SUMMARY

7+ years of experience in business process analysis, business requirements modeling and development of Web Based, and Client/Server applications in diverse business domains of Healthcare, Insurance and Service Industry Sectors.

• Proficient in gathering and converting User Requirements into Business Requirements and Functional Requirement Specifications (FRS) and use Modeling tools like Rational Rose and Microsoft Visio for requirements modeling.
• Expertise in Business Process Modeling, Business Process Re-design and in designing Process Architecture.
• Strong knowledge of managed claims management process, Knowledge of Medicaid and Medicare Services. CMS, Health Assessment Systems , Hl7 Standards, HIPAA ,PPACA(Patient Protection and Affordable Care Act), Compliance issues, LOINC and SNOMED Mapping, HL7 Message Validation, ICD 9, Electronic Health Records, Electronic Medical Records.
• Sound understanding of Gap Analysis, requirement management, risk analysis and project plans.
• Strong experience with different project methodologies including Agile, Scrum Methodology, SDLC, RUP.
• Solid understanding of Rational Unified Process (RUP) using Rational Rose, Requisite Pro, Unified Modeling Language (UML), Object Modeling Technique (OMT), Extreme Programming (XP), and Object Oriented Analysis (OOA).
• Excellent understanding of Data Models and Information Architecture and sound skills in SQL.
• Excellent understanding of Software Quality Assurance Techniques, CMM, Master Data Management,` Six Sigma and ISO Standards and highly acquainted in working in SOX Compliance Environment.
• Experience in Risk Management process and technology reengineering, Sarbanes Oxley implementation, valuation review process and technology, strategic sourcing, metrics and benchmarking
• Experienced with BI Reporting Tools like SAS, Databases like SQL, Oracle.
• Excellent in designing business models using UML diagrams such as use case diagrams, class diagrams, activity diagrams, sequence diagrams and collaboration diagrams using Rational Rose and MS Visio.
• Experience in conducting Joint Application Development (JAD) sessions and White Board Sessions with end-users, Subject Matter Expert (SMEs) team, Architects and design group development and QA team for project meetings, walkthroughs and customer interviews commensurate with excellent communication skills.
• Defining Test Cases, analyzing bugs, interaction with team members in fixing errors and User Acceptance Testing (UAT)
• Creative and aggressive self-starter with integrative thinking skills, capable of communicating creative ideas through graphical analysis charts and statistical data display.

Project Management: MS-Project2010, MS-SharePoint
Project Methodologies: SDLC, Agile, Rational Unified Process (RUP), UML
Business Modeling Tools: Rational Rose, MS Visio
Requirement Management Tools: Rational RequisitePro, Rally
Defect Tracking Tools: Rational Clear Quest, Quality Center, Test Director
Operating Systems: Windows 7/XP/2000, UNIX
Database: Access, Oracle, SQL server, DB2, Teradata
Scripting Languages: HTML, CSS, XHTML,JAVA SCRIPT.
Quality Assurance: Software Application Testing Life Cycle
Business Applications: Microsoft Office Suite, MS VISIO, MS Project, SharePoint
Content Management Systems: Drupal, Joomla, Interwoven.

Confidential,Feb 2012- Present
Jefferson City MO
HL7 Business Analyst
Project Description: The Project implemented the Electronic Lab Reporting to Center for Communicable Diseases(CDC) in HL7 Format from the State Communicable Disease Surveillance Application.

