SUMMARY:

• Over 10 years of IT experience in the diverse fields like teaching, software analysis, design, development, testing, training, implementation, support and project management with strong analytical skills and a broad range of computer expertise. Thorough knowledge of Business Processes, Business Requirements gathering, Process Flows, UML Modeling, and related technical processes skilled in eliciting user requirements and translating them into data, functional, and usability requirements and also experience in development/programming part of the applications.
• Experience in defining, analyzing enterprise business rules to meet business requirements through solution approach.
• Experienced with FACETS Configuration with Benefits and member enrollment.
• Experienced in gathering user requirements, analyzing and preparing Project Deliverables such as Project Charter, Business Requirement Document (BRD) and Functional Requirement Document (FSD) and proposed changes for process improvement using Rational Requisite Pro.
• Skilled in Analysis and Design with experience in creating Use Cases, Class Diagrams, Activity Diagrams, State Diagrams, Sequence Diagrams, Unified Modeling Language (UML) using MS Visio and Rational Rose.
• Experience in FACETS with various applications involving Sales & Enrollment, Claims Processing (Dental, Medical/Hospital), and Customer Service and Billing areas.
• Experience with TriZettos FACETS Application Groups: Claims Processing, Guided Benefit Configuration, Medical Plan, Provider, Subscriber/Member, Utilization Management.
• Experience working in a FACETS environment and extensive knowledge about various modules of a FACETS system such as claims, membership
• Experience in healthcare FACETS data model and configuration.
• Acted as liaison between the design & technical team and the end users, stakeholders, product managers and business team to understand and translate the requirements.
• Experience in managing the challenging issues and resolving the conflicts necessary to drive projects.
• Involved in business side of E - Commerce and helped a business achieve the full potential of E-Commerce using the right E-Commerce Strategies, business processes and digital tools.
• Experience with working in fast-paced AGILE development environments.
• Good understanding of Object Oriented Programming and Software Project Planning concepts.
• Extensive experience in designing multi-tier Web Application architecture using UML (Unified Modeling Language), IBM Rational Rose and MS Visio.
• Led onsite and offshore teams for project implementations.
• Key Strengths: Data Center Operations/Migrations, Change Management, Risk Assessment and Mitigation, Infrastructure Capacity Planning and Customer Relationship Management.
• Experienced in Application Development, B2B, E-Commerce, GUI, Infrastructure and Operations.
• Demonstrated ability to work actively in different phases of Software Development Life Cycle (SDLC) using Rational Unified Process (RUP) and Agile methodologies (SCRUM) in multi-tier web-based architecture.
• Highly proficient in working with users and stakeholders to elicit, analyze, validate requirements using JAD, and Brainstorming sessions, identifying Functional, Non-Functional, and Business Rules, and then subsequently modeling them.
• Comprehensive understanding of the Organizational Framework that helps to mapping the AS-IS and TO-BE model using the GAP Analysis and plan monitoring effective approach to build/buy solutions to the business problems/needs/opportunities.
• Excellent Documentation skills to generate Business Requirement Document (BRD), Functional Specification Document (FSD), and Project Charter.
• Created Test-Cases and Test-Plans, hands-on experience of different QA Testing Methods including Functional Testing, System Testing, GUI Testing, Black Box Testing, UAT, and Automated Test Scripts.
• Demonstrated ability to work actively with different Design Tools to create Use Cases and UML diagrams such as Use case diagrams, Work Flow Diagrams/Process Flow Diagrams; and Entity Relationship Diagrams and Data Flow Diagrams.

