SUMMARY

• Technical Business Analyst with 9 years of experience in Healthcare, P C, Life and Financial applications
• In depth knowledge of HIPAA 4010, 5010 , ICD 9, 10 , HL7, EDI file formats like 837 I/P/D, 835 270/271, 276/277, , Managed Care, Claims and Medicare business areas
• Hands on Experience in implementations for various domain areas in Property Casualty Insurance.
• Extensive design experience in creating UML diagrams such as Use Cases, Activity Diagrams and Sequence Diagrams using MS Visio and Rational Rose
• Adept at creating and transforming business requirements into functional requirements and designing business models using UML diagrams- Use Case Sequence and Activity Diagrams Data-Flow Diagrams Data Modeling.
• Good conceptual understanding of Data Warehousing. Proven experience in complete project life cycle - Design, Development, Maintenance and Documentation of Enterprise Data Warehouse, Data Marts, and Operational Data Stores ODS
• Proficient with web technologies such as HTML, XML, Web Services, Ektron and Alfresco
• Comprehensive knowledge of SDLC with experience in black box, regression, integration, UAT, load and performance testing
• Expertise in implementing systems Development in Agile Scrum , RUP Waterfall Methodologies
• Excellent communication and presentation skills with experience in development, implementation and integration of strategies within a team oriented environment

SKILL SETS

PROJECT DETAILS

Lead Business Analyst

CONFIDENTIAL , a leading non-profit public sector Managed Care Company based in Dayton Ohio has been meeting the needs of health care consumers for more than 24 years. The project involved successfully implementing an EDW Incremental data load for which the Claim Administration system was the primary source. The project also involved integration of other sources such as Med Impact Drug claims into the EDW.

Responsibilities:

• Established RUP Rational Unified Process methodology and provided assistance in developing Use cases and project plans
• Prepared Business Process Models that included modeling of all the activities of business from conceptual to procedural level.
• Conducted JAD's and walkthroughs with Content Managers and Product Managers.
• Gathered requirements and Business Rules for Reference Data repository with the LOINC Master Data.
• Worked with Catalog management, Enterprise master Catalog, Global Data Synchronization modules of the InfoSphere MDM enterprise Edition.
• Planned and defined system requirements, Use Case Scenarios and Use Case Narrative using the UML methodologies.
• Developed detailed data mapping spreadsheets with test Code and LOINC code mappings for various Labs within Quest.
• Assisted Data modelers in developing the Metadata for the Content Management system based on the Master Business Data.
• Created Detailed Functional requirements for the LMDM application and the configuration requirements for alfresco CMS.
• Created Integration requirements document for integration with Website Search and other Quest partners.
• Maintained the Requirements Traceability Matrix RTM across the deliverables.
• Participated Testing and Evaluation of projects at established integration points to assess progress and identify key functionality issues.
• Tracked UAT issues/bugs and prepared reports.

CONFIDENTIAL

Scrum Business Analyst

CONFIDENTIAL The project scope is to successfully implement CDM Incremental data load for which Claim Administration system is primary source and there after integrate many other sources like Provider Administration into CDM.

Responsibilities:

• Provide major contribution in the implementation of EDW Incremental pull and load that constitutes different modules like claims, providers, members, products for different source systems
• Interact with business users for better understanding of individual subject areas and modified specifications to reflect accurate user needs
• Gathered user requirements by interviewing focus groups and brainstorming with SMEs, Business users and Product owners. Created targeted questionnaires for SMEs to refine requirements and translated into business rules
• Used AGILE methodology and worked in short SPRINTS to achieve goals.
• Participated in SCRUMS and discussed the open issues and statues.
• Participated in Agile Planning Sessions and assumed the Product Owner role for the agile initiative.
• Developed the Epics and Themes for the Scrum Project
• Devised and prioritized the Product Backlog by conducting requirement churning sessions with various Business / Product Teams.
• Created and explained the User Stories to the Scrum Team and helped them design the Tasks.
• Designed acceptance criteria for validating the output of each Sprint.
• Reviewed Team Velocity on a frequent basis and advised Scrum Master at various stages.
• Participated in Sprint Planning and Sprint review meetings for Finalizing the Sprint Backlogs and Verifying the sprint outputs respectively
• Created Release Tracking Document in order to track the necessary changes.
• Participated in Business Demonstrations and Decisions for the Release of the Sprint Output to Production.
• Worked Extensively with HIPPA EDI 834 forms received from various Vendors, Partners and Producers in validating the Data in Stage Environments, Test running the formats and conducting issue analysis.
• Worked with HIPPA EDI 837 835 files for data validation and created Data mapping and ETL process requirements for loading data into the EDW.
• Work closely with team leads in process of standardizing job parameters, job flows, audit process and rollback strategies that hold major attention for the successful implementation of EDW Incremental
• Address production, UAT issues, proper action was taken accordingly based on priority and requirement

CONFIDENTIAL

Business Analyst / UAT Specialist

CONFIDENTIAL major service lines include Insurance through Employers, Medicare and Individuals Family's. As a Business Analyst at CONFIDENTIAL I was involved in development of web based Enrollment for various types of Plans. Web enrollment system is supported at the backend by an Enterprise Content Management system.

