Experience Summary

• Proficient in developing and executing Test Plans / Procedures / Cases / Scripts by performing functional usability, stress testing and ensuring that the project meets the system requirements by performing User Acceptance Test UAT .
• Extensive Knowledge in performing of data analysis, data modeling, data mapping, batch data processing and capable of generating reports using reporting tools such as Crystal Reports.
• Expert in creating UML Diagrams including Use Cases, Activity/State Chart Diagrams, Flow charts, Sequence Diagrams, Collaboration Diagrams, Object Oriented Analysis and Design OOA D and Deployment Diagrams, Data Flow Diagrams using MS Visio Enterprise Architect.
• Good knowledge in project planning, workflow, business process, process flow, user interface, application interface and system integration.
• Over 12 years' experience as a Senior Business Analyst possessing both Health Care Business and Technical knowledge.
• Specialized in Healthcare, Insurance, Risk and Compliance and Document management.
• Comprehensive knowledge of Software Development Life Cycle SDLC , having thorough understanding of various phases like Requirements, Analysis/Design, Development and Testing.
• Good knowledge of Business Analysis methodologies, Iterative and Incremental Software Development Life Cycle SDLC using Rational Unified Process RUP .
• Proficient in gathering business and technical requirements from both formal and informal sessions with SMEs, Business Groups and IT groups for new and re-engineering the existing applications.
• Facilitation of Joint Application Development JAD sessions and interviews, written correspondence, reports, implementation requirements, project status reports, oral presentations, e-mails, etc. to keep executive staff and team members apprised of goals, project status, and resolving issues and conflicts.
• Extensive experience in Gap analysis, SWOT analysis, Risk analysis and Cost/Benefit analysis.
• Excellent writing skills in preparing business requirement documents BRD's , system requirement specifications SRC's , system design specifications SDS's and defining project plans.
• Good working knowledge of Change Request Management CRM using Rational Clear Quest and Defect tracking solutions in the project implementation.
• Expertise in using various tools like MS-Visio for Functional Flow charts, Organizational charts, Business Process diagrams along with MS-Project for project management.
• Strong Experience in Claims Processing and Claims in Medicare and Medicaid.
• Experience in EDI 270,271,835,834,837 transactions.
• Worked on healthcare standards such as HIPPA 4010, 5010, DICOMM, CPT and ICD-9.
• Worked on various Professional billing and Hospital billing products.
• Knowledge on medical necessities, software validation and healthcare compliance auditing.
• Created SQL queries to retrieve the data from database.
• Exposure in educating internal customers on business systems and procedures and working with other analysts and QA team to set priorities and schedules.
• Creative and innovative thinker with excellent communication skills bringing energy, enthusiasm and leadership to problem resolution.
• Detail-oriented with proven ability to work under pressure, and meet deadlines.
• Worked as a mediator between the Off-Shore and On-Shore team.