TECHNICAL SKILLS:

Modeling Tools: Rational Rose, MS Visio, MS Project, Rational Team Concert, Quality Center, BPT, SAS Macro LanguageLanguages: JAVA, Visual Basic, PL/SQL Testing, Requirements/Defect Tracking, Version Control Tools: Rational RequisitePro, ClearCase, ClearQuest, Mercury Quality Center (Test Director)

Web Technologies: MS SilverLight, ASP.NET, HTML, DHTML, ASP, XML

Methodology: Rational Unified Process (RUP), Agile, Waterfall

RDBMS: SQL Server, MS Access, Oracle

Operating Systems: Windows NT 4.0/XP/2000

Utilities: MS Office, FrontPage

PROFESSIONAL EXPERIENCE:

Confidential, Raleigh, NC

Sr. Business System Analyst

Role & Responsibilities

• Perform a baseline assessment of Hospital-Provider systems and related interfaces, the existing service level agreements and/or policies and operational business procedures for readiness to comply with HIPAA as well as ICD-10 requirements.
• Facilitated the daily scrum meetings, sprint planning, sprint review, and sprint retrospective.
• Have strong experience in requirements gathering by conducting interviews with end users.
• Strong requirements Elicitation and Documentation, Customer Service, Liaison With Stakeholders andSystem Documentation and problem Solving and Resolution Skills, Solution Evaluation and recommendations with agile and scrum.
• Actively worked on Data analysis and Report analysis with respect to ICD-10 impact.
• Extensively worked on Data Mapping and ETL.
• Analyzed System flows of various department of the hospital.
• Configured FACETS to adhere to customers work flow for claims processing, claims automation and group administration.
• Tested claims in FACETS to ensure that appropriate products are built and system configuration was accurate. Loaded shell agreements into Production environment.
• Used FACETS Workflow to route the claims according to the priority.
• Worked on NetworX Pricer which routes the Claims based on Configuration made on FACETS and configured with Benefits and member enrollment.
• Worked on Accumulator Batch export system to facilitate the periodic transmission of current data in the FACETS Member Accumulator and Family Accumulator tables.
• Worked on FACETS configuration payment methodology.
• Worked on FACETS Benefits Configuration to simplified benefit plan maintenance and renewal processes based on CSD provided by Benefits Analyst.
• Identified risks, problems, requirements and concerns of the Hospital in order to comply with ICD-10 changes. 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.
• Highly involved in understanding of department workflows and process flows with respect to applications. Developed business process models in RUP to document existing and future business processes. Improved process for payment of Medicare Secondary Payer claims through revised workflows.
• Collected the information related to ongoing application upgrade and their impact on ICD-10 implementation and created awareness within the departments regarding the need, impact, benefits and risks of ICD-10 code application.
• Wrote SQL queries/joins for Oracle database and prepared test data.
• Worked with development team to work on systems development in Visual Studio.
• Designed and developed user interface screens for visualization of reports and various user inputs with cross-functional teams.
• Re-Organized the collected data and prepared documentation for implementation.
• Involved in providing education about the ICD-10 codes and 5010 standards, its requirements, complexity and accuracy to Physicians and Nurses of the hospital. Figured out the requirement of training in various departments of the hospital based on their daily work.
• Performed impact analysis on applications for deadliness of ICD-10 conversion.
• Responsible to meet the information demands of our business users by delivering timely, accurate, meaningful and standardized data and reporting.
• Mapped the collected data with the existing data provided by the hospital departments.
• Used Word, Excel and Visio as a working tool.
• Hands-on experience and good understanding of the hospital working system including Registration, Scheduling, Radiology, Laboratory, Pharmacy, Patient Accounting, HIM, Claim Processing etc.
• Met the deadlines and scheduled day to day meeting sessions.
• Used Agile Rapid Application Development, Lean Six Sigma. Built UI, Dashboard, KPIs.

Environment: Windows 2007, Packet Tracker, MS office suite, UI / UX, FACETS, Visual Studio 2010, MS Visio, UML, RUP (SDLC), MS SQL Server.

