SUMMARY

• 7 years of experience in business process analysis, business requirements modeling and development of Web Based, and Client/Server applications in diverse business domains of Healthcare, Banking, Mortgage, Insurance and Service Industry Sectors.
• Proficient in gathering and converting User Requirements into Business Requirements and Functional Requirement Specifications FRS and use Modeling tools like Rational Rose and Microsoft Visio for requirements modeling.
• Strong understanding of project life cycle and SDLC methodologies including RUP, RAD, Waterfall and Agile.
• Expertise in Business Process Modeling, Business Process Re-design and in designing Process Architecture.
• Strong knowledge of managed care payer requirements and procedures.
• Strong experience in RUP Business Modeling process.
• Sound understanding of Gap Analysis, requirement management, risk analysis and project plans.
• Solid understanding of Rational Unified Process RUP using Rational Rose, Requisite Pro, Unified Modeling Language UML , Object Modeling Technique OMT , Extreme Programming XP , and Object Oriented Analysis OOA .
• Responsible for architecting integrated HIPAA, Medicare solutions, Facets.
• Experienced in with SQL and PL/SQL with familiarity in RDBMS such as MS SQL Server and Oracle.
• Expertise in UML class diagrams, object diagrams, GAP Analysis, use case diagrams, state diagrams, sequence diagrams, activity diagrams, and collaboration diagrams as a business analysis methodology for application functionality designs using IBM's Rational Rose.
• Experience in Risk Management process and technology reengineering, Sarbanes Oxley implementation, valuation review process and technology, strategic sourcing, metrics and benchmarking
• Experience in Mapping ICD 9 codes with corresponding ICD 10 Diagnosis and Procedure Codes.
• Knowledge of 837, 835, 277, 270, 271, NCPDP, 4010, 5010 and ICD-9/ICD-10.
• Experience in Other Utilities/Tools/Scripts like Korn Shell Scripting, Perl 5.0, SQL Plus, SQL Loader, Export and Import utilities, TOAD 9.1 and Visio 10.0.
• The HIPAA component efforts included mapping and gap analysis of legacy claims formats, CMS 1500 and UB92 to 837P and 837I.
• Excellent in designing business models using UML diagrams such as use case diagrams, class diagrams, activity diagrams, sequence diagrams and collaboration diagrams using Rational Rose and MS Visio.
• Mentoring team members in ETL Area performance optimization area.
• Wrote PL/SQL statement and stored procedures in Oracle for extracting as well as writing data.
• Experience in conducting Joint Application Development JAD sessions and White Board Sessions with end-users, Subject Matter Expert SMEs team, Architects and design group development and QA team for project meetings, walkthroughs and customer interviews commensurate with excellent communication skills.
• Creative and aggressive self-starter with integrative thinking skills, capable of communicating creative ideas through graphical analysis charts and statistical data display.

DISCIPLINES:

• Business Analysis, Business Architecture, Data Mapping, Data Modeling, Requirements Gathering, Functional Specification Design, Testing Test Cases Manual Testing Automated Testing tools , Quality Assurance QA , Documenting Process Flow, Process Re-Engineering, Process Mapping, Business Contingency/ Business Continuity Planning BCP , GAP Analysis, SDLC
• Software/Hardware: Rational Team Test, OOAD OOA/OOD , RUP, UML, Rational Rose, Clear Case, Clear Quest, WinRunner, Load Runner and Test Director, C, C , Java, HTML, J2EE, VB 6.0, SQL, Windows 9x/NT/2000/XP, Unix, xml, Linux, Solaris, Oracle, SQL Server and MS Access, TSL, SQL Basic, WebSphere, RDBMS, Shell Scripts, MS Visio, MS office, Adobe PageMaker, Adobe PhotoShop, MS Project 2002, Adobe workflow systems, Weblogic Server, iRise, Mercury Quality Center

PROFESSIONAL EXPERIENCE:

Confidential

Sr.Business System Analyst

The project was to handle the modifications to the Medical Data Code Set Standards for ICD-10-CM Clinical Modification and ICD-10-PCS Procedure Coding System provided by CMS Centre for Medicaid and Medicare Services . Identify the scope of the system that will be modified by the ICD-10 project to accommodate its code and /or downstream impacts steaming from these codes. I was also involved in system testing of both inbound and outbound EDI transactions like 270,271, 834, 837 and 835.

Responsibilities:

• Elicit requirement to be able to generate the tools and info needed to process the ICD-10 information by 2013 Claims Processing, Training etc.
• Involved in all phases of software development life cycle SDLC in RUP framework.
• Mapping of ICD-10 codes to procedure and diagnostic codes in Facets.
• Reviewing all codes and appropriately applying them.
• Conduct meeting with the stakeholders and assess their accurate involvement with ICD-10.
• rovide implementation assessment, strategy, and mentoring services for Rational Rose, UML and RUP.
• Identify processes and systems to enable to trade files with non ICD-10 complaint trading partner.
• Designed and analyzed Business Process Model, Use Case model and test procedures based on RUP methodology.
• Planned and defined Use Cases created Use Case diagrams, Scenarios and Use Case Narratives using the UML methodologies.
• Established questionnaires and resource leveling required for implementing HIPAA 5010 and upgrading ICD-9 diagnosis codes to ICD-10 codes
• Designed and developed project templates based on RUP Methodology
• Consulted with healthcare insurance company to develop conversion specifications for other insurance Coordination of Benefits including Medicare .
• Involved in the development of test plans and created test cases and test scripts needed to validate the requirement.
• Involved in requirement gathering and database design and implementation of star-schema, dimensional data warehouse using Erwin. Generated XML documents using the XML Output Stage.
• Help the developers to understand the requirements in order to design the software modifications needed to support the requirements.
• Review Implementation Plan and testing types, techniques and environmental needs.
• Defect Management triage, provide expertise to resolve defects that raise business issues.
• Actively involved in documentation of UAT User Acceptance Test , Functional Test, Integration Test Scenarios and Bug Log.
• Coordinated data profiling/data mapping with business subject matter experts, data stewards, data architects, ETL developers, and data modelers.
• Actively participated in weekly status meeting with Team members, Team managers, Business analysts Technical team and also generated Weekly Status Reports to the Team manager.
• Tracking Software defects collected from different sources and categorized severity in HP Quality center.

