Summary

• A top-performing Business Analyst credited with extensive hand-on experience in Business management role, Healthcare Sectors, Insurance Processes, and Software Development Life Cycle methodologies. Proven ability to develop Business Requirement Documents, Functional Requirement Documentation and Software Requirement Specification across the deliverables of a project. Expert ability to interpret and manipulate data. Analytical and resourceful problem solver with measurable success in meeting short and long-term business, financial and system requirements. Exceptional communicator and leader within team and individual settings.
• UML Visualization Documentation JAD/JAR Sessions Risk Analysis Security
• Visual Data Models XML/XSD/XSL/XSLT/DOM .Net Development Web Based Applications
• Rational Requisite Pro Project Plan Scheduling ETL Data Management BI Tools
• .Net Remoting/Application Blocks Technical Writing HIPAAStandards Agile/Waterfall
• Transformation Tools QNXT 3.4/4.6 Facets 4.71 Inbound Outbound Interfaces
• EDI Configuration Data Mapping ANSI X12 4010/5010 T-SQL MS Office Lotus Notes
• User Interviews Project Management Development Testing UserAcceptance Testing

PROFESSIONAL EXPERIENCE

Confidential

Business Analyst

Responsibilities:

• Experience in providing the backward compatibility from Facets 4.71.
• Provided technical direction for personnel performing system and software development tasks including the review of products for quality.
• Prepared Data Flow Models for code sets validating in Facets and Claim Process Engine.
• Worked on the MMIS Medicaid Management Information Systems .
• Wrote Use Cases, prepared use case diagrams using Rational Rose UML and followed Agile at every stage of the processes
• Facets Product Configuration of new products and components including research, testing and trouble shooting in FACETs.
• Worked directly with CMS to develop, interpret and implement health care financing policy and affect the disbursement of billions of dollars each year. Among other things, they also analyze Medicare and Medicaid policies, identified the trends in health care utilization, studied about the private health insurance industry, and participate in inspections and program evaluations.
• Mapped all as-is business processes using BPMN standards on MS Visio.
• Followed the CMS rules and regulations in regards to ACA Obama care.
• Was involved in phone meetings once a week with CMS to coordinate the Heath exchange information.
• Facets Product Configuration of new products and components including research, testing and trouble shooting in FACETs.
• Used Facets 4.71 to receive, store and send HIPAA-standard transactions 835, 837, 270, 271, 276, 277 and to administer HIPAA privacy rights
• Helped with building the test scripts and reviewed the data extracts coming from five different customers.
• Heavily involved in analyzing data by using Ultra Edit, TFS for error report, SQL server R2, 2008 for running queries for data output.

Confidential

Business System Analyst

Environment: Windows XP, SQL Plus, Oracle 9i, TOAD, Rational ReqPro, MS Office, SQL Navigator, Business Objects

• Converted the business ideas into technology system changes
• Worked offered their VOIP and telecom products to different telecom companies.
• Negotiated with telecom companies that provide phone, internet plans to customers.
• Introduced the BC model understanding technology that rapid increased the sales of the company.
• Provided daily supervision to supporting analysts and technicians as needed to support IT Care Coordination project
• Helped the company in increasing their sales in providing different packages to corporate and individuals.
• Managed and oversight the manufacturing department, and the development team.
• Worked on beating the prices of our competitors by analyzing the trends and doing a SWOT analysis
• Maintaining on-floor stock levels of gift cards and merchandising standards performing resets placing point of purchase POP materials and price signage and collecting and reporting detailed product and stock level information.
• Worked closely with retail associates and managers, informing them of new product releases and promotions. The ability to build relationships and maintain strong partnerships with store personnel is key in achieving the goals of this program.
• Collaborate with business users and within IT
• Work with development team to push changes to completion
• Communicate project updates to peers, business departments, and management
• Applied modern SDLC processes and tools
• Responsible for the timely and accurate invoicing of all customer accounts
• Ensure accuracy through the review and validation of a controlled sample population of invoices on an ongoing basis to identify billing issues/improvements
• Document all billing issues/improvements for resolution/change implementation
• Audit daily bill runs to identify issues coordinate resolution and re-bill requirements to ensure accurate bill creation post resolution
• Communicate billing issues with the technical department s and leadership to ensure timely resolution
• Assist with the development of requirements and prioritization of billing enhancements
• Act as subject matter expert for billing related questions internally
• Ensure the timely processing of all billing transactions
• Monitor and track billing transactions to ensure efficient and accurate processing
• Resolve issues related to the receipt, processing and transmission of transactions
• Recognize, reconcile, and correct mismatched billing data based on, established business rules
• Build internal and external relationships through exceptional problem solving, ownership, and follow-through
• Interacted with the Users for collecting their requirements for report design and formatting. Documented the creation and maintenance of the Business Objects Universe/Reports and Standard Operating Procedures.
• Performing Data Analysis, writing SQL Queries for Testing and Troubleshooting against Data Warehouse. Analyzed user statement of requirements to develop new reports
• Worked on writing functional specification for reporting module that handled credit and consumer risk management services.
• Planned and defined Use Cases created Use Case diagrams, Scenarios and Use Case Narratives.
• Created RTM Requirements traceability matrix mapping Requirements to Design Artifacts to SIT Cases to UAT Cases.
• Created Activity Diagrams, Sequence Diagrams and ER Diagrams in MS VISIO.
• Analyzed Business Requirements, performed gap analysis and segregated them into high level and low level Use Cases, Activity Diagrams/State Diagrams and Class Diagram Documented and maintained requirements traceability matrix to ensure that all requirements are traceable from top to bottom and to provide a basis for test plan
• Maintain documentation related to difficulties, complexities and anomalies that may arise during the ETL process.
• Extensive interactions with the client and the management teams to understand the requirements and report the status of the testing efforts on their applications
• Involved in Configuration Management, Requirement management and analysis
• Creation of reports like, Reports by Agent, Reports by Customer and Reports by Period
• Analyzed reports in Business objects and Web Intelligence using the Universes as the main Data Providers and writing the complex queries.
• Performed report validation writing SQL queries using TOAD on an Oracle database.
• Wrote standard SQL Queries to perform Data Validation.
• Created reports using Features like Master/Detail, Charts, Cross tabs, Slice Dice, Drilletc
• Checked validation of the application against the requirements
• Was involved in writing several test cases for UAT and Unit Testing
• Responsible for weekly status reports

