Skills

Please use this table to list the skills noted in the Required/Desired section of the Peoplefluent requirement. In addition, please respond with the years of experience for each skill and the last time each skill was used. Add or delete rows as necessary.

Conducting JAD sessions

6 Years

2012

Documenting functional and non-functional requirements

6 Years

2012

Creating application prototypes and screen mock-ups

6 Years

2012

Creating graphical representations of complex business processes

4 Years

2012

Experience in using Microsoft products such as; Visio, PowerPoint, Excel and Word

5 Years

2012

Experience working as part of an Agile SDLC team

3 Years

2012

Confidential,
System analyst/Facets configuration

Project 1:
PCMH (Patient centered medical Home) implementation for large groups (new healthcare reform) project. Different work stream include Enrollment, ID card changes and WEB provider search changes.
Project 2:
VBB (Value based benefit) extended functionality to accommodate multiple conditions. Different work stream include implementation of new module of Trizetto
Project 3:
Consumer Transparency: - Blue cross blue shield Association project for practitioner transparency
Project 4:
Health promotions: - In-house project for data migration from vendor to SQL Server.

Sr. Business Analyst:

• Closely worked with SMEs capture requirements
• Facilitated Requirement gathering sessions
• Conducting JAD sessionsRequired
• Documenting functional and non-functional requirements
• Creating application prototypes and screen mock-ups
• Creating graphical representations of complex business processes
• Experience in using Microsoft products such as; Visio, PowerPoint, Excel and Word
• Followed agile methodology with weekly scrum meetings.
• System analysis for current flow and to decide future state of project.
• Facets configuration with all global modules like benefits, enrollment, eligibility, pricing, provider and expert level configuration experience in Facets Medical Plan Applications
• Created use cases from functional and technical requirement.
• System validation and end to end testing.

Environments: Facets, CDMA, Daptive, crystal reports, SQL

Confidential,
MI August 2011 – January 2012
Business System Analyst

Responsibilities:

• Analyzed the systems to do upgrade for facets 5010 and ICD10 as per CMS regulation
• Analyzed stored procedures using Informatics and sql Queries
• Created Business requirement document, Technical design documents, function design document and mockup
• Organized many Joint Application Developments (JAD) sessions, scrum meetings and Joint Requirement Planning sessions (JRP)
• Took part in all stages of development for smooth transaction from development to deployment.
• Data from various sources and to targets like Flat files, Oracle, Teradata.
• Generated test cases from business requirement documents.
• Worked with the design and development team to implement the requirements.
• Performed execution of Test Cases manually to verify the expected results.
• Worked on SQL tools like TOAD, Rapid SQL to run SQL queries and validate the data
• Experienced in designing business process models using UML diagrams such as Use Case diagrams, Flow Charts and Activity Diagrams in Rational Rose, and MS Visio.
• Worked with various EDI transactions like 834,835,837,276,277 in accordance with HIPPA standards.
• Initial scanning for Impacted system with ICD10 changes
• Implemented SDLC, QA methodologies and concepts in MS Project
• Worked with Agile methodology and scrum master for project implementation.
• Analyzed data with Informatics for field to target mapping
• Run Sql queries to check xml files running.
• Created test cases from requirement document. Performed back end and user acceptance testing.

Environment: Informatics Power Center 8.1, Cognos 8 BI Cognos Connection, , Vitria, SQL Plus, Sql oracle DBX, Remedy, Test Director / Quality Center.

Confidential,
Ohio July 2009 – May 2011
Business Analyst
Project 1
DATA ANALYST
Created central database system, to provide easy access to information faster than before. Followed Business requirement documents to create functional and non-functional requirement and test cases. In extension of project secure login for central site provided with extreme protection with a lot more features than before. Worked on sprint interactions with close deadlines...
Project 2:
Defined more healthcare products. Responsibility included requirement gathering to test cases and test script for Health insurance online access and possibly electronic response with less human interaction. Provided support for EDI for insurance claims to set up standards with the use of HIPPA. Provided impact analysis for conversion of HIPPA 4010 to HIPPA 5010. TriZetto’s QNXT modules (case management, IT House, Dental) used for automated submission of insurance claims and provide response.

