SUMMARY:

• Over 8 years’ of experience in Business System Analysis/Data Analysis with extensive understanding of business products, operations and Information Technology on the Health Care Services, Pharmaceutical and Vendor Human Resource Industry
• Proven track record as value - adding, delivery-loaded project hardened professional with hands-on expertise spanning in System Analysis, Data warehousing, Conversions, Migrations, Data Processing and balance priorities and simultaneous projects.
• s in analysis of large-scale business systems, Project Charters, Business Requirement Documents, Business Overview Documents, Authoring Narrative Use Cases, Functional Specifications, and Technical Specifications, data warehousing, reporting and testing plans.
• Organized Joint Application Developments (JAD) sessions, Kickoffs, Ad-hoc meetings, walkthrough, Interviews, Workshops sessions with end-user/clients/stake holders and the IT group.
• Expertise in creating UML based Modeling views like Activity/ Use Case/Data Flow/Business Flow /Navigational Flow and/or Wire Frame diagrams using Rational Products & MS Visio.
• Facilitated change management across entire process from project conceptualization to testing through project delivery, Software Development & Implementation Management in diverse business & technical environments, with demonstrated leadership abilities.
• Experienced in working on Business Rules and Centers for Medicaid and Medicare (CMS) Data Mapping of EDI Transactions. Knowledge on HIPAA 4010 transitioning to 5010 Standards.
• Knowledge of ACA (Affordability Care Act) and certain programs like Medicaid Shared Savings Program for Affordable Care Organizations.
• Excellent knowledge of Director, Quality Center. Knowledge of SQL Queries
• Experience in implementing EDI Transaction (835,837,270,271,820,834,276,277,278,977) and HIX and XML
• Deep understanding of Database management system and Data warehousing concepts
• Extensive experience with databases like Oracle, Teradata, SQL Server, DB2, and MS Access, IBM IMS, IBM AS400
• Knowledge in the ETL (Extract, Transform and Load) of data into a data ware house/date mart and Business Intelligence (BI) tools like Business Objects Modules (Reporter, Supervisor, Designer, and Web Intelligence).
• Expertise in implementing the RUP (Rational Unified Process) and agile methodology procedures within the system development model being followed based on the deadlines to be met.
• Adept in formulating Test plans, Test cases, Test Scenarios, Test Approach, Setting up testing environment in conjunction with the Testing team.
• Experience in testing Business Intelligence reports generated by various BI Tools like Cognos and Business Objects
• Proficient in performing Gap Analysis, by evaluating the key differences between the As-Is and the To-Be system and identifying the key requirements for system reengineering.
• Innovative, excellent team player and possess good requirement and data analysis skills.

TECHNICAL SKILLS:

Business Modeling: MS Visio, Word, Excel, Outlook, Project

Configuration Tools: Rational Clear Case, Rational Clear Quest, Rational Rose, Pro-Requisite, UML, DB2, IBM AS400, DOORS

Aggregate Spend Tools: Informatica, Data Stage, Business Objects, Cognos, Erwin, TOAD, PeopleSoft

Methodologies: Waterfall, RAD, RUP, Agile, Business Modeling

Quality/Security Management: HIPAA, PPACA CR 21.

RDBMS: Oracle, MS Access, and SQL Server, Terradata

Operating Systems: UNIX, Windows 95/98/NT/2000/XP/Vista, Windows server 2003

ECM: Microsoft SharePoint

Others: ERP-SD, Remote ware 4.3, PL/SQL, Reflection,FACETS 4.11,4.31,4.41,4.71

PROFESSIONAL EXPERIENCE:

Confidential

Integration Systems Analyst

Responsibilities:

• Schedule meetings with technical team to determine technical parameters for each TIBCO ESB service
• Analyze the PeopleSoft database tables to create the data mapping documents
• Gather technical requirements based on the JAD sessions and Team meetings
• Create Requirements Specification documents and
• Document the Process flow diagrams and Conceptual diagrams using Power designer
• Create the Meeting Notes, Specification documents, Data Mapping documents required for the project.
• Validate the requirements for different TIBCO ESB service operations
• Create the documentation for TIBCO ESB service validation using SOAP UI
• Run SQL query in TOAD environment to propose solutions to development team
• Perform Audit Report Analysis
• Identify the selection criterion for various TIBCO ESB service operations
• Review and update the existing specification documentation as per new project enhancements
• Perform user acceptance testing and regression testing for the TIBCO ESB services
• Production support for the current processes in production
• Help Manager is scheduling and project planning documentation
• Lead the offshore development and testing team in India

