Summary:

• Qualified professional with 7 years of extensive experience in the field of Business Systems Analyst.
• Working with the implement management and staff's business requirements into the software application in Healthcare Industry.
• Highly motivated team player with excellent communication, presentation and interpersonal skills, always willing to work in challenging and cross-platform environment.
• Highly proficient in working with users to gather requirements, analyze them and subsequently use the Rational project and design tools to model the requirements.
• In-depth knowledge of creating use cases, Claims Processing and functional design specifications, activity diagrams, logical, component and deployment views to extract business process flow.
• Knowledge of health information and health care services regulatory environment including HIPAA, Medicaid/Medicare and EDI
• Expertise in understanding of Business Requirements Gathering, Business Process Flow, Business Process Modeling and Business Analysis.
• Experienced in preparing Business Process Re-engineering Models
• Gathered and documented Non-functional requirements.
• Expertise in Claims, Subscriber/Member, Plan/Product, Claims, Provider, Commissions and Billing Modules of Facets.
• Worked with Rational Suite of tools to create requirements documents Requisite Pro , visual data models Rose , manage and track defects Clear Quest
• Extensively used rational tools for UML, tracking and reporting and applied the Rational Unified Process in all areas of a software development life cycle.
• Used Query Analyzer, Execution Plan to optimize SQL Queries.
• Expertise in the use of tools such as Caliber RM, Rational Rose, Requisite Pro, Starteam, Test Director
• Build EDI test environment and provide parallel testing and start-up process
• Responsible for integrating with Facets .Designing test scripts for testing of Claims in Development, Integration and production environment.
• Written multiple Use Cases for EDI transactions Inbound and Response including 837, 276, 277, 835, 834, 820, 270, 271 transactions.
• Strong project management skills including planning, scheduling, monitoring and budgeting with experience in requirement gathering, gap analysis, risk analysis, effort estimation etc.
• Familiar with HIPAA EDI transactions such as 834,835, 837 P, D, I 276, 277, 278 etc
• In depth knowledge of SDLC and implementation of the Rational Unified Process RUP in all four phases of a project: Inception, Elaboration, Construction and Transition.
• Test Data Generation for Quality Assurance using various testing tools like EDISIM or EDIFECS, conducting JAD Joint Application Design sessions.
• Good hands on experience testing of inquiry screens to support EDI transactions.
• Utilized a fusion of industry knowledge and technical programming to provide executive management the development and implementation of interactive business tools, and strategic analysis, vital for use in mission-critical decision-making
• Extensive Knowledge about all the phases of Business Analysis Life cycle like Requirements Elicitation, Requirements Analysis, Requirements Documentation and Requirements Management.
• Conducting requirement gathering sessions, feasibility studies and Impact Analysis and organizing the software requirements in a structured way using Rational Requisite Pro to track development.
• Interacting regularly with the development team, creative services, database designer, system administrator and the higher management to meet the deadlines of Project milestones.
• Worked in close co-ordination with the testing team in developing test plan and test cases from functional and business requirements.
• Performed UAT and exposure to User Certification Testing UCT and Operational Readiness Testing ORT
• Expertise in understanding and supporting the client with Project Planning, Project Definition, Requirements Definition, Analysis, Design, Testing, System documentation and user training.
• Used Rational ClearQuest for tracking and prioritizing defects and for enhancements after base lining the requirements.

TECHNICAL SKILLS:

• Business Tools: Rational Suite Requisite Pro, Rose, Clear Quest, Clear Case , MS Visio, MS Project, MS Access, MS Office Suite, Visual Paradigm, Doors, Erwin Data Modeler 4x, Business Object Crystal Reports
• Business Skills: Business Definition Requirements, Business Process Analysis, Gap Analysis, Use Case Modeling Analysis, Business Environment and Market Research Analysis
• Methodologies: RUP, OOAD, UML Business/Data Modeling
• Project Management Tools: MS Project, Microsoft Office, Lotus Notes
• Testing Tools: Win Runner, Load Runner, Test Director, Quick Test Pro, PR Tracker
• Operating Systems: Windows XP/95/98/NT/2000, Mac OS X, DOS, UNIX, Linux
• Databases: Oracle 8i/9i SQL Server 7.0 2000 Access 2000, MS SQL Server, DB2
• Languages: UML, C, C , HTML, Java, SQL, PL/SQL, ASP.NET
• Automation Tools: Requisite Pro, Win runner, QTP, Test Director, Quality Center

