SUMMARY

• Extensive experience in Analysis, implementation of Healthcare/Pharmaceutical Applications.
• Proficient in creating and documenting use case scenarios storyboards. Extensive knowledge to creating story cards for Sprint planning to release phase in the Agile Methodology.
• Extensively involved in the Member Enrollment and Billing information Migration from Legacy (WGS) system to Medisys / Facets.
• Have experience on HIPPA and NPI as a business analyst.
• Extensive experience in gathering, analyzing, and validating business requirements.
• Requirement gathering through interviews, Joint Application Development (JAD) sessions with clients and referring to existing documentation and procedures.
• Knowledge and Experience on Membership, Billing, Claims Payment Processing in relation to HIPAA, EDI 4010, ICD - 9 & ICD-10, codes 834, 837,835, 270, 271 and 820.
• Extensively involved in preparing Functional Design Document (FDD), Report Design Document (RDD), and Letter Design Document (LDD).
• Wrote complex SQL queries and PL/SQL stored procedures to identify granularity issues and relationships between data sets
• Experience working with ETL (Extract, Transform and Load) of data into a data warehouse/date mart and Business Intelligence (BI) tools.
• Extensively involved in the analysis on conversion of Claims and Members files from Legacy systems into Facets and to its downward PBM and other systems.
• Managed requirement activities using an iterative and incremental methodology such as Agile and Rational unified process (RUP)
• Well verse in creating functional Test cases, Test plans, Test Scenario.
• Involved in the Facets implementation and conversion of 4.41 /4.51 / 4.71 / 4.81.
• Extensive Knowledge and Experience on Membership, Billing, Claims Payment Processing in relation to HIPAA, EDI 4010, X12 codes 834, 837,835, 270, 271 and 820.
• Skills in developing Use Case diagrams, Sequence diagrams, Data Flow diagrams, and Class diagrams using Object Oriented Analysis & Design (OOAD).
• Performed planning and development of Test Plans, Test Cases and Test Scenario to meet product’s business requirements and Conducted User Acceptance Testing (UAT).
• Experienced in analyzing business requirement at all stages of Software development life cycle (SDLC).

TECHNICAL SKILLS

Software Applications: Facets, Data warehouse, ETL, BI

Requirement Tracking: Rational Requisite-Pro, Mercury’s Test Director and MQC

Operating Systems: MS Windows NT/98/2000/XP, UNIX

Databases: Oracle, Sybase, SQL server, DB2, MS Access

Office Tools: MS Word, Excel, MS Project, MS Outlook

Methodologies: SDLC, RUP, UML, RAD, JAD

UML Diagram Tools: Rational Rose / Microsoft Visio.

Requirement Tools: Rational Requisite pro, clear case. Clear Quest.

PROFESSIONAL EXPERIENCE

Confidential, Solon, Ohio

Sr.Business System Analyst

Responsibilities:

• Involved in Analysis, implementation of Healthcare Application using FACETS 4.81.
• Involved in the analysis on conversion of Members files from legacy systems MBEST into Facets and to its downstream systems.
• Extensively involved in Facets enrollment module mainly in Back - End system process for membership’s enrollment info to downstream system and also involved in Front - End system process for the information feed to Facets from Source system.
• Analyzed business requirement at all stages of Software development life cycle (SDLC).
• Updated design documents related to Membership Eligibility Information file / interface, feed to PBM system for PDP migration in Medicare PartD project.
• Extensively involved in Designing and updating Mapping documents based on BTRD and through Change Requests / SSCRs as required to downstream systems.
• Involved in development of Financial Business Use Cases from Business Requirements.
• Highly involved in writing SQL queries for the call center to pull the members from the database depending upon the requirements.
• Created Data Element Mapping document to help ETL development.
• Developed Business Process Flow Diagrams using MS Visio.
• Managed requirement activities using an iterative and incremental methodology such as Agile and Rational Unified Process (RUP).
• Very good knowledge of SQL. Used SQL queries to retrieve required data from Database.
• Documented Business Requirements for As Is & To Be Business Processes.
• Performed GAP analysis for any available requirements and communicated through the CR process.
• Reviewed Test Cases and provided feedback to testers for assigned CRs completion.
• Attended JAD sessions and Test meetings to discuss and resolve issues and change requests.
• Provided technical and procedural support for User Acceptance Testing (UAT).
• Involved in Configuration Management, Requirement management and analysis.
• Worked on Billing, Subscriber/Member, and Accounting application.
• Involved in building complex SQL query to extract data from Oracle and SQL databases

