Summary

Business Analyst with 8 years of extensive experience performing Business Analysis, Business Modeling, Requirement Gathering and Technical Documentation and Expertise in the Healthcare Health Insurance domain involving all stages of the Software Development Life Cycle and a business level understanding of the technologies involved, those including front-end web services, XML, HTML,CSS, JavaScript , Middleware and back-end SQL, TSO. Also proficient in working with the SharePoint Server as well as CASE tools in gathering, analyzing and documenting requirement artifacts.

Skills Summary:

• Have strong experience in requirements gathering by conducting interviews with end users. Excellent analytical and interpersonal skills and expert at managing multiple projects simultaneously.
• Comprehensive knowledge of SDLC methodologies including AGILE methodology and traditional methodologies like WATERFALL having thorough understanding of various phases like Requirements, Analysis/Design, Development and Testing.
• Extensive experience in creating Business Requirement Specification BRS , Systems Requirement Specification SRS , Functional Design Document FDD and Use Cases.
• Experience communicating effectively with upper management, SME's, senior BAs, developers and QA engineers.
• Proficient in documenting and conducting GAP Analysis, SWOT Analysis, Cost Benefit Analysis, Risk Analysis , Impact Analysis , Data Analysis, Status Report, Requirement Traceability Matrix RTM as well as expert use of Surveys and Questionnaires in gathering information.
• Experience in effectively handling multiple Applications and opportunity to represent as one of the key SME from the team.
• Good control on MS Office suite, MS Visio and MS Project.
• Excellent presentation skills with MS Power Point, which was extensively used in different JAD sessions and to track progress.
• Organized Joint Application Developments JAD sessions, SCRUM meetings and Joint Requirement Planning sessions JRP , walkthrough, Interviews and Rapid Application Development RAD sessions with end-user/clients and the IT group.
• Adept at creating and transforming business requirements into functional requirements and designing business models using UML diagrams - Context, Use Case, Sequence, Activity diagrams in MS Visio and Rational Rose.
• Expertise in creating Static Wire Frames using MS Visio and mock-up tools to assist UI/UX team in UI Prototype designing.
• Assisted the Project Manager with activities like development of business processes, effort estimation, resource management, issue/risk analysis, milestone tracking, and System process flow and associated documentation.
• Ability to communicate both on a business and technical level and coordinate well with business and technical resource.
• Excellent track record for meeting deadlines and submitting deliverables on time.
• Experience with various ETL, data warehousing tools and concepts.
• Designed and implemented data integration modules for Extract/Transform/Load ETL functions.
• Understand and implementation experience with both relational and data warehousing models including star-schema, dimensional design, data mart, and database architecture.
• Basic understanding of the star-schema data warehousing model.
• Excellent knowledge of Health Insurance and Portability and Accountability Act HIPAA .
• Good working knowledge of Claims processing, FDA regulations ,HIPAA Regulations and EDI Transactions 278, 276/277,270/271,837,275, 835 for health care industries and understanding of ICD 9 and ICD-10 structures and format.
• Well versed with Facets, claim adjustments, claim processing from point of entry to finalizing, claim review, identifying claims processing problems, their source and providing corresponding solutions.
• Exposed to using ICD 9/ICD 10/ANSI/HL7 coding standards in Medicare and Medicaid domains of the healthcare systems and industry for both Inpatients, Outpatients, Reimbursement methodology.
• Knowledge on Medicare, Medicaid, CMS, HMO, PPO and other LOB's.
• Knowledge of SharePoint including experience working with SharePoint 2010/2013.

