SUMMARY:

• Business Analyst with over 8 years industry experience in business data modelling, software requirement analysis, process modelling, process flow and quality assurance skills using different methodologies, mainly OOA, OOAD and UML
• Highly motivated team player with excellent communication, presentation and interpersonal skills, always willing to work in challenging and cross - platform environment.
• Experienced as a Business/Systems 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.
• Highly proficient in working with users to gather requirements, analyze them and subsequently use the Rational project and design tools to model the requirements.
• 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.
• Used Query Analyzer, Execution Plan to optimize SQL Queries.
• Strong understanding of project life cycle and SDLC methodologies including RUP, RAD, Waterfall and Agile.
• Expert with SQL queries and RDBMS such as Oracle, MS SQL Server .
• 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
• Gathered and documented Non-functional requirements.
• Experience in writing SQL queries and optimizing the queries in Sybase, Oracle and SQL Server 2.
• 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.
• Having knowledge on Microsoft TFS (Team foundation Server).
• Worked in close co-ordination with the testing team in developing test plan and test cases from functional and business requirements.
• Expertise in Software Development Life Cycle (SDLC), Use Cases, Business Process Modeling Notation (BPMN), Object-oriented Analysis and Design, Rational Unified Process (RUP) and Rational tools used during all four phases of RUP: Inception, Elaboration, Construction, and Transition.
• 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 ClearQuest 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, facets

Processes/Technologies: Rational Unified Process (RUP), Waterfall, UML & Microsoft Office SharePoint 2007, OOAD

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

PROFESSIONAL EXPERIENCE:

Confidential, San Antonio, TX

Sr System Facets Analyst

Responsibilities:

• Conducted user interviews, gathered Requirements, analyzed the Requirements and managed changes. Participated with leads to develop the prototypes and improvise the user interface with the system.
• Work closely with Business Owners and Stakeholders to outline Business Requirements and as is v/s To Be process and document.
• Developed test cases based on the crosswalks and compliance guidelines for 277/288, 834, 835, 837 Professional, Institutional and Dental claims and for 270/271 eligibility benefit inquiry and response.
• Analysis of new Business Requirements and preparation of the Functional Design Specifications.
• Supported UAT/business testing shadow testing activities using TFS as the tool to track Agile progress
• Sound understanding of Object Oriented Analysis and Design OOAD and proficient in documentation of as-is and To-be business processes.
• Document step by step Facets configuration steps for Quality Assurance team.
• Work and triage Facets configuration issues and route work back for correct processing.
• Acquired domain knowledge in Claims Processing and Medical, Dental and Drug Benefits.
• Translated high level business / data requirements into Process, Workflow, and Data Flow Diagrams using Rational Rose / MS Visio / BPMN towards facilitating clear understanding of the business process
• Analyzed and studied the technical, structural and data content changes for EDI transaction sets 834 (Enrollment and Maintenance), 837 (Professional, Institutional and Dental Claims) and 835 (Claim Payment/Advice).
• Worked on TFS (Team Foundation Server) for managing bugs and SharePoint for document storage.
• Analyze and trouble shoot all issues surrounding Provider Agreements, Network Rows, Supplemental Mappings, and all facets of claim and system issues.
• Used Microsoft Visio for Business Process Modelling and Data flow diagrams
• Created Use Case Diagrams, Activity Diagrams, Sequence Diagrams and ER Diagrams in MS Project. Designed the business requirement collection approach based on the project scope and SDLC Methodology.
• Working so closely with PMO and help maintain project portfolio and portfolio data analyst in MS project and MS Excel.
• Interface and back-end testing of web-based Health Benefit Adjudication applications. Adjudication of EDI transactions and submission of manual claims for Pharmacy and Dental.
• Creating and running EDI claims for Pharmacy and Dental heating different functionality of the adjudication system.
• Work with BI team and Infrastructure teams to understand the flow of data and use them for backend testing validation.
• Debugged and fixed several production issues. Created Struts actions which encapsulate business logic of the application. Designed the UI (web interface) of the application, along with prototyping. Documented and delivered Functional Specification Document to the project team.
• Healthplan business Systems Engineering on Core Facets V4.21 conversion to V4.41
• Coordinated with offshore people and updated the tasks to project manager and team.
• Performed UAT testing along with call center managers to make sure that application meets their requirements.
• Built SQL scripts for demonstrating the prototypes and for verifying the result sets.
• Take part in decision making of converting manual test cases into automated test scripts and analyzing their life time and time required to update the scripts.
• Defined the test criteria, project schedules and base lined the Test Plan with the help of project meetings and walkthroughs.
• Prepared and executed test cases for Navigational test, Functionality testing and GUI testing.
• Responsible for modification and executing of the Test Scripts.
• Manually testing the whole application before going for the automated testing.
• Performed user acceptance and parallel testing for coding, pricing, and benefit builds in Facets.
• Backend testing of the DB by writing SQL queries to test the integrity of the application
• Identify and resolve issues by working with all portfolio teams
• Actively participated Black Box Testing on the application and validated the dataflow in the application.
• Performed functional testing, end to end User testing for following Application CECC, Televantage, CIC3.0, CIC4.0 Careportal, MESO and Cview
• Testing and validating 270 and 271 coming from client to store data in our eligibility file to serve clients member.
• Responsible Testing and validating FTP file from FTP server Extract process to deliver daily and monthly extract to client to full fill client data requirement for service provide.
• Help testing call center call recording form Televantage and CIC4.0 for meet client recording requirement and deliver recording Extract to client.
• Help production support team to identify issue and apply hot fix to production by coordinating testing and production release process.
• Participating in big upgrade release and new implementation release to production during hour and after hours.

