Summary

• Over seven years of experience as a Business Systems Analyst/System Analyst in Health Care and Insurance industry.
• Broad domain exposure in the areas of EDI, HIPAA Testing privacy with multiple transactions related to claims, payments, registration etc and extensive knowledge in Medical Management Information Systems MMIS and National Provider Identification.
• Well Familiar with current industry standards, such as HIPAA, SOX, ISO, Six Sigma, and Capability Maturity Model CMM .
• Extensive knowledge and experience working with CASE TOOLS.
• Strong experience of working with Medicare and Medicaid insurance data, Medicare parts A, B, C D and insurance claims.
• Excellent experience and exposure in gathering Business and Functional Requirements, Business Scope and Vision Document, developing Business Requirement document, Functional specification document, communication plan, Use cases, conducting Gap Analysis and Risk Analysis.
• Extensive experience in UML diagrams Sequence diagrams, Activity diagrams and writing Use Cases, Business process, work flows, process flows using Microsoft Visio.
• Involved in Software development processes using SDLC, RUP and RAD and proficient in applying RUP in all the four phases of development.
• Conducted JAD sessions and interviews. Adept in implementing requirements, creating project status reports and presentations.
• Extensively worked with Enterprise Content Management and Data models and Meta data definitions for content management.
• Good project management skills including business analysis, strategic planning, problem solving and decision making abilities. Can work under pressure, enjoy working with teams and yet flexible to take independent responsibilities.
• Adept in conducting Use Case Analysis, Impact Analysis and Requirements Traceability.
• Strong knowledge of Data Modeling, Data Warehousing and Data Mapping.
• Experience in RDBMS and Data Warehousing experience in design, development, testing, implementation and support of enterprise data warehouse.
• Experience in development of ETL mapping scripts.
• Strong understanding of Data Modeling in data warehouse environment such as star schema and snowflake schema.
• Well versed with ICD9, ICD10, CPT, HIPAA, claim adjustments, claim processing claim review, identifying claims processing problems, their source and providing alternative solutions.
• Developed Test plans, Test cases and Test scenarios to be used in testing based on business requirements, technical specifications and or product knowledge.
• Experience in working with Microsoft Office suite word, excel, Access, Visio, PowerPoint and outlook for documentation, analysis and presentation

Management tools/skills

• Operating Systems: Linux, HP UNIX, Sun Solaris and Windows 2000/XP/Vista
• MS Office Tools: MS Word, MS Excel, MS Access, MS PowerPoint 2003/07, MS SharePoint
• Languages: SQL, PL/SQL, JAVA
• Packages: MS Office, MS Visio, MS Project
• Tools: CVS, Subversion, Rational Rose, HP Quality Center, Win Runner, Load Runner, FileZilla
• Databases: Oracle, MS Access, SQL Server 2000, Sybase
• Methodologies: Rapid Action Development RAD , Joint Application Development JAD ,
• Rational Unified Process RUP , Unified Modeling Language UML , System Development
• Life Cycle SDLC , Waterfall Model.

Professional Experience

Confidential

Sr. Business Systems Analyst

• Brought on-board to be part of the global team responsible for developing fully automated, real-time claims processing system for complete, on-line medication of medical, dental, vision, and disability claims and encounters as per HIPAA 5010/ ICD 10 guidelines.
• In ICD 9 to ICD 10 Enhancement project, the current exhaustive Procedural and Diagnostic code sets are being replaced by a new version complying with Federal mandated ICD 10 standards.

Responsibilities:

• Extensively involved in gathering requirements from clients and created Business Requirement Document BRD and facilitated in creating System Requirement Specifications SRS Document.
• Analyzing Business requirements and segregating them into high level and low level Use cases, Activity diagrams, State chart diagrams using Visio according to UML methodology.
• Applying RUP methodology with its various workflows, artifacts and activities throughout the software development life cycle from Inception to Transition phase.
• Involved in JAD sessions with SMEs and business users to analyze and gather the requirements for UI.
• Responsible to insure that EDI Process is HIPAA Health Insurance Portability and Accountability ACT compliant and worked on ANSI X12 standards.
• Working on EDI transactions: 270, 271, 835, and 837 to identify key data set elements for designated record set.
• Active involvement in daily triage calls discussing blocking issues, defects and troubleshooting if and when required.
• Created Views, Alerts and Custom Lists in SharePoint.
• Developed collaborative, portal, and Content Management solutions using SPS 2003 by analyzing user requirements and processes.
• Expert in understanding the root cause of the defect and overall impact on validation cycle execution.
• Responsible to run specific and customized SQL queries in brokerage data warehouse Production for the business requirement proposes along with Service Oriented Architecture SOA .
• Analyzed 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.
• Acting as the primary liaison between the business stakeholders and technical teams to make communication and development efforts more effective.
• Involved in creating test cases for system testing Development environment , Integration testing, Regression testing and User Acceptance testing.
• Good knowledge of using SQL and PL/SQL to access databases Oracle, Sybase .

