SUMMARY:

• Senior Business Analyst with Full SDLC and PLC experience as Business Systems Analyst, Business intelligence analyst, Functional Analyst, Requirements Analyst, Quality Assurance Analyst, Data Modeler, Usability Specialist and Technical Writer.
• Experience in working with clients in implementing EDI initiations related to Healthcare, Trading/Securities, Financial, Insurance, Energy, Retail, Ecommerce, and Clinical Domains/Verticals.
• Instrumental in designing Inbound & Outbound interfaces, transactions, Mercator/EDI configurations, Mercator data mapping using ANSI X12 standards in both Windows and UNIX Environment.
• Experience in working with Enterprise Data warehouse (ETL), Data warehousing 2.0, Business Intelligence, Business Analytics, Dashboards, EPM and BI 2.0.
• Worked with ERP/CRM such as Oracle R12 EBS, SAP and Salesforce.com.
• Experience in RAD, UML, RUP, Structured Systems Analysis and Design Method (SSADM).
• Experience in working with custom development & "Off the Shelf" apps configuration and customization.
• Ability to Define explicit and implicit requirements using UML(Use cases and UML diagrams), Use Cases, Case Models, User Interface designs, Current State Analysis, Process Modeling, Data Modeling, Paper Prototyping, GAP Analysis, UI Prototypes, Frameworks, Report Prototypes, Sitemaps, wireframes, "Day in the life of analysis" and copy decks using Rational Rose, Enterprise Architect, iRise, Caliber, HP Quality Center etc.
• Facilitated requirements gathering/JAD Sessions in compliance with AGILE and SCRUM methodologies.
• Ability to understand IIBA and Business Analyst Body of Knowledge (BABOK).
• Ability to research, analyze and translate complex business and technical information to Managers, CIO, Developers and Testers Confidential all verticals & horizontals.
• Experience with vendor management, RFP, RFQ, and RFI Processes.
• Experience with Change Management, Identity management, Issue resolution and Risk management Processes.
• Worked closely with development teams as business subject matter expert during Technical Design, Development, Testing, Deployment and maintenance stages of the project.
• Provided class Diagrams and ERDs in providing the Solution Designing.
• Designed Ecommerce P/Vortals, Client Server applications, Software Usability Analysis for new and existing applications.
• Used user centered approaches in analyzing user personas, information Architecture, Tasks, Scenarios to determine future state recommendations.
• Working experience with all stages of software development such as Legacy Systems, Mainframes, Macintoshes, Client Server systems, Virtualization, Cloud computing, Mobile Cloud, Grid computing, Web 2.0, Social Networking in compliance with RIM, SAAS, PAAS, IAAS, and ASP infrastructure.
• Complete Understanding of web Technologies such as LAMP, Cloud Computing, Flash, Flex, HTML5 etc.
• Working experience with Resource Management, Team Building, Project Plan, Budget Management and Cost Avoidance.
• Worked with SQL, PL/SQL, Joins, Sequences, Stored Procedures, indexes, views, Teradata, Data ware housing, xml, open standards, schema systems, openxml, SOAP, xhtml, tags, elements, attributes etc.
• Experienced in working with Client Facing, End User, in house, Near Shore and off shore development teams.
• Experience with Project Management, Scheduling, Budgeting, Estimates, ROI etc.
• Excellent Communication, Interpersonal, Consulting and facilitation skills.
• Experience with HIPAA compliance and 21 CFR Part 11 code of federal regulation for electronic records and electronic signatures.
• Experience with PBM, claims process and adjudication in the Medicare, Medicaid and Private Insurance Sectors.
• Experience in EDI automated claim adjudication, requiring thorough understanding of claim processing, both front and backend operations.
• Experience with Enrollment, Eligibility verification for members and providers, benefits setup, and backend payment cycle.
• Experience with Trizetto QNXT/Facets System implementation, Claims and Benefits configuration set - up testing, Inbound/Outbound Interfaces and Extensions, Load and extraction programs and proprietary format files and Reports development.
• Experience in configuration of claims adjudication systems, i.e., Amisys, Facets, QNXT.
• Experience with Bluecross, Medicare, Medicaid, and commercial insurances in HIPAA ANSI X12 formats including 834, 835, 837, 997 for interfaces and images to third part vendor applications

