SUMMARY:

• 8+ years of experience in Business Systems Analyst, business requirements gathering, and data analysis,data validation,data modelling, process flow and quality assurance with hands on experience in Healthcare Sectors.
• Extensive experience with Medicare/Medicaid processing as well as the Claims/Billing, Provider/Member in the markets.
• Strong knowledge of the Software Development Life Cycle methodologies phases and gates like Agile and Waterfall models
• Performed Gap Analysis to check the compatibility of the existing system infrastructure with the new business requirements
• Working with a variety of stakeholders to gather requirements, manage implementation and drive delivery of agile projects to include planning and facilitating requirements elaboration sessions, and documenting the output utilizing Pega PRPC.
• Experience with TriZettos Facets Application Groups: Claims Processing, Guided Benefit Configuration, Medical Plan, Provider, Subscriber/Member, Utilization Management.
• Worked on Facets Data tables and created audit reports using queries. Manually loaded data in Facets and have good knowledge on Facets business rules.
• Worked on the mainframe reports for member/eligibility/claims and mapped the fields with Facets, run batch jobs and reports for analysis.
• Tested the changes for the front end screens in Facets related to following modules, test the Facets batches (membership).
• Conducted extensive analysis on migration and conversion of Provider and Member data, Group configurations, plan codes, benefit set - ups, fee schedules, provider pricing, capitation set-ups, etc from Legacy system (AGP) to Facets (Client Server based system).
• Providing consultation on concurrent Pega projects and serves as a specialist in most phases of systems analysis. Considers the business implications of the application of technology to the current and future business environment.
• Good knowledge and extensively used SQL, Data Mapping, Data analysis and reporting.
• Used SQL to query the database and performed data analysis for Customer Care application.
• Experience writing SQL queries, extract, transform and load data in development environmnet for validation using SSIS and Tidal job schedular.
• In-depth knowledge of creating use case, activity, logical, component and deployment views with rational tools to extract business process flows and workflows thereby helping development and quality assurance teams in understanding the requirements.
• Prepared test scenario and test cases.Reviewed and updated test cases, test scenario and conducted smoke testing in development and validate in production.
• Analytical, methodical, and resourceful approach to problem solving, identifying and documenting root causes and corrective actions
• Worked on Internal Process Improvement created new pages, updating existing flows upon implementing new changes in the system using Confluence and Sharepoint.
• Worked on EDI transactions: 270, 271, 834, 835, and 837 to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
• Expertise in broad range of technologies, including business process tools such as Microsoft Project, MS Access, MS Visio, technical assessment tools, Data Warehousing concepts and web design and development.
• Well versed in project management tool (MS Project) for status reporting, planning and resource allocation.
• Designed and developed process flows for customer care application integration with other systems and tools and platforms.

TECHNICAL SKILLS:

Programming Languages: C, VB, VB.NET, ASP.NET, Java, SQL

Development Methodologies: RUP, AGILE, Waterfall

Databases: MS-Access, MySQL, SQL Server, Oracle, Teradata, DB2

Internet: HTML, XML, VBScript, ASP, JavaScript, JSP, J2EE.

Automation Tools: MS Visio, Rational Rose, Rational ClearCase, Rational RequisitePro

Bug Tracking Tools: Mercury Test Director, Rational ClearQuest

Utility Tools: MS Office Suite, MS Project, TOAD

Reporting Tools: Crystal Reports, SQL Server Reports (SSRS )

Data warehousing Tools: Informatica, Business Objects, Cognos, Erwin

Testing Tools: Quick TestPro (QTP), TestDirector, WinRunner, LoadRunner

PROFESSIONAL EXPERIENCE:

Confidential, Norfolk, VA

Sr. Business System Analyst

Responsibilities:

