SUMMARY:

• Over 9 years of experience in Software Development and Business Analysis role using both iterative software development life cycle principles and classic waterfall methodologies.
• Good understanding of Healthcare, Finance and Insurance industries. Adept in interacting and coordinating between end - users, expert teams, development and QA teams and drawing key changes to the business architecture.
• Able to discover the appropriate resources in the organization, extract information, develop alternatives and obtain level of effort estimates from impacted work groups. Knowledgeable of dimension modeling for data warehousing.
• Experienced in developing and testing distributed client/server, web based and intranet applications, .NET, C#.NET, Web services, Service Oriented Architecture (SOA), VB, ASP, VBScript, HTML, XML, XSL, data warehousing concepts OLAP, OLTP.
• Worked with users to gather, analyze, model and subsequently apply various tools to capture, link, trace, and manage requirements changes.
• Proficient in using Visio & Enterprise Architect and Rational Suit to model Use cases & business process flows by utilising activity diagrams, logical, component and deployment views.
• Knowledge of tools that assist in creating Business Process Model and Design (BPM and BPD), system definition model (SDM), use cases, functional specifications as well as requirements management, defect tracking, testing, traceability and status reporting.

TECHNICAL SKILLS:

Methodologies: RUP, Agile, Waterfall

Project Management: MS Project, Primavera, SharePoint, SharePoint.

Requirements Management: RequisitePro

Change Management Tools: Rational ClearCase

Operating Systems: Windows 95/98/NT/2000/03/XP, MAC OS, LINUX, UNIX

Databases/RDBMS: Oracle 8.x/9.x,10.x, DB2, MS SQL Server, MS Access, Teradata, TOAD

Business Modeling Tools: MS Visio, MS PowerPoint, Enterprise Architect, Rational Rose

Business Intelligence Tools: COGNOS 8, ReportNet

Documentation Tools: MS Word, MS Excel, Rational SoDA

Reporting Tools: Crystal Reports, Rational SoDA

Automated Test/Bug Tracking Tools: Win Runner 7.6, Quick Test Professional 8.0, Load Runner 7.x, 8.0, Test Director 8.0, Quality Center 9.0, Clear Quest, PVCS, SQA Administrator, SOAP UI

PROFESSIONAL EXPERIENCE:

Confidential, Farmington, CT

Lead Business Systems Analyst

Responsibilities:

• Conducted GAP analysis to figure out the impact on the organization’s business rules and subsequently on the adjudication, member and provider systems.
• Involved in vendor interviews and selection exercise to implement a hosted solution for member eligibility/actuals and claim status data transmission to providers and clearing houses.
• Facilitated JAD sessions to determine the status of business and functional requirements and development of a Functional Requirements Documentation (FRD) that supported the overall strategy, goals, and objective of the State and Federal Government.
• Developed To-Be Business Process Models (BPMs) in MS Visio by conducting interviews and workshops with different project stakeholders, and by analyzing existing State and Federal BPMs.
• Created detailed Use Case Diagrams/User Stories and Activity Diagrams to help all stakeholders understand the niceties of the data process and activities
• Led detailed design sessions to identify unique user scenarios and effective UI designs, and conducted joint sessions to develop Wireframes in Justin-Mind Prototyping tool and detailed Use Cases.
• Developed the project management process for traceability of project artefacts using IBM Requirement Composer.
• Presented project deliverables for validation and sign-off.
• Coordinated deliverable walkthroughs and knowledge transfer with interface and back-end team to identify and document external interfaces and technical requirements.
• Created detailed process flows utilizing Swim Lanes and Class Diagram patterns.
• Performed GAP Analysis between existing State Health Exchange System and Federal To-Be Business
• Process Models to understand the additional functionalities required to meet the PPACA mandate.
• Developed and implemented Project Schedule and Plan for organization and execution of project wide activities.
• Created test plan and detailed test scenarios and test scripts for testing the data output Claims Status (276/277), Member Eligibility (270/271), Electronic Remittance Advice (835) and Electronic Funds Transfer (CCD+) files.
• Conducted sessions for call center, member and provider department representatives as part of Admin Simplification rules preparedness process to handle future provider and member queries.

Environment: MS Office Suite, MS Visio, MS Project, MS SharePoint, Agile, UML, SSIS, SSMS, Oracle SQL Developer, Quality Center, STAR.