PROFESSIONAL EXPERIENCE

Confidential

Senior Business Systems Analyst

The project modifies the Confidential to allow the processing and payment of claims processed by Value Options, implement the pricing methods for Inpatient, Home Health and outpatients services. MMIS Medicaid Management Information System also includes Medicaid Management Care support, the project also deals with Child Support Enforcement. CHARTS .This application is updated daily by different Govt. and Federal offices.

Responsibilities:

• Performed Requirement Gathering Analysis by actively soliciting, analyzing and negotiating customer requirements and prepared the requirements specification document for the application using MS Word.
• Assumed ownership of Use Case Diagrams, Use Case narratives and other various artifacts.
• Identified opportunities for business process improvement through various meetings with business users and developers and initiated efforts to make improvements.
• Interacted with users for verifying User Requirements, managing Change Control Process, updating existing Documentation
• Developed the project plan with assistance from the management, and included provisions for project scope changes and issues and initiated efforts to make improvements.
• Working within a growing knowledge of X12 5010 HIPAA 837 I, P, D, 835, 834, 820, 270, 271, 276, 277, 278, EDI, Privacy, Security, and Medicaid.
• Extensively worked on the SOA to implement a Medicaid Management Information System MMIS
• Expertise in Claims, Subscriber/Member, Plan/Product, Claims, Provider, Commissions and Billing Modules of Facets.
• Responsible for architecting integrated HIPAA, Medicare solutions, Facets.
• Identify Member, Provider, Coverage, Medicare, and Medicaid.
• Conducted project kick off meetings with team members to explain roles / responsibilities, relationships with other groups, deliverables, timelines, assignments and status reporting.
• Utilized Mercator as an EDI mapping tool to map the claims data that passes through the EDI gateway to the Facets claims processing application.
• Designed and developed Use Cases, Use Case Diagram, Activity Diagrams, Sequence Diagrams, Data Flow Diagrams using Object Oriented Design OOD concepts and UML using Rational Requisite Pro.
• Performed Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data.
• Supervise and manage projects throughout SDLC to ensure that project management methodology based on RUP is followed during the project lifecycle using MS Project and NIKU Workbench.
• Conducted meeting with the EDI team and other stakeholders team members to discuss the requirements
• Involved in meetings with product manager, project manager, onsite and offshore team members to resolve issues and roadblocks during the project.
• Worked Consistently recognized and tasked to improve organizational effectiveness and efficiency through expertise that aligns the business processes and EDI applications design to realize cost savings, accelerate performance, and sustain strategic flexibility to create a competitive advantage for the organization.
• Prepared Demo on MS SharePoint 2007 for various Business to get new approvals like the Therapist and Nursing divisions.
• Identifying and modeling Use case diagrams, Sequence diagrams, Activity diagrams, Collaboration diagrams using UML.
• Involved in requirement gathering and database design and implementation of star-schema, dimensional data warehouse using Erwin.
• Created requirements analysis and design phase artifacts using, Rational Software Modeler and MS Visio to create DFDs, ER diagrams, Use Case, Activity/State chart, Sequence, Collaboration and Deployment Diagrams.
• Coordinated with EDI team, developers and production support team at various stages of the project
• Wrote PL/SQL statement and stored procedures in Oracle for extracting as well as writing data.
• Requirements Elicitation, Analysis, Communication, and Validation according to Six Sigma Standards.
• Created RUP activity diagrams and sequence diagrams to analyze the requirements and recommend solutions.
• Develop Logical and Physical data models that capture current state/future state data elements and data flows using Erwin.
• Conducted user interviews, gathered requirements, analyzed the requirements by using Rational Rose, Visio and Requisite pro - RUP
• Prepared scenarios, Use Cases UML State Diagram for scenarios using Rational Rose.
• Prepare presentation slides in MS Project, which was extensively used in different JAD sessions and to track progress.
• Assisted the technical team in translating application functionality into application architecture.
• Participated in the bug review meetings, updated requirement document as per business user feedback and changes in the functionality of the application.
• Clarified QA team issues and reviewed test plans and test scripts developed by QA team to make sure that all requirements will be covered in scripts and tested properly.
• Organized meetings to discuss outstanding issues with QA and developers.

