SUMMARY

• Business Systems Analyst with more than 8+ years of industry experience in Business Requirement Gathering, data modeling, software requirement analysis, process modeling, process flow, data warehousing and quality assurance skills using different methodologies.
• Strong knowledge of Confidential industry including HIPAA with emphasis on Business Requirements and Functional Requirements.
• Extensive experience working with Financial projects including banking domain
• Extensive knowledge of GAAP and IFRS
• Expert in GAP Analysis, Traceability Matrices, SWOT Analysis, Risk Analysis, Data Analysis, Competitive Analysis, Impact Analysis, and Cost Benefit Analysis
• Have worked with financial client for more than 2 years
• Extensive experience in Strategic development of a Data Warehouse and in Performing Data Analysis and Data Mapping from an Operational Data Store (ODS) to an Enterprise Data Warehouse (EDW)
• Extensive experience working in back end tester by writing SQL Queries and PL/SQL scripts on large data warehouse systems
• Ability to collaborate with peers in both, business, and technical areas, to deliver optimal business process solutions, in line with corporate priorities.
• Knowledge of Data Warehousing concepts including Meta data and Data Marts.
• Familiar with HIPAA EDI transactions such as , 837 (P, D, I) 820etc
• Extensive knowledge of all phases of the software development life cycle (SDLC) and the iterative Rational Unified Process (RUP)
• Good understanding of Medical Claim processing, Health Care plans, HIPAA, Facets.
• Experience working on Confidential systems like authorizations,, referrals, eligibility, provider, with understanding of Pharmacy Benefit Management (PBM) or payer concepts.
• Organized many Joint Application Developments (JAD) sessions and Joint Requirement Planning sessions (JRP), walkthrough, Interviews, Workshops and Rapid Application Development (RAD) sessions with end - user/clients/stake holders and the IT group.
• Experience in development methodologies like RUP, SDLC, AGILE, SCRUM and Waterfall
• Experience in conducting GAP analysis, User Acceptance Testing (UAT), SWOT analysis, Cost benefit analysis and ROI analysis.

TECHNICAL SKILLS

Business Methodologies: RUP, Agile, JAD, GAP Analysis, SWOT Analysis

Business Modeling Tools: UML, Rational Rose, MS Visio 2010, Brio

Requirement Analysis: Rational Requisite Pro, Test Director, Quality Centre

Databases/ languages: Confidential, SQL Server, XML

Operating Systems and Languages: Linux, Unix, Windows XP

Others: SAP Material Management Module, Facets, MS Office Suite, MS Project, Toad, SQL Developer

PROFESSIONAL EXPERIENCE:

Confidential

Sr. Business System Analyst

Responsibilities:

• Implemented SDLC, agile (SCRUM) methodology for the developing life cycle and followed the standards process in the application and elicited requirements from Business users and stakeholders by interacting with them and asking them detailed questions, and through JAD sessions, Focus Groups, Brainstorming, Prototyping and carefully recording and documenting the requirements in a format easily understood and reviewed by both business and technical people.
• Used JIRA for issue tracking, User Story management and requirement traceability and created, managed, tracked and analyzed sprint Burn Down Chart and Product Burn Down chart to estimate sprint velocity, Development team's capacity and release planning respectively, to improve and maximize value while focusing to achieve the Sprint Goal.
• Created Data mapping documents between various data elements, XML files, flat files, excel files, HIPAA EDI files X12 837, 270, 271, 276, 277, 278, 835, 275, and 5010 and web services, to perform verification and validation.
• Defined Data Maps to validate and customize Claims daily load into FACETS for processing the transactions.
• Worked on Pharmacy Benefit Management (PBM) Requirement gathering for Negative Balance Forwarding regulation.
• Worked on PBM application that provide discounts from pharmaceutical manufacturers to lower benefit costs for consumers and clients
• Conducted Impact Analysis and Gap Analysis to derive and document requirements for Web based Claim Processing System (CPS) and identified AS-IS and TO-BE business processes based on which created business process models.
• Identified gaps between current policies and procedures and new HIPAA 5010 compliance, to check the compatibility of the existing system capabilities with the new requirements and developed an action plan for the migration process.
• Implemented Test Driven Development (TDD) to ensure quality of application is maintained through SDLC.
• Developed Mockup screens and wireframes using UI components such as Radio Buttons, down lists, Check Boxes, and Data Entry Fields for web based custom dashboard of the CPS application for Business Users and Stakeholders.
• Worked with Front end and UI developers and Created HTML and CSS files using HTML5 and CSS3 for web based custom dashboard, and ensured that the client side validation and server side validation were implemented.
• Created XSD schemas and verified XML files based on XSD schemas. Assisted testers with validating XML requests.
• Developed HL7 messaging for patient EMR in text and XML formats, in accordance with HL7specifications and performed functional (API) testing and worked with QA team in reviewing and executing test plans and test cases.

Environment: SCRUM Methodology, JIRA 5.0, JAVA, Eclipse 4.3, MS Visio 2013, UML, Apache, AWS, AMI, Confidential EC2, Confidential ALM v11, Confidential 10g, Tableau 9.0, Altova XML spy, SOAP UI PRO, MS outlook 2013, MS office Suite 2013 (Excel, Word, Power point).

