SUMMARY

• Senior Business Analyst with 7+ years of experience in business process analysis/modeling, business requirements gathering, database design and development of Web Based, and Client/Server applications.
• Experience as Business/Systems Analyst with expertise in Insurance, Healthcare processes, Business Process Engineering, Systems/ Solutions Engineering, Strategic Planning, and Systems Analysis.
• Industry experience as a Business/Data Analyst with solid understanding of Business Requirements Gathering, Data warehousing, Data Modeling, Evaluating Data Sources, Translating Requirements into Specifications, Application Design.
• Extensive experience in Healthcare domain.
• Proficient in business process modeling, documentation, and testing using Rational Suite (Rational Rose, RequisitePro, SoDA, ClearQuest, Robot) as well as MS Visio and MS Project in combination with UML 2.0 diagramming techniques.
• In - depth knowledge of creating use case, activity, logical, component and deployment views with rational tools to extract business process flows and workflows thereby helping development and quality assurance teams in understanding the requirements.
• Knowledge in the ETL (Extract, Transform and Load) of data into a data ware house/date mart and Business Intelligence (BI) tools like Business Objects Modules (Reporter, Supervisor, Designer, and Web Intelligence).
• Extensive experience with Front end and Back end System Integration Testing
• Results-oriented Joint Application Development (JAD) Facilitator and meetings coordinator with excellent interpersonal skills.
• Expertise in the EPIC Medical software application (EMR).
• Knowledgeable of HL7 Messaging protocols.
• Extensive experience in all phases of RUP and SDLC processes
• Managed content using Docushare 5 and DocushareCPX and integrated it with other products like Liberty, Xerox Advanced Multifunction Devices
• Analytical, methodical, and resourceful approach to problem solving, identifying and documenting root causes and corrective actions
• Performed Gap Analysis to check the compatibility of the existing system infrastructure with the new business requirements
• Business Analysis and Testing with hands on experience in Healthcare and Insurance Sectors.
• Extensive experience with Medicare/Medicaid processing as well as the Claims/Billing.
• Skills include defining Project Scope, Business Process Analysis, Business Process Reengineering, Requirements Gathering, Data and Process Modeling
• Strong knowledge of the Software Development Life Cycle methodologies (phases and gates) like Agile and Waterfall models
• Extensive experience in Business Requirements gathering and writing skills with expertise in developing and documenting Business Requirement document (BRD), Functional Requirement Document (FRD),Software Requirement Specification (SRS) across the deliverables of a project.
• Knowledge Data Flow Diagrams, Business Flow Diagrams, Sequence Diagrams using MS Visio
• Experience in working with QA team to develop the Test plans, Test scenarios, Test procedures, and Test cases to ensure adequate testing of software both before and after completion.
• Excellent verbal/written communication skills and analytical abilities and can perform well both independently and as a team player.
• Proficient in Technical and Business Writing, Business Process Flow, Business Process Modeling, Business Analysis and testing various methodologies.
• Expertise in Project Management i.e. Project Scoping, Planning, Estimating, Scheduling, Organizing, Directing, Controlling, Budgeting and Drafting Remedy Procedures.
• Extensive experience in Strategic development of a Data Warehouse and in Performing Data Analysis and Data Mapping from a Operational Data Store to a Enterprise Data Warehouse
• Strong knowledge of all phases in Software development life cycle (SDLC) and the iterative Rational Unified Process (RUP)
• Expertise in Claims, Subscriber/Member, Plan/Product, Claims, Provider, Commissions and Billing Modules of Facets.
• Extensive experience in Strategic development of a Data Warehouse and in Performing Data Analysis and Data Mapping from a Operational Data Store to a Enterprise Data Warehouse.
• Ability to effectively speak to people about complex subject matter Expert.
• Extensive qualifications in all facets of information systems methodology from conceptual design through documentation, implementation, user training, quality review, analyzing business specification using both Object and Structured Oriented Design (OOD) methodology, translating user requirement into functional use cases for development and analysis of business needs
• Experience in development methodologies like RUP, SDLC, AGILE, SCRUM and Waterfall
• Extensive experience working in back end tester by writing SQL Queries and PL/SQL scripts on large data warehouse systems involving Terabytes worth of data.
• Created and generated reports to communicate all facet of the project to address budget, time line, labor, revenue, billing etc.
• Expertise in broad range of technologies, including business process tools such as Microsoft Project, Primavera, MS Access, MS Visio, technical assessment tools, Data Warehousing concepts and web design and development.
• Experience in Change Management Process (Identify, Analyze, Evaluate, Plan, Implement, Review and Close).
• Strong oral and exceptional written business communication skills
• Hard working, positive thinking, self starter with a strong goal orientation
• Excellent meetings facilitator with excellent inter-personal and conflict resolving skills.
• Proven success as a business analyst through the years, providing a well-balanced understanding of business relationships, business requirements, and technical solutions.

