Profile Summary

• Extensive experience of working with Government, Payer Provider domain in healthcare industry.
• 9 years of progressive industry experience with cross technology teams.
• 7 years of Client facing Business analysis consulting experience in healthcare domain.
• Hands on technical experience on various platforms, tools diverse technologies.
• SME of Patient Protection and Affordable Care PPACA .For SHOP Individual Market.
• Versatile experience of Medicare A, Medicare B, Medicare D Medicaid projects.
• Strong exposure towards Mainframe, CRM, Web, Mobile technology data mart house based projects.
• Strong exposure of claims, benefits, eligibility, Medicare, annual enrollment, recovery, member facing healthcare applications and payer domain.
• Experience in soliciting client requirements through interviews, requirements workshops, document analysis, survey, site visits, business process descriptions, use case scenarios, business analysis, and workflow analysis.
• Ability to interact with individuals at all levels with exceptional skills in forming and facilitating Joint Application Development JAD and Rapid Application Development RAD teams.
• Analytical, methodical, and resourceful approach to problem solving, identifying root causes RCA and corrective actions to meet short and long-term business, financial, and system requirements, good understanding of team management, communication, and presentation skills.
• Proficient in creating UML Diagrams including Use Cases Diagrams, Activity Diagrams, Sequence Diagrams and SWOT analysis.
• Excellent verbal and written communication skills and the ability to interact professionally with a diverse group, executives, managers, and subject matter experts.
• Preparation of AS IS and TO BE Business and System Process Maps.
• User Interaction design Experience.
• ALM and LOMA trained.
• Experience with Medicare, Medicaid Commercial insurances in HIPA ANSI X12 4010, 5010 834, 837, 820, TA1, 999, 8001.
• ICD 9, ICD 10 Experience.
• Business Intelligence Analytics Research with various OLAP tools.

TECHNICAL SKILLS

PROFESSIONAL EXPERIENCE

Business Intelligence Analytics

Confidential

Responsibilities:

• Subject matter expert for Individual Market SHOP analytics and reporting using Cognos BI.
• Handling a team of five Cognos developers and testers to implement reporting requirements for Maryland government Directors and Program managers.
• Handling requirement testing for Enrollment, Brokers, Customer Service Financial Management.
• Analysis of various X12 transactions inbound outbound from exchanges 8001,834, 820, 999, TA1.
• Plan management and reporting for Broker, Eligibility, Claims, and SHOP Financial Metrics.
• Data Analysis and Data issues reporting to core systems like Curam etc using SQL Developer.
• Analysis of OLAP systems and ETL Mappings.
• Handling POC for Data Mart and Reporting Performance Evaluation in various environments.
• Report Demonstration, Review, UAT approvals from DHMH, MHBE other government departments.
• Handling of various IRS, CMS, Appeal Ad-hoc reports for other government agencies

Confidential

Requirement Manager

Responsibilities:

• Subject matter expert for Individual Market SHOP for CareFirst BCBS.
• Leading a team of five business analysts and two testers to implement requirements HIX project streams.
• Handling requirement testing for Enrollment, Financial management, Customer Service reconciliation.
• Interacting with CMS, State Agencies brokers for requirement gathering, system implementation and testing.
• Analysis of various X12 transactions inbound outbound from exchanges 834, 820, 999, TA1.
• EDI Review of incoming outgoing data in various test environments and issue reporting to CMS.
• Analysis of various Exchange related XML, US10, Audit Reporting requirement traceability matrix.
• Writing, Reviewing and tracking of various mandate requirements for CareFirst BCBS as an issuer.
• Handling end to end exchange related business rules, APTC, CSR, Binder Payments, plan development, plan compare, broker data.
• Creation of process maps , conducting JAD sessions , Workshops , PRD Peer review , test cases creation defect monitoring , UAT and product approval.
• Interaction with developers, testers, issuer community, offshore teams and communication to business stakeholders about project status through dashboards presentations.
• Performing Regulatory analysis, ambiguity review and analytics for overall HIX project.
• Status Reporting to CareFirst Management for Federal Exchange Related work.

Confidential

Lead Business Systems Analyst

Responsibilities:

• As a Business Analyst participate in business process for software development projects during all phases of SDLC:
• Perform analysis and translates business needs to create Business Requirements and Functional Specifications documentation for different applications.
• Define and document business transformation logic and required business rules based on requirements.
• Analyze business workflow and system needs for data conversions and migrations.
• Facilitate JAD Join Application Development sessions and requirements walkthrough with clients to gather and document requirements and explore potential solutions.
• Presented, discussed and verified the requirements and the analysis with the stakeholders and gained the approval for the construction phase.
• Involved with SIT team for functional technical queries.
• Initiated Participated UAT sessions with business users.
• Recorded, maintained tracked defects, assigned type severity levels.
• Was responsible for defect tracking, coordinated the defect resolution process and generated management reports.
• Strong subject matter expertise of multiple development environments, e.g., relationships of development, QA, staging and production instances.
• Competitor Analysis.
• Interaction Diagram Navigational analysis.
• Maintained the Traceability Matrix table to uniquely trace the identified business requirements to general design to testing as proof that requirements requested have been developed into a solution and that it has been tested and tracked
• Knowledge of Apple, Android and other mobile ecosystems, hardware and trends.

