SUMMARY

• 8+ years of experience working as a Business Analyst/Project Manager.
• Strong knowledge of applied principle of the iterative methodologies of Software Development Life Cycle (SDLC) including Feasibility Study/Gathering Requirements, Analysis/Design and Development, User Acceptance Testing (UAT), Implementation and Post - Implementation Validation.
• Expertise in HIPAA Testing Privacy with multiple transactions exposure such as Inbound Claims 837-Institutional, 837-Professional, 837-Dental, 835-Claim Payment/Remittance Advise, 270/271-Eligibility Benefit Inquiry/Response, 276/277-Claim Status Inquiry/Response Transactions and testing in Client Server systems and Mainframe Applications.
• Experience in data mapping of HIPAA 4010 codes to HIPAA 5010 codes and ICD 9 codes to ICD 10 codes.
• Identified the major differences between HIPAA 4010 and HIPAA 5010 through GAP analysis of implementation guides.
• Experienced in facilitating Joint Application Development (JAD), Rapid Application Development (RAD) and Joint Requirement Planning (JRP) sessions, interviews, workshops and requirement elicitation sessions with end-users, clients, stakeholders and development team.
• Well versed with Joint Application Development method, Rational Unified Process, have knowledge of Agile Application development methods.
• Experienced in interacting with business users to identify their needs, gathering requirements and authoring Business Requirement Documents (BRD), Functional Requirement Document (FRD) and Software Requirement Specification (SRS) across the deliverables of a project.
• Expert-level experience in writing SQL queries for data retrieval and management.
• Excellent knowledge of Medicare (Part A, B, C and D) and Medicaid Health Insurance Policies, worked using Maintenance Management Information System (MMIS) for claims processing and information retrieval.
• Proficiency in creating Business Process Modeling including Use Case diagrams, Activity diagrams, Sequence diagrams, Collaboration diagrams, Data-Flow diagrams using UML Methodology, in MS Visio and Rational Rose, as crucial project deliverables.
• Professional experience in writing Test Scenarios, Test Conditions, Test Cases and Test Scripts for Functional and Regression Testing based on the Design Document and User Requirement Document for the Functional, Security, and Performance Testing.
• Experienced with Rational tools like Rational Requisite Pro, Clear quest, Clear Case and Rational Rose.
• Strong knowledge of Health Insurance Plans like Health maintenance organization (HMO), Point-of-service (POS) and Preferred provider organization (PPO).
• Managed complex business initiatives to balance requirements for functionality, efficiency and quality.
• Excellent communication and presentation skills.
• Professional with extensive experience in the development, implementation and integration of strategies within a team oriented environment, utilizing quantitative and qualitative analytical skills.
• Creative person capable of forming and maintaining positive and productive team environment, highly developed planning, management, problem solving and decision making capabilities.

TECHNICAL SKILLS

Methodologies: SDLC, Agile, RUP, UML, Waterfall

Business Modeling Tools: Rational Rose, MS Visio, Rational Requisite Pro

MS Office: MS Word, MS Excel, MS Access, MS Power point, MS Project, MS Visio

Change Management Tools: Rational Clear Quest and Rational Clear Case

Databases: MS SQL server, MS Access

Operating Systems: Windows, *NIX, Mac

Programming Languages: SQL, HTML, CSS

Testing Tools: HP Quality Center

PROFESSIONAL EXPERIENCE

Confidential, New York, NY

Business Analyst/Project Manager

Responsibilities:

• Tasked with preparing and managing project documentation, deliverables, milestones, resource management and schedules. Define, verify and manage project scope. Identify and mitigate internal/external project risks.
• Develop, execute and maintain project plans. Manage resources and track project progress against the baseline.
• Create roles/responsibilities matrix (RACI) to facilitate project communication.
• Reviewed business case and analyzed stakeholder requirements to document project charter and obtained project charter approval from the HARP business sponsor.
• Developed detailed project plan based on the project timeline, scope and resource plan, in order to manage timely completion of all the internal and external (NYS) deliverables
• Reviewed RFQ and extracted high-level IT requirements for implementing shared technology platform
• Reviewed NYS BH Offsite Review Tool and submitted responses to NYS
• Reviewed NYS feedback on the submitted responses and establish strategy for on-site readiness review
• Designed clinical process flow diagrams by interacting with senior management personnel from Medical Management, Behavioral Health, Delegated Vendors Relations Spec, Network Development & Contracting, Quality Management and Channel Outreach.
• Updated Member Eligibility File layout by adding HCBS eligibility and Health Home Enrollment fields (data source: New York State)
• Conducted meetings with the delegated vendors to finalize file layouts for Member Eligibility, historical medical claims and Daily Claims Extract files
• Scheduled phase gate meetings and presented SDLC documents to the PMO governance committee
• Documented Change management and communication plan
• Documented Training outline and developed training schedule with Training Lead
• Documented and maintained RAID (Risk, Assumptions, Issues and Dependencies) log
• Conducted meetings with Empire’s BH vendor for designing and developing integrated shared platform
• Conducted meetings with Empire’s BH vendor for transitioning current MEDSIII format to EDI 837 format for encounter data reporting to NYS
• Provided monthly implementation plan status updates to NYS
• In charge of partnering with IT to promote open lines of communication and maintain vendor relationship.
• Identify business objectives and participate in strategic planning to map/align long-term goals.
• Spearhead multiple cross-functional projects with the goal of obtaining synergy between projects and programs.
• Conduct project status meetings with project team and business stakeholders.

Environment: Windows 7, MS Visio, MS Project, MS Excel, MS Office, SQL

Confidential, NYC, NY

Project Manager/ Business Analyst

Responsibilities:

• Familiarized with their TB EMR and STD EMR.
• Attended several demos of their current EMRs and disease control software.
• Responsible for co-coordinating requirement gathering sessions with stakeholders, steering committee and Bureau of Tuberculosis Committee (BTBC) staff (executive sponsors).
• Responsible for co-coordinating requirement gathering session with Bureau of STD staff.
• Created high level requirements document for BSTD.
• Created requirements document for BTBC in MS Excel.
• Created several TB forms templates in MS Excel.
• Responsible for setting up meeting with vendors and Confidential staff for demos of new EMRs in the market.
• Maintained 'Perform', a web page where all project managers will manage the time line and budget for their respective projects.
• Visited the clinics several time to observe the work-flow of TB and STD clinics and with vendors for project(s) kick-off.
• Created several specific work-flow diagrams of TB clinics in MS Visio and detailed version of all work-flows in MS Word.
• Created an MS Excel document capturing all the EMR fields
• Worked with my manager on budget and certificate to proceed for Office of Budget Administration (OBA).
• Worked with my manager on EMR CP request for Office of Management and Budget (OMB) and worked on several questionnaires and flow diagrams, regarding the same.
• Worked with my manager on System Integration (SI)request document for TB EMR.
• Researched on various EHR soft-wares/vendors and cost involved.
• Created documents to review each meeting held on EMR (TB/STD).
• Created Functional Requirement Document (FRD).
• Created Request for Proposal (RFP) document.
• Maintained Weekly Status Report.
• Responsible for scheduling weekly check-in conference calls with vendor for RIS implementation and PACS upgrade.
• Noted meeting minutes for each check-in call and distributed among the participants.
• Scheduled vendor on-site visit for project kick-off.
• Created current and future state work-flow diagrams for RIS in MS Visio.
• Created interface and work-flow diagrams for PACS/RIS in MS Visio.
• Created GAP Analysis document for E-billing project, including HL7 (mainly A01, A08, P03) requirements.
• Responsible for co-coordinating weekly conference calls for EMR migration.
• Responsible for maintaining meeting notes for each meeting and distributing among the participants.
• Maintained the time-line for all projects.
• Participated in project progress biweekly meetings.
• Familiarize myself with APG and meaningful use.
• Scheduled APG kick-off meetings and requirement gathering meetings with with stakeholders, steering committee and Bureau of Tuberculosis Committee (BTBC) staff (executive sponsors)
• Created meeting notes and updated them weekly.
• Assisted TB staff in testing the EMR with new features and updates.
• Assisted TB staff with mock-ups of APG changes.
• Assisting vendors in setting up VM/staging/production servers
• Reviewing all the documents send by vendors, with TB staff.
• Managed all the documentation and made them available to all the team members.

