PROFESSIONAL SUMMARY:

• Over 10 of experience as Business Analyst and Lead Quality Analyst on large time boxed projects with strong domain knowledge in Health care, Commercial, and Investment banking industries.
• Extensive experience in training corporate and independent clients on subjects like Business Analysis, Business Process Re-engineering, Business Process Modeling BPM and other core areas of Business Analysis like, Enterprise Analysis, Effective Requirement Gathering, Skills to survive as a BA for clients on job and SOA Service Oriented Architecture and ESB based architect. Also worked on legacy modernization methodology including the tasks, models and techniques.
• Having excellent knowledge and worked as a SME on Medicaid Management Information Systems MMIS including Medicare, Medicaid, Medicare Advantage, MediGap, ICD-9 and ICD-10 Codes, HL7, HIPAA, The Accredited Standards Committee X12 ASC X12 standard EDI transactions and integration 270/271 Benefit Inquiry- Eligibility, 276/277 Status Request- payment advise, 278 Request for Review/Response, 834 enrollment, 835 Payment/Advice, 837 Claims integration, 837P Claim: Professional, 837I Claim: Institutional, and 837D Claim: Dental , Electronic Health Record EHR , Health Information Exchange HIE , Omnibus Budget Reconciliation Act OBRA , Protected Healthcar Information PHI and Healthcare reform processes.
• Worked on the Disease management system that is able to facilitate for coordination with people's healthcare interventions. Also worked on medical management and used CEDRIC information system for managing chronic diseases as well.
• Worked on different projects having Line of Businesses, Critical Illness Products CI , Disability Insurance DI , Riders Facility, and other service policy and policy admin type of projects.
• Having work experience and expertise level knowledge on different claim adjudication systems e.g. Bluechip, FEP Express, FACETS, Magic, Coordinator Mouse, PREP, BlueSource, TSO, Availity, VDR, and also used Clarity PPM, SharePoint, Lotusnotes, WebEx, citrix, and NetMeeting for communication and information. And, also worked on web portal to increase the effectiveness of CRM.
• Worked on claim adjudication system including Inter-Plan Teleprocessing Services ITS , BlueCard Program, BlueExchange transactions.
• Well known and having sound understanding of comprehensive health reform, the Patient Protection and Affordable Care Act ACA and medical claim policies and requirements including benefits, membership, enrollment and implementation.
• Prepared multiple Statement Of Works SOW as formal document that captured and defined the work activities, deliverables, and timeline a vendor must execute in performance of specified work for a client. Also worked on Request For Proposals RFP that an organization posts to elicit bids from potential vendors.
• Experienced in creating operational procedures to promote applications from development to production for technical and non-technical staff and used different tools and techniques e.g. Joint Requirement Planning JRP , Joint Application Development JAD and Rapid Application Development RAD sessions with Business users, SME's and Stake holders alike in gathering requirements, collating and analyzing them to identify the real business need and facilitating the development of a customized solution which delivers maximum cost and usability benefit to the client and company.
• Documented the Requirement Traceability Matrix for tracing the Test Cases and requirements and documented and assisted the QA Team with the Test Plan. Also worked on different types of testing in different environments e.g. UAT, UIT, and SIT testing including regression, parallel, load runner and many of other testing techniques.
• Worked for the whole testing cycle including understand project vision and context, identify reasons for testing performance, identify value of testing performance, configure test environment, identify and coordinate tasks, execute tasks, analyze result and create report, and reprioritize the testing task.
• Wrote Test Cases, Documented the Requirement Traceability Matrix for tracing the Test Cases, executed test cases, managed and assisted the QA Team with the Test Plan. Also worked on different types of testing environments e.g. UAT, UIT, and SIT testing including Path testing, Data set testing, Unit testing, System testing, Integration testing, Black-box testing, White-box testing, Regression testing, Automation testing, User acceptance testing, Software performance testing, and stress testing or load testing. And also have excellent knowledge on COBOL, Oracle, and java, Oracle ADF platform, SQL queries, and SAS Methodology for centralized stress testing.
• During testing phase, worked on Defects management including analysis, retesting, verifying, and approving process, also worked as a HP QC, ALM administrator.
• Excellent knowledge in Corporate Finance, Investment Banking, Credit tracking, Asset Management, Wealth Management, Derivative products such as Options and Futures, Swaps and Swap Options involving Credit and Interest rate and other OTC derivatives, Fixed Income, Trade Life Cycle, FIX protocol, Mortgage, Insurance, Bonds, Section 508, Sarbanes Oxley Act SOX , and GAAP.
• Worked on utilization of Wireframes at many levels and for many projects. First, gathered requirements on what is need on the page and start the dialogue with business people to make sure that what is being wire-framed function and makes sense to the end user. Used the Iterative user-centered design to meet the business needs and to create the user-centered design mainly on java, Oracle, and COBOL based development environments. Also, having sufficient experience on Middleware and peripherals, application server, and database management.
• Working expertise in Software Development Life cycle SDLC , Project Life cycle, Business Process Modeling BPM , Six Sigma, ITIL and in Software Development Methodologies including Rational Unified Process RUP , Waterfall, and Agile.
• Extensive knowledge and working experience in converting business requirements into UML diagrams using Rational Rose and MS Visio and also managing and tracking those requirements.
• Experience in process modeling using Use Cases, Sequence Diagrams, Collaboration diagrams, Activity Diagrams, Class Diagrams.
• Extensive experience in producing documents like Business Requirements Documents BRD , Functional Requirement Specifications FRS , Software Requirement Specifications SRS , Creating Request for Proposals RFP , creating Requirements Traceability Matrix RTM .
• Experience in developing and imparting pre and post implementation training, conducting GAP Analysis, User Acceptance Testing UAT , SWOT Analysis, Cost Benefit Analysis and ROI analysis.
• Driven by creative ideas and backed by strong Analytical and methodical problem solving skills, identifying causes, corrective actions and providing innovative solutions, building strategic partnerships with senior business leaders and getting commitments to actions from individuals at all levels.
• Experience in Use Case Analysis, creating Key performance indicators KPI , Enterprise Risk Management, Business Continuity Planning BCP , and Change Management.
• Knowledge in Business Intelligence, Business Architecture and Data Warehousing including Data Analysis and Data Mapping.
• Extensive experience on Excel, Word, PowerPoint, MS Project, MS Visio, Rational Suite and SQL.
• Highly motivated self-starter with excellent communication, presentation and interpersonal skills, can perform well both independently and with a team, always willing to work in challenging and cross-platform environments.

