SUMMARY

• 8 years of Professional experience in the Healthcare Domain as a Senior Business Systems Analyst.
• As part of assignments, Involved in entire Software Development Life Cycle (SDLC) phases like Project Management and Implementation, Planning and Scheduling, Requirement gathering/analysis, end to end design, development (floor level functionality clarifications), testing (requirement traceability matrices, system and functionality) and utilizing quantitative and qualitative skills.
• Experience highlights are given below:
• Widespread experience in interfacing with stakeholders and senior management.
• Exceptional problem solving and sound decision making capabilities recognized by alternative solutions, confident and accurate decision - making.
• Excellent track record for meeting deadlines and submitting deliverables on time.
• Strong subject matter expertise in Health Insurance Portability and Accountability Act (HIPAA) transaction and code set rules such as EDI 837,270,271,276,277,834,835.
• Adept at implementation of HIPAA 4010 and HIPAA 5010 changes in the existing claim processing integrated system.
• Experience in implementation of ICD-9-CM codes and ICD-10-CM codes changes in the current claim processing system.
• Experienced working in Medicare and Medicaid projects.
• Well versed in gap analysis in changing old MMIS mixed up with testing new MMIS.
• Experienced at all phases of the Software Development Life Cycle (SDLC), Rational Unified Process (RUP) and SCRUM methodology.
• Excellent facilitation skills in conducting walkthroughs, surveys, questionnaires, interviews, brainstorming and JAD sessions.
• Experience in for requirements gathering, analysis and design in Rapid Application Development (RAD) sessions to converge an advanced customer friendly design and viable for the developers.
• Knowledgeable in different management scenarios like Change Control, Quality Assurance, Defect Tracking, System Integration, and Scheduling.
• Concrete understanding of Business Process flow, Business Process Modeling and Analysis, Design and Documentation. Strong knowledge of Rational Rose and MS Visio for business process modeling (BPM) and designing data flow diagrams (DFD).
• Extensive knowledge in using methodologies such as APM (Agile Project Management) and OOAD (Object Oriented Analysis and Design).
• Experience in developing Requirement Traceability Matrix (RTM), conducting SWOT analysis, GAP analysis, Cost Benefit analysis, User Acceptance Testing (UAT) and ROI Analysis.
• Adept at creating and transforming business requirements into functional requirements and designing business models using UML diagrams - Context, Use Case, Sequence, Activity diagrams in Enterprise Architect, MS Visio and Rational Rose.
• Very good understanding of Relational Database, Data Modeling, Data Mapping and Data-Warehousing.
• Prepared Functional Specification Documents, AS-IS and TO-BE workflows.
• Expertise in writing Requirements, Technical Specs, Test Plans and Test Cases.
• Managed a Test Director environment for the test team. This includes accompaniments to all forms in the TestDirector application (i.e. Defects, Test Plan, and Test Lab & Requirements) and provides server maintenance when needed.
• Broad knowledge in creating Test plans, analysing Test Procedures and detailed test plans for User Acceptance Testing (UAT), Test scenario, defining Test cases, both System & Integration and executed many test cases.
• Strong skills performing impact analysis, risks analysis, data analysis, writing test cases for User Acceptance Testing.
• Gathered Functional and Data Requirements, analysed workflows and created Requirement Specifications, Use Cases, Data Requirements, Data Mappings and Data Flow Diagrams and Report Specifications.
• Familiar in designing and developing manual/automation test cases along with test scripts analysing bugs and interacting with team members in fixing errors.
• Facilitated test plan/test case walk-through for the Business and Development teams to obtain feedback and/or approval sign-off.
• Extensive proficiency in databases like SQL, MS Access.
• Have exposure in educating internal customers on business systems & procedures and worked with other analysts and QA team to set priorities & schedules.
• Comprehensive work on B2B applications and B2C applications in transaction processing and E-commerce applications.

