Summary

• 7 years of diverse experience in Business Analysis, Quality Assurance QA and Software Development Lifecycle SDLC .
• Extensive knowledge of Object Oriented Analysis and Design OOAD using Unified Modeling Language UML , Rational Unified Process RUP , Waterfall model. Also worked using various methodologies such as Agile, RAD Rapid Application Development , JAD Joint Application Design and Prototyping.
• Participated in requirements Analysis reviews, Business reviews and working sessions to understand the requirements and system design.
• Experienced in all phases of the Software Development Life Cycle SDLC , Rational unified process RUP , PPO, CMS, EMTALA and HMO.
• Extensive experience with Rational Rose, Requisite Pro, Rational Clear Case and MS Visio.
• Experience in negotiating with clients from diverse backgrounds and industries.
• Responsible for multiple responsibilities during stint at Insurance co. such as requirements gathering and solution development across the full insurance life cycle from CRM marketing, sales, service to underwriting quoting, policy administration, commissions broker management, claims, financial reporting and analytics.
• Experience in development of documents such as Functional Specification Document FSD , Requirement Specifications SRS , Standard Operating Procedures SOPs .
• Extensive experience using tools such as Rational RequisitePro, Rational ClearQuest, MS Project, MS Visio, Rational Rose, Crystal reports.
• 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.
• Worked with ANSI X12 5010 as well as ANSI X12 4010 including medical transactions such as 837 medical claims , 835 medical claim payments , 270 eligibility inquiry , 271 eligibility response , 276 claim status , 277 claims status response , 820 enrollment .
• Good knowledge of Health Insurance Plans Medicare Part A, B, C and D , managed care concepts Medicaid and Medicare and experienced in determining the membership eligibility, billing experience within life and disability in health plans with thorough understanding of CPT coding, CMS-1500 claim forms and reimbursement forms.
• Knowledge with MMIS Medicaid Management Information System , HL7, HIX Health Insurance Exchange .
• Worked in various technologies such as XSLT, CSS, XML,BPEL andHTML.
• Gained extensive experience with Ajax and JavaScript.
• Extensive experience in White Box, Black Box, Unit, Functional, Integration, Back End and System Level Load and Stress Testing for many type of applications including web and client/server applications.
• Experience in estimation of test effort and coordinate test schedule with overall project schedule.
• Experience in writing System test plans, defining test cases, developing and maintaining test scripts. Documented all phases of QA process. Experience in developing business based functional test scenarios.
• Developed and maintained databases in SQL/PL-SQl, Oracle and MS Access.
• Knowledge of PPACA Health Care Reform and patient Protection and Affordable Care act .
• Experience in estimation of test effort and coordinate test schedule with overall project schedule.
• Expertise in Problem solving and Bug Tracking Reports using Bug tracking Tools.

Technical Skills

• Programming Languages: Java,VB.NET, C , XSLT, ColdFusion
• Database: Oracle, SQL/PL-SQL, MS Access,
• Web Technologies: HTML, DHTML, XML, CSS, XSLT
• Scripting Language: JavaScript
• Server: IBM Websphere
• Methodologies: RUP, UML, Six Sigma, CMM
• Change Management Tools: Rational Clear Quest, Test Director
• Business Process Modeling Tools: MS Visio, MS Project, Rational Rose, UML, MS Office 2007, Daptiv
• Version Control Systems: Rational Clear Case
• Platforms: Windows 9x/NT/2000/XP.

Confidential

Sr. Business Analyst

Responsibilities:

• Facilitated JAD sessions and Focus Groups to gather requirements for Health Services, Enrollment, Grievance Appeals, Pharmacy, and Provider Relations Lifecycle streams, and documented the requirements in a traceability matrix.
• Performed Gap Analysis for the states of KY IN enrollment processes resulting from the regulatory requirements.
• Developed the Business Requirement Documents BRD and System Requirements Specification SRS documents for the 834 Inbound Outbound, Medical Pharmacy Benefits Integration, Provider Relations Lifecycle, Grievance Appeals, and Health Services lines of the Health Exchange project.
• Updated the BRDs with renewal and state specific business rules and functional requirements resulting from the expansion.
• Developed Swim Lanes, Use Cases and Process Flowdiagrams illustrating various functionalities as per the requirements.
• Developed Functional Decomposition Diagram to specify the requirements into functions, sub-functions, process and sub-process groups.
• Coordinated with Software Vendors to ensure the baseline of the project plan are accurately met and served as a lead point of contact for addressing the issues to the business users and vice versa.
• Leading the team to identify scenarios for solutions testing and drafting the plan for User Acceptance Testing UAT .
• Coordinated with the Health Services departments to gather the reporting requirements for the Dashboard.
• Act as a liaison for the IT development, business and enterprise architecture teams to ensure project deliverables are met according to the project plan.
• Overall monitoring the design process in coordination with the IT leads to ensure business requirements are met as per the Business Owners' expectations.
• Facilitated daily scrum meetings for Provider Lifecycle Provider Relations to check on current status of work assignments to the application development team.
• Gathered and documented vendor managementprocedures and requirements for contracting and credentialing Healthcare Providers prior to them becoming a part of the network.
• Highly engaged in documenting requirements for the development of the Member and Provider web portals before they could be launched for the open enrollment period.
• Worked with CareSource's pharmaceutical partner CVS in determining the requirements for file formats that will be utilized to exchange medical and pharmacy data for benefits integration.
• Performed test data entry into Facets 5.1 application in the test environment for creating and viewing groups, subscribers, and family member information.
• Entered functional requirements and business rules into HP ALM and linked them to Use Cases and User Stories to be utilized for running test cases and scripts.
• Worked with the EDW team to help identify the fields that needed to be moved into Facets to facilitate the integration of Medical and Pharmacy benefits for the HIX project.
• Entered defects for failed test cases and assigned them to the appropriate developers for resolution.
• Performed Claims validation in Facets through analyzing claims pend statuses and member effectuation statuses.
• Worked with both the Claims and IT departments to ascertain the calculation of Members' maximum out of pocket amounts for deductibles, copays, and coinsurance for various health plans.