Responsibilities:

• Participated in the analyzing and understanding the business requirements. Worked with the Business Users to understand the existing process.
• Developed the Uses cases by analyzing the various scenarios and documented the Use case Document.
• Worked on the GUI ,user profile, created workflow processes documentation & charts.
• Developed the test plan and designed the test strategy.
• Implemented the Agile Software Development Life Cycle throughout the Project.
• Created LOINC/SNOMED Vocabulary Mapping based on Missouri Reportable Conditions.
• Created the data mappings for the digital pathology LOINC Codes
• Participated in testing of Orion Rhapsody Route to receive and process HL7 ORU^R01 Version 2.5.1 messages to Websurv
• Tested the HL7 ORU^R01 Version 2.5.1 to receive messages from HL7 ORU^R01 version 2.3.1.
• Gathered the Requirements for Enhancement of Electronic Lab Reporting Dashboard and implemented the timely status/error messages in the Dashboard
• Designed a Document of Identifying and marking outbound laboratory results to public health entity to be accommodated on the Websurv.
• Testing of HL7 Message Validation and sending of ADT Messages like ADT^A01, ADT^A04 and ADT^A08.
• Created a Data Dictionary Mapping the Reportable Health Conditions with LOINC/SNOMED codes and Master Data Management Documents.
• Participated in JAD Sessions with SME’s and Business Users for gathering the requirements.
• Created error/ defect reports and communicated with developers and application owners for application defect tracking & resolution
• Involved in Testing of the various results generated by the reports against the data present in the database tables and used UAT on that data involving the users.
• Work with the Cross-Functional teams to proactively automate the applications. Maintained the Requirements Traceability Matrix and also conducted the Gap Analysis to and also maintain and review test metrics/results/KPIs for analysis and audit purpose.
• Provided functional inputs to the software development team, to enable them understand the role of the software in the business process of the client.
• Wrote SQL Queries to extract data from the SQL Server Databases.
• Designed and implemented basic SQL queries for QA testing and report / data validation.
• Worked extensively with the QA team for designing Test Plan and Test Cases for the User Acceptance Testing.
• Involved in manual testing and UAT with the development team and QA team.
• Assisted the Test lead with estimations and also got the opportunity to work with the project manager in preparing the project schedules, milestone tracking, and resource allocation

Environment: MS Windows, Quality Center, Rhapsody version 2.3.1, 2.5.1,HL7, SQL, MS Visio, MS Project, MS Office (PowerPoint, MS Word, MS EXCEL), Web 2.0, SQL, Oracle, SDLC, Agile, MS-Project2010.

Confidential,May2008-Dec 2011
Albany NY
Sr.Business Systems Analyst/Project Co-ordinator

Project Description:
Coordinated requirements and testing with third-party vendor and state policy experts for changes to Medicaid Managed Care and Child Healthcare Plan Plus (CHP+) claims and enrollment systems

Responsibilities:

• Facilitated requirements gathering sessions with the business unit managers and subject matter experts to document requirements.
• Documented the work flow using the flow charts for the application to be accessed by different types of Business Users.
• Documented the user Stories, Functional Specifications Documents and also Designed Data Flow Diagrams using MS-Visio.
• Published detailed guide describing data file content and structure for business partners; created quick reference guide for HIPAA EDI ASC X12 834 transaction set for Medicaid enrollment.
• Coordinated testing for contract set-up, enrollment and claims processing for four new managed care contracts for Medicaid mental and physical health providers.
• Involved in intensive system level testing of analyzing the HL-7 messages coming out and in of EPIC Bridges.
• Responsible for the mainframes that receive the HL-7 message in pre-approved format from the middleware as disclosed in the documentation.
• Researched and documented data variances reported by managed care contractors
• Reverse engineered processes where no documentation for system existed.
• Studied existing business application and processes, current source system, collected end user requirements and suggested the improvised business process model
• Assisted Project manager to create project timelines, milestones, resource planning etc.
• Analyzed the “As is” and “To be” system documents to show the current and proposed functionalities of the system using MS VISIO.
• Reviewed extensive SQL Queries with complex multi-table joins and nested queries.
• Involved in reviewing complex SQL queries, views, functions and stored procedures and spotting issues before/during code migration.
• Rigorously tested SQL’s implementation of existing code.
• Participated in design of the Master Test Plan Documents, Test Cases, Test Plan.
• Participated in User Acceptance Testing with Business Users.
• Co-ordinated with the Development Team and Testing team to track the Defects and Resolution.
• Participated in Analysis of High Priority issues and risks as part of Risk Assessment.
• Designed the Test Metrics Documents for tracking the Status and Compliance of the Application.
• Performed Gap Analysis of client requirements, generated workflow process, flow charts and relevant artifacts.
• Participated in the walkthroughs and meetings specifically for Assessments and The report Generation.
• Created the report from the databases using Crystal Reports.
• Coordinate with Development and Business team to develop high level Business and Technical documents.
• Worked with the clients on the verification process for the requirement phase documents
• Implemented Agile Framework throughout the software Development Life Cycle (SDLC).

