SUMMARY:

• Over 7+ years of diverse experience in the Information Technology industry with a focus on Business System Analysis.
• Experience in business process analysis, modeling and Business requirement gathering.
• Ability to collaborate with peers in both business and technical areas to deliver system solutions
• Designed and developed Enterprise level applications supporting various business units
• Extensive experience in analyzing and requirements gathering and writing system functional specifications including use cases.
• Experience in Identity and Access Management products like SailPoint.
• Experienced in EDI and HIPAA with multiple transactions involving claims handling and processing, with payer and provider experience ( 270 & 271, 276 & 277, 820, 837 P/I/D, 834, 835 ) Proficiency in documenting Test Cases, Test Plans, Test
• Functional experienced in Claim Life Cycle and Health Care Payer domain process along with various line of health insurance system like PPO, HMO, POS.
• Experience in ServiceNow on implementing end - to-end Service Catalog.
• Extensive Experience in Functional, Integration, Regression, User Acceptance UAT, System.
• Utilized corporation developed Agile SDLC methodology.
• Industrial experience includes Healthcare HIPAA and EDI, EHR clinical Systems
• Functional Knowledge of Medicaid Management Information System MMIS.
• Excellent in Developing and evaluating business process Models.
• Ability to support prototyping activities that will validate business requirements and solution definition
• Hands on experience in creating Use Cases, Activity Diagram, and Sequence Diagrams
• Comprehensive knowledge of RUP, Waterfall and Agile (Scrum & Xp) methodology.
• Expertise in creating Data flow diagrams, Entity Relation diagrams, Gap Analysis, Developing Business Process Re-Engineering and Process Modeling using MS Visio .
• Administration of Clinical R&D software including Oracle clinical, Clinapps PMD, Forecasting and sales and marketing software Spotfire and Cognos
• Work for support the application of the Scrum and SAFE Agile Methodologies in developing and managing the application development process.
• Good knowledge and extensively used RDBMS, Oracle, SQL, PL/SQL.
• Well versed with HIPAA, Facets , claim adjustments, claim processing from point of entry to finalizing, claim review, identifying claims processing problems, their source and providing corresponding solutions.
• Knowledge in the ETL (Extract, Transform and Load) of data into a data warehouse/date mart and Business Intelligence (BI) tools like Business Objects Modules (Reporter, Supervisor, Designer, and Web Intelligence).
• Experience in Medicaid Management Information System (MMIS). Expertise in various subsystems of MMIS- Claims, Provider, Recipient, Procedure Drug and Diagnosis (PDD), Explanation of Benefits (EOB).
• Created Mock-ups, established Reporting Requirements and worked with DBAs to create reporting solution.
• Prepared Business process documents, project management process Documents, Functional Specifications, project plans, methodology and scope documents, release plans, upgrade plans and production support documents.
• Experience in developing using ETL (Informatica) and Cognos Business Intelligence Suite with multiple data sources like Oracle, MS SQL and DB2 databases
• Familiar with Data warehousing tools. Used ETL tools like Informatica 8.x/7.x to extract and load data
• Strong experience in design and development of ETL process from Staging to Data warehouse and to Data mart.

TECHNICAL SKILLS:

Visual Modeling Tools: Rational Rose, Requisite Pro, Clear Quest, Clear Case and MS Visio.

Testing Tools: HP Quality Center, Win Runner, Load Runner and TOAD

Data Modeling Tools: Erwin, Informatica 7.1.1/6.5

BI Tools: Cognos 8.4/8.3/8.2/8.1 Cognos ReportNet 1.1, Cognos Enterprise 7.1 Series, SSRS 2005, SSAS 2005.

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

Methodology: RUP, Safe Agile, OOAD, SDLC, and Waterfall.

Standard and Codes: HIPAA 4010A1/5010, ICD-10, ICD-9, ANSI X12, HL7, CPT and CMS form.

Languages: C, C++, SQL, PL/SQL, HTML, XSLT, Xpath, R&D, ASC X12, X11 and XML.

Database: Oracle 8i/9i/10g, DB2, MS SQL Server.

Web Servers: Microsoft Internet Information Server (IIS) 4.0/3.0, SunOne Server 5.2.

Operating Systems: UNIX, Windows 95/2000/NT/XP, and MS-DOS.

