PROFESSIONAL SUMMARY:

• 8 years of experience as a Business Systems Analyst/PMO in Health Care Industry with extensive Health Care domain knowledge.
• Worked on various projects, including State projects with an excellent track record of meeting deadlines and producing results.
• Experience in Project Coordination, Project Planning and Project Management.
• Expert in various tools and techniques for Business Requirements Gathering, including conducting Joint Application Development (JAD) sessions, Subject Matter Experts (SME) interviews, developing questionnaires. Also calculated Return on Investment (ROI) and SWOT Analysis.
• Conducted Business Process Reengineering/Gap Analysis. Developed Business Process Flow, Business Process Modeling and Analysis, Design Documentation.
• Worked in various environments of the Software Development Life Cycle (SDLC), Rational Unified Process (RUP), and Agile Methodology.
• Expertise in Analysis and Review of Software and Business Requirement Documents.
• Managed business initiatives to balance requirements for full functionality, efficiency and quality.
• Excellent knowledge of Health Insurance Portability and Accountability Act (HIPAA) transactions and code set rules such as EDI 837, 270, 271, 276, 277, 834, 835, and 997.
• Worked on projects pertaining to both Medicare and Medicaid. Intricate knowledge of ICD 10 options and implementations within the industry.
• Expertise with HL7, ISO, Six Sigma, CMM standards.
• Exceptional documentation skills for writing Use Cases, Functional Requirement Documents and Business Process Documentation.
• Ability to bring industry knowledge to solution sessions with Business and IT.
• Has excellent analytical, problem - solving, communication and interpersonal skills.
• Clear understanding of RDBMS/SQL.

TECHNICAL SKILLS:

Databases: SQL, Oracle, MS Access, SQL Server 2000

Packages: MS Office, MS Visio, MS Project

MS Office Tools: MS (Word, Outlook, Excel, Access, PowerPoint), 2003/07, MS SharePoint

Tools: Clear case, Clear Quest, Rational Rose, Requisite Pro, Confidential Quality Center

Operating Systems: Linux, Confidential UNIX, Sun Solaris, and Windows 2000/XP/Vista

Languages: SQL, PL/SQL, VB, JAVA, .Net.

Methodologies: RUP,UML, Waterfall Model, Agile model, SCRUM, Crystal Reports

Business Documentation Skills: BRD, FRD, FRS, Use Case Specifications, UML Diagrams, Traceability Matrix, Project Estimate, Change- Training and User Manuals, Master Test Plan Review .

Professional experience:

Confidential, Quincy, MA

Project Manager/ Technical Senior Analyst

Responsibilities:

• Provided support to MA EOHHS business and IT assessment efforts, including data gathering, gap analysis, process discovery and validation, deliverable creation and validation and the establishment of a software vendor tracking tool.
• Participated in and supported working sessions designed to gather information from business and technical stakeholders within MA EOHHS, including documenting requirements for validation and inclusion in related deliverables.
• Supported the development of recommendations and deliverables to guide MA EOHHS in their ICD-10 remediation efforts, including the Business and IT Assessment, Developing a Release Strategy, Implementation Plan for various projects and systems.
• Developed high level Design and Development Recommendations, ICD-09 to ICD-10 Code (Diagnosis and Procedure) Mapping efforts as well as project planning and coordination.
• Coordinated meetings and sessions between multiple teams across multiple functional units.
• Oversaw ICD-10 remediation activities in MassHealth and provide project support
• Assist with developing communication plan and training needs assessment
• Gathered status reports and present it to ICD-10 Committee
• Participated in and support design sessions for multiple departments
• Developed work plans and timelines to complete projects in the most timely and efficient manner possible.
• Researched and gathered data regarding tools, techniques, industry’s best practices, etc.
• Assisted in performing critical analysis utilizing proven methodology applicable to healthcare industry.
• Assisted in analyzing and identifying trends in healthcare operations.
• Identified operational inefficiencies and inconsistencies.
• Researched/analyzed data and recommend solution alternatives
• Provided project status/updates as required.
• Assisted in the implementation of operational improvement solutions; develop measures of success and monitor
• Ensured that completed projects are implemented with proper oversight and perform subsequent reviews after implementation to ensure project goals are achieved.
• Kept Director and/or Manager informed of the progress of each special project.
• Assisted in cross training of project team members.

