- Over all 8+ years of professional experience as a Business/Systems/Data Analyst in Healthcare/Insurance Domain.
- Extensive experience in analyzing and requirements gathering and writing system functional specifications including use cases.
- Excellent in Developing and evaluating business process Models.
- Proven success as a business analyst through the years, providing a well-balanced understanding of business relationships, business requirements, and technical solutions.
- Deep understanding of enterprise data warehouses.
- Strong experience in RUP Business modeling process.
- Expertise in UML (class diagrams, object diagrams, GAP Analysis, use case diagrams, state diagrams, sequence diagrams, activity diagrams, and collaboration diagrams) as a business analysis methodology for application functionality designs using IBM’s Rational Rose.
- 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.
- Experience designing and developing SQL statements and queries for Oracle Sybase and SQL Server 2000 database.
- Well versed with client server environment and tools like SQL*Loader, UNIX shell scripts and TOAD
- Used Query Analyzer, Execution Plan to optimize SQL Queries.
- Expertise in managing requirements and traceability using Requisite Pro and Doors.
- Very well experienced using Microsoft Office Suite – Word, Excel, Access, and PowerPoint.
- Strong experience in conducting User Acceptance Testing (UAT) and documentation of Test Cases. Expertise in designing and developing Test Plans and Test Scripts.
- Experienced in manual and automated testing for both front-end and backend. Extensively used automated test tools of Mercury like Quality Center, Quick Test Pro, Win Runner, Test Director, Performance and Load Runner Testing.
- Used Sparx Enterprise Architect, IBM Telelogic DOORS and Rational Requisite Pro for requirements management and to follow configuration management processes.
- Experience in development methodologies like RUP, SDLC, AGILE, SCRUM and Waterfall
- Experience in various programming languages (SQL, XML) and operating hardware and software applications including TOAD, SOAPUi, Crystal Reports, Oracle Discoverer, Query Analyzer and SQL Navigator.
- Professional experience in business analysis, operations management and development, design, documentation and testing.
Software/Hardware: OOAD (OOA/OOD), RUP, UML, SDLC, Waterfall, QA, WAP, CVS, TEAMMATE, MS Access, SQL Server, MySQL, PL/SQL, Oracle DBA, DB2, PeopleSoft, Teradata, Windows 98/2000/XP, basic UNIX, HTML, basic DHTML, basic XML, MS Office Suite-Excel Macros, Project, Visio, Agile, Scrum, Lean, Adobe Photoshop, Flash, Rational- Rational Rose, Rational XDE, DOORS, HP-ALM, TOAD, RequisitePro, Win Runner, Load Runner, CaliberRM, Test Director, Quick Test Pro, Crystal Reports, Sharepoint, Docushare
- Performed In-Depth analysis of systems and business processes of Medicare Part B as per CMS rules and procedures.
- Gathered requirements for the facets implementation and performed solution analysis.
- Conducted SME interviews, gathered requirements, and analyzed the requirements for the Claim processing system.
- Identified the USER types and roles to prepare a process modeling diagram and Information flow diagram.
- Designed and developed Use Case Diagrams for the Facets process modules.
- Developed As-Is document and Gap analysis documents for detailed requirements to meet CMS standards.
- Developed entity diagrams, data interface mapping to map all the possible inputs and outputs.
- Assisted Project with the project plan and conducted status report meeting to finish on the time scheduled.
- Involved in discussions and meetings with implementation team to verify the proposed functionality.
- Traced requirements using traceability matrix to trace the requirements.
- Created test cases to test the requirements with the requirement and performed UAT testing billing and invoice on facets.
- Prepared a document with the reporting specification and reporting requirement and trained decision makers on the report analysis.
Environment: RUP Methodology, Mainframe, DB2, MS SQL, Facets Application, MS Visio, MS Office (MS Excel, MS Word, MS PowerPoint).
- Worked exclusively on the I-9 re-write process.
- Conducted workflow, process diagram and GAP analysis by identifying existing technologies, documenting the enhancements to meet the end state requirements
- Used MS Visio to develop Use Case diagrams, Activity Diagrams and Sequence Diagrams.
- Acted as a liaison between the technical group and business users (PM, PMA and trader).
- Wrote user requirements specification (URS) and Functional requirements specification (FRS) Documents as per the Business requirements and process flow.
- Analyzed system performance and initiated process improvement measures for mainframe and Web based applications.
