PROFESSIONAL SUMMARY

• Extensive experience 8 years in analysis and solution design in the Healthcare-Life Sciences, Health Insurance /Pharmaceutical/ Group Insurance/Pharmacy Benefit Management domain
• Experienced in the application of Business Analyst and select Project Management practices, methodologies and tools as applicable Business Analysis: SDLC Process, Requirement Gathering, Business Systems Planning, Procedural Development Implementation, Business Process Mapping, Problem Solving/Workarounds and Business Contingency Planning/Disaster Recovery, Gap and Impact Analysis - Project Management: Work Breakdown Analysis, Project Scheduling, Executive/Stakeholder Reporting, Solution Analysis and Design Business Perspective
• Excellent communication, interpersonal, analytical skills and strong ability to perform individually and as part of a team in CMMI accredited and CMS-compliant companies
• Experienced in being a part of different types of projects COTS Commercial Over the Shelf Product Customization, Building
• of new in-house Web Applications, Application Implementation/Enhancement/Maintenance, Enterprise Content Management
• Well-versed in the usage of: Elicitation Techniques, Requirement Writing Applications, Requirement Repositories, Change/Defect Management Tools, Process Mapping Tools and Workflow Development

TECHNICAL SKILLS

Languages: UML, SQL Business Tools: MS Office Suite - MS Project, MS Visio, Clear Quest and Clear Case, GP I-Many, My Support Center, Optimal Trace Requirements Documentation Tool , Documentum, SharePoint/Teamsite, Crystal Reports, SQL Squirrel, Informatica, Document Analyzer, Breeze , Rumba, CLM Contract Tool, Livelinks, LiveMeeting, GITS Government Issue Tracking System Application, PTA Packet Tracker Application/Requirements Documentation Tool , MKS Integrity Code Promotion Request Application, AMISYS, WISDOM, MILLIMAN, HPLM Quality Center Methodologies: SDLC, RUP, JAR/JAD, UML, Agile, UAT, Waterfall Other Software: MS Visio, MS Word 97/2000, MS Excel 97/2000, MS Access 97/2000, MS Project Operating Systems: MS Windows 2000/NT/98/XP, UNIX, MSDOS

PROFESSIONAL EXPERIENCE

Confidential

MARKETPLACE QUOTING TOOL MQT PROJECT

• Techniques used to elicit requirements are interviews, collaborations, mini JAD Sessions with the GHP Sales Team, GHP Marketing Team, Web Team and the update and maintenance of a project log to produce the following deliverables:
• Quote Submission Protocol
• Client Quote Trend Association and History Tracking
• Document Generation
• Client Profile Parsing/Data Entry/Retention Configuration
• Rule Engine Development
• Workflow Implementation Lifecycle of a Quote
• As a Sr. Business Analyst, the role entails the creation of Functional Requirement Documents using the Agile Methodology for the Marketplace Quoting MQT Tool used by the GHP Sales Team and appointed brokers to provide quotations for plans and products intended for Small Business Groups SBG . This project is an off-shoot of the Health Exchange Project.
• The development of this user interface tool, the Marketplace Quoting Tool which managed the production of health plan quotations for employer groups included the development of the following:
• Functional Requirement Documents
• Supporting documents
• MQT Requirement and Question Log
• Process Flows
• Activity Diagrams
• Workflow Diagrams
• Wireframes
• User Permission Document
• User Stories
• Glossary
• Icon Reference

ICD-10 PROJECT

• As a Jr. Project Manager/ Business Analyst in the GHP ICD-10 Team, the role deals with investigation into the different functional areas to identify ICD-10 impacted points from a process/system/tool/training/reporting perspective and creation of impact analysis, requirements and remediation documentation such as:
• ICD-10 Impact Assessment
• High Level Requirements
• Detailed Business Requirements
• Business Remediation Planning
• Test Case Design Documentation
• Functional areas dealt with and experienced, range through the horizontal spectrum of the Healthcare Insurance domain such as:
• Customer Service Operations Claim Adjudication, Payment Integrity, Claim Configuration, Proven Care
• Health Services Accreditation, Appeals, Case Management, Medical Management, Medical Policies , Pharmacy Quality Improvement, Wellness
• Informatics Actuarial and Clinical for Corporate and Mandatory/Compliance Reporting
• In line with project management, the following duties are performed:
• Regular application of business analysis and project management skills
• Work breakdown analysis, project scheduling and timeline agreements
• Regular reporting/escalation of status to management and stakeholders
• Conduction of Implementation Design Sessions for solution analysis and decision

