SUMMARY:

• Very Strong PL/SQL skills writing queries and verifying data with solid understanding of Databases, Data Warehouse, OLTP, OLAP, Data Modeling, Business process design, application systems analysis, object oriented analysis, Business Intelligence tools like Business Objects involved in gathering data mart requirements from business users
• Proficient in developing Data Flow Diagrams DFD , Use Case Diagrams, Flowchart Behavior Diagrams Sequence diagrams and Activity diagrams based on UML methodology using Rational Rose and MS Visio.
• Expert in working with SME's Subject Matter Experts across each group during entire SDLC with strong experience in conducting GAP Analysis, Cost Benefit Analysis, SWOT Analysis and Return of Interest ROI Analysis.
• Expertise in defining Scope of projects based on gathered Business Requirements including Documentation of Constraints, Assumptions, Business Impacts, Project Risks Scope Exclusions.
• Thorough Understanding of SDLC Software Development Life Cycle involved in all phases from Planning to the Implementation stage. In depth knowledge and experience in Classic Waterfall, Rational Unified Process RUP , Agile, Scrum, RAD Rapid Application Development methodology.
• Extensive experience in gathering requirements by conduction of JAD sessions Joint Application Development , Interviews, Workshops and Requirement Elicitation sessions with end-users, clients, stakeholders and development team and converting them in to BRDs Business Requirement Documents and FRDs Functional Requirement Documents or NRFD Non-Functional Requirement Document .
• Over 7 years of extensive experience in Business Analysis with hands on experience in integrating business needs into IT solutions with core activities like: Requirement Gathering Analysis, GAP Analysis, Designing, Software Development, Implementing, Software Validation/Testing, Project Cycle Management PCM in industries like Healthcare, Insurance and Pharmaceuticals and extensively worked on Insurance Claims, Medicare/Medicaid Claims.
• Experience in Change Management Process Identify, Analyze, Evaluate, Plan, Implement, Review and Close
• Experienced with HIX Health insurance Exchange , PPACA Patient Protection and Affordable Care Act , Plan Management, Eligibility and Enrolment process, SHOP Small Business Health Options Program as well as Financial Management.
• In depth understanding of the HIPAA 4010 and 5010 compliance standards, CPT/ HCPCS, HIPAA insurance regulations and claims processing, ICD-9, ICD-10 coding and HL7.
• Excellent knowledge of Medicare Part A, Part B, Part C and Part D.
• Thorough Understanding Experience in EDI Electronic Data Interchange transactions and Codes like: ANSI X12 837 Health care claims , 820, 835, 270/271 Inquire/response health care benefits , 276/277 Claim-status , 278 Health Care Services Review Information , 834 Benefit-enrollment , 835 Payment/remittance advice , 999 Implementation Acknowledgement document transactions and ICD-10 Code sets, and CMS.
• Experience with conducting assessments and impact/gap analysis concerning State Medical Management Information System MMIS .
• Experienced in Conversion of HIPAA X12 4010 codes to X12 5010 codes.
• Experienced in-depth knowledge in Conversion of, ICD 9-CM Clinical modification to ICD-10-CM/PCS Clinical modification/procedure coding system and CPT codes for mental and medical health.
• Adjudicated Medical Professional and Institutional and Pharmacy Claims in Claims adjudication and procedures, pay professionals and members, select Individual claims for payments, change the claims status of an individual payment to hold or release, create, print, or display EOB explanation of benefits for a member or EOP explanation of payments for a provider.
• Experience in Conversion of HIPAA X12 4010 transactions to X12 5010 transactions.
• Hands on experience in Claims Adjudication System and Complete Revenue Life Cycle
• Worked with Claims NASCO , provider, enrollment, finance, benefits and Vendor Management Business Areas.
• Experience in White Box, Black Box, Unit, Functional, Integration, User Acceptance Testing UAT , Back End and System Level Load and Stress Testing for many types of applications including web and client-server applications.
• Assisted QA Quality Assurance team in writing test plans, defining test cases, test scenario and data sets.
• Expertise in designing and building Work Flows using MS SharePoint 2007/10/13.
• Excellent understanding experienced in HTML/CSS, Javascript, VB Visual Basic VB Scripting,JAVA J2EE and ability to read codes of languages like C/C , PHP etc.
• Possess strong business technical writing skills required for documenting Business Process Documents.
• Excellent communication, business understanding, critical thinking and analytical skills with the ability to communicate appropriately in business and technical situations at all levels.
• Highly motivated, organized and target oriented team player who enjoys working with multi-functional team towards a common goal.

