EXPERIENCE SUMMARY:

• Around 9 years of experience in systems and Business analysis in Health care, with FACETS and extensive interaction with client.
• Insightful knowledge of business process analysis and design, domain & technology expertise with strong integration skills.
• Experienced as a FACETSBusinessSystems Analyst in gathering the business requirements from the existing stored procedures, supporting the Interfaces and reports development in explaining the functional requirements, proposing technical solutions, supporting the unit testing and system integration testing with the functional flow.
• Experience as a Business Systems Analyst in mapping business requirements, designing customized solutions with strong analytical skills and ability to analyze business practices and define optimal procedures.
• Experienced working with Facets changes analysis, design and migration strategy
• Immense knowledge in Health care payer operations, Interfaces, Reports, Letters and system Migrations, Health Administration - Claims processing (auto adjudication), Claims pricing and testing, HIPAA, enrollment, Medicare, Medicaid, CDHP.
• Expertise in HealthCare Administration/Managed Care Systems working with various Claims Systems/Applications with multiple healthcare client systems, with prime focus on claims adjudication, provider, eligibility.
• Expert in SDLC (System Development Life Cycle) methodologies like the RUP and the waterfall.
• Knowledge of the following HealthCare EDI Transactions for 4010/5010 like (278) Referral Certification and Authorization, (834) Benefit and Enrollment, (835) Payment & Remittance Advice, (837 I & P) Institutional and Professional HC Claim
• Functional experience with concentration on Use Case modeling using UML, Business Process Modeling, Data Modeling, Change Management, Technical Training, Software Development methodologies, QA testing, and Systems Testing interfaces, Reports, Letters.
• Good expertise in creating Test Cases on the basis ofproduct features, client requirements and technical documents.
• Developed, executed and maintained Test Scripts, Reviewed and documented system and implementation Test Strategy Documents for Parallel Testing, and system integration testing.
• Great communication skills, client relations, presentation and negotiations with creative approach to problem solving through use of excellent analytical skills.
• Involved in building the Health care center of Excellence across by involving in creating and sharing the knowledge base and conducting sessions across the organizations.
• Managing requirements traceability information and tracking requirements status throughout the project.

TECHNICAL SKILLS:

Data Base: MS Access, Oracle (SQL Series), SQL server 2005, Sybase

Operating Systems: MS: DOS, Windows95/98/NT/2000/XP/2007

Software: MS Office Suite (Word, Excel, Access, PowerPoint Outlook), MS Visio, Adobe Acrobat, Lotus Notes, Crystal Reports, SharePoint.

Requirement Tools: Requisite Pro, RTM

Healthcare Domain: Claims, Providers, Membership, etc.

HealthCare System: FACETS, Trizetto, FACETS Applications and Configuration

Project Methodologies: SDLC, Agile, Rational Unified Process (RUP), UML, JAD, JAR

PROFESSIONAL EXPERIENCE:

Confidential, Bronx, NY

Business System Analyst

Responsibilities:

• Interacting with client’s team SME’s and key users to understand their business processes and solution management within timelines.
• Followed Workgroup for FACETS Electronic Data Interchange standards for testing that need to comply with the HIPAA guidelines.
• Involved in project planning, coordination and QA methodology in the implementation of the FACETS in the EDI transaction of the claims module.
• Running queries of the product database
• Reviewed Test Scripts, Technical Specification Documents, and worked on application’s input / output data definitions.
• Worked in FACETS Output generation, Interface development and FACETS Migration Projects.
• Documents the results of the audit and make recommendations as needed
• Prepare detailed system requirements, specifications and documents and provide consultative services through all phases of the System Development Life Cycle
• Elicit and prepare detailed system requirements through conducting JAR/JAD sessions, interpreting business requirements and working with business partners and development teams
• Ensures coding and Configuration, meets current business policies and practices, and supports the efforts of compliance review and audit of employer group benefits.
• Undertaking Quick Gap Analysis; current / future business process analysis, generating documents of future business process and validating same from the company.
• Prepare requirement specifications such as Use cases and System requirement specifications and Supplementary specifications
• Worked on the database analysis part by helping the technical team in identifying the data sources required for the application and coordination with the IT team in migration of the data within the databases.
• Conceptualizing and developing functional specifications across different business areas such as Claims, Membership, PBM etc.
• Preparing business use cases; map Business Requirement / Software Requirements Specifications (SRS) document (As-Is & To-Be Analysis) and GAP Analysis and translating them into functional specifications, detailed test plans and coordinating for Go-Live.
• Involved inFACETSConfigurationto make sure all information will be sent without any error
• Created and managed project templates, Use Case project templates, requirement types and trace-ability relationships in Requisite Pro.
• Involved in developing database objects usingTrizettoFACETSdatabasein both SQL Server and Sybase environments.
• HIPAA Gap Analysis.
• Performing knowledge transfer to the technical/development and QA team by creating quality test cases and providing accurate test data.
• Involved inConfigurationManagement, Requirement management and analysis.
• Design and review of various documents including the Software Requirement Specifications (SRS), including USE Cases, Business requirements document (BRD), Use Case Specifications, Functional Specifications (FSD), Systems Design Specification (SDS), Requirement Traceability Matrix (RTM) and testing documents
• Documenting requirements and creating functional design documents, process flow and design flow diagrams. Defined Functional Test Cases, documented, Executed test script in FACETS system.

Environment: Trizetto FACETS, Windows, Quality Center, MS Project, EDI Gateway, Rational Enterprise Suite (Rose, RequisitePro, ClearCase, Clear Quest), SQL, PL/SQL, SQL Server, Oracle.

Confidential, Atlanta, GA

Business System Analyst

Responsibilities:

• Offer support tobusinesscustomers in dealings with Technology Services and translates requirements intoConfigurationsolutions
• Design, build and testFACETSConfigurationin support ofbusinessrequirements
• Worked on FACETS extensions mapping attributes.
• Participate in functional specification and design reviews, validatingConfigurationaspects
• Executing system test scripts on query output and quantifying, analyzing, and summarizing test results.
• Gathering business requirements and converting them into functional requirement specifications and user requirement specifications. Used Rational RequisitePro for Requirement Document preparation.
• Analyzed the current Business Requirements gathering process with BPM and re-established/optimized the process JAR.
• Conducting data driven analyses to help break down, prepare and analyze data for testing, auditing, and improvement of query performance.
• Gathering and documenting project requirements/specifications and experience with the System Development Life Cycle.
• Developing and executing SQL queries against data warehouses to support data mapping and ad-hoc analysis.
• Conducted one on one interviews with high level management team and participated in the JAD session with the SME’s.
• Primarily support Enrollment, Billing and Fulfillment systems for Individual and Group products
• Conducted Business validations for different FACETS modules Providers, Claims, enrollment and Membership
• Migration of Data was done from the previous version to the next version
• Experience working with Trizetto FACETS and its Provider contracts and Member benefit modules.
• Transitioning design deliverables to the development team and supporting development team during build and unit test phase.
• Involved in Testing the Member portal website and worked on the requirement gathering and Analysis for developing the Ad-hoc reports that are extracted from the consumer portal back end data.
• Involved in process analysis and defined executed data and Facets migration plans for local data for global applications.
• Actively working with business users, development, QA teams and onsite/offshore team.
• Conducting reviews of SRS written by peers and junior colleagues.
• Setup reoccurring HIPAA 5010 and/or JAD sessions to review both physical and logical models for business processes and data transaction processing and adjudication processes.
• Involved in Facets Output generation, Interface development and Facets Migration Projects.
• Defined Functional Test Cases, documented, Executed test script in FACETS system.
• Created Process Flow diagrams, Use Case Diagrams, Class Diagrams and Interaction Diagrams.

