SUMMARY

• Around 8 years of experience as Business System Analyst in deployment of web - based, client-server applications, developing business processes and system solutions for healthcare and pharmaceutical industries for various projects from conceptualization to implementation.
• Excellent Technical Writing skills to create Business Requirements Document (BRD), Functional Specifications Document (FSD), Non-functional Requirements Document and Use Cases Specifications.
• Excellent in interpreting conceptual, logical, and physical models to include context, data flow, process flow, logical diagrams, and data dictionaries.
• Highly experienced in creating UML (Unified Modeling Language) diagrams such as Activity, Use Case and Sequence Diagrams.
• Strong in writing SQL queries (view, join, table, store procedure, data tuning) and reporting the results to the business team.
• Developed Traceability Matrix in the process of managing the requirements.
• Detailed knowledge of various phases of Software Development Life Cycle (SDLC) and Software Testing Life Cycle (STLC).
• Developed and documented test plans, test cases, and test scripts in HP Quality Center based on project requirements.
• Interacting with stakeholders, gathering requirements, rating them and assigning priorities to each of them. Possessed exemplary presentation, listening, time management, JAD session facilitation, interpersonal, organizational, interpretation, problem escalation, leadership, decision making, motivational, issues management, and influencing skills.
• Followed UAM change management/SOX guidelines for all IT processes.
• Complied with all guidelines established by the Centers for Medicare and Medicaid (CMS) and guidelines set forth by other regulatory agencies.
• Skilled in processing HIPAA EDI Transaction sets such as 837, 835, 834, 270 and 271 (not limited).
• Excellent oral and written communication skills with ability to communicate with higher levels of management and development team.
• Ability to solve complex problems independently and generate innovative solutions. Highly motivated self-starter with excellent communication, presentation and interpersonal skills, can perform well both independently and with a team, always willing to work in challenging and cross-platform environments.

TECHNICAL SKILLS

Operating Systems: Windows 2000/7/8/XP, iOS, OS X, Linux

Project Management: Microsoft Project, Microsoft Office (Word, Excel, PowerPoint)

Databases: MS Access, SQL Server 2008, 2012, Oracle 8/8i, Teradata

Reporting Tools: Cognos Reporting, SSRS, Crystal Reports

Business Intelligence Tools: SQL Server Business Intelligence Development Studio, SAS

Programming Language: SQL

Web Technologies: HTML, XML, JavaScript, .NET

Dashboard Tool: Tableau

Others: ScriptMed, GlobalShip, McKesson, MedeAnalytics

PROFESSIONAL EXPERIENCE

Confidential, IL

Business System Analyst

Responsibilities:

• Optimized business performance by designed/implemented business algorithm to evaluate efficiencies of operations.
• Assisted developing business cases and related financial literacy to support cases, and successfully demonstrated ability to write business cases improving future direction for leveraging information in the member, product, regulatory, care management, and provider domains.
• Developed and coordinated solution development processes, including requirements gathering, analysis, design, and development (Agile methodologies).
• Independently interacted with and influenced a wide range of stakeholders, and demonstrated a consistent track record of delivering results.
• Developed and implemented efficient and effective data related technical and QA processes including data validation, data integration, user acceptance testing, code and documentation, workflow and process maps.
• Analyzed data sets from SQL processes and provided business direction to technical resources to articulate client needs.
• Produced datasets and reports for analysis using system reporting tools like Cognos.
• Created SQL script, stored procedures, triggers, view, table and joint.
• Identified and troubleshoot data issues, validated result sets using MS Access and Teradata.
• Provided support within VBC team researching data anomalies and inquires, and working with the HEDIS application vendor to identify and resolve data related application issues and measure calculation issues.
• Synthesized complex/diverse information; collected and researched data outside of the HEDIS application; used intuition and experienced to complement data.
• Demonstrated proficiency in analyzing medical and claims data including various codes such as CPT, HCPCS, ICD - 9/10, Revenue Codes etc.
• Worked with multiple departments to drive results and resolved issues, including the ability to asses and course - correct as necessary.

