SUMMARY

• Over 7 years of experience as highly skilled Systems Analyst on large time boxed projects with strong domain knowledge in Healthcare and Pharmaceutical industries.
• Extensive experience in Software Development Cycle (SDLC), application design, development, system testing and quality control methodologies such as Waterfall, Agile & RUP.
• Having expertise in ICD - 9CM to ICD-10 CM/PCS Conversion, legacy 4010 claim processing systems, EDI Transactions (4010 and 5010), Financial neutrality (Organization wide) and prior authorization submission processes.
• Working expertise in Project Development Life cycle (PDLC), Business Process Modeling (BPM), Software Development Methodologies including Rational Unified Process (RUP), Waterfall, and Agile.
• Actively used Unit Sessions, Joint Application Development (JAD) and Rapid Application Development (RAD) sessions with Business users, SME’s and Stake holders alike in gathering requirements, collating and analyzing them to identify the real business need and facilitating the development of a customized solution which delivers maximum cost and usability benefit to the client and company.
• Extensive knowledge and working experience in converting business requirements into UML diagrams (Use Case Diagram, Class Diagram, Sequence Diagram, Collaboration Diagram, Streamline process flow diagrams) using Rational Rose and MS Visio and also managing and tracking those requirements.
• Extensive experience in producing documents like Business Requirements Documents (BRD), Functional Requirement Specifications (FRS), Software Requirement Specifications (SRS), Request for Proposals (RFP), Requirements Traceability Matrix (RTM).
• Experience in developing and imparting pre and post implementation training, conducting GAP Analysis, User Acceptance Testing (UAT), SWOT Analysis, Cost Benefit Analysis and ROI analysis.
• Knowledge in Business Intelligence, Business Architecture and Data Warehousing including Data Analysis and Data Mapping.
• Extensive experience on Excel, Word, PowerPoint, MS Project, MS Visio, Rational Suite and SQL.

TECHNICAL SKILLS

Domain/Industry: Healthcare, Pharmaceutical

Operating System: Windows XP,2007,WindowsNT/ 2000/2005/2008

Application Software: MS Project, MS Office Suite

Methodologies: RUP, UML, Waterfall, Agile

Requirements Management Tools: Rational Rose, Requisite Pro

Reporting Tools: Rational SODA, Crystal Reporting

Databases: Oracle, MS Access, SQL Server 2005/2008,DB2

Process Modeling: MS Visio, Rational Rose

Testing Tools: Test Director, QTP, Clear Quest

Programming Language: JavaScript, SQL, C++

PROFESSIONAL EXPERIENCE

Coventry Health Care, Minneapolis, MN

Systems Analyst

Responsibilities:

• Served as aliaisonbetween business community and IT organization in order to provide functional/ technical solutions to meet user needs.
• Proficient in discussing and defining project, Gap Analysis with the clients from both a business and technical perspective.
• Understanding and assessment of the existing current EDI Transactions, Pharmacy Transactions from an NCPDP 5.1 perspective and current ICD 9 codes used by the State
• Responsible for addressing, diagnosing and resolving issues that arise on a day to day basis for the team. Also responsible for documenting the causes, analysis and final resolution to the issues/errors.
• Identified areas of risk exposure and loss techniques adopted.
• Wrote functional requirements and non-functional requirements based upon the approved business requirements by following UML processes and standard procedures for developing use cases, use case diagrams and other supporting documentation.
• 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
• Worked on MS Visio to develop use cases, class diagrams and sequence diagrams.
• Worked on Requirement Change Management System in Requisite-Pro.
• Setting up document hierarchy and standards to define different levels of requirements using Requisite-Pro.
• Engaged in analyzing requirements, identifying various individual logical components, expressing the system design through UML diagrams.
• 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, the Drug Utilization Review System, Operational Analysis Document for Medicaid Subrogation and the Drug Rebate Analysis and Management System
• Manage Scope and change throughout the life cycle of the product.
• Created the Edit Checks error codes excel sheet for the entire team.
• Developed detailed auditing and reporting of the current status and history of all components related to a product.
• Translated customer/client needs into new features and new services.
• Develop process improvement projects by gathering and analyzing data.
• Actively involved in assisting QA team to writeTest Cases and Test Scripts and documented and resolve the defects in HP Quality Center.
• Divided the project into different key modules and implemented different test suites on them using Quality Centre.
• Led the team duringUnit Testing, System Testing, Volume testing, Integration TestingandUser Acceptancetesting

Environment: Rational Rose, Requisite-Pro, SQL Server, MS Project, MS Visio, MS Word, MS Excel, Quality Centre, ASP.Net, VB Script.

