Professional Summary:

• An accomplished facilitator between Business Systems and Information Technology with over 6+ years of extensive experience in the field of business analysis and process re-engineering.
• Good understanding of Business Process and Requirements Management.
• Strong Project Management skills including Planning, Scheduling, Monitoring and Budgeting.
• Excellent communicator, highly capable of interfacing with both internal and external stakeholders.
• Proven experience in Requirements Gathering and translation into functional specifications.
• Proficient in creating UML Diagrams including Use Cases Diagrams, Activity Diagrams, Sequence Diagrams, Data Flow Diagrams (DFDs).
• Possess excellent verbal and written communication skills. Dynamic and Assertive team player with strong commitment.
• Expert in working in different SDLC processes, RUP, RAD, SCRUM, and WATERFALL.
• Role player in any kind of situation and finding success in the situations.
• Interacting and coordinating between end-users, expert team, development and QA team and suggesting key enhancements and changes to the business architecture.
• Skilled in understanding the Business Rules and effectively implementing them into Business Process flow.
• Experienced in conducting JAD sessions and interacting with the Stakeholders to resolve issues.
• Extensively worked on Sharepoint for Document Management and to process change control requests
• Excellent analytical skills for understanding and gathering the requirements, business rules/processes and detailed design of the application, generating use case models, analyzing ER Diagrams and Data Flow Diagrams.
• Adept at creating and transforming business requirements into software requirement specification (SRS) and designing business models using use case model, analysis model, activity diagrams ,sequence diagrams in Rational Rose and MS Visio, Project time-risk analysis using MS project.
• Strong knowledge of SWOT, GAP Analysis, Risk Analysis, Cost Benefit Analysis.
• Proficient with using Rational Clear Quest.
• Ability to organize, document and track changes and defects using the MR tool-ClearQuest and Quality Center.
• Experience in interacting with client and the IT Department and thus acted as a Facilitator between the client and the IT Department to resolve and conflicts and thus possess excellent co-ordination, negotiation and interpersonal skills.

Specific Expertise:

• TriZetto Compliance Certified for HIPAA/HITECH in 2012
• Strong Knowledge of Health care Industry, Insurance industry and their Business process.
• Strong knowledge of HIPPA 4010, 5010, ICD 9, ICD 10.
• Expertise in EDI Transactions, HIPPA Gateways, Adjudication Systems(Facets, Mainframe) Insurance regulations, Medicare, Medicaid, Pharmacy.
• Expertise in the EDI (837, 835, 834, 270,271,997)

Technical skills:
Microsoft Tools( MS Project, MS Word, MS Excel, MS PowerPoint, MS Access, MS Visio), Rational Suites,(Rational RequisitePro, Rational Rose, Rational ClearCase)Enterprises Architect.9, DreamWeaver 5.5, SQL Server, IBM Cognos, MS SharePoint, Open Project, HP Quality Center.

Education:
Bachelors in Business Administration.

Confidential, Denver, CO April2012-Current
Sr. Business Analyst/ Technical Analyst

Confidential,have come together to establish a Blues Utility (shared services) as joint venture which will be known as Topaz. The TriZetto group is contracted to provide hosting services to the Client (Topaz) to do the hosting setup for the company for the Individual, Small Group and the 65 market under the hosted services environment for the enrollment, claims adjudications and billing only at this time. TriZetto launched the custom development project (code 2067) for the “The Stack” (group of softwares) including Facets 5.1 hosting services where they are making arrangements for all the functionalities to work together even though the BCBSNC does not uses the Facets but legacy system. This is the reverse engineering methodology where one client is already on Facets system but they are looking to economize by reducing administrative cost structure for their services under same roof in the form of Topaz shared services.
Responsibilities:

• Completed the HIPAA/HITECH compliance training necessary for the Project.
• Analyzed and assessed the SOW 1(align and confirm phase) for the Project.
• Reviewed the System Architecture for the Project and provided ideas on the necessary improvements that can be made with the past Project experiences.
• Conducted the work sessions and Brainstorming sessions with the onsite team and remote resources by teleconference.
• Documented the TriZetto assumed inventories and compared with clients MKS repository of assumed inventories by creating a traceability matrix.
• Analyzed and converted the stored Procedures into the Pseudo codes for the extensions provided by the client for better understanding of business logics behind the extensions.
• Created the Technical Specifications for the Extensions, Extracts, Interfaces, Boundary applications.
• Created the Process flow diagrams for the extracts that will be made from the facets 5.01 database by the vendors who will require information for their roles as a third party.
• Created the Gaps list realized from the inventory from the client in the form of Spreadsheet
• Attended the daily status call with the team through the conference.
• Submitted and created the report of the Project Progress to the Team Lead every Friday COB.
• Uploaded the documents for the clients and project team on MS Project (known as Work Engine for this Project) for the validation by client.
• Updated the inventory list, SOW as per the updates from the clients and the Project Manager.
• Extracted the information from the company’s earlier documents that involved the relevant work for different clients using the customer exchange.
• Extracted the information required from the facets data model (5.01), Data dictionary for the documentation involving the data and documented it.

Environment:
Facets 5.01, MS Project 2010 (Work Engine), Agile (Scrum), MS Outlook, MS SharePoint, Office Communicator, MS Excel 2010, MS Visio 2010, Sql Server 2008, Facets Extensibility Guide, Customer Exchange, MKS Repository, PVCS

Confidential, Baton Rouge, LA June2010 April2012
Sr. Business/System Analyst
Confidential, is the second largest health care payer in Louisiana and provides variety of health insurance plans for both individuals and groups. The main scope of the project was conversions of ICD-9 to ICD-10 code which required significant changes across the operations including departments like Claim Adjudication, Pre- Authorization, Provider Reimbursement, Acknowledgement, and EOB. The main scope of the Project was to implement the new codes for the further processing and mapping the codes to destined database tables which might be accessed at times when required
Responsibilities:

• Analyzed, coordinated, documented and managed project requirements, project processes and procedures and its changes throughout the software development lifecycle.
• Created the impact analysis documents to determine different sectors that will be affected with the implementation of ICD10 by using Informatica.
• Created the Gap Analysis (AS-IS, TO-BE) for the new process implementation.
• Designed the work flow process for the ICD 10 compliance to visualize diagrammatically the structure of the inbound and outbound files.
• Inquired and extracted information from different database tables using various Sql queries to ensure that the datas are routed to correct destination tables.
• Designed, developed and testing of the mappings using Informatica Power center.
• Worked for various teams such as Claims, Reporting, Adjudication and Code Adjustment affected by the ICD 10 Enhancement Project.
• Equipped the FACETS for different batch processing (medical batch, hospital batch, ITS Financial batch, adjudication batch).
• Creating reports of Medicare claims for the management.
• Worked in the Data Mapping and the section mapping of the new codes.
• Used Sql Server to extract the information to validate that the datas and check the codes and Procedures form the tables.
• Worked closely with the developers to make necessary changes in the FACETS GUI for the adaptation of new ICD codes in Membership, Provider, Claim modules.
• Worked on dashboard architecture and structure to make it more efficient for non-technical resources, Designed it to make it efficient for query and reporting
• Documented and adjusted the necessary changes needed in the FACETS Database.
• Created a well developed system for the FACETS to adjudicate the new ICD codes in claim processing.
• Involved in the testing of the different EDI transactions 834, 837, 835, 270,997, 271.
• Worked on Business Requirement documents and Use Cases for creation of Test Scenarios and Test Case development for number of releases/phases.
• Prepared and maintained requirements traceability matrix (RTM) throughout the project lifecycle.
• Prepared different mock ups for several kinds of configuration use cases.
• Documented Test plans, Test Cases and schedules for Test Case Execution
• Performed software testing and technical writing for user manuals following certain quality assurance standards.
• Conducted System Testing, Regression testing, GUI testing during the releases and interacted with the developers to resolve any technical issues.
• Organized JAD sessions and workshops with BAs, SMEs, Network Administrators and Developers
• Validated HIPAA Compliance to track defects and test results in Rational Clear Quest.
• Conducted regular project meeting calls with onsite and off shore teams
• Solved the different kind of queries in the database to verify the existing trading partners

