Qualification Overview

Business Analyst with over 7 years of diverse progressive experience in Information Technology, with emphasis on Business Analysis and technical knowledge Expertise in working with Business Analysis, Business Processes, Business Process Models, Business Flow Diagrams and Business Requirement Documents for Financial, Banking and Brokerage, Mortgage and Healthcare Industries.

Summary

• Expertise in Business Systems Analysis and Requirements Management.
• Strong analytical, problem-solving and communication skills with particular emphasis on clear, detailed Business Requirements and Functional Specifications, as well as reports for management.
• Team player, result-oriented, fast learner, excellent communication skills with strong research capability.
• Direct responsibilities include experience with requirements gathering, planning, organizing, and Change Management.
• Experience in all phases of Software Development Life Cycle SDLC aspects.
• Extensive experience in Data Analysis, Data Cleansing, Requirements gathering, Business Analysis, Entity Relationship diagrams ERD , Architectural design docs, Functional and Technical design docs, and Process Flow diagrams.
• Experience in creating business process flow diagrams.
• 6 years of experience in Information technology, with proven background on successfully managing all facets of development, from initial design and architecture to deployment and project management.
• Experience in developing and writing functional business requirements and process flows.
• Experience in participating JAD sessions for project definition involving analyzing requirements, creating prototypes, user interface.
• Experience in Business Process definition, Risk Analysis, and Use case Analysis.
• Developed design and functional specifications and produced deliverables related to the projects assigned.
• Experience in Business Analysis using Functional Flow charts, Check sheets, Interrelationship diagrams, Workshops and Brainstorming Sessions.
• Extensive exposure to Rational Unified Process RUP methodology including UML.
• Experience in creating test cases, test scripts and test plans.
• Experience with User Acceptance Testing UAT release skill sets.
• Developed use case diagrams, sequence diagrams, state diagrams and activity diagrams using UML to make users and developers understand the system.

Tools

• Task Performed Tools Used
• Requirements Management Rational Requisite Pro, Enterprise Architect, HP Quality Center Wireframe Tools MS Visio, Axure, Smart Draw, MS Paint, SnagIt Database DB2, MS Access, Oracle, MS SQL Server, IMS, Sybase UML Diagrams MS Visio, Rational Rose, Enterprise Architect Test Cases HP Quality Center Defect Tracking HP Quality Center, Rational Clear Quest, TRAC , QNext, Microsoft Office, Microsoft Outlook, Trizetto CCA

Professional Experience

Confidential

Sr. Business Analyst

Confidential works to improve the health care system, and advance the health and well-being of individuals and communities so that people can enjoy better, fuller lives. Worked on MMIS . Worked in Stratagen Plexis systems inputting participant information, set up appts for clients

Responsibilities

• Gathered business requirements by driving user-group meetings and working with various global, cross-functional and virtual teams
• Responsible for business system analysis of customizing the BPS Risk Management product with involvement through the whole SDLC
• Developed plan for data feeds and data mappings for integration between various systems, including XML, to follow ICD 10 Code set and ANSI X12 5010 formats.
• Teamed up with both internal and external software development groups to provide functional requirements specifications in form of use cases, business process flows, and prototypes and management reporting requirements
• Requirements Elicitation, Analysis, Communication, and Validation according to Six Sigma Standards.
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, OOD using UML
• Involved in all phases of software development life cycle in RUP framework.
• Used Rational Rose to model the process using UML to create behavioral and structural diagrams.
• 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
• Facets Enterprise Application Solutions team supports Facets application for CDPHP. Facets is a leading product in health care for medical claim processing.
• Developed detailed Developer specification to reflect technical details of the business requirements
• Performed data analysis by using SQL queries using the DB Artisan tool
• Extensive experience in using collaborative tools like Mercury Quality Center to facilitate development across disparate teams
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, OOAD using UML and Business Process Modeling.
• Developed business process models in RUP to document existing and future business processes.
• Participated in the creation of a SONAR application's Test Planning, Test Scripts, Testing, Defect Reporting and Management
• Developed and conducted statewide HIPAA 5010 and ICD-10 awareness program for all IDS staff in the client.
• Provided management support to the off-shore End to End Integration / Regression Test Team
• Prepared UAT Materials UAT Test Cases to include various steps involved for UAT and to have proper coverage of requirements
• Interacted with the users and logged any defects, enhancements from the UAT and communicated them to the development team
• Acted as a Subject Matter Expert on Application knowledge for preparing training presentation, Quick Reference Guides and assisting with any issues/questions that arose from training
• Managed various release cycles starting from enhancements to production for the RADAR application
• Provided production support on both SONAR and RADAR including any communications for the development team and to log defects/enhancements in order to plan future releases

Confidential

Business/Systems Analyst

Member of team that supports the financial portion of the claim payment System for the state of VA Medicaid program. Facilitate meetings with state of VA Medicaid representatives to determine requirements for changes to the financial portion of the claim system that pays over 100 million dollars a week in Medicaid claims.

