SUMMARY

• Over 8 years of varied experience in the fields of IT and Business applications.
• Business System Analyst with solid understanding of Business Requirements Gathering, Business Process Flow and Business Process Modeling (UML or BPMN)
• Highly Experienced Quality Analyst with extensive knowledge in creating test plan, strategy, scenarios, test case, test script and executing those test cases.
• Highly Skilled in using CLM tools like Rational Requirements Composer, Rational Team Concert, Rational Quality Manager
• Very experienced using and configuring SharePoint for document management and storage system
• Proficient in using UML for Business Process Modeling, Use Cases, Activity Diagrams, Entity Relationship Diagrams, Sequence Diagrams, Collaboration Diagrams, Class Diagrams and document them using Rational Rose and MS Visio.
• Expertise in Client - Server application development using Oracle 11g/10g/9i/8i, PL/SQL, SQL Developer, SQL *PLUS, TOAD and SQL*LOADER
• Very good knowledge in advanced DML and DDL queries as well as creating trigger and indexes.
• Strong knowledge in Data warehouse testing and development, data profiling and data mapping.
• Good knowledge on logical and physical Data Modeling using normalising Techniques.
• Solid knowledge in JAVA technologies, servlet, JSP, API like SOAP and RESTful web service
• Over 5 years of experience with Claim Processing applications MMIS, Medicaid and Medicare claims processing systems including eligibility policies like SNAP and Cash
• Over 5 years of experience working on BusinessIntelligence tools, employee benefits, health insurance, defined-benefit pensions, healthcare payer operations and Reporting applications.
• Expert level knowledge of HIPAA X12, 4010 and 5010 / ICD 9, ICD 10, version for all EDI healthcare transactions like (834, 835,837, 270/271, 276/277/U277, 820) & Medical Terminology.
• Highly skilled on analysis of RX (Prescription drug) claim in different formats including real time D.0, Real time 5.0, Batch 1.2, Batch 1.1 and Flat file PDE.
• Experience with Gap Analysis working with during ICD 9 - ICD 10 conversion and 4010-5010 conversion.
• Highly skilled on using Business Intelligence Reporting Tool like Business Object.
• Participated in JAD sessions with superior organization and presentation skills.
• Experienced in management of requirements throughout the Software Development Life Cycle (SDLC).
• Experienced in developing Test Plans and Test Cases based upon business need and strong knowledge of UAT process.
• Excellent skills in Business Analysis, OO Analysis, Data Analysis, Requirement Analysis, Business Modeling and Use Case Development using UML methodology, Project Management Methodologies include AGILE, RUP, SDLC, and Waterfall.
• Excellent communication and presentation skills. Experience working with business and management.

TECHNICAL SKILLS

Operating Systems: Microsoft Windows /XP/VISTA/7, UNIX

Languages: SQL, Java, HTML, CSS and UML

Databases & Tools: SQL Server 2005 & 2008, Access, MYSQL, Oracle 9i/10g

Internet Technologies: PHP, ASP, .NET 3.5, C#, Visual Basic 6, HTML, XML

Quality Management: Rational Tester, ALM Quality Center, QTP, Load Runner, Performance Center

Business Modeling Tools: Rational Rose, Microsoft Visio

Change Management Tools: Rational Clearquest 7.1, Requisitepro v7.1

Reporting Tools: Crystal Reports, Business Objects, Cognos v8.0

Project Management: Microsoft Project Professional

SDLC Methodologies: Waterfall, Prototyping, Spiral, Rational Unified Process (RUP) and Agile methodology

SDLC Tools: Rational Requirements Composer, Rational Team Concert, Rational Quality Manager, Rational Rose, Clearquest, SharePoint

Others: MS Office 2013 (Outlook, Access Word, Excel, PowerPoint), Lotus Notes, Visio

PROFESSIONAL EXPERIENCE

Confidential

Business System Analyst- Lead

Responsibilities:

• Worked as lead BSA in the upgrading of mainframe application to java application for auto loan and mortgage processing system.
• Used Data Warehousing tool Informatica for ETL, oracle and DB2 as databases and SQL developer and DbVisualizer as DBMS.
• Worked closely with database engineers and architects to maintain integrity and stability of database.
• Used ALM Quality Center, QTP, Load Runner, Performance Center as quality management tools.
• Responsible for developing monthly reports on database needs and issues.
• Assisted several important teams in backing up financial projections with real data.
• Actively participated in the review of the project charter and helps outline the approach to the scope and requirement phase and associated deliverables
• Created solution process maps that build upon the current and future state business process maps to support the creation of use cases and design
• Used BPMN to create AS-IS and TO-BE business process model and perform the gap analysis and provided possible business improvement scenarios.
• Developed Use Cases, wrote user stories to support the design, build and testing of the approved requirements.
• Develops, documents and maintains use cases for future project use
• Actively participated in and lead the review sessions of scope and requirements deliverables
• Actively participated in the review of architectural and technical design specifications to ensure requirements coverage
• Actively participated in the design and build phases to provide clarification and support for the approved project requirements.
• Actively participated in the review of the project’s test strategy to ensure the approach will provide full requirements coverage
• Created Gherkin test script for each business scenario and documented them in Cucumber.
• Worked closely with the QA staff to ensure test script and cases covers the project requirements being developed.

Environment: Microsoft Visio, Clearquest, Microsoft Project, Waterfall, Oracle,DB2, UNIX, MS Excel, MS Access, SharePoint, ALM Quality Center, QTP, Load Runner, Performance Center

Confidential

Business System Analyst

Responsibilities:

• Worked as Business System Analyst to elicit and document requirement for integration of the Georgia IDD (Java application) project with Service Care Connect (Java application) of the Confidential health options.
• Performed the data profiling and mapping work of input and output data parameter for different transaction sets. It involved the creating different data schema for XML and Jason transaction sets.
• Used SOAP UI and Postman in API testing, DB2 as database and DbVisualizer as DBMS.
• Worked in creating the entire new relational data model for new application and leverage the existing data vault to save data files, letters and documents.
• Used HP ALM Quality Center, QTP, Load Runner, Performance Center for quality management.
• Created API ends points to execute the services as per the demand of the client systems to access the core application system.
• Performed the GAP analysis for the data requirement of the Service Care Connect of the Confidential Health Options.
• Created business process workflow diagrams with pools and swimlanes using Business Process Modeling Notation (BPMN)
• Provided recommendations for operational efficiencies and process improvements and assists in policy development to support change initiatives.
• Wrote the validation logics to verify the data requirement of the inbound data when creating web services for different client systems.
• Created the authentication logics of the client system based on SingleSignOn (SSO) method using Jason Web Token.
• Created roles and permission matrix and implemented the app user validation when client system is requesting for the services in the core application system.
• Supported the SIT and UAT, worked as SME and resolve defects.
• Prepared the functional specs documents for different projects like prior authorization, claims, registration, best match and letter generation.
• Worked in the data sync between two databases using ETL batch process.

Environment: Microsoft Visio, Clearquest, Jira, Microsoft Project, AGILE, Oracle,DB2, UNIX, MS Excel, MS Access, SharePoint, Java, ALM Quality Center, QTP, Load Runner, Performance Center

Confidential

Business System Analyst

Responsibilities:

• Worked as Business System Analyst on MITS project to during designing, developing and implementing ICD 10, MyCare Ohio and pharmacy benefit manager from JAD session to UAT process.
• Developed interface files to send data between MMIS (.net application) and PBM (java application). It involved the data profiling, mapping and transformation.
• Worked intensively in processing of pharmacy claims (in D.0) format sent by POS and managed care providers.
• Worked on HIPAA 5010, EDI X12 formats, transaction like 834, 835,837, 270/271, 276/277/U277 and 820. Similarly, worked on NCPDP D.0 and 1.2 formats.
• Worked on ALM Quality Center, QTP, Load Runner, Performance Center for software quality management
• Worked in Informatica, BO and other data analytical tools.
• Used SharePoint application to integrate with MMIS application to access the data, reports, letters and other documents
• Worked as senior Business System Analyst in creating test plan, test strategy, test scenarios and test scripts for User Acceptance Testing.
• Created test cases, acceptance criteria, executed test cases and validate test result with acceptance criteria.
• Worked in creating defects, lead the effort to resolve it and worked closely with other team members to fascinate the issue.
• Worked on logical and physical Data Modeling using normalising Techniques.
• Worked on different Ohio Medicaid eligibility plans including SNAP and CASH in enrollment and disenrollment of recipients/customers with those eligibility plans, also validated the medical and pharmacy claims submitted for those recipients.
• Work closely with Managed Care Providers to communicate the MMIS changes, facilitated their testing efforts and assisted to resolve the issues.
• Very efficient in billing of medical claims (professional, institutional, and dental) and pharmacy claims and have extensive knowledge in Edits/Audits/EOBs/HIPAA status codes regarding claims.
• Coordinated effort to identify and resolve Production Defect Support to the client.
• Used MS Excel in data computing, creating charts, graphs, pivot tables and MS Words producing documents, MS Powerpoint to create the presentation slides and Visio to create flow charts.
• Developing GAP Analysis documents and process flows diagrams to meet the new requirements to improve the current functionality.
• Worked on configuration of Audits, EOBs and Edits, HIPAA compliance codes associated to Claims, Providers, Recipients, Benefit Plans, Pricing and Prior Authorization.
• Conducted sessions with SME, Product Managers and Technical Leads to identify best approach to client’s requirements and Elicited Business Requirements through Focus group meetings and maintained Product Backlogs and timelines for Agile projects.
• Led efforts to elicit, review and secure sign-off of business requirements, functional requirements and reporting requirements through engagement with the business stakeholders and subject matter experts (SMEs).
• Managed Project Schedules, Resource Planning, Scope, Business and Functional Requirements aspects of the project and reported Project status and current activities to the PMO.

Environment: Microsoft Visio, Clearquest, Microsoft Project, AGILE, Oracle, Java, UNIX, MS Excel, MS Access, SharePoint

Confidential

Business Systems Analyst

Responsibilities:

• Worked on GAP analysis of ICD 9 - ICD 10 conversion and validated the ICD 10 conversion is accurate and precise.
• Developed use case diagram, user stories, process flow diagram (PFD), data flow diagrams (DFD), various different type of wireframes setup
• Worked on advanced DML and DDL queries, trigger and indexes.
• Used ALM Quality Center, QTP, Load Runner, Performance Center as quality management tools during the software development.
• Helped business understand the EDI and pharmacy claims file (D.0 and 1.2), format, billing, pricing and processing.
• Conducted meeting with managed care providers to explain the edits, audits, EOBs and HIPAA compliance codes.
• Assisted the UAT team and business in creating and testing business scenarios.
• Worked with the testing team to identify and log the defects and participated actively to resolve the issues
• Prepared Test Strategy, Test Plan, test report and Gap Report.
• Created use case diagram, user stories, process flow diagram (PFD), data flow diagrams (DFD), various different type of wireframes setup.
• Worked on Fee for Service Claims, Encounter Claims (including medical and pharmacy claims), and Prior Auth workflows. Clams included Portal, EDI and NCPDP formats.
• Proficient in designing process flows, system designs and workflows for complex implementations.
• Worked with MS Office 365 and very skilled in using MS excel, MS visual Basic, Outlook and MS Access.
• Developed and reviewed business specifications, workflows, GAP Analysisandproject schedules.
• Worked on Business Intelligence Analytics Reports (BIAR)/Business Object
• Involved on daily touch based meeting, defect meetings, claims meetings to report the status and identify the issues to send it to right people.
• Created test plan, test cases, test scenarios, defect management and daily defect calls.

