OBJECTIVE

• Obtain a position as a Business Systems Analyst, where I can effectively utilize my management skill and organizational skills with the help of strong Information Technology background, in order to contribute to the organizations changes and processes.

SUMMARY

• Strong analytical skills, with the ability to resolve difficult situations.
• Strong Information Technology background.
• Profound ability to effectively present information in one - on-one and small group situations to customers, clients, and other employees of the organization.
• Flexible and patient under pressure; ability to meet challenges in an ever-changing fast paced multi-tasked environment.
• Good Presentation and Organizational skills.
• Excellent verbal and written communication skill.
• Extensively Worked on Facets conversion projects.
• Strong understanding of Healthcare terms and experience of Claims management process.
• Diversified experience in the following areas: Ability to Elicit, Analyze, gather and document Business Requirements, experienced in writing Use Cases. Proficiency in SDLC life cycle, understands the workflow concept, ability to gather and document the 'As-Is' and 'To-Be' processes
• Good experience working with ClaimsProcessing Enrollment, Billing, Finance, Fulfillment and Reporting.
• Experience in creating and maintaining the requirements definition documents that included 5010 business requirements and functional requirements.
• Knowledge of the following HealthCare EDI Transactions for 4010/5010 like (278) Referral Certification and Authorization, (834) Benefit and Enrollment, (835) Payment & Remittance Advice, (837 I & P) Institutional and Professional HC Claim
• Immense knowledge in Health care operations, Interfaces, Reports, Letters and system Migrations, Health Administration - Claims processing (auto adjudication), Claims pricing and testing, HIPAA, enrollment.
• Experience in developing Use Case diagrams, Sequence diagrams, State Chart diagrams, and Class diagrams.
• Experience facilitating JAD (Joint Application Design) sessions and maintenance of Test Matrix and Requirements Traceability Matrix.
• Performed planning and development of test plans, test cases and test scenario to meet product’s business requirements.
• Excessive use of documentation to avoid any form of miscommunication or misinterpretation during the entire software development process. Prepared Systems Proposal Reports, Change Request Forms and Business Plans.
• Use of UML/RUP for modeling views in Microsoft Visio
• Involved in maintaining Traceability Matrix and performing GAP analysis.
• Conducted User Acceptance Testing (UAT).
• Good knowledge of SQL queries.
• Creative and aggressive self-starter with integrative thinking skills, capable of forming and maintaining positive and productive working relationships in internal, external, independent, and team environments

TECHNICAL SKILLS

Project Methodologies: SDLC, Agile, Rational Unified Process (RUP), UML, JAD, JAR

Business Modeling Tools: MS Visio, UMLOperating Systems Windows NT/XP/2000/2007, UNIX

Database: Oracle, SQL server

Quality Assurance: Quality Center, Test Director

Business Applications: Microsoft Office Suite, MS VISIO, MS Project, Outlook, Lotus Notes

PROFESSIONAL EXPERIENCE

Confidential - Waltham, MA

Sr. Business Systems Analyst

Responsibilities:

• Assisted PM in formulation of the Project Plan and Scope, preliminary and definitive Budget.
• Developed documents to describe current and future state of the system.
• Conducted daily meetings with End Users using one on one and group interviews techniques to better understand the requirements.
• Assisted in identifying appropriate subject matter experts and stakeholders to participate in requirements elicitation sessions.
• Liaised with the organizational stakeholder community to understand their needs and requirements and help translate these into systems, processes and tools that will meet those needs.
• Involved in change management panel to measure the impact for any requirement change request.
• Coordinated with change panel members and evaluated the change request.
• Authored Business Requirement Document, Requirement Specification Documents and Use Cases to define the business rules.
• Created extensive use case, activity and sequence diagrams of the required system to enable clarity on project goals.
• Created Wireframe diagrams to define the new look and feel of the web pages
• Produced and maintained changes in Requirement Traceability Matrix throughout the project.
• Created application specific test plans and test case to support User Acceptance Testing (UAT).
• Produced supporting materials, helped conduct training, and supported the business users during the system implementation as necessary, in order to guarantee successful adoption/support of the project deliverables.
• Provided weekly status updates to project stakeholders on the progress of project development activities.

Environment: RUP, MS Suite, MS Project, Rational Requisite Pro, Rational Rose and Clear Quest.

Confidential, Virginia Beach, VA

Business Systems Analyst

Responsibilities:

• As a Systems Analyst I worked with other Business Analysts liaison between customers and corporate staff and between IT and Business Units
• Gap Analysis of client requirements, generated workflow process, flow charts and relevant artifacts.
• Review Business Requirement Documents, Functional Requirements Specification, User Interface Design Documents and Use Cases to understand the functionality and working of the custom developed application.
• Lead JAR sessions with internal/external business and IT partners
• Identifies and documents business processes, issues, value levers, metrics, and capabilities
• Conducts interviews to gather business requirements
• Develop Gap and Impact documentation for all HIPAA EDI transactions.
• Produce RTM and RTM gap analysis reports for less complex enhancements, automations and implementations
• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims.
• Performs PMO activities related to project time tracking, work plan updates, service metric reporting, and related project administration task
• Worked on Amerivantage project, familiar with Medicare, Medicaid and Crossover products terms and industry standards.
• Involved in Facets Configuration to make sure all information will be sent without any error.
• Configure Facets modules based on the design approach.
• Worked on Facets extensions mapping attributes.
• Evaluated and performed testing within Facets for Rejected QA Scenarios.
• Defined Functional Test Cases, documented, Executed test script in Facets system
• Design and review of various documents including the Software Requirement Specifications (SRS), Business requirements document (BRD), Project Requirement Document (PRD), Use Case Specifications, Functional Specifications (FSD), Systems Design Specification (SDS), Requirement Traceability Matrix (RTM), Requirements Management Plan (RMP) and testing documents.
• Conducted business analysis activities on a large Medicaid Design, Development, and Implementation (DDI) Project
• Completed all the proof of concepts to create overall proof of concept end system.
• Worked on Health Plan Services especially Medicaid and Medicare programs in contract with the state of Kansas and New Jersey
• Involved in the Medicaid benefits requirement gathering, referencing provider manuals, State contract documents.
• Conducted Validations for different FACETS modules Providers, Claims and Membership
• Analyzed and worked with HIPAA specific EDI transactions for claims, member enrollment, billing transactions. Worked specifically with 820, 837, 835, 834, 270/271
• Worked on Facets extensions mapping attributes.
• Analyzing business and system requirements to identify payer issues that affect claim
• Created EDI Export and Import processes and work with EDI Trading Partners, Payers or Vendors.
• Experience in creating and maintaining the requirement traceability matrix (RTM) & software requirement specifications (SRS). Created milestones which clearly defined the goals and able to track progress of projects using RUP methodologies.
• Extensively involved in data modeling, Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data within the Oracle database
• Worked with Claims, enrollment, eligibility verification for members and providers, benefits setup, fee schedules and backend payment cycle in claim processing system.
• Involved in developing database objects using FACETS database in both SQL Server and Sybase environments.
• Experience with various modules like membership management, premium billing, enrollment, claims processing & adjudication, benefits administration within Healthcare industry.
• Executing SQL Queries for the reports before mass and after mass reports to check for claims routing
• Performed backend testing for data validation using SQL Queries.
• Experience with various modules like membership management, premium billing, enrollment, claims processing & adjudication, benefits administration within Healthcare industry.
• Setup reoccurring HIPAA 5010 and/or JAD sessions to review both physical and logical models for business processes and data transaction processing and adjudication processes.
• Designed and developed Use Cases, Activity Diagrams and Sequence Diagrams using UML

Environment: Facets, Windows, Quality Center, MS Project, EDI Gateway, SQL, PL/SQL, SQL Server, Oracle.

Confidential, Boise, ID

Business Systems Analyst

Responsibilities:

• Organized and conducted extensive JAD sessions with users to identify, understand and document requirements.
• Implemented SDLC which included requirements specifications, design, analysis and testing.
• Worked with a cross functional and diverse team of business users and developers to enable accurate communication of requirements and ensure consensus.
• Participated in review and analysis of business requirements, adding additional cases as needed, insuring they are complete and testable.
• Familiar in Medicare CRM, Member Eligibility and Enrollment and Claimssubsystems
• Wrote Use Cases, prepared use case diagrams (using Rational Rose) and followed Rational Unified Process at every stage of the process.
• Used Agile and Rational methodology in the project development for Rational Test Suite for various phases of RUP
• Conducted business analysis activities on a large Medicaid Design, Development, and Implementation (DDI) Project
• Expertise in leading collaborative sessions with the leads to document Medicaid business processes (“as is” and “to be”) by reviewing and commenting on “as is” and “to be” business process work flows.
• Dealt with data mapping issues between various source systems and staging area and data-marts
• Produced functional specifications and led weekly meetings with developers and business units to discuss outstanding technical issues and deadlines that had to be met.
• Identified Actors, Activities, Artifacts and Workflows and developed use case diagram using Rational Rose.
• Participated in Automated regression and Non-Functional test plans.
• Performed GUI testing, Integration testing, Regression testing, Ad -hoc testing, Negative testing, End to End testing, Smoke testing Load testing, User Acceptance testing and Pilot testing
• Wrote Test Scenarios, Test cases in excel sheet and imported them to Rational Manual Tester/Test Manager
• Logged defects in Rational Clear Quest, re-tested defects, analyzed defect with Users and Developers

Environment: Windows, MS Office, MS Visio, MMIS, Quality Center, SAS, Cobol, HIPPA Gateway, PL/SQL, MS Project, SQL, SQL Server

Confidential, Nashville, TN

Business Analyst

Responsibilities:

• Prepared the Business requirement Document (BRD) and system requirement document (SRD) for the enhancement of the existing services.
• Created workflow diagrams, UML diagrams, process models, activity diagrams, use cases, for incorporating design changes in the system.
• Developed an automated approach for capturing all 837 data received that supports claim utilization and reporting.
• Developed business requirement for online web form for capturing application information
• Requirements Gathering & Analysis always ensured HIPAA Compliance Auditing.
• Analysis and Design of existing transaction sets, and modification of these transaction sets to ensure HIPAA compliance.
• Created, executed and translated manual test cases and scenarios into automated test scripts in order to validate functional requirements using HP Quality stage.
• Extensively worked Claims, Enrollment, Eligibility verification for Members and Providers, benefits setup, and backend payment cycle.
• Conduct Proof Of Concepts as and when required
• Conducted Risk Analysis to identify the risks associated with developing the patches, and formulated a Mitigation Plan to eliminate or reduce risks of high severity and any major effects.
• Conducted JAD sessions with business SMEs and developer.
• Collaborated with Quality Assurance Analyst in testing.
• Developed test cases and performed UAT testing for all the files and reports

Environment: SQL Server 2000, Windows XP, XML, Excel, Access, Visio.