Responsibilities:

• Gathered Business Requirements through brainstorming sessions on global calls.
• Documented the business logic and associated validation logic.
• Designed the online screens and reports for the Medicaid Online Electronic Claims Submission System.
• Managed the team of consultants responsible for developing on-demand Medicaid Management System reports.
• Analyzed, designed, and coded several online subsystems for the Medicaid System.
• Involved in creating sample mappings for the conversion of EDI X12 transactions code sets version 4010 to 5010 and translation of ICD 9 codes into ICD 10 codes.
• Documented and tracked requirements in Mercury Quality Center.
• Acted as a liaison between the development team, QA team and the Business team and resolved any conflicts due to change in requirements.
• Provided suggestions and ideas more from a strategic and long term perspective.
• Created Requirements Specification Document that translated business requirements into Technical specification including business and validation logic for ease of understanding to the development team.
• Used Requisite Pro for the Requirement Documents Preparation and Prepared Business Process Models that includes modeling of all the activities of the business from the conceptual to procedural level. Followed top down, leveled technique for building Business Process Models.
• Involved with the coders in evaluation of CPT and ICD-9 codes to ensure that the diagnosis meets medical necessity for the specific CPT code.
• Designed and developed Use Cases using UML and Business Process Modelling.
• Used MS-Visio for flow-charting, process model and architectural design of the application.
• Designed and developed project document templates based on SDLC methodology
• Analyzed and translated business requirements into system specifications utilizing UML and RUP methodology
• Ensured that all Lines of Business specifications were consistent in form and function to the Diamond Base System.
• Involved in analysis for wide range of Six Sigma and Web-based initiatives, including user requirements.
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, and OOD
• Generated wireframes and prototype for the GUI.
• Reviewed test scripts and made sure that the Test scripts covered all scenarios of the requirements.
• Reviewed the data model and reporting requirements for Cognos Reports with the Data warehouse/ETL and Reporting team.
• Logged defects into QC while doing Functional Testing and followed through the process until the defects were closed.
• Reviewed the Defects entered by the QA team and prioritized the defects and assigned them to the development team
• Prepared UAT Materials, including the UAT Process, UAT Test document which would include step-by step process for UAT as well as all the tests that would cover all requirements.
• Interacted with the users and logged any defects, enhancements from the UAT.
• Worked with the Training Group to build training materials as well provided any suggestions/ tool tips to assist in User Training

Confidential

Business Analyst

• Cigna major service lines include workers compensation claims administration and healthcare management services, property and casualty claims management, class action services and risk management information services.
• As a Business Analyst in Cigna I performed pivotal role in multiple projects handling three releases at the same time. Release 1 2 was web-based service application developed for streamlining office workflow processes involved in Electronic Data Interchange EDI transactions and benefits in claims management cycle based on HIPAA Guidelines. Release three was based on reporting the policy premium. There were seven reports, which were generated in Brio portal.

