PROFESSIONAL SUMMARY:

• 7 years of experience in systems process analysis, business requirements modeling, and Client/Server applications in diverse business domains of Healthcare, Insurance and Service Industry Sectors
• Proficient in gathering and converting User Requirements into Business Requirements and Functional Requirement Specifications (FRS) and use Modeling tools like Rational Rose and Microsoft Visio for requirements modeling
• Excellent understanding of Software Quality Assurance Techniques
• Good understanding of Healthcare Enrollment and Billing, claims, Medical Care Management
• Experience in Life Science, HealthCare and Insurance industries with solid understanding of Business Process Flows, Case Tools, and Business Analysis
• Defined Functional Test Cases, documented, Executed test script in Facets system
• Experience with health care Systems: FACETS, MemberEdge, GBD FACETS, WGS, STAR, CS90, ACES, ACMP, NPS
• Extensive hands - on and HealthCare management experience in a variety of projects involving the customization, design, development, implementation, and testing of automated systems to support the Medical Management Information System (MMIS) as well as day-to-day business operations
• Expertise in Business Process Modeling, Business Process Re-design and in designing Process Architecture
• Strong knowledge of managed care payer requirements and procedures
• Sound understanding of Gap Analysis, requirement management, risk analysis and project plans
• Solid understanding of Rational Unified Process (RUP) using Rational Rose, Requisite Pro, Unified Modeling Language (UML), Object Modeling Technique (OMT), Extreme Programming (XP), and Object Oriented Analysis
• Excellent understanding of Data Models and Information Architecture and sound skills in SQL
• Familiar with HIPAA EDI transactions such as 834, 835, and 837 (P, D, I)
• Experience in Risk Management process and technology reengineering, Sarbanes Oxley implementation, valuation review process and technology, strategic sourcing, metrics and benchmarking
• Experience in development methodologies like RUP, SDLC, AGILE, SCRUM and Waterfall
• Expertise in Healthcare- domain. Hands on experience in FACETS
• Experience in Healthcare product and billing configuration
• Design and review of various documents including the Software Requirement Specifications (SRS), Business requirements document (BRD), Use Case Specifications, Functional Specifications (FSD), Systems Design Specification (SDS), Requirement Traceability Matrix (RTM) and testing documents
• Experience in Forward Mapping and Backward mapping analysis of ICD 9 - ICD 10 Conversion for CM (Diagnosis Codes) and PCS (Procedure Codes)
• Excellent in designing business models using UML diagrams such as use case diagrams, class diagrams, activity diagrams, sequence diagrams and collaboration diagrams using Rational Rose and MS Visio
• Experience in conducting Joint Application Development (JAD) sessions and SOAP project with RESTful API’s - REST, GET, PUT and DELETE.
• Creative and aggressive self-starter with integrative thinking skills, capable of communicating creative ideas through graphical analysis charts and statistical data display
• Experience in working with Agile and waterfall methodology
• Experience in working as a proxy product owner and business system analyst, business analyst

TECHNICAL SKILLS:

Microsoft Technologies: Project, Visio, Excel, Word, Outlook, PowerPoint

Requirements Management Tools: Rational Requisite Pro, Rational Rose, MS Visio, SharePoint

Business Skills: Business Process Analysis & Design, Requirement Gathering, Use Case Modeling, JAD/JRP Sessions, and Gap Analysis

Languages/Standards: SQL, XML, HTTP, HIPPA 4010/5010, ICD9/10, SOAP, APIs- REST, GUT, PUT

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

Other Tools: Facets, WGS, STAR, Ignite, Tindal, Boss, Visual Basic, Toad, JIRA, FET, UltraEdit, SnagIT, Sybase, Treads, Cosmo, ODBC, Exploring Facets DB, Confidential, SDLC, SCRUM, KANBAN, Mainframe, NPS, MemberEdge.

PROFESSIONAL EXPERIENCE:

Confidential, Virginia

Business System Manager

Responsibilities:

• Responsible for gathering business requirements and documentation from business
• Responsible for writing Business Requirement document (BRDM) and User Requirement Specification (URS)
• Creating Business Service Specification Document (BSSD)
• Analyzing the Requirements by Conducting Gap Analysis using the ‘AS-IS, TO-BE’ model
• Created Use Case Diagrams, Activity Diagrams, and Sequence Diagrams
• Prepare 837 Professional and Institutional data mapping for Askben Project
• Design the business requirement collection approach based on the project scope and SDLC Methodology
• Query databases for day to day activities and pulls up the information and provides analysis of the data to higher management for decision in mainframe
• Participate in internal and external sessions & supports the development team during the product development
• Support the Portfolio team in impact analysis
• Support the Project and program manager in reviewing the requirements from Clients/Plan
• Assist the Program manager in prioritizing the work items
• Assist the Program manager in accepting or rejecting the development activities during the demo session in model office
• Work with the PM, Director, and development team for time estimation of the project and ensure that capacity is managed based on the CSR.
• Coordinate the activities for offshore and onsite team and Resolve daily
• Conduct UAT testing, prepare test document and approve final testing result

Environment: MainFrame MS Word, MS Excel, MS Power point, MS Visio, OneNote, SQL developer, Altova XML SPY, SOAP UI 5.4.0, Nshare, Notepad++,Citrix,Webex, Mainframe, EDI 837, and NPS.

