Professional Summary

• Over 9 years of Information Technology IT experience as Business System Analyst in Healthcare and Banking and Insurance domains.
• Computer Science graduate with expertise in Business/Requirement analysis.
• Experience in business scope definition, developing functional and technical specifications, creating business and application use case documentation,
• Excellent knowledge of Software Development Life Cycle SDLC while supporting the technical analysis of the requirements as well as software development and testing teams.
• Experience with Database Development including Database Design and Entity-Relationship Modeling as well as Data Maintenance.
• Excellent knowledge of SQL along with hands on experience of Data manipulation, using SQL Navigator, Toad and MS Access.
• Experience with Health Insurance Portability and Accountability Act HIPAA , Medicare Parts A, B, C D.
• Knowledge of Programming languages like Java and C .
• Strong working experience with DIAMOND Claims Processing System.
• Good understanding of ANSI X12 4010 and X12 5010 versions of HIPAA transaction standards including 837, 835, 834, 820, 270, 271, 276, 277, 278 and 997 as well as ICD-9, ICD-10 and CPT code sets.
• Involved in creation of Enterprise Data Warehouse.
• Experience in creation and generation of various Reports using EDW.
• Used Tableau Software to create Dashboard.
• Knowledge of Big Data and Hadoop Ecosystem with experience of Hive Programming.
• Used Datameer for Data Visualization.
• Strong knowledge of User Interface Development while helping in Website Development.
• Excellent knowledge of industry standard methodologies like Iterative Software Development Life Cycle Process as per Rational Unified Process RUP , and Rational Tools such as Rational RequisitePro used during various phases of RUP.
• Experience in implementing Agile and Waterfall Methodologies throughout the Software Development Life Cycle of the project.
• Experience with Unified Modeling Language UML methodologies to design Use Case Diagrams, Data Flow Diagrams, Process Flow Diagrams, Activity Diagrams and ER diagrams
• Excellent communication and presentation skills. Experience working with business users as well as senior management.
• Conducted and led individual and group Joint Application Development JAD/JAR sessions with business stakeholders and technical units.
• Created the Business Requirement Document BRD and System Design Specification SDS from the requirements gathered from stakeholders
• Experience in conducting GAP analysis, User Acceptance Testing UAT , SWOT analysis, Cost benefit analysis and ROI analysis.
• Strong experience in the creation of Test Plan and Test Cases from the Requirements document.
• Experience in developing documentation of the Test Plans, Test Cases, Test Scripts, based on the Design Document and User Requirement Document for the Unit, Integration, Regression, Functional, Performance and User Acceptance Testing.
• Used Quality Center, API Tool with QA team for testing the Application.
• Maintain a Requirements Traceability Matrix RTM to keep the stakeholders informed of the progress of the project.

Technical Experience

Professional Experience

Confidential

Business Data Analyst

• Worked closely with the senior management to understand the business needs, to drive the requirements.
• Responsible for interacting with client business users, project stake holders, and implementation team members to gather requirements and provide recommendations
• Understood the flow of data from e-Client Requirement Document eCRD and e-Clinical Program Management eCPM to RxCLAIM via Benefit Builder and vice versa
• Analyzed all the possible scenarios for mapping Benefit Builder Fields to eCRD and eCPM and vice versa
• Extensive experience performing Data Analysis and developing source to target mapping document
• Created the System Design Documentation, FRS and BRD using MS Word
• Created and updated Use-Cases for multiple subject areas including Accumulations, Restrictions, Rules, Services, Patient Pay, Drug Coverage and Transition Fill.
• Created and updated Mapping Use-Cases for all subject areas given above.
• Extensively used SharePoint for uploading and sharing the mapping documents.
• Conducted extensive Unit Testing of the application using Quality Center
• Gained knowledge of Big Data and Hadoop Ecosystem
• Experience of Hive Programming.
• Used Datameer for Data Visualization.

Environment: Benefit Builder, RxCLAIM, eCRD, eCPM, MS Office Excel, Word, PowerPoint, MS Visio, SQL, SDLC,