- Involved in project management methodologies.
- Conducted JAD sessions to allow different stakeholders to communicate their perspectives, resolve issues and reach agreements
- Identified all necessary UML Business Use Cases from requirements, including Use Cases Diagrams, Class Diagrams, State Diagrams, Entity-Relationship diagrams, Sequence diagrams using MS Visio
- Conducted user interviews, gathered and analyzed Business requirements
- Interacted with clients to gather all requirements to formulate business specifications and translate those into application functionality, decide when to advocate and when to compromise to arrive at a mutually acceptable solution.
- Communicate and document system changes to business models
- Used SalesForce for generation of various forms of Interactive Reports
- Customized various reports in SalesForce to meet the Business requirements
- Performed SQL Queries and PL/SQL stored procedures on the database to extract and prepare test data.
- Used the Unified Change Management from Rational to track changes to multiple artifacts by versioning artifacts, associating requirements to specific change request/defects to streamline the defect/change tracking process.
- Acting as the interface and a single point of contact with the customer for his security related, technical issues and for the entire documentations and the written as well as the verbal correspondence
- Involved in UAT, test plans, documentation of test reports etc.
- Documented Test Plans that contains test scripts, test cases, test data and expected results for the User Acceptance testing.
Environment: Agile, Scrum, Requisite Pro, Rational Rose, Agile, PL/SQL, HTML, MS Office, MS Visio, XML, Teradata, UNIX, Rational Req. pro, clear case, Rational Rose, Clear Quest, UML, MS Project.
Business Systems Analyst
- Testing various change orders of Medicaid applications received from the System Engineer’s
- Regression Testing of Web applications and applications dealing with MEDICAID and MEDICARE Services
- Conducted weekly meetings for deciding the Policies and Procedures to be followed while constructing new sites.
- Conduct complex documentation and user needs analysis. Interface with team and staff to develop HL7 integration
- Incorporated Rational Unified Process (RUP) to create Business Requirement Document Specifications using MS Visio and MS Word.
- Developed the strategy for developing and implementing new EDI (HL7 and X12) interfaces and converting historical clinical and data.
- Conducted business-impact assessment and the results were compared with the new HIPAA 5010 standards to determine the current level of compliance and developed an action plan for approval by the project steering committee
- Developed plan for data feeds and data mappings for integration between various systems, including XML, to follow ICD 10 Code set and ANSI X12 5010 formats.
- Created Use Cases for NASCO claims processing system.
- Involved in gap analysis and implementation of HIPAA 5010, ICD 10 and Claim Validations
- Conducted Gap Analysis, and Gathered User Requirements by Interviews, user meeting, JAD session, and Requirement Elicitation Sessions
- Utilized corporation developed Agile SDLC methodology. Used ScrumWork Pro and Microsoft Office software to perform required job functions.
- Involved in analyzing activities for a variety of major projects including Medicare Plan part D, Coordination of Benefits, New Client Implementations, Consumer driven and regularly scheduled system upgrades.
- Extensively interacted with the stakeholders and the IT Department in finalizing the requirements according to the CMS Compliances/Regulations and HIPAA Regulations.
- Prepared graphical depictions of Use Cases, Use Case Diagrams, State Diagrams, Activity Diagrams, Sequence Diagrams, Component Based Diagrams, and Collateral Diagrams and creation of technical design (UI screen) using Microsoft Visio.
- Analyzed trading partner specifications and created EDI mapping guidelines
Environment: Requisite Pro, Rational Rose, Agile, PL/SQL, HTML, Axure, MS Office, MS Visio, EDI, Rational Clear Quest, Rational Clear Case, UML, RUP, Microsoft Excel, Microsoft Word, Microsoft Power Point, Visio.
- Worked with the account managers, managements, and report requestors to gather requirements, get report requests.
- Analyzed legacy system documentation, file and record formats, system flow charts and other information to develop a comprehensive depiction of the existing environment as it relates to HIPAA rulings.
- Facilitated JAD sessions with stakeholders, developers and SMEs to analyze system needs and integration requirements.
- Worked with the SMEs from the business area, Access Recertification & Reporting team to get their requirements for improving, streamlining and automating the data pulls from the environment into the
- Streamlined ability to perform data pulls for organizational number crunching requests.
