SUMMARY

• Business Analyst with over 8 years industry experience in business data modelling, software requirement analysis, process modelling, process flow and quality assurance skills using different methodologies, mainly OOA, OOAD and UML
• Extensive hands - on and HealthCare management experience in a variety of projects involving the customization, design, development, implementation, and testing of automated systems to support the Medical Management Information System (MMIS) as well as day-to-day business operations.
• Experienced in testing EDI and HIPAA Transactions 837, 835, 820, 276, 277, 278,270.271 code sets testing in Health Insurance.
• Extensive knowledge of all phases of the software development life cycle (SDLC) and the iterative Rational Unified Process (RUP)
• Understandingand mappingof the variousICD9/ICD10 Codesapplicable for tracking of diseases for which diagnostic testing isdone in the area ofBiochemistry.
• Organized many Joint Application Developments (JAD) sessions and Joint Requirement Planning sessions (JRP), walkthrough, Interviews, Workshops and Rapid Application Development (RAD) sessions with end-user/clients/stake holders and the IT group.
• Design and review of various documents including the Software Requirement Specifications (SRS), Business requirements document (BRD), Use Case Specifications, Functional Specifications (FSD), Systems Design Specification (SDS), Requirement Traceability Matrix (RTM) and testing documents.
• Proficient in creating Risk Analysis documents, Risk Management Plan, User Requirement Specification, Functional Requirement Specification and Business Process Flows.
• Proficient in using UML in behavioural, structural and architectural modelling - in creating Use Case, State, Activity, Class and Sequence diagrams using Rational Rose.
• Very Good understanding of Managed Care Techniques.
• Used Microsoft Visio for Business Process Modelling and Data flow diagrams.
• Worked with Rational Suite of tools to create requirements documents (Requisite Pro), visual data models (Rose), manage and track defects (Clear Quest).
• Well versed in project management tool (MS Project) for status reporting, planning and resource allocation.
• Experience with HIPAA 4010 EDI gateway healthcare transactions like 270, 271, 276, 277, 837, 835, 834, 820, and 278.Knowledge of HIX (Health Insurance Exchange), HIPAA 5010 transaction set.
• Experience in conducting GAP analysis, User Acceptance Testing (UAT). SWOT analysis, Cost benefit analysis and ROI analysis..
• Successful as a team player to work in conjunction with other DBA’s, testers, developers and other team members in validation and testing complex scenarios and projects and in the maintenance of Quality Standards in Projects especially with Test Director.
• Expertise in Analysis of Problem Severity, Defect tracking and reporting system.
• Strong communication, problem solving, organizational, interpersonal, and presentation skills.

TECHNICAL SKILLS

Business Tools: Rational Suite (Requisite Pro, Rose, Clear Quest, Clear Case), MS Visio, MS Project, MS Access, MS Office Suite, Visual Paradigm, Doors Erwin Data Modeller 4x, Business Object (Crystal Reports)

Business Skills: Business Definition Requirements, Business Process Analysis, Gap Analysis, Use Case Modelling & Analysis, Business Environment and Market Research Analysis.

Methodologies: RUP, OOAD, Agile, UML & Business/Data Modeling

Testing Tools: Win Runner, Load Runner, Test Director, Quick Test Pro, PR Tracker

Operating Systems: Windows XP/95/98/NT/2000, Mac OS X, DOS, UNIX, Linux

Databases: Oracle 8i/9i; SQL Server 7.0 & 2000; Access 2000, MS SQL Server, DB2

Languages: UML, C, C++, HTML, Java, SQL, PL/SQL, ASP.NET

PROFESSIONAL EXPERIENCE

Confidential, Baton Rouge, LA

Business System/Analyst

Responsibilities:

• Defined a complete set of metrics report requirements including a framework that will meet the needs of regional and national business leaders
• Provided analytical data to enable management to make informed decisions to drive continuous revenue cycle improvements by realizing gains in operational efficiency, cost savings and member experience
• Created drill down from the high level summary metrics to the supporting detail in the current report format
• Identified performance indicators that provide reliable daily trend information as a primary input towards the monthly executive dashboard report.
• Worked in fulfilling the gaps for Medicare Part D based on State of North Dakota’s rules and standards.
• Worked on EDI X12 transaction set 837, 835, 270, 271, 277 feeds to allow change in the claim number.
• Developed HIPAA EDI Transmissions. Work includes complete business cycle management and hands-on production as well. Create EDI Testing process, documentation, and performance matrices.
• Technical Specification Creation for EDI. Schedule meetings with technical personnel to determine technical parameters for EDI and other related processes, including communication, security, and privacy.
• Incorporated HIPAA standards, EDI (Electronic data interchange), Implementation and Knowledge of HIPAA code sets, ICD-9, ICD-10 coding.
• Create transaction sets requirements, usually with Microsoft Excel, for transactions such as: HIPAA 270/271, 276/277, 835, 837-(I, P, &D), 835 Remittances and others.
• Worked within Agile/ Scrum methodology.
• Developed user stories and attended stand up meetings.
• Analyzed and drafted a functional and technical features list for each vendors, thus identifying the best to send out a RFP
• Documented Requirements for Management Reporting out of Clear Quest using Crystal Reports.
• Created a prototype presentation in Visio for the SCAL region, thus showing a pictorial representation on the various drill downs from the report to the metrics to the database.
• Identified and drafted the calculations used for various regions, using their source SQL’s for standardization purpose.
• Performed Requirement Analysis and developed Use Cases, Activity Diagrams using Rational Rose
• Prepared for GAP Analysis; identified and documented improving areas to meet capital requirement regulations.
• Developed UML Use Cases using Rational Rose and developed a detailed project plan with emphasis on deliverables.
• Worked with in the areas of Clinical, Corporate and Finance, Pharmacy, Sales, Provider Network and identified the use of ICD 9 codes and prepared documents for the conversion of ICD 9-10 and vice versa.
• Worked with (ACS) X12 5010 and (ASC) X12 4010A including the various Claims Transactions such as: 837 (submit medical claims), 835 (medical claim payments), 270 (benefit/eligibility inquiry), 271 (benefit/eligibility response), 276 (claim status request), 277 (claim status notification), 820 (premium payments), and 834 (enrollment).
• Involved in interactions with Subject Matter Expert, Project Manager, Developers, and the end-users in more than one JAD sessions. MS Project proved useful in coordinating activities with project manager and various other teams.
• Modelled the information and then came up with the requirements prioritization. Eliminated false requirements by screening out multiple versions of user input. Final prioritization was based on both, product and process requirements.
• Responsible to import the data from Crystal reports by using Business Objects Live office into Microsoft Excel and Word
• Provided clear and concise documentation regarding requirements management plans, functional requirements, supplemental requirement
• Performed GAP analysis for the modules in production, conducted feasibility study and performed impact analysis for proposed enhancements.
• Coordinated JAD session with system analysts, development team, project manager for application development and Pre-validation specifications

Environment: Windows XP, Oracle, PL/SQL, Agile, MS-Project, MS-Office Suite, Crystal Report, MS Visio, Rational Requisite Pro, UML, Clear Case, Clear Quest, MS Visual Source Safe

Confidential

Sr. Business 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).
• 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.
• Involved in creating sample mappings for the conversion of EDI X12 transactions code sets version 4010 to 5010 and translation of ICD 9 codes into ICD 10 codes.
• Performed impact analysis for deadliness of ICD-10 conversion.
• Assist coders to be competent in using ICD-10-CMS/PCS
• Designed and development of test cases based on functional requirements for Institutional and Professional claims for EDI and HIPAA Transactions 837/835, 834, 276/277, 270/271 testing.
• Performed System testing of the Claims processing systems (Pricing Rules, Duplicate/Limits validation, Member Eligibility, Provider Enrollment, et al).
• Performed testing for Medicare, Medicaid and X-Over claims for Medicaid Management Information System (MMIS)
• Assisted front-end development teams in integrating Crystal Reports in the .NET application
• Interacted with department heads to finalize business requirements, functional requirements and technical requirements and also created Business process model.
• Facilitated JRP sessions between technical and regulatory teams for meeting requirements as well as solving problems on a daily basis
• Assisted in building a Business Analysis Process Model using Rational Rose and Visio.
• Use Cases and other Process Flow Models were designed using Visio and Rational Rose.
• Involved in creation and reviewing of Functional Specifications and created a Functional Requirement Document
• Used Rational Requisite Pro to improve the communication of project goals, enhance collaborative development, reduce project risk and increase the quality of application before deployment.
• Worked with the scrum master to get the estimates of the project for developing user stories and defining the sprint periods.
• Created and maintained Narrative Use Cases (Business Use Cases, System Use Cases) and modelled Use Case Diagrams, Activity Diagrams, Data Flow Diagrams using MS Visio.
• Followed the adaptive RUP framework for the whole Project life cycle (PLC)
• Fine tuned search engines and pulled data from different databases and migrated data back and forth using SQL.
• Involved in creation and execution of manual test cases in Mercury Test Director and automated Test Cases in QTP and analyzed the Test Results.
• Involved with the QA team to conceptualize, determine and develop test approaches and methods for unit testing, integration and functional testing, load and usability testing according to the application complexity and test requirements.

