Skills

Please use this table to list the skills noted in the Required/Desired section of the requirement. In addition, please respond with the years of experience for each skill and the last time each skill was used. Add or delete rows as necessary.

Employment History

Confidential

Business System Analyst

Responsibilities:

• Utilized Agile Methodology to configure and develop process, standards and procedures
• Conducted JAD sessions workflow diagrams, UML diagrams, process models, activity diagrams, use cases, for incorporating design changes in the order creation/ management system.
• Actively participated on creating Migration strategy from existing PDE Microsoft Access files to Gold Data Repository.
• Clearly understood coding standards required for all Medicare Part D 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.
• Developed Test scripts and performed Regression Testing, Smoke Testing, Functional Testing, Blackbox Testing and Load/stress Testing.
• Analysis and Design of existing transaction sets, and modification of these transaction sets to ensure HIPAA compliance.
• Created new Web / User Interface wireframes and mockups for marketing initiatives.
• Did data analysis, created data mapping and data interface documents and kept the documents updated with changes in requirements and functional specifications.
• Defined HL7 interface requirements gap analysis and develop detailed specifications for ADT Admit- Discharge-Transfer , Lab orders, results charges.
• Used General equivalence Mappings GEM to convert ICD 9 to ICD 10.
• Involved in forward mapping from ICD 9 to ICD10 and backward mapping from ICD10 to ICD9 using GEM.
• Did gap analysis for HIPAA 4010 837P and 835 transactions and HIPAA 5010 837P and 835 transactions.
• Involved in impact analysis of HIPAA 5010 835 and 837P transaction sets on different systems
• Involved in requirement gathering of Cognos reports like Class-plan verification report, Medicare broker license validation report, and Medicare letters report to enrollment.
• Created a Data Dictionary Mapping the Reportable Health Conditions with LOINC/SNOMED codes and Master Data Management Documents.
• Attended daily SCRUM and guided QA and Developer regarding the defects, Technical Specification Documents and Mapping Documents.
• Coordinated with data architects and ETL team to understand/drill down on the data mart requirements. Came up with the plan to roll out data mart development efforts in different phases, coordinated efforts to analyze the data mart requirements between teams responsible for various source systems, scoped out the work required on behalf of different teams to adhere to the interface documents to provide data to the data-marts.
• Used SQL extensively to test the data, Data mapping, Data mining and support to ETL team.
• Worked closely with business users and IT team in War room to solve the issues in time
• Provided Production support and post-production support/explained the changes to the business users/did one on one sessions/one to many sessions to make the business uses aware of the system changes.

Environment:

SDLC, Agile, Requisite Pro, SQL, Toad 9.7, SharePoint, MS Access, MS Visio, MS office, MS word, MS Excel ClearCase, ClearQuest, Quality Center, Oracle 9i, RDBMS, DB2, JAVA, Informatica 7.1, Cognos 8.4.

Confidential

Business Analyst/Business System Analyst

Responsibilities:

• Working as business system analyst for migration of SSB State Sponsored Business Health Plan business from Diamond system to WellPoint Group System PBM Platforms .
• Gathered and analyzed requirements for PRM integration.
• Communicated Project Requirements, Business Issues, Solutions and made recommendations.
• Assisted project manager to prepare business document, project schedules, resource allocation, project duration and cost by using MS Project.
• Implementing a fully integrated and efficient system for maintaining PDE Medicare Part D data in a single Database that has the capacity to interface and query data from primary claims adjudication systems. Extensively tested claim data using SQL from different prospective. Dealt with following table from QA and BA prospective: Claim, Claim Line, Claim Line CDHP, Max Revision, Claim Paid, Provider, Pharmacy, Member Product Enrollment, and Pharmacy MED D.
• Understanding and working with development team to load NCPDP 2500, 1750, 1000 byte file to the staging area. Worked with dev team to load claim and other files into Enterprise Data-warehouse ED Ward . Understood, documented and explained the data loading logic to the dev team. Heavily involved in testing and creating Claim reduction logic.
• Involved in EDI Process for electronic document/data transformation. Worked on ICD 9 and ICD 10 codes that depend on 278 v.5010 support project.
• Working on Pharmacy Claims/Rx claims, Claims adjudication, Membership, Eligibility, Prior Authorization, Accumulators, Drug Step edits, PHI and different managed care products like POS, HMO and PPO.
• Working directly with Project managers, Business Team, Technical team, QA Team to analyze and eliminate errors.
• Involved in all phases of system development including requirement gathering and analysis, Designing, Development, Testing, Implementation, deployment, maintenance.
• Gathering Requirements from business, created BTRDs, BRDs, TDD and supported technical and testing team.
• Prepared the Prototype and mockup screens.
• Documenting all system changes and request for changes RFC for user access using change management forms and prepared LOE, FIT documents for budgeting purpose.
• Used MS Excel to create test cases and import the data to Quality Center and performed system testing, stress testing, functional testing and defect management according to Test plan and test scripts.
• Creating error categories: based on error codes, correction type, necessary intervention type, etc, documented error correction protocols develop auto and manual correction processes, wrote requirements to develop Web based Reporting tool which will be capable to generate recurring reports, Ad-hoc reports, and track reports.

Environment:

Agile, WebLogic server, Portal server, Oracle,MS SharePoint, Excel, Test Director, Mainframe, NDM, FTP, MS Access, MS Project, ClearQuest, SDLC, Luminous, ITS, PHI, RDBMS.

Confidential

Business Analyst

Responsibilities:

• Conduct JAD sessions periodically with various stakeholders at various phases of the Software Development Life Cycle SDLC to discuss open issues and resolve them.
• Interacted with the Subject Matter Experts SME's and Stakeholders to get a better understanding of client business processes and gather business requirements.
• Baseline a business workflow document to ensure an accurate understanding of the steps needed to complete the process.
• Provide projects with pre-project planning expertise high-level and detailed project definition, as well as acted as the primary liaison between IT and Business Partner s on a daily and project basis.
• Comprehensive set of reports that provides the user with information such as customer and supplier details, customer and supplier transactions, receipts, outstanding customers, items list, items sales register, items below minimum quantity, stock ledger and cash ledger.
• Experience with Medicare, Medicaid, and commercial insurances in HIPAA ANSI X12 formats including 270, 271, 276/277, 820, 834, 835, 837 P, I, D , 997, and NSF formats for interfaces and images to third party vendor applications including.
• Used SQL queries for extracting desired data from multiple databases.
• Developed Use Case Diagram and Activity Diagram using MS Visio, and a detailed project plan with emphasis on deliverable.
• Developed and Implemented Test Strategies using the Test Director.
• Assisted QA team in testing phase by creating Test Plans and Test Cases documents.
• Facilitated User Acceptance Testing UAT and reported the results to the Business Stakeholders.
• Maintained proper communication with the developers so that they addressed the modifications and requirements and also monitored these revisions.
• Developed test plans, test cases and test scenarios, provided test data to the QA Group and also performed User Acceptance Testing UAT .
• Created as-is and to-be process models, specifications, and process flow diagrams.
• Worked with stakeholders and project team to prioritize collected requirements.
• Validated business rules and all artifacts with users, approval and sign off.

Environment:

RUP, CMMI, Rational Rose, Requisite Pro, ClearCase, ClearQuest, SQL, Oracle, J2EE technology, Java, Cognos, MS Visio, MS Project, MS PowerPoint, MS Word, Hyperion, NASCO, Oscar claims processing .

Confidential

Business Analyst

Responsibilities:

• Elicited and gathered user and business requirements through JAD sessions and interviewing clients.
• Troubleshoot systems related issues regarding the functioning of core Part D Operations systems.
• Analyzed enrollment and billing workflows and procedures in order to assist in the development of new or modified systems.
• Provided technical assistance in identifying, evaluating, and developing systems and procedures.
• Call Center experience for resolution of member's inquiries and issues.
• Performed gap analysis and root cause for the failure of letters send to the vendor.
• Prepared the Business requirement Document for the enhancement of the existing services.
• Prepared system Use case specification document with Use Case diagram.
• Created Activity Diagrams, Flow Charts and Process diagrams.
• Created crosswalks for the letter values and codes.
• Worked with SharePoint to manage teams and companies data.
• Worked with business users to understand their requirements, worked with developer team to develop prototypes/Mockups, demonstrated prototypes to the business users.
• Conducted united testing after each module and tracked Defects.
• Performed SQL querying to relational databases.
• Prepared and implemented test cases for System Testing as well as for User Acceptance testing.
• Worked directly with The Fulfillment /MES and QV Team to understand vendor SLAs and print production timeframes and process letter timely.
• Mapped letters and their respective fields.
• Worked TRR Transaction reply report , accretion file.
• Conducted Integration Testing and Regression Testing with developers in development and QA, also conducted user acceptance testing with UAT team. Safety reporting on system-based projects, acted as a liaison, writing documentation and increased project coordination.

Environment:

Waterfall, Rational Robot, MS Word, MS Visio, MS Project, MS Excel, MS PowerPoint, SharePoint, Filenet, Fazal.