SUMMARY

• 7 years of experience in IT, Healthcare environments with primary skill on the Analysis, Design, Development, Implementation and Testing Client/server applications.
• Working knowledge on various development methodologies like Waterfall, Agile, SDLC, Rational Unified Process RUP and Scrum.
• Excellent skills in Business Analysis, Data Analysis, Requirement Analysis, Business Modeling and Use Case Development using UML methodology.
• Adept at creating and transforming business requirements into functional requirements and designing business models using UML diagrams, Use Case, Sequence, Activity diagrams in Enterprise Architect , MS Visio and Rational Rose.
• Mostly worked on Use Cases and Test cases and Manual Mapping of the transactions.
• Experience using advanced Business Process Management BPM and Business Rules Engine.
• Created Business Process Model and identified issues for Business Process Re-engineering work elements.
• Worked with BI Architect to implement logical data process model.
• Worked on Business Process Model and Data Flow Diagram and created GUI design documents using UML methodology.
• Good Knowledge on healthcare practices - MMIS, HIPPA 5010, ICD 10.
• Knowledge on Medicaid Information Technology Architecture MITA in initiating Center for Medicaid and Children's Health Insurance Program CMCS .
• Thorough understanding of consistently developing and maintaining the health care industry databases, health care insurance and health care industry related aspects. Experienced in HIPAA compliance.
• Expertise in identifying and prioritizing needs of multiple clients simultaneously to ensure compliance with various industry regulations including HIPAA, PCI, SOX and others.
• Worked extensively on Business Requirements Elicitation, Process Modeling, Gap analysis, Risk analysis, SWOT analysis and development of Functional Specifications.
• Expertise in broad range of technologies, including business process tools such as MS Project, MS Excel, MS Access, MS PowerPoint, MS Share point, MS Visio and Rational Suite.
• Proficient in Quality Assurance Life Cycle like developing Test Strategies, Test Plans, Test Cases Manual / Automated , Defect Reports and developing Test Scripts.
• Created efficient and effective Test Scripts to implement and execute the Test Procedures. Execution of Test cases manually using Test Director and Automating Tests using Win Runner, Quick Test Pro.
• Extensive use of Mercury and Rational Tools for Functional and Performance Testing.
• Strong experience in conducting UAT and documentation of test cases.
• Extensive experience in writing Test Plans, Test Cases and Test Scripts for Manual and Automated Testing for various business applications and writing SQL queries for complete end to end testing.
• Excellent track record for meeting deadlines and submitting deliverables on time.
• Hands on experience in writing requirement for data centric application, which uses RDBMS such as Oracle, MS SQL Server and MS Access
• Have excellent analytical, problem solving, communication and interpersonal skills, with ability to interact with individuals at all levels and can work as a part of a team as well as independently.

SKILLS

• Methodologies: AGILE, Waterfall, SCRUM,
• Management: MS Project, MS Visio, Word, Excel, PowerPoint
• Tools: Rational Rose, Rational Requisite Pro, Clear Case, Clear Quest.
• Testing/Reporting Tools: Test Director, Win runner, Load runner, Business Objects, Crystal Report
• Programming Languages: SQL, XML, Html, VB
• Platforms: Windows NT/95/98/2000/XP/Vista, UNIX.
• Database: Oracle 10g/9i/8i, IBM DB2, MS SQL Server, MS Access.
• Graphical User: Adobe Acrobat, MS FrontPage, MS Outlook, MS SharePoint.

EXPERIENCE

Confidential

Business System Analyst

Optum being the implementation partner is the subsidiary of United Health Group. Our focus is to Improve the Healthcare system, Population health management and Care Delivery.

Closed Enrolment Verification:

Responsibilities:

• Worked for Commonwealth of Massachusetts in implementing DELL's verification process.
• Main role was to gather requirements.
• To implement the process, had to Analyze and write a lot of Test Cases and Test scenarios.
• Coordinated with the Team in documenting Functional and Technical Specifications.
• Performed Internal testing of the Tool.
• Assisted the Test Lead and coordinated with the Team in User Interface Testing.

Program Determination:

Responsibilities:

• Main role was to gather all the Functional Requirements and convert them into Technical Requirements.
• Had to constantly view the changes and updates made in JIRA for the CR's and HIXTT's Change Request and Troubled Tickets.
• With the help of Technical Requirements prepared the Tactical Estimate Summary for the Change Requests C.R and HIX Troubled Tickets HIXTT .
• Was responsible in documenting all the Technical Specifications for the Change Requests and Troubled Tickets.
• Worked with the OPA Team in changing the Eligibility Business Rules or Business Rules Specifications.
• Was part of Knowledge Transfer from CGI to Optum for Tools like Worker Portal and Worker Portal Lite.
• Worked for a brief time on how to access the Worker Portal Tool.

