PROFESSIONAL SUMMARY:

• Experienced and versatile Business Analyst with 6+ years of extensive experience as a Quality Analyst, Business and Data Analyst in different domain, primarily in Health care domain.
• Experience in working with various tools like OOD Visual Basic which is used for requirements gatherings in business.
• Strong knowledge of the Software Development Life Cycle methodologies like Agile and Waterfall models.
• Extensive knowledge of Health Care Reform
• In - depth knowledge of RUP (Rational Unified Process), Agile and Waterfall methodology and its application to health care industry process management.
• Extensive knowledge of Medicaid, Medicare, Procedural and Diagnostic codes and Claims Process.
• Experience in Conversion of HIPAA X12 4010 codes to X12 5010 codes and ICD 9 codes to ICD 10 codes
• Functional knowledge of Medicaid Management Information System (MMIS).
• Excellent knowledge on industry standards such as Six Sigma, CMM and Electronic Health Record.
• Strong knowledge of Business Process Modeling, Business Intelligence and Business Architecture.
• Exposed to using ICD9-ICD 10 coding standards in Medicare and Medicaid domains of the healthcare systems and industry for in Confidential ts, out Confidential ts, and Reimbursement methodology.
• Experience in interacting with business users to identify their needs and gathering Business and Functional Requirements, developing Project Plan, Business Requirement document, Functional Specification document, Test Plans, conducting Gap Analysis and Impact Analysis, preparing manuals and knowledge transfer manuals.
• Experienced in facilitating Joint Application Development (JAD), Rapid Application Development (RAD) sessions, interviews, workshops and requirement elicitation sessions with end-users, clients, stakeholders and development team.
• Experienced in using UML and tools like Rational Rose, Visio, and Requisite Pro.
• Gathering business requirements for ICD 10 Groupings/ classes pertaining to maintenance process, ICD 10 business rules remediation process, Medical Claims Processing System (MCPS).
• Analyzing and understanding ICD 9-CM, ICD 9-PCS to and from ICD 10 -CM and ICD 10 -PCS GEM'S tool.
• Experience in calculating function points for software development.
• Knowledge of EDI for healthcare (837& 835).
• Strong understanding of health care analytics and ability to effectively interface with employees at all levels.
• Excellent organizational, verbal and written skills to understand interpret and communicate ideas.

TECHNICAL SKILLS:

Methodologies & Concepts: RUP, Agile, Scrum, Waterfall, UML, Root cause Analysis, Forecasting analysis, Business Intelligence, Data Analysis, Data mapping, Data Warehouse.

Business Modeling & Versioning Tools: MS VISIO, Rational Rose; Rational Requisite Pro, Rational Clear Case

Methodologies: RUP, OOD, SOA and Agile Methodologies such as SCRUM and XP

Project Management: Microsoft Project, Microsoft Office.

Versioning Control: Rational Clear Case, VSS

Databases: Databases Access, Oracle, MS SQL Server

Testing tools: Rational Robot, Rational Clear Quest Test Manager

PROFESSIONAL EXPERIENCE:

Confidential - Dallas, TX

Business Analyst

Responsibilities:

• Used system process analysis tools and methods to analyze and document business processes and metrics and identify improvement opportunities to streamline and automate processes and functions.
• Agile coaching and mentoring to the team, helping in sprint planning, retrospective and sprint zero grooming.
• Identified and documented how applications/systems interact to support business processes.
• Produced reports, analyzed data and developed Business Cases.
• Negotiate commitments by facilitating the communication between business unit(s) and IT from initial requirements to final implementation.
• Developed functional designs, assesses project impact of system changes on users and internal and external customers and stakeholders.
• Worked on SOAP UI for integration mapping documentation.
• Regular communication with end-users & team members - both written and face-time.
• Rigorous adherence to status/activity updates per department reporting policy and procedure.
• Calculated function points for software development.
• Performed counting based on Productivity.
• Performed point counting based on independent measure of the software’s logical size.
• Assisting in writing efficient and effective Test Plans, Test Strategy, System testing, End-to-End Testing and User Acceptance testing.
• Participating in the planning, development, coordination and presentation of specific testing needs as appropriate to the quality assurance needs of the end user.
• Assisting business users in defining UAT test cases and plans; Established and maintained test cases and test data in Quality Center.
• Coordinated with the QA Team for testing activities across multiple systems and managed Conversion test execution.
• Helps in conducting Gap Analysis (GAP), User Acceptance Testing (UAT), and System Integration testing (SIT) and SWOT analysis.
• Involved in implementation of HIPAA EDI Transactions ( 835,837)
• Facilitated Electronic Data Interchange.
• Performed GAP Analysis for HIPAA 4010 and 5010 transactions.
• Used EDI tools to verify mapping to X12 format.
• Recommend changes for system design, methods, procedures, policies and workflows affecting Medicare/Medicaid claims processing in compliance with government compliant processes like HIPAA/EDI formats and accredited standards ANSI.
• Analyze HIPAA EDI transactions in X12 responses and of 837, 835, 277CA and 999 and looked for defects.
• Do data analysis for various version changes of EDI messages on different sub-systems.
• Providing the required test data for the developers in order to fix the defects.
• Participating in QA team meeting and bug tracking meetings.

