SUMMARY:

• Over 8+ years of experience in Requirements Analysis, Requirements Management, Use Case modeling using UML, Business Process Modeling, Data Analysis, Asset Management, Change Management, Project Management with focus on Health Insurance.
• Strong experience with Scrum methodology and well versed in writing user stories.
• Proficient in using Agile Scrum methodologies, performed roles of an Interim Scrum Master following sprint/standup sessions and wrote user stories, analyzed the Iteration Burn Down charts and reviewed defects
• Strong Knowledge of Software Development Life Cycle (SDLC), with thorough understanding of various phases such as Requirements, Analysis/Design, Development, Testing and Implementation.
• Experienced in conducting Joint Application Development (JAD) sessions with SMEs, Business Analysts, Software Developers and Quality Assurance teams for New Corporate Accounts or Clients.
• Knowledge of health information and health care services regulatory environment including HIPAA, Medicaid/Medicare, CHIP & EDI
• Have experience in healthcare industry in working with various modules which includeclaims processingusingEDI X12transactions like837, 834, 835, 270/271, and 276as per theHIPAAcompliance.
• Experienced working with the centers for Medicare and Medicaid services (CMS), the Healthcare Common Procedure Coding System (HCPCS), Electronic Data Interchange (EDI), Medicare Part D Services, and State Pharmaceutical Assistance Program (SPAP) services
• In - Depth knowledge HL7 Standards, HIPAA, PPACA (Patient Protection and Affordable Care Act), and Compliance issues, and SNOMED Mapping, HL7 Message Validation (EHR & EMR), ICD 9, Electronic Health Records (EHR), Electronic Medical Records (EMR).

PROFESSIONAL EXPERIENCE:

Confidential, Grand Rapids, MI

Business Analyst/Project Co-Ordinator

Responsibilities:

• Responsible for gathering the functional requirements for the health benefit claims receiving and processing system
• Participated in brainstorming sessions and walkthroughs with subject matter experts (SME).
• Developing Use Case Models, Activity Diagrams, State Diagrams and Data Flow Diagrams (DFD) using MS vison & Gliffy Prepared reports and presentation of key components and milestones to Top Management.
• Coordinated and prioritized outstanding defects and enhancement/system requests based on business requirements, allowing sufficient time frame to ensure accuracy and to meet deadlines.
• Used confluence software for document storage along with Share Point.
• Worked on all modules of SDLC life cycle from Initiation, plan, design, develop, test, deploy & maintenance and created artifacts to support all phases and help the Dev Team and test Team with questions/concerns around BR/FR requirements.
• Maintained the Business Impact Analysis Template (BIAT) to analyze and document the effect of proposed changes on the project schedule.
• Worked on different EDI modules usingEDI X12transactions like837, 834, 835, 270/271, and 276

Environment: Waterfall, MS Visio, MS Office, Agile, HP-ALM, Qvidian (RFP tool), SharePoint, AWS-IAM, Confluence 4.3, Gliffy 3.7, Gatherspace

Confidential, Portland, OR

Business System Analyst

Responsibilities:

• Involved throughout the Software Development Life Cycle, (SCRUM) including sprint planning meetings, review meetings and backlog refinement meetings.
• Prepared business requirements documents by conducting client group interviews, JAD sessions and with other internal departments.
• Managed roles offshore and served as a liaison between development team and business team.
• Prepared detailed requirements as per USER STORIES to provide details of each business and functional requirement, development and implementation plan of these requirements, timelines, owners, etc.
• Worked on Claims adjudication, benefits as well as member and provider data.
• Prepared change request form to provide details of the changes requests and obtained approvals from the appropriate stakeholders.
• Implemented HEDIS reporting tool to measure the performance on critical dimensions of healthcare data, to file products with CMS
• Provided to the users and involved in facilitating UAT sessions to gain user confidence and approval.
• Supported BRD by creating various UML diagrams such as; Flow chart, Network diagrams, Floor plans, Site maps, Business process modelling software and Venn diagrams.