Business Analyst:

• Prepared Business requirement documents, functional requirements documents and design documents
• Converted Business requirement documents into functional requirement and use cases into test cases.
• Followed AGILE methodology for project.
• Facilitated JAD sessions to gather BRD documents.
• Took part in the preparation of Project plan, user acceptance testing.
• Got a detailed understanding of business functionality and took the responsibility of preparing the Functionality Test Plan.
• Created Wireframe/Mockup Screens to give a look and feel of the system to stakeholders
• I also took part in the meetings with Sr. Business Analyst and managers and understood various process plans, business process, and functionality in detail.
• Provided documentation to support all levels of SDLC
• Provided communication between stake holders and technical team.
• Created articraft such as Use cases, Use case diagrams, Activity Diagram, Sequence diagram using Vision.
• Helped in conversion of HIPPA 4010 to 5010. Facets configuration to provide new products and plans based on customer need.
• Set up of Outpatient and inpatient discharge and billing with ICD 10 conversions.
• Claim processing and pharmaceutical expenses determination with QNXT modules.
• Used HEDIS Quality compass to measure performance and important dimensions of health care plans and services.

Environment: AGILE Methodology, Mainframe systems (COBOL, JCL, VSAM), SQL Developer, SSIS, UML, Visio, MS office.

Confidential,
Newport Beach, CA September 2007 –May 2009

Project 1
Created a database with which seniors can excess the patient information from their homes. This system helped reduce surgery cost and provided efficiency to treat more patients.
Project 2
Updated the computer system and hand devices to provide more security and easy excess for the all employees. This project has reduced administrative work and saved resources for other creative work.

Business Analyst:

• Worked closely with Directors, Doctors, SMEs and Technical team to identify the requirement and provide best result.
• Conducted JAD sessions to understand the requirement.
• Created Wireframe/Mockup Screens to give a look and feel of the system to stakeholders
• Followed SDLC for this project and created financial, documents, Use cases and diagrams to provide detail to technical team.
• Followed HIPPA standards for providing billing information.
• Worked closely with project manager to provide all necessary
• Followed UAT, Database testing, and environment testing for deployment of the project.
• Implemented project management processes and methodologies to help
• Used Waterfall and Agile methodology throughout the different levels of project.
• Experience working HIPPA compliance conditions and strong knowledge of FDA Regulatory guidelines
• Created graphical representations of complex business processes
• Used Clarity tool for reporting and tracking
• Followed GXP Quality Standards, ANSI ASC X12 and EDI X12 for creating EDT system for claim processing and FACETS has provided support for compliance with rules, governing EDI and have boost the volume of Electronic transaction.
• Provided EDI update with FACETS under TriZetto’s supervision.
• FACETS HIPPA has provided entry and maintenance of member and privacy information and improvement in efficiency and record-keeping activities.
• Worked with FACETS’ QNXT (Connect module) to establish connection between support batch and real-time data.

Environment: Water fall and Agile methodology, MS Word, MS Excel, Visio, MS PowerPoint, Windows 2000, MS Visual, Share point, Clarity, Crystal Report.

Confidential,
NOIDA June 2005 – June 2006
Operations Executive - Insurance domain

Exlservice Inc is a US incorporated BPO providing integrated solutions to global clients operating in BFSI domain.
Provided FACETS updated products to stay competitive in Competitive decade.

Client: Conseco Inc, USA is America's leading sources for Life Insurance, Health Insurance and Annuities
Provided Healthcare, EDI transactions with FACETS for all kind of transactions made by consumers, providers, employers and brokers.
Life Insurance - New Business (June 2003 – Aug 2005 i.e. 26 Months)

Sr. Business Analyst:

• Extensively trained in “New Business Process” & significantly contributed in its transition from USA to India.
• Proven extended knowledge in RUP methodology.
• Interacted with globally located insurance agents and policyholders
• Query resolution & transaction processing using software tools (LifePro, Image Tracking System etc).
• Performing root-cause analysis for queries that cannot be resolved upfront.
• Healthcare Insurance - Policy administration (Sept 2005 – Oct 2006) i.e. 13 Months)
• The web has become a prevalent and cost-effective solution for organization which has extended application processing.
• Handling queries from international Health Care Centers, Medical facilities and individual customers.
• Products handled - Disability Insurance, Medicare Supplement, Long Term Care, Specified disease plans etc.
• Providing operational support to the Claims team & assisting customers in filing their claims.
• QNXT provided significant account receivable effectively than any other product.
• HEDIS provided expert reporting and base connection for queries
• Created BRD (Business requirement documentation), FRD (Financial requirement documentation.

Environment: RUP methodology, MS Word, MS Excel, Visio, Share point, Clarity, Crystal Report., UML diagrams.