TECHNICAL SKILLS

• Win 2000/XP/Vista & UNIX
• MS SQL
• MS Access
• Oracle
• Facets.
• SQL
• C
• .Net
• Test Director
• Quality Centre
• Quick Test Pro (QTP)
• Win Runner
• HP Quality Centre
• HIPAA
• ISO
• Research Analysis
• SOX and CMM
• Clarity
• Rally Tracking Tool
• MS Project
• Visio
• Rational Rose
• RequisitePro
• Rational SODA
• Doors
• PROLOG
• ClearCase
• Clearquest
• Microsoft Office 2010 (Project
• Word
• Excel PowerPoint
• Access
• Visio)
• Presentation Software.

PROFESSIONAL EXPERIENCE

Confidential, Portland, Oregon

Sr. Business Systems Analyst

Responsibilities:

• Analysed the existing Business which involves a wide range of external and internal stakeholders.
• Understood the existing SDLC process at the client’s side, and created Process improvements plan and Flow Diagrams.
• Understood the Shared Accumulators Application and managed multiple work requests on a very aggressive timeline.
• Consulted with the Sales and Ops Teams on the feasibility and estimated timeframe to deliver a custom solution within a competitive timeframe.
• Created a stronger partnership with Ops and Sales by actively supporting the Sales cycle and removing worry from the IT work they depend upon.
• Engaged in discussions with Business and external vendors to gather requirements and enable the Systems Analyst to complete the functional specifications.
• Coordinated with external vendors throughout the interface implementation to clarify any missing/additional requirement, provided status reports, and eliminate any roadblocks.
• Worked with the IT team to estimate the requirements, and staged the estimate to the Governance Committee for budget approval.
• Updated the Physical Data Mapping document (PDM), generated ROX reports, worked on Scope documents, Business Requirement Documents, and Requirements Traceability Matrix (RTM).
• Worked with Business representatives to understand requirements and priorities and ensure that IT works is appropriately aligned.
• Accountable for numerous steps in the estimating, communicating, design and coordinating the process, meetings, and delivery of Shared Accumulators work.
• Responsible for creating, following, and improving process for consistent delivery and cross functional communication for customer on-boarding.
• Created Project Plan, Project Charter, and Project Schedule. Created Features, EPIC, and User Stories in Rally to break down the work requests, and based on the Project Schedule assigned the stories to respective Sprints.
• Assisted the business with Salesforce software for case management and escalating important events.
• Used Rally tool to track the status of the User Stories in Progress. Used Clarity tool to track the Actual effort utilized by the team, and submitted a Change Request if required.
• Created cross-functional checklists, work break structures, and identifying standard vs custom deviation to help improve and inform Customers’ upfront coordination with Sales Department.
• Identified and escalated project risks to Senior Management along with a Mitigation Plan.
• Worked extensively with the QA Testers and assisted with System Testing by validating the generated Test File(s) against the respective Test Scenarios.
• Incorporated stakeholder feedback throughout project lifecycle to ensure project quality and customer satisfaction.
• Responsible for improving Client’s delivery capabilities through improved requirements documents, understanding the cross team development and vendor coordination activities.

Environment: Facets4.82, Facets5.1x, Clarity, Rally, SQL, Remedy, Oracle Database, Sybase DB, Java, IBM InfoSphereDataStage, Microsoft Visio, Microsoft Project, Windows 7.

Confidential, Pleasanton, California

Sr. Business Analyst

Responsibilities:

• Responsible for designing future state processes forHIPAA 5010 transaction processing EDI’s 837 and 835.
• Analyzed CMS comparison documentation highlighting changes of ICD10 diagnosis and procedure codes.
• Supported all QNXT modules initiatives in improving overall efficiency for Quality Standard and Claims Adjudication.
• Worked with the individual sub-project managers to translate these into PRDs (Product Requirement Documents) for the development teams.
• Experienced in creating mapping for loading Benefits in Facets.
• Analyzed a wide range of FACETS configuration change requests for the purposes of determining the technical scope of the change, its impact on existing systems configuration.
• Hands on experience on Oracle Identity Manager and Identity and Access Management.
• Performed analysis in Membership and billing data from Facets.
• Maintained Requirement Traceability Matrix (RTM) throughout the project for requirement elicitation and linkup to deliverables.
• Used Remedy and JIRA to communicate the issues; key in communications between onsite and offshore
• Conducted GAP analysis on the old MMIS system and created Test plan/ test cases for new MMIS system.
• Analyzed and model Test plans, Use Case Model cases & Test procedures based on RUP and SDLC methodology.
• Worked on Data warehouse appliances like Java Database Connectivity (JDBC), and OLE DB interfaces to integrate with other extract-transform-load (ETL) tools and business analytic (BA) applications.
• Designed and developed Quality Assurance standard and processes to all levels of project team
• Mentoring end-users on requirements specifications techniques and the software development life cycle.
• Created standards / guidelines for Business Process Modeling, Use Cases, Work Flows, Data Dictionary, and Requirements Specifications.
• Critically evaluated the information gathered from multiple sources during requirement gathering and analysis and responsible for tracking, tracing and managing requirements using Rational Requisite
• Proficient in MS Office tools - particularly Excel (macro), Power point and used MS Project for various planning and budgeting activities.
• Wrote clear, concise detailed System Requirements Specification(SRS) documents and user documentation in accordance to guidelines and standards of a level where developers can interpret, design and develop the application with minimum guidance
• Participated in discussions/conference call on all technical problems