Skills Matrix:

Responsibilities

• Gathered, analyzed, and documented Systems Requirement Documents SRD , Functional Design Document FDD and all the affiliate artifacts like UML diagrams Use Case, Activity, and Sequence Diagrams .
• Planned and supervised target meetings with SME's , JAD sessions, direct interview sessions, conference calls and produced detailed artifacts such as Surveys/Questionnaires and minutes of meetings covering issues discussed.
• Conduced GAP Analysis, Risk Analysis, Data Analysis between the current system and new requirements to be implemented, thereby mapping the business requirements of the application.
• Effectively managed project risks by creating and managing a Risk Register which identifies, prioritizes and measures risk, risk drivers and expected loss.
• Assisted the Project Manager in developing, tracking and managing the project triple constraint schedule, cost, resources and scope using MS Project.
• Involved in daily Scrums to determine the status of the project and impediments if any.
• Worked on Error Analysis of the failed Transactions coming from different Vendors System.
• Used QDQ for requesting document approval and Sign-offs.
• Identified and documented Business Rules, created detailed Use Cases.
• Used Rational Requisite Pro for overall requirements management and to build the Requirements Traceability matrix.
• Developed different Unified Modeling Language UML Diagrams using MS Visio to help developers and stakeholders in order to understand the 'AS IS' and 'To BE' systems.
• Effectively managed change by deploying change management techniques such as Change Assessment and Impact Analysis.
• Verify and validate all the build or release related issues and resolve then through discussion with business analysts with the users approval.
• Engaged with operations teams and systems analyst to understand and translate business requirements into operational designs for data warehouse and business intelligence programs.
• Develop the Requirement management Plan and disseminating the Plan to the PM Project Manager
• Configure, test and deliver the solution as per the requirements.
• Facilitated the Designed and development of Business Rule Engines to support SOA architecture and web services.
• Assisted design and validation processes by performing explanatory Data Mapping.
• Involved in defining the Business Rules Engine BRE for making decision about aggregating federated information in real time, resolving sourcing system conflict and coordinating data visibility with data quality rules incorporated in the in-house application.
• Part of, Test Cases review and UAT testing.

Environment: Water Fall, AGILE SCRUM Methodology, RUP Tools Requisite Pro , Oracle, Microsoft Office 2010 Outlook, Word, Excel, PowerPoint, and Access , HP Quality Centre, Java, SharePoint, ALM, QDQ, EAS, TSO, Visio Professional 2003

Responsibilities

• Gathered, analyzed, documented high level Business Requirement Documents BRD , Requirement Traceability Matrix and all the affiliate artifacts like UML diagrams Use Case, Activity, and Sequence Diagrams .
• Coordinated with PM to discuss and create template for Project Technologies, Methodologies, Budget, Time factor, Risk register, MS project timeline, Project mile stones, Critical path analysis,.
• Planned and supervised target meetings with SME's such as Financial Advisors , JAD sessions with all Project stakeholders including Tech Leads , direct interview sessions, conference calls and produced detailed artifacts such as Surveys/Questionnaires and minutes of meetings covering issues discussed.
• Prepared Requirement Traceability Matrices RTM and managed every change requests effectively throughout the software development life cycle.
• Designed Mock-ups and wireframes using MS-Visio to get feedback from UI/UX team about the web form designed.
• Conducted detailed Process Analysis and Decision Tree Analysis and assisted in Business Process Re-engineering procedures including identifying bottle necks and failure points, and developing alternative paths for process flow.
• Effectively managed project risks by creating and managing a Risk Register which identifies, prioritizes and measures risk, risk drivers and expected loss.
• Involved in defining the source to target data mappings, business rules and data definitions.
• Assisted the Project Manager in developing, tracking and managing the project triple constraint schedule, cost, resources and scope using MS Project.
• Assisted UI/UX team in translating client graphical requirements to reality by creating Mockup Screens.
• Effectively managed change by deploying change management techniques such as Change Assessment and Impact Analysis.
• Applied Agile SCRUM and conducted Sprint Planning meeting, stand up meetings, retrospect meeting and created spring backlog.
• Assisted design and validation processes by performing explanatory Data Mapping and supervised Data Migration protocols.
• Facilitated the Designed and development of Business Rule Engines to support SOA architecture and web services.
• Worked closely with System Architect to implement Service Oriented Architecture SOA , Client side Validations, Server side Validations, Web Method definitions and data modeling.
• Extensively involved in Data Governance process. Assisted in data grouping and defined relationship among the different tables.
• Identified and documented Business Rules, created detailed Use Cases, and Conducted User Acceptance Testing.