TECHNICAL SKILLS:

CHRONOLOGICAL SUMMARY OF EXPERIENCE:

Confidential

Responsibilities:

• Conducted meetings, workshops, discussions, and in-person conversations with key client stakeholders and developed the detail focused and IEEE standard SRS, SFS and SDS documentation for all system modules.
• Leveraged extensive industry and domain experience to identify and suggest best practices. Worked with SMEs, key decision makers and enterprise leadership and translated business strategy to clear objectives.
• Conducted workshops with key client stakeholders to understand the current state and formulation of actions needed to achieve the desired test case documentation and uploaded in to the ALM.
• Provided technical leadership and direction to the testing solution including formulation development of test strategy test architecture, drive quality processes initiatives and ensure quality of deliverables, design Automation framework and identify need for custom components.
• Worked on the Pharmacy based Disease Management system that is able to facilitate for coordination with people's healthcare interventions. Also worked on GI-RADS, HMS Radiology, eLab, and CPOE-CDS drug prescription system.
• Worked on business requirements and translated into test architecture design, used testing and domain expertise to test the product, developed test cases in-line with the requirement documentation, developed custom components, if any, to accomplish testing goals, and also build data-sets for test.

Confidential

Business Analyst

Hardware/Software:

FEP Express, BlueChip, PRAP, VDR, BlueSource, Availity, HPQC, ALM, CM Mouse, System Magic, SharePoint, MS Visio, MS Project Professional, MS Project, Lotus Notes, WebEx, and Microsoft Office package with Blue's Outlook Express and Blue's Link.