Confidential

Senior Business Analyst

Responsibilities:

• As a Business Analyst participate in business process for software development projects during all phases of SDLC:
• Act as a liaison between business stakeholders and the IT team to ensure requirements are accurately captured and fully understood by involved parties.
• Analyze and document business requirements and processes communicate these requirements to technical personnel by constructing basic conceptual data and process models, including workflow, use case, domain models, and activity diagrams.
• Perform gap analysis to define and map current and future state processes
• Create wireframes and/or mock-ups to graphically represent the functionality
• Capture, define, analyze and translate functional and non-functional business requirements into activity diagrams, system use cases and supplemental specifications that contribute to effective software development.
• Assists in coordinating business analyst tasks on information technology projects and provide support to other team members.
• Work with the quality assurance team to validate system acceptance and user acceptance test plans and test scripts to ensure error free applications, tools and reports. Assists in analyzing testing results throughout the project.

Confidential

Business Analyst

Responsibilities:

• Gather Business Requirements from the Subject Matter Experts SMEs and document the requirements in the BRD. Utilized data flow diagrams, use case diagrams and process flow diagrams to represent information provided by the Business Owners.
• Perform GAP analysis to assess AS IS and TO BE scenarios
• Create process flows diagrams for all As Is and To Be scenarios using MS Visio.
• Involved in Business Process Redesign and its documentation
• Organize meetings and led JAD sessions to ensure legal and compliance deadlines of CMS Centers for Medicare and Medicaid Services are met.
• Effectively elaborated the Current process and gave a clear picture of the proposed process for the projects in the organization. Work aggressively towards timely completion of High Priority Tasks.
• Manual Testing for checking the flow of the application functionality.
• Work closely with the technical team to ensure functional requirements are accurate and complete. Ensure detail design documents accurately reflect customer needs and expectations.
• Work closely with different healthcare insurance companies to shakedown their system / process before real enrollment begins through a slew of test files verifications.
• Prepares appropriate documentation to communicate and validate the information.
• Coordinates and leads cross-functional task forces to identify and document functional requirements, work flow, information sources and distribution paths, and system specifications.
• Reviews the development of business cases to ensure the cost, service, and benefit dimensions of proposed large, complex IT projects are appropriately reflected.
• Develops, produces, gathers and improves executive and line of business scorecards.
• Handling management of offshore onshore team members.
• Verification of test result matrix for Unit/Integration/UAT/Acceptance Testing.
• Business support for post production issues.

Confidential

Business System Analyst

Responsibilities:

• Gathered and prioritized requirements, developed business scenarios to check how the system would work with the roles and processes of the departments, and developed acceptance criteria
• Created various use cases to develop the product, provider and the sales portals for myCigna.com
• Involved in meetings with SME's for doing analysis on the obtained requirements.
• Acted as a liaison between business staff and technical staff to articulate needs, issues and concerns.
• Converted various SQL statements into stored procedures thereby reducing the Number of database accesses.
• Communication : To communicate with functional users , vendors Medco, Caremark, Ceridian etc. and end users to ensure streamlined execution of system requirements.
• Articulate requirements to technical and business groups in a variety of ways, including via Functional Technical specifications documentation, BRDs, logical diagrams, use cases, and data samples.
• Conduct requirements reviews to improve the quality of requirements deliverables.
• Develop specs for application rules that will auto-trigger specific reports based on business needs.
• Determine where data for various custom reports will be sourced from within the application.
• Hold and lead meetings with IT, Business and vendor teams to review requirements, address open issues/questions, close gaps.
• Engage in prioritization and problem-solving with technical resources in order to deliver robust solutions as quickly as possible.
• Represent business interests and ensure that all technical designs meet or exceed business needs.

Confidential

System Analyst

Responsibilities:

• Analysis / documentation of JCL COBOL codes in existing system for PeopleSoft team.
• KM representative: Initiatives for effective knowledge related activities within team.
• Requirement Analysis: This involves understanding the requirements, analyzing the elements that require changes and creating unit test cases/test data for the deliverables.
• Coding: This comprises incorporating new functionality to the system by making code changes to the existing programs or to give permanent fix to an existing bug.
• Documentation and process/data flow preparation in VISIO-2000.
• QC activity: MCR, UTC Code Review and Unit Testing.