SUMMARY:

• More than 10+ years of experience as Business Systems Analyst in Healthcare and Banking Industry.
• Thorough Knowledge of various SDLC methodologies like Waterfall, Rational Unification process (RUP) and Agile models.
• Experienced in Business analysis, Risk analysis, SWOT analysis, GAP analysis, and Project Planning.
• Experienced with Iterative approach for Software Development as per Rational Unified Process (RUP). Involved in inception, elaboration, construction and transition phases.
• Broad knowledge and experience of Medicare, Medicaid, PPO, POS, diagnostic codes and claims process.
• Experienced in facilitating Joint Application Development (JAD), Rapid Application Development (RAD), interviews, workshops, and requirement elicitation sessions with end - users, clients, stakeholders and development team.
• Strong Knowledge of HIPAA standards (Title I & Title II), NCPDP 5.1/D.0, ICD9/ICD10, HL7, EDI transactions & 4010/5010 versions.
• In depth experience in HIPAA ANSI X-12 EDI series such as 270/271, 276/277, 278, 834, 835, 837 and version 5010 of this transaction.
• Extensive experience in claims processing and billing, Medicare/Medicaid billing and claims management including Medicare (Part A, B, C, D), /Medicaid, Trizetto Facets, MMIS (Medicaid Management Information System), HL7, HIX (Health Insurance Exchange).
• Strong experience in Business and Data Analysis, Data Profiling, Data Migration, Data Integration .
• Hands on experience in analyzing and documenting Business Requirements (BRD) and System Functional Specifications including Use cases.
• Strong experience in writing SQL for Data Analysis and QA report testing.
• Excellent analytical skills in understanding the business process (AS-IS and TO-BE), understanding the functional requirements and translating them to system requirement specifications.
• Extensive experience in using UML (Unified Model language) tools to create Activity, Sequence, Use Case, Class, and collaboration diagrams.
• Extensive experience in ETL process consisting of data transformation, sourcing, mapping, conversion and loading.
• Strong experience in working in web-based application development environment.
• Excellent Knowledge of Industry standards such as Six Sigma, ISO 9000 and CMM levels.
• Expert in writing complex SQL queries, Stored Procedures & ETL to extract and load data from multiple source on to data mart. Designed complex dataflow tasks to integrate, transform and load the data from different sources.
• Professional with extensive experience in the development, implementation and integration of strategies within a team oriented environment, utilizing quantitative and qualitative analytical skills.
• Excellent communication and presentation skills.

TECHNICAL SKILLS:

Business applications: Microsoft Office Suite- Word, excel, Power pointProject and Outlook

Project methodologies: Rapid Action Development (RAD), Joint Application Development (JAD)Rational Unified Process (RUP), Unified Modelling Language (UML), System Development Life Cycle (SDLC), Agile, Six Sigma and CMM.

Business modelling tools: MS Visio, MS Project

Languages: SQL, UML, C

Operating systems: Windows 95/98/NT/XP/Vista, MS Dos

Databases: SQL server, MS access, DB2, Oracle 8i/9i

Requirement Management Tools: Rational Requisite Pro, MS Visio, MS Project

PROFESSIONAL EXPERIENCE:

Confidential, Albany, NY

Sr. Business Analyst

RESPONSIBILITIES:

• Analyze before and after reports to validate successful execution of Small Business Marketplace renewal jobs.
• Validate that Small Business Marketplace notices are generated as per TSD and run daily duplicate check.
• Developed Small Business Marketplace notices markups and validate against PDFs generated by IT vendor and make sure that notices requirements are met.
• Generate weekly SHOP only EDI 834 report, FM reinstatement & term recon report.
• Validating and analyzing various reports and documentation generated by IT vendor for SBM. E.g.: End effective date, Renewal notices TSD.
• Extensive experience in claims processing and billing, Medicare/Medicaid billing and claims management including Medicare (Part A, B, C, D), /Medicaid, Trizetto Facets, MMIS (Medicaid Management Information System), HIX (Health Insurance Exchange) and SOA, HL7, web technologies, and integration and data warehouse/reporting pro.
• Regression testing, Release UAT testing, Notice dup check, defect validation, adhoc testing.
• Group response ( XML ) files issue analysis and remediation.
• Hands on experience with HIPAA X12 837 and NCPDP D.0 transactions, HIPAA EDI compliance requirements and tools, and implementations using the X12 and NCPDP Im.
• Review documentation (RSDs, TSDs) provided by IT vendor and make sure requirements are met.
• Review benefit templates and validate plan data submitted by issuers meets set standard.
• Change Request documentation review and evaluate requirements gap and testing needs.
• Worked with vendor for Provider Network Data Transfer (PNDS) network adequacy check.
• Transfer test plan data from SERFF (DFS system) to vendor systems and documenting errors generated during the process.
• Defined and designed the Data and Application security matrix spreadsheet which spans through different organizations in Emblem and describes their capability of accessing specific applications and data elements in the Medicaid eligibility verification system.
• Worked with Business Owner (PM Director) to transfer production plan data from SERFF to IT vendor systems.
• Maintained issuer support log as part of production support and made sure all issues are discussed and resolved in daily issuer support meeting. Total of 2500+ issues were resolved.
• Work on specific EDI 834 issues and make sure that Business Owners gets required 834 data.
• QA various reports generated by IT vendor including EDI report, Daily SHOP report, All 834 report etc.

Environment: MS Office Suite, MS Visio, MS Word, MS Project, Adobe, MS Visio, Windows 7, Snag it, JS, Cognos, Oracle 11g, XML, Java, SOA, Rational Requisite Pro, Clear Quest, HTML, SQL, MS SharePoint, HP Quality Center, HTML, TOAD, RQM, RTC

Confidential, Southborough

Sr. Business Systems Analyst

RESPONSIBILITIES:

• Developed Metadata Attribute specification deliverable, which contained details about attributes for newly added tabs.
• Developed enhancement FRD, which contained details about new functionality design details, security details and additional system design details.
• Conducted JAD sessions with IT team and Business and evaluated various scenarios as per the requirement.
• Designed new processes (Deletion, Data tracking, and Carry forward).
• Developed workflow diagrams, use cases, Mock ups as part of FRD.
• Conceptual Knowledge of Documentum EDMS.

Environment: Documentum, MS-Visio, MS Word, MS Excel, Adobe, MS Project, Windows 7, Snag it, Java, Teradata, DB2, XML, SOA, MS word, Rational Requisite Pro, Clear Quest, Quality Manager, eRoom, HP Quality Center.

Confidential

Sr. Business Systems Analyst

RESPONSIBILITIES:

• Developed Global style Guide, which contains road map to enhanced website layout and CSS attributes.
• Layout change analysis of existing and new website and develop HTML container diagrams.
• Analyze CSS attributes of new website and make sure it is in sync with requirements.
• Developed BRD, SRS and wireframes as per requirement for new WOL website.
• Having good experience in Medicaid and healthcare.
• Develop activity, use case diagram around new functionalities using MS Visio .
• Prototype analysis and documentation and HIX (Health Insurance Exchange) and SOA, HL7, web technologies, and integration and data warehouse/reporting pro.
• AS-IS and TO-BE state analysis and develop mock ups and narratives.
• Conduct JAD session with UI devs, SMEs, business and stakeholders to make sure requirements meet general expectations.
• Support design of the visual framework, look and feel elements, and work flow.
• Help develop processes and collaterals for moving designs to development.
• Participation in full SDLC from concept and design to implementation.
• Business analysis and requirements definition activities for web based UI application.
• Through use of MS Visio, Snag it .
• Conceptual knowledge of HTML5 / CSS3 .

Environment: MS Office Suite, MS Word, Adobe, MS-Visio, MS Project, Windows 7, Snag it, OBIEE, Cognos, JS, Teradata, Oracle 11g, XML, Java, SOA, Web Sphere, Rational Requisite Pro, Clear Quest, HTML, Quality Manager, MS SharePoint, HP Quality Center, HTM, CSS

Confidential

Sr. Business Systems Analyst

RESPONSIBILITIES:

• Created Business & Technical Requirement Documents (BTRDs), Use-Cases including business process workflow diagrams, Call Flows, wireframes and Requirements Traceability Matrix spreadsheets based on any of the projects need.
• Anticipated impacts to enterprise services with respect to the migration from 4010 to 5010. More specifically, impacts related to the support of the following HIPAA Transactions: 837, 834, 270 /271 and 276/277.
• Worked on several functional areas of MMIS claims processing unit and EDI for transfer of data between organizations by electronic means.
• Utilized EDIFECS Spec Builder to create data map, short companion guides, long companion guides, test data creation
• Created, Analyzed, Managed the various versions of all requirement artifacts utilizing Project Share-point sites.
• Extensively used MS Visio to create business process workflows, call flows and system architecture diagrams that involved activity and sequence diagrams
• Created existing business process work flows and presented to new hires to help them better understand the existing EDI flows.
• Coordinated the upgrade of Transaction Sets 837(IPD), 835(Claim processing), 834(Membership Enrollment), Moreover worked as a substitute on a change requests for EDI Transactions 276 (Healthcare claim status), 277(Claim Response), 278(Request for Review), 270(healthcare Eligibility) to HIPAA compliance.
• Defined and designed the Data and Application security matrix spreadsheet which spans through different organizations in Emblem and describes their capability of accessing specific applications and data elements in the Medicaid eligibility verification system.
• Determined user/business/functional requirements. Created Business vision, scope, and Use Case documents; Business Process Models, Use Case diagrams, Activity Diagrams, and Sequence Diagrams.
• Extensive use of MS Project to maintain record of recommendations, communications, activities, schedules and to monitor progress of project in real time.
• Facilitated JAD sessions with management, development team, users and other stakeholders to refine functional requirements and HIX (Health Insurance Exchange) and SOA, HL7, web technologies, and integration and data warehouse/reporting pro.
• Hands on experience with HIPAA X12 837 and NCPDP D.0 transactions, HIPAA EDI compliance requirements and tools, and implementations using the X12 and NCPDP Im.
• Executed SQL queries to test the database for records that detect and submit functional acknowledgement and remittance advice in the claims application
• Created EDI documents for EDI maps to generate requirement documents and Project Charter, and logical design documents for EDI transactions and code sets.
• Interacted effectively with internal and external parties and worked closely with project manager in handling the whole and project.

Environment: MS Office Suite, MS-Visio, MS Project, Windows 7, SQL, OBIEE, Cognos, Humming Bird, Teradata, Oracle 11g, Oracle Warehouse builder, Java, Web Sphere, Rational Requisite Pro, Cognos, Clear Case, Quality Manager, MS SharePoint, MS Word, Snag it, Adobe, HP Quality Centre, HTM, Unix server

Confidential, Water Street, NY

Sr. Business Systems Analyst

RESPONSIBILITIES:

• Functioned as the primary link between business line, operations and the technical areas throughout the project.
• Conducted meetings to gather requirements from Business Managers, Supervisors, stakeholders, Data Governance Team and subject matter experts to gain knowledge about needs of the system.
• Worked on HIPAA ANSI X-12 EDI series such as 270/271, 276/277, 278, 834, 835, 837 and version 5010 of this transaction.
• Facilitated JAD sessions, user meetings, interviews and Requirement Elicitation Sessions to extract business requirements and to confirm that those requirements are in alignment with up gradation of existing system to 5010.
• Worked on several functional areas of MMIS claims processing unit and EDI for transfer of data between organizations by electronic means.
• Conducted GAP analysis to identify and document gaps between existing 4010 compliant system and proposed 5010 compliant system.
• Thorough use of UML and MS Visio to develop Use Cases, Activity Diagrams, Sequence Diagrams.
• Identified, researched, investigated, analyzed and documented business processes and use case scenarios.
• Conducted product presentations, facilitated JAD sessions and interview sessions to collect requirements.
• Used a Meta Data repository to capture and present mapping, standards and application within the enterprise and HIX (Health Insurance Exchange) and SOA, HL7, web technologies, and integration and data warehouse/reporting pro.
• Managed and tracked change control process of requirements and design changes using Rational Requisite Pro. Documented the changes, issues and their impact on the system design and delivery
• Responsible for ensuring that privacy and security environments of healthcare data remained intact.
• Extensive use of MS Project to maintain record of recommendations, communications, activities, schedules and to monitor progress of project in real time.
• Prepared Business Process Reengineering (BPR) documents by interacting with SMEs.
• Executed SQL queries to test the database for records and generate mapping documentations from master document.
• Hands on experience with HIPAA X12 837 and NCPDP D.0 transactions, HIPAA EDI compliance requirements and tools, and implementations using the X12 and NCPDP Im.
• Defined and designed the Data and Application security matrix spreadsheet which spans through different organizations in Emblem and describes their capability of accessing specific applications and data elements in the Medicaid eligibility verification system.
• Interacted effectively with internal and external parties and worked closely with project manager in handling the whole and project.

