PROFESSIONAL SUMMARY

• Over 9 years of IT and Management experience in Software Development Life Cycle (SDLC) and Project Life Cycle working as Business Analyst.
• Experience with Health care and Finance sector.
• Experienced in interviewing business users and customers, providing recommendations to resolve issues for various business/technical groups and defining strategic solutions to business problems in a multiple project environment.
• Efficient in MS Project for planning and status reporting.
• Experience in developing functional specs through JAD sessions and user interviews.
• Experience with Object Oriented Analysis and Design (OOAD) using UML, Rational Unified Process (RUP), Agile/Extreme Programming, the Waterfall life cycle, Rational Suite (Rational Rose, Rational Requisite Pro, Rational ClearCase, Rational ClearQuest).
• Strong in developing Use Case Diagrams and creating Use Case Specification document (USD).
• Expertise in managing multiple projects and teams with an excellent track record.
• Strong experience in documenting existing process, analyzing business requirements, working with requirements traceability matrix, re-engineering business processes and designing.
• Experience with 21CFR Part II code of federal regulation, which deals with electronic records and electronic signatures along with HIPAA compliances.
• Experience with claims process and adjudication in the Medicare, Medicaid and Private Insurance Sectors.
• Experience in business requirements gathering and writing, EDI. Versed on HIPAA regulations and requirements. Experienced in HIPAA Transactions 270/271, 278, 837, 835, 834, 820, 276/277.
• Experience in configuration of claims adjudication systems, i.e., MMIS, Amisys, Facets.
• Experience in Quality Assurance of client server and web-based systems with focus on Healthcare (HIPPA).
• Have Incorporated Zachman framework to make Real-time information to make decision. Also used Zachman for New and evolving regulatory requirements. Zachman frameworks are used for Intra and inter company business models and processes.
• Comprehensive experience in business analysis, gap analysis, cost/benefit analysis, testing, development of business requirements specifications, and project planning working with project managers and business sponsors.
• Actively involved in developing, executing and managing User Acceptance Testing (UAT).
• Used Agile methodology and Extreme Programming concepts of system development and fully coordinated the sprint activities.
• Production support for Cognos and Crystal Reports.
• Experience with Peoplesoft EPM.
• Experience with dimensional modeling using ETL tools like Informatica/PL/SQL.
• Experience with analyzing the requirements of datamart. Worked with business users to understand their reporting requirements, worked with Reporting team to develop report prototypes, demonstrated report prototypes to the business users, came up with FRDs for the datamarts.
• Coordinated with data architects and ETL team to understand/drill down on the datamart requirements. Came up with the plan to roll out datamart development efforts in different phases,coordinated efforts to analyze the datamart requirements between teams responsible for various source systems, scoped out the work required on behalf of different teams to adhere to the interface documents to provide data to the data-marts.
• Lead the testing efforts of the datamarts in development, coordinated moving/setting up of processes in dev/qa/production. Worked with QA team and UAT team to go over the various test scenarios for different types of loads in the datamarts.
• Documented the evaluation test cases/test results/feasibility study of various ETL tools like DataStage/Informatica/AbInitio.
• Documented the evaluation of various reporting tools like Cognos/Business Objects, made recommendations about the product depending on the reporting requirements.
• Worked with the reporting team to understand the capabilities of Cognos ReportNet and PowerPlay. Demonstrated these capabilities to the business users, conducted one-on-one and group sessions to educate the business users on various reporting capabilities of Cognos. Worked with vendor teams like Informatica/Cognos to resolve various issues with being faced by development teams.
• Used sqls to test various reports and ETL load jobs in development, QA and production.
• Wrote BRD, FRD, use cases, test scenarios, test cases for testing the functional and non-functional aspects of both ETL jobs and Reporting jobs.
• Proven skills in the areas of Enterprise Content Management using Siebel CRM and Business Process Management (experience with IBM Process Modeler).
• Good knowledge of RDBMS and SQL with experience in Data analysis and reporting.

TECHNICAL SKILLS

Process/Modeling Tool:

(SDLC) Software Development Life Cycle, Agile, Extreme Programming, MS Visio, MS Project, Rational Rose, Rational RequisitePro, ClearCase, ClearQuest, TestDirector, WinRunner, Load Runner, HP Quality Center, File-Aid, TSO.

Methodology:

OOAD, UML, RUP, Business Modeling and Data Modeling.

Databases:

MS Access, SQL server 2000, Oracle 9i/10g, DB2, COLD Repository.

Languages:

SQL, COBOL and HTML

Operating Systems:

WINDOWS 2007/2000/NT 4.0/XP, Vista.

Office Tools:

MS Office 2007/2003/2000, Word, Excel, PowerPoint, Visio, Outlook.

Project Management:

MS Project 2007/2003/2000.

