Professional Summary :

• Over Six years of Experience as a Business Analyst, proficient in developing business processes and system solutions for HealthCare Insurance industry.
• Strong knowledge of the Software Development Life Cycle methodologies like Agile and Waterfall models.
• Experienced with Iterative approach for Software Development as per Rational Unified Process RUP . Involved in inception, elaboration, construction transition phases using rational tools like Requisite Pro, Clear Case and Clear Quest during various phases of RUP.
• Experienced in developing different type of documents like BRD, FRD, File Transfer Specification and different diagrams like Use Case, Flow Chart, Traceability Matrix, Data flow diagram.
• In-Depth Knowledge in facilitating Joint Application Development JAD , Rapid Application Development RAD and Joint Requirement Planning JRP sessions, interviews, workshops and requirement elicitation sessions with end-users, clients, stakeholders and development team
• Expertise in UML class diagrams, object diagrams, GAP Analysis, use case diagrams, state diagrams, sequence diagrams, activity diagrams, and collaboration diagrams as a business analysis methodology for application functionality designs using IBM's Rational Rose.
• Drafted requirement gathering sessions, Feasibility studies, cost/benefit analysis and Impact Analysis in organizing the software requirements in a structured, base lining acceptance criteria
• Importing data from SQL to Excel to perform in depth analysis on the data.
• Extensive experience in Functional, Integration, Regression, User Acceptance UAT , System, Load and Black box testing.
• Worked on healthcare standards such as HIPPA 5010, 4010, ICD-9 and SOAP.
• Performed data mapping and created workflow to load the data from the external source to the Enterprise Data Warehouse.
• Analyzed data flow and business requirements to create High Level Design document.
• Knowledge of system implementation and data processing through SQL. Strong knowledge of databases and data modeling and data mining.
• Experience writing queries in SQL server and SQL developer to retrieve data.
• Highly experienced in implementing Agile Scrum methodology.
• Drafted the guidelines and artifacts of the Rational Unified Process RUP to strategize the implementation of Rational Unified Process, in different iterations and phases of the Software Development Life Cycle
• Experienced in UML, modeling Activity, Use case and Sequence diagrams using tools such as Rational Rose, Microsoft Visio
• Through understanding of Practice Management Systems Patient Registration, Scheduling, Eligibility Verification, Billing, and Claims Scrubbing and EDI exchange.
• Appraised the AS-IS and TO-BE business processes Gap analysis and experienced in converting these requirements into technical specifications for preparing test plans.
• Guided to organize, document and track changes and defects using Rational ClearQuest and JIRA
• Participated in formal review meetings with project teams and developers to report, demonstrate, prioritize and suggest resolution of issues discovered during testing
• Formulating Test Distribution of test effort, documenting the progress and updating team members with the Project Team and Configuration Management Team for build release.
• Experience with health care Systems: FACETS, QNXT, Payer and Medicare Part D and Medicaid systems, Mainframe System.
• Facilitated UAT with the stakeholders and the business users
• Created and documented traceability matrix to help the test team and the analysts trace the requirements during the testing phase.
• Excellent Communication, Presentation and Management skills with experience in conflict resolution, creative problem solving techniques and working in a challenging environment.

Technical Skills:

Professional Experience:

Confidential

Senior Business System Analyst

Confidential is one of the leading healthcare providers in the country. Worked as a Sr. Business Analyst, working closely with project team to identify user's business requirements, interpret complex business needs and translate them into system requirements, write business specifications and forward to technical staff for system integration.

Responsibilities:

• Worked with QA team to test the application quality and perform UAT, conducted root cause analysis for UAT environment.
• Provide the overall coordination and support of all internal Electronic Data Interchange EDI objectives and tasks.
• Helped QA/UAT in developing test cases, test scripts, QTP for Integration testing and logged the defects in and Clear Quest.
• Refined the requirements Use Cases and Business Process Models to detailed level requirement appropriate for technical analysis and system design.
• Involved in claim adjudication process of facets application.
• Worked on developing the business requirements and use cases for Facets batch processes automating the billing entity and commission process.
• Integrated the data from multiple systems mainframe, Oracle, Notes and Access/SQL into a universal sales data warehouse to provide unique enterprise reporting capabilities for the sales organization.
• Experience in business requirements gathering and writing including the EDI transactions from 4010 to 5010.
• Responsible for the Claims Adjudication System Managed Care application training for all departments administration of control files.
• Reviewed and finalized the User Requirement Specification URS , Functional Requirement Specification FRS , Technical Specification, and Detailed Design documents.
• Worked on HL7 to provide framework to carry out transfer of electronic healthcare information.
• Revised the Use Case, Collaboration, Object, Sequence, Activity, and State Diagrams using Rational Rose.
• Conducted requirement gathering sessions to allow different stakeholders to communicate their perspectives with each other, resolve any issues and come to an agreement quickly.
• Involved in testing different interfaces and web application for FACETS.
• Converted User Requirements into Business Requirements, and segregated them into High Level and Low Level business requirements.
• Initiated walkthroughs and interviews with the Subject Matter Experts SME and stakeholders to keep track of user requirements.
• Worked with FACETS Team for HIPAA Claims Validation and Verification Process Pre-Adjudication .
• Involved in Testing by using SQL and developed test Scenarios and test cases. Designing and architecting end-to-end ETL process including data Extraction, Transformation and Loading from source systems using Informatica.
• Conducted functional walkthroughs, User Acceptance Testing UAT sessions, and supervised the development of User Manuals for customers.
• Worked extensively with the end users team in understanding the business rules and writing requirement specs, technical specs and mapping documents from staging to data mart, cubes and reporting needs to the end user community.
• Reviewed EDI companion guides for all payers to ensure compliance, edit integrity and maintain up-to-date list of payer contacts.
• Worked with the client architecture team in defining tools, processes and technologies to be leveraged on the data warehouse.
• Was heavily involved in implementing changes to Data Warehouse.
• Imported data from SQL to Excel to perform in depth analysis.
• Acted as a liaison between the business users and technical teams to enhance the applications based on the business requirements.
• Participated in all the phases in the project management life cycle
• Applied the SQL scripts to the test database and execution of the scripts on the database.
• Created Business Functional Requirement Document BRD and FRD and Physical and Logical Data models for Claims process from legacy system.
• Performed impact analysis by identifying the functional business areas and supporting information technology that will be impacted by the conversion from ICD 9 to ICD 10.
• Performed GAP analysis of 4010 and 5010 EDI transactions using implementation guides to identify the changes in the segment and data elements.
• Facilitated JAD sessions taking into consideration the agenda and meeting minutes with stakeholders to analyze system needs and integrate requirement to develop a consistent navigation structure.
• Conducted JAD sessions with management, vendors, users and other stakeholders for open and pending issues to and pull out stuff from the backlog.
• Work experience in data warehousing projects dealing with ETL extraction, transformation and load tools like Informatica/PLSQL/SQL.
• Assumed DBA roles and responsibilities as needed for DB2 and/or Oracle mainframe and/or client server environments.
• Deal with the EDI transaction 835 claims payments and remittance advice, which deals the payment from payer to provider.
• Analyzed data and created reports using SQL queries for all issued Action Items. Performed the Gap Analysis to find the existing gap between the HIPAA 4010 and HIPAA 5010 EDI transactions.
• Involved in design review and preparation of ETL/Reporting design documents.
• Project management, update and controlling to ensure on time delivery using MS Project.

Environment: Windows NT, MS-Visio, Oracle, DB2, SQL, MS Access, Facets, ETL, UAT, Quality Center, Test Manager, Office, MS Project, Requisite Pro, EDI, HIPAA 5010 and ICD-10, Rational, HL7, HP ALM ClearQuest.

Confidential

Senior Business Systems Analyst

Confidential. is one of the nation's leading operators of general acute care hospitals. Project was to develop online software pharmacy and clinical applications that would cater to client focused initiatives with regard to the HMS applications.

