SUMMARY:

• Over 6 years of diverse experience as a Business /System/Technical Analyst in developing and implementing innovative business processes.
• In - depth knowledge and experience in full SDLC with RUP, Agile and waterfall methodologies.
• Ability to elicit, analyzes, gather, document, and prioritize requirements for business support system and operational support system.
• Excellent Analytical skills to understand the PMO business process and Functionality, Requirements and to translate them into system requirement specifications using JIRA.
• Experience in facilitating Joint Requirement Planning (JRP) sessions with Business User Groups, conducting Joint Application Development (JAD) sessions with IT Groups and Conflict Management with Project team members.
• Extensive experience in developing BRD, Use Cases, conducting Gap Analysis, and Impact Analysis, SWOT analysis.
• Strong understanding of Curam Business Models and Documentation center.
• Extensive knowledge of IBM Curam system application solution for Eligibility and Enrollment.
• Extensive experience with Medicare (Part A, Part B, Part C and Part D) and Medicaid benefits, NASCO, TriZettos FACETS, QNXT and IBM Curam.
• Expertise in impact analysis on the key application systems (claims processing, reporting, payments) and business process of health insurance companies.
• Strong knowledge of healthcare standards such as HIPAA 4010, 5010, ICD-9 and ICD-10.
• Medical Claims experience in Process Documentation, Analysis and Implementation in 835/837/834/270/271/277/997 (X12 Standards) processes of Medical Claims Industry from the Provider/Payer side.
• Possess strong analytical and problem solving skills with the ability to adapt to a new environment and meet stringent deadlines.
• Responsible to Track, Document, Capture, Manage and Communicate the Requirements using Requirement Traceability Matrix (RTM) which helped in controlling numerous artifacts produced by the teams across the deliverables for a project.
• Involved in Test Planning, Test Preparation, Test Execution, Issue Resolution, and Report Generation to assure that all aspects of a Project are in Compliance with the Business Requirements.
• Experienced in gathering and documenting test scenarios and ability to train users to translate technical requirements to a business and have experience in conducting UAT.
• Experience in the ETL (Extract, Transform and Load) of data into a data ware house/date mart and Business Intelligence (BI) tools like Business Objects Modules (Reporter, Supervisor, Designer, and Web Intelligence).
• Documented business requirements for the Cognos BI reports. Derive Cognos report requirements from already existing report template.
• Expertise in data analysis and reporting using Business Intelligence tools like Business Objects, Crystal Reports and creating visual representation of data using Tableau.
• Creative, Aggressive and highly motivated team player capable enough to work and lead a team besides being capable to work independently.
• Extensive knowledge of reporting tools such as SQL and ACCESS for underlying database tables and resolve data issues.
• Extracting data from multiple data sources and conducting data analysis using SQL queries.

TECHNICAL SKILLS:

SDLC Methodologies: Agile, RUP, Waterfall

Operating Systems: Microsoft Windows, Unix, Linux

Languages: SQL, Java, Java Script, HTML, XML and UML

Databases & Tools: SQL, Access, MYSQL, Oracle

Quality Management: HP ALM/Quality Center, Rational Test Manager, Rally, JIRA, TFS

BI Tools: Tableau, SSRS, Business Objects Business Intelligence, Crystal Reports, Cognos

ETL Tools: Informatica, SSIS

Business Modeling Tools: Rational Rose, Microsoft Visio, MS Excel, MS PowerPoint

Change Management Tools: Rational Clear Quest, Requisite Pro

Project Management: Microsoft Project Professional

Others: MS (Visio, Outlook, Access, Word, Excel, PowerPoint) Share point

PROFESSIONAL EXPERIENCE:

Confidential, Montgomery, AL

Curam Business Analyst/ Technical Business Analyst

Responsibilities:

• Performed the requirement analysis, impact analysis and documented the requirements using Rational Requisite Pro.
• Gathered requirements by conducting meetings with key stakeholders, end users and Subject Matter Experts (SMEs).
• Developed detailed BRDs and FSDs using various modeling tools and developed databases based on the system model following the techniques in Agile.
• Conducted GAP analysis and Impact Analysis and prepared an Implementation and Recommendations Report communicated to the stakeholders.
• Worked with the project manager for planning and organizing the project activities, and in communicating with other business center managers and stakeholders of the project.
• Produced customer functions, complicate SQL commands in Business Object Enterprise and Oracle, Crystal Reports environments.
• Worked with Curam Business Application suite.
• Used IBM Curam software to manage different operations of social program management and care management.
• Used Curam to design Business solutions and Business requirements.
• Curam Business Analyst worked as a key part of the DHHS team working with a systems integrator to implement a large-scale, complex integrated eligibility and enrollment solution based on IBM Curam Social Program Management Platform.
• Used Curam framework to drive requirements, process flow documents, and subsequent design estimation.
• Helped the clients review policies on healthcare programs (Medicaid and CHIP) to understand the business requirements to implement program eligibility and entitlement solution.
• Run JAD sessions to understand business requirements from the business stakeholders. Conduct workshops with the clients highlighting all the new features and enhancements in the latest releases of IBM Curam.
• Acted as an SME on various subject areas including state reporting, death benefits, Medicare, Bill review and RX eligibility.
• Developed standard Business Process Models detailing the Curam Eligibility Enrollment solution process and presented the models to the State.
• Performed testing on application Renewals to determine case is renewed and program determination given as per CURAM rules engine.
• Actively participated in weekly CURAM Product Development meeting.
• Developed UAT test cases associated with the functional requirements.
• Maintained a bi-weekly status report for the requirements team and incorporated the same to the PMO status reports send to CMS.
• Identified all necessary Business and System Use Cases from requirements, created UML diagrams including Use Case Diagrams, Activity Diagrams, and Sequence Diagrams using Microsoft Visio.
• Reported errors and defects via JIRA tool and kept an eye on its status to retest to determine final status of defects and errors.
• Responsible for UAT project planning like creating testing scenario, test plans, and test scripts.
• Responsible for Analyzing report requirements and developing the reports by writing Teradata SQL Queries and using MS Excel, Power Point.
• Reviewed ETL and Business Objects defects and proposed fix for defects as per the scheduled timeframe.
• Researched internal data integrity issues using SQL database queries, Business Objects reporting, and other forms of data analysis.
• Used ETL tool for Extraction, Transformation and Loading the data into target database.
• Involved in developing and integrating the tasks performed and uploading the resources to SharePoint for access across the organization.
• Performed Data mapping, logical data modeling and used SQL queries to filter data within the Oracle database.
• Performed Back-End Testing to check database integrity by writing SQL queries.
• Reviewed extensive SQL Queries with complex multi-table joins and nested queries.

Confidential - Jeff City, MO

Business System Analyst /IBM Curam BA

Responsibilities:

• Developed detailed BRDs and FSDs using various modeling tools and developed databases based on the system model following the techniques in Agile.
• Worked closely with the Project Manager and Product Manager to ensure that projects progress on expected timelines and alerts team to risks and issues.
• Worked closely with SMEs and analyzed the core requirement and key features of the ongoing project.
• Facilitated meetings and interviews with the client and subject matter experts to gather and/ or define requirements.
• GAP Analysis of client requirements, generated workflow process, flow charts and relevant artifacts.
• Responsible for working with Curam Business Application suite.
• Worked on bug tracking reports on daily basis using JIRA.
• Followed a systematic approach to eliciting, organizing, and documenting requirements of the system.
• Worked Extensively on CURAM HCR portals Universal Access As well as case worker Portal.
• Performed scope and feasibility analysis for different business requirements against IBM product's functionality.
• Provided continuous business knowledge to the technical team and helped them to understand the requirements for solution implementation Interaction with the IBM Product development to understand the new release functionalities and bug fixes that could impact the project.
• Coordinated and worked with IBM Curam team on Curam requirements and then verified the test cases/scenarios for the same.
• Active participation in development of Curam Business Application suite.
• Worked on component of Curam Verification which allows administrators to define the verification rules that are associated with case and participant evidence.
• Reviewed the Joint Requirement Documents (JRD) with the cross functional team to analyze the High-Level Requirements.
• Created plan for implementing new web based technology of IBM Curam product for ACA implementation.
• Responsible for supporting RFP responses and demos and advice management on Curam solution design.
• Used Query Analyzer, Execution Plan to optimize SQL Queries.
• Interacted with client and the Technical Team for requirement gathering and translation of Business Requirement to Technical specifications.
• Prepared graphical depictions of Use Cases, Use Case Diagrams, State Diagrams, Activity Diagrams, Sequence Diagrams, Component Based Diagrams, and Collateral Diagrams and creation of technical design (UI screen) using Microsoft Visio.
• Worked with the Project Manager on -various Project Management activities like keeping track of Project Status, Deadlines, Environment Request, and Compliance Issues.
• Analysis of existing data requirements using SQL to document functional requirements from high level User Stories.
• Participated in Data Analysis and Design with the Data analyst in defining data sources and required data content for the data warehouse component.
• Coordinated with the ETL team and developed new reports using business objects enterprises on SQL Server, focusing on data verification and query performance.
• Performed data profiling to determine how well data matches metadata, supports stated business rules and relation to other data.
• Created Data Mapping, Database Queries, and Data Dictionaries.
• Created complex Stored Procedures, triggers tables, views and SQL joins statements for applications.
• Performed Data Analysis, writing SQL Queries for Testing and Troubleshooting against Data Warehouse.
• Facilitated User Acceptance Testing (UAT) with the stakeholders and the business users.
• Wrote SQL Queries for data analysis and manipulation.
• Developed Data Conversion Strategy for converting data from the existing site to the new site.
• Designed and developed project document templates based on SDLC methodology.
• Designed workflows and allocated permissions within SharePoint.
• Worked on business process analysis and mapping within the CURAM Application Suite.

Confidential, Hartford, CT

Business System Analyst

Responsibilities:

• Studied existing business application and processes, current source system, collected end user requirements and suggested the improvised business process model.
• Acted as a liaison between client and payer/intermediary.
• Analyzed and developed business and functional requirements-BRD, FRD for the Financial Client Reporting website including Medicare part D Banking Payment Option for the members & Clients in the Company Home Page.
• Worked Extensively with Inbound 837 I and 837 P, 835s (Out bounds) claims processing systems.
• Conducted data research to resolve healthcare Medicare/Medicaid eligibility, enrollment and billing issues.
• Developed Schemas of EDI ANSI X12 Claims (837) and Eligibility forms in XML.
• Closely worked with business users and clients for processing of different transactions at EDI Gateway such as Benefit Enrollment and maintain (834), Healthcare Payment (835) and claims (837).
• Worked on regulation and services including HIPAA, Medicaid and Medicare.
• Worked on EDI transactions: 270, 271, 834, 835, and 837 (P.I.D) to identify key data set elements for designated record set.
• Worked on designing business requirement collections approach based on the Agile Scrum SDLC Methodology.
• Tested SOAP request and response in XML format using SOAP UI.
• Analyzed the “As is” and “To be” system documents to show the current and proposed functionalities of the system using MS VISIO.
• Gathered requirements during inception phase, documented and delivered functional specification documents, and assisted architecture analysis and design using UML and Rational tools.
• Prepared user instruction manuals and used case to conduct User acceptance testing (UAT).
• Gap Analysis of client requirements, generated workflow process, flow charts and relevant artifacts.
• Involved in the development of Business and Technical Requirements Document (BTRD) for the project.
• Participated in the JAD session with the SME’s and project team members.
• Created and managed project templates, Use Case project templates, requirement types and traceability relationships in Requisite Pro.
• Used JIRA tool to capture all the Business and Technical User stories.
• Conducted UAT; facilitated discussion between business team and QA team on determining the test requirements and pass/fail criteria; documented and reported user feedbacks to management team.
• Analyzed and defined testable requirements and created test cases.
• Developed Test Plans, Test Cases for the test.
• Wrote Test Cases in Excel based on Technical Specifications, Functional Specifications and Business rules for online application system
• Wrote SQL queries for data validation, analysis and manipulation, and maintaining the integrity of the database.
• Involved in data design and created and maintained databases objects, complex Stored Procedures, Triggers, and Tables, Views and SQL Joins and SQL statements for inserting/modifying/deleting data in relational tables.
• Designed Data mapping and filtering, consolidation, cleansing, Integration, ETL, customization of data mart.
• Used data analysis techniques to validate business rules and identified low quality missing data in the existing enterprise data warehouse (EDW).
• Participated throughout the Extraction, Transformation, and Loading (ETL) process of data mapping, cleansing, standardization and implementations.
• Created various Informatica mappings and mapplets to load the data mart. The mappings involved extensive use of transformations like Aggregator, Filter, Router, Expression, Joiner, Sequence generator.
• Created dashboards, metrics, analytics, goals, alerts using Business Objects to streamline processes and procedure.
• Created reports using Business Objects functionalities like Drill down, @functions, Cross tab, Chart, Formulas, etc.
• Wrote SQL Queries to validate the data integration between the various Database tables.
• Acted as a liaison, writing documentation and increased project coordination.
• Used Data warehousing for Data Profiling to examine the data available in an existing database.