• Worked on FACETS Data tables and generated outbound data files by extracting data using queries.
• Manually loaded data into Development environment for validation purpose.
• Did the forward and backward data mapping between the fields in mainframe and FACETS.
• Analyzed the mainframe reports for member/eligibility/claims and mapped the fields with FACETS batch jobs and reports.
• Responsible for working with the State to review and modify process flows to increase productivity and effectively utilize FACETS features not provided by the legacy systems.
• Facilitate UAT Testing by providing necessary support to the Business users
• Analyze and make specific recommendations on improvements that can integrate into the business process.
• Performed backend testing on database tables using SQL queries.
• Good understanding of data flow architecture, system integration, database behavior, and testing strategy, Implement, maintain and improve upon the reporting and visualization of data, metrics and Key Performance Indicators (KPI) within local specified sharepoint.
• Extensively use SQL queries for backend testing and also to query the Oracle Database for Data Validation and Data Integrity.
• Provided daily extract with changes on adhoc basis to eligibility/enrollment department.
• Works with team, management, and on own to identify and document benefits, costs and risks associated with solution alternatives.
• Works with technical staff to help design/develop tools, models, and reports.
• Leads activities to help understand business objectives, assumptions and constraints related to a particular question/problem with staff at all levels through clear interpretation of data and analytics.
• Leads the on-going enhancements to the analytic/reporting process by using a strong knowledge of the business need and careful application of analytic/reporting tools.
• Worked in Compass team on change control and fetures for customer care application (Compass).
• Reviewed stories and features with product owner and provided technical input in pre-refinement.
• Worked on Service items like Authorization Request, Correspondance, Billing, Claims search, Membership, Provider Search,Update Authorization, complaints and grievance.
• Co-ordinate with webservice team, Facet, Enrollment, Nexgen and other internal and external teams for integration and impacts.
• Using SQL queries to retrieve the data from Facets for validation purpose.
• Testing members and providers data in lower environments and validate in production after go live.
• Provided test data to developers to verify members and providers in Pega PRPC Compass application.
• Worked with agile team played scrum master role and follow the scrum process and hosted stand up meetings with development and testing teams to identify impediments.
• Successfully implemented migration of Avaya to Genesis call data project into Compass application.
• Worked on spikes before pulling in the stories to identify the dependency on other teams .
• Helped Develpers and testers to understand the requirements, in-scope and out of scope items and process flows.
• Assist developers and testers to create test scenarios through Agile ATDD(Acceptance Test Driven Development) method.
• Performed smoke testing on each story after development and identify errors in functionalities.
• Imlemented functionalities and applied business rules for existing and new markets and line of business LOB (Medicare and Medicaid).
• Assist product owner on all elaboration meetings by adding technical inputs and dependancies.
• Developed the new workflows and updated the existing workflows for change request.
• Provided input on the requirements for existing functionalities in service item.
• Co-ordinate with end users (Customer Care Representatives) to review the requirements for clarifications.
• Assist team and product owner in PI Planning to pull the user stories in each sprint with capacity and load.
• Updated documentation in confluence once all stories approved by product owner and implemented into production.
• Demonstrated all stories and process flows to business and all internal teams by using powerpoint and Compass application process flow.
• Developed the single document for Compass application which include all integrations, impacts and business rules based on markets and line of business for better visibility.

Confidential, Tampa, FL

Sr. Business Systems Analyst/ Technical Analyst

Responsibilities:

• Interfaced with the client as part of the Requirements Engineering team to finalize the project scope.
• Conducted user interviews, gathered Requirements, analyzed the Requirements and managed changes using Rational Suite.
• Met with report users and stakeholders to understand the problem domain, gathered customer requirements through surveys, interviews (group and one-on-one) along with JAD sessions
• Prepared Business Context Diagram, Use Case diagrams and corresponding Activity Diagrams using Rational Rose to depict the workflows to be incorporated into the development of Pega Business Process Management (BPM) tool.
• Identify Member, Provider, Coverage, Medicare, and Medicaid.
• Worked on service items like Additional Actions, Add Newborn, Auth Request, Auth Search, Call Transfer, Claims Research, Complaints and Grievances, Correspondence, Document Request, Membership, Payment etc
• Created screens and work flows for service items updated confluence pages with new changes.
• Created current and future state processes, along with prototype BPM solution at medical device company
• Established questionnaires and resource leveling required for implementing the regulatory reports that satisfy the state / federal mandates.
• Created Business Rules Document and Requirement Traceability Matrix(RTM) to track the requirements for Pega PRPC.
• The project team used “agile” methodology, EMMA, HP ALM, and Pega PRPC.
• Involved in mentoring specific projects in application of the new SDLC based on the Agile Unified Process, especially from the project management, requirements and architecture perspectives.
• Worked on a strategic EDI project to migrate to a new translator and implement HIPAA 5010/ICD10 initiatives.
• Extremely proficient in using Agile and XP methodologies performed roles of Scrum Master following sprint sessions and used Rally software extensively to write User Stories, assign tasks to individual team members.
• Worked with business sponsors and SME’s to create project charters and develop project deadlines.
• Interacted with the SMEs and stakeholders to get a better understanding of client business processes and gather business requirements to document into BRD and FRD.
• Since it was an agile environment I have worked with scrum master and product Owner on User Stories, Product Backlog, Sprint Backlog and Sprint Burn down chart.
• Helped in project testing efforts for doing integration tests, regression tests and user acceptance tests.
• Documented business rules for process mapping (source to destination) and maintained and updated data dictionary.
• Involved in understanding the current business process, defining scope of the project along with position statement.
• Used MS Visio for Process modeling, Process mapping and Business Process flow diagrams.
• Created Process Flow diagrams, Use Case Diagrams, Class Diagrams and Interaction Diagrams using Microsoft Visio.
• Validated business rules and all artifacts with users, approval and sign off.
• Project tracking and documentation using MS Project, Excel, Access and Word.

