SUMMARY:

• Over eight years of experience as a business analyst with complete knowledge in various methodologies including business analysis, requirement gathering, and ITIL.
• Skilled in stakeholder analysis, management and communication by working with executives, senior business sponsors and technical specialists. Acted as an association between the business and development teams for requirements.
• Extensive experience in creating Business Requirement Document (BRD), Functional Requirements Specification (FRS), Project Plans, Requirements Traceability Matrix (RTM) throughout the Life Cycle of the project.
• In depth knowledge on different phases of Software Development Life Cycle (SDLC) and Software Testing Life Cycle (STLC). Expertise in requirements gathering using ‘Water fall’ and ‘Agile’ methodology (including ABRD), root cause analysis, creating workflows, process map and activity flows. Strong in documentation and communication of business design on business requirements using various methodologies.
• Complete understanding of the AS - IS and TO-BE business processes and experience in converting these requirements into technical specifications for preparing test plans.
• Conducted ‘GAP Analysis’ so as to analyze the variance between the system capabilities and business requirements. Managed meeting sessions with the SMEs to review business requirement.
• Experience and skilled in creating and analyzing UML, Data flow diagrams and Entity Relationship (ER) diagrams. Expertise in Data Modeling, Data Analysis, Requirement Analysis and Business Modeling.
• Proficient in User Acceptance Testing (UAT), Functionality Testing, Unit testing, System Testing, Integration Testing and Regression Testing.
• Strong experience with Medicare, Medicaid, and commercial insurances inHIPAA ANSI X12formats including270/271, 276/277, 835, 837, 834, 997 and NSF formatsfor interfaces and images to third party vendor applications.
• Have extensive knowledge in Insurance products like HMO, PPO, POS, Managed Care, Life Insurance various products like annuity, family Plan, Investment, Childcare Guidelines.
• Hands on experience of Medicare and Medicaid Management Information System (MMIS), HIPAA rules and transaction code sets enforced during EDI - Electronic data Interchange and ICD 9 to ICD 10.
• Effective team player, self-motivated, capable of adapting to new technology, strong problem solving and analytical skills, and inter-personal communication skills with a desire to achieve specified goals.

TECHNICAL SKILLS:

Methodologies: SDLC, RUP, UML, JAD, CMM, RAD, Waterfall, Agile (Scrum Approach)

Testing Tools: Rational Enterprise Suite, Quick Test Pro, Win Runner, Load Runner, Test Director

Change Management Tools: Rational Clear Quest

Business Modeling Tools: Microsoft Visio, Rational Rose, Power Designer

Version Control Systems: Rational Clear Case

Databases: SQL Server, MS-Access

Project Management: Microsoft Project, Microsoft Office

Operating System: Windows XP/Vista, MAC, UNIX, LINUX, DOS

PROFESSIONAL EXPERIENCE:

EDI Product Manager

Confidential, Austin, TX

Responsibilities:

• Gathered and prioritized the customer's product requirements, the product vision, driving product planning and worked closely with the business owner stakeholders in addition to development, QA and production support to ensure revenue and that the customer satisfaction goals were met.
• Interacted with the vendor’s to document the mapping specifications which acts as a key documentation for the developers to produce the data files (institutional and professional claims, medical claims, provider’s data, member’s data and pharmacy data).
• Conducted structured walk through and JAD sessions for consensus on baseline.
• Provided subject matter expertise in areas including EDI, proprietary flat files and system integration to the development, QA and production support teams on core system enhancements.
• Provided knowledge for transferring the sessions to the key shareholders and worked with partner companies where applicable to deliver solutions.
• Supported baseline system documents for roll-out activities and assisted in the creation of companywide SDLC standards to utilize agile methodologies.
• Designed and implemented basic SQL queries for QA testing and report/data validation.
• Prepared the project status reports and represented the EDI team in the PMO meetings.
• Participated in UAT along with the development and testing teams.
• Gathered requirements from enrollment, claims, pharmacy operations and finance.
• Played an integral role as part of a core program management team for the turnover to a new outsourcing vendor.

