SUMMARY

• Senior Business System Analyst with 6 plus years of diverse IT implementation experience in Hospital, Pharmaceutical and Health Insurance domains.
• With strong knowledge inPharma and Claims system background. Thorough knowledge of industry standard SDLC practices and UML tools. Expertise in Change Management and Quality Assurance.
• Excellent analytical skills and understanding of business processes, functional requirements, DFD’s and ability to translate them to System Requirement Specifications.
• Extensive knowledge of Microsoft PowerPoint, FrontPage, Google Docs.
• Experience with EDI translators, HIPAA X12 EDI transaction sets, Edifecs, IBM Web sphere Message Broker and Transformation Extender.
• Expertiseas a system consultant in HIM functions in development of an electronic patient record.
• Implementation and training of doctors and nurses on the Electronic Medical Record (EMR).
• Excellent knowledge of Health Insurance Portability and Accountability Act (HIPAA) transaction, code set rules such as 837 - Institutional, 837-Professional, 835-Claim Payment/Remittance Advise, 270/271-Eligibility Benefit Inquiry/Response, 276/277-Claim Status Inquiry/Response Transactions and testing in Client Server systems and Mainframe Applications, EDI 834, ICD9-ICD10.
• Database and table design and implementation for data warehouse and related ETL processes.
• Facilitated and leaded Scrum meeting,Sprint planning sessions and Story writing sessions.
• Build SQL queries to validate data and handled the queries regarding XML and troubleshoot the complex technical XML problems.
• Experience in HIM (Health Insurance Management), to manage the administrative, financial and clinical aspects of a hospital and also encompasses paper-based information processing as well as data processing machines.
• Experience with Cloud Computing. Understands the technical nuts and bolts of cloud computing and convert legacy applications to private cloud platform.
• Negotiated and re-negotiate Medicare, Medicaid and Commercial contracts with providers.
• Working with project business analysis to exchange ideas on how front-end functional requirements will align with HL7 interface requirements. Knowledge of PBM (Pharmacy Benefit Management).
• Understand the overall business model of Medicare Part D products and the PBM claim adjudication system and translate concepts into practice.
• Serve as a SME for PBM functional questions for client’s clients as well as internal team members.
• Extensive experience in analyzing and creating Use Cases, Use Case Diagrams, Data Flow Diagrams, Business Flow Diagrams, and Navigational Flow diagrams and Wireframes.
• Conducted black box, system, integration, functional, regression, compatibility, security testing. Great knowledge of Requirement Traceability, .Net, SQL and XML.
• Experience in conducting User Acceptance Testing (UAT), SWOT and Root Cause analysis, Cost Benefit Analysis and Gap Analysis.
• Excellent knowledge of industry standard methodologies like Software Development Life Cycle (SDLC), Iterative Software Development Life Cycle Process as per Rational Unified Process (RUP).

TECHNICAL SKILLS

Methodologies: RUP, UML, BPR, Waterfall, Agile, SWOT,OOAD

Testing Tools: Rational Enterprise Suite, Quick Test Pro, Win Runner, Load Runner, Test Director

Change Management Tools: Power Designer, MS-Visio

Business Modeling Tools: Microsoft Visio, Power Designer

Databases: SQL Server, MS-Access

Project Management: Microsoft Project, Microsoft Office

PROFESSIONAL EXPERIENCE

Confidential, Quince St, Olympia

Business Analyst

Responsibilities:

• Participated for the creation of Business Process Workflow Diagrams with Stakeholders.
• Involved throughout the business Software Development Life Cycle (SDLC).
• Conducted JAD sessions with business users and SMEs to identify and gather various functional and non-functional requirements.
• Worked on GAP analysis of ICD 9 and ICD 10
• Hands on experience on electronic medical record management system (EMR) and electronic health record (EHR)
• Using of Request Tracking System, which is a part of the proprietary CMS application for fulfilling actions on different action codes relating to a corresponding number of actions.
• Utilized Rational Unified Process (RUP) to configure and develop process, standards, and procedures to create a Functional requirement Document (FRD).
• Work with Facets software for maintaining data about the enrolment, billing and health care claims management and to store, send, receive HIPAA transactions and facilitate the administration of HIPAA privacy rights.
• Created artifacts such as Use Cases, Activity Diagrams, and Sequence Diagrams using MS Visio.
• Come up with change enabling ideas and lead initiatives executing the same. Should have a significant impact at the Service Line level in terms of revenue, processes or people.
• Demonstrate expertise in multiple payers.
• Ensure that data reconciliation activities are performed regularly.
• Ensure timely approval of data loads and timely escalation of data issues.
• Identify all possible automation opportunities on the project and get the reports automated.
• Reviewed System Test Plans, wrote test scripts and worked with business folks to validate and execute the test scripts.

Environment: HTML, XML, MS Visio, MS Excel, MS SQL, Rational Requisite Pro, UML, Rational Unified Process, SQL.

Confidential, Cleveland OH

Sr. Business System Analyst

Responsibilities:

• Gathered requirements from claims business area, prepared process flows and diagrams for the project.
• Performed gap analysis for HIPAA 4010/4010A - 5010 conversion - Involved in the documentation of HIPAA 5010 changes to EDI 837 transaction.
• Performed gap analysis of ICD 9 to ICD 10 conversion for procedure and diagnosis codes in accordance with the HIPAA compliant.
• Effectively elaborated the current process and gave a clear picture of the proposed process for the projects in the organization and aggressively worked towards timely completion of high priority tasks.
• Led the change control process for changes submitted for the BRD after the document was submitted to IT department.
• Worked with IT team to resolve issues and clarify business requirements from the business owners.
• Documented the UAT plan for the project and worked with the UAT Team to ensure every acceptance criteria for the requirements has been included in the UAT task plan.
• Maintained the traceability matrix to uniquely trace the identified business requirements of general design to testing as proof that requirements requested have been developed into a solution and tested.

Environment: MS Office, RUP, UML, Power designer, SQL, SWOT analysis

Confidential, Princeton, NJ

Business Analyst

Responsibilities:

• Attended and Facilitated JAD Sessions, Personal interviews with the Stakeholders, SME’s and Quality analysts.
• Gathered information regarding the software’s and hardware’s (Server, Network.) involved in the project.
• Acted as a SME for the application team and the Infrastructure team.
• Implemented the concepts of data warehousing by creating relational/multidimensional databases that was designed for query and analysis.
• Actively involved in the creation of Technical Disaster Recovery Plan.
• Supported design efforts by lead architects by defining data models and Use Case analysis models
• Gathered requirements and created Functional Specifications Document as a part of the Inception Phase.
• Organized the Project plan using Microsoft Project and delivered the documents on a timely basis.
• Collaborated with the business and application team in the creation of Business Continuity plan (Business Work Arounds) as a part of the Disaster Recovery Documentation.
• Responsible for translating BRDs into use-cases, and context diagrams and used UML to visually model the system.
• Created Process models for the DR processes using Microsoft Visio.
• Responsible for calculating ROI financial documents.
• Gathered requirements to document the Interaction of Service Center application with
• External (through bridge Server) and Internal Interfaces.
• Gathered requirements to confirm the functional and data validation for the various Service Center modules.
• Used Data modeling to understand various elements of data that could be stored, the size of these elements and the kind of information each element can contain.
• Extensively used Microsoft office suite of products and Cognos 8 for documentation and data interpretation for reporting test status.
• Coordinated with the application team and Quality Analysts in the creation of test plans, User Acceptance Test scripts and Regression test cases (for upgrade).

