PROFESSIONAL SUMMARY:

• Over Seven and half years of experience in the field of Information Technology in the Healthcare-Life Sciences / Pharmaceutical / Pharmacy Benefit Management PBM / Insurance domain encompassing business systems planning, procedural development, reporting and validation.
• Experienced in Requirement Gathering, Business Systems Planning, Procedural Development Implementation, Business Process Mapping, Problem Solving/Workarounds and Business Contingency Planning/Disaster Recovery, Creation of Domain Models and Creating Reports for Analytics
• Understanding and mapping of the various ICD9/ICD10 Codes applicable for tracking of diseases for which diagnostic testing is done in the area of Biochemistry.
• Knowledge and experience in implementation of HIPAA and NCPDP standards.
• Experience in preparing documentation which is in compliance with 21 CFR Part 11, Medicare Part D requirements, HIPAA ANSI X12 Transaction sets, and in accordance with NCPDP National Council for Prescription Drug Programs Standards.
• Worked as in a team with Account Management, Company Management to document requirements, process flows, wire frames, for corporate accounts/external clients.
• Application of Software Development Life Cycle SDLC , with thorough understanding of various phases such as Requirements, Analysis/Design, Development, Testing and Implementation.
• Extensive experience with Business Use Cases, Functional Use Cases, Business Process Models, Test Cases.
• Extensive experience in process modeling using UML, flowcharts, sequence diagrams, activity and diagrams.
• Strong knowledge of UML, RUP, Rational Suite including Rational Rose Requisite Pro, Clear Quest and Clear Case, Microsoft Visio.
• Experienced in conducting Joint Application Development JAD sessions with SMEs, Business Analysts, Software Developers and Quality Assurance teams for New Corporate Accounts or Clients.
• Excellent communication, interpersonal, analytical skills and strong ability to perform as part of a team in for four years in CMMI accredited and CMS Compliant Medicare Part D companies.
• Worked with ETL Developers and Process Analysts in preparing the requirements data and functional , and writing documenting work flows and process flows
• Understanding of the Lab Requirements mandated by the College of American Pathologists
• Strong attention to detail and proficient in working in high pressure environments with tight deadlines
• Experience with Data Warehousing and Business Intelligence Tools like Informatica, Business Objects, Broadcast Agent, and Web Intelligence
• Experience with conducting assessments and impact/gap analysis concerning State MMIS

TECHNOLOGY:

• OLAP Reporting Tools: Business Objects, Web Intelligence, Broadcast Agent, Crystal Reports, Query Studio, Cognos, Microstrategy
• Databases Tools: Oracle, SQL Server, TOAD
• Languages: UML, C, UNIX, SQL
• Business Tools: MS Visio, Rational Rose Requisite Pro, Clear Quest and Clear Case
• Methodologies: SDLC, RUP, JAR, JAD, UML
• Other Software: MS Visio, MS Word 97/2000, MS Excel 97/2000, MS Access 97/2000, MS Project
• Operating Systems: MS Windows 2000/NT/98/XP, UNIX, MSDOS.

WORK EXPERIENCE:

Confidential

Business Analyst

• Part of the PBSI proposal team in Business Development alliance. Work to develop Project Management Office. PMO
• Worked on to gather the requirements for Healthcare transactions which must convert to the HIPAA-compliant version 5010

Worked on the following areas of the proposal:

Project Management

• Project Management Plans
• Scope Management Plan
• Time Management Plan
• Change Management Plan
• Cost Management Plan
• Risk Management Plans
• Issue Management Plan
• Quality Management Plan
• Human Resource Management Plan

Turnover and Contract Closeout

• Turnover Planning
• Turnover Project Plan
• Turnover Reports
• Turnover Deliverables
• Successor Contractor Operation
• Archived Materials
• Contract Close out services
• State responsibility for turnover
• Contractor Closeout Services
• State Responsibility for turnover
• Contractor Responsibility for turnover

Center of Medicaid Services CMS Certification Plan and Phase

• Certification Readiness Plan
• Completed Certification Checklist
• Arkansas Medicaid Enterprise Certification
• CMS certification Planning
• Meet with Federal and State Certification Team
• State Responsibilities for CMS Certification Phase
• Contractor Responsibilities for CMS certification Phase
• CMS Certification Phase Milestone and Deliverables

Confidential

Business Analyst

Responsibilities:

Was part of the Accenture team that was contracted by Arkansas DMS to create a proposal response to RFP to replace the existing MMIS platform

Worked on the following areas of the proposal:

Project Management and System Engineering

Project Management

• Project Management Plans
• Work Break Down structure
• Project Work plan
• Project Performance Monitoring Plan
• Staffing and Resource Management Plan
• Quality Assurance Plan
• Issue Management Plan
• Project Communication Plan
• Project Training Plan
• Risk Management Plan
• Change Management Plan

