SUMMARY:

• 7 years of experience in business process analysis, business requirements modeling and development of Web Based, and Client/Server applications in diverse business domains of Healthcare, Insurance and Service Industry Sectors.
• Proficient in gathering and converting User Requirements into Business Requirements and Functional Requirement Specifications FRS and use Modeling tools like Rational Rose and Microsoft Visio for requirements modeling.
• Expertise in Business Process Modeling, Business Process Re-design and in designing Process Architecture.
• Strong knowledge of managed care payer requirements and procedures.
• Experience in creating custom site templates and list templates for developing web part pages for the portal using SharePoint Portal Server 2003.
• Sound understanding of Gap Analysis, requirement management, risk analysis and project plans.
• Solid understanding of Rational Unified Process RUP using Rational Rose, Requisite Pro, Unified Modeling Language UML , Object Modeling Technique OMT , Extreme Programming XP , and Object Oriented Analysis OOA .
• Expertise with Microsoft servers like Microsoft Office SharePoint Server 2007 and Microsoft Performance Point server 2007
• Excellent understanding of Data Models and Information Architecture and sound skills in SQL.
• Excellent understanding of Software Quality Assurance Techniques, CMM, Six Sigma and ISO Standards and highly acquainted in working in SOX Compliance Environment.
• Familiar with HIPAA EDI transactions such as 834, 837, P, D, I 276, 277, 278 etc
• Experience in Risk Management process and technology reengineering, Sarbanes Oxley implementation, valuation review process and technology, strategic sourcing, metrics and benchmarking
• Excellent in designing business models using UML diagrams such as use case diagrams, class diagrams, activity diagrams, sequence diagrams and collaboration diagrams using Rational Rose and MS Visio.
• Experience in conducting Joint Application Development JAD sessions and White Board Sessions with end-users, Subject Matter Expert SMEs team, Architects and design group development and QA team for project meetings, walkthroughs and customer interviews commensurate with excellent communication skills.
• Creative and aggressive self-starter with integrative thinking skills, capable of communicating creative ideas through graphical analysis charts and statistical data display.
• DISCIPLINES:
• Business Analysis, Business Architecture, Data Mapping, Data Modeling, Requirements Gathering, Functional Specification Design, Testing Test Cases Manual Testing Automated Testing tools , Quality Assurance QA , Documenting Process Flow, Process Re-Engineering, Process Mapping, Business Contingency/ Business Continuity Planning BCP , GAP Analysis, SDLC

Software/Hardware: Rational Team Test, OOAD OOA/OOD , RUP, UML, Rational Rose, Clear Case, Clear Quest, WinRunner, Load Runner and Test Director, C, C , Java, HTML, J2EE, VB 6.0, SQL, Windows 9x/NT/2000/XP, Unix, Linux, Solaris, Oracle, SQL Server and MS Access, TSL, SQL Basic, Shell Scripts, MS Visio, MS office, Adobe PageMaker, Adobe PhotoShop, MS Project 2002, MS SharePoint, MS SharePoint Designer, Adobe workflow systems, Weblogic Server, iRise, HP Quality Center

PROFESSIONAL EXPERIENCE:

Sr. Business Analyst

Member of team that supports the financial portion of the claim payment System for the state of VA Medicaid program. Facilitate meetings with state of VA Medicaid representatives to determine requirements for changes to the financial portion of the claim system that pays over 100 million dollars a week in Medicaid claims.

Responsibilities:

• Gathered business requirements by driving user-group meetings and working with various global, cross-functional and virtual teams
• Managed the team of consultants responsible for developing on-demand Medicaid Management System reports.
• Designed the online screens and reports for the Medicaid Online Electronic Claims Submission System.
• Analyzed, designed, and coded several online subsystems for the Medicaid System.
• Responsible for business system analysis of customizing the BPS Risk Management product with involvement through the whole SDLC
• Teamed up with both internal and external software development groups to provide functional requirements specifications in form of use cases, business process flows, and prototypes and management reporting requirements.
• Took lead role in migrating pages and data from old intranet to new SharePoint platform
• Upgrading and Patching of SharePoint and its' related systems
• Requirements Elicitation, Analysis, Communication, and Validation according to Six Sigma Standards.
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, OOD using UML
• Was responsible for the hardware, software, upgrades, and patching of SharePoint equipment.
• Involved in all phases of software development life cycle in RUP framework.
• Used Rational Rose to model the process using UML to create behavioral and structural diagrams.
• Managed the transition to new development standards, procedures and processes including the introduction of UML, Rational Products including Rational Software Architect, ClearCase and ClearQuest as well as the HP Test Suite
• Developed detailed Developer specification to reflect technical details of the business requirements
• Performed data analysis by using SQL queries using the DB Artisan tool
• Extensive experience in using collaborative tools like HP Quality Center to facilitate development across disparate teams
• Logged defects into QC while doing Functional Testing and followed through the process until the defects were closed.
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, OOAD using UML and Business Process Modeling.
• Developed business process models in RUP to document existing and future business processes.
• Participated in the creation of a SONAR application's Test Planning, Test Scripts, Testing, Defect Reporting and Management
• Provided management support to the off-shore End to End Integration / Regression Test Team
• Prepared UAT Materials UAT Test Cases to include various steps involved for UAT and to have proper coverage of requirements
• Interacted with the users and logged any defects, enhancements from the UAT and communicated them to the development team
• Acted as a Subject Matter Expert on Application knowledge for preparing training presentation, Quick Reference Guides and assisting with any issues/questions that arose from training
• Managed various release cycles starting from enhancements to production for the RADAR application
• Provided production support on both SONAR and RADAR including any communications for the development team and to log defects/enhancements in order to plan future releases

Confidential

Business/Systems Analyst

One of the Team Leaders responsible for the successful implementation of an IBM mainframe state of Georgia Medicaid Management Information System MMIS . Interfaced closely with the Georgia executive Medicaid Management committee while defining system and reporting requirements. Proactively created project plans to manage changes in scope, identified potential risks, and devised contingency plans.

Responsibilities:

• Gathered Business Requirements through brainstorming sessions on global calls.
• Documented the business logic and associated validation logic.
• Implement SharePoint for team collaboration and Document Management.
• Created screen-mockups using iRise to review the requirements and provide feedback on the screen design. Also, used Microsoft Paint to create ad-hoc screen mock-up to review with the users.
• Documented and tracked requirements in HP Quality Center.
• Responsible for installation and configuration of the SharePoint Server 2007 along with Office 2007 and worked on Site designing using SharePoint Designer 2007.
• Acted as a liaison between the development team, QA team and the Business team and resolved any conflicts due to change in requirements.
• Provided suggestions and ideas more from a strategic and long term perspective.
• Created Requirements Specification Document that translated business requirements into Technical specification including business and validation logic for ease of understanding to the development team.
• Extensive experience in using collaborative tools like Mercury Quality Center to facilitate development across disparate teams
• 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.
• Designed and developed Use Cases using UML and Business Process Modelling.
• Used MS-Visio for flow-charting, process model and architectural design of the application.
• Designed and developed project document templates based on SDLC methodology
• Analyzed and translated business requirements into system specifications utilizing UML and RUP methodology
• Ensured that all Lines of Business specifications were consistent in form and function to the Diamond Base System.
• Involved in analysis for wide range of Six Sigma and Web-based initiatives, including user requirements.
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, and OOD
• Generated wireframes and prototype for the GUI.
• Reviewed test scripts and made sure that the Test scripts covered all scenarios of the requirements.
• Reviewed the data model and reporting requirements for Cognos Reports with the Data warehouse/ETL and Reporting team.
• Logged defects into QC while doing Functional Testing and followed through the process until the defects were closed.
• Reviewed the Defects entered by the QA team and prioritized the defects and assigned them to the development team
• Prepared UAT Materials, including the UAT Process, UAT Test document which would include step-by step process for UAT as well as all the tests that would cover all requirements.
• Interacted with the users and logged any defects, enhancements from the UAT.
• Worked with the Training Group to build training materials as well provided any suggestions/ tool tips to assist in User Training

Confidential

Business Analyst- Healthcare claiming systems provider and payer

• Cigna major service lines include workers compensation claims administration and healthcare management services, property and casualty claims management, class action services and risk management information services.
• As a Business Analyst in Cigna I performed pivotal role in multiple projects handling three releases at the same time. Release 1 2 was web-based service application developed for streamlining office workflow processes involved in Electronic Data Interchange EDI transactions and benefits in claims management cycle based on HIPAA Guidelines. Release three was based on reporting the policy premium. There were seven reports, which were generated in Brio portal.