Environment:
MS office tools, MS Project, Agile, MS PowerPoint, Requisite Pro, Rational Rose, Quality Centre, SQL Server, Share Point 2007

Confidential, Miami, FL Feb 2009- June 2010
Business Analyst

Leon Medical Centers Health Plans, Inc. was established to meet the needs of Medicare patients of Leon Medical Centers. A project at Leon Medical Center Health Plans was undertaken to migrate the adjudication system from Mainframe to Facets 4.51. The new adjudication system is believed to bring better performance with the proper configuration and customization helping in reduced administrative cost and increase in speed and accuracy of claim processing.

Responsibilities:

• Attended 2 weeks Facets training from the Trizetto team
• Coordinated and worked with Project Manager to prepare Project Plan in MS Project
• Assisted in preparing Scope Document by analyzing various business domains interdependencies, end to end business processes of claims adjudication, various business domains scope statement, current business process flows and current system documentations.
• Participated and organized Requirement Gathering sessions with the stakeholders to elicit and analyze requirements.
• Worked on Facets Membership module to and validated the database with the Medicare patients.
• Worked on Enrollment batches (ErCmcRunElig) , Mass Plan change batch, Group transfer batch, ID card batches
• Analyzed and Created gap analysis “As-Is system” and “To-Be systems”.
• Created the Functional Requirements documents for the Business Requirements.
• Enrolled the Medicare recipients in the Facets, Migrate the Existing Medicare members from Mainframe to Facets in Enrollment Batches
• Gave end to end support to mappings in Informatica.
• Involved in creating new codes from existing mappings to new mappings in Informatica.
• Involved in reporting the records of Medicare members to CMS.
• Created a successful system for the Adjudication of Medicare Patients into the Facets systems 4.51
• Created various UML diagrams of business process including Use Cases, Activity Diagrams, and Process Flow Diagrams to segregate high-level and low-level requirements using MS Visio.
• Worked extensively in the configuration and setup of the Applications (Member, Provider, Claims module configuration)
• Followed Workgroup for Facets Electronic Data Interchange standards for testing that need to comply with the HIPAA guidelines.
• Worked on the Data models of the HIPAA Gateway (Trade Partner and Trade Agreement tables)
• Executed business process gap analysis “As-Is system” and “To-Be systems”.
• Worked on the EDI 834-file load to Facets through MMS (Membership maintenance sub-system).
• Worked on solving the errors of EDI 834 load to Facets through MMS.
• Worked on the different EDI files including 835, 834, 837, 997, 270,271 to check their integrity by writing the test plans and test cases for the EDI transactions.
• Worked on different batch processing of Member Enrollment batch, mass plan change batch.
• Worked on the report customization of the facets for different departments.
• Created keyword files to have member data bulk loaded into the Facets system through the MMS batch
• Formed a bridge between project manager and different teams with effective presentations.
• Was involved in Integration Testing, and User Acceptance Test.
• Interacted with other teams through walkthroughs, meetings, etc. to resolve various issues.
• Validated the scripts to verify they have been executed and meet the scenario description.

Environment:
Windows 2008/XP, UNIX, Oracle 9i, Quality Center, Quick test Pro, HIPAA Standards, FACETS 4.51, MS Visio, MS Project, SharePoint 2007

Confidential,Charlotte, NC Jan 2008- Feb 2009
Business Analyst

Project Description:
The project scope is to develop an application to AUTOMATE REPORTING of various manually generated reports and provide a consistent view of them to the Senior Management in a Reporting Dashboard. Creating a one stop Platform where the Senior Management and Stakeholders can see the Performance of the Company in an EASY TO READ MANNER on a Dashboard and can make decisions quickly and with Integrity. Reports are generated in the form of Diagrams, Charts, Text, Pdf for ease and quick understanding of the current situation of the Performance by the company.

