Summary:

• Experience in health information and health care services regulatory environment including HIPAA, Medicaid/Medicare, CCHIT, EDI and XML
• 7 years of extensive experience in Business Analysis, Software Validation and business process re-engineering with proven ability to articulate business values in healthcare, insurance and finance industry.
• Exposed to diverse business processes, that includes Pharmaceutical and health care.
• Directly managed multiple projects involving multiple team sizes. One of the key projects involved Clinical Trial using SCRUM development methodology handling highly sensitive data. Recommendations established new firm wide coding and testing standards.
• Experienced in testing EDI and HIPAA Transactions 837, 835, 820, 276, 277, 278 code sets testing in Health Insurance
• Working within a growing knowledge of X12 4010 HIPAA Transaction Processing 837 I, P, D, 835, 834, 820, 270, 271, 276, 277, 278, EDI, Privacy, Security, and Medicaid.
• Proficient at creating and transforming business requirements into software requirement specification SRS using Rational RequisitePro and designing business models using UML diagrams such as use case model, Class Diagrams, Activity Diagrams, Sequence Diagrams and Collaboration Diagrams in Rational Rose and MS Visio.
• Experience in conducting Joint Application Development JAD sessions with end-users, expert team, development and QA team for project meetings, walkthroughs and customer interviews.
• Expert in Root Cause Analysis, Feasibility studies and Risk Assessment studies.

Technical Skills:

• Project Management Tools/Methodology: Object Oriented Analysis and Design. OOAD using Unified Modeling Language UML , Rational Unified Process RUP , Casewise Corporate Modeler, Rational Rose, Rational Requisite Pro, CaliberRM, Rational Clear Quest, Rational Clear Case, MS-Visio, MS-Project.
• Operating System: MS-DOS, Windows, Linux RH 8.x
• Testing Tools: Win Runner, Test Director.
• Defect Tracking tools: Test Director, Rational ClearQuest
• ETL Tool: Informatica
• Database: MS-Access, SQL Server 2000/2005, Oracle 8i/9i/10g.
• Office Tools: MS Word, MS Excel, MS PowerPoint, MS SharePoint, MS Visio, MS Project
• Quality Management: HIPAA

Professional Experience:

Confidential

Business Analyst

Clients of Atlantic Financial include corporations, institutional investors and individuals throughout America and the world. This is a re-engineering process project and it is a web-based trading management system to be accessible to its users anywhere and anytime to support multiple business area including fixed income security trading, Asset management, Portfolio management and Risk management. It provides all necessary guidance to Group companies to enable them to follow the risk management policies and set up their own appropriate risk management systems. It also monitors the implementation of risk management according to the regulation requirement.

Job Responsibilities:

Formulated and defined systems scope and objectives through research and fact-finding combined with an understanding of applicable business systems and industry requirements following RUP. Involved in extensive DATA validation using SQL queries and back-end testing Actively involved in validating the requirements and applying the RUP framework throughout the SDLC. Managing the CPI Library Infrastructure Development and pioneering the POA Architecture in MicroStrategy/BIDW environment Analyzed business and user needs, documenting requirements. Conducted performance analytics. Wrote SAS syntax code for analytical purpose. Designed and prepared Excel spreadsheets and charts for reporting. Documented requirements and provided testing support for the project. Use Cases and other Process Flow Models were designed using Visio and Rational Rose. Helped managing project envisioning activities including the execution and documentation of project definitions, scope, deliverables, business analysis, acceptance criterion and team structure and budget. Involved in creating automated Test Scripts representing various Transactions, Documenting the Load Testing Process and Methodology. Created meaningful reports for analysis and integrated the Performance Testing in the SDLC. Created the business process model using MS Visio for better understanding of the system and presented it to Project Manager and other team members for validation. Took key initiatives in working with users in defining project and system requirements. Designed and developed Use Cases, Activity Diagrams, OOD using UML. Used SQL queries to test the integrity of data by querying the database Created test cases and scripts Organized and performed both, the Systems Testing and the UAT.

Environment: Windows 2000 Prof/XP, Oracle 8i, MS Access2000, Rational Rose, Requisite Pro, Clear Quest, RUP, UML, MS Visio 2002.

Confidential

Business Systems Analyst

• Description: My role at KMHP was of a Sr. Business Analyst for the National Provider Identification NPI for the providers. Coordinated with subcontractors of IS Business units, also performed as point of contact for Offshore team associated with KMHP towards implementing the new Guidelines for HIPAA Transaction Processing 837 835 . The National Plan and Provider Enumeration System hereafter referred to as NPPES would begin assigning these NPIS to health care providers upon request. All covered health care providers and health care plans will need to completely transition from the use of older legacy provider ID numbers to the new NPI numbers, wherever the Provider ID is used in standard HIPAA transactions.
• The Department of Health and Human Services published 45 CFR Part 162 HIPAA Administrative Simplification: Final Rule. This document mandated that all covered health care providers and health care plans as described in the document begin using a single, assigned National Provider Identifier referred as the NPI .