Confidential, Oklahoma City, OK

Sr. Business System Analyst

Responsibilities:

• Extensively worked withSMEto better understand the existing claim processing at Integris Health.
• Developed cross-walk for understanding major changes fromICD-9 to ICD-10versions.
• Gathered requirements by conducting JAD sessionswith the purpose of defining the functional business requirements.
• Performed GAP AnalysisofEDI 837 transactionfromHIPAA 4010 to HIPAA 5010.
• Identified the scope, business objective and documented the functional requirements for each release.
• Determined impact ofHIPAA-5010on current business operations to define and develop business and technical requirements within and across transactions.
• Coordinated and facilitated meetings with the management and the development team tobetter understand the Business Requirement.
• Direct involvement inprocess improvement plans and implementing business change,creating and managingProject Templates,Use Case Project Templates,Requirement TypesandTraceability RelationshipsinRequisite Pro.
• DevelopedBusiness Flow Diagrams, Activity/State diagramsandSequence Diagramsso that the development team and other stake holders can understand the business process.
• Created artifacts forRational Unified Process (RUP)- system architecture document, supplemental requirements document, architecture diagrams; verifying technical production infrastructure; designing and executing performance tests; and documentation.
• UsedMS-Visioto createData Flow Diagramsas aStructured Analysistool.
• Wrote clear, concise and detailedSystem 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.
• DevelopedBusiness flow diagrams, Activity/State diagramsandSequence diagramsso that the development team and other stake holders canunderstand the business process.
• Collaborated withQA team and Developer to establish Traceability Matrixto ensure the completeness of the enrollment procedure.
• Worked in collaboration with the QA team to writeTest Cases and Test Scriptsto confirm the displayed information andalso tested to print the image in the paper.
• Developed risk reports using SQL to conduct Stress Test and feasibility studies for Data Migration.
• PerformedFunctional Testingof the application as per the5010changes.
• Documented andanalyzed all defects usingQuality Centerand tracked them to completion by communicating with the team every day.
• Supported the development and installation team.
• ImplementedAlpha Testin order to confirm the functionality of recent conversion.

Environment: Mercury Quality Center, Windows,MS SQL,RUP, MS Visio, Java, SQL

Confidential, Franklin, TN

Sr. Business System Analyst

Responsibilities:

• Performed SWOT and Gap Analysis for the new functionality requirements
• Used HIPAA 4010 transactions to support the analysisof current business processes and worked with management to improve and implement enterprise solutions to ensure compliance. Also, got involved in designing future state processes forHIPAA 5010 transaction processing EDIs 837 and 835.
• Analyzed HIPAA 5010 related to 837, 835, 834 transactions and performed gap analysis between 4010 and 5010.
• Worked in accordance to HIPPA rules and regulations to draft business rules and claim processes.
• Interacted with the client and the Technical Team for Requirements Gathering and translation of Business Requirements to Technical specifications.
• Leveraged the initial ICD 10 assessment and detailed risks, gaps and issues.
• Conducted JAD sessions.
• Involved in processing Medicare stand-alone plan part D and Part C managed care plans.
• Worked onhealthcareEDIsystems and electronic claim transaction technology.
• Hosted the application online using Microsoft Share Point excluding some functionality which was meant for internal uses (employees only).
• Identified and documented the dependencies between the business processes.
• Created and documented the Use Cases and prepared the Use Case, Activity, Sequence diagrams and Logical views using MS Visio, MS Office and Rational Rose for providing a clearer understanding of the requirements for the development team.
• Data modeling using UML.
• Worked with Medicare operational management to monitor, trend, and report on operational metrics such as timeliness, workload, and staff trending, customer satisfaction, and other key measures to facilitate performance excellence.
• Handled HIPAA claim adjustments and claim processing from point of entry to finalizing, claim review, identified claims processing problems, their source and provided alternative solutions using best practice model and principles.
• Involved in preparing project plans and identifying major milestones for each stage as per the SDLC Model (RUP Methodology).
• Implemented the HIPAA privacy and security regulations to enhance the capabilities of the systems to process new products.
• Responsible for teaching sessions for providing end user with tools training.
• Used MS Project for various planning and budgeting activities.
• Used Quality Center to upload, execute and run scripts to compare and verify two outputs.

