SUMMARY

• 7+ years of industry experience as a Business Analyst with solid understanding of Business Requirements Gathering, Business Process Flow, Business Process Modeling and Business Analysis.
• Advanced level knowledge in software development life cycles (SDLC)followed in CMMI Level 5 Company. Performed Requirement Gathering/Analysis, System analysis, Design & Data Modeling, Development, Testing, Performance tuning and Functional Consulting.
• Good knowledge of the claims process and how that process is related to the FACETS system.
• Proficient in conducting JAD sessions with SME's, vendors, users and other stakeholders.
• Worked on the conversion of existing legacy system to the FACETS 4.7 in accordance to HIPAA 5010 upgraded version from the HIPAA 4010.
• Experience in HIPAA EDI transactions 837 (Institutional/Professional), 835(Payment Remittance Advice), 270 (Eligibility Request) / 271 (Eligibility Response), 276 (Claims Status Inquiry Request) / 277 (Claims Status Inquiry Response), 834 (Benefit Enrollment and Maintenance Transaction), 278 (Prior Authorization), 997 (Transaction Acknowledgement).
• Knowledge of ICD-9 and ICD-10 systems implementations and upgrades.
• Good experience in performing GAP analysis.
• Knowledge of EDI Tools like Edifecs.
• Excellent Experience in a number of Sequential and Agile Software Development Life Cycle (SDLC) methodologies such as Waterfall, Rapid Prototyping and the Rational Unified Process (RUP).
• Knowledge in the ETL (Extract, Transform and Load) of data into a data ware house/date mart.
• Serves as the liaison between the QA team and the technical team for ETL mapping
• Excellent Business writing skills in developing Business Requirements Document (BRD), Use Case Specifications, Functional Specifications Document (FSD), Systems Design Specification (SDS), Systems Requirements Specification (SRS), Workflows and Project Plan.
• Developed, maintained test plans andexecuted test Script from Quality Center.
• Participate and contribute to lessons learned sessions and prepare the documents Logged and reviewed Defects, documented the whole Bug life cycle using Quality Centre.
• Understanding of Data validation and warehouse concept.
• Extensive knowledge in writing and Tuning SQL queries & improving the performance of the Database.
• Strong communicator and creative problem-solver skilled at analyzing business needs and transforming them into technical designs, applying technical skills and business knowledge to achieve sound results.

AREAS OF EXPERTISE

Operating Systems: Mac OS X, Windows 2000/XP/NT, UNIX
Project Management Tools: MS Office, MS Project
Programming Languages: C, C++, Java, SQL, and PL/SQL
Data Bases: Microsoft Access, MS SQL Server 2000
Version Control System: Rational Clear Case
Testing Tools: QTP, HP quality center
Web Technologies: HTML, XML, MS Front Page
Reporting Tools: Cognos and Crystal Reports

Confidential, Minnesota, MN March3012 - Present
Information Delivery lead BSA
Claims Migration
BCBSMN claims adjudication system STAR , is a legacy mainframe system. It is dependable in performing current functions, but it presents challenges to large projects requiring foundational changes. Additionally, it lacks the flexibility required to enable critical future markets requirements and business capabilities. Blue Cross Blue Shield of Minnesota (BCBSMN) has chosen to migrate to NPS system which is provided by NASCO. All lines of business and products will be migrated during a phased implementation of the NPS system . This project will cover the claims migration process for commercial claims to NASCO for different assets.
Responsibilities:

• Worked as a unit BSA lD lead with DataWarehouse team for transferring information between the business, developer, data modeler and testing team.
• Performed data analysis for claims system business unit and performed GAP analysis for current claim system (STAR ) to NASCO.
• Facilitated meetings with different Business unit to identify and complete data requirements.
• Developed Business Requirements Document (BRD), , High level Functional Specifications Document (FSD), technical mapping documents and Workflows .
• Serves as the liaison between the QA team and the technical team for ETL mapping and logic verification.
• Prepared mapping documents for GAP analysis to identify the scope, approach, resources and estimation for Claims Migration from BCBSMN STAR to NASCO.
• Performed intensive data analysis at data element level to identify the GAP between BSBSMN STAR data and NASCO data before implementation of the pilot phase.
• Attended regular INBOUND and OUTBOUND meetings to resolves the issues during gap analysis .
• Attended weekly ID leads meeting for lessons learned and share new discoveries within Claims migration OUTBOUND team.
• Conducted JAD sessions with members of the UNIT on regular basis to review and update the gaps based on inbound and outbound team input and involved in extract production.
• Involved in analysis of the Statement of Work (SOW) and asset extracts.
• Performed and created impact analysis for data coming in from NASCO to STAR
• Involved in Regression Testing every new build in UAT, QA and Pre-Production Environments.
• Followed and provided input in regards to Agile methodology and keep aligned all aspects of the Project.
• Identified issues and worked with application and data team to resolve any issues.
• Wrote and Enhanced test cases and test scripts to meet new functional requirements as per the new business requirements.

Environment: EDIFECS,MS Office, MS-Visio, Lotus Notes, Mainframe, SAS- EG, Teradata SQL Assistant, EMMA, Metadata manager.

Confidential, Denver, CO March 11- March 12
Senior Business System Analyst
Core 5010 837 / PDI -Data Validation

Cigna health care is one of the largest providers of health care benefits and health services in the US. CIGNA is in the process of conversion of Existing Claim application to FACETS and the corresponding Legacy gateway will be converted to FACETS HIPAA gateway. I worked as a Senior Business Analyst involved in the implementation of Claim Payments that involved Facet patches. Worked on various EDI transactions that include 837(I, P), 835, 270/271 transactions to implement HIPAA 5010. I also served as a data validation analyst for ODS team for supporting the test team.

Responsibilities:

• Analyzed and studied the different Business Processes across various Business Units.
• Gathered detailed business and technical requirements and participated in the defining of business rules and data standards.
• Created SRS (system required specifications) document and analysis document explaining all the aspect of 5010 837.
• As a Facets Analyst,participated in regularFACET patches weekly meeting and work with FACET SA's to find the solution for proposed fixes.
• Assist testers to perform mock up test for FACET patches( fixes).
• Work with Data Validation team and assist testing and validation.
• Serves as the liaison between the QA team and the technical team for ETL mapping and logic verification.
• Participate in regular ODS team meeting for updates coming up for the project.
• Worked extensively for 837 Multiplan Inbound and outbound transactions for 5010 migration.
• Responsible for requirement input in Caliber.
• Created maps & layouts for HIPAA as imposed during Electronic Data Interchange (EDI): 837 Claims and Encounters, 834 Benefit Enrollment and Maintenance, 835 - Claim Payment/Advice, 270/271 - Eligibility Benefit Inquiry and Response, 277/275 - Claim Request for additional Information and Response, 276/277 Claim Status Request / Response.
• Worked on Claim processing and Configuring COB (Coordination of Benefits)
• Wrote and Enhanced test cases and test scripts to meet new functional requirements as per the new business requirements for Data validation.
• Worked with the Business Users through interviews and (Joint Application Development) JAD sessions.
• Did extensive data analysis and converted the full logic to plain SQL codes and put it in data selection strategy document for Data Validation team.
• Prepared test plan for Data validation team and Confirm that all test scripts and results have been documented and presented to internal project personnel.
• Involved in Regression Testing every new build in UAT, QA and Pre-Production Environments.
• Performed back-end testing by extensively using SQL commands to verify the database integrity on Oracle Database.
• Participated in writing data mappingdocuments and performing gap analysis on the systems.

Environment: TriZetto FACETS 4.7,Oracle,TIBCO,Onyx, Caliber, Clarity, Mercury Quality center ,TOAD, SQL, ANSI X12, XML, JavaScript, HTML ,MS office and Lotus Notes.

Confidential Tampa FL Aug 09-Jan 11
Senior Business System Analyst

Well Care Health Plans, Inc. provides managed care services exclusively for government-sponsored healthcare programs, focusing on Medicaid and Medicare, WellCare offers a variety of health plans for families, children, aged, blind and disabled and prescription drug plans. Worked in the process of migrating the current EDI Gateway to a new Gateway platform. Worked on EDI transaction's inbound and outbound activities through HIPAA gateway.