Office tools: MS Office 2003 (Word, Excel, Power Point, Outlook), MS Visio, MS Project, and MS FrontPage.

PROFESSIONAL SUMMARY:

Confidential, Columbus, OH

Sr. Healthcare Business Analyst

Responsibilities:

• Applied RUP methodology with its various workflows, artifacts and activities to manage life cycle from Inception to Transition phase.
• Reviewed EDI companion guides for all payers to ensure compliance, edit integrity and maintain up-to-date list of payer contacts.
• Experience on all phases of Software Development Life Cycle (SDLC) from project initiation to deployment. Experience in Agile and Scrum methodology.
• Assisted JAD sessions to identify the business flows and determine whether any current or proposed systems in SOA are impacted by the EDI X12 Transaction, XML, XSLT, Code set and Identifier aspects of HIPAA.
• Involved in GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims.
• Good Understanding of the EDI (Electronic data interchange), Implementation and Knowledge of HIPAA code sets.
• Integrated SailPoint IIQ with their existing provisioning system in order to cater existing requirements.
• Involved in the User Acceptance testing UAT to check the reliability for end users.
• Designed Test Plans and Test Cases for User Acceptance testing (UAT) with the help of QA teams.
• Strong HIPAA EDI 4010 and 5010 and ICD-9 and ICD-10 processes for member, payers, providers including Coordination of benefits, Copays, benefits and etc.
• Create Mapping documents, ETL technical specifications and various documents related to data migration.
• Participating in HEDIS performance reporting and intervention analysis.
• Implemented & supported Identity Management, LDAP Directories, Provisioning/Identity Workflows.
• Have proven business insight and the technical know-how to implement large-scale EMR and EHR engagements
• Worked on the EDI 834-file load to Facets through MMS (Membership maintenance sub-system)
• Worked with FACETS edits and EDI HIPAA Claims (837/835/834) processing.
• ICD 9 - ICD 10 Conversion Project - Worked in the analysis of the ICD 9 - 10 codes conversion Project.
• Documented the Requirement Traceability Matrix (RTM) for tracing the Test Cases and requirements in Blueprint.
• Responsible for Medicaid Claims Resolution/Reimbursement for peach state health plan using MMIS.
• Modified and created vendor specific maps for the 850, 820, 834, 855 and 856 transactions (EDI to XML, XML to EDI and delimited to XML). Worked on XSLT, XML schemas and xpath.
• Developed and prepared EDI documentation for 837 outbound EDS claim processing.
• Worked on HIPAA Transactions and Code Sets Standards according to the test scenarios such as 270/271, 276/277,837/835 transactions.
• Coordinated with the EDI team in developing and documenting the detailed testing work plans and created the various testing documents for the assigned EDI transactions.
• Responsible for attaining HIPAA EDI validation from Medicare, Medicaid and other payers of government carriers.
• Created Requirement Traceability Matrix (RTM), Defect Report and Weekly Status Report.
• Tested the HIPPA EDI, 834, 270/271, 276/277, 820, 837/835 transactions according to test scenarios and verify the data with Facets on different modules.

Environment: MS SQL Server, Payer, SDLC, UAT, Rational Unified Process (RUP), EDI, Rational Rose Requisite Pro, TIBCO, ETL, SSIS, SSRS, Informatica, Sailpoint, Tableau, Safe Agile, Quality Center Test Director, Clear Quest, and MS Office Tools.

Confidential - Nashville, TN

Business System Analyst

Responsibilities:

• Gathered analyzed, documented business and technical requirements from both formal and informal sessions and validate the needs of the business stakeholders.\
• Involved in the User Acceptance testing UAT to check the reliability for end users.
• Developed and prepared EDI documentation for 834 (Benefit & Enrollment Maintenance) for client processing the 834 transaction.
• Responsible for facilitating systems and business processes, function and organization design, working collaboratively with the enterprise architecture team, business strategists, process owners and subject matter experts.
• Created different Transform maps to import data into ServiceNow .
• Performed Requirement Analysis and developed UML Use Cases, Activity Diagrams using Rational Rose to understand the requirements.
• Responsible for architecting integrated HIPAA, Medicare solutions, Facets.
• Created test cases for the new data warehouse objects and managed defect tracking using HPQC (Quality Center).
• Worked in accordance with the Safe Agile/Scrum methodology for various phases of the business and created business vision, business architecture documents and mock reports.
• Used the guidelines and artifacts of the Agile Process to strategize the Implementation in different sprints of the Software Development Life Cycle.
• Create Mapping documents, ETL technical specifications and various documents related to data migration.
• Assess system, business process impact of the ACA act on the existing Medicaid business process and systems.
• Performing some ETL operations. Creating ETL Jobs and validating data flow through various ETL stages.
• Worked with ETL developers to provide mapping / data conversion from OLTP to OLAP.
• Wrote complex SQL queries to extract and validate the data from the Facets database.
• Perform Analysis, Design, Development and Implementation of X12 EDI maps by using Ramp Manager Application (an EDIFECS Program).
• Worked with SAOP UI to test cases with XML, WSDLS and web services
• Worked closely on 834 transaction code for Benefit Enrollment and was involved in Validation of HIPAA for 837, 270/271, 276/277, 835, 834 EDI transactions.

Environment: Oracle, RUP, Oracle, EDI, ServiceNow, UML, UAT, E cams, Rational Rose, UAT, ETL, SSIS, SSRS, Informatica, Tableau, Rational Requisite Pro, ACA, ICD, HIPPA, Lo inc, MMIS, HIX, Safe Agile, Scrum

Confidential, Atlanta, GA

Business 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).
• Acted as a Subject Matter Expert (SME) on many occasions to explain in brief to the business users about the internal systems.
• Worked with Google Analytics (Web data Analytics) and Razorfish on Tagging and Analytics for tracking and reporting purposes.
• Custom tools upgrade client had created marketing, merchandising, promotion and product tools to support their custom web application which needed to be re-architected to work with ATG eCommerce suite.
• Created lot of A/B testing strategies on websites and familiar with UI/UX and bootstrap.
• Analyzed the complete Supply Chain, from receiving an order in OMS (Order Management System) and complete processing till final delivery to customer.
• Conducted walkthroughs with the end users and stakeholders to gather the modification requests from the user to upgrade or change the specifications for the product.
• Performed GAP Analysis, designed new business process flows, and documented various business scenarios.
• Responsible for E-commerce website developed in ATG Platform for new enhancement of existing B2B and B2C applications.
• Followed RUP and AGILE development methodology and adhered to strict quality standards in requirement gathering
• Designed and implemented service-oriented architectures (SOA) suitable for secure, reliable, and high-performance system. Created several API/web services as per business needs.

Environment: Rational Rose, PL/SQL, HTML, ETL Informatica, MS Office, MS Visio, EDI, UML, RUP, SCRUM, JIRA, Confluence, Web sphere, SOA, Web service, MQ Series TIBCO, Agile, SOA, Java, J2EE, MS Office, Oracle, Teradata, Erwin, SoapUI, SOA, SQL Server, MS Project, POS system (Ciao), Seibel CRM

Confidential, Fort Washington, PA

Business Analyst/Quality 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).
• Acted as a Subject Matter Expert (SME) on many occasions to explain in brief to the business users about the internal systems.
• Facilitated JAD sessions with the management, developers and analysts from all the dependant systems/applications and backlog.
• Proficient in creation of source to target data mapping documents in a data warehouse environment and execute sql queries in a data warehouse environment.
• Experience managing requirements using JIRA, Remedy and HP Quality Center.
• Implemented Web Services (SOAP, UDDI and WSDL) to integrate different applications.
• Gathered requirements for the integration of POS system with the supply chain system
• Worked with UI and UX designers to create prototypes and Website workflow.
• Gathered requirements for the integration of Point-Of-Sale (POS) system with the supply chain system.
• Composed white papers and custom surveys proving the need for retail executives to transform their organizations into unified omni-channel shopping experiences
• Collected business requirements to set rules for proper data transfer from Data Source to Data Target in Data

Environment: Rational Rose, PL/SQL, HTML, ETL Informatica, MS Office, MS Visio, EDI, UML, RUP, SCRUM, JIRA, Web sphere, SOA, Web service, MQ Series TIBCO, Agile, SOA, Java, J2EE, MS Office, Oracle, Teradata, Erwin, SoapUI, SOA, SQL Server, MS Project, POS system (Ciao)