PROFESSIONAL EXPERIENCE

Confidential

Sr. Business / Data Analyst

Responsibilities:

• Designed the business requirement collection approach based on the project scope and SDLC methodology.
• Created Use Case Diagrams, Activity Diagrams, Sequence Diagrams, Dataflow Diagrams in MS Visio.
• Worked extensively with VISIO and ERWIN to do reverse engineering of Database for reporting
• Gathered and documented business requirements for existing and future business systems.
• Lead multiple project teams of technical professionals through all phases of the SDLC using technologies including Oracle, Erwin, Data Stage, Data Warehousing, Websphere and Cognos.
• Interacted with the Subject Matter Experts SMEs and stakeholders, gathering business requirements to get a better understanding of client's business processes.
• Developed data conversion programs for membership, claims, and benefit accumulator data - converted thirteen corporate acquisitions. Developed data field mappings. Provided programming and support for claims processing functions and auto-adjudication.
• Actively involved in developing, executing and managing User Acceptance Testing UAT .
• Managed Scope and change throughout the SDLC process of the product.
• Performed extensive data modelling to differentiate between the OLTP and Data Warehouse data models
• Defined Functional Test Cases, documented, Executed test script in Facets system.
• Analyzed trading partner specifications and created EDI mapping guidelines.
• Healthcare system implementation including enterprise Electronic Medical Records EMR software.
• 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.
• Designed and developed use cases, activity diagrams, and sequence diagrams using UML.
• Used the DataStage Designer to develop processes for extracting, cleansing, transforms, integrating and loading data into data warehouse database.
• Maintained and enhanced NextGen Electronic Medical Records EMR , Electronic Practice Management EPM , and Imaging Control System ICS software.
• Troubleshooted file transmission problems and assisted customers in a call center environment with EDI and Medicaid Insurance claim related inquiries explained and enforced guidelines in the X12 Implementation guides 837P, 837I, 837D, 270/271 .
• Used Query Analyzer, Execution Plan to optimize SQL Queries
• Ensured that all Lines of Business specifications were consistent in form and function to the Diamond Base System.
• Documented workflows and executed comprehensive testing and training plans to ensure the new acknowledgement results demonstrated in the 999 and 277CA were properly interpreted and managed to ensure Payer acceptance of the 837 files.
• Tracked all required resolutions required that were identified as needed from Vendors or Payers based on testing results.
• Worked closely with the Enterprise Data Warehouse team and Business Intelligence Architecture team to understand repository objects that support the business requirement and process.
• Used MS-Visio for flow-charting, Use- Case process model and architectural design of the application.
• Designed robust 5010 testing and 4010 regression SIT and UAT Testing Scripts for the 5010 Project. Scripts were written on an application level and subset by payer resulting in over 600 combined scripts with a maximum of 70 testing scripts steps per script.
• Performed Black Box testing and conducted Functionality and Regression testing on various phases of the Management software
• Used different ad-hoc analysis, the Reports assist in defining strategy for each customer category. Informatica was used for ETL process and Business Objects 6.5.1 XI R2 are used for Reporting duties.

Environment: Microsoft Office 2003 Professional Outlook, Word, Excel, Visio, Access, etc. , Microsoft SharePoint 2003,UML, RUP, UAT, db2, Mercury Test Director, SQL, .NET, Clear Case .

Confidential

Senior Business Analyst

Responsibilities:

• Performed the requirement analysis and documented the requirements using Rational Requisite Pro.
• Developed UML Use Cases using Rational Rose and developed a detailed project plan with emphasis on deliverables.
• Involved with the QA team to Conceptualize, determine and develop test approaches and methods for Unit testing, Integration and Functional testing, Load and Usability testing according to the application complexity and test requirements.
• Implemented Data Modeling standards, including element-naming conventions.
• Experience in EDI automated first-pass claim adjudication, requiring thorough understanding of claim processing, both front and backend operations.
• Assisted JAD sessions to identify the business flows and determine whether any current or proposed systems are impacted by the EDI X12 Transaction, Code set and Identifier aspects of HIPAA.
• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims. Worked on EDI transactions: 270, 271, 834, 835, and 837 P.I.D to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
• Supported SOA, data warehousing, data mining, and Enterprise Service model standards in designs, and developed standardization of processes like configuration management.
• Performed Unit Testing and User Acceptance Testing and documented detailed defects.
• Evaluated testing results for each potential release build using Test Director, Quality Center and Bugzilla reports, listing summarized bug information in priority sequence, recommended viability of release for production.
• Extensive success in translating business requirements and user expectations into detailed specifications employing Unified Modeling Language UML in an SOA environment..
• Created business plans for integration of front end applications to communication with the back end mainframe.
• 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, Windows XP, NT/2000, HTML, Vignette Content management Tool, J2EE JSP1.2 , SOA, XML, XSL, XSLT, HTML, Oracle 9i.