TECHNICAL SKILLS

Software/Hardware: .Net, SQL,MS, Windows 95/98, Windows XP, MS Project, MS-Office, Access, Excel, Lync, OneNote, PowerPoint, Project, Visio, Word and Microsoft Outlook, Internet, and various accounting programs, Tally7.0, Internet Savvy, Oracle.

Methodologies: Agile, Waterfall, RUP, UML, SDLC.

IDE Tools: Rational Rose, Rational Clearcase, MS Visio 2007, UML

Requirements Management Tools: Rational Requisite Pro, DOORS, SharePoint, IBM Blueworks Live, JIRA, Confluence

Project Management: MS Project

Software Packages: MS-Office - Word, Excel, PowerPoint, Share Point, Outlook

Testing Tools: Quality Center, Load Runner, Rational ClearQuest, IBM Rational Test Manager

Databases: Oracle 10.6, MS-SQL Server 2000, MS Access

Reporting tools: Crystal Report, Excel

PROFESSIONAL EXPERIENCE

Confidential, Detroit, MI

Business System Analyst

Responsibilities:

• Worked as a Business Analyst the primary liaison between the business line operations, and the technical team throughout the project life cycle.
• Conducted Requirement Validation (RV) and Joint Application Design (JAD) sessions to define requirements.
• Followed RMLC process of documenting, analyzing, tracing, prioritizing and agreeing on requirements and then controlling and communicating to relevant stakeholders.
• Interviewed users, stakeholders to manage and map business requirements of new system with existing legacy system by performing gap analysis, risk assessment, modifications and design specification mapping.
• Prepared Training materials and conducted Training sessions to train end users for exercising full use of application.
• Published Crystal Report on Crystal Enterprise.
• Provided support and business solutions to front office clients on functionalities such as pricing analytic and trade capture on fixed income and foreign exchange.
• Provided weekly status report to project managers with over all progress Incidents development and testing progress or any other system blocker major issues preventing users to complete work.
• Documented Functional Specifications to include incremental business requirements, functional design and scope.
• Implement Data warehouse processes like Data Extraction/Transformation and Load (ETL).
• Updated Topic Papers to Include enhanced functionality and got end users sign off.
• Performed GAP and Risk analysis of existing system and evaluated benefit of new system.
• Conducted project related presentations and provided reports to the higher management.
• Worked closely with PMO in all the phases, Project Initiation, Project Planning & Design, Execution & Build, Implementation, Project Closeout
• Extensively involved in using of formula fields, parameter fields, Group selection and record selection in Crystal reports 7.0.
• Conducted workgroup sessions with client and security team to analyze system role-based access and panel security.
• Created stored procedures and used ETL tools to automate activities for extraction, transformation and loading into the corporate data warehouse.
• Developed the ETL Informatica Mappings for importing data from ODS into subsequent data marts.
• Interacted with client and the Technical Team for requirement gathering and translation of Business Requirement to Technical specifications.
• Participated in several weekly cross-departmental team meetings. Coordinated with DST on outstanding AMISYS program fault/failure issues in the department.
• Expertise in System Integration (X12 EDI-HIPAA-835) with Health plans eligibility and claim (CPT, ICD 9 codes).
• Defined and documented a clear set of policies and procedures for all facet of operation for all personnel.
• Conducted interviews, meetings and JAD sessions during the process of Requirement Gathering.Applied guidelines, standards and regulations such as HL7 CDA, CDISC, MedDRA, Code of Federal Regulations (CRFs) to clinical data modeling.
• Planned and documented procedures for data processing and prepared data flow diagrams for the application.
• Analyzed and translated business requirements into system specifications utilizing UML and RUP methodology
• Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data within the Oracle database
• Generated Requirement Specification Document and Design Specification Document.
• Created Test Plans, Wrote Test Cases, Executed Test Cases, Maintain Issue Logs, Logged Triage Issued in Clear Quest, attend Triage Meetings addressing daily issues and actively participated in User Acceptance Testing
• Performed data quality analysis on data by writing queries to ensure data integrity across tables in DB2 database environment
• Documented System Design Documentation (SDD) describing the systems requirement, operating environment, files and database design, input format, output layout, detailed design
• Analyzed customer needs and existing functions in the area of HIPPA transactions to determine feasibility, consistency with the established scope of work
• Responsible for mapping of ICD9 to ICD10 and also did testing for 837I/P, 835 transactions to migrate to HIPAA 5010