Confidential

Senior Business Systems Analyst

Responsibilities

• Worked in Business Intelligence and Reporting team.
• Conducted user interviews, gathered requirements in JAR/JAD sessions with Business team to help create Business Requirement Documentation, using MS Word.
• Created the System Design Documentation, FRS and BRD using MS Word
• Worked extensively with HomeSTAR, NBC and Finance departments of the company.
• Completely responsible for the AR Triangle report developed by the team for Finance Dept. Worked extensively, validated, updated, maintained as well as provided support for the same to Finance Dept during audit.
• Unity Database was the data source for AR Triangle reports. Involved as Business Analyst for all projects where changes to Unity database were made to determine the possible impact on the AR Triangle reports.
• Involved in creation of Enterprise Data Warehouse.
• Attended and conducted Daily meetings.
• Worked closely with ETL Developers and DW Architect to gain in-depth understanding of Data Warehouse.
• Gathered requirements to create various Reports for top management of various Departments for most of the projects for Data Warehouse.
• Responsible for timely delivery of Reports to various departments.
• Created and manipulated various reports for Billing department and HomeSTAR using SQL
• Involved in creation of Dashboard for the Sleep Management Solutions.
• Used Tableau Software for creation of Dashboard.
• Gathered complete requirements and c reated complete BRD and FRS for the above dashboard for both Operational and Financial aspects.
• Gathered requirements to incorporate the Data Mining changes in various reports generated for HomeSTAR.
• Worked closely with SSRS developers.
• Worked as a Project Manager on various Projects for Reports Development.
• Ensured that the application could be upgraded to X12 5010 Standard Code set
• Understood the ICD-9 and ICD-10 differences and upgrades. Worked with ICD-10 team to upgrade the reports involving ICD-10 changes.
• Worked with 837, 835 and 277 files.
• Involved in translating the requirements into a design document after gaining the clear understanding of the requirements. Helped in the preparation of Functional Design document.
• Acted as liaison between the business and application development for better understanding of the project.
• In direct contact with Business on the data flow and system functionality to deliver a quality product.
• Developed project plans and managed project scope.
• Retrieved and manipulated the data in Unit environment using Toad for Oracle and Toad for Data Analysts.
• Worked extensively as Production Support.
• Created Test Plans and Test Strategy for the tests to be conducted for each project.

• Developed Test cases based on Functional Specifications Documented,
• Conducted extensive Manual Testing by retrieving data using SQL queries.

Environment: Toad for Oracle 10.1, Toad for Data Analysts 2.5.1, Unity Database, MS Office Excel, Word, PowerPoint, Access, MS Visio, SQL, SDLC,

Confidential

Business Systems Analyst

Responsibilities

• Conducted user interviews, gathered requirements in JAR/JAD sessions with Business team to help create Business Requirement Documentation, using MS Word and MS Visio.
• Analyzed the requirements using Rational Requisite Pro
• Created Use Case Survey and System Vision using Rational Requisite Pro
• Created and updated Use-Cases using Rational Requisite Pro. Translated the Business Requirements into Use Cases.
• Created the System Design Documentation using MS Word
• Researched and understood the claims adjudication and reimbursement systems based on HIPAA X12 4010 and 5010 standards.
• Ensured that the application could be upgraded to X12 5010 Standard Code set
• Worked extensively with health insurance claims.
• Extensively used DIAMOND Claims Processing System for adjudication and pricing of healthcare insurance claims.
• Understood the Provider Contracts and Pricing of claims as well as the Member Benefits to be applied on the claims
• Used and Worked with Pricing tools such as APT and SSPT Single Source Pricing Tool
• Worked with Accumulators.
• Understood the ICD-9 and ICD-10 differences and upgrades.
• Used API Tool for adjudication of Professional as well as Institutional claims
• Experience working with Medicare Claims processes.
• In depth knowledge of Medicaid Claims processes.
• Involved in translating the requirements into a design document after gaining the clear understanding of the requirements. Helped in the preparation of Functional Design document.
• Retrieved and manipulated the data in Unit environment using SQL Navigator.
• Developed Test cases based on Use cases and Functional Specifications Documented,
• Created Test Plans and Test Strategy for the tests to be conducted for each project.
• Conducted extensive Manual Testing by retrieving data using SQL queries.
• Conducted extensive Unit and Regression Testing of the application using Quality Center, Application Lifecycle Management and API Tool as well as Diamond Claims Processing System.
• Provided extensive support to Business Solutions Quality Assurance Department
• Worked closely with Business Solutions Quality Assurance while testing using EDI. Hands- on experience with EDI testing
• Reviewed and verified testing procedures for compliance to Interface Quality Assurance and Development standards and policies for BSQA

Environment: DIAMOND Claims Processing System. API Tool, Quality Center, Application Lifecycle Management, MS Office Excel, Word, PowerPoint, Access, MS Visio, SQL Navigator 5.5 and 6.4, SQL, SDLC, Rational Unified Process RUP , Rational RequisitePro, ReqWeb, Windows XP., HTML, PHP, XML.

