SUMMARY

• Business System Analyst with wide body of experience in varied lines of business across multiple platforms, most recently in the managed healthcare field, to include Medicaid and EDI. Experience training staff on a wide variety of software and computer systems including client - server and mainframe. Reporting experience. Experience in leading projects and coordinating upgrades of software.
• Over Seven (7+) years of experience in the IT industry specializing in Business System Analysis with strong knowledge of the Software Development Life Cycle.
• Experience in health information and health care services regulatory environment including HIPAA, Medicaid/Medicare, CCHIT, EDI and XML
• Experience of FGA Sales Management, Finance and Commissions Group and Preparing quarterly Sales Performance and Commissions Report, Forecasting & Budgeting.
• Good understanding of POS system, Medical Claim processing, Health Care plans, HIPAA, Facets, PPO, COPAY, Retails.
• Liaison between business stakeholders and technical teams to ensure proper translation of Business Requirements to System Requirements.
• Involved in regular client Interaction to discuss project progress.
• Excellent time management skills with the ability to prioritize critical and non-critical duties.
• Motivated self-starter with exceptional team building, Leadership, and interpersonal skills.
• Highly analytical in developing the methods and measures to meet requirements and solve any issues that arise during the project.
• Experienced with various Business Analysis SDLC Methodologies, such as RAD, RUP, JAD, and Spiral Methodologies.
• Understanding and interpreting requirement specifications.
• Designed Use Cases, Activity Diagrams, Sequence Diagrams, and Class Diagrams, Data flow Diagrams by using MS Visio.
• Extensive use of UML/RUP for modeling views in Microsoft Visio, Excellent analytical skills.
• Strong healthcare and Medicaid business configuration experience with focused primarily on claims adjudication, pricing, provider, member, enrollment, prior authorization
• Expertise in Project Planning, Project Design, Gathering requirements, creating Functional Specifications, and Data Flow Diagrams.
• Experience in conducting/facilitating Focus Groups Sessions, Stakeholder Interviews, Joint Application Development (JAD) and Joint Requirement Planning (JRP) Sessions for effective requirement gathering.
• Experience in creating documents such as Feasibility Reports, Systems Request, and Risk Assessments.
• Experience in development methodologies like RUP, SDLC, AGILE, SCRUM and Waterfall
• Establish documentation for agile methodology for implementation with a very water-fall-centric development team.
• Experience with TriZetto Facets 4.21/4.31 and TriZetto HIPAA Gateway 4.11 - supported new business requirements by extending the functionality of the core Facets system using the Facets extensibility architecture feature.
• Experience with TriZetto Facets Application Groups: Claims Processing, Guided Benefit Configuration, Medical Plan, Provider, Subscriber/Member, Utilization Management.
• Strong experience in conducting User Acceptance Testing (UAT) and documentation of Test Cases. Expertise in designing and developing Test Plans and Test Scripts.
• Experience in assisting Project Managers in creating Cost/Benefit Analysis Reports.
• Involved in preparation of Cost proposals to perform projects.
• Experience in customer / client interaction, on a regular basis; Involved in maintaining Requirements Traceability Matrix.
• Good knowledge of System Testing, Integration Testing; Experience in writing SQL queries to generate reports.
• Excellent Documentation skills to ensure proper communication channels between Business sponsors and technical teams during the entire software development process.

TECHNICAL SKILLS

Tools: Test Director, JIRA, Rational Clear Quest, Quality Center, MS VISIO, SQL Developer, Toad, Agile

Testing Software: QTP, Test Director, Win Runner

Bug Reporting Tools: Test Director

Operating Systems: Windows 2003 Server, Windows 2000 Server, Windows NT / XP and Windows 2000

Programming Languages: SQL, UML, JAVA, .Net, RUP, Agile

PROFESSIONAL EXPERIENCE

Confidential, NY

Sr. Business Analyst

Responsibilities:

• Gathered analyzed, documented business and technical requirements from both formal and informal sessions and validate the needs of the business stakeholders.
• Performed Cost benefit, ROI and ROM studies
• Conducted user interviews and documented business and functional requirements.
• Performed Requirement Analysis and developed Use Cases, Activity Diagrams using Rational Rose
• Defined, developed specs for federal reporting specific to Medicare Advantage
• Intricately involved in Business Process Flow development, Business Process Modeling, and ad hoc Analysis
• Completed the documentation of Claims Scenario’s for the source system
• Analyzed the existing claims process and specific business rule logic will be applied in the ACP model.
• Prepared for GAP Analysis; identified and documented improving areas to meet capital requirement regulations.
• Conducted interviews, meetings and JAD sessions during the process of Requirement Gathering
• Designed High level design, for New process, integrating with legacy and Facets
• Involved in creating business processes and modeling diagrams using Rational Unified Process (RUP).
• Wrote SQL queries to for Data Mining and Data manipulation in MHS.
• Created use case scenarios and documented work flow and business process using Rational Rose
• Involved in project management using MS Project
• Collaborated with External Auditors and documented SOX compliance requirements
• Documented requirements associated change requests with requirements and connected requirements with Use cases.
• Used Test Director, PL/SQL for testing the application.
• Wrote test cases and test scripts for the User Acceptance Testing
• Incorporated Rational Unified Process (RUP) to create Requirement Document Specifications using Visible Analyst.
• Performed extensive data modelling to differentiate between the OLTP and Data Warehouse data models
• Identified/documented data sources and transformation rules required populating and maintaining data warehouse content.
• Responsible for creating test scenarios, scripting test cases using testing tool and defect management for Policy Management Systems, Payables/Receivables and Claims processing.
• Involved with all the phases of Software Development Life Cycle (SDLC) methodologies throughout the project life cycle.
• Served as conduit for managing system requirements between the business and the software development team.

