SUMMARY:

• Over 8 years of professional experience as Lead Business/System Analyst in HealthCare with complete understanding of Systems Development Life Cycle SDLC , Rational Unified Process RUP , Business Process Flow and Business Process Modeling.
• Extensive experience in System Analysis, Requirement Gathering, Requirement Management, Document Processing, Process Re-Engineering, Design and Development. Excellent analytical, communication, leadership and management skills and perform exemplary role in cross-disciplinary teams through all development phases of SDLC

Business proficiencies:

• Worked in all phases of SDLC by using Waterfall, Spiral, Agile and RUP methodologies
• Extensive experience in HealthCare applications/systems, NPS Nasco , EAB, NMS, Latron, PNO, BeneFACT, MetaVance, OBN, BlueExchange, UCSW, MembersEdge, QNXT and Facets 4.7
• Experience in Business Requirements Gathering and GAP Analysis
• Proficient in preparing Use Cases by using Unified Modeling Language UML , used RequisitePro and DOORS for requirement management
• Expertise in diagrams such as Use Case diagrams, Class diagrams, Activity diagrams, Data Flow diagrams and Sequence diagrams
• Extensive experience in Rational Rose and MS Visio for modeling
• Reviewed and assisted Testers in creating Test Plans
• Used Rational Clear Quest for Defect Tracking
• Used ClearCase for vision control
• Proficient in developing and documenting User Acceptance Test UAT cases
• Experience in conducting Joint Application Developments JAD sessions walkthrough, Interviews, Workshops and developed User Manuals
• Experience in HIPPAA transaction 4010, 5010 and ICD-9/10
• Extensive experience in the development, implementation and integration strategies within a team oriented environment, utilizing quantitative and qualitative analytical skills
• Self motivated, hard working, team oriented and an excellent track record of productivity
• Effective Communication, Leadership, Time Management, Interpersonal, Multi-tasking and problem solving ability at all levels

TECHNICAL SKILLS:

HealthCare Systems/ Applications/Products Methodologies

NPS Nasco , EAB, NMS, Latron, PNO, SDLC, Waterfall, Spiral, Agile,

BeneFACT, MetaVance, OBN, UCSW, Rational Unified Process RUP

MembersEdge, Screensurfer, HCIF 7.1,

QNXT, Facets 4.7, Monarch Pro 7.0,

BlueExchange, BenefitFocus, TRMS,

FEP Direct/Mainframe DC/MD ,

Informatica Data Quality, Hyperion 11,

HIPPAA 4010/5010, ICD-9/10

Rational Suite RDBMS

Rational ReqPro, Rational Rose, Microsoft SQL Server 2000, MS Access

Rational ClearCase, Rational Administrator,

Rational ClearQuest

Languages Operating Systems

ASP, JSP, .Net, C, Java, Visual Basic, Windows Vista/XP/NT/ 2000 /98,

PL/SQL, HTML, XML, PHP, CSS, DHTML, Mac OS X v10.4

ColdFusion

Design Tools QA Tools

• Unified Modeling Language UML , Rational Robot, Rational Administrator,
• Rational Software Modeler, MS Visio, Rational Test Manager, Win Runner,
• Joomla, MS FrontPage, Macromedia Load Runner, Quality Center QC ,
• Dreamweaver, Fireworks, Flash, Quick Test Pro QTP
• Adobe Photoshop CS, Adobe Premier Pro 7.0,
• Adobe Image Ready 7.0, J-Album, LeapFTP,
• PageMaker 7.0, Camtasia, SnagIt

Software Packages

• SAP R/3, SAP Solution Manager SolMan ,
• RWD InfoPak, PeopleSoft 8x, MS Office,
• MS Project, MS Publisher, MS SharePoint,
• MS Communicator, MS Lync, Team Track,
• Clarity, Lotus Notes, Ultra Edit, Beeline, Clarity

PROFESSIONAL EXPERIENCE:

Confidential

Position: Lead Business Analyst/Assistant Project Manager

• Care Cinfidential is one of the largest health insurers with more than 80 of the region's health care providers participating in its various medical care networks. Worked on two follow projects:
• Automated Benefits Administration ABA : The scope of the project is to: migrate large account 200 plus - risk/non-risk with PPO, indemnity, MPOS, BlueChoice and CDH from a legacy system EAB to NASCO and FACETS. The project also focuses on to accommodate feeds and services such as: Paper vs. Automated Enrollment, COB, account receivable AR , claims processing, and provider/customer/member services
• Large Groups Migration LGM : Cinfidential, in conjunction with CareFirst support, now developing a system that creates a source of record repository for all Benefit information and drastically reduces the need for the research, coding, maintenance and testing of benefits code by standardizing, modularizing, and automatically coding reusable benefit code applicable to multiple Plans. This system will also provide benefit reporting and documentation to Plans and data interfaces to BlueExchange and OBN. Tools required for the creation and maintenance of benefit information on the NASCO platform are: Benefit Library, Benefit Builder and Benefit Automator

Responsibilities:

• Conducted Brain-Storming sessions/Facilitated Joint Application Development JAD sessions and serves as a liaison between the internal/external customers
• Extracted requirements from NAEGS for PPO, EPO, BluePreferred, BlueChoice, POS products to create Benefit variables and build benefit strings/templates
• Perform data mapping for OBN, BlueExchange and EB segment for new variables
• Used Unified Modeling Language UML to develop Use Case diagrams, Sequence diagrams, and Activity diagrams by using MS Visio to present the workflow in visual form
• Performed GAP Analysis between EAB vs. NASCO, Facets 4.3 vs. Facets 4.7, HIPAA transaction 4010 vs. 5010 and ICD-9 vs. ICD-10
• Validate all service types, variables in each benefit string/template in Benefit Builder and OBN
• Managed 32 Coders/QA Outsource resources during BeneFACT production/QA phases
• Prepared MembersEdge Project Plans and Account Migration Status reports
• Created/Reviewed template creation Tradability Matrix to fulfill project deadlines
• Developed Issue Management Process to manage/resolve issues during Coding/QA
• Documented Over 200 Standard Operating Procedures SOPs to define/ensure step by step procedures from billing/enrollment/payment and recording perspective
• Created Business Requirement and Systems Requirement tradability matrixes
• Maintained/updated and modified all project related documentation at CareFirst online SharePoint
• Gathered new ID Card requirements and performed Data Mapping for new IDs
• Performed GAP analysis on 3 daily extracts i NRCF0005 for AR's , ii NRCF0006 for cash and iii NRCF0007 for Membership billing detail and activity for the day
• Performed Data Mapping for Referral and Authorization in NASCO system from CARE
• Performed and supported the Claim Accumulation testing in Model Office and production environment
• Resolved coding/QA issues by preparing/managing Master Issue Logs
• Created Daily Status reports to accommodate needs of higher management
• Serves as a liaison between internal, external and outsourced teams/customers

Confidential

Position: SDLC/ Sr. Business Analyst

Confidential the largest health care insurer and serving nearly 3.1 million members. The Federal Employee Program Operations Center FEPOC provides centralized enrollment and data processing functions for the Government Wide Service Benefit Plan. Services include enrollment processing, claims processing, information retrieval of centralized databases and statistical databases The scope of the project was to improve quality of the overall Software Development Life Cycle SDLC , gather/document the business requirements and synchronize them with Quality Center. The FEPDirect Claims Processing System requirements include transactions claims entry, FEPDirect retrieval, claims history and FEPDirect enrollment that provides member enrollment information

Responsibilities:

• Conducted Brain-Storming sessions with project focus groups and Facilitated Joint Application Development JAD sessions
• Conducted interviews with Software Development Life Cycle SDLC Subject Matter Experts SMEs to identify the current processes
• Identified and documented all Business Requirement Documents BRD from Director's Office, stakeholders, business process owners and communicated to the team in support of the project
• Identified all the requirements and feeds from Blue Plans MQDirect , Connect Direct NDM , FEPDirect web interface application , Blue Exchange, FEMS and FDR Robot.
• Created Use Case diagrams, Sequence diagrams, and Activity diagrams in the Business Requirement Documents BRD
• Documented current Claim Adjudication Engin CAE edits that includes: VTC, Eligibility, Benefit Determination BD , Transaction Table Manger TTM edits from HFCR Database to provide detail description about the particular edits
• Documented As-Is Process of Mainframe Data Extraction Strategy and Entry/Exit Criteria of all the phases of SDLC FEPOC that includes: Analysis, Design, Development, Testing, Implementation and Post Implementation
• Performed Gap Analysis for various Type-of-Services TOS for a particular set of claim data and Team Tracks

Confidential

Position: Sr. Business Analyst

Confidential, the only licensed Confidential plan in New Jersey provides health insurance coverage to nearly three million people throughout all of Confidential.The scope of the project was migration of Horizon Dental Operations from legacy system Latron to thin client base system QNXT TriZetto's Product with no impact to the Dental business. It also focused on analysis of all Dental data and associated business logics.

Responsibilities:

• Conducted Brain-Storming sessions with project focus groups and Facilitated Joint Application Development JAD sessions
• Conducted interviews with Dental Subject Matter Experts SMEs to identify the current processes
• Implemented Rational Unified Process RUP methodology
• Identified and documented all Business Requirements from Dental users, stakeholders and business process owners
• Created Membership, Group Benefits, Claims, HDC-Capitation, EDI Transaction, Security, Portals and Provider Business Requirement Documents BRD
• Identified all the feeds from legacy system Latron to different claim engines to accommodate these feeds from QNXT in future like OCR-able claim feed to EDI Gateway, Dentemax Provider feed, Provider feed for online/hardcopy directories, Provider feed 1099s to UPS, Federal Employee Provider FEP and National Group feed to NASCO Processing System NPS
• Created Use Case diagrams, Sequence Diagrams, and Activity diagrams in the Business Requirement Documents BRD

Confidential

Position: Sr. Business Analyst

Confidential carefully combines highly experienced professionals with industry best practices and optimized business processes. GDS is providing high-quality services in dental management including Call Center, Fulfillment, Claims, Business Intelligence Reports, Web Services, Eligibility and Electronic Data Interchange EDI . Worked on three following projects:

• The Electronic Data Interchange project addressed the exchange of eligibility and group data files between GDS and Wonderbox Enterprise System. This project included all activities necessary to support the systems analysis, design, construction, testing, implementation user manuals and training with Health Insurance Portability and Accountability Act HIPAA transaction standards
• The scope of the Interactive Voice Response IVR project was to gather all functional requirement and HealthCare system requirements and document all architecture of existing operational IVR system, services provided by Angel.com, voice remote servers GoDady.com and comply with Health Insurance Portability and Accountability Act HIPAA customer service guidelines
• The scope of the project was to Develop and Update different websites for internal/external customers. These websites include Provider Search, Customer Care, and Frequently Asked

Responsibilities:

• Identified and gathered all the Functional, Non-Functional and System Requirements from the users, stakeholders and business owners
• Identified and defined actors, developed Application Use Case AUC , Business Rules and developed Data Mapping Matrix and Performed GAP Analysis for new requirements
• Perform analysis of exchange of data included member information eligibility records, product information, group information and fulfillment information comply with Health Insurance Portability and Accountability Act HIPAA transaction standards
• Created Business Requirement, Systems Requirement, Standard Operating Procedures SOP documents and developed Use Case, Sequence and Activity diagrams to present the Workflow in visual form
• Perform analysis of exchange of data included member information eligibility records, product information, group information and fulfillment information comply with Health Insurance Portability and Accountability Act HIPAA transaction standards.
• Provided solutions to enhances the IVR system for Kaiser Permanente KP , Administrative Services Only ASO Denex Provider and Union Provider
• Successfully complied the Health Insurance Portability and Accountability Act HIPAA customer service guidelines during EDI and IVR projects
• Implemented and developed Business Process models in RUP to document existing and future Business Processes and implemented Open Ticket Request System OTRS for Issue Tracking
• Assisted developers in designing and coding Frontend and Backend of Database driven websites
• Developed database-driven web applications to support dynamic content and Integration to back-end systems using multi-tiered approach
• Analyzed and evaluated the performance of the websites from various dimension and conducted User Acceptance Test UAT
• Worked closely with both development and testing teams to improve quality of the application and assisted in Test Plans, Test Cases and Test Scripts
• Analyzed and evaluated the performance of the application from various dimension
• Conducted User Acceptance Test UAT and Designed and developed Training Manuals

Position: Business Analyst

largest business, Patterson Dental provides a virtually complete range of consumable dental products, clinical and laboratory equipment, and value-added services to dentists, dental laboratories, institutions and other healthcare providers throughout Confidential.The project involves enhancing the EagleSoft software through better interface, automatically capturing images to digital x-rays and store x-rays in one patient record. It also focuses to make the patient appointment very efficient, comfortable and personal which requires on schedule dynamic appointment calendar. The appointment details show the appointment status of the patient, insurance and personal information. The enhancement of the project helps doctors to detect an absence and visually explain the concern to the patient.Job role involves interacting with business stakeholders and documenting their requirements for IT Department.

Responsibilities:

• Performed GAP analyses to derive requirements for existing systems enhancements
• Involved in Requirement Gathering including interviews, brainstorms and meetings with stakeholders and created requirement specification
• Worked in converting Business Requirements into Functional Requirements
• Involved in the creation and maintenance of the Workflow plans
• Conducted brain-storming sessions with project focus groups and Facilitated Joint Application Development JAD sessions
• Prepared Business Process Models that includes modeling of all the activities of the business from the conceptual to procedural level
• Translate all Business Requirements into detailed Use Cases for capturing the functional specification
• Created Use Case diagrams, Class diagrams, Sequence diagrams, Activity diagrams
• Worked with the User Interface team to create the User Interface screenshots to be presented to the Business
• Collaborated with the QA team to ensure adequate testing of software both before and after completion
• Maintained and kept track of stakeholders requests for enhancements and changes
• Communicate with system end users to gather system feedback and conducted User Acceptance Testing UAT
• Provided End-User training and assisted in User Manual

Position: Business Analyst

Confidential land area. As a result, more than 2,400 community organizations are better managed, more efficient, and more financially viable.The scope of the project was to develop an intranet based HR application incorporating the functionality of MS Access Application. It also focuses to cover Employee Set up, Employee Transactions and HR Transactions. The project required full involvement in Gathering Requirements and writing Use cases for two main segments Employee Setup and Employee Transactions.

Responsibilities:

• Worked as a Business Analyst to guide the process of building an intranet application
• Identified and gathered information so as to understand Employee Setup, Employee Transactions and to document every process
• Developed Use Case diagrams, Sequence diagrams, and Activity diagrams by using MS Visio to present the Workflow in a visual form
• Developed business process models in RUP to document existing and future business processes
• Documented and delivered Functional Specification Document to the project team.
• Collaborated with development architect and the business stakeholders to develop both high-level and detailed application architecture to meet the business needs.
• Assisted in Test Plans, Test Cases and Test Scripts
• Worked closely with both development and testing teams to improve quality of the application
• Analyzed and evaluated the performance of the application from various dimension and conducted User Acceptance Test UAT
• Provided End-User training and managed workshops
• Designed and developed Training Manuals for Educating the Users