SUMMARY:

• Senior business analyst with 7 years of hands on experience in the domain of Insurance, health care, pharmacy and life sciences with strong understanding of business process modeling, business process flow, elicitation techniques and experience in management of business requirements using SDLC methodologies and RUP processes, UML modelling, Proto type design, RAD and JAD sessions.
• Experience in using Agile and water fall methodologies and working knowledge in all areas of project life cycle in a structured change management environment.
• Good subject knowledge in insurance, pharmacy and health care sectors.
• Proficient in gathering and analysis of requirements and creation and development of financial specifications.
• Skilled at performing GAP analysis, Financial Analysis, User Acceptance Testing (UAT), SWOT analysis, Cost benefit analysis and ROI analysis.
• Good knowledge on various insurance products and plans like Endowment Insurance Products, Term Insurance Products and Unit Linked Insurance Plans, Health Insurance, Life Insurance Products, Pension plans, Retirement plans and Annuities etc.,
• Expertise in ICD - 9 to ICD-10 Conversion.
• Medical Claims experience in Process Documentation, Analysis and Implementation in 835/837/834/270/271/277/997 (X12 Standards) processes of Medical Claims Industry from the Provider/Payer side.
• Worked on healthcare standards such as HIPPA 4010, 5010, ICD-9 ICD 10.
• Strong experience and understanding of Medicaid and Medicare Services in health care industry, claims management process.
• Demonstrated ability to work both in independent and team-oriented environments with well-developed organizational skills, excellent interpersonal and communication skills, solving and delivering solutions under high stress environment.
• Dynamic experience as professional in domains of healthcare and insurance industry.
• Strong experience in documenting test cases, existing process, requirements and working with requirements traceability matrix, re-engineering business processes and designing.
• Facilitated workshops and developed metrics, measures, dash boards and reports to support management and client group needs.
• Sound health care finance domain knowledge of Relative value units, Operational statements, economic order quantity analysis, strategic financial plans and ratio analysis etc.,
• Good knowledge of HIPPA compliance life cycle, insurance regulations and HIPPA 5010 transaction standards.
• Proficient in using Use Cases, Activity Diagrams, Sequence Diagrams, Entity Relationship Diagrams, Collaboration Diagrams, Class Diagrams and document them using MS Visio and Rational Rose.
• Experience with various Facets modules such as Subscriber/Member, Claims, Plan/ Product.
• Worked on Pharmaceutical Validation regulations for Pharmaceutical Company on 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.
• Proven record of high accuracy in designing and building healthcare benefits on the clinical trial management system.
• 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.
• Effective in executing multiple tasks and assignments ahead of schedule.
• Participated on multiple analysis projects for various applications, developed internally and by other solution providers.

TECHNICAL SKILLS:

Microsoft Technologies: Microsoft Project, Word, Visio, Power point

Methodologies: Rational Unified Process (RUP), Waterfall, Agile

Languages/Standards: SQL, PLSQL, ICD9, ICD10, HIPPA 5010, XML

Requirements test management: Rational Rose, Requisite Pro & Rational test manager

Testing Automation Tools: Quick Test Professional, Rational Robot

Defect Tracking Tools: Rational Clear Quest, Mercury Quality Center

Operating systems: MS Windows X, Mac OS X.

Quality Management: Concepts and Tools of Quality Management Test Director and load Runner, Six Sigma Techniques

PROFESSIONAL EXPERIENCE:

Confidential, NJ

Sr. Business Analyst

Responsibilities:

• Used the mapping tools to map 4010 and 5010 transactions along with ICD 9 and ICD 10 codes, and validated the HIPAA Syntax.
• Developed Incident documents and portrayed the As-Is reporting structures versus To-be Reporting needs for data integrity and accuracy.
• Identified the scope, business objective and documented the functional requirements for each release.
• Directly involved in process improvement Plans and implementing business change.
• Produced clear user manuals & guides for User Acceptance Testing (UAT) and deployment for end-clients with step-by-step instructions and appropriate GUI screenshots.
• Strong knowledge of Business Intelligence, Data Warehousing and Business Architecture.
• Utilize SharePoint and Excel as necessary to work through daily inventory assignments.
• Identifies and escalates root cause issues to supervisor for escalated review.
• Interacted with the development team on regular basis to ensure and balance practicalities with innovative and efficient business systems solutions.
• Created use cases specifications, use case diagrams, swim lane diagrams, component diagram and context diagrams to define the workflow and segregate high-level and low-level requirements using MS Visio.
• Conducted and Participated JAD sessions to gain consensus on various issues related to the project. Acted as a facilitator on different occasions.
• Held regular meetings with the Business users and SME’S to priorities the business Requirements.
• Facilitated the resolution of project-related issues, identified risks, and mitigation steps to manage risk using PLSQL in RDBMS.
• Conducted walkthroughs and code reviews with developers, project managers and stakeholders and users to comprehend business work flow of applications.
• Analyzed business processes, requirements, and data necessary to provide detailed logic for ETL development.
• Understanding the User Experience Designs (UXD) and designing according to user requirements.
• Extensive experience in translating business requirements and user expectations into detailed specifications by using various Text formats & Unified Modeling Language (UML).
• Collaborated efforts with technical staff and subject matter experts to establish the technical vision of product and analyze triple constraint tradeoffs.
• Expertise in working with Market Prominence in compliance with CMS and HIPAA requirements.

Environment: MS Access, MS Visio, MS Project, MS Office, HTML, SQL, MS Access, Windows XP/2000, Mercury Quality Center.