Environment: Windows 7/8, Business Objects, Zachman Framework, XML, TFS, MS Word, Excel, Visio, PowerPoint, Access, Casewise Corporate Modeller, power point, SQL, COBOL, PL/SQl, DB2, SAS database

Confidential, Cincinnati, OH

Business Systems Analyst / Technical Analyst

Responsibilities:

• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims.
• Worked with HIPAA rules and regulations to draft business rules and claim processes.
• Involved in analyzing the claims on basis of Primary and Secondary Payers and performed Medicare subsidy eligibility check for employee group plans.
• Extensively supported and worked with EDI programmers and came up with many complicated business and technical solutions to customers’ requirements. This led to new standard EDI mappings which were easily integrated into other EDI projects.
• Work with the full SDLC, elicit, analyze and define requirements.
• Strong HIPAA EDI 4010 and 5010 with ICD-9 and ICD-10, analysis & compliance experience from, payers, providers and exchanges perspective, with primary focus on Coordination of benefits.
• Created MS Excel spreadsheet that integrated both bug and task status directly from TFS queries.
• Managing simultaneous projects with multiple clients, through full system development life cycle, ensuring delivery success using Agile/Scrum methodology and Team Foundation Server (TFS).
• Worked on EDI transactions: 270, 271, 834, 835, and 837 (P.I.D) to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
• Led internal JAD sessions to elicit & review requirements.
• Documented high level and detailed Use Cases to include all the functionalities of the new system.
• Collaborated with QA to create test plan, test cases and test scripts.
• Prepared system Test Plan and scenarios for Test Scripts.
• Assigned tasks among development team monitored and tracked progress of project following agile methodology.
• Worked on Agile Scrum methodology performed roles of Scrum Master following sprint/standup sessions and used Excel extensively to write user stories, analyzed the Iteration Burn Down charts and reviewed defects.
• Created Test Plans and Test Cases based on user requirements and functional specifications.
• Experience with healthcare system, Medicaid and with prime focus on claims adjudication, provider, eligibility and prior authorization.
• Facilitated meetings between IT and various other department team members regarding current and future projects.

Environment: Windows 7/XP Professional, Oracle, MS Access, MS Excel, MS Visio, MS Office, RUP, Oracle, UML, Rational Rose, Requisite Pro, Clear Case, Rational Clear Quest, MS Office suite, MS Visio.

Confidential, Yonkers, NY

Business Systems Analyst/ QA

Responsibilities:

• Interviewed SMEs and Stakeholders to get a better understanding of client business processes and gather business requirements. Requirement gathering, Business Process flow development, Business Analysis.
• Conducted controlled brainstorming sessions with project focus groups for collecting high level business requirements.
• Strong working experience in the Data Analysis, Design, Development, Implementation and Testing of Data Warehousing using Data Conversions, Data Extraction, Data Transformation and Data Loading (ETL).
• Good working knowledge of Claims processing, HIPAA Regulations and 834, 837P, 837I, 837D EDI Transactions for health care industries
• Data modeling and design of databases, tables and all objects.
• Used SQL to query the database and performed data analysis.
• Contributed to writing technical proposals to bid on IV&V, QA, and system testing contracts for business development purposes.
• Involved in data mapping, field mapping of the data elements responsible for the migration BRD.
• Performed GAP analysis of business rules, business and system process flows, user administration to be used for the new migration platform
• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims. Worked on EDI transactions: 270, 271, 834, 835, and 837 (P.I.D) to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
• Strong experience with SQL Demonstrated working knowledge of data warehousing / business intelligence technologies
• Performed personnel actions and performance appraisal reviews, and approved time sheets for IV&V/QA/Testers.
• Created and maintained a project schedule using MS Project showing all target dates for deliverables.
• Successfully conducted JAD sessions, which helped synchronize the different stakeholders on their objectives and helped the developers to have a clear-cut picture of the project.
• 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.
• Extensive experience in Data Analysis and ETL Techniques for loading high volumes of data and smooth structural flow of the data.
• Develop and maintain sales reporting using in MS Excel queries, SQL in Teradata, and MS Access.
• Created logical data model from the conceptual model and it’s conversion into the physical database design.
• Troubleshooted file transmission problems and assisted customers with EDI and Medicaid Insurance claim related inquiries explained and enforced guidelines in the X12 Implementation guides (837P, 837I, 837D, 270/271).
• Involved in creating sample mappings for the conversion of EDI X12 transactions code sets version and translation of ICD 9 codes into ICD 10 codes.
• Planned and documented procedures for data processing and prepared data flow diagrams for the application. Worked in close co-ordination with the testing team in developing test plan and test cases from functional and business requirements.
• Used MS-Visio for flow-charting, Use- Case process model and architectural design of the application.
• Generated data element matrix encompassing all the data element report wise including the data mapping for the data warehouse.

Environment: MS Office, SQL Server, Agile, MS Project, MS FrontPage 2003, MS Access, EDI, Documentum 2.0., Microsoft Excel, Microsoft Word, Microsoft Power Point, SharePoint, Visio.

Confidential, Washington DC

Business Systems Analyst

Responsibilities:

• Defined the scope and implemented business rules of the project, gathered business requirements and documentation.
• Responsible in writing & Execution of Test Plan and Test Cases for different applications like MBSG, PCC, Syndication Server. Etc.
• Generated test cases in Claims Analyzer Editor Professional to ensure unification with CPT-4 and ICD-9 codes
• Analyzed trading partner specifications and created EDI mapping guidelines.
• Gathered and analyzed the requirements and converted them into Business Requirement Specifications (BRS) and Functional Requirement Specifications (FRS) for the designers and developers and QA Team to understand them as per their perspective.
• Performed compliance testing on 837 I and P, 834 and 820 EDI transactions.
• Generated test cases in Claims Analyzer Editor Professional to ensure unification with CPT-4 and ICD-9 codes. Worked on Implemented and Migration of HIPAA 4010/ICD 9/10, version for all EDI transactions.
• Designed and developed use cases, activity diagrams, and sequence diagrams using UML.
• Used the DataStage Designer to develop processes for extracting, cleansing, transforms, integrating and loading data into data warehouse database.
• Extensively used Star Schema methodologies in building and designing the logical data model into Dimensional Models.
• Performed extensive Requirement Analysis including data analysis and gap analysis.
• Worked on data modeling and produced data mapping and data definition documentation
• Created context and workflow models, information and business rule models, Use Case and Object Models during the analysis using rational tools.
• Created interface requirements documents which became the baseline and standard for all data exchanges
• Ensured that project requirements are properly tracked and documented.
• Expertise in broad range of technologies, including business process tools such as Microsoft Project, Primavera, Promodel, MS Excel, MS Access, MS Visio, technical assessment tools, MicroStrategy Data Warehouse Data Modeling and Design.
• Worked in mainframe environment and used SQL to query various reporting databases
• Created and maintained Narrative Use Cases (Business Use Cases, System Use Cases) and modeled Use Case Diagrams, Activity Diagrams, Data Flow Diagrams using MS Visio.
• Used Test Director, PL/SQL for testing the application
• Wrote PL/SQL statement and stored procedures in Oracle for extracting as well as writing data.
• Used different ad-hoc analysis, the Reports assist in defining strategy for each customer category. Informatica was used for ETL process and Business Objects 6.5.1 & XI R2 are used for Reporting duties.
• Tracked UAT issues/bugs and prepared reports.
• Capture and Formulation of Business Rules and delivery of Business Rules Templates.
• Creation of UML Diagrams including Context, Business Rules Flow, and Class Diagrams
• Created Business process workflow diagrams using IBM business process modeler
• Implemented RUP recommended visual models to draft business requirements by using Use Cases.

