SUMMARY OF QUALIFICATIONS

• Senior Analyst with 7 years of experience in business process analysis/modeling, business requirements
• gathering, database design and development of Web Based, and Client/Server applications.
• Experience as Business Intelligence/Systems/Data/Business Analyst with expertise in Insurance, Healthcare processes, Business Process Engineering, Systems/ Solutions Engineering, Strategic Planning, and Systems Analysis.
• Proficient in business process modeling, documentation, and testing using Rational Suite Rational Rose,
• RequisitePro, SoDA, ClearQuest, Robot as well as MS Visio and MS Project in combination with UML 2.0
• diagramming techniques.
• In-depth knowledge of creating use case, activity, logical, component and deployment views with rational
• tools to extract business process flows and workflows thereby helping development and quality assurance
• teams in understanding the requirements.
• Experience in Designing, Creating and maintaining the Universes, Business object reports, WEBI reports
• and Domains Security, Universe, Document in Business Objects.
• Results-oriented Joint Application Development JAD Facilitator and meetings coordinator with excellent
• interpersonal skills.
• Excellent knowledge of HIPAA standards, EDI Electronic data interchange Transaction syntax like ANSI
• X12, Implementation and Knowledge of HIPAA code sets, ICD-9, ICD-10 coding and HL7.
• Analytical, methodical, and resourceful approach to problem solving, identifying and documenting root causes and corrective actions
• Performed Gap Analysis to check the compatibility of the existing system infrastructure with the new business requirements
• Expertise in broad range of technologies, including business process tools such as Microsoft Project,
• Primavera, MS Access, MS Visio, technical assessment tools, Data Warehousing concepts and web design
• and development.
• Experience in Change Management Process Identify, Analyze, Evaluate, Plan, Implement, Review and
• Close .
• Strong oral and exceptional written business communication skills
• Hard working, positive thinking, self starter with a strong goal orientation
• Excellent meetings facilitator with excellent inter-personal and conflict resolving skills.
• Proven success as a business analyst through the years, providing a well-balanced understanding of business relationships, business requirements, and technical solutions.

WORK EXPERIENCE

Sr. Business Analyst

Confidential

• Wellpoint aids various government and private owned health care programs in order to make the customers
• more educated, motivated and self-educated. The organization provides various disease management and
• high-risk pregnancy management programs geared for health enhancement. The web based loan application system keeps a record of the customer's medical history and provides them
• with other health related benefits.

Responsibilities:

• Gathered and documented business requirements for existing and future business systems.
• Acted as a liaison between business staff and technical staff to articulate needs, issues and concerns.
• Lead multiple project teams of technical professionals through all phases of the SDLC using technologies
• including Oracle, Erwin, Data Stage, Data Warehousing, Websphere and Cognos.
• Performed testing for Medicare, Medicaid and X-Over claims for Medicaid Management Information System
• MMIS
• Performed extensive data modelling to differentiate between the OLTP and Data Warehouse data models
• Analyzed trading partner specifications and created EDI mapping guidelines.
• Healthcare system implementation including enterprise Electronic Medical Records EMR software.
• The project was to design, develop and implement extensive software changes in TANF Temporary
• Assistance for Needy Families program.
• Created Data Stage jobs to extract, transform and load data into data warehouses from various sources like
• relational databases, application systems, temp tables, flat files etc.
• Designed and developed use cases, activity diagrams, and sequence diagrams using UML.
• Used the DataStage Designer to develop processes for extracting, cleansing, transforms, integrating and
• loading data into data warehouse database.
• Troubleshooted file transmission problems and assisted customers in a call center environment with EDI
• and Medicaid Insurance claim related inquiries explained and enforced guidelines in the X12 Implementation
• guides 837P, 837I, 837D, 270/271 .
• Converted various SQL statements into stored procedures thereby reducing the Number of database
• accesses.
• The goal of this project was to implement TANF Temporary Assistance for Needy Families Loan Program,
• which is a Mainframe-COBOL based application.
• Developed plan for data feeds and data mappings for integration between various systems, including XML,
• to follow ICD 10 Code set and ANSI X12 5010 formats.

Developed estimates, project plans Microsoft project , training material, BI reports using Microstrategy

Used Query Analyzer, Execution Plan to optimize SQL Queries

Ensured that all Lines of Business specifications were consistent in form and function to the Diamond Base

System.

• Worked closely with the Enterprise Data Warehouse team and Business Intelligence Architecture team to
• understand repository objects that support the business requirement and process.
• Ensured that project requirements are properly tracked and documented.
• Used MS-Visio for flow-charting, Use- Case process model and architectural design of the application.
• Assisted in monitoring ancillary data transactions and addressed problems with HL7 messages.
• 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.

Worked in mainframe environment and used SQL to query various reporting databases

Lead Business Intelligence reports development efforts by working closely with Microstrategy, Teradata, and ETL teams.

