SUMMARY

• Over 6+ years of comprehensive knowledge of Business/System Analysis methodologies, Software Development Life Cycle (SDLC) using Waterfall and Agile (Scrum)
• Experience in gathering system requirements, defining business processes, UML modeling, sequence diagram and activity diagram.
• Assisted the Project Manager in the development of SDLC methodology and documentation strategy.
• Experience in developing project plans, identifying documents, validating requirements and re - engineering process.
• Experienced in complete AGILE, SDLC, Client /server architecture providing a balanced understanding of business relationships, business requirements, worked for financial and technical solutions and helped the teams at all levels until final product release.
• Strong experience and understanding of healthcare industry, claims management process, Knowledge of Medicaid and Medicare Services.
• Worked extensively with professional User Interactive (UI) web applications using with the help of HTML, HTML, XML, XHTML and CSS.
• Knowledge and Implementation experience in Eligibility System, Facets Data model, Configuration Implementation of FACETS module.
• In-depth knowledge of payer operations including claims, enrollment, eligibility, underwriting, etc.
• Expertise in the full cycle of software development including Requirements Analysis, Program Design, Development, Unit testing, System Testing, Integrated Testing, Maintenance and Documentation with Strong programming skills with and Sound analytical and problem solving skills.
• Well experienced in working with Billing Provider, Rendering Provider, member subscriber, and NetworX modules of FACETS as well as in validation of subsequent loops and segments of the EDI files
• Performed Functional, Regression, and system testing for Pricing Application
• Knowledge and expertise in working with Claims, Provider, Enrollment, Finance, Benefits, and Vendor Management Business Areas.
• Conducted JAD Session and communicated with Stakeholders, Development team, SMEs, System Analyst, Business Analyst and Project Manager.
• Excellent analytical skills for understanding the business requirements, business rules, business process and detailed design of the application.
• Proficient in evaluating and creating Use Cases, Use Case Diagrams, Activity diagrams, Class diagrams, Data Flow Diagrams, Business Flow Diagrams and Sequence diagrams using MS Visio and Rational Rose.
• Excellent skills in Business Analysis, (OO) object oriented analysis, requirement analysis, Business modeling and Use Case development using UML Methodology.
• Heavily involved in preparation of BRD (Business Requirement Document), FRD (Functional Requirement Document), Non-functional Document and Use Case Documents
• EDI 835, 837I, 837P, 278 and proprietary conversions utilizing Facets extensions and development of new scripts and extensions to meet proprietary origination formats and reformat them into HIPAA standardized formats.
• Create wireframes and mockups for customer facing user interface (UI) changes.
• Design, program, and implement software application packages customized to meet specific client needs.
• Experienced in manual testing, recreating errors and provide support to programmers to correct defects in the system. Facilitated UAT with the stakeholders and the business users
• Facilitated JAD sessions with business owners, IT team & Users to drive out detailed business requirements. Experienced in Systems Testing, Integration, Testing, and Software Quality Standards, Training, Documentation and implementation in a business environment.
• Knowledge of SQL and experience of writing SQL commands.

TECHNICAL SKILLS

Methodologies: UML, Agile, Waterfall

Testing tools: HP Quality Center, ALM, QTP

Change Management Tools: Clear Quest, TriZettos

Office Tools: MS Project, MS Word, Excel, PowerPoint

Operating Systems: UNIX, Windows NT/2000/XP/Vista/7

Business Modeling Tools: Microsoft Visio, Axure, PowerPoint

Database: MS SQL Server, Oracle, Teradata

PROFESSIONAL EXPERIENCE

Confidential, Irvine, CA

Business Systems Analyst

Responsibilities:

• Worked with diverse team of Business users to gather requirement and prepared BRD and FRD.
• Conducted numerous JAD sessions with Business users, developer and SMEs.
• Prepared several use cases and designed use case diagram, activity diagram and sequence diagram.
• Conducting business validations, covering the following deliverables: FACETS Providers, Facets Claims and Facets Membership and Operational reports.
• Worked on Facets Claims and Enrollment Application implementation and Enrollment Application Implementation.
• Worked with Facets Application Groups: Claims Processing, Customer Service, Guided Benefit Configuration, Medical Plan, and Enrollment, Pricing Profile, Provider, Subscriber/Member, and Workflow Configuration.
• Also worked on production support team and enrollment issues resolution team and real time resolution of existing interfaces, extensions and custom reports related to enrollment issues.
• Reviewed various customer transactions using theFACETSapplication.
• Worked on the EDI 834-file load toFacetsthroughMMS(Membership maintenance sub-system) for member eligibility and benefit enrollment.
• Performed GAP analysis for ICD - 10 and EDI Message Structure with the 4010 Structure
• Worked with QA team, System Administration to validate environment smoke test.
• Remediated the store procedure of Extracts to make ICD 10 Compliant.
• Extracted different reports as per the Business User’s Request using SQL.
• Worked with QA team to write test plans and scripts.
• Work with solutions/delivery teams to implement data quality processes during acquisition, ETL, and delivery stages for Business Intelligence solutions and changes to Data Warehouses.
• Performed Data analysis from the data warehouse along with business intelligence solutions delivery team.
• Acted as liaison between business team and testing team to resolve issues and participated in bug review meetings
• Worked with NetworX Pricer and Modeler to verify the updated Pricing for Service Procedures and updated Agreements Contracts.
• Prepared requirement specification, functionality trace matrix, quality assurance plan and designed test cases. Communicated with business, technology leadership for overall project/ program office milestone.
• Identified Use Cases from Business Requirements and created UML diagrams like use case diagrams, activity diagrams for various stakeholders.
• Wrote SQL Queries for data analysis and manipulation.
• Reviewed test cases and test plan for UAT testing.