Confidential

Sr. Business Data Analyst

Job Responsibilities:

• Provide reviews and feedback for test results.
• Took part in the design of letters that were sent to Ohio Medicaid stakeholders.
• Develop letters as per the specified requirements then conduct testing to ensure they worked as intended.
• Assisted PMs in setting realistic project expectations and in evaluating the impact of changes on the project plans accordingly and conducted project related presentations.
• Work closely with project manager in handling whole project.
• Work with the QA team for designing Test Plan and Test Cases for the User Acceptance Testing.
• Responsible for defining the scope and implementing business rules of the project, gathering business requirements and documentation.
• Run the SQL queries using Oracle SQL Developer.
• Conduct user interviews, gather and analyze requirements using Microsoft Visio.
• Track and manage all Change Requests, using Rational Clear Quest.
• Maintain and track stakeholders requests for enhancements and changes using Unified Change Management tool UCM such as Rational ClearQuest
• Developed strategic partnerships with the business units to develop a solid knowledge base of the business line including the business plan, products, and process and revenue streams.
• Perform User Acceptance Testing UAT for various web-based and database related applications.
• Assist with user testing of systems, developing and maintaining quality procedures, and ensuring that appropriate documentation is in place.
• Reduced project development costs and time through the application of Agile methodology's Inspect and Adapt approach by utilizing the BABOK standards.
• Verify that Medicaid recipients were eligible to enroll in Managed Care and Medicaid Advantage Plans.
• Developed Knowledge Management documentation such as subsystem workflows and development guides that facilitated the assignment of resources within the project.
• Assist the Project Manager to develop both high-level and detailed application architecture to meet user requests and business needs.
• Involved in the project for implementing Best Practices for Business Analysis in the organization and instrumental in the transition plan for Agile Development methodology using SCRUM.
• Perform manual testing in parts of the projects as required.
• Worked with SME to create 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.
• Responsible for weekly status meetings to discuss development plans, quality assurance test plans, and user documentation with developers and testers.
• Maintain adequate communication with the developers to ensure that proposed modifications and requirements are addressed, and subsequently monitor these revisions.

Environments: Microsoft Office Suite, Microsoft Visio, HP Exstream Letter Generator, Quality Center, Microsoft SharePoint 2010, Rational Clear Case,Rational ClearQuest, Oracle 10g

Confidential

Business Analyst.

Responsibilities:

• Defined the data sources, data loads and data transformation using ER Diagrams using ER-Win.
• Designed process diagrams using MS Visio and also context, dataflow, decomposition diagrams for different visibility to management and developers.
• Used MS-Visio for model diagrams and Rational Rose for UML class modeling and Visual modeling.
• Created front-end prototypes as deliverables and projected the end-delivery modules as part of the efforts towards joint application development.
• Conducted JAD sessions to work with the business users through discussion to further understand the complexity of the issues.
• Implemented Rational Requisite Pro for maintaining the requirements document and traceability matrix.
• Analyzed and collected business requirements, generated business models, identified system interfaces and created the requirement specification document.
• Developed requirements specification and process diagrams including context, dataflow diagrams.
• Interacted with various members at the management level to understand project scope analysis in order to prepare Software Requirement Specifications SRS for relevant data reports.
• Responsible for interacting with client for requirements gathering, analyzing requirements, and creating detailed specifications.
• Analyzed plan requirements and then contributed further defining the plan requirements with their Project Manager.
• Entered and verified test scenario data into Facets 4.7 upon receipt of 834 files to ensure correct data is reflected on member accounts.
• Developed Use Case diagrams by analyzing the business process followed by Class diagrams, Activity diagrams and Collaboration diagrams in UML.
• Designed and documented Test Cases according to the application requirements using Test Director.
• System Integration testing, Functionality testing Performance testing is done as per HIPAA Health Insurance Portability and Accountability Act .
• Coordinated and attended meetings to review these specifications with the Quality Assurance Manager, Business Systems Analysts, RUP Engineers, Project Manager others on the team.
• Worked closely with the development team to communicate client requirements.
• Responsible for reporting status ensuring accurate coverage of requirements and business rules.
• Involved in decision making with regards to identifying and prioritizing high impact improvements through the analysis of current processes.
• Provided support to the other analysts in gathering data and reporting requirements. Consulted with clients regarding data analysis, data sources available for query.
• Evaluated application testing results and recorded the discrepancies using Test Director to track, analyze and report on them. Designed and documented test cases according to the application requirements.
• Created issues list, tracked resolutions, and documented all final outcomes.

