SUMMARY

• Senior business analyst with 7+ years of industry wide experience in the domain of Insurance, Healthcare, Pharmacy, Life Sciences with solid understanding of Business Requirement elicitation techniques, Business Intelligence and experience in envisioning, representing and translating the product vision from the business sector to the software development.
• Strong systems expertise with various FACETS ( ), HEALTH RULES, and QNXT.
• Superior skills in Product and Plan building in Facets NetworX Pricer.
• Script developing and testing in Facets Client, Development and Production environments.
• 4+ years of professional experience in Healthcare domain (2 yrs. in TriZetto)
• 2+ years of work experience with Facets, Worked on the latest 5.0 version of Facets for Vision care Development with Eye Med.
• Experience with various Facets modules such as Subscriber/Member, Claims, Plan/ Product.
• Experienced with multiple payer applications including AMISYS and FACETS and DIAMOND, XLESYS.
• Expertise in understanding HIPAA 835, 834, 820, 270, 271, 276, 277, and 278, EDI, Privacy, Security, and Medicaid.
• Worked on implementing HIPAA 4010 and HIPAA 5010 transaction set rules.
• Business Analyst with solid understanding of Business Requirements Gathering, Business Process Flow and Business Process Modeling
• Great knowledge on Pharmaceutical/ Life Sciences industry, worked as a Quality Manager in the Circular Practical Training for Pharmaceutical Company while in the School. Had great Experiences in handling all the analytical instruments such as HPLC, mass spectroscopy.
• Proven record of high accuracy in designing and building healthcare benefits on the AMISYS system.
• Worked on Pharmaceutical Validation regulations for Pharmaceutical Company 0n 21 CFR Part 11. Worked extensively with R&D team in Clinical Trials.
• Extensive use of BABOK guidelines and practices in Life sciences.
• Strong experience of Pharmaceutical Clinical Trials, financial industry with sound knowledge of SOX and Basel accords.
• Extensive experience in translating business requirements and user expectations into detailed specifications by using various Text formats & Unified Modeling Language (UML).
• Experienced with all the phases of SDLC throughout the project life cycle in Rational Unified Process (RUP) environment and the creation of artifacts and management of various roles specified by RUP.
• Solid background in Software Development Life Cycle methodologies such as the Traditional Waterfall Model as well as iterative approach to software development.
• Expertise in requirement analysis and designing Use Cases.
• Experience with Brokerage Industry
• Proficient in creating Use Cases, Sequence Diagrams, Activity Diagrams, Class Diagrams etc.
• I have strong technology and analytical skills in Annuity
• Ability to gather business and technical requirements from both formal and informal sessions utilizing a variety of software tools to format them into formal documents.
• Strong experience in Requirements gathering techniques - conducting user interviews and JAD sessions.
• Created Access databases and data mapping document for data stage ETL transactions.
• Experienced in performing Business Process Analysis to check the compatibility of the existing system infrastructure with the new business requirements.
• Effective in executing multiple tasks and assignments ahead of schedule.
• Reputation for dedicated teamwork, high energy, work ethics and commitment with capability to handle new technologies and situations.
• Participated on multiple analysis projects for various applications, developed internally and by other solution providers.
• Involved in reviewing test procedures, defining test cases, reviewing and maintaining test scripts, analyzing bugs and User Acceptance Testing (UAT).
• Extensive experience in using MS Project for status reporting and planning.
• Team player, result-oriented, fast learner, excellent communication skills with strong research capability.
• New Loan Setup, Payment Application/Remittance, Escrow and Reserve Administration, Collateral Inspection and Monitoring.
• Strong knowledge of Business Intelligence, Data Warehousing and Business Architecture.
• Excellent communication and Presentation skills. Experience working with business users as well as senior management.