Environment: Windows XP, MS Visio, MS Project, MS Excel, MS Office, Citrix based application

Confidential, Denver, CO

Business Analyst

Responsibilities:

• Worked with the statisticians and underwriting team to analyze and validate run-time decision models.
• Gathered and analyzed requirement for HIPAA 5010 and ICD 10 changes.
• Analyzed and documented the changes in the compliance rules for adverse action redesign.
• Worked on different EDI scenarios for batch processing.
• Ensure day-to-day EDI transmission, Reject tracking and Reconciliation.
• Run EDI Reconciliation reports daily and document in MS Excel.
• Involved in up-gradation of HIPAA X12 4010 transaction to HIPAA X12 5010 and ICD 9-CM (Clinical modification) to ICD-10-CM/PCS (Clinical modification/procedure coding system) simultaneously.
• Maintained and monitored project progress and status through MS Project.
• Extensive use of Use cases, written business flows, and work flow diagrams for effective plans.
• Integrated Requisite Pro to provide all teams visibility and maintains tractability among requirements, use cases and change requests.
• Managed all the requirements, making requirements available to all team members.
• Created requirements analysis and design phase artifacts using Rational Requisite Pro and MS Visio.
• Attended JAD sessions to define System Requirement Specifications (SRS) and Detailed Designed Discussions with the technical team.
• Worked extensively with the users and with different levels of management to identify requirements, use cases and to develop functional specifications.
• Created Use cases, Activity, Sequence and Collaboration diagrams.
• Conducted Asset Management, Risk Analysis of the Requirements and Traceability focus areas of the various projects and worked with the project team to help them identify the high-risk areas.
• Traces and manage all the requirements with Metadata to ensure the delivery of deliverables on time.
• Data mapping, logical data modeling, used SQL queries to filter data within the Oracle and Sybase.
• Responsible for co-coordinating business meetings and generating monthly status reports etc.
• Assisted QA team with Test Plans and executing Test Cases.
• Design specifications and Test Case usages for the HIPAA 837i, 270/271, 276/277, 835, 824, 275 and others.
• Involved in assembling, organizing and analyzing patient information, including medical history, symptoms, examination results, test results and prior treatments for EHR software development.

Environment: MS SQL, Windows XP, Requisite Pro, Clear Case, UML, Business Objects, MS Visio, MS Project, MS Excel, Rational Rose

Confidential, Virginia Beach, VA

Sr. Business Analyst

Responsibilities:

• Employed Rational Rose to visually determine the proper structure, key elements and optimal design for database and to aid efficient creation of tables, stored procedures.
• Employed impact analysis, data analysis and risk analysis for User Acceptance Testing (UAT).
• Strong Knowledge and understanding of ICD-9-CM and ICD -10-CM coding and claims processing. Also, well versed in Medicare Part A, Part B, Part C and Part D enrollment.
• Reviewed information gathered from multiple sources during requirement gathering and analysis and employed rational requisite for tracking, tracing and managing requirements
• Accountable for designing future state processes forHIPAA 5010 transaction processing EDI’s 837 and 835.
• In addition Reviewed HIPAA 5010 related to 837,835, 834 Transactions and conducted gap analysis between HIPAA 4010 AND HIPAA 5010.Proficient in creating and maintaining Workflow plans and artifacts.
• Enforced an integrated RUP solution with complete line of traceability for all the artifacts of web development projects
• Employed MS Project for various planning and budgeting activities.
• Supervised, reviewed and model Test plans, Use Case Model cases & Test procedures based on RUP methodology
• Wrote viable detailed user documentation and System Requirements Specification(SRS) documents with the purpose that developers could formulate application with minimum guidance
• Organized SWOT Analysis for better market understanding and fool proof project implementation
• Conducted UAT and registered test results according to the test plans using Test Director.
• Create Business Process Models that includes modeling of all the activities of the business from the conceptual to procedural level. Followed top down, leveled technique for building Business Process Models
• Supervised the functional aspect in accordance with the Business Process and validated the interfaces with the other systems and data conversion from the existing system
• Conducted Requirement Traceability Matrix(RTM) for requirement elicitation and linkup to deliverables
• Formulated Quality Assurance standard and processes for all levels of project team
• Conducted Gap analysis for the modules in production, organized feasibility study and conducted impact analysis for proposed enhancements
• Proficient in creating and maintaining Workflow plans and artifacts