Responsibilities:

• Modified and used Project Templates to gather the requirements and carry on the project. Also worked on legacy transformation methodology including the tasks, models and techniques especially on UAT, UIT and SIT Environments. Also lead the QA team to execute the mainframe testing together with databases, screens, reports and auxiliary files.
• Worked on different claim adjudication systems e.g. Bluechip, FEP Express, Magic, Coordinator Mouse, PREP, BlueSource, MS Project 2010, TSO, Availity, VDR, and also used Clarity PPM, SharePoint, Lotusnotes, Webex, citrix, and NetMeeting for communication and information. Also, worked on Service and Request Tracking System SRTS of the ITG Department of the company.
• Worked on FEP Streamline which has different Line of Businesses, Critical Illness Products CI , Disability Insurance DI , Riders Facility, and other service policy and policy admin type of projects.
• Worked on healthcare reform process and procedure for Montana Streamline project.
• Worked as a SME Medicaid Management Information Systems MMIS including The Accredited Standards Committee X12 ASC X12 standard EDI Transactions-834 and other, ICD 9 10, HL7, Medicare, Medicare Advantage, MediGap, HIPAA, HIE, , EHR and all other compliances.
• Coordinated the project team for JAD and BRD Sessions for different projects. Used MS Project and MS Project Processional for management of the project.
• Having experience on Omnibus Budget Reconciliation Act OBRA while working for the FEP streamline project. Worked on Medicare allowable benefit reimbursement for federal retirees who enrolled in the Federal Employees Health Benefits Program FEHBP .
• For the FEP Streamline project, I worked on claim adjudication system including Inter-Plan Teleprocessing Services ITS , BlueCard Program, BlueExchange transactions types of claims.
• Followed a structured approach to organize requirements into logical groupings of essential business processes, business rules, information needs and insured that critical requirements are not missed
• Coordinated activities between business unit and technical staff, developed new methods, policies, and procedures to meet the business needs.
• Analyzed and translated business requirements into system specifications utilizing UML and RUP methodology.
• Prepared Functional Design Specifications FRS employing Use case scenarios, sequence diagrams, DFDs and class diagrams.
• Identified and clearly defined functional issues and supported IT development staff throughout the design, development, unit testing, and implementation phases of the software development life cycle.
• Documented the Requirement Traceability Matrix for tracing the Test Cases and requirements.
• Documented and assisted the QA Team with the Test Plan. Also worked on different types of testing in different environments e.g. UAT, UIT, SIT testing including regression, parallel, load runner and many of other testing techniques.
• Worked on Defects management including analysis, retesting, verifying, and approving process.
• Worked as a HP QC/ALM administrator.
• Assisted Project Manager for successfully completion of the above mentioned projects.

Confidential

Business System Analyst

Hardware/Software:

SharePoint, MS Visio, MS Project Professional, MS Project, FACETS, Lotus Notes, MS Project, WebEx, and Microsoft Office package with Blue's Outlook Express and Blue's Link.

Responsibilities:

• Developed the High Level Project Requirements HLR for a very large project.
• Worked on user-centered Wireframes design mainly on java and COBOL system.
• Modified and used Project Templates to gather the requirements and carry on the project. Also worked on legacy transformation methodology including the tasks, models and techniques.
• Worked on FACETS for healthcare plan administration. Also, experienced on claims adjudication to provide the best claims management service.
• Worked as a SME on Medicare, Medicaid, EDI Transactions 270/271 Benefit Inquiry- Eligibility, 276/277 Status Request- payment advise, 278 Request for Review/Response, 834 enrollment, 835 Payment/Advice, 837 Claims integration, 837P Claim: Professional, 837I Claim: Institutional, and 837D Claim: Dental , HL7, HIPAA, PHI, EHR, HIE, , ICD 9 10, and all other compliances.
• Worked on web server IIS Internet Information Services 7.5 to create and manage Web sites, and share and distribute information over the Internet. Also worked on SQL Server Reporting Services SSRS 2005 and 2008 R2 to prepare and deliver a variety of interactive and printed reports
• Coordinated the project team for JAD and BRD Sessions. Also, followed the SOA model for architectural design. Used MS Project 2010 for entire project life.
• As the company has group members around the US and the world, specially the auto manufacturing employees, I worked on Inter-Plan Teleprocessing Services ITS , BlueCard Program, BlueExchange type of transactions for my social security randomization project.
• Followed a structured approach to organize requirements into logical groupings of essential business processes, business rules, information needs and insured that critical requirements are not missed
• Coordinated activities between business unit and technical staff, developed new methods, policies, and procedures to meet the business needs.
• Analyzed and translated business requirements into system specifications utilizing UML and RUP methodology.
• Prepared Functional Design Specifications FRS employing Use case scenarios, sequence diagrams, DFDs and class diagrams.
• Identified and clearly defined functional issues and supported IT development staff throughout the design, development, unit testing, and implementation phases of the software development life cycle.
• Documented the Requirement Traceability Matrix for tracing the Test Cases and requirements.
• Documented and assisted the QA Team with the Test Plan.
• Developed Data Conversion Strategy using ETL functions for converting data from the existing site to the new site.
• Assisted Project Manager to complete the project approval process.