Bi-weekly status Report

3Project Reviews and Meetings

Turnover and Contract Closeout

• Turnover Planning
• Turnover Project Plan
• Turnover Reports
• Turnover Deliverables
• Successor Contractor Operation
• Archived Materials
• Contract Close out services
• State responsibility for turnover
• Contractor Closeout Services
• State Responsibility for turnover
• Contractor Responsibility for turnover

Confidential

Business Analyst

• Understanding and assessment of the current EDI Transactions used
• Understanding and assessment of the current Pharmacy Transactions from an NCPDP 5.1 perspective
• Understanding and assessment of the current ICD 9 codes used by the State
• Creation of a Gap/Impact Analysis Document for changes of the EDI Transactions 837, 835, 276/277, 270/271
• Creation of a Gap/Impact Analysis Document for changes to Pharmacy Transactions real time and batch based on NCPDP 5.1 to NCPDP D.0 , specifically concerning the data elements
• Creation of a Mapping Document for ICD9 Codes to ICD 10 Clinical Modifications and Procedural Codes.
• Creation of Gap/Impact Analysis Document for the Prescription Drug Point of Sale System
• Creation of Gap/Impact Analysis Document Operational Analysis Document for the Drug Utilization Review System
• Creation of Gap/Impact Analysis and Operational Analysis Document for Medicaid Subrogation
• Creation of Gap/Impact Analysis Document and Operational Analysis Document for the Drug Rebate Analysis and Management System

Environment: MS Office Suite, MMIS, POS, GEMS, Document Analyzer, SharePoint

Confidential

Business Analyst

• Understand current Contract Management business process for all group insurance products by interviewing SME's and team members
• Assisting the Requirements Lead in formulating Workshop Session agendas and facilitating Workshop/JAD Joint Application Session agendas
• Create, analyze and finalize the improved Contract Management business process workflows for all the group insurance products
• Creating documentation for all identified data models such as Domain Model-Data Mapping, Data Dictionary and ER Diagrams from Legacy Systems, Book Of Record and CLM Solution Tools for Question Tree co-relation purposes
• Creating Business Rules and User Interface Rules for data elements/fields
• Utilizing the Waterfall Methodology in creating the requirements for eventual Contract Management tool implementation in a system-agnostic manner
• Creating artifacts for weekly distributions to the business and maintaining the Requirements Traceability Matrix
• Creation of feedback update template for incorporating business feedback and updating requirements
• Performing and tracking feedback analysis
• Handling of and coordination with a team of Off-Shore Resources in India.

Environment: Waterfall Methodology, LIMS, MS Office Suite, Livelinks, LiveMeeting, CLM Contracts Tool

Confidential

Business Analyst

• Analyzing existing laboratory processes, and LIMS legacy system and auxiliary system functions.
• Set-up, facilitate and manage meetings to address the agenda.
• Coordinating with the Business to understand what improvements are needed and coordinating with the IT Department on the possibilities to accomplish the goal.
• Conducting Gap Analysis to bridge the distance between what is and what should be as well as mapping the ICD9/ICD10 codes for the diagnostic testing conducted by the company. This data then gets incorporated into the requirements documentation.
• Utilizing the RUP Rational Unified Process methodology to produce the requirements.
• Create and deliver, complete and verified Business and Functional Requirement Documents in compliance with FDA regulations and CAP College of American Pathologists requirements.
• Creating Business Rules and User Interface Rules for functionalities
• Acquire sign-offs from the Business and Stakeholders.
• Coordinate with QA to ensure set-ups are in place.

Environment: RUP Methodology, LIMS, Fusion, Clear Quest, SCC SoftPreanalytical, MS Office Suite, Livelinks

