OOA/OOD)
• RUP
• UML
• SDLC
• Waterfall
• QA
• WAP
• CVS
• TEAMMATE
• MS Access
• SQL Server
• MySQL
• PL/SQL
• Oracle DBA
• DB2. Basic UNIX
• HTML
• JIRA basic DHTML
• Documentum
• SharePoint
• Interwoven
• IBM ECM
• BPM
• IBM FileNet P8
• FileNet basic XML
• MS Office Suite-Excel Macros
• Project
• Visio
• Adobe Photoshop
• Flash
• Agile
• Waterfall
• Scrum
• Rational- Rational Rose
• Rational XDE
• DOORS
• Cobol
• RequisitePro
• CaliberRM
• Crystal Reports various NIKU products
• C
• C++
• SharePoint
• Docushare
• BASIC
• Intermediate level-Visual Basic

PROFESSIONAL EXPERIENCE:

Confidential, Columbus, OH

Sr. Business Analyst/ Claims Processing

Responsibilities:

• Gathered and documented requirements in order to process Change request in reporting for 834 and 837 transaction.
• Gathered and documented requirements to resolve issues in Reporting for Business operations and remodeled the existing reporting to a more informative aspect for 837,834.
• Worked with the management as a part of Business Operations support team for 837, 834 and 820 transactions
• Gathered new requirements and traced them back to the original requirements gathered for processing change request regarding reporting issues with ODS in specific with 834 and 820 transactions.
• Assigned priority for the reports based on their help in facing client.
• Conducted daily Control and balancing procedures to balance 834 and 820 transactions for audit purposes and interacted with the internal client on daily basis beyond working hours to resolve issues regarding 834, 837 and 820transactions and performed End to End Validation process for 834 and 820 transactions
• Created and run SQL query to retrieve specific data and information from the HP Database in order to circulate daily AdHoc activity and rejection reports to assist internal client and tower lead for 834and 820 transactions
• Performed Defect Analysis in 834 and 837 transactions using Quality center and proposed the resolution and fix for the defect by using Mapping document and implementation guide and also deployed to appropriate developer to fix the defect.
• Performed root cause analysis for production and reporting issues encountered with 834, 837 transactions and also performed Risk Analysis.
• Conducted Analysis of the potential fallouts and rejects on daily basis for 834 and 820 transactions and traced the corrections required for successful replay of the 834s and 837 claims.
• Facilitated frequent meetings with the management team to prioritize the gap list and performed Gap Analysis based on the expected process and current process.
• Involved with the management to improve and to enhance the future processes for HIPAA5010 transaction sets of EDI including 837, 835, 834 and 820
• Participated in Change Request processing by gathering requirements for the process and conducted meetings to analyze the proposed process and validate the requirements gathered with the technical and client teams
• Remodeled many activity diagram, process flow and business flow documents using Ms Visio and conducted 4010 recovery tasks by building up the linkage on some of the trading partners and replayed 4010 claims, loaded in Operational Repository and HTR- Historical repository
• Monitored analyzed and escalated to the right resources the various errors and issues associated with the Business process manager and exchange service bus and other HP Intake service gateways for 834, 820, 837, 835 and 277 transactions.
• Worked with the reporting team to access, retrieve and analyze Business Operations Reports in terms of visibility and usability for end to end validation purposes.
• Designed and drafted manuals for accessing, retrieving and using Business Operations Reports for performing balancing procedure for 834 and 820.
• Conducted review sessions with the IT auditors to train them use of Desk level procedures.

Environment: HL7, Windows 2000/XP, Microsoft Office Share Point 2007, MS Office, SQL Server, Agile, Rational Clear Quest, Rational Clear Case, Rational Requisite Pro, JIRA, Rational Rose, UML, UAT, RUP, Microsoft Excel, Microsoft Word, Microsoft Power Point, Visio.