Environment: Java Server Faces, IceFaces, Seam, UML, MS-Project, MS-Sharepoint, Windows XP, Microsoft visio, XMl, SAS, SPSS, Rational Requisite Pro, SQL, Oracle, Agile.

Confidential, May2007-April2008
Rockville, MD

Project Description: The project involved implementing a web enabled children immunization registry for the State of Maryland. These registries are confidential, population based, computerized information systems that attempt to collect vaccination data about all children within the geographic area.

Responsibilities:

• Authored business system analysis reports based on state regulations, HIPAA compliance and product business rules.
• Conducted weekly meetings for deciding the Policies and Procedures to be followed while constructing new sites.
• Worked with the SMEs (Subject Matter Experts), IT managers, software architects to identify the key changes pertaining to HIPAA , and participated in Health Management to communicate effectively with them.
• Performed the requirement analysis, impact analysis and documented the requirements using Rational Requisite Pro.
• Gathered the Requirements for Medicare, Medicaid Systems as part of Patient Protection Affordable Care Act(PPACA).
• Worked on billing system a cash management module and enhanced the encrypting standards that are required for the application.
• Followed a systematic approach to eliciting, organizing, and documenting requirements of the system.
• Reviewed the Joint Requirement Documents (JRD) with the cross functional team to analyze the High Level Requirements.
• Used Query Analyzer, Execution Plan to optimize SQL Queries.
• Conducted interviews, meetings and JAD sessions during the process of Requirement Gathering.
• Planned and documented procedures for data processing and prepared data flow diagrams for the application.
• Evaluating various open source architecture framework in the architecture framework to come up with the architecture roadmap for the client.
• Expertise with supply chain strategies/vendor manufacturing process methods to determine level of procurement and strategic sourcing strategies/plans and worked with vendors/peers to determine lead times, schedules and cycle counts, established requirements needs.
• Experience in EDI automated first-pass claim adjudication, requiring thorough understanding of claim processing, both front and backend operations.
• Prepared and documented System Requirements and workflows for the Content Management Application tool.
• Validated the following: 837 (Health Care Claims or Encounters), 835 (Health Care Claims payment/ Remittance), 270/271 (Eligibility request/Response), 834 (Enrollment/Dis-enrollment to a health plan)
• 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.
• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims.
• Experience of working with Medicare and Medicaid insurance data, Medicare parts A, B, C & D, FACETS 4.5/4.7 system, Claims Processing, Insurance Pricing and Claim Adjudication. Strong Experience in FEP (Federal Employment Program) and CDA (Clinical Development Analytics). Healthcare Domain Knowledge with SQL knowledge (in Oracle environment) and 5010, ICD-10 experience.
• Participated in 1CD 9 to ICD 10codes mapping sessions as well as status meetings and provided comments and suggestions on challenges. Gathered requirements on Trading Partner Registration and certification. Verified Trading Partner configuration and the profiles.
• Looked up ICD-9 codes to verify if a code has been changed and entered deposited and updated patients\' demographics using the Medisoft system and ePACES online system to verify a their Medicaid status.
• Mentored business analysts in methodology for defining ICD-10 mapping processes and documenting business requirements. Developed additional processes specifically designed to handle Benefits Administration.
• Participated in changing of 4 digit numeric codes of ICD-9 to Alpha-numeric codes in ICD-10.
• Created an enterprise workflow application based on CRUD rules for Customer Data that would allow for future integration of data infrastructure across various business areas into a single User Interface.
• Worked on EDI transactions: 270, 271, 834, 835, and 837 (P.I.D) to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
• Involved in the design of the Automation framework.
• Performed data analysis by using SQL queries
• Designed the Master Test Plan, Test Plans,Test Cases and also Test Metrics Documents.
• Performed Unit Testing and User Acceptance Testing and documented detailed defects.
• Designed and developed project document templates based on SDLC methodology
• Designed workflows and allocated permissions within SharePoint.
• Performed Unit Testing and User Acceptance testing (UAT) and documented detailed results.
• Expertise in BI Reporting for Reporting the data.
• Provided input (scope, goals, risks, constraints, timelines and interfaces) to PM for project planning and control.

