Summary:

• Well versed with client server environment and tools like SQL Loader, UNIX shell scripts and TOAD
• Worked on HIPAA standards, EDI Electronic data interchange Transaction syntax like ANSI X12, Implementation and Knowledge of HIPAA code sets, ICD-9, ICD-10 coding and HL7.
• Business Systems Analyst with 8 years of experience in Business, Data analysis/modeling, business requirements gathering, database design and development of Web Based, and Client/Server applications.
• Proficient in business process modeling, documentation, and testing using Rational Suite Rational Rose, Requisite Pro, SoDA, Clear Quest, Robot as well as MS Visio and MS Project in combination with UML 2.0 diagramming techniques.
• 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.
• Experience with TriZettos Facets Modules: Claim Processing, Benefits Contracting, Capitation and Membership.
• Knowledge in the ETL Extract, Transform and Load of data into a data ware house/date mart and Business Intelligence BI tools like Business Objects Modules Reporter, Supervisor, Designer, and Web Intelligence .
• Experience in Designing, Creating and maintaining the Universes, Business object reports, WEBI reports and Domains Security, Universe, Document in Business Objects.
• Results-oriented Joint Application Development JAD Facilitator and meetings coordinator with excellent interpersonal skills.
• Lead Business Intelligence reports development efforts by working closely with Microstrategy, Teradata, and ETL teams
• Extensive experience in all phases of RUP and SDLC processes
• 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
• Development Methodologies: RUP, AGILE, Waterfall, ESDM, STV
• Databases: MS-Access, MySQL, SQL Server, Oracle, Teradata, DB2, Sybase
• Internet : HTML, XML, VBScript, ASP, JavaScript, JSP, J2EE.
• Automation Tools: MS Visio, Rational Rose, Rational Clear Case, Rational Requisite Pro.
• 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

Professional Experience:

Confidential

Lead Business/Systems analyst

Responsibilities:

• Conducted complex documentation and user needs analysis. Interface with team and staff to develop HL7 integration
• Assisted JAD sessions to identify the business flows and determine whether any current or proposed systems are impacted by the EDI X12 Transaction, Code set and Identifier aspects of HIPAA
• Developed automated test scripts to test ASP.NET web pages server controls, user controls and custom controls.
• Tested all types of WEDI testing for HIPAA including Integrity testing using the web tools like EDIFECS and Data Transformation Application in Mercator.
• Developed the strategy for developing and implementing new EDI HL7 and X12 interfaces and converting historical clinical and data.
• Gathered high-level requirement for all the external projects in a release.
• Assisted the IT team to develop service oriented architecture SOA , and data warehouse system to utilize data mining for data analysis
• Facilitated JAD sessions with SMEs and business analysts from other feeder systems for a detailed analysis and a better understanding of impact of various projects on each other.
• Personally responsible for attaining HIPAA EDI validation from Medicare, Medicaid, and other payers or government carriers.
• Developed HIPAA EDI Transmissions for both government carriers and commercial entities. Work includes complete business cycle management and hands-on production as well. Create EDI Testing process, documentation, and performance matrices.
• Created test cases to validate that the configured Trizetto Facets product configuration functions as intended and to uncover any risks or issues with the solution.
• Provided recommendations for improving testing approaches and techniques including integration testing, functional testing and user acceptance testing expertise to ensure that the configured Trizetto products and services are functioning as expected and will meet end user requirements.
• Working on problem solving skills to recognize and reduce redundancies in testing efforts, minimize complexity and created efficiency without compromising effectiveness.
• Acted as a peer leader for the testing efforts of Facets configured solutions for Projects.
• Demonstrated good judgement in defining methods Techniques for obtaining solutions and data requires a review of a variety of factors.
• Used SDLC System Development Life Cycle methodologies like the RUP and the waterfall.
• Performed criteria table updates for each project.
• Extensively interacted with the stakeholders and the IT Department in finalizing the requirements according to the Compliances/Regulations and HIPAA Regulations.
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, OOAD using UML and Business Process Modeling.
• Worked extensively with MS Excel and MS access
• Developed test plans with QA team and helped to develop test cases for system testing, integration testing and performance testing.
• Worked with the management for improving and giving new ideas for designing future processes of the HIPPA transactions dealing out with EDI'S 271, 276 and 270, 470, 835, 837, 834, HIPAA 4010 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 and also well versed with ICD10, FACETS.
• Lead several small to medium complexity testing efforts with in a team.
• Provided guidance on complex issues to others as needed.
• Created Mapping Documents, Report Mock-ups and modified existing report mock-ups and finalized for development.
• Created a fast track mapping document for the defects filed which help the developing team to fix those defects.
• Understand the flow of data, Reviewed and analyzed data from various sources.
• Conducting session with developing teams for the coding of functional requirement for projects.
• Studied previously created mapping document and updating them according to the new requirement.
• Work with testing team to create the testing scenarios, Queries, helping them to understand the logic.
• Work with developing team to solve the defects generated by the Testing team.
• Conducted UAT to confirm that all derivative products can be successfully processed through stages of the trade life cycle.
• Worked with Testing Team to solve the defects identifying during the regression testing, System testing and UAT testing.
• Uploading and Modifying document on SharePoint Site.

