SUMMARY

• Over 8 years of diverse experience as Business Analyst with projects focused in the field of Healthcare Medicare, Medicaid and Pharmaceutical based industries and Finance.
• Strong project management skills including planning, scheduling, monitoring and budgeting with experience in gap analysis, risk analysis, effort estimation.
• Hands on experience in eliciting user demands and translating them into data, functional, quality, and usability requirements.
• Experienced in gathering user requirements, analyzing and preparing Project Deliverables such as Business Requirement Document (BRD) and Functional Requirement Document (FRD) and proposed changes for process improvement using Rational Requisite Pro.
• Experienced in Business Processes, Business Process re - engineering, Business Requirements gathering, Process Flows, Process Modeling, Use Case Modeling and Unified Modeling Language (UML) using MS Visio and Rational Rose.
• In depth knowledge of Software Development Life Cycle (SDLC) with Waterfall and Agile methodologies(SCRUM),Rational Unified Process (RUP) in all four phases of a project: Inception, Elaboration, Construction and Transition.
• Experienced on Batch Processing &EDI interfaces in healthcare domain.
• Working knowledge of requirement gathering by conducting personal interviews, developing questionnaire, brainstorming, conducting JAD (Joint Application Development) sessions, or role playing to get a better understanding of client business processes and creating requirements traceability matrix for tracking the requirements.
• Experienced on Health insurance exchange programs during the project and worked with many insurance clients and companies for the billing and claiming issues.
• Worked on various Line of business PPO, HMO, FEP, Medicare and Medicaid (CMS), Health-Insurance Exchange (HIX), Healthcare Claims processing.
• Deep knowledge of Medicare- Medicaid rules, NCPDP, HIPAA, ICD9/ICD10 codes, CPT,EMR, EDI transactions (270/271, 276/277, 820, 834, 837/835)
• Deep knowledge in conversions from HIPAA .

TECHNICAL SKILLS

Methodologies: RUP, Agile, Waterfall,, Six Sigma,, UML, Business Process Modeling and Data Modeling

Office Tools: MS Word, MS Excel, MS PowerPoint, MS Access, MS Project

Process/Modeling tools: MS Visio, Rational Rose, Rational Requisite Pro, Smart Draw, Clear Case, ClearQuest

Database: MS Access, SQL Server 2000, Oracle

Quality Management: HIPAA, Six Sigma, TQM

Operating System: Windows Vista, NT/2000/2003/ XP/98, MS DOS

Languages: C/C++, Java, SQL, PL/SQL, HTML, XML

PROFESSIONAL EXPERIENCE

Confidential, Virginia Beach, Virginia

Business Analyst

Responsibilities:

• Mapping data of EDI 837I & P and Paper claims from EC gateway to excel spread sheet.
• Gap analysis to change EC gateway to Pega
• Followed the HIPAA implementation guides for preparing the EDI files.
• Developed business process models in Agile to document existing and future business processes.
• Created and maintained Business Use cases and System Use cases, Use Case diagrams, Flow Diagrams, Business Flow Diagrams, Activity diagrams, Sequence diagrams throughout the SLC using MS Visio.
• Supporting developers with unit testing and troubleshoot where the issues emerging.
• Using Facets to compare and test the claims Facilitated requirement gathering sessions with the business team to collect the business, security and service level requirements and documented them.
• Performed Gap Analysis to compare all elements of existing "as is" with desired "to be" processes. Reengineered the user interface of the application.
• Thoroughly studied the existing application features and functions and then assessed and analyzed the scope and impact on business needs.
• Extracted, discussed, and refined User and Business Process Requirements from SME’s from Business User Groups. Also, co-authored User and Functional Requirements Documents by interacting with development team.
• Developed business process models in Agile to document existing and future business processes.
• Created and maintained Business Use cases and System Use cases, Use Case diagrams, Flow Diagrams, Business Flow Diagrams, Activity diagrams, Sequence diagrams throughout the SLC using MS Visio.
• Processed EDI 837P, 837I and 837D transactions, verified 837 transactions were converted correctly to XML file format and verified the claims data loaded to Facets for further processing.
• Worked with Medicare part D for drug validation project.
• Drafted thePhysical Data Mapping document for the data flow from Facets to the data warehouse.
• Followed the HIPAA implementation guides for preparing the EDI files.
• Documented various key elements of HIPAA compliance and made sure that they are understood by the development teams. Test cases written for the project were HIPAA complaint.
• Managed the team of consultants responsible for developing on-demand Medicaid Management System reports.
• Prepared Need Analysis Documents of the requirements gathered through JAD sessions and individual elicitation sessions with different IT Group Department Managers and refined the requirements. Conducted user interviews, facilitated Joint Requirement Planning (JRP) to reduce the Scope Creep and document analysis in requirements elicitation.
• Extensively worked on version control, library services, work flow, lifecycle management, security and audit trails using Document.
• Authored progress and completion reports, which were then submitted to project management on a weekly basis. Worked closely with management to keep track of the status of project and draft strategies for the near future. Used MS Project to manage schedules, deadlines, and resources for the project.
• Involved in both Manual and Automated test scripts representing various transactions, documenting the load testing process and methodology at various phases of the PLC.
• Conducted and participated in walkthroughs to discuss certain issues with the development, design team and QA team.
• Prepared test data for positive and negative test scenarios as per application specifications and application requirements, test plans and provided test data for the QA team for testing and also generate reports. System Integration Testing and User Acceptance tests were also carried out.
• Used Rational Clear Quest for defect tracking, facilitating and monitoring the process
• Re-engineering and capturing of EDI transactions with legacy systems Enrollment -834, Eligibility Transaction (270/271).
• Solely responsible for pharmacy operation coordination for HIX project for the states migration. Migration was from Different systems to one system. ( FACETS).

