SUMMARY:

• Around 6 years of experience as a Business Analyst with in-depth knowledge in the Health Care and Informatica domain
• Expert Knowledge in SQL and PL/SQL programming for testing database integrity
• Experience with data mapping and data validation
• Skilled in analyzing business processes and maintaining requirements
• Experience in creating a Business Requirements Document BRD and Functional Requirement Document FRD from business users
• Experience conducting Joint Application Development JAD and Rapid Application Development RAD sessions
• Extensive expertise in traditional Software Development Life Cycle SDLC methodology variants such as Agile, Waterfall, Spiral, and Rational Unified Process RUP
• Proficient in executing test cases for User Acceptance Training UAT and performing post deployment verification procedures
• Competent in creating Unified Modeling Language UML diagrams such as Use Case Diagrams and Activity Diagrams
• Experience with ICD 9 ICD 10
• Proficient using HIPAA Transactions and Code Sets
• Experience with Health Information and Health Care Services regulatory environment including EDI, Facets 4.3 and 4.7, and NASCO
• Experience in 834, 835, 270/271, 276/277 837 processes of medical claims
• Good understanding of EDI transaction syntax like ANSI X12, MMIS, and CMS.
• Hands on experience with business functionalities like Medicare, Medicaid, Commercial Claims, Managed Care, AR Reduction, Bulk Billing, Denial Analysis Insurance Specific Trends
• Thrive to meet deadlines, a highly motivated individual with proven ability to lead and motivate high performance teams focused on maximizing productivity
• Ability to manage multiple priorities in a fast paced environment. Strong communication, organizational and interpersonal skills

TECHNICAL SKILLS:

PROFESSIONAL EXPERIENCE:

Confidential

Informatica Systems Analyst

My role at CareFirst was working to support the Data Intelligence and Integrity department for data validation and verification. As an informatica systems analyst I am centered in day to day support as well as part of the Revenue and Fee and Discount Projects supporting the sunset of the EDW database into the EDM.

Responsibilities:

• Using IBM software Initiate Inspector to sort through memberships and validate their Life ID's are unique
• Validating Product Skeys for fields being populated incorrectly in the test environment
• Conducting monthly Sox Audits for Facets, NASCO, and EAB and analyzing and compiling the results through various backend and front-end testing
• Completing the EDM Month End Balancing Process
• Compiling source to target data mapping between the soon to be sunset EDW database to the EDM for various source systems such as FEP, Facets, and NASCO
• Created and maintained Data Dictionary and pursued to reach consensus
• Developed detailed Business Requirements Document BRD to communicate the business needs
• Heavy analysis using Facets to identify voids, total deletes, and Subscriber ID Changes so as to get such memberships reprocessed and identified
• Conducting front-end and back-end testing on NASCO Enrollment Tables
• Running and analyzing TRMS reports to report and see errors and dropouts for memberships across all source systems
• Conducting various UAT testing to support 15.18 and 15.20 revenue and fee and discount projects for Facets and NASCO
• Backend Testing using SQL queries on SQL Server tables and generating reports to ensure data integrity.
• Loading data into SQL and running queries on it to ensure validation
• Analyzing CareFirst cafeteria accounts to filter out members whose ancillary coverage is greater than subscribed

Environment: Oracle SQL Developer, Mainframe, Facets, NASCO, Initiate Inspector, SharePoint, BRD, Windows, Excel, Outlook, PowerPoint and word, MS Office, MS Visio, , UML, Use Case Diagrams.

Confidential

Business Analyst

Confidential website provides health insurance directly to individuals and families. I worked on a project where we teamed with client personnel for project WellPoint group of system WGS . WGS is the Claims Processing system, which receives the claims as input from various sources like the EDI Gateway systems, electronic applications and few other manual entries. The claims are further processed by interacting with the appropriate system in the WGS family like Membership, Provider, Contracts, Plans, Products, etc.

