PROFESSIONAL SUMMARY

• 7 years of experience as a Business Analyst in Health Care Industry.
• Worked on various projects, including State projects with an excellent track record of meeting deadlines and producing results.
• Expert in various tools and techniques for Business Requirements Gathering, including conducting Joint Application Development JAD sessions, Subject Matter Experts SME interviews, developing questionnaires.
• 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/Scrum Methodologies.
• Experience in development of Process Flow Diagram, Use Case Diagram, Activity Diagram, and Sequence Diagram using tools such as Rational Rose and MS Visio..
• Expert in creating Use-Cases, Wireframes and State Diagrams to demonstrate software architecture and interaction of system components before prototyping.
• 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.
• Well versed with FACETS, claim adjustments, claim processing from point of entry to finalizing, claim review, identifying claims processing problems, their source and providing corresponding solutions.
• Strong knowledge of FACETS backend functionality like Member table, Subscriber table, Claims table and Providers table.
• Worked on projects pertaining to both Medicare and Medicaid. Intricate knowledge of ICD-10 options and implementations within the industry.
• Excellent working knowledge of ACA Obama Care , HIX, MMIS etc.
• Excellent knowledge of PPO, POS, diagnostic codes and claims process.
• Exceptional documentation skills for writing User Stories, Functional Requirement Documents and Business Process Documentation.
• Very Strong SQL skills writing queries and verifying data and solid understanding of databases, data ware house, OLTP, OLAP, Data Modeling, Business Intelligent tools like Business Objects.
• Collaborated with QA team and Developer to establish Requirement Traceability Matrix RTM to ensure the completeness of the enrollment procedure.
• Worked in collaboration with the QA team to write Test Cases and Test Scripts to confirm the displayed information and also tested to print the image in the paper.
• Developed risk reports using SQL to conduct Stress Test and feasibility studies for Data Migration.
• Performed Functional Testing of the application as per the 5010 changes.
• Documented and analyzed all defects using Quality Center and tracked them to completion by communicating with the team every day.
• Excellent analytical, problem-solving, communication and interpersonal skills.

Projects:

Confidential

Senior Business Analyst

Roles and Responsibilities:

• Check the data structure ensuing the data format matches with PUMA's criteria
• Restructure data if needed e.g correct effective date or termination date form, delete empty spaces, etc.
• Write SQL queries to retrieve data from back end database to valid data integrity
• Write and Modify SQL scripts to create Triggers, Views and Events to do Fee Schedule Polling and Automation
• Migrate data from source to target which is from FACETS 1D to 1Q to 1P using a web-based front end tool named Migration Tool
• Coordinate with developers and Business side to make sure the FS files are most updated and consistent in FACETS
• Migration Validation
• Conduct Interviews and JAD sessions with SME's and stakeholders to understand BRD and FRD.
• Perform detailed analysis for the functional areas that will be impacted by implementation of ICD-10 codes.
• Implement the procedure for the system development phases through UAT testing for the UT MMIS.
• Conduct GAP analysis and Impact Analysis and prepared an Implementation and Recommendations Report communicated to the stakeholders.
• Develop Use Case diagrams, Business Flow diagrams- Activity/State diagrams and Sequence diagrams so that developers and other stakeholders can understand the business process.
• Create and maintain a Requirement Traceability Matrix RTM to see if all the requirements are being captured and are being worked on.
• Work extensively with IT team on building the architecture and underlying logics of the system.
• Non-Functionality Testing: UI Display testing, Stress Performance Testing, Vanity URL testing etc.,
• Functionality Testing: Migration Testing, Positive Negative Testing Smoke Testing, Regression Testing, System Testing.
• Make Testing Plan and Test Cases and executed them using Quality Center and Zephyr
• Coordinate with Developers and Business Owners for Defect Tracking

Environment: Zephyr, Clear Quest, MS Project, Quality Center, MS Visio, XML, JAVA, HTML, Microsoft SQL Server, Oracle, MS SharePoint, Toad, FACETS

Confidential

Roles and Responsibilities:

• Worked on capturing and mapping, member enrollment and eligibility and contribution data.
• Created/Validated HIX, ACA requirements with the SME's.
• Created requirements for the HIX ACA website for users to have instant easy access to coverage
• options.
• Involved in drafting the migration plans for the Claims Processing data, implementation of the new ICD-10 codes, guidelines and mapping everything from ICD- 9 to ICD-10 and vice versa using General Equivalence Mapping GEM .
• Analyzed the impact of ICD-10-CM/PCS coding system and Identified General Equivalence Mappings to facilitate the conversion from ICD-9-CM codes to ICD-10-CM/PCS codes to ensure that both the application and Health Record comply with new regulations.
• Created requirements and process flows for SHOP and map the requirements in Enterprise Architect.
• Created process flows for Eligibility.
• Facilitated requirements gathering sessions.
• Wrote complicated SQL queries to do data validation.
• Responsible for gaining a detailed understanding of components of the business and translating that knowledge into the requirements for systems or processes.
• Evaluated and recommended enhancements to application efficiency and reliability.
• Performed administrative functions, such as time reporting and project status reporting.
• Modeled business process diagrams, swim lane diagrams, planned and defined system requirements to Wire Frame with Use Case, Use Case Scenario and Use Case Narrative.
• Involved in designing and developing Data Models and Data Marts that support the Business Intelligence Data Warehouse.
• Created User Acceptance Testing UAT .

Environment: MS Project, Requirement Traceability Matrix RTM , Rational Rose, Axure, JAD, RUP, MS Visio, Windows OS, MS Office, SharePoint, Server, Quality Center, SQL Server.

Confidential

Senior Business Systems Analyst

Roles and Responsibilities:

• Used GEMs to convert ICD9 to ICD10
• Conducted Interviews and JAD sessions with SME's and stakeholders to understand BRD and FRD.
• Performed detailed analysis for the functional areas that will be impacted by implementation of ICD-10 codes.
• Implemented the procedure for the system development phases through UAT testing for the UT MMIS.
• Conducted GAP analysis and Impact Analysis and prepared an Implementation and Recommendations Report communicated to the stakeholders.
• Created Functional Requirement Documents FRD based on the signed-off business requirements.
• Developed Use Case diagrams, Business Flow diagrams- Activity/State diagrams and Sequence diagrams so that developers and other stakeholders can understand the business process.
• Created and maintained a Requirement Traceability Matrix RTM to see if all the requirements are being captured and are being worked on.
• Managed all the Change Requests Document that came in through after signoff and maintained all the artifacts on SharePoint.
• Analyzed ICD-10-CM/PCS coding system and conducted data migration and mapping between ICD9 and ICD10.
• Worked extensively with IT team on building the architecture and underlying logics of the system.
• Extreme involvement in production and development phase to report out to the stakeholders about the current status of the project.
• Created test cases and facilitated user acceptance testing with developers and testing team.

Environment: Rational Rose, Rational Requisite Pro, MS Project, Quality Center, MS Visio, Clear Case, Axure, Clear Quest, XML, JAVA, HTML, Microsoft SQL Server, Oracle, MS SharePoint

Confidential

EDI Analyst

Roles and Responsibilities:

• Prepared Project Requirements Document and Design Information Systems Business Solution.
• Actively Involved in Pre-Analysis of project with SME Subject Matter Experts and developers.
• Created Business Requirements and converted them into System Requirement Specifications.
• Worked on HIPAA 5010 compliance and EDI 837 transactions, ICD-9,ICD-10 Codes.
• Worked on Claims payment and implementation, HIPPA compliance ANSI X12-837 EDI Transaction Code, 837 claims encounter and 835 Claim Payment.
• Responsible for upgrading and documenting end to end claims processing starting from compliance validation on EDI X12 837I and 837P transaction to adjudication and then resultant production of a compliant 835 transaction in a batch environment.
• Worked with FACETS team for HIPAA Claims validation and verification process Pre-Adjudication .
• Generated various SQL queries whenever required and worked on the documentation of the databases.
• Performed data analysis and Data mapping from source system to target system.
• Created Functional Requirement Specification Document which included UML, Use case diagrams, Scenarios, activity, work Flow diagrams and data mapping, and Data modeling with MS VISIO.
• Experience in ETL process consisting of data transformation, sourcing, mapping, conversion and loading.
• Worked on the Documentation of databases like the SQL, Oracle and did the documentation for the Data Marts.
• Wrote complex SQL queries like Joins, Update, Stored Procedures, Indexes, Reports, ETL packages to understand the low level requirements.
• Used Agile Methodology throughout the project.
• Implemented Business Intelligence BI to help users make better business decisions.
• Prepared workflow, process diagram and conducted GAP Analysis to derive requirements for existing systems enhancements.
• Assisted with user testing of systems, developed and maintained quality procedures and ensured that appropriate documentation was in place.
• Worked on the Data warehouse for the requirement gathering and updated to the SharePoint.
• Created business rules, business vision document, business glossary and implementation up to functional and technical specifications.
• Extensive experience in managing project requirements, which includes requirement gathering, requirement rating/analysis and requirement priority assignment.
• Performed GAP Analysis on the existing solution and its transition into the new HIPAA 4010/ 5010.
• Assisted the business areas and technical teams to develop or update the test scenarios to ensure sufficient testing of ICD-10 impacted key system functions technical changes, as well as enterprise wide integration testing.
• Created data flow and sequence diagrams to describe how EDI Healthcare Transaction set 837 was used to submit health care billing information.
• Implemented Automation Testing using Quick Test Professional QTP .
• Experience in Data Modeling and documentation of the database architecture.
• Developed and executed test cases Change Control Requests CCRs and updated scope with new changes.
• As a Business Analyst/Data Analyst involved in business requirements, analysis, design, project planning scheduling, creating UAT Test Plans / Test Cases.
• Developed Test Cases from Use Cases, reviewed Test Plans to ensure Use Cases accurately.
• Reflected Functional and User Interface testing.
• Wrote SQL Queries and did the Documentation for the Databases.
• Designed the Test Plan and Test Cases for all processes and Web Services.

Environment: Agile, UAT, GAD Gap Analysis Document , Facets 4.71, Microsoft Office 2003 Professional Outlook, Word, Excel, Visio, Access , Test director, Abinitio, HTML, SQL, Quick Test Professional, Mercury Quality Center, BAM, ESB.

Confidential

Business Systems Analyst

Roles and Responsibilities:

• Worked with integrated environment of large scale Order Entry and/or Order Management systems that is part of a complex Service Oriented Architecture environment and is composed of several legacies OM systems.
• Worked closely with customer and development team, lead architects and analysts to develop assessments and project phasing.
• Defined business process flows and work flows within network environment.
• Worked through approach, business requirement meetings to gather requirements, plan timeline, Work Plans, Design, Development, and Testing Cycle Document, organize and distribute session outcomes, requirements, changes, issues, process and workflow.
• Assessed development, test, and support impacts for Order Management OM system. As part of the assessment, coordinated and delivered approach and assessment details within the OM system and with external systems and organizations.
• Designed Wireframes which allowed development of variations of a layout to maintain design consistency throughout the site.
• Translated business needs into Functional/Technical Requirements and approaches, design documents, report mockups and define technical solutions for developers via EDI Electronic Data Interchange and various tools.
• Developed and maintained Requirement Tractability Matrices RTMs , and developed design documentation based on assessment, approach, and project RTM.
• Managed all requirement and technical approach aspects of projects through entire SDLC.
• Represented organization in multi-system approach definition meetings, document meeting outcomes, and coordinated all internal and external follow-ups to close issues in support of the project requirements and system approach.
• Communicated project status and issues across the organization and to external customers.
• Analyzed project request documentation and existing system documentation to develop detailed system flows, scenario flows, approach documents, and assessments including level of effort and system impacts, risks, and dependencies.
• Controlled project scope through change control Supported and drove maintenance and change requests, business process improvements and enhancements.
• Worked with system architect and development leads to document necessary software changes to meet the project requirements.
• Worked with Development/Engineering, QA and BA teams to complete testing and user acceptance at design, functional and UI levels.
• Supported multi system data mapping efforts to define OM impacts.
• Worked heavily with Data Mapping and BOD Business Object Document tools and documents.
• Supported full System Development Life Cycle SDLC with understanding of various technologies and platforms such SOA Service Oriented Architecture , ESB Enterprise Server Bus , BOD Business Object Document , web, client/server and mainframe, entity-relationship diagrams ERDs and relational database concepts, and object-oriented programming.
• Used skills to support Software test, System integration, Quality Assurance, and delivery of technical solutions while focusing on business products and customer satisfaction.

Environment: Agile, Windows, Rational Unified Process, SAS, Rational Clear Quest, MS Access, Microsoft Project, UNIX, MS Access, MS visio, Mercury Quality Center