Environment: Windows 2000/XP, Microsoft Office SharePoint 2007, TOGAF, Rational Requisite Pro, MS Office, SQL Server, Agile, MS Project, MS FrontPage 2003, MS Access, EDI, Documentum 2.0.,UML.

Confidential,Aug2006-May2007
Indianapolis, In
Business Systems Analyst

Scope of the Project is to enhance Claims processing system within the company for scanning and capturing of data including working on UB-92 claims forms. Involved in using the technology to recognize, validate, and store claims and their attachments using HIPAA compliance interface.
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Responsibilities:

• Gathered legacy system requirements by shadowing Customer Service Representatives (CSRs), Customer Relationship Representatives (CRRs), preparing questionnaires, to identify limitations in the current system and GAPS in the proposed system.
• Created an enterprise workflow application based on CRUD rules for Customer Data that would allow for future integration of data infrastructure across various business areas into a single UI.
• Prepared logical data model in the form of Business Context diagram to include various entities and attributes in order to facilitate the design of Data model in the form of ER Diagrams. Studied current information structures and data models of the current databases to better understand the design of target data source.
• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims. Worked on EDI transactions: 270, 271, 834, 835, and 837 (P.I.D) to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
• Co-ordinated with enhancement of AMISYS(Accounting and Management Systems) responsible for Billing of Claims.
• Responsible for architecting integrated HIPAA, Medicare solutions, Facets.
• Identify Member, Provider, Coverage, Medicare, and Medicaid.
• Performed custom data conversions and developed custom software for risk management applications including general claims, vehicle accident and administrative tracking. Performed all data field mappings.
• Used Rational Rose to model the process using UML to create behavioral and structural diagrams.
• Used Rational Clear Quest to track required changes and Rational Clear Case to maintain different versions of the project documentation
• Involved in integration of various Customer Data Sources and provided Data Mapping from various sources like CCD, LPCD, DCD into the target centralized customer data source.
• Modeled Business requirements into workflows to depict various scenarios of system to request RFI and RFP responses from major vendors.
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, OOAD using UML and Business Process Modeling.
• Intricately involved in Business Process Flow development, Business Process Modeling, and ad hoc Analysis
• Performed detailed comparative analysis of response to RFPs of vendors and Graphically Represented the recommended solutions in PowerPoint to Senior Management
• Prepared Business Context Diagram, Use Case diagrams and corresponding Activity Diagrams using Rational Rose to depict the workflows to be incorporated into the development of Pega Business Process Management (BPM) tool.
• Conducted Requirements walk- through with the Business Team to ensure that all their needs are met and gathered sign off on the requirements for SOX compliance after the requirements were base lined.
• Prepared and maintain Business Rules Spreadsheets (BRS) identifying Rules, Triggers and corresponding data fields from Legacy to target CRM application.
• Involved in testing of claims processed through Claim Processing Engines like Facets.
• Followed a methodical Change Management Process and documented any Change Requests into Clear Case for any changes in the requirements after the requirements were base lined.
• Conducted Architectural Discussions to prepare the Proposed Architecture and provided insight in the Business Case to the Architecture Review Board (ARB).
• Lead the effort of Data Migration from disparate data sources into normalized data to eliminate redundant information and organizing the tables to easily maintain the table structures.
• Prepared Test Cases based on base-lined Requirements Document, prepared Requirements Traceability Matrix and provided Performance Testing Requirements. Worked very closely with the Test team to Test all iterations during the Testing Phase and documented all the defects.
• Facilitated the User Acceptance Testing (UAT) with Pega System Administrators and Business Users, documented any issues or defects and eventually got sign off from the right parties.
• Prepared training materials in the form of User manuals by preparing step-by-step guide to all screen flows in CMS.
• Assisted in development of User Interfaces and prepared screenshots to get business’s buy-in on the requirements.
• Worked on BI Reporting Tool to retrieve, analyze and report data.
• Worked with Siebel trainer to prepare training materials and conducted on-site training with Siebel to train the various types of audience like Customer Relationship Representatives (CRRs), administrators and Account Managers (AMs).

