Profile Summary:

• Business Systems Analyst with over 8 years of IT Experience with proven skill in Business Process Modeling, Requirement elicitation, System testing, development of Web Based and Client/Server applications for major HealthCare, Insurance and Financial clients.
• Experienced working with project management team and stake holders in identifying the scope of the project and providing estimates for project planning purpose.
• Solid experience in documentation of user requirements, as well as organizing interviews, user meetings, workshops, Joint Application Development JAD , Joint Application Analysis JAA sessions.
• Profound understanding of Healthcare, Insurance and Banking domains.
• Experienced in analyzing business and user requirements for clarity, completeness, scope, and technical feasibility and translate business and user requirements into detailed system and software functional requirements.
• Experienced in creating detailed Use-Case Models, Data Flow Diagrams, Sequence Diagrams, Collaboration diagrams and Activity Diagrams.
• Very good working knowledge of HIPAA EDI transactions, EDI X12 4010/5010, ICD, MMIS and Medicare/Medicaid Claims processes.
• Worked closely with Project Managers and process users to identify core business processes and workflows.
• Involved in all Software Development Life Cycle SDLC Requirements, Analysis, Design, Development and Testing phases and have understanding on Lean process and SIX Sigma
• Extensive experience in creating Screen Mock-ups, conducting Gap Analysis , Impact Analysis, and Risk Analysis.
• Documented, Tracked, Managed and communicated the Requirements using Requirement Traceability Matrix RTM which helped in controlling numerous artifacts produced by the project teams.
• Acted as a SME between product team, technical team and end-users to gain common understanding on the requirements
• Experienced working on mobile application.
• Experienced in identifying, defining, exercising the scope of BPA project and drawing use cases.
• Experienced working towards building quality software products in complex fast paced multi-project environments.
• Managing the incidents which are of critical or High priority, and monitoring of tickets and taking necessary actions including user escalations for incidents and user service requests.
• Expertise in the management of User Request Change, and efficiently handled User Conflicts.
• Expertise in Business Process Modeling, Conducted training sessions for internal users, vendors and business owners.
• Experienced in managing and writing Preliminary project proposals for various tasks.
• Managing high and critical incidents to ensure timely completion.
• Experienced in System, Integration, Regression, Functional, User Acceptance, Performance Testing, and Database Testing. Collected evidence and resolved system defects and addressed changes through change management process.
• Experienced in File Transfer Model , Client Model and Peer-to-peer model using the Distributed Computing System.
• Worked on End-To-End E2E Testing that involves coordination of different enterprise wise software applications
• Experienced in performing back-end testing by developing and executing SQL Queries to verify data integrity
• Developed proficiency on Client's internal processes and guidelines, adhered to Client standards, including templates and style guides for artifacts and internal documents.
• Profound experience in creating user guides, deployment procedures, and end-user support documentation power point presentation and training new system users.
• Experience dealing with cross functional teams, presenting test findings and results using MS office tools, online meetings.
• Creation and implementing Organizational change management strategies and plans that maximize employee adoption and usage and minimize resistance.
• Support change management at the organizational level, Enterprise Change Management
• Produced and managed documentation on release activities to support problem resolution and post-release analysis.
• Experienced in Supporting data center infrastructure program with vendors by data gathering and performing analytical efforts for business initiatives.

TECHNICAL EXPERIENCE

PROJECT highlights

Confidential

Position: Sr Business Systems Analyst

Description:

• Confidential provides managed care services targeted to government-sponsored health care programs, focusing on Medicaid and Medicare.
• WellCare made a business decision to participate in the Florida Public Health Insurance Exchange HIX , which is the result of Patient Protection and Affordability Act.
• This project was to review and build/enhance claim processes that are required to participate in the Exchange.
• I worked on the Professional Claims side of the process which included Business process improvements to support Exchange members, Potential claim adjudication and EOB changes, Cost Sharing transparency and Monthly claims reconciliation to account for cost sharing reductions and subsidies

Responsibilities:

• Functioned as the primary liaison between the business line, operations, and the technical areas throughout the project cycle.
• Gathered Business requirements, facilitated meetings and analyzed the business requirements to carefully convert them to Functional specifications.
• Created Business Requirement documents BRD for Business end user review and communicated with the business on a non-technical level.
• Modified the existing Claim Process to make sure that for HIX Member's Co-payment per visit should not be more than allowed amount.
• Updated the Member Accounting module to keep track of co-pays and deductible when member s switch between plans for HIX Members.
• Modified the Claims Process to make sure that for HIX members the 1st three primary care visits per calendar year to which the deductible should not be applied
• After 3 primary care visits in a calendar year for all the following visits in that year, cost sharing should be applied to the claim and member accounting
• Modified the Claim Process System to waive the co-pay for HIX members when they are directly transferred from hospital setting to Skilled Nursing Facility or rehab
• Configured the Claim Process System to keep track of Home Infusion Therapy done by a Nurse as part of Home Health Care Services
• Periodically conducted project review meetings, daily project update meetings, published weekly status updates on both Portal and BI track created WBS and coordinated resource allocation to make sure timely deliverables.
• Created Functional Specification Documents FSD for IT by converting the Business needs into System needs.
• Conducted and Managed JAD sessions with business users of all the levels and development/technical team to drive out detailed business requirements for planning, Requirements gathering and gathered Meeting minutes. MOM .
• Conducted Walkthroughs over the Business requirement documents and clearly defined functional issues.
• Involved in the peer review of Test Plans, Test Cases with the QA team to verify implementation of new features and enhancements. Tested Performance Accuracy related queries under PL/SQL Developer and SQL Server.
• Developed and maintained the issue / defect matrix and provided status reports to management.
• Verified Mobile processing vs. regular UI functionalities.
• Developing customized screens on mobiles with limited necessary options
• Communicated changes to requirements promptly and precisely to all personnel involved and created Project Change Request PCR documents for the changes.
• Engaging Corporate Incident Management when a Major Incident is identified or when client requests escalation.
• Providing support to the teams as required for Critical and High priority.
• Direct the Incident Management process by assigning tickets to the appropriate individual on a service provider team.
• Discuss prioritization with Service Provider Incident Management
• Worked with UAT team to test and validate the Mappings and seeking approvals for the draft.

Environment: SDLC, Windows 2003, JAVA, SAS, COGNOS, Oracle 9i, PL/SQL Developer tool, SQL Server 2008, MS Visio and MS Office Word, Excel, PowerPoint .

Confidential

Role: Business Systems Analyst

Description

• Confidential provides managed care services targeted to government-sponsored health care programs, focusing on Medicaid and Medicare.
• According to the Department of Health and Human Services HHS guidelines for medical data code sets used in reporting diagnoses and inpatient hospital procedures in health care transactions ICD-10 final rule . The standards adopted under this final rule will replace the ICD-9-CM code sets. The compliance date for the ICD-10 final rule is Oct. 1, 2014, ICD-10 final rule implementation will be handled by the ICD-10 I10 program at WellCare
• Involved in Business requirements elicitation and analysis discussions on multiple tracks of proposed health exchanges.
• Involved in discussions in understanding and elaborated the functionality and specifications of the claims system module.
• Involved and contributed to fit - gap requirement analysis and operational readiness for compliance and system functionality
• Conducted requirement understanding and clarifications calls with the development team.
• Modified the existing Claims processing system to accommodate the ICD Field Expansion from 5 to 7 character length
• Modified the Members Benefit coverage to incorporate ICD-10 codes
• Modified the Preauthorization module to accommodate the ICD Field expansion and maintain the existing workflow intact
• For Overlap codes created a workflow to distinguish between ICD-9 ICD-10 codes
• Modified the Claims Adjudication Process to process the claims with pre-existing conditions using ICD-10 codes
• Involved in the Suppression of EOB's and generation of Letters for ICD-10 Non-Compliant Claims
• Updated all the Reference Tables like POS/TOS with ICD-10 codes.
• Scheduled the release plans and the go-live production dates with business owners.
• Involved in assigning the project-testing resources as per testing phases for the Transition tracks.
• Reviewed Test Strategy, Detailed Test Plans, created test data required to complete testing and outlined UAT data needs.
• Involved in developing process flows and mapping for functional and regression testing plans on the legacy systems.
• Analysis done for the application Impacts of ICD 9 to 10 Conversion for the Mid-Range Systems by assessing the versions of code and database in order to evaluate the actual change impacted.
• Served as single point of contact in absence of any business lead or SME on the project.
• Coordinate with the developer and business in conducting walk through of Impact Assessments
• Defined scenarios for functional testing, Designed regression test plans, and created test data required to complete testing.
• Applying a structured methodology and lead change management activities
• Lead daily defect and status update meetings and presented progress updates to the project management team.

Confidential

Role: Business Systems Analyst

Confidential had business plans to develop Healthcare IT solutions contemplated on a start-up Healthcare portal as they had in-house expertise in content management and Artificial Intelligence AI based social networking platforms. Firm was also involved in developing customized IT solutions for State Agencies.

Business Analyst:

• Involved in contributing to diligent bid preparation and submission to State agencies and private firms.
• Organize periodic Customer Touch Points and meetings to get feedback on delivery of services and also generate leads on new business opportunities.
• Conducted SME's, stakeholders, doctors, patients and business user's interviews to gather Business Process Requirements BPR and Software System Requirements SSR .
• Prepared business process models using Visio to create use case diagrams, data flow and business flow diagrams.
• Developing specialized adaptation techniques on mobile to provide optimized representations of Web sites to mobile devices regardless of the browser they use.
• Developed use cases, workflow, screen mock-ups, and conversion requirements while converting business specifications into technical specifications and ensured compliance.
• Organizing JAD/RAD sessions for web site development, defined business case to ensure artifacts compliance with TCC's SDLC Policies and guidelines.
• Prioritized defects and system problems, ensured accuracy through compliance analysis. Assist testing teams with test scripts and UAT.
• Identifying the impact of Oracle Apps Financial development requests on other application functionality for standard and custom applications
• Performed GAP analysis defined business rules, business and system process flows, user administration, and electronic data interface health transaction requirements per HIPAA guidelines and EDI health transactions while business modeling.
• Providing training and guidance to the level 2 and level 1 application support to advanced users regarding new functionality and enhancements on mobile banking designs.
• Compile global, cross-functional business requirements into definable, executable technology solutions that are consistent with Mobile banking long-term architecture strategy
• Designed test plans and defined test cases for functional, non-functional, integration and user acceptance testing.
• Review test cases with UAT teams, and in house testing teams.

