SUMMARY

• Experienced Business Analyst with over 6+ years of proven skills in requirement gathering, interacting with developers, documenting various business processes, coordinating various projects contributing 3 - Years of experience in Medicare D in region of Healthcare Industries.
• Solid Experience in Business Requirement Management (Elicitation, Validation, Specification, Verification), Gap Analysis, Business Process Modeling, Process Management, Change Management, and Application Development, in diverse business domains like Insurance, Healthcare, Retail Banking, Financial Services, and Real Estate
• Experienced in interfacing with stakeholders and senior management with excellent communication and interpersonal skills.
• Exemplary consulting, client demonstration, system implementation, customer service and user training skills
• Adept in implementing vendor supplied software packages including installation, customization and ongoing support
• Experience in Business Analysis using Functional Flow charts, Check sheets, Interrelationship diagrams, Workshops and Brainstorming Sessions.
• Served as a primary liaison between the business teams and the technology teams located onshore and offshore.
• Executed end to end business level testing and full-scale production parallel testing.
• Very good understanding ofRelational Database,Object Oriented Programming,Data Modelling,Data MappingandData-warehousing.
• Well versed with HIPAA, Facets, claim adjustments, claim processing from point of entry to finalizing, claim review, identifying claims processing problems, their source and providing corresponding solutions
• Ability to inculcate new relevant skills with ease in a time sensitive frame.
• Organized, goal-oriented, self-starter, and ability to master new technologies, manage multiple tasks while following through from start to completion.

TECHNICAL SKILLS

System Architectures: Web, VB Client/Server, Main Frame, Windows

Languages: SQL, Java, HTML, C++, C

Databases: SQL*LIMS, Oracle, MS Access, MS SQL

Test Tools: MS Visio, Front Office, Rational Rose, Rational Requiste Rose Pro, Software Modeler, Team Test, MS Office 2010(Project, Word, Excel, Powerpoint, Access, Visio) OLAP

Standard skills: HIPAA, SOX, ISO, Six sigma, CMM, FACET

PROFESSIONAL EXPERIENCE

Confidential, Boston, MA

Business Systems Analyst

Responsibilities:

• Experience with AGILE Tool and worked with Six Sigma methodology
• Monitor Medicare Part D PBM contract including, but not limited to, rebate amounts, claim pricing and benefits, formulary coverage/tiering application and contractual performance measures. Performance measures include validation of claim adjudication accuracy from both a pricing and benefit perspective. Participate in User Acceptance Testing to ensure system corrections are accurate.
• Experience in Rational Rose & HP Quality Centre
• Establish and conduct monitoring activities centered on key CMS audit findings and best practices including, but not limited to, formulary administration, point of sale edits, coverage, and claim reject reports.
• Experience in leading eBusiness development
• Provide internal departments with monitoring and audit support of Medicare Part D claims to ensure CMS compliance. Provide the necessary support to internal departments during CMS audits to document ongoing monitoring activities.
• Participate in and/or lead cross departmental workgroups.
• Extract pharmacy claims, benefit and eligibility data for studies. Gather any necessary enrollment, formulary, pricing, benefit and trend information from internal departments and the PBM.
• Knowledge of pharmacy data (claims, fees, eligibility, benefits, formulary) and statistical analyses
• Extensively participated in verification of EDI file formats against Standards
• General process improvement input by attending conference calls and partner visits.
• Responsible for managing relationships with the business units as well as interacting with software vendors and consultants for development and support.
• Analyzed trading partner specifications and created EDI mapping guidelines

Confidential, Denver, CO

Responsibilities:

• Built Portfolio models for clients and back tested models to analyze return on portfolio versus S&P500.
• Analyzed securities with the aid of research reports and presented recommendations to supervisor.
• Determined the benefit of using covered call option to increase portfolio return.
• Reviewed the asset allocation of existing portfolios to determine the need for rebalancing based on portfolio models.
• Performed cost basis analysis for securities sold for tax purposes.
• Gained in-depth understanding of market conditions and investment opportunities through conference calls and proprietary research reports.
• Managed current and prospective client information using Sales force and researched on the securities especially stocks and mutual funds.
• Experience in stock selection process involved looking at Bank of America research reports of various companies across all the industries. On the other hand, Morning Star rating and analysis was used for evaluating mutual funds.
• Developed functional requirements and a proposed data warehouse strategy for supporting employee compensation and compliance reporting/analytics.
• Involved in defining the scope of the project, gathering business requirements and documenting and managing them using Rational rose and Rational Requisite Pro respectively.
• Presented high level requirements and interaction diagrams using use cases, to user groups, as well as documenting requirements and getting them reviewed and base lining the same.
• Analyze business requirements and segregated them into high level and low level Use Cases, activity diagrams using UML methodology.
• Prepared Business Workflow models that cover "How" business processes are accomplished.
• Involved in process modeling, reviewing and writing URS and Functional Requirements.
• Interviewed business experts, asking detailed questions and carefully recording the requirements in a format that can be reviewed and understood by both business and technical communities.
• Utilized Rational Unified Process (RUP) to configure and develop processes, standards, and procedures.
• Performed UAT and Performance testing on the application.
• Used MS Office extensively (Word, Excel, Visio, Power Point, Outlook, Project) for analysis, presentation and documentation throughout the project.

Confidential, Atlanta, GA

Responsibilities:

• Defined Project Scope, high-level business requirements, documented the constraints, assumptions & business impact. Identified project Risks & mitigations.
• Baselined the business requirements by conducting the requirement analysis meetings and translated them into functional requirements specifications.
• Developed the business process workflow, functional workflow diagrams and screen mock-ups for user reviews.
• Prepared and presented the budget estimation report with details of cost and resource allocations with effective timelines.
• Organized JAD sessions with business managers, application owners and developers. Designed the strategies to overcome potential obstinacy which could result from limited scope of the applications involved and its impact on the intertwined business processes workflows.
• Developed the parent-child data relationship models, ER modeling, database connections; defined data reports using RDL.
• Developed data flow diagrams and business process workflow diagrams and also developed file monitor screen designs to efficiently streamline and monitor the inbound & outbound data flows.
• Provided a thorough knowledge transfer of the project to the QA team prior to their test plan and test case preparations; discussed various positive and negative test scenarios; reviewed and approved test cases.
• Prepared UAT schedules and coordinated with Business users and technical teams to resolve issues during UAT and production parallel testing; performed end to end business level testing .

Confidential, Durham, NC

Business Analyst/System Analyst

Responsibilities:

• Prepared interview questionnaires for the users and gathered requirements to write specifications and to shape software development process.
• Documented business workflows textually as well as in UML diagrams, according to RUP for a better understanding of the user community.
• Organized meetings with the development teams to elicit use cases and document them.
• Created and managed project template, use case project templates, requirement types and traceability relationships in Requisite Pro.
• Created Use Case Diagrams, Activity Diagrams, Sequence Diagrams and ER Diagrams using MS Visio.
• Involved in executing test cases, evaluating test results and preparing test summary reports.
• Worked as a liaison between CRM analysts and users.
• Documented timely reports using MS Project 2000.
• Checked business readiness and determined activities of flow.
• Assisted CRM Analyst in customization of sales force CRM as per the requirements of the stakeholders.

Confidential, Indianapolis, IN

Business Analyst

Responsibilities:

• Also created business requirements document, functional specifications document and design documents
• Analyzed and Processed Medicare claims using the EDI transactions 270/271, 278
• Identified the scenario based on business requirement and HIPAA compliance for each transaction such as 837 and 276/277
• Involved in claim adjudication process of Facets application
• Documented and gathered functional specification for 837(claims), 278(Authorizations), 276/277(Claim status/response), 834(enrollment) and 835(claim adjustment).
• Worked in ICD 9/ANSI health codes in claims environment and participated in meeting for recommended changes for system design, methods, procedures, policies and workflows affecting Medicare/Medicaid claims processing in compliance with government compliant processes like HIPAA/EDI formats and accredited standards like ANSI
• Created Requirement Traceability Matrix and User Requirement Specification Document (URS) verified the functionality coverage/user requirement coverage.