Environment: MS Office Suite, Agile, Oracle, SQL, Java, Java Script, Business Objects, MS Visio, OPA, BPM, OSB.

Business System Analyst

Confidential

Cognosante being the implementation partner is one of the leading Healthcare transformation enterprise. The changes it has implemented were relating to Health Insurance Exchange HIX and Eligibility and Enrollments to improve and access quality healthcare. The primary function of this role included scope definition, specification, requirement gathering and eligibility determination to fulfill the requirements of the Maryland Health Insurance Exchange MD-HIX which in turn will assist in determination of the eligibility of individuals enrolling on the Health Insurance Exchange portal.

Responsibilities:

• Main role was to gather requirements Health Insurance Exchange HIX and add those changes to the present system.
• Process was based on an Agile methodology.
• Worked on documenting the details and executing the requirements to determine eligibility of the individual case worker portal.
• Had to work on live Caseworker portals.
• Worked on with Test Lead and Eligibility determination specialists in gathering requirements.
• Analyzing the requirements and creating Test Plans, Test Scenarios, Test Cases.
• Created Business Process Model and identified issues for Business Process Re-engineering work elements.
• Worked with BI Architect to implement logical data process model.
• Worked on Business Process Model and Data Flow Diagram and created GUI design documents using UML methodology.
• Running the Test Cases in the Test Environment using Manual input method involving different criteria and determining the final eligibility.
• Maintained close integration across the group and communicating effectively with seniors for day to day task.
• Accessed the individual's eligibility through IBM Curam Tool.
• Compared the results with various databases and determined the final eligibility using different versions of Medical Charts based on the FPL .
• Also involved in the automated testing of Test Cases via Rational Functional Tester.
• Creating queries in Rational Functional Testing Tool RFT's , running it and determining final eligibility of the individuals.
• Reported errors and defects via JIRA tool and kept an eye on its status to retest to determine final status of defects and errors.
• Involved in developing and integrating the tasks performed and uploading the resources to SharePoint for access across the organization.
• Involved in designing Test Plan Flow via MS Visio and reporting Test Strategies during the Daily/Weekly Standup meetings.
• Assisted Senior Testers/Business Analysts/Test Lead in explaining the difficulties or errors encountered by the team during the testing span.
• Performed Data mapping, logical data modeling and used SQL queries to filter data within the Oracle database
• Detailed examination of individual's eligibility in terms of eligibility spans, FPL , age, sex, AI/AN, Lawful presence, Nationality and Residency and determination of eligibility based on these factors.
• Assisted Analysts in Error Rate Analysis and helped them in developing the expected results for an individual.
• Worked on the Production Environment to capture the data from the applications and keying it the same onto the high-level spreadsheet and updating the results onto the SharePoint.

Environment: MS Office Suite, Agile, IBM Curam, Oracle, SQL, Java, Java Script, Win Runner, Business Objects, MS Visio, FileNet, Rational Quality Manager, Rational Functional Tester.

Business System Analyst

Confidential

Project was intended to comply with Health Information Exchange HIX and how HIX helped the State of Massachusetts or the Commonwealth Connector Authority to put forward its inputs on Affordable care Act ACA or also Known as Obama Care. Dell Services being the implementation partner.Project was totally divided into 8 work streams, with my work stream being Reporting and Quality Monitoring. Since I was working on Reporting and Quality, I had to be associated with all other work streams starting from Call Center IVR , Enrollment, Financial Management Systems FMS , Eligibility, Interfacing, Member Transitions and Vendor Transitions.

I had the opportunity to work on all the 78 reports from contract and bundle them with the Service Level Agreement SLA section and Performance Expectations PE section. The SLA's had another 25reports and PE's had 50 reports.