Confidential

Business Analyst

Hardware/Software:

ARC Memo Manager, Amadeus Ticket Quota System TQS , sabre software, Lotus Notes, Oracle SCM, QuickBooks Accounting Software, Project Management, and Microsoft Office package.

Responsibilities:

• Followed a systematic approach to eliciting, organizing, and documenting requirements of the system.
• Reviewed the Business Requirement Documents BRD with the cross functional team to analyze the High Level Requirements.
• Interacted with client and the Technical Team for requirement gathering and translation of Business Requirement to Technical specifications. For reporting, worked on web server IIS Internet Information Services 6.0 to create, edit, delete and move files and directories, and share documents. Also, worked on SSRS Microsoft SQL Server Reporting System 2008 R2 to accelerate and well management of reporting services.
• Developed process flow depicting business activities, and performance metrics.
• Conducted interviews, meetings and JAD sessions with financial advisors during the Requirement Gathering process.
• Planned and documented procedures for data processing and prepared data flow diagrams for the application.
• Responsible for chargeback debit memo department, Investigates cause of debit memos and handled relevant correspondence to the airlines, hotels, car renting companies, banks, credit card companies, customers and other line agencies for settlement of the chargebacks. Also worked on Audit and Support activities to complete the project.
• Used different software e.g. ARC Manager software for electronically process and settle memos, Sabre Online-- unique workflow application, and Amadeus leading transaction processor, to analyze the company's outstanding debit memos and possible recovery.
• Worked for information gathering, analyzing the information gathered, and documenting as of functional or business requirements. And used various research techniques, financial and accounting tools and techniques to find out the current market position as well as the future predictions.
• Used in proper way of 'HRMS by Sage' software for personnel management
• Provided input scope, goals, risks, constraints, timelines and interfaces to PM for project planning and control.
• Involved in various business operations and helped the organization to achieve cost-effective services with increased quality, efficiency and satisfied customer service.
• Successfully utilized project management software to increase recovery rate. Developed various short term recovery projects and implemented.
• Performed User Acceptance testing and documented results.
• Trained customer team on new processes and operational procedures

Confidential

Business System Analyst

Hardware/Software:

Medicare Software, ezclaim, Oracle, FACETS, Medicaid, HIPAA-compliant patient information management and billing system and Microsoft Office package, Metadata, Data Warehouse, SQL,

Responsibilities:

• Developed the prototype for PDA application Rehab without walls for interfacing with billing and invoice application
• Worked under the Governmental compliances like HL7, EDI, PHI, and HIPAA standard.
• Worked on 'FACETS Healthcare Solution' to make the organization efficient in responding quickly and effectively to the change around the healthcare market.
• Developed Templates to gather the requirements for applications to be added in SATS
• Worked on Medicare, Medicaid, including compliances like HL7, HIPAA, EDI Transactions 270/271 Benefit Inquiry- Eligibility, 276/277 Status Request- 834 enrollment, 835 Payment/Advice and more , PHI, ICD 9 and many other compliances.
• Followed a structured approach to organize requirements into logical groupings of essential business processes, business rules, information needs and insured that critical requirements are not missed
• Involved in planning, execution, coordination of entire testing QA life cycle
• Developed strategies for Test Planning, Test Case Designing, Test Scheduling, Test Estimation, Test Execution and Defect Tracking
• Assisted the QA team in SIT and Business in UAT

Confidential

• Northern Queens Health Coalition in a NGO categorized under Advocacy Group. It offers: Digestive Health Services, Legacy Health Services, Community care Health Services, St Francis Health Services and Swedish Health Services.
• Worked on internet based Electronic Laboratory Reporting ELR system to record, store, analyze, and communicate patient health data electronically for the purpose of patient care and billing.
• Worked on The McKesson Radiology Manager workflow management software solution to tracks and manage patients, exams and charges to improve the administrative and clinical workflow of radiology activities.
• Built a system to enable seniors, infants and disabled clients in receiving comprehensive health package
• Built a system to resolve common medical insurance issues e.g. Medicare, Medicaid, and other dental, vision, and health plans.