Environment: MS Project, SQL, .Net, Remedy, Rational Unified Process (RUP), Rational Requisite Pro, Rational Rose, Clear Quest, Microsoft Visio, Windows XP/Vista/Windows 7, Mercury Test-Director, MS Visio, Business Objects.

Confidential, Bellevue, WA

Sr. Business System Analyst

Responsibilities:

• Responsible for the full HIPAA compliance lifecycle from gap analysis, mapping, implementation and testing for Medicaid Claims.
• Responsible for gap analysis in changing old MMIS and involved in testing new MMIS. Also, accountable for Medicaid Claims Resolution/Reimbursement for each state health plan using MMIS.
• Conducted Joint Application Development (JAD) sessions among user community, stake holders and technical management; Developed project plans & schedules and managing changes.
• Recorded requirements in the Requirement Traceability Matrix (RTM) defining each technical requirement in detail from areas like: main hardware, application software, networks, servers, internet and desktop configuration.
• Had a clear understanding of Medicare (Part A, Part B and Part D) benefits, Coinsurance, Medicare Supplements, Fraud and Disputes as well as business processing.
• Responsible for multiple roles such as requirements gathering and solution development across the full insurance life cycle from CRM (marketing, sales, service) to underwriting & quoting, policy administration, commissions & broker management, claims, financial reporting and analytics for Property and Casualty division.
• Analyzed the existing business process and created AS-IS workflow to illustrate the existing system.
• Adept in implementing analytical skills like business models, P&L, ROI, cost structure.
• Actively involved in updating internal processes (submit claims, check eligibility), updating data collection and data reporting.
• Collaborated closely with solutions teams to resolve road-blocks and product defects over a period of 3 test cycles; used Quality Center, Remedy, and JIRA tools to communicate issues.
• Supported QNXT modules initiatives in improving overall efficiency for Quality Standard and Claims Adjudication
• Hands on experience on Oracle Identity Manager and Identity and Access Management.
• Actively analyzed current business processes (Claims, Recipient eligibility and enrollment etc.) and worked with management to improve and implement enterprise solutions to ensure compliance
• Ensured that the checks generated had accurate and compliant explanation of benefits.
• Coordinated with various stakeholders to investigate any discrepancies in processing claims or billing.
• Created detailed design of the system with the project team including class diagrams, activity diagrams, and sequence and collaboration diagrams.
• Responsible for creating business work flows and processes and created management reports based on the analysis.
• Served as a liaison between the internal and external business community (Claims, Billing, Membership, Capitation, Customer service, membership management, provider management, advanced Healthcare management, provider agreement management) and the project team
• Used Rational Clear Quest to maintain and track the requested enhancements and changes by the stakeholders.

Environment: Rational Unified Process (RUP), .Net, Remedy, UML, Dreamweaver, Rational Test Manager, Rational Clear Quest, Windows, MS Office, HTML, Windows (all versions).

