SUMMARY:

• 6+ years of extensive experience in the field of Business Systems Analysis, working with the technical staff to implement management and staff's business requirements into the web/ software application in Healthcare Industry.
• Highly motivated team player with excellent communication, presentation and interpersonal skills, always willing to work in challenging and cross - platform environment.
• In-depth knowledge of creating use cases, functional design specifications, activity diagrams, logical, component and deployment views to extract business process flow.
• Expertise with healthcare Insurance systems with claim entries, validation, pricing, audits analyzing information across the verticals.
• Strong understanding of project life cycle and SDLC methodologies including RUP, RAD, Waterfall and Agile.
• Implemented data correction mechanisms for bad data or missing information and input the corrected data using reject loader utility.
• Expertise in broad range of technologies, including business process tools such as Microsoft Project, Primavera, MS Access, MS Visio, technical assessment tools, Data Warehousing concepts and web design and development.
• Excellent knowledge of HIPAA standards, EDI (Electronic data interchange) Transaction syntax like ANSI X12, Implementation and Knowledge of HIPAA code sets, ICD-10 coding and HL7.
• Interviewed SMEs and Stakeholders to get a better understanding of client business processes and gather business requirements.
• Experience in Medicaid Management Information System (MMIS). Expertise in various subsystems of MMIS- Claims, Provider, Recipient, Procedure Drug and
• Extensive experience with the SAS analytics and in data step and with various SAS Procedures in MS Access.
• Experience in writing SQL queries and optimizing the queries in Oracle and SQL Server 2008.
• Extensive experience in Strategic development of a Data Warehouse and in Performing Data Analysis and Data Mapping from a Operational Data Store to a Enterprise Data Warehouse
• Conducted JAD sessions, created Use Cases, work flows, screen shots and Power Point presentations for the Web Applications
• Extensively worked on wire frames, prototypes using software tools.
• Conducting requirement gathering sessions, feasibility studies and Impact Analysis and organizing the software requirements in a structured way using Rational RequisitePro to track development.
• Performed UAT and exposure to User Certification Testing (UCT) and Operational Readiness Testing (ORT)
• Expertise in understanding and supporting the client with Project Planning, Project Charter, Project Definition, Requirements Definition, Analysis, Design, Testing, System documentation and user training.
• Experience in Conflict Management and Change Management Process (Identify, Analyze, Evaluate, Plan, Implement, Review and Close).

TECHNICAL SKILLS:

Data Base: MS Access, Oracle (SQL Series), Teradata

Reporting Tools: Crystal Reports, SSIS, Web Services (API’s)

Operating Systems: Windows 8/7, Mac, Linux

Software: MS Office Suite(Word, Excel, Access, PowerPoint & Outlook), MS Visio, Rational Rose, Rational Requisite Pro, Adobe Acrobat, MS Project, MS Office FrontPage, Lotus Notes, Visual Studio 2010.

Performance Testing Tools: Virtual User Generator, Load Runner

BI Tools: SAS, Cognos /reporting dashboards

Processes/Technologies: Rational Unified Process (RUP), Agile SCRUM, Waterfall, UML & Microsoft Office SharePoint 2010

Automation Tools: Requisite Pro, Win runner, QTP, Jira, HP Quality Center/ALM, Junit

PROFESSIONAL EXPERIENCE:

Confidential, Hartford, CT

Sr.Business System Analyst

Responsibilities:

• Perform posting of patient information at the set production level.
• Communicating verbally and via electronic platforms to ensure accurate information for billing such as Insurance, Diagnosis levels,Ordering and performing Physicians
• Work billing exceptions report in an electronic format by utilizing the system tools for resolution or phone calls to the customer for needed billing information and update accordingly.
• Assisted customers process workflows and improved the special billing request, such as charges, credits or refunds
• Identify trends and ways to help prevent billing exceptions and notify management.
• Analyze routine front end billing issues.
• Documenting necessary account information and offering solutions that benefit the customer.
• Delivered extraordinary customer care by responding to questions concerning customer accounts
• Research, translates, and updates demographic data to ensure prompt payment from customers and or Healthcare insurance companies.
• Facilitateed business requirements gathering sessions with SMEs, internal and external stakeholders;
• Participated in Joint Application Design (JAD) sessions with development teams to represent the interests of business stakeholders
• Performed validation of documented business requirements against business processes to ensure that business requirements accurately represent the needs of business stakeholders;
• Performed and Prepared UAT Materials UAT Test Cases to include various steps involved for UAT and to have proper coverage of requirements.
• Created Validations rules for error handling to filter the data during the preprocessing stage and catch bad data to avoid garbage in garbage out scenario.
• Worked with Cognos Administration team in creating data sources, migrating reports and models, involved in setting up the standard procedures and the SLA's for the requests from the users.
• Prepared test Data sets and performed data testing using the PL/SQL scripts. Also used MS excel for data mining, data cleansing, data mapping, data models, data dictionary and clinical data analysis (Oracle Analytics).
• Used Jira for defect tracking and reporting. Worked on MS Office (Visio, PowerPoint, Word, and Excel)

Environment: Rational Enterprise Suite (Rose, RequisitePro, ClearCase, ClearQuest), Microsoft Office Products (Word, Excel, PowerPoint), MS Visio, Visual Basic, SQL, SQL Server, Oracle, C#.Net, XML, WebLogic,

Confidential, Mineapolis, MN

Business Data/Systems