Confidential, Bloomfield, CT

Sr. Business Analyst

Responsibilities:

• Conducted one on one sessions and team meetings with the team leads and SME’s to understand the business requirements
• Created Test Plan, Test case / test script in BPT, logged bugs/ defects in HP Quality Center and JIRA
• Prepared the Charter/BUR and functional design document
• Designed and development of test cases based on functional requirements for Institutional and Professional claims for EDI and HIPAA Transactions 837/835, 834, 276/277, 270/271 testing.
• Prepared UAT Materials, UAT Test Cases to include various steps involved for UAT and to have proper coverage of requirements
• Monitored the project processes, making periodic changes, authoring progress and completing reports which were then submitted to the Project Management Office (PMO) on a weekly basis
• Use JIRA to create defects, close defects, and provide updated statuses
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, OOAD using UML and Business Process Modeling (BPM).
• Performed Unit and Integration testing with the Development team, UAT and regression testing of the application services using QTP, HP Quality Center and Jira
• Involved in applications analysis, which involves claims processing in NASCO
• Implementing REST API Layer, Process flow, workflow services and patterns design for the entire application in IBM BPM
• Updated the functional design document for NPI related changes in the Encounters project.
• Arranged meetings with other teams to gather the functional and system requirement for EPC project
• Responsible for maintaining and managing requirements and defects in JIRA
• Worked on Client/Server tools like SQL Server Management Studio to administer SQL Server.
• Analyzed encounters claims file (837 P, I, D) using SpecBuilder
• Wrote defects of mobile devices through JIRA and QC working on both retesting and reopening scenarios
• Analyzed Business Requirements and segregated them into high level and low level Use Cases, Activity Diagrams / State Chart Diagrams using Rational Rose according to UML methodology thus defining the Data Process Models.
• Developed straightforward DBMS queries, knowledge of HL7 and xml interface messaging.
• Assisted in monitoring ancillary data transactions and addressed problems with HL7 messages.
• Responsible for architecting integrated HIPAA, Medicare solutions, Facets.
• Analyzed and tested various Common Eligibility Outbound Interface Process and other Inbound/Outbound Facets interfaces.
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, OOAD using UML and Business Process Modeling.
• Presented discovery documents to the IT activities for acceptance into the integrated and point releases via Statement of Business Requirements documents using MS Word, MS Excel, Telelogic Doors, and Visio tools. modeling team and have used SOA (Service Oriented Architecture)
• Extensive success in translating business requirements and user expectations into detailed specifications employing Unified Modeling Language (UML) in an SOA environment.
• Analyzed the change detection process on Facets database tables to capture the daily changes done by Users through Online Facets Application.
• Identify Member, Provider, Coverage, Medicare, and Medicaid.
• Involved in writing Job Automation process i.e. writing shell scripts using Korn shell, as scheduled daily, weekly, monthly, and sending these jobs to client’s email-ids.
• These reports were earlier prepared manually by a team of underwriters who could have otherwise spent time in writing new business.
• Managed the team of consultants responsible for developing on-demand Medicaid Management System reports.
• Analyzed, designed, and coded several online subsystems for the Medicaid System.
• Involved in Service Oriented Architecture (SOA) of the claims processing system
• Responsible for writing test plan and test cases and execution of test cases manually.
• Used SDLC (System Development Life Cycle) methodologies like the RUP and the waterfall.

Environment: Edifecs SpecBuider 6.1, EDI ANSI X12/HIPAA, JIRA, PL/SQL, UAT, MS OFFICE,TESTDIRECTOR 7.0, WINDOWS XP, XML, SOA, MS Word, MS Excel, MS Access, MS PowerPoint, MS Project.

Confidential, Portland, OR

Business Analyst

Responsibilities:

• Conducted one on one telephonic and face to face interview with the end users (the healthcare professionals) of the doctor-centric portal to research their areas of interest so as to be able to identify key challenges, define project scope deliverables and ultimately developing the application features for their benefit.
• Responsible for providing overall leadership and program/project management to a range of software application development and integration projects
• Intricately involved in Business Process Flow development, Business Process Modeling (BPM) and ad hoc Analysis
• Interacted with the users and logged any defects, enhancements from the UAT and communicated them to the development team
• Created and ran test passes in Excel, logging and tracking issues in JIRA as they were found.
• Maintain JIRA database for the project and triage issues as needed
• Provided super-user training on the various processes involved and also on how to use IBM BPM
• Interacted with the Subject Matter Experts (SMEs) and stakeholders, gathering business requirements to get a better understanding of client’s business processes.
• Used UML, for gathering requirements, created Use Case Diagrams, and Use Case Specification document (USD).
• Responsible for researching and documenting existing system features and capabilities and documented findings in user guide for the purpose of various stakeholders and team members in the project to understand the features and functionality of the application accurately
• Involved in applications analysis, which involves claims processing in NASCO.
• Cleaning of incomplete, inconsistent and noisy data to form a more organized data warehouse to ensure consistency in coding and naming. Organizing this data in terms of various major subjects to provide a simple and a concise view around the entities.
• Used Unified Modeling Language (UML) for process modeling and use cases.
• Generated daily, weekly, and monthly reports using MS OFFICE Tools and submitted to the Team Leads and Manager for reporting, status reporting and analyzing purpose.
• Developed gap analysis document, logical and physical design and remediation plan.
• Functioned as a liaison and advocate between the technical teams and the business teams and end users and taught other members of the team business and functional rules and business concepts.
• Assisted the Senior Business Analyst in writing Functional Requirement Specifications (FRS) and User Requirement Specification (URS).
• Helped in writing Training manuals and helped business with the Training on a one to one sessions.
• Wrote PL/SQL statement and stored procedures in Oracle for extracting as well as writing data.
• Involved with all the phases of Software Development Life Cycle (SDLC) methodologies throughout the project life cycle.
• Implemented data access, storage and validation routines on the database server using Procedural Language/Structured Query Language (PL/SQL).
• Designed and developed, Use Cases, Activity Diagrams, Sequence Diagrams, Visio and Business Process Modeling.
• Involved in the full HIPAA compliance lifecycle from gap analysis, mapping, and implementation and testing for processing of Medicaid Claims.
• Captured, communicated, managed system requirements and Maintained requirement tractability to keep team members up to date with the latest requirements and changes if any.
• Responsible for training and testing of transactions.
• Analyzed existing procedures and reported to management to improve productivity

Environment: EDI ANSI X12/HIPAA, MEDISTAT, UAT, JIRA, MERCATOR, MS Word, MS Excel, MS Access, MS PowerPoint, MS Project, XML, SOA, RATIONAL ROSE, TESTDIRECTOR, WINDOWS NT/XP.

Confidential, Atlanta, GA

Business Analyst

Responsibilities:

• Analyzed user requirement documents (URD), software requirement specification document (SRS) and prepared System test plan by dividing the application into manageable units.
• Analyze and prepare specifications for the improved functionality of the Nasco
• Involved in writing Detailed Test Plan for the Application under Test (AUT)
• Understanding the process and business requirements such as process flow, existing application functionality thoroughly and providing better solution through IBM BPM
• Responsible for developing and executing activities related to end-to-tend project management, including project plans and estimates, scoping and requirements through implementation and deployment
• Responsible for writing Functional Requirement Specifications (FRS) and User Requirement Specification (URS).
• Enhanced the Test Cases by analyzing the Specification Documents
• Touched point with business partners on a daily basis to review the status of the project thru SIT “System Integrated Testing”, UAT Functional “User Acceptance Testing”, UAT Regression and Implementation phase
• Developed, implemented and executed test methodologies and plans to ensure software product quality as per the RATIONAL UNIFIED PROCESS (RUP) methodology. Test some of the Extensions in Facets application manually.
• Created the business process model using MS Visio for better understanding of the system and presented it to Project Manager and other team members for validation.
• Developed business process models in RUP to document existing and future business process.
• Collected and processed quantitative and qualitative data analysis.
• Prepared spreadsheets with the help of MICROSOFT OFFICE EXCEL to show like specific geographic regions etc.
• Conducted several demos driven by MICROSOFT POWERPOINT Presentations.
• Reported status to the project manager weekly.
• Involved with the business users, developers to make sure the reports were developed right to the specification.
• Documented existing applications with the creation of UML sequence diagram and class diagram to document.
• Involved in prioritizing the defects and writing business requirements to resolve them.
• Extensive experience in analyzing and requirements gathering and writing system functional specifications including use cases.
• Lead multiple project teams of technical professionals through all phases of the SDLC using technologies including Oracle, Erwin, Data Stage, Data Warehousing, Websphere and Cognos.
• Involved in generating various reports using the SQL Server Reporting Services (SSRS).
• Used Test Case distribution and development reports to track the progress of test case planning, implementation and execution results.
• Wrote PL/SQL statement and stored procedures in Oracle for extracting as well as writing data.
• Involved in creating use case diagrams for the purpose of the team to understand the workflow of the system.
• Analyzed and formatted data to a consistent format using MEDSTAT TOOL.

Environment: RATIONAL REQUISITE PRO, UAT, RATIONAL CLEARQUEST, JIRA, RATIONAL CLEARCASE, VB, JAVA, WINDOWS NT, UNIX, XML, SOA, MS Word, MS Excel, MS Access, MS PowerPoint, MS Project.