Sr. Business System Analyst

Role & Responsibilities

• Facilitated all aspects of the scrum framework, including sprint planning sessions, backlog grooming sessions, daily scrums, product demos, sprint reviews and sprint retrospectives.
• Supported and consulted product owner in developing, maintaining and grooming product backlog.
• As Scrum Master maintained the capacity plan, iteration board, sprint backlog, velocity charts and burn down charts
• Identified and removed impediments to the success of the sprint by working with every single team member.
• Strong requirements Elicitation and Documentation, Customer Service, Liaison With Stakeholders andSystem Documentation and problem Solving and Resolution Skills, Solution Evaluation and recommendations with agile and scrum.
• Analyzed the change detection process on FACETS database tables to capture the daily changes done by Users through Online FACETS Application.
• Worked on FACETS claims processing, payment adjustments, claims inquiry, benefits & dental claim pricing.
• Built UI, Dashboard, KPIs and strong wire frames and mock-ups.
• Tested the changes for the front end screens in FACETS related to following modules, test the FACETS batches (membership, Billing, Provider, etc).
• Designed High level design, for New process, integrating with legacy and FACETS
• Involved in configuration of FACETS Subscriber/Member Application group.
• Analyzed the member/eligibility information on claim to that in FACETS.
• As Scrum Master communicated dependencies and potential risks to the completion of the sprints including resources, costs and systems.
• Conducted JAD sessions, workflow diagrams, UML diagrams, process models, activity diagrams, use cases, for incorporating design changes in the order creation/ management system.
• Actively participated on creating Migration strategy from existing PDE (Microsoft Access files) to G­old Data Repository.
• Clearly understood coding standards required for all Medicare Part D Users transactions involving electronic data interchange as provided by department of health and human services and incorporated at every stages of the project wherever found necessary.
• Prepared the Business requirement Document (BRD) and Functional requirement document (FRD) for the enhancement of the existing services.
• Analysis and Design of existing transaction sets, and modification of these transaction sets to ensure HIPAA compliance.
• Did data analysis, created data mapping and data interface documents and kept the documents updated with changes in requirements and functional specifications.
• Worked on developing the business requirements and use cases for FACETS batch processes; automating the billing entity and commission process.
• Coordinated the upgrade of Transaction Sets 837P, 835 to HIPAA compliance.
• Worked on the EDI 834-file load to FACETS through MMS (Membership maintenance sub-system).
• Did gap analysis for HIPAA 4010 837P and 835 transactions and HIPAA 5010 837P and 835 transactions.
• Involved in impact analysis of HIPAA 5010 835 and 837P transaction sets on different systems.

Environment: Rally, Agile, Microsoft Office, UI / UX, Wireframes, HTML, FACETS, Microsoft Visio, Share Point, Mega, XML schema, J2EE, UML, Quality Center

Business System Analyst

Role & Responsibilities

• Developed Scope model as a basis for defining and delimiting the scope of business analysis and project work.
• Defined and maintain a long term plan for the solution in conjunction with the rest of the team that is consistent with the business needs and value proposition.
• Analyzed the business problems and transformed these into requirements/user stories/epics to be utilized by the development team.
• Supported the planning of upcoming releases by taking the Roadmap concepts and prioritizing needs per release.
• Prioritized the requirements/user stories in conjunction with the development team and provide clarification and adjustments as needed; managing the backlog of user stories.
• Participated in the appropriate planning and development process steps, including the agile steps of Sprint Planning, Scrum, Sprint Review, and Sprint Retrospective.
• Strong requirements Elicitation and Documentation, Customer Service, Liaison With Stakeholders andSystem Documentation and problem Solving and Resolution Skills, Solution Evaluation and recommendations with agile and scrum.
• Built UI, Dashboard, KPIs and strong wire frames and mock-ups.
• Coordinated with the project leads and other application teams to make sure that interfaces and coordinated development aspects are properly planned and sequenced.
• Supported reviews of development, architecture and testing artifacts.
• Analyzed the overall solution and understand how it works together and how it might evolve over time
• Supported cost/benefit analyses in the planning process.
• Reviewed plans for application documentation required and support the review of the documentation.
• Gathered new business requirements, analyzed solution approach documents and verified data elements.
• Analyzed the impacted systems and interface with new data elements that business requirements used.
• Analyzed gap, all data element, API element.
• Analyzed the data flow in the system from backbends to frontends.
• Coordinated with the development team offshore and onshore.

