SUMMARY

• Astute, detail - oriented Business System Analyst with around 8 years of consulting experience including Healthcare and Insurance.
• Possess strong business process modeling skills, and performs interviews and meetings to conceptualize business processes, gather requirements, and to design artifacts including UML Use Cases and Activity diagrams.
• Demonstrated expertise with Medicare and Medicaid, including Claims, Adjudication and Billing. Skilled at activity diagramming, and developing use cases Models and documents.
• Skilled at facilitating JAD sessions, interviewing, document review, and brainstorming, in order to document artifacts such as BRDs, FRS, Use Cases, Activity Diagrams, Test Cases, and Test Plans.
• Extensive experience in Healthcare industry including HIPAA regulations, and EDI standards (X12 and HL7).
• Experience developing process maps, and AS-IS and TO-BE process conceptualization and improvements.
• Have strong facilitation, collaboration, and communication skills.
• A hard-working and results-oriented analyst who consistently goes the extra mile, and is known for teamwork, and character.

TECHNICAL SKILLS

Business Modeling Tools: Visual Paradigm, MS Visio, PowerPoint, Rational Rose

Requirements Gathering Tools: Rational RequisitePro, MS Word, MS Excel

Microsoft Tools: MS Office, MS Visio, MS Project

SDLC Methodologies: RUP, Prototyping, RAD, Waterfall

Testing Tools: Mercury Test Director

Database: MS Access, Oracle 9i, MySQL

Operating Systems: Windows 2000/XP, Vista, DOS

Programming Languages: PL/SQL,VB.Net, QBasic, HTML,PHP, ASP.Net

Defect Management Tools: Mercury Test Director, Rational ClearQuest

PROFESSIONAL EXPERIENCE

Confidential

Sr. Business System Analyst

Responsibilities:

• Conducted weekly meetings for deciding the Policies and Procedures to be followed while constructing new sites.
• Worked with the SMEs (Subject Matter Experts), IT managers, software architects to identify the key changes pertaining to HIPAA, and participated in Health Management to communicate effectively with them.
• Performed the requirement analysis, impact analysis and documented the requirements using Rational Requisite Pro.
• Gathered business requirements by driving user-group meetings and working with various global, cross-functional and virtual teams
• Provided systems analysis, requirement definition, system design, and code and unit test for environmental information systems development.
• Prepared ad-hoc reports that analyze a specific scenario based on a situation that monitors current performance, creates a potential opportunity, or supports other functions.
• Analyzed and identified gaps/issues in claims, encounters and remittance advice process flow.
• Managed the team of consultants responsible for developing on-demand Medicaid Management System reports.
• Designed the online screens and reports for the Medicaid Online Electronic Claims Submission System.
• Analyzed, designed, and coded several online subsystems for the Medicaid System.
• Implementation of SQL Logins, Roles and Authentication Modes as a part of Security Policies for various categories of users.
• Worked closely with the Enterprise Data Warehouse team and Business Intelligence Architecture team to understand repository objects that support the business requirement and process.
• Maintaining SQL Script for creation of Database Objects using VSS (Visual Source Safe).
• Worked with CURAM System implementation, Claims and Benefits configuration set-up testing, Inbound/Outbound Interfaces and Extensions, Load and extraction programs involving HIPPA 834 and proprietary format files and Reports development.
• Utilized ESDM and Agile Methodology to configure and develop process, standards, and procedures.
• Worked on billing system a cash management module and enhanced the encrypting standards that are required for the application.
• Followed a systematic approach to eliciting, organizing, and documenting requirements of the system.
• Reviewed the Joint Requirement Documents (JRD) with the cross functional team to analyze the High Level Requirements.
• Designed Workflows and implemented the requirements following the Use Case documents and Pega Guardrails.
• 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
• Worked in Healthcare Claims Administration - Healthcare Claims Processing (837/835) includes facility claims and professional claims
• Automation of Test Scripts for Functional and Regression testing using QTP, WinRunner and Silk Test.
• Code and execute SQL and PL SQL Queries for data validation and backend testing using Toad.
• Used Query Analyzer, Execution Plan to optimize SQL Queries.
• Performed System testing, Regression testing and UAT for several claim types and test scenarios
• Planned and documented procedures for data processing and prepared data flow diagrams for the application.
• Wrote test cases based on the business requirements that involved market risk analysis and risk management.
• Developed the Master RTM to map BRD, Test cases and Test results.
• Various versions of the documents generated during the project were maintained and managed using Rational ClearCase and performed defect tracking using Rational ClearQuest.
• Documented the Business Requirement Document to get a better understanding of client's businessprocesses of both the projects using the agile methodology.
• Coordinating and working with IBM Curam team on Curam requirements and then verifying the test cases/scenarios for the same.
• Create XML paths using Accord dictionary, identify the Coverage and option codes including unique identifiers.
• Test Management and Test Case generation was done using Mercury's Test Director.
• Assisted JAD sessions to identify the business flows and determine whether any current or proposed systems are impacted by the EDI X12 Transaction, Code set and Identifier aspects of HIPAA.
• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims.
• Strong Experience in Claims Processing and Claims Scrubbing in HMO, PPO, Medicaid and Medicare.
• Developed UML Use Case diagrams for faster and more efficient communication with stakeholders, by utilizing MS Visio.
• Performed various queries, performance matching, troubleshooting batch programs, identifying error logs, analyzed and test configuration changes in facets.
• Designed the business requirement for the project scope, more efficient ETL process and Software Development Life Cycle methodology.
• Performed Unit Testing and User Acceptance Testing and documented detailed defects.
• Designed and developed project document templates based on SDLC methodology
• Designed workflows and allocated permissions within SharePoint.
• 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.
• Performed Unit Testing and User Acceptance testing (UAT) and documented detailed results.
• Provided input (scope, goals, risks, constraints, timelines and interfaces) to PM for project planning and control.