Responsibilities:

• Identified, researched, analyzed and documented business process work flows
• Developed detailed Business Requirements Document BRD , Technical Requirements Document TRD and Use Case documents to effectively communicate the requirements
• Prepared Gap Analysis for the consumer website
• Facilitated highly interactive JAD sessions with project stakeholders, subject matter experts SME , end-users, developers, testers and project management team for identifying and resolving issues
• Performed the gap analysis for the various loop segment elements like ICD 9 and ICD 10 diagnostic codes
• Worked with defect tracking and reporting tools like Rational Clear Quest
• Conducted extensive user interviews to understand medical claim submission and billing procedures
• Extensively used SharePoint to communicate and version control project processes/procedures documentation
• Backend Testing using SQL queries on SQL Server tables and generating reports to ensure data integrity.
• Reviewed test strategy and test plans to ensure that test cases reflects user needs for the functional, user interface UI , usability and security requirements
• Developed test cases and performed User Acceptance Testing UAT
• Conducted extensive user interviews to evaluate the process flow and recommended alternate flows for business process improvement
• Assisted Project Manager in managing requirements by coordinating and facilitating requirement tracking using Requirement Traceability Matrix RTM
• Actively monitored client expectations during all phases of SDLC
• Identified the scenarios based on business requirement and HIPAA compliance for each transaction
• Experience with developing HIPAA Companion Guides for 835 Claim Payment / Advice to support reimbursement processing for health care products and services
• Experience in 834, 835, 270/271, 276/277 837 processes of medical claims/underwriting for support and point of reference for the vendor in business issues
• Experienced in X 12 transactions 835/837/834/271 of medical claims/underwriting for support and point of reference for the vendor in business issues.
• Involved in Medicaid business configuration with focused primarily on claims adjudication, pricing, provider, member, enrollment, prior authorization
• In depth knowledge of Medicare/Medicaid Claims processes from Admin/Provider/Payer side which were later part of the training program to vendors
• Executed the EDI Load Process to verify that Claims are validated as per Business Rules and good claims are successfully loaded for the adjudication
• Responsible for initiating and managing change request from the client by filling Change Control document
• Conducted training for Business and IT team on effectively using Use Cases

Environment: SQL, RTM, SharePoint, Gap Analysis, BRD, Quality Center, Rational Clear Quest, Windows, Excel, Outlook, PowerPoint and word, MS Office, MS Visio, Rational Unified Process, UML, Use Case Diagrams.

Confidential

Business Analyst

The project was about the development of application based on FDA and CFR guidelines, with which the business users can process the application through electronically and process on-line, to have all the providers on the same account to detect the updates and needs of the researchers and development teams at Eisai.

Responsibilities:

• Developed and executed test scripts, test cases, data sets and user procedures
• Created targeted Questionnaires for SMEs to gather requirements.
• Followed Rational Unified Process RUP methodology for creating artifacts.
• Worked with business and technical teams to develop business requirements for implementation
• Provided the primary liaison between business/operations/vendors and development
• Studied and analyzed competitor's applications and brainstormed to gather effective requirements for a quality product.
• Participated in design walk-through with SME's to baseline the business architecture.
• Used Visio to carry out the business modeling and object modeling effort to develop the business architecture for the application for rapid and controlled application development.
• Created Business Requirements and converted them into System Requirement Specifications SRS
• Involved in Requirement Scoping and analyzing high priority requirement for implementation
• Analyzed Requirements and created UML diagrams of Use Cases, Use Case Diagrams, Activity Diagrams using Rational Rose and Microsoft Visio
• Used Rational RequisitePro for managing and configuring the requirement analysis effort
• Wrote PL/SQL statement and stored procedures in Oracle for extracting data.
• Have good understanding of the compliance rules of FDA Guidelines and CFR
• Developed business and system requirements, program functions, best practices GMP, GLP , FDA validation, and 21 CFR Part 11 conditions in a highly regulated environment, for submission of regulatory documents pertaining to drug development
• Familiar with clinical practices, clinical research ethics, ICH guidelines, FDA CFR, pharma codes, and other applicable local regulations
• Created user acceptance testing designs, test procedures and scripts
• Drove UAT testing
• Utilized Microsoft Word, Excel, Microsoft Outlook, Microsoft Visio, Microsoft Access, Lotus Notes, Clarity

Environment: Windows NT, Oracle Database, SQL, MS Office, MS Visio, Rational Rose, WinRunner, LoadRunner, TestDirector, Lotus Notes, Clarity

Confidential

Business Analyst

Worked as a Business Analyst for a project that involved creating the medical claims processing system for Confidential. It consisted of different modules like provider enrollment, member enrollment, programs and coverage. This project also involved the maintenance of claims workstation that automatically handles the entire claims life cycle.

