PROFESSIONAL SUMMARY:

• An astute professional with 6 plus years of enhanced Techno functional experience in system and Business Systems Analyst in Health care with FACETS and extensive interaction with client.
• Insightful knowledge of business process analysis and design, domain & technology expertise with strong integration skills.
• Hands on experience in Design, Development, Enhancement and Maintaining applications in Oracle using SQL in Windows and UNIX/Linux environments
• Experienced as a Business Systems Analyst in gathering the business requirements from the existing stored procedures, supporting the Interfaces and reports development in explaining the functional requirements, proposing technical solutions, supporting the unit testing and system integration testing with the functional flow.
• Experience as a Business Systems Analyst in mapping business requirements, designing customized solutions with strong analytical skills and ability to analyze business practices and define optimal procedures.
• Expertise in scripting the Test Plan, Release Plan, Test Cases and Defect Tracking and Reporting.
• Immense knowledge in Health care payer operations, Interfaces, Reports, Letters and system Migrations, Health Administration - Claims processing (auto adjudication), Claims pricing and testing, HIPAA, enrollment, Medicare, Medicaid, CDHP.
• Expertise in Healthcare Administration/Managed Care Systems working with various Claims Systems/Applications with multiple healthcare client systems, with prime focus on Claims adjudication, provider, eligibility.
• Functional experience with concentration on Use Case modeling using UML, Business Process Modeling, Data Modeling, Change Management, Technical Training, Software Development methodologies, QA testing, and Systems Testing interfaces, Reports, Letters.
• Involved in developing database objects using Trizetto FACETS database in both SQL Server and Sybase environments.
• Good expertise in creating Test Cases on the basis of product features, client requirements and technical documents.
• Substantial development experience in creating stored procedures, PL/SQL Packages, Triggers and Functions.
• Developed, executed and maintained Test Scripts, Reviewed and documented system and implementation Test Strategy Documents for Parallel Testing, and system integration testing.
• Great communication skills, client relations, presentation and negotiations with creative approach to problem solving through use of excellent analytical skills.
• Comprehensive knowledge and practice of Software Development methodologies such as Waterfall, Agile and Scrum. Well versed in SDLC.
• Involved in building the Health care center of Excellence across by involving in creating and sharing the knowledge base and conducting sessions across the organizations.
• Managing requirements traceability information and tracking requirements status throughout the project.

TECHNICAL SKILLS:

Project Methodologies: SDLC, Agile, Rational Unified Process (RUP), UML, Agile, RAD, JAD/JAR

Business Modeling Tools: MS Visio, UML, BPMN

Operating Systems: Windows, UNIX

Database: SQL server, DB2, Oracle, Informatica

Reporting Tools: Cognos, Business Objects and Crystal Reports

Quality Assurance: Quality Center, Software Application Testing Life Cycle

Business Applications: Microsoft Office Suite, BPEL, MS VISIO, MS Share Point, Outlook, Clear Quest, Lotus Notes.

PROFESSIONAL EXPERIENCE:

Confidential, Minneapolis, MN

Sr. Systems Analyst

Responsibilities:

• Extensively involved in analyzing and defining the project scope to modernize the existing legacy application. Involved in planning a phased approach to provide a business disruptive modernization effort.
• Extensively involved in capturing High level business requirements and produce Functional Specification Document along with Use Case Diagrams, Activity Diagrams, Business Flow Diagrams, Data Flow Diagrams.
• Build analysis reports to assess data quality, integrity and statistics during requirement analysis using SQL
• Collaborating with Technical Design Team, converted the high level requirements into detailed design specification document to capture the database schema, data dictionary, workflows, ETL requirements, interfaces, reports and security controls.
• Documented System requirements for Informatica data quality rules and system requirements for Information quality at source.
• Followed and implemented Agile Methodology, attended daily scrum calls and business orientation sessions.
• Represent and present Informatica perspective/methodology on MDM and Data Governance at conferences
• Supported developers with creating database objects like Tables, Triggers, and Indexes using T-SQL Management Studio.
• Interacted with other team members and participated in daily scrum meeting to make sure the all team members are on the same page.
• Involved in performing several database tuning tasks and built reports using PL/SQL.
• Extracted large volumes of data from legacy systems and uploaded into the Oracle database using SQL*Loader and PL/SQL.
• Created T-SQL objects such as tables, views, joins and store procedures to meet client requirements.
• Wrote PL/SQL statement and stored procedures in Oracle for extracting as well as writing data.
• Carried out detailed and comprehensive business analysis with the Agile methodology.
• Identified and gathered requirements for analytical, dashboard reports for Management, worked with data warehouse team to build the data model, report layouts and analyzing data using SQL queries
• Responsible for conducting Direct Capture of Objective sessions with business SMEs from all membership enrollment, provider management, claims processing, eligibility and benefits configuration (medical/pharmacy) to capture requirements
• Actively participated in presenting business demo of the application to business stakeholders
• Maintained Requirement Traceability Matrix (RTM) throughout the project for requirement elicitation
• Coordinated with integration teams and produced interface specification document with solutions for functional requirements (web service changes).
• Collaborated with testing team to plan, develop and execute testing and supported UAT, bug tracking with HP QC

Environnent: HP Quality Center, Agile (Scrum), Informatica, MS Project, MS Access, MS Excel, MS SharePoint, T-SQL and PL/SQL.