Responsibilities:

• Defined a complete set of metrics report requirements including a framework that will meet the needs of regional and national business leaders.
• Created specifications for EDI HL7 A28, A31, ADT and X12 837/835 transactions that were transmitted between Claims Editor and Legacy Billing application and external Payers
• Provided analytical data to enable management to make informed decisions to drive continuous revenue cycle improvements by realizing gains in operational efficiency, cost savings and member experience
• Identified performance indicators that provide reliable daily trend information as a primary input towards the monthly executive dashboard report. Developed HIPAA EDI Transmissions. Work includes complete business cycle management and hands-on production as well.
• Create EDI Testing process, documentation, and performance matrices.
• Worked on EDI transactions: 270, 271, 834, 835, and 837 P.I.D to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
• Technical Specification Creation for EDI. Schedule meetings with technical personnel to determine technical parameters for EDI and other related processes, including communication, security, and privacy.
• Assisted in preparation of Request for Proposal RFP . Analyzed and drafted a functional and technical features list for each vendor, thus identifying the best to send out a RFP.
• Recommended changes for system design, methods, procedures, policies and workflows affecting Medicare/Medicaid claims processing in compliance with government compliant processes like HIPAA 4010 / EDI formats and accredited standards like ANSI.
• Identified and drafted the calculations used for various regions, using their source SQL's for standardization purpose. Performed Requirement Analysis and developed Use Cases, Activity Diagrams using Rational Rose
• Implement SharePoint for team collaboration and Document Management.
• Prepared for GAP Analysis identified and documented improving areas to meet capital requirement regulations. Developed UML Use Cases using Rational Rose and developed a detailed project plan with emphasis on deliverables.
• Involved in interactions with Subject Matter Expert, Project Manager, Developers, and the end-users in more than one JAD sessions. MS Project proved useful in coordinating activities with project manager and various other teams.
• Provided clear and concise documentation regarding requirements management plans, functional requirements, supplemental requirement. Performed GAP analysis for the modules in production, conducted feasibility study and performed impact analysis for proposed enhancements.
• Coordinated JAD session with system analysts, development team, project manager for application development and Pre-validation specifications

Environment: RUP, Rational RequisitePro, Rational Soda, Rational Rose, Rational Clear Case, Rational Clear quest, Java, VISIO, Oracle 9 , Sybase , UNIX, XML SPY, GOXML, LINUX, HTML, WINDOWS

Confidential

Business Process Analyst/Systems Analyst

As a Business Analyst worked on Integrated Drug Information System This Application was designed to store drug information data in to database, which was made particularly for Pharmaceutical Companies. Other features of this application include maintaining records for drug availability from a variety of manufacturers, interacting with other distributors/companies and providing efficient dispensing and pricing etc. Periodic reports were also generated by the application for various levels of management for decision and control purposes. The integration project used an extensive repository of drug information and provided means for efficient dispensing and pricing of drugs in pharmacies.

Responsibilities:

• Used Requisite Pro for the Requirement Documents Preparation and Prepared Business Process Models that includes modeling of all the activities of the business from the conceptual to procedural level. Followed top down, leveled technique for building Business Process Models.
• Defined the current clinical and financial business processes re-engineering and practices.
• Reviewed administrative and clinical practices and procedures: point of care, scheduling, registration, clinical documentation, patient care, and charge entry, medical coding and diagnostic testing procedures associated with multiple business units.
• Assisted with development of strategy for managing SharePoint permissions in conjunction with Active Directory and future implementation of Identity Lifecycle Management functionality
• Involved in creating and testing Professional, Institutional and Pharmacy claims through API to Diamond. Performed EDI duties such as FTP of files to and from our Clinical Trading Partners.
• Converted Business Requirements to the Functional Specification and Conducted JAD Sessions to develop an architectural solution that the application meets the business requirements, resolve open issues, and change requests.
• Coordinated defects routing in the team and created Excel macros to generate daily defects report status from Quality center across multiple teams. Generated test cases in Claims Analyzer Editor Professional to ensure unification with CPT-4 and ICD-9 codes
• Captured Data flow diagrams and formatting of the data flowing through interfaces.
• Interaction with underwriters to understand multiple data points.
• Prepared data flow diagrams using MS Visio for better clarity and to ensure documented process
• Adhere to project deliverables as specified in the project lifecycle methodology and prepare all documentation to conduct a successful tollgate review at the end of each phase in the lifecycle.
• Extensive experience in all phases of RUP and SDLC processes
• Monitored client expectations through client involvement and communication throughout the lifecycle of the project educate clients and stakeholders on the benefits and risks associated with the project.
• Evaluated the Rational comprehensive approach to software development, featuring seamless integration between tools, services and best practices, enables the organization to successfully deliver high quality software while deriving impressive business benefits for their customers.