Responsibilities:

• Analyzed Business Requirements and segregated them in to high level and low level Use Cases, Activity, and Sequence using MS Visio according to UML methodology
• Conducted JAD sessions with project's stakeholders such as users, QA's, and project management team to identify and resolve issues
• Involved in analysis of HIPAA compliance and EDI transaction sets and took part in discussions for designing the EDI transactions such as HIPAA 4010 sets 835/837/834/271 and new version of EDI Transaction 5010 of the X12 standard to the use of ICD-10 codes
• Conducted Claims and HIPAA Compliance Training to run the test case
• Designed and developed Use Cases, Activity Diagrams, and Sequence Diagrams using UML
• Manage RTM Requirement Traceability Matrix to track the project flow
• Prepared BRD and derived Functional Requirement Specifications FRS based on User requirement specifications and delivered to the project team
• Articulated business requirements from user interviews and then converted requirements in to technical specifications
• Used MMIS Medicaid Management Information System for electronic processing of claims and retrieving informational data for audit purposes
• Prepared Business Process Models that includes modeling of all the activities of the business from the conceptual to procedural level
• Facilitated User Acceptance Testing UAT with stakeholders and the business users
• Frequently updated the requirements and defect status as per the current status of the Testing project in the ClearQuest
• Used project management and controlling to ensure on time delivery using MS Project
• Participated in Integration Testing and System Testing using WinRunner
• Used guidelines and artifacts of RUP to strategize the implementation of the Rational Unified Process effort in different iterations and phases of the Software Development Life Cycle SDLC
• Documented the Use Cases and prepared the Use Case and Activity Views using MS Visio and Rational Rose for a clear understanding of the requirements by the development team
• Developed timelines for project delivery, and managed projects and resources to successful completion.

Environment: Microsoft Office 2003 Professional Outlook, Word, Excel, Visio, Access, etc. , Microsoft SharePoint 2003,UML, RUP, UAT, db2, Peoplesoft GI, Mercury Test Director, SQL, .NET, Clear Case

Confidential

Jr. Business Analyst

The project-involved enhancement of the current system and encoders used for medical imaging at client locations. The current encoders were not proficient enough in encoding, storing and retrieving images in the current format.

Responsibilities:

• Defining Software Development Lifecycle SDLC and planning the entire process using MS Project
• Defining functional requirements and specifications for use by the development team
• Conducting Joint Application Development JAD sessions for communicating with the all project leads and stakeholders the proposed process workflows
• Creating design document UML diagrams using Microsoft Visio for proposed system
• Identified Use cases from the requirements and wrote Use Case Specifications
• Participated in meetings with Developers, Project Managers and Quality Analysts to discuss business requirements, test planning, resource utilization, and defect tracking.
• Tracking and managing requirement changes.
• Involved in walkthroughs and meetings with development team to discuss related issues.
• Used Rational Rose to visually determine the proper structure, key elements and optimal design for your database and to aid efficient creation of tables, stored procedures.
• Wrote clear, concise detailed System Requirements Specification SRS documents and user documentation in accordance to guidelines and standards of a level where developers can interpret, design and develop the application with minimum guidance
• Verified the functional aspect as per the Business Process and validated the interfaces with the other systems and data conversion from the legacy system
• Involved EDI as methodological base to enhancement of the project
• Performed back-end-testing, performance testing and load testing via navigation and workflow of the application

Environment: SQL, Quality Center, Windows, Excel, Outlook, PowerPoint and word, MS Office, MS Visio, UML, Use Case Diagrams.