SUMMARY:

• More than 8 years of experience in Business Process Analysis, Development of requirement specifications using industry standard tools and languages such as Unified Model Language, Business Process Model notations.
• Experienced in Requirements Analysis, Requirements Management, and Use Case modeling using UML, Business Process Modeling, Data Analysis, Asset Management, Change Management, and Project Management with focus on Health Insurance.
• Expert in Project Planning, Project Design, Gathering requirements, creating Functional specifications, and UML diagrams (data flow, swim lanes, sequence wire frames) and extensive knowledge with SDLC life cycle.
• Expert in translating user requirements into Technical specifications and mapping the process design, work flows for SDLC with documenting, managing business requirements.
• Designed Use Cases, Activity Diagrams, Sequence Diagrams, and Class Diagrams, Data flow Diagrams by using MS Visio, jiffy.
• Experience with Agile Software Development Methodologies in particular Crystal and Scrum Methods.
• Experience working with HealthCare Applications like Power MHS.
• Vast experience in multi - tasking, managing multiple projects and work streams in parallel.
• Knowledge of health information and health care servicesregulatory environment including HIPAA, Medicaid/Medicare, CCHIT, EDIand XML.
• Experienced working with the Centers for Medicare andMedicaid services (CMS), the Healthcare Common Procedure Coding System(HCPCS),Electronic Data Interchange (EDI), Medicare Part D Services,and State Pharmaceutical Assistance Program (SPAP) services
• Have experience in healthcare industry in working withvarious modules that include claims processing using EDI X12transactions like 837, 834, 835, 270/271, and 276, 278 which fall under theHIPAA compliance.
• Comprehensive knowledge on SQL queries

PROFESSIONAL EXPERIENCE:

Confidential, Minnetonka, MN

Sr. Systems Analyst

Responsibilities:

• Work on software product development in solutioning and architect capacity.
• Understand and mitigate of complex systems involved in backend entities, like integration, SQL queries, APIs, data mapping and file transfers.
• Communicate efficiently (written and verbal) across the organization such as Business, Developers, Quality Assurance,
• Infrastructure, Networking and Project Management Office.
• Partner with business users, understand the business and technical requirement and covert into solution architecture.
• Documentation of technical specific document and data mapping documents.
• Analysis on Healthcare EDI transactions (x12’s), HIPPA, PHI/PII, PCI
• Created Functional Design documents for EDI 278, 835, 837I 837P and 837D based on the HIPAA 5010 EDI implementation guides from ASC X12
• Analyze and understand healthcare systems like claims, provider network, member repository etc.
• Lead Joint Application Development/Joint Application Requirement sessions to understand business scenarios, identify gapsand provide solutions.

Environment: CA Agile Central, SQL, MS Office, MS Excel, MS Word, MS Visio, MS SQL Server Management Studio(SSMS) 2014, SharePoint

Confidential, Philadelphia, PA

Sr. Business Systems Analyst

Responsibilities:

• Implemented Agile framework for the SDLC.
• Worked closely with the PMO (Project Management Office) group in defining timelines & schedules for the project.
• Monitored Apex Controllers, Apex Classes & Triggers and linked them to manage the workflows implemented in the system and Created Profiles. Implemented Object and field level security to hide critical information.
• Gathered requirements to replace the Electronic Health Records (EHR) and Electronic Medical Records (EMR) Company’s legacy system to the newly developed platform.
• Proactively worked in creating Apex Triggers and Apex classes and developed and managed complex workflows, approvals, assignment rules and system triggers.
• Facilitated in creating health plans for customers such as Health Medical Organization (HMO), Preferred Provider Organization (PPO), Point of Service (POS) and Exclusive Provider Organization (EPO).
• Ensure operational readiness and customer satisfaction to maintain the star rating program for Medicare advantage.
• Worked on creating different custom objects, fields, and different relationships between them.
• Helped in implementing EDI 834 enrollment file for exchanging health plans.
• Facilitated UAT meetings with the Business User and Stakeholders by demonstrating the Potentially Shippable Product Increment (PSPI).

Environment: Outlook, ALM, Saleforce.com platform, Apex triggers, Apex Data Loader, HEDIS, CSS, MS Excel, MS Visio, Visual Force Pages, Sandbox, SSO, Outlook, and Eclipse IDE Plug- in

Confidential, Seattle, WA

Systems Analyst

Responsibilities:

• Reviewed, analyzed and evaluated business process systems and user needs right from the inception phase.
• Initiated the project with Waterfall methodology and based on extremely tight schedule, adopted Agile methodology to adapt to the changing scope of the dynamic project
• Analyzed massive and highly complex data sets, performing ad-hoc analysis and data manipulation.
• Conduct JAD sessions to finalize the Billing system design, re-architect and streamline existing design changes impacting other BSS projects for Middleware services, Ensemble Billing, XIUS Prepaid and Retail systems.
• Maintained contracts from 4 different clients located between California, Minnesota, Connecticut and New York and travelled 6 months in a row for 4 days a week to capture business requirements.
• Monitored the developing team to ensure that the Potentially Shippable Product Increment (PSPI) met the requirements of the business user.
• Improve capacity planning by evaluating methods for estimating work in Clarity to assess hardware and labor costs as part of the sales pursuit process which can then be translated into demand against Clarity primary roles and potentially asset capacity
• Modified test scripts created by the system test team to meet User Acceptance Testing (UAT) needs

Environment: Rally, Jira, SharePoint, SDLC, UML, User Count Tool, Rational Tools Suite, WMB, MS Project, Basel, MS Office, Mainframes, Windows XP, SQL, DB2.

Confidential, Minneapolis, MN

Business Systems Analyst

Responsibilities:

• Involved in business analysis and project management, coordinating between the team members, addressing budget issues and creating test plans according to the business requirements.
• Worked with the project manager for planning and organizing the project activities, and in communicating with other business center mangers and stakeholders of the project.
• Met with various groups, including business owners, SMEs (subject matter experts) and marketing team, for requirements gathering in definition Stage.
• Followed the Waterfall methodology for the entire SDLC.
• Developing Use Case Models, Activity Diagrams, State Diagrams and Data Flow Diagrams (DFD) using Rational Rose prepared reports and presentation of key components and milestones to Top Management.
• Mapped EDI 834, EDI 837 from legacy system to the new system
• Identified structural difference between nesting and looping procedures for ANSI X12 and EDIFACT 3
• Worked on modules which include claims processing using EDI X12 transactions like 837, 834, 835, 270/271, and 276 which fall under the HIPAA compliance.
• Used SQL for inserting columns in Tables and deletion of Rows.

Environment: MS SharePoint, Telelogic DOORS, MS Visio, MS Office (Excel, Word, PowerPoint), Waterfall, HP-ALM, SharePoint, Confluence 4.3, Gliffy 3.7

Confidential

Business Analyst

Responsibilities:

• Extracting the business requirements from the end users keeping in mind their need for the application, and documenting it for the developers.
• Gathering and Documenting Functional and Non-Functional requirements from the business user.
• Conducted meetings with the Business User and Stakeholders to meet their requirements for Quality Assurance purposes.
• Analyze business requirements and segregated them into Use Cases and activity diagrams using Rational Roseaccording to UML methodology thus defining the Data Process Models.
• Analyzed Business Requirements to produce System Requirements for the technical team using MS Visio.

Environment: Waterfall, SQL, MS Office, MS Excel, MS Word, MS Visio, SharePoint, Rational Tools, UML,