Environment: / Application: Java, Business Object, Quick Test Pro 8.2, facets, Mercury Quality Center, J2EE, UNIX, XML, SQL, SQL management Studio, MS Visio, MS Office, Quality Center 9.0, QTP, SharePoint, Five9, TFS, MESO, Careportal, OOAD, Crystal Report, CECC, Televantage, Interactive Intelligence CIC3.0 & CIC4.0, Adopter application for CECC

Confidential, Greenwood village, CO

Sr . System Analyst

Responsibilities:

• Participated in requirements meetings, writing requirements in Caliber RM, converting requirements from Caliber RM to HP Quality Center.
• Gathered Business Requirements, analyzed data/workflows & performed GAP analysis for Dental Data Migration in compliance to the protocol.
• Updated provider tables, diagnosis tables, fee schedules, and service ids contained in Facets back end tables
• Validating migration of existing users to Pre-Prod environment before going live.
• Participated in the JAD sessions along with the technical team members and clients to elicit requirements for HIPPA migration process.
• Reviewing the defects and Reporting the Defects through Quality Center.
• Mapped all as-is business processes using BPMN standards on MS Visio.
• Assisted in the designing and development Quality Assurance standard and processes to all levels of project team.
• Transferred data (ETL) to Data ware house Environment using SSIS and SSAS.
• Created Functional and Technical requirement documentation using Facets data model, also, was the gatekeeper for the change control process.
• 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, LO INC and SNOMED Mapping, HL7 Message Validation, ICD 9, Electronic Health Records, Electronic Medical Records.
• Used the BPMN to GAP Analysis to bridge the gap between business processes.
• Schedule meetings with technical personnel to determine technical parameters for EDI and other related processes, including communication, security, and privacy. Create transaction sets requirements, usually with Microsoft Excel, for transactions such as: HIPAA 270/271, 276/277, 278/278, 820, 834, 271U, 835, 837-(I,P, &D), 835 Remittances and others. Resource for UB04 and CMS1500 billing formats, transaction sets requirements, EDI development and Design, X12 protocols through Version 5010 and Errata; conversion needs and understanding of legacy EDI formats
• Participated in testing of Orion Rhapsody Route to receive and process HL7 ORU R01 Version 2.5.1 messages to Websurv
• E xperience working with Medicare and Medicaid insurance data, Tricare and Dental Insurance Plan along with knowledge of the expertise surrounding HIPAA 4010/ transactions such as 837, 835, 834, 278, 270 and 271. .
• Assisted the PM on various projects throughout the Project Management Life Cycle (PMLC) including Project Charter, Project Plan and Resource allocation.
• Performed Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data
• Created and managed project templates, use case project templates, requirement types and traceability relationships in DOORS.
• Manage HL7 Interface Development and oversee integration activity for primary interface engines and applications
• Analyzed and translated business requirements into system specifications utilizing UML and Agile methodology.
• Designed workflows and allocated permissions within SharePoint.
• Utilized corporation developed Agile SDLC methodology. Used Scrum Work Pro and Microsoft Office software to perform required job functions.
• Testing of HL7 Message Validation and sending of ADT Messages like ADT A01, ADT A04 and ADT A08.
• Provided expertise in strategic planning, business process modeling, business process analysis, object-oriented analysis & design, use case modeling, use case analysis, component-based development, and quality assurance.
• Prepared Business Process Models that includes modelling of all the activities of the business from the conceptual to procedural level. Followed top down, leveled technique for building Business Process Models.
• Created Use-Case Models using Rational Rose to depict Actors and Use-Cases in various Business Processes and identification of Basic/Alternative flows and definition of preconditions and post conditions of the system.
• Worked with the UI team to create the User Interface screenshots to be presented to the Business.
• Performed Gap analysis for the modules in production, conducted feasibility study and performed impact analysis for proposed enhancements.
• Verified the functional aspect as per the Business Process and validated the interfaces with the other systems and data conversion from the legacy system.
• Provided key input in working with System’s architect to baseline System Performance, identified expected Bottlenecks and set Load and Stress Targets.
• Maintained and kept track of stakeholder’s requests for enhancements and changes.