Environment: Agile-SCRUM, MS Office, MS Access, MS Visio, iRise, MS SQL Server, Informatica Power Center, Rally, MS Project, SharePoint, TFS, Versionone, Abacus

Confidential, Buffalo, NY

Business Analyst

Responsibilities:

• Conducted scope of analysis sessions to understand the true scope of requirements and the project.
• Created a Requirements Work Plan (RWP) based on the scope of analysis sessions to estimate the hours and plan the sessions needed to successfully deliver the project.
• Proficient in using Agile-Scrum & Waterfall methodologies between different project & performed roles of Scrum Master following sprint/standup sessions and used Rally tool extensively to write user stories, analyzed the Iteration Burn Down charts and reviewed defects
• Created and maintained a SharePoint site for the project to allow easy document sharing. Assisted core team members by providing general support related to SharePoint and ensuring all project related artifacts are stored on the site.
• Conducted project Kick-Off session to review the business case/project vision and scope as well as get everybody on the same page in respect to roles and responsibilities of core team members.
• Gathered business requirements from SMEs as well as CMS call letter and BCBSA requirements and related documents and used it as a means to perform SWOT & Gap Analysis.

Environment: Agile-Scrum, Rally, Balsamiq, SharePoint, Snagit, Lotus Notes, Creately 2.0, MS Office (Word, Excel, PowerPoint, MS Access), Waterfall-Agile

Confidential, Philadelphia PA

Business Analyst

Responsibilities:

• Coordinated with the stakeholders and project key personnel to gather functional and non-functional requirements duringJAD sessions.
• Responsible for the full HIPAA compliancelifecycle from GAP analysis, mapping, implementation and testing for Medicaid Claims.
• Responsible for GAP analysis in changing oldMMISand Involved in testing withMMIS System.
• Responsible for Medicaid Claims Resolution/Reimbursement for peach state health plans.
• Assisting the project manager in creating thebusiness case and project plan.
• Work with business representatives to understanddata martsrequirements and priorities and ensure that IT works is appropriately aligned.
• Responsible for creatingbusiness work flows and processesand creating management reports based on the analysis.
• Followed the UML based methods usingRational roseto create use cases, activity diagram, sequence diagram, collaboration diagram that include functional and non-functional specifications to hand off to development teams.

Environment: Waterfall, UML, Windows, SQL, Microsoft Office, Clarity CA PPM, MS Visio, SharePoint, MS Suite (Word, Excel, Power Point, MS Project)

Confidential

Business System Analyst

Responsibilities:

• Conducted user interviews, gathered requirements, analyzed the requirements using RUP methodology involving Rational Suite (Rational Rose, Requisite Pro) and performed the iterative process to develop Use Cases
• Worked with the SMEs (Financial Analysts, Risk Managers, Project Managers) to define business requirements and analyze the possible technical solutions
• Created Business Requirement Document (BRD), Functional Requirement Specification, and User Requirement Specification (URS) for application development
• Conducted joint requirements planning (JRP) sessions as a facilitator to gather requirements from the business area and conducted JAD sessions with IT group
• Used Rational Suite to analyze business requirements and segregated them into Use Cases and activity diagrams using Rational Rose according to UML methodology thus defining the Data Process Models
• Strong knowledge of managed claims management process, Knowledge of Medicaid and Medicare Services. CMS, Health Assessment Systems, HL7 Standards, HIPAA, PPACA(Patient Protection and Affordable Care Act), Compliance issues, LO INC and SNOMED Mapping, HL7 Message Validation, ICD 9, Electronic Health Records(EHR), Electronic Medical Records(EMR).
• Developed and managed project plans and schedules. Managed resolution of project issues and conflicts documentations

Environment: Waterfall, Rational Tools Suite (Rose Requisite Pro), MS Project, MSOffice, HL7, MS word, SQL