Environment: Microsoft Visio, Clearquest, Microsoft Project, AGILE, Oracle, UNIX, MS Excel, MS Access, SharePoint,.net, Java, ALM Quality Center, QTP, Load Runner, Performance Center

Confidential

Business/Data Analyst

Responsibilities:

• Developed and implemented databases, data analytics and other strategies that optimize statistical efficiency and quality
• Used SDLC tools like Rational Requirements Composer, Rational Team Concert, Rational Quality Manager as Collaborative Lifecycle Management in software development
• Worked to identify, analyze, and interpret trends or patterns of paid and denied claims in Managed Care Claims and Encounter Data Report (S-35 report).
• Worked on creating and improving stored procedure in Oracle database to improve the application functionality.
• Responsible for checking new data for accuracy and removing inaccurate or corrupted data
• Worked with data reporting tools, Business Object, ETL, Cognos 8, Crystal Report, MS SQL.
• Worked in developing reporting applications using Cognos Business Intelligence components like Report Studio, Framework Manager, Query Studio, Analysis Studio, Metric Studio and Cognos Connection
• Created Field mapping document for various objects like Accounts, Contacts, Tasks, Opportunity, and Lead.
• Used MS Excel in data computing, creating charts, graphs, pivot tables and MS Words producing documents, MS Powerpoint to create the presentation slides and Visio to create flow charts.
• Worked on Data Warehousing and Mining: Concepts, Methodologies, Tools, and Applications.
• Created Process Flow diagrams, Use case diagrams (UML) using MS-Visio.
• Prepared Test Strategy, Test Plan, test report and Gap Report.
• Provided effort to locate and define new process improvement opportunities
• Worked on documenting the types and structure of the business data (logical modeling),
• Involved on analyzing and mining business data to identify patterns and correlations among the various data points,
• Extensively interacted with the stakeholders and the IT Department in finalizing the requirements according to the CMS Compliances/Regulations and HIPAA Regulations.
• Established a business Analysis methodology around the SDLC, helped to develop use cases, project plans and manage scope for Coram health and human services applications.
• Worked on Creating Business Requirement Documents (BRD), Functional Requirement Specification (FRS) document, User Requirement Specifications (URS) document, UML Modeling - Use Case Diagrams, object diagrams, Activity Diagrams,and Sequence Diagrams, SOA Orchestration Charts.

Environment: AGILE, MS Project 2004, BI, SFDC, MS excel, MS Word, MS Visio, MS .NET, Java, MS SQL, MS FrontPage, MS Power Point, SharePoint, ALM Quality Center, QTP, Load Runner, Performance Center

Confidential

Data Analyst

Responsibilities:

• Strong knowledge of annuity and annuisty products
• Performed the project analysis for financial viability of the renewable energy projects
• Processing of all individual insurance applications (life, disability & long term care) and investment application.
• Efficient in using MS access and handling large scale data files
• Extensively worked with Risk Management, Mortgage Loan Servicing, investment application and Commercial and Residential mortgage, CMBS, MBS.
• Used Salesforce.com to Eliminate and merge duplicate Accounts and Contacts.
• Studied and assessed the client systems and business processes
• Streamlined clerical work processes and mapped to the automated system
• Provided management to quick and easy access to all current economics (i.e. construction status, leasing status, etc.) of the collateral pertaining to all the loans in the portfolio
• Assisted in building a business analysis process model using Rational Rose and Visio
• Performed requirement analysis, went through all the use cases and workflows
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, OOD using UML

Environment: Windows 2000/NT, BI, Oracle 8i, SQL, HTML, XML, Microsoft Office suite, Rational Requisitepro, Microsoft Visio, Test director, Clearquest, Mercury Quality Center, UML, Rational Unified Process (RUP)