TECHNICAL SKILLS:

WORK EXPERIENCE

Confidential

HIX Business Consultant/Sr. Business Analyst

Responsibilities:

• Worked as a liaison between the Business and Technology Department.
• Worked with the managers, management and report requestors to gather requirements.
• Validated the following Transaction Processing: 837 Health Care Claims or Encounters , 835 Health Care Claims payment/ Remittance , 270/271 Eligibility request/Response , 834 Enrollment/Dis-enrollment to a health plan
• Gathered requirements, analyzed them and created formal Business Requirement Document BRD Functional Requirement Document FRD
• Constantly researching best practices for health insurance issuer accreditation, reinsurance, and risk adjustment.
• Creating of Business Process Workflow Diagrams with Stakeholders throughout the Business System Development Life Cycle SDLC , to create the provider portal which allows providers to access patient information to increase convenience.
• Involved in requirements gathering sessions with Business Analysts and Architects to understand requirements in terms of business change.
• Created and maintained the Requirements Traceability Matrix RTM
• Owned the entire reporting process and interacted with the ETL team, developer s , management, and account holders to get the requirements, document them, design templates, and write specifications.
• Designed Functional Specification Documents for the reports and worked in RUP environment using Rational Requisite Pro
• Analyzed trading partner specifications and EDI mapping guidelines.
• Conducted JAD sessions for the report users, requestors, developers and prepared Need Analysis Documents of the requirements gathered through JAD sessions. .
• Created presentations explaining the entire report development process, while drawing a comparison between the legacy the new report.
• Developed and conducted statewide HIPAA 5010 and ICD-10 awareness program for all IDS staff in Assurant.
• Coordinated with the developer, on day-to-day basis, during the development process.
• Helped with Data Mapping between the data mart and the Source Systems.
• Participated in workshops and update meetings with Insurance carriers
• Conducted Claim/Encounter Management, claim data collection, claim quality check, and filtered claims for Risk Adjustment.
• Conducted Stakeholder Analysis.
• Facilitated Health Insurance Form Filing requirement sessions.
• Developed Preliminary Business Object Model for Health Insurance Form Filing, Requirement Document for Health Insurance Form Filing.
• Wrote and maintained project requirements, facilitated meetings, built business and system flows, managed defects and wrote test scripts and use cases.
• Successfully used Scrum Analysis Model Agile for gathering requirements by facilitating Use Case Workshops and sessions.
• Involved with the subject matter expertise for the implementation of Health Exchange Business Process with a special focus on Medicaid Integrated Eligibility, Plan Management, SHOP/SHOPPING, and Financial Management Business domains.
• Followed the Agile Scrum SDLC System Development Lifecycle methodology,
• Validated System requirements for the Certifications, Accreditations and Attestations of Insurance Carriers
• Involved in communicating with the software development team for the online application.
• Created Test Scripts Test Scenarios to validate report content, layout, and parameters using VBScript and JavaScript and Conducted weekly meetings to validate and verify the testing process
• Wrote PL/SQL statement and stored procedures in Oracle for extracting as well as writing data
• Migrated Data from MS Excel to SQL Server Reporting Service Using DTS and SQL loader utilities.
• Modified System flow diagrams using Visio.
• Created Wireframes, UI Mockups using Mockup screen and maintained Requirement traceability Matrix RTM by using MS Visio based on UML.
• 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 .

Environment: J2EE,MS Word, MS Visio, MS Excel, SharePoint, UML,HTML, CSS,XML, PL/SQL, Javascript, JSP,VB Script, Mercury Quality Center/HP ALM, Rational Requisite Pro, Rational Quality Manager, Rational Clear Quest.

