PROFESSIONAL SUMMARY:

• 7years of experience as a Business Analyst with extensive experience leading Business Intelligence Information Management (BIIM) assessments, facilitating requirements gathering, developing methodology and implementing Master Data Management (MDM), Reporting, Data Governance and Stewardship strategies in Pharma and Healthcare Industry.
• In depth knowledge of Software Development Life Cycle (SDLC) and experience in management of requirements throughout SDLC.
• Excellent Knowledge of Business Requirement Document (BRD), Functional Requirement Document (FRD), Functional Specification Document (FSD)
• Experienced in performing end - to-end User Acceptance Testing (UAT).
• Experienced in designing, capturing, consolidating, and maintaining key metrics with Agile and Scrum Protocols.
• Hands on proficiency and experience with Windows; MS Project, PowerPoint, Excel, Word, Access, Outlook, Visio, Photoshop, Illustrator, Outlook, and Microsoft Office SharePoint Server (MOSS) to create effective inter-organizational, client, management communications and presentations.
• Extensive experience in working with MS Excel. Created various charts, graphs, pivot tables, and ad-hoc reports in excel.
• Involved in project management using MS Project.
• Highly Motivated Team Player with experience in working with large organizational environment.
• Ability to work with several partners/colleagues and deliver the results in time and/or resource constrained environments.
• Excellent oral and written communication skills.

TECHNICAL SKILLS:

Software/Hardware: Rational Team Test, OOAD (OOA/OOD), RUP, UML, Rational Rose, Rally, Clear Case, Clear Quest, WinRunner, Load Runner and Test Director, C, C++, Java, HTML, J2EE, VB, SQL, Windows 9x/NT/2000/XP, Unix, Linux, Solaris, Oracle, SQL Server and MS Access, SPSS, RDBMS, DB2, Teradata, Mainframe, JSON, TSL, SQL Basic, Shell Scripts, Crystal Reports, Cognos, MS Visio, MS office, Adobe PageMaker, Adobe PhotoShop, Altova Mapforce, MS Project, Waterfall, Agile, Adobe workflow systems, Weblogic Server, iRise, Mercury Quality Center, MS SharePoint Server, Quick Development Case and Quality Review Tool(QDQ), Informatica Data Quality (IDQ), MDM, IMS.

PROFESSIONAL EXPERIENCE:

Confidential, Trumbull, CT

Sr. Business Analyst

Responsibilities:

• Experienced in large enterprise projects, leadership experience, requirements interviewing, meeting facilitation, project management, state health/public health, HEDIS, SOA.
• Worked on project life cycle and SDLC methodologies including RUP, RAD, Waterfall and Agile.
• Led and conducted JAD sessions for requirements gathering, analysis and design of the system.
• There are no co-pays for members as the company is a Managed Medicaid and Medicare Advantage Company With the implementation of the Affordable Care Act, CareSource entered the health insurance marketplace.
• Involved in investigating ofActuarialand submission date from CMS on yearly basis based on the new/updated members enrolled to minimize the risk.
• 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.
• Performed System testing of the Claims processing systems (Pricing Rules, Duplicate/Limits validation, Member Eligibility, Provider Enrollment etc.).
• Worked on eligibility files with the Claims dept. ensuring all the data and enrollments were correct and updated in AMISYS Advance.
• Facilitated, documented and oversaw the provider set-up and contract configuration in AMISYS Advance.
• Experienced with Trizetto Facets System implementation, Claims and Benefits configuration set-up testing, Inbound/Outbound Interfaces and Extensions, Load and extraction programs involving HIPPA 837 and proprietary format files and Reports development.
• Strong Functional knowledge in the core Facets modules such as Plan/Benefits,, Provider, Claims, Billing, Customer Service & Utilization Management, Care Management.
• Documented Medicare claims processing.
• Provided test data to all the testers including UAT Business Edge team and UI testing team.
• Involved in preparing Test Data based on the functionality of all the HIPAA Related Transactions (837/835, 270/271, 276/277) and AMISYS transactions.
• Comprehensive understanding of HIPAA Standards (4010 & 5010) and Compliance issues, Medicare, Medicaid, ICD9, ICD10 and Claims adjudication process.
• Involved in HIPAA EDI transactions & Electronic Interface Standards such as NCPDP & 835, 837 (P, D, I) 276, 277, 278.
• Produced Gap Analysis documents for HIPAA 5010 and ICD-10.
• Involved in creating sample mappings for the conversion of EDI X12 transactions code sets version and translation of ICD 9 codes into ICD 10 codes.
• Used MS Visio to create business process flowcharts and workflow diagrams, Involved in detailing project mission, Data Process Flow Diagrams and timelines, prepared data interfaces using XML and JSON data formats.
• Analyzed and translated business requirements into system specifications utilizing UML and RUP methodology.
• Developed straightforward DBMS queries, knowledge of HL7 and xml interface messaging.
• Worked in mainframe environment and used SQL to query various reporting databases.

