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Project Medical

Columbus, Ohio, United States
January 21, 2019

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Business Analyst

**** **** **** ****, *** Albany, Ohio 43054




Experienced and well organized Business Analyst with 8+ years of experience in Healthcare and Insurance Domain

Hands on working experience in requirement gathering, reporting, documentation, process mapping, scheduling, planning, and data analysis

Experienced in Software Development Life Cycle (SDLC) methodologies—Traditional Waterfall Model and iterative approach to software development as per Agile (Scrum) methodology and Rational Unified Process (RUP)

Experienced in performing Impact Analysis, Gap Analysis (As Is-To Be), SWOT analysis and Risk Analysis.

Facilitated Joint Application Development (JAD) sessions, Workshops and requirement facilitation sessions with end-user/clients/stake holders and the IT group.

Proficiency in documenting Business Process Design, authoring Business Requirements Document (BRD), Use case Specifications, Functional Specification Document (FSD), Detailed Design Specifications (DDS), User Interface Specification (UIS) and other related artifacts

Experience in developing Story Boards, Screen Mockups, and Screen Flows for design feedbacks

Proficient in analyzing and creating Unified Modeling Language (UML) Diagrams such as Use case diagrams, Activity diagrams, Sequence diagrams, Data flow diagrams, Business flow diagrams using MS Visio and Rational Rose.

Experience in distributed healthcare domain and User Acceptance Testing (UAT)

Knowledge of health care services regulatory environment in compliance with HIPAA, ICD, MITA, MMIS and EDI.

Proficient in writing SQL queries for testing and data validation

Proficient in conducting User Acceptance Testing and verifying performance, reliability and fault tolerance issues. Also familiar with testing tools to design and develop Test Plans and Test Scripts

Involved in post implementation support and training of end users

Strong verbal and written communication skills

Result oriented, motivated and an organized team player with a capability of working for a common goal

Composed, professional and a well-balanced individual with strong understanding of business relationships and business requirements


Software Methodologies


Agile (SCRUM), Waterfall Model

Business Modeling Tools


MS Visio, Rational Requisite Pro, LucidChart,



MS Access 2003/2007, Microsoft SQL Server

Software Tools


JIRA, BM Remedy, SysAid, Issue Tracker, Confluence, Blueprint

Testing Tools


SOAP UI, Postman, Version One, HP Quality Center, Load Runner, ClearQuest

ETL, BI and Reporting Tools


SQL Server Data Tools – Business Intelligence, SSAS, Tableau Desktop, Qlikview, Crystal Reports, Business Objects, Micro Strategy, Tableau, PEGA

Microsoft Office Suite


MS Project, MS Word, MS Excel, MS SharePoint concept, MS PowerPoint, MS Visio

Operating Systems


Window Server 2008R2/2012, Windows XP, Windows 7,8,10

Project Management and Business Skills


HIPAA, ITIL(Information Technology Infrastructure Library), Change Management, SWOT Analysis, Project Planning, Project Budgeting, Content management, Scheduling, Cost and Time estimation


Requirement Gathering /Business Analysis

Agile Development

Cross Functional Collaboration

BI Reporting Solution Design

Data/Metadata Modeling

Client/ Stakeholder Communication

Report/Dashboard development

Team Leadership/Mentoring

Team Leadership/Mentoring


Client: Mississippi State Division of Medicaid, Jackson, MS June 2017- Present

Project Description:

Mississippi State Division of Medicaid has to comply with CMS mandated standards such as HIPAA 5010 and ICD-10 by the deadline specified by CMS. I worked on 2 projects with the Mississippi State Division of Medicaid for HIPAA 5010 and ICD-10 compliance.

1.HIPAA 4010 to 5010 migration: Performed GAP analysis between HIPAA 4010 and HIPAA 5010 standards. Also involved in user acceptance testing to ensure that the system is 5010 compliant.

2.ICD-9 to ICD-10 migration: Performed Impact analysis to determine systems impacted by ICD 9 to ICD-10 migration


Worked as a liaison between technology and the business clients to improve business processes and support critical business strategies.

Involved in overview Interview sessions, training presentation sessions and detailed interviews.

Worked with State-Client to gather the information about the documents and business processes

Contributed in ICD-10 Awareness Training Management Plan, created evaluation tool, and survey questions

Responsible for writing Functional Requirement Specifications (FRS) and User Requirement Specification (URS).

Contributed in process development, issue solving process, and creation of the process flow documents and diagrams

Conducted JAD session with management, vendors, users and other stakeholders for open and pending issues.

Studied the internal sub-systems of Mississippi MMIS to do an impact analysis of ICD-9 to ICD-10 migration.

Involved in mapping/ cross-walking of ICD-9/ ICD-10 codes.

Created reports for business analysis purposes using Crystal Reports.

Extensively involved in HIPAA 5010 User Acceptance Testing (UAT). Defined and maintained Test Cases for EDI transactions.

Worked with multiple clearing houses to ensure their EDI files are compliant with the internal format for Mississippi Medicaid and helped resolve issues.

Reporting the bugs in ClearQuest, interacting with the developer for resolving the same and retesting the resolved bug.

Client: Ranbaxy Pharmaceuticals - Princeton, NJ May 2016 - June 2017

Project Description:

Ranbaxy is a Global Research driven Pharmaceutical Company dedicated to putting patients first. The company discovers, manufactures and market vaccines and medicines in over twenty therapeutic categories .The striving efforts of Ranbaxy is to provide society with superior products and services by conducting innovative research that improves the quality of life and satisfy customer needs. The objective of the project was to create a Data Mart for Senior Management. This Data Mart allows the Management to view Pattern and Sequence in the region with various perspectives of Business and Research.