Environment: Rational Suite Rose, Requisite Pro , Dreamweaver, Rational Unified Process RUP , Windows NT/XP/2000, UML, UNIX, MS-Project, MS-Office Suite, Casewise Corporate Modeller, WinRunner, Test Director

Confidential

Senior Business Systems Analyst

The project was to redesign the financial portion of the claims payment System for the state of VA Medicaid program. Facilitate meetings with state of VA Medicaid representatives to determine requirements for changes to the financial portion of the claim system that pays over 100 million dollars a week in Medicaid claims.

Responsibilities:

• Studied the CMS regulation for reporting requirements Attended HIPAA training
• Work closely with Business Owners and Stakeholders to outline Business Requirements using rational requisite pro.
• Work with System analyst and IS teams to understand the flow of data.
• Reviewed and analyzed data from various sources.
• Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data within the Oracle database
• HIPAA EDI transactions such as 834,835, 837 P, D, I 276, 277, 278.
• Implemented Facets NASCO claims management system to allow for more efficient claims processing, membership enrollment and provider data maintenance.
• Created context and workflow models, information and business requirement models, Use Case and Object Models during the analysis using Rational tools.
• Managed timely completion of multiple projects in parallel- worked in close conjunction with the Project Management Office PMO to define scope of the project and its deliverables
• Created Mapping Documents, Report Mockups and modified existing report mockups as to CMS requirements and finalized for development
• In-depth knowledge and solid experience in the design, development, implementation, management, and testing of EDI applications.
• Specifically responsible for providing business analysis support through an understanding of MMIS and SDLC processes, guiding client through requirements validation sessions, documenting as-is and to-be processes, providing understanding of the proposed systems functionality, testing and documenting new systems features, and participating in training client personnel.
• Planned and documented procedures for data processing and prepared data flow diagrams for the application
• Created requirements analysis and design phase artifacts using, Rational Software Modeler and MS Visio to create DFDs, ER diagrams, Use Case, Activity/State chart, Sequence, Collaboration and Deployment Diagrams.
• Defined Functional Test Cases, documented, executed test script in Facets system.
• Authored progress and completion reports which were then submitted to project management on a weekly basis in MS project.
• Deploy three Electronic Data Interchange EDI interfaces linking nation-wide network of 250 drug wholesalers for electronic price contract awards, processing of change-back claims and tracking of wholesaler inventory using Sterling Software via GENTRAN server.
• Analyzed trading partner specifications and created EDI mapping guidelines
• Review requirements and understand technical recommendations and constraints, and develop comprehensive and accurate functional specifications Data Mapping, and process flows.
• Used MS-Visio for flow-charting, Use- Case process model and architectural design of the application.
• Involved in creating automated Test Scripts representing various Transactions, Documenting the Load Testing Process and Methodology. Created meaningful reports for analysis and integrated the Performance Testing in the SDLC.
• Reviewed the data model and reporting requirements for Cognos Reports with the Data warehouse/ETL and Reporting team.
• Analyzed the test results with Win runner reports
• Analyzed results and EDI ANSI X12 file mapping and reported on standard analysis spreadsheet. Reviewed EDI companion guides for all payers to ensure compliance, edit integrity and maintain up-to-date list of payer contacts. Acted as a liaison between client and payer/intermediary.
• Highly experienced Senior EDI Programmer Analyst with a record of developing and supporting successful IT applications and solutions, with an emphasis on technical, as well as non-technical, Customer Service. Skilled at utilizing EDI translation software, including mapping, debugging, trading partner relationships, and user files. Extensively uploaded test cases from MS Excel, MS Word to Test Director Quality Center.

