SUMMARY:

• Over 7 years of experience as Business Systems Analyst with focus on business logics, identifying implementation requirements and solutions to business processes based on complex software projects including system development, business process improvement, strategic planning and development of system policy.
• Valuable operational knowledge of Health Insurance Portability and Accountability Act (HIPAA) with updated contents of recent code sets ICD - 10.
• Experience in Medical Claims and Process Documentation, Analysis and Implementation in 835, 837 IPD, 834, 270/271, 276/277, 999/TA1 (X12 Standards) processes of Medical Claims Industry from the Provider/Payer side.
• Proficient understanding of Medicare Part A, Part B, Part C and Part D.
• Extensive knowledge of Medical Management Information Systems (MMIS), and National Provider Identification (NPI).
• Proficient in creating Business Requirement Documents (BRD), Functional Specification Documents (FSD), UAT documents, working with Requirements Traceability Matrices (RTM), Test Scripts and Cases.
• Organized many Joint Application developments (JAD), Joint Requirement Planning sessions (JRP), and Rapid Application Development (RAD) sessions.
• Experienced in creating Data Flow Diagrams (DFD), Use Cases, Class Diagram, Activity Diagrams, Sequence Diagram, and UML Modeling and inRational Rose and MS-Visio.
• Expertise in Software Development Life Cycle (SDLC) including Waterfall, Agile, RAD, SCRUM, RUP methodology.
• Involvement in Content management system (CMS) and Software requirements specification(SRS) implementation by working with end, users, technical staff and vendor.
• Facilitate sessions to analyze workflows, define requirements and Document business processes.
• Experienced in GAP Analysis, Cost Benefit Analysis, facilitating and coordinating JAD sessions, weekly meetings, conference calls and other regular project meetings.
• Experience with collaborating user guidance and training as needed to support operational activities after project implementation while being able to provide regular updates including project accomplishments, issues and next steps.
• Focus in delivery of project Roll outs through white box/ black box testing, user test cases, acceptance testing and full implementation through successful sign-offs.
• Able to handle multiple initiatives, Identify project-related issues, risks and solutions.
• Excellent verbal and written communication, presentation skills and flexible to a wide range of work environments and capable of meeting deadlines.
• Expertise in Data Mining, Data mapping, Data modeling and Data validation documentation.
• Experience implementing IT projects (custom application development and COTS).
• In-depth understanding and experience working with object oriented Relation Database Management System
• (RDBMS), Online Transaction Processing (OLTP), Online Analytical Processing (OLAP) and Data Warehousing concepts.
• Excellent analytical and problem solving skills in designing, developing, and implementing innovative business processes using tools like word, Excel, Access, Power Point and Outlook.
• A committed team player and goal-oriented professional with excellent organizational & analytical skills.

TECHNICAL SKILLS:

Business Skills: Business Process Analysis & Design, Process Improvement and Implementation assessment, Requirement Gathering, Use Case Modeling, JAD/JRP Sessions, Gap Analysis, Impact Analysis.

Methodology: RUP, Agile, Scrum and Waterfall.

Standard and Codes: HIPAA 4010A1/5010, ICD-10, ICD-9, ANSI X12, HL7, CPT, CMS form.

Languages: C, C++, SQL, PL/SQL, HTML and XML.

Management Tools: SharePoint, Requisite Pro, Rational Rose, ClearQuest, MS Visio

Testing Tools: HP Quality Center, TOAD, WinRunner, LoadRunner.

Data Modeling Tools: Informatica.

BI Tools: Cognos 8.4/8.3/8.2/8.1 and Microstrategy

Database: Oracle 10g/9i/8i, DB2, MS SQL Server.

Operating System Tools: UNIX, Windows XP/NT/2000/95, MS-DOS

PROFESSIONAL EXPERIENCE:

Confidential, Washington, DC

Lead Business Systems Analyst/Data Analyst

Responsibilities:

• Developed the following documentations and presented to the SME and BSG team to get signoff prior to moving to the next stages: Business Use Case Diagrams, Business Use Case Activity Diagrams, Business Use Cases, Use Cases, and Use Case Activity diagrams using MS Word, MS Visio and Rational Requisite Pro/SharePoint.
• Facilitating JAD sessions with management, development team to refine functional requirements while managing effective communication and brainstorming sessions using SharePoint.
• Conducted project with SCRUM development methodology to keep up with timeline and scheduled signoffs.
• Worked extensively with SME’s and performed Gap analysis to arrive at the gaps between current and future systems and the modules to be impacted.
• Involved in Healthcare claims - such as 270, 271,837 (P, D, I), 276, 277, 834, 820, 278,999/TA1, and 277 CA.
• Analyzing the impact of ICD-10-CM/PCS coding system and Identified General Equivalence Mappings to facilitate the conversion from ICD-9-CM codes to ICD-10-CM/PCS codes.
• Experience with AR, Payments, Billing Invoicing and collection Tools.
• Involved with SLA (Service level agreements) and KPI (key performance indicators) for current and past business performance to benchmark performance levels and provide indicators to reduce cost and risk.
• Working in conjunction with the project manager, design team to utilize prototypes and structured walkthroughs, developing test cases and test scenarios to ensure that all relevant requirements are properly addressed.
• Involving in design and development of Data Models that support the Business Intelligence Data Warehouse for development of PACER system.
• Involved with Middleware, SOAP and REST Calls.

Environment: HIPAA ANSI X12, SDLC, .Net, CPT and ICD-9 Coding, Rational Rose, SharePoint, Rational Requisite Pro, Microsoft Visio, SAS, Java, MS word, MS Excel, MS outlook, MS Access, XML, HTML EDI, MS SQL Server.

Confidential, Brooklyn, NY

Sr. Business Systems Analyst/Data Analyst

Responsibilities:

• Working with the Business users and tech leads in gathering requirements and data transaction information.
• Participated in user interface, conversion requirement and business requirements from business/user group and documenting User, Business, Functional and Technical requirement specifications using MS Word and MS Visio that provides appropriate scope of work for technical team to develop prototype and overall system.
• Facilitating JAD and JRP sessions with management, development team, users and stakeholders to refine functional requirements.
• Create better team communication and brainstorming sessions using SharePoint.
• Interacting with both business team and development team in coming up with a Sequence diagrams.
• Developing internal algorithms, condition-action tables and decision trees and tables that incorporate member’s personal and medical information.
• Expertise in Healthcare claims - such as 270, 271,837 (P, D, I), 276, 277, 834, 820, 278,999/TA1, and 277 CA.
• Analyzing the impact of ICD-10-CM/PCS coding system and Identified General Equivalence Mappings to facilitate the
• conversion from ICD-9-CM codes to ICD-10-CM/PCS codes to ensure that both the application and Health Record comply with new regulations.
• Extensive knowledge of Medical Management Information Systems (MMIS), and National Provider Identification (NPI), Paid without Prejudice concept.
• Understanding of GL and Knowledge of Domestic and International Tax providing a system with a broad range of federal, state, local and international tax services to meet client needs.
• Using UML to perform Use-Case analysis to capture the dynamic aspect of the application.
• Developing UI document with UI designs and mock-ups through wireframes. Utilized Story boards and screen mock-ups to obtain client feedback and approval. Suggested changes when the user interface was confusing or needed rewording.
• Authoring Companion Guide to support all the information needed to process HIPAA transactions with Confidential .
• Working in conjunction with the project manager, design team and developers to prepare project status reports and presented reports to clients in order for successful project rollout. Utilizing prototypes and structured walkthroughs, developing test cases and test scenarios to ensure that all relevant requirements are properly addressed.
• Involving in design and development of Data Models and Data Marts that support the Business Intelligence Data Warehouse.
• Preparing user acceptance criterion and testing strategy that will be utilized by QA team to validate the addressed
• Functionality of all critical requirements. Developed and maintained Test Matrix and Traceability Matrix.
• Utilized Quality Center to plan and execute and review tests, track defects and create change alerts to sign off on tested components. Conducted User Acceptance Testing (UAT).

Environment: HIPAA ANSI X12, SDLC, .Net, CPT and ICD-9 Coding, Rational Rose, SharePoint, Rational Requisite Pro, Microsoft Visio, SAS, Java, MS word, MS Excel, MS outlook, MS Access, XML, HTML EDI, MS SQL Server.