Environment: Rational Unified Process (RUP), HL7, UML, Dreamweaver, Rational Test Manager, WinRunner, Rational Clear Quest, Windows, MS Office, HTML, Windows, Quality Center.

Confidential, Bethesda, MD

Business Analyst

Responsibilities:

• Conducted SWOT Analysis of Project Plan.
• Gathered and analyzed the User Requirements and converted it into Business Requirement Documents (BRD).
• Conducted GAP Analysis to business process.
• Monitor for issues at IVR, Call Routing andSoft phoneapplications.
• Created Requirement Documents and BPM to document the business needs using tools like MS-Visio.
• Created business Process Workflow Diagrams (Activity diagrams) in Rational Rose
• Developed Business Use Case Diagrams, Business Use Case Activity Diagrams, Business Use Cases, Use Cases, Use Case Activity Diagrams during different stages of the requirement gathering process and presented it to SME’s to get sign-off.
• Send out root cause, resolution and impact analysis of all production issues.
• Involved in conducting in Feasibility Analysis and Risk Analysis of the project.
• Analyze the call flows and call details to track and report an ongoing issue at IVR and work with other impacting teams to get to the resolution.
• Participated in UAT sessions to test and validate the system.
• Collaborated with the QA team to develop the Test Plan, Test Conditions and Test Cases.
• Created and managed project templates, Use Case templates, Requirement Types and Traceability Matrix in Rational Requisite Pro.
• Gathered and documented business requirements to define business needs and defining business deliverables.
• Facilitated Joint Application Development (JAD) sessions with the SME’s and stakeholders.
• Supported in the design and implementation and deployment phase, as well as helping in maintaining the application in post deployment period.
• Ensured proper management and control of contents of project documentation using MS-SharePoint.

Environment: Oracle, Axure RP Pro, Rational Rose, Windows XP, MS Project, MS Word, MS Excel, MS Visio, Rational Requisite Pro, SharePoint.

Confidential, Springfield, IL

Business Analyst

Responsibilities:

• Gathered the requirements from stakeholders and users by meeting them personally and by interviewing them. Utilized Requisite Pro to prepare a BRD by complying with the HIPAA regulations.
• Extensively used SharePoint for project documentation facilitated JAD sessions, interviews, brainstorming sessions and document analysis with management, development team, users and other stakeholders to refine functional requirements.
• Prepared Work Breakdown Structures (WBS) to comply with the triple constraint: time, cost and scope.
• Developed the Business Process Mode (BPM) for the current state and future state for each area of the project and identified the Business Use Cases.
• Used SDLC (System Development Life Cycle) methodologies like the RUP and the waterfall.
• Conducted Lean Analysis throughout the project.
• Prepared a roadmap for a product that can exceed market and user expectations.
• Dealt with Data Mapping issues between various source systems, Staging Area and Data-Marts.
• Created and updated data mapping document(s) with reference to the source for 270/271, 276/277 and 837, 834, 820, 278.
• Maintained documentation related to difficulties, complexities and anomalies that may arise during the ETL process.
• Documented Test Plans and prepared Requirements Traceability Matrixes (RTM) that contains Test Scripts, Test Cases, Test Data and expected results for the User Acceptance testing.
• Developed use cases using UML diagrams and MS Visio; depicted clear relations associated between the entities.
• Collaborated with Quality Analysts for unit, integration, system and User Acceptance Testing (UAT).
• Worked on all Medicaid Users transactions involving electronic data interchange.
• Reviewed and analyzed the business environment and identical process improvements.
• Evaluated alternative solutions and recommend solution that best meets the need of the business.

Environment: SDLC, SQL, Java, Microsoft Excel, Microsoft Word, MS Visio, MS SharePoint, MS Project 2000/2003, JAVA, .Net, Rational Clear Quest, ETL, Rational Requisite Pro, Oracle, UML, Lotus Notes.