Generated Questionnaires for in Person Interview, Meeting, and JAD Sessions.

Created BRD (Business Requirement Document) and got Sign Off from the Users.

Analyzed and documented Business requirements using Requisite Pro and detail design for full understanding of the business.

Analyzed, Documented and managed all Project Requirements with RUP Methodologies

Used MS Visio to create Business Flow Diagrams and Work Flow Diagrams

Maintained Requirement Traceability Matrix (RTM) and managed requirements

Wrote SQL Statements to extract Data from Tables.

Created Use Cases and did intensive Use Case Analysis

Developed User Acceptance Test Cases and completed User Acceptance Testing.

Used Test Director Tool for implementing Test Scripts and Tracking Defects

Used MS Share Point for sharing documents, calendars and other artifacts between users in different locations.

Client: Affiliated Computer Systems, Helena, MT Feb 2015 – May 2016

Project Description:

The project was undertaken by ACS for remediation of the Montana Medicaid Management System. The project goal was to achieve NPI compliance mandated by the Federal Government in the year 2006. The project was undertaken by ACS for the government of Montana to remediate their existing Medicaid management system in line with the HIPAA guidelines to include NPI numbers in all HIPAA mandated transactions. The project involved remediation of all areas of Medicaid Management System, EDI and PBM interfaces.


Identified and documented impact areas, systems, interfaces, layouts for remediation of the Medicaid management system.

Responsible for Detail system design documents which identified impacted areas and detailed logic to address issues arising due to the introduction of NPI number in all system processes.

Conducted JAD sessions, Video conferencing and coordinated offshore operations with developers to meet deadlines.

Used documentation tools such as MS Office, MS Visio and MS Excel to document and deliver Business Requirement documents to the state for approval.

Gathered business Requirements, analyzed data. Created work flow diagrams and identified scope creep. Progressed from problem statement to well-documented Designs for state approval and for production, and implementation.

Identified and defined technical specifications in liaison with the development team for system design, coding and testing.

Prepared and maintained status report, charted out schedules, allocated and managed technical and human resources using MS Excel and MS Project.

Defined core business rules and validations for the entire project and established change control procedures.

Coordinated and documented maintenance procedures in liaison with the production team and established procedures and defined regions and procedures for future maintenance work.

Client: Cigna Healthcare, New York, NY Jan 2014 – Feb 2015

Project Description:

Cigna Healthcare is a company providing customers with benefits, expertise and service that improves the health, well-being and productivity. As a BA, I was involved in developing fully automated, real-time claims processing system for complete, on-line mediation of medical, dental, vision, and disability claims and encounters as per HIPAA guidelines. System allowed the efficient and timely management of all relevant data clinical, financial, and administrative throughout the organization enabling the sharing of information between subsystems.


Extensively involved in implementation of effective requirements practices, including gathering User Requirements, and analyzing User Requirement Document (URD), and functional specification document (FSD), use and continuous improvement of a requirement gathering processes.

Applied RUP methodology with its various workflows, artifacts and activities to manage life cycle from Inception to Transition phase.

Acted as liaison between external clients and SMEs to generate and standardize product requirements specification documents such as URS/FRS/UseCases.

Employed UML methodology in creating UML Diagrams such as Use Cases, Sequence Diagrams, State Diagrams, Activity Diagrams and business process and workflows.

Was engaged in applying CMM standards which provided guidance for improving organization’s processes and the ability to manage the development, acquisition, and maintenance of products or services Cigna was providing to its clients.

Involved in implementing Six Sigma practices to systematically improve processes and standards and by eliminating defects

Assisted JAD sessions to identify the business flows and determine whether any current or proposed systems are impacted by the EDI X12 Transaction, Code set and Identifier aspects of HIPAA. Involved in GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims. Worked on EDI transactions: 270, 271, 835, and 837 (P.I.D) to identify key data set elements for designated record set.

Involved in designing & determined 3-tier architecture for the claim processing system. Assisted team lead in developing Requirements Traceability Matrix (RTM) to trace the relationship between business and functional requirements to test cases. Prepared and executed different Test Cases and Test Scripts.

Involved in conducting Functionality testing, Integration testing, Regression testing and User Acceptance testing (UAT). Provided analysis and insight to QA Team in defects and bugs tracking.

Client: Fresenius Medical Care, Waltham, MA July 2010 – Dec 2013

Project Description:

Fresenius Medical Care North America is a wholly owned subsidiary of Fresenius Medical Care AG & Co. KGAA, located in Bad Homburg, Germany. Fresenius Medical Care operates more than 1,700 outpatient dialysis and renal service clinics in the U.S. The project involved the development and implementation of a new electronic medical record system. It will allow the clinics to better manage their patients and their records.


Involved in the design, review, implementation, testing, and release of databases, sign specifications, and application software.

Analyzed, reviewed and co-coordinated with SME and developers to understand business requirements

Created business flow diagrams and charts.

Conducted user interviews, gathered requirements, analyzed, and documented Business requirements. Performed Gap Analysis, Identified impact areas.

Participated in several sessions related to quality management, joint application development (JAD), defects management, business requirement and professional development.

Defined system requirements as Use Cases, Use case scenarios and Use Case narratives using the UML Methodologies.

Worked on claims processing and testing of pre authorization of claims.

Conducted weekly status meeting, discussed and resolved outstanding issues, prepared status report and sent it to project manager.

Educational Qualification

Bachelors in Micro Biology from Osmania University-1988

Masters in Business Administration from Franklin University -2007

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