SUMMARY

• Over 7+ years of experience as a Business Systems Analyst on HealthCare Domain.
• Extensive knowledge of the Software Development Life Cycle (SDLC) like Agile, and Waterfall.
• Hands - on experience in Business Process Management (BPM) to improve business processes through system enhancement, workflow revision.
• Extensive knowledge of design using Unified Modeling Language (UML) and skilled in creating Use Case, Activity, and Data Flow Diagrams using tools like MS Visio and Star UML.
• Proficient in using Agile Scrum methodologies, performed roles of Scrum Master following sprint/standup sessions and used Excel extensively to write user stories, analyze the Iteration Burn Down charts and reviewed defects.
• Excellent knowledge of Health Insurance Portability and Accountability Act (HIPAA) transaction, code set rules such as 834- Benefit of Enrollment and Maintenance, 835-Claim Payment/Remittance Advice, 270/271-Eligibility Benefit Inquiry/Response, 276/277-Claim Status Inquiry/Response Transactions and testing in Client Server systems and Mainframe Applications, EDI 834.
• Analyze business process, creating requirements documents, maintaining vision documents, and supplementary documents.
• Done requirement gathering by conducting formal interviews, surveys, questionnaire, and joint application development (JAD) sessions with the subject matter experts (SME’s) and stakeholders of the projects and developed the details Business Requirement Document (BRD) for the Application.
• Managed appropriate business documentation to support development needs, including agile stories, workflows, and gap analysis.
• 837 (medical claims), 835 (medical claim payments), 270 (eligibility inquiry), 271 (eligibility response stakeholders SMEs and development team.
• Expert in Health Care testing,FACETSproduct, EDI transactions.
• Validated the following: EDI 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).
• Strong understanding of SQL (can create own SQL to check the integrity of database), database schema, ETL, and data warehouse concepts.
• Expertise in designing and developing test plans and test scripts. Performed Functional testing, Regression testing, Performance testing, GUI testing, User Acceptance Testing (UAT) and assisted the testing team.
• Excellent communication, interpersonal, team skills, and work ethics
• Articulate written and verbal communication skills with ability to work independently

TECHNICAL SKILLS

Databases: Oracle, MS SQL Server, DB2 and MS Access

Microsoft Technologies: MS Project, Visio, Excel, Word, Outlook, PowerPoint

Requirements Tools: Rational Requisite Pro, Requisite Rose, Doors, Quality Center

Change Management Tools: Remedy, Rational Clear Case, Clear Quest (CQ), JIRA, Mercury Quality Center (MQC)

Business Modeling: Rational Rose, MS Visio

Methodologies: RUP Methodology, Agile, Scrum, Waterfall.

Operating Systems: Windows Vista, Windows 95/98/00, Windows XP and Windows 8

Browsers: Internet Explorer, Firefox and Google Chrome

Bug Tracking and Reporting: HP Quality Center, Hyperion, JIRA, Rational Clear Quest and MS Excel

Languages/Standards: SQL, XML, HTTP, Java, HIPPA 4010/5010, ANSIX12

Methodologies: Rational Unified Process (RUP), Agile, Waterfall

Other Tools: MS Visio, TOAD, SQL Navigator, Test Manager, SharePoint, MS Office, Excel, Power Point

PROFESSIONAL EXPERIENCE

Confidential, Hartford, CT

Facets Business Systems Analyst

Responsibilities:

• Performed GAP Analysis to analyse the current system and worked with internal users to help define system requirements.
• Assisted the project manager in the creation of the project charter BRD, FRD & vision document during the inception phase of the project.
• Facilitated JAD sessions with business teams and the architects to understand the impacts of the migration process and different ETL loads and their SLA’s.
• Reviewed extensive SQL Queries with complex multi-table joins and nested queries
• Participated with the developers to comprehend the ERD Entity Relationship Diagram and thus create wide-ranging test plans
• Involved in Data modeling, E/R diagrams, normalization and denormalization as per business requirements.
• Created Logical/physical Data Model in Powerdesigner and have worked on loading the tables in the Oracle based Data Warehouse
• Identified Multiple Dimensions and Fact tables. Used advance data modeling concepts of Degenerated dimension, sub-dimension, Fact less fact table, Aggregate fact tables in Multidimensional model.
• Acted as an SME for the application team and the Infrastructure team.
• Involved in complete SDLC process in upgrading Facets system, system analysis, system support, migration support, profile changes, security tracking, and code deployment.
• Efficiently accelerated planning schedules so as to adequately manage release timelines
• Used Requisite Pro for writing/analysing project vision, goals, specifications, and requirements.
• Identified and documented in the test plan, dependencies between the business processes.
• Responsible for the full mapping, implementation, and testing for accurate accumulator’s update.
• Performed complete SDLC process in upgrading Facets system, system analysis, system support, migration support, profile changes, security tracking, and code deployment.
• Proposed FACETS claims adjudication procedures, standards, and editing guidelines.
• Analysis and Design of the Facets data model to ensure optimal system performance and tuning
• Configured facets modules such as Claims, Membership, Billing, Benefit and plan
• Developed the business anomalies workarounds and described them in documentation and presented the matter to the upper management for review using SharePoint.
• Hosted the application online using Microsoft sharepoint excluding some functionality those were developed to use by employees only.
• Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data within the Oracle database.
• Conducted Joint Application Development (JAD) sessions and walk in interview with the business users to gather requirements.
• Tested the changes for the front end screens in FACETS related to following modules, test the FACETS batches (membership, Billing, Provider, etc).
• Interacted with database developers for formulating the ER diagrams and data flow diagrams.
• Used HP Quality Center for tracking Defects and tracing requirement functionality performances.
• Conducted Statistical Modelling of data on how providers submit outpatient authorizations using Pivot Tables in Excel.
• Assisted Business User during deployment in formulating User Acceptance Testing (UAT) for customized application and getting confirmation for product Release.
• Developed non-functional requirements and documented them as Business Rules, Quality attributes, and constraint documents.
• Held regular meetings with the system architects, developers, database developers, during the entire project to assure that the critical, as well as the minute details of the project, were discussed and issues were resolved beforehand.