Environment: Oracle9i, MS Access, MS Excel, MS Project, MS PowerPoint, RUP, UNIX, Oracle Pl/SQL, UML, Rational Rose, Requisite Pro, Clear Case, Rational Clear Quest 2002, MS Office suite, MS Visio

Confidential, New York, NY

Business Systems Analyst

Responsibilities:

• Interacted with business heads to finalize the Business Requirements for the application.
• Performed the requirement analysis and documented the requirements using Rational Requisite Pro.
• Used the requirement attributes (priority, effort, and risk) as the basis for negotiating the inclusion of the requirement, to manage the scope of the system efficiently.
• Developed UML Use Cases using Rational Rose and developed a detailed project plan with emphasis on deliverables.
• Successfully conducted JAD sessions, which helped synchronize the different stakeholders on their objectives and helped the developers to have a clear-cut picture of the project.
• Used SDLC (System Development Life Cycle) methodologies like the RUP and the waterfall.
• Understand the As Is system and develop the To Be system concept and also prepare the System Process Maps.
• Managed changing requirements which included establishing a baseline, keeping track of the history, determining dependencies that are important to trace, tracing relationship between related requirements and maintaining version control.
• Prepared and documented System Requirements and workflows for the Content Management Application tool.
• Responsible for integrating with Facets .Designing test scripts for testing of Claims in Development, Integration and production environment.
• Involved in interactions with Subject Matter Expert, Project Manager, Developers, and the end-users in more than one JAD sessions. MS Project proved useful in coordinating activities with project manager and various other teams.
• Performed Unit Testing and User Acceptance Testing and documented detailed defects.
• Wrote Procedure Manuals and was responsible for continuity preparedness.
• Managed various tests, stored test information, reviewed and analyzed test results.
• Conducted presentations of the Q/A test results with analysis to the stakeholders and users and documented modifications and requirements.
• Helped in writing Training manuals and helped business with the Training on a one to one sessions.
• Employed Rational Clear Quest for effective Change Management (Requirements Creep) and bug tracking during the testing lifecycle.

Environment: Rational Rose and Requisite Pro, MS Visio, MS Project, UML, XML, Rational Clear Quest, Rational Clear Case, RUP, Microsoft Excel, Microsoft Word, Microsoft Power Point

Confidential

Business Analyst

Responsibilities:

• Gathered Business Requirements through brainstorming sessions on global calls.
• Documented the business logic and associated validation logic.
• Met with various HMO, PPO, Medicaid/Medicare, and Tricare / Champus Representatives discussing benefits of contracts on behalf of facilities or appeals from denials and compliance issues
• Worked with Data Extraction, Transformation and Loading. Metadata architecture was also provided, for the purposes of query enhancement and clarification of data relationships. Also built the foundation for process implementation in MS-SQL.
• Reviewed the data model and reporting requirements for Cognos Reports with the Data warehouse/ETL and Reporting team.
• Responsible for architecting integrated HIPAA, Medicare solutions, Facets.
• Duties included maintenance of existing and development of new Unix Korn and C shell scripts for sales/marketing EDI data extraction and uploading to Excel spreadsheets and MS Project files
• Created Requirements Specification Document that translated business requirements into Technical specification including business and validation logic for ease of understanding to the development team.
• Designed High level design, for New process, integrating with legacy and Facets
• Responsible for integrating with Facets .Designing test scripts for testing of Claims in Development, Integration and production environment.
• Designed test cases for Billing and Account Management, Recoveries, and Financial forecasting systems
• Identified gaps and performed gap analysis with respect to CMS requirements.
• Used MS-Visio for flow-charting, process model and architectural design of the application.
• Designed Data Flow Diagrams (DFD’s), Entity Relationship Diagrams (ERD’s), and web page mock ups using modeling tools.
• Designs and develops the logical and physical data models to support the Data Marts and the Data Warehouse
• Involved in formatting data stores and generate UML diagrams of logical and physical data.
• Analyzed and translated business requirements into system specifications utilizing UML and RUP methodology
• Ensured that all Lines of Business specifications were consistent in form and function to the Diamond Base System.
• Lead Business Intelligence reports development efforts by working closely with MicroStrategy, Teradata, and ETL teams
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, and OOD
• Generated wireframes and prototype for the GUI.
• Reviewed test scripts and made sure that the Test scripts covered all scenarios of the requirements.
• Reviewed the data model and reporting requirements for Cognos Reports with the Data warehouse/ETL and Reporting team.
• Identified/documented data sources and transformation rules required to populate and maintain data warehouse content.
• Reviewed the Defects entered by the QA team and prioritized the defects and assigned them to the development team
• Checked the schema of Oracle database manually or using TOAD after every upgrade.
• Interacted with the users and logged any defects, enhancements from the UAT.
• Worked with the Training Group to build training materials as well provided any suggestions/ tool tips to assist in User Training