• Actively participated in JAD sessions to pull out the requirements.
• Project was mostly worked on Agile Methodology and a lot of Uses-Cases had to be defined to meet the needs of the client.
• Carried out detailed and comprehensive business analysis with Agile methodology.
• Role was to bundle all the 78 reports to 25 SLA's and 50 PE's.
• Worked with different studios in Agile methodology to comprehensively unique and high priority of work. Complex flow strategies, project issues to leaders, training less experienced team members to have a superior understanding and long term solutions.
• Created Business Process Model and identified issues for Business Process Re-engineering work elements.
• Worked with BI Architect to implement logical data process model.
• Worked on Business Process Model and Data Flow Diagram and created GUI design documents using UML methodology.
• Functional requirements are considered as the Reporting section which has 78 reports is considered to be a functional specification.
• Data Gathering was the main goal as it had a lot of Business Process Flows associated with 7 other work streams.
• Visio was the main Tool to express how Reporting worked.
• Had to check how Reporting worked in other 7 work streams like capturing the Reporting specifications from Call Center IVR , Enrollment, Eligibility, Financial Management Systems, Interfacing, Member Transitions and Vendor Transitions.
• Non-Functional Requirements are considered as Quality Reports.
• Identify and Review the HIX Work track 12 reports and compare with the Contract Reporting section.
• Created queries using Oracle Stack to extract, transform, load data from OLTP to data warehouse based on the transformation mentioned in the requirement
• Used Agile methodology and used 15 day iterations for completion of projects and conducted daily SCRUM/Stand-up meetings to track the progress of the Team on a day to day basis.
• Created Report Inventory and Wireframes for all the reports.
• Created Reporting Requirements Packets.
• Created Quality Monitoring Requirements Packet.
• Did GAP analysis by comparing the past HIX reports with present Contractual Reports to create the Future Reports.

Environment: MS Office Suite, Agile, IBM Curam, Oracle, SQL, Java, Java Script, Win Runner, Business Objects, MS Visio, FileNet, Rational Quality Manager, Rational Functional Tester.

Business Analyst

• Project intended to comply with HIPAA 5010 standards. This was involved in the analysis of EDI transactions including 834, 820 and 275 based on HIPAA 4010 and mapping them in order to comply with HIPAA 5010 standards and also support of Facets Claims and Member/Subscriber modules. The new application also allows the agents to track and manage the status of a health benefit claims.
• Lead and actively participate in the development of written, detailed business requirements, Interviewed Clients and defined the Functional and non-Functional requirements.
• Experience in Healthcare ICD-10 HIPAA Gateway and 5010 transactions and migration.
• Identified and Created Business Process flow using MS Visio.
• Facilitated JAD sessions with the Business Users to capture Business requirements.
• Participated in LEAN events and facilitated the meetings for identifying quality problems to ensure smooth flow.
• Worked on MMIS claims adjudication which were Eligibility, Correct Coding, Suspend Duplicates and Utilization of Services.
• Have MMIS relating knowledge of claims processing adjustment/credit requests.
• Working knowledge of Agile development methodology to adapt the change for simple clean implementation and designs.
• Transferred data using the ETL process from the existing database to the new system.
• Excellent knowledge of analyzing requirements for data migration, data reconciliation, mapping rules, staging rules and transformation rules for the ETL processes.
• Tested and analyzed relational and OLAP data.
• Worked as a Data Warehouse consultant in the enhancement of Business Application.
• Adept at writing SQL queries and scripting in PL/SQL Oracle .
• Developed test plans, test cases and test scripts based on the functional specifications.
• Create Customer Requirement, Product Requirement, Software Specifications Developed DFD Diagrams and Entity Relationship Diagrams.
• Identified the Pain points, process flaws and work around in the existing process and provided solutions.
• Performed requirements elicitation and systems and business analysis to implement a database.
• Performed Unit testing of code as required by test plan and Produce high quality documentation
• Environment: Windows, PL/SQL, ETL, SharePoint, Microsoft Office Suite, Oracle, Microsoft Visio, Test director, Win Runner, Clear Case, Clear Quest, UML.

Confidential

Business Analyst

• Played a dynamic role in the IT team as a Business Analyst on several projects on enrollment, claims, finance, provider admin, and group admin business areas in healthcare domain. My recent project was the analysis of ICD 9 - ICD 10 code set conversion. I was also involved in the high level requirements gathering with providers, clearing houses and employer groups for the EDI transactions of the HIPAA 4010 5010 conversion
• Gathered Business Requirements, interacted with the Users, Designers, Developers, Project Manager, and SMEs to get a better understanding of the Business Processes, and analyzed and optimized the process.
• Worked on HL7 and EDI transaction sets, such as 270-271, 276,277,278.
• Actively involved in the entire Software Development Life Cycle SDLC Process.
• Prepared RFP's Request for Proposal that accurately communicated organization's software requirements to IT Vendors specializing in providing ACH software systems.
• Created reports containing all the information regarding the publishers, distributors and retailers using crystal reports.
• Facilitated demonstration of a major ACH software systems and performed evaluations with a group of experts to select a package that best suits the need of the business.
• Experience working with ICD-9, EDI 834,835 and 837 claims processing, claim review.
• Knowledge about Medicare and Medicaid processes.
• Experience in application of MMIS from procurement and requirements definition to operational readiness testing and post implementation stabilization.
• Worked on MMIS mostly based on Issue, Approach and Impact.
• Experience working with Electronic Claims clearing houses like Web MD and Automated Clearing Houses ACH for electronic payment, remittance data processing and services.
• Executed SQL queries using PL/SQL on Oracle database for validating and analyzing the data during scenario presentation to the client as part of requirement gatherings.
• Created the user requirement specifications and helped convert them to functional requirements, and assisted the developers with system requirement specifications.
• Responsible for ensuring data integrity and coordinating efforts with testing and implementation Responsible for the development and execution of test plans.
• Environment: Rational Clear Quest, Rational Clear Case, SQL, Oracle, Crystal Reports, Unified Change Management, MS office Suite

