SUMMARY

• Over 7+ years of experience in all phases of SDLC (Software Development Life Cycle) as Sr. Business Analyst.
• Experience in conducting Joint Application Development (JAD) sessions for requirements gathering, analysis, design and Rapid Application Development (RAD) sessions.
• Assisted in user acceptance testing (UAT) of the system.
• Documented Requirement Traceability Matrix in Requisite Pro, Test Director and MS - Excel for traceability of requirements through test cases.
• Strong functional expertise in the Healthcare Payer Area - Membership claims, benefits, eligibility, ICD10, HIPAA, and CMS HCPCS Exposure toHealth Care Industry standards like HIPAA / PHI and data format like EDI, XML, and HL7 Interface Implementation.
• Broad knowledge of 837 EDI file generation using flat files includes detailed experience working on Pro-EDI and 837 formatter tool.
• In-depth Understanding of Payer plan sponsor and the EDI transactions like 837, 835, 834
• Served as a SME for EDPS return files 999, 277, MAO 001, MAO 002 and MAO 004 etc.
• Extensive knowledge of EDPS errors which includes 254, 19, 255, 465etc., alsoinclude RAPS Errors 450, 451, 455, 400, 500 etc.
• Expert on US Health Care Industry, Electronic Data Interchange (EDI),Health Level 7(HL7) and Health Insurance Portability and Accountability Act (HIPAA)
• Developing functional specifications for business process refinement and automation, conducting feasibility studies, analyzing scope and vision of the project.
• Good knowledge of Medicare, Medicaid, andMMIS (Medicare Management Information System)
• Perfectionist in requirements collection, from clients and processing information to the project team
• Good knowledge of Business Process Modeling and Business Process Re-Engineering and experience with SWOT analysis.
• Expert in iterative software development life cycle AGILE with experience in SPRINT planning and SCRUM meetings.
• Extensive experience with process modeling using Unified Modeling Language (UML), use case diagrams, including the business workflow using Rational Suite, Rational Rose and MS Visio.
• Experience in working withWork Breakdown Structure (WBS), in project management and systems engineering.
• Assisted teams in creating different SSIS packages in different Control Flow and Data Flows.
• Strong Subject Matter expertise (SME) in Healthcare, ARMS Medical Billing Information System, Market Research, Risk Management, Product Development, Banking, Risk Analysis, Asset Management- risks and returns.
• Experience in conducting GAP analysis, User Acceptance Testing (UAT), SWOT analysis, Cost benefit analysis and ROI analysis.

TECHNICAL SKILLS

Business Process Automation: JIRA,MS Project, Rally, Blueprint

Pro-EDI, 837 Formatter: SSIS, Talend, SAS

Requirement Management: Rational Requisite pro, UML, Microsoft Project, JIRA, Microsoft SharePoint

Modeling & Designing Tools: MS Visio, SnagIt

Business Analysis Structure: Agile/Waterfall/Scrum/JAD/RAD/BPM

Testing Tools: Quick Test Pro, Load Runner, Win runner, HP Mercury Quality Center

Databases tools: Oracle9i/10g/SQL/SQL Server/Microsoft Access/Toad for SQL, SAS, Essbase, SSIS, SPSS

Reporting Tool: Jasper Soft, Crystal Reports, BRIO Query, SSRS

Communications: MS Outlook, Lotus Notes, TCP/IP, and MS NetMeeting/Chat

Languages: VB, SQL, XML, UML, ASP

PROFESSIONAL EXPERIENCE

Confidential

Sr. Business Analyst

Responsibilities:

• Analyzed existing Business units, Business process, System/ Application and their Interfaces through KT session, open-ended discussions, brainstorming sessions, prototyping etc., which heled in designing business process restructure and automation.
• Conducted KT session and developed Job Aids for different RAPS and EDPS claim file generation process for other team member reference purpose and to help in audit too.
• Developed claim submission and return tracking structure using SQL and also helped with automation with the help of SSIS packages which also include reconciliation report, served to top management in weekly status meetings.
• Asset classes include equity, fixed income, derivatives, commodities and foreign exchange - Exchange traded (ETD) and OTC Interest Rate derivatives, Interest rate derivatives (IRD), equity and equity swaps, Foreign exchange swaps, Equity options, swap options, Futures and forwards.
• Assisted in automation with the help of TalEND, SSIS packages, MS Excel etc.
• Extensive knowledge of Pro-EDI tool and generated EDI file for EDPS submission to CMS.
• Took initiative to work on development of 837 formatter to replace Pro-EDI tool, used to generate 837 EDI Claim files getting submitted to CMS.
• Processed EDPS return files including 999, 277, MAO 001, MAO 002 and MAO 004.
• Performed UAT on 837 formatter and validate all the features and process.
• Successfully brought 837 Formatter in production environment and with the efficiency of 95% time saving in file conversion.
• Strong understanding of financial valuation concepts and various capital market instruments and processes including Equities, Fixed Income, Foreign Exchange, Derivative (OTC) & Back-Office operations.
• Comprehensive knowledge of and solid experience in Derivatives including Credit Derivatives, Interest Rate Derivatives, FX Derivatives, Equity Derivatives and OTC Derivatives.
• Intensively worked on Fixed Income, OTC derivatives and Risk reporting (market and credit risk for Basel II).
• Created detailed Business Requirements Specifications, detailed Systems Requirements Specifications, using alternate views such as process/work flows, diagrams, models, use cases, data mappings/crosswalks for system integration.
• Experience in Derivatives Pricing, Counterparty Risk, Market Risk, and OTC Derivative Clearing.
• Extensive experiences in Investment Banking projects specialized in Securities Trading (stock trading, fixed income trading, and derivatives trading), wealth management and risk management.
• Excellent knowledge of OTC derivatives instruments and their impacts on daily PnL or balance sheet as well as regulatory reporting requirements
• Assisted and organized inbound KT session from offshore team to on shore team which held mostly on 3rd shift for more than 3 months.
• Produced BRD for RAPS and EDPS file return process which helped to increase efficiencyin reducing processing time by more than 95%.
• Researched un-submitted and invalid claims pending for submission by achieving remarkable goal by generating extra 99 million in revenue also got served by Bravo award.
• Streamlined OPTUM EDPS claim generation and submission process with achievement of 99% acceptance rate.
• Created dashboard for Wireless Sales using Qlikview.
• Using OTC and ETD financial Derivatives
• The project was to centralize the management of website, call center and order management systems. Completed implementation of Netsuites integrated CRM/ERP system which included: defining implementation strategy; converting company's legacy financial system, Point-Of-Sale (POS) system and internet store to NetSuite; training office, sales and warehousing personnel on the software; and redesigning Internet, Warehouse, and Order Fulfillment and Shipping operations.
• Telecom Background Technical Experience Billing Experience (a plus) Functional expertise in business process reengineering, transformation, organizational design/change management, implementation planning and execution, migration and conversion, testing and/or training
• Functioned as a CMS point of contact for whole RAPS and EDPS claim submission process, also include tracking all claim submission and their return file processing on time.
• Restructured SQL scripts to generate claims which helped reducing query running time by 80%.
• Investigated errors claims in RAPS and EDPS process and worked on its correction and submitting them followed by 70% acceptance rate.
• Worked on RAPS Errors which includes 450, 451, 455, 400, 500 etc., and EDPS errors which includes 254, 19, 255, 465 etc.
• Developed submission schedule Jan 16 and 17 sweep time helping timely submission of 14 & 15 DOS for the last time to CMS.
• Create data mapping documents to define required elements on inbound SWIFT, XML, messages, as well as to define the expected data format; specific to OTC derivatives, ETD's, Commodities and FX transactions.
• Helped new team members with on boarding process, getting required system access, providing system knowledge and sharing documentation.
• Successfully finished and meet all the deadline in sweep time which includes claim submission of all DOS 2014 as this was the last chance to get everything submitted to CMS.

Confidential, New York City, NY

Business Analyst

Responsibilities:

• Conducted Joint Application Development(JAD)sessions and walk in interview with the business users to gather requirements.
• Did impactanalysisforchanging requirementsand coordinated withbusiness usersand Project Manager for prioritizing the testing/release of the changes through CAB.
• Work as part of anAgile teamto solve problems and deliver projects in a fast paced environment
• Helpedcreating Reportsfor Claims processing, Provider and Member.
• Prepared theBusiness requirement Documentfor the enhancement of the existing services. WroteTRDfor the requirements and RTM for testing anddefect tracking
• Enter Point Click Care Issues into a NetSuite Ticketing System.
• Modeled theAS-IS systemand performedGAP Analysisfor the existing system in order to map it to theTO-BE system.
• Enter Point Click Care Issues into a NetSuite Ticketing System.
• Worked on improvement of Claims Reimbursement User Interface for a better experience and incorporate changes as perHIPAAguidelines using the gap analysis.
• Assisting business users in definingUAT test cases and plans; Established and maintained test cases and test data inQuality Center.
• Coordinated with the QA Team for testing activities across multiple systems and managed Conversion test execution.
• Involved in providing requirements for Data Modelling, ETL Process, and prepared Data Mapping documents to determine necessary elements on inbound XML messages also to explain the expected data format to OTC derivatives, ETD's, Commodities and FX transactions.
• Wrote SQL queries to perform to pull data from OTC derivatives data to perform data analysis, conduct data verification & expected results based on the user requirements.
• Performed Feasibility, Adaptability and Risk Analysis to identify the business critical and high-risk areas of the application.
• Crystal Reports was used to generate reports from different databases of different asset classes like equities, bonds, OTC derivatives, and commodities, for all business needs.
• Helps in conducting User Acceptance Testing(UAT), and System Integration testing(SIT)andSWOTanalysis.
• Performed GAP Analysis forHIPAA 5010transactions and Performed Analysis ofICD 9Procedure and Diagnosis Codes in accordance withICD 10 CM and ICD 10 PCSConversion Compliances
• ProvidedSQLqueries to developer as source queries to identify the data provided logic to assign.
• Responsible for providing theData Mapping documentand rewrite of theSQLqueries fromAs-Is To-Beand validating the data throughSQL.
• Lead through UAT procedure and also conducted training sessions for the end users along with the necessary documentation
• Managing IT/Telecom system set-up for current centers and new center openings; providing sales support and consultancy to the region for Regus Technology Products
• Createdtest planand facilitated its implementation, createTest casesand assisted manual testing
• Worked closely with the testing team to discuss the functionality and fix any defects found in the Crystal reports created
• UsedSharePointto ensure all team members have easy access to all the documents created
• Lead through UAT procedure and also conducted training sessions for the end users along with the necessary documentation

CONFIDENTIAL

Responsibilities:

• Visual modeling using Unified Modeling Language. Prepared detailed Use-Cases to describe the design, architecture and dynamic behavior of the system.
• Developed and managed all the work plans, acted as the key client contact, handled all kinds of scheduling, resource planning and allocation matters, ran all status meetings and compiled various reports.
• Imported requirements from Word and Excel format into RequisitePro Projects. Organized and Categorized requirements into FURPS (Functional, Usability, Reliability, Performance and Supportability) in Rational RequisitePro.
• Coordinated work plans between project manager and client using Microsoft Project. Implemented and managed migration process. Scheduled and tracked progress of team members through project completion.
• Worked extensively with business on NetSuite ERP module including new implementations, enhancements, integrations, support, and other special projects for different teams.
• Work directly with business users to lead requirements gathering, functional documentation development, validation and data mapping to NetSuite functionality.
• Working with SMEs to understand various assets and security classes, exchange traded derivatives (such as futures, options on futures, equity options and index options), OTC derivatives (such as interest rate swaps, swaptions, credit default swaps and total return swaps) and portfolio allocation and management Knowledge of STP and SWIFT messages.
• Worked extensionally on life cycle OF OTC derivatives like IRS, CDS, CDX, Swaption, Inflation Swap, Asset Swap, FX Option and 3-legged Commodity Swap.
• Assist in the documentation of good faith fair value pricing procedures and reporting on fixed income, equity securities and listed or OTC derivatives instruments.
• Studied the MISMO standards as a part of interface to quick mortgage loan (QML) software. Used custom Visio shapes to quickly design efficient process flows and module line layouts.
• Analyzed and evaluated all the information gatheird from multiple sources, reconciled conflicts, decomposed high-level information into details, abstracted up from low-level information to a more general understanding, distinguished user requests from the underlying true needs and distinguished solution ideas from requirements.
• Coordinated the Interface testing between Business Analysts/Testers and respective Interfacing Systems Operational contacts and technical representatives.
• Coordinated and attended meetings to review the requirement specifications with the Quality Assurance Manager, Business Systems Analysts and other team members.
• Used Rational ClearQuest as the change request management tool to track and manage all defects and enhance the development process.
• Adopting Rational Unified Process (RUP) methodology with emphasis on its six best practices for iterative and incremental development. Planned all the RUP iterations and documented the artifacts throughout various phases. Conduct analyses of Business requirements and System specifications.

Environment:Blueprint, Rational Rose, Rational Requisite Pro and UML, Rational Clear Quest, SQL, Microsoft Visio, Test Director, HP Quality Center, Crystal reports, MS SharePoint, MS Project, ER-Win, MS Office.