PROFESSIONAL SUMMARY:

• 6+ years of experience as Service - oriented Senior Business Analyst /System Analyst with an extensive background in identifying business with State and Healthcare clients.
• Experience in Business Requirements Gathering, Application Design, Data Modeling, Development, Implementation and Testing of Client/Server applications, with a sound working knowledge in Data Warehousing/Business Intelligence Systems Health Care domain
• In depth understanding on handling every aspects of the project from requirement gathering, documentation t o working with development team and test plan execution.
• Strong experience in Data Analysis, Data Migration, Data Cleansing, Transformation, Integration, Data Import, and Data Export through the use of multiple ETL tools such as Ab Initio and Informatica.
• Experience in testing and writing SQL Queries, Stored Procedures, Functions, Triggers and packages.
• Thorough understanding of healthcare industry including Eligibility, Enrollment, Benefits, Claims, Medicare, Medicaid and implementation of HIPAA key EDI (ANSI X12) transactions
• Well-versed experience in all EDI transactions like 270/271, 834, 837 P, 835 and conversion of and ICD- 9 and ICD- 10.
• Worked on Power MHS built environment which includes various sub-systems like Claims (Claims Processing & Claims Loading), HIPAA/EDI transactions, Provider Enrollment, PA (Prior Authorization), Client, Common Components, COB/TPL, Rate Settings, Drug Rebate, Reference, Managed Care, Interfaces etc.
• Experience with FACETS solution for healthcare and strong understanding of Managed Care such as HMO, PPO, & Long Term Care.
• Well versed with HIPAA, FACETS, claim adjustments, claim processing from point of entry to finalizing, claim review, identifying claims processing problems, their source and providing corresponding solutions.
• Good Knowledge in Health Care Transaction, EDI HIPAA X12 transactions (837,835,834,270/271,276/277) Inbound and Outbound 837 Institutional, Professional, Dental and Pharmacy Claims.
• Experience in training developers and advising technical groups on reporting best practices.
• Proficient in Requirement Management, including gathering, analyzing, detailing and tracking requirements.
• Specialist in developing User Interface (UI) design and ware framing.
• Extensive expertise in the writing and interpretation of Story Card, User Stories, Use Cases, Functional Requirements, Screen Specs, and Data Mapping Documents
• Strong knowledge of the Software Development Life Cycle (SDLC) methodologies such as Water Fall, Agile, Scrum and RUP.
• Proficiency in orchestrating Joint Application Development sessions that bring all elements of the project together in an effort to maximize efficiency and outline vision.
• Proficiency in MS Visio in creating, analyzing and implementing business workflow diagrams including use case diagrams, activity diagrams, state diagrams, sequence diagrams, collaboration diagrams and deployment diagrams.
• In depth knowledge in SDLC involved in all stages from defining, designing, to developing, debugging and deployment of application.
• Expert in creating all sorts of business artifacts such as Business Requirement Document (BRD), Functional Requirement Document (FRD), Use Cases, UML diagrams, Data Mapping Documentation, Requirement Traceability Matrix (RTM)

TECHNICAL SKILLS:

OS: Win XP, Vista, Windows Server, Linux/UNIX

Project methodology: Rational Unified Process (RUP), UML, Agile

Database: Oracle, MS SQL Server, Teradata, MS access

MS office tools: MS Visio, MS Project, MS Excel, MS SharePoint, MS outlook

Testing Tools: HP Quick Test Professional, HP Quality Center

Scripting: PL/SQL, T-SQL, XML, HTML, C#, .NET, jQuery, JAVA

Querying Tools: Quest TOAD, SSMS, Teradata SQL Assistant

Modeling tools: ERwin, ER studio (embarcadero), toad data modeler

BA Tools: IBM DOORS, Remedy suite, IBM RAT, RQA, DXL

ETL/BI Tools: SAS, Informatica Power Center, Tableau, Spotfire, Report Builder

BI Developer Tools: Crystal Reports XI, Business Object XI, Crystal Enterprise, SSIS, SSAS, SSRS

PROFESSIONAL EXPERIENCE:

Confidential, Detroit, Michigan

Sr. Healthcare System Analyst

Responsibilities:

• Involved in all SDLC stages under Agile process requirement analysis, implementation, testing (functional and use acceptance) and deployment.
• Conducted numerous JAD sessions with Business users, developer, CQA and SMEs.
• Prepared the Business Requirement Document (BRD) and Functional Requirement Document (FRD) for the enhancement of the existing services.
• Documented the complete process flow to describe program development, logic, testing, and implementation, application integration, coding.
• Involved in defining the source to target data mappings, business rules and data definitions.
• Responsible for defining the functional requirement documents for each source to target interface.
• Documented, clarify, and communicate requests for change requests with the requestor and coordinate with the development and testing team.
• Worked on FACETS Subscriber/Member application requirement. Worked on FACETS Data tables and created reports using queries.
• Worked with testing team on manually loading data in FACETS.
• Did the forward and backward data mapping between the fields in mainframe and FACETS.
• Analyzed the mainframe reports for member/eligibility/claims and mapped the fields with FACETS batch jobs and reports.
• Tested the changes for the front end screens in FACETS related to following modules, test the FACETS batches (membership).
• Implemented automated COB processing of Medicare claims into Facets
• Performed GAP analysis as it pertains to membership management and claims processing to evaluate the adaptability of the new application with the existing process.
• Produced Activity diagrams with defined swim lanes as part of the claims process analysis.
• Validating the EDI 837 claim billing (professional, institutional and dental claims) & 835 (remittance advice or payment) claims adjudications
• Understood the Provider Contracts and Pricing of claims as well as the Member Benefits to be applied on the claims.
• Analyzed conversion of Provider and Member data, Group configurations, plan codes, benefit set-ups, fee schedules, provider pricing, capitation set-ups, etc.
• Analyzed the functional details of various modules in mainframe and did the GAP analysis with the new system.
• Worked with offshore team and helping them in understanding the client business requirement and facets core functionality.
• Designed and implemented data integration modules for Extract/Transform/Load (ETL) functions.
• Supported documentation on collaboration amongst the plan, providers and members.
• Created Reports on clinical data exchange for payment between providers and payers.
• Worked with internal architects in the development of current and target state data architectures
• Used data analysis techniques to validate business rules and identify low quality missing data in the existing enterprise data warehouse (EDW).
• Analyzed data flow and business requirements to create High Level Design document.
• Created Reports using combined Queries, Slice and Dice, Drill Down, Cross tab and Master Detail Reports.
• Ability to navigate relational databases, Excel files, text files or other forms of data sources to conduct data analysis activities, when needed.
• Deployed Business Intelligence solution using Business Objects to ensure proper delivery of information to the users and Oracle Projects Suite for proper Project Management.
• Setting up Enterprise Data Warehouse (EDW) and associated ETL service to generate business reports.
• Worked extensively in the executing of SQL queries on the database to verify data integrity.
• Created several Ad-hoc reports in Business Objects to validate the data.
• Responsible for managing the Data Warehouse and Business Intelligence functions.

Confidential, Hartford, CT

Business Analyst/ System Analyst

Responsibilities:

• Performed Requirements Gathering and Analysis, interviewed the SME (Subject Matter Experts), and ensured that contributors and all key stakeholders were motivated to complete assigned tasks.
• Involved in gathering the requirements that were critical to the business process flow and using those requirements for the Business Requirements Document (BRD), for the implementation of the NPI in EDI X12 transactions as mandated by the Federal Regulation.
• Facilitated Joint Application Development (JAD) Sessions for communicating and managing expectations.
• Manage the Requirements (Business as well as System requirements), performed requirements analysis along with the creation of Use Case Scenarios.
• In corporate Agile to create Business Requirement Document Specifications using MS Visio and MSWord.
• Assisted in the development of HIPAA and other regulatory requirements for the department/area.
• Created Process Work Flows and responsible for preparing Functional Requirement Specifications
• Performed Gap Analysis to identify the deficiencies of the current system and to identify the requirements for the proposed system.
• Used Data warehousing for Data Profiling to examine the data available (Data Analysis) in an existing database.
• Assisted Project Manager for a commissioning subsystem project. Duties included: developing project strategy, project planning and monitoring, and coordinating activities with related projects on other sites.
• Maintained knowledge of Medicare and Medicaid rules and regulations pertaining to the s configuration and evaluating the impact of proposed changes in rules and regulations.
• Worked on EDW gaps which came into existence after small group migration for EDW client on subject areas like product & group.
• Recommend ways and workarounds for HIPAA 5010 (EDI X12 837,834, 820, Reviewed HIPAA 270/271, 276, 277, 835, 837, and 820 standards for the process and products developed.
• Recommend on implementation of HIPAA 5010 (EDI X12 837,834, 820, 278,270,999) in the new System.
• Created Use Case diagrams by analyzing the business process followed by Activity diagrams using MS-Visio and participate in production of HIPAA 5010 EDI Test data.
• Produced Gap Analysis documents for HIPAA 5010 and ICD 10.
• Did Presentations making Stakeholders understand how the changes would affect different modules w.r.t. Medicare and Medicaid.
• Involved in claim adjudication process of facets application.
• Worked on the EDI 834-file load to Facets through MMS (Membership maintenance sub-system)
• Involved in claims submission and payment (remittance) retrievals by using ASCX12N 820 for the In- bound premium payments; ASC x12N 834 for the Inbound Enrollment and Maintenance; ASCX12 276/277 for the claims status enquiry and response; and ASC X12 835 for the Health care Claim Payments.
• Worked on Data Mapping to map Facets data to outbound eligibility extracts.
• Worked on FACETS subsystem such as billing and enrollment.
• Created Business Requirement Document outlining detailed Business requirements (Functional and Non Functional), Data Requirements, ETL Specs, Timing, Constraints and Exceptions etc. Collaborate with data modelers, ETL developers to create the Data mapping document.
• Gathered business requirements by conducting meetings with presentations with stakeholders and business users using Visio and PowerPoint.
• Assisted the team members to develop Service Oriented Architecture (SOA), and data warehouse system (EDW) to utilize data mining for data analysis.