Environment: Windows XP, Oracle, PL/SQL, MS-Project, MS-Office Suite, MS Visio, Crystal Report Rational Requisite Pro, Clear Case, Clear Quest, Agile, MS Visual Source Safe, Test Director 7.6, Quick Test Pro (QTP)

Confidential, Indiana

Systems Analyst

Responsibilities:

• Met with various HMO, PPO, Medicaid/Medicare, and Tricare / Champus Representatives discussing benefits of contracts on behalf of facilities or appeals from denials and compliance issues
• Integrating systems of record into conformed dimensions and fact tables.
• Involved in analyzing the claims on basis of Primary and Secondary Payers and performed Medicare subsidy eligibility check for employee group plans.
• Tested claims adjudication and group and enrollment in Amisys for New Medicare advantage members.
• Track and archive monthly receipts and payments, update budget tracking programs
• Managed the team of consultants responsible for developing on-demand Medicaid Management System reports.
• Prepared automated generic Test Scripts and Functions using Rational Robot for functional/GUI and regression testing
• Provider inquiry about the status of claims. This involved checking the MMIS claims subsystem to see the status of claims sent and informing the providers if the claims have been suspended / denied or paid. .
• Experience with data migration (ETL development), document data manipulation processes and scripts
• Developed detailed use case models and supporting specifications.
• Involved in decision making of converting manual test cases into automated test scripts and analyzing their life time and time required to update the scripts.
• Used Castor to create objects from XML documents. Involved in Logical & Physical Data Modeling. Database Schema design and modification of Triggers, Scripts, Stored Procedures in Sybase Database Servers.
• Uploaded documents produced onto SharePoint, an intranet website for all Technology Information Group members to download, revise and upload shared documents.
• Assisted front-end development teams in integrating Crystal Reports in the .NET application using SDK.
• Reported and analyzed all application defects, user issues and resolution status to the higher manager using Mercury Quality Center..
• Implemented data access, storage and validation routines on the database server using Procedural Language/Structured Query Language (PL/SQL).
• Responsible to import the data from Crystal reports by using Business Objects Live office into Microsoft Excel and Word.
• Used Lotus Notes for project delivery and internal communication
• Created use cases, activity diagrams and process diagrams using Microsoft Visio.
• Derived the requirement dependencies by working with other business analysts from different modules.
• Validate test plans/scripts and perform final reviews of test results.
• Supported in creating test cases to check the functionality of the enhanced application.

Environment: Rational Rose, Clear Quest, Microsoft Project, Crystal reports, SharePoint, Mercury, Lotus Notes, Erwin, Microsoft Visio, Microsoft Office suite, Business Objects, ETL, Oracle, Windows NT, Mainframes, COBOL.

Confidential, Montvale, NJ

Business/System Analyst

Responsibilities:

• Liaison between the client and development team to support the client’s data analysis and reporting needs.
• Proficient in discussing and defining project, Gap Analysis with the clients from both a business and technical perspective
• Provide current market, economic and technical information and updates as well as external changes impacting trading activities to customers.
• Gather requirements for the listed options risk management system, specifically for index options risk management spreadsheet. Defining requirements for product control and risk management end of day feeds.
• 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.
• Engaged in analysing requirements, identifying various individual logical components, expressing the system design through UML diagrams
• Worked on Rational Rose to develop the use cases, class diagrams and sequence diagrams.
• Worked on Requirement Change Management System in Rational Requisite Pro.
• Setting up document hierarchy and standards to define different level of requirement using Rational Requisite Pro.
• Manage Scope and change throughout the SDLC process of the product.
• Analysed existing data and used tools available to successfully forecast the pricing models.
• 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.
• Developed detailed auditing and reporting of the current status and history of all components related to a product.
• Translated customer/clients needs into new features and new services.
• Develop process improvement projects by gathering and analysing data.
• Define Key Process Areas for different Projects.

Environment: Rational Suite (Rose, Requisite Pro), Rational Unified Process (RUP), Windows XP/2000, Oracle, PL/SQL, MS-Project, MS-Office Suite, MS Visio, MS Word, MS Excel