Environment: Medicare, Oracle, Facets, Agile, Medicaid, HIPAA-compliant patient information management and billing system and Microsoft Office package, Metadata, Data Warehouse, SQL, DB2, RDBMS, Erwin, Oracle, Rally, Rose, MS Word, MS PowerPoint, MS Excel, MS Visio, HP Quality Center.

Confidential, Southfield, MI

Business Analyst

Responsibilities:

• Used Agile Scrum for the Requirement Documents Preparation and Prepared Business Process Models that includes modeling of all the activities of the business from the conceptual to procedural level. Followed top down, leveled technique for building Business Process Models.
• Used SDLC (System Development Life Cycle) methodologies like RUP, Agile and waterfall.
• Involved in data migration from the existing system Cerner (Internal Application for Account Receivable and Coding) to new systemIMS(Intelligent Medical Software).
• Worked as a Business Analyst for ETL projects that extract data from various source systems for subject areas - Revenue, Billed, Medical Claims, Pharmacy Claims, and Capitation.
• Worked on Claims, enrollment, billing, eligibility verification for members and providers, benefits setup, and backend payment cycle in facets.
• Experienced in Facets andPharmacydata.Worked with Claims, enrollment, eligibility verification for members and providers, benefits setup and backend payment cycle in Facets.
• Experienced in EDI automated first-pass claim adjudication, requiring thorough understanding of claim processing, both front and backend operations.
• Extensive experience in Clinical Data Management, data analysis and generated CRT tables, reports, graphs for FDA submission according to protocol.
• Extensive experience in assessment of the integration of Electronic Health Records (EHR) and its’ integrity with the new system that aims to automate the existing E-Clinical workflow (ECW).
• Extensive experience in E-Clinical workflow (ECW), HIM, quality and case management workflow.
• Worked under the Governmental compliances like EDI, PHI, and HIPAA standard.
• Involved in configuring and validating Laboratory Information System (LIS) for QC and Clinical Laboratories.
• Participated as a core team member of a Clinical Development initiative to create an architectural business end-to-end solution for clinical trials as a standard for all remote data capturing clinical trials.
• Involved in Utilization management, Claims adjudication, grievance and appeals, 820, 834, 837/278 EDI transactions to update claims and Prior Approval (Pre authorization) process for professional and Facility claims.
• Strong experience with largedatasets, EMR,PharmacyData, Claims and Encounter, ICD 10, NCPDP, Disease Management, Care Management, HEDIS, HIPAA.
• Responsible for sales and marketing specializing in practice management, managed care systems, thin-client technology, Electronic Media Records (EMR/EHR/PHE/PMR), ASP technology, and full integration tools.
• Strong knowledge of managed care payer requirements and procedures.
• Provided Network Filedatato a single platform (ProviderDataExchange) for specific Medicaid state program markets.
• Implemented the entire Rational Unified Process (RUP) methodology of application development with its various workflows, artifacts, and activities.
• Obtained business requirements from business users and stakeholders using JAD sessions, brain storming sessions, focus groups and personal interviews to get a better understanding of the client's business process.
• Created meaningful reports for analysis and integrated the Performance Testing in the SDLC.
• Tracked defects using JIRA and assisted QA teams to resolve defects.

Environment: Windows XP, Microsoft Office SharePoint, HP Quality Center, Rational Requisite Pro, XML, SOA, PL/SQL Server, Agile, MS Project, MS FrontPage, MS Access, MS Visio, MS Excel, MS word, EDI, Documentum, IMS

Confidential, Chicago, IL

Business Analyst

Responsibilities:

• Served as Liaison between business users and technical solution developers.
• Experienced in large enterprise projects, leadership experience, requirements interviewing, meeting facilitation and project management.
• Experienced in development methodologies like RUP, SDLC, AGILE, SCRUM and Waterfall.
• Performed Requirement Gathering & Analysis by actively soliciting, analysing and negotiating customer requirements and prepared the requirements specification document for the application using MS Word.
• Directed the oracle clinical trial data capture and worldwide data collection systems for various therapeutic areas.
• Tested the ETL Informatica mappings and other ETL Processes (Data Warehouse Testing).
• Participated in Salesforce.com and Veeva, Master Data Management, Customer Data Integration, Roster database upgrade, and other significant Siebel related projects.
• Involved in testing the Pharmacy Claims adjudication and Billing processing is done through PBM (Health Trans) and Claims Accumulation and Adjudication is done through Diamond.
• Developed strategy for managing identified utilization patterns for online portal for PBM (Pharmacy Benefit Manager) Implemented and performed outcomes analysis for above strategies.
• Created RUP activity diagrams and sequence diagrams to analyse the requirements and recommend solutions.
• Involved with all the phases of Software Development Life Cycle (SDLC) methodologies throughout the project life cycle.
• Prepared scenarios, Use Cases & UML State Diagram for scenarios using Rational Rose.
• Prepared presentation slides in MS Project, which was extensively used in different JAD sessions and to track progress.
• Implemented Rational Unified Process (RUP) and Business Process Mapping (BPM) across the organization.
• Carried out GAP analysis and prepared workflow diagrams, designed new process flows and documented the business process and various business scenarios.
• Conducted Requirement Workshop to gather requirements from various departments. Conducted Focus Groups and Interviews with stake holders and subject matter experts to understand functionalities to be incorporated in the platform, deemed critical for the respective organizational needs.
• Employed MS VISIO for creating Use Case diagrams and Sequence diagrams for a clear understanding of business process by the development team and other stake holders.
• Participated in UAT and worked with Mercury Quality Center for bug and defect tracking.
• Managed Product Backlog with the help of Product owner and Scrum development team by employing JIRA to generate reports to analyze the performance of the application.