EDUCATION

• Master in Business Administrative
• Bachelor of Science in Engineering

PROFESSIONAL EXPERIENCE

Client:Confidential March 2008 till present
Project: State of Missouri, Medicaid Management Information System (MMIS)
Position: Business Information Analyst (BIA)
Environment: Requisite Pro, Rational Rose, Lotus notes, Mainframe COBOL language, VSAM, TSO, COLD, FileNet, DB2, Expediter, ESP WM, Java, SAR, File-Aid, ClearCase, Clear Quest, Tape Manager, AbendAid, Cognos8, Informatica 6.1/7.1, Hourglass.
Description: Worked for the team that is responsible for receiving, documenting, processing the claims including the eligibility verification. The team is also responsible for making the system changes if there are any changes need to be made in the current policies, rules & regulations due to the business necessities. Also, tracking and addressing the problems on timely manner encountered by the providers, billers as well as vendor companies, health plan groups while generating 837 Professional, Institutional, and Dental claims, Acknowledgement 997, Claim Status Inquiry/Response 276/277, Remittance Advice 835, Eligibility Inquiry/Response 270/271, Prior Authorization 278, Drug/Pharmacy rebates and reimbursements, etc. The team is also actively involved to verify the data while it is converting from web portal to mainframe layout as well as in returning from mainframe to web portal.

My Job Responsibilities:

• Performed a project analysis on new projects, including requirements, personnel, and costs.
• Developed and maintained a work plan for system projects.
• Responsible for the execution for the project life cycle, including requirements gathering, design, testing, implementation and documentation, as required.
• Provided reports and other documentation on projects to client and internal staffs, as needed.
• Worked with team leaders and supervisors to ensure project and organizational deadlines are met.
• Ensured tracking of State Task Requests (STRs), including timelines for all phase of development.
• Coordinated updates with client’s staff and implement efficiencies in documentation maintenance.
• Organized and conducted extensive JAD sessions with users to identify and understand requirements.
• Responsible fordoing the gap analysis for the interfacing system.
• Documented the Business Requirements Document (BRD) and the Functional Specification Document (FSD).
• Coordinated with the different teams distributed at different geographic locations for various releases.
• Identified Actors, Activities, Artifacts and Workflows and developed use case diagrams using Rational Rose.
• Wrote Use Cases, prepared use case diagrams (using Rational Rose) and followed Rational Unified Process at every stage of the process.
• Prepared and performed training to Client and Internal staff as a result of system changes.
• Coordinated with Reporting team for developing report prototypes in Cognos8(ER Studio), dash-boards, Mainframe, etc.
• Resolved/tracked production issues with Reports in Cognos and Mainframe.
• Facilitated requirements gathering activities, including meeting with users to discuss System Task Requests (STRs), Enhancements, and Project Assessment Quotations (PAQs) requirements.
• Documented issues and resolutions, and wrote specific requirements for system changes.
• Initiated test plans, develop and execute test cases and scenarios; worked with users to develop specific acceptance criteria and prepare test exhibits.
• Made changes to online user help as required by system changes.
• Coordinated production control and scheduling activities with external parties.
• Prioritized and communicated status of projects, schedules. Open issues, and project risk/mitigation plans to all the impacted teams.
• Coordinated system specification development, testing and maintained all project related documentation on SharePoint.

Client: Confidential ,Jan 2007 to Feb 2008
Project: Enterprise Practice Management (EPM)
Position: Business Systems Analyst
Environment: Lotus notes, Requisite Pro, Rational Rose, Peoplesoft EPM, ClearCase, HP Quality Center, Oracle 9i, Cognos8, Cystal Reports, Informatica 6.1/7.1
Description: Worked for the team that is responsible for receiving, documenting, tracking and addressing the problems encountered by the customers of Flagship software product EPM (Enterprise Practice Management) while generating 837 Professional, Institutional, and Dental claims, Functional Acknowledgement 997, Claim Status Inquiry/Response 276/277 Unsolicited for their destination direct Payors or ClearingHouses such as ProxyMed, WebMD, Per Se, THIN, ViaTrack, NaviCure, McKesson, Champus-TriCare, PayerPath, ViaTrack, Access, etc.
Worked on the National Provider ID (NPI) implementation where the multiple Provider IDs needed to be unified into one. The resolutions were delivered by first testing the file attachments in the applicable ClearingHouse environment where available and then analyzing the deficiencies or completeness of the created files by the software at the Submitter level as well as safeguarding the confidential security, integrity, and availability of electronic protected health information.
My Job Responsibilities:

• Delivered solutions and closed problems in the Problem Queue assigned by running the tests in CLAREDI, HIPAADESK and other applicable Clearing Houses that act as vendors for NextGen’s EPM clients by analyzing the test results.
• Organized and conducted extensive JAD sessions with users to identify and understand requirements.
• Responsible fordoing the gap analysis for the interfacing system.
• Documented the Business Application Requirement Specification (BARR) and the Business Specification Document (BSD).
• Coordinated with the different teams distributed at different geographic locations for various releases.
• Identified Actors, Activities, Artifacts and Workflows and developed use case diagrams using Rational Rose.
• Wrote Use Cases, prepared use case diagrams (using Rational Rose) and followed Rational Unified Process at every stage of the process.
• Followed Scrum development process using agile methodology. Coordinated monthly Sprint planning meetings. During the sprint period, held small daily meetings to ensure the monthly deliverables. Got user feedback at every step of the development process.
• Coordinated with Reporting team for developing report prototypes in Cognos8(Report Studio, PowerPlay), dash-boards, etc.
• Resolved/tracked production issues with Reports in Cognos.
• Coordinated with the ETL team to come up with processes for ETL involving Oracle/Sybase/Informatica.
• Created the test plan and test scripts in the Quality Center.
• Reviewed Test Strategy and Test Plans to ensure that they reflect and include all functional, Performance, Usability and Security requirements.
• Participated in Automated regression and Non-Functional test plans.
• Assisted informational needs in mapping of Test Cases.
• Maintained Test Matrix with the test results obtained.
• Clarified QA team issues and reviewed test plans and test scripts developed by development team and QA team to make sure all requirements have been covered in scripts and tested properly.
• As a point person need to train and guide the testing team during test script preparation.
• Involved in identifying the base testing efforts on a prioritized feature schedule.
• Came up with methods to reduce risks of releasing new upgrades to the system in production by doing a controlled release of new features (upgrades).
• Reviewed Performance/Stress testing results done by analyzing Task distribution diagram, Transaction Profile and User profile, creating virtual users and analyzing different reports.
• Effectively communicated user acceptance test results between users and development team and provided recommendations for change control requests (CCR)

Client: Confidential Nov. 2005 to Dec. 2006
Project: Medicaid, Electronic Protected Health Information
Position: Business Systems Analyst
Environment: Mercury Test Director 8.0, PVCS Tracker, Oracle 9i, Java/J2EE, RequisitePro, ClearCase, ClearQuest, MS Project, Cognos(ReportNet), DataStage 7.0

Project Description: The project included determining risks, process flow holes, business rules anomalies when the preexisting application was compared to that of the proposed transaction set(s) IG’s. The directions of the industry as perceived by WEDI-SNIP, CMS, NCPDP, NIH, NIST and other national support groups were taken into consideration for the delivered solution as well as safeguarding the confidential security, integrity, and availability of electronic protected health information.
My Job Responsibilities:

• Helped create Level I and Level II specifications including VISIO data and program flow charts utilizing Gentran Translator’s capabilities and limitations. These techno-commercial documents were presented to the state of New York for their approval for claims (837I/837P/837D), Service Review Request and Response or Prior Authorizations (278), Eligibility Verifications (270/271) and Claim Status Request/Notification (276/277). Outbound batch transactions included Claim Payment Advice (835)
• Researched the then current application, various compliance issues, providing insights to the architecture group, Security group, and resource management group for effective budgeting, bridging with the Translator vendor’s technical group and converting these semantics to the eMedNY application.
• Helped alleviate the problem of insufficient test data, inaccurate test files by creating large and complex, compliant and non-compliant test files with positive and negative test conditions. Helped achieve conformance by doing unit testing, system testing, regression testing, volume testing, end-to-end testing, user acceptance testing (UAT), Trading Partner enablement by first promulgating test cases and test scenarios and creating a test result documentation methodology that supports a stringent pedantic testing but also eventually supports a realistic production environment.
• Create customized Implementation Guides using the SpecBuilder 5.1 module of EDIFECS software for 837 Professional, 837 Institutional, 837 Dental, 835 Remittance Advice, 276/277 Claim Status/Response transactions, 278 270/271 and all NCPDP transactions like B1, B2, B3, B4, E1, P1, P2, P3, P4
• Involved in Validating the System in Accordance with 21CFR Part 11
• Created use case narratives to record Subscription business rules.
• Analyzed the business rules for the international user subscription and impact of localization.
• Followed SDLC, which included requirements specifications, design, analysis and testing. Followed RUP methodology with Agile/Extreme Programming and using Rational Test Suite for various phases of RUP.
• Provided technical Expertise on the use of Rational Clear Case and Requisite pro, which were used for Data archiving and Requirements Management.
• Defect Tracking with Clear Quest, Configuration Management with Clear Case.
• Involved in preparing test plan and test cases based of functional requirements using Rational Test Manager.
• Work experience in maintaining datamarts dealing with ETL (extraction, transformation, load) using Oracle and Informatica.
• Dealt with data mapping issues between various source systems and staging area and data-marts.
• Worked with Business users to come up with Reporting Requirements. Reports were developed in Cognos.
• Produced various artifacts Functional Requirement Specifications (FRS) and User Requirement Specification (URS).
• As a point person responsible for resolving business rules/conflict resolution for the development team.
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• As member of system architecture team designed and reviewed user interface.
• Developed Business case and assessed the ROI.