SUMMARY

• Over Six years of experience as a Business Analyst with strong understanding of Business Requirements Gathering, Business Process Flow, Business Process Modeling and Business Analysis.
• Experienced in gathering/Capturing business requirements from application users and skilled in preparation of business requirements document (BRD) that provided appropriate scope of work for technical team to develop prototypes and overall system.
• Experience in all areas of project life cycle in a highly structured change management environment using both proprietary methodologies, Agile Techniques and Rational Unified Process
• Excellent Business writing skills in writing Business requirements document, USE Case Specifications, Functional Specifications, Systems Design Specification (SDS), Systems Requirements Specification (SRS).
• Proficient knowledge of Six - Sigma methodology.
• Extensive experience with process modeling using UML, Flow charts, Sequence diagram, Activity diagram and Use cases.
• Experienced in conducting Joint Application Development (JAD) sessions with end-users, Subject matter experts (SME’s) and quality assurance teams.
• Experienced in using rational tools, Requisite Pro, Rational rose and Rational DOORS.
• Worked extensively with data modeling tools to identify key elements and table structures and aid database design.
• Coordinated the development, design and execution of User Acceptance Testing (UAT) program.
• Experienced in Functional Testing plans, preparation and execution of Test Ideas list, Test cases and Test Scripts and logging defects using Quality Centre.
• Excellent Decision making, Team building and analytical problem solving skills in conjunction With strong management background
• Experienced of creating applications that are 21CFR Part 11 compliant.
• Experienced with Medicare, Medicaid, and commercial insurances in HIPAA ANSI X12 formats including 270/271, 276/277, 810, 820, 834, 835, 837, 997.
• Deep understanding of X-12 Implementation Guide for Healthcare Domain and SOX compliance auditing.
• Able to prepare RTM (Requirements Traceability Matrix) & do requirements analysis
• Proficient in using UML for Business Process Modeling, Use Cases, Activity Diagrams, Sequence Diagrams, Data Flow Diagrams, Collaboration Diagrams, Class Diagrams and document them using Microsoft Visio.
• Used MS Office extensively (Word, Excel, MS Access Visio, Power Point, Outlook, Project) for calculations, graphs, analysis, presentation and documentation throughout the projects.

TECHNICAL SKILLS

Operating Systems: Mainframe, Windows 9x, 2000, XP & NT, Linux, UNIX

Scripting Languages: SQL, PL/SQL

Tools: & Technologies: Microsoft Visio, SharePoint Site, Microsoft Exchange Messaging, SQL Server, SQL Navigator, TOAD, Erwin, Rational Rose and UML Design, Live Link, MS Front page. Quality Center, HP ExStream, Client Letter®

Database Server: MS SQL Server, Windows, Sun Solaris, Bea Weblogic app server

Database: Oracle, DB2, Mainframe, MS Access, SQL Server

Methodologies: Rational Unified Process (RUP), Agile and Scrum.

Reporting Tools: Crystal Reports, Business objects

Source Control Software: Rational Clear Case, Clear Quest, Perforce, Documentum, SharePoint

PROFESSIONAL EXPERIENCE

Confidential, Rochester, MN

Data management specialist

Responsibilities:

• Performed business assessment in the areas of metadata capture a clinical problem list and terminology services solution sets.
• Tracked and reported project deliverables directly to the managers responsible for metadata capture and terminology management solutions.
• Assisted in project coordination and provided direction and support to the project team.
• Organized and communicated project policies and procedures to project team.
• Created source system non manipulated raw data validation reports.
• Developed and executed test cases for the new terminology HLI mapping tool LEAP I-10.
• Performed forward and backward ICD-10 mapping to any ICD-9 code, and worked on List conversion projects.
• Provided assistance and support to the ICD-10 mapping process, and successfully worked on maximizing the production through-put.
• Collected, modeled and analyzed data to facilitate recommendations to increase work efficiency and meet target goals.
• Provided regular ad hoc status reporting to support project administration, management, and communication
• Created and maintained complex access databases in support of the ICD-10 implementation effort.
• Created ICD-10 compliant documents and training material.