Confidential, Denver, CO

Systems Analyst

Responsibilities:

• Developed the High Level Project Requirements (HLR) for a very large project.
• Modified and used Project Templates to gather the requirements and carry on the project.
• Facilitated the requirement gathering work sessions with stakeholders, SME’s and Business owners to understand and incorporate the potential requirements in the BRD.
• Coordinated the project team for JAD and BRD Sessions.
• Contributed in implementation of 4010 to 5010 transition in accordance with HIPAA standards.
• Created 837(P, I, D) claims, and maintained data mapping documents in reference to HIPAA transactions primarily 837(P, I, D), 835, 270/271, 276/277 and 278.
• Worked on 837 and 835 projects, including syntax and business rules for X12 HIPAA 4010 and 5010 validation for loops, segments, elements, qualifiers and code sets.
• Performed System testing, Regression testing and UAT for several claim types and test scenarios.
• Compared and validated 5010 system test results with 4010 results for the same test scenarios.
• Executed Step-down testing from 5010 to 4010 to validate the EDIFECS results.
• Created X12’s for 4010 and 5010 standards to meet test scenarios.
• Followed a structured approach to organize requirements into logical groupings of essential business processes, business rules, information needs and insured that critical requirements are not missed.
• Frequently resolved the issues with EDIFECS and ACTT Now, primarily the generation of 997, 999, 824, 277CA reports.
• Coordinated activities between business unit and technical staff, developed new methods, policies, and procedures to meet the business needs.
• Analyzed and translated business requirements into system specifications utilizing UML and RUP methodology.
• Prepared Functional Design Specifications (FRS) employing Use case scenarios, sequence diagrams, DFDs and class diagrams.
• Identified and clearly defined functional issues and supported IT development staff throughout the design, development, unit testing, and implementation phases of the software development life cycle.
• Documented the Requirement Traceability Matrix for tracing the Test Cases and requirements.
• Documented and assisted the QA Team with the Test Plan.
• Developed Data Conversion Strategy using ETL functions for converting data from the existing site to the new site.
• Assisted Project Manager to complete the project approval process.

Environment: MMIS portal, EDIFECS, Facets, HIPAA, Oracle, SQL, QTP, Caliber, MS Office, MS-Visio

Confidential, Houston, TX

Systems Analyst

Responsibilities:

• Gathered business and system requirements from various departments like accounting, Fund Management, Legal and Human Resource through focus groups, surveys, interviews, and JAD sessions.
• Analyzed data to generate information about clients and their attributes, and drafted a data requirement document.
• Held meetings with users and stakeholders to identify problems, resolve issues and improve the process to ensure a stable and accurate solution.
• Prepared Business Workflow models and process diagrams depicting how business processes are accomplished.
• Created Activity Diagrams, Data Flow Diagrams, Use Cases, Business Process flowcharts for the To-Be process.
• Created detailed workflow diagrams, business flowcharts of existing and proposed systems.
• Actively involved in creating/updating Work Breakdown Structure (WBS), preparing deliverable tasks in the project plan.
• Created Use Cases to identify automated processes and the actors (vendors, systems) involved in the project to ensure reliable results of implemented business/functional needs.
• Involved in feasibility analysis and risk analysis of the project.
• Gathered and documented business requirements in order to describe the business needs in terms of the main deliverables.
• Facilitated meetings with Subject Matter Experts (SMEs) to create the process requirements, process improvements and to proper explain the development team the flow of future data modules.
• Functioned effortlessly and efficiently, as a liaison between four work streams and its task leads, SMEs, development team, and management group. Actively participated in Joint Meetings with the various teams involved in the development process.
• Helped in designing and implementing deployment process, and thus maintaining the application in post deployment process.
• Reached out to vendors for clarification of data.