Environment: Windows XP SP-3 , Caliber,HL7, Toad-11,Toad-Data Modeler, HP Quality Center, MS Excel, MS Word, Visio, MS Power Point, SQL, DB2, SharePoint 2010.

Confidential

Lead Business Analyst

Responsibilities:

• Planned and documented procedures for data processing and prepared data flow modeling for the application.
• Designed Data Flow Diagrams DFD's , Entity Relationship Diagrams ERD's , and web page mock ups using modeling tools.
• Integrated Requisite Pro with Clear Quest and Rose to provide all teams visibility and maintain tractability among requirements, use cases and change requests
• Created Use-Cases and Business Use-Case Model after accessing the status and scope of the project and understanding the business processes
• Worked with developers and designers of BPM System to make sure development understands business process and detailed technical requirements.
• Worked in development front-end production entry screen and batch interfaces between remote AS/400s and the corporate mainframe
• Created business process workflow diagrams Activity diagrams in Rational Rose
• Identified Use cases from the requirements and wrote Use Case Specifications
• Analyzed and translated business requirements into system specifications utilizing UML and Agile methodology.
• Met with Business Users, Project Manager and SMEs, discussed the project scope and main end-to-end pipelines in the present system.
• Conducted CR Change Request walk-thru and approved FSD, BRD, Artifacts, CR Sign-offs.
• Collected and evaluated business requirements, functional specifications, project schedules, documentation and test plans for the Online Account Management system to ensure the registered customers had online web based access to their accounts and investment portfolios.
• Interacting with the stakeholders to get a better understanding of client business processes and gather business requirements.
• Performed Data Analysis of existing data through SQL.
• Created test plan and test cases for user acceptance testing. Used Rational testing tools.
• Participated in UAT and worked with Mercury Quality Center for bug and defect tracking.
• Developed detailed Test plan, Test Cases, Test scripts for testing the functionality, GUI and security testing.
• Used the Unified Change Management from Rational to track changes to multiple artifacts by versioning artifacts, associating requirements to specific change request/defects to streamline the defect/change tracking process.

• Assured that all Artifacts are in compliance with corporate SDLC Policies and guidelines.

Environment: Quality Center, Rational Rose, Rational Requisite Pro, DB2, Rational Clear Quest, JAD, Rational manager, Rational Administrator, Web logic, SQL, Java, J2EE, VB.Net, Oracle, HTML, UML.