Confidential,Jan2005-July2006
Minnetonka, MN
Delivery Systems Requirements & Planning
Business Systems Analyst

Responsibilities:

• Analyzed existing reports and defined business requirements and business process flows
• Gathered requirements for making changes to the existing Electronic Medical Records(EMR), Electronic Health Records(EHR) and Ambulatory Services for the existing Epic Interfaces.
• Co-ordinated for enhancement to the EPIC Reporting Workbench.
• Involved in development of the system for data exchange from EMR, EHR to Electronic Lab Reporting Systems.
• Conducted JAD sessions with PM, SMEs; facilitated interviews with end users and hospital administrators to collect business requirements
• Involved in Web Development and Content Management system like Planning and execution of digital projects; developing schedules; defining and owning feature requirements for website development; managing website content, establishing and enforcing content governance, creating business requirements documents, and offering input on content migration plans, workflows, testing plans, and quality assurance
• Built a business process model using Rational Rose and Visio.
• Gather detailed business and technical requirements and participate in the definitions of business rules and data standards.
• Facilitated SME interviews and assisted in identifying and analyzing the possible technical solutions.
• Assist DW data analyst in analyzing existing reports and identifying iteration metrics;
• Performed requirement analysis, went through use cases according to the flow of patient data and rules of security sharing.
• Created SAS programs that are used for data validation, statistical report generation and program validation and automated the Edit Check programs using Macros
• Used SAS ODS to create output files in different formats including PDF and RTF
• Formulated logical statements of business requirements researched and evaluated alternative solutions and recommend the most efficient solution for system design.
• Participate in business systems planning for integrated analytic needs; participate in defining approaches and priorities for satisfying needs.
• Aided management in standardizing web applications by preparing GUI standards and recommending alternatives for incorporation in a phased, iterative manner.
• Was responsible for Prior Authorization & Treatment Authorization Request forms.
• Assisted in data mart design and prototyping
• Designed and Administered Teradata Scripts, Tables, Indices and Database Objects
• Created test scripts for all the test cases in PL/SQL.
• Involved in creating reports for the end users using Crystal reports from the gathered requirements.
• Wrote PL/SQL statement and stored procedures in Oracle for extracting as well as writing data.
• Assisted in mapping the requirements to the source systems, the DW and applicable data marts.
• Assisted in designing and validating source target mappings and transformation logical data model required to support information requirements.
• Assumed DBA roles and responsibilities as needed for DB2 and/or Oracle (mainframe and/or client server) environments.
• Tracked and documented defects and communicated them to the technical developers.
• Used Test Director for bug and defect tracking.
• Assisted the project manager in preparing the project schedules, milestone tracking, resource allocation using Microsoft project.
• Prepared Business Object / Business Process Models that included modeling of all the activities of business from conceptual to procedural level.
• Worked extensively with the QA team for designing Test Plan and Test Cases for the User Acceptance Testing.
• Involved in manual testing and UAT with the development team and QA team.

Environment: Rational requisite Pro, Clear case, Clear Quest, Rational Rose, HP Quality center, MS Project, MS Office, Windows 2000, Rational Method Composer, MS Visio, Rational Software Architect

EDUCATION:
Bachelor of Technology