Confidential

Role: Business Systems Analyst

Project Role Description

This Confidential is a web-based project for the users of investment banking domain for Bank of America. This web application is basically a Search engine for the vast repository of reports and financial data, and sending to the clients in the mail format with their predications and suggestions. Financial Market's Research Analyst will use this frequently to search for the completed Analyst report and mail it to their clients. This data of reports we get from the Research Library Data store. It is having lot of advanced feature for searching the documents, with their own criteria. Analysts can view the readership statistics of the users who have read the mails, can send the compilations on Behalf of. We are using metadata search to bring the accurate results for the search Keywords and filters. So that users can filter the results as they want it exactly in the user friendly manner. This application is integrated with the Compass application, research Library application to get the data from these applications and uses bulk email application to distribute the repots and get the statistics.

Responsibilities:

• Conducted and Managed JAD sessions with business users of all the levels and development team/technical team to drive out detailed business requirements for planning and Requirements Gathering and gathered Meeting minutes.
• Created Functional Specification Documents FSD and HLDs for IT by converting the Business needs into System needs.
• Scheduled the calls between QA and the development team and kept track of the Defects.
• Involved in the business calls in the Go no Go calls of the releases, supported the production releases and kept tracking calls till the final compilation of the production release and updated the management.
• Collected the requirement from the business and prepared the requirements for the development team, tracked the versions of the requirement modification.
• Conducted the requirement understanding and the requirement clarification calls with the development team using WebEx.
• Periodically conducted project review meetings, daily project update meetings, published weekly status updates on the progress of the tasks. Created the progress graphs and coordinated resource allocation to make sure timely deliverables.
• Provided Site design inputs and facilitated Metrics display views on coordinated with UI and UX design to the development and client teams.
• Gathered Business requirements, facilitated meetings and analyzed the business requirements to carefully convert them to Functional specifications.
• Functioned as the primary SME between the business line, operations, and the technical areas throughout the project cycle.
• Created Business Requirements Documents BRDs , Functional Requirements Document FRDs , Minor Development Documents MDD and developed Use Cases.
• Presented the proof of concept to the business for the approvals.

Confidential

Role: Software Engineer /Business Analyst

Project Description: Confidential is India's largest and most vibrant Finance Company with its presence all over India. Provides people insurance policies, mutual funds, and credit cards. The Insurance Data warehousing project was developed in an effort to streamline the entire process of Insurance and to keep track of various financials on a daily, weekly, monthly basis. Claims, Premium, Loss and Contracts were some of the modules we were basically dealing.

Responsibilities:

• Lead and actively participate in the development of written, detailed business requirements, Interviewed Clients and defined the Functional and non-Functional requirements.
• Identified and Created Business Process Flows using MS Visio.
• Followed Agile methodology and SCRUM meetings to track, optimize and tailor features to customer needs
• Facilitated JAD sessions with the Business Users to capture Business requirements.
• Gathered Customer Business Requirements Proposals and defined pre-sales action plan.
• Worked with the project manager to come up with Project related deliverables using MS Project extensively.
• Audited database files for accuracy of information produced for special research projects by using SQL.
• Developed required SQL scripts for database testing and Performed Backend Testing, by executing the SQL queries. Wrote SQL Queries to extract data from the Tables.
• Executed the Test Scripts on different releases and validated the actual results against the expected results.
• Captured the Existing Screens and Views and Developed new Screen Mock ups.
• Helped technical teams to understand the requirements by giving presentation of artifacts, and by interacting with them on a regular basis.
• Conducted UAT. Created Test Plans, Test cases in Test Case Design Documents for different scenarios of the UAT.

Confidential

Role: Software Engineer /Business Analyst

Project Description: Confidential started in 2001 specializes in IT Support responsible for developing and enhancing applications in Health Care products. Out of its diversification, it is also providing the Quality Services for their Medical Coding Projects.

Responsibilities:

• Assure Quality Coding utilization and management of resources geared towards process excellence.
• Direct liaison with client and stakeholders to guide them through the documentation requirements as per Medical Coding Ethics.
• Facilitated JAD Joint Application Development sessions to identify business rules and requirements and then documented them in a format that can be reviewed and understood by both business people and technical people.
• Led the Quality Review Meetings and analyzing high priority requirement for implementation.
• Analyzed Requirements and created Standard of Procedures, Current business process document, Future business process documentation, Sample Reports Analysis, etc.
• Led QA efforts by conducting training sessions, clinical document improvement, refresher training, test sessions, etc.