SUMMARY

• Over 6 years of experience in Business Analysis, System Analysis and testing in healthcare and pharmaceutical industries.
• Excellence in collecting, managing and documenting business and functional requirements and ability to create, translate and transform business requirements into functional requirements.
• Strong knowledge of software development life cycle (SDLC) including Waterfall, Agile Methodology, RUP having understanding of various phases like requirement, design, development and testing.
• Used Rational Rose to carry out the business modeling, data modeling, and object modeling efforts to develop the business architecture for rapid and controlled application environment development.
• Experience in creating Data Flow Diagrams, Use Cases, Class Diagram, Activity Diagrams, Sequence Diagram, and UML Modeling in MS Visio and Rational Rose.
• Used Rational RequisitePro for overall requirements management and to build requirement traceability matrix.
• Experience with various analysis methodologies, documentation processes, and project management tools includes: SDLC; Agile; Short - Cycle Iterations; Daily "Stand-Up" Meetings; Use Cases; UAT; MS-Project; SharePoint; eRoom; Visual Source Safe; etc.
• Facilitating JAD sessions with business user and development team to drive out detailed business requirements.
• Excellent knowledge of Health Insurance Portability & Accountability Act (HIPAA) standards.
• Worked with HIPAA conversion and Electronic Data Interchange (EDI) with Transaction code sets such as 837 (medical claims), 835 (medical claim payments), 270 (eligibility inquiry), 271 (eligibility response), 276 (claim status), 277 (claim status response), 820 (enrollment), and 834 (premium payments).
• Knowledge of ICD-9-CM and ICD -10-CM coding and claims processing.
• Extensive experience in Electronic Health Records, Medicare, Medicaid, Health Care reform, and Patient Protection and Affordable Care Act (PPACA).
• Extensive knowledge about the various types of health insurance programs such as: Medicaid, Medicare, PPO (Preferred provider organization), POS (Point of Service), and HMO (Health maintenance organization).
• Experience in conducting GAP analysis, SWOT analysis, Cost Benefit analysis, and ROI Analysis.
• Extensive knowledge of compliance to FDA 21CFR Part11, 50, 56, 58, 210, 211, 312, 314.80, 820.
• Worked closely in clinical trials environment and accurate knowledge on Adverse Events (AE), Laboratory data, Demographic Data, CDISC SDTM, EMR, EHR and Regulatory Authorities.
• Knowledge of HL7 message structures, data definitions, and usage.
• As a liaison between developers and management and between end users and stakeholders, was instrumental in resolving conflicts between the various teams.
• Defining test cases, creating test scripts, analyzing bug, interacting with testing & developing teams in fixing errors.
• Analyzed business requirements from black box testing perspective, business process and system design.
• Expertise in preparing required documents for Computer System Validation (CSV) lifecycle, including Validation Master Plan (VMP), Installation Qualification (IQ), Operational Qualification (OQ), Performance Qualification (PQ) and Validation Summary Report (VSR).
• Good working experience in cGXP (cGMP, cGCP, cGLP, cGDP) aspects.
• Expert in using different automated testing tools like QTP, Load runner and Quality Center.
• Performed Gap Analysis, understanding disparate Functional Processes, ability to identify and mitigate Risks and develop remediation plan.
• Experience in Corrective Action Prevention Action (CAPA), Change Control Process, Training, Investigations and Document Management Process.
• Experience working with on-shore, offshore, on-site and off-site individuals and teams.
• Extensive Competency in writing, reviewing and executing Validation Protocols as per federal regulations.
• Excellent Communication, Interpersonal, Analytical skills and strong ability to work with minimal supervision as well as a part of team.

TECHNICAL SKILLS

Operating System: Windows 95/98, NT, 2000, XP, Vista, UNIX, DOS

Languages: SQL, HTML, SAS, XML

Databases: Oracle, MS SQL server, MS Access

Tools: MS Office, MS Project, TOAD, MS Visio, Rational Rose, Rational Requisite Pro, Clearquest, Clearcase.

