SUMMARY

• Facilitator between Business Systems and Information Technology with 7 years of various environment experiences in the field of business analysis and project management.
• Advance knowledge of the Systems Development Life Cycle (SDLC), and project life cycles like Agile, Rapid Application Development (RAD), Extreme Programming (XP), Rational Unified Process (RUP)
• Experienced in conducting GAP analysis, User Acceptance Testing (UAT), SWOT analysis, Risk Analysis and mitigation plan, Cost benefit analysis and ROI analysis.
• Exposure to Healthcare, Insurance and Finance business domains.
• Extensive experience with Business Process Management (BPM).
• Have extensive knowledge on Explanation of Benefits (EOB), Coordination of Benefits (COB), Facets, EMR, EHR, PPACA (Obamacare), MMIS, HIX (Health Insurance Exchange)
• Extensively worked and presented several documents and Use Cases for multiple transactions include 837I, 837P, 835, 276, 277, 270, 271(both inbound and outbound) transactions for ongoing industry projects.
• Good knowledge of Health Insurance Plans (Medicare Part A, B, C and D), managed care concepts (Medicaid and Medicare) and experienced in determining the membership eligibility, billing experience within life and disability in health plans.
• A sincere, committed, quick learner, oriented, motivated team player with excellent communication, analytical, leadership, interpersonal and problem solving and management skills. Exceptional Problem Solving and Sound Decision - Making capabilities, along with the ability to resolve difficult situations.
• Strong knowledge and working experience of industry standards such as HIPAA, HL7, Six Sigma, and SOX, ICD-9, ICD-10 coding, EDI (Electronic data interchange), transaction syntax like ANSI X12
• Participated and actively functioned in Joint Application Development (JAD)
• Strong Experience in Test Plans development, Test Conditions and Test Cases, test data creation and analysis, interaction with the development team for error detection and correction.
• Worked extensively with Dimensional Modeling and Data Migration. Experience in Data Transformation, Data Loading, Data Modeling, Metadata Model, Catalog Creation, Cube Modeling, SDK Development and Performance Tuning.
• Experience in understanding database structures and write SQL/PLSQL.
• Extensive experience in Data Analysis and ETL Techniques for loading high volumes of data and smooth structural flow of the data.
• Worked on System Changed Requests Issue resolution related to Medicare and Medicaid.
• Vast experience in requirement gathering for business and application requirements, business processes, identifying risks, impact analysis, UML modeling, Sequence and Activity Diagrams using Rational Rose and Microsoft Visio.
• Have worked intensively on the PL/SQL for creating and working on the database for multiple projects.
• Adapt at writing Data Mapping Documents, Data Transformation Rules and maintaining Data Dictionary, Data Migration and Interface Requirements Documents.
• Experience in gathering reporting requirements from the business users for Business Intelligence, Data Warehouse application.
• Experience in writing Test Plans, Creating Test Suites, Test Cases/Test Scripts, Defect Tracking.
• In house experience with project management tools like MS-Project, JIRA, Creative Pro Office for status reporting, planning and error tracking and correcting.
• Proficient in working with UML development tools like MS Visio, Enterprise architecture framework, UML2 Tools, and Power Designer etc.
• Extensive management background within varied sectors of the healthcare industry including HMOs, PPOs, Integrated Hospital Systems, Out-Patient Surgery Centers, Dental and Vision

TECHNICAL SKILLS

Business Analysis: MS Visio, Test Manager, UML

Project Management: MS Project (Server), Creative Pro Office, JIRA

Operating System: Windows, UNIX, Linux, Mac OS

Languages: C++, Java, VB, HTML, XML, SQL, PLSQL, C#, JavaScript

Application: Microsoft Word, Microsoft Excel, Microsoft PowerPoint, Microsoft Access, Visual Studio, Eclipse, Share Point

Database: MS SQL Server, Oracle, MS Access

Other Tools: SQL*Plus, Apache Tomcat, Business Objects, Net beans

PROFESSIONAL EXPERIENCE

Confidential, Paramus, NJ

Business Analyst

• Gathered Business Requirements. Interacted with the Users, Designers and Developers, and the Project Manager to get a better understanding of the Business Processes.
• Collected, documented and managed business requirements, functional requirements and non-functional requirements using MS Word.
• Facilitated meetings with the technical team and client team to analyze the current process and gather requirements for the proposed process.
• Presented several documents and Use Cases for multiple transactions and worked with standards for medical transactions like 837I, 837P, 835, 276, 277, 270, 271 (both inbound and outbound) transactions.
• Performed data extraction utilizing PL/SQL via Manager Studio, analyze and discuss relevant HEDIS measurement information with stockholders.
• Created System Requirement Specifications ( SRS ) document entailing business rules, conditions, calculations, triggers, visual representation, type of text (smart text, static text, free text, special formatting, metrics) of various dynamic elements present within the reports.
• Conducted meetings to work in coordination with DBA’s, Developers, Tech Leads and Data Architects to achieve enhanced clarification, consistency and assist in design sessions.
• Followed AGILE methodology, created self-organizing team, induced enhanced communication for quick issue resolution & minimization of change control processes & its impacts. Obtained & recorded Business Approvals, Quality Review Approvals, and Architectural Approvals for future references & cross validations.
• Played a key resource as Business Analyst, Systems Analyst & Data Analyst during the entire SDLC phases of the project.
• Conducted meetings with business/corporate editor to capture information and create Large & Small Group Renewal Package Mockups (reports) in Power Point.
• Analyze EDI - X12 data elements captured by the existing system to validate it against the data elements required for new system.
• Responsible for mapping documents, test plan, test scenarios, test cases for unit, system and system integration testing.
• Developed UAT test cases associated with the functional requirements.
• Used the Rational Unified Process ( RUP ) to build the different phases of Software development life cycle.
• Involved in GAP analysis around the identification of business rules, business and system process flows, user administration, requirements and assumptions.
• Worked closely with QA and Developers to clarify/understand functionality, resolve issues and provided feedback to nail down the bugs.
• Wrote policy or procedure handbooks/manuals for use in a child welfare business operations
• Followed a structured approach to organize requirements into logical groupings of essential business processes, business rules, and information needs, and ensured that critical requirements are not missed.
• Conducted user interviews, attended JAD (Joint Application Development) sessions, created agendas and documented analysis in requirement gathering
• Excellent in writing Agile User Stories . Created and managed project templates, use case templates, requirement types and traceability relationships
• Trained and acted as point of contact for new employees.