Confidential, FL

Business Analyst

Responsibilities:

• Met with client groups to determine requirements and goals. Utilized Rational Unified Process (RUP) to configure and develop process, standards, and procedures and create a Business requirement Document.
• Worked as a business analyst for various other areas of Medicare Part D, such as EOB letter generation, Transition letter, CMS reporting and various other processes with CMS mandates.
• Created and revised Business Requirement document (BRD) and Functional requirement Document (FRD) using the Scope and Interview with stakeholders
• Involved in with data migration (ETL development), document data manipulation processes and scripts.
• Responsible for preparing Software Requirement Specification (SRS) and documenting them.
• Created Process Work flows, Functional Specifications documents and documented system requirements.
• Develop detailed unit test plans and scripts and conducted rigorous testing per requirements and assisted in data mapping.
• Provide implementation assessment, strategy, and mentoring services for Rational Rose, UML and RUP.
• Interacted with various cross-functional teams on building business use cases, and understanding expenses and revenue stream.
• Facilitated the process for arriving at a common understanding and agreement on the organizational work models for information exchange to strengthen decision support, and developing a new approach to integrated eligibility as a foundation for defining key business requirements.
• Participated in multi-organizational, multi-disciplinary teams to determine, articulate, and document workflows, use cases, logical data models, and functional (business) and non-functional (technical, implementation, performance) requirements.
• Good understanding in processing of Medicare and Medicaid eligible claims.
• Working on different area of expertise in Medicaid domain related to various subsystems involving Professional, Dental and Encounter claims.
• Good understanding of CMS 416 Form submission for each fiscal year.
• Key role in conducting JAD session with the State and writing detailed requirements. Performed the requirement analysis, impact analysis and documented the requirements.
• Followed a systematic approach to eliciting, organizing, and documenting requirements of the system.
• Interacted with client and the Technical Team for requirement gathering and translation of Business Requirement to Technical specifications.
• Conducted interviews, meetings and JAD sessions during the process of Requirement Gathering.
• Performed the requirement analysis, impact analysis and documented the requirements.
• Prepared Functional Design Specifications (FDS) employing Use case scenarios, sequence diagrams and class diagrams.
• Prepared Report using SQL Server Reporting Services (SSRS)
• Planned and documented procedures for data processing and prepared data flow diagrams for the application.
• Analyzed and translated business requirements into system specifications utilizing UML.
• Collaborated with other team members to work on different Change Orders.
• Communicating the business requirements to the Development and Testing teams for a successful deliverable.
• Writing Test Scenarios and helping in Test execution in Quality Center.
• Documented the Traceability Matrix for tracing the Test Cases and requirements related to them.
• Prepared Demo on SharePoint for various businesses to get new approvals.
• Designed workflows and allocated permissions within SharePoint.
• Participated in User Acceptance testing and documented detailed results.
• Provided input (scope, goals, risks, constraints, timelines and interfaces) to PM for project planning and control.
• Performed extensive Requirement analysis and developed use cases and workflows.
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, and OOD
• Worked with Quality Control Teams to develop Test Plan and Test Cases.
• Interaction with the developers to report and correct bugs.
• Developed Test Plans and Test Cases according to Business Requirements.
• Use HL7 implementation methodology to create specifications, assist with unit testing, and perform integrated testing for messaging between the state Departments of Health and the location office
• Conducted JAD sessions with extensive involvement from Business, Development, Testing teams, Architects, SME’s (Subject Matter Experts) and Managers of various Business Units
• Analysis of new Business Requirements and preparation of the Functional Design Specifications