TECHNICAL SKILLS

Languages: C++, SQL, Java

Operating Systems: Win 95/98/NT/2000, XP

Internet Technologies: HTML, XML

Databases: MS SQL Server, MS Access, Oracle 8i

Tools: MS office, MS Project, Visio, Rational Rose, RequisitePro, Rational SODA, Clear case, Clear quest, MS Front Page

Reporting Tools: Crystal Reports

Quality Management: Concept and Tools of Quality Management Test Director and Win Runner, ISO Concepts, Six Sigma Techniques

Web Technologies: ASP, JavaScript, HTML, DHTML, IIS, and FrontPage

User Interface: HTML, XHTML, CSS, Java Script

PROFESSIONAL EXPERIENCE

Confidential

Sr. Business Analyst

Responsibilities:

• Performed the requirement analysis, impact analysis and documented Business Requirements Document (BRD) and Functional Specification Document (FSD) using Rational Requisite Pro.
• Prioritized deliverables, identified gaps, tracked defects, defined software requirements, created artifacts for testing and development.
• Gathered knowledge on Medicare Part- B, D HL7, HIPAA rules and regulations.
• Worked with customers in resolving acute issues, fixes involving Meditech (MT) software & coordinating all activity within each assigned Meditech module.
• Performed Impact analysis for readiness of ICD-10 conversion.
• Mapped HIPAA compliant EDI transactions for 837: healthcare claims and 835: payment advice transactions, Captured all HIPAA-related EDI data in the repository using FACETS, Supported integrated EDI batch processing and real-time EDI using FACETS. Accepted inbound transactions from multiple sources using FACETS.
• Collaborated efforts with technical staff and subject matter experts to establish the technical vision of product and analyze triple constraint tradeoffs.
• Analyzed business processes, requirements, and data necessary to provide detailed logic for ETL development.
• Created UML diagrams- Use Case Diagrams, Activity Diagrams, Sequence Diagrams and ER Diagrams in MS Visio.
• Documented the Traceability Matrix for tracing the Test Cases and requirements related to them.
• Conducted GAP Analysis of current state for Medicare Part-D (As-Is) ICD 9 and proposed state (To-Be) ICD 10 situations and represented the same on MS Visio.
• Supported development of UAT cycle test scripts, Review User Acceptance Test Plan (UATP) and attend walkthrough
• Recommended changes for system design, methods, procedures, policies and workflows affecting Medicare/Medicaid claims processing in compliance with government compliant processes like HIPAA/ EDI formats and accredited standards like ANSI.
• Managed the planning / test process for Medicare Part D Pharmacy Claims (PBM).
• Analyzed, maintained and updated FAQ knowledge base in SharePoint for better data accuracy and better timely data availability

Environment: Java, JSP, Oracle Clinical, LIMS, CSS, cGMP, SAS, UI, FDARegulations, Windows NT, MSOffice (MS Excel for reporting), Rational Rose, Requisite Pro, Xcelys.

Confidential, CT

Sr. Business Analyst

Responsibilities:

• Performed the requirement analysis, impact analysis and documented Business Requirements Document (BRD) and Functional Specification Document (FSD) using Rational Requisite Pro.
• Prioritized deliverables, identified gaps, tracked defects, defined software requirements, created artifacts for testing and development.
• Interacted with customers and established new corporate business. Fast paced customer service and sales driven work environment with sales force.
• Gathered knowledge on Medicare Part- B, D HL7, HIPAA rules and regulations.
• Worked with customers in resolving acute issues, fixes involving Meditech (MT) software & coordinating all activity within each assigned Meditech module.
• Performed Impact analysis for readiness of ICD-10 conversion.
• Mapped HIPAA compliant EDI transactions for 837: healthcare claims and 835: payment advice transactions, Captured all HIPAA-related EDI data in the repository using FACETS, Supported integrated EDI batch processing and real-time EDI using FACETS. Accepted inbound transactions from multiple sources using FACETS.
• Collaborated efforts with technical staff and subject matter experts to establish the technical vision of product and analyze triple constraint tradeoffs.
• Analyzed business processes, requirements, and data necessary to provide detailed logic for ETL development.
• Created UML diagrams- Use Case Diagrams, Activity Diagrams, Sequence Diagrams and ER Diagrams in MS Visio.
• Documented the Traceability Matrix for tracing the Test Cases and requirements related to them.
• Conducted GAP Analysis of current state for Medicare Part-D (As-Is) ICD 9 and proposed state (To-Be) ICD 10 situations and represented the same on MS Visio.
• Supported development of UAT cycle test scripts, Review User Acceptance Test Plan (UATP) and attend walkthrough
• Recommended changes for system design, methods, procedures, policies and workflows affecting Medicare/Medicaid claims processing in compliance with government compliant processes like HIPAA/ EDI formats and accredited standards like ANSI.
• Managed the planning / test process for Medicare Part D Pharmacy Claims (PBM).
• Analyzed, maintained and updated FAQ knowledge base in SharePoint for better data accuracy and better timely data availability