Environment: SQL, Facets 4.81, ETL, PL/SQL, Toad for Oracle, SQL server management studio, Oracle SQL developer, MS Outlook, MS Excel, MS Access, MS Visio.

Confidential, Buffalo, NY

Business Analyst

Responsibilities:

• Reviewing the Use Case Requirement, Functional Design Documents and Technical Specification documents.
• Involved in gathering requirements and documentation of business requirements
• Involved in development of Financial Business Use Cases from Business Requirements
• Documented Business Requirements for As Is & To Be Business Processes
• Developed Business Process Flow Diagrams using MS Visio.
• Worked with SQL queries for data validations and supporting UAT.
• Designed and Documented Business Process Model for Solution Design Methodology.
• Assisted the EDI team in the development and documentation of the test strategies for the EDI transactions which included all standard transactions, auditing and error correction processes, and the creation of the transactions.
• Preparation of technical specifications for the development of ETL mappings to load data into various tables in Data Marts and defining ETL standards.
• Coordinated with the EDI team in developing and documenting the detailed testing work plans and created the various testing documents for the assigned EDI transactions.
• Attended JAD sessions and Test meetings to discuss and resolve issues and change requests.
• Analyzed requirements to create scenarios and test cases for different conditions of NPI present in 837 I and P, 270/271, 276/277 transactions.
• Created lists of providers for test database and loaded it into mass load environment in database.
• Wrote basic SQL queries for validating the data and the business rules.
• Implemented RUP process to develop the application modules using Microsoft .NET
• Modeled the detailed design of the system using Use Case Diagrams
• Worked on Billing, Subscriber/Member, and Accounting application, and EDI HIPAA Claims(837/835/834) processing
• Involved in life-cycle documentation from product requirements in the developmental stage to functional specifications for the completed modules of application components
• Participated in entering, tracking system defects in Rational Clear quest
• Involved in Configuration Management, Requirement management and analysis
• Provide technical and procedural support for User Acceptance Testing (UAT).

Environment: Configuration and Testing Management (In house Tool), Facets 4.71, Sybase, Interactive SQL, PL/SQL, MS Word, MS Project, MS Excel, Clear case, Cognos, MS Visio, Share point Portal.

Confidential, MD

Business Analyst

Responsibilities:

• Facilitated JAD sessions to collect requirements from system users and prepared business requirement that provided appropriate scope of work for technical team to develop prototype and overall system.
• Identified processes for developing and documenting detailed business requirements. Data was collected from end-users, and analysts.
• Created Use-Cases and Requirements documents to document business needs and involved in Writing use case based on HIPAA standards.
• Gathered Requirement from the Client to fulfill the Application need for FACET Implementation.
• Created and maintained the Requirements Traceability Matrix (RTM).
• Ensured Use-Cases were consistent and covered all aspects of the Requirements document.
• Refined the requirements (use-cases) and Business Process Models to detailed level appropriate for technical analysis and system design.
• Extensive Analysis of HIPPA rules to in corporate in the Development of Utility applications which are not HIPAA compliant.
• Was responsible for tracking issues that are detected and updating the status of existing issues based on the daily meetings with the off-shore team.
• Identified and analyzed the data requirements for the various site teams and made sure that the required data is available in the testing environment.
• Worked Facets Data Models and their relationship between all functional areas.
• Designed and developed new Interfaces based on business requirements and systems needs.
• Developed requirements integrating E-R diagrams and designed the testing process flows.
• Followed agile methodology for the entire SDLC.
• Was involved in Functional System Testing, Integration Testing, Regression Testing, and User Acceptance Test using the test cases given by the client before releasing the application.
• Interacted with other teams through walkthroughs, teleconferences, meetings, etc. to resolve various issues.
• Involved in project status meetings, QA review meeting, and System Test meeting.