Environment: Windows NT/2000, MS SQL Server, Rational Unified Process RUP , UML, Rational Rose Requisite Pro, Mercury Quality Center, Clear Quest, MS Office Tools, MS Outlook.

Confidential

Sr. Business Systems Analyst

As a Business Analyst I was part of a conversion team to bring on new plans, provider, member, claim and group information directly into the Data Warehouse. Routing and tracking of provider contracts, developing documentation for fee schedule policies and procedures, fee file transfers, and trouble-shooting configuration conflicts for more efficient and accurate auto-adjudication of claims Involved in gap analysis and implementation of HIPAA 5010, ICD 10 and Claim Validations. I was involved with drafting the migration plans for the Claims Processing data, implementation of the new ICD-10 codes and HIPAA 5010 guidelines and for mapping everything from business processes and policy changes to communication plans.

Responsibilities:

• Prepared the appropriate documentation BRDs and SRSs to communicate and validate the information.
• Worked closely with a project team for gathering business requirements and interacted with business users to translate business requirements into technical specifications.
• Developed functional specifications and system design specifications per trading partner requests.
• Performs As-Is/Current-State analysis and drafts To-Be/Future-State process based on identified requirements in Visio as process and/or data flows.
• Responsible for management of claims fraud and abuse data analysis. Presented quarterly reports/findings to executive staff.
• Performed as a single point of contact for all extracts member eligibility, provider, product, medical and pharmacy claims in documenting technical requirements, detailed data analysis, data mapping and verification and validation testing.
• Provided comprehensive data selection criteria, and clear data mapping to the development team.
• Demonstrated use of Use Cases, UML, Context diagrams, Swim Lane diagrams, Data Flow DFD diagrams etc.
• Executed the project plan for those areas of the SDLC that span from Planning through Testing.
• Assisted in moving contractual information needed for claims processing from claims software to intranet site to facilitate claims processing.
• Extracted large volume of data feed from different sources, performed transformation and loaded the data into various targets.
• Create data flow diagrams, data mapping from source to stage and stage to target mapping documents indicating the source tables, columns, data types, transformation required and business rules to be applied.
• Implemented CDC Change Data Capture for inserting and updating slowly changing dimension tables in target for maintaining the history data.
• Manage work/time to optimize client interactions. Includes: preparing for sales calls to clients, placing outbound calls to existing clients/prospects, setting and holding regular quarterly meetings with current and prospective clients, gathering and documenting information to ensure compliance requirements are met, facilitation of appropriate business processes and the monitoring of interactions and next step.
• Designed Informatica mapping such as pass through split, Type1, Type2, and used various transformations such as lookups, Aggregation, Ranking Maplets, Connected and Unconnected lookup, SQL Overrides etc.
• Validate ETL mappings and tuned them for better performance and implemented various performance and tuning techniques.
• Created and Maintained Requirement Traceability Matrix RTM , tracking relationships between Requirements, Use Cases and Test Cases using Rational Requisite Pro .
• Worked on Microsoft Dynamics CRM integration with Informatica Cloud
• Worked with HIPAA transactions sets for 4010/ 5010 support in 837I 837P claims data for ICD-10 compliance.
• Gathered requirement documents for transition from ICD-9 to ICD-10
• Audited coverage determinations to ensure Centers for Medicare and Medicaid Services CMS policies and procedures were followed appropriately.
• Performed GAP analysis between areas to flush out requirements and explore opportunities of improvement.
• Host and/or facilitate team meetings for cross dependencies between tracks.
• Identify areas of business process improvement and supported in facilitating which resulted in reduce cycle times by 50 .
• Analyzed different data crosswalks, complicated logic looks up required by different fields for the source to target transformation.
• Perform Unit and Regression Testing, for Configuration updates and changes for all aspects of claims processing and premium billing.
• Provided first-tier production support for all performance management system issues.
• Wrote PL/SQL statement and stored procedures in Oracle for extracting as well as writing data.
• Ensured all documents created followed standards and uploaded into TFS and SharePoint.
• Effectively managed work load on multiple initiatives concurrently, with a very tight timeline.

