SUMMARY:

• Senior Business System Analyst with 7+ years of experience in the healthcare and retail industries. Focused mainly on the business process analysis/modeling, business requirements gathering, database design and development of web based, and client/server applications.
• In - depth knowledge of creating use case, activity, logical, component and deployment views with rational tools to extract business process flows and workflows thereby helping development and quality assurance teams in understanding the requirements.
• Expertise in all the phases of the Software Development Life Cycle (SDLC), Agile Development methodology.
• Responsible to manage through sensitive issues, resolve undefined problems, and deliver on competing timelines involving multiple parties/departments within the same organization.
• Results-oriented Joint Application Development (JAD) Facilitator and meetings coordinator with excellent interpersonal skills.
• Experienced with reviewing and writing BRD, FRD, Technical Specification document for the Functional and Technical team.
• Strong knowledge of Facets and actively involved in end-to-end implementation of Facets Billing, Enrollment, Claim Processing and Subscriber/Member module.
• Overseen requirements for POS system, warehouse & distribution system, inventory management system, and demand planning & forecasting system; Reviewed Charter Documents, BRD, FSD, and Use-Cases.
• Well experienced with the complex tasks of ICD 9 to ICD
• 10 conversion and mapping.
• Hands on experience in Medical Claims in Process Documentation, Analysis and Implementation in EDI X12 Standards and 835/837/834/270/271/277/997 processes of Medical Claims Industry from the Provider/Payer side.
• Knowledge and experience working with FACETS claims processing.
• Managed and Facilitated JAD sessions with Business Directors, IT Directors, Business & IT Project managers, Developers and Testing Teams and other SMEs.
• Experienced in preparing Score Cards and metric reports using MS Access and MS Excel
• Efficient in MS Project/MS Excel for planning/status reporting/writing test scenarios.
• Performed Gap Analysis to check the compatibility of the existing system infrastructure with the new business requirements
• Knowledge of HIPAA standards, EDI, Implementation and Knowledge of ICD-9, and ICD-10.
• Experience in integration of various data sources with Multiple Relational Databases like Oracle, SQL Server, MS Excel, MS Access and Flat Files
• Extensive knowledge and experience of ACA, Medicare, Medicaid, ICD, HIPAA, HITECH, FACETS, EDIFACT, FFM, HIX, DSH, ITS, APTC, and CSR
• Well versed in Data Extraction, Data Compilation, Data Analysis, Data Manipulation and Data Validation using SQL queries in a MS SQL Server environment.
• Identified success criteria including both leading and trailing measurement of budget/forecast, schedule, financial returns and business success criteria for all projects.
• Expertise in broad range of technologies, including business process tools such as Microsoft Project, Primavera, MS Access, MS Visio, technical assessment tools, Data Warehousing concepts and web design and development.

TECHNICAL SKILLS:

P roject Methodologies: Rational Unified Process (RUP), Waterfall, Agile, Spiral, Scrum

Requirement Management Tools: Rational Requisite Pro

Project Management Tools: MS Project

Defect Tracking Tools: Rational Clear Quest, Quality Center, (Application Lifecycle Management) ALM 11

Databases: Oracle, MS SQL Server, MS Access

Languages: XML, SQL, Visual Basic, HTML

Front End Tools: MS Office Suite (Word, Access, Excel, Outlook, PowerPoint, SharePoint)

Version Control Systems: Rational Clear Case

Operating System: Windows, MAC OS, UNIX

Content Management/other: SharePoint, Facets, QNXT

PROFESSIONAL EXPERIENCE:

Business System Analyst

Confidential, Woonsocket, RI

Responsibilities:

• Worked on gathering the high level requirements and documenting it in the business requirements document (BRD).
• Performed testing for the newly built reports from the new vendor ININ.
• Worked with corporate application installation, support and maintenance such as QNXT, VITAL.
• Prepared the UML and Use Case Diagrams for different measures requested by the BU.
• Prepared the mockups for the BU to help them understand as-Is and To-Be process.
• Prepared Technical Specification Document for the development team with diagrams built in MS Visio.
• The crystal reports originally were used by BU to analyze the amount of incoming/outgoing calls.
• To monitor the performance of the agents answering the calls and tracking their logging on/off time.
• With these reports the BU will analyze the high priority incidents/calls raised and whether the priority call met the SLA or not?
• Extensively worked on writing the Test Plan and uploading the Test Cases into the ALM or the HP QC with the requirements based on Business Requirement Document (BRD).
• Assisted in implementation and deployment of the best Supply Change Management (SCM) processes with global order management and integration among various phases of Software Development Life Cycle (SDLC) such as Change Request and Product Life Cycle Management.
• Maintained trouble tickets and issues utilizing Magic Service Desk Express application and entered change requests and enhancements.
• Prepared Traceability Matrix to understand the functional requirements and track them easily once the testing is scheduled.
• Worked with the SSIS and SSAS packages to understand the logic behind as-Is reporting for the aspect reports.
• Worked extensively on the SQL Server2008 to understand the tables and views being developed by the development team and connect those views with the tableau to build the dashboard.
• Created multiple worksheets and dashboard in Tableau based on the requirements from the functional document and discuss it with the BU.
• Created BRD/FRD documents utilizing diagrams, scenarios and screen mockups.
• Finalized user stories and customer facing screens with use of Photoshop.
• Scheduled daily sync up calls with the development team to keep on track the prioritized measures and help them understand the requirements already in the functional document.
• Prepared user manual for the new Tableau dashboard, to help the BU understand the derivations and various functionalities in tableau.
• Participated in the testing process and raised the defects and made sure that the bugs were resolved in a timely manner.
• Environment: Agile/Scrum, PL/SQL, Load Runner, UAT, QTP, SQL Server, MS Office, MS Visio, SCM, Photoshop, Dreamweaver, SharePoint, Business Intelligence, Magic Service Desk Express, QNXT, SSIS, SSAS, Crystal Reports, MS Project, UML, Clear Case/Clear Quest, tableau.