Responsibilities:

• Analyzed and studied the different Business Processes across various Business Units.
• Studied and gathered the business requirements from the end users by conducting GSD (General system design) and DSD (Detail system design) JAD sessions as well as VB scripts written from previous implementations, and documenting it for the developers
• Conducted DSD level JAD sessions with the subject matter experts (SMEs) for each and every domain. Recommended alternatives on processing business processes and gained agreement on a wide range of difficult business processes.
• Interacted with developers and documented the functionality process of all the components.
• Worked with the development team to provide remedies and an end-to-end system solution, conducted performance testing with the help of the fault monitoring system.
• Involved in the Review of Requirements Specification with functional manager and technical specialists of the application.
• Performed Gap Analysis for HIPAA 5010 and HIPAA 4010A1.
• Created Use cases for 835 (Claim Payment/Advice transaction set) and also performed gap analysis and impact analysis for the 835 transaction 5010 changes.
• Worked on ICD-10 validation for EDI records.
• EDI 837 claim validation based on the automated ICD 10 codes validation.
• Documented the entire process across all employer groups for implementation in Facets extended enterprise administration
• Participate and contribute to lessons learned sessions and prepare the documents Logged and reviewed Defects, documented the whole Bug life cycle using Quality Centre.
• Maintained test metrics and bug database and generated day to day reports using Quality Center.
• Also worked on the claim transaction for billing information through the EDI 837 transaction set.
• Involved in Inception Phase and prepared Logical Data Models that contains set of diagrams and BRDs (Business Requirement Documents) supporting documents containing the essential business elements, detailed definitions, and descriptions of the relationships between the actors to analyze and document business data requirements.
• Used power point presentations for conduction of walkthroughs with the stakeholders.
• Planned and defined system requirements to Use Case, Use Case Scenario and Use Case Narrative using the UML (Unified Modeling Language) methodologies.
• Excellent Experience in a number of Sequential and Agile Software Development Life Cycle (SDLC) methodologies such as Waterfall, Rapid Prototyping and the Rational Unified Process (RUP).
• Participate and contribute to lessons learned sessions and prepare the documents Logged and reviewed Defects, documented the whole Bug life cycle using Quality Centre.
• Responsible for requirements gathering, configuration design, prototyping, and configuration auditing
• Generated and performed configuration work plans and will assist in gathering meaningful metrics in support implementation objectives
• Worked on Claim Processing Data Entry Logic, Processing of Medical & Hospital Claims, Additional Claim Processing Functionality, Intern Billing in Hospital Claims, Service Related Parameters, Pre Pricing Claims, Logging Claims, Claim Adjudication, Claim Status, and Claim Payment.
• Liaison between the business units, technology teams and support teams.
• Formulates, defines and documents the functional system specifications.
• Formulates and defines systems scope and objectives through research combined. with an understanding of applicable business systems and industry requirements.
• Performed back-end testing by extensively using SQL commands to verify the database integrity.
• Created and maintained SQL Scripts to perform back-end testing on the oracle database.
• Worked on Configuring COB (Coordination of Benefits) & EOB (Explanation of Benefits).
• Wrote and Enhanced test cases and test scripts to meet new functional requirements as per the new business requirements. Configured benefits EOB imports batch job which populates EOB table stores the EOB (Explanation Of Benefits) amounts information
• Prepared a package of Process flow diagrams to document the existing system.
• Worked with the Business Users through interviews and (Joint Application Development) JAD sessions.
• Created a single architecture for viewing, querying, analyzing, and authoring for collaborative contributions to any report including dashboards.
• Wrote requirements for various reports to be generated.
• Participated in writing data mapping documents and performing gap analysis on the systems.
• Done extensive data analysis and converted the full logic to plain SQL codes and put it in data selection strategy document
• Pioneered innovated team building and cross-functional training programs to expedite workflow, simplify process and reduce operation cost
• Conduct de-briefing sessions with selected users and/or other designated project personnel following UAT, to:
• Confirm completion of all UAT activities;
• Confirm that all outstanding issues have been resolved or agreed to be resolved later;
• Confirm that all required workarounds have been defined, agreed, implemented, documented and presented to internal project personnel; and
• Confirm that all UAT test scripts and results have been documented and presented to internal project personnel

