SUMMARY

• Over 8 years of progressive industry experience in the field of business system analysis, business process design, application system analysis, object oriented analysis, system analysis in Insurance and corporate business environment with solid understanding of SDLC, performing analysis, design, implementation and deployment using Scrum Agile, Waterfall methodologies and excellent experience in working with clients to understand and implement requirements and providing team leadership to development support team.
• Efficient in documenting existing processes, preparing Business Requirement Documents (BRD), analyzing Business Requirements, working with Requirements Traceability Matrices (RTM), re - engineering business processes.
• Expertise in Software Development Life Cycle (SDLC) including Waterfall, Agile, RAD, Scrum methodology.
• Experienced in GAP Analysis, Cost Benefit Analysis, organizing, facilitating and coordinating JAD sessions, weekly meetings, conference calls and other regular project meetings.
• Experienced in creating Data Flow Diagrams (DFD), Use Cases, Class Diagram, Activity Diagrams, Sequence Diagram, and UML Modeling.
• Ability to interact with developer and manager for system enhancements, transforming business requirements to use case models using MS Visio, Rational Rose.
• Strong knowledge of Business Intelligence, Data Warehousing and Business Architecture.
• Ability to work closely with stakeholders and SMEs to assist the fulfillment of the project goals and objectives.
• Involved in the development of Test Plans, Test Cases and maintaining the Traceability and Test Matrix.
• Excellent knowledge of HIPAA standards, EDI (Electronic data interchange), Implementation of HIPAA code sets, ICD-9, ICD-10 coding and HL7 and Trizetto NetworkX pricer
• Extensive experience within the field of project management, business analysis, Business process design, application systems analysis, object oriented analysis, system analysis & design.
• Medical Claims experience in Process Documentation, Analysis and Implementation in 835, 837IPD, 834, 270/271, 276/277, 999/TA1 (X12 Standards) processes of Medical Claims Industry from the Provider/Payer side
• Strong experience and understanding of healthcare industry, knowledge of Medicaid and Medicare Services.
• Strong knowledge of Facets.
• Expert knowledge of Medicare Part A, Part B, Part C and Part D.
• Able to manage multiple initiatives, projects and deadlines.
• Proficient self-management and organizational skills.
• Ability to apply a mature and diplomatic approach to prioritization of tasks and conflict resolution.
• Adaptive capability for working in different environment and as required.
• Exceptional track record for meeting deadlines and submitting deliverables on time.
• Excellent verbal and written communication skills and a dedicated team player.

TECHNICAL SKILLS

Operating Systems: Linux, HP UNIX, Sun Solaris, and Windows 2000/XP/Vista

MS Office Tools: MS Word, MS Excel, MS Access, MS PowerPoint 2003/07, MS SharePoint

Languages: C, C++, SQL, PL/SQL, JAVA, .Net.

Packages: MS Office, MS Visio, MS Project

Tools: Clear case, Clear Quest, Rational Rose, Requisite Pro, HP Quality CenterDatabases SQL, Oracle, MS Access, SQL Server 2000, DB2& terra data.

Methodologies: Agile, Scrum, Joint Application Development (JAD)Rational Unified Process (RUP), Unified Modeling Language (UML), System DevelopmentLife Cycle (SDLC), Waterfall Model, Crystal Reports, Visual Source Safe.

Business Documentation Skills: Business Requirement document, Use Case Specifications,Functional and Non-functional Specification, System Requirement Specification, UMLDiagrams (Use case, Class and Sequence), Traceability Matrix, Project Estimate, Change-Version Control, and User Manuals, Master Test Plan Review (Integration, System andAcceptance)

PROFESSIONAL EXPERIENCE

Confidential, NYC

Sr Business Analyst

Responsibilities:

• Experienced in Healthcare Industry with knowledge of Health Insurance Portability and Accountability Act (HIPAA) with updated knowledge of recent code sets ICD -10.
• Involved in gathering, analyzing and documenting business requirement in the Business requirement document related to upgrading ICD-9 diagnosis codes to ICD-10 codes.
• Created PCR documents related to upgrading ICD-9 diagnosis codes to ICD-10 codes.
• Performed GAP analysis to assess the flaws in the existing system and made clear recommendations for business process improvements and incorporated them in the future to-be system design.
• Performed validation to verify that provider contracts are correctly mapped to the Rate sheet in the Trizzeto Network X Pricer for accurate claim pricing.
• Mocked up EDI transactions like 834,820 and 837 according to requirements and test cases.
• Worked on various EDI 834 transactions like add, cancel, term, change and reinstate.
• With the given company standard templates, created test plans and test strategies.
• Plan test schedules and strategies in accordance with the project scope and delivery dates.
• Prepared functional test cases based on business requirements and system functionality and incorporated applicable test conditions (Positive and Negative scenarios).
• Tracked and logged the defects using Application Life Cycle Management (ALM).
• Involved in UAT sessions to test and validate the system along with the stakeholders and user groups.
• Performed UAT testing.
• Created test cases to validate functionality for end users (UAT),
• Executed test cases comparing expected results to actual result, analyzed discrepancies and recorded the defects in ALM for UAT.
• Prepared and maintained requirements traceability matrix (RTM).
• Retrieved data from different data sources and imported it into MS Excel for data validation.
• Used mainframe front end application like Q-CARE to update and validate different files in the system.
• Reported status of test cases executed to the team lead.
• Participated in meetings to provide feedbacks to help improve business requirement document, functional requirement document and review of the test cases.

Environment: SDLC, MS Excel, Java, J2ee, MS Power point, MS Word, MS Project, Rational Requisite Pro, Rational Clear Quest, Load Runner8.2.

Confidential, CT

Sr. Business System Analyst

Responsibilities:

• Analyzed the functional specs provided by the data architect and created technical specs documents for all the data mappings.
• Created data flow diagrams, data mapping from Source to stage and Stage to target mapping documents indicating the source tables, columns, data types.
• Utilized Agile and Waterfall Methodology to configure and develop process, standards and procedures.
• Worked with the Business users and tech lead in gathering their requirements and data transaction information.
• Developed a Conceptual data model based on requirements analysis
• Prepared the Business requirement Document (BRD) and functional requirement document (FRD) for the enhancement of the existing services.
• Authored Companion Guide to support all the information needed to process HIPPA transactions with Aetna.
• Conducted GAP Analysis between the proprietary source file format and Facets file format.
• Worked on various Facets systems such as Benefits, Claims, and Billing
• Worked with external vendors and interfaced with Facets claims and billing system.
• Experienced in working with EDI file formats like X12, EDIFACT, SWIFT messages for data conversion and compliance to industry standards.
• Made questionnaires and resource leveling required for implementing HIPAA 5010.
• Involved in all steps of Software Development Life Cycle (SDLC).
• Presented Requirements Gathering and Analysis by actively soliciting, analyzing and negotiating customer requirements while leading the technical requirements analysis, driving the system design and construction.
• Performed user interviews, JAD sessions.
• Strong knowledge of Business Intelligence, Data Warehousing and Business Architecture
• Used Rational Requisite Pro for overall Requirements Management and to build the Requirements Traceability Matrix.
• Developed a Conceptual data model based on requirements analysis.
• Designed Data Stage ETL jobs for extracting data from heterogeneous source systems, transform and finally load into the Data Marts.
• Developed UML Use Cases for the application using Enterprise Architect and prepared the detailed Work flow diagram based on the proposed enhancement for the system.
• Wrote test cases to validate functionality for end users. Performed User Acceptance Testing (UAT).
• Used Rational Clear Quest for all types of change requests, including defects, enhancements, issues and documentation changes with a flexible workflow process.
• Collaborated with the QA team to develop the test plan, test conditions and test cases to be used in manual testing based on business requirements, technical specifications and/or product knowledge.