Environment: Mercury Quality Center, ETL, Caliber RM, HP Quality Center, EDI Transactions, HIPPA 4010 and 5010, ICD-9, ICD-10, PMLC, ER diagrams, SQL queries, SQL Server 2005, DOORS, UML, OOAD, Agile methodology, SharePoint, SDLC, Microsoft Office, Rational Rose

Confidential, NY, NY

Sr. System Analyst

Responsibilities:

• Conducted weekly meetings for deciding the Policies and Procedures to be followed while constructing new sites.
• Performed the requirement analysis, impact analysis and documented the requirements using Rational Requisite Pro.
• Working knowledge of healthcare Technology standards such as HL7, ANSI ASC X12, IHE XDS/XDM, HITSP, CCR(continuity of Care Record), CCD(Continuity of Care Document),NCPDP Script 8.1, ELINCS, and CDA
• Responsible for architecting integrated HIPAA, Medicare solutions, Facets.
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, OOAD using UML and Business Process Modelling
• Documented the server farm requirements and requirements related to security within Share Point and using Windows Active Directory.
• Performed Gap Analysis to check the compatibility of the existing system infrastructure with the new business requirements.
• Used JavaScript for client side validations extensively along with .NET validation controls.
• Designed High level design, for New process, integrating with legacy and Facets
• Used Query Analyzer, Execution Plan to optimize SQL Queries.
• Tested the claims processing with EDI transactions (270, 271, 835, 837) in HIPPA and HL7 Environment.
• Meticulously assessed data from various sources and generated conceptual and logical database designs using ERwin data modeling tool.
• Interacted with client and the Technical Team for requirement gathering and translation of Business Requirement to Technical specifications.
• Validated the reports and files according to HIPPA and HL7 enforced standards.
• 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.
• Involved in Managing Data modeling project from Logical design and implementation of Sybase Database.
• Worked on SQL queries and PL/SQL stored procedures for QA testing and data validation of MIS reports, data analysis for problem identification and recommendation of temporary or permanent solutions. Toad was used for accessing the Oracle 10g database.
• Facilitate installation and configuration of HL7 interfaces based on facility workflow and vendors’ configuration requirements
• Analyzed and translated business requirements into system specifications utilizing UML and RUP methodology
• 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.
• Interacted with line of business managers and coordinated the transition into the security database to assure business compliance with SOX.
• Analyzed trading partner specifications and created EDI mapping guidelines

Environment: MS Office, SQL Server, Agile, MS Project, MS FrontPage 2003, Oracle, MS Access, EDI, Documentum 2.0., Microsoft Excel, Java, Microsoft Word, Microsoft Power Point, Visio.

