PROFILE SUMMARY:

• Around Eight years of experience as a Senior Business Systems Analyst wif the expertise in Software Development Life Cycle (SDLC) and project lifecycle primarily in HealthCare Domain.
• Excellent Business writing skills in writing Business requirements document BRD, Use Case Specifications, Functional Requirement Specifications (FRS), Software Requirements Specification (SRS), Technical Requirement Document (TRD), Workflows and RTM.
• Experienced in data warehousing projects dealing wif ETL mappings (extraction, transformation and load) tools like Teradata, SQL.
• Good noledge on different modules wifin healthcare (Membership, billing, enrollment, Eligibility, claims, capitation, providers, Attribution).
• Experience working on EDI transactions and following norms of HIPAA.
• Experienced wif health information projects such as ICD9, ICD10 and CCD verification.
• Extensive working experience in Agile Methodology.
• Involved in (PBM) Pharmacy Benefit Management for the successful implementation of short and long term projects.
• Demonstrated experiences of Claim lifecycle: First Notice, Assignment, Evaluation, Settlement, Recovery and File Review.
• Expert noledge in generating - Use Case Diagrams, Sequence Diagram, Activity Diagrams, Data Flow Diagrams and Process Models.
• Strong communication skills when working wif developers, project managers, subject-matter experts, stakeholders, system implementers, and application end-users.

TECHNICAL SKILLS

Modeling Tools: Microsoft Visio

Version Control Systems: Clear Quest, Mainframe

Databases: SQL Server, Teradata, Oracle

Methodologies: SDLC, Agile, SCRUM

Change Management Tools: Clear Quest, Document Direct, RUMBA, AS400, Epicenter, MS SharePoint

BI Tools: SAS, Hyperion

Project Management: MS Project 2010, MS Office

PROFESSIONAL EXPERIENCE

Confidential, Bloomfield CT

Sr. Business Systems Analyst/Informatics Specialist

Responsibilities:

• Responsible for the process to encounter data that can be utilized by grouper processes.
• Responsible to perform project delivery functions in support of CIMA Enterprise Reporting Hub.
• Being the Analyst, handling requirement gathering, documentations (TRD, FRD and RTM), data validation, and data production activities to ensure client satisfaction.
• Writing and Running SQL queries using Teradata, TOAD, SAS, Avaya, Cisco and Hyperion to create different reports.
• Responsible for preparing Test Cases, Test Scenarios, and Use Cases based on the business requirements so as to test the functionality of the system.
• Responsible for preparing mapping documents (STTM) for the developers to code reports from the new warehouse.
• Monitoring claim adjudication process from FACETS to keep the track on inbound, outbound batch processing. This involves both medical and pharmacy claims.

Environment: Mainframe, MS Office, MS Project, SAS, Teradata Client 14.00, TOAD, Tableau 8.1, Hyperion, Cisco, Avaya, MS Visio, SQL Server, Teradata Studio, MS SharePoint, CenSys, Actuate (Application)

Confidential, Newark NJ

Sr. Business Analyst/ Business System Analyst

Responsibilities:

• As the Business system analyst, responsible for analyzing the data, requirement gathering from the client’s/consumer perspectives, requirement analysis taking both the considerations and transferring the same in to technical requirements
• Responsible for the documentations such as Business Object Documents, requirement document, BRD, TRD, FRD, RTM.
• Responsible for mapping data to create the Reports using SAS.
• As the part of the technical team, responsible for analyzing the data, data profiling, and data validation by using SQL Queries in SQL Assistance and Teradata.
• Assisting to the data modelers in data modeling process.
• Working as source exchanger for the operational and analytical reporting requirements that informatics and HHI departments might have.
• Responsible for preparing STTM (Source to Target Mapping) document for the data coming from the source till development.
• Assisted SAS analyst in SAS related process and analysis.

Environment: Clear Quest (CQ), Teradata, SAS, Teradata (STUDIOS), SQL assistance, MS Office, MS Outlook 2010, MS SharePoint, MS Visio, and MS Project.

Confidential, Franklin Lakes NJ

Business Analyst Professional

Responsibilities:

• Being wif pharmacy Benefit Management Company for more than 2 years, responsible for leading CDH Business Team.
• As the lead of the CDH Operation, responsible for preparing Monitoring process creating BRDS, FRD as well as preparing test cases for the further vendor testing and vendor outreach wif ESI and Medco Vendors.
• Conducted JAD sessions to define the project and to reduce the time frame required to complete deliverables.
• Involved in training business team in claim adjudication process including, real time activities, such as contacting vendors or clients in case of issue.
• Conducted sessions for the training in comparison to different tools, such as RUMBA Vs. ESD, as well as CICS, CBM, POS Research Tool, PTS.
• Performed data Monitoring and Member data Validation tasks, using SQL and mainframe for the new book of business, Migration and Health Care Reforms clients.

Environment: RUMBA (Mainframe), SQL, E-Service Delivery (ESD), PTS (Project Tracking System), CBM (Client Benefit Management Tool), POS (Point of sales research tool), UAT, MS Visio, MS Project, AS400, MS Office, MS Outlook 2010, MS SharePoint, Epicenter, TSG(CERT CAT), BTT, RADAR, Document Direct.