Environment:Oracle, Sybase, CMS, Clarity, Mercury Quality center ,Web logic, SQL, Cognos reports, ANSI X12, XML, Java, JavaScript, HTML and Lotus Notes

Confidential, Portland, OR Dec 08-Jul 09
Senior Business System Analyst

Regence is nonprofit healthcare company with more than 2.5 million members offer individual and group medical, dental, vision and life insurance, Medicare and other government programs and pharmacy benefit management. I worked as a Senior FACETS Business Analyst on the configuration of FACETS 4.51 with different extension. Worked on various EDI transactions to implement HIPAA 5010, which was upgraded from HIPAA 4010A1.Worked in the configuration of system between trading partners and transaction manager. Worked on implementation of Claim Processing system, which was upgraded from the legacy system. As a Senior HIPAA Business Analyst worked with Providers on many issue retailed to billing and reconciliation. Involved in mapping data for various partners and clients transmitting EDI 837, 835, 270/271. Worked on Claims adjudication and different EDI Inbound and outbound activity of those Exchanges. Also worked on Customer service and Billing modules of the Application.

Responsibilities:

• Worked closely with Business end-users and developers for detailed understanding of the opportunities for improvements of systems in order to Gathered Requirements and prepared a comprehensive set of documents to define the specifications and business value of the system.
• Provides hands-on expertise for implementation, configuration and on-going support of Facets to include analysis, system configuration, operational implementation, process documentation and testing for managed care clients.
• Elicited and documented business requirements, perform data and transaction mapping, complete a GAP analysis and document the impact of the migration from HIPAA 4010A1 to HIPAA 5010 on current business processes and applications.
• Wrote uses cases for EDI transaction 270/271, 276/277, 835/837.
• Performed Gap Analysis for HIPAA 5010 and HIPAA 4010A1.
• Developed functional specs for development team
• Worked on Accumulator Batch export system to facilitate the periodic transmission of current data in the Facets Member Accumulator and Family Accumulator tables.
• Worked for configuration of Benefits, Claims and Billing system.
• Incorporated Rational Unified Process (RUP) to create Business Requirement Document Specifications using MS Visio and MSWord.
• Successfully executed many enhancements to the system that were not a part of the Production Support Scope, by meeting with clients and user groups to understand their needs
• Used power point presentations for conduction walkthroughs with the stakeholders.
• Extensive experience in writing business documents such as Business Requirements Documents (BRDs) and Functional Specification Documents (FSDs) and Business Process Blueprint and Process Flow Diagrams (PFDs) and Data Flow Diagrams (DFDs).
• Created Use Case Diagrams, Activity Diagrams, Sequence Diagrams and ER Diagrams in MS Visio.
• Extensive Analysis of HIPPA rules to incorporate in the Development of Utility application which is not HIPAA compliant.
• Worked on Configuration of benefits and enrollment system with FACETS by setting up the functionalities.
• Administered the benefits and enrollment as required by the business user
• Develop and recommend operational processes and/or process improvements in support Facets clients.
• Worked on configuration of FACETS with Benefits, Claim processing and Enrollment
• Design and development of inbound and outbound maps.
• Worked on EDI transactions like 270/271, 276/277, 835/837 and EDI's. Worked on Use Cases for Batch processing for EDI's.
• Involved in Writing use case based on HIPAA standards.
• Used UML/RUP to develop requirements and architect a solution.
• Gathered Requirement from the Client to fulfill the Application need for FACET Implementation.
• Wrote Test Cases and Test Plans for Testing HIPAA Transactions and Code Sets Standards such as 837/835, 270/271, 276/277 transactions.
• Prepared GUIs with detailed screen layouts with regards to various types of corporate actions.
• Identified High-Level Requirements for developing and documenting detailed business requirements
• JAD Sessions were conducted to understand the detailed requirements.
• Analyzed system requirements and developed detailed Test plan and Test cases for EDI Testing.
• Evaluated the results and the project timeline by setting milestones in RUP.
• Conducted Value Analysis, Regression Analysis, and Risk Management.
• Prepared the Business Documentation for future reference.
• Helped the project manager in project status reporting, ensuring that the project's product delivers the benefits called for and resolution of conflicts within the project and between cross-functional teams.