Confidential

Business Analyst

Responsibilities

• Conducted user interviews, gathered requirements to help create Business Requirement Documentation, using MS Word and MS Visio
• Analyzed the requirements using Rational Rose Requisite Pro RUP in Clinical Phases
• Performed Use-Case analysis using UML. Worked on the Flowchart and process diagram along with sequence diagram using Microsoft Visio.
• Researched and understood the claims adjudication and reimbursement systems based on HIPAA X12 4010 and 5010 standards
• Ensured that the application could be upgraded to X12 5010 Standard Code set
• In depth knowledge of Medicare/Medicaid Claims processes.
• Worked with EDI transaction 837 and 835.
• Conducted Claims and HIPAA Compliance Training to run the test cases
• Developed project plans and managed project scope.
• Involved in the Daily Standup Meetings.
• Analyzed Business Requirements, performed gap analysis and segregated them into high level and low level Use Cases, Activity Diagrams using Rational Rose.
• Maintained a good working relationship with departments such as, Research, Clinical Trial, and Regulatory departments and often communicated with them and provided technical support throughout the product development
• Identified and documented issues, risks, gaps and their impact to the project life cycle. Provided recommendations and alternatives.
• Extensively used SQL for Data Manipulation and maintenance.
• Involved in Web Page design.
• Maintained and submitted periodic/monthly status reports to the Program Manager to serve as the team's assessment of the project and its schedule
• Provided key input in working with users in defining project and system requirements.
• Involved in developing Test plan and Test cases based on Use cases and Functional Specifications Documented, reviewed, and verified testing procedures for compliance to Interface Quality Assurance and Development standards and policies

Environment: MS Office Excel, Word, PowerPoint, MS Project, MS Visio, UML, SQL, Oracle, SDLC, Rational Unified Process RUP , Rational Suite RequisitePro, Rational Rose, Windows XP., HTML, PHP, XML.

Confidential

Business Systems Analyst

Responsibilities

• Implemented RUP methodology for iterative and incremental development of the system.
• Involved in planning RUP iterations and preparation of documents throughout the various phases of the development process.
• Assisted in creation of Process Flow, Use Case and Sequence Diagrams using MS Visio during the Analysis Phase of Software Development Life Cycle SDLC .
• Worked closely with the development team to clarify/understand functionality.
• Created Entity-Relationship Diagrams to represent the internal design of the data as well the relationships between various tables using MS Visio.
• Prepared Data Flow Diagrams to represent the flow of data throughout the application to facilitate development process
• Used Rational RequisitePro to organize and categorize the requirements for their functional, usability, reliability and performance.
• Created a detailed Use Case Specification Documents using Rational RequisitePro.
• Helped in various stages of development of this Java-based project for the Web using Java API.
• Involved in the Java Database Connectivity while creating the database and connecting to the frontend.
• Used Cascading Style Sheets CSS for various web pages which did not involve extensive user interaction and consisted of text and other components as images and buttons.
• Helped in the User Interface development keeping in mind the rules of User Interface development
• Involved in Database design and manipulation of Data using SQL while maintaining the Integrity Constraints.
• Ensured that HIPAA guidelines and Privacy rules were never violated during development.
• Understood and explained the functionality of the Medicare Part A, B, C and D, Medicaid and X12 4010 Standard code set.
• Developed the Test Plans and Test Cases for functional specifications.
• Assisted the Testing team for extensively testing the application to ensure complete privacy of the Patients' records and claims as per HIPAA guidelines.
• Coordinated and facilitated user acceptance testing UAT . Reported and documented any issues occurred during UAT.

Environment: MS Visio, SQL, Rational RequisitePro, Rational Rose, MS Office, MS Project 2000, HTML, CSS, Java, JDBC, MySQL, Windows XP, SDLC, Oracle 9i,

Confidential

Business Analyst

Responsibilities

• Analyzed Business Requirements using Use Case, Activity and Sequence Diagrams with Rational Rose
• Derived Functional Requirement Specification based on User Requirements
• Documented the traceability of requirements using Requirement Traceability Matrix in RequisitePro.
• Created Entity Relationship Diagrams to represent the relationship between the different entities represented by Tables used in the Database.
• Involved in Database Design while implementing the Entity and Referential Integrity rules
• Performed the Data Manipulation using SQL and maintained the database.
• Conducted JAD sessions with users, QA Analysts and Project Management Team to identity and resolve issues.
• Involved in performing GAP analysis.
• Involved in SWOT analysis for the company
• Worked with UI team to develop User Interface.
• Involved in Risk-Management Process to identify the critical areas of business risk and modified the business process to reduce the same.
• Helped in feasibility studies and document generation as well as conducting sessions.
• Helped in User Acceptance Testing with stakeholders and business users the errors discovered were fixed and then tested using Regression Testing
• Worked directly with Developers, Project manager and Business Users to develop Test Plans and Test Cases
• Reviewed Test Cases written by Testing Team and modified them for better execution.
• Involved in Training the end users about the working of the new system.

Environment: MS Visio, Rational Rose, RequisitePro, Windows NT/2000 Microsoft Office Project, Excel, Word, PowerPoint , Java, SDLC, Oracle 9i.