• Involved in gap analysis and implementation of HIPAA 5010, ICD 10 and Claim Validations.
• Used different ad-hoc analysis, the Reports assist in defining strategy for each customer category. Informatica was used for ETL process and Business Objects 6.5.1 XI R2 are used for Reporting duties.

Responsible for cost estimation and timelines for various BusinessIntelligence reports

• Designed and Developed the Business Objects Universes which suit the standard, analytical and ad-hoc
• reporting requirements of the Business Objects users.
• Environment:
• Microsoft Office 2003 Professional Outlook, Word, Excel, Visio, Access, etc. , Microsoft SharePoint 2003,
• UML, RUP, UAT, db2, Peoplesoft GL, Mercury Test Director, SQL, .NET, Clear Case

Business Analyst

Confidential

• Confidential is assisting US Steel in IT related works which include upgrading several older systems, converting paper
• based applications into web based applications etc.The US Steel has 15 plant allover the country and being
• Business Analyst I m responsible for IT related work of three plants of US Steel.
• Responsibilities:
• Gathering and documenting business requirements for existing and future business systems.
• Acting as a liaison between business staff and technical staff to articulate needs, issues and concerns.
• Creating Business requirement documents and design documents to give better understanding to the
• technical team regarding what is required to be done
• Performing the datamapping of data form older systems to the newer systems
• Used MS-Visio for flow-charting, Use- Case process model and architectural design of the application.
• Analysis of the requirement in case there is anykind of issues related to the improper functioning of the
• software.
• Handling several projects simultaneously and working closesly with technical team through all phases of the SDLC using technologies including Oracle, SQL ,.NET and various other tools.
• Facilitating JAD sessions between business group and technical groups to get better understanding of the
• requirements.

Data Analyst

• Confidential is one of America's leading providers of affordable health
• insurance for the self-employed, individuals and families, as well as small businesses. Project involves
• integrating Market Prominence and the Claims processing System with the data warehouse to support the
• reporting requirements. My duties were included designing the model of ODS to automate and maintain the
• ETL process
• Responsibilities:
• Played key role in System Development Life Cycle Process consisting of: Design and Gap Analysis, Business
• Requirements, Systems Requirements, Test Criteria, and Implementation to have the outputs of project dealt
• with the automation of correspondence directed to Insurance policy owners.
• Led the development of a training program to train users on a custom web application and a Cognos adhoc
• reporting environment.
• Used knowledge of Health Care Information Systems EMR model to develop proposed workflow in MS Visio.
• 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.
• Design, development, implementation and roll-out of Microstrategy Business Intelligence applications
• Conducted Functional Walkthroughs, User Acceptance Testing UAT , and supervised the development of
• User Manuals for customers.
• Extensively involved in data modeling.
• Facilitated mini JAD sessions to assess and refine business, functional and system requirements for TANF,
• Food Stamp and Child Care program enhancements/development
• Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to
• filter data within the Oracle database
• Gathered requirements and modeled the data warehouse and the underlying transactional database
• Perform Gap Analysis of the processes to identify and validate requirements.
• Identified/documented data sources and transformation rules required populating and maintaining data
• warehouse content.
• Extensively used calculations, variables and sorted inputs, drill down, slice and dice, alerts for creating
• business object reports.
• Involved in creating sample mappings for the conversion of EDI X12 transactions code sets version 4010 to
• 5010 and translation of ICD 9 codes into ICD 10 codes
• Generated complex reports using business object XI and web intelligence
• Scheduled business object reports using Broadcast agent
• Involved in the testing phase right from the Unit testing to the User Acceptance testing.
• Used SDLC System Development Life Cycle methodologies like the RUP and the waterfall.
• 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.
• Use Cases and other Process Flow Models were designed using Visio and Rational Rose.

Environment:

RUP, UAT, GAD Gap Analysis Document , Microsoft Office 2003 Professional Outlook, Word, Excel, Visio,

Access , Microsoft SharePoint 2003.

Business Systems Analyst

Confidential

• Responsible for systems and applications start-up of FCHP a hospital-based community health plan payer .
• Responsible for the Claims Adjudication System Managed Care application training for all departments
• administration of control files, formulary, provider demographic, provider payment, enrollee maintenance,
• benefit configuration Claims Systems Processing, fee schedules, capitation schedules, data warehouse, online
• pharmacy over 200 pharmacies claim and benefit troubleshooting, ID cards, and system generated Plan
• correspondence design and maintenance.