Confidential

Business System Analyst

Responsibilities:

• Worked closely with the Project Manager and Product Manager to ensure that projects progress on expected timelines and alerts team to risks and issues.
• Documented Scope, Vision, High-Level Business Requirements, High-Level Milestones and Risks/Mitigation Plans.
• Involved in Recipient, Claims entry, Claims adjudication, Prior approval authorization, and TPL subsystems.
• Involved in requirements gathered by interacting with MMIS business analyst and translating those business needs into a systems design specification.
• Prepared Statement of Work (SOW) document based on client specification requirements.
• Collaborated SOW with business analyst and technical expertise’s to ensure the functional specifications identified have been met.
• Performed volume, regression and integration testing by loading production claims into test regions.
• Acted as a liaison between the project group and the operations group. Helped design scope document and the Request for Proposal (RFP) after extensive analysis and coordinated with top management for the approval process.
• Communicate effectively with customers about requirements and report designs.
• Participate in Report Design sessions to array easy to understand and qualitative data results.
• Developed diagrams for user documentation plans. Hosted interview sessions with developers, support personnel, and additional subject matter experts to gather content information.
• Verify and validate of data model with changing business information and rules.
• Created Technical Specifications and process documentation.
• Suggest corrections to existing data model and test new data model for validity.
• Worked closely with and interviewed SMEs (developers, QA, support, consulting, etc.) to determine documentation content and design of user interfaces.
• Provided recommendations and improvements to processes and projects.
• Assisted in creating and maintaining reports to track and analyze Managed Care initiatives including Average Wholesale Price (AWP), Funnel Report, New Business Repor and Profit Improvement.
• Responsible for doing the gap analysis for the interfacing system.
• Defined test bed, Develop test plans, Create expected results and Troubleshooting.
• Responsible for executing Volume Testing, Compliance Testing, Data Quality Testing, Unit Testing, Regression Testing, Acceptance Testing and Stress Testing.
• Reported and tracked defects using HP Quality Center.
• Generated reports using document generator of HP Quality Center.
• Responsible for status check at regular timeframe.
• Understanding for process and design improvement
• Experienced in working with Cross Functional Groups and reporting JAD Sessions.
• Managed the Enterprise Data Warehouse running on Teradata, including monthly data acquisition, Extraction, Transformation and Loading, Reports etc.
• Used SQL and MS Access to test warehoused data.
• Developed test cases and performed data quality testing using Teradata SQL Assistant.
• Facilitated User Acceptance Testing (UAT) with the stakeholders and the business users.
• Helped in project testing efforts for doing integration tests, regression tests and user acceptance tests.