Environment: PeopleSoft, Oracle TOAD, .net, TIBCO, FileZilla, PowerDesigner, HP ALM, MS Word, MS excel, MS Outlook

Confidential, New York City, NY

Technical Business System Analyst

Responsibilities:

• As a Technical Analyst played active role in production support for Member and Provider Portal Issues.
• Investigated into the production issues using SQL, QRACLE TOAD and MS Access
• Conducted root cause analysis and documented solutions.
• Identified issues and discrepancies in the web database tables and emblem health member and provider websites.
• Reported the data discrepancies to the Technical Team
• Played active role communicating with the back end - “database” team and front end - “web” team for resolving the production issues
• Researched and resolved various production support high priority technical issues
• Documented Vytra Member Reset Pin Functionality related issues and proposed resolution steps
• Documented Connecti Care VIP Medicare Member login issues and proposed resolution steps
• Prepared Test Plan document which included test data and test scenarios and test results.
• Document all the steps throughout the testing of the business requirements
• Participated in Business Meetings and JAD sessions which involved the enhancement of the existing member and provider portal
• Captured Meeting Minutes and distributed to the Business Teams
• Captured action items during the JAD sessions and assigned them appropriately to the business groups
• Followed up on the open action items on weekly Business and Technical meetings
• Used Office Clip tool to open tickets newly identified bugs and tracked defect resolutions
• Participated in Production release and conducted UAT and Regressions testing to ensure stability of the website

Environment: Dot net, Oracle, TOAD for Oracle 11, SQL Server Management studio, QCARE, ESAWS, Office Clip, MS Visio, MS Access, MS Word, MS excel, MS Outlook.

Confidential, Rockville MD

Data Analyst/ Business Analyst

Responsibilities:

• Analyzing data received by internal and external systems for the purpose of Sunshine Act Reporting
• Track and analyze data from multiple vendor sources and provide appropriate feedback.
• Work directly with the business unit to understand project concept, objectives, approach, and Healthcare rules and regulations
• Work closely with the business unit to analyze and remediate data received from internal and external source systems
• Conduct workshops with various business and IT resources and SME’s to identify the reportable data
• Prepare meeting minutes for all working sessions and create and update the Functional Requirements Document (FRD) and Data Mapping Specifications, Source to Target Mapping Documents.
• Assist Project Manager in creating and updating the project plans
• Understand and detail requirements and act as the go to person for requirement explanation, questions and issue resolution.
• Conduct User Acceptance Testing (UAT) for all enhanced internal sources
• Ensure systems analysis procedures and practices are identified and implemented
• Gather requirements for new tool called “Alanda” which feeds data and Spits out the Federal and State Reports
• Work on Error and Data Remediation in “MedPro” Aggregate Spend Tool
• Created Inbound Detailed Reports and Ad -Hock Reports to identify Data Errors
• Worked on Data Error Remediation in the Aggregate Spend Tool
• Run Sample reports in the new tool to meet the CMS Federal reporting requirements.

Environment: Alanada Aggregate Spend Tool, MedPro Aggregate Spend Tool, Oracle E Business Suite, Agile Scrum, Qucik Test Pro, UML, MS Visio, Java.

Confidential

Data Analyst

Responsibilities:

• Participate in States workshop meetings to build the data elements that can potentially be included in the data dictionary to carry out the EDI Data Exchanges.
• Capture the responses from the different participating states on the availability of the data elements
• Create Data Mapping Reports for different EDI Transactions including Eligibility, Enrollment, Provider, Managed Care, TPL and Claims ( LT,OT, IP 837) Files
• These reports were submitted to stake holders like CPI, CMMI and FMG by CMS
• Interacted with the SMEs to get a better understanding of client business processes
• Prepared and documented Business Rules through JAD Sessions and research on Existing Rules Engine
• Created DTS Packages for migration of data between MS SQL Server database and other databases like MS Access, MS Excel and Flat
• Monitored and assisted in designing and development of Use Cases, Activity Diagrams, and Sequence Diagrams using UML.
• Document and review the high level Meeting Minutes
• Create, Maintain and Manage the Systems Requirements Documents, Action Items log and represent in appropriate forum
• Mitigate project Issues, Constraints during the requirements analysis
• Perform Data Mapping and Data Analysis and Data Profiling. Used Advanced Query Tools like DbVisualiser for extracting data for analysis and reporting.
• Perform data analysis on all results and prepare presentations for project managers and clients
• Developed & executed several Optimized queries in SQL on this data.
• Involved in extensive DATA validation by writing several complex SQL queries and Involved in back-end testing and worked with data quality issues.
• Develop concept diagram for the projects using UML in MS Visio
• Document Test Plan Document Including Test Cases and Test Scenarios and Data Mapping Documents and perform an internal review of the artifacts.