Environment: HIPAA, Rational Unified Process RUP , UML, EDI, Oracle, Rational Rose, Requisite Pro, Windows XP, HP Quality Center, MS Office Suite 2010 Excel, Word, PowerPoint ,, MS Project, MS Visio, PL/SQL, Query Analyzer, Team Foundation Server, MS SharePoint 2010

Confidential

Sr. Business Systems Analyst

This web-enabled application enables actions like registering new policy holders on the internet directly and incorporating complete details of the customer and their vehicles. It also helps validate all these service operations at the end. American Family Insurance provides a whole range of insurance products to its diverse group of customers in the US. Many of its products have been rated Aa1 by top credit rating agencies such as Moodys.

Responsibilities:

• Involved in gathering Business Level Requirements and reviewed manual testing methods
• Prepared Test plans which includes an introduction, various test strategies, test schedules, QA teams role, test deliverables, etc.
• Identified the data requirements for the application and wrote the data dictionary for insurance products.
• Interacted closely with End users from Underwriting Claims teams and SMEs to understand and gather the business needs and requirements.
• Responsible for strategic direction of the content from individual sites to be migrated on to the Portal.
• Use SQL Loader utility to upload data files into tables, Export and Import Oracle Utilities to move tables between Schemas.
• Integrated Audience based Web Parts, Reminders, SharePoint custom style sheet, Security groups and permissions.
• Assigned to take over a floundering content management project using the Team site architecture and bring it to the point where it could be launched.
• Potential users developed detailed gap requirements to bring the project up to speed including details content data model documentation and application flow.
• Performing data analysis by identifying the different data sources, creating logical data models and establishing relationship between entities.
• Developed complex multilevel workflows that will send email notices to the users and approvers using SharePoint Designer.
• Performed initial manual testing of the application as part of sanity testing Managed the whole testing process using Mercury Interactive Test Management tool Quality Center.
• Used SQL and MS Excel using macros for all Data validation based on the Business Rules.
• Created dummy accounts on our system and verified the account generation process and date integrity
• Created Mapping Documents, Report Mockups and modified existing report mockups as to CMS requirements and finalized for development
• Participated in designing and coding for web forms of the application with ASP.NET. Assisted in building a Business Analysis Process Model using Rational Rose and Visio.
• Created reports using Mercury Interactive Test Director.
• Developed Shell Scripts to automate loading processes.
• Created test cases and scenarios for Unit, Regression, Integration as well as Back-end, GUI and Black box testing.
• Used SQL queries to the integrity of data by querying the database Interacted with the development team to assure that all the defects are addressed in time
• Participated in the team meetings to discuss the issues arising out of testing. Organized meetings to discuss outstanding issues with QA and developers.
• Wrote test scripts for User Acceptance Testing UAT .

Environment: Windows 2000/XP, Microsoft Office SharePoint, DB2, Java/J2EE, Rational Requisite Pro, MS Office, SQL Server, MS Project,

Confidential

Systems Analyst

Objective of the project was to develop Medicaid Management Information System MMIS for State of Washington following HIPAA standards. The web based Health Care Management System is developed using HIPAA guidelines and regulations which keeps track of Healthcare transactions like Eligibility Request/ Response, Request and Response for Claims Status, Prior Authorization, Claims Vision and Claims Payment. This application also keeps record of all transactions, subscriber's medical history and provides data to other State agencies as required.

Responsibilities:

• Performed the requirement analysis, impact analysis and documented the requirements using Rational Requisite Pro.
• Performed UAT and exposure to User Certification Testing UCT and Operational Readiness Testing ORT
• Documented the server farm requirements and requirements related to security within Share Point and using Windows Active Directory.
• Followed a systematic approach to eliciting, organizing, and documenting requirements of the system.
• Reviewed the Joint Requirement Documents JRD with the cross functional team to analyze the High Level Requirements.
• Experience in EDI automated first-pass claim adjudication, requiring thorough understanding of claim processing, both front and backend operations.
• Managed the team of consultants responsible for developing on-demand Medicaid Management System reports.
• Designed the online 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 the UML Unified Modeling Language methodologies.
• Used Query Analyzer, Execution Plan to optimize SQL Queries.
• Interacted with client and the Technical Team for requirement gathering and translation of Business Requirement to Technical specifications.
• Conducted interviews, meetings and JAD sessions during the process of Requirement Gathering.
• Planned and documented procedures for data processing and prepared data flow diagrams for the application.
• Identified/documented data sources and transformation rules required to populate and maintain Data Warehouse Content.
• Analyzed and translated business requirements into system specifications utilizing UML and RUP methodology
• Participated in the development of the Data Modeling methodology to be used in the project.