Environment: Rational Rose and Requisite Pro, MS Visio, MS Access, MS Project, MS SharePoint, UML, XML, Windows XP, NT/2000, HTML, MicroStrategy, J2EE (JSP1.2), XML, XSL, XSLT, HTML, Oracle 9i

Confidential, Nashville, TN

Business Analyst

Responsibilities:

• Gathered business requirements by driving user-group meetings and working with various global, cross-functional and virtual teams
• Managed the team of consultants responsible for developing on-demand Medicaid Management System reports.
• Designed the online screens and reports for the Medicaid Online Electronic Claims Submission System.
• Ensured that all Lines of Business specifications were consistent in form and function to the Diamond Base System.
• Responsible for business system analysis of customizing the BPS Risk Management product with involvement through the whole SDLC
• Incorporated Rational Unified Process (RUP) to create Business Requirement Document Specifications using MS Visio and MS Word.
• Identified formal acceptance tests for the Eligibility Management system. Produced a system test plan that included detailed test cases and measurable exit criteria.
• Extensive use of MS Office tools like MS Access, MS Word, MS Excel, MS PowerPoint MS Project for data migration in to the CI System Knowledge Data Base in Microsoft SharePoint Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, OOD using UML
• Involved in all phases of software development life cycle in RUP framework.
• Used Rational Rose to model the process using UML to create behavioral and structural diagrams.
• Managed the transition to new development standards, procedures and processes including the introduction of UML, Rational Products including Rational Software Architect, ClearCase and ClearQuest as well as the Mercury Test Suite
• Developed detailed Developer specification to reflect technical details of the business requirements
• Performed data analysis by using SQL queries using the DB Artisan tool
• Extensive experience in using collaborative tools like Mercury Quality Center to facilitate development across disparate teams
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, OOAD using UML and Business Process Modeling.
• Interacted with the users and logged any defects, enhancements from the UAT and communicated them to the development team

Environment: J2EE (JSP 1.1), EJB(2.0), Servlets 2.2, JMS, Java2 (JDK 1.3), STRUTS,JDBC2.0, XML, XSL, XSLT, RUP, UML, SDLC, UAT, Agile, Rational Rose, PL/SQL, HTML, CSS, MS Visio, MS SharePoint, MS Office

Confidential, Stamford, CT

Business Analyst

Responsibilities:

• Involved in Inception Phase and prepared vision statement and initial data models that contain Business Requirement Documents and supporting documents that contain the essential business elements and detailed definitions.
• Working with customers to better understand their needs and present solutions using structured SDLC approach.
• Gathered user and business requirements through open-ended discussions, brainstorming sessions and role-playing.
• Documented the user requirements Analyzed and prioritized them and converted them have system requirements that must be included while developing the software.
• Analyzed data and created class diagrams and ER diagrams for designing databases.
• Suggested web security using encryption and authentication technologies for reporting and complaint filing procedures.
• Established RUP (Rational Unified Process) methodology and provided assistance in developing Use cases and project plans.
• Conducted user interviews, gathered requirements, analyzed the requirements by using Rational Rose, Visio and Requisite pro - RUP
• Planned and defined Use Cases created Use Case diagrams, Scenarios and Use Case Narratives using the UML methodologies.
• Created Activity Diagrams, Sequence Diagrams and ER Diagrams.
• Created Mock-up forms in MS word for better visualization and understanding of the software solution.
• Tracked change requests and monitored workload and schedule.
• Facilitated JAD sessions with management, development team, users and other stakeholders to refine functional requirements.
• Scheduled meetings with developers, System Analysts and testers to collaborate resource allocation and project completion.
• Created and managed project templates, use case templates, requirement types and tractability in matrix Requisite Pro.
• Managed workload, schedules and coordinated status review meetings with project managers, business managers and team members.
• Authored progress and completion reports which were then submitted to project management on a weekly basis in MS project.
• Identified various frequently used modules with in the application as well as the peak user volume for load testing purposes.
• Analyzed the test results from QA teams using Performance Studio Analysis to create various scenarios.
• Developed strategies with Quality Assurance group to implement Test Cases in Test manager for User Acceptance Testing.
• Collaborated with Quality Assurance Analyst in Automated and Manual Black box testing.
• Helped in creating end user manuals and procedure manuals.

Environment: Java, J2EE technology, Windows 2000 Advanced Server, UNIX / Oracle Platform, MS Visio, RUP, Rational Rose 2002, interwoven, Rational Clear Quest, Rational ClearCase, Rational requisite pro, ROMP, rational test manager, Rational Robot, MS Office, MS project, MS Word, MS Excel