TECHNICAL SKILLS:

Transaction sets: Health insurance and disability insurance claims and administration systems; HIPAA compliance, data store, X12N 837, 835, 270/271 and 276/277 transaction sets; Billing, Claims Adjudication, Payment, EOB, Commissions, PPO, Accounts Receivable, Accounts Payable.

Skills: Remedial Plan, Audit Objectives and Scope, Configuration Management, Traceability Matrix, GAP Analysis, Impact Analysis, Risk Analysis and Risk Mitigation, Validation Protocols, Security Audit, Test protocol design using UML, SDLC using CASE Methodology, Configuration, Mapping, Component Rules, Map Rules, Functions, EDI Auditing, Exception handling, Mercator/EDI connector, Testing, Documentation and Regulatory Compliance.

Data Formats: EDI, ANSI X12, XML, HIPAA, UB 92.

Project Management: Change Point, Remedy, MS Project

WORK EXPERIENCE:

Sr. Business Analyst

Confidential - Detroit, MI

Responsibilities:

• Analysis of existing processes and performing gap analysis based on results.
• Understanding of existing Products and offerings of the business to gather and arrive Confidential requirements for the purpose of configuration.
• Scheduling requirement gathering and follow - up meetings with the Business and Configuration Team using Lotus Notes.
• Elicitation of detailed requirements from Stakeholders through interviews and requirement gathering meetings.
• Working knowledge in ICD 9 ANSI Health codes HL7 in the claims environment for inpatients and outpatients, reviewed the implementation of the changes made in the systems as per the formats and compliance.
• Collected the information related to ongoing application upgrade and their impact on ICD-10 implementation and created awareness within the departments regarding the need, impact, benefits and risks of ICD-10 code application.
• Established questionnaires and resource leveling required for implementing HIPAA 5010 and upgrading ICD-9diagnosis codes to ICD-10 codes.
• Actively worked on Data analysis and Report analysis with respect to ICD-10 impact.
• Preparing detailed Functional requirements documents and flow charts based on requirements gathered.
• Obtaining sign off from the Business and handover of approved BRD to the Configuration Team.
• Facilitating JAD sessions with the Configuration Team and the Project Manager for brainstorming to arrive Confidential best practices for the process of Facets configuration.
• Worked with Business Owners from both Medicare and Commercial lines of business on various products like Specialty Pharmacy, Vision, Dental, and Vaccines.
• Conducted post testing defect analysis, working with both the Business and Configuration Teams to identify and define requirements.

Environment: Agile Methodology, UML, MS Office (MS Word, MS Excel, MS PowerPoint, MS Visio), Quality Center.

Business Analyst

Confidential, Artesia, CA

Responsibilities:

• Worked with Medicare, Medicaid, Duals, Hospice, LTSS, Vision, Dental, Pharmacy and behavioral health benefits.
• Developed solutions for Managed Care in association with state, federal and autonomous apex institutions such as CMS.
• Experience in conducting JAD Sessions, Collecting requirements related to 834, 837, 835, 276, 277, 834, 820, 270, 271 Transactions and developed UI and Business solution design for various healthcare projects.
• Provided usability documents, Software Design Documents (High Level/Low Level), Technical Specification Documents etc.
• Involved in security audit, privacy checklists, Transaction compliance Gap analysis, contingency plans, risk analysis and mitigation procedures.
• Participated in customization of 834, 835, 837 transactions using EDI ANSI X12, Mercator 6.0, Windows NT 4.0 platform, XML data and Oracle Server as back-end.
• Involved in preparing the Methodology document for the HIPAA implementation
• Involved in Project planning, project monitoring activities- used MS Project and Ms Visio extensively
• Implementation of all the key aspects of HIPAA compliance in terms of - Transactions, Identifiers, Codes, Privacy and Security, Non-Compliance issues and penalties
• Developed Schemas of EDI ANSI X12 Claims (837) and Eligibility forms in XML.
• Created Maps between the native and HIPAA formats using Mercator tool, with embedded business rules.
• Prepared test plan and test cases for testing of the system and tool for validation / compliance.
• Designed Security Incident Response Procedures.