Environment: GAP Analysis, Data Mapping, Data element, UI / UX, Wireframes, Service Layer, API, SharePoint, Agile.

Engineer Computer

Role & Responsibilities

• Developed Scope model as a basis for defining and delimiting the scope of business analysis and project work.
• Gathered business requirements through interviews, surveys, prototyping and observations of account managers while preparing RFP, Business Requirements and Technical Requirements.
• Conducted JAD Sessions.
• Provided strategic and tactical inputs and coordinated with business functions and technical project teams.
• Linked business processes to organizational objectives, perform critical path analysis, and identify opportunities for business process improvement.
• Conducted JAD sessions with Management, SMEs (Subject Matter Expertise), Vendors, Users and other Stakeholders for open and pending issues to develop specifications
• Analyzed and prioritized user and business requirements, as system requirements, that were included while developing the software.
• Team member while assessing IT risks on the quarterly basis.
• Translated business requirements to Charters, Service Agreements (SLA’s) and Key Performance Indicators (KPI’s) etc
• Prepared High Level Logical Data Models and Business Requirement Documents (BRD) supporting documents containing essential business elements, detailed definitions, & descriptions of the relationships, to analyze and document business data requirements.
• Developed Requirements Tractability Matrix (RTM) for functional coverage.
• Created UML Diagrams like Sequence Diagrams, Activity Diagrams and Process Flow Diagrams to elaborate the new processes.
• Built UI, Dashboard, KPIs and strong wire frames and mock-ups.
• Coordinated daily activities with the IT Developers, QA and Product teams along with the project management group.
• Strong requirements Elicitation and Documentation, Customer Service, Liaison With Stakeholders andSystem Documentation and problem Solving and Resolution Skills, Solution Evaluation and recommendations with agile and scrum.
• Created UI mockups and presented it to the project team for review.
• Building and deploying web platforms for various online data reporting projects.
• Assigned and tracked problems to the appropriate software development team for fixes.
• Developed some software using MS Visual Basic, MS Access and Crystal Report for reporting.
• Worked on the Supply Chain Mgmt. system.
• Interacting with the developers on resolving the reported bugs and various technical issues.
• Resolved incident or request tickets from users and provided solution/ support as needed.
• Team member while developing and approving technical specifications of IT related goods and services for procurement.
• Team member while performing Physical Delivery Inspection (PDI) of IT related goods and services during the procurement process.
• Provided consultations and trained staff and users in IT related matters.
• Trained bank staff in using different automation and productivity tools like MS Word, MS Excel, MS PowerPoint, emails, Internet, trouble shooting, office equipment’s setups and handling etc.
• Developed the system documentation of the in house built banking system for head office and branch offices using Reverse Engineering.
• Oversee a day to day function of the assigned servers and Supported Infrastructure (MS Windows Server, Novell Netware, Swift Server, Linux servers, LAN, WAN, Firewall, Backup, and Troubleshoot etc.) as needed.
• Team member while networking and wiring/rewiring various equipment’s in different departments and offices.

Environment: Requirements Analysis, Data Mapping, Data element, ERP, Service Layer, Procurement, Support, Agile, SDLC, Java, JSP, HTML, JS, VBS, UML, ER Diagram, UI / UX, Wireframes.

Software Engineer

Role & Responsibilities

• Worked as a member of a web group.
• Developed e-banking module of banking software.
• Worked in different projects throughout its life cycle.
• Working with the web technologies like ASP, JSP, JavaScript, VBScript, HTML, Java, IIS, CSS, OOA/OOD technologies.
• Worked on the database technologies like Dbase IV, Oracle, MS SQL Server, MS Access etc.

Environment: Requirements Analysis, Data Mapping, Data element, ERP, Service Layer, UML, ERD, Procurement, Support, Agile, Java, JSP, ASP, JavaScript, VBScript, HTML, CSS.