SUMMARY

• Around Eight years of experience as a Senior Business Analyst with the expertise in Software Development Life Cycle (SDLC) and project lifecycle primarily in HealthCare Domain.
• Excellent Business writing skills in writing Business requirements document BRD, Use Case Specifications, Functional Requirement Specifications (FRS), Software Requirements Specification (SRS), Technical Requirement Document (TRD), Workflows.
• Experienced in data warehousing projects dealing with ETL mappings (extraction, transformation and load) tools like Teradata, SQL.
• Good knowledge on different modules within healthcare (Membership, billing, enrollment, Eligibility, claims, capitation, providers, Attribution).
• Experienced in requirements gathering sessions, feasibility studies and Impact Analysis.
• Experience working on EDI transactions and following norms of HIPAA.
• Experienced with health information technologies such as ICD9, ICD10 and CCD verification.
• Involved in (PBM) Pharmacy Benefit Management for the successful implementation of short and long term projects.
• Expert in developing, writing and maintaining gap analysis, business requirements and technical documentation.
• Demonstrated experiences of Claim lifecycle: First Notice, Assignment, Evaluation, Settlement, Recovery and File Review.
• Experience in identifying and gathering the information from useful sources and also prepared Requirement Traceability Matrix.
• Expert knowledge in generating - Use Case Diagrams, Sequence Diagram, Activity Diagrams, Data Flow Diagrams and Process Models.
• Strong communication skills when working with developers, project managers, subject-matter experts, stakeholders, system implementers, and application end-users.

TECHNICAL SKILLS

Project Management: MS Project 2010, MS Office

Modeling Tools: Microsoft Visio

Version Control Systems: Clear Quest, Mainframe

Databases: SQL Server, Teradata

Methodologies: SDLC, Agile

Change Management Tools: Clear Quest, Document Direct, RUMBA, AS400, Epicenter, Document Direct, SAS

PROFESSIONAL EXPERIENCE

Confidential, Bloomfield CT

Sr. Business Systems Analyst/Informatics Specialist

Responsibilities:

• me am responsible for the process to encounter data, dat can be utilized by grouper processes.
• me am responsible to Perform project delivery functions in support of CIMA Enterprise Reporting Hub.
• Being the Analyst, me am handling requirement gathering, documentations, data validation, and data production activities to ensure client satisfaction.
• Responsible to Coordinate with internal and external ERH teams and perform project tasks such as, efforts analysis, defining scope, presentations, and team leading.
• As the senior system’s analyst, leading team of other analysts to ensure the resource allocation in the right directions and to the right tasks.
• me am responsible to Develop business requirements and provide support for technical specifications, as needed.
• Writing and Running SQL queries using Teradata, TOAD and Hyperion to create different reports.
• Performing testing and provide business signoff on Source to target mappings.
• Working closely with customers, IT, and other CIMA partners to meet project objectives.
• Assisting Project manager in communicating daily project statuses with the project team.
• Engaged in operational readiness activities to ensure dat project “go-live” is stable and successful by performing gap analysis.
• Responsible for preparing mapping documents for the developers to code reports from the new warehouse. This task involve cross collaboration with different teams using different warehouse to pull the data.
• Responsible for creating reports from different warehouse and running through SAS.
• Handling Call Metrics reports from different systems such as Avaya, Cisco.
• As the informatics analyst, responsible for creating different healthcare reports such as Total Health monthly reports, Provider performance reports, Care metrics reports, Cost savings, and Quality output reports to obtain current stats of the performance via Teradata and SAS.
• Monitoring claim adjudication process from FACETS to keep the track on inbound, outbound batch processing. This involves both medical and pharmacy claims.
• Working across teams including CIMA ERH, CIMA Analytics, and CIMA BIS to deliver new capability and efficiencies to customers.
• Maintaining breadth of knowledge on all product types and business processes.
• Maintaining in-depth knowledge of CIMA tools and data sources.
• Responsible for delivery of medium to high complexity project work.
• Conducting JAD sessions between various teams to ensure feasibility and accuracy of the requirements.

Environment: Mainframe, MS Office, MS Project, SAS, Teradata Client 14.00, TOAD, Tableau 8.1, Hyperion, Cisco, Avaya, MS Visio, SQL Server, Teradata Studio, MS SharePoint, CenSys, Actuate (Application)

Confidential, Newark NJ

Sr. Business Analyst/ Business System Analyst

Responsibilities:

• As the Business system analyst, me am responsible for analyzing the data, requirement gathering from the client’s perspectives and from the consumer perspectives, requirement analyzing taking both the considerations and transferring the same in to technical requirements
• Responsible for the documentations such as Business Object Documents, requirement document, BRD, TRD, FRD, RTM.
• With the large data store project (HDH), involved in the planning stage to assist on the Estimates of the total work needs to be done or analysis in the estimates for the total efforts required to complete each tasks.
• Responsible for conducting the JAD session between Business team and Technical team.
• As the part of the technical team, responsible for analyzing the data, data profiling, and data validation by using Teradata.
• Assisting to the data modelers in data modeling process.
• Working as source exchanger for the attribution data exchange required for the payment innovations as well as all operational and analytical and reporting requirements dat informatics and HHI departments might has.
• Involve in storing various attribution results, reports, member/provider data, claims data (RX, Medical, NHost) in Teradata storage to make the data available for the consumers.
• HDH is the large data hub where all cleansing and data validation activities need to be performed from the different small data hubs. Responsible for monitoring and validating the data from the different storages.
• In the data warehouse project of HDH, source to target mapping is the most crucial task needs to perform. Responsible for preparing STTM (Source to Target Mapping) document for the data coming from the source till development.
• Preparing Technical requirement documents, Functional requirement document and Requirement Traceability document to transfer the business requirement into technical terms to provide to the development team for the coding purpose.
• As the Business System analyst, working closely with the business team, clients, reporting team, and various other project team who are mainly the consumer of the data we produce.
• Working as an assistant to the project manager in setting up the JAD, providing inputs to the various other projects such as automation of the rules, PI Finance, etc.
• Assist SAS analyst in SAS related process.

Environment: Clear Quest (CQ), Teradata, SAS, Teradata (STUDIOS), SQL assistance, MS Office, MS Outlook 2010, MS SharePoint, MS Visio, and MS Project.

Confidential, Franklin Lakes NJ

Business Analyst

Responsibilities:

• Being with pharmacy Benefit Management Company for more than 2 years, was responsible for leading CDH Business Team.
• me was Responsible for working with Helpdesk for the team access, obtaining access for the new joiners and further processing for their enrollment into organization.
• As the lead of the CDH Ops Team, me was responsible for preparing Monitoring process using documentations, as well as preparing test cases for the further vendor testing and vendor outreach with ESI and Medco Vendors.
• Conducted JAD sessions to define the project and to reduce the time frame required to complete deliverables.
• Worked as a trainer for the folks for the Monitoring and validation activities using RUMBA
• Worked as an SME for the team access process.
• Daily interaction with other SMEs as well as directors of the project having JAD sessions on team progress.
• Involved in training business team in claim adjudication process including, real time activities, such as contacting vendors or clients in case of issue.
• Worked closely with different teams, such as Issue Management, CDH IT, as well as CDH triage team, to cooperate in closing issues related to.
• Besides CDH Ops, also performed tasks as the part of CDH triage and issue management teams.
• Conducted sessions for the training in comparison to different tools, such as RUMBA Vs. ESD, as well as CICS, CBM, POS Research Tool, PTS.
• Analyzed gaps between IT and Business teams by taking various process steps using MS VISIO.
• Performed Monitoring and Member Validation tasks, for new book of business for the Migration and Health Care Reforms clients.
• me was responsible for documenting all requirements, process and identifying the changes into process as per tiers and updating the same to clients as well as vendors.
• Created product documentation, including online halp, printed user
• Responsible for preparations for presentations and presenting process and ongoing activities to onshore and offshore teams.

Environment: RUMBA (Mainframe), E-Service Delivery (ESD), PTS (Project Tracking System), CBM (Client Benefit Management Tool), POS (Point of sales research tool), UAT, MS Visio, MS Project, AS400, MS Office, MS Outlook 2010, MS SharePoint, Epicenter, TSG(CERT CAT), BTT, RADAR, Document Direct..

Confidential, Woonsocket, RI

Lead Business/ Data Analyst

Responsibilities:

• Worked as theLead Business Data Analystto improveBusiness Processes through investigation, analysis, review and documentation of all or part of aDataLife Cycle.
• Responsible for analyzing and identifyinggaps between the targetdataand required client attributes.
• CreatedTransformation Rules Document for the Benefits Data Mapping by conducting and facilitating requirement gathering sessions with the CVS SME’s.
• Done extensiveData AnalysisandValidationof the Source to TargetData MappingUsingMS Excel.
• Responsible for the identification of the UAT test scenarios. Helped in the Generation ofProduction Reportswith the purpose of making conclusions from the Data for Business Decision Making Process.
• Created extensive BRFR Documents, Test Case, Use Case and Mapping Rules Document.
• UsedMS Excel,MS AccessandSQLto analyze large sets of Data from Multiple Sources.
• DevelopedMSPowerPointPresentations, Spreadsheets, Graphs and Analysis of project related information.
• Conducted Daily Huddle Meetings with the Onsite and Offshore Teams.

Environment: Rational Requisite Pro, RUP, UML, Rational Rose, MS-Visio, MS-Project, Rational ClearQuest, SQL Server and Windows, MS Share point, UAT.

