PROFESSIONAL SUMMARY

• Over 7 years of IT and Management experience in Software Development Life Cycle SDLC and Project Life Cycle working as Business Analyst mainly in Healthcare sector.
• Experience with Rational Unified Process RUP , Agile/Extreme Programming, the Waterfall life cycle, Rational Suite Rational Rose, Rational Requisite Pro, Rational ClearCase, Rational ClearQuest .
• Extensive experience with analyzing business processes and documenting them using MS Visio, MS Powerpoint, MS Excel, MS Project.
• Experienced in interviewing business users and customers, providing recommendations to resolve issues for various business/technical groups and defining strategic solutions to business problems in a multiple project environment.
• Strong experience in developing Use Case Diagrams and creating Use Case Specification document USD , BRD business requirement document , FRD Functional Requirement document
• Strong experience in documenting existing process, analyzing business requirements, working with requirements traceability matrix, re-engineering business processes and designing.
• Experience in developing functional specs through JAD sessions and user interviews.
• Expertise in managing multiple projects and teams with an excellent track record.
• Experience with 21CFR Part II code of federal regulation, which deals with electronic records and electronic signatures along with HIPAA compliances.
• Experience with claims process and adjudication in the Medicare, Medicaid and Private Insurance Sectors.
• Experience in business requirements gathering and writing, EDI. Versed on HIPAA regulations and requirements. Experienced in HIPAA Transactions 270/271, 278, 837, 835, 834, 820, 276/277.
• Experience in configuration of claims adjudication systems, i.e., FACETS MMIS. Experience with ITS systems involved in Blue Square applications.
• Experience in Quality Assurance of client server and web-based systems with focus on Healthcare systems.
• Experience with analyzing the requirements of datamart. Worked with business users to understand their reporting requirements, worked with Reporting team to develop report prototypes, demonstrated report prototypes to the business users, came up with FRDs for the datamarts.
• Used sqls to test various reports and ETL load jobs in development, QA and production.
• Good knowledge of RDBMS and SQL with experience in Data analysis and reporting.

TECHNICAL SKILLS

PROFESSIONAL EXPERIENCE

CONFIDENTIAL

Position: Business Analyst

Environment: Requisite Pro, Rational Rose, Facets, ClearCase, HP Quality Center, Quick Test Pro, FACETS 4.41, Cystal Reports, SharePoint. CONFIDENTIAL , to Facets based Claims processing system. This migration project is a substantial project for United Health Group IT team. Migrating to new system requires generating new reports which will use Crystal Reports, more advanced technology.

Responsibilities:

• Responsible to gather requirements for PDF reports generated from Amisys and to convert them to So that they can be generated from Facets.
• Responsible to locate and map tables in database with Reports.
• Generated Data Mapping and Data flow diagrams.
• Validate EDI Claim Process according to HIPAA compliance
• Facilitated Joint Application Development JAD sessions to focus on defining the United Health Claims Processing Process and had a solid understanding on 4010 HIPAA EDI Transaction Codes such as: Health Care Eligibilities /Benefit Inquiry 270/271 , Claim Status and Response 276/277 , Health Care Payment Order 820 , Health Plan Enrollment 834 , Health Care Payment/Remittance Advice 835 , Health Care Claims 837 I , 837 P , 837 D .
• Assisted development team to translate requirements into technical specifications.
• Participated in Life of a Claim training, detail Claim process tour included HIPPA compliance, electronic EDI 837, EDI 835, etc. and paper claim processing CMS 1500, UB04, ADA claim form and Vision .
• Working with mappings using expressions, filters, lookups, router, update strategy transformations to implement Type 2 dimensions.
• Performed risk analysis of the requirements to identify key business areas for the project.
• Worked with major components of EDI 837 or hardcopy claims input and 270/271, 276/277 queries, and Coordination of Benefits COB for Dual Member and Dual Coverage Customers.
• Worked with initial membership load programs, input files were in both Proprietary and HIPAA EDI 837 formats
• Wrote SQL to verify Report data with raw data in database.
• Integration testing of newly developed reports with River Valley IT system.
• Participated in Design, Development and Implementation of a Reporting system for Business management using Cognos impromptu, powerplay and configured various components Transformer/Powerplay
• Created interface to export reports to Excel.
• Conducted User Acceptance Testing UAT sessions with business users and prepared document for enhancements and bug fixes.

