SUMMARY:

• Senior Business Analyst with 9 years of experience in business process analysis/modeling, business requirements gathering, database design and development of Web Based, and Client/Server applications.
• Experience as Business Intelligence/Systems/Data/Business Analyst with expertise in Insurance, Healthcare processes, Business Process Engineering, Systems/ Solutions Engineering, Strategic Planning, and Systems Analysis.
• Assisted the PM participated in Product demonstration and highly involved in RFP Selections and closely worked with SMEs / Users to prioritize the Change / Work requests and adjust the budget accordingly.
• Proficient in business process modeling, documentation, and testing using Rational Suite (Rational Rose, Requisite Pro, Clear Quest) as well as MS Visio and MS Project in combination with UML 2.0 diagramming techniques.
• Experience configuring QNXT applications for case management, flexi conversion, provider, member, member eligibility, and prior authorization.
• Proficient in all aspects of QNXT configuration including eligibility and enrolment, provider reimbursement and network management, referral and authorizations, claims processing, and premium billing and accounting.
• In - depth knowledge of creating use case, activity, logical, component and deployment views with rational tools to extract business process flows and workflows thereby helping development and quality assurance teams in understanding the requirements.
• Results-oriented Joint Application Development (JAD) Facilitator and meetings coordinator with excellent interpersonal skills.
• Analytical, methodical, and resourceful approach to problem solving, identifying and documenting root causes and corrective actions
• Performed Gap Analysis to check the compatibility of the existing system infrastructure with the new business requirements
• Expertise in broad range of technologies, including business process tools such as Microsoft Project, Primavera, MS Access, MS Visio, technical assessment tools, Data Warehousing concepts and web design and development.
• Experience in Change Management Process (Identify, Analyze, Evaluate, Plan, Implement, Review and Close).
• Strong oral and exceptional written business communication skills
• Hard working, positive thinking, self-starter with a strong goal orientation
• Excellent meetings facilitator with excellent inter-personal and conflict resolving skills.
• Proven success as a business analyst through the years, providing a well-balanced understanding of business relationships, business requirements, and technical solutions.

TECHNICAL SKILLS:

Programming Languages: C,C++,C#,VC++,VB,VB.NET,C#.NET, ASP.NET, Java, SQL, PLSQ

Development Methodologies: RUP, AGILE, Waterfall, ESDM, STV

Databases: MS-Access, My SQL, SQL Server, Oracle, Teradata, DB2, Sybase

Application Servers: IBM WebSphere, ATG Dynamo, BEA Web Logic.

Internet: HTML, XML, VBScript, ASP, JavaScript, JSP, J2EE.

Automation Tools: MS Visio, Rational Rose, Rational Clear Case, Rational Requisite Pro, Documentum

Bug Tracking Tools: Mercury Test Director, Rational Clear Quest

Utility Tools: MS Office Suite, MS Project, TOAD, Adobe Photoshop

Reporting Tools: Crystal Reports, SQL Server Reports (SSRS)

Data warehousing Tools: Informatica, Business Objects, Cognos, Erwin

Testing Tools: Quick Test Pro (QTP), Test Director, Win Runner, Load Runner, Niku Project Work Bench

PROFESSIONAL EXPERIENCE:

Confidential, Plymouth, MI

Business Analyst

Responsibilities:

• Designed the business requirement collection approach based on the project scope and SDLC Methodology.
• Used XML for building and parsing of Application Configuration file.
• Conceptualized primary process flow diagrams using Microsoft Visio and Case Wise tool sets.
• Did project planning using Project Workbench.
• Facilitated and managed meeting sessions with committee of SMEs from various business areas including Mortgage Servicing, Loan Monitoring and Asset Management.
• Conducted interviews with key business users to collect requirement and business process information.
• Acted as a peer leader for the testing efforts of Facets or QNXT configured solutions for Projects.
• Demonstrated good judgement in defining methods & Techniques for obtaining solutions and data requires a review of a variety of factors.
• Mentored staff in methodology and consulting excellence and encouraged best practice in project managementproject planning.
• Lead several small to medium complexity testing efforts with in a team.
• Provided guidance on complex issues to others as needed.
• Established Project Management Office at client site.
• Developed business process models in RUP to document existing and future business processes.
• Performed extensive requirement analysis including data analysis and gap analysis.
• Designed and developed project document templates based on SDLC methodology.
• Designed and developed all Use Cases and UML models using Rational.
• Developed Sequence Diagrams, OOD using UML.
• Established a business analysis methodology around the RUP (Rational Unified Process). Helped develop use cases, project plans and manage scope.
• Developed requirement reports for day-to-day retail banking needs for opening account, online banking using rational SoDA.
• Responsible for the recruiting, management and career development of consulting staff.
• Provided project turn-around expertise at the customer site with emphasis on regaining customer confidence.
• Responsible for staff/account management and prioritization and forecasting.
• Provided delivery management to ensure customer satisfaction and -ability
• Developed project plans and assumed responsibility for project profit and loss.
• Developed strategic partnerships with the business unit to develop a solid knowledge base of the business line, including the business plan, products, process and revenue streams.
• Worked with marketing team in knowing what exactly bank’s client wants.
• Used Rational Clear Case and Clear Quest as Configuration Management and Change control tools.
• Developed strategies with Quality Assurance group to implement Test Cases in Mercury Test Director
• Performed User Acceptance Testing (UAT).
• Full knowledge of most phases of the Systems Development Life Cycle.