Responsibilities:

• Documented Test plans, Test cases, Test scenarios using Rational Test Manager
• Analyzed Teradata and DB2 Source System and determined the necessary data for the requirement.
• Manage team as part of large scale software implementation project, replacing legacy and Medicaid mainframe based systems with the COTS solution.
• Acted as User Acceptance Testing coordinator and monitored business testing and interfaced with the development team regarding defect status and fixes on a daily basis.
• Developed Test Plans and Test Cases according to Business Requirements
• Used SDLC System Development Life Cycle methodologies like the RUP and the waterfall
• Used Rational Clear Quest to track required changes and Rational Clear Case to maintain different versions of the project documentation Change Management .
• Reverse-engineer several databases, such as research, business, and clinical in order to extract metadata to leverage it for ETL design and reporting.
• Prepared demo on MS SharePoint MS Project Server for various Business to get new approvals like the Therapist and Nursing divisions.
• Analyzing and drafting the system requirements specifications and mappings for the, Claims Flow, Billing and Payment release 2 and EDM related projects.
• Developed, modified and executed test cases and scripts using QTP for Integration testing.
• Identifying duplicate, redundant and bad patient, billing and claims data across several systems and data layers/databases, updating business process flows, data mappings, and reporting issues through the defect management system MQC
• Working and coordinating with the to Batch operations, reports development and testing staff in rectifying production problems leading to successful resolutions of critical and priority tickets
• Performed Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data
• Conducting user interviews, gathering requirements by JAD and RAD sessions, analyzing the requirements using Rational Rose requisite pro.
• Created job schedules to automate the ETL process.
• Was involved in Functional System Testing, Integration Testing, Regression Testing, and User Acceptance Testing before releasing the application.
• Responsible for co-ordinating integration of HIPAA, Medicaid solutions.
• Charted out project plan with project manager and ensured the compliance of EDI transactions.
• Assisted in prioritizing, scheduling and categorizing tasks to continuously track work progress.
• Documented the Traceability Matrix for tracing the test cases and requirements related to them.
• Performed Unit Testing and User Acceptance testing and documented detailed results.
• Provided input scope, goals, risks, constraints, timelines and interfaces to PM for project planning and control
• Used Rational Rose to model the process using UML to create behavioural and structural diagrams
• Created Use Cases / Activity Diagrams, Sequence Diagrams, and Collaboration Diagrams thus defining the Data Process Model and Business Process Model.
• Created a well developed system for the FACETS to adjudicate the new ICD codes in claim processing.
• Responsible for attaining HIPAA EDI validation from Medicare, Medicaid and other payers of government carriers.
• Worked closely with the developers to make necessary changes in the FACETS GUI for the adaptation of new ICD codes in Membership, Provider, Claim modules.
• Developed business process models in RUP to document existing and future business processes
• Performed Project Management activities and acted as a Technical Resource from a system requirement standpoint, to both business users and the technical team.
• Staged projects and document types, requirement types, requirement attributes, enabling email for discussion groups in RequisitePro.

Environment: RUP, Mercury Quality Center, Db2, EDI, Facets, QTP, UAT, SQL, Unified Modeling language, Microsoft Visio, MS SQL Server, Business Objects.

Confidential

Systems Analyst

Confidential is an Confidential diversified global insurer and the third-largest property and casualty insurer in the Confidential. Passenger automobile, homeowners, life, annuity, and other property and casualty insurance products are available via Confidential.

Responsibilities:

• Exhaustive management and documentation of project requirements, leading to cost-effective delivery of the business application.
• Work closely with production underwriters to review commercial property insurance renewal and new business opportunities to ensure proper risk identification, analysis and assessment and the development of a profitable portfolio of business.
• Understand the existing system processes and worked with business process people to develop the mobile application for Property and Casualty Insurance claims system.
• Implemented the Rational Unified Process of Software development with active involvement in defining the iterations through the entire process.
• Documented Software System Requirements SSR and BPR.
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, and OOD object oriented development using UML.
• Assumed ownership of Use Case Diagrams, Use Case narratives and other various artifacts.
• Facilitated JAD Joint Application Development sessions to identify business rules and requirements and then documented them.
• Interfaced with business users to prepare and update Business Process Requirements BPR and Software System Requirements SSR . Created test cases and test scripts.
• Participated in designing walk-through with SMEs to baseline the business architecture.
• Used MS Visio to carry out the business modeling, data modeling, and object modeling effort to develop the business architecture for the application for rapid and controlled Application development.
• Played a substantial role in the process definitions and business and functional requirements gathering, in an effort to develop a practical technology solution for automating sales methodology.
• Acted as a liaison between stakeholders: system users, clients and managers, who have a business problem, and software development team to gather requirements.
• Implemented and monitored Individual Development Plans focusing on total performance, including both quality and productivity.
• Documented the errors using ClearQuest and tracked them to completion by communicating and co-coordinating with the development as well as the support group.
• Created UML diagrams Use Cases Diagrams, Activity Diagrams, State Chart Diagrams, Sequence Diagrams thus defining the Business Process Model.
• Responsible for collecting and analyzing the test metrics and then submitting the reports, which kept track of the status and progress of the testing effort.