Responsibilities:

• Mapped process flow assess as-is process through user interviews, data collection and analysis, design and evaluation of to-be process solutions.
• Prepared Business Process Models that included modeling of all the activities of business from conceptual to procedural level.
• Reviewed EDI companion guides for all payers to ensure compliance, edit integrity and maintain up-to-date list of payer contacts.
• Established RUP Rational Unified Process methodology and provided assistance in developing Use cases and project plans
• Planned and defined system requirements to Wire Frame with Use Case, Use Case Scenario and Use Case Narrative using the UML Unified Modeling Language methodologies.
• Designed and developed Use Cases using UML and Business Process Modeling.
• Consulted with healthcare insurance company to develop conversion specifications for other insurance Coordination of Benefits including Medicare .
• Developed data conversion programs for membership, claims, and benefit accumulator data - converted thirteen corporate acquisitions. Developed data field mappings. Provided programming and support for claims processing functions and auto-adjudication.
• Validated the 834 Enrollment/Dis-enrollment to a health plan
• Performed Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data
• Assisted process owners in process training and implementation.
• Coordinating with the development team to set up test environment for issue escalation and issue resolution process for SIT and UAT testing to enable smooth operation
• Assisted the QA team in designing the Test Plan and Test Cases for User Acceptance testing
• Involved in reviewing test plans and test cases and ensuring test cases reflect user needs. Also responsible for conducting user training and User Acceptance testing to ensure and verify system is designed according to user needs.

CONFIDENTIAL

Business Analyst

Responsibilities were to gather requirements needed for Oracle team to configure and develop the Clinical Trial Relationship Management System CTRM . This system is to help CONFIDENTIAL keep all the clinical data for all their clinical trials in one central area that is accessible to all authorized users. This will also allow Pfizer to keep a better relationship between them and their researchers and clinicians. This system will address all the pain points that their many current system brings. The CTRM system will provide all the centralized data and communication to all the study teams and clinical study technicians in the CONFIDENTIAL and abroad.

Responsibilities:

• Met with the business group to get final requirements.
• Documented the objectives, constraints and scope of the system.
• Responsible for business requirement gathering and reporting for the CTRM project.
• Interacted with different risk management and analytic groups, Pfizer BA's and Oracle team to get the requirements for the application.
• Built corporate wide risk mitigation and issue resolution guidelines for project teams.
• Conducted Joint Requirements Planning JRP sessions as a Facilitator to gather requirements from the group.
• Maintained the Requirements Traceability Matrix RTM across the deliverables.
• Performed Gap Analysis for new functionality requirements, as well as prioritized them based on actual business needs so as to align them with the product release roadmap.
• Involved in writing use cases and other design documents like Data Flow diagrams, and Activity diagrams for better understanding of the system.
• Conducted workshops with Oracle design and developmental team to determine how CTRM will be configured.
• Identified critical failure points in technical architecture to design and test for fail over.
• Conducted analytics workshops and gathered and also documented requirement using Enterprise Architect needed for the project.
• Had knowledge of Enterprise Analysis, Requirements planning Management, Requirement elicitation, Requirements communication, Requirements Analysis documentation and solution Assessment validation.

CONFIDENTIAL

Business Analyst

The project was the application for hospital management Support System. The patient data which is relating to patient health check-up, insurance, up gradation of different lab reports was captured using an Electronic Medical Record Management System. The purpose of this system was to have a Paperless Medical Record and instant retrieval of data by the persons in medical department. The patient's medical record contains information such as physical examination and information specific to the medical discipline. The system also captures information about the patient's appointments, medical summary and flow of medical activities of his/her throughout the clinic visits

Features:

• Application for hospital management support system
• To capture patient data using an Electronic Medical Record Management System
• Patient data which is relating to:
• Up gradation of different lab reports
• Insurance
• Patient health check-up
• This system also captures data about:
• Flow of medical activities of his/her throughout the clinic visits
• Medical summary
• Patient's appointments
• This system was to have a paperless Medical Record and instant retrieval of data by the persons in medical department
• Patient's medical record contains information such as:
• Physical examination
• Information specific to the medical discipline

Responsibilities:

• Conducted user interviews, gathered Requirements, analyzed the Requirements and managed change requirements by implementing change management methodology
• Worked according to Health Insurance and Portability and Accountability Act HIPAA Worked on 837 I, P, D , 277, 276 transactions
• Worked with HL7, EDI ANSI 4010 and 5010 Standards Knowledge of ICD 10
• Documented and delivered Functional Specification Document to the project team
• Understand and articulate business requirements from user interviews and then convert requirements into technical specifications.
• Used TOAD to connect the database and ran SQL queries to view data and analyze data for business requirement
• Create Data Flow Diagrams DFD to depict the source-to-Target Mapping and Data Lineage Analysis.
• Identify source systems, their connectivity, related tables and fields and ensure data suitably for mapping
• Worked on data mapping of source to target elements performing gap analysis Conducted interviews
• Identified and documented issues, risk and gaps, their descriptions, their impact and provided recommendation and alternatives to develop the application to meet the user requirements
• Worked in a team to develop use cases for their newly added application layout. I understood all the business processes related to newly added layout and designed use cases that helped Application developers to build application.
• Interacting with the developers on resolving the reported bugs and various technical issues
• Involved in UAT to confirm that the system under test meets the user needs and provides confidence in its use
• Performed verification tests to make sure the data had integrity
• Worked cross functionally with developers, QA and project managers to make sure each the data could address their needs
• Developed documents and implemented appropriate policies and procedures related to patient accounting, including follow-up on all patient accounts receivables