Environment:Process/Model Tools/Database: MS Visio, FACETS 4.51, EDI, UML, Use Case Diagrams, Activity Diagrams, State Diagram, MS Office. Windows XP/2000, SQL, Java/J2EE, HTML, XML.

Confidential, Mechanicsburg, PA Sep 07-Nov 08
Business System Analyst

Unemployment Compensation Modernization System (UCMS) is a type of income support system. UCMS is a SOA-based application, which will provide a new platform for growth and innovation that will serve the Commonwealth. The Department of Labor and Industry (DLI) constructed a request for proposal that would replace its aging legacy unemployment compensation systems with a new, Service-Oriented Architecture (SOA) based, custom developed family of applications that would manage unemployment taxes, wage record, benefits and claims for employers and constituents of the Commonwealth. UCMS gives DLI to simplify work, automate workflow and document management, expand self-service for claimants and employers and create a consistent unemployment compensation/insurance system, which will drive the business transformation of the DLI.

Responsibilities:

• Conducted business requirement analysis, feasibility and cost benefit analysis. Split Unemployment Compensation (UC) into different domains (Accounting payable (AP), Audit, Collections, Common Processes, Compliance, Rating, Payments and Receivables, Registration, Tax Appeals, Profit Center Accounting (PCA) and US DOL Reporting) by conducting series of JAD sessions with DLI
• Created PMO Team Room on IBM's Quick Place and managed the information and artifacts.
• Worked on the project plan and scheduled the deadlines for the final deliverables (both GSD and DSD).
• Conducted quality assurance, risk management, project server, and project web access and issue management presentations. Resolved questions and issues regarding the same.
• Conducted DSD level JAD sessions with the subject matter experts (SMEs) for each and every domain. Recommended alternatives on processing business processes and gained agreement on a wide range of difficult business processes.
• Conducted work sessions on Functional Design and documented them in the functional design document. Reviewed the Functional Specifications created by the architect and conducted knowledge transfer sessions on iProcurement and iExpenses to ensure understanding of the BRs.
• Produced Data Dictionary and Interfaces Matrices along with many other Matrices for mapping the data flow.
• Designed Business Process Flow Models for all the domains using IBM's WBM tool.
• Conducted Work Sessions for gathering features for UCMS and documented the Features Document. Features document defined specifications for the upcoming system.
• Conducted gap analysis and documented the gap analysis document using Excel.
• Created the AS-IS and TO-BE documents.
• Defined UML Sequence diagrams, activity diagrams, state diagrams process flows etc., using the Rational Software Modeler tool.
• Created test plans, test cases, test scripts and testing traceability matrix. Developed test strategies for User Acceptance Testing (UAT).
• Respond to user questions regarding reports and products, including the sources of the data flow and the meaning of each data element which helps simplifying the technical aspect for the users.

Environment:Microsoft Project Server (v2007), Java, Java Script, Web Sphere Business Modeler, QuickPalce, Rational Tools Suite (Rose, Requisite Pro, Clear Quest and Rational Software Modeler), SDLC, MS Project, MS Visio, UML(state diagrams, sequence diagrams, process flows etc.), Microsoft Office (Word, Access, Excel, Outlook, Power Point), Windows XP, Test Director, Web Sphere, Crystal Reports.