Environment: Mercator, Windows NT, Windows 2000 Server, Unix, SQL Server 2008, SSIS, SSRS, SSAS, SharePoint, NextGen, Facets, Access Express etc.

Business Analyst

Confidential, Pasadena, CA

Responsibilities:

• Implemented large scale healthcare claims processing systems such as Medicare/Medicaid developed with HIPAA standards.
• Analyzed business requirements, suggested most effective database solutions to fulfill those requirements, setting up access methods for data (view, APIs etc), management of Reference data, creation and maintenance of reference / test data scripts. Performed code reviews.
• Created Case Models and UI using iRise and Enterprise Architect.
• Involved in Upgrading 4010 documents to 5010 in conjunction with HIPPA/EDI Standards.
• Worked actively in creating data flows of EDI Health Care Eligibility/Benefit Inquiry documents such as … 276, … 834, 835, 837, 820, 997.
• Electronically exchange professional medical Claims data in ANSI X12 v. 7 format with Payers, Providers, trading Partners and clearinghouses.
• Monitored EDI transmissions related to Group health, Workers Comp network demographic information, rate information, facility & professional provider health care claims, group Enrollment, Eligibility feeds and Facility Fee schedule feeds.
• Performed content Gap analysis and identified gaps in elements. Identified mapping issues with functional teams, process owners related to mapping breaches.
• Identified potentially critical data content slits and assisted resolving solutions in EDI Architecture, standards, Analysis and Issue resolution.
• Designed inbound and outbound transactions using Mercator 5.0. Defined and obtained file layouts, output data, input requirements Confidential element level.
• Knowledge in type Trees, IDOCS, Flat files.
• Actively participated in resolving production and performance issues.
• Experience with MQ series in facilitating Queues to avoid bottlenecks.

Environment: UNIX, Cognos, Erwin, Pro*C, Visio, SQL Server, MS Office, Team Play, ARIS Business Designer, Rational Suite, Rational Clear Quest, Rational Requisite Pro, Workday HCM, Oracle 10g Database, Oracle Designer (10g or CASE), TOAD, PL/SQL, SQL, Confidential DB2, ZOS, SAS, LoadRunner, Sharepoint, Stored Procedures etc.

Business Analyst

Confidential, Baltimore, MD

Responsibilities:

• Gathered, Documented, Analyzed, Participated, Managed, Validated complex Business requirements & Functional specifications in migrating data from existing SAP ECC 5.5 system to the newly implementing Oracle R12 ERP system.
• Dedicated to Business Analysis, Quality Assurance practices such as agile process, daily scrum, iteration review and planning meetings.
• Worked extensively with SAP Business Objects and Oracle ERP, OBIEE and Hyperion.
• Developed Preliminary project plan, Project work Breakdown Structure (WBS), project timelines, project analysis, impact analysis and risk Analysis on project plans, methodologies, resources and participate actively in their implementation.
• Gathered and validated requirements from Joint Application Development (JAD) sessions with Business Units to ensure Legal and Audit Compliance with Logistics, SCM and Ware House Management modules.
• Created User Interface Prototypes, Business Use Cases, System Interface Documents, Business process design, process flow diagrams, Information Mapping Diagrams, Functional Specification Documents (FSD), Software Requirement Specification Documents (SRS), Software Design Documents (SDD), Input Process Output (IPO), Context (Business and Design), Vision, Traceability matrix, Use case diagrams, Activity diagrams using Rational Unified Process(RUP) artifacts with Agile team SDLC.
• Involved in JAD sessions in implementing Smart Meter & Smart Grid systems.