Environment: Windows NT 4.0, Erwin, XML, Dbase3, DOS and UNIX Sequential Files, MS Access, HTML, ERWIN

Confidential - Durham, NC

Business Analyst

Responsibilities:

• Worked on the entire reporting process. Interacted with the ETL team, developer(s) and management.
• 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 coordination and conduct system requirements walkthroughs in JAD sessions with Business Owners, Stakeholders, SMEs and technical team
• Worked on all the environments of QNXT which includes the Test Environment, Development Environment and Production Environment.
• Defined Functional Test Cases, documented, Executed test script in Facets system.
• Analyzed trading partner specifications and created EDI mapping guidelines.
• Involved in gap analysis and implementation of HIPAA 5010, ICD 10 and Claim Validations.
• Identify business area/agency SME’s to participate in sessions where input will be gathered as part of SS-A
• Healthcare system implementation including enterprise Electronic Medical Records (EMR) software.
• Performed Gap analysis for better understanding of transition from HIPAA 4010 to HIPAA 5010 inside Trizetto QNXT different modules.
• Created Data Stage jobs to extract, transform and load data into data warehouses from various sources like relational databases, application systems, temp tables, flat files etc.
• 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.
• HEDIS and other healthcare quality metric software and services to support a customer base primarily composed of health plans and providers located around the US.
• Created the business process model using MS Visio for better understanding of the system and presented it to Project Manager and other team members for validation.
• Using Shared Containers and creating reusable components for local and shared use in the ETL process.
• Trouble shoot file transmission problems and assisted customers in a call center environment with EDI and Medicaid Insurance claim related inquiries explained and enforced guidelines in the X12 Implementation guides (837P, 837I, 837D, 270/271).
• Conducted QNXT backend database analysis relating to finance module for internal/external reporting purposes.
• Converted various SQL statements into stored procedures thereby reducing the Number of database accesses.
• Responsible for integrating with Facets .Designing test scripts for testing of Claims in Development, Integration and production environment.
• Developed estimates, project plans (Microsoft project), material, BI reports using MicroStrategy
• Used MS-Visio for flow-charting, Use-Case process model and architectural design of the application.
• Assisted in monitoring ancillary data transactions and addressed problems with HL7 messages.
• Worked in mainframe environment and used SQL to query various reporting databases

Environment: Microsoft Office 2003 Professional (Outlook, Word, Excel, Visio, Access, etc.), Microsoft SharePoint 2003,UML, RUP, UAT, Mercury Test Director, SQL, .NET, Clear Case

Confidential

Business Analyst

Responsibilities:

• Involved in gap analysis and implementation of HIPAA 5010, ICD 10 and Claim Validations
• Performed Gap analysis for better understanding of transition from HIPAA 4010 to HIPAA 5010 inside trizetto QNXT different modules.
• With QNXT(TM) Connect reduced the cost of HIPAA transactions and code-sets implementation
• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims. Worked on EDI transactions: 270, 271, 834, 835, and 837 (P.I.D) to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
• Responsible for supporting clients using different products like FACETS, QNXT, QicLink and Claims Exchange.
• Design, development, implementation and roll-out of MicroStrategy Business Intelligence applications
• Designed and implemented basic SQL queries for QA Testing and Report / Data Validation.
• Conducted Functional Walkthroughs, User Acceptance Testing (UAT), and supervised the development of User Manuals for customers.
• Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data within the Oracle database
• Perform Gap Analysis of the processes to identify and validate requirements.
• Identified/documented data sources and transformation rules required populating and maintaining data warehouse content.
• Used SDLC (System Development Life Cycle) methodologies like the RUP and the waterfall.
• Successfully conducted JAD sessions, which helped synchronize the different stakeholders on their objectives and helped the developers to have a clear-cut picture of the project.
• Use Cases and other Process Flow Models were designed using Visio and Rational Rose.

Environment: QNXT, RUP, UAT, GAD (Gap Analysis Document), Microsoft Office 2003 Professional (Outlook, Word, Excel, Visio, Access), Microsoft SharePoint 2003