Summary:

• Seven years of extensive experience in the field of Business Systems Analysis, working with the technical staff to implement management and staff's business requirements into the software application in Healthcare Industry.
• Highly motivated team player with excellent communication, presentation and interpersonal skills, always willing to work in challenging and cross-platform environment.
• Experienced as a Business Analyst in using the iterative software development life cycle principles of Rational Unified Process to manage, develop and test distributed client/server, internet and intranet applications on heterogeneous environments.
• Highly proficient in working with users to gather requirements, analyze them and subsequently use the Rational project and design tools to model the requirements.
• In-depth knowledge of creating use cases, functional design specifications, activity diagrams, logical, component and deployment views to extract business process flow.
• Used Query Analyzer, Execution Plan to optimize SQL Queries.
• Experience with SOX, Regulatory Compliance and Controls.
• Strong understanding of project life cycle and SDLC methodologies including RUP, RAD, Waterfall and Agile.
• Interviewed SMEs and Stakeholders to get a better understanding of client business processes and gather business requirements.
• Conducted JAD sessions, created Use Cases, work flows, screen shots and Power Point presentations for the Web Applications
• Familiar with HIPAA EDI transactions such as 835, 837 P, D, I 276, 277, 278 etc
• In depth knowledge of SDLC and implementation of the Rational Unified Process RUP in all four phases of a project: Inception, Elaboration, Construction and Transition.
• Utilized a fusion of industry knowledge and technical programming to provide executive management the development and implementation of interactive business 1 s tools, and strategic analysis, vital for use in mission-critical decision-making

PROFESSIONAL EXPERIENCE:

Confidential

Sr. Business Analyst/Project Manager

Confidential is a full health management company providing full range of HMO, PPO, and POS benefit plans. HIP wanted to have data consistency and proper data mapping between the old and the new system. Developed the Business Crosswalks for 837 P, I, D , 835 and 276/277 according to HIPAA implementation rules. This project also involved creating the medical claims processing system. It consisted of different modules like provider enrollment, member enrollment, programs and coverage. This project also involved the maintenance of claims workstation that automatically handles the entire claims life cycle.

Responsibilities

• Conducted weekly meetings for deciding the Policies and Procedures to be followed while constructing new sites.
• Performed the requirement analysis, impact analysis and documented the requirements using Rational Requisite Pro.
• Documented the server farm requirements and requirements related to security within Share Point and using Windows Active Directory.
• 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.
• Used Query Analyzer, Execution Plan to optimize SQL Queries.
• Meticulously assessed data from various sources and generated conceptual and logical database designs using ERwin data modeling tool.
• Interacted with client and the Technical Team for requirement gathering and translation of Business Requirement to Technical specifications.
• Involved with all the phases of Software Development Life Cycle SDLC methodologies throughout the project life cycle.
• Conducted interviews, meetings and JAD sessions during the process of Requirement Gathering.
• Planned and documented procedures for data processing and prepared data flow diagrams for the application.
• Analyzed and translated business requirements into system specifications utilizing UML and RUP methodology
• Expertise with supply chain strategies/vendor manufacturing process methods to determine level of procurement and strategic sourcing strategies/plans and worked with vendors/peers to determine lead times, schedules and cycle counts, established requirements needs.
• Experience in EDI automated first-pass claim adjudication, requiring thorough understanding of claim processing, both front and backend operations.
• Prepared and documented System Requirements and workflows for the Content Management Application tool.
• 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.
• 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.
• Performed Unit Testing and User Acceptance Testing and documented detailed defects.
• Designed and developed project document templates based on SDLC methodology

Confidential

Sr. Business Analyst/QA Analyst

• Humana major service lines include worker's compensation claims administration and healthcare management services, property and casualty claims management, class action services and risk management information services.
• As Business Analyst in Humana performed pivotal role in multiple projects handling three releases at the same time. Contributed to design a prototype for future system claim processing 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. In order to access these report each user had a different access level as an authorized user id. Also Coordinated with subcontractors of IS Business units, also performed as point of contact for Offshore team associated towards implementing the new Guidelines for HIPPA 837 835.

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.
• HIPAA EDI transactions such as 835, 837 P, D, I 276, 277, 278.
• Involved in all phases of software development life cycle SDLC in RUP framework
• Designed and developed project templates based on SDLC Methodology
• Worked with NASCO teams to get current work flow for detailed business process.
• Involved in applications analysis, which involves claims processing in NASCO.
• Defined Functional Test Cases, documented, Executed test script in Facets system.
• 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.
• Conducted presentations of the Q/A test results with analysis to the stakeholders and users and documented modifications and requirements.
• 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 UAT , 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.
• 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
• 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.

Confidential

Business Systems Analyst/Data Analyst

Confidential is an innovative leader in the health and well-being industry serving approximately 55 million Americans. MHC has a system called Enterprise Customer Information Claim System CICS that provides to check the contract information, deductible pay of the contract and allows creating claims and viewing or deleting the claims. Providers can be hospitals or health care centers, doctor's office or an insurance agent who can sell the MHC's insurance. The purpose of this project involves population of the Enterprise Data Warehouse EDW which is used in critical reporting and analysis. This system also allows members to log into their account and check their contract information, deductible, company information and provider's information.