Environment: MS Office, Microsoft Visio, RUP, Microsoft Project, and Microsoft Share Point

Confidential, CA

Business Analyst/Subject Matter Expert

Responsibilities:

• Interacted closely with the Business users along with the administration and management to gather business requirements and analyze the functionalities to be incorporated into the system
• Worked on HIPAA 5010 transaction requirements and analyzed and tested HIPAA ANSI X12 formats including 270/271, 276/277, 834, 835, 837, 997, and NSF formats for interfaces and images to third part vendor applications
• Analyzed processes in medical coding and transition from ICD 9 - ICD 10.
• Worked with BA and UAT tasks.
• Attended demo sessions to understand existing system functionalities
• Arranged interviews with all the stakeholders to review and understand the gathered business requirements
• Coordinated with system architects and developers to convert business requirements into system requirements
• Conducted meetings to document Change Requests for new requirements
• Analyzed business requirements and segregated them into Use Cases.
• Created Use case diagrams and documented Use case specifications
• Maintained various versions of the documents generated during the project using Rational Clear Case
• Was responsible for creating and updating project schedule and managing resources and timeline using MS Project
• Prepared the project status reports and represented the BA team in the PMO meetings
• Participated in UAT along with the development & testing teams
• Gathered requirements from collection, claims, Billing, and insurance appeal departments
• Working with the business and various technology departments, and acting as a liaison between the underwriters and application developers to provide production support for the National Pricing Solution web based application
• Interacting with National Pricing Staff (Underwriting, Actuarial & Sales/AM) on daily basis with regards to how the NPS application functions, troubleshooting incidents/issues for Users and completing defect and enhancement requests on daily basis
• Performing system administrator duties i.e. adding/removing users to system
• Participating in UAT and working
• Maintaining and modifying training documents
• Extracting data from databases and preparing reports for auditing/SOX compliance purposes
• Traveling throughout regional offices to provide support and training to end users as an SME (Subject Matter Expert) in Claims processing & management, mentored & trained entry levels

Environment: Microsoft Word, Project, Excel, PowerPoint, Visio, Oracle 10g/11g

Confidential, Iselin, New Jersey

Business Systems Analyst

Responsibilities:

• Processed EDI test files and verified system is able to validate certified and non-certified trading partners. Worked with cross functional business teams to design SharePoint applications that best meet their content and document management requirements.
• Participated in 1CD 9 to ICD 10codes mapping sessions as well as status meetings and provided comments and suggestions on challenges. Gathered requirements on Trading Partner Registration and certification. Verified Trading Partner configuration and the profiles.
• Created an enterprise workflow application based on CRUD rules for Customer Data that would allow for future integration of data infrastructure across various business areas into a single User Interface.
• Conducted interviews with key business users to elicit, collect and manage requirements and prepared business process flowcharts. Created RFPs and evaluated vendor proposals.
• Developed scripts, scenarios and performed comprehensive testing - User Acceptance - UAT, Alpha and Beta testing of applications.
• Performed relational database design and modeling and conducted multiple SQL querying
• Participated in meetings with Developers, Project Managers and Quality Analysts to discuss business requirements, test planning, resource utilization and defect tracking
• Used Rational Clear Quest for defect tracking and prioritizing defects and for enhancements after base lining the requirements

Environment: RUP, UML, SQL, MS Office, MS-Project, Quick Test Pro

Confidential

Business Analyst

Responsibilities:

• Played a key role in the planning, testing, and implementing system enhancements and conversions.
• Aided documentation of Computer system validation lifecycle per FDA regulations.
• Worked on functions such as system audit, Change Control and Request, CAPA and managed complaints to ensure customer satisfaction.
• Experience of managing multiple stakeholders across the organization, and in QA integration of systems.
• Involved in detailing project mission, data process flow diagrams, and timelines.
• Worked with SQL queries for data manipulations.
• Assisted in building a business analysis process model using Rational Rose, Requisite Pro and Visio.
• Aided documentation of Computer system validation lifecycle per FDA regulations.
• Designed and developed Use Cases, Activity Diagrams and Sequence Diagrams.
• Assisted in process modeling; conducted and participated in JAD sessions with system users; helped with design walkthroughs with stakeholders for base lining architecture.

Environment: Rational Rose, Requisite Pro, QTP, cGMP, CICS, CFR, MS Visio, RUP, MS Project, SQL, MS Access, MS Excel and MS Word