Confidential, Manhattan, NY

Sr. Business Systems Analyst

Responsibilities:

• Reviewed GAP Analysis to enumerate major differences between 4010 and 5010 trnasactions format.
• Assisted in getting sign off on Gateway architecture prototype from concerned department directors and SMEs.
• Led a team of BA’s in preparing the BRDs (Business Requirement Document), TRDs (Technical Requirement Document) and Mapping Doc. For 837I, P and D transactions as well as other associated transactions like 270/271, 276/277, 999/TA1, 277CA and 278 transactions.
• Worked as an SME/advisor for flawless execution of gateway contingency plan to be achieved through SUSD (Step Up & Step Down) approach led by EDIFECS.
• Created new data maps to depict data flow from trading Partner to Gateway and from Gateway to Mainframe systems. Also brought some old data maps in synchronization with the new process by mapping revised X-12 elements to the FasTrak HLLAPI and GHI pre-processor copybook fields.
• Utilizing HP Quality Center to streamline testing efforts. Establishing traceability of each test scenarios with corresponding business and functional requirement and conducting UAT based on pre-approved test plan.
• Planned and defined system requirements to Wire Frame with Use Case, Use Case Scenario and Use Case Narrative using the UML (Unified Modeling Language) methodologies.
• Wrote Use cases and Functional Specifications (FS) document corresponding to the requirements in the BRD.
• Designed, developed and tested data mart prototype (SQL 2008), ETL process (SSIS) and OLAP cube (SSAS) for Computer Maintenance Management System (CMMS)
• On another project I was responsible for preparing the ICD-10 - Claims Process/Medical Management Workstream Project Charter to scope the high level business requirements
• Authored the Business Requirement document to elaborate the in-scoped high level requirements with more level of decomposition
• Facilitated several work sessions with Business owners (owning individual requirements), SME’s, and Information Systems Supervisors to gather the requirements
• Represented the project in final walkthrough session and concluded with sign-offs on the Business Requirement Document
• Facilitated several JAD session to develop a common understanding among Implementation owners owning requirements in different operational areas
• Prepared RTM that incorporates individual business requirement to it’s corresponding technical requirement followed by the test cases
• Managed documents and web content using SharePoint Server.
• Coordinating with IT to in corporate the technical details in the Technical Requirement Document that would advocate the development and implementation process
• Responsible for coordinating Joint Application Development (JAD) sessions with business users, technical team, DBAs, testing team to analyze and validate the requirements, application lifecycle, gather and define the key performance indicators, document and present the requirements specifications.

Environment: Windows 98/2000, Window2003/2008, Linux, Mainframe, Solaris IBM Web sphere, Kintana, Ultra Edit,, Max MC, FasTrak, QCare, Lotus Notes, SharePoint, Point, MS Office Suite, EDIFECS, HP Quality Center 10.0, Load Runner 8.2, Sun Java, MSJVM, Oracle 8i/9i/10g, SQL Server 2000, DB2, Toad, MS-Project 2000/2003.

Confidential, Bloomfield, CT

Sr. Business Systems Analyst/Lead BSA

Responsibilities:

• Accounted for and anticipated impacts to the enterprise services with respect to ongoing Confidential Projects.
• Reviewed GAPs between current data availability and future data needs to meet the requirements of Incentive Enhancement Project.
• Created and reviewed Service Delivery Artefacts for each operation of the SI enterprise service and conducted internal, schema and consumer review of SOA web services we built.
• Created Functional Specification Document (FSD), Data Sheet (DSD), Invocation Outcome Document (IOD), Thought Log (TLD), Business Condition (BCD), Consumer Usage Plan (CUP) and Mapping documents based on Thought Log that we prepare at the commencement of the project.
• Consulted developers in designing database schemas using UML based on the needs and prospective uses of the data to feed one or many services.
• Reviewed the data model and reporting requirements for Cognos Reports with the Data warehouse/ETL and Reporting team.
• Created data mapping document to connect each individual data from source to destination within the SOA environment and heighted various data transformation and conversions at every step of the way.
• Sketched out the End-to-End SOA process flow to point out each individual data streams as source of data, relevant translation and transformation involved and its eventual delivery to the consumer of the data.
• Involved in designing and developing Data Models and Data Marts that support the Business Intelligence Data Warehouse.
• Worked closely with the Enterprise Data Warehouse team and Business Intelligence Architecture team to understand repository objects that support the business requirement and process
• Worked on Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data within the Oracle database.
• Conducted benefits enquiries and checked the data flow from front end to back end and used SQL queries to examine the data extraction from the stored procedure.
• Elicited business needs to figure out best manner to present Eligibility request and response reporting details based on Market Segment, Vendor Channels and Trading Partner.
• Designed Eligibility request and response (270/271) report layout based on business needs using Cognos BI tool in order to enable business plan its future course of actions.
• Conducted analysis of existing marts and databases to identify the current availability of data and plan on future tables and data attributes to be added based on consumer needs.
• Done in depth review of business/consumer needs and wireframes in order to come up with the required and optional parameters for the service input.
• Researched and identified various data streams feeling information in multiple systems and pursued impact analysis to figure out how existing data streams could be used for a new Enterprise Service.
• Mapped the data mart fields to the stored procedure to the XML schema that was created as primary design SOA structure of the service.
• Reviewed and suggested amendments to the Service Mart solution which is used as a convey customer related data spiralling in from different data streams and engines to various consumers after passing through distinct web services.
• Reviewed post deliverable WSDLs and XML Schemas located in UDDI to verify that each and every data element from the DSD has been included in the SOA environment.
• Supported QA team by providing necessary project details through knowledge Transfer sessions and active support during System, Integration and PVS testing.
• Tested and tracked invocation data flow from service consumer to data source and back from data source to the service consumer through SOAP UI.
• Actively participating in SI-SA community of practice to establish enterprise level standards for all SI artefacts so it could be leveraged by everyone working under the realm of SI.
• Worked on various service operations designed to serve various consumer applications that live within Enterprise service realm including Search Customer Incentive Eligibility, Search Customer Incentive Goals; Search Customer Incentive Details; locate Personal Health Plan Details; Search Pharmacy Claims By Members. Also created artefacts to serve as basis for enterprise service designed to serve My Confidential portal with a particular Customer’s personal health plan information.

ENVIRONMENT: MS Office Suite, RequisitePro, Rational Product Suite, DB2, ReportNet 1.1 MR 2/3, Quality Center, SQL Server, SSIS, Oracle, Toad, Cognos, SOAP UI, STC 7.5.1, Clarity, ASP.Net, XML Spy and Notepad++.

Confidential, Manhattan, NY

Sr. Business Systems Analyst

Responsibilities:

• On this project I was responsible for preparing the ICD-10 - Claims Process/Medical Management Workstream Project Charter to scope the high level business requirements
• Reviewed GAP Analysis to enumerate major differences between ICD 9 and ICD 10 code set content and format.
• Created new data maps to depict data flow from trading Partner to Gateway and from Gateway to Mainframe systems. Also brought some old data maps in synchronization with the new process by mapping revised ICD 9 codes sets to the ICD 10 code sets.
• Utilized HP Quality Center to streamline testing efforts. Establishing traceability of each test scenarios with corresponding business and functional requirement and conducting UAT based on pre-approved test plan.
• Authored the Business Requirement document to elaborate the in-scoped high level requirements with more level of decomposition.
• Facilitated several work sessions with Business owners (owning individual requirements), SME’s, and Information Systems Supervisors to gather the requirements
• Represented the project in final walkthrough session and concluded with sign-offs on the Business Requirement Document
• Facilitated several JAD session to develop a common understanding among Implementation owners owning requirements in different operational areas
• Prepared RTM that incorporates individual business requirement to it’s corresponding technical requirement followed by the test cases
• Implemented Traceability Matrix and User Requirement Specification Document (URS) to verify the functionality.
• As a part of Claims Process/Medical Management workstream, analyzed and identified different systems and their interfaces/data feeds/file transfers/databases that must be remediated as a part of ICD-10 remediation program
• Assessed the Vendors that send proprietary feeds that contain diagnosis codes and must be remediated as a part of ICD-10. Also, coordinated with Relationship Managers for different vendors to help them understand the need for having their systems compatible with ICD-10 diagnosis codes by effective ICD- 10 compliance date
• Worked on EDIFECS Compliance tool to inhouse mapping rules to crosswalk ICD-9 diagnosis codes to its corresponding ICD-10 diagnosis codes
• Managed documents and web content using SharePoint Server.
• Coordinating with IT to in corporate the technical details in the Technical Requirement Document that would advocate the development and implementation process
• Responsible for coordinating Joint Application Development (JAD) sessions with business users, technical team, DBAs, testing team to analyze and validate the requirements, application lifecycle, gather and define the key performance indicators, document and present the requirements specifications.

