PROFESSIONAL SUMMARY:

• Worked with the technical staff to implement management and staff's business requirements into the software application in Healthcare Industry.
• Highly motivated team player with excellent communication, presentation and interpersonal skills, always willing to work in challenging and cross - platform environment.
• Experienced working with iterative software development life cycle principles of Rational Unified Process to manage, develop and test distributed client/server, internet and intranet applications on heterogeneous environments.
• Highly proficient in working with users to gather requirements, analyze them and subsequently use the Rational project and design tools to model the requirements.
• Good knowledge of Health Insurance Plans and experienced in determining the FACETS Membership Eligibility, Claims, Billing experience within life and disability in health plans with thorough understanding of CPT coding, CMS-1500 claim forms and reimbursement forms.
• Knowledge in the ETL (Extract, Transform and Load) of data into a data ware house/date mart and Business Intelligence (BI) tools like Business Objects Modules (Reporter, Supervisor, Designer, and Web Intelligence).
• In-depth knowledge of creating use cases, functional design specifications, activity diagrams, logical, component and deployment views to extract business process flow.
• Good Knowledge of HIPAA Compliance Lifecycle, HIPAA Insurance Regulations and Claims Processing.
• Experience in electronic (HIPAA X12 standards-270, 271, 275, 276, 277, 278, 835, 837, and 997) and paper claim forms such as UB04, HCFA-1500, CMS1500, etc
• Experience with SOX, Regulatory Compliance and Controls .
• Strong understanding of project life cycle and SDLC methodologies including RUP, RAD, Waterfall and Agile.
• Strong experience in conducting JAD sessions, created Use Cases, work flows, screen shots and Power Point presentations for the Web Applications
• Gathered and documented Non-functional requirements.
• Knowledge of healthcare standard Health Level Seven (HL7).
• Conducting requirement gathering sessions, feasibility studies and Impact Analysis and organizing the software requirements in a structured way using Rational RequisitePro to track development.
• Interacting regularly with the development team, creative services, database designer, system administrator and the higher management to meet the deadlines of Project milestones.
• Worked in close co-ordination with the testing team in developing test plan and test cases from functional and business requirements.
• Performed UAT and exposure to User Certification Testing (UCT) and Operational Readiness Testing (ORT)
• Expertise in understanding and supporting the client with Project Planning, Project Definition, Requirements Definition, Analysis, Design, Testing, System documentation and user training.
• Used Rational Clear Quest for tracking and prioritizing defects and for enhancements after base lining the requirements.

TECHNICAL SKILLS:

Programming Languages: C, C++, HTML, XML, SQL.

Data Base: DB Visualizer, MS Access, Oracle (SQL Series), DB2

Reporting Tools: Crystal Reports 8.0

Operating Systems: MS-DOS, Windows95/98/NT/2000/XP, Apple McIntosh, Linux

Software: MS Office Suite (Word, Excel, Access, PowerPoint & Outlook), MS Visio, Rational Rose, Rational Requisite Pro, Adobe Acrobat, MS Office FrontPage, Lotus Notes

Performance Testing Tools: Virtual User Generator, Load Runner

Processes/Technologies: Agile, Rational Unified Process (RUP), Waterfall, UML & Microsoft Office SharePoint.

Automation Tools: Requisite Pro, Win runner, QTP, Test Director, ALM

PROFESSIONAL EXPERIENCE:

Confidential, Minneapolis, MN

Sr Business Systems Analyst

Responsibilities:

• Served as a primary liaison between IT technical staffs and end users.
• Analyzed and documented high level and detailed business requirement and translate in use case diagram.
• Defined and documented high-level business detail business requirements to meet stakeholder’s expectation.
• Participated in facilitation of business process review and developer walkthroughs based on business requirements.
• Conducted workflow, process diagram to derive requirements for existing systems enhancements.
• Translated technical applications specification into functional and nonfunctional business requirements.
• Executed SQL queries to test back end data validation of DB2 database tables based on business requirement.
• Enhanced existing systems based on business needs. Involved in identifying the requirements and enhancement of the Auditing system.
• Facilitated and arranged conference calls, JAD Sessions, and business Interviews with stakeholders and end users.
• Worked in Agile Development environment with frequently changing requirements and features.
• Created Epic/User stories in Jira (Agile)
• Created wireframes based on business needs and worked with UI interface designers for visual designs and mockups using HTML and CSS.
• Worked on ETL file transfers using Data Stage as the ETL tool to transform internal and external data into the application.
• Assisted the ETL Team during Data Mapping, Data Integration, Process Mapping and Process Integration.
• Error handling of the rejected records in the file at both data stage and System level.
• Mapping of XML elements in the XSD schema to the target database tables
• Worked with Data Architect and created conceptual and logical data models.
• Created data dictionaries
• Worked on data profiling and data mapping.
• Developed testing scenarios and scripts. Analyzed, evaluated, tested and coordinated all levels of system, participated in user acceptance testing.