TECHNICAL SKILLS

Confidential

Professional Experience

Confidential

Senior Business Analyst

• Segmented the BOM module into Billing Payment Processing Collections , EOD Stored Procedures, and Accounting Reporting and conducted separate meetings with different business groups based on their expertise on the subject.
• Created the documentation that assisted in developing interfaces of BOM with existing 3rd party payment processor FDMS as well as collections agency NARS .
• Assisted in creating prototypes for BOM in order to provide screenshots for better visualization of the billing and accounting process flows.
• As a Senior Business Analyst, lead a team of Business Analysts, System Analysts and User Interface Designers and acted as a liaison between business units.
• Involved in the complete SDLC and handled key responsibilities in Project Management.
• Gathered Business Requirements and generated workflows for claims using DOORS, underwriting in coordination with business users and development teams.
• Developed Business Analysis Model that includes entity classes, Use Case Diagrams, sequence diagrams and Object Oriented Analysis and Design OOA D .
• Initiated Use Case Analysis using Unified Modeling Language UML by creating Data Flow diagram, which provided the framework for potential use case deliverables and their inter-relationships, and allow for maximizing software reuse.
• Performed Gap Risk analysis from As-Is and To-Be documents, to evaluate product features for
• Traceability to functional business requirements.
• Analyzed and designed business reprocesses flow diagrams, which impacted various regulations, like HIPAA, Medicare and Medicaid.
• Analyzed and optimized the process, prepared business requirement document and then converted into Functional Specification using Requisite Pro.
• Conducted Joint Application Development JAD process with Stakeholders to analyze deliverables and system constraints.
• Presentation and co-ordination with project stakeholders and executive committee for the approval for the whole application for the development.
• Produced executive reports on assigned project to keep management apprised of project status and scope changes.
• Developed Test Plans, Test Cases for Quality Assurance and developed root-cause analysis reports, ensured proper placement of business controls, re-engineered business processes, implemented performance measures, presented project presentations to executive management, provided user training, and performed a variety of ad-hoc project.
• Worked on various projects that dealt with enrollment, benefits data for various plans like health and pharmacy.
• Assisted in mapping of data from legacy systems and also involved in the process to gather migration legacy system requirements and document them into new system.
• Conducted JAD sessions involving the user community to identify, analyze and formalize requirements and establish working relationships with business functions and solution delivery teams to meet the stake holder and individual needs of the business functions
• Worked extensively within the framework of Rational Unified Process RUP .
• Analyzed comprehensive health claims and membership data received from various vendors like BCBS, UHC, and Aetna based on NASCO system and others systems. Performed data quality checks and analyzed data for inconsistencies. Used data mining applications to generate models and refined rules based on the data analysis.
• Extensive experience working with relational databases and writing/executing SQL scripts.
• Experience with HL-7 interfaces with different hospitals and labs.

Environment: J2EE JSP 1.1 , SQL, Oracle PL/SQL, Rational Unified Process RUP, RequisitePro, Rational Rose, Clear Quest, Clear Case, Business Objects, MS-Office, MS-Project, MS-Visio, File Net P8, MOSS SharePoint 2007 , Windows XP.

Confidential

Senior Business Analyst

Confidential is a part of the Confidential. It provides a wide range of health services including full range of hospitals, home-based care and emergency services. The project with the medical center was in relation to the Medicare population base being HIPAA complaint. This included gathering and documentation of user requirements, analyzing the existing system and performing gap analysis to relate to the target system.

Responsibilities:

• Analysis for making system compliant with HIPAA. Involved in making the Medicare patient profiles being compliant with the HIPAA regulations. Management of patient profile transfer PPT reports created by data team by verifying the associated data.
• Involved in analysis, design, and implementation of the following systems: Control Management Reporting and Security Systems: generation of daily, weekly, and monthly reports of hospital patients' activity. Medical Billing and Collection Systems: generation of daily billing activity based on patient records and establishment of collection protocols. Accounting Systems: Financial Statement generation and analysis according to government standards and protocols.
• Coordinated and conducted system requirements walkthroughs/sessions JRDs/JADs with business Owner/stakeholders/SMEs as well as design/development teams. Worked with business area SMEs/analysts to develop and finalize test plans/scripts/use cases. Analysis of key business requirements and assisted in the development of Business Requirement BRS , Functional Requirement FRS , and System Requirement Specification SRS .
• Working knowledge of Epic Rx /Epic Lab/Epic Care Inpatient/Health Information Management and chart tracking.
• Experience with the use of clinical laboratory information systems within a medium to large clinical laboratory.
• Experience with Epic Resolute Professional and Hospital Billing system.
• Experience in a highly regulated environment healthcare, financial, SOX, HIPPA etc .
• Hands on experience on Mercury Quality Center.
• Member of the patient information reporting project team for analyzing and designing responsible for analyzing and designing a system that would improve reporting of patient data especially with relation to Medicare population.

Environment:EDI ANSI X12/HIPAA, UML, MS Access, MS Office, MS Visio and Rational Suite, J2EE JSP 1.1 , SQL, Oracle PL/SQL, Rational Unified Process RUP, RequisitePro, Rational Rose, Clear Quest, Clear Case, MS-Office, MS-Project, MS-Visio, Windows XP.