Business Tools: Rational Suite (Requisite Pro, Rose, Clear Quest, Clear Case), MS Visio,MS Project, MS Access, MS Office Suite, Visual ParadigmReporting Tools Doors Erwin Data Modeller 4x, Business Object (Crystal Reports),Cognos,informatica

Business Skills: Business Definition Requirements, Business Process Analysis, Gap Analysis, Use Case Modelling & Analysis, Business Environment and Market Research Analysis.

Methodologies: RUP, OOAD, UML & Business/Data Modeling

Packages: MS Office Suite, Dream Weaver, Adobe Photoshop.

PROFESSIONAL EXPERIENCE

Confidential, Williston, VT

Business/ Systems Analyst

Responsibilities:

• Worked closely with State Technical & Business SME’ for gathering Technical and Business requirements definition and activities as described in the Request for Proposal (RFP)
• Actively worked with both internal and State team to leverage existing materials such as the latest Centers for Medicare & Medicaid Services (CMS) certification/checklist requirements for new MMIS in order to establish baseline system requirements
• Involved in facilitating strategic visioning activities, team meetings with the State and key stakeholders
• Coordinate with current MMIS vendors/FAS in researching activities including, but not limited to, allowing the MMIS vendors to provide relevant potential process and technology solutions for the State of Vermont and key stakeholders to consider.
• Interact with current MMIS vendors and collected necessary information regarding their creative and industry best practice solutions
• Developed Agency Enterprise Architecture Analysis - Vision Documents, Business and Functional Requirements, Technical Requirements and General System Design documents
• Worked with internal team for developing Business, Information and Technical Architecture sections and further validate them with State SME’s for accuracy
• Involved in developing Business Functional and Technical Requirements for Fiscal Agent Services and MMIS Procurement
• Mapping of Vermont’s identified Business and Technical processes to MITA business areas and business processes that are specific to State Divisions/Agencies and Departments.
• Schedule meetings with SMEs to review MITA results for both Technical and Business areas
• Involved in preparing Technical and Business process templates and compile with received agency SME’s input and further revalidate them with agency stakeholders prior to finalizing the documents
• Generate “To-be” project road map that describes and prioritizes tasks and provides a high-level implementation schedule.
• Worked closely with agency SME’s for capturing the “As-Is”, “Evolving” and “To-Be” (5-10 years out) picture of the Vermont Medicaid Enterprise Business and Technical Architecture information
• Gap Assessment using the SS-A as the “As-Is” inventory and identifying the gaps between the current Vermont Medicaid processes, systems and the MITA Framework 2.1.
• Involved in assessing current “As Is” and “To Be” against MITA Maturity Model
• Assist in the development of an Implementation Advanced Planning Document (IAPD)
• Worked with internal team to design, create and maintain SharePoint portal

Environment: VISIO 2007, MS Project 2007, MS Office, Excel, Power Point, MS Access, SharePoint and RFP evaluation tools (internal)

Confidential, Franklin Lakes, NJ

Business Analyst

Responsibilities:

• As a Business Analyst, was responsible for gathering requirement, preparing BRD, and various process documents.
• Being with pharmacy Benefit Management Company for more than 2 years, was responsible for leading CDH Business Team.
• I 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, I 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.
• 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.
• Worked as a trainer for the folks for the Monitoring and validation activities using RUMBA
• I was responsible for reporting to project managers as well as senior managers.
• 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.
• Involved in HIPAA/EDI Medical Claims Analysis, Design, Implementation and Documentation
• Performed Monitoring and Member Validation tasks, for new book of business for the Migration and Health Care Reforms clients.
• I 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 help, printed user manual and training materials
• 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

Confidential, Hartford, CT

Business Systems Analyst

Responsibilities:

• Developed understanding of business requirements while working with business partners, subject matter experts (SME), enterprise architects, and application developers for integration of COTS and Custom applications
• Involved in design and development of Clinical Trial Management System (CTMS) integrated with EMR and customized to suit protocols following CDISC, GCP and other FDA standards.
• Developed data model, database architecture, database diagram etc.
• Running ETL Process using Microsoft SQL Server - SSIS to transform Operational Data to local database to generate dashboards, Ad-Hoc reports and customized user reports.
• Building Data Marts, ensure data is clean and credible to support business need, generate correct report etc.
• Developing & utilizing the organization's strategic Data Warehouse & Producing Ad Hoc requests.
• Ensure Report System is user friendly and data capture modules enable error free capture for critical fields.
• Gather critical, real-time and historical data, summarize and provide detailed results with timeliness and accuracy.
• Involved in data-mining to understand and discover patterns and behaviors.
• Wrote SQL queries to make sure data was in the appropriate format to ensure compliance with CDISC standards.
• Responsible for documentation with an understanding of 21 CFR Part 11, FDA, CDISC, ODM standards and SDLC standards for documentation.
• Performed requirement validation and eCTDs for FDA and Documentum Management.
• Create Change Controls and managing change controls and create Validation Scripts.
• Execute Validation Scripts (IQ, OQ, PQ) for Computer Systems, BMS systems and calibration systems
• Served as liaison for various business units to gather requirements and resolve issues for the upgrade of existing ERP system.
• Gathered business requirements, analyzed work flows, defined the scope, and performed GAP analysis.
• Performed planning and developed detailed schedules for all the projects; use MS Project Server to update and manage the schedule on a day-to-day basis and used it for reporting to client and upper management.
• Created all the required project deliverables as per standards and procedures. Met with client groups to convert user requirements into business requirements and user and functional requirement specification.
• Facilitated collection of functional requirements from system users, and prepared business and technical requirement specification documents.
• Utilized RUP to configure and develop processes, standards, and procedures and to perform system analysis and organizational review of existing QA processes.

Environment: MS Excel, MS Visio, MS Project, SharePoint, R, SAS, SQL Server 2008, Quality Center, QTP, Trackwise.

Confidential, Medford, MA

Business System Analyst

Responsibilities:

• Conducted JAD session’s workflow diagrams, UML diagrams, process models, activity diagrams, use cases, for incorporating design changes in the order creation/ management system.
• Clearly understood coding standards required for all Medicaid Users transactions involving electronic data interchange as provided by department of health and human services and incorporated at every stages of the project wherever found necessary.
• Prepared the Business Requirement Document (BRD) and functional requirement document (FRD) for the enhancement of the existing services.
• Analysis and Design of existing transaction sets, and modification of these transaction sets to ensure HIPAA compliance.
• Performed data analysis, created data mapping and data interface documents and kept the documents updated with changes in requirements and functional specifications.
• Experienced with business intelligence tools such as Cognos products, Crystal Reports
• Applied a structured change management approach and methodology for the people side of change caused by the respective projects and change efforts.
• Worked on developing the business requirements and use cases for automating the billing entity and commission process.
• Created UI mock up and functional specification.
• Gap analysis for HIPAA P transactions and HIPAA P transactions.
• Involved in impact analysis of HIPAA and 837P transaction sets on different systems
• Performed access queries including retrieves data, tables, joins, extract, creates, and analyzes to presents reports and data crosswalk from database.
• Perform excel functions and formulas including Vlookups, Conditions, concatenate, substring and other formulas for data analysis.
• Created mapping table for the Transactions accepted by the Sybase translator move into an Interface Database for 837 transactions.
• Coordinated with data architects and ETL team to understand/drill down on the data mart requirements.
• Designed strategy for up gradation of system and implementing User interfaces (UI) to be 5010 compliant.

Environment: MS Office, MS Visio, Rational Requisite Pro, ICD-10, ICD-9, HIPAA 4010, 5010, GUI, Test Director, Agile Scrum, BPR, XML, UAT, and SQLServer 2008.