Confidential, PA

Sr. Business Analyst

Responsibilities:

• Provided support to the Trial Management Organization in the management of clinical trial planning and implementation in order to ensure on-time and on-budget fulfillment of deliverables.
• Worked with sponsor companies and investigators to evaluate the safety and effectiveness of new therapies for a variety of medical conditions through Phase III and IV clinical trials.
• Reviewed drafted protocols for potential new studies, provided input to the Principal Investigator(s) and Research Manager regarding clinical and research issues in order to determine the financial and clinical feasibility of potential studies.
• Participated in the development of research study budgets for new clinical trials, ensuring that appropriate billing or charging mechanisms were in place for all research charges related to the study.
• Conducted weekly teleconferences with sponsor companies and internal physicians to discuss open slots, potential patients, and present on the overall status of studies and upcoming amendments.
• Working knowledge on Pharmaceutical Validation regulations for Pharmaceutical Company on 21 CFR Part 11. Worked extensively with R&D team in Clinical Trials.
• Created and maintained, Internal document for the Data Management Plan, completion of eCRF Guidelines, Coding Guidelines, and reviewed the data listing plans for manual review of entered study data by the clinical sites.
• Validated PQ’S of Mass Spectroscopy, Color Chromatography.
• Maintained records for lab assay data and converted them to Electronic lab notebook. Also conducted statistical analysis of data to predict impact and outcome.
• Completed the manual data listing reviews, reconciling third party vendor data, comparing the data to the data the study site entered into the database. Issued queries to the site and/or the CRA when data discrepancies were present or further information was needed.
• Assisted in the audit of third party vendor, noting key issues and escalating findings to management.
• 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.
• User Stories, Acceptance Criteria, Scrum Meeting, Product Backlog.
• 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, Reviewed User Acceptance Test Plan (UATP) and attended walkthrough.
• 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, MS Excel, MS Access, Waterfall SDLC

Confidential

Business Analyst

Responsibilities:

• Gathered Business Requirements. Interacted with the Users, Designers and Developers, Project Manager to get a better understanding of the Business Processes.
• Responsible for the full HIPAA compliance lifecycle from gap analysis, mapping, implementation and testing for Tenn Care processing of Medicaid Claims.
• Liaison between the Business needs (business users and sponsor) and the Technical solutions (development and testing staff), ensuring technical solutions satisfied business requirements.
• Performed Web Page Mock-Ups using MS Visio and thus defining the Business Process Model and Data Process Model.
• Experienced in RUP software development cycle methodology with four consecutive phases - Inception, Elaboration, Construction and Transition.
• Developed gap analysis document, logical and physical design and remediation plan for State.
• Responsible for mapping documents, creation of test plan, test scenarios, test cases for unit, system and system integration testing.
• Worked with business owners, content staff, IT and other stakeholders in creating a content management solution for managing the information in the supplier portal using WebSphere Application Server.
• Built and customized SoDA for Word templates and extract information from information sources such as Requisite Pro and Rose, and created a highly automated system for handling approvals, exceptions and priorities.
• Used the Rational Unified Process (RUP) to build the different phases of software development life cycle.
• Created Project management plans for managing on time delivery using MS Project along with writing test cases, unit and systems integration test plans in Win Runner and used Load Runner to check if application works fine with load.
• Creating and analysing numerous clients’ reports for various financial requirements.
• Documenting workflow and results of analysis for the aging accounts.

Environment: Modeling, Rational Requisite Pro, Rational Rose, RUP, UML, Load Runner, MS-Project, MS Visio, Java, MS Office, Windows XP

Confidential

Jr. Business Analyst

Responsibilities:

• Gathered user/business requirements by meeting with business users and generated business models and use case analysis.
• Prepared the Software Specification Document for the application based on business user information.
• Created use case document to elaborate user experience taking into account the business objective.
• Converted Business Requirements to the Functional Specification to develop an architectural solution that the application meets the business requirements, resolve open issues, and change requests.
• Assisted in on-going process improvement efforts to ensure Test Planning, Execution, and Reporting is effective, efficient, standardized, coordinated, and integrated.
• Assisted the Senior Business Analyst in writing Functional Requirement Specifications (FRS) and User Requirement Specification (URS).
• Conducted JAD Sessions periodically with various stakeholders at various phases of the Software Development Life Cycle (SDLC) to discuss open issues and resolve them.
• Feature identification, defining and documenting business requirements and priorities.
• Critically evaluated the information gathered from multiple sources during requirements and analysis and responsible for tracking, tracing and managing requirements using Requisite Pro.
• Developed Test Plans and Test Cases according to Business Requirements.
• Interacted with development team for communicating the requirements and use cases.
• Involved in generation and execution of SQL queries.

Environment: s: MS Visio, MS Office, SQL, PowerPoint, MS Word, MS EXCEL, Windows.

Confidential

Pharmacy Manager

Responsibilities:

• Provided leadership and direction to pharmacy personnel/staff including evaluating and coaching.
• Developed a team of dedicated professionals to improve community wellbeing and to achieve company's goals and objectives.
• Worked in collaboration with providers and health insurances to provide quality health care.
• Prepared 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.
• Ensured high level of quality, competency, and accuracy by developing and maintaining quality assurance.
• Maintained compliance with Central and State laws, regulations and standards.
• Proposed, developed and implemented efficient innovations to improve retail pharmacy services.
• Provided scientifically accurate medical and technical information in response to inquiries from healthcare professionals, consumers, and internal staff for Lee companies, pharmaceuticals and surgical products.
• Ensured that all responses provided aligned with global labeling and licensing regulations regarding off-label product use.
• Maintained a state of FDA audit readiness regarding responses to inquiries.
• Identified and documented customer quality complaints and adverse reactions, promptly escalating to the Customer Service or Medical Safety department for further investigation.