Environment: MS Visio, MS Office Suite, HealthRules, Samanage and SQL Teradata

Project Lead/Business Analyst

Confidential, San Antonio, TX

Responsibilities:

• Interacted closely with the business users along with the administration and management to gather business requirements and analyze the functionalities to be incorporated into the system.
• Responsible for creating and updating the Business Needs and Test Scenarios (BNTS) document.
• Conducted meetings with the various stakeholders to gather requirements (High level business and functional needs) for creating the BNTS.
• Conducted structured walk through and JAR sessions for creating the Detailed Level Requirements (DLR) and Detailed Level Design (DLD).
• Responsible for reviewing and approving the IT QA test plans and detailed test cases.
• Responsible for post-production monitoring and validation of all code enhancements and set up changes in support of the government program groups.
• Collaborated with the business systems analysis specialist team members to monitor the business project portfolio in an effort to identify synergies between projects.
• Conducted weekly meetings to update on the status of the project and to discuss on any prior issues.
• Acted as a TAG (Technology Alignment Group) lead for IMS (Issue Management System) issues assigned and worked as a liaison between the IT team working on the issue and the issue owner(s) on the business side.
• Ensured that the systems were functioning as expected and the member’s claims were being processed correctly.
• Coordinated with the managers and technicians to amend business process functions.
• Created a current state process map and documentation.
• Reviewed the data of business functions and analyzed how the business infrastructure was affected.
• Performed continuous research on ways to improve the business process.
• Communicated with the licensing authorities to understand the special business process requirements.
• Developed procedures according to the product needs and state guidelines.
• Drafted reports and created diagrams on the business process.
• Conducted GAP analysis in understanding how the upgraded systems carries out the business functions and assists in ensuring the timely and effective implementation.
• Interacted with the top management and business users on a daily basis with regards to how the application functioned, troubleshooting incidents/issues for users and completed defect and enhancement requests on a daily basis.
• Designed and developed all Use Cases and UML models.
• Involved in the drawing process Flow Diagrams and Work Flow Diagrams in all phases of the SDLC.
• Involved in preparing the Software Requirement Specifications (SRS) and User Interface Design.
• Conducted functional walkthroughs, User Acceptance Testing (UAT).
• Created post implementation feedback loops to update senior executives on lessons learned to support ongoing organizational continuous improvement efforts.

Environment: MS Visio, MS Office Suite, MS Project, Rational Clear Case, Rational Requisite Pro, Test Director, Rational Tool, eSD Maintenance, eSD Production, Claims Research Tool POS, RUMBA, CBM, PEGA (Adjustments front end tool), IW and SQL Teradata

Business Systems Analyst

Confidential, Dallas, TX

Responsibilities:

• Defined the scope of the project and developed a vision plan that defined the primary goals and objectives of the project.
• Worked with Rational Unified Process rights from the initiation to the transition phase.
• Gathered and analyzed business requirements for inbound and outbound files, managing all requirements using Rational Requisite Pro (RRP).
• Conducted researches to make and approve updates regarding the appropriate enterprise standards.
• Took charge of process definition and results of applicable enterprise IT metrics; organized events to aid with broad skill development.
• Kept track of each entity’s usage of the enterprise project management standard processes.
• Conducted brain storming sessions to analyze provider contracts, provider reimbursement, benefit rules, medical policies and medical management rules to see the impact of ICD 10 diagnosis codes.
• Conducted working sessions to gather and document the high level business requirements and detailed level business requirements for different business units impacted by ICD10 such as EDI claims intake, medical management-utilization management, case management and provider reimbursement and provider payments.
• Organized impacted systems into high, medium and low impact to help the business analyze the level of efforts for remediation activities and to ease resource allocation work
• Analyzed healthcare transaction flow for HIPAA healthcare transactions like 834, 835, 270, 271, 276, 277, and 278.
• Conducted impact analysis gap analysis and assisted in risk-management analysis.
• Designed and developed all Use Cases and UML models.
• Developed the business requirement specification documents as well as a high-level project plan.
• Experience in gap analysis, data mapping and manually tested the interfaces and functionalities.

Environment: Rational Rose, Rational Clear Case, Rational Requisite Pro, Test Director, Rational Tool, MS Visio, MS Office Suite, MS Project, Oracle 10g, SQL loader.