Confidential - San Jose- CA

Business Analyst

Responsibilities:

• Involved in gathering Business Requirements from State, Users and Internal Offices.
• Analyzed the client's applications to determine the impact of the Enhancements on EDI Transactions Set and Code List implementation and defined the changes to bring the affected systems into compliance.
• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims.
• Worked on EDI transactions. Interacted with Claims, Payments and Enrollment teams, hence analyzing and documenting related business processes.
• Organized and hosted JAD sessions to identify the business flows and determine the impact on current and proposed systems.
• Produced Gap Analysis documents for both HIPAA 5010 and ICD-10 Enhancements.
• Worked on EDI transactions, submitting and tracking claims until adjudication and Remittance Advice.
• Experienced creating and submitting Claims including Paper, Electronic/Online/Batch, Real-Time and POSL.
• Created TARs (Transaction Authorization Request) including Paper, Electronic and Pharmacy, for all Claim types and Transactions.
• Worked closely with multiple teams to improve the overall reporting of the Claims, payments, Real-time adjudication information.
• Developed test cases based on the crosswalks and compliance guidelines for 837 Professional and Institutional claims and for 270/271 Eligibility inquiry and response.
• Created Technical specifications for the Business Objects Reporting Applications.
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, Object Oriented Design (OOD).
• Experience in Forward Mapping and analysis of ICD 9 - ICD 10 Conversion, for CM (Diagnosis Codes) and PCS (Procedure Codes).
• Actively worked with quality control teams to develop test plans and test cases.
• Developed tables, Views, Stored Procedures and Triggers using SQL Scripting.
• Worked closely with the overall project team in planning, coordinating and implementing QA methodology on various phases of project.
• Analyzed results of System and Regression Testing performed by Test team and held meetings with Client and Management for Deliverable Approvals, Project closure and Sign off.

Confidential - Reno, Nevada

Business Analyst

Responsibilities:

• Involved in Analyzing the System to understand the business process and rules.
• Functioned as a primary bridge between the business, operations, and the technical team throughout the project cycle.
• Participated and contributed in daily scrums, Sprint meeting and Sprint review meetings.
• Also assisted in managing Stand-ups, Backlogs, Sprint Planning Meetings, Retrospectives, Demos, Story Board, Story Writing and Information Radiator.
• Designed wire frames and activity diagrams using MS Visio to outline the “To-Be” screens and “To-Be” processes
• Developed Proto types (iRise) and Process Flow Diagram (iRise)
• Created As-Is Business Process Models using MS Visio
• Conducted Joint Application Development (JAD) sessions with Sales Rep, Sales Manager, Campaign Analysts and Analysts Managers to identify business rules, functional and non-functional requirements
• Responsible for defining Functional Requirement Specifications following the Agile methodology using HP Quality Center
• Participated in daily Scrum and bi-weekly project status meetings
• Created release notes to support the monthly releases

Confidential

Business Analyst

Responsibilities:

• Helped engage the consulting team in the project’s pilot phase and converted to long term contract with successful delivery, team leadership and client management
• Responsible for managing all phases of Ecommerce and Content Management web development projects with extreme attention to detail.
• Worked with strategic acquisition team for Salesforce.com and FileNet, prepared Business Case study for the same.
• Collaborated with Confidential team in selecting a vendor for web-analytics and supervised the implementation on various sites.
• Wrote requirements for ecommerce modules for EDI requirements and B2B integration needs.
• Did screen mock ups and prepared wire frames for the Confidential portlet used IRise for their mobile application.
• Implemented various Interfaces across Telecom Service providers.
• Articulated complex information into concise, readable, non-ambiguous user stories. The articulation was often expressed through pictorial graphics (mock-ups) to facilitate understanding among the teams, especially in user graphical interface (GUI) requirements. Here, I organized a meeting of around 15 people.
• Created test plans and test cases for Confidential IN and executed testing according to plan.
• Provided concept recommendation for all the key sites of the manufacturer by doing pre-study, competitive benchmarking and feasibility checks
• Concepts worked on - HTML Troubleshooter, Warranty checker, Personalization, Consumer Survey.
• Transitioning of COBRA ( corporate brand and reputation analysis), a powerful IBM research text-mining tool that mines a wide range of COM (consumer generated media) contents for brand and reputation analysis, also worked with BD team in strengthening CoBRA proposal building and pitching it to IBM clients
• Analyzed and synthesized various competitive industry data, including both domestic and global markets.
• Served as the primary liaison between Marketing/Sales and IT and facilitated requirement gathering workshops, documented, analyzed and prioritized detailed business requirements based on users and business needs.
• Bluebook preparation entails Data collection, Data Analysis and Presentation.
• This involves comprehensive study and analysis of company, peers and industry as a whole, thereby identifying Key Business issues and possible solutions IBM can offer to the client which enables to fill in the performance gaps