Confidential, Philadelphia, PA

Business System Analyst

Responsibilities:

• Developed project scope statements, business requirements documents and functional specifications for all the projects.
• Conducted walkthrough of BRD in the JAD Sessions with users and developers. Collected specific information to include in the Functional Requirements Document (FRD).
• Determined eligibility benefits for customers with EDI Health Care Eligibility/Benefit Inquiry (270).
• Performed the GAP Analysis and Impact Analysis for all business requirements having an impact on the existing application.
• Developed test plans to validate required functionality. Test plans were written with both positive and negative data to verify that only valid data was moved according to business rules.
• Extensively used ETL methodology for supporting data extraction, transformations and loading processing, in a complex EDW using Informatica.
• Worked on SQL statements against the Teradata tables in order to analyze data during the requirements phase. Also worked with data modelers to ensure new requirements worked into the physical and logical data models for the AEDW.
• Conducted data mapping from source files to AEDW tables to ensure data was mapped correctly. Worked with the data acquisition team to ensure data feeds (flat files) are interrogated and analyzed.
• Studded the issues of failing in the production or not working properly, explored the root cause and fix issues.
• Developed stored procedures for new FACETS interfaces and outputs.
• Created new and update FACETS security profiles as per the template provided by the clients.
• Troubleshoot any problems found within FACETS and when testing the SQL data database while validating the business rule.
• Worked on developing the business requirement and use cases for FACETS batch process, automating the billing entities and commission process.
• Worked in testing the Professional, Institutional Claims processing and adjudication and validate data with FACETS.
• Contacted with Client to accommodate any new change in requirements as well to discuss the project status.
• Coordinated between the project group and the operations group. Helped design scope document and the request for proposal after extensive analysis and coordinated with top management for the approval process.
• Facilitated the customer in defining the high-level functional requirements and needs.
• Responsibilities involved product direction, including new platform, architecture enhancements and customizations.

Confidential, Chicago IL

Business Analyst

Responsibilities:

• Interacted closely with the Business users along with the administration and management to gather Business Requirements and analyze the functionalities to be incorporated into the system.
• Attended demo sessions to understand existing system functionalities.
• Followed the Agile methodology during the entire SDLC.
• Arranged interviews with all the stakeholders to review and understand the Business Requirements.
• Formulated Data Mapping Guide for the technical team.
• Coordinated with system architects and developers to convert business requirements into system requirements.
• Conducted meetings to document Change Requests for the new requirements.
• Analyzed business requirements and segregated them into Use Cases. Create Use case diagrams, and document Use case specifications.
• Involved in project status meetings, QA review meeting, and System Test meetings.
• Coordinated with the Project Manager to prioritize outstanding defects in Quality Center or enhancement/system requests based on business requirements and available human resources, allowing sufficient time to ensure accuracy and consider deadlines.
• Documented project plans, process flow, timelines and other requirements.
• Ensured that all the artifacts were in compliance with corporate SDLC Policies and Guidelines.
• Facilitated meetings and Joint Application Development (JAD) sessions with business stakeholders and technical units.
• Implemented best practices, facilitated meetings between business users, and Third party application vendors.
• Used MS Excel/Word/MS Office for status reporting and planning.
• Created Requirements Traceability Matrix (RTM), and managed changes to requirements for the MARS application.
• Used Quality Center for bug tracking
• Reviewed extensive SQL Queries with complex multi-table joins and nested queries
• Maintained various versions of the documents generated during the project using Rational Clear Case.
• Was responsible for creating and updating project schedule and managing resources and timeline using MS Project.
• Worked with the ETL development team on migrating data from the old data mart to the new IDW (Insurance Data Warehouse,) and validated data integrity.
• Prepared project status reports, and represented the BA team in the PMO meetings.
• Participated in UAT along with the Business SME’s.