Environment: Oracle Financial application, SAS, Microsoft Excel 2000, ColdFusion, Windows 2003 Server, HP-UNIX.

Business Analyst

Confidential, Newark, DE

Responsibilities:

• Made detailed Functional, business and technical analysis and developed web interfaces for ETSF (Electronic Trade Submission & Fulfillment) System. (Products include Equity Trading/ Equity Settlement - including Order Routing, Trade Matching and Confirmation for Stocks, and Trading / Matching strategies - Limit Order, Market Order, Stop Loss Order).
• Immense working knowledge and experience with Equities (Stocks, Warrants, ETF, Equity Linked Notes), Futures(Equity Futures, Index Futures, Commodity Futures, Forex Futures), Options(Equity Options, Index Options), Fixed Income (Municipal Bonds, Munis, Treasury, Repos, Caps and Floors, MBS, ABS, CDO, CMO, CLO, CBO, CDO, Convertibles), Derivatives and Swaps (Interest Rate Futures, Interest Rate Swaps, Equity Swaps, Credit Default Swaps, Total Return Swaps, Credit Linked Notes, Swaptions, VIX), FX (Euro dollar Futures, Cross Currency Swaps, FX Futures, FX forwards, FX Options, Currency Forwards, FX Futures), and Money Market securities, Spots, FRA), Credit Products (Credit Default Swaps, Total Return Swaps, Credit Linked Notes, Collateralized Debt Obligation, Credit Indices/CDX/iTraxx, Caps/Floors and Swaptions, Asset Backed Securities, Floating Rate Notes) for re-engineering Trading/Investments workflow with MS Visio.
• Documented detailed Business Requirements (BRD) for the complete life cycle of the Asset Allocation, Investments/ Trading (Trade Capture/ Blotter, Valuation with FinCad XL, Trade Execution, Deal Management, Margin Management), Operations (Netting, Collateral Management, ISDA Confirmations/ Affirmations, Recovery, Settlement and Reconciliation in Smart Stream)

Environment: Visio, Oracle 9i, teradata, UNIX (Sun OS 5.9), RUP, UML, Windows … MS Project, Word, Excel, PowerPoint, Rational Rose, Requisite Pro, Java script, Ajax, ColdFusion, Lamp, HTML etc

Business Analyst

Confidential, Chicago, IL

Responsibilities:

• Produced High level Design and Low Level Design of solutions detailing exact functional and technical requirements against respective needs detailing exact Configuration / Database changes required to address various business functionalities and changes.
• Customized eCommunications, eChannel and eSales application for Order Management and Service Management application to in corporate unique business rules of online business and interactions with backend systems.
• Customization includes creating new or modifying the existing/vanilla business components, applets, business services, workflows.
• Designed and driven the implementation of common validation business services, which are reused in various channels of the business Web, eCommunications, and XML BB channels.
• EAI, Web Services, MQ and MS SQL scripts were used to communicate with other systems for order progression and processing.
• Created a detailed project plan with well defined tasks, milestones, signoffs & specifications.
• Identified risks and defined appropriate mitigation strategies.
• Monitored weekly status to track the Target Vs Achieved performance.

Environment: Erwin, Pro*C, Visio, MS Office, Team Play, ARIS Business Designer, Rational Suite, Rational Clear Quest, Rational Requisite Pro, Oracle 10g Database, Oracle Designer (10g or CASE), TOAD, PL/SQL, SQL, Confidential DB2, MS Office Visio2007, CVS (Source Control), Java, Stored Procedures etc.