CONFIDENTIAL

Position: Business Analyst

Environment: Requisite Pro, Rational Rose, Peoplesoft EPM, ClearCase, HP Quality Center, Quick Test Pro, Oracle 9i, Cognos8, Cystal Reports, SharePoint.

• Description: MassHealth CONFIDENTIAL . The NewMMIS project is a large IT project replacing the Medicaid claims payment system. Participated in all aspects of testing the NewMMIS. Primary responsibilities is to ensure that the system functions as designed, meets the requirements of the business community and conforms to all applicable CONFIDENTIAL
• . Worked as an active member of the functional teams in all phases of testing including System Integration Testing, User Acceptance Testing, Trading Partner Testing, and Pilot Testing. Execute test cases written by myself and others, analyzed results, reported defects and to work with the functional teams to resolve issues.

Responsibilities:

• Utilized Rational Unified Process RUP to configure and develop process, standards and procedures.
• Created workflow diagrams, process models, activity diagrams, use cases for incorporating design changes in the order creation/ management system.
• Prepared the Business requirement Document for the enhancement of the existing services.
• Wrote FRDs for the defects and enhancements and got approval from business for the developers.
• Analyzed HIPAA EDI transactions in XML and X12 responses and of 270 and 276 and looked for defects for amendment. Did data analysis for various version changes of EDI messages on different sub-systems.
• Performed task estimations and documentation of procedures.
• Created non-functional system requirements pertaining to data quality and system performance.
• Designed, prepared and implemented test cases for system testing as well as for User Acceptance testing.
• Conducted integration testing and regression testing with developers in development and QA, also conducted user acceptance testing with UAT team. Safety reporting on system-based projects, acted as a liaison, writing documentation and increased project coordination.
• Came with release plans, backout plans, got signoff from UAT team/business users before scheduling different production releases.
• Provided Production support/explained the changes to the business users/did one on one sessions/one to many sessions to make the business uses aware of the system changes.
• Analyzed and documented system release/deployment issues according to version management, backward compatibility, load balancing of components in production environment.
• Did impact analysis for changing requirements and coordinated with business users for prioritizing the testing/release of the changes.
• Analyzed the source data coming from Flat Files, and DB2 coordinated with data warehouse team in developing Dimensional Model.
• Did data analysis, created data mapping and data interface documents and kept the documents updated with changes in requirements and functional specifications.
• Performed Risk Analysis based on defect severity and priority
• Tested User Interface inconsistency and application functionality
• Developed Reports and Graphs to present the Stress Test results to the management
• Created BPR charts for AS IS and TO BE processes of different business functionalities NewMMIS application
• CONFIDENTIAL CONFIDENTIAL

Position: Business Analyst

Environment: Mercury Test Director 8.0, PVCS Tracker, Oracle 9i, Java/J2EE, RequisitePro, ClearCase, ClearQuest, MS Project, Cognos ReportNet , DataStage 7.0

Project Description: The project included determining risks, process flow holes, business rules anomalies when the preexisting application was compared to that of the proposed transaction set s IG's. The directions of the industry as perceived by WEDI-SNIP, CMS, NCPDP, NIH, NIST and other national support groups were taken into consideration for the delivered solution as well as safeguarding the confidential security, integrity, and availability of electronic protected health information.