Environment: FACETS 4.21, FACETS 2.96,RUP, UML, Lotus Notes, sMs office suite, DB2,Rational ClearQuest, Rational Clear Case, Rational Requisite Pro, SQL, PL/SQL, File Parser, HTML, XML, Windows xp/2000,MS Project

Confidential, Woodland Hill, CA

Business Analyst

Responsibilities:

• Performed Requirements Gathering and Analysis, interviewed the SME (Subject Matter Experts), and ensured that contributors and all key stakeholders were motivated to complete assigned tasks.
• Facilitated Joint Application Development (JAD) Sessions for communicating and managing expectations.
• Manage the Requirements (Business as well as System requirements), performed requirements analysis along with the creation of Use Case Scenarios.
• Modeling of the business and application using Rational Unified Processing (RUP) and Unified Modeling Language (UML).
• Responsible for Documentation in each phase of RUP Methodology, Risk Assessment, and Validation & Verification process.
• Created Process Work Flows, Functional Specifications, and responsible for preparing Software Requirement Specifications (SRS), Functional Specification Document (FSD).
• Performed Gap Analysis to identify the deficiencies of the current system and to identify the requirements for the proposed system.
• Worked with the development team to make sure that they understood the user requirements and that the system developed met those requirements.
• Participated in developing test plans and test procedure templates and guidelines to be used by the project team with detailed screen layouts with regards to various types of corporate actions.
• Defined and promulgated test cases based on the requirements outlined in the test plan as part of the development cycle.
• Was involved in Functional System Testing, Integration Testing, Regression Testing, and User Acceptance Test using the test cases given by the client before releasing the application.
• Involved in the development of Test Plans, Test Cases and Expected Results, and coordinated the tests with the QA team to verify implementation of new features and enhancements.
• Worked with the Project Manager on various Project Management activities like keeping track of Project Status, Deadlines, Environment Request, and Compliance Issues.

Environment: Windows XP, SQL, MS-Visio, Rational Rose, HTML, JSP, Oracle, Requisite Pro

Confidential, Cleveland, OH

Business Analyst

Responsibilities:

• Participated in all the phases in the project management life cycle
• Acted as a liaison between the business users and technical teams to enhance the applications based on the business requirements
• Provided a single point of contact for user communication, managed issue tracking, prioritization and resolution
• Helped in the development of the scope document that defines the primary goals and objectives
• Worked closely with the business users to gather the high level user requirements and functional requirements
• Developed functional requirements and specifications
• Organized meetings and worked together with the PM to during the various stages of project planning
• Developed use cases to explain / demonstrate business requirements / specifications to the IT team
• Implemented CMS (Content Management System) in automating various aspects of Web and Publication Content Creation, Document Management and Delivery
• Refined the requirements (use-cases) and Business Process Models to detailed level requirement appropriate for technical analysis and system design
• Participated in various sessions to define the solution approaches, and identifying assumptions, constraints, risk and issues
• Revealed unidentified requirements, evaluated changes in requirements, and assessed impact of changes
• Recommended process or system changes intended to eliminate identified risks or gaps
• Worked with Finance and IT department to operate across functions and worked with resources external to the Project Team
• Provided regular verbal and written status reports to IT management team
• Published meeting minutes and maintained project plans
• Coordinated with the project team and testing team to revise project artifacts (such as use-case specifications, test scripts, and so on) to reflect requirement changes
• Worked independently with minimum supervision as part of a dynamic IT team

Environment: Windows XP, Quality Center, HTML, Java, MS Visio, SQL, Requisite Pro.