Environment: SQl, oracle, facets, Pega, MS Visio, SharePoint, JIRA,MS Outlook, MS Project, MS Word, MS Excel

Confidential, Tempe, AZ

Sr. Business Analyst

Responsibilities:

• Research and review of custom code developed computer software systems, applications which require use of advanced computational and quantitative methodologies.
• Involved in the compliance and regulatory requirements are met through process review and documentation.
• Ensures functionality as defined in the specification is properly applied to the custom application development.
• Participated in the required product validation activates required to ensure established quality requirements.
• Participates in development of traceability matrices used to ensure project completeness and enforcement of quality requirements.
• Involved in the detail documentation required for regulatory and FDA submission.
• Participated in the execution of testing both of an automated nature and manual execution.

Environment: Windows XP/2000, XML, XSLT, MS Office Suite, C#, C++, Visual Basics, HTML, JavaScript, VB Factory Works, Oracle.

Confidential, St. Petersburg, FL

Business System Analyst

Responsibilities:

• Responsible for gathering and synthesizing business requirements and translated into functional and non-functional requirements to be used as input to the functional design specifications.
• Gathered business requirements through interviews, surveys, prototyping and observing from account managers and User Interface (UI) and Business Process of the existing Insurance Architecture. Conducted brainstorming sessions with project focus groups.
• Studied the existing functions and problems to arrive at cost-effective, sound solutions that can be implemented quickly.
• Authored the Business Requirements Documents (BRD) containing the essential business elements, detailed definitions, and descriptions of the relationships between the actors to analyzed and document business data requirements.
• Analyzed and prioritized Business Process and User Interface (UI) requirements as system requirements that must be included while developing the Application. Created automation profile of the process.
• Planned and defined system requirements to Use Case Scenarios and Use Case Narratives using the UML methodologies and created UML based models: Use Case Diagrams, Activity Diagrams, Sequence Diagrams in MS Visio.
• Involved in testing EDI Transactions 834, 837, 835, 270/271 & 276/277
• Extensive knowledge of Medicaid, Medicare, Procedural and Diagnostic codes, and Claims Process. Also, have worked on FACETS.
• Worked with FACETS Team for HIPAA Claims Validation and Verification Process (Pre-Adjudication).
• Claim validation and Pend/Denied Claims Analysis for the Health plans Medicaid programs.
• Worked with Claims, enrollment, eligibility verification for members and providers, benefits setup, and backend payment cycle in Facets.
• Conducted Project Management activities and acted as a Technical Resource from a system requirement standpoint, to both business users and the technical team.
• Scheduled and conducted JRP sessions with client/user work group (Subject Matter Experts) members to identify requirements, documented them in System Requirement Specification Documents and Identified Priorities
• Involved in analysis of the technical specifications of the current system and the infrastructure needs, performed Gap analysis
• Analyzed the flow diagrams on the application and design test scenarios and test scripts
• Involved in Technical writing of documents for Function and User Requirements Documents, Test Plan, various Test Plans, Test Cases and Test Scripts.
• Performed project planning, project scheduling, and status reporting, cost and time estimation using MS Project.
• Used Visual SourceSafe to make safe alterations to existing code and track changes across users, projects, and time.
• Worked closely with both development and testing teams to improve quality of the application.
• Worked on Black Box and White Box Testing. Experience with QA Methodology and QA Validations to ensure the QA Control.
• Conducted training sessions for the users and also prepared user manuals for better understanding of the designed system for the users.
• Worked as Product Manager in conjunction with marketing team to build strategies and implement them
• Experienced in system study and testing Health Care applications developed on QNXT
• Experienced in setting up contracts and benefits in QNXT

Environment: UML, RUP, MS Office, MS- Visio, Quick Test Pro, Rational Requisite Pro, Rational Clear Quest

Confidential, California

Business System Analyst

Responsibilities:

• Responsible to build enterprise reporting system to support Risk Analysis, Securities and their valuation, Asset Management- risks and returns, Bond Pricing, Financial Derivatives, Strong knowledge of financial statements, cash flow etc, Financing Structures, Capital Management, Portfolio Analysis, Stock Valuation, Amortization, Capital Structures and Budgeting, Value Based management, P& C insurance.
• Created targeted Questionnaires for SMEs (Subject Matter Experts) to gather requirements.
• Conducted requirement workshops among all project stakeholders to verify and validate the business requirements in UI designs.
• Defined program and project goals, objectives, products, services, constraints, assumptions, risks and facilitated processes by working with the project team, sponsor, and stakeholders to baseline the scope of the work and enable development of the plan.
• Implemented the full software development lifecycle phases including requirements gatherings, development and quality assurance.
• Involved in GUI Testing, Unit Testing, System Testing, Integration Testing, Regression Testing.
• Involved in the Preparation and execution of Test Plans, Test cases, Writing Test scripts using Test Director
• Conducted user interviews at both in-house and client locations.
• Monitored and assisted in designing and development ofUse Cases, Activity Diagrams, Sequence Diagrams using UML using MS Visio.
• Conducted Joint Application Development (JAD) sessions as a facilitator and moderator to gather requirement.
• Identified, researched, investigated, analyzed, defined and documented business processes and Use Case Scenarios.
• Performed Gap analysis by identifying existing technologies, documenting the enhancements to meet the end state requirements.
• Assist with user testing of systems (User Acceptance Testing), developing and maintaining quality procedures, and ensuring that appropriate documentation is in place
• Worked with development and testing teams to accomplish timely release objectives.
• Provided superior client interaction to ensure all needs are met.
• Ensured on-time and on-budget performance of the assigned efforts to the mutual satisfaction of the business partners/ sponsors.
• Review or update supply chain practices in accordance with new or changing environmental policies, standards, regulations, or laws.

Environment: MS Visio, Java, ASP, Rational Requisite Pro, MS Project, MS Office Suite, Crystal Reports, Java, PL/SQL, Windows 2000

Confidential, Shelton, CT

Business Analyst

Responsibilities:

• Gathered and analyzed requirements and transformed into Business Requirement Documents (BRD).
• Created detailed functional specification document for each functionality (e.g. New Accounts, Product, Service Policy etc.) for the developers and QA team.
• Created detailed Reports for the Congo’s developers.
• Gathered requirement for P&C insurance.
• Created Data Requirement documents (DRD) containing data elements list and its explanation.
• Managed Requirements using Application Lifecycle Management.
• Designed and developed all User stories and UML models using MS Visio for structuring / modeling the whole project.
• Involved in creating detailed GUI screen mock-ups.
• Participated in periodical Joint Application Development (JAD) sessions with the management and IT teams.
• Utilized Rational Unified Process (RUP) to configure and develop processes, standards, and procedures.
• Developed Sequence Diagrams, Activity Diagrams.
• Used MS Office extensively (Word, Excel, Visio, Power Point, Outlook, Project) for analysis, presentation and documentation throughout the project.
• Involved in the design stages of the Application and participated in the meetings with the Development team and QA team.

Environment: MS Outlook, MS Project, MS Word, MS Excel, MS Visio, Agile Methodology, SOX

Confidential

Business Analyst/Product manager

Responsibilities:

• Expertise and understands the concept of Sales, Marketing.
• Designs Campaigns for promotion of products.
• Played a key role in the planning, testing, and implementing system enhancements and conversions.
• Provided key project inputs by working with users in defining the project and system requirements.
• Reviewed business process and functional requirements.
• Worked on Pharmaceutical data processing for improving database for storing user files.
• Analyzed business needs, created and developed new functionality to meet real time data integration that facilitated decision.
• Worked on Pharma sales targeting issues in Pharma industry.
• Managed the team of consultants responsible for developing on-demand Medicaid Management System reports.
• Worked on Pharmacy benefit management portion and all other claiming issues.
• AnalyzedRequirements andcreated business requirement document (BRD), current business process flow, future business process flow, use case diagrams, and activity diagrams using Microsoft Visio.
• Prepared BRD, crosswalk and traceability matrix.
• Experienced of managing multiple stakeholders across the organization and in QA integration of systems.
• Involved in detailing project mission, data process flow diagrams, and timelines.
• Assisted in process modeling, conducted and participated in JAD sessions with system users, helped with design walkthroughs with stakeholders for base lining architecture.
• Assisted in building a business analysis process model using Requisite Req Proand MS Visio.
• Worked on Siebel CRM to deliver transactional, analytical, and manage all customer-facing operations.

Environment: MS Access, Oracle, SQL & PL/SQL Server, DB2, MS Visio, MS Office Suite, MS Project, C, C++, Java, JSP, HTML, DHTML, Java Servlets, Java Beans, VB,SOX