SUMMARY:

• Qualified professional with over Six years of extensive experience in the field of Systems Analysis, working with the technical staff to implement management and staff's business requirements into the software application in the Healthcare Industry.
• Highly motivated team player with excellent communication, presentation and interpersonal skills, always willing to work in challenging and cross - platform environment.
• Experienced as a System Analyst in using the 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.
• In-depth knowledge of creating use cases, functional design specifications, activity diagrams, logical, component and deployment views to extract business process flow.
• Extensively used rational tools for UML, tracking and reporting and applied the Rational Unified Process in all areas of a software development life cycle.
• Extensive knowledge of Medical Management Information Systems (MMIS), National Provider Identification (NPI), Health Insurance Portability & Accountability Act (HIPAA) standards, Electronic Data Interchange (EDI), Health Level -7 (HL7), HIX (Health Information Exchange), EMR/EHR, Health Care Reform and Patient Protection and Affordable Care Act (PPACA).
• Experience as a Facets Business Analyst in mapping business requirements, designing customized solutions with strong analytical skills and ability to analyze business practices and define optimal procedures.
• Worked on developing the business requirements and use cases for Facets batch processes; automating the billing entity and commission process
• Interviewed SMEs and Stakeholders to get a better understanding of client business processes and gather business requirements.
• Conducted JAD sessions, created Use Cases, work flows, screen shots and Power Point presentations for the Web Applications
• Utilized a fusion of industry knowledge and technical programming to provide executive management the development and implementation of interactive business1s tools, and strategic analysis, vital for use in mission-critical decision-making
• Conducting requirement gathering sessions, feasibility studies and Impact Analysis and organizing the software requirements in a structured way using Rational RequisitePro to track development.
• 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: 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: Rational Unified Process (RUP), Waterfall, UML & Microsoft Office SharePoint 2007

Automation Tools: Requisite Pro, Win runner, QTP, Test Director, Quality Center

PROFESSIONAL EXPERIENCE:

Confidential, Long Beach, California

Business Analyst

Responsibilities:

• Gathered Business Requirements, created Functional Requirements Document (FRD) and analyzed data/workflows, defined the scope, financial projections and cost/benefit analysis; progressed from Problem Statement to well-documented designs. Prepared user guidelines for easy access of the application.
• Managed, analyzed, and implemented the project following the Agile SCRUM Methodology throughout the entire application development lifecycle.
• Created technical mapping document, technical specifications document, technical flows and Involved in feature and user story creation.
• Worked with the implementation and ongoing support of the Health Insurance Exchange (HIX) and compliance with Affordable Care Act (ACA) mandate and Health Care Reform Act.
• Practiced agile methodology, lead sprints and prioritize line items based on key business initiatives with respect to the Affordable Care Act (ACA) mandate and Health Care Reform Act.
• In Agile process, actively participated in gathering the business requirements by interviewing the Subject matter experts (SMEs) and documented them in a format that could be reviewed and understood by both business and technical teams.
• Worked closely with the business owners to gather their financial needs and features. Organized information and developed business cases offering recommendations to our clients.
• Develop, design & implement department plan to configure new Facets integrated processing system, to include but not limited to, workflow, management oversight and performance analysis.
• Involved in identifying and studying the Facets system data and conducting field by field analysis of Facets system for the attribute mapping purpose.
• Worked out to get the correct count on number of Members, their Eligibility status and their Demographic information to set Groups/Subgroups/Subscribers/Members accurately in Facets.
• Analyzed the data in the Facets source system to map into the correct field and attribute in the target storage.
• Participated in all phases of the Facets Extended Enterprise administrative system implementation to include the planning, designing, building, validation, testing, and Go-live support phases.
• Performed Claims Unit and Regression testing.
• Led and managed the User Acceptance Testing (UAT) for the implementation of Facets Extended Enterprise administrative system with emphasis on ensuring that the HIPAA regulation are met across all the modules.
• Prepared basic design diagrams including flow charts, data flow diagrams using MS Visio following the UML conventions
• Analyzed Business Requirements and created Use Cases, Use Case Diagrams, Navigation Flow, Business Flow Diagrams and Work Flow Diagrams for applications and created Activity Diagrams / State Chart Diagrams using MS Visio and created conceptual model, behavior diagrams.
• Translating business requirements into technical flow as well as Creating mapping document, design technical flow and technical design document.
• Ensures documentation and maintain integrity of patient records on McKesson and Epic problems and requests.
• Conducted JAD sessions to get SME's input on how to implement the application for Group Disability Claims.
• Worked as an Interface between the users and the different teams involved in the application development for better understanding of the business and IT processes.
• Create documentation for both IT peers and users
• Performed GAP analysis to identify the gap between the optimized allocation and integration of the inputs, and the current level of allocation.
• Created AS-IS and TO-BE business process flow diagrams, Integrate process flow diagrams to show end-to-end business model and business process mapping exercise including swim lanes.
• Identified Test Harnesses, which assisted QA effort in reducing the redundancy of Automation Scripts and
• Experience in the documentation of system and business requirements and specifications, design and development of use and test-case scenarios and root-cause analysis, GAP analysis, developing traceability Matrix, test plans, test scripts using SQL, conducting System Integration testing (SIT), user acceptance testing (UAT), training, and implementing new processes and technology.