Confidential, Des Moines, IOWA

Sr. Business System Analyst

Responsibilities:

• Extensively worked in designing the Testing approach for the ETL process in the Credit Data Provisioning Enterprise Data Warehouse (CDP).
• Facilitate product/content reviews for assigned projects to ensure accuracy and market sensitivity of programs.
• Managed Cross Team Collaboration and Offshore Testing team.
• Performed Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data.
• Interacting with different departments like claim, FEP, Blue Card, Membership & Enrollment, Medical and customer service regarding the finalization of data elements required to build the new data mart.
• Documenting High Level Requirements as per the business users and converted them in to Detailed Business Requirements.
• Responsible to execute UAT test cases, to report a Bug if any.
• Responsible for creating a new data mart for reporting and analytics and also finalized the new data elements.
• Working on MS CRM Dynamics for handling the customer claim inquiries, Validation and case creation.
• Part of the ICD 10 implementation team and worked in the Expansion and Reference files programs.
• Interacted with the stakeholders and the IT Department in finalizing the requirements according to the HIPAA Regulations.
• Responsible for writing Use Cases, Business Flows, Process maps and Work Flows Diagrams for TEMPeffective plans

Environment: MS Office, MS SharePoint Server 2010, Activity Diagrams, MS Project, EDW, UAT, Test Plan, Use Cases, SQL, UML, Test Cases, GUI, Agile, Data modeling (Visio).

Confidential, Des Moines, IA

Business Analyst

Responsibilities:

• Ensured dat X12 transactions can be carried out as per the EDI standards during any of the system changes as well as system upgrades.
• Utilized Agile Methodology to configure and develops process, standards and procedures.
• Responsible to arrange UAT sign off meetings with the stakeholders.
• Conducted JAD sessions with business units and stakeholders to define project scope, to identify the business flows and determine whether any current or proposed systems are impacted by the new development efforts.
• Prepared the Business requirement Document (BRD) and functional requirement document (FRD) for the enhancement of the existing services.
• Did data analysis, created data mapping and data interface documents and kept the documents updated with changes in requirements and functional specifications.
• Involved in claim adjudication process of facets application.
• Conducted Gap Analysis for HIPAA P and 835 transactions and HIPAA P and 835 transactions.
• Ran SQL queries to analyze the requirements and for testing the files and reports.

Environment: MS Visio, MS Office, Rational Rose, Requisite Pro, SQL, Oracle, FACETS, UAT.

Confidential, St Louis, MO

System Analyst

Responsibilities:

• Requirement gathering and preparation of business requirement documents (BRD).
• Responsible for translating BRD into functional specifications and test plans. Closely coordinated with both business users and developers for arriving at a mutually acceptable solution.
• Involved in preparing the Test Scenarios for Health Care Claim Payment/Advice.
• Conducted JAD sessions to define the project and to reduce the time frame required to complete deliverables.
• Efficiently handled claims processing as well as enrollment, medical-management and workflow processes involved during and for the project given.
• Developed and maintained all operational and technical flows using Visio and Power point.
• Responsible for the regulatory management process for the services provided by the pharmacy.
• Helped in development and functioning in workflow analysis and process design.
• Actively involved in Knowledge Transfer Phase.
• Maintained Requirement Traceability Matrix (RTM).
• Involved in HIPAA/EDI Medical Claims Analysis, Design, Implementation and Documentation
• Creation and maintenance of documents for change request and implemented procedures for testing changes.

Environment: Windows 2000, UAT, MS Project, MS Visio, Axure & SQL Server 2005, Microsoft Visio, Load runner, Test director, Win runner.

Confidential, Philadelphia, PA

Business Analyst

Responsibilities:

• Involved in creating Software Requirement Specifications (SRS) / Functional Specification Documents (FSD).
• me was responsible for the success storage and process of the E Commerce store.
• Used Rational Clear Case to maintain different versions of the system documentation with description about all versions.
• Created business process flow diagrams and charts using MS-Visio.
• Involved in project management, developing project plans, setting project schedules and milestones, scheduling tasks and activities using MS Project.
• Played a key role in the planning (UAT) User Accepted Testing and implementation of system enhancements and conversions.
• Created product documentation, including online halp and training materials.

Environment: Rational Requisite Pro, ClearQuest, RUP, UML, Win runner, Load Runner, Oracle, SQL, MS Office, MS-Project, MS Visio and Windows, UAT.

Confidential

Business Analyst

Responsibilities:

• Gatheird business requirements through user interviews for employer, broker & member portals.
• Analyzed business requirements, created functional specification & translated them into technical specifications.
• Developed test plans and test cases as per business process requirements to match functionality requirements and UML diagrams.
• Created Use Cases, UML diagrams and implemented processes, procedures and guidelines for the development team and QA team.
• Developed an integrated repository of current and historical data, encompassing all operational and research areas.
• Developed a user group specific data mart, based on the central repository.
• Provided extensive metadata for a clear organization of the data.
• Responsible for identifying and documenting business rules and creating detailed Use Case.

Environment: Windows 2000, Microsoft Project 2000, Java, HTML, Oracle, MS Visio, Rational Unified Process