Confidential

Business Analyst

• Liberty Mutual is one of the largest Insurance companies dealing in commercial as well as personal lines of insurance. The project was to automate the claims processing system and enhance the CRM by providing real time monitoring and services for their auto insurance division. The project involved end-to-end integration of disparate systems, providing remote access through a web interface and demonstrate how to implement a number of advanced Process Manager Features.
• Conducted several meetings and workshops with clients to understand and articulate the clinic trial requirements and incorporated them in the Business Requirements Document BRD
• Converted the business requirements into technical specifications
• Designed the feasible workflow of the clinic studies.
• Summarized the stakeholders' needs and the opportunities in the Vision Definition Document VDD
• Implemented the HIPPA norms in the clinic trial procedures
• Generated Use Case Diagram, Class Diagrams, Sequence Diagrams, Activity Diagrams to present the developed strategic system using UML methodology
• Cooperated with Project Technical Lead/SME to complete assisted documentation and tools for contract deliverables
• Performed GAP analysis to the current Electronic Health Record System EHR and proposed enhancements to it
• Assisted the technical team to improve the existing EHR System which is more efficient for patient management and patient treatment as well as compatible with the clinic trial system
• Coordinated and communicated timely with the clinic study team to manage the study status and provide necessary technical support
• Prepared the status report for the progress and budget of the project periodically
• Environment: Rational Rose, Rational Requisite Pro, Rational Clear Case, MS Project, MS Vision, Crystal Report, PL/SQL, Java.

Confidential

Business Analyst

• Captured all the functional requirements in the Functional Specification Document FSD
• Negotiated the baseline scope, budget and schedule to prepare the compatible Work Breakdown Structure WBS
• Conducted multiple interviews and brainstorming with stakeholders and users to identify the problems and opportunities, and developed Business Requirement Document BRD
• Followed Prototype model of SDLC in developing software
• The main aim of the project was to provide an expertise in healthcare cost for the mid-market companies and analyzing the healthcare programs, how they are working and where they can have the greatest potential improvements in cost and how it can be implemented.
• Apollo Health Street is one of the world's leading professional service firms. Healthcare consulting is one of the important and profitable aspects of the company.
• Conducted Lean Analysis throughout the project and conveyed my team a message, 'Think big, Act small, fail fast learn rapidly'
• Responsible for the status reports to the top management to ensure all the IT initiatives and involvement all clearly communicated and fully implemented in the new software
• Interfaced with Quality Analysts to help unit, integration, system and User Acceptance Testing
• Mitigate risks all the time
• Reviewed and analyzed the business environment and identical process improvements
• Generated the roadmap for the software that can expand the market share and user expectations

Environment: MS Visio, MS Office, LAMP, AJAX, SharePoint, Smart Cards, Video on Demand PHP, ERD and Extended ERD, SDLC Models, Risk assessment tools.

Confidential

Business Analyst

• To provide a full breadth of services to our customers, Apollo also offers services to support business practices, telemedicine services, education, training programs, research services, and a host of other non-profit projects. Apollo Health Street and Huron Healthcare have joined efforts to provide comprehensive revenue cycle solutions to our healthcare clients.
• Reviewed/Modified System Requirements and Specifications using Business Requirement Document BRD for project.
• Designed Test Plan, Test Script, Test cases in Quality Center.
• Created Exception handlers and user-defined functions involved in regression testing, unit testing and system testing.
• Liaised with different functional units for detail analysis sessions to deduce and accomplish action plans, meeting deadlines and standards.
• Assigned and reported business requirements using the SDLC methodology from the business team.
• Organized meeting with business users to prepare and update business process requirements and system requirements.
• Composed test cases and scripts.
• Ensured all artifacts were in accordance with the corporate SDLC policies and guidelines.
• Prioritized outstanding defects and system problems, ensuring that accuracy and deadlines were met.
• Engaged GAP analysis of business rules, business and system process flows, user administration and requirements.
• Created use cases, work flow, screen mock-ups and conversion requirements.
• Enhanced tests with programming by adding methods, conditional statements, and comments to the test and by sending messages to the test results.
• Environment: Java, RUP, UML, Rational Requisite Pro, Rational Rose, Rational ClearQuest, MS Visio.