Confidential

Data Analyst

Responsibilities:

• Led the development of a training program to train users on a custom web application and a Cognos ad-hoc reporting environment.
• Used knowledge of Health Care Information Systems Electronic Medical Records EMR model to develop proposed workflow in MS Visio.
• Assisted to develop the Test Plan, Test Cases and Test Scenarios to be used in testing based on Business Requirements, technical specifications and/or product knowledge.
• Design, development, implementation and roll-out of Microstrategy Business Intelligence applications
• Responsible for conducting GAP analysis, User Acceptance Testing UAT . SWOT analysis, Cost benefit analysis and ROI analysis..
• Designed High level design, for New process, integrating with legacy and Facets
• Conducted Functional Walkthroughs, User Acceptance Testing UAT , and supervised the development of User Manuals for customers.
• Experience with Data Mappings including ANSI 4010A1 837, 835, 276/277, 270, 810, 820, 850, 855, 834, 997 for institutional, professional, and commercial claims.
• Perform Gap Analysis of the processes to identify and validate requirements.
• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims.
• Coordinated with Business Owner, Application Vendor, Business Project Teams, Payers and Clearinghouses to bring all processes to a level of execution to mitigate any impact to current revenue flow under the 5010-compliancy requirements.
• Generated complex reports using business object XI and web intelligence
• Involved in the testing phase right from the Unit testing to the User Acceptance testing.
• Used SDLC System Development Life Cycle methodologies like the RUP and the waterfall.
• 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.
• Use Cases and other Process Flow Models were designed using Visio and Rational Rose.

Environment: RUP, UAT, GAD Gap Analysis Document , Microsoft Office 2003 Professional Outlook, Word, Excel, Visio, Access , Microsoft SharePoint 2003.

Confidential

Business Analyst

Responsibilities:

• Consulted with healthcare insurance company to develop conversion specifications for other insurance Coordination of Benefits including Medicare .
• Experience with Trizetto Facets System implementation, Claims and Benefits configuration set-up testing, Inbound/Outbound Interfaces and Extensions, Load and extraction programs involving HIPPA 837 and proprietary format files and Reports development.
• Designed High level design, for New process, integrating with legacy and Facets
• Validated the following: 837 Health Care Claims or Encounters , 835 Health Care Claims payment/ Remittance , 270/271 Eligibility request/Response , 834 Enrollment/Dis-enrollment to a health plan
• Implemented automated COB processing of Medicare claims into Facets
• Involved in large scale Enterprise Implementation experience varying from Payer.
• Created SQL reports, data extraction and data loading scripts for different databases and Schemas.Gathered requirements from users of the Clear Quest CQ tool for any Enhancements or change requests for any defects.
• Created context and workflow models, information and business rule models, Use Case and Object Models during the analysis using Rational tools.
• Designed and developed project document templates based on SDLC methodology
• Identify Member, Provider, Coverage, Medicare, and Medicaid.
• Worked with Claims, enrollment, eligibility verification for members and providers, benefits setup, and backend payment cycle in facets.
• Facilitated Change Control Board and Governance Board meetings and acted as a liaison between parties impacted by the change requests.
• Provided training on new features within CQ and prepared training materials like Quick Reference Guides and Job aids.

Environment: Windows XP Professional, Oracle9i, MS Access 2000, MS Excel, MS Visio, MS Office, RUP, Oracle, UML, Facets ,Rational Rose, Requisite Pro, Clear Case 2002, Hyperion, Rational Clear Quest 2002, MS Office suite, MS Visio 2003.

Confidential

Business Analyst

Responsibilities:

• Used UML, for gathering requirements, created Use Case Diagrams, and Use Case Specification document USD .
• Incorporated Rational Unified Process RUP to create Requirement Document Specifications using Visible Analyst.
• Authored Business Requirements Document BRD with project teams. Extracted, discussed, and refined business requirements from business users and SME's.
• Responsible for integrating with Facets .Designing test scripts for testing of Claims in Development, Integration and production environment.
• Created source table definitions in the DataStage Repository by studying the data sources.
• Generated Surrogate ID's for the dimensions in the fact table for indexed and faster access of data.
• Tested and delivered Inbound/Outbound Facets interfaces.
• Responsible for architecting integrated HIPAA, Medicare solutions, Facets
• Tested and delivered Inbound/Outbound Facets interfaces.
• Involved in making Use Case Diagrams, Activity Diagrams, and using analysis and design models tools like MS Visio, Rational Rose through Agile and Waterfall Model
• Performed Requirements Traceability and managed changes to requirements for this application using Rational Requisite Pro.
• Wrote BRD, FRD, use cases, test scenarios, test cases for testing the functional requirement.

Environment: Requisite Pro, Rational Rose, Agile, HL7Interfaces ,PL/SQL, HTML, MS Office, MS Visio, MS Access, EDI, UML.