Confidential, Watertown, MA

Business/ Systems Analyst

Responsibilities:

• Gathered Requirements from Users, Technical Team and Sales Executives.
• Conducted JAD sessions with business users, SMEs and stakeholders to understand requirements in detail.
• Performed task estimations and documentation of procedures.
• Analyzed many T-SQL procedures to understand the flow of data and data process.
• Quality Center administrator and used Quality Center for defect tracking and reporting
• Conducted integration testing and regression testing with developers in development and QA, also conducted user acceptance testing with UAT team. Safety reporting on system-based projects, acted as a liaison, writing documentation and increased project coordination.
• Identify customer-marketing opportunities by applying data mining models and writing advanced T-SQL stored procedures and queries.
• Created Summary Use Cases for next phase of Forward Engineering
• Worked with 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.
• Attended Health Rules Payor fundamentals training class and gained an understanding of Member enrollment, premium billing and claim processing in Health Rules Payor.
• Designed and developed project document templates based on agile methodology.
• Extensive use of UML to draw Business Process Flow, Use Cases Modeling, Sequence, Sequential Diagram and Activity Diagrams
• Managed SIT and UAT testing coordination activities for the projects.
• Conducted gap analysis for major payor Medicare Part D compliance program; rigorously tested its Pharmacy Benefit Management Company's Prescription Drug Event Reporting and Rebate Program.
• Utilizing FACETS Security methods to provide security solutions in order to create various test accounts and data.
• Did impact analysis for changing requirements and coordinated with business users for prioritizing the testing/release of the changes.
• Maintained a very close interaction between business users and developers to avoid any gaps in understanding or implementation of requirements.
• Did data analysis, created data mapping and data interface documents and kept the documents updated with changes in requirements and functional specifications.
• Used Agile Scrum Methodology for the iterative development of the application and facilitated bi-weekly sprints and daily stand up meetings.
• Created BPR charts for AS IS and TO BE processes of different business functionalities.
• Implemented shared object repositories and shared data tables to ensure minimal repetitive effort.
• Constantly involved in review meetings and made sure testing is done based on the QA master plan and deadlines are met.
• Trained associates for business process improvement and delivery management.

Environment: Networx Pricing, Rational Tools, Agile/Scrum, Informatica, Trizetto FACETS, SQL, T-SQL Server, UAT, Windows XP, XML, Excel, Access, Visio, MS Office, MS Access etc.

Confidential - Boston, MA

Business Analyst

Responsibilities:

• Served as a liaison between the internal and external business community (Claims, Billing, Membership, Capitation, Customer service, membership management, provider management, advanced Healthcare management, provider agreement management) and the project team
• Followed Workgroup for FACETS Electronic Data Interchange standards for testing that need to comply with the HIPAA guidelines.
• Involved in FACETS Implementation, FACETS billing, enrollment, and Claim Processing and Subscriber/Membership module.
• Followed Workgroup for FACETS Electronic Data Interchange standards for testing that need to comply with the HIPAA guidelines.
• Comprehensive understanding of specific provider type reimbursement methodologies. Including Dental, Anesthesia and DME
• Worked on Member Management, Eligibility, Claims and Billing modules within FACETS.
• Analyzed and reviewed Service applications, built functional requirements for existing functionalities. Worked closely with Customer Service Reps.
• Conducted Joint Requirements planning sessions (JRP) as a facilitator to gather requirements from the Business User and conducted many Joint Application Development (JAD) and Joint Application Management (JAM) and conducted many Rapid application development (RAD) sessions.
• Deliver requirements under the Agile Scrum SDLC methodology to meet a very fast release schedule.
• Prepare requirement specifications such as Use cases and System requirement specifications and Supplementary specifications; Tag and trace system requirements to business requirements
• Develop functional design details and specifications through collaboration with development teams and using system architecture and other technical considerations
• Provide analyst support during all phases of the Software Development Life Cycle including development and testing (unit/system) phases
• I was responsible to analysis of the proposed system and prepare the gap analysis document and functional design documents.
• Actively analyzed current business processes (Claims, Billing, Recipient eligibility and enrollment etc.) and worked with management to improve and implement enterprise solutions to ensure compliance
• Designed and implemented basic SQL queries for QA Testing and Report / Data Validation
• Responsible to perform the quotes and purchases operations from the database by running the SQL queries
• Extensively involved in data analysis, data modeling, Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data within the Oracle database

Environment: Windows, XML, SQL, Agile, MS Office (MS Word, MS Excel, FACETS, MS PowerPoint, MS Visio), RUP, RequisitePro, Crystal Reports, Clear Case, Clear Quest