Confidential, Cranberry Township, PA

Lead Business System Analyst

Responsibilities:

• Interacted with business heads to finalize the Business Requirements for the application.
• Performed the requirement analysis and documented the requirements using Rational Requisite Pro.
• Used the requirement attributes (priority, effort, and risk) as the basis for negotiatingthe inclusion of the requirement, to manage the scope of the system efficiently.
• Involved in creating sample mappings for the conversion ofEDI X12transactions code sets version4010to5010and translation ofICD 9codes intoICD 10codes.
• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims. Worked on EDI transactions: 270, 271, 834, 835, and 837 (P.I.D) to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
• Involved with Diagnosis-related group(DRG) system to update system to identify products provided.
• Experience in Content management system (CMS) and Software requirements specification(SRS) implementation and rollout of updated/ developed system.
• Involved inmentoring specific projects in application of the new SDLC based on the Agile Unified Process, especially from the project management, requirements and architecture perspectives.
• Represent Operations Team as Client Liaison for Medicare PartD Plan.
• Provided clear and concise documentation regarding requirements management plans, Functional requirements, supplemental requirements, test plans and test cases.
• Executed and reviewed test runs to sign off on tested components after conducting certain change requests.
• Conducted Joint Application Development (JAD) sessions with IT groups. Identified the Key Changes, and participated in Stakeholder Management to communicate effectively with them
• Implemented Data Modeling standards, including element-naming conventions.
• Used SDLC (System Development Life Cycle) methodologies like the RUP and the waterfall.
• Understand theAs Is system and develop the To Be system concept and also prepare the System Process Maps.
• Developed extensive experience in eligibility and benefits calculation for state, federal and local services such as Medicare and Medicaid.
• Review requirements and understand technical recommendations and constraints, and develop comprehensive and accurate functional specifications; Data Mapping, and process flows.
• Created and managed project templates, Use Case project templates, requirement types and traceability relationships in Requisite Pro.
• Followed the UML based methods using Microsoft Visio to create:Use Cases Diagrams,Activity Diagrams,State Chart Diagrams,Sequence DiagramsandCollaboration Diagrams.

Environment:Rational Rose and Requisite Pro, MS Visio, MS Office, MS Project, Agile, UML, XML, Windows XP, NT/2000, HTML, Cobol, DB2, SQL Server 2000, JAVA, J2EE, HL7, Vignette Content management Tool.

Confidential

Lead Business System Analyst

Responsibilities:

• Facilitated JAD sessions with management, development team, users and other stakeholders to refine functional requirements.
• Worked on all Medicaid Users transactions involving electronic data interchange.
• Implemented Diagnosis Related Grouper (DRG) payment methodology for system updates on new payment system.
• Gathered the requirements from stakeholders and users by meeting them personally and by interviewing them.
• Used SDLC (System Development Life Cycle) methodologies like the RUP and the waterfall.
• Utilized Rational Requisite Pro to prepare a BRD by complying with the HIPAA regulations.
• Maintained documentation related to difficulties, complexities and anomalies that may arise during the ETL process.
• Gave functional specs to the requirements gathered and communicate it to the developers.
• Developed a use case and UML diagrams using rational rose; depicted clear relations associated between the entities.
• Used design and prototyping tools such as Photoshop and Rational Rose.
• Prepared Work Breakdown Structures (WBS) to comply with the triple constraint: time, cost and scope.
• Defined and planned software releases in accordance with other software applications
• Prepared a roadmap for a product that can exceed market and user expectations.
• Create and implement a test plan and thereby assist Quality Analysts to test the product in a timely manner.
• Interfaced with Quality Analysts for unit, integration, system and User Acceptance Testing.
• Interfaced with top management to ensure that IT initiatives and involvement are clearly communicated and understood.
• Mitigate risks; motivate all the team members to meet the deadlines since time was very limited.
• Developedtest scenariosand implementedtest cases while working with users in defining project and system requirements.
• Reviewed and analyzed the business environment and identical process improvements.
• Evaluated alternative solutions and recommend solution that best meets the need of the business.

Environment: SDLC, SQL, Microsoft Excel, Microsoft Word, MS Visio, MS Project 2000/2003, JAVA, Rational Clear Quest, ETL, Rational Requisite Pro, Axure, Oracle, UML, Lotus Notes.