Confidential, Woonsocket, RI

Lead Business/ Data Analyst/ Claims Processing UAT

Responsibilities:

• Worked as theLead Business Data Analystto improveBusiness Processes through investigation, analysis, review and documentation of all or part of aDataLife Cycle.
• Responsible for analyzing and identifyinggaps between the targetdataand required client attributes using SQL in warehouses.
• CreatedTransformation Rules Document for the Benefits Data Mapping by conducting and facilitating requirement gathering sessions wif the CVS SME’s.
• Done extensiveData AnalysisandValidationof the Source to TargetData MappingUsingMS Excel and SQL.
• Helped in the generation ofProduction Reportswif the purpose of making conclusions from the Data for Business Decision Making Process.
• Conducted daily huddle meetings wif the Onsite and Offshore teams on the project status.

Environment: Rational Requisite Pro, RUP, UML, Rational Rose, MS-Visio, MS-Project, Rational ClearQuest, SQL Server and Windows, MS Share point, UAT.

Confidential, Des Moines, IA

Sr. Business System Analyst

Responsibilities:

• Extensively worked in designing the Testing approach for the ETL process in the Credit Data Provisioning Enterprise Data Warehouse (CDP).
• Performed Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data.
• Interacting wif different departments like claim, FEP, Blue Card, Membership & Enrollment, Medical and customer service regarding the finalization of data elements required to build the new data mart.
• Documenting High Level Requirements as per the business users and stakeholders regarding HIPAA regulations and converted into detailed Business Requirements. Also prepared UAT cases and helped in bug fixing to development team.
• Responsible for creating a new data mart for reporting and analytics and also finalized the new data elements.
• Working on MS CRM Dynamics for handling the customer claim inquiries, Validation and case creation.
• Part of the ICD 10 implementation team and worked in the Expansion and Reference files programs.

Environment: MS Office, MS SharePoint Server 2010, Activity Diagrams, MS Project, EDW, UAT, Test Plan, Use Cases, SQL, UML, Test Cases, GUI, Agile, Data modeling (Visio).

Confidential, Des Moines, IA

Business Analyst

Responsibilities:

• Ensured that X12 transactions can be carried out as per the EDI standards during any of the system changes as well as system upgrades.
• Utilized Agile Methodology to configure and develops process, standards and procedures.
• Responsible to arrange UAT sign off meetings wif the stakeholders.
• Conducted JAD sessions wif business units and stakeholders to define project scope, to identify the business flows and determine whether any current or proposed systems are impacted by the new development efforts.
• Prepared the Business requirement Document (BRD) and functional requirement document (FRD) for the enhancement of the existing services.
• Performed data analysis, created data mappings (For ETL Processing) and data interface documents.
• Work for the Production team to make sure the end results are meeting the client’s requirements.
• Conducted Gap Analysis for HIPAA 4010 837P and 835 transactions and HIPAA 5010 837P and 835 transactions.
• Ran SQL queries to analyze the requirements and for testing the files and reports.

Environment: MS Visio, MS Office, Rational Rose, Requisite Pro, SQL, Oracle, FACETS, UAT.

Confidential, St Louis, MO

System Analyst

Responsibilities:

• Responsible for analyzing requirements, documenting BRD, translating BRD into functional specifications, requirement traceability mappings (RTM) and test plans. Closely coordinated wif both business users and developers for arriving at a mutually acceptable solutions and sign off.
• Involved in preparing the Test Scenarios for Health Care Claim Payment/Advice.
• Conducted JAD sessions to define the project and to reduce the time frame required to complete deliverables. Handled claims adjudication processing as well as enrollment, medical-management, workflow process validation using Mainframe and regulatory process of the pharmacy.
• Helped in development and functioning in workflow analysis, Data validation, Data profiling, process design and production support requirements.
• Involved in HIPAA/EDI Medical Claims Analysis, Design, Implementation and Documentation

Environment: Windows 2000, UAT, MS Project, MS Visio, Axure & SQL Server 2005, Microsoft Visio, Load runner, Test director, Win runner.

Confidential, Philadelphia, PA

Business Analyst

Responsibilities:

• Involved in creating Software Requirement Specifications (SRS), Functional Specification Documents (FSD) by analyzing requirements, reaching out to clients and customers in detail analysis.
• Used Rational Clear Case to maintain different versions of the system documentation wif description about all versions.
• Created business process flow diagrams and charts using MS-Visio.
• Played a key role in the planning (UAT) User Accepted Testing and implementation of system enhancements and conversions.

Environment: Rational Requisite Pro, ClearQuest, RUP, UML, Win runner, Load Runner, Oracle, SQL, MS Office, MS-Project, MS Visio and Windows, UAT.

Confidential

Business Analyst

Responsibilities:

• Gatheird business requirements through user interviews for employer, broker & member portals, analyzed business requirements to create functional specifications and technical specifications.
• Developed test plans and test cases as per business process requirements to match functionality requirements and UML diagrams.
• Developed an integrated repository of current and historical data, encompassing all operational and research areas along wif group specific data mart and central repository.
• Provided extensive metadata for a clear organization of the data.

Environment: Windows 2000, Microsoft Project 2000, Java, HTML, Oracle, MS Visio, Rational Unified Process