Confidential

Business Analyst

Confidential of business position us to serve many types of consumers, including seniors, military members, and self-employed individuals. Humana has received several awards for our products, services, and business practices.

Responsibilities:

• Gathered Business requirements and Interacted with the End users, Designers and Developers, Project Manager and Conducted JAD Sessions to get better understanding of the Business Processes.
• Responsible for creating and reviewing business requirements, functional specifications, project schedules, technical documentation and test plans.
• Involved in requirements discussions with business units, ensuring all business requirements were satisfactorily met accordingly to the user requirements.
• Gathered user/business requirements by meeting with business users and generated business models and use case analysis. Considered HIPAA rules while data validation and testing.
• Exposure to HIPAA Compliance requirements and HL-7 standards.
• Facilitated requirements meeting, group discussions with business users and subject matter experts SME to elicit requirements
• Interfaced with internal clients and technical vendors on new feature requirements and conducted a thorough analysis of the system features to assist project team with implementation of new features according to HIPPA Rules.
• Created several materialized views for reporting purpose and better performance.
• Assisted project managers with the development of project schedules and manage scope using MS Project and Excel.
• Responsible for creating UML modeling plans, Use cases, process flows, Wire Frames and business requirements documentation using Define IT, Visio, CaliberRM and Star Team.
• Analyzed and modeled the system using Data flow Diagrams, Functional Diagram and Process Diagram.
• Contracted with the HCFA Health Care Financing Administration / Medicare Centers and Medicaid Services to provide quick, easy, and affordable access to the health care service of their choice.
• Claims such as commercial, Medicaid reinsurance and Medicare are prepared and reviewed.
• Responsible for installing claims system for clients that related to professional, re-insurance, global claims etc.
• Reviewed and processed medical health claims for Self Insured Groups including verification of coverage and adjudication of claims.
• Examined reports and similar insurance claims or precedents to determine extent of insurance coverage.
• Developed risk assessments, generate recommendations for process improvements, prepare written reports, and written/oral presentations.
• Designed the performance testing environment for SQL Reporting Services SSRS using the SQL Tracer.
• Systems Documentation included Business Requirements Document BRD , Functional Requirements Document FRD and test plans using CaliberRM.

Environment:Java,J2EE,PL/SQL, Rational Unified Process RUP , FACETS, Caliber RM, MS Project, MS Visio, MS Word, MS Excel, Test Director, Business Objects, Microsoft Reporting Services, Windows NT/2000.

Confidential

Business Analyst

Confidential is one of the oldest banks in the Confidential, which is well known for its global financial services. It is a global leader in providing a comprehensive array of services that enable institutions and individuals to manage and service their financial assets in more than 100 markets worldwide.

Responsibilities:

• Assist with user testing of systems User Acceptance Testing , developing and maintaining quality procedures, and ensuring that appropriate documentation is in place
• Performed SQL query on databases using SQL server
• Interacted with Business Users to gather requirements with different Elicitation Techniques and documented those requirements
• Worked throughout whole SDLC process from requirement analysis till deployment
• Facilitated the Customer in defining the high-level Functional Requirements
• Conducted meetings and JAD sessions with Business Process Owners, SME Subject Matter Experts and Marketing Team for Requirement gathering in Definition Stage
• Prioritized user requirements using MS Project in order to save time, manage and organize
• Gathered requirements, developed process models using BPMN, and modified the business requirement document
• Revised and updated the technical feasibility report to ensure that it matches functional requirement specifications
• Created use cases, activity, class diagrams and workflow process diagrams using MS Visio
• Experienced with the planning and estimation of the project effort and coordinated with PM with the development of project plans and timelines using MS Project
• Utilized MS FrontPage in developing prototypes of web pages
• Performed Risk Assessment with the Project manager and developed risk assessment report
• Performed software testing of the application using automated tools such as Win Runner
• Participated in weekly meeting and discussed modification request with management team
• Interacted with the developers to report and track bugs using Test Director

Environment: Windows XP, SharePoint, WPF, Win Runner 7.0, MS Project, HTML, MS PowerPoint, Oracle9i, MS FrontPage, Quick Test Pro, MS Word, .NET, Crystal Reports, SQL Server Oracle Financial App and Rational Requisite Pro.