Business System Analyst

Confidential, Norfolk, Virginia

Responsibilities:

• Responsible for gathering business requirements and documentation from business
• Responsible for writing Technical Requirement document (TR) and User Requirement Specification (URS)
• Creating Mapping document from source to target data
• Analyzing the Requirements by Conducting Gap Analysis using the ‘AS-IS, TO-BE’ model
• Created Use Case Diagrams, Activity Diagrams, Sequence Diagrams and ER Diagrams in MS Project
• Designed the business requirement collection approach based on the project scope and SDLC Methodology
• Queried databases for day to day activities and pulls up the information and provides analysis of the data to higher management for decision
• Performed requirement & impact analysis for the prioritized epics
• Created the user stories with all the appropriate details
• Participated in grooming sessions & supports the development team during the sprints
• Supported the Portfolio team in impact analysis
• Supported the Product Owner in reviewing the requirements from portfolio teams
• Assisted the product owner in prioritizing the backlog items
• Assisted the product owners in accepting or rejecting the story during the Demo
• Was responsible & accountable for the user stories and ensuring that all the appropriate fields are populated (component, work id, IT Team, acceptance criteria etc.)
• Created stories and conducts grooming sessions
• Supported the Portfolio team in the impact analysis, as required
• Approved or rejects the developed features during demo(s)
• Was responsible for ensuring the migration of swaggers to Dev Portal
• Worked with the Scrum master(s) and product Owner to ensure that capacity is managed based on the backlog
• Coordinated the activities for offshore and onsite team and Resolve daily
• Reviewed test plan, test document and approved final testing result

Environment: ACMP, Care Management, Claim, Facets, STAR, CS90, MS Excel, MS Access, MS Visio, SQL developer, Jira, UltraEdit, Teradata, Altova XML SPY, SOAP, Confluence, Safe Agile.

Confidential, Mason, Ohio

Business System Analyst

Responsibilities:

• Performed the role of a Product Owner Delegate, as approved by the product owner
• Performed requirement & impact analysis for the prioritized epics
• Created the user stories with all the appropriate details
• Participated in grooming sessions & supports the development team during the sprints
• Supported the Portfolio team in impact analysis
• Supported the Product Owner in reviewing the requirements from portfolio teams
• Assisted the product owner in prioritizing the backlog items
• Assisted the product owners in accepting or rejecting the story during the Demo
• Represented the Product Owner in the Meta-Roadmap or Scrum-of-scrum meetings
• Represented the Product Owner in requirement walkthrough sessions with the portfolio team and clarification sessions with the customers
• Was responsible & accountable for the user stories and ensuring that all the appropriate fields are populated (component, work id, IT Team, acceptance criteria etc.)
• Created stories and conducts grooming sessions
• Supported the Portfolio team in the impact analysis, as required
• Approved or rejects the developed features during demo(s)
• Was responsible for ensuring the migration of swaggers to Dev Portal
• Worked with the Scrum master(s) and product Owner to ensure that capacity is managed based on the backlog
• Experienced in SOAP project and RESTful API’s- REST, PUT, GET and DETELE.
• Conducted the Meta-Roadmap meeting to plan for the future sprint work
• Coordinated the activities for offshore and onsite team and Resolve daily two offshore team queries based on data mapping and swagger
• Reviewed test plan, test document and approved final testing result.

Environment: Windows, Central Facets, STAR, Confidential, eHUB, Ignite, SOAP UI, MS Excel, MS Access, MS Visio, SQL developer, Power Point, Jira, UltraEdit, Teradata, Altova XML SPY, SOAP, APIs- REST, GUT, PUT, Confidential .

Confidential, Indianapolis, IN

Business Analyst

Responsibilities:

• Supported new business requirements by extending the functionality of the GBD Facets system using the Facets extensibility architecture feature.
• Extensively worked with GBD FACETS migration project implementation, GBD FACETS Subscriber/Member module and Billing module.
• Gathered high level and details level business requirements
• Conducted Interviews and JAD sessions with SME’s and stakeholders to understand the business requirements.
• Writing system change requirement
• Analyzed the Facets Requirements by Conducting Gap Analysis using the ‘AS-IS, TO-BE’ model.
• Created Use Case Diagrams, Activity Diagrams, Sequence Diagrams and ER Diagrams in MS Project. Designed the business requirement collection approach based on the project scope and SDLC Methodology.
• Queried databases for day to day activities and pulls up the information and provides analysis of the data to higher management for decision.
• Prepared member eligibility bi-weekly and weekly reconciliation and redetermination report for State. Achieved 100% accuracy within six months and automated reconciliation report.
• Participated meetings and conference calls with IT implementation partners.
• Coordinated with various departments and business group for GBD Facets migration from central Facets software
• Prepared 834 file data mapping for enroll SQL and keyword file
• Identified various points of integration among the new and existing applications and required integration with other IT components.
• Performed Data Analysis, writing SQL Queries for Testing and Troubleshooting against enroll SQL, and FACETS.
• Worked closely with the business team, development and IT team and the quality assurance team to ensure that desired functionalities will be achieved by the application.
• Identified the impacts the HIPPA 5010 & ICD 10 project had on Confidential Government Business division (Medicare and Medicaid program).
• Provided business and technical suggestions and recommendations
• Writing business use cases and test case for new system and validate the test case.
• Executed UAT testing for Enrollment and Billing module
• Defined the test criteria, project schedules and base lined the Test Plan with the help of project meetings and walkthroughs.
• Prepared and executing test cases for Navigational test, Functionality testing and UAT testing.
• Created test plans, test scripts, Mockup 834 file run Tidal jobs and load test file using SPARX
• Coordinated User Acceptance and Quality Assurance testing of mainframe applications, identifying mock up data, preparing user manual and conducting training seminars, installing applications on users.
• Reported defects and bugs to development team using JIRA.