Environment: Windows 2000/XP, Microsoft Office SharePoint, Cobol, DB2, Cognos, Java/J2EE, HL7, Rational Requisite Pro, MS Office, SQL Server, MS Project, MS FrontPage, MS Access, EDI

Confidential

Business Analyst

Progressive offers the following types of insurance to customers throughout the country: boat/personal watercraft insurance, commercial auto insurance, homeowners insurance, motorcycle insurance, RV insurance and Segway insurance. The project involved streamlining Progressive's Insurance claims-processing system, providing an all-digital workflow and the ability to track performance. The automated web-based system allowed users to remotely monitor repair shop performance, make better use of claims staff and quickly add new functionalities to key systems.

Responsibilities:

• Conducted user interviews and JAD sessions with end users, stake holders and developers to gather functional and non-functional requirements of the system, and creation of user stories
• Involved in developing the business model for expediting the claim settlement process
• Performed document analysis involving creation of Use Cases and Use Case narrations using Microsoft Visio, in order to present the efficiency of the gathered requirements.
• Defined frameworks for the application development and analyzed the areas of improvement
• Highly interacted with the development team and claim settlement experts making sure that the development of the project is meeting the business requirements.
• Involved in the analysis of the functional, technical specifications, data mapping document and conceptual diagrams.
• Effectively documented business requirements for the subrogation scoring functionality which helps the business users in deciding whether to assign the claim to a subrogation specialist
• Identified critical areas of business risk and modified the business process to reduce the same.
• Wrote business requirements specification BRS and functional requirements specification FRS documents as per the business requirements and process flow.
• Used SCRUM methodology in supporting system development cycle.
• Jointly responsible for monitoring the progress of the system development by preparing status reports, charting out schedules, allocating and managing technical and human resources using MS Excel and MS Project
• Conducted daily interaction with both the development team and stake holders
• Analyzed the security implementation of the application with respect to users perspective
• Documented user stories and modeled use case diagrams by utilizing MS Visio
• Prepared test data for the functional test cases.
• Evaluated test results and prepared test summary reports
• Interacted with developers various members of my team to discuss and resolve defects and their priorities
• Performed bug tracking using Clear Quest.

Environment: Windows 2000/XP, Microsoft Office SharePoint, DB2, Java/J2EE, Rational Requisite Pro, MS Office, SQL Server, MS Project,

Confidential

Functional Analyst

Confidential Tata AIG General is a joint venture company, formed by the Tata Group and American International Group, Inc. AIG . Tata AIG General combines the Tata Group's pre-eminent leadership position in India and AIG's global presence as the world's leading international insurance and financial services organization. I entered in this company as a Beginner but after working on an important project I found myself bit improved in context of employee prospective. The focus of the project was to upgrade the existing website to provide a wide range of features like policy value, rider information, billing option, beneficiary information and agent information for current policyholders and new customers. I worked on enhancements of the already available online products of AIG as well as implemented new products like opening accounts online, policy value comparison, etc.

Responsibilities:

• Acted as liaison between Information Systems group and Business User group.
• Conducted business requirements, functional and technical walk-through meetings.
• Met with key business unit stakeholders to gather requirements and needs.
• Coordinated with SME's to gather requirements and document Gaps in functionality.
• Developed written requirements to clearly, define and detail the needs of the business unit. Requirements included screen design and process flow charts.
• Created and updated use cases, use case diagrams and work flows.
• I was Involved in the entire project life cycle from evaluation, installation, development, testing to production of end user reports.
• Defined user and system requirements for existing and proposed system during existing system integration and new system development initiatives.
• Worked with GUI team for designing the screens and assisted in developing mockup screens and prototyping of the user interface and usability testing.
• Designed the System Flow, Data Flow diagrams, using these as the base to obtain requirements and wrote Use Cases.
• Built catalog using Impromptu Administrator and created joins, custom folders for easy access and understanding.
• Assisted the business unit and teammates with resolving production issues.
• Used Flat Files at a very basic level for configuration of data storage.
• Managed Portia report writing for trading and operations business units. Managed import and reconciliation of historical performance data.
• Used MS SharePoint for the purpose of managing documents and for hosting websites which was used to access shared work spaces and documents.
• Experienced in creating training materials, SOP and handling documentation.
• Documented business processes and communicated potential business and systems impact based on analysis of the data.
• Tasked with documenting, storing, and sharing the issues and documentation using Rational Clear Case.
• Created Export Archives to deploy reports and packages from development to test environment.
• Assisted QA Team in designing the Test Cases, and collecting the Test Metrics.
• Documented functional and technical designs and user guides.

Environment: MS Office, MS Visio, MS Project, MS SharePoint, Rational Clear Case, UML, SQL, Rational Rose.