Responsibilities

• Gathered analyzed, documented business and technical requirements from both formal and informal sessions and validate the needs of the business stakeholders.
• Conducted user interviews and documented business and functional requirements.
• Performed Requirement Analysis and developed Use Cases, Activity Diagrams using Rational Rose
• Analyze and prepare specifications for the improved functionality of the Nasco.
• Performed Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data
• Completed the documentation of Claims Scenario's for the source system
• Analyzed the existing claims process and specific business rule logic will be applied in the ACP model.
• Involved in creating business processes and modeling diagrams using Rational Unified Process RUP .
• Exposed to Agile methodology.
• Created use case scenarios and documented work flow and business process using Rational Rose
• Involved in project management using MS Project
• Collaborated with External Auditors and documented SOX compliance requirements
• Documented requirements associated change requests with requirements and connected requirements with Use cases.
• Wrote test cases and test scripts for the User Acceptance Testing UAT .
• Involved with all the phases of Software Development Life Cycle SDLC methodologies throughout the project life cycle.
• Incorporated Rational Unified Process RUP to create Requirement Document Specifications using Visible Analyst.
• Performed extensive data modelling to differentiate between the OLTP and Data Warehouse data models
• Identified/documented data sources and transformation rules required populating and maintaining data warehouse content.
• Maintained benchmark controls to policies, company standards and contracts, performed vendor sourcing, pricing and contract negotiation, performed procurement, ensured compliance with service/joint interest contracts.
• Used Rational Clear case for version control
• Responsible for creating test scenarios, scripting test cases using testing tool and defect management for Policy Management Systems, Payables/Receivables and Claims processing.
• Involved with all the phases of Software Development Life Cycle SDLC methodologies throughout the project life cycle.
• Served as conduit for managing system requirements between the business and the software development team.
• Queried database using SQL for backend testing
• Used Rational clear quest for defect management

Confidential

Business Analyst/QA Tester

Confidential is an organization dedicated to the delivery of quality health care plans and products working together with its customers, consultants, brokers, providers and employers. 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

• Interacted with business heads to finalize the Business Requirements for the application.
• Performed the requirement analysis and documented the requirements using Rational Requisite Pro.
• Used the requirement attributes priority, effort, and risk as the basis for negotiating the inclusion of the requirement, to manage the scope of the system efficiently.
• Developed UML Use Cases using Rational Rose and developed a detailed project plan with emphasis on 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.
• Used SDLC System Development Life Cycle methodologies like the RUP and the waterfall.
• Responsible for business system analysis of customizing the BPS Risk Management product with involvement through the whole SDLC
• Understand the As Is system and develop the To Be system concept and also prepare the System Process Maps.
• Managed changing requirements which included establishing a baseline, keeping track of the history, determining dependencies that are important to trace, tracing relationship between related requirements and maintaining version control.
• Prepared and documented System Requirements and workflows for the Content Management Application tool.
• Responsible for integrating with Facets .Designing test scripts for testing of Claims in Development, Integration and production environment.
• Checked Business Readiness and determined activities of flow.
• Developed executed several Optimized queries in SQL on this data.
• Performed Unit Testing and User Acceptance Testing and documented detailed defects.
• Wrote Procedure Manuals and was responsible for continuity preparedness.
• Managed various tests, stored test information, reviewed and analyzed test results.
• Conducted presentations of the Q/A test results with analysis to the stakeholders and users and documented modifications and requirements.
• Helped in writing Training manuals and helped business with the Training on a one to one sessions.
• Employed Rational Clear Quest for effective Change Management Requirements Creep and bug tracking during the testing lifecycle.

Confidential

Business Analyst/Systems Analyst

Responsible for systems and applications start-up of FCHP a hospital-based community health plan payer . Responsible for the Claims Adjudication System Managed Care application training for all departments administration of control files, formulary, provider demographic, provider payment, enrollee maintenance, benefit configuration Claims Systems Processing, fee schedules, capitation schedules, data warehouse, on-line pharmacy over 200 pharmacies claim and benefit troubleshooting, ID cards, and system generated Plan correspondence design and maintenance.

Responsibilities

• Met with client groups to determine requirements and goals. Utilized Rational Unified Process RUP to configure and develop process, standards, and procedures and create a Business requirement Document.
• Responsible for preparing Software Requirement Specification SRS and documenting them.
• Created Process Work flows, Functional Specifications documents and documented system requirements.
• Provide implementation assessment, strategy, and mentoring services for Rational Rose, UML and RUP.
• Interacted with various cross-functional teams on building business use cases, and understanding expenses and revenue stream.
• Working with clients to better understand their needs and present solutions using structured SDLC approach.
• Designed and developed project document templates based on SDLC methodology
• Followed a structured approach to organize requirements into logical groupings of essential business processes, business rules, and information needs. Ensured that critical requirements are not missed.
• Aided management in standardizing web applications by preparing GUI standards and recommending alternatives for incorporation in a phased, iterative manner.
• Interacted with client and the Technical Team for requirement gathering and translation of Business Requirement to Technical specifications.
• Analysis of new Business Requirements and preparation of the Functional Design Specifications
• Interacted with clients like SPF Securities to finalize their website look and contents.
• Analysis of the new requests specified by the end users for the future releases and discussion with the functional and technical teams.
• Communicated changes to requirements promptly and precisely to all personnel involved.
• Identified and clearly defined functional issues and support IT development staff throughout the design, development, unit testing, and implementation phases of the software development life cycle.
• Analyzed and translated business requirements into system specifications.