Environment: MS Project, SQL, SOA, Rational Unified Process (RUP), Rational Requisite Pro, Rational Rose, Clear Quest, Microsoft Visio, Windows Vista/XP, MS Visio, Adobe, Snag it, Cognos, SQL, DB2, Office Suite (Word, Excel, Power Point).

Confidential, Farmington

Sr. Business Systems Analyst

RESPONSIBILITIES:

• Conducted interview sessions with users and different levels of management so as to extract requirements and to develop use cases and functional specifications.
• Involved in validating run-time decision models by supporting statisticians and underwriting team.
• Designed and developed Use Case, Activity Diagrams, Sequence Diagrams using Rational Rose and Visio.
• Facilitated smooth completion of project by providing insurance subject matter expertise to the team and utilizing subject matter know-how for quality assurance purposes.
• Careful analysis and documentation of changes in the compliance rules for successful action design.
• Involved in the development of different EDI 834 scenarios for batch processing.
• Facilitated successful completion of HIPAA X12 4010 transaction to HIPAA X12 5010 and ICD 9-CM to ICD-10-CM simultaneously.
• Complete knowledge of different MMIS databases like Provider Databases, Recipient Databases, and Payee Databases etc.
• Extensively used MS project to maintain and monitor project progress.
• Involved in conducting team meetings and weekly client meetings to discuss project progress and resolve issues.
• Defined and designed the Data and Application security matrix spreadsheet which spans through different organizations in Emblem and describes their capability of accessing specific applications and data elements in the Medicaid eligibility verification system.
• As a QA lead worked with vendor QA team to develop the test plan, test conditions and test cases to be used in testing based on BRD, technical specifications and/or product specifications Effective planning through extensive use of work flow diagrams, written business flows and Use cases.
• Accountable for facilitating business meetings and developing monthly status reports etc.
• Assisted QA team with Test Plans and in executing Test Cases.
• Designed DataStage ETL Jobs for extracting data from heterogeneous source systems, transform and finally load into datamarts and HIX (Health Insurance Exchange) and SOA, HL7, web technologies, and integration and data warehouse/reporting pro.
• Implemented data access, storage and validation routines on the database server using structured Query Language (SQL)
• Design specifications and Test Case usages for HIPAA 837, 270/271, 276/277, 835, 824, 275 and others.
• Involved in overall development of the projects including status reports, client presentations, risk analysis and mitigation, defining milestone deliverables and defining critical success factors.

Environment: MS SQL, Windows Vista/XP, Requisite Pro, Clear Case, Snag it, Adobe, MS Word, UML, SOA, Business Objects,, .net, ETL, MS Visio, MS Project, SQL, Oracle 9i, MS Excel.

Confidential

RESPONSIBILITIES:

• Developed business requirement documents based on HIPAA Guidelines by extracting business requirements from clients and users by conducting JRD and JAD sessions keeping in mind their requirements for the application (Internet, Claims, Provider and Recipient) and coordinated with developers for the successful completion of the project.
• Collected both User requirements and Business requirements from Business user group such that to document Business/User/Functional/Technical Requirement Specification using MS word and MS Visio thereby providing proper guidance to technical team to develop prototype and overall system.
• Involved in HIPAA Claims Validation and Verification Process (Pre-Adjudication).
• Developed Use Case diagrams, Sequence diagrams and Activity diagrams for better understanding of the project and HIX (Health Insurance Exchange) and SOA, HL7, web technologies, and integration and data warehouse/reporting pro.
• Complete knowledge of different MMIS databases like Provider Databases, Recipient Databases, and Payee Databases etc.
• Broad knowledge and experience of Medicare, Medicaid, PPO, POS, diagnostic codes and claims process.
• Hands on experience with HIPAA X12 837 and NCPDP D.0 transactions, HIPAA EDI compliance requirements and tools, and implementations using the X12 and NCPDP Im.
• Worked on claim processing module which involved Receipt and Verification of Claim Forms (837) and Claims Attachment (275), Claims Enquiry and Response (276/277), Adjudication, Health Claim Payment/Advice (835) as per HIPAA guidelines.
• Understanding of complete EDI (Electronic data interexchange) format used in electronic documentation which was part of knowledge transfer program to the vendors as per the requirements.
• Provided support to UI architect to develop new UI for claims reimbursement process.
• Involved in the day-to-day implementation of the rational unified Process (RUP) methodology of application development with its various work flows, artefacts and activities.
• Designed and developed Business Flow diagrams, Dataflow diagrams, UML Activity diagrams and Use Case diagrams.
• Developed complex SQL queries, Stored Procedures and packages using T-SQL.
• Conducted GAP analysis and documented business and system level use cases to derive the requirements illustrating functional behaviour.
• Reviewed and prioritized defects within a functional area by actively participating in the Weekly Defect Status meetings.
• Engaged in different stages of testing process like Integration testing, Black box testing, user Acceptance testing, Regression testing and Back End testing.