Environment: SQL, Quality Center , Unified Modeling language, Microsoft Visio, MS SQL Server, SSR, UAT, Business Objects.

Confidential

System Analyst

Emergency medical services EMS offers an array of healthcare related services to consumers, hospitals, healthcare systems, health plans and local, state and national government entities. EMS provides medical benefit plans, dental coverage, behavioral health coverage, pharmacy benefits and products and services that integrate and analyze information to support consumerism and health advocacy.

Responsibilities:

• Elicited requirements and designed functionalities for case management, claims processing and medical billing.
• Extensively involved in Data Warehousing Environment and tools such as Informatica for Business Analysis
• Conducted detailed walkthrough of business requirements and functional requirements with Business users, Development and QA Team.
• Translated Business Requirements and user expectations into detailed specifications employing Unified Modeling Language UML , MS Visio.
• Enrolled the Medicare recipients in the Facets, Migrate the Existing Medicare members from Mainframe to Facets in Enrollment Batches.
• Provide 3rd level application support for our EMR, Pharmacy, Time Keeping Ultipro software to our helpdesk.
• Worked on Facets Membership module to and validated the database with the Medicare patients.
• Used Rational Tools for creating use cases, version control and defect tracking, monitoring. Use Rational Unified Process RUP methodology in all areas of the software development life cycle SDLC .
• Performed GAP analysis for requirements and used them to draft detailed system specification requirements.
• Drafted various documents such as Use Cases and Activity Diagrams in a format that can be reviewed and understood by both business and technical people.
• Involved in HIPAA/EDI Medical Claims Analysis, Design, Implementation and Documentation.
• Involved in preparing the Test Scenarios for Health Care Claim Payment/Advice.
• Worked with business people to complete sufficient number of recoded medical policies to reflect the ICD-10 based benefits/coverage.
• Successfully conducted JAD sessions, which helped synchronize the different stakeholders on their objectives and helped the developers to have a clear-cut picture of the project.
• Conducted presentations of the Q/A test results with analysis to the stakeholders and users and documented modifications and requirements.
• Used Rational Rose to model the process using UML to create behavioral and structural diagrams.
• Used Rational Clear Quest to track required changes and Rational Clear Case to maintain different versions of the project documentation.
• Generated detailed Data Mapping document which included source and target column names for the process.
• Managed the change request in Rational Clear Quest and analyzed the impact of the change request on the application in regards to Project Plan, Project Scope and Project Schedule.
• Created Test cases and Test strategy for the functional system testing and automated testing.
• Extensive use of SQL to extract data from different data sources.

Environment: Mainframe RUP, Rational Rose, Quality Center, MS Office Tools, UML, MS Visio, Windows XP, SAS, PL SQL, Rational Clear Quest.

Confidential

Junior Business Analyst

Responsibilities:

• Implemented RUP methodology of SDLC throughout the project.
• Coordinated cross functional task forces to remove impediments.
• Designed and created a database of all the remitter and their means using a SQL
• Identify, gather, analyze, prioritize, and document all the system specific requirements
• Interfaced with Quality Analyst to ensure unit testing, integration testing, system testing, and user acceptance testing.
• GAP Analysis to figure out what we have and what we ought to have to be at better-off.
• Created a use case using UML.
• Performed a Change Management Role to make software compatible with different means.
• Conducted JAD sessions with stakeholders and business users.
• Implemented knowledge of ERP.
• Interact with the developers and involved in walkthrough meetings with them
• Responsible for weekly status reports.

Environment: Microsoft Office, MS Visio, SQL, JAD, UML, HTML, Oracle, XML RUP.