Responsibilities:

• Helped in defining Change Management Process for Release Management Team.
• Prepared Business Object / Business Process Models that included modeling of all the activities of business
• from conceptual to procedural level.
• Consulted with healthcare insurance company to develop conversion specifications for other insurance
• Coordination of Benefits including Medicare .
• Developed data conversion programs for membership, claims, and benefit accumulator data - converted
• thirteen corporate acquisitions. Developed data field mappings. Provided programming and support for claims
• processing functions and auto-adjudication.
• Validated the following: 837 Health Care Claims or Encounters , 835 Health Care Claims payment/
• Remittance , 270/271 Eligibility request/Response , 834 Enrollment/Dis-enrollment to a health plan
• Teamed up with both internal and external software development groups to provide functional requirements
• specifications in form of use cases, business process flows, and prototypes and management reporting
• requirements
• Created the business process model using MS Visio for better understanding of the system and presented
• it to Project Manager and other team members for validation.
• Performed the requirement analysis and documented the requirements using Rational Requisite Pro.
• Facilitated mini JAD sessions to assess and refine business, functional and system requirements for TANF,
• Food Stamp and Child Care program enhancements/development
• Assisted the Project Manager to develop both high-level and detailed application architecture to meet user
• requests and business needs.
• Develop and maintain sales reporting using in MS Excel queries, SQL in Teradata, and MS Access.
• Created and segregated SQL views and stored procedures for obtaining meaningful set of data.
• Planned and defined system requirements to Wire Frame with Use Case, Use Case Scenario and Use Case
• Narrative using the UML Unified Modeling Language methodologies.
• Sound understanding of Object Oriented Analysis and Design OOAD and proficient in documentation of
• as-is and To-be business processes.
• Led and conducted JAD sessions for requirements gathering, analysis and design of the system.
• Created context and workflow models, information and business rule models, Use Case and Object Models
• during the analysis using rational tools.
• Designed and developed project document templates based on SDLC methodology
• Established RUP Rational Unified Process methodology and provided assistance in developing Use cases
• and project plans.
• Analyze business requirements and segregated them into Use Case Diagrams, Activity Diagrams, Sequence
• Diagrams
• Documented Requirements for Management Reporting out of Clear Quest using Crystal Reports.
• Environment: Requisite Pro, Rational Rose, Agile, PL/SQL, Oracle, HTML, MS Office, MS Visio, EDI, Rational
• Clear Quest, Rational Clear Case, UML, RUP, Microsoft Excel, Microsoft Word, Microsoft Power Point, Visio.

Business Analyst

Confidential

• Member of team that supports the financial portion of the claim payment System for the state of Texas Medicaid program. Facilitate meetings with state of Texas Medicaid representatives to determine requirements for changes to the financial portion of the claim system that pays over 100 million dollars a week in Medicaid claims.
• Responsibilities:
• Involved in Inception Phase and prepared vision statement and initial data models that contain Business
• Requirement Documents and supporting a document that contains the essential business elements and
• detailed definitions.
• Working with clients to better understand their needs and present solutions using structured SDLC approach.
• Worked closely with the Enterprise Data Warehouse team and Business Intelligence Architecture team to
• understand repository objects that support the business requirement and process.
• Created job schedules to automate the ETL process.
• Accurate processing of Medicare claims using the Diamond system
• Gathered user and business requirements through open-ended discussions, brainstorming sessions and
• role-playing.
• Designed and development of test cases based on functional requirements for Institutional and Professional
• claims for EDI and HIPAA Transactions 837/835, 834, 276/277, 270/271 testing.
• Met with stakeholders to identify requirements to modify Federal TANF reporting system.
• Represent Operations Team as Client Liaison for Medicare Part D Plan
• Troubleshot the designed jobs using the DataStage Debugger.
• Tuned DataStage transformations and jobs to enhance their performance.
• Wrote PL/SQL statement and stored procedures in Oracle for extracting as well as writing data.
• Used the DataStage Director and its run-time engine to schedule running the solution, testing and debugging
• its components, and monitoring the resulting executable versions on an ad hoc or scheduled basis.
• Designed DataStage ETL jobs for extracting data from heterogeneous source systems, transform and finally
• load into the Data Marts.
• Worked with Cognos and micro strategy reporting systems to extract the data for analysis using filters based on the analysis.
• Prepared Demo on SharePoint for various Business to get new approvals like the Therapist and Nursing
• divisions.
• Designed workflows and allocated permissions within SharePoint.
• Wrote detailed specifications for various reports generated using Cognos
• Analyzed data and created class diagrams and ER diagrams for designing databases.
• Performed felid-by-field mapping of interface between parent EMR system and downstream system.
• Developed extensive experience in eligibility and benefits calculation for state, federal and local services
• such as Medicare and Medicaid.
• Planned and defined Use Cases created Use Case diagrams, Scenarios and Use Case Narratives using
• the UML methodologies.
• Responsible for designing and developing universes for development of reports using business object
• designer
• Used Query Analyzer, Execution Plan to optimize SQL Queries.
• Query optimization using SQL Profiler and performance monitors to enhance the performance of database
• servers.
• Converted various SQL statements into stored procedures thereby reducing the Number of database
• accesses since Stored Procedures passes the whole block at one time.
• Created Activity Diagrams, Sequence Diagrams and ER Diagrams.
• Created Mock-up forms in MS word for better visualization and understanding of the software solution.
• Analyzed the test results from QA teams using Performance Studio Analysis to create various scenarios.
• Developed strategies with Quality Assurance group to implement Test Cases in Test manager for User
• Acceptance Testing.