Confidential, Huntsville, AL

Sr. Business Analyst

Responsibilities:

• Involved in Trizetto Facets System implementation, Claims and Benefits configuration set-up testing, Inbound/Outbound Interfaces and Extensions, Load and extraction programs involving HIPPA 837 and proprietary format files and Reports development.
• 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 according to UML methodology thus defining the Data Process Models.
• Guided development team in the Oracle 9i based database.
• 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.
• Prepare HL7 threads, ports and type for all systems within facilities for testing, clinical workflow and readiness for interface conversions
• 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
• Establish timeline and communicate project milestones to all vendors Manage connectivity (IP/VPN), unit, integrated, and parallel testing for all HL7 interfaces
• Understand the As Is system and develop the To Be system concept and also prepare the System Process Maps.
• Used CSS, HTML and Javascript for GUI front end designing and validations.
• 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.
• Thorough rounds of testing of each HL7 message types (ADT,ORU,ORM,ZFN,DFG), ports, from unit testing phases to integration phases through "go-live"
• 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 the 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.
• Wrote PL/SQL statement and stored procedures in Oracle for extracting as well as writing data.
• 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 also monitored these revisions.
• Involved in compatibility testing with other software programs, hardware, Operating systems and network environments.

Environment: Requisite Pro, Rational Rose, Agile, HL7Interfaces, PL/SQL, HTML, MS Office, MS Visio, EDI, Rational Clear Quest, Rational Clear Case, Oracle, UML,RUP, Microsoft Excel, Java, Microsoft Word, Microsoft Power Point, Visio.

Confidential, Marlton NJ

Sr. Business Analyst - Prior Authorization (Claim Processing)

Responsibilities:

• Gathered, analyzed, documented business and technical requirements from both formal and informal sessions and validate the needs of the business stakeholders.
• Responsible for integrating with Facets .Designing test scripts for testing of Claims in Development, Integration and production environment.
• Conducted user interviews and documented business and functional requirements.
• Performed Requirement Analysis and developed Use Cases, Activity Diagrams using Rational Rose
• Defined, developed specs for federal reporting specific to Medicare Advantage
• Performed Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data
• Upgraded HMO Medicare EDI and reporting.
• Completed the documentation of Claims Scenario’s for the source system
• Analyzed the existing claims process and specific business rule logic will be applied in the ACP model.
• Prepared for GAP Analysis; identified and documented improving areas to meet capital requirement regulations.
• Documented Medicare claims processing.
• Designed High level design, for New process, integrating with legacy and Facets
• Involved in creating business processes and modeling diagrams using Rational Unified Process (RUP).
• Organizing JAD sessions, personal interviews and surveys in the process of collecting requirements including that of G.M.’s and other higher management
• Exposed to Agile methodology.
• Involved in Service Oriented Architecture (SOA) of the claims processing system
• Created use case scenarios and documented work flow and business process using Rational Rose
• Involved in project management using MS Project
• Collaborated with External Auditors and documented SOX compliance requirements
• Documented requirements, associated change requests with requirements and connected requirements with Use cases.
• Wrote test cases and test scripts for the User Acceptance Testing
• Incorporated Rational Unified Process (RUP) to create Requirement Document Specifications using Visible Analyst.
• Performed extensive data modelling to differentiate between the OLTP and Data Warehouse data models
• Identified/documented data sources and transformation rules required populating and maintaining data warehouse content.
• Maintained benchmark controls to policies, company standards and contracts, performed vendor sourcing, pricing and contract negotiation, performed procurement, ensured compliance with service/joint interest contracts.
• Used Rational Clear case for version control
• Responsible for creating test scenarios, scripting test cases using testing tool and defect management for Policy Management Systems, Payables/Receivables and Claims processing.
• Involved with all the phases of Software Development Life Cycle (SDLC) methodologies throughout the project life cycle.
• Served as conduit for managing system requirements between the business and the software development team.
• Queried database using SQL for backend testing
• Used Rational clear quest for defect management

Environment: Windows XP Professional, Oracle9i, MS Access 2000, MS Excel, RUP, Oracle, UML, Rational Rose, Requisite Pro, Clear Case 2002, Java, Rational Clear Quest 2002, Oracle, MS Office suite, MS Visio 2003.