Business System Analyst

Confidential, San Francisco, CA

Responsibilities:

• Played key role in System Development Life Cycle Process consisting of: Design and Gap Analysis, Business Requirements, Systems Requirements, Test Criteria, and Implementation to have the outputs of project dealt with the automation of correspondence directed to Insurance policy owners.
• Analyzed and worked with Facets for claims, member enrollment, billing transactions. Worked specifically with 837, 835, 834, 270/271, and 276/277.
• Analyzed and testing data on different Facets billing and membership functionality manually and writing queries on database for validating data
• Led the development of a training program to train users on a custom web application and a Cognos ad-hoc reporting environment.
• Worked on MS Access, MS Excel, MS Word, PowerPoint, SQL, MS Project
• Managed the team of consultants responsible for developing on-demand Medicaid Management System reports.
• Used SDLC (System Development Life Cycle) methodologies: Agile and the waterfall.
• Involved in claim adjudication process of FACETS application and FACETS data model
• Worked with issues coming from Reference, Cross Reference, Operational tables in the Oracle database and updating the tables per the requirements using Oracle, SQL.
• Used MS Project for status reporting and planning.
• Created SQL to test source to target data warehouse transforms, using TOAD.
• Wrote Use cases by using requisite pro and sometimes by using MS Word, for simple Use Cases.
• Reports test and work status on a daily or periodical basis in MS Access and MS Share Point.
• Performed extensive testing in Facets Subscriber/Member, tested Groups, Eligibility, and Enrollment and validated outbound 834 Extracts to different Vendors.
• Analyzed, designed, and coded several online subsystems for the Medicaid System.
• Gathered requirements and modeled the data warehouse and the underlying transactional database
• Setup JAD sessions for each application and helping the individual BAs to plan for the JAD sessions by mentoring and guiding them.
• Tested the eligibility inquiry, enrollment in Facets, Billing and Invoice in Facets.
• Worked extensively on Business Requirements, Functional Specification, Data-Integration, Data Mapping, and Data Warehouse access using SQL and Crystal Reports, ETL process, use cases modeling (UML) using MS Office (Word, Excel, Access, Visio) and dashboards
• Worked to create interfaces and extensions for Facets Billing & Enrolment and Provider contract applications.
• Extensively used calculations, variables and sorted inputs, drill down, slice and dice, alerts for creating business object reports.
• Worked on Unix Platform and experienced in back end testing by executing SQL Queries
• Generated complex reports using business object XI and web intelligence
• Successfully conducted JAD sessions, which helped synchronize the different stakeholders on their objectives and helped the developers to have a clear-cut picture of the project.
• Used Cases and other Process Flow Models were designed using Visio and Rational Rose.
• Developed & executed several Optimized queries in SQL on this data.
• Involved in Facets implementation, end-to-end testing of modules like Billing, Payment, and Provider and Claim of Facets applications.
• Environment:
• Agile/waterfall, UAT, GAD (Gap Analysis Document), XML, SQL, Quality Center, Microsoft Office Professional (Outlook, Word, Excel, Visio, Access), Microsoft SharePoint, MS Visio, MS Project, Oracle, DB2

Business System Analyst

Confidential, Dublin, OH

Responsibilities:

• Followed the Agile/SCRUM methodology for the entire SDLC.
• Performed the Front-end billing testing by validating the paper claims and electronic claims file which load in to the Facets database for the tracking
• Actively worked on Data analysis and Report analysis with respect to ICD-10 impact.
• Performed Gap analysis for better understanding of transition from HIPAA 4010 to HIPAA 5010 inside Trizetto Facets different modules.
• Responsible for creating test scenarios for different module of Facets application like Claims, Members/Subscribers, Providers and portals.
• Identified risks, problems, requirements and concerns of the Hospital in order to comply with ICD-10 changes.
• Highly involved in understanding of department workflows and process flows with respect to applications.
• Extensively worked on MS Access, MS Excel, MS Word, PowerPoint, SQL, MS Project
• 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.
• Involved in FACETS Implementation Testing, involved end to end testing of
• FACETS Billing, Claim Processing and Subscriber/Member module
• Tracking the assigning work and defect by using ALM/ MS Access and MS SharePoint.
• Re-Organized the collected data and prepared documentation for implementation.
• Connected to SQL plus in UNIX and created and executed complex SQL queries.
• Extracted data from various sources like Oracle, flat files and SQL Server
• Tested all the HIPAA regulation in Facets HIPAA privacy module transactions for multi version support (4010 to 5010) and validating the database to element file.
• 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.
• Set claim processing data for different Facets Modules.
• Involved in FACETS Implementation, involved end-to-end testing of FACETS Billing, Claim Processing
• Got involved in designing future state processes for HIPAA 5010 transaction processing EDI 820, 834, 835 and 999.
• Tested all the ETL processes developed for fetching data from OLTP systems to the target Market Data warehouse using complex SQL queries
• Used MS Project for various planning and budgeting activities.
• Analyzed HIPAA 5010 related to EDI 837 (I, P and D), 270, 271, 276 and 277 transactions (both inbound and outbound) and performed gap analysis between the 4010 and 5010.
• Performed gap analysis between Legacy System (Diamond) and Facets in terms of Group Structure.
• Responsible to meet the information demands of our business users by delivering timely, accurate, meaningful and standardized data and reporting.
• Mocked - up the X12 EDI 834 states file for the system testing purpose and very well known to the loading process of the MMS file into Facets database.
• Mapped the collected data with the existing data provided by the hospital departments.
• Drafted the Physical Data Mapping document for the data flow from Facets to the data warehouse.
• Experience in working and conducting requirement engineering process and Business process Modelling.
• Used Word, Excel and Visio as a working tool.
• Assisted the QA team and worked on Quality Center.
• Interacted with developers to report software bugs and re-tested the fixed issues.
• 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.

Environment: Agile/SCRUM, MS Visio, Rational Requisite Pro, Rational Rose, Rational Clear Quest, SQL, Visual Basic, MS Project, Microsoft Office Professional (Outlook, Word, Excel, Access, PowerPoint), Microsoft SharePoint, UML, XML, Test Director, Oracle, Java Script

Business Analyst

Confidential, San Francisco, CA

Responsibilities:

• Conducted Joint Application Development (JAD) Sessions as a Facilitator and moderator to gather requirements from the group.
• Interacted with Business Users to assess needs, identify key challenges, and define project scope and deliverables.
• Managed and helped write descriptive training and user manuals for Agile enablement project
• Process mapping, data cleansing, data migration and validation of data table structure in areas of sales, inventory, procurement, production and distribution.
• Streamlined operations and optimize resources for ecommerce platform.
• Successfully used Waterfall methodology for gathering requirements by facilitating Use Case Workshops and sessions.
• Managed program and project efforts for Logistics and E-Commerce, POS, Supply Chain, CMS, and Web based applications, business strategy and web site content.
• Involved in Data Driven Testing for positive and negative scenarios, by creating and storing data sets in MS Access.
• Performed SQL queries for retrieving, organizing the database with general commands like select, create, update, and joins.
• Used Advanced Query Tool for Querying Oracle, SQL server for DB2,Teradata SQL Assistant for Querying Teradata and HIVE for big data Hadoop system
• Worked with internal and external trading partners and carriers in determining requirements and development for all EDI transactions
• Worked on the Agile methodology of SDLC
• Used MS Project for status reporting and planning.
• Documented business workflows textually as well as in UML diagrams (State diagrams) according to RUP, for the stakeholder review.
• Used Word, Excel and Visio as a working tool.
• Formulated a team, which is apt for the purpose of executing the project.
• Worked with relational databases, and developed PL/SQL queries to interact with Databases
• Prepared Business Requirements Document (BRD) and then converted business requirements into Functional Requirements Specification (FRS).
• Facilitated RAD Session to understand user requirements, design applications and define business processes for logistics in IT operations
• Defined release plans for ecommerce platform with release managers according to gathered information from various IT departments.
• Responsible for supply chain management, MRP, inventory control models, demand management, logistics and forecasting Supply Chain optimization using SCOR model - source, deliver processes
• Conducted Walkthroughs for better understanding of the business user requirements.
• Designed Object Oriented Diagrams representing Use Case Diagrams and all necessary sub-features using UML.
• Assessed impacts of user change requests on application and document associated functional requirements and design changes.
• Prepared test cases, test plans, and execution plans to support UAT.

Environment: Rational Rose, Requisite Pro, SQL, Agile, MS-Project, MS-Visio, MS-Word, MS-Excel, UML, MS-Access, Oracle, JIRA