Confidential

Senior Business Analyst

Responsibilities:

• Identifiedandvalidatedhighpotential business opportunitiesfor stakeholders anddevelop customized business strategiesthat are aligned with corporate strategic objectives.
• Processes claim adjustment requests in Xcelys following all established adjustment and claim processing guidelines.
• Utilize SharePoint and Excel as necessary to work through daily inventory assignments.
• Identifies and escalates root cause issues to supervisor for escalated review.
• Reviews and responds to internal escalated provider disputes transferred by management and other associates.
• Acts as liaison with other departments when additional clarification is needed about claims payment policy disputes.
• Assists team members with training opportunities and coaching.
• Assists with special projects as assigned or directed.
• Lead analyst for AMISYS advance system migrations. Implementation of web-based Healthcare platform.
• Designed and tested processes and vendor integrations supporting membership, medical management, claim adjudication, and accumulator integration.
• Successfully completed system upgrades of core AMISYS system from legacy version to AMISYS advance 3.1 in 2008.
• Lead for defect resolution with vendor and implementation of patches from DST health solutions.
• Manage the creation of virtual (VMware ) and physical environment builds for TriZetto clientele and manage their environment portfolios.
• Interviewing business area experts (R&D), asking detailed questions and carefully recording the requirements in a format that can be reviewed and understood by both business people and technical people.
• Responsible for interaction with Client on the technical and business issues/clarification.
• Responsible for creating Web service based Interface for FACETS-MLM.
• Validated PQ’S of Mass Spectroscopy, Color Chromatography.
• Maintained records for lab assay data and converted them to Electronic lab notebook. Programmed SAS based Monte Carlo simulation models for real business scenarios. Also conducted statistical analysis of data to predict impact and outcome.
• ConductedJAD sessionsto develop anarchitectural solutionthat the application meets the business requirements, resolve open issues, and change requests
• PreparedBusinessProcess Modelsthat includes modeling of all theactivities of businessfromconceptual to procedural level.
• Followed theUMLbased methods usingRational Rose and Visioto createUse Cases, Activity Diagrams/State Chart Diagrams, Sequence Diagrams, Collaboration Diagrams
• Assuring that allvalidation documentationsuch as IQ's, PQ's, Process Validation, Cleaning Validation, and Software Validation are in compliance with cGMP's.
• Wrotedocumentationfor all aspects of the computer systems validation lifecycle, in accordance with FDAregulations, particularly CFR 21, part 11.Validating processesandequipmentutilized to manufacture active pharmaceutical ingredients inFDAenvironment.
• PerformedUnit and System testing, UI before integrating all theseparatemodules for further testing to assure an efficient operation.
• Involved in weeklywalkthroughs,inspectionsandverification meetingswith various stakeholders in the project.Conducted periodicSoftware Quality Assessment meetingsto come up withtest metricsand gauge the progress of the testing effort.

Environment: Java, JSP, Oracle Clinical, LIMS, CSS, cGMP, SAS, FDARegulations, Windows NT, MSOffice (MS Excel for reporting), Rational Rose, Requisite Pro, Xcelys.