Business Analyst

Confidential, Manhattan, NY

Responsibilities:

• Project to test and validate the brokerage system components affected by changes of requiring to support valid short transactions and short positions on Confidential Type 2 margin accounts
• All the components including Accel trading platform, Fidessa OMS, Wash Manager, Intact agent, BPSA SOD and Real time agent, Portfolio Manager (for rebate processing and interest calculation), RBC Prime blotter processor, RBC Prime trade entry GUI, Prime transaction and validation manager, Anvil Rebate system, Axiom RiskMonitor system, Utopia Collateral & Margining system, Prime report manager, Advent P&L manager, PB Direct, are validated and tested affected by consolidating short transactions in ADP type 2 accounts, BNYM Workbench
• Wrote use cases for unit testing of trades flow for BPSA (ADP through Intact), Trade Entry screen and SOD batch
• Prepared project plans, work breakdown structure, schedule, cost and other project related documents including requirement traceability matrix.
• Conducted JAD sessions with treasury product and ACH SMEs, vendors, users, PMO and other stakeholders and monitoring for open requirements and pending issues.
• Restructured business workflows to enhance applications' capability to meet business needs.
• Managed a team of associates for software development and QA in .Net based web technology leveraging agile scrum development methodology.
• Oversaw offshore shared technology resources for release and implementation activities.

Environment: Erwin, Oracle 9i, UNIX (Sun OS 5.9), Unix, Windows XP, RUP, UML, Windows 2000, MS Project, Visio, Word, Excel, PowerPoint, Rational Rose, Requisite Pro

Business Analyst

Confidential, Poughkeepsie, NY

Responsibilities:

• Developed and maintained Point of Sale terminal applications, user interfaces according to end client specifications.
• Worked with Systems Analysts who in turn certify all new applications and equipment.
• Provided 4th-Level technical support for product troubleshooting.
• Facilitated JAD session with external clients and internal development teams, in order to develop artifacts to support the development and implementation of Enterprise Architecture, Business Transformation and systems development.
• Used Business Applications Oriented Modeling (BAOM) approach to define artifacts, which include UML Use Cases and UML Diagrams (Use Case, State, Activity), Business Process Models, Data Models(Class Diagrams), Data Dictionaries, Report Prototypes, Functional Requirements, Non- Functional Requirements, Gap Analysis, UI Wireframes, UI Specifications, Site Maps, "day in the life of " analysis, and Copy Decks.
• Reservation application analysis and development, Release Management, enhancements, Troubleshooting, testing, configuration, implementation, Joint Application Development (JAD), Walkthroughs and Review meetings with Project Manager, QA Engineers and Development team.
• Used PVCS Dimensions Process Modeler for adding users and roles into Oracle database.
• Documented all system changes and request for user access using Change Management Forms in the SharePoint document library.
• Worked in various ERP implementations for Confidential clients.
• Worked with development and support teams to implement SAP, Oracle Financials and PeopleSoft for Confidential retail clients.

Environment: VC++, C++, RUP, UML, VISIO, Oracle, DB2, SAP, Visual Basic, Java, ASP, C#, PVCS Dimensions, UNIX, Windows XP, z/OS, Tivoli.

Business Data Analyst

Confidential, New Jersey

Responsibilities:

• Gathered user requirements and directed developers for practical deliverables.
• Worked with the full SDLC, elicit, analyze and define requirements.
• Conducted JAD sessions with the clients to identify the requirements.
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, OOAD using UML and Business Process Modeling.
• Used Rational Unified Process (RUP) for streamlining the team's development activities.
• Followed the UML based methods using Rational Rose to create: Use Cases, Activity Diagrams/State Chart Diagrams, Sequence Diagrams, and Collaboration Diagrams.
• Worked extensively with insurance brokers
• Participated Testing and Evaluation of projects Confidential established integration points to assess progress and identify key functionality issues.
• Performed the requirement analysis, impact analysis and documented the requirements using Rational Requisite Pro. Perform data profiling to analyze and to support devising data quality controls (valid value ranges, relationships between data elements, business rules & reasonability checks).
• Obtained Data requirements, identified data sources, determined the content of data fields and created Data Mapping Documents and performed Data Extraction and Data Compilation using SQL queries.
• Responsible for integrating with Facets .Designing test scripts for testing of Claims in Development, Integration and production environment.
• Migrated Data from MS Excel to SQL Server Reporting Service Using DTS and SQL loader utilities.
• Deep understanding of Structured System Development Methodologies
• Designing and customizing data models for Data warehouse supporting data from multiple sources
• Assisted Project Management in developing Scope/ Vision Documentation and Project Plan, tracking project process, and developed Risk Mitigation Plan
• Defined, developed specs for federal reporting specific to Medicare Advantage
• Conducted user interviews, gathering requirements, analyzing the requirements using Rational Rose, Requisite Pro - RUP.
• Prepared Logical Data Models that contains set of Entity Relationship Diagrams and Data Flow Diagrams and supporting documents and descriptions of the Relationships between the data elements to analyze and document the Business Data Requirements. Developing ETL in SAS, Teradata and SQL to load the campaign management data mart from different business sources.
• Tested claims adjudication and group and enrollment in Amisys for New Medicare advantage members
• Well versed with HIPAA, claim adjustments, claim processing from point of entry to finalizing, claim review, identifying claims processing problems, their source and providing alternative solutions using best practice model and principles.
• Worked with Claims, enrollment, eligibility verification for members and providers, benefits setup, and backend payment cycle in facets.
• Establish documentation for Agile methodology for implementation with a very water-fall-centric development team.
• Work with project manager to build out plans using project management tool.
• Researched the existing client processes and guided the team in aligning with the HIPAA rules and regulations for the systems for all the EDI transaction sets.
• Interacted with Business Users to conduct thorough Requirements Analysis.
• Created Interface test cases, report test cases, expected results validation, defect tracking using clear quest, version control using Clear Case VOB.
• Responsible for creating a business process and workflow documentation using BPMN standards.
• Worked in Data Analysis, Data Reconciliation and Data Mapping for ETL process
• Created standard test case template according to the company requirements and standards.
• Reviewed Stored Procedures for reports and wrote test queries against the source system (SQL Server) to match the results with the actual report against the Data mart (Oracle).
• Used MS Visio for Process modeling and Business Process flow diagrams
• Solid Experience in Collection, analyses, and documentation of User Requirements, as well as Organizing interviews, User meetings, workshops, JAD sessions and requirement elicitation sessions
• Proficient in creating Use Cases, Use Case Diagrams, Activity Diagrams etc.
• Tracked UAT issues/bugs and prepared reports.
• Performed job of contact point for all stakeholders (business, legal, compliance, development).
• Documented monthly status reports for enhancement and modification requests for the development team to assist them in efficient tracking and monitoring of open issues of the project.

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

Business Systems Analyst

Confidential, Detroit, MI

Responsibilities:

• Understanding the current business process, defining scope of the project along with vision statement.
• Actively participated in gathering requirements from various SMEs, Financial Analysts, Risk Analysts and Portfolio Management via JAD/JAR sessions.
• Extracted the Business Requirements from the end users keeping in mind their need for the application and prepared Business Requirement Documents (BRD) using Rational RequisitePro.

Technologies Familiar with: Crystal Reports, XML, EDI, mappings, ETL, Web Services, SOAP, FTP, MQ Series, .NET, JAVA, SQL, C, VBA Enterprise Architect, Requisite Pro, Visio, TFS-Team Foundation Server, Word, Microsoft Power Point, Erwin Access, Excel, SQL, JIRA. SQL Server, SSIS, SSRS, SSAS, Informix, C#, .NET, ASP, Oracle, PL/SQL, Trading, Securities, Commodities, data modeling, data transformation, data analysis, Business Process modeling, lean Agile, testing, system architecture, release, VBA, project management, Microsoft Project, Pivot tables, Cognos, Micro Strategy, Business Objects, Clarity.