Confidential, Milwaukee, WI

Business Analyst

Responsibilities:

• Analyze and evaluate highly complex business and market data; interpret data for the purpose of determining organizational/program performance, trends and/or probability; perform and consult on analysis/evaluation using enterprise data miner tool of Microsoft R.
• Prepare business requirement document (BRD) from extracted data analysis and consensus with stake holders in MS Word.
• Generate detail project estimation and evaluate project cost in Microsoft Excel spread sheet. Get approval from business account department for the project cost.
• Prepare system design diagrams using Microsoft Visio and Microsoft word software.
• Worked with MS SQL developers to prepare relational database diagram model. Helped developers to create schemas, constraints, foreign key relationships.
• Prepare mapping document using Microsoft Excel. Distribute and acknowledge the response among integration team and database team.
• Validated documentation and validations in compliance with Affordable Care Act (ACA).
• Extensively worked on Facets, the claim processing tool used in the project.
• Involved in configuration of Facets Subscriber/Member Application group.
• Analyzed the member/eligibility information on claim to that in Facets.
• Worked on Facets to efficiently execute core administrative functions, including claims processing, premium billing and customer service.
• Worked with diverse team of Business users, internal and external stakeholders by conducting meetings, interviews and focus group sessions to Elicit and understand ACA and HIX, FFM and SBM policies, requirements and prepared and document BRD and FRD
• Committed to establishing FFM/FFE (Federal facilitate Exchange) under HIX (Health Insurance Exchange) that meet the functional requirements of Patient Protection and Affordable Care Act (PPACA)
• Worked with SME close to analyze the Claim Adjudication Process setup in Facets.
• Implemented automated COB (Coordination of Benefits) processing of Medicare claims into Facets.
• Worked with Claims, enrollment, eligibility, benefits verification for members and providers, benefits setup, and backend payment cycle in Facets.
• Analyzed the change detection process on Facets database tables to capture the daily changes done by Users through Online Facets Application.
• Apply forecasting and predictive modeling techniques to enhance strategic thinking and business planning using Microsoft project.
• Prepare project deployment plan. Discuss with development, database and infrastructure teams. Resolve issues for the production deployment and system delivery.
• Analyze and monitor transportation service line portfolio mix including financial and market performance to assist in business and strategic Planning activities using graphics and presentation.
• Researches, analyzes, and interprets data by monitoring logistics environment, market and competitor information to continually identify opportunities, threats and trends to support the planning and marketing activities of the organization using econometrics and time series analysis.
• Coordinates and completes ad-hoc inter-department requests and requests from strategic partners and consultants by providing decision support and consultative services using application facility (AF).
• Ensures coordination with other internal and external databases to provide accurate and timely information and analysis for decision making, market research, strategic planning, business development and service evaluation.
• Build strong relationships with the business community and freely exchange new ideas and suggestions for improvement within the IT and business community.
• Maintains and develops databases and analytics utilized for strategic and business planning efforts, decision-
• Experience in creating advanced statistics such as: regression, clustering, decision trees, exploratory data analysis methodology, simulation, scenario analysis and modeling

Confidential, Chicago, IL

Business Analyst

Responsibilities:

• Conducts the detailed analysis of network that exists at case managers at insurance and attorney offices that interact with our injury clinics.
• Integrate client networks with the clinic's network using established best practices
• Contribute to the implementation of software products to meet application needs.
• Created new web applications using MVC pattern for better user interface
• Integrate client system security with clinic's systems security.
• Worked on analysis of Facets claims processing system and to gathered requirements to comply with HIPAA 5010 requirements.
• Extensively worked with HIPAA Privacy Facets application groups.
• Monitor SQL based software Autumn 8 with the functionalities of database administrator
• Integrate the case management software's administration modules across all clinics managed by the management company
• Creates technical solutions for function, performance, reuse and availability and prepares technical specifications
• Use Active directory (directory services) and resource Administrator to create and maintain user accounts, email accounts.
• Consistently uses industry-standard tools required to accomplish a development task.
• Involved in project management using MS Project and performed GAP analysis
• Documented requirements, associated change requests with requirements and connected requirements with Use cases.