Environment: Agile Scrum, TFS, Rational Rose, UML, Use case, Activity and Sequence diagram, C , MS Visio, Windows 2000/XP, MS Office, Oracle, SOA

Responsibilities

• Assisted in defining the project milestones and work breakdown structure and prepared risk documentation. Act as the mediator in business and technical capacity.
• Involved in gathering the requirements that were critical to the business process flow and using those requirements for the Business Requirements Document BRD and Use Cases.
• Defined various UML diagrams activity, sequence, sequential and contextual to create a graphical representation for the developers and the database architect.
• Conducted Gap analysis, SWOT analysis, Communication Analysis, Business Rules Analysis, Document Analysis and other related analysis such as Scope creep assessments and Goal Orientation Assessments.
• Used Scrum methodology for the SDLC.
• Assisted UI/UX team in translating client graphical requirements to reality by creating Mockup Screens.
• Extensively used Share point to define documents library, list, Web-Parts, Workflows and InfoPath.
• Implement the functionality necessary to support correct end-to-end processing of Coordination of Benefits COB to ensure compliance with the Centers for Medicare and Medicaid CMS regulations in with regard to COB.
• Worked on the following list of HIPAA- EDI Transaction: 276/277,837, 275 for products like HRA.
• Captured all HIPAA-related EDI data in the repository using FACETS.
• Accepted inbound transactions from multiple sources using FACETS.
• Supported integrated EDI batch processing and real-time EDI using FACETS.
• Defined Business rules on data model and developed Crosswalks.
• Defined business rules under .net framework for client side validation and defined business rules in business layer. These business rules can talk to all web services and database.
• Developed static wireframe that will assist the UI/UX team to develop the UI.
• Directly interacted with the Stakeholders/Business Managers and served as a primary point of contact.
• Analyzed and conducted data mapping of the metrics with the member profile data and also the negotiated contract data to understand the overall profiles of the members.
• Responsible for defining the Test plan, analyzing the Test scenarios, preparing Test case documents, defining the performance environment requirements.
• Involved in UAT planning and testing. Created clear user manuals and training guides for UAT.

Environment: MS SQL, XML, MS Visio, Rational Requisite Pro, FACETS, Microsoft Office 2010 Outlook, Word, Excel, PowerPoint, and Access , MS Project, SharePoint 2010

Responsibilities:

• Act as a bridge between the Business, Information Technology and vendors in gathering, documenting and developing functional requirements and specifications for project enhancements.
• To complete gap analysis, impact assessment, process flow documentation and business process models.
• Identifying and conducting meetings with various stakeholders to analyze and document requirements that could be consumed downstream by the integration developers.
• Identify and analyze integration opportunities.
• Analyzed and identified areas for the future integration of the legacy systems.
• Provide expertise and support in the resolution of cross functional issues.
• Performed manual data mapping using Altova Spyware system to convert source XMLs to Target XMLs HL7, Inspire XML etc
• Use MS Visio to create various diagrams and prototypes during the process cycle.
• Support interfaces in production by identifying and appropriately tackling issues.
• Develop project delivery schedule, manage project timeline and identify resources for successfully orchestrating the project deliverables.
• Verified the functional aspect as per the Business Process and validated the interfaces with the other systems and data conversion from the legacy system.
• Identifying data elements for interfacing the new system with billing, client demographics and slide scanning systems
• Involved in weekly walkthroughs and inspection meetings to verify the status of the effort and the project as a whole.
• Provided group facilitation and additional forms of knowledge transfer.
• Create and conduct various other presentations to cater to the Business as well and the IT audience.

