PROFESSIONAL SUMMARY:

• Creative and innovative thinker, team player with excellent communication and analytical skills, bringing energy, enthusiasm and leadership to problem resolution
• Over 8years of IT industry experience working as a Business System Analyst
• Extensive experience in Requirements gathering using interviews, JAD sessions, BPMN/UML models experience in documenting business and functional requirements BRD, FRD effective verbal and written communication skills
• Deep knowledge of all facets of SDLC process experienced in managing projects using Agile and RUP methodologies
• Strengths include big picture focus while developing strategic business solutions which can include:

Areas of Business Knowledge include:

• Relational database experience includes ORACLE, MS SQL SERVER,.NET knowledge of Data Warehousing concepts, experience in designing and mapping ETL processes.
• Experienced in Data Analyses, Data Mapping using SQL and UML diagrams
• Successfully provided UI design using wire frames, mockups supplemented by functional requirements

TOOLS:

Requirements Excel, Word, Rational Requisite Pro

Project status MS Project

UML/BPMN models Visio, Rational Rose

Traceability RallyDev, Excel

Data modeling, mapping ORACLE SQL, MS SQL SERVER Erwin, .NET

ETL, Date Warehousing DWH , Reporting MS SSIS, SSRS, SAP Business Objects, Excel, Visio

Reports Design :Gather requirements from business users, functional design of reports for BI implementation

WORK EXPERIENCE:

Confidential solution is one of the leading providers of health insurance services. The Confidential up project is to implement a centralized Claims Module that maximizes automation. The Facets based system performs all the functions of claims administration, Data Exchange, HIPPA Validation for the various EDI File formats. Implemented Claims adjudication module facets online with EMR/EHR in compliance with Confidential approved transactions such as claim filing 837 , Claim Remittance 835 , and Health plan Eligibility 270/271 .

Responsibilities:

• RUP combines with Scrum Methodology was followed throughout software development cycle.
• Coordination with onsite, offsite and offshore teams during the project implementation period for development and testing activities.
• Coordinated extensive JAD sessions with Design, Development, DBA's and SME's to tree down the business requirements into Functional requirements Technical .
• Performed GAP analysis and analyzed system effectiveness in meeting the requirement.
• Extensive Requirement illustration and documentation was performed and any changes were controlled by Change control board CCB .
• Worked with FACETS Team for HIPAA Claims Validation and Verification Process Pre-Adjudication .
• Worked intensively on FACETS for audit trails made on the used account and check and store information related to the HIPPA authorizations.
• Worked with FACETS to port the system from and check the system responds equally fast and also is complying with the standards of the institution all the time.
• Developed Use Case Models, Activity Flow, Business process flow, Sequence and well documented for future reference
• Implemented Claims adjudication module facets online with EMR/EHR in compliance with HIPPA approved transactions such as claim filing 837 , Claim Remittance 835 , and Health plan Eligibility 270/271 .
• Involved in daily scrum meetings and implemented Agile methodology.
• Participated in discussion about pricing the new product of the company.
• Executed various SQL queries to perform data validation and check data integrity.
• Assisted QA team in creating Test plans, Test Scenario and Test Cases for smoke, Functional, system integration and regression testing.
• Conducted UAT testing with the Business end-users and Developed Training Manuel/Guide for performing claim remittance 835 , claim status 276/277 , and health Plan eligibility 270/271 transactions.
• Defect process management was performed with QA and Developers to resolve defects.
• Confidential a leading pharmacy benefit manager PBM , with the nation's largest mail order pharmacy operations. Through advanced pharmacy,Medimpactimproves the health and lowers the total cost of care for clients and their members. Working directly with drug manufacturers and a nationwide network of retail pharmacies,Medimpactprovides flexible options backed by quality customer service.
• The project involved Modifying the Point of Sale application to ensure the removal of special drugs from being dispensed from pure play pharmacies and all retail pharmacies depending on the clients and the list of drugs.
• The Project was meant to design a comprehensive pre authorization PA / Utilization management. MedResponse automates the Therapeutic PA process.

Responsibilities: -

• Developed detailed work flow document and Process flow diagrams.
• Interacted with cross-functional teams for collection of detailed business requirements.
• Analyzed Business Requirements and segregated them into high and low level Use Cases, Activity Diagrams and Sequence Diagrams using MS Visio.
• Gathered user requirements by interviewing focus groups and brainstorming with SMEs, Business users and Product owners. Created targeted questionnaires for SMEs to refine requirements and translated into business rules
• Ensured that functional team understands requirements to implement the Specialty
• Reviewed and revised a comprehensive list of Retail and Pure play Pharmacies, to include them in the rules Station, with the help of the SME.
• Worked in coordination with the Legal standards department to incorporate mandatory and specific State laws, related to sale and distribution of Specialty drugs, in to the Rules Station.
• Conducted Gap Analysis to determine ways that allow Prior Authorizationbased on different Rules Engines.
• Conducted Business process study to establish link between BA front-end tool, File Management review/approval process, and creation of back-end rules in Authorization module.
• Used AGILE methodology and worked in short SPRINTS to achieve goals.
• Participated in SCRUMS and discussed the open issues and statues.
• Participated in Agile Planning Sessions and assumed the Product Owner role for the agile initiative.
• Developed the Epics and Themes for the Scrum Project
• Devised and prioritized the Product Backlog by conducting requirement churning sessions with various Business / Product Teams.
• Created and explained the User Stories to the Scrum Team and helped them design the Tasks.
• Designed acceptance criteria for validating the output of each Sprint.
• Reviewed Team Velocity on a frequent basis and advised Scrum Master at various stages.
• Participated in Sprint Planning and Sprint review meetings for Finalizing the Sprint Backlogs and Verifying the sprint outputs respectively
• Created Release Tracking Documentin order totrack the necessarychanges.
• Participated in Business Demonstrations and Decisions for the Release of the Sprint Output to

Reports Design :Gather requirements from business users, functional design of reports for BI implementation.

Responsibilities:

• Interacted closely with the Business users Physicians along with the administration and management to gather business requirements and analyze the functionalities to be incorporated into the system
• Participated in JAD sessions / conducted interviews for analyzing business requirements and reviewing them with business and technical teams
• Identified all necessary Business and System Use Cases from requirements, created UML diagrams, including Use Case Diagrams, Activity Diagrams and Data Flow Diagrams using MS Visio.
• Attended demo sessions to understand existing system functionalities
• Arranged interviews with all the stakeholders to review and understand the gathered business requirements
• Developed UID Documents, FRD and other SDLC Artifacts
• Coordinated with system architects and developers to convert business requirements into system requirements
• Conducted Demos and walkthroughs for Confirming Business requirements
• Developed UAT strategy, UAT Plan and facilitated UAT
• Verified and validated all build or release related issues and resolved them through discussion with business analysts with users' approval.
• Conducted Smoke tests in Production and Documented Lessons Learnt during the Project.