Environment: Agile Jira, SQL, MS Visio, MS Project, SharePoint, HP ALM, Axure, Snagit 11 Editor, HTML, .Net, XML, MS Office, MS Visio, DB Visualizer, Data Stage.

Confidential, Minneapolis, MN

Senior Systems Analyst

Responsibilities:

• Involved in multiple projects that include introducing new functionalities and/or enhancement of the existing design.
• Examining and clarifying business requirements with Business Analyst or Product Owners and segregate them into high level and low-level use cases
• Prepare business process flowcharts and workflow diagrams using MS Visio
• Conduct & Participate in JAD sessions, to help synchronize the different stakeholders on their objectives and help the developers to have a clear-cut picture of the project.
• Work with Architects and development resources to provide solution design and business logic.
• Extensively worked on Agile projects.
• Create wireframes and mockups using Axure to provide a visual guide of the user interface.
• Elicit and develop detailed High-level design, User Specification and technical specifications documentations
• Form a bridge between the Product owners and different teams.
• Work with developers and data architect to identify and finalize database model. Responsible for defining the data type for the new data element. Review the new schema and verify the Schema changes does not impact the existing functionality.
• Performed Logical Data Modeling, Mapping to Data Dictionary and Creating mapping documents.
• Performing Impact analysis to identify the internal and external application impacts
• Create API’s to integrate with 3 rd party products using SOAP and RESTFUL Web services. Creating the WSDL Data mapping of the XML request and response objects, mapping to the database and validations. Used canonical model to represent data elements to allow for a flexible, extensible, robust approach to meet future needs.
• Worked on EDI 278A,278N, 278I transactions. Mapping of the canonical xml schema to the ICUE schema. ‘
• Experience working on ETL file transfers using Data Stage as the ETL tool to transform internal and external data into the application. Responsible for defining the XML/CSV file characteristics and mapping of the XML attributes to the database
• Worked with XML, CSV and other text formats on a regular basis.
• Worked with the ETL team to develop ETL Rules, Data Survivorship Rules and Data Algorithm.
• Created Data mapping documents between various data elements, XML files, flat files, excel files, HIPAA EDI files X12 837, 270, 271, 276, 277, 278, 835, 275, and 5010 and web services, to perform verification and validation.
• Worked on Cloud migration projects. Design SaaS based application and implement authentication capabilities using enterprise approach including consideration of SSO, Ping Federate, Site Minder.
• Checked the data flow through the front end and back end and used SQL Queries to extract the data from the database.
• Assisted the Scrum Master in maintaining User Stories, creating and prioritizing the (Product, Release, Sprint) Backlog in Rally, coordinated Sprint Planning Sessions, conducting Sprint Reviews and Retrospectives and Acceptance Criteria.
• Collaborated with Quality Assurance Analysts to create test cases, test scripts and execute test planning.
• Performed regression testing and UAT testing.
• Log and track defects in ALM

Environment: Agile Rally, SQL, SVN Tortoise, MS Visio, MS Project, MS Office Suite, SharePoint, ALM, Axure, SOAP UI SOA, HTML, Java, XML, JSON, DB Visualizer, Data Stage.

Confidential, Bloomington, IL

Business Systems Analyst

Responsibilities:

• Performed stakeholder analysis to identify key players for project success
• Identified and involved all key stakeholders, contributors, business, operations and technical resources that must participate in a project and ensured that contributors are motivated to complete assigned tasks within the parameters of the project plan
• Played an active and lead role in gathering, analyzing, and writing business requirements.
• Followed the RUP and UML methodology throughout the SDLC.
• Collected and documented business processes as well as business rules. Provided key input in working with users in defining project and system requirements.
• Involved in developing the business model for expediting the claim settlement process.
• Translated the business needs into functional requirements and communicated with the business users on a non-technical level.
• Conducted GAP analysis in the AGILE processes.
• Documented the System Specifications Document.
• Created and maintained the Requirements Traceability Matrix (RTM).
• Created use cases and Use case diagrams.
• Interacted with other teams through walkthroughs, teleconferences, meetings, etc. to resolve various issues.
• Conducted JAD sessions when needed.
• Used Visio for the presentation of Process flows to various groups. Developed data flows and ER Diagrams and technical specifications
• Retrieved Data using SQL queries and did Data Mapping and Data analysis
• Gathered technical requirements in an agile environment in line with RUP iterations.
• Designed and developed scenarios based on business requirements.
• Worked on Unix Platform and experienced in back end testing by executing SQL Queries.
• Checked the data flow through the front end to backend and used SQL Queries to extract the data from the database.
• Carried out User Acceptance Testing (UAT).
• Performed bug tracking using Quality Center.
• Consolidated the status reports of the team for the Project manager.

