PROFESSIONAL SUMMARY:

• Solution oriented Business Systems Analyst with over 9 years of experience in the Health Care & Retail Domain.
• Excellent knowledge of Healthcare Product ( Confidential - Confidential Tele Processing Services) & Process (Medicare Advantage Claims) Development and Confidential (IT Sales, Services and Marketing), BI related tools like Informatics.
• Served as a liaison between business owners and development teams in order to provide solutions to meet user needs.
• Gathered and documented business requirements during JAD sessions and also maintained Q & A log for issues and concerns raised by the SME’s and the Stakeholders.
• Translated business requirements into functional specifications, managed changes to such specifications
• Interpreted business needs and issues by gathering, analyzing, documenting and validating the Business area’s user and technical (functional/non-functional) requirements
• Conducted Gap Analysis between “As Is” and “To Be” systems in every phase to check the compatibility of the existing system infrastructure with the new business requirements.
• Used MS Visio and IBM Blueworks Live to draft the Current State and Future State diagrams.
• Identified and documented Risks, Assumptions, Issues and Dependencies involved with the future process in the Operations and Support plan.
• Have a good understanding of 270/271-Eligibility Confidential Inquiry/Response, 834 - Membership Enrollment, 837-Institutional, 837-Professional, 835-Claim Payment/Remittance Advise, 276/277-Claim Status Inquiry/Response Transactions.
• Authored System Use Cases to document different scenarios of functional requirements and business rules for system.
• Excellent knowledge of Medicare Advantage and Medigap.
• Extensive experience in working closely with testers and collaborated in the creation of test plans, test cases, test data for system and integration testing.
• Led User Acceptance Testing (UAT) and obtained approvals from internal and external customers.
• Good understanding of change management using IBM Rational Clearquest and repository management using SharePoint.
• Facilitated and participated in daily and weekly standup and status calls.
• Team player, result-oriented, fast learner, excellent written and verbal communication skills with strong research capability.
• Excellent in problem solving, conflict resolution, analytical and presentation skills.
• Facilitated project estimation and Gate Funding sessions with the project owners.
• Managed and completed multiple projects successfully on-schedule and on-budget.

TECHNICAL SKILLS:

Business Modeling Tools: MS Visio, IBM Blueworks Live

Methodologies: Waterfall, Agile, SDLC, Scrum

Repository/Version Management: Confluence, IBM Rational Clear Quest, Share Point, Planview

Change Management: JIRA, IBM Rational Clearquest

Databases: MS Access, MS-SQL Server, Oracle, Siebel

Communication: Lotus Notes, MS Outlook, MS Lync

Project/ Portfolio Management Tools: Planview, VPMi, Team Track(project tracking)

QA Tool: HP Quality Center,Zephyr

ETL Tool: Informatica

BI Tool: Informatics (for reporting and data mining)

PROFESSIONAL EXPERIENCE:

Confidential, South Borough, MA

Lead Claims Business Analyst

Responsibilities:

• Gathered, analyzed, compared and documented requirements for during different releases.
• Worked with the development team to understand the system limitations, impacts, changes required for Authorization Load logic, Event Codes, Confidential Categories, BPIDs, UI changes needed for MA Confidential Host, Home claims.
• Participated in test case & test data review sessions.
• Made UI configuration changes (Mapped ika Event code to different SFMC and DFMC in the Confidential Crosswalk table)
• Drafted and updated RTM for each release.
• Facilitated GCT, Inter- plan testing process by modifying claims EDI files to accommodate new scenarios in different test regions.
• Documented release plan and participated in production implementation.

Environment: Waterfall, MA Confidential Host, Home claims, UB & HCFA form types, Claim Adjustments, Authorizations, TOB (Type of Bill), BPIDs, UI change, Confidential Host SF generation, Blueweb, PlanConnexion, MS Word, JIRA, Confluence, MS Project Plan, RTM.

Confidential

Responsibilities:

• Gathered, analyzed and documented requirements applicable for Confidential of Michigan.
• Worked with the development team to understand the system limitations, impacts, changes required for the Confidential Host claim SF generation process, one time ETL load, provider info table.
• Reviewed test cases and test data. Also, participated in SIT and UAT.
• Facilitated the UAT process by modifying EDI files to accommodate new scenarios.

Environment: Waterfall, MA Confidential Host claims, ETL Load process, Confidential Host SF generation, Provider Info Module, RTM, JIRA, Confluence, and MS Project Plan.

Confidential

Responsibilities:

• Gathered, analyzed, compared and documented requirements from previous release Confidential 14.5.
• Worked with the development team to understand the system limitations, impacts, changes required for Authorization Load logic, Event Code, Confidential Categories, BPIDs, UI changes needed for Confidential Host, Home and Local claims.
• Configured Event code through UI.
• Facilitated the UAT process by modifying claims EDI files to accommodate new scenarios, modified Authorizations to test the Confidential change.