Environment: Rational Enterprise Suite (Rose, Requisite Pro, Clear Case), IBM Web Sphere, XML, Mercury, MS Office, Oracle, SQL Server Reports

Confidential, Bloomington, IL

Systems Analyst

Responsibilities:

• Performed Requirement Analysis by gathering both functional and non-functional requirements based on interactions with the process owners & stake holders and document analysis, represented them in Requirements Traceability Matrix (RTM).
• Coordinated the project team for JAD and BRD Sessions.
• Worked with SME’s in Finance, Investment, Commercial and Personal banking to collect the Business process requirements, documented them in Business Requirement Document (BRD) and performed Business Process Re-engineering.
• Worked on data modeling and produced data mapping and data definition documentation.
• Performed System testing of the Claims processing systems (Pricing Rules, Duplicate/Limits validation, Member Eligibility, Provider Enrollment, et al).
• Executed Extract, Transform, and Load (ETL) process from the data warehouse.
• Performed testing for Medicare, Medicaid and X-Over claims for Medicaid Management Information System (MMIS)
• Wrote BRD, FRD, use cases, test scenarios, test cases for testing the functional and non-functional aspects of both ETL jobs and Reporting jobs.
• Database table review and data mapping for large scale data conversion project Oracle database to Mainframe.
• Use Cases and other Process Flow Models were designed using Visio and Rational Rose.
• Worked on NASCO system on Claims, Membership and Benefits
• Involved in creation and reviewing of Functional Specifications and created a Functional Requirement Document
• Created and maintained Narrative Use Cases (Business Use Cases, System Use Cases) and modeled Use Case Diagrams, Activity Diagrams, Data Flow Diagrams using MS Visio.
• Created product documentation, including online help, Printed User Manual, and training materials.
• Conduct QA testing of ETL data transformation and data warehouse for reporting solutions

Environment: Waterfall, Agile, FINEOS, Web Application, Incoming Documents, Integration, HIPAA, Java, SQL, QTP, MS Office, MS-Visio

Confidential, Richmond, VA

Systems Analyst

Responsibilities:

• Conducted System Analysis & Design along with the Business Continuity and Crises Management.
• Authored blueprint of all Functional Requirement Specifications (FRS) and Business Level Specifications (BLS) including job profiles using UML with department collaboration and sequencing diagrams.
• Conducted JAD sessions with multi location team and authored Use Cases and Use Case diagrams.
• Captured business requirements using Rational Rose methodology.
• Prepared Data Flow Diagrams (DFDs) and Sequence diagrams.
• Created X12’s for 4010 and 5010 standards to meet test scenarios.
• Followed a structured approach to organize requirements into logical groupings of essential business processes, business rules, information needs and insured that critical requirements are not missed.
• Frequently resolved the issues with EDIFECS and ACTT Now, primarily the generation of 997, 999, 824, 277CA reports.
• Utilized UML notations to document activity, deployment and workflow diagrams in Visio.
• Conducted User Acceptance Testing (UAT).
• Created an initial use case for the Log books signing-off process under Healthcare rules and Healthcare compliance.
• All procedures occurred under the compliance of Good Manufacturing Processes (GMP).
• Conducted full Life Cycle which included Business requirements/Workflow analysis, Change Management, Liaison between Technical/Functional, QA, Testing, Security Analysis, and Blueprint Delivery.
• Suggested recommendations for integrated systems and Business Process optimization, by eliminating redundancies and reducing cycle time.

Environment: Rational Rose, Test Director, RUP, UML, MS Office, MS-Project, MS Visio, RQM, UNIX, Crystal Reports.

Confidential

Systems Analyst

Responsibilities:

• Conducted SME’s meetings for requirements gathering and created functional specifications.
• Performed the requirement analysis and documented the requirements in the Business Requirement Document (BRD).
• Gathered the new process requested by the stakeholders and listed a summary of all new reports that needed to be produced.
• Co-authored business requirement documents. Extracted, discussed, and refined business requirements from business users and team members. Also, co-authored functional requirement documents by interacting with the development team.
• Successfully used RUP Analysis Model for gathering requirements by facilitating Use Case Workshops.
• Created Change Requests records in Rational Clear Case for making changes in the Business Document.
• Conducted GAP Analysis in understanding how the upgraded system carries out the business functions and assists in ensuring the timely and effective implementation.
• Achieved results by addressing multiple project requirements concurrently with a focus on client workshops to gather critical information and establish strategic vision.
• Created an initial use case for the Log books signing-off process under Healthcare rules and Healthcare compliance.
• All procedures occurred under the compliance of Good Manufacturing Processes (GMP).
• Conducted full Life Cycle which included Business requirements/Workflow analysis, Change Management, Liaison between Technical/Functional, QA, Testing, Security Analysis, and Blueprint Delivery.

Environment: Rational Rose, Test Director, RUP, UML, MS Office, MS-Project, MS Visio, RQM, UNIX, Crystal Reports.