- Assisted JAD sessions to identify the business flows and determine whether the EDI X12 Transaction, Code set and Identifier aspects of HIPAA, impacts any current or proposed systems.
- Introduced Agile and RUP methodologies to reflect liquid nature of front-office improving time-to-market
- Wrote Business Requirements, analyzed them and tested them.
- Worked on client server environment and tools like SQL*Loader, UNIX shell scripts and TOAD
- Compiled Weekly, Monthly, Daily Financial analysis reports as per Business Groups requests with help Teradata SQL Assistant, UNIX.
- Worked on EDI transactions: 4010, 270, 271, 834, 835, and 837 (P.I.D) to identify key data set elements for designated record set. Interact with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
- Assured that all Artifacts are in compliance with corporate AGILE Policies and guidelines.
- Extensive experience with the SAS programming and in data step and with various SAS Procedures in Base SAS and SAS/Stat, including thorough knowledge of SAS Macro.
- Performed Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data
- Used Test Director and Mercury Quality Center for updating the status of all the Test Cases & Test Scripts that are executed during testing process.
- Create and maintain requirements, test cases and defects in Mercury Quality Center
- Responsible to import the parts of the existing reports using Business Objects Live Office to develop the required reports in Microsoft Excel and Word.
- Wrote BRD, FRD, use cases, test scenarios, test cases for testing the functional and non-functional aspects of both ETL jobs and Reporting jobs.
- Wrote PL/SQL statement and stored procedures in Oracle for extracting as well as writing data.
- Extracted data from Oracle database with MS Access, and performed SQL query, data analysis and verification.
- Experienced in automating standardized reporting by integrating corporate data export tools (e.g. Cognos Reportnet) and Microsoft Office tools (e.g. MS Visual Basic, MS Access, and MS Excel) seamlessly into scheduled, hands-free reporting solutions
- Worked with SQL queries using MS Access for data manipulations.
Environment: TOAD, AGILE/LEAN, OLAP, Crystal Reports XI/XI R2, Oracle 10g, DB2, SQL Server 2000, Rational Suite, XML, VBA, Teradata, UNIX, SAS, Crystal Reports, Oracle, UML, MS Project, MS Office, MS Visio
Business Analyst/Systems Analyst
- Gathered requirements, organized team meetings requirements from business users such as insurance policy managers, generated business process models, & use-case models, and created business requirements document (BRD) & functional requirements document (FRD).
- Wrote Test Cases in MS Excel for user registration, access to training material, and activity log-in, reviewed the test cases and finalized
- Extracted data from disparate sources by SAS/ACCESS.
- Performed monthly and quarterly audits for some of the accounts using MS Access
- Extracted the data from SQL Server, Oracle, Files, and Access into Data warehouse.
- Personally responsible for attaining HIPAA EDI validation from Medicare, Medicaid, and other payers or government carriers. Developed HIPAA EDI Transmissions for both government carriers and commercial entities.
- Work includes complete business cycle management and hands-on production as well. Create EDI Testing process, documentation, and performance matrices.
- Maintained business requirements, use cases, Functional Requirement Specifications, and business rules in DOORS and linked them to UAT test cases in Quality Center.
- Extensive use of MS Office tools like MS Access, MS Word, MS Excel, MS PowerPoint MS Project for data migration in to the CI System Knowledge Data Base in MS Share Point.
- Involved in creating business processes and modeling diagrams using Rational Unified Process (RUP).
- Created use case scenarios and documented work flow and business process using Rational Rose
- Involved in project management using MS Project
- Designed DataStage ETL jobs for extracting data from heterogeneous source systems, transform and finally load into the Data Marts.
- Involved in creation and execution of manual test cases in Mercury Test Director and automated Test Cases in QTP and analyzed the Test Results.
- Maintained test notes and requirement using DOORS.
- Developed UNIX Shell scripts to automate repetitive database processes.
- Used Rational Clear case for version control
- Involved with all the phases of Software Development Life Cycle (SDLC) methodologies throughout the project life cycle.
- Served as conduit for managing system requirements between the business and the software development team.
- Queried database using SQL for backend testing
Environment: TOAD, Agile, XML, MS Access 2000, MS Excel, MS Project, RUP, Oracle, UML, DOORS, Rational Rose, Requisite Pro, Clear Case 2002, Teradata, SQL, UNIX, SAS, DB2, VBA, MS Office suite, MS Visio 2003
Business Analyst/Systems Analyst
- Utilized corporation developed Agile SDLC methodology. Used ScrumWork Pro and Microsoft Office software to perform required job functions.