Environment: Rational Requisite Pro, UML, Rational Rose, Trizetto Facets, MS Visio, MS Office, MS Project, Test Director

Confidential

Business Analyst

Responsibilities:

• Responsible for requirement and design documentation review, test plans, identifying and reporting software anomalies and test results.
• Rapid Application Development RAD principle was used in acute functionalities to design, document and manage requirements throughout the lifecycle of the project, i.e. definition, design and testing phases.
• Attended and conducted meetings and workshops to discuss high level requirements and developed User Requirements Specification Document.
• The URS contained detailed requirements, which were formatted such a way that a set of traceability could be matched from features to test cases.
• Developed business use cases and also extensively worked on Rational Requisite Pro in gathering the requirements.
• Responsible for implementing the Key process areas and Impact analysis. Generated Use Case diagrams, Sequence diagrams, Business Objects, Domain Object Model using Visio, to depict process flows and PowerPoint presentations.
• Worked with ANSI X12 5010 as well as ANSI X12 4010 including medical transactions such as 837 medical claims , 835 medical claim payments , 270 eligibility inquiry , 271 eligibility response , 276 claim status , 277 claims status response , 820 enrollment .
• Used code sets such as HIPAA code sets, ICD-9, ICD-10 coding and HL7.
• Managed Version Control, each version of the application was stored in Clear case and necessary modifications, updates, analysis was done. Developed ER diagrams for depicting relationships between entities. Mapped ER Diagrams to relational database.
• Worked with Oriented Programming OOP environments such as Java, VB.net and C .
• Worked in various other technologies such as XSLT, CSS, XML andHTML.
• Worked extensively with Oracle and SQL Server.
• Designed and developed database for various projects.
• Worked closely with Developers, User Representatives and participated in the product design process including specifications and other document reviews.
• Configured test environment for specific test cases, created test data, executed automated or manual tests, document results and updated defect-tracking systems.
• Used Test Director to invoke the scripts, initially performed the baseline testing, organized all the scripts systematically and generated reports.
• Queried Oracle Databases to verify test case results. Randomly executed test scripts developed by QA team to check main functionality of application. Interacting with Development and QA Team to ensure overall quality of the software.

Environment: MS Visio, MS Project, Rational Requisite Pro, MS Project, Rational Clear Case, UML, Oracle 9i, MS Office, Windows, Crystal Reports, Java, J2EE, C Oracle, SQL, XSLT, XML, HTML, CSS, Lombardi, MS Visio.

Confidential

Business Analyst

Job Responsibilities:

• Facilitated JAD sessions utilized for the creation of design documents and system specifications for applications.
• Documented the Use Cases and prepared the Use Case, Activity, Sequence diagrams and Logical views using MS Visio, MS Office and Rational Rose for a clear understanding of the requirements by the development team.
• Interacted with the client and the Technical Team for requirement gathering and translation of Business Requirements to Technical specifications.
• Used SoDA and created product documentation including online help, printed user manual, and training materials.
• Followed HIPAA rules and regulations to draft business rules and claim processes.
• Understanding of the complete EDI format used in electronic documentation which was part of the knowledge transfer program to the vendors as per the requirements.
• Used MS Project for various planning and budgeting activities.
• Created Use cases, Activity, Sequence and Collaboration diagrams.
• Data mapping, logical data modeling, used SQL queries to filter data within the Oracle and Sybase.
• Responsible for co-coordinating business meetings and generating monthly status reports etc.
• Syndicated with various cross-functional teams for building business use cases.
• Prepared detailed reports of the Bug Report, Pass-Fail report, Comparison Chart.
• Assisted QA team with Test Plans and executing Test Cases.
• Assist end users and IT staff in the use of data to satisfy informational and reporting requirements and implementing and using SQL and DBMS.

Environment: Rational Unified Process RUP , UML, Dreamweaver, Rational Test Manager, Win Runner, Rational Clear Quest, Windows, MS Office, HTML.