Environment: - SDLC, .Net, MS Excel, Java, J2ee, MS Power point, MS Word, MS Project, Rational Requisite Pro, Rational Clear Quest, Load Runner8.2.

Confidential, NJ

Sr. Business System Analyst

Responsibilities:

• Involved in gathering, analyzing and documenting business requirement and data specifications.
• Created and reviewed business requirements, functional specifications, project schedules and documentations.
• Diagrams using MS Visio and developed test plans, test cases to analyze match results.
• Reproduce, verify and validate issues documented in a defect tracking system and writing tractability matrices based on use cases and business requirements (BRDs) performed the requirement analysis and documented the requirements using Rational Requisite Pro.
• Created FRD for developing the ETL logics and the data maps for loading the tables.
• Involved in designing and developing Data Models and Data Marts that support the Business Intelligence Data Warehouse
• Involved in constructing an integrated IVR CRM application to provide system access to real time customer data and information.
• Organized impacted systems into high, medium and low impact to help business analyze the level of effort for remediation activities and ease resource allocation work.
• Created use case models, analysis models, implementation models, authored use cases, use case diagram, behavior diagrams(sequence diagrams, activity diagrams) based on UML methodology using Rational Software Modeler and MS Visio.
• Performed Gap Analysis to identify the gap between the optimized allocation and integration of the inputs, and the current level of allocations.
• Involved in UAT sessions to test and validate the system with stakeholders.
• Analyzed the test results from QA teams using Performance Studio Analysis to create various scenarios.
• Prepare schedule work flow, following agile methodology of software development.
• Prepared and maintained requirements traceability matrix (RTM) throughout the project lifecycle.
• Worked with the compliance and audit team to make sure we were following correct HIPAA guidelines/protocols throughout the project lifecycle.
• Included in selection committee for the selection of a code mapping tool.
• Involved in SWOT analysis of project plan.

Environment: SQL, JAD, Java, Oracle, UML, Windows XP, Business Objects, Informatics, MS Project 2000, MS Word, MS Excel, MS Visio, SharePoint.

Confidential

Business System Analyst

Responsibilities:

• Gathered the requirements from stakeholders and users by meeting them personally and by interviewing them.
• Utilized Requisite Pro to prepare a BRD by complying with the HIPAA regulations.
• Maintained documentation related to difficulties, complexities and anomalies that may arise during the ETL process.
• Gave functional specs to the requirements gathered and communicate it to the developers.
• Developed a use case and UML diagrams using ERD; depicted clear relations associated between the entities.
• Prepared Work Breakdown Structures (WBS) to comply with the triple constraint: time, cost and scope.
• Conducted Lean Analysis throughout the project and conveyed my team a message, “Think big, act small, fail fast; learn rapidly”.
• Prepared a roadmap for a product that can exceed market and user expectations.
• Used SDLC (System Development Life Cycle) methodologies like the RUP and the waterfall.
• Create and implement a test plan and thereby assist Quality Analysts to test the product in a timely manner.
• Interfaced with Quality Analysts for unit, integration, system and User Acceptance Testing.
• Facilitated JAD sessions with management, development team, users and other stakeholders to refine functional requirements
• Interfaced with top management to ensure that IT initiatives and involvement are clearly communicated and understood.
• Mitigate risks all the time; motivate all the team members to meet the deadlines since time was very limited.
• Worked on all Medicaid Users transactions involving electronic data interchange.
• Reviewed and analyzed the business environment and identical process improvements.
• Evaluated alternative solutions and recommend solution that best meets the need of the business.
• Defined and planned software releases in accordance with other software applications.
• Used design and prototyping tools such as Axure, Photoshop and Visio.

Environment: SDLC, SQL, Microsoft Excel, Microsoft Word, MS Visio, MS Project 2000/2003, JAVA, Rational Clear Quest, ETL, Rational Requisite Pro, Axure, Oracle, UML, Lotus Notes.