Confidential

Business Analyst

Responsibilities:

• Assisted stakeholders and PMO to create Business Requirement Documents by identifying functional and non-functional requirements.
• Acted as an interface between Project Managers, Subject Matter Expert’s (SMEs), Developers and QA Team on requirement gathering.
• Product Development process used for designing the application that included making Use Cases & Use Case Diagrams
• Involved in creating and analyzing current state flow diagrams of processes & UML Diagrams using MS Visio. Thereby, depicting the future state flow diagrams using MS Visio by interviewing various SMEs and feedback from IT solution architects.
• Worked on iRise for creating stimulations along with MS Visio
• Conducted Requirement gathering sessions with various SMEs located at the different company locations across US related to assigned tasks.
• Managed clients contact management including monitoring and recording interactions and communications through CRM (Customer Relationship Management).
• Involved in documenting Functional Requirements in Functional Requirements Definition Documents (FRD) for Vendor selection, Appraisal, skip tracer and Recovery processes.
• Depicted User Requirements, Change Management, and Dependencies between other assignments within the project as well as other applications interacting with the assigned application and other possible risks.
• Created the future state screen shots in Power Point to represent to the business for final validation and signoff.
• Wrote Test Scripts, Did UAT and a part of Manual Testing
• Actively involved in walkthroughs and meetings with Project Team members including other Business analysts assigned within the same application and team lead to discuss related issues.

Environment: MS Excel, MS Word, MS PowerPoint, MS Outlook, Windows 7/ ME/ XP, MS SQL Data Base, JAVA, SharePoint, MS Visio, MS Project, Confidential ALM (Quality Center).

Bismarck, ND

Responsibilities:

• Studied business requirements and conduced User Interviews to identify and document the data discrepancies and their sources as related to Government Contract Compliance (GCC), Government Disclosures, Government Pricing, Customers, Products, Product pricing.
• Involved in performance testing of Medicaid client server claims processing system, Medicaid MCC / MCO and Medicaid Management Information System (MMIS)
• From payers perspective (MMIS) all transactions are made compliant to ANSI ASC 4010A1 X12N standards to talk with various Legacy system.
• Analyzed CMS comparison documentation highlighting changes of 5010 format and ICD10 diagnosis and procedure codes.
• Designed and developed project document templates based on SDLC methodology.
• Develop Technical Capability Matrix (TCM), Business Service & Technical Service in alignment with MITA Technical Architecture.
• Responsibility included modifications to a customer’s mainframe system to support new product features or regulatory requirements and, in some cases, involved a system upgrade
• Documented workflows and executed comprehensive testing and plans to ensure the new acknowledgement results demonstrated in the 999 and 277CA were properly interpreted and managed to ensure Payer acceptance of the 837 files.
• Develop Conceptual Data Model & Logical Data Model in alignment with MITA Information Architecture.
• Develop MITA Maturity Model (MMM)&Business Capability Matrix (BCM) to identify the maturity level of SD Medicaid Enterprise.
• 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.
• Used the Data Stage Designer to develop processes for extracting, cleansing, transforms, integrating and loading data into data warehouse database.
• Worked on Client/Server tools like SQL Server Management Studio to administer SQL Server.
• Established a RUP (Rational Unified Process) centric business analysis methodology.
• Used Test Director and Mercury Quality Center for updating the status of all the Test Cases & Test Scripts that are executed during testing process.
• Planned and defined system requirements to Wire Frames with Use Case, Use Case Scenario and Use Case Narrative using the UML (Unified Modeling Language) methodologies.
• 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.
• Used MS SharePoint for the purpose of managing documents and for hosting websites which was used to access shared work spaces and documents.
• Evaluated testing results for each potential release build using Test Director, Quality Center and Bugzilla reports, listing summarized bug information in priority sequence, recommended viability of release for production.

Environment: Windows 98/2000, Window2003, Window NT, Linux, Mainframe, Solaris Confidential Web sphere, Apache Tomcat, IIS 6.0, Web Logic, Java, SharePoint, MS Office, Quick Test Pro 8.2, Mercury Quality Center 9.0, Load Runner 8.2, Sun Java, MSJVM, Confidential 8i/9i/10g, SQL Server 2000, DB2, Toad, MS-Project 2000/2003.

Confidential

Business Analyst

Responsibilities:

• Defined the scope of the project and worked with the project manager in creating the business case and project plan.
• Performed GAP analysis to identify the AS-IS process and TO-BE processes required to achieve the targeted goal.
• Analyzed and synthesized results from Joint Application Development (JAD), proposed alternative tasks and transformed those into Business Requirement Document (BRD).
• Strong communication, problem solving, organizational, interpersonal, and presentation skills.
• Actively analyzed current business processes (Claims, Recipient eligibility and enrollment) and the impact on the enhancements on these processes in order to get the desired results.
• Worked on 834, 837, 835, 276, 277 and EDI Gateway.
• Wrote test cases and test scripts for the User Acceptance Testing
• Participated as appropriate in decision- making activities associated with the development and management of programs related to insurance exchange (HIX) products.
• Worked deeply into Health Insurance Portability & Accountability Act (HIPAA) standards, Electronic Data Interchange (EDI), HL7 and ICD-9 to ICD-10 coding.
• Worked on Facets data tables and created audit reports using queries. Manually loaded data in Facets and have good knowledge on Facets business rules.
• Analyzed the functional details of various modules in mainframe and did the GAP analysis with the new enhanced system.
• Gathered Business Requirements, interacted with the users, designers and developers, project manager and QA team to get a better understanding of the Business Processes
• Performed GAP analysis of 5010 EDI transaction using implementation guide to identify the changes in segments and data elements.
• Conducted discussion sessions to make sure that systems are in compliance to HIPAA

Environment: Confidential Outlook, MS Access, MS Project, Crystal Report, TOAD, Sharepoint, Confidential 10g, DB2, PL/SQL, SQL Server, AQT, XML, UNIX, Rational Suite (Rose, Requisite Pro), Clear Quest, UML, MS Visio, MS Project, MS Office, TIBCO, WS-FTP Pro, iWAY, Facets, PeoplSoft