Confidential

Business Analyst

Hardware/Software:

Windows 2000/XP, Rational Requisite Pro, MS Office, Lotus Notes, SQL Server, MS Project, SOX, MS Access, UML, Cognos 8.4, SharePoint, Sales Force.

Responsibilities:

• Analyzed software requirement specification documents. Created processing model diagrams in UML/Visio using the business process information captured in the business context analysis documents.
• Worked on the Disease management system that is able to facilitate for coordination with people's healthcare interventions. Also worked on CEDRIC information system for managing chronic diseases and other clinical tools as well.
• Elicited requirements by employing information-gathering techniques e.g., Interviews, surveys, business process analysis , competitive product analysis, reverse engineering of existing systems, etc.
• Participated in the corporate wide BPR roadmap process to define the To be process based on Design for Six Sigma Methodology.
• Developed functional requirements and a proposed data warehouse strategy for supporting employee compensation and compliance reporting/analytics.
• Involved in defining the scope of the project, gathering business requirements and documenting and managing them using Rational rose and Rational Requisite Pro respectively.
• Presented high level requirements and interaction diagrams using use cases, to user groups, as well as documenting requirements and getting them reviewed and base lining the same.
• Analyze business requirements and segregated them into high level and low level Use Cases, activity diagrams using UML methodology.
• Prepared Business Workflow models that cover How business processes are accomplished.
• Involved in process modeling, reviewing and writing URS and Functional Requirements.
• Participated in periodical Joint Application Development JAD sessions with the management and IT teams.
• Interviewed business experts, asking detailed questions and carefully recording the requirements in a format that can be reviewed and understood by both business and technical communities.
• Utilized Rational Unified Process RUP to configure and develop processes, standards, and procedures.
• Performed UAT and Performance testing on the application.
• Used MS Office extensively Word, Excel, Visio, Power Point, Outlook, Project for analysis, presentation and documentation throughout the project.

Confidential

Business Analyst

Hardware/Software:

Rational Rose, Clear Quest, Microsoft Project, Oracle, UNIX, MS Excel, MS Access.

Responsibilities:

• Responsible for creating and reviewing business requirements, functional specifications, project schedules, documentation and test plans.
• Worked extensively with SMEs in understanding and documenting their requirements pertaining to the Credit Card processes. Worked with all levels of client staff in the process of solution definition.
• Analyzed user problems, including automated and manual business processes, and identified, researched, investigated, defined and documented business processes.
• Designed and developed Use Cases, Use Case Diagrams and Activity Diagrams using UML.
• Co-authored business requirements documents with the business users. Extracted, discussed, and refined business requirements from business users and team members.
• Assisted the project managers with the development of project schedules.
• Involved in documentation during various phases of development life cycle.
• Coordinated activities between business unit and technical staff, developed new methods, policies, and procedures to meet the business needs, as well as acted as primary trainer in educating the business units, related to business applications.
• Performed UAT on business requirements, technical specifications and product knowledge.

Confidential

Business Analyst/Data Analyst

Hardware/Software:

MS Word, Excel, Access, Visio, Load Runner, Rational Requisite Pro, Rational Rose, Rational Clear Case, , ERWin 4.5, UNIX, SQL server, Ab Initio, Business Objects XI R2, ASP .NET, Crystal reports 7.0, Windows XP.

Responsibilities:

• Involved in gathering Business Requirements for new models through JAD sessions, E-mails and Surveys.
• Performed extensive Use Case analysis.
• Performed extensive Business Process Modeling using Swim-Lane diagrams, Sequence diagrams, Workflow diagrams and Activity diagrams using MS Visio.
• Conducted Feasibility Analysis to study the benefits of using the application thro' Data Flow Diagrams and used Trace-ability Matrix to find out the best possible technologies to be used.
• Coordinated with all Allstate agents to gather requirements for the application and managed them using Rational Requisite Pro.
• Involved in Gap Analysis and ROI Analysis of existing policy management system with the Enterprise system.
• Integrated Requisite Pro with Clear Quest and Rose to provide all teams visibility and maintain tractability among requirements, use cases and change requests.
• Coordinated with Quality Analyst to develop test plans and performed UAT.