Environment: Windows, Facets, MS Excel, MS Access, MS Visio, SQL, Power Point, Tindal, Toad, Jira, Sybase, MACESS, UltraEdit, Teradata, Cosmo, ODBC, Exploring Facets DB

Confidential, New York

Business System Analyst

Responsibilities:

• Responsible for defining the scope and implementing business rules of the project, gathering business requirements and documentation.
• Responsible for writing Functional Requirement Specifications (FRS) and User Requirement Specification (URS).
• Analyzed Business Requirements and segregated them into high level and low level Use Cases, Activity Diagrams / State Chart Diagrams using Rational Rose according to UML methodology thus defining the Data Process Models.
• Understand the As Is system and develop the To Be system concept and also prepare the System Process Maps
• Extensive work in Encounter and Claim process EDI 837 file.
• Developed the systems implementation project management plan with milestones and steps from procurement of vendors to project implementation and maintenance
• Gathered requirements for procurement of vendor applications for specific modules
• 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.
• Created Web-based reports using SSRS
• Responsible for working with the team to review and modify process flows to increase productivity and effectively utilize FACETS features not provided by the legacy systems
• Conducted presentations of the Q/A test results with analysis to the stakeholders and users and documented modifications and requirements.
• Review with business owners to identify data requirements and business rules based on the changes within 834 transaction set
• Develop and certify test cases for 5010 compliancy for all HIPAA transactions 837
• Coordinating and Developing QA activities.
• Worked with SQL Server 2005 Analysis Services (SSAS) for reporting and online analytical processing analysis
• Performed Data Mapping around HIPAA EDI transactions
• Created Process Flow diagrams, Use Case Diagrams, Class Diagrams and Interaction Diagrams using Microsoft Visio and Rational Rose.
• Wrote Test Cases and performed User Acceptance Testing, documented the in detail defects using the Defect Tracking report.
• Used Test Case distribution and development reports to track the progress of test case planning, implementation and execution results.
• A developed standardized FACETS testing, implementation and QA processes.
• Wrote PL/SQL statement and stored procedures in Oracle for extracting as well as writing data.
• Created Use cases, activity report, logical components and deployment views to extract business process flows and workflows involved in the project. Carried out defect tracking using Clear Quest
• Worked extensively with the HIPAA EDI transaction sets- 270, 835 and 837
• Maintained proper communication with the developers ensuring that the modifications and requirements were addressed and also monitored these revisions.
• Involved in compatibility testing with other software programs, hardware, Operating systems and network environments.

Environment: Microsoft Office SharePoint 2007, Rational Requisite Pro, MS Office, SQL Server, Oracle, Agile, MS Project, MS FrontPage 2003, MS Access, EDI, Documentum 2.0.,UML.

Confidential

System Analyst

Responsibilities:

• Worked with the Confidential IT team to define their requirements and deliver results and maintained industry standard, procedures for in-house/outsourced applications and IT service management.
• Proposed and implemented required IT infrastructures for smooth IT operations for Helath program
• Maintained relationship with key stakeholders internally as well as interface with third-party contractors, vendors and consultants.
• Prepared and reviewed all agreements, contracts and project plan
• Developed and monitored work-breakdown structures, project tracking and variance reports
• Identified and assembled risk management plans and work effort documents and follow project management standards to manage projects throughout the project lifecycles of initiation, planning, execution and closure
• Prepared requirement analysis, technical documentation, workflow diagram and UAT of new modules and for new requirement of the existing system as well as for the ERP system.
• Provided prompt support to the country IT, according to the priority of problems and guide them to resolve the problem of ERP, RADAR and other existing applications and infrastructure
• Identify new requirements, prepare proposals, outline activates, budgets and schedulers for information technology projects
• Ensured timely and cost- effective implementation of all IT projects as well as ERP application
• Managed and controlled scope creep from business and setting right expectations for both business and IT and giving a realistic execution time frame to Management
• Wrote PL/SQL statement and stored procedures in Oracle for extracting as well as writing data.
• Created Use cases, activity report, logical components and deployment views to extract business process flows and workflows involved in the project. Carried out defect tracking using Clear Quest

Environment: Windows XP, Microsoft Office SharePoint, SQL Server, Oracle, MS Project, UML