Environment:, UAT, GAD (Gap Analysis Document), MS Visio, SQL, HTML, Windows, Rational Requisite Pro, Clear Case, Clear Quest, Mercury Test Director Oracle, .Net, TOAD, UNIX, IBM AS 400

Confidential, Reston, VA

Business Systems Analyst

Responsibilities:

• Schedule meetings with technical personnel to determine technical parameters for EDI and other related processes, including communication, security, and privacy. Create transaction sets requirements, usually with Microsoft Excel, for transactions such as: HIPAA 270/271 (Eligibility), 276/277 (Claims Status Request/ Response), 278/278, 820, 834 (Benefit Enrollment and Maintenance), 835, 837 (Claims) -(I,P, &D), 835 Remittances and others.
• Integration of legacy systems onto payer system. Designed, developed, and maintained various Business unit reports by using SQL, and Ms Excel.
• Documented Data Mappings/Transformations, and Informatica sessions as per the business requirement.
• Involved working on different set of layers of Business Intelligence Infrastructure.
• Create Physical Data Mapping document and Logical Data Requirements document to add/update new tables in the existing data model.
• Assisted the PM on various projects throughout the Project Management Life Cycle (PMLC) including Project Charter, Project Plan and Resource allocation.
• Worked on designing the data structure in SQL Server and implemented to design 3 database based on the requirement for Dashboard
• Monitored and assisted in designing and development of Use Cases, Activity Diagrams, and Sequence Diagrams using UML.
• Utilized corporation developed Agile SDLC methodology. Used Scrum Work Pro and Microsoft Office software to perform required job functions.
• Provided expertise in strategic planning, business process modelling, business process analysis, object-oriented analysis & design, use case modelling, use case analysis, component-based development, and quality assurance.
• Prepared Business Process Models that includes modelling of all the activities of the business from the conceptual to procedural level.
• Worked closely with CTO in writing Stored Procedures in MS Access and MSSQLfor structure consistency.
• Experience in creating UNIX scripts for file transfer and file manipulation.

Environment: Rational Rose, Rational Req Pro, RUP, WinRunner, LoadRunner, HTML, SQL Server. PL/SQL, MS Office, MS Excel, MS Project, MS Visio, TOAD, LINUX

Confidential

Business Analyst

Responsibilities:

• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Eligibility, Enrollment and Claims.
• Managed all the requirements in repository (SharePoint), making requirements available to all team members.
• Lead Business Intelligence reports development efforts by working closely with Business teams
• Provided support and resolvedinbound and outbound electronic datainterchange (EDI) transactions between billing services, clearinghouses, and providers.
• Managed the external partnership with vendors to integrate applications to support HIPAA 270/271 X-12 EDI Transactions for Payor eligibility
• Tested results and EDI ANSI X12 file mapping and reported on standard analysis spreadsheet
• Tuning of Informatica Mapping, With Respect to Lookup Transformation Aggregation, SQL Transformation
• Performed data analysis and ran various SQL queries to critically evaluated test results and Wrote PL/SQL statement and stored procedures in Oracle for extracting as well as writing data.
• Responsible for preparation of cross walk for HIPAA logic (data manipulation) (ANSI 837 I to FACETS XC file and to keyword file extraction)-Inbound and outbound.
• Documented the dimensional models of ETL system. Develop and maintain reporting using in MS Excel queries, SQL in Teradata, and MS Access.
• Used Excel’s functions and various other features like Pivot Table, PivotChart Report and Goal Seek tool for reconciling various reports and for debugging purpose.
• Reviewed the Joint Requirement Documents (JRD) with the cross functional team to analyze the High Level Requirements.
• Worked in writing SQL Queries in Oracle for data manipulations
• Worked on data modeling and produced data mapping and data definition documentation.
• Planned and documented procedures for data processing and prepared data flow diagrams for the application.