Environment: Project Life Cycle (PLC), RUP, SQL, UNIX, MS Visio, MS Project, Ms Office Suite, Oracle Financials and Quality Center

Confidential, Durham, NC

Business Systems Analyst

Responsibilities:

• Responsible for defining the scope and implementing business rules of the project, gathering business requirements and documentation.
• Responsible for writing Functional Requirement Specifications (FRS) and User Requirement Specification (URS).
• Analyzed Business Requirements and segregated them into high level and low-level Use Cases, Activity Diagrams / State Chart Diagrams using Rational Rose per UML methodology thus defining the Data Process Models.
• Developed straightforward DBMS queries, knowledge of HL7 and xml interface messaging.
• Assisted in monitoring ancillary data transactions and addressed problems with HL7 messages.
• Designed a claim processing system for the healthcare management client system. It allowed the user to inexpensively capture information regarding patient, summary of medical history, symptoms (ICD-9 codes), and treatment (CPT).
• 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. 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.
• Responsible for architecting integrated HIPAA, Medicare solutions, Facets.
• Identify Member, Provider, Coverage, Medicare, and Medicaid.
• Involved in Service Oriented Architecture (SOA) of the claims processing system
• Understand the As Is system and develop the To Be system concept and prepare the System Process Maps.
• Performed extensive requirement analysis including Data analysis and Gap analysis.
• Defined Functional Test Cases, documented, Executed test script in Facets system.
• 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.
• Conducted presentations of the Q/A test results with analysis to the stakeholders and users and documented modifications and requirements.
• Coordinating and Developing QA activities.
• Assigned tasks among development team, monitored and tracked progress of project following Agile methodology.
• Created Process Flow diagrams, Use Case Diagrams, Class Diagrams and Interaction Diagrams using Microsoft Visio and Rational Rose.
• Wrote Test Cases and performed User Acceptance Testing, documented in detail defects using the Defect Tracking report.
• Used Test Case distribution and development reports to track the progress of test case planning, implementation and execution results.
• Created Use cases, activity report, logical components and deployment views to extract business process flows and workflows involved in the project. Carried out defect tracking using Clear Quest
• Maintained proper communication with the developers ensuring that the modifications and requirements were addressed and monitored these revisions.

Confidential

Business Analyst

Responsibilities:

• Documented business requirements by working with Subject Matter Experts (SME) and communicated these requirements to the development team for the design and implementation of business solutions
• Carried out detailed and comprehensive business analysis with Rational Unified Process (RUP) methodology
• Coordinated brainstorming and JAD sessions with stakeholders and end-users for requirement analysis and documented the same
• Created Use Case models, Analysis models, Design Models, Implementation Models, Activity diagrams based on UML methodology using MS Visio
• Developed UML Use Cases using Rational Rose and developed a detailed project plan with emphasis on deliverables.
• Prepared and Analyzed AS IS and TO BE work flow scenario and performed GAP Analysis
• Created Mock-up’s for better visualization and understanding of the software solution and regularly worked with the CMA (Change Management Application) and CDA (content Display Management) teams
• Created and segregated SQL views using Oracle SQL Developer and stored procedures for obtaining meaningful set of data.
• Facilitated in developing the Test scenarios, Test plan, Test conditions and Test cases to be used in testing based on business requirements and technical specifications
• Successfully implemented Change Request and defect tracking using Mercury Quality Center
• Coordinate with the plan owners to update the project plans with any impact due to change request. Verify if the contingency plan will absorb any delay in project due to change request.
• Facilitated UAT and Test strategies with the developers and testers and performed manual front-end testing to check all the functionalities incorporated with the different modules

Environment: RUP, Mercury Quality Center, MS office Suite, SharePoint, MS Project, MS Visio, SQL, HTML, Java, XML, MS Office, MS Visio, DB2.