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PROFESSIONAL SUMMARY

Over 7 years of diversified experience as a Business Analyst with in-depth knowledge of Quality Assurance in HealthCare processes: Expert in all phases of Requirement Management, including gathering, analyzing, tracking requirements and quality assurance. Worked closely with project managers, SMEs, and staff to understand and brief the requirements and specifications for new applications along with re-engineering the existing applications. Strong understanding of various SDLC methodologies such as RUP, Waterfall and Agile with hands on experience in all of them. Experienced in writing and preparing business requirements documents (BRDs), system requirements specifications (SRS), system design specification (SDS), functional specifications, defining project plan and change request. Conducted JAD sessions, Gap analysis, and prioritized requirements using interviews, document analysis, and requirements workshops. Experienced in documenting requirement using Unified Modeling Language (Use Case and Activity Diagrams) and building business Process Flow Charts. Expert in organizing and managing all phases of the application testing process using Mercury Quality Center. Strong understanding of test plans, test cases, test scripts and defects tracking/reporting. Extensive knowledge of SQL queries and back end system integration testing. Conducted User Acceptance Testing (UAT) and verification of performance, reliability and fault tolerance issues for web based and client/server applications. Strong understanding of Functional, Integration, System, and Regression testing. Experienced in various Healthcare areas like Enrollment, Benefits, Claims, Medicare, and implementation of HIPAA key EDI (ANSI X12) transactions. Involved in HIPAA gateway transactions 997/999 and converting HIPAA 4010 messages into HIPAA 5010. Well versed experience in all EDI transactions like 834, 837 P, 835, 27x and conversion of 4010 to 5010. Dealt with the complexity of migrating from the ICD-9 set of diagnostic codes to ICD-10. Experienced on Medicaid Management Information System (MMIS) and Medicare Part A, B and D products and procedures. Excellent communication and writing skills and adept at facilitating walkthrough and training sessions.

TECHNICAL SKILLS
Defect Management Tools: Testing Tools: Operating Systems: Databases: MS Office Tools: Methodologies: Languages: Quality Center, Rational Clear Quest Quick Test Pro, Load Runner MS Windows NT/98/2000/XP, UNIX Oracle, MS SQL Server, MS Access, DB2 MS Office, MS Project, MS Visio, MS Outlook SDLC, RUP, UML, RAD, JAD Java (Basics), SQL, HTML/CSS/XML
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WORK EXPERIENCE