Environment: Rational Requisite Pro, Rational Rose, Rational Clear Quest, RUP, UML, MS Office, MS Project, MS Visio, MS Word, MS Excel, Adobe, Snag it, Windows XP, SQL.

Confidential, Worcester,

RESPONSIBILITIES:

• Conducted focused interview sessions with SMEs, project stake holders and Business users so as to obtain maximum details of requirements and involved in documenting business Requirements Documents.
• Ensured credibility and accuracy of business specifications by carrying out brainstorming sessions, development meetings and other collaborative efforts.
• Developed thorough Functional Requirements Document (FRD) by applying analytical questioning and critical reasoning to business user requirements.
• Conducted interview sessions with SME’s and different application owners so as to ensure the credibility of GAP analysis.
• Business Process Modelling: Business process improvement and optimization, Document and model business processes, automated workflows and Manage business rules.
• Careful documentation of business requirements ensured that they are aligned with UI from the initial stage itself.
• Complete knowledge of different MMIS databases like Provider Databases, Recipient Databases, and Payee Databases etc.
• Broad experience of Medicare, Medicaid, PPO, POS, diagnostic codes and claims process.
• Substituting legacy systems which were originated through unplanned, stovepipe development with detailed enterprise architecture models.
• Developed various modelling diagrams using UML.
• Develop complex ad hoc SQL scripts to monitor various initiatives, analyse data, locate data infractions, and develop reports .
• Proper use of RTM (Requirement traceability matrix) so as to capture all the features of the project.
• Performed application functionality user acceptance testing experience (i.e. front-end application testing) in a controlled testing environment that replicates the end user usability of the application.
• Documentation of test plan, test cases and test summary to confirm the credibility of application functionality.
• Hands on experience with HIPAA X12 837 and NCPDP D.0 transactions, HIPAA EDI compliance requirements and tools, and implementations using the X12 and NCPDP Im.
• Discussed and documented post implementation summary with senior management regarding Gaps found during the project.

Environment: MS Office, MS Excel, UML, Rational Requisite Pro, JAD, .net, RUP, MS Visio, MS Word, Snag it, Adobe, MS Project, MS Power Point, MS Share point, Windows XP, MS AccessConfidential, Chennai,

Responsibilities:

• Functioned as the primary link between the business line, operations, and the technical areas throughout the project cycle.
• Involved in re-design of Mortgage Asset Management System.
• Tailored business requirement documentation process with project scope and SDLC methodology used.
• Designed Sequence diagrams, OOD using UML.
• Collected information about business processes and requirement by conducting interviews with key business users.
• Conducted brain storming sessions and collected information from committee of SMEs from various business areas such as Mortgage servicing, loan monitoring and asset management.
• Designed and implemented basic SQL queries for QA testing and report / data validation.
• Developed Proprietary business analysis methodology based on RUP (Rational unified Process) and supported in the design of Use cases and project plans.
• Assisted in resolving problems associated with technical areas of system and business processes.
• Rational SodA was used to develop daily reports on requirement reports for day-to-day retail banking needs for opening account and online banking.
• Performed User Acceptance Testing (UAT)
• Change control request and configuration management was attained by using Rational Clear Case and Clear Quest.
• Excellent team player skills and good at following project through SDLC (Software development life cycle) method thereby ensuring business targets are met.

Environment: Windows XP, Vista, UML, MS Share point, MS Project, Rational Requisite Pro, SOA, Rational Clear Quest, Rational Rose , MS Word, MS Excel, Adobe, Snag it and MS Visio.