Confidential

System / Business 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:

• Formulated and defined systems scope and objectives through research and fact-finding combined with an understanding of applicable business systems and industry requirements following RUP.
• Documented the business logic and associated validation logic.
• Actively involved in validating the requirements and applying the RUP framework throughout the SDLC.
• 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.
• Worked with XML feeds from multiple sources systems and loaded the same into Enterprise data warehouse.
• 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.
• Write and execute positive and negative test cases to ensure the data originating from the data warehouse Oracle dB is accurate through to the SQL dB in the applications.
• Senior level SQL query skills Oracle and TSQL in analyzing and validating SSIS ETL database data ware house processes.
• 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.
• 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
• Created job schedules to automate the ETL process
• Used Rational Rose to model the process using UML to create behavioral and structural diagrams.
• 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.
• Implemented the entire Rational Unified Process RUP methodology of application development with its various workflows, artifacts and activities.
• Reviewed the Defects entered by the QA team and prioritized the defects and assigned them to the development team
• Used IBM WebSphere Business Modeler to fully visualize, comprehend, and document the business processes. To model and optimize the business-critical processes. Define and refine process models through the company's best practices.
• 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

System Analyst

• Kaiser Permanente is a leading consumer health services and health insurance provider in North America. They are committed to assisting physicians and hospitals to their members to improve the extraordinary quality of healthcare.
• 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.
• Used SDLC System Development Life Cycle methodologies like the RUP and the waterfall.
• Responsible for architecting integrated HIPAA, Medicare solutions, Facets.
• Performed GAP analysis for ICD - 10 and EDI 5010 X12 Message Structure with the 4010 Structure.
• Produced Gap Analysis documents for HIPAA 5010 and ICD-10.
• Established questionnaires and resource leveling required for implementing HIPAA 5010 and upgrading ICD-9 diagnosis codes to ICD-10 codes
• 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
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, OOAD using UML and Business Process Modeling. Extensively involved in the modeling and development of Reporting Data Warehousing System.
• Responsible for creating mapping documents required for the ETL team.
• 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
• Identify Member, Provider, Coverage, Medicare, and Medicaid.
• 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.
• Worked with Medicare/ Medicaid, denials, billing, claims, codes, mapping, and processing.
• 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.

Confidential

Business Analyst

Developed a Policy and Procedure Manual for all departments including the implementation of Accreditation Process as defined by the Accreditation Commission for Healthcare. This Policy and Procedural manual was instrumental in Royal Medical Supply receiving full Accreditation from the ACHC. ACHC accreditation was a prerequisite for Royal Medical Supply to receive a Medicare provider number and other major Insurance and Payer contracts.

Responsibilities:

• Understanding the current business process, defining scope of the project along with vision statement.
• Met with users and stakeholders to understand the problem domain, gathered customer requirements through surveys, interviews group and one-on-one along with JAD sessions.
• Defined, developed specs for federal reporting specific to Medicare Advantage
• Applied Unified Modeling Language UML methodologies to design Use Case Diagrams, Activity Diagrams and Sequence Diagrams in Rational Rose.
• Established RUP Rational Unified Process methodology and provided assistance in developing Use cases and project plans.
• Created use-case scenarios and storyboards in MS Word and MS PowerPoint for better visualization of the application and managed them using Rational Requisite Pro.
• Designed the UI of the application, prototyping and wire framing in MS Visio for better illustration of the application.
• Requirements Elicitation, Analysis, Communication, and Validation according to Six Sigma Standards.
• Designed and developed Use Cases using UML and Business Process Modelling.
• Resolved issues and improve the process to ensure a stable and accurate solution.
• Used MS Visio for Process modeling and Business Process flow diagrams.
• Used UML notations for Object Oriented Design and Documentation.
• Organized Joint Application Development JAD sessions with data steward and ETL teams while having walkthroughs for mapping documents.
• Performed cost-benefit analysis, generated reports for analyzing various investments and their profitability and also for analyzing various lost opportunities due to time delay in investing.
• Validated business rules and all artifacts with users, approval and sign off.
• Analyzed data, logical data modeling, created class diagrams and ER diagrams in Rose for designing databases.
• Extracted data from various sources like Oracle, XML, Excel and COBOL Flat Files.
• Worked with the team on security features: web, encryption, authentication and SSO possibilities
• Updated and modified progress and resources allocation in MS project for the team.
• Created test plans and scripts, facilitated user acceptance testing and tested strategies with developers and testing team.
• Performed manual front-end testing to check all functionalities of different modules.
• Upgraded HMO Medicare EDI and reporting.
• Ensured that the application met user and management expectations.
• Suggested measures and recommendations to improve the application performance.
• Designed and created Excel sheets to provide market analysis charts.