Environment: Rational Requisite, Microsoft Office( MS Word, MS Excel, MS PowerPoint, MS Visio, MS Access), RUP, UML, SQL.

Confidential, Nashville, TN

Business Analyst

Responsibilities:

• Worked in Healthcare Claims Administration - Healthcare Claims Processing (837/835) including the facility claims and professional claims.
• 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.
• Worked on HIPAA Claims Validation and Verification Process (Pre-Adjudication).
• Worked on claim processing module which involved Receipt and Verification of Claim Forms (837) and Claims Attachments (275), Claims Enquiry and Response (276/277), Adjudication, Healthcare Claim Payment/Advice (835) as per HIPAA guidelines.
• Knowledge of the complete EDI format used in the electronic documentation which was part of the knowledge transfer program to the vendors as per the requirements.
• Assisted the UI architect in developing a new UI for the claims reimbursement process.
• Thorough understanding of the business process to help determine the user needs.
• Prepared Dataflow diagrams, Business Flow diagrams, UML Activity diagrams and Use Case diagrams.
• Performed GAP analysis and documented business and system level use cases to derive the requirements illustrating the functional behavior.
• Organized use case documents and developed RTM using Rational Requisite Pro.
• Submitted change requests and worked with change request records in Clear Quest.
• Participated in entering, tracking system defects in Rational Clear Quest.
• Followed Six Sigma discipline and methodology for eliminating defects in process.
• Actively participated in the Weekly Defect Status meetings to review and prioritize the defects within a functional area.
• Involved in the different phases of test effort like Integration testing, Black Box testing, User Acceptance testing, Regression testing, and Back End testing.

Environment: Rational Requisite Pro, Rational Rose, Rational Clear Quest, RUP, UML, MS Office, MS Project, MS Visio, Windows XP, SQL.

Confidential, Wichita, KS

Business Analyst

Responsibilities:

• Analyzed current business process flow by understanding preset business rules and conditions.
• Conducted formal interviews, Live Meetings and JAD sessions with business users Subject Matter Experts (SME’s)
• Designed and developed Use Cases, Activity Diagrams and Sequence Diagrams using UML.
• Involved in Backend Testing to verify data integrity by using SQL.
• Documented, organized and tracked the requirements using Rational Requisite Pro.
• Created Data Flow Diagrams (DFDs), ER diagrams for data modeling and Web-page mock-ups using MS Visio for acceptance from end users.
• Defined project milestones, schedules, and monitored progress using MS-Project and updated plans as required.
• Analyzed and tested Data Interface needs with external systems.
• Analyzed, manipulated and updated Database using SQL.
• Gap Analysis: Analyzed the client’s applications programs to determine the impact of the HIPAA rule on EDI Transaction Set
• Code List implementation and defined the changes to bring the affected systems into HIPAA compliance.
• Assisted with user testing of systems and maintained quality procedures and ensured appropriate documentation is in place.
• Maintained Requirement Traceability Matrix (RTM) and Utilized Clear Quest for change requests and defect tracking.
• Claim validation and Pend/Denied Claims Analysis for the Health plans Medicaid programs.
• Worked closely with the technical team to look up for the best possible solution on requirements by keeping business needs and technical constraints in mind.
• Updating, transferring and sharing Files using FTP between Windows and UNIX machines.

Environment: UML, MS Word, Rational Requisite Pro, Rational Clear Quest, Quality Center, SQL.