Environment: MS Office Word, Excel, PowerPoint , XML, UML, MS Visio, MS Project, Oracle, Agile, Clear Case

Responsibilities:

• Conducted detailed and comprehensive Business Analysis by working with end users and other stake holders to identify the system, operational requirements and proposed enhancements.
• Supported business process flow for the claims processing EDI transactions which included hospital claims and prescription drug claims.
• Facilitated Joint Application Development JAD sessions with all IT group members for communicating managing expectations and to discuss various means for integrations with current system using an adoption through execution strategy.
• Conducted Gap Analysis on the AS-IS and TO-BE business processes and technology and identified potential pitfalls, risks, and issues.
• Mitigated risks and developed contingency plans for risk management
• Identified all necessary business and System Use Cases from requirements, created UML diagrams including Use Case Diagrams, Activity Diagrams and Sequence diagrams using Microsoft Visio.
• Understood the business Logic, User Requirements and test-objectives to develop Test plans, Test cases, Use Case Scenarios.
• Involved in comprehensive testing of the system to check it satisfies functional specifications.
• Responsible for checking the benefit set and adjudication of claims.
• Gathered Data Hub requirements and responsible for creating test cases and test scripts under Quality Center Test Plan and Test Lab modules.
• Developed Test Scripts using Test Director and coordinated with developers to quickly resolve the defects associated with them.
• Analyzed and evaluated User Interface Designs, Technical Design Documents and Quality Assurance to test the performance of the application from various dimensions.
• 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.
• Data Hub testing scope includes testing the Data Hub requirements, documenting and testing source system records, change requests and assist SMEs with validation of daily error files.
• Verified and validated all the build or release related issues and resolve then through discussion with business analysts with the users approval.

Environment: MS Office, MS Visio, Agile Scrum, UML, Mainframe, .Net, Sequence, Use Case, Activity Diagram

Requirements:

• Responsible for requirements gathering, analysis design, and preparing artifacts.
• Responsible for planning timelines, schedules and dates for multiple releases and upgrades that are delivered to Service/Channel stake holders.
• Facilitated JAD sessions to identify, understand and document requirements and operated as a liaison between the technical team and the business users.
• Created use case diagram, use case document, activity diagram and business process flows.
• Elicited requirements for agile projects by documenting User stories, Product Backlogs and Acceptance Criteria.
• Participated in User Story Estimation, User Story Prioritization, Sprints, User Story Testing, and Project Documentation.
• Developed business requirements, user requirements and functional requirements, and documented the same by creating business requirement document, use case document and functional requirement document.
• Documented workflow and results of business analysis done and obtained sign-off from client on specifications.
• Communicated with multiple stakeholders, including cross-functional vendors and offshore.
• Conducted gap analysis and documented the gap analysis document using Excel.
• Documented all the artifacts in Microsoft SharePoint for version controlling and common point accessibility purpose.
• Communicated the project status and ensured the team stays on track to satisfy the business needs.
• Provided daily status and prepared weekly project status reports.

Environment: Agile/Scrum, MS Visio, MS Access, XML, HP Quality Center, MS Office, Windows 2000/XP.

Requirements:

• Perform quality review and cleanup of old account receivables utilizing the SMS Invasion.
• Patient Accounting System and SSI Billing and Claims Transmission software for correct claims administration.
• Perform trouble shooting on SSI, SMS, charge master, claims administration and system related issues as warranted.
• Identified major electronic claims transmission problem causing claims transmission failure.
• Corrective action resulted in substantial cost savings.
• Advise charge master analyst of changes in Medicaid/Medicare codes to update billing system.
• Performed GAP Analysis between different applications to bridge the gap.
• Assist in development of training materials for End User Support on new technology and process improvements

Environment: Waterfall, MS Visio, Java, HP Quality Center, MS Office, Windows2000/ XP, MS Access