- Gathered requirements and modeled the data warehouse and the underlying transactional database
- Perform Gap Analysis of the processes to identify and validate requirements.
- Identified/documented data sources and transformation rules required populating and maintaining data warehouse content.
- Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims.
- Designed the online screens and reports for the Medicaid Online Electronic Claims Submission System.
- Communicating and interacting with the Project Manager, worked from large data pulls to breakdown the actions based on standard operating procedures and develop functional requirements.
- Created EDI documents for EDI maps to generate requirement documents and Project Charter, and logical design documents for EDI transactions and code sets.
- Migrated data pull for Physician Profile quarterly reports to new Oracle-based Health Services Data Mart.
- Extensively worked with Teradata, Oracle, Mainframes, Microsoft Business Intelligence tools
- Converted the systems database from Sybase to oracle & vice versa.
- Prepared Business Requirement Documents (BRD’s) after the collection of Functional Requirements from System Users that provided appropriate scope of work for technical team to develop prototype and overall system.
- Maintain requirements in DOORS.
- Establish documentation for Agile methodology for implementation with a very water-fall-centric development team.
- Worked closely with the Enterprise Data Warehouse team and Business Intelligence Architecture team to understand repository objects that support the business requirement and process.
- Lead Business Intelligence reports development efforts by working closely with Microstrategy, Teradata, and ETL teams
- Analyzed data for migration from TcSE to Rational DOORS using Integrator.
- After needs assessment, analyzed the Business Requirements Document and System Requirement Specification and documented the requirements in the Rational Requisite Pro.
- Implemented data access, storage and validation routines on the database server using Procedural Language/Structured Query Language (PL/SQL).
- Worked on following applications Business Objects, Enterprise Architect, Toad, PlanView (project management), Microsoft Suite (Word, Excel, PowerPoint, Visio, Access, Project)
- Develop and maintain sales reporting using in MS Excel queries, SQL in Teradata, and MS Access.
- Performed criteria table updates to determine the billing needs send to the insurance companies using MS access tables as a tool.
- Responsible for cost estimation and timelines for various Business Intelligence reports
- Design, development, implementation and roll-out of Microstrategy Business Intelligence applications
- Involved in mentoring specific projects in application of the new SDLC based on the Agile Unified Process, especially from the project management, requirements and architecture perspectives.
- Established traceability matrix using Rational Requisite Pro to trace completeness of requirements in different SDLC stages.
Environment: Agile, Scrum, Crystal Report, SAS, TOAD, Oracle 10g, DB2, PL/SQL, SQL Server, DOORS, XML, Teradata, UNIX, Rational Req. pro, clear case, Rational Rose, Clear Quest, UML, Ms Visio, Ms Project, MS Office.
Greenwood Village, CO
Data Analyst/Business Analyst
- 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.
- Created new database objects like Tables, Procedures, Functions, Indexes and Views using T-SQL in Development and Production environment for SQL Server 2000.
- Designed and development of test cases based on functional requirements for Institutional and Professional claims for EDI and HIPAA Transactions 837/835, 834, 276/277, 270/271 testing.
- Experience in EDI automated first-pass claim adjudication, requiring thorough understanding of claim processing, both front and backend operations
- Created Process Work flows, Functional Specifications documents and documented system requirements.
- Performed all necessary programming, testing and documentation for COBOL, DB2 batch programs and sub-routines.
- Created data mapping document from Legacy to Facets.
- Conducted interviews, meetings and JAD sessions during the process of Requirement Gathering.
- Implemented SDLC that included requirements, specifications, design, analysis and testing using RUP methodology.
- Developed business process models in RUP to document existing and future business processes.
- Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims. Worked on EDI transactions: 270, 271, 834, 835, and 837 Provide implementation assessments, strategy, and mentoring services for Rational Rose, UML and RUP.
- Analysis of inbound and outbound interfaces and extensions to FACETS claims processing system.
- Interacted with various cross-functional teams on building business use cases, and understanding expenses and revenue stream.
- Performed extensive Requirement analysis and developed use cases and workflows.
- Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, and OOD
Environment: VB 6.0, Oracle, VBA, Windows, SQL, UNIX, DB2, SAS, Rational Enterprise suite, MS Office, MS Project.