Confidential - Chicago, IL

Business Analyst

Responsibilities:

• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims.
• Upgraded the existing Test Scripts and created new scripts for client application to be able to work for new versions and patches, which improved product quality.
• Provider inquiry about the status of Remittance Vouchers (RVs). This involved checking the MMIS provider subsystem and checked the setup of their Remit Media
• Created Data Stage jobs to extract, transform and load data into data warehouses from various sources like relational databases, application systems, temp tables, flat files etc.
• Accumulated system requirements from various departments through surveys and interviews.
• Performed Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data
• Conducted JAD sessions with management, SME, vendors, users and other stakeholders for open and pending issues.
• Created Use Case Diagrams, Activity Diagrams, Sequence Diagrams and ER Diagrams in MS Project.
• Assisted in the development, design and implementation of new relational or multi-dimensional databases, including the analysis of user needs.
• Created and managed project templates, Use Case project templates, requirement types and traceability relationships in Requisite Pro.
• Involved in writing the detailed Test Plan using Mercury Quality Center, after analyzing business requirements and software/functional requirement artifacts.
• Worked extensively with MS Excel and MS access
• Performed data analysis by using SQL queries using the DB Artisan tool
• Suggested measures and recommendations to improve the current application performance.

Confidential

Business Analyst/ Business System Analyst

Responsibilities:

• Prepared Business Process Models that includes modeling of all the activities of the business from the conceptual to procedural level. Followed top down, leveled technique for building Business Process Models
• Gathered Business Requirements, analyzed data/workflows, defined the scope, and performed GAP analysis.
• Conducted workshop sessions with the client to gather HR business requirements for blueprinting.
• Conducted SWOT Analysis for better market understanding and fool proof project implementation
• Reviewed ANSI X12 documents for potential impacts
• Provide user with the structural overview of the ANSI ASCX12 837 standard
• Met with client groups to determine User Requirements and Goals, thus converting User Requirements into Business Requirements and User and Functional Requirement Specification.
• Involved in designing and developing Data-Flow diagrams, E-R diagrams, and logical and physical database design.
• Facilitated collection of Functional Requirements from system users, and prepared Business and Technical Requirement Specification documents.
• Responsible for writing Business Use Cases, Business Rules, logical analysis and change management of requirements.
• Utilized RUP to configure and develop processes, standards, and procedures and to perform System analysis and organizational review of existing QA processes.
• Involved in development of Business and Technical Requirements in preparation of System Architecture, Information Strategy, and Detailed Design documents for Business Needs and Processes.
• Appointment scheduling and recalls, accounts receivable management and collections, reporting and filing claims trough EDI X12 format transaction sets in compliance with HIPAA standards
• Reports the Defects using Rational Clear Quest and HP QC.
• System, integration and acceptance testing of the client-server component.

Confidential - Columbia, SC

Business Analyst

Responsibilities:

• Successfully defined the scope and business rules of the project, gathered business requirements and documented them textually or using models.
• Facilitated JAD sessions and worked with business users through interviews, workshops, and brainstorming sessions.
• Researched and understood the claims adjudication and reimbursement systems based on HIPAA X12 4010 standards.
• Exposed to using ICD 9/ANSI/HL7 coding standards in Medicare and Medicaid domains of the healthcare systems and industry for both Inpatients and outpatients.
• Ensured that ICD-9-CM procedure codes used for inpatient services and CPT codes for outpatient and physician services were not outdated.
• Interacted with developers to report software bugs and retested the fixed issues.
• Facilitated User Acceptance Testing and test strategies with developers and testers and participated in manual front-end testing to check all functionalities of different modules.
• Used Rational Rose/MS Office Suite for creating use cases, workflows and sequence diagrams according to the UML methodology thus defining the Data Process Models.
• Involved in HIPAA/EDI Medical Claims Analysis, Design, Implementation and Documentation.
• Maintained Requirement Traceability Matrix (RTM).
• Developed queries using SQL to automate the weekly and monthly reports.
• Involved in preparing the Test Scenarios for Health Care Claim Payment/Advice.
• Coordinated Regression Testing and created test scenarios for User Acceptance Testing (UAT).
• Maintained documents for change request and implemented procedures for testing changes.