Environment: Windows 2000/XP, Pega, Microsoft Office SharePoint 2007, Java, Oracle, .NET, Rational Requisite Pro, MS Office, MQ and SOAP messaging, XML,AGILE,MQ Explorer, SQL Server, Agile, MS Project, QTP, Test Director,MS FrontPage 2003, MS Access, EDI, Documentum 2.0.,UML.

Confidential

System Analyst/Tester

Responsibilities:

• Established a Business Analysis methodology around the Rational Unified Process.
• Created Testing Inventory report, Test Scripts and developed Formal Integration Test Cases. Also, assisted the technical team with parallel testing by being onsite with client as well as providing remote assistance.
• Documented requirements along with a detail data analysis of the systems involved and defined data mapping rules and created source data for the ETL.
• Worked on healthcare standards such as HIPPA 4010, 5010, ICD-9 and SOAP.
• Working with Medicare operational management to monitor, trend and report on operational metrics such as timeliness, workload, and staff trending, customer satisfaction, and other key measures to facilitate performance excellence.
• Involved in Report testing with IBM Cognos tool. Generation and creation of reports that gives us information of how many users are using the Curam application.
• Assisted the team with ad-hoc requests and performed data gap analysis.
• Designed workflows and allocated permissions within SharePoint.
• Executed automated functional Test Cases using SOAPUI to test Web service API using both RESTFUL and SOAP interfaces.
• Requirement Analysis, Business Process Optimization, Process Design, lead development, Testing, User training of the following custom interface
• Validating the EDI 837 claim billing (professional, institutional and dental claims) & 835 (remittance advice or payment) claims adjudications.
• Used Rational ClearCase for Version Control of requirement documents.
• Provided data analysis, conversion and validation scripts using SQL.
• Mentored and Knowledge transfer on how to create and implement test assets in RQM - Test Plan, Test Case, Test Scripts, Test Execution Records, Test suites, how to execute test and report on the test result using RQM Reports.
• Used MS Excel and MS Word to create a field-to-field data map that was used as a main specification document for the conversion program.
• Created Data Stage jobs to extract, transform and load data into data warehouses from various sources like relational databases, application systems, temp tables, flat files etc.
• Performed forward and backward data mapping between fields in Mainframe and Facets
• Tested the changes for the front-end screens in FACETS related to Membership, Benefit and Plan modules
• Experience in working for FacetsMigration/Regulatory/Facets Upgrade projects.
• Assisted to develop the Test Plan, Test Cases and Test Scenarios to be used in testing based on Business Requirements, technical specifications and/or product knowledge. Conducted User Acceptance Testing, gathered and documented User Manuals and Business Rules
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, and OOD
• Played a key role in the planning, User Accepted Testing, and Implementation of system enhancements and conversions.
• Managed the transition to new development standards, procedures and processes including the introduction of UML, Rational Products including Rational Software Architect, ClearCase and ClearQuest as well as the Mercury Test Suite
• Used UML to perform Use-Case analysis to capture the dynamic aspect of the application.
• Ensured the accuracy and consistency of the data during the data loading process.
• Developed State Diagrams, Activity diagrams and Class Diagrams in MS Visio using UML for various modules of the project.
• Used the DataStage Designer to develop processes for extracting, cleansing, transforms, integrating and loading data into data warehouse database.
• Introduced Agile and RUP methodologies to reflect liquid nature of front-office improving time-to-market
• Applications tested were integrated to mainframe Vantage system which included business applications for new sales, policies, quotes, and web based applications.
• Performed functional testing on Rest webservices using SOAP UI.
• Involved in testing Web services and XML with tool called SOAP UI and using this tool to locate WSDL file on internet, create Test cases and run them.
• Involved in creating automated Test Scripts representing various Transactions, Documenting the Load Testing Process and Methodology. Created meaningful reports for analysis and integrated the Performance Testing in the SDLC.
• Provided UAT and Ad-Hoc testing to support client requirements before product releases into production.
• Provided key input in working with users in defining project and system requirements.
• Developed strategic partnerships with the business units to develop a solid knowledge base of the business line; including the business plan, products, and process and revenue streams.
• Documented and delivered Functional Specification Document to the project team.
• Developed Use Case driven test scripts using Mercury Quality Center.
• Developed business requirement specification documents as well as high-level project plan.
• 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.
• Assist the PM in setting realistic project expectations and in evaluating the impact of changes on the organization and plans accordingly and conducted project related presentations.
• Conducted benchmarking activities to identify best practices.