Environment: Requisite Pro, Rational Rose, Agile, HL7Interfaces, PL/SQL, HTML, MS Office, MS Visio, EDI, Rational Clear Quest, Rational Clear Case, UML, RUP, Microsoft Excel, Microsoft Word, Microsoft Power Point.

Confidential

Business Systems Analyst

Confidential Medicare Buy-In and Financial subsystems. Responsibilities include attending Requirements Validation sessions with the customer to identify and clarify system and business implementation requirements. Schedule and attend career-tracking meetings with Team Manager periodically development plans performance, and issues will be addressed/reviewed. Define and meet personal development objectives. Develop technical expertise in project toolset.

Responsibilities

• Worked with the account managers, managements, and report requestors to gather requirements, get report requests.
• Assisted the project manager in preparing the project schedules, milestone tracking, resource allocation using Microsoft project.
• Wrote Business Requirements, analyzed them and tested them.
• Analyze requirements utilizing various methods. E.g. sample data from SQL queries, Screen Shots, reports, prototype screens, sourcing information, and other data models.
• Interaction with underwriters to understand multiple data points. Prepared data flow diagrams using MS Visio for better clarity and to ensure documented process.
• Used Rational Rose to model the process using UML to create behavioral and structural diagrams.
• Designed Functional Specification Documents for the reports.
• Conducted meetings with insurance brokers
• Had planned deadlines assigning the responsibilities, monitored and summarized project progress on weekly basis.
• Worked with project management to analyze change requests to determine what is being requested and programming required.
• Responsible for architecting integrated HIPAA, Medicare solutions, Facets.
• Worked on EDI transaction 834,835, 837 to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
• Analyzed trading partner specifications and created EDI mapping guidelines.
• Extensive use of Excel to create Functional Specification Documents Templates.
• Designed the process flow diagrams for flow of information and report creation process.
• Worked with a cross functional team including Sales and Marketing
• Conducted RAD sessions for the report users, requestors, and the developers.
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, and OOD Generated wireframes and prototype for the GUI. Tested claims adjudication and group and enrollment in Amisys for New Medicare advantage members
• Prepared Need Analysis Documents of the requirements gathered through JAD sessions.
• Documented all the changes in the initial templates and was responsible for Release Management.
• Reviewed Requirements deliverables for delivery timeline.
• Used MS Visio to create Flow diagrams and Use Case Diagrams.
• Created presentations explaining the entire report development process, while drawing a comparison between the legacy the new report.
• Coordinated with the developer, on day-to-day basis, during the development process.
• Involved in manual testing and UAT with the development team and QA team.
• Created Test Scripts Test Scenarios to check report content, layout, and parameters.
• Worked on Report Re-engineering Project and made enhancements to the system flow.
• Modified System flow diagrams using SDLC.
• Tracked the defects in legacy reports as per account managers and end users. Compared the results and tracked the differences in excel
• Reviewed Stored Procedures for reports and wrote test queries against the source system SQL Server to match the results with the actual report against the Data mart Oracle .
• Responsible for writing Test cases to cover overall quality assurance using Test Director
• Performed initial manual testing of the application as part of sanity testing
• Created various checkpoints in the script using Win Runner
• Application and network performance testing analysis

Environment: PL/SQL, SQL Server, XML, Windows, ODBC, Internet Explorer and Netscape, Web Logic, UNIX, Rational Req. pro, clear case, Rational Rose, Clear Quest, UML, MS Visio, and MS Project

Confidential

Business Analyst

Confidential of a new Underwriting System for the new Individual Line of Business catering to MMIS .The purpose of this project was to build a reliable and extendable underwriting system using BPM tool. The system was designed to auto adjudicate 50 of all applications that meet minimum standards and reduce the amount of time it takes to process an application that requires an underwriter's intervention by 50 .