Responsibilities:

• Helped create Level I and Level II specifications including VISIO data and program flow charts utilizing Gentran Translator's capabilities and limitations. These techno-commercial documents were presented to the state of New York for their approval for claims 837I/837P/837D , Service Review Request and Response or Prior Authorizations 278 , Eligibility Verifications 270/271 and Claim Status Request/Notification 276/277 . Outbound batch transactions included Claim Payment Advice 835
• Researched the then current application, various compliance issues, providing insights to the architecture group, Security group, and resource management group for effective budgeting, bridging with the Translator vendor's technical group and converting these semantics to the eMedNY application.
• Helped alleviate the problem of insufficient test data, inaccurate test files by creating large and complex, compliant and non-compliant test files with positive and negative test conditions. Helped achieve conformance by doing unit testing, system testing, regression testing, volume testing, end-to-end testing, user acceptance testing UAT , Trading Partner enablement by first promulgating test cases and test scenarios and creating a test result documentation methodology that supports a stringent pedantic testing but also eventually supports a realistic production environment.
• Create customized Implementation Guides using the SpecBuilder 5.1 module of EDIFECS software for 837 Professional, 837 Institutional, 837 Dental, 835 Remittance Advice, 276/277 Claim Status/Response transactions, 278 270/271 and all NCPDP transactions like B1, B2, B3, B4, E1, P1, P2, P3, P4
• Involved in Validating the System in Accordance with 21CFR Part 11
• Created use case narratives to record Subscription business rules.
• Analyzed the business rules for the international user subscription and impact of localization.
• Followed SDLC, which included requirements specifications, design, analysis and testing. Followed RUP methodology with Agile/Extreme Programming and using Rational Test Suite for various phases of RUP.
• Provided technical Expertise on the use of Rational Clear Case and Requisite pro, which were used for Data archiving and Requirements Management.
• Defect Tracking with Clear Quest, Configuration Management with Clear Case.
• Involved in preparing test plan and test cases based of functional requirements using Rational Test Manager.
• Work experience in maintaining datamarts dealing with ETL extraction, transformation, load using Oracle and Informatica.
• Dealt with data mapping issues between various source systems and staging area and data-marts.
• Worked with Business users to come up with Reporting Requirements. Reports were developed in Cognos.
• Produced various artifacts Functional Requirement Specifications FRS and User Requirement Specification URS .
• As a point person responsible for resolving business rules/conflict resolution for the development team.

CONFIDENTIAL

Environment: WebSphere, TIBCO, Windows NT/XP, Requisite Pro, Rational Rose, ClearCase

CONFIDENTIAL is one of the top ten insurance companies in the US. They wanted to come up with a Portal and to integrate all the independent applications running all over the US by their Agents. There were two ways an application can integrate with the portal, as a portlet or via link and launch.

Responsibilities:

• Identified and analyzed business and technical requirements.
• Conducted regular meetings with business users, documented requirements.
• Work with the business to ensure their intent is truly captured in the system. Creating new requirements making appropriate changes to requirements attributes in Rational Requisite Pro. Such as changing the requirement text to make them more precise/testable.
• Having change control using Rational Clear Quest required. Followed the changed requirements with test team the vendors.
• Responsibilities included writing technical documents for operation specifications, bulletins, and service manuals.
• Developed BRD business Requirement document , FRD functional requirement document , Test cases, Production Release plan/backout plan.
• Performed risk analysis of the requirements to identify key business areas for the project.
• Played a key role in the planning, testing, and implementation of system enhancements and conversions.
• Worked with a cross functional and diverse team of business users and developers to enable accurate communication of requirements and ensure consensus.
• Analyzed the requirements corresponding to coding the insurance rules in various processes.
• Facilitated weekly meetings with the review teams to continuously improve the QA process for the application development.
• Conducted walkthroughs with the end users and stakeholders to gather the modification requests from the user to upgrade or change the business specification for the product.
• Followed a structured approach to organize requirements into logical groupings of essential business process, business rules and information needs.
• Assisted with product evaluation, product customization and system integration.