SUMMARY

• Around 9 years of experience in systems and Business analysis in Health care, with FACETS and extensive interaction with client.
• Insightful knowledge of business process analysis and design, domain & technology expertise with strong integration skills.
• Experienced as a FACETSBusinessSystems Analyst in gathering the business requirements from the existing stored procedures, supporting the Interfaces and reports development in explaining the functional requirements, proposing technical solutions, supporting the unit testing and system integration testing with the functional flow.
• Experience as a Business Systems Analyst in mapping business requirements, designing customized solutions with strong analytical skills and ability to analyze business practices and define optimal procedures.
• Experienced working with Facets changes analysis, design and migration strategy
• Immense knowledge in Health care payer operations, Interfaces, Reports, Letters and system Migrations, Health Administration - Claims processing (auto adjudication), Claims pricing and testing, HIPAA, enrollment, Medicare, Medicaid, CDHP.
• Expertise in HealthCare Administration/Managed Care Systems working with various Claims Systems/Applications with multiple healthcare client systems, with prime focus on claims adjudication, provider, eligibility.
• Expert in SDLC (System Development Life Cycle) methodologies like the RUP and the waterfall.
• Knowledge of the following HealthCare EDI Transactions for 4010/5010 like (278) Referral Certification and Authorization, (834) Benefit and Enrollment, (835) Payment & Remittance Advice, (837 I & P) Institutional and Professional HC Claim
• Functional experience with concentration on Use Case modeling using UML, Business Process Modeling, Data Modeling, Change Management, Technical Training, Software Development methodologies, QA testing, and Systems Testing interfaces, Reports, Letters.
• Good expertise in creating Test Cases on the basis ofproduct features, client requirements and technical documents.
• Developed, executed and maintained Test Scripts, Reviewed and documented system and implementation Test Strategy Documents for Parallel Testing, and system integration testing.
• Great communication skills, client relations, presentation and negotiations with creative approach to problem solving through use of excellent analytical skills.
• Involved in building the Health care center of Excellence across by involving in creating and sharing the knowledge base and conducting sessions across the organizations.
• Managing requirements traceability information and tracking requirements status throughout the project.

TECHNICAL SKILLS

Data Base: MS Access, Oracle (SQL Series), SQL server 2005, Sybase

Operating Systems: MS-DOS, Windows95/98/NT/2000/XP/2007

Software: MS Office Suite (Word, Excel, Access, PowerPoint Outlook), MS Visio, Adobe Acrobat, Lotus Notes, Crystal Reports, SharePoint.

Requirement Tools: Requisite Pro, RTM

Healthcare Domain: Claims, Providers, Membership, etc.

HealthCare System: FACETS 4.71 to 5.01, Trizetto, FACETS Applications and Configuration

Project Methodologies: SDLC, Agile, Rational Unified Process (RUP), UML, JAD, JAR

PROFESSIONAL EXPERIENCE

Confidential, Bronx, NY

Business System Analyst

Responsibilities:

• Interacting with client’s team SME’s and key users to understand their business processes and solution management within timelines.
• Followed Workgroup for FACETS Electronic Data Interchange standards for testing that need to comply with the HIPAA guidelines.
• Involved in project planning, coordination and QA methodology in the implementation of the FACETS in the EDI transaction of the claims module.
• Running queries of the product database
• Reviewed Test Scripts, Technical Specification Documents, and worked on application’s input / output data definitions.
• Worked in FACETS Output generation, Interface development and FACETS Migration Projects.
• Documents the results of the audit and make recommendations as needed
• Prepare detailed system requirements, specifications and documents and provide consultative services through all phases of the System Development Life Cycle
• Elicit and prepare detailed system requirements through conducting JAR/JAD sessions, interpreting business requirements and working with business partners and development teams
• Ensures coding and Configuration, meets current business policies and practices, and supports the efforts of compliance review and audit of employer group benefits.
• Undertaking Quick Gap Analysis; current / future business process analysis, generating documents of future business process and validating same from the company.
• Prepare requirement specifications such as Use cases and System requirement specifications and Supplementary specifications
• Worked on the database analysis part by helping the technical team in identifying the data sources required for the application and coordination with the IT team in migration of the data within the databases.
• Conceptualizing and developing functional specifications across different business areas such as Claims, Membership, PBM etc.
• Preparing business use cases; map Business Requirement / Software Requirements Specifications (SRS) document (As-Is & To-Be Analysis) and GAP Analysis and translating them into functional specifications, detailed test plans and coordinating for Go-Live.
• Involved in FACETS Configuration to make sure all information will be sent without any error
• Created and managed project templates, Use Case project templates, requirement types and trace-ability relationships in Requisite Pro.
• Involved in developing database objects using Trizetto FACETS database in both SQL Server and Sybase environments.
• HIPAA4010-5010 Gap Analysis.
• Performing knowledge transfer to the technical/development and QA team by creating quality test cases and providing accurate test data.
• Involved in Configuration Management, Requirement management and analysis.
• Design and review of various documents including the Software Requirement Specifications (SRS), including USE Cases, Business requirements document (BRD), Use Case Specifications, Functional Specifications (FSD), Systems Design Specification (SDS), Requirement Traceability Matrix (RTM) and testing documents
• Documenting requirements and creating functional design documents, process flow and design flow diagrams. Defined Functional Test Cases, documented, Executed test script in FACETS system.

Environment: Trizetto FACETS, Windows, Quality Center, MS Project, EDI Gateway, Rational Enterprise Suite (Rose, RequisitePro, ClearCase, Clear Quest), SQL, PL/SQL, SQL Server, Oracle.

Confidential

Business System Analyst

Responsibilities:

• Offer support to business customers in dealings with Technology Services and translates requirements into Configuration solutions
• Design, build and test FACETS Configuration in support of business requirements
• Worked on FACETS extensions mapping attributes.
• Participate in functional specification and design reviews, validating Configuration aspects
• Executing system test scripts on query output and quantifying, analyzing, and summarizing test results.
• Gathering business requirements and converting them into functional requirement specifications and user requirement specifications. Used Rational RequisitePro for Requirement Document preparation.
• Analyzed the current Business Requirements gathering process with BPM and re-established/optimized the process JAR.
• Conducting data driven analyses to help break down, prepare and analyze data for testing, auditing, and improvement of query performance.
• Gathering and documenting project requirements/specifications and experience with the System Development Life Cycle.
• Developing and executing SQL queries against data warehouses to support data mapping and ad-hoc analysis.
• Conducted one on one interviews with high level management team and participated in the JAD session with the SME’s.
• Primarily support Enrollment, Billing and Fulfillment systems for Individual and Group products
• Conducted Business validations for different FACETS modules Providers, Claims, enrollment and Membership
• Migration of Data was done from the previous version to the next version
• Experience working with Trizetto FACETS and its Provider contracts and Member benefit modules.
• Transitioning design deliverables to the development team and supporting development team during build and unit test phase.
• Involved in Testing the Member portal website and worked on the requirement gathering and Analysis for developing the Ad-hoc reports that are extracted from the consumer portal back end data.
• Involved in process analysis and defined executed data and Facets migration plans for local data for global applications.
• Actively working with business users, development, QA teams and onsite/offshore team.
• Conducting reviews of SRS written by peers and junior colleagues.
• Setup reoccurring HIPAA 5010 and/or JAD sessions to review both physical and logical models for business processes and data transaction processing and adjudication processes.
• Involved in Facets Output generation, Interface development and Facets Migration Projects.
• Defined Functional Test Cases, documented, Executed test script in FACETS system.
• Created Process Flow diagrams, Use Case Diagrams, Class Diagrams and Interaction Diagrams.

Environment: TrizettoFACETS, Windows, MS Office, MS Visio, Quality Center, SAS, Cobol, HIPPA Gateway, PL/SQL, MS Project, SQL, SQL, Server, Rational RequisitePro