SUMMARY

• More than Seven years of professional experience as a Business Analyst in Healthcare, Insurance and Retail industry.
• Adequate knowledge in Health Administration - Claims processing (auto adjudication), EOB/Drafts, Claims pricing and testing, HIPAA, enrollment, EDI, Medicare, Medicaid, EPO, HMO, POS, PPO.
• Experience with healthcare system, Medicaid and with prime focus on claims adjudication, provider, eligibility and prior authorization.
• Extensive experience in analyzing and requirements gathering and writing system functional specifications including use cases.
• Proven success as a business analyst through the years, providing a well-balanced understanding of business relationships, business requirements, and technical solutions.
• Strong experience in SDLC methodologies, Waterfall, Agile, RUP (Rational Unified Process), RAD (Rapid Application Development).
• Excellent documentation skills with exhaustive experience in preparing Business Requirement Document (BRD), Functional Requirement Document (FRD), Use Cases.
• Experience in conducting JAD sessions, project meetings, and walk through.
• Expertise in UML (class diagrams, object diagrams, use case diagrams, state diagrams, sequence diagrams, activity diagrams, and collaboration diagrams) as a business analysis methodology for application functionality designs using MS Visio and IBM’s Rational Rose.
• Experience with SharePoint for Document Management
• Good experience in performing Gap Analysis using AS-IS and TO-BE business processes.
• Excellent team player with positive outlook, adaptable, time management and leadership skills
• Strong experience in conducting User Acceptance Testing (UAT) and documentation of Test Cases, designing and developing Test Plans and Test Scripts.
• Excellent in developing and evaluating business process Models.
• Design and review of various documents including the Software Requirement Specifications (SRS), Business requirements document (BRD), Use Case Specifications, Functional Specifications (FSD), Systems Design Specification (SDS), Requirement Traceability Matrix (RTM) and testing documents
• Familiar with HIPAA EDI transaction sets such as 835, 837 (P, D, I) 276, 277, 278
• Professional experience in business analysis, operations management and development, design, documentation, document management and testing.
• Excellent Analytical, methodical, and resourceful approach to problem solving
• Identifying and documenting root causes and corrective actions to meet short and long term business and system requirements.

TECHNICAL SKILLS

Methodologies: Waterfall, RAD, RUP, Agile, CMMI, CMM, Six Sigma, OOAD, UML, Modeling, Process Modeling and Data Modeling

Office Tools: MS Word, MS Excel, MS PowerPoint, MS Access, MS Project, MS Outlook

Process/Modeling tools: MS Visio, Rational Rose, Rational Requisite Pro, Smart Draw, ClearCase, ClearQuest

Testing Tools: Test Director, Quality Center, Win Runner, Selenium

Operating Systems: Windows Vista, NT/2000/2003

Quality Management: HIPAA, CMMI, CMM, Six Sigma, TQM

Languages: C/C++, Java, SQL, PL/SQL, HTML, XML

Database: MS Access, SQL Server 2000

Other Tools: Macromedia Dream Weaver, Macromedia Flash and Adobe Photoshop.

PROFESSIONAL EXPERIENCE

Confidential, Twinsburg, OH

Business Analyst

Responsibilities:

• Identified Business needs and performed Requirement Analysis and suggested Business Solutions
• Gathering User and Business Requirements and creating Scope document, Business Requirement documents (BRD), Functional Requirements, (FRD), Use Cases, Work flow, Wireframes.
• Conducted Joint Application Development (JAD) sessions, requirement elicitation sessions, workshops, interviews sessions with Subject Matter Experts (SMEs)/ end users/development group/Client, asking detailed functionality aspects of business process and carefully updating the information to the requirements in an easily understandable format.
• Defined the business requirements for Identifying payer, Insurance Verification, and Prior Authorization and delivered Use cases, Process flows and Wire frames.
• Captured requirements for using a Web Crawler application to collect information from MCO and Federal websites related to member benefits, eligibility and contract pricing to support the smart database project and support information requested by the compliance team.
• Working with Medicare and Medicaid insurance data, Medicare parts A, B, C & D, and other Private Insurances
• Developed EDI specifications and applications structures for data feeds and mappings for integration between many systems to follow ICD 10 Code set.
• Tested ANSI X12 / EDI 4010 transactions for (270, 271, 276, 277, 278, 834, 837P, 837I, and 837D).
• Involved in resolving and documenting issues related to these EDI transactions including 837 transactions using Test Director.
• Validating the EDI 837 claim billing (professional, institutional and dental claims) & 835 (remittance advice or payment) claims adjudications.
• Wrote SQL queries for manipulating the data
• Facilitated system requirements gathering sessions with the client, and overlooked the creation of Use Cases/Activity Diagrams, Functional Specifications using UML/Visio.
• Performed Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data.
• Implemented FDA Guidelines to avoid non-compliance, delays in production and increased costs.
• Working knowledge of regulatory requirements (HIPAA, 21 CFR Part 11) and audits.
• Facilitated and managed meeting sessions with System Users to review system requirement capture. Set-up meeting and JAD Sessions with the Stakeholders, Systems Users and Technical leaders.

Environment: MS Project, MS Office (Outlook, Word, Excel, Visio, Access), GAD (Gap Analysis Document), UAT, Windows NT, Sharepoint, HTML, UML.