Confidential, Worcester, MA

Business Analyst

Responsibilities:

• Gathered high-level requirement for all the external projects in a release.
• Facilitated JAD sessions with SMEs and business analysts from other feeder systems for a detailed analysis and a better understanding of impact of various projects on each other.
• Responsible for acting as a liaison with operational and financial management, systems support and sales to identify business opportunities.
• Created DTS and SSIS Packages to vendors in which records were loaded Daily, also to other data resources such as Excel, Access, flat file, and XML in order to Create and maintain a centralized data warehouse.
• Write and execute positive and negative test cases to ensure the data originating from the data warehouse (Oracle dB) is accurate through to the SQL dB in the applications.
• Developed a file of ACORD Forms used as the standards in all Property and Casualty markets, for both Personal and Commercial Lines of Business.
• Performed extensive data modelling to differentiate between the OLTP and Data Warehouse data models
• Created test scripts for all the test cases in PL/SQL
• Used SDLC (System Development Life Cycle) methodologies like the RUP and the waterfall.
• Created functional requirement documents for the impacting projects
• Performed criteria table updates for each project.
• Analysis of business and system requirements and system requirements of the client and also for Property and casualty modules
• Facilitated and led JAD sessions aimed at functional requirement walkthroughs for all the impacting projects and updated the documents based on recommendations (if any).
• Created UAT plans with several test cases for each project to ensure that the system runs smoothly after the proposed enhancements or changes have been made.
• Reviewed test results and coordinated with testing and development team to correct the issues.
• Analyze business/system requirements and segregated them into Use Case Diagrams, Activity Diagrams, Sequence Diagrams, and OOD using Borland Together according to UML methodology thus defining the Data Process Models.

Confidential

Business Analyst

Responsibilities:

• Member of the Core Program Team on the (P.I.A) Enterprise Application Modernization Program, a project to update all of (P.I.A)current pension administration, health insurance benefits, and general accounting software, as well as, overall system architecture
• General BA support within Agile/Scrum methodology environment. Day to day scrum support, participated in grooming sessions, contributed to user stories, gap analysis, reviewed wireframes and prototypes with (IT) developers and BAs to ensure the desired project outcome.
• Create work-flow documentations for the ‘future’ processes
• Conduct intensive testing for the various business scenarios related to diverse functional area
• Detect and log defects with HP Application Lifecycle Manager (ALM) for analysis and solutioning during triage sessions
• Communicate issues for solutioning with team leads
• Assist in the creation and analysis of SQL reports to help ensure data integrity across the enterprise
• Interpret and translate business unit needs into effective application and operational requirements
• Assist business areas in process redesign to take maximum advantage of information systems
• Conduct research and investigations into information technology solutions for business problems
• Provide support with other activities as required by the Business Process Manager and team in the development of information technology service requests and project scoping

Confidential

IT Business Analyst

Responsibilities:

• Researched on the design and essential functionalities of the official website.
• Gathered Requirements, translated the requirements into specifications.
• Discussed the specifications with Development team before code was developed.
• Performed GAP Analysis to identify the current situation and the future state want to reach on the current website.
• Conducted JAD sessions and contributed to technical designs
• Worked in SCRUM environment and attended daily SCRUM meetings, Sprint planning, and Sprint review.
• Strongbusinessprocess modeling skills using UML (Use Cases, Sequence Diagrams, Activity Diagrams). Adept at designingbusinessmodels using UML diagrams (Use Case Diagrams, Sequence Diagrams, Activity Diagrams, etc.).
• Involved in User Acceptance Testing (UAT)
• Required to collect feedback and improve designs during UAT phase
• Responsible for reviewing all artifacts before and after the design process