Environment: Windows, MS Project, MS Office MS Visio, SQL, ETL, Facets, Quality Center.

Business Analyst

Responsibilities:

• Worked closely with business and technical stakeholders to prioritize requirements and use cases.
• Created detailed FRD to capture overall requirements for the system.
• Gatheird Business Requirements, reviewed design requirements to validate the Health Exchange /Medicaid/ICD projects to meet all the requirement.
• Elicited functional and non-functional requirements, conducting and facilitating requirement sessions
• Led sprint planning session to identify the features and functionalities that should be achieved by the new application where me prioritized and determined level of work for PBIs in line with Agile Scrum methodology.
• Created Business Requirement Documents because of meetings with the Business Areas and obtained business sign offs on the documents after reviewing the final documents with them.
• Analyzed and evaluated User Interface Designs, Technical Design Documents and the performance of the application from various dimensions.
• Extensive experience with Data Warehouse/ETL testing by using SQL scripts. Areas of testing included cardinality (number of rows) and data Transformation (Business rules) testing.
• Maintained the Traceability Matrix Table to uniquely trace the identified business requirements to general design to testing as proof that requirements requested have been developed into a solution and that it TEMPhas been tested and tracked.
• Gatheird requirements and developed process flows diagrams in accordance with care and Medicaid rules and regulations pertaining to the FACETS configuration and evaluated the impact of proposed changes.
• Worked with providers and Medicare or Medicaid entities to validate EDI transaction sets or Internet portals.
• Documented the UAT Plan for the project and worked with the UAT Team to ensure every acceptance criteria for the requirements TEMPhas been included in the UAT task plan.
• Supported new business requirements by extending the functionality of the core FACETS system using the FACETS extensibility architecture feature.
• Involved in FACETS Implementation, including end to end testing of FACETS Billing, Claim Processing and Subscriber/Member module.
• Wrote business case scenarios for HIPAA EDI Transactions.
• Analyzed plan requirements and then contributed further defining the plan requirements with their Project Manager. Observed the compliance of the requirements with federal and state government regulations Medicaid, Medicare, and accreditation body requirements.
• Validated HIPAA Transactions and Code Sets Standards according to the test scenarios such as 270/271, 276/277, 837/835, 834, 999 acknowledgments for enrollment transactions and performed UAT.

Environment: QC, MS Visio, SQL Server, EDW, MS Access, MS Office Suite, UAT, ETL, Agile, JAD, Windows XP, MS Project, Facets, Requisite pro, Doors.

Confidential

Business Analyst

Responsibilities:

• Monitored the quality ofdatasubmitted to regulatory agencies.
• Performed numerous SQL Statements to load and extractdatato and from database for testing.
• Developed, documented and performed testing and validation as needed.
• Worked with SMEs to develop business rules that support the transformation ofdata.
• Performed the Back-end testing manually by writing and executing SQL statements on Oracle Source
• Database and Teradata target.
• Utilized EDIFECS Transaction Management software to perform trading partner setups for various transaction types such as 837 and 835
• Created ANSI X12/EDI transactions, processed them via EDIFECS spec builder for format and validated the EDI transactions
• Tested and resolved defects identified in theMDMimplementation. Defectmanagementand resolution were entered, managed, and resolved using HP Quality Center.
• Worked on data modeling and produced data mapping and data definition documentation
• Conducted design reviews and validated data models and was involved in MDM (Master Data Management)
• Conducted JAD sessions with business units and stakeholders to define project scope
• Implement, maintain, provide support and improve upon use of Microsoft SharePoint and Strategic Management System (SMS) capabilities to support the needs of the organization
• Escalated issues that were related to project to resolve them without impacting deliverable or timelines.
• Worked in team environment to successfully deploy the projects and was involved in status update meetings.
• Created test plan and scripts for user acceptance testing (UAT) to ensure business requirements are exceeded.
• Performed functional testing of questionnaire system after development to ensure business requirements are exceeded.
• Defined clear targets and objectives and communicate them to other team members to ensure projects are completed on time, under budget and exceeding expectations.
• Supervised work of four team members, offering constructive feedback on work performance to increase staff skill levels.
• Document defects and execute test cases to ensure issues are resolved in a timely manner.

Environment: Windows, MS Project, SAFe, EDIFECS, MS Office MS Visio, EDW, ETL, SQL, Facets, Quality Center.