Business Analyst

Confidential, Boston, MA

Responsibilities:

• Attended demo sessions to understand the existing system functionalities.
• Arranged interviews with all of the stakeholders to review and understand the gathered business requirements.
• Coordinated with the system architects and developers to convert business requirements into system requirements.
• Conducted meetings to document change requests for new requirements.
• Analyzed business requirements and segregated them into Use Cases.
• Created Use case diagrams and documented Use case specifications.
• Maintained various versions of the documents generated during the project using Rational Clear Case.
• Responsible for creating and updating the project schedule and managed the resources and timeline using MS project.
• Prepared the project status reports and represented the BA teams in the PMO meetings.
• Participated in UAT along with the development and testing teams.
• Gathered requirements from collection, claims, billing and insurance appeal departments

Environment: Windows 7, MS Office Tools 2010, MS Project 2010, Windows Server 2003, Microsoft SQL Server 2008, MS Visio 2010, Rational Requisite Pro.

Business Analyst

Confidential, Wilmington, DE

Responsibilities:

• Involved in Business Process Reengineering (BPR), analyzed the existing business processes and implemented new improved processes.
• Analyzed the business needs and drafted process maps.
• Created Use cases diagrams using Microsoft Visio.
• Involved in technical designing to develop blueprints.
• Conducted requirement gathering using focus groups, document analysis, interviews, prototyping and authoring blueprints.
• Involved in designing the systems with the systems architect and the development team, implementing technology based solutions.
• Conducted the initial study of health care management to collect the customer’s information like data about the existing systems at the customer site and specific customer requirements.
• Designed and implemented the basic SQL queries for QA testing and report/data validations.
• Authored and monitored progress reports on a weekly basis
• Developed Sequence Diagrams and Activity Diagrams.
• Conducted JAD sessions between the end users and the development teams.
• Performed User Acceptance Testing (UAT) and reported the bugs to the development team.

Environment: Rational Rose7.0, JAD, UML, Microsoft Office Visio, Microsoft Office Project 2010, UAT, SQL Server 2005, MS Access, Windows Server 2003, Mercury Quality Center, Visual studio 2005, Power Center.

Business Analyst

Confidential, Providence, RI

Responsibilities:

• Responsible for requirement and design documentation reviews, identification of customer management software anomalies and test results, customer interaction and IT management.
• Managed all the requirements and change requests and made updated requirements available to all team members involved in the project
• Worked extensively through Agile development methodology by dividing the application into iterations and working on each iteration through full SDLC.
• Conducted GAP analysis in understanding how the upgraded system carries out the business functions and assists to ensure the timely and effective implementation.
• Conducted feasibility studies and performed impact analysis for proposed enhancements.
• Worked closely with the developers and User representatives, participated in the product design process, including specifications, end-user reviews and application walk-through.
• Developed business use cases in most instances, worked extensively on Rational Requisite Pro in gathering user requirements, managed Workflows and elicited communication plans.
• Generated Use Case diagrams using MS Visio to depict the process flows, timelines and cost-benefit models.
• Interacted with the development and QA teams to ensure overall quality and scalability of the software.

Environment: HTML, Oracle 10g, MS Office, MS Project 2010, MS Visio, UML2.2.

Business Analyst

Confidential

Responsibilities:

• Interviewed clients to gather business requirements and provided input on possible non-technical solutions.
• Developed project schedules, timelines, status, system schematics and process work flows using MS project.
• Studied the existing documentation and for certain components performed business process re-engineering.
• Conducted Joint Application Development (JAD) sessions to expedite the requirements gathering.
• Prepared Functional Requirements specifications from the Business Requirement Document.
• Extensive experience in writing technical specifications using MS Word.
• Created UML diagrams such as Use Case Diagrams, Activity Diagrams and State Chart Diagram using MS Visio and Rational Rose to define the business process.
• Performed extensive requirement analysis and gap analysis.
• Developed business requirement specification documents as well as high-level project plans.
• Worked on multiple modules like life insurance, annuities retirements and investment services.
• Comprehensively worked with requirement gathering using Requisite Pro.
• Established a business analysis methodology around the RUP (Rational Unified Process).
• Assisted in the QA testing by providing the detailed functional aspects of the system.
• Worked on validating the data in MS excel before being fed into the applications.
• Wrote SQL queries to conduct data validation tests and data integrity tests.

Environment: Java, Web logic, Oracle, SQL, Quality Center, Windows, MS Office, MS Visio, Rational Requisite Pro