SUMMARY

• 10 years plus experience as Business Analyst in Healthcare and Insurance sector with an understanding and ability to work independently and in cross functional teams.
• Extensive knowledge of Software Development Cycle (SDLC) and quality control methodologies such as Waterfall, Agile & RUP.
• Proficient in creating BRD (Business requirement Document), TRD (Technical Requirement Document), FSD (Functional Specification Document) and UAT Documents, Use Case Narrative & Use Case Diagram.
• Comprehensive understanding of HIPAA Standards (4010 & 5010) and Compliance issues, Medicare, Medicaid, ICD9, ICD10 and Claims adjudication process.
• Proven track record of creating and transforming business requirement into functional requirements and non functional requirements.
• Well versed with GEM’s (Data Mapping)
• Experienced in Dodd Frank implementation
• Savvy in Volcker Rule impact in Capital Market and investment Banking Domain
• Analytical, methodical, and resourceful approach to problem solving, identifying and documenting root causes and corrective actions
• Performed Gap Analysis to check the compatibility of the existing system infrastructure with the new business requirements
• Expertise in broad range of technologies, including business process tools such as Microsoft Project, MS Access, MS Visio, technical assessment tools, Data Warehousing concepts and web design and development.
• Exceptional presentation skills including verbal and written skills, and flexibility in adapting to new relevant information and changes.
• Demonstrated an exceptional ability to adapt to new developments in the world of technology and working environment. Ability to prioritize and schedule multiple tasks on a day - to-day basis
• Extensive hands on experience with tools such as Req Pro, Clear Case, and Clear Quest & SharePoint.
• Carried out systematic problem identification, analysis, and resolution
• Analysed and reduced complex problems into simple, manageable components HIPAA EDI compliance and validation, defect analysis, and reporting.

TECHNICAL SKILLS

Operating Systems: MS Windows98/2000/XP/VISTA/7.

Project Methodologies: SDLC, Agile, SCRUM (TFS & Jira) Waterfall, RAD, RUP.

Business Modeling Tools: MS Visio, Rational Rose.

Project Management: Microsoft Project, Microsoft Office.

Requirement Management: Requisite Pro, HP Quality Center & SharePoint. BluePrint

Documentation Tools: MS word, MS Excel, MS PowerPoint S

Data Reporting/Analysis: Toad for Oracle 11.6

Hipaa Validations Tools: Ingenix claredi/IBM WTX/Edifecs RampManagement/Trizetto EDM(Encounters Data Management. IBC Pitching Tool, Edifecs Spec Builder, EDI Notepad 7.1

Databases: Oracle, MS SQL Server

Healthcare Softwares: HealthRules, Mainframe(CICS), Facets, NaVinet

PROFESSIONAL EXPERIENCE

Confidential, Fort Washington, PA

Sr Business Systems Analyst

Responsibilities:

• Elicits and documents detailed business and/or functional requirements for use by business stakeholders, development and QA accurately
• Able to identify scenarios and downstream impacts to business deliverables or technical processes that are not readily evident
• Transforms business requirements to solutions
• Effectively documents the functionality to support business requests
• Analyses business needs and translates them to clearly defined rules or deliverables
• Ability to navigate relational databases, Excel files, text files or other forms of data sources to conduct data analysis activities, when needed.
• Understanding of file layout specifications and how to interpret them
• Flexibility to quickly ramp up in new domains
• Conveys ideas clearly and tailors communication based on selected audience (technical and non-technical)
• Facilitate meetings with various business stakeholders, IS/IT and external entities
• Follow-up with appropriate folks to achieve results and remove barriers for the project team
• Comfortable with interacting with all levels of management
• Understands, Plans, Executes, Follows-up. Interacts with others (internally and externally) diplomatically. Possesses effective and active listening skills.
• Sets clear unambiguous expectations, delivers, promptly follows-up, does not leave customer guessing. Negotiates and compromises effectively to reach group consensus when necessary.
• Mapped Bupa’s ClaimCanonical To X12EDI837P /837 I/835
• Mapped Bupa’s FF DF To DF Canonical
• Mapped HRFinancialAdjustmentResponse To DFResponse
• Created test scenarios for 276/277 & 270/271 and Conducted UAT testing
• Opened/ logged the Bugs in HP ALM Quality Centre
• Looked up members in CMD and HealtRules.
• Validate members sitting on CR3 workbasket
• Created a BRD for the Routing of claims/ Request 270/271/Navinet and CMD to the Existing systems at AHA( legacy& HealthRules)
• Created a BRD for the automation of the claims reconciliation process( both ITS/Non ITS)
• Created FRS for BizTalk Team with respect to HPA integration: When CAS Segment = PR Drop the claim
• Created Tasks Plan for ITS software upgrade 15.0 and 15.5
• Conduct impact analysis for ICD 10 Migration
• Leaded the ICD 10 Remediation process
• Update frequency of ICD10 cross-walk updates
• Met with Health Edge to understand functionality and define high level tasks
• Reviewed test environments and defined approach
• Met with Clinical Services to discuss Arial
• Discussed EDW approach for outbound feeds
• Remediation of the Systems/ Processes to use ICD as received without mapping or translating to an equivalent ICD