Cigna Healthcare, Norcross, GA Sr. Business Analyst (Feb 2010 to Present) Cigna Health is one of the nations leading non-profit networks of community-based healthcare providers, delivering high-quality care. The project was to implement the conversion of 837 P/835 EDI transactions from 4010 to 5010 along with ICD 9 to ICD 10 codes. I was also responsible for preparing requirements documents for conversion of 834 4010 to HIPAA compliant 5010. Responsibilities: Performed Requirements Gathering and Analysis, and ensured that contributors and all key stakeholders were satisfied. Coordinated with developer and testers for migration of EDI X12 4010 series to 5010 series. Performed GAP analysis of 4010 and 5010 EDI transaction using implementation guide to identify the changes in the segments and data elements. Used the mapping tools to map 4010 and 5010 transactions along with ICD 9 and ICD 10 codes, and validated the HIPAA Syntax. Gap Analysis of client requirements, generated workflow process, and relevant artifacts. Conducted testing on data & release, versatile in working with the EPO programme manger, Worked on conversion of 4010 to 5010, 834 compliant transactions. Daily Status reports to the Business owner, Project executives & Team. Developed Incident documents and portrayed the as-Is reporting structures versus Tobe Reporting needs for data integrity and accuracy. Identified the scope, business objective and documented the functional requirements for each release. Created Business requirement for generation of 997. Directly involved in process improvement Plans and implementing business change. Produced clear user manuals & training guides for User Acceptance Testing (UAT) and deployment for end-clients with step-by-step instructions and appropriate GUI screenshots. Created use cases specifications, use case diagrams, swim lane diagrams, component diagram and context diagrams to define the workflow and segregate high-level and low-level requirements using MS Visio. Conducted JAD sessions to gain consensus on various issues related to the project. Facilitated the resolution of project-related issues, identified risks and mitigation steps to manage risk using PLSQL in RDBMS. Environment: Windows 2008/XP, UNIX, Oracle 9i, Quality Center, Quick test Pro, HIPAA Standards, FACETS, MS Visio, MS Project, SharePoint United Health Group, Frisco, TX Business Analyst (March 2009 Dec 2009)
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Project involved in working on Electronic Administration of 834 memberships Enrollment system. UHG was involved in setting up an automated 834 automated processing system. Involved in converting the 834 4010 to HIPAA compliant 5010 from the vendor Benefit Focus. The UHG Enroll Application is currently live and in Production. Responsibilities: Gathered requirements from the Business users; interacted with them on constant basis. Worked along with Project Manager in scheduling the project flow. Defined and documented the vision and scope of the project. Conducted one on one interviews with high level management team and participated in the JAD session with the SMEs. Worked on Business Requirement Documents, business use cases, and test strategy. Kept assure whether the aggressive timeline of the project is maintained, Worked on Technical design documentation (TDD) of the claims processing system. Daily Status reports to the Business owner, Project executives & Team, Gap Analysis of client requirements, generated workflow process, and relevant artifacts. Worked on conversion of 4010 to 5010, 834 compliant transactions. Receiving 4010 to 5010, 834 transactions from vendor benefit focus and testing those transactions. Managed the entire UAT set up & UAT testing effort with the Business users, Participated in weekly status meetings to present status and incorporate any digressions from the original scope. Carried out a thorough target organization assessment and risk analysis. Analyzed the As is and To be system documents to show the current and proposed functionalities of the system using MS Visio. Worked with the clients on the final signing process in the User Acceptance stages. Environment: UNIX, Facets, Oracle, HIPAA EDI, Mainframe, XML, MQC, QTP, SharePoint.

Infocrossing HealthCare Services Inc, Jefferson City, MO Business Analyst (Jan 2008 Dec 2008) I worked for State of Missouri, Medicaid Management Information System (MMIS) project. The team that is responsible for receiving, documenting, processing the claims including the eligibility verification. The team is also responsible for making the system changes if there are any changes need to be made in the current policies, rules & regulations due to the business necessities. Also, tracking and addressing the problems on timely manner encountered by the providers, billers as well as vendor companies, health plan groups while generating 837 Professional, Institutional, and Dental claims, Acknowledgement 997, Claim Status Inquiry/Response 276/277, Remittance Advice 835, Eligibility Inquiry/Response 270/271, Prior Authorization 278, Drug/Pharmacy rebates and reimbursements, etc. The team is also actively involved to verify the data while it is converting from web portal to mainframe layout as well as in returning from mainframe to web portal. Responsibilities: Performed a project analysis on new projects, including requirements, personnel, and costs. Developed and maintained a work plan for system projects. Responsible for the execution for the project life cycle, including requirements gathering, design, testing, implementation and documentation, as required.
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Strong visual modeling and business process modeling skills in Rational Unified Process (RUP) and Agile Modeling with tools like Rational Rose, MS Visio. Provided reports and other documentation on projects to client and internal staffs, as needed. Worked with team leaders and supervisors to ensure project and organizational deadlines are met. Coordinated updates with client's staff and implement efficiencies in documentation maintenance. Organized and conducted extensive JAD sessions with users to identify and understand requirements. Responsible for doing the gap analysis for the interfacing system. Documented the Business Requirements Document (BRD) and the Functional Specification Document (FSD). Coordinated with the different teams distributed at different geographic locations for various releases. Identified Actors, Activities, Artifacts and Workflows and developed use case diagrams using Rational Rose. Wrote Use Cases, prepared use case diagrams (using Rational Rose) and followed Rational Unified Process at every stage of the process. Resolved/tracked production issues with Reports in Cognos and Mainframe. Facilitated requirements gathering activities, including meeting with users to discuss System Task Requests (STRs), Enhancements, and Project Assessment Quotations (PAQs) requirements. Documented issues and resolutions, and wrote specific requirements for system changes.

Environment: Windows, UNIX, Oracle, Requisite Pro, Rational Rose, Mainframe, MS Office, Visio.

Independence Blue Cross, Philadelphia, PA Business System Analyst (Jan 2007 to Oct 2007) I Involved in building up a new Medicare Insurance Policy using Power MHS for PFFS, which helps health insurance with its Membership and Claims Management Information Tracking System, Finance, and Utilization management System modules, which integrates directly with Power MHS. Responsiblities: Involved in various meetings with business user and SME to define business requirements. Worked as the communication line in between the technical groups and the business group. Conducted JAD sessions to complete the prerequisite for the business requirement. Discussed, interpreted and redefined the business requirement for testing effort. Involved in planning Gantt chart for scheduling the testing process. Created use case, and entity-relation diagrams to illustrate for testing effort Performed sanity and smoke testing on the application. Involved in analyzing and testing of Power MHS Conducted positive and negative testing by implementing various scenarios. Performed UAT testing by testing same members repeatedly in different iterations. Investigated system defects, reported & tracked testing process.
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Environment: Windows, UNIX, Oracle, Ms Visio, Ms Project. Keystone Mercy Health Plan, Philadelphia, PA Business Analyst Jan (Feb 2006 Nov 2006) KMHP was working with EDS for the State of Florida (AHCA) and Commonwealth of Kentucky besides several other state agencies. I was involved in performing gap analysis to identify and gather the missing business rules and creating business requirements documents and functional specifications documents along with updating HIPAA Companion guides which were customized based on the HIPAA Implementation guides to make sure they were in compliance with the HIPAA Transaction Code Sets. I worked extensively on their 834 Membership Enrollment for LOB 3100 (Florida) and 837 Institutional Outbound for LOB 1300 (Kentucky). Responsibilities: Created documents that incorporated both the technical and functional details. Involved in creating documents and diagrams for Membership Enrollment according to the HIPAA 834 Compliance Standards for Membership Enrollment. Used requirement elicitation techniques such as JAD Sessions and Document Analysis to gather information regarding the application from the KMHP SME and EDS along with the State of Florida people. Involved in bi-monthly Technical and Operational Issues (T&O) Conference Calls with AHCA, EDS and various providers who worked with AHCA to answer and resolve issues pertaining to a smooth transition from AHCAs previous fiscal agent ACS to EDS. Co-authored and reviewed Operational Guidance Documents along with Design Documents and Deployment Plan Documents. Created UI Documents as supporting documents for the Business Requirements Documents. Involved in Data Flow/Business Process Diagrams to illustrate the flow, input and output of data.

Environment: Windows 2000, UNIX, Oracle, Ms Visio, Ms Project. Kaiser Permanente, Reston, VA Jr. Business Analyst (Jan 2004 to Dec 2005) The system was involved in various kinds of testing of the Power MHS application and legacy conversion of the data modules like Membership, Providers, Finance and Claims to ensure that all modules of the system satisfied the business needs. Responsibilities: Assembled business requirement documents (BRD) and the functional specifications as per the user requirements. Created Business Workflow based on the requirements gathered from the client. Created functional specification documents based on the business requirement documents. Evaluated business requirements for enterprise business applications integration while delivering new/modified enhancements. Interacted extensively with the client and the management teams to understand the requirements and to report the status of the testing efforts on their applications. Created programs to analyze legacy system data and generated error reports.
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Conducted individual and group joint application development (JAD) sessions with business stakeholders and technical units. Participated in various meetings and discussed enhancement and modification request issues. Actively worked with developers as needed to isolate the Root Cause Analysis of defects. Worked with the clients on the final signing process in the User Acceptance stages.

EDUCATION
Master of Management Information Systems (Chicago, IL)

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