Confidential

• As a Business Analyst in the Client Services Team, the role was to support the CCM Corporate Compliance Management Team in the analysis of Government Pricing and Compliance requirements understanding of the different price types and the complexity of calculations associated with it, and the reporting aspect to CMS within the legacy systems of Merck Pharmaceuticals and Schering Plough as part of their harmonization system integration initiative. The duties performed for this role are as follow:
• Understanding of the flow of information in the GP System and GPAS System for Government Price Reporting as
• required by CMS for participating in Government Programs and creation of BRD Business Requirement Document
• and Master BRD documents for business review and corporate compliance purposes
• Adherence to timelines, approval protocols, and updating of documents necessary for audit purposes in compliance with SOX

Confidential

As a Business Analyst and a part of the gap analysis and implementation team of ACS, the role was to understand the gaps /changes for the EDI Transactions, Pharmacy Transactions from an NCPDP 5.0 to D.0 perspective and current ICD9 codes being used by the State of Mississippi. The objective was to conduct a gap/impact analysis and create documentation in order to adhere to HIPAA Compliances required by CMS for the years 2012 and 2013.

Confidential

• As a Business Analyst and a part of the implementation team in CIGNA, the role was to understand the existing business process for the Contracts Management System, gather requirements and create documentation for an improved Contract Management process in a system-agnostic manner to be used for Enterprise Content Management for the following products Short Term Disability Insurance STD , Long Term Disability Insurance LTD , Life, General Accident GA and Business Travel Accident Insurance BTA . The objective is to elicit requirements for an improved and effective group insurance Contract Management business process for a potential Contract Management tool CLM implementation. The duties performed for this role are as follow:
• Participated in the elicitation and documentation of Enterprise Content Management ECM requirements through SME and team member interviews, workshop/JAD sessions to create, analyze and finalize the improved Contract Management business process workflows for all the group insurance products
• Creating documentation for all identified data models such as Domain Model-Data Mapping and ER Diagrams from Legacy Systems, Book Of Record and CLM Solution Tools for Question Tree co-relation purposes
• Utilizing the Waterfall Methodology in creating the requirements for eventual Contract Management tool implementation in a system-agnostic manner
• Handling of and coordination with a team of off-shore resources

Confidential

As a Business Analyst in Genzyme Genetics, the role is to understand the legacy LIMS Lab Information Management System and create requirements to transition it to an off-the-shelf customized application called the SCC SoftBiochemistry System and ensuring that all data is converted and forwarded from the auxiliary systems in a smooth manner.

Confidential

• In the Retiree Solutions Team for Medicare Part D, the focus is on ensuring that the EOB Explanation of Benefits content, computation and reporting to satisfy client needs and remain compliant with all CMS mandates. The EOB Explanation of Benefits information compilation and derivation is a part of the overall MMIS Medicaid Management Information System .
• As a Business Analyst in Medco Health Solutions, the role required working in two teams and producing FRDs Functional Requirement Documents as needed. The team focus is listed below.
• In the POS Point OF Sale Business Requirements team for Medicare Part D, the focus is on ensuring that the POS Point Of Sale Systems function properly as far as Claims Processing and Medicaid Subrogation is concerned and are in accordance with NCPDP Standards, as well as HIPAA compliance. Requirements produced were also customized according to Client needs while maintaining all required healthcare protocols. The POS Point Of Sale is a part of the overall MMIS Medicaid Management Information System .
• Confidential
• As a Business Analyst in the Government Pricing/PPD Division, the focus is on maintaining the data integrity based on the flow of information from various sources and interfaces into the Government ODS System Operational Data Store which in turn feeds data to various applications including the GP I-Many for completing calculations based on laid out government regulations for products sold to the government. In line with this, the responsibilities are as follows:
• Acted as a liaison between business clients and technical personnel to acquire and record requirements for upgrades, enhancements/ interface changes and new projects
• Processing DBCR Database Change Request and SDDs Software Design Documentation documentation and coordination with technical team
• Adhered to existing CMMI and Sarbanes Oxley compliant protocols incorporated in daily standard procedures.