Confidential, Philadelphia, PA

Senior Business Analyst/Project Manager

Responsibilities:

• Managed the overall project lifecycle according to SDLC methodology specifically using Waterfall method.
• Supported Technical Delivery team in effectively driving the implementation from project management perspective.
• Organized and facilitated Requirement Elicitation sessions, Business and Functional Requirement walkthroughs and detailed discussions linking tasks for various Functional Areas.
• Created and maintained Project Plans for various functional areas and updated on a weekly basis to be viewed on the Project Management Office’s project dashboard.
• Designed and implemented a next generation Executive Dashboard and KPR report for project teams to utilize and effectively convey project status to Executive level associates.
• Documented and updated the Risks/Issues log for Business, PMO and IS Teams while creating an effective Mitigation plan to resolve any items affecting the project’s critical path.
• Created a presentation for the proposed Change Control process presented to the Executive and Business sponsors to support an organized process that includes a Governance Board and Change Control log.
• Created workflow diagrams, organization charts and RACI matrices showcasing future state of the process for Change Control process and clearly define the individuals for the Governance Board and their roles and responsibilities.
• Assisted TDM and Program Manager in performing analysis of project deliverables, project forecasting, managing change and producing weekly status reports.

Confidential, NY, NY

Functional Analyst

Responsibilities:

• Defined the Functionalities to implement Dodd Frank Act
• Analysed components for distributed rule-based aggregation infrastructure for the Liquidity Risk management platform
• Worked on upstream and downstream data analysis for regulatory and data warehouse
• Helped testing teams with their test case development and review BRD
• Assisted/liaised with development teams in Design and Development to ensure requirements understood.
• Design test procedures, maintenance procedures and configurations
• Worked on FSD and Identify gaps at all stages of the project SDLC proactively
• Managed work stream effectively to minimize the schedule impacts
• Collaborated with technical leads in identifying the deliverable dependencies.
• Executed SIT to validate quality of deliverable before UAT.
• Coordinated UAT testing with consumers, getting test plan/test cases and sign-off. assisted with other project/program level documentation.
• Coordinated with external teams (business, infrastructure, change management,

Confidential, Philadelphia, PA

Sr. Business Systems Analyst

Responsibilities:

• Worked with Customers/Business and gather Functional Requirements for Encounters and claims support applications. Liaise with Lead Programmer/Analysts to understand and meet customer requirements and design specifications. Analysis & Testing
• Carried out systematic problem identification, analysis, and resolution
• Analysed and reduced complex problems into simple, manageable components.
• DC Charter: Data Warehouse Development, QA and Production Support
• HIPAA EDI compliance and validation, defect analysis, and reporting.
• Leaded the Lacare line of business, the Medicaid program for the state of Louisiana
• Initiated system modifications, system expansions and many new systems releases
• Worked with the encounters team on creating an 837 for our subcons
• Created the FRS for the technical team and successfully got the final sign-off
• Reviewed business process and Functional requirements
• Receiving, validating, and submitting 837 files to the state
• Making 837 file corrections if necessary, and resubmitting them to the state creating reporting requirements, assisting with report design/layout, and testing/data validation
• Analyzing the 835 on a weekly business
• Created detailed reports to the state, upper managements and to the subcons
• Wrote SQL queries in Oracle for data manipulations Worked with SQL queries for data manipulations Conducted UAT.
• Deep technical background and solid working knowledge of SQL Server Data warehouse systems

Confidential, Wilmington, DE

Sr. Regulatory Risk Analyst

Responsibilities:

• Define business architectural vision and scope
• Establish governance framework including working groups and prioritization process
• Identify and communicate key project risks, define mitigation strategies and manage to resolution.
• Analyze data and present key metrics leveraging the tools
• Develop test strategies and coordinate the execution of test scripts
• Support the PMO by ensuring that all risks and issues are communicated effectively
• Lead peer reviews and inspections of requirement documentation.
• Qualifications
• Knowledge of Derivatives Products, i.e. Equity, Credit, Rates, Commodities, FX Derivatives or Loans and Leases understanding of Front Office (Sales & Trading) Processes understanding of counterparty credit risk management
• Understanding of a Firms financial reporting, e.g. Balance Sheet, Income Statement
• Worked with the team of business analyst and developers to inplement and be compliant with Dodd Frank and Volker Rule
• Conducted end to end analysis to identify gaps and synthesizing ambiguous information into manageable strategic deliverables
• Able to quickly grasp and master new requirements and related knowledge
• Managed tight deadlines or unexpected requirement changes
• Strong analytical and problem solving skills
• Well organized and good attention to detail
• Strong communication skills both verbal and written
• Ability to present to senior levels of management
• Comfortable interacting and building consensus across functions and levels of seniority
• Team player in both solid and matrix line reporting organizations