Responsibilities

• Helped in defining Change Management Process for Release Management Team.
• Mapped process flow assess as-is processes through user interviews, data collection and analysis, design and evaluation of to-be process solutions.
• Prepared Business Object / Business Process Models that included modeling of all the activities of business from conceptual to procedural level.
• Designed and developed Use Cases using UML and Business Process Modelling.
• Consulted with healthcare insurance company to develop conversion specifications for other insurance Coordination of Benefits including Medicare .
• Developed data conversion programs for membership, claims, and benefit accumulator data - converted thirteen corporate acquisitions. Developed data field mappings. Provided programming and support for claims processing functions and auto-adjudication.
• Validated the following: 837 Health Care Claims or Encounters , 835 Health Care Claims payment/ Remittance , 270/271 Eligibility request/Response , 834 Enrollment/Dis-enrollment to a health plan
• Identified gaps in the business process.
• Defined roles and responsibilities of participants in the business process.
• Developed and maintain information and documentation related to developing and modifying business processes and systems.
• Recommend system/process solution approaches to minimize risk and workflow impacts while capitalize strategic goals.
• Assisted process owners in process training and implementation.
• Streamlined the Restatement Financial Data Warehouse access review Process.
• Gathered requirements from users of the Clear Quest CQ tool for any Enhancements or change requests for any defects.
• Involved in Six Sigma process analysis.
• Planned and defined system requirements to Wire Frame with Use Case, Use Case Scenario and Use Case Narrative using the UML Unified Modeling Language methodologies.
• Led and conducted JAD sessions for requirements gathering, analysis and design of the system.
• Created context and workflow models, information and business rule models, Use Case and Object Models during the analysis using Rational tools.
• Designed and developed project document templates based on SDLC methodology
• Established RUP Rational Unified Process methodology and provided assistance in developing Use cases and project plans.
• Analyze business requirements and segregated them into Use Case Diagrams, Activity Diagrams, Sequence Diagrams, and OOD using Borland Together according to UML methodology thus defining the Data Process Models.
• Documented Requirements for Management Reporting out of Clear Quest using Crystal Reports.
• Worked as a CQ administrator by assisting customer with any issues and by running queries for ad-hoc reports for management team.
• Facilitated Change Control Board and Governance Board meetings and acted as a liaison between parties impacted by the change requests.
• Provided training on new features within CQ and prepared training materials like Quick Reference Guides and Job aids.

Confidential

Business/Data Analyst

As a Business Analyst Worked on the Claims processing system within the company for scanning and capturing of data including working on UB-92 claims forms. Involved in using the technology to recognize, validate, and store claims and their attachments using HIPAA compliance interface.

Responsibilities:

• Gathered legacy system requirements by shadowing Customer Service Representatives CSRs , Customer Relationship Representatives CRRs , preparing questionnaires, to identify limitations in the current system and GAPS in the proposed system.
• Created an enterprise workflow application based on CRUD rules for Customer Data that would allow for future integration of data infrastructure across various business areas into a single UI.
• Prepared logical data model in the form of Business Context diagram to include various entities and attributes in order to facilitate the design of Data model in the form of ER Diagrams. Studied current information structures and data models of the current databases to better understand the design of target data source.
• Performed custom data conversions and developed custom software for risk management applications including general claims, vehicle accident and administrative tracking. Performed all data field mappings.
• Used Rational Rose to model the process using UML to create behavioral and structural diagrams.
• Used Rational Clear Quest to track required changes and Rational Clear Case to maintain different versions of the project documentation
• Involved in integration of various Customer Data Sources and provided Data Mapping from various sources like CCD, LPCD, DCD into the target centralized customer data source.
• Modeled Business requirements into workflows to depict various scenarios of system to request RFI and RFP responses from major vendors.
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, OOAD using UML and Business Process Modeling.
• Intricately involved in Business Process Flow development, Business Process Modeling, and ad hoc Analysis
• Performed detailed comparative analysis of response to RFPs of vendors and Graphically Represented the recommended solutions in PowerPoint to Senior Management
• 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.
• Conducted Requirements walk- through with the Business Team to ensure that all their needs are met and gathered sign off on the requirements for SOX compliance after the requirements were base lined.
• Prepared and maintain Business Rules Spreadsheets BRS identifying Rules, Triggers and corresponding data fields from Legacy to target CRM application.
• Followed a methodical Change Management Process and documented any Change Requests into Clear Case for any changes in the requirements after the requirements were base lined.
• Conducted Architectural Discussions to prepare the Proposed Architecture and provided insight in the Business Case to the Architecture Review Board ARB .
• Lead the effort of Data Migration from disparate data sources into normalized data to eliminate redundant information and organizing the tables to easily maintain the table structures.
• Prepared Test Cases based on base-lined Requirements Document, prepared Requirements Traceability Matrix and provided Performance Testing Requirements. Worked very closely with the Test team to Test all iterations during the Testing Phase and documented all the defects.
• Facilitated the User Acceptance Testing UAT with Pega System Administrators and Business Users, documented any issues or defects and eventually got sign off from the right parties.
• Prepared training materials in the form of User manuals by preparing step-by-step guide to all screen flows in CMS.
• Assisted in development of User Interfaces and prepared screenshots to get business's buy-in on the requirements.
• Worked with Siebel trainer to prepare training materials and conducted on-site training with Siebel to train the various types of audience like Customer Relationship Representatives CRRs , administrators and Account Managers AMs .
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