PROFESSIONAL SUMMARY:

• Business/System Analyst with 7 years of progressive experience actively involved in Healthcare domain with personal communication, leadership, problem solving with an ability to work independently as well as dynamic team member.
• Excellent communication, writing and client handling skills to preserve positive and productive client relationships with an ability to handle sensitive personnel related communication and issues with discreteness and sound judgment.
• Managed requirement changes by monitoring Version Control.
• Handful experience in requirement gathering, documenting, verification, validation, analysis and design.
• Experience in designing business models using Business Intelligence, use case models, workflow models, analysis models, activity diagrams, sequence diagrams, and collaboration diagrams.
• Strong working experience in the Data Analysis, Design, Development, Implementation and Testing of Data Warehousing, DataMarts and ODS using Data Conversions, Data Extraction, Data Transformation and Data Loading (ETL).
• Involved in providing about the ICD - 10 codes and 5010 standards , its requirements, complexity and accuracy to Physicians and Nurses of the hospital. Figured out the requirement of in various departments of the hospital based on their daily work .
• Create relevant artifacts to support usage of the Agile Framework such as: Business Owner View, Process Flows, User Stories, Use Cases, and User Interface Requirements.
• Expertise in enhancement and testing of the FACETS application like Enrollment, and Claims.
• Strong organizational and planning skills, ability to work well under pressure, result-oriented, self-motivating and versatile in problem solving.
• Experienced in Agile and Scrum, and the development of associated project artifacts (i.e., user stories, acceptance criteria).
• Skillfully used techniques like interviews, surveys, workshops, JAD, JRP sessions by using design modeling tools like Microsoft Visio.
• Prepared workflow diagrams by analyzing “As Is” and “To Be” scenarios
• Inclusive knowledge in Software Development Life Cycle (SDLC) involved in all stages Including Defining, Designing, Developing, Debugging, and Deployment of applications using different methodologies such as Agile, Waterfall and RUP.
• Experience with TriZetto FACETS and HIPAA Gateway - supported new business requirements by extending the functionality of the core Facets system using the Facets extensibility architecture feature.
• Good knowledge of ICD-9/ICD-10 and HIPAA 4010/5010 Transaction requirements.
• Strong experience working with HIPAA ANSI X12 Transactions ( 837 / 835/834/ 270/271/276/277 )
• Firm understanding of HIPAA regulations and experienced working in all phases of healthcare insurance processing like defining Eligibility and Enrollment and various Medical Claims processing, including Medicaid and Medicare claims processing.
• Supported in generating deeply integrated applications and automation system in entire system.
• Good Documentation and Process Management skills with an ability to effectively understand the business requirements to develop a quality product.
• Developed thorough artifacts like BRD, functional specifications, Use Cases, UML diagrams, data mapping documentation, pre and post RTM, weekly reports, Data flow diagrams using Microsoft Visio.
• Capability to communicate with configuration manager, production manager and end users.
• Expertise in handling onshore and offshore development team through WebEx.
• Worked extensively on testing tools like ALM, Quality Center, QTP.
• Analyzed test results to ensure existing functionality and recommend corrective action where necessary.
• Good experience with Sanity Testing, Smoke Testing, White Box testing, Black Box Testing, GUI Testing, Functionality Testing, Positive and Negative Testing, Security Testing, Integration Testing, System Testing, Load Testing, User Acceptance Testing (UAT) and Regression Testing of Web Based Applications and Client-Server Applications.
• Knowledge of QA methodologies and processes.
• Involved in test planning, test preparation, test execution and issue resolution and report generation to assure that all aspects of the project are in compliance with the business requirements.

TECHNICAL SKILLS:

Project Methodologies: Rational Unified Process (RUP), Agile, Waterfall

Business Modeling Tools: Rational Rose, MS Visio

Defect Tracking Tools: Rational Clear Quest, Mercury QC, Jira

Operating Systems: Windows NT/XP/2000/2003, UNIX

Databases: Oracle, SQL Server, MS Access, DB2

Languages: C, SQL, HTML, PHP, ASP

Quality Assurance: STLC, Bug Life Cycle

Automated Testing Tool: Quick Test Professional, Win Runner, ALM, Test Director

Business Applications: MS Project, MS Office Suite, MS Share Point

PROFESSIONAL EXPERIENCE:

Confidential, Watertown, MA

Sr. System Analyst

Responsibilities:

• Served as a liaison between the internal/external customer support and the IT organization as an attempt to construct an accurate picture of the purpose the implemented system is expected to serve.
• 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.
• Participated in all Iteration, Scrum, Daily stand-ups and Iteration review meetings working in an agile development methodology.
• Documented FDDs - working with Tech teams for TDD and Functional test review.
• Coordinated and worked with Project Manager to prepare Project Plan in MS Project for Process Claim Domain.
• Performed the GAP analysis to find the Root Cause of the issues.
• Evaluate business requirements and prepare detailed functional and technical specifications.
• Helped creating Provider Reports i.e. Financial, Claims processing.
• Recommended changes for system design, methods, procedures, policies and workflows affecting Medicare/ Medicaid claims processing.
• Worked on developing the business requirement and use cases for FACETS batch process, automating the billing entities and commission process.
• Developed business case, objectives, cost analysis and budget for implementation clinical and financial business systems.
• Involved in various Facets Data models like Gateway, Claims,, Provider, Billing, Capitation, Invoice, Benefits, Product and Plan.
• Gathered information about the organization’s work processes and information flows using sequence diagrams and class diagrams.
• Documented existing process in technical model format in order to evaluate and define new IT solutions
• Acted as a primary contact in all the phases of Software Development Life Cycle SDLC, including Quality Assurance Testing, Performance & User Acceptance testing.
• Worked on the FACETS front end and backend for testing and for documenting the Business requirement documents.
• Investigated and analyzed feasibility of low to moderately complex enhancements, automations and processes.
• Involved in FACETS Implementation, involved end-to-end testing of FACETS Billing, Claim Processing and Subscriber/Member module.
• Worked on Facets to efficiently execute core administrative functions, including claims processing, premium billing and customer service.
• Participated in creating Facets data model.
• Utilized SQL in every step of creating data warehouse including data warehouse design, data warehouse database, and loading data into data warehouse.
• Developed complex queries by joining different Dimensional tables to Fact tables and retrieved the data From EDM and validated the data against EDW.
• Involved in data dictionary management, extraction, transformation and loading (ETL) of data from various sources. Participated in ETL requirements process during data transition from source systems to target systems.
• Involved in Data Analysis & Mapping to track all data elements used in the application from the user interface through different interfaces to the target databases in which they are stored.
• Developed tables, Views, Stored Procedures and Triggers using SQL Scripting.
• Assisted the team members to develop Service Oriented Architecture (SOA), and data warehouse system (EDW) to utilize data mining for data analysis.
• Established Inner Join, Outer Joins and created primary key indexes (paired with foreign keys) for dimension tables whenever necessary.
• Involved in Data Analysis & Mapping to track all data elements used in the application from the user interface through different interfaces to the target databases in which they are stored.
• Documented the dimensional models of ETL system.
• Formed advanced SQL Queries and used Microsoft Excel to investigate data issues in the Data Warehouse and worked with the Users and Technology Team to formulate a solution to resolve the issue.
• Extensively worked on SQL queries and good experience on data transformation and data mapping from source to target database schema.
• Maintained requirements/business rules for Enterprise Data Warehouse, Business Intelligence Tools.
• Worked closely with lead Data Warehouse developers to evaluate impact on current implementation, redesign of all ETL logic.
• Created Mock-up forms in MS word for better visualization and understanding of the software solution.
• Supported the production of Requirements Traceability Matrixes (RTM) and RTM gap analysis reports for complex enhancements, automations and implementations. May produce RTM and RTM gap analysis reports for less complex enhancements, automations and implementations.

Confidential, Dayton, OH

Business System Analyst

Responsibilities:

• Responsible for requirements analysis, design and developing technical requirements.
• Used Agile methodology during the development of the project. Involved in Scrum Calls, Stand up meetings
• Acted as a SME for the application team and the Infrastructure team.
• Reviewed BRD, FDD and Technical Design to determine the Risk Analysis of the application and to create a test plan.
• Conducted interviews, meetings, and JAD sessions during the process of Requirement Gathering.
• Followed and implemented Agile Methodology, attended daily scrum calls and business orientation sessions.
• Efficiently accelerated planning schedules so as to adequately manage release timelines
• Used Requisite Pro for writing/analyzing project vision, goals, specifications, and requirements.
• Performed Gap Analysis to check the compatibility of the existing system infrastructure with the new business requirements.
• Worked with both technical and non-technical users throughout the project.
• Gathered business requirements (functional and non-functional) and documented then in the BRD.
• Created swim lane diagrams for “As-Is” and “To-Be” Business Process Flow using MS Visio.
• Worked closely with the project team to identify use case dependencies and planned the use case development.
• Worked on analysis of FACETS claims processing system and to gathered requirements to comply with HIPAA 5010 requirements.
• Analysis and Design of the Trizetto FACETS Data Model to ensure optimal system performance and tuning.
• Prepared the Source To Target Map for Claims Inpatient, Claims Others, and Claims Long Term and Financial Transactions.
• Configured facets modules such as Claims,, Billing, Benefit and plan.
• Worked on 837, 835, 276 and 277 Institutional and Profe ssional EDI Gateways.
• Involved in development of claim management to assist claim professionals to analyze and administer the Medicaid and Medicare claims in an efficient manner.
• Validated X-12 files sent by external vendors to ensure that they are passing EDI Gateway level using Spec Builder.
• Worked on multiple 837 and multiple Eligibility (270/271) and healthcare claim status (276/277).
• Tested the changes for the front-end screens in FACETS related to following modules, test the FACETS batches (, Billing, Provider, etc.).
• Worked with the QA team in writing Test Plan and conducting the testing process.
• Performed (ETL) extract, transform and load data into the repository and created complex stored procedures, Functions, views, indexes for the logic package.
• Responsible for providing BI support and ensuring high levels of availability in the Business Intelligence environment.
• Managed key Data Warehouse project implementations requiring working with vendors and developers to provide ideal platform for their application using SQL, PL/SQL.
• I have interacted with DBA for the process of data extraction, data transformation, data load, data integration and conversion processes using business intelligence tools.
• Logged issues and kept track of them until they were resolved.
• Worked with Trizetto Facets claims data for claims subject area, Enrollment and billing data for member/Subscriber, and Product subject areas.
• Conducted walkthroughs and s after the application was deployed to make sure the end users knew to navigate the new changes in the application.
• Utilized Agile methodologies to analyze and document any proposed requirement.
• Used MS Visio to create Business Flow Diagrams and Work Flow Diagrams to illustrate the structure of the system and the relationship amongst its various components. (objects)
• Maintained Requirement Traceability Matrix (RTM) and managed requirements.
• Involved in writing Data Mapping Documents for the system and involved in documenting the ETL process and writing SQL Queries for the retrieval of the data
• Responsible for managing the Data Warehouse and Business Intelligence functions.
• Setting up Enterprise Data Warehouse (EDW) and associated ETL service to generate business reports.
• Reconciled any inconsistencies between data warehouse information when constructing specific Data Marts that deal with different vaccination domains.
• Developed SQL queries, functions, stored procedures and triggers to perform the backend testing of the data
• Performed backend testing to check the system data integrity for insert, update, delete and retrieve transactions by being involved in writing complex SQL queries including joins, group by, having clause etc.
• Used TOAD for Oracle in creating and executing SQL queries for testing ETL process.
• Maintained meeting minutes, meeting agenda and communicated them with the SMEs and the stakeholders on timely manner using MS Word, MS PowerPoint and created reports using MS Excel.
• Verified referential integrity between dimension and fact tables to ensure that all records relate to appropriate records in other tables if a system report is to cover all aspects of a given record.
• Ran specific SQL queries that would successfully distinguish between seemingly homogenous categories in an effort to create specific and accurate patterns.

Confidential, Schenectady, NY

System Analyst

Responsibilities:

• Utilized SDLC Methodology to configure and develop process, standards and procedures
• Conducted JAD sessions with business units and stakeholders to define project scope, to identify the business workflows & task analysis, and determine whether any current or proposed systems are impacted by the new development efforts
• Designed Test Plans, Scripts after analyzing various scenarios/requirements & performed defect tracking using Test Director & Clear Quest.
• Updated System Requirements Document (SRD) and Business Requirements Documents (BRD).
• Conducted SME interviews, gathered requirements, and analyzed the requirements for the Claim processing system.
• Performed Gap Analysis to check the compatibility of the existing system infrastructure with the new business requirements.
• Created and update Functional design documents. Created Change control document based on the changes in the requirement and update the FDD.
• Performed User Acceptance testing & End to End testing in interaction with Offshore QA/dev teams for various system releases & pushed them to production
• Provided Production support, documented System Release/deployment issues & SOX documentation for Business Signoff.
• Experienced in data warehouses and data marts for business intelligence reporting and data mining along with developing and documenting process flows for business processes.
• Experience in forward mapping and backward mapping analysis of ICD 9 - ICD 10.
• Conversion for CM diagnosis code and procedure code.
• Coordinated the upgrade of Transaction Sets 837P, 835 and 834 to HIPAA compliance. Responsibilities include the Analysis of inbound and outbound interfaces and extensions to FACETS claims processing system.
• Managed Financial Processing that served as primary lead for corporate financial systems, including accounting processes for accounts receivable and accounts payable systems. Manage financial spreadsheets and vendor accounts. Spearhead collection processes and manage accounts receivable personnel.
• Participated in changes for system design, methods, procedures, policies and workflows affecting Medicare/Medicaid claims processing in compliance with government compliant processes like HIPAA/ EDI formats and accredited standards ANSI.
• Completed Data Mapping for Group and detail Product analysis and report writing
• Analysis and Design of the FACETS data model to ensure optimal system performance and tuning
• Worked extensively with facets modules such as Claims,, Billing, Benefit and plan
• Work closely with EDI to ensure accuracy in data transmissions and shared processes. Transaction sets processed (837P, 835, 834)
• Conducted Testing on EDI claims with Quality Analyst Team using HP Quality Center.
• For testing purposes, manipulated members information in the QA environment through Facets front-end application.
• Involved with the requirement validation for Enterprise Data Warehouse (EDW) with the state stakeholders.
• Worked on Data mapping, logical data modeling used SQL queries to filter data within the Oracle database tables.
• Used Microsoft Office suit to develop the documents such as Visio for creating wireframes, Word, Excel and PowerPoint for creation of Business Requirement documents.
• Responsible for managing the Data Warehouse and Business Intelligence functions.
• Responsible for writing the Test Cases and Test Scenarios based on the Functional Specification and technical Specification and documented in Quality Center.
• Responsible for Back-End Testing Using SQL Commands using TOAD.
• Developed SQL queries, functions, stored procedures and triggers to perform the backend testing of the data

Confidential, Chicago, IL

Business System Analyst

Responsibilities:

• Used UML, for gathering requirements, created Use Case Diagrams, and Use Case Specification document (USD).
• Authored Business Requirements Document BRD with project teams. Extracted, discussed, and refined business requirements from business users and SME’s.
• Analyzed User and Functional requirements to point out gaps between used SQL queries to extract the data from the database.
• Documented and circulated FDD’s to the Business, Development & Tech teams for Signoffs and ensuring base lining in RTC
• Conducted GAP analysis for process improvement between the As-Is and the To-Be risk assessment processes.
• Delivered a requirements document and maintained a requirements traceability matrix.
• Conducted numerous JAD sessions with Business users, developer, CQA and SMEs.
• Responsible for integrating with Facets. Designing test scripts for testing of Claims in Development, Integration and production environment.
• Created source table definitions in the Data Stage Repository by studying the data sources.
• Generated Surrogate ID’s for the dimensions in the fact table for indexed and faster access of data.
• Developed a detail project plan and helped manage the data conversion migration from the legacy mainframe system to the target SQL Server database.
• Responsible for architecting integrated HIPAA, Medicare solutions, Facets.
• Tested and delivered Inbound/Outbound Facets interfaces.
• Created Data Flow Diagrams and Process flow diagrams for various load components like FTP Load, SQL Loader Load, ETL process and various other processes that required transformation.
• Involved in making Use Case Diagrams, Activity Diagrams, and using analysis and design models tools like MS Visio, Rational Rose through Agile and Waterfall Model.
• Used SQL to test various reports and ETL load jobs in development, QA and production environment.
• Performed Data analysis from the data warehouse along with business intelligence solutions delivery team.
• Created and executed test plans that improved data warehouse report quality using Word, Excel and Access.
• Wrote BRD, FRD, use cases, test scenarios, test cases for testing the functional requirement.