Environment: TrizettoFACETS, Windows, MS Office, MS Visio, Quality Center, SAS, Cobol, HIPPA Gateway, PL/SQL, MS Project, SQL, SQL, Server, Rational RequisitePro

Confidential, Dallas, TX

Business System Analyst

Responsibilities:

• Developed plan for data feeds and data mappings for integration between various systems, including XML, to follow ICD 10 Code set and ANSI X12 5010 formats.
• Used Crystal Reports for .NET and Crystal Report Viewer to create quick-in-time reports.
• Participated in project meetings to support the team as required, Organized various meeting with SME’s and testing Team to ensure that we are on track with all of our deliverables, tracked all our deliverables on a daily basis by using Deliverables tracking Template. Teamed up with both internal and external software development teams to provide functional requirements specifications in the form of use cases, business process flows, and prototypes and management reporting requirements.
• Designed Data Flow Diagrams (DFD’s), Entity Relationship Diagrams (ERD’s), and web page mock ups using modeling tools. Involved in formatting data stores and generate UML diagrams of logical and physical data. Used Query Analyzer, Execution Plan to optimize SQL Queries.
• Produced Gap Analysis documents for HIPAA 5010 and ICD-10.
• Networked with Subject Matter Experts, Project Manager, Developers, and Process Analysts to understand the business process, gathered Business Requirements and identified enhancements.
• Extensively developed project documentation, process flow documents, formal proposals, RFQ’s and RFP’s. Formulated methodologies and developed SDLC phases, strategies, time & cost estimates with milestones for each phase.
• Prepared Business Requirement Documents (BRD’s) after the collection of Functional Requirements from System Users that provided appropriate scope of work for technical team to develop prototype and overall system.
• Worked with ICD-9 encoding to verify the validity of incoming claims, documented ICD-9 codes presently used by the system.
• Understanding and assessment of the current ICD 9 codes used by the State
• Creation of a Gap/Impact Analysis Document for changes of the EDI Transactions (837, 835, 276/277, 270/271)
• Creation of a Gap/Impact Analysis Document for changes to Pharmacy Transactions (real time and batch) based on NCPDP 5.1 to NCPDP D.0, specifically concerning the data elements
• Creation of a Mapping Document for ICD9 Codes to ICD 10 Clinical Modifications and Procedural Codes.
• Creation of Gap/Impact Analysis Document for the Prescription Drug Point of Sale System

Environment: MS Office Suite, POS, GEMS, Document Analyzer, SharePoint, MS-Visio, MS Excel, MS Access, Mainframe, ETL, UML, Rational Requisite Pro, Rational Rose, Rational Clear Case, Rational Clear Quest, html, JAVA, Asp, MS Window Server.

Confidential

Business Analyst

Responsibilities:

• Conducted JAD (Joint Application Development) Sessions and RAD (Rapid Application Development) Sessions with stakeholders.
• Assisted the PM in managing the Agile Scrum process to ensure smooth delivery of projects.
• Performed Data Profiling of current state of data in the Data Warehouse by doing Data Analysis using advanced SQL Queries and Microsoft Excel, finding Gaps in Data and formulating solutions for the same.
• Set and Maintained targeted inventory levels for customers while addressing shortage or overstock situation, SKU at Warehouse.
• Successfully took part and implemented new process change and implementation for better customer delivery.
• Checked to make sure orders from customers are accurate and free of any variance by working closely with the sales, shipping department and warehouse.
• Conducted interviews with key business users to collect requirement and business process information.
• Designed the business requirement collection approach based on the project scope and SDLC methodology.

Confidential

Business Analyst

Responsibilities:

• Worked with the project manager for planning and organizing the project activities, and in communicating with other business center mangers and stakeholders of the project.
• Gap Analysis of client requirements, generated workflow process, flow charts and relevant artifacts.
• Gathered requirements, developed Process Model and detailed Business Policies.
• Designed Use Cases using UML and managed the entire functional requirements life cycle using RUP.
• Worked with the project manager to estimate best/worst case scenarios, track progress with weekly estimates of remaining work to do, conducting informal meetings ad hoc and as needed.
• Followed the RUP methodology for the entire SDLC.
• Involved in writing and implementation of the test plan, and various test cases for UAT.
• Prepared the Business Workflow using MS-Visio with input, output, Pre and Post conditions.
• Enhanced test cases and scripts by adding the required functionality as per the new business requirements. .
• Participated in various meetings and discussed Enhancement and Modification Request issues.
• Attended weekly meeting to discuss progress and modification to test plans due to change in business requirements.