Environment: Waterfall, MA Confidential Host, Home and Local claims, RTM, Authorizations, TOB (Type of Bill), BPIDs, UI change, Confidential Host SF generation, JIRA, Confluence, MS Project Plan.

Confidential

Responsibilities:

• Analyzed and compared requirements from Confidential applicable for Confidential of Michigan.
• Aligned the Eligible Professionals (EPs) to internal Rendering Provider List and Specialty Type for Confidential and Confidential Home claims.
• Worked with the development team to accommodate and align Confidential requirements to the internal system configuration (for Confidential Provider Classification, Performing Provider Type at the claim/header and the line level)
• Aligned the Measure Codes from Confidential
• Tested and validated detail and summary files before check generation

Environment: Waterfall, MA Confidential Home and Local claims, RTM, JIRA, Confluence, and MS Project Plan.

Confidential

Responsibilities:

• Analyzed and compared requirements from Confidential applicable for Confidential of Michigan and aligned it to the users stories required for development.
• Worked with the development team to accommodate and align Confidential requirements to the internal system configuration (for Confidential Provider Classification, Performing Provider Type at the claim/header and the line level, Modifiers, PPRVU file)
• Tested and validated detail and summary files before check generation
• Participated in daily scrum calls.

Environment: Agile, Confidential Compliance group, MA Confidential Home and Local claims, RTM, JIRA, Confluence, MS Project Plan.

Confidential

Responsibilities:

• Analyzed, captured and documented business and functional requirements for Confidential of Michigan for the year of 2013/2014 using Claims Based Reporting Options and generate voucher.
• Aligned the business and functional requirements with the test case and updated the RTM
• Aligned the Measure Codes from Confidential to the claims systems
• Tested and validated the detail and summary files

Environment: Agile, MA Confidential Home and Local claims, Manual Check Payment process, EFT process, Check Register, RTM, JIRA, Confluence, MS Project Plan.

Confidential

Responsibilities:

• Gathered, analyzed functional requirements during JAD sessions.
• Worked with the development team to during walk thru, code review sessions.
• Participated in QA sessions for test case and test data review.

Environment: MA Confidential Home and Local claims, RTM, JIRA, Confluence, MS Project Plan, MS Excel.

Confidential

Responsibilities:

• Gathered, analyzed functional requirements during JAD sessions.
• Worked with the development team to during walk thru, code review sessions.
• Participated in QA sessions for test case and test data review.

Environment: MA Confidential Home and Local claims, RTM, JIRA, Confluence, MS Project Plan, MS Excel.

Confidential

Responsibilities:

• Gathered, analyzed functional requirements during JAD sessions.
• Worked with the development team to during walk thru, code review sessions.
• Participated in QA sessions for test case and test data review.

Environment: MA Enrollment Unit, Data Reports, RTM, JIRA, Confluence, MS Project Plan, MS Excel.

Confidential, Tampa, Florida

Lead Business Analysts/PM

Responsibilities:

• Had provided extensive industry knowledge, innovative, turn-key solutions for insurance carriers like Cigna and United Concordia. Projects included managing Master Brokers, agencies and affinity groups, and even the end consumers and paying commission.
• Provided end-to-end sales, marketing, retention and BPO solutions for the individual, voluntary and group insurance market segments to Cigna and United Concordia.
• Managed projects for OB 834 and IB 834 files and enrollment.
• Worked on projects like Sales Link which is HPS’ state-of-the-art online marketplace solution that offers a multi-carrier, multi-product platform where customers and prospects can browse, compare and purchase insurance coverage from a vast assortment of the nation’s leading carriers.
• Had managed projects which offered solutions like Confidential - a business solution that allows insurance carriers to connect with every public and private exchange through a single connection. Rather than connecting on a one-to-one basis, the strategy was to offer a one-to-many solution.

Environment: Waterfall, MS Word, HPQC, VPMi, Team Track, MS Excel, MFT, Share Point.

Confidential, New Jersey

Sr. Business System Analyst and IT Project Lead

Confidential

Responsibilities:

• The Confidential project was launched by Confidential of New Jersey in order to successfully position Confidential to engage in technology implementations in fiscal year 2013 and Confidential .
• The objective of this project was to automate the existing manual Broker Data entry process from the paper application into ACOM3 and i Confidential ease data integrity and to generate an error report for the submitted applications and also paying the General Agents for the approved applications.

Environment: Waterfall, ACOM3, MS Excel, MFT, Confidential, Clear Quest, Share Point, Lotus Notes Database, Master Broker Payment commissions, RTM, Planview.

Confidential

Responsibilities:

• The new process of extraction of Language Type and Media data from ika had eased the delivery of alternate language materials for a given subscriber.
• By automating the Confidential extraction will resolve the delay and humane errors.
• This was part of the Bluelist projects.

Environment: Waterfall, IVR, Informatica, MFT, Confidential, MS Excel, Share Point, Clear Quest, Lotus Notes DB, MS Lync, MS Visio, IBM Blueworks Live, RTM, Planview.