Responsibilities:

• Helped in defining Change Management Process for Release Management Team.
• Mapped process flow assess as-is processes through user interviews, data collection and analysis, design and evaluation of to-be process solutions.
• Prepared Business Object / Business Process Models that included modeling of all the activities of business from conceptual to procedural level.
• Designed and developed Use Cases using UML and Business Process Modelling.
• Consulted with healthcare insurance company to develop conversion specifications for other insurance Coordination of Benefits including Medicare .
• Conducted UAT to confirm that all derivative products can be successfully processed through stages of the trade life cycle
• Developed data conversion programs for membership, claims, and benefit accumulator data - converted thirteen corporate acquisitions. Developed data field mappings. Provided programming and support for claims processing functions and auto-adjudication.
• Validated the following: 837 Health Care Claims or Encounters , 835 Health Care Claims payment/ Remittance , 270/271 Eligibility request/Response , 834 Enrollment/Dis-enrollment to a health plan
• Identified gaps in the business process.
• Defined roles and responsibilities of participants in the business process.
• Developed and maintain information and documentation related to developing and modifying business processes and systems.
• Recommend system/process solution approaches to minimize risk and workflow impacts while capitalize strategic goals.
• Assisted process owners in process training and implementation.
• Streamlined the Restatement Financial Data Warehouse access review Process.
• Gathered requirements from users of the Clear Quest CQ tool for any Enhancements or change requests for any defects.
• Involved in Six Sigma process analysis.
• Planned and defined system requirements to Wire Frame with Use Case, Use Case Scenario and Use Case Narrative using the UML Unified Modeling Language methodologies.
• Led and conducted JAD sessions for requirements gathering, analysis and design of the system.
• Created context and workflow models, information and business rule models, Use Case and Object Models during the analysis using Rational tools.
• Designed and developed project document templates based on SDLC methodology
• Established RUP Rational Unified Process methodology and provided assistance in developing Use cases and project plans.
• Analyze business requirements and segregated them into Use Case Diagrams, Activity Diagrams, Sequence Diagrams, and OOD using Borland Together according to UML methodology thus defining the Data Process Models.
• Documented Requirements for Management Reporting out of Clear Quest using Crystal Reports.
• Worked as a CQ administrator by assisting customer with any issues and by running queries for ad-hoc reports for management team.
• Facilitated Change Control Board and Governance Board meetings and acted as a liaison between parties impacted by the change requests.
• Provided training on new features within CQ and prepared training materials like Quick Reference Guides and Job aids.

Confidential

Business Analyst

The Health Data Repository HDR System Independent Verification and Validation IV V Evaluation project is responsible for validating and verifying that the HDR system and application for the Veterans Health Administration VHA works as designed.

Responsibilities:

• Created and maintained development plans that include As Is Work Flows, Functional specifications, Data Layouts, Use Case Modeling, Risk Assessment, Internal Workflows and External Workflow.
• Translated Business Requirements and user expectations into detailed specifications employing Unified Modeling Language UML , MS Visio.
• Used Rational Tools for creating use cases, version control and defect tracking, monitoring. Use Rational Unified Process RUP methodology in all areas of the software development life cycle SDLC .
• UAT testing performed along with call center managers to make sure that application meets their requirements.
• Liaison between developers and business users to communicate requirements for building third party interfaces.
• Performed all aspect of testing to ensure system changes are meeting identified business requirements.
• Developed and distribute necessary documentation required for releasing changes into the company's production environment. Also, follow the software development life cycle and documentation standards.
• Created appropriate business work flows suitable for systems developers and users for project planning in the future.
• Conducted walkthroughs with the end users to gather the modification requests from the user to update or change the business specifications
• Conducted business process modeling and analysis identified, assessed and articulated gaps/operational risks associated presented risk-mitigation and operational enhancement solutions to project management team
• Used UML notations for Object Oriented Design and Documentation
• Developed prototype for auto quote processing system for QuickQuote, Full Quote and NewBusiness.
• Provided mapping of XML from Auto Web to policy management system.
• Integrated RequisitePro with ClearQuest and Rose to provide all teams visibility and maintain tractability among requirements, use cases and change requests
• Managed all the requirements in RequisitePro, making requirements available to all team members.
• Set up test environment to facilitate Test Plan.
• Used automated test tools Win Runner to verify functionality, predict system performance and test scalability prior to deployment.
• Conversion of data from different database environments, while performing Back End Testing.
• Responsible for executing Volume Testing, Compliance Testing, Data Quality Testing.
• Responsible for status check at regular timeframe.