Confidential, San Francisco, CA

Business Analyst

Responsibilities:

• Process claims for all lines of business including but not limited to HMO, PPO, POS, TPA and Medicaid/Medicaid.
• Audit claims for accuracy as it relates to State Medicaid and appeal denials as needed.
• Work all pending holds according to plan benefits to ensure timely and proper payment.
• Create and implement workflows to use for claims processing.
• Assist in all trainings and meetings related to claims processing and implementations.
• Educate providers on benefits and eligibility related to member utilized health services.
• Collaborate with the health improvement department to create and implement health related activities.
• Performed the requirement analysis, impact analysis and documented Business Requirements Document (BRD) and Functional Specification Document (FSD) using Rational Requisite Pro.
• Prioritized deliverables, identified gaps, tracked defects, defined software requirements, created artifacts for testing and development.
• Gathered knowledge on HL7, HIPAA rules and regulations.
• Mapped HIPAA compliant EDI transactions for 837: healthcare claims and 835: payment advice transactions
• QNXT, Care Advance, CWS, Facets and a host of 3rd party software suites are included with the build outs of the environments.
• Collaborated efforts with technical staff and subject matter experts to establish the technical vision of product and analyze triple constraint tradeoffs.
• Analyzed business processes, requirements, and data necessary to provide detailed logic for ETL development.
• Created UML diagrams- Use Case Diagrams, Activity Diagrams, Sequence Diagrams and ER Diagrams in MS Visio.
• Documented the Traceability Matrix for tracing the Test Cases and requirements related to them.
• Conducted GAP Analysis of current state (As-Is) ICD 9 and proposed state (To-Be) ICD 10 situations and represented the same on MS Visio.
• Supported development of UAT cycle test scripts, Review User Acceptance Test Plan (UATP) and attend walkthrough
• Recommended changes for system design, methods, procedures, policies and workflows affecting Medicare/Medicaid claims processing in compliance with government compliant processes like HIPAA/ EDI formats and accredited standards like ANSI.
• Managed the planning / test process for Medicare Part D Pharmacy Claims (PBM).
• Analyzed, maintained and updated FAQ knowledge base in SharePoint for better data accuracy and better timely data availability

ENVIRONMENT: MS PowerPoint, Requisite Pro, XML, MS Visio, Dreamweaver, UI, MS Excel, MS Access, Oracle, Waterfall SDLC.

Confidential

Business Analyst

Responsibilities:

• Researched and assessed client systems and business processes.
• Explored all aspects of theclaim processing lifecycle, starting from identifying a claim to its closure.
• UsedMS Worddocument for requirement gathering.
• Worked intensively on various phases in the project lifecycle to design the system in such a way that the high risk claims could be easily identified and monitored.
• Participated in preparing basis for Project Vision documentation.
• Involved in walkthroughs with business team, architects and developers to refine the requirements.
• Generated use-case diagrams usingUML.
• Implemented Traceability Matrix, User Requirement Specification Document(URS)toverify the functionality.
• Streamlined clerical work processes and mapped to the automated system
• Involved with theSoftware Quality Assurance(SQA) Team to develop Test plans.

Environment: MS Visio, UML, Oracle, SQL, MS Office and Windows 2000.

Confidential

Business Analyst

Responsibilities:

• Develop a team of dedicated professionals to improve community wellbeing and to achieve company's goals and objectives.
• Work in collaboration with providers and health insurances to provide quality health care.
• Prepare the biweekly schedule, payroll, and monitors personnel utilization in accordance with the operating budget or workload requirements. Supervise, recruit, hire/fire, train and manage/improve employee performance.
• Worked intensively on various phases in the project lifecycle to design the system in such a way that the high risk claims could be easily identified and monitored.
• Managed the planning / test process for Pharmacy Claims.
• Ensures high level of quality, competency, and accuracy by developing and maintaining quality assurance.
• Ensure compliance with Federal and State laws, regulations and standards.
• Propose, develop and implement efficient innovations to improve retail pharmacy services.