Confidential

Business Analyst

Confidential is one of the nation's largest bank-based financial services companies, with assets of approximately 90 billion. Sun companies provide investment management, retail and commercial banking, consumer finance, investment banking products and customer services. The company's businesses deliver their products and services through branches and offices a network of 1,547 ATMs.

Responsibilities:

• Interacted with the stakeholders to get a better understanding of client business processes and gather business requirements
• Planned and managed the execution of project deliverables and developed the related project artifacts
• Performed extensive requirement analysis including Data analysis and Gap analysis
• Prepared Business requirement document BRD and Functional requirement document FRD as well as high-level project plan and managed all the requirements in Requisite Pro
• Identified Use cases from the requirements and wrote Use Case Specifications
• Created business process workflow diagrams Sequence, Collaboration, Activity diagrams using Rational Rose and BPMN
• Maintained traceability among requirements, use cases and change requests
• Designed and developed all Use Cases and UML models using MS Visio
• Utilized a variety of reporting tools such as SQL and ACCESS for querying underlying database tables and resolve data issues
• Implemented basic SQL queries for QA testing and report/data validation
• Facilitated User Acceptance testing UAT , SMOKE/MONKEY testing and AD-HOC testing developed test plans using Rational Tools
• Ensured that all Artifacts are in compliance with all standards and guidelines
• Coordinated and prioritized outstanding defects and enhancement/system requests based on business requirements, allowing sufficient time frame to ensure accuracy and consider deadlines
• Monitored client expectations and conducted user interviews

Environment:.Net,Sharepoint,WPF,SQL Server,Oracle,Clear Case,Clear Quest,UML,MS Office,Oracle Reports,Oracle Financial App,MS Visio,MS Office,Windows XP.

Confidential

Business Systems Analyst

Description: Confidential, which provides the quality level of Health services for customers. The web site and the supporting system are developed to provide online insurance services to their customers and Agents. The insurance Application involves quotation tool and also enables the customer to complete the transaction after selecting the insurance plan, pricing, location details etc. Also agents are allowed to quote or complete the application online on behalf of the customer. This includes Health insurance, Policy and Claim Service modules. Health insurance claims automation was the module I focused on. The existing mainframe based batch processes were gradually replaced with distributed processes

Responsibilities:

• Met with client groups to determine requirements and goals. Utilized Rational Unified Process RUP to configure and develop process, standards, and procedures and create a Business requirement Document.
• Responsible for preparing Software Requirement Specification SRS and documenting.
• Created Process Work flows, Functional Specifications documents and documented system requirements.
• Provide implementation assessment, strategy, and mentoring services for Rational Rose, UML and RUP.
• Interacted with various cross-functional teams on building business use cases, and understanding expenses and revenue stream.
• Interaction with the developers to report and correct bugs.
• Followed a structured approach to organize requirements into logical groupings of essential business processes, business rules, and information needs. Ensured that critical requirements are not missed.
• Aided management in standardizing web applications by preparing GUI standards and recommending alternatives for incorporation in a phased, iterative manner.
• Interacted with client and the Technical Team for requirement gathering and translation of Business Requirement to Technical specifications.
• Analysis of new Business Requirements and preparation of the Functional Design Specifications.
• Interacted with clients like SPF Securities to finalize their website look and contents.
• Analysis of the new requests specified by the end users for the future releases and discussion with the functional and technical teams.
• Communicated changes to requirements promptly and precisely to all personnel involved.
• Identified and clearly defined functional issues and support IT development staff throughout the design, development, unit testing, and implementation phases of the software development life cycle.

Environment: J2EE JSP 1.1 , EJB 2.0 , Servlets 2.2, JMS, Java2 JDK 1.3 , STRUTS,JDBC2.0, XML, XSL, XSLT, Rational Rose, PL/SQL, HTML, CSS, JavaScript, Websphere4.0,Oracle 8.0, Web Sphere Studio Application Developer v5.0, Win2000, Unix.x