PROFILE SUMMARY

• 5+ years’ experience in Healthcare & Insurance domain; in - depth understanding of programming languages &Software Development Life Cycle (SDLC) methodologies likeWaterfall,RUP, Agile, Scrum, RAD
• Deft at conducting &documenting As-Is/To-Be processes and Business Process Re-engineering (BPR) exercises as per UML development, Rapid Application Development (RAD)&System Development Methodology (SDM)
• Gather &analyze requirements, model business process flows, write business requirements document (BRD), use case specifications, systems requirements specification (SRS), and workflows using UML&RUP methodology
• Skilled in creating Narrative Use Cases, Use Case diagrams, Sequence Diagrams and Activity Diagrams
• Worked with credit card analytics, credit card rewards, credit risk, Enterprise resource planning (ERP) and mortgage loan origination process; maintained Requirement Traceability Matrix (RTM) across the deliverables of a project.
• Trade reporting experience in EMIR and ESMA platforms with exposure in regulatory and transaction reporting.
• Deft at creating System Specification (SS), System Design Specification (SDS), &System Implementation(SI)
• Facilitate construction of Business Rules Engine (BRE), use case design &analysis, use case specifications, scenarios, business processes, work flow diagrams, process flows and technical documents, following RUP&Agile
• Experience in creating Use Cases diagrams, collaboration diagrams, Sequence diagrams, Activity diagrams, State Charts, Process Models using Rational Rose, Requisite Pro &MS Visio.
• Experience in implementing HIPAA Gateway EDI X12 Transactions. Experienced in HIPAA transactions EDI 837 (Dental/Institutional/Professional), 835 (Payment Remittance Advice), 270 (Eligibility Request) / 271 (Eligibility Response), 276 (Claims Status Inquiry Request) / 277 (Claims), Status Inquiry Response), 834 (Benefit Enrollment and Maintenance Transaction), 997/999 (Transaction Acknowledgement)
• Extensive experience with Medicare/Medicaid processing as well as the Claims/Billing. Experience in EDI automated first-pass claim adjudication. Expertise in Claims, Subscriber/Member, Plan/Product, Claims, Provider, Commissions and Billing Modules of Facets.
• Experienced in managing various aspects of the software development lifecycle (SDLC) including requirements gathering, design, development, testing, deployment and support.
• Expert in developing and managing MS AccessandSQL Server data base for data entry, storage and generation of reports to facilitate management decision making processes.
• Conducted JAD sessions for project definition involving analyzing requirements, creating prototypes, user interface.
• Extensive exposure to Rational Unified Process (RUP), Agile Scrum and Waterfall methodologies with UML diagrams like sequence diagrams, collaboration diagrams, state diagrams and activity diagrams.
• Proficient in User Acceptance Testing (UAT), as well as Functionality, Unit, System, Integration &Regression testing
• Worked in MRP/ supply chain & logistics solutions and experienced in implementing COTS based solutions.

TECHNICAL SKILLS

SDLC Methodologies: Waterfall, RUP, Agile, Scrum, RAD

Testing Tools: Quality Centre, QTP, QA Wizard Pro, Test Tracker,Test Director

Microsoft Tools: SQL Developer, MS Visio, MS SharePoint, MS Project, MS Access, Word, PowerPoint, Excel

Databases: Oracle 8i/9i, MS Access, DB2

Business Skills: Business Definition Requirements, Business Process Analysis, Gap Analysis, Use Case Modeling & Analysis, Data Analysis, credit risk analysis

Operating Systems: Windows XP/95/98/NT/2000, UNIX

WORK EXPERIENCE

Business Analyst

Confidential - Portage, MI

Responsibilities:

• Gathered and documented business requirements for existing and future business systems.
• Acted as a liaison between business staff and technical staff to articulate needs, issues and concerns.
• Performed extensive data modelling to differentiate between the OLTP and Data Warehouse data models
• Reverse Engineered the existing ODS in to Erwin.
• Responsible in writing & Execution of Test Plan and Test Cases for different applications like MBSG, PCC, Syndication Server. Etc.
• Defined Functional Test Cases, documented, Executed test script in Facets system.
• Generated test cases in Claims Analyzer Editor Professional to ensure unification with CPT-4 and ICD-9 codes
• Analyzed trading partner specifications and created EDI mapping guidelines.
• Generated test cases in Claims Analyzer Editor Professional to ensure unification with CPT-4 and ICD-9 codes. Worked on Implemented and Migration of HIPAA 4010/ICD 9/10, version for all EDI transactions.
• Designed and developed use cases, activity diagrams, and sequence diagrams using UML.
• Used the DataStage Designer to develop processes for extracting, cleansing, transforms, integrating and loading data into data warehouse database.
• Reverse-engineer several databases, such as research, business, and clinical in order to extract metadata to leverage it for ETL design and reporting.
• Converted various SQL statements into stored procedures thereby reducing the Number of database accesses.
• Used Query Analyzer, Execution Plan to optimize SQL Queries
• Created interface requirements documents which became the baseline and standard for all data exchanges
• Ensured that project requirements are properly tracked and documented.
• Expertise in broad range of technologies, including business process tools such as Microsoft Project, Primavera, Promodel, MS Excel, MS Access, MS Visio, technical assessment tools, MicroStrategy Data Warehouse Data Modeling and Design.
• Worked in mainframe environment and used SQL to query various reporting databases
• Develop and maintain sales reporting using in MS Excel queries, SQL in Teradata, and MS Access. Produce performance reports and implement changes for improved reporting. Interface with internal customers. Provide ad-hoc reporting and analysis from data sources including PeopleSoft (SET) and Teradata
• Used Test Director, PL/SQL for testing the application
• Wrote PL/SQL statement and stored procedures in Oracle for extracting as well as writing data.
• Used different ad-hoc analysis, the Reports assist in defining strategy for each customer category. Informatica was used for ETL process and Business Objects 6.5.1 & XI R2 are used for Reporting duties.
• Tracked UAT issues/bugs and prepared reports.
• Capture and Formulation of Business Rules and delivery of Business Rules Templates.
• Creation of UML Diagrams including Context, Business Rules Flow, and Class Diagrams
• Created Business process workflow diagrams using IBM business process modeler
• Implemented RUP recommended visual models to draft business requirements by using Use Case

Environment: Windows XP Professional, Oracle9i, MS Access 2000, MS Excel, RUP, SQL, UML, Agile, Rational Rose, Requisite Pro, Clear Case 2002, Rational Clear Quest 2002, Mainframe, MS Office suite, MS Visio 2003.

Business Analyst

Confidential - Revere, MA

Responsibilities:

• Gathered all the requirements from the stakeholders in form of User stories based on project scope
• Ensured all transactions followed HIPAA’s latest 5010 standards; diagnostic codes converted to ICD 10 versions
• Prepared Business Requirement Documents (BRD) as well as high-level project plans and used Rational RequisitePro to manage, analyze, and convert business requirements into functional specifications.
• Identify the business flows and determined whether the EDI X 12 Transaction, Code set and Identifier aspects of HIPAA affect any current or proposed systems.
• Use Electronic Data Interchange (EDI) codes for verifying patient eligibility and receiving the insurance benefits, patient information, health care claim request, and healthcare claim through the new EHR System.
• Prepared Business Process Models of all activities from planning to procedural level; also created Mock ups
• Created project templates, use-case templates, requirement types & trace-ability relations in Requisite Pro.
• Involved in documenting business process by identifying and finding the system requirements.
• Creates business requirements and provides analysis to increase operational efficiency for deliverable's thru out the project lifecycle (Agile, Waterfall) E2E.
• Followed a structured approach to organize requirements into logical groupings of essential Business Processes, Business Rules, and Information Needs, thus ensuring that Critical Requirements are not missed.
• UsedRational Rose &UML to produce Use Case models, required class diagrams, sequence diagrams, & OOD
• Used Rational Clear Case to keep different versions of documents and Rational Clear Quest to report bugs/defect
• Involved with the project from its inception phase to transition and production rollout phase.
• Have provided projects with pre-project planning expertise; high-level and detailed project definition, as well as acted as the primary liaison between IT and Business Partner(s) on a daily and project basis.
• Coached teams in Agile concepts, principles, practices and behaviors.
• Have followed project management principles to develop project plans in order to deliver the project product.
• Worked closely with the Business Partners and IT teams to mentor and share their specialized knowledge base
• Arranged JAD sessions with business users and development team to drive out detailed business requirements.
• Developed and maintained a requirements work plan and assessed the performance metrics of the team members.
• Responsible for claim processing in MMIS.
• Served as a liaison between the internal and external business community (Claims, Billing, Membership, Capitation, Customer service, membership management, provider management, advanced Healthcare management, provider agreement management) and the project team.
• Facilitated JAD sessions for Requirement Validation and requirement gathering for the new MMIS.
• Analyze EDI -X12 data elements captured by the existing system to validate it against the data elements required for new system.
• Involved in business operations and helped organization to achieve cost-effective production with increased quality, efficiency and satisfied customer service.
• Prepared the Test plans and Test cases to successful perform the system integration testing, functional testing.
• Designing Functional Specifications for the target physical database.
• Developed UAT test cases associated with the functional requirements.
• Maintained a bi-weekly status report for the requirements team and incorporated the same to the PMO status reports send to CMS.

Environment: Windows XP Professional, Oracle9i, MS Access 2000, MS Excel, RUP, SQL, UML, Agile, Rational Rose, Requisite Pro, Clear Case 2002, Rational Clear Quest 2002, Mainframe, MS Office suite, MS Visio 2003.

Business Analyst

Confidential - Hartford, CT

Responsibilities:

• Reviewed MMIS documents to understand the customer requirement
• Worked on payer plan sponsor and the EDI transactions like 837
• Provide ad-hoc and structured reporting document to partners and stakeholders.
• Was involved in maintaining dashboards, reports, visualisations, and alerts that concerned business decisions.
• Create and maintain data sources
• Mine information from data, prepare reports and visualizations, and present findings to management.
• Identify, design, create, code, test and maintain queries, ETL jobs, reports, and visualizations required by any or all operating entities to support business analysis objectives.
• Created actor tables denoting the different actors in the project and the attributes they possessed. From there utilised the information to create roles, business rules and various process.
• Utilized Agile Methodology to configure and develop process, standards and procedures.
• Designed and reviewed various documents including the Software Requirement Specifications (SRS), Business requirements document (BRD), Use Case Specifications, Functional Specifications (FSD), Systems Design Specification (SDS), Requirement Traceability Matrix (RTM) and testing documents.
• Created documents like Root-Cause, Cost-Benefit, SWOT and ROI with excellent track record as a JAD facilitator and knowledge of all the best practices for requirements gathering.
• Prepared data analysis, writing data mapping documents, data transformation rules and maintained data dictionary for business intelligence and data warehouse applications.
• Used industry standards like ISO, Six Sigma and HIPAA within the project
• Single point of contact between business users, development teams and QA teams for sign-offs and finalization of requirements.
• Identified gaps between 4010 and 5010 specifications.
• Tested and implemented HIPAA 4010 and 5010 and ICD 10, version for all EDI transactions.
• Acted as an SME on different subject areas including state reporting, death benefits, Medicare, Bill review and RX eligibility.
• Created Test Strategy Planning (TSP) and assisted testing team to implement test plans during UAT kickoff.
• Involved in creating sample mappings for the conversion of EDI x12 transactions code sets.
• Assisted clients in resolving billing issues for Medicare, Medicaid, and private insurance.
• Created lists of ICD 10 CM/PCS codes with reference to the usage percentile and provided to Stakeholders to determine if codes were best fit or all possibilities.
• Tested claims to ensure that the system would recognize and accept the ICD-10 changes.
• Used complex SQL queries to analyze the data pattern to accommodate the various business scenarios.
• Designed and document Business Requirements by using HIPAA EDI guides and reviewed as well as interviewing business process owners and companion guides

Environment:MS Projects, MS Visio, MS Word,EDI, Claims, Hadoop, MS Excel, MS PowerPoint, Agile, MS Outlook, UML, Windows 2000, SQL, Rational Rose.