Confidential

Sr. Business Systems Analyst

Achievements:

• Worked on the MMIS Medicaid Management Information Systems
• Produced Gap Analysis documents for HIPAA 5010 and ICD-10.
• Involved in Six Sigma process analysis.
• Worked with FDA guidelines 21CFR and HIPAA.
• Worked directly with CMS to conduct research and test new policies and processes designed to improve program operation.
• Created questionnaires and recourse leveling required for implementing HIPAA 5010 and upgrading ICD-9 diagnosis codes to ICD-10 codes.
• Improved program management and control through the use of MITA data sharing.
• Produced Use Cases, Activity Diagrams, Sequence Diagrams and OOD using UML.
• Used CMS management analyst documents to focus on CMS's internal operations with the goal of improving organizational effectiveness.
• Through the CMS documentation, I was able to deliver their focus of the administrative feasibility and implementation of laws, regulations, and policies to the entire team.
• Also helped in designing information systems institute productivity improvements provided advice on organizational structure and work methods and prevent fraud, waste, and abuse by following CMS regulations.
• Enabled the backwards compatibility from Facets 4.71 to all earlier versions.
• Used Rational Rose to model the process of creating behavioral and structural diagrams.
• Performed frontend configurations for Facet profiles in room type profile configuration builds.
• Mapped all as-is business processes using BPMN standards on MS Visio.
• Created an automation Framework solution to facilitate pricing engines on NetworX Pricer.
• Implemented data access, storage and validation routines using PL/SQL.
• Wrote Use Cases, prepared diagrams and followed Agile at every stage of the process.
• Translated Web Content requirements from business units into wireframe designs.

Confidential

Business Analyst

Achievements:

• Assisted in Win-forms development using .Net
• Contributed to the security model in .Net framework for the administration module using verification processes, Code Access security, and Role-Based security.
• Created current and future state processes, as well as prototype BPM solutions.
• Automated Shell scripts to handle data from operational resources for BI reporting.
• Introduced Agile and RUP methodologies to reflect liquid nature of front-office improving time-to-market.
• Through CMS documentation and attending seminars/meetings , I Monitored and evaluated state Medicaid programs for compliance with Federal regulations. Staff provides advice about the law, regulations, and policy in such issue areas as eligibility, coverage and payment. They also monitor and evaluate the work of organizations that contract with Medicare.
• Confirmed that all the team members strive to ensure compliance with provisions of the contract, the law and Federal regulation of CMS.
• Developed SSIS Packages to transfer data between SQL Server databases and files.
• Implemented Data Modeling standards, including element-naming conventions.
• Designed and developed the Business Objects Universe to suit the standard, analytical and ad-hoc reporting requirements of the Business Objects users.

Confidential

Business Analyst

Achievements:

• Executed UAT, User Certification Testing UCT and Operational Readiness Testing ORT .
• Designed and developed three tier architecture using .Net frameworks with C using MVC.
• Produced and rolled-out Microstrategy Business Intelligence applications.
• Supported coders in the evaluation of CPT and ICD-9 codes.
• Created sample mappings for the conversion of EDI X12 transaction code sets.
• Managed a team of consultants to develop on-demand system reports.
• Wrote BRD, FRD, Use Cases, test scenarios and test cases for testing the functional and non-functional aspects of both ETL and Reporting Jobs.
• Created screens and reports for the Medicaid Online Electronic Claims Submission System.
• Planned and defined system requirements to Wire Frames with Use Case, Use Case Scenario and Use Case Narrative using UML methodologies.
• Used Query Analyzer, Execution Plan to optimize SQL Queries.
• Documented procedures for data processing and prepared data flow diagrams.
• Created Business Requirement Documentation, Functional Requirement Specifications, User Required Specification, and Change Request documentation for system development.
• Identified data sources and transformation rules required to populate and maintain content.

Confidential

Business Analyst

Achievements:

• Extracted,discussedand refined business requirements from users and SME's.
• Developed plans for data feeds and mappings for integration between various systems.
• Drafted detailed developer specs to reflect the technical details of business requirements.
• Performed data analysis using SQL queries through the DB Artisan tool.
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams and OOAD using UML and Business Process Modeling.
• Produced business process models in RUP to document existing and future processes.
• Aided the creation of a SONAR application's Test Planning, Test Scripts, Testing, Defect Reporting and Management.
• Prepared UAT Materials and Test Cases to include proper coverage requirements.
• Delegated tasks to development team and tracked progress using Agile methodology.
• Interacted with users and logged issues from the UAT, supporting the development team.
• Oversaw release cycles from start to production for the RADAR application.
• Supported SONOR and RADAR production, noting any issues for the development team.