Confidential, Sunrise, FL

Lead Business System Analyst

Responsibilities:

• Identifiedsystem integration requirements, and coordinated the collection and verification of business needs.
• Collected and documented business processes as well as business rules.
• Participated in the identification, understanding, and documentation of business requirements, including the applications capable of supporting those requirements.
• Translated the business needs into system requirements, communicating with the business on a non-technical level, and with the System Analyst on a more technical level.
• Gained extensive experience with tools such asLombardiandMS Visio.
• Performedgap analysis.
• Documented and deliveredFunctional Specification Documentto the project team.
• Responsible for multiple roles such as requirements gathering and solution development across the full insurance life cycle fromCRM(marketing, sales, service) to underwriting & quoting,policy administration, commissions & broker management, claims, financial reporting and analytics for Property and Casualty division.
• Participated in thelogical and physical design sessions, developeddesign documents.
• Worked extensively withOracleandSQLServer.
• Designed and developed the database for various projects.
• Also helped the business units understand howdata warehousinganddata miningtechniques can help them do their decision making in a more organized and easy manner.
• Helped the developer team understand the needs of the business environment using the programming terminology.
• Collaborated with development architect and the business to develop both high-level and detailed application architecture to meet the business needs.
• Conducted User Acceptance Testing (UAT) with the help ofTest Director.
• Assist the PM in setting realisticproject expectationsand in evaluating the impact of changes on the organization and plans accordingly.
• Developedtest scenariosand implementedtest plan, providing key input in working with users in defining project and system requirements.
• Conductedprojectrelatedpresentations.

Environment: Windows, MS Office, MS Visio, Lombardi, Oracle, SQL, Test Director, UML, MS Project, Rational Requisite Pro, Rational Clear Quest

Confidential, Philadelphia, PA

Business Analyst

Responsibilities:

• Met with client groups to determine requirements and goals. Utilized Rational Unified Process (RUP) to configure and develop process, standards, and procedures and create a Business requirement Document.
• Created new database objects likeTables, Procedures, Functions, Indexes and Views using T-SQLinDevelopment and Productionenvironment forSQL Server 2000.
• Designed and development of test cases based on functional requirements forInstitutionalandProfessionalclaims forEDI and HIPAATransactions837/835, 834, 276/277, 270/271testing.
• Experience in EDI automated first-pass claim adjudication, requiring thorough understanding of claimprocessing, both front and backend operations
• Created Process Work flows, Functional Specifications documents and documented system requirements.
• Performed all necessary programming, testing and documentation for COBOL, DB2 batch programs and sub-routines.
• Conducted interviews, meetings and JAD sessions during the process of Requirement Gathering.
• Extensive involved in Conducting Market Research, Feasibility Studies, Data Analyses, System Analyses, Gap Analyses, and Risks Analyses.
• Develop detailed unit test plans and scripts and conducted rigorous testing per requirements and assisted in data mapping.
• Provide implementation assessment, strategy, and mentoring services for Rational Rose, UML and RUP.
• Interacted with various cross-functional teams on building business use cases and understanding expenses and revenue stream.
• Performed extensive Requirement analysis and developed use cases and work flows.
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams and OOD
• Worked with Quality Control Teams to develop Test Plan and Test Cases.
• Interaction with the developers to report and correct bugs.
• Developed Test Plans and Test Cases according to Business Requirements.
• Use HL7 implementation methodology to create specifications, assist with unit testing, and perform integrated testing for messaging between the state Departments of Health and the location office.

Environment:Servlets 2.2, JMS, Java2 (JDK 1.3), STRUTS,JDBC2.0, DB2, XML, XSL, XSLT, Rational Rose, PL/SQL, HTML, CSS, JavaScript, Cognos, HL7, MS Word, Excel, Access, Project, Visio.

Confidential

Business Analyst

Responsibilities:

• Business Analyst internally representing software clients to technical staff.
• Participated in facilitation of Joint Application Design (JAD) sessions and interviews, written correspondence, reports, implementation requirements, project status reports, oral presentations, e-mails, to keep executive staff and team members apprised of goals, project status, and resolving issues and conflicts.
• Conducted weekly team meetings and prepared weekly Status Reports.
• Analyzed, planned, implemented various aspects of the sales and marketing department.
• Managed the entire marketing department, which included starting up a new division, qualifying and managing leads, product development, territory development, trade shows, evaluating sales performance and some advertising.
• Coded and mapped business processes in order to track all corporate information through various data models. .
• Involved in SWOT analysis of project plan.

Environment: Agile, MS Office Suite, MS Project, UML, Use Case Analysis.