Confidential

Business Analyst

PacifiCare is committed to an ongoing emergency planning program, PacifiCare merge with United Health Group, The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 MMA creates a prescription drug benefit for Medicare beneficiaries and establishes a new Medicare Advantage program to replace the current Medicare Choice program. Participation in the new program MA-PD is necessary to ensure PacifiCare preserves the 5.5 billion in annual revenue received from CMS for the Secure Horizons product.

Responsibilities:

• Conducted weekly meetings for deciding the Policies and Procedures to be followed while constructing new sites.
• Performed the requirement analysis, impact analysis and documented the requirements using Rational Requisite Pro.
• Documented the server farm requirements and requirements related to security within Share Point and using Windows Active Directory.
• Lead multiple project teams of technical professionals through all phases of the SDLC using technologies including Oracle, Erwin, Data Stage, Data Warehousing, Websphere and Cognos.
• Built business requirements into the Medicare Advantage MA requirements database and created the Project Requirements Document for the three functional areas
• Worked on billing system a cash management module and enhanced the encrypting standards that are required for the application.
• Worked in mainframe environment and used SQL to query various reporting databases
• Worked with COBOL, JCL, VSAM.
• Analyzed system performance and initiated process improvement measures for mainframe and Web-based applications.
• Followed a systematic approach to eliciting, organizing, and documenting requirements of the system.
• Reviewed the Joint Requirement Documents JRD with the cross functional team to analyze the High Level Requirements.
• Been a part of Architecture and modeling team and have used SOA Service Oriented Architecture
• Extracted data from disparate sources by SAS/ACCESS.
• Used Query Analyzer, Execution Plan to optimize SQL Queries.
• Meticulously assessed data from various sources and generated conceptual and logical database designs using ERwin data modeling tool.
• Interacted with client and the Technical Team for requirement gathering and translation of Business Requirement to Technical specifications.
• Conducted interviews, meetings and JAD sessions during the process of Requirement Gathering.
• Planned and documented procedures for data processing and prepared data flow diagrams for the application.
• Created SAS programs that are used for data validation, statistical report generation and program validation and automated the Edit Check programs using Macros.
• Analyzed and translated business requirements into system specifications utilizing UML and RUP methodology
• Expertise with supply chain strategies/vendor manufacturing process methods to determine level of procurement and strategic sourcing strategies/plans and worked with vendors/peers to determine lead times, schedules and cycle counts, established requirements needs.
• Interacted with line of business managers and coordinated the transition into the security database to assure business compliance with SOX.
• Analyzed trading partner specifications and created EDI mapping guidelines
• Documented the Traceability Matrix for tracing the Test Cases and requirements related to them.
• Developed UML Use Cases using Rational Rose and developed a detailed project plan with emphasis on deliverables.
• Designed and developed project document templates based on SDLC methodology
• Prepared Demo on SharePoint for various Business to get new approvals like the Therapist and Nursing divisions.
• Designed workflows and allocated permissions within SharePoint.
• Performed Unit Testing and User Acceptance testing and documented detailed results.
• Provided input scope, goals, risks, constraints, timelines and interfaces to PM for project planning and control.

Environment: Windows 2000/XP, Microsoft Office SharePoint 2007, Rational Requisite Pro, MS Office, SQL Server, Agile, MS Project, MS FrontPage 2003, MS Access, EDI, Documentum 2.0.,UML.