Confidential, Nashville, TN

Business Analyst

Responsibilities:

• In depth knowledge of Health Insurance process, Claims, HIPAA & its approved transaction codes.
• Interacted with business owners to identify business system needs, evaluated solutions for business problems and proposed alternate methods to increase efficiency
• Analyzed and documented requirements and the corresponding impact on business processes
• Analyzed and transmitted the business requirements into detailed project plans.
• Analyzed business requirements and organized high-level and low-level Use Cases, represented Activity, and State Charts
• Gathered user requirements and directed developers for practical deliverables.
• Worked with the full Software Development Life Cycle and its phases using Agile methodology
• Involved in eliciting, analysis and defining requirements.
• Conducted JAD sessions with the clients to identify the requirements. .
• Used Rational Unified Process (RUP) for streamlining the team’s development activities.
• Followed the UML based methods using Rational Rose to create: Use Cases, Activity Diagrams/State Chart Diagrams, Sequence Diagrams, and Collaboration Diagrams.
• Participated in Testing and Evaluation of projects at established integration points to assess progress and identify key functionality issues.
• Tracked UAT issues/bugs and prepared reports in Excel
• Performed job of contact point for all stakeholders (business, legal, compliance, development).
• Documented monthly status reports for enhancement and modification requests.
• Co-ordinated in development team to assist in efficient tracking.
• Involved in monitoring of open issues of the project.

Environment: UNIX, MS Power Point, MS Excel, Rational Rose, System Analysis, Load Runner, Crystal reports, SQL.

Confidential, Chicago, IL

Business Analyst

Responsibilities:

• Gathering and documenting the requirements that are critical to the business and using those requirements to design application software.
• Analyzed business requirements and segregated them into high level and low level Use Cases, Activity and Sequence using Rational Rose according to UML methodology.
• Derived Functional Requirement Specifications (FRS) based on User Requirement Specification URS. Understand and articulate business requirements from user interviews and then convert requirements into technical specifications.
• Implemented RUP and followed iterative process for Use Case driven processes of requirement documentation and their deployments and also created a Traceability Matrix.
• Worked as an Interface between the users and the different teams involved in the application development for the better understanding of the business and IT processes.
• Held regular JAD sessions with the system architects, developers, database developers, quality testers during the entire project to assure that the critical as well as the minute details of the project were discussed and issues were resolved beforehand.
• 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.
• Worked with development staff and 3rd party vendors to ensure that the requirements are sufficiently detailed and clearly understood. Facilitate discussions between business partners, development team, and vendors to ensure that proposed technical solutions adequately meet the business needs.
• Built and maintained close relationships with internal customers and retail systems vendor to ensure efficient development processes are being followed and that business priorities are met, and that projects/development are on schedule
• Documented the process flows and procedures using MS Visio
• Created screen mockups to aid requirement process.
• Assisted with the system testing/user acceptance testing of the functional enhancements as needed.
• Ensured applications are designed to support business objectives, business processes and will provide superior user and customer experiences.
• Wrote various SQL queries and statements for data reconciliation for Policy Administration System.
• Used MS Office suite (Word, Excel, Access, Visio, Power Point), for project tracking, documentation and presentation.
• Worked extensively with the QA team for designing Test Plan and Test Cases for the User Acceptance testing.

Environment: J2EE, Windows XP, RUP, MS Visio, Quality Centre

Confidential, Bentonville, AR

Business Analyst

Responsibilities:

• Worked as an Interface between the users and the different teams involved in the application development for the better understanding of the business and IT processes.
• Collected and documented business processes as well as business rules. Participated in the identification, understanding, and documentation of business requirements, including the applications capable of supporting those requirements.
• Reviewed and analyzed the business requirements document to derive the functional specifications document and assisted in the preparation of System Requirement Specifications.
• Formed a bridge between the Project Manager and different technical teams with effective presentations as well as verbal and written communication.
• Met with all developers and project stakeholders to lead a kickoff meeting. Defined and introduced the project, team members' roles, and key deliverables. Mapped out timelines, milestones, communication processes, question and answer session.
• Generated excitement and buy-in to secure commitment to project objectives, and shared a group vision to start the team on a motivated track.
• Involved in Customizing the Test Cases and Test Plan according to the requirements of the project.
• Assisting QA testers and analysts with the report generation feature and mentoring them in interpreting the test result graphical charts
• Facilitated business requirements gathering sessions with the client, and developed Use Cases/Activity Diagrams as well as Functional Specifications using UML/Visio.
• Document, clarify, and communicate requests for change requests with the requestor and coordinate with the development and testing team
• Created Traceability Matrix to ensure that all the requirements are covered by the test cases using MS Excel spreadsheet.

Environment: UML, MS Visio, Windows XP, RUP.

Confidential

Business Analyst

Responsibilities:

• Used Rational Unified Process (RUP) methodologies in software development life cycle (SDLC)
• Used Unified Modeling Language (UML).
• Conducted interviews with key business users.
• Involved in collecting requirement and business process information.
• Documented Functional Requirements for business level components.
• Documented user interface, and system security.
• Defined Core Business Rules and Core Business Validations for the entire application.
• Analyzed the technical specifications and business requirements.
• Developed business requirement specification documents, business process models in RUP to document existing and future business processes.
• Wrote Use Cases, Business Flows and Work Flows Diagrams for effective plans.
• Documented and delivered Functional Specification Document to the project team.
• Involved in benchmarking activities to identify best practices.

Environment: MS Office, MS Visio, RUP, UML, PL SQL, SQL, Oracle 8i.