Confidential, Los Angeles, CA

Business Analyst

Responsibilities:

• Conducted interview sessions with users and different levels of management so as to extract requirements to understand the functional specifications of the AS IS system.
• Did the GAP and IMPACT analysis to design the TO BE system.
• Responsible for the execution for the project life cycle (SDLC), including requirements gathering, design, testing, implementation and documentation, as required.
• Facilitated smooth completion of project by providing insurance subject matter expertise to the team and utilizing subject matter know-how for quality assurance purposes.
• Gathered and documented business requirements in order to describe the business needs in terms of the main deliverables.
• Actively involved in creating/updating Work Breakdown Structure (WBS), preparing deliverable tasks in the project plan.
• Provided issue resolution recommendations by ensuring that there is regular and effective communications of issues and corrective actions between teams.
• Identified Actors, Activities, Artifacts and Workflows and developed use case diagrams.
• Assisted clients during UAT Environment.
• Performed Requirement Analysis and developed Use Cases, Activity Diagrams using Rational Rose.
• Completed the documentation of Claims Scenarios for the source system.
• Helped in designing and implementing deployment process, and thus maintaining the application in post deployment process.

Confidential, Greenwood Village, CO

Business Analyst

Responsibilities:

• Gathered business and system requirements from various departments like accounting, Fund Management, Legal and Human Resource through focus groups, surveys, interviews, and JAD sessions.
• Analyzed data to generate information about clients and their attributes, and drafted a data requirements document.
• Held meetings with users and stakeholders to identify problems, resolve issues and improve the process to ensure a stable and accurate solution.
• Prepared Business Workflow models and process diagrams depicting how business processes are accomplished.
• Created Activity Diagram, detailed Data Flow Diagrams, Use Cases, business process flowcharts for the As-Is and To-Be process.
• Actively involved in creating/updating Work Breakdown Structure (WBS), preparing deliverable tasks in the project plan.
• Created Use Cases to identify automated processes and the actors (vendors, systems) involved in the project to ensure reliable results of implemented business/functional needs.
• Involved in feasibility analysis and risk analysis of the project.
• Gathered and documented business requirements in order to describe the business needs in terms of the main deliverables.
• Facilitated meetings with Subject Matter Experts (SMEs) to create the process requirements, process improvements and to proper explain the development team the flow of future data modules.
• Functioned effortlessly and efficiently, as a liaison between four work streams and its task leads, SMEs, development team, and management group. Actively participated in Joint Meetings with the various teams involved in the development process.
• Helped in designing and implementing deployment process, and thus maintaining the application in post deployment process.
• Assisted System Architects and Quality Assurance Analysts in creation of various tests.
• Assured that all artifacts are in compliance with corporate SDLC policies and guidelines.
• Assisted in deletion of defects and bugs, in order to meet specific requirements and deadlines for successful execution of the project.
• Coordinated UAT of the product with Business Users.

Confidential, Hoboken, NJ

Business Analyst

Responsibilities:

• Obtained business requirements from business users and stakeholders using JAD sessions, brain storming sessions, focus groups and personal interviews to get a better understanding of the client’s business process.
• Worked with the business to document and develop formulas for the calculation of premiums and losses statistics in the marts (e.g. Written Premium, Earned Premium, Unearned Premium)
• Elicited, documented, modelled, validated and prioritized functional and non-functional requirements using interviews, data analysis, and different modelling tools.
• Actively involved in preparing and writing the business requirement documents, functional requirement documents and data mapping documentation.
• Performed in depth data analysis identifying data issues in legacy system and worked with business to develop resolutions to those issues.
• Used MS Project for status reporting and planning.
• Utilized MS Visio for designing Use Case Diagrams, Activity Diagrams and Sequence Diagrams, after accessing the status and scope of the project and understanding the business processes.
• Analyzed the as-is and to-be state of the project and performed Gap analysis, Impact analysis and SWOT analysis.
• Created data mapping documents for the movement of data from production databases to the warehouse and from the warehouse to the policy and claims marts.
• Used the guidelines and artifacts of the SCRUM methodology for project implementation and development.
• Assisted System Architects and Quality Assurance Analysts in creation of various tests.
• Assured that all artifacts are in compliance with corporate SDLC policies and guidelines.
• Assisted in deletion of defects and bugs, in order to meet specific requirements and deadlines for successful execution of the project.
• Worked as an SME for identifying the scope of End-to-End testing with different teams.
• Coordinated UAT of the product with Business Users.