Confidential, Seattle, WA

Sr. System/Quality Analyst

Responsibilities:

• Clear understanding of Medicare (Part A, Part B and Part D) benefits, Coinsurance, Medicare Supplements, Fraud and Disputes as well as business processing.
• Monitored change requests and documented requirements, wireframe test accuracy and integrating them with Use Clear Cases.
• Analyzed Business and Requirements to develop Functional and detail Design Specifications of the application from SDLC development logic.
• Involved in Data Modeling for ensuring data integrity, consistency and avoiding redundancy
• Applied advanced Excel skills (pivot tables, macros, lookups, charts) and Access database querying skills in streamlining and automating accounting processes.
• Executed Smoke, Functional, Integration, End-to-end and Regressions Tests in each environment by tracking the test status in Quality Center (Test Director).
• Conducted Requirement Gathering Sessions with the stakeholders.
• Acted as liaison between the senior management and different teams with effective presentations.
• Conducted JAD sessions, daily meetings, brainstorming sessions to solve the problems and enhance the workflow.
• Interacted with the project team to help define the Business and System Objectives, confirmation of scope, identify constraints and the measures of success for the system to be developed.
• Implement business modeling using MS Visio to develop screens for the application Gathered Functional Requirements from users and the management. Coordinated all the requirements in team based environment.

Environment: Server, UML, Rational Requisite Pro, Test Manager, Clear Quest, Windows XP, MS Visio, MS Access, MS Project, UAT, SDLC, JAD, UML Diagrams, MS Visio.

Confidential, Akron, OH

Business Analyst

Responsibilities:

• Followed the UML based methods using MS Visio to create Use Case Diagrams, wireframe data model updates, State Chart Diagrams and Sequence Diagrams.
• Performed day-to-day EDI activities related to HIPAA compliant and NSF data submissions.
• Duties included technical and non-technical telephone or email communications with physicians, clearinghouses, billing services, and hospitals who submitted or received electronic claim data (NSF or ANSI X12 4010 version).
• Extracted the Business & Technical Requirements from the client and end users keeping in mind their need for the application (Internet, Claims, Provider, and Recipient) and documented it for the developers following the HIPAA Guidelines for an Individual functional area by conducting JAD sessions.
• Followed a structured approach to organize requirements into logical groupings of essential business processes, business rules, and information needs, and ensured that critical requirements are not missed.
• Acted as Subject Matter Expert for HIPAA requirements.
• Developed prototype of a new mobile information processing application and performed walkthroughs of the prototype with end users to better understand user needs.
• Coordinated with the offshore UI designer to prepare the prototype for the application.
• Facilitated collection of Functional Requirements from system users, and prepared Business Requirement documents and have applied the RUP model throughout the entire development and testing process.
• Prepared Logical Process and Data Models that contained set of diagrams and supporting documents containing the essential business elements, detailed definitions, and descriptions of the relationships between the data elements to analyze and document Business Data Requirements.
• Used Rational Clear Quest to maintain and track the requested enhancements and changes by the stakeholders.
• Worked closely with the offshore team to convey Technical and Functional specifications.
• Worked closely with Business users to determine the workflow of the product

Environment: Quality Center, UAT, SDLC, SQL, .Net, UML diagrams, USE cases, Business Objects SCRUM, Black Box testing practices, MS Visio, MS Access, PowerPoint

Confidential

Business Systems Analyst

Responsibilities:

• Implemented a structured system development methodology with emphasis on Rational Unified Process (RUP) that dramatically improved productivity and reduced errors.
• Prepared Use Cases for various parts of the project.
• Attended business and tech SME (Subject Matter Expert) presentations on the system and functionalities, its present shortcomings, and the pain points for the business.
• Gathered business and technical requirements for new system enhancements from both SME’s.
• Made business presentations, identified opportunities for the new design, and obtained final sign-off from the business for the requirements gathered and systems analyzed.
• Used Requisite Pro for gathering requirements.
• Involved in developing and implementing web application with Microsoft Visual Basic .NET and Microsoft Visual Studio .NET
• Used features like ER diagrams, XML export, Call Tree, Usage Analysis, Value /Attribute list.
• Conducted workflow, process diagram and gap analysis to derive requirements for existing systems enhancements. Interacted with management, system analysts and technical developers for successful completion of set project goals.
• Worked closely with the Risk and Compliance team to make sure business division was SOX compliant.
• Led and provided strong direction to development team in understanding and implementing requirements.