Responsibilities:

• Gathered the Business Requirements from the Stakeholders.
• Created the Functional Requirements Documents.
• Assisted the Project Manager in Project Planning and Work Breakdown Structure.
• Conducted brainstorming sessions with Project focus Groups.
• Prepared Feasibility analysis for automation of the report and inclusion into the Dashboard.
• Stored and modified requirements in MS - Word.
• Documented business requirements with wireframes and mockups to explain in detail the business implications and impacts.
• Created Use Case Diagrams, Activity Diagrams, Sequence Diagrams, Dataflow Diagrams in Enterprise Architect.
• Analyzed and prioritized user and Business Requirements as system requirements that must be included while developing the software.
• Analyzed various resource files being used to generate the report and documented data mapping and data source interface documents to assist the development team.
• Worked with the Business Objects developers to provide input for generating automated and ad-hoc Business Objects reports.
• Used SQL for querying and analysis purposes on various source tables and conditions applied.
• Helped the testing team in creating the test plans and test scripts.
• Created the Requirements Traceability Matrix.
• Assisted Testing Team in System and Unit Testing.
• Assisted the users in UAT testing by providing test scenarios and test data.
• Assigned problems to appropriate software development team for fixes.
• Authored progress and completion reports, which were then submitted to project management on a weekly basis.

Environment:
MS SQL Server , MS Word, MS Excel, MS PowerPoint, MS Access, MS Project, Enterprise Architect, TestDirector, MS SharePoint 2007, RUP.

Confidential,KTM, Nepal Jan 2006-Dec 2007
Business Analyst/ Quality Analyst

Project Description:
Confidential, is a financial institution dedicated to providing quality customer service with a strong customer base. This project involved building an on-line e-banking web site for the bank, where customers can access their banking information and can perform different operation from any place without walking into the bank which will save the time of the bank employees and as well as the customer. This will give and industry edge to the NIBL, and at the same time they can utilize their resources in different sector.

Responsibilities:

• Gathered the Business Requirements through Meetings, Questionnaires from Business Team
• Created and maintained a project schedule using MS Project showing all of the deliverables target dates.
• Created the Functional Requirements Documents On MS Excel.
• Actively participated in designing Test Plans, Test Cases on TestDirector
• Created the Requirement Traceability Matrix in MS Excel to ensure all the Business Requirements are covered.
• Conducted walkthroughs with the end users and stakeholders to gather the modification requests from the user to upgrade or change the business specifications for the product.
• Ensured all applications were tested for functionality and were adequately controlled in production.
• Provided support Interacted with business heads to finalize the business requirements for the application.
• Used AGILE SDLC methodology for requirements and object oriented analysis tasks.
• Involved in JAD Sessions, used Visio for presentation of process flow to various groups.
• Closely interacted with designers and software developers to understand application functionality and navigational flow and keep them updated about business user’s sentiments.
• Developed and managed Requirements, UML Analysis and Design documents.
• Developed Use Case diagrams, business flow diagrams, Activity diagrams and Sequence diagrams so that developers and other stakeholders can understand the business process.
• Assisted the QA team with Black box testing and White box Testing.
• Developed detailed ERDs and DFDs using various modeling tools and developed databases based on the system model following the techniques in SDLC (software development life cycle).
• Created in the UAT and working with the client to resolve the Bugs during the testing and Prioritize the defects for the solving the problems.

Environment:
Waterfall, MS Visio, MS SharePoint, MS SQL, HP Quality Center, MS Project 2003, Microsoft Office 2000 Tools, HTML and XML