Business Analyst

Confidential, Detroit, MI

Responsibilities:

• Interacted with stakeholders & end users to define purpose &scope of application and gather User Requirements.
• Created requirement specification documents after end users interview, JAD sessions &analyzingcurrent systems
• Involved in Medicare, Medicaid & International Classification Disease (ICD); also ICD-9 to ICD-10 conversion
• Part of the team for migration of HIPAA - EDI X12 4010 series to 5010 series for EDI Transaction code sets:835 - Claim Payment/Advice, 837 - Claim &Encounters and 834 - Benefit Enrollment &Maintenance
• Worked as a Business Analyst developing and supporting transactional and relational web-based interface using the Agile/Scrum software development Methodology.
• Developed Use cases & Activity process flow diagrams using MS Visio for Facets membership enrollment
• Developed gap analysis and risk assessments for the FACETS upgrade project including effects on internally developed extensions and third party software for pricing and contract configuration.
• Analyzed the functionality and came up with test scenarios for split-billing process on FACETS.
• Analyzed “As is” &“To be” system documents to show current &proposed system functionalities using MS VISIO.
• General patient chart maintenance, assisted in implementation of EMR system, maintaining current procedures and helping introduce others to increase patient co-pay collection rate and patient attendance rate.
• Involved in HL7 standard messages, designed to provide framework in which data is exchanged between systems.
• Monitored Defect Tracking using Rational Clear Quest to ensure testing effort progress with development team
• Developed business models, process flow maps, work flow diagrams &use cases using MS Visio & Oracle BPM
• Involved in GUI Design sessions with the Usability Team and testing Browser compatibility and navigation.
• Analyzed As-Is process &designed to-be process as part of business process re-engineering module, using TQM as a tool to handle various problems encountered during the effort to improve the process continuously.
• Managed change request and analyzed its impact on application w.r.t. Project Plan, Scope &Schedule.
• Interacted with users using Mainframe system for better understanding of business flow and implementation.

Environment:SQL, Jira, Rational Clear Quest, Polarion, Cradle, Windows XP/2000, facets, MS Project, MS Visio, MS Outlook and MS Office, Rational Requisite Pro, MS Office, UML.

Business Analyst

Confidential

Responsibilities:

• Business Analyst/ Data Analyst for a major equipment maintenance project.
• Provided business consulting, data analysis &MS Access expertise with mobile application implementation effort.
• Defined &designed process and data capturing strategy ensuring device compatibility with existing applications
• Designed the relational database and application for managing the data to track efforts of the team.
• Handled preventative maintenance and calibration of equipment's on mobile device helped to analyze and improve the business processing & productivity of the underwriting effort.
• Workedin multiple project phases, interfaced & supported users, associates, and other technical project members.
• Provided user friendly solution, including analyzing process using SMP to mobilize and load data into device
• Used RAD to analyze issues and correct data exceptions; handled Logistics, supply chain, & fulfillment
• Involved in data preparation/loading, application installation and training for employees, data analysis and issue correction, application testing, and client interaction for all the process.
• Acted as a liaison between business users and the development team.
• Interacted with customers &internal support groups to analyze & respond to service issues/requests, preparing requirements specification documents with identified test cases, &testing to meet requirements
• Documented user and data requirements in formal design specifications for the development team.

Environment:UML, MS Visio, MS Office Suite, Win Runner, SQL, HTML.