Confidential

Business Analyst

Responsibilities:

• Conducted business analysis, acted as a liaison between project manager, business users', IT team, and used MS Office for the documentation.
• 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
• Performed the requirement analysis, impact analysis and documented the requirements using Rational Requisite Pro.
• Prepared Business Context Diagram, Use Case diagrams and corresponding Activity Diagrams using Rational Rose to depict the workflows to be incorporated into the development of Pega Business Process Management BPM tool.
• Worked on Claim processing system Professional, Institutional, Pharmaceutical Claims
• Prepared documents for business requirements document BRD , systems requirements specification SRS , high level design documents HLDD , and traceability mapping / matrix with the assistance from the business group, and the IT team members.
• Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data within the Oracle database
• Validated the member group, subgroup, class codes and billing entity information in Facets application
• Defined the test criteria, project schedules and base lined the Test Plan with the help of project meetings and walkthroughs.
• Worked on projects independently and also managed a Facets testing effort.
• Tested the Members, Claims, Providers and Services in Facets.
• Developed the strategy for developing and implementing new EDI HL7 and X12 interfaces and converting historical clinical and data.
• Worked on Claim processing system Professional, Institutional, Pharmaceutical Claims
• Worked on Accounting Systems such as General Ledger GL , Accounts Receivables A/R and Accounts Payable A/P
• Extracted the Business Requirements from the end users keeping in mind their need for the application and prepared Business Requirement Documents BRD using Rational Requisite Pro.
• Created workflow diagrams, and flowcharts using MS Visio, which were used to diagrammatically represent the process of placing a request and getting approved or rejected.
• Wrote Test Plans in MS Word for Manual Testing, System Testing, Integration Testing, Performance Testing, Regression Testing reviewed their consistency with the business requirements
• Used Test Director and HP Quality Center for updating the status of all the Test Cases Test Scripts that are executed during testing process.
• Generation of XML Messages as test data and expected result data for various HL7 messages.
• Extensively worked in preparing the EDI transmission files, dropping them in Inbound, Outbound Interfaces and validate the data according to our test scenarios.
• Worked with the management for improving and giving new ideas for designing future processes of the HIPPA transactions dealing out with EDI'S 271, 276 and 270, 470, 835, 837, 834, HIPAA 4010 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 and also well versed with ICD10, FACETS.
• Testing on EDI scenarios EDI 270/271, EDI 275/276, EDI 834/837
• Followed HIPAA Standards 4010 5010 , EDI and Compliance issues, Medicare, Medicaid, ICD 9, ICD 10
• Very good experience in creating the 837 I and 837 P claims and verify the all the data elements are mapped correctly on the 835.
• Involved in various HIPAA and HL7 testing and validation for EDI transactions using 820, 834, 835, 837, 270/271, 267/277, 278.
• Involved in Large volume data conversion, data cleansing, production report generation and upholding scheduled data delivery standards.
• Performed data validation and massaging to ensure accuracy and quality of data
• Monitored and resolved all customer invoice data issues and coordinate with various vendors and manage all previous balance.
• Migrated Data from MS Excel to SQL Server Reporting Service Using DTS and SQL loader utilities.
• Analyzed the requirements of data marts. Worked with business users to understand their reporting requirements, worked with Reporting team to develop report prototypes, demonstrated report prototypes to the business users, came up with FRDs for the data
• Designed and developed Use Cases using UML and Business Process Modeling.
• Extensively involved in the automation of Regression Test Cases by scripting.
• Applied Unified Modeling Language UML methodologies to design Use Case Diagrams, Activity Diagrams and Sequence Diagrams in Rational Rose.
• Created business use case, user requirement document URS , functional FRS and technical documents for trading system.
• Responsible for identifying and documenting business rules and creating detailed Use Case.
• Created test cases to test the liability,comprehensive,collision coverages.
• Developed several detail and summary reports including line and pie charts, trend analysis reports and sub-reports according to business requirements using SQL Server Reporting Services SSRS .
• Created the SQL scripts for demonstrating the prototypes and for verifying the result sets

Environment: Microsoft Office 2003 Professional Outlook, Word, Excel, Visio, Access, etc. , Microsoft SharePoint 2003,UML, RUP, UAT, db2, HL7,Mercury Test Director, SQL, .NET, Clear Case