Confidential

Business Analyst

• In the POS Point OF Sale Business Requirements team for Medicare Part D, the focus is on ensuring that the POS Point Of Sale Systems function properly and are in accordance with NCPDP Standards as well as HIPAA compliant. Requirements produced were also customized according to Client needs while maintaining all required healthcare protocols.
• In the Retiree Solutions Team for Medicare Part D, the focus is on ensuring that the EOB Explanation of Benefits content, computation and reporting satisfy Client needs and remain compliant with all CMS mandates.
• The duties performed while working with above-mentioned teams are as follow:
• Understanding of POS, TelePAID System, Co-Pay Benefit Pricing, Claim Adjudication Protocol
• Initiate, facilitate and manage meetings to address agendas
• Create and drive presentations designed for knowledge transfer and corporate training
• Understand the client's needs and translate it into plausible requirements while working on the Corporate Account requirements
• Translate and clarified Business Requirement Documents into Functional Requirements for Point of Sale POS -Ex: F1/F2/F3 Transactions, Explanation of Benefits Troop and Drug Spend EOB
• Creating Business Rules, User Interface Rules and Use Cases for functionalities captured within the Functional Requirement documents in preparation for HIPAA D.0 changes
• Work closely with the business stakeholders to extract and secure requirements.
• Coordinate with Development to ensure that requirements are understood
• Collaborate with QA to ensure all set-ups are available and validate results through test cases
• Acquire sign-offs and maintain proper documentation
• Initiate Change Control as per CMMI standard protocol
• Conduct Work-Sessions for Work-Around planning
• Knowledge and experience in creating requirements for HIPAA EDIX12 Transactions
• Knowledge and experience in applying NCPDP standards.
• Training and experience in Medicare Part D in a CMS Compliant and CMMI
• Understanding and resolving of CMS Compliance issues Medicare Part D
• Experience using Agile software development methodologies, including experience creating and managing SCRUM artifacts User Stories, Product Backlog, facilitating Scrum meetings
• Analysis of metrics based on KPI's

Environment: RUP, JAD Sessions, GAP Analysis, Breeze, Communicator, Clear Quest, Optimal Trace, Rumba, PTS Web, PTS Time, MS Office Suite, SharePoint, Agile Methodologies

Confidential

Business Analyst

• Acted as a liaison between business clients and technical personnel to acquire and record requirements for upgrades, enhancements and new projects.
• Processed DBCR Database Change Request documentation and coordination with technical team
• Discussed and documented impact analysis for numerous interface changes while being part of the team representing the Reporting and Analytic Finance team
• Updated SDDs Software Design Documentation
• Applied pharmaceutical data understanding as per Government Pricing.
• Ran queries monthly to verify tie-outs for the business prepared by the technical resource to provide support for applications solutions supported by the Reporting and Analytic Finance team with emphasis on the Corporate Finance Cognos Planning Models.
• Created and published reports using Query Studio
• Followed existing CMMI and Sarbanes Oxley compliant protocols incorporated in daily procedures.
• Built effective partnerships with business and systems communities by demonstrating an understanding of the interdependencies between application functionality and associated business processes to provide best service.
• Manages application service requests problem resolution, new functionality, testing, and documentation .
• Interfaces with partner systems personnel to collaboratively resolve issues.
• Provides functional application and business expertise to support end users or interface partners.

Environment: Lotus Notes, Microsoft Visio, Squirrel, GITS Government Issue Tracking System Application, PTA Packet Tracker Application , MKS Integrity Code Promotion Request Query Studio

Confidential

Business Analyst

• Schedule and run meetings to extract analytics requirements for senior management reporting needs
• Review all available data inflow and create a logical model for discussion with users on possibility of reports.
• Create analytics artifacts using Crystal Reports after definition of required data has been established to build a consumer-centric profile by leveraging data from traditional data sources eligibility and claims, including third-party medical or pharmacy claims as well as clinical interventions and the health risk assessment.
• Scheduled running of reports for specific periods for reference
• Coordinated with business users in order to produce accurate Data Requirement documents
• Created report mock-ups for supplementary documentation and approval
• Conducted walk-through with development team to discuss the Functional Requirement Documents which contained detailed data needs of users and to confirm data mapping and traceability
• Participated in discussions for the Technical Specification Documents created by the development team based on the Functional Requirement Document.
• Participated and provided input during QA Document walk-through
• Followed existing CMMI and HIPAA compliant protocols incorporated in daily standard procedures.

Environment: .Net Platform, Rational Rose, Rational Unified Process RUP , MS Project 2002, PowerPoint, MS Visio, MS Word, MS Excel, Windows NT/2000, Requisite Pro, Clear case, Clear quest, Crystal Reports

Confidential

Business Analyst

• Managed the output requirement project for various life insurance products Whole, Term, Universal.
• Participated and facilitated JAD Sessions.
• Played key role in System Development Life Cycle Process consisting of design and gap analysis, business system requirements gathering, and UAT.
• Coordinated participation and sign-off of various business partners and customers.
• Created business requirement documents and integrated the requirements and functionality.
• Interfaced between business new product builders and system platform builders.
• Worked with systems area to translate business needs into system requirements.
• Used SDLC System Development Life Cycle methodologies like the RUP and the waterfall.
• Use Cases and other Process Flow Models were designed using Visio and Rational Rose.
• Followed existing CMMI and HIPAA compliant protocols incorporated in daily standard procedures.

Environment: RUP, UAT, GAD Gap Analysis Document , MS Visio, Windows, Rational Rose, Requisite Pro, Clearcase, Clearquest,