Environment: Oracle, Test Director, Win Runner, Load Runner, Apache, MS Project, MS office Suite

Confidential, Naperville, IL

Business Systems Analyst

Responsibilities:

• Worked as a Business Systems Analyst to translate customer product requirements into comprehensive, complete and accurate business requirements and functional specification.
• Performed criteria table updates to determine the billing needs send to the insurance companies using MS access tables as a tool
• Involved in creating Data mapping specifications and execute detailed system test plans. The data mapping specifies what data will be extracted from an internal data warehouse, transformed and sent to an external entity.
• Understanding the Business Process and the Functional Specifications of the entire web sales process that included Underwriting, Evaluation, Enrollment, and Billing, and the Vendors Business Processes.
• Utilized Business Objects Data Integrator for ETL purpose in creation of data mart, as initial data source coming quarterly from Hospital groups through Flat files.
• Automated themanual test casesin Quick Test Pro (QTP) forQuality MeasureWeb Application
• Performed Defect Tracking and Change Control Procedures using Quality Center
• Developed strategies with Quality Assurance group to implement Test Cases in Mercury Test Director for stress testing and UAT (User Acceptance Testing)
• Documented and evaluated test cases/test results/feasibility study of various ETL tools like DataStage/Informatica.
• Involved in requirement gathering and database design and implementation of star-schema, dimensional data warehouse using Erwin
• Created Test Cases and scenarios for Data Integration as well as Back end and System testing.
• Provide inputs to development team in performing extraction, transformation and load for data marts and data warehouses.
• Analyze Source and Target systems and validate the joins between various tables to establish accurate data mapping
• Conducted CR “Change Request” walk-thru and approved FSD, BRD, Artifacts, & CR Sign-offs.
• Performed Gap analysis by identifying existing technologies, documenting the enhancements to meet the end state requirements
• Worked on data modeling and produced data mapping and data definition documentation.
• Data validation using database tools such as SQL and Access queries and following up with the development and QA team for the same.

Environment: MS Visio, MS Project, MS Excel, UML, SQL Server,PL/SQL.NET, Oracle, Clear Case, Clear Quest, Rational Requisite pro, HTML, Mainframe

Confidential, Wayne, NJ

Business Analyst

Responsibilities:

• Worked to develop Mapping, Business Rules design and testing of EDI 837 (Health Care Claims Transaction), 997 (Functional Acknowledgment), 277 (Unsolicited Claim Status), 835(Remittance Advice) for both Institutional and Professional claim.
• Documented the process flow & Business Use Case for the EDI transaction 835, 837 & tagged them in RequsitePro
• Performed Analysis to check if EDI Type trees for transaction sets 834, 837, 835are HIPAA Complaint.
• Provide support to developers, and executives in building and managing project plans using Clarity PM and Project Workbench.
• Prepared Business Requirement Documents (BRD’s) after the collection of Functional Requirements from System Users that provided appropriate scope of work for technical team to develop prototype and overall system
• Involved in the design of Data Flow Diagram for the visualization of data processing and in the Conceptual and Logical Design of the Database Management System. Assisted in Data Migration by developing Data Mapping Diagram
• Extensive experience with User acceptance testing (UAT), System testing, Integration testing and build verification testing.
• Worked with Subject Matter Experts (SME), project team members (business and technical), to define technology application for the business and system requirements.
• Used different ad-hoc analysis, the Reports assist in defining strategy for each customer category. Informatica was used for ETL process and Business Objects are used for Reporting duties.
• Wrote ad-hoc queries in SQL for report generation
• Assisted the IT team to develop service oriented architecture (SOA), and data warehouse system to utilize data mining for data analysis.
• Worked with DOORS for requirements management and to create Requirements Traceability Matrix
• Worked with the Business community, Tech Lead and 3rd party vendors in gathering the requirements.
• Assisted with user testing of systems (User Acceptance Testing), developing and maintaining quality procedures, and ensuring that appropriate documentation is in place.
• Used Rational Clear Case and Clear Quest as Configuration Management and Change control tools.

Environment: MS Visio, MS Project, MS Excel, RUP, UML, SQL Server, AIX, Cobol, PL/SQL,Oracle, Clear Case, Clear Quest, Rational Requisite pro, HTML, Mainframe