Environment: Rational Unified Process (RUP), SQL, MS Visio, MS Project, MS Office, UML, Windows, HP Quality Center.

Confidential, Lincoln, NE

Business Analyst

• Conducted formal interviews, Live Meetings and JAD sessions with business users and matter experts.
• Designed and developed Use Cases, Activity Diagrams and Sequence Diagrams using UML.
• Involved in Backend Testing to verify data integrity by using T-SQL.
• Documented, identified, organized and tracked the requirements using Rational Requisite Pro .
• Created Data Flow Diagrams (DFDs), ER diagrams for data modeling and Web-page mock-ups using MS Visio for acceptance from end users.
• Defined project milestones, schedules, and monitored progress using MS-Project, creative pro office and modified, updated the project scheduled plans as required.
• Analyzed and tested Data Interface needs.
• Worked on System Change Request (SCR) sent by the clients to change the current work process and work methodology for some pre-entered process using IBM Lotus Notes, Microsoft Access and Microsoft SharePoint.
• Worked on IBM Mainframe dealing with different claim types, by adjusting, processing or entering new claims.
• Worked on the maintenance and backend support of pre-existing PBM systems that satisfied multiple external partners client system for their members.
• Worked extensively on both inbound and outbound transactions, creating test cases for multiple transaction types including 837, 835, 276, 277, 270 271
• Worked on changes for HIPAA Transaction from version 4010 to 5010. Documented the detailed business as well as technical requirements to upgrade the current system to 5010 transactions.
• Got involved in designing future state processes for HIPAA 5010 transaction processing EDI’s 837,835, 270, and 271.
• Analyzed HIPAA 5010 related to 837,835, 270, and 271. Transactions and performed gap analysis between the 4010 and 5010.
• Intensive working on the current ICD code conversion from ICD 9 to ICD 10, assisting and leading various teams by complying with already going works in the health care domain and work with the conversion.
• Gap Analysis: Analyzed the client’s applications programs to determine the impact of the HIPAA final rule on EDI Transaction Set and Code List implementation and defined the changes to bring the affected systems into HIPAA compliance.
• Worked with FACETS Team for HIPAA Claims Validation and Verification Process (Pre-Adjudication).
• Worked intensively on FACETS 4.6.1 for audit trails made on the used account and check and store information related to the HIPAA authorizations.
• Worked on claim adjudication process with different clients applying different adjudication process and methodology.
• Assisted with user testing of systems and maintained quality procedures and ensured appropriate documentation is in place.
• Maintained Requirement Traceability Matrix ( RTM ) and Utilized Clear Quest for change requests and defect tracking.
• Claim validation and Pend/Denied Claims Analysis for the Health plans Medicaid programs.

Environment: UML, MS Word, MS Share Point, MS Access, IBM Lotus Notes, IBM Main Frame, Rational RequisitePro, Quality Center, SQL, FTP.

Confidential

Business Analyst

• Drove the requirement-gathering phase (Provider, Claim components and HIPAA).
• Interaction with the business user and the IT team for understanding the requirements.
• Work with business representatives to understand data marts requirements and priorities and ensure that IT work is appropriately aligned
• Conducted workflow, process diagram and gap analysis to derive requirements for existing systems enhancements
• Conducted joint discussion sessions with business users, stakeholders to understand the requirements in more detail
• Responsible for creating business work flows and processes and creating management reports based on the analysis.
• Used the Rational Unified Process (RUP) to build the different phases of Software development life cycle.
• Developed this application for management to analyze the market trends, behavior, habits etc by collecting relevant data at various point and organizing the data into appropriate data warehouses and data marts the processing the data into various statistical reports (ad-hoc/canned for strategic management decision making) by utilizing SAS
• Applying the SQL scripts to the test database and execution of the scripts on the database
• Studied Oracle 11i data elements and provide a mapping from the existing legacy system.
• Worked with ANSI X12 4010 including medical transactions such as 837 (medical claims), 835 (medical claim payments), 270 (eligibility inquiry), 271 (eligibility response), 276 (claim status), 277 (claims status response), 820 (enrollment).
• Incorporated HIPAA standards, EDI (Electronic data interchange), transaction syntax like ANSI X12
• Worked on Medicaid and other claims processing division of the company.
• Followed the UML based methods using Rational rose to create use cases, activity diagram, sequence diagram, collaboration diagram that include functional and non-functional specifications to hand off to development teams.
• Data mapping, logical data modeling, used SQL queries to filter data within the Oracle database tables.
• Created and tested Scripts for the premium calculations and Claims limits and deductibles (Claims calculations).
• Developed Base line scripts for testing the future releases of the application
• Came up with test cases for various reports on the data marts and identified that the test case documents are updated timely.
• Clarified QA team issues and reviewed test plans and test scripts developed by development team and QA team to make sure all requirements have been covered in scripts and tested properly.
• Maintained Test Matrix with the test results obtained.

Environment: Windows, UNIX, C++, Java, HTML, XML, Oracle, Rational Requisite Pro, UML