Environment: Microsoft Office 2003 Professional (Outlook, Word, Excel, Visio, Access, etc.), Microsoft SharePoint 2003,UML, RUP, UAT, ERWIN, UNIX, db2, Oracle 10g, PeopleSoft GL, Mercury Test Director, SQL, PL/SQL

Confidential, Murrysville, PA

Systems Analyst

Responsibilities:

• Responsible for defining the scope and implementing business rules of the project, gathering business requirements and documentation.
• Used Master Data Management (MDM) technology, tools to create and maintain consistent and accurate lists of Master Data. Part of team conducting logical data analysis and data modeling JAD sessions, communicated data-related standards.
• Understood existing data model and documented the performance of the system.
• Validated the model with response to questionnaire from analysts.
• Wrote Test cases for Enterprise Data Warehousing (EDW) Tables and Data Mart Staging Tables.
• Involved in Data Modeling of both Logical Design and Physical design of data warehouse and data marts in Star Schema and Snow Flake Schema methodology.
• Prepared the Test Plan and Testing Strategies for Data Warehousing Application. Worked closely with the architect, database administrator and technical team during Data Mapping and Data Integration.
• Engaged in different phases of SDLC of the project executing RUP methodology of iterative software development from Inception to Transition phase.
• Extensively used the UML methodology to create various use case diagrams for the system. Authored Use cases, Business Requirement Documentation, System Requirement Change Request.
• Integrate Data from wide range of sources including in-house test data management systems, labs and contract research organizations and perform data cleaning.
• Database table review and data mapping for large scale data conversion project Oracle database to Mainframe. Created Data Dictionary and ER diagrams for data mapping purposes.
• Conducted Gap Analysis, and Gathered User Requirements by Interviews, user meeting, JAD session, and Requirement Elicitation Sessions. Applied RUP methodology with its various workflows, artifacts and activities to manage life cycle from Inception to Transition phase.

Environment: Clear Quest, Clear Case, MS Access, MS Excel, MS Word, MS Project, MS Visio.

Confidential, Marietta, GA

Business Systems Analyst

Responsibilities:

• Involved in Inception Phase and prepared vision statement and initial data models that contain Business Requirement Documents and supporting a document that contains the essential business elements and detailed definitions.
• Working with clients to better understand their needs and present solutions using structured SDLC approach.
• Wrote PL/SQL statement and stored procedures in Oracle for extracting as well as writing data.
• Created test scripts for all the test cases in PL/SQL.
• Designed DataStage ETL jobs for extracting data from heterogeneous source systems, transform and finally load into the Data Marts.
• Automated UNIX Shell scripts to pull and load data from operational resources into the Data Staging Area and Data Warehouse for business intelligence reporting.
• Worked with Cognos and micro strategy reporting systems to extract the data for analysis using filters based on the analysis.
• Developed business process models in RUP to document existing and future business processes.
• Query optimization using SQL Profiler and performance monitors to enhance the performance of database servers.
• Converted various SQL statements into stored procedures thereby reducing the Number of database accesses (since Stored Procedures passes the whole block at one time.)
• Conducted Black Box Testing on the application and validated the dataflow in the application.
• Manually tested the whole application before going for the automated testing.
• Involved in testing the conversion of the application into web application using XML web services.
• Analyzed the test results from QA teams using Performance Studio Analysis to create various scenarios.
• Developed strategies with Quality Assurance group to implement Test Cases in Test manager for User Acceptance Testing.

Environment: Java, J2EE technology, SQL, PL/SQL, Windows Advanced Server, Liberty, UNIX / Oracle Platform, MS Visio, RUP, UAT, ERWIN, Rational Rose, Rational Clear Quest