Confidential, Schaumburg, IL

IT Business System Analyst & QA Analyst

Responsibilities:

• Worked with business stakeholders to gather requirements and completed artifacts, including solution and design support.
• Validated requirements with stakeholders and project team; provided suggestions and recommendations.
• Translated highly complex concepts in ways that can be understood by a variety of audiences (leadership, business groups, IT, developers, and vendors) and lead internal review sessions with them.
• Developed technical specifications and design documents.
• Documented, discussed and resolved business, data and reporting issues within team, across functional teams, and with business stakeholders.
• Collaborated with project stakeholders and technical teams regrading enhancements, changes, issues and defects that may impact development, data, workflow and/or functionality.
• Presented written and verbal data analysis findings, to both the project team and business stakeholders.
• Built constructive partnership with business leadership to proactively recommended solutions to business issues through practical, elegant, and effective business intelligence and reporting vehicles.
• Lead direct deployment of enterprise data strategy vision through successful program delivery.
• Incorporated best practices and standards in metadata and report/dashboard development.
• Functioned as mentored for other team members, providing assistance where needed.
• Created and executed test plans, test strategy, performed hands - on functional testing, and lead user acceptance testing.
• Demonstrated proficiency in analyzing pharmacy claims data and lab results.
• Showed strong technical knowledge of SQL, database and relational data models.

Confidential, New York City, NY

Business System Analyst & QA Analyst

Responsibilities:

• Strong Domain knowledge of Pharmacy Benefit Management including Pharmacy Network, Formularies, Electronic Prescribing Modulation and Clinical Management.
• Experienced in Healthcare and Pharmacy standard software like ScriptMed, GlobalShip and also working knowledge of Specialty Pharmacy and Home Delivery Lines.
• Analyzed and prioritized User and Business requirements (BluePrint Requirements Center) as System Requirements that defined code lines in developing the new member portal.
• Analyzed As-Is system and To-Be system, gathered User and Business requirements through UI (User Interface).
• Created High Level Functional Specifications and the Scope Documents.
• Built many Wireframes for various applications using MS Visio.
• Worked with all members of the project team, following the project through the Systems Development Life Cycle and ensuring business objectives are met (extensive project life cycle experience).
• Extensive background in CMS Medicare Advantage and State Medicaid reporting requirements.
• Prepared consolidated Benefits Summary for various plans available for Confidential .
• Prepared a list of the test accounts from Confidential and HIP and converted these into Confidential accounts for pre-production testing.
• Created Test Plan and Test Cases for all the functionalities for the new Confidential member portal.
• Performed an aggressive Manual Testing Cycles for the whole portal in test and pre-production environment.
• Prepared the Defect Reports and assigned problems to appropriate software development team for fixes.
• Was involved in the UAT testing, assisted the business users during the testing process.

Confidential, Arlington, VA

Business System Analyst

Responsibilities:

• Performed GAP Analysis to define gaps between AS-IS and TO-BE processes.
• Acted as a facilitator in JAD sessions to analyze and prioritize competing business needs.
• Determined traceability and dependability between the requirements using Rational Requisite Pro.
• Assured that all RUP artifacts are in compliance with corporate SDLC policies and guidelines.
• Used Rational Rose model the process using the UML to create Use Case Diagrams, Activity Diagrams, Data Flow Diagrams, and Sequence Diagrams.
• Created BRD, Vision, Scope, Wireframes and Functional Spec.
• Highly experienced in Medicare Advantage/State Medicaid encounter data 5010.
• Liaison with customer’s business unit managers, stakeholders and functional subject matter experts (SME). Created and managed project charter, scope and schedule.
• Extensive background in CMS Medicare Advantage and State Medicaid reporting requirements.
• Performed change management system during change requirement.
• Developed the Test Plan, Test Conditions and Test Cases to be used in testing based on business requirements, technical specifications and product knowledge.
• Used Test Director to manage testing and defect life cycles, and map requirements to test cases. Performed role of administrator for Test Director.

Confidential, Philadelphia, PA

Business System Analyst

Responsibilities:

• Analyzed As-Is system, gathered User and Business requirements through interviews, surveys, prototyping, building Wireframes and UI (User Interface). Performed GAP Analysis to define gaps between AS-IS and TO-BE processes. Medicare Part D - A federal program, developing the use cases for MyCigna.com related to the retirement plans. Conducted JAD sessions with management, SME, vendors, users and other stakeholders for open and pending issues. Planned and defined system requirements to Use Case, Use Case Scenario and Use Case Narrative using the UML (Unified Modeling Language) methodologies. Created Vision and Scope document for the Project.
• Analyzed if the system abides HIPAA regulations. Good experience in HIPAA compliance along with HIPAA 837, 4010 and 5010 data format.
• Created and managed Project Templates, Use Case Project Templates, Requirement Types and Traceability Relationships on SharePoint.
• Created Use Case Diagrams, Activity Diagrams and Sequence Diagrams in MS Visio.
• Worked with all members of the project team, following the project through the Systems Development Life Cycle and ensuring business objectives are met (extensive project life cycle experience). Prepared and analyzed any changes during the project make with the help of a Change request form. Planned and Prepared the Master Test Plan which includes Automation Test Plan for the Testing Phase with the Testers. Played a major role in Interface testing both functionally and manually. Assigned problems to appropriate software development team for fixes. Developed strategies with Quality Assurance group to implement Test Cases in Mercury Test Director 8.0

Confidential, Gold River CA

Business System Analyst

Responsibilities:

• Liaison between business units and technical groups.
• Have content knowledge of Utilization Management. (For e.g. Collection of data about diagnosis, required services, diagnostic test results, and symptoms). Coordinated the implementation of system updates and releases with management, systems personnel and end users.
• Created Fit Analysis for the New products been developed. Performed maintenance and documentation of client application upgrades and source server.
• Maintain source control/versioning system.
• Designed user interfaces and wireframes for the application. Created User and training Manuals.
• Provided hands-on training to client staff.
• Worked with business users to document scope statements, define business requirements, perform analysis and provide recommendations for new systems or improvements and redesign of current systems.
• Facilitate design sessions, mapping and configuring data values, workflow development, functional testing, training and user support. Good understanding of HIPAA standards and experience in testing and verifying the systems and applications for compliance with HIPAA.
• Created test strategies and test plans for configuration updates and managed implementation of configuration changes. Executed user acceptance testing.
• Prepared Business Requirement Documentation and Functional Documentation. Assimilate, integrate, and interface technical knowledge with business/systems requirements. Verify that technical system specifications meet business requirements. Developed following user interfaces Chief Complaints & HPI, Medications & Allergies, Medical History, Social History, Physical Exam, Review of Systems, Plan.

Confidential, Austin, TX

Business System Analyst

Responsibilities:

• Involved in BRD’s (Business Requirement Documents) supporting documents containing the essential business elements, detailed definitions, and descriptions of the relationships between the actors to analyze and document business data requirements. Analyzed As-Is system, gathered user and business requirements through interviews, surveys, prototyping. Analyzed and prioritized user and business requirements as system requirements that must be included while developing the software. Used power point presentations for conduction walkthroughs with the stakeholders. Conducted JAD sessions with management, SME, vendors, users and other stakeholders for open and pending issues. Created Use Case Diagrams, Activity Diagrams, Sequence Diagrams, Wireframes and ER Diagrams in MS Visio. Created and managed project templates, use case project templates, requirement types and traceability relationships on Share Point. Analyzed if the system abides HIPAA regulations as portal displays members’ private information. Played a major role in developing the user manual for security configuration, and for the marketing department. Extensively worked with Project Manager to determine the current best practices for requirement gathering.