Confidential

Business Systems Analyst Ecommerce

Responsibilities:

• Gathered high level requirements and developed scope of the project for the implementation of the project.
• Conducted weekly meetings for deciding the Policies and Procedures to be followed while constructing new sites.
• Gathered requirements for the integration of POS Point of Sale system with the supply chain system and assisted with the BRD for the POS implementation project.
• Performed the requirement analysis, impact analysis documented the requirements using Rational Requisite Pro
• Validated technical design documents created by IT developers against functional specifications
• Coordinated participation and sign-off of various business partners and customers.
• Performed Gap Analysis to check the compatibility of the existing system infrastructure with the new business requirements.
• Designed and developed Activity Diagrams, Sequence Diagrams, Use Cases and other Process Flow Models using Visio and Rational Rose.
• Followed a systematic approach to eliciting, organizing, and documenting requirements of the system.
• Reviewed the Joint Requirement Documents JRD with the cross functional team to analyze the High Level Requirements.
• Assisted with the creation of Physical Inventory process for retail stores, consisted of data integration and inventory processes with third party vendor
• Interacted with client and the Technical Team for requirement gathering and translation of Business Requirement to Technical specifications.
• 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.
• Used the Data Stage Designer to develop processes for extracting, cleansing, transforms, integrating and loading data into data warehouse database.
• Developed, maintained and published project plan scheduled project deliverables using MS Project.
• Extensively involved in the modeling and development of Reporting Data Warehousing System.
• Was involved in the creation of new E-Commerce Products Arrival Notices and Customized Reporting
• Accumulated system requirements from various departments through surveys and interviews.
• Involved in prioritizing the defects and writing business requirements to resolve them.
• Conducted JAD sessions with management, SME, vendors, users other stakeholders for open end pending issues.
• Involved in mentoring specific projects in application of the new SDLC based on the Agile Unified Process, especially from the project management, requirements and architecture perspectives.
• Create technical design documentation for the data models, data flow control process, metadata management.
• Assisted in writing detailed specifications for various reports generated using Cognos.
• Analyzed the data collected and processed maps to determine the root causes and identify opportunities.
• Planned and defined system requirements to Wire Frame with Use Case, Use Case Scenario and Use Case Narrative using the UML Unified Modeling Language methodologies
• Interfaced between Business new product builders and System platform builders.
• Documented the Traceability Matrix for tracing the Test Cases and requirements related to them.
• Developed Data Conversion Strategy for converting data from the existing site to the new site.
• Designed workflows and allocated permissions within SharePoint.
• Performed Unit Testing and User Acceptance testing UAT and validated user acceptance test plans UAT and documented detailed results.
• Involved with all the phases of Software Development Life Cycle SDLC methodologies like RUP and the waterfall. throughout the project life cycle.

Environment: RUP, UAT, GAD Gap Analysis Document , Clarity, MS Visio, Rational Rose, Java, J2EE ,Agile, SQL Server, Windows 2000 Advanced Server, UNIX / Oracle Platform, EDI, Documentum 2.0.,UML, Web Form, Cognos.

Confidential

Business Analyst

Responsibilities:

• Interacted with client to assess needs, identify key challenges, and define project Scope and deliverables
• Analyzed software requirements specification SRS , prepared functional specification document FSD , and designed documents as per standards
• Conducted group JAD sessions with business units and stakeholders to define project scope and deliverables
• Extensively used the UML methodology to create various use case diagrams.
• Responsible for creating artifacts for Rational Unified Process RUP - use cases, system architecture document, supplemental requirements document, architecture diagrams verifying technical production infrastructure
• Review architectural templates, process flow diagrams, cross walk documentation for the current systems
• Assisted Quality Assurance QA team in writing test plans, defining test cases, test scenario and data sets
• Developed Process flow charts which helped in better understanding of the system
• Performed integration testing, product testing, User Acceptance Testing UAT and data driven testing

Environment: Rational Rose, Rational Requisite Pro, MS Project, MS Access, MS Excel, MS PowerPoint, Quality Center 8.2,DB/SQL, MS Project, MS Visio, Rational Clear Quest, XML, J2EE, Microsoft SQL Server.