Responsibilities:

• Gathered user requirements and directed developers for practical deliverables.
• Worked with the full SDLC, elicit, analyze and define requirements.
• Conducted JAD sessions with the clients to identify the requirements.
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, OOAD using UML and Business Process Modeling.
• Used Rational Unified Process RUP for streamlining the team's development activities.
• Followed the UML based methods using Rational Rose to create: Use Cases, Activity Diagrams/State Chart Diagrams, Sequence Diagrams, and Collaboration Diagrams.
• Worked extensively with insurance brokers
• Participated Testing and Evaluation of projects at established integration points to assess progress and identify key functionality issues.
• Performed the requirement analysis, impact analysis and documented the requirements using Rational Requisite Pro.
• Obtained Data requirements, identified data sources, determined the content of data fields and created Data Mapping Documents and performed Data Extraction and Data Compilation using SQL queries.
• Responsible for integrating with Facets. Designing test scripts for testing of Claims in Development, Integration and production environment.
• Migrated Data from MS Excel to SQL Server Reporting Service Using DTS and SQL loader utilities.
• Deep understanding of Structured System Development Methodologies
• Designing and customizing data models for Data warehouse supporting data from multiple sources
• Assisted Project Management in developing Scope/ Vision Documentation and Project Plan, tracking project process, and developed Risk Mitigation Plan
• Defined, developed specs for federal reporting specific to Medicare Advantage
• Conducted user interviews, gathering requirements, analyzing the requirements using Rational Rose, Requisite Pro RUP.
• Prepared Logical Data Models that contains set of Entity Relationship Diagrams and Data Flow Diagrams and supporting documents and descriptions of the Relationships between the data elements to analyze and document the Business Data Requirements.
• Tested claims adjudication and group and enrollment in Amisys for New Medicare advantage members
• Well versed with HIPAA, claim adjustments, claim processing from point of entry to finalizing, claim review, identifying claims processing problems, their source and providing alternative solutions using best practice model and principles.
• Worked with Claims, enrollment, eligibility verification for members and providers, benefits setup, and backend payment cycle in facets.
• Establish documentation for agile methodology for implementation with a very water-fall-centric development team.
• Work with project manager to build out plans using project management tool.
• Researched the existing client processes and guided the team in aligning with the HIPAA rules and regulations for the systems for all the EDI transaction sets.
• Interacted with Business Users to conduct thorough Requirements Analysis.
• Created Interface test cases, report test cases, expected results validation, defect tracking using clear quest, version control using Clear Case VOB.
• Responsible for creating a business process and workflow documentation using BPMN standards.
• Worked in Data Analysis, Data Reconciliation and Data Mapping for ETL process
• Created standard test case template according to the company requirements and standards.
• Reviewed Stored Procedures for reports and wrote test queries against the source system SQL Server to match the results with the actual report against the Data mart Oracle .
• Used MS Visio for Process modeling and Business Process flow diagrams
• Solid Experience in Collection, analyses, and documentation of User Requirements, as well as Organizing interviews, User meetings, workshops, JAD sessions and requirement elicitation sessions
• Proficient in creating Use Cases, Use Case Diagrams, Activity Diagrams etc.
• Tracked UAT issues/bugs and prepared reports.
• Performed job of contact point for all stakeholders business, legal, compliance, development .
• Documented monthly status reports for enhancement and modification requests for the development team to assist them in efficient tracking and monitoring of open issues of the project.

Environment: Windows XP Professional, Oracle9i, MS Access 2000, MS Excel, RUP, Oracle, UML, Rational Rose, Requisite Pro, Clear Case 2002, Rational Clear Quest 2002, MS Office suite, MS Visio 2003.