Confidential, Mahwah, NJ Jan 06- Aug 07
Business Analyst

Enterprise Contact Management (ECM) was designed to enable agents across all Business Units (Supply Chain Solutions, UPS Freight, Small Package International and Small Package US) of UPS to ID the Caller, manage Cases (concerns and messages), and route them to the appropriate destination for research and resolution. The benefits by implementing this project was that it would reduce concerns and messages and their average handling time, improve International Preferred Service/channel Agent's (PSA) Case processing, reduce Inaccurate Information Processing review costs and reduce churn among Strategic Preferred Service/channels. ECM will help all the Business Units of UPS to work on a common platform and keep track of all the Concerns for reporting. It was developed on SAP-BW using the Siebel Call Center and Data Warehouse was used for retrieving the data elements.

Responsibilities:

• Analyzed and studied the different Business Processes across various Business Units in UPS.
• Designed a common process for all the Business Units across UPS and developed Process flow diagrams using MS Visio.
• Conducted Work Sessions with the Business Users for capturing Business Requirements and documented them in MS Word which was saved it in the central repository.
• Used a 3 - Phased RUP methodology
• Defined Business Rules after capturing the Business Requirements and took sign offs from the Business Users.
• Used MS-Project for status reporting and planning.
• Created Scenarios and by using MS Office Power Point demonstrated the new Process flow of ECM.
• Used File Net content manger to work with workflow and process capabilities to automate and drive content related tasks
• Conducted work sessions on Functional Design and documented them in the functional design document. Reviewed the Functional Specifications created by the architect and conducted knowledge transfer sessions on iProcurement and iExpenses to ensure understanding of the BRs.
• Produced Data Dictionary and Interfaces Matrices along with many other Matrices for mapping the data flow.
• Used Electronic document management system (EDMS) to track and store electronic documents and images for processing paper documents.
• Conducted, documented and implemented the Gap Analysis.
• Prepared Use Cases and drafted business Use Cases such that any future changes could be easily detected and managed.
• Created Test Cases for ECM and assisted the Users in using ECM.

Environment: Rational Tools Suite (Rose, Requisite Pro, Clear Quest), RUP, MS Project, MS Visio, Microsoft Office (Word, Access, Excel, Outlook, Power Point), Windows XP, Test Director, SAP-BW, Siebel Call center and Data Warehouse.

Confidential, New York, NY Oct 04-Dec 05
System Analyst

The personal banking portal of Deutsche Bank targeted for Brazilian market. It allows users to open Personal Accounts on the web and provides various features like accounting maintenance, wire transfer within and outside the portal. Credit Derivatives Management (CDM) System. CDM is an intranet-based system for management and allocation of credit derivative trades. It gives users the ability to manage derivatives from a single, unified workstation. The application is capable of handling electronic import and export of trade details. Post-trade allocation, trade history and reporting are also handled by this system.

Responsibilities:

• In Banking Portal, analyzed the processes involved in Opening an Online Bank Account.
• Worked on different domains of corporate action involving Cash Dividend, Bond Redemption, interest payment, Bond Conversions, Tenders, and Stock Splits etc.
• In CDM project, analyzed traditional Swaps and Credit Default Swaps and their trading and allocation processes.
• Suggested product features by conducting Competitor Analysis.
• Analyzed business requirements, business process and system architecture/design.
• Assisted in establishing and managing a common SDLC (System Development Life Cycle) process for all regulated system development/procurement, review regulated documents (SOPs, Policies and Procedures).
• Assisted in educating clients, stakeholders and end users on the benefits and risks associated with the project.
• Used Open link's risk management and operations processing system which allowed all the transactions move in real-time in a straight-through-processing (STP) environment giving users greater control over the risks connected with each and every transaction.
• Used UML based methods to create Use Case diagram, Sequence diagram and Activity diagram.
• Identified and involved all key stakeholders, contributors, business, operations and technical resources in the project.
• Ensured that contributors were motivated to complete assigned tasks in parameters of the project plan.
• Retrieved Data by writing SQL queries.
• Created and managed project templates, Use Case project templates, requirement types and trace-ability relationships in RequisitePro.
• Initiated and validated changes (Clear quest) and facilitated new user training and ongoing training.

Environment: Rational Tools Suite (Rose, Requisite Pro, Clear Quest), Java, Java Script, RUP, Open link's risk management tools, MS Project, MS Visio, Microsoft Office (Word, Access, Excel, Outlook), Windows XP