Medicare Broker

Confidential

Responsibilities:

• The objective of this project is to automate the existing manual Broker Data entry process from the paper application into ACOM3 and i Confidential ease data integrity and to generate an error report for the submitted applications.

Environment: Waterfall, RTM, ACOM3, MFT, MS Excel, Clear Quest, Share Point, MS Outlook, MS Lync, Lotus Notes Database, Planview.

Confidential

Responsibilities:

• Created and maintained requirement documents for provider portal.
• Linked the project to Enterprise Priorities and Long Term Objectives
• Gathered requirements for mobile application (Get Appy).
• Have a good understanding of multi-channel apps, underlying data sources .
• Performed gap analysis between the platforms (Objective C for iOS, Java, HTML) for the development, Market place, target users, User testing focus group.
• Logged the mobile management challenges (security issues).
• Analyzed the HTML frame work that can be used with very little hardware integration, raster and vector visual assets.
• Created a Strawman diagrams and performed Geo Analysis.
• Authored and documented test case for the mobile application and created User Acceptance Testing (UAT) Plan.
• Worked with the project manager to develop the Ops Support plan.

Environment: SharePoint, Provider Portal, MS Visio, IM Blueworks Live, MS Word, Clear Quest, Lotus Notes DB for PDS (Process Documentation System), MS Excel.

Confidential, Milwaukee, WI

Business Analyst

Responsibilities:

• Performed Gap Analysis for better understanding of transition from HIPAA 4010 to HIPAA 5010.
• Worked on changes for HIPAA Transaction and proposed changes to be made in the current system for an easy transition from version .
• Documented the detailed business as well as technical requirements to upgrade the current system to 5010 transactions.
• Got involved in designing future state processes for HIPAA 5010 transaction processing EDI’s 837,835, 270, and 271.
• Worked on ICD9 to ICD10 conversion with respect to the claims related to Medicare (Part A, Part B, Part C, and Part D).
• Worked with Source system Subject M Confidential er Experts (SMEs) to ensure that the extracts are properly mapped. Used SQL for data mapping and querying.
• Involved in analyzing and profiling the data to verify the business need by writing SQL queries.
• Worked with solutions/delivery teams to implement data quality processes during acquisition, ETL, and delivery stages for Business Intelligence solutions and changes to Data Warehouses.
• Assisted with user testing of systems and maintained quality procedures and ensured appropriate documentation is in place.
• Created ETL test data for all ETL mapping rules to test the functionality of the Informatica Mapping
• Responsible for data validation testing using SQL and executing testing on data Warehousing projects.
• Tested the ETL Informatica mappings and other ETL Processes (Data Warehouse Testing)
• Assist end users and IT staff in the use of data to satisfy informational and reporting requirements and implementing and using SQL and DBMS.

Environment: Facets (Community Strategic Platform), Oracle, MQJ Explorer, SQL.

Confidential, Lincoln, NE

Business/ Data Analyst

Responsibilities:

• Worked with FACETS Team for HIPAA Claims Validation and Verification Process (Pre-Adjudication)
• Involved in claim adjudication process of facets application
• Worked on the EDI 834-file load to Facets through MMS (Membership maintenance sub-system)
• Assisted the EDI team in the development and documentation of the test strategies for the EDI transactions which included all standard transactions, auditing and error correction processes, and the creation of the transactions.
• Worked with the project manager to estimate best/worst case scenarios, track progress with weekly estimates of remaining work to do, conducting informal meetings ad hoc and as needed.
• ETL mappings fine-tuned to load i Confidential emental data and for better performance
• Applied heavy customizations for ETL process and reports and designed complex ETL mappings
• Created Data Mapping, Database Queries, and Data Dictionaries.
• Used Informatica ETL tool for Extraction, Transformation and Loading the data into target database.

Environment: Facets, Oracle, MQC, QTP, MQJ Explorer, SQL.

Confidential, Austin, TX

Business System Analyst

Responsibilities:

• Assisted with training of associates on small enhancement processes; worked with Confidential claims data for claims subject area, Enrollment and billing data for membership subject area
• Conducting business validations covering the following deliverables: Facets Providers, Facets Claims and Facets Membership areas
• Participated in weekly status meetings to present status and in corporate any digressions from the original scope.
• Worked with the clients on the final signing process in the User Acceptance stages.

Environment: Facets, Oracle, HIPAA, EDI, Mainframe, XML, SharePoint.

Confidential, New York, NY

Business Analyst

Responsibilities:

• Followed a structured approach to gather and formalize business requirements expressed by stake holders, process owners and business users of system. Involved in designing UI for developing prototypes.
• Drafted Test Cases in an RTM before UAT to validate the requirements.
• Interacted with development, testing and production teams concerning release management policies and procedures.

Environment: MS Word, Lotus Notes, MS Excel, MS Project, MS Visio.