Environment: Mainframes, COBOL,XML,Agile,SQL, SQL Server,Db2, Oracle, Crystal Reports, Rose, Agile,Mercury, Lotus Notes, ETL, Perl, MS MS Excel, Word, MS Excel, MS Visio, LoadRunner, WinRunner

Confidential

Data Analyst

Responsibilities:

• Interfaced with the client as part of the Requirements Engineering team to finalize the project scope.
• Assisted the PM in developing Use Cases and project plans and also managed changes to the scope of the project.
• Conducted user interviews, gathered Requirements, analyzed the Requirements and managed changes using Rational Suite.
• Coordinated with the business testing team to explain and develop the Test Plans, Test cases, Testing & Evaluation strategy and methods for user acceptance testing (UAT).
• Developed business process models in RUP to document existing and future business processes.
• Performed extensive Requirement Analysis including data analysis and gap analysis.
• Developed test plans with QA team and helped to develop test scenarios for system testing, integration testing and performance testing.
• Understand client’s As-Is process and provide support to the end-to-end To-Be process design
• Designed and developed project document templates based on SDLC methodology.
• Analyzed the ICD conversion information provided by the CMS (Centers for Medicare & Medicaid Services) to gain understanding of the ICD-9 versus the ICD-10 code sets
• Provide and support segment analyst with ad-hoc reporting and data modeling based on stakeholder requirements.
• Participated in various stages of data and requirement analysis for project needs.
• Define Agile user stories and acceptance criteria, perform business and technical analysis related to stories and construct documentation in support of the stories
• Followed the HIPAA implementation and Companion guides for preparing EDI files.
• Interacted with the developers for bug fixes and problem resolving through Test director.
• Analyzed the mainframe Reports for Member/Eligibility/Claims and mapped the fields with Facets batch jobs and reports.
• Manually loaded data in FACETS and have good knowledge of Facets Business rules
• Worked extensively on Clariid's system to trace out the exact root cause of Errors in the 834 test files.
• Developed business requirement specification documents as well as high-level project plan.
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, and OOD using UML.
• Did gap analysis and impact analysis for the new Medicare PPO product.
• Performing PMO activities related to project time tracking, work plan updates, status reporting, service metric reporting, and related project administration tasks.
• Setup Procedures to Extract, Transform and Load (ETL) data from Operational and Legacy Systems to the Data Warehouse by Using Informatica.
• Involved in designing and developing Data Models and Data Marts that support the Business Intelligence Data Warehouse.
• Identified scope systems that will be modified by the ICD-10 project to accommodate ICD-10 code and/or downstream impacts steaming from ICD-10 codes.
• Actively involved in creation of the UML diagrams such as sequence, activity and class diagrams for certain modules of the application using MS Visio.
• Coordinated preparation and submission of quarterly Credit Balance reports to Medicare.
• Assumed ownership of Use Case Diagrams, Use Case narratives and other various artifacts.
• Developed use cases, user interface documents and report specification documents for the MMIS application.
• Reviewed test cases and maintained them in HP Quality Center.
• Worked with HIPPA rules and regulations to draft business rules and claim processes.
• Documented and delivered Functional Specification Document to the project team.
• Created specifications for EDI HL7 (A28, A31, ADT) and X12 (837/835) transactions that were transmitted between Claims Editor and Legacy Billing application and external Payers
• Assisted the Project Manager to develop both high-level and detailed application architecture to meet user requests and business needs.
• Participated in the logical and physical design sessions, assisted and developed high and low level design documents.
• Rational ClearCase was used to manage all the changes and change requests in the projects.
• Conducted interviews and gathered requirements from Subject Matter Experts (SMEs).
• Assisted the PM in setting realistic project expectations and in evaluating the impact of changes on the project plans accordingly and conducted project related presentations.
• Assisted with user testing of systems, developing and maintaining quality procedures, and ensuring that appropriate documentation is in place.
• Conducted User Acceptance Testing (UAT).
• Assisted and directly involved with QA team in creation of Test Cases and tests implementations.
• Designed and implemented basic SQL queries for QA testing and report / data validation.
• Performed task decomposition, delegated tasks and monitored project milestones using MS Project.
• Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data within the Oracle database
• Assisted the PM in performing Risk Assessment, Management and Mitigation.

Environment: Microsoft Office Suite, Microsoft Visio, Documentum, UML,Agile, Windows NT/XP, Oracle, SQL, SQL Server, Sybase, VBScript, C#. NET, XML,Agile,ASP.NET, Rational ClearQuest, ClearCase,Business Objects, TestDirector, LoadRunner