Environment: Windows XP Professional, Oracle, XML, SOA, MS Access, MS Excel, MS Visio, MS project, RUP, Oracle, UML, Rational Rose, Requisite Pro, Clear Case, Rational Clear Quest, MS Office suite, MS Visio, PL/SQL, Business Objects, ETL, Oracle, Mainframes, COBOL, IMS.

Confidential, Mettawa, IL

Business Analyst

Responsibilities:

• Gathered user requirements and directed developers for practical deliverables.
• Worked on following applications Business Objects, Enterprise Architect, Toad, PlanView (project management), Microsoft Suite (Word, Excel, PowerPoint, Visio, Access, Project).
• Strong understanding of various PMO techniques used in SDLC such as Rational Unified Process (RUP), Waterfall, Agile and SCRUM with hands on experience in each of them.
• Worked on receiving Encounter files from their PBM (Pharmacy Benefit Manager), verifying the data content by transactional analysis.
• Simultaneously managed multiple SDLC enhancement projects in Pharmacy Benefit System (PBM).
• Succeeded in implementing a Pharmacy Benefits management (PBM) program using encrypted FTP data feeds.
• Informed the business and the team about a new Veeva Releases enhancements, and set up the Kick-off Meeting with the senior manager and SME's.
• Facilitated sessions with SME’s in understanding the requirements pertaining to billing Origination to billing Processing.
• 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.
• Participated Testing and Evaluation of projects at established integration points to assess progress and identify key functionality issues.
• Fixed issues /defects rose during UAT by working with the IT team.
• Conducted JAD sessions to facilitate discussion between the different users to resolve issues and come to an agreement.
• Performed job of contact point for all stakeholders (business, legal, compliance, development)

Environment: Mainframes, COBOL, RDBMS, Oracle, SQL, Agile, Java, J2EE, SOAP, Rally, Rose, MS Word, MS PowerPoint, MS Excel, MS Visio, JSON, LoadRunner, Mercury, WinRunner, HP Quality Center, ETL Informatica, IMS.

Confidential, Columbus, OH

Business Analyst

Responsibilities:

• Obtained business requirements from business users and stakeholders using JAD sessions, brain storming sessions, focus groups and personal interviews to get a better understanding of the client's business process.
• Prepared UAT Materials, including the UAT Process, UAT Test document which would include step-by step process for UAT as well as all the tests that would cover all requirements.
• Performed Gap Analysis to check the compatibility of the existing system infrastructure with the new business requirements. Data Warehousing (DWH)/Business Intelligence (BI) expertise, wherein actively involved in Datamart Design, Modeling and Implementation.
• Developed implementation guidelines and principles for practice-based clinical applications, including various practice management and EMR systems.
• Analyzed, designed and successfully completed the full product development life cycle of a high visibility, high throughput screening Laboratory Information System (LIS).
• Extensively involved in every phase of the RUP process starting from Inception to Transition
• Implemented the entire Rational Unified Process (RUP) methodology of application development with its various workflows, artifacts, and activities.
• Implement an electronic medical record (EMR) system using a Windows basedAllscriptssolution that provided physicians and other medical staff with faster, more streamlined access to patient records.
• Experienced inAllscriptsEMR healthcare systems.
• Responsible for sales and marketing specializing in practice management, managed care systems, thin-client technology, Electronic Media Records (EMR/EHR/PHE/PMR), ASP technology, and full integration tools.
• Produced UML Activity diagrams with defined swim lanes using MS Visio as part of claims process analysis
• Responsible for building a Business Analysis Process Model using Rational Rose and Visio.

Environment: Rational Requisite Pro, Share Point, SQL, UML, Agile, MS Visio, Win Runner, Test Director, HP Quality Center, MS Access, Window, Java, J2EE, Oracle, RDBMS.