Environment: Windows 98/2000, Window2003/2008, Linux, Mainframe, Solaris IBM Web sphere, Kintana, Ultra Edit,, Max MC, FasTrak, QCare, Lotus Notes, SharePoint, Point, MS Office Suite, EDIFECS, HP Quality Center 10.0, Load Runner 8.2, Sun Java, MSJVM, Oracle 8i/9i/10g, SQL Server 2000, DB2, Toad, MS-Project 2000/2003.

Confidential, Lincoln, NE

Sr. Business Systems Analyst

Responsibilities:

• Responsible for implementation of transition in compliance with new HIPAA standards.
• Responsible for coordinating Joint Application Development (JAD) sessions with business users, technical team, DBAs, testing team to analyze and validate the requirements, application lifecycle, gather and define the key performance indicators, document and present the requirements specifications.
• Authored business requirements and conduced User Interviews to identify and document the data discrepancies and their sources as related to Government Contract Compliance (GCC), Government Disclosures, Government Pricing, Customers, Products, Product pricing.
• Involved in performance testing of Medicaid client server claims processing system, Medicaid MCC / MCO and Medicaid Management Information System (MMIS)
• Utilized Sybase EDI gateway for HIPAA compliance purposes. Identified and manually resolved HIPAA level 1 to 3 compliance issues by making corrections to the EDI x12 transactions on macros enables spreadsheet.
• Involved in creating sample mappings for the conversion of EDI X12 transactions code sets version and translation of ICD 9 codes into ICD 10 codes.
• Created 837 I, P & D claims using macro enabled claim spreadsheets. Created and maintained data mapping document(s) in to the HIPAA transactions: 270/271, 276/277, 837, and 835.
• Organized and documented Use Cases, Business Rules and Functional Requirements for all system functionalities. Maintained traceability GSD and DSD through updates to RTM.
• Identified testing scenarios and defined test cases for detailed functional testing.
• Planned and documented NPI CrossWalk procedure including NT&Z into the provider database.
• Ensured smooth claims processing while passing 837 claims for compliance check and running through load processing.
• Analyzed business scenarios to track possible business outcomes for the functions which could be incorporated into more detailed test scripts.
• Analyzed CMS comparison documentation highlighting changes of 4010 format and ICD 10 diagnosis and procedure codes.
• Performed In-Deapth analysis of systems and business processes of Medicare Part D as per CMS rules and procedures.
• Performed workflow analysis toward automated disability claims process.
• Documented Requirements for Management Reporting out of Clear Quest using Crystal Reports.
• Worked on Client/Server tools like SQL Server Management Studio to administer SQL Server.

Environment: Windows 98/2000, Window2003, Window NT, Linux, Mainframe, Solaris IBM Web sphere, NDM (FL), Ultra Edit, Clarity, File Viewer, Lotus Notes, Apache Tomcat, IIS 6.0, Web Logic, Java, SharePoint, MS Office Suite, Quick Test Pro 8.2, Mercury Quality Center 9.0, Load Runner 8.2, Sun Java, MSJVM, Oracle 8i/9i/10g, SQL Server 2000, DB2, Toad, MS-Project 2000/2003.

Confidential, Austin, TX

Business Analyst

Responsibilities:

• Identified business functions within business and system processes - existing and new - that can be developed as enterprise services
• Provided Initial Assessment(s) - estimate of work required to fulfill the requirements - and successfully identified lists of candidate services
• Formulated and defined system’s scope and objectives based on both user needs and a good understanding of applicable business systems and industry requirements/ regulations
• Decomposed business components to facilitate a logical understanding of business design that can be leveraged to provide finer levels of detailed analysis on how the process operates
• Produced service functional specifications for services and service operation(s) that serve not just the requesting business unit, but the entire corporation.
• Facilitated schema/WSDL and code review to validate that code is enabling the functionality defined in the SA artefacts; bridged the gaps (if any found) between analysis and design
• Created EDI documents for EDI maps to generate requirement documents and Project Charter, and logical design documents for EDI transactions and code sets.
• Created and updated data mapping document(s) with to the source for 270/271, 276/277 and 837.
• Ensured that developed services are in compliance with HIPAA Standards.
• Accounted for and anticipated impacts to enterprise services with respect to the transition from . More specifically, impacts related to the support of the following HIPAA Transactions: 837, 835, 270/271 and 276/277.
• Utilized EDIFECS SpecBuilder to create data map, short companion guides, long companion guides, test data creation X12 data conversion etc.
• Created test case documentation for batch as well as interactive tractions for manual testing to be done in SOA based environment using xml web services.
• Tested and tracked transaction data flow from X12 to TFE and back from TFE to X12 through TANDEM for batch transactions and through SOAP UI for interactive transactions.
• Identified and carried over HIPAA edits from CLAREDI to XEngine, identified scenarios and created FD requirements and test cases.
• Played an active role in non-project activities, such as task and flow decompositions and creation of templates for artefacts produced by the SA.
• Constantly worked as a member of CoP for establishment of best practices for BSD.
• For UI Projects: Analyzed and translated High Level Functional Requirements into more detailed functional requirements; created new and made updates to the existing Use Cases. Worked along with UI Designer to draft screen mock-ups. Created wireframes and demo prototypes.
• Received of Appreciation for contribution to the success of one of the core projects.

Environment: Oracle 10g, DB2, WAS, WPS/ Java, HP Quality Center, MS Word, Excel, Visio, EDIFECS SpecBuilder, SOAP UI, WSDLs and XMLs, 4010/5010, TANDEM, Outside View, Phoenix and PSWin Provider Gateway.

Confidential, Hartford, CT

Business Analyst

Responsibilities:

• Developed business requirement updates while working with different user groups to define priorities concerning project development.
• Documented business requirements, and communicated these requirements to the development team for the design and implementation of business solutions in technical specification document.
• Conducted brainstorming and JAD sessions with stakeholders and end-users for requirement analysis and documented the same.
• Assisted in development of staging database and inquiry screens to support EDI transactions.
• Used UML during requirements gathering and created Use Case Models and Use Case Diagrams for the purpose of stakeholders in the project to help them understand the workflow of the system associated with the requirements.
• Analyzed, coordinated, documented and managed project requirements, project processes and procedures and its changes throughout the software development lifecycle.
• Involved in writing test plans, defining test cases, test scenarios and data sets; developed and maintained test scripts, analyzed bugs and interacted with development team in fixing the errors.
• Worked with Subject Matter Experts (SME), project team members (business and technical), to define technology application for the business and system requirements. Also worked with the QA Team Lead to develop QA standards and ensured compliance with all regulatory requirements.
• Created and segregated SQL views and stored procedures for obtaining meaningful set of data.
• Extensively used MS Project 2003 for status reporting and planning throughout the project lifecycle

Environment: MS Office, MS Project, RequisitePro, Rational Rose, Rational ClearCase 6.0, SQL Navigator, Teradata, Test Director, ReportNet 1.1 MR 2/3, Cognos, MOSS 2007, Windows Server 2003. .NET, Siebel, PeopleSoft, Java, J2EE

Confidential

Business Analyst

Responsibilities:

• Defined program and project goals, objectives, product services, constraints, assumptions, risks and facilitated the processes by working with the project team, sponsor, and stakeholders to baseline the scope of the work and enable development of the plan.
• Worked as business analyst team to build enterprise reporting system to support Risk Analysis, Securities and their valuation, Asset Management- risks and returns, Bond Pricing, Financial Derivatives, Financing Structures, Capital Management, Portfolio Analysis, Stock Valuation, Amortization, Capital Structures and Budgeting, Value Based management.
• Implemented the full project lifecycle phases including requirements gatherings, development and quality assurance.
• Performed Gap Analysis by identifying existing technologies, documenting the enhancements to meet the end state requirements.
• Developed the test plan, test conditions and test objectives to be used in testing of the system.

Confidential

Business Analysis

Responsibilities:

• Researched and assessed client systems and business processes.
• Explored all aspects of the claim processing lifecycle, starting from identifying a claim to its closure.
• Used MS Word document 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.
• Involved in walkthroughs with business team, architects and developers to refine the requirements.
• Generated use-case diagrams using UML.
• Involved with the Software Quality Assurance (SQA) Team to develop Test plans.