Confidential, San Francisco, CA

Business Analyst

Responsibilities:

• Conducted analysis to make the system compliant with HIPAA 5010.
• Involved in making the Medicare patient profiles being compliant with the HIPAA regulations.
• Management of patient profile transfer (PPT) reports created by data team by verifying the associated data.
• Conducted JAD sessions with different Business Users to develop new policies and procedures for Hospital billing, coding, special coding requirements for BCBS and Claim processing.
• Coordinated and conducted system requirements walkthroughs/sessions (JRDs/JADs) with business Owner/stakeholders/SMEs as well as design/development teams.
• Managed, and shared the documents internally using SharePoint.
• Worked with business area SMEs/analysts to develop and finalize test plans/scripts/use cases. Analysis of key business requirements and assisted in the development of Business Requirement (BRS), Functional Requirement (FRS), and System Requirement Specification (SRS).
• Performed GAP analysis for the HIPAA Data Migration and Conversion.
• Identified the impacts and training the users on new policies /procedures changes.
• Developed Use cases, Test Cases for the Business users and QA team.
• Performed Impact analysis for readiness of ICD-10 conversion.
• Identified the Security Risks in the application that being built and addressed them in the requirement document to avoid the security breaches.
• Improved the new revenue cycle management and Electronic Medical Record (EMR) for PARTNERS. Developed an implementation guide for Partners for EDI X12 transactions such as 834, 835,837,270 and 271.
• Supported the Business Users after go live.

Environment: MS Project, MS Visio, RUP, Rational Suite (RequisitePro, ClearQuest, Clearcase), Blueprint, ETS and EDI ANSI X12/HIPAA. Meditech, Soarian.

Confidential, San Francisco, CA

Business Analyst

Responsibilities:

• Assist with creation and maintenance all necessary documentation and training materials for Epic Ambulatory application.
• Performed analysis, design, development and maintenance of the Epic Ambulatory applications and other clinical information systems.
• Experience with EPIC user and provider record provisioning, including the development of role-based access, security classes, and user profiles.
• Experience in Epic Resolute product implementation and deployment.
• Hands on experience with Epic Hospital Billing and Ambulatory.
• Experience with Epic Healthcare Information Systems.
• Conducted user interviews, gathered requirements, and analyzed the requirements.
• Worked with the business team to collect the business requirements, security and service level requirements and documented them.
• Analyzed set behavior and contribution to business performance, critical business metrics & tracking underlying business trends using Business Objects.
• Working with different IT & Business groups to understand and determine the Impacts to the Data Warehouse and/or Data Marts for different project.
• Participated in the logical and physical design sessions and developed design documents.
• Designed new process flows for the existing system as well as for the enhanced system.
• Conducted and lead status report meetings with the business and the IT team on a weekly basis.
• Manage Scope and change throughout the life cycle of the product.
• Performed collection, coding, assessment and reporting of adverse event data using ARISg.
• Worked in the ARISg Implementation of the EHR-Pharmacy Module.
• 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.
• Recommended tactic to implement HIPAA 4010 (EDI X12 837,834,278,270) in the new System.
• Worked on Electronic health record system as a CRM web based application.
• Working Experience in Electronic Submissions in standard format E2B.
• Knowledge of regulatory issues including State, Federal, AABB, CAP, CLIA, and JCAHO.

Environment: MS Project, Microsoft Visio, EPIC, FACETS

Confidential, Sacramento, CA

Business Analyst

Responsibilities:

• Gathered requirements from Business Managers, Supervisors, stakeholders, Data Governance Team and the subject matter experts through meetings to understand needs of the system.
• Used the guidelines and artifacts of the Rational Unified Process (RUP) to strategize the Implementation of Rational Unified Process effort in different iterations and phases (Inception, Elaboration, Construction and Transition) of the Systems Life Cycle methodologies. Prepared various artifacts for all the phases of RUP.
• Led JAD sessions with stakeholders to analyze system needs and integrate requirement to develop a consistent navigation structure
• Created business workflows on the claims module for the client to get a better understanding of the software and prepared a detailed BRD including all functional and nonfunctional requirements Involved in Validation of HIPAA for 837, 270/271, 276/277,835, 834 EDI transactions.
• Performed the Gap analyses of the earlier systems, generated a detailed Requirements document describing new system architecture through Use Cases and Activity diagrams.
• Worked with the QA (Quality Assurance) team for designing Test Plan and Test Cases for the User Acceptance testing- Defined test cases, creating test scripts, analyzing bugs, interacting with QA / development teams in fixing errors and User Acceptance Testing (UAT).
• Created functional flow diagrams, context diagrams and other high level diagrams for documenting the functionality of separate modules using MS-Visio and UML.
• Implemented Traceability Matrix and Business Requirement Specification Document verified the functionality coverage.
• Used MS Project to maintain the project schedule and track its status.
• Responsibilities involved interface with end-users, obtaining approval, identifying information, procedures and decision flows, evaluating existing procedures, methods and technical documentation.

Environment: UML, RUP, Requisite Pro2002, MS-Project 2000, MS-VISIO, CMMI, TestDirector7.6, WinRunner7, windows 2000,EDI, HIPAA compliances.

Confidential, Long Beach, CA

Business Analyst

Responsibilities:

• Extracted the Business 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 JRD and JRM sessions.
• Facilitated collection of User Requirements and Business Requirements from Business User Group such as to document Business/User/Functional/Technical Requirement Specification n using MS Word and MS Visio that provided appropriate scope of work for technical team to develop prototype and overall system.
• Created Use Case diagram, Sequence diagram and Activity diagram for understanding the business processes.
• Involved in the day-to-day implementation of the Rational Unified Process (RUP) methodology of application development with its various work flows, artifacts and activities.
• Identified system integration requirements, coordinated the collection and verification of business needs to reach the Requirement Analysis (Requirement Validation Specification), Detailed System Design Documentation Milestones.
• Involved in Independent verification and validation of requirements (IV and V) to ensure that all the requirements are satisfied and meet the security objectives.
• Developed Traceability Matrix using Rational Requisite Pro.
• Documented how business goals were reflected in the Functional requirements.
• Identified actors and use cases to create use case Scenarios that described the behavior of the system.
• Analyzed client’s data mart performed metadata modeling and developed reports with analytical views (charts, tables,).
• Performed tuning of reports, creating subset tables, required changes of repository and database.
• Created UML Activity diagrams, use case diagrams and sequence diagrams to view the system from different perspectives.
• Developed all operational and technical flows using MS Visio for prototyping of wireframes.
• Reviewed and approved technical recommendations related to software and hardware proposals (RFP).Also written Request for proposal (RFP) for getting new Meta Vance 2.3 system.
• Involved in development of Advance Planning Document (APD) to request for federal funds .During the Implementation of Advance Planning Document (IAPD) also released RFP for new Meta Vance 2.3 system.
• Conducted Brain Storming sessions to gain consensus on various issues related to the project.
• Involved in analysis of HIPAA compliance and took part in discussions for designing the healthcare transactions to be HIPAA compliant (837/835, 270/271, 276/277, 278, 820).
• Validated technical designs documents created by IT developers against functional specifications.
• Participated in claims submission and payment (remittance) retrievals by using ASC X12 820 for the In- bound premium payments; ASC X12 834 for the Inbound Enrollment and Maintenance; ASCX12 276/277 for the claims status enquiry and response; and ASCX12 835 for the Health care Claim Payments.
• Created test plan and test cases and meetings with users to generate and review business test cases.
• Got involved in the User acceptance Testing (UAT) and documented the test scenarios and outcomes.
• Created online help systems for software applications.
• Designed and developed "Troubleshooting Guide" for the above application using Microsoft Office, Visio, HTML, Adobe Photoshop and Corel Capture.
• Prepared training material to cater to various training needs of the company.

Environment: ACH, Cognos 8.2, COBOL, MS SQL, MS server 2000, MS Office Suite, MS Project, MS Visio, HTML, XML, MS Windows.

Confidential, Cypress, CA

Business Analyst

Responsibilities:

• Reported Business Growth and projections to Senior Management.
• Compiled Vision and Scope documents to better define the rationale for the project.
• Updated the Functional Requirement Specifications (FRS) based on User Requirement Specification (URS).
• Gathered and articulated business requirements from users and SME interviews and maintained the document repository on Requisite Pro.
• Created Business Process Modeling Notation (BPMN) using swim lanes and use cases for the exploration phase.
• Developed and maintained business process modeling notation (BPMN) standards for flow charting, developed and maintained flow diagrams, using Visio, of all identified processes.
• Scheduled meetings with technical personnel to determine technical parameters for EDI and other related processes, including communication, security, and privacy.
• Worked on multiple 837s and multiple Eligibility (270/271) and healthcare claim status (276/277).
• Used guidelines and artifacts of RUP to strategize the implementation of Rational Unified Process effort in different iterations and phases of software development life cycle (SDLC).
• Redefined use case, process flow, and activity diagrams using MS Visio for a clear understanding of the requirements.
• Played a pivotal role in conducting Functional testing, Regression testing, and User Acceptance Testing (UAT).
• Reviewed test plan based on Requirement Traceability Matrix (RTM) and defect tracking using Clear Quest.
• Collaborated with developers and quality assurance analyst to track defects and used Rational Clear Case to maintain consistency in the builds.
• Suggested possible schema for the XML structure for automation of data processing and generation and acceptance of feeds over the web.
• Designed and validated schema for XML structure.
• Researched on XML Diff and Validation tools and recommended to the management.
• Analyzed System and Functional Specification documents for the Web Portal System.
• Utilized HP ExStream tool for document automation.
• Utilized Client Letter® tool to automate the communication process related to production, assembly and output.

Environment: .NET, WebSphere, HP ExStream, Client Letter®, Windows XP,RUP, UML, Visual Basic,Rational Rose, Rational Requisite Pro, Rational Clear Case, UML