Environment: Java, J2EE, SQL, PL/SQL, Windows 2000 Advanced Server, MS Office Suite MS Word, MS Excel, MS Access, MS PowerPoint , UNIX/Oracle Platform, CSV Files, MS Visio, RUP, UAT, ERWIN, Rational Rose 2002, Rational Clear Quest

Confidential

Business/Systems Analyst

Philips Healthcare is a diversified Health and Well-being company, focused on improving people's lives through timely innovations. As a world leader in healthcare, lifestyle and lighting, Philips integrates technologies and design into people-centric solutions, based on fundamental customer insights and the brand promise of sense and simplicity .

Responsibilities:

• Interfaced with the client as part of the Requirements Engineering team to finalize the project scope. Conducted analysis of HIPAA compliance and took part in migration of HIPAA 4010.
• Assisted the PM in developing Use Cases and project plans and also managed changes to the scope of the project. Conducted user interviews, gathered Requirements, analyzed the Requirements and managed changes using Rational Suite.
• Conducted interviews with end-users to collect requirement and business process information.
• Requirements Elicitation, Analysis, Communication, and Validation according to Six Sigma Standards. Implemented data access, storage and validation routines on the database server using Procedural Language/Structured Query Language PL/SQL .
• Developed business process models in RUP to document existing and future business processes. Performed extensive Requirement Analysis including data analysis and gap analysis.
• Designed and developed project document templates based on SDLC methodology.
• Identified internal and external business requirements, design and configuration set-up, also created User Documentation and conducted training classes.
• Developed business requirement specification documents as well as high-level project plan.
• Analyze business requirements for new system requests, system upgrades, and system replacements to ensure compatibility with IT security policies and HIPAA standards.
• Documented and delivered Functional Specification Document to the project team.
• Worked with Medicaid Management Information System MMIS to determine problem claims and communicated this with the provider community.
• Maintained current updates of Medicaid policies and regulations.
• Created MS Access database s and forms to capture training evaluations and attendance
• Assisted the PM in setting realistic project expectations and in evaluating the impact of changes on the project plans accordingly and conducted project related presentations.
• Assisted with user testing of systems, developing and maintaining quality procedures, and ensuring that appropriate documentation is in place. Conducted User Acceptance Testing UAT .

Environment: Microsoft Office Suite, Microsoft Visio, Documentum, UML, J2EE, Windows NT/XP, Oracle, SQL, SQL Server, Sybase, PL/SQL, UNIX, Business Objects, Test Director, LoadRunner

Confidential

Business Analyst

National City was in need of an improved credit card processing system. The project was about implementing a centralized, web-based application infrastructure to improve development time, provide online data access and reengineer the credit card process in order to expand the company's business and E-commerce applications. I was involved in the creation of application of access management to protect business and customer information from unauthorized disclosure.

Role Achievements:

• Established a RUP Rational Unified Process centric business analysis methodology.
• Collaborated in building a business analysis process model using Rational Rose, RequisitePro, and Visio. Responsible for creating Business Requirement Specifications, to capture functionalities at all E-Commerce touch points.
• Worked extensively with Business and IT in understanding and documenting system requirements pertaining to the Credit Card Authorization Project in the E-Commerce department.
• Provided key initiatives in working with users in defining project and system requirements.
• Provided inputs in the strategic development of detailed project plans, work assignments, target dates etc.
• Developed strategic partnerships with the business unit to prepare a solid knowledge base of the business line, including the business plan, products, and process' and revenue streams aimed towards problem solving.
• Apply UML notations and methodology in developing models that accurately represent the business process re-engineering and workflows and clearly communicate them to the stakeholders.
• Functioned as the primary liaison between the business line, operations, and the technical areas throughout the project cycle.
• Created workflow scenarios, designed new process flows and documented the Business Process and various Business Scenarios and activities of the Business from the conceptual to procedural level. Perform Gap Analysis of the processes to identify and validate requirements.
• Partnered with the technical areas in the research and resolution of system and process problems especially related to Power Builder platform.
• Played a key role in the planning, testing, and implementation of system enhancements and conversions
• Performed analysis on enterprise data/report integration provided functional specification to development team to build Enterprise Reporting Systems.
• Performed UAT and exposure to User Certification Testing UCT and Operational Readiness Testing ORT . UAT testing performed along with managers to make sure that application meets their requirements.
• Assisted in presenting reports and analysis to help guide the management.
• Assisted in development of training materials for new technology and process improvements

Environment: Windows, MS Office MS Word, MS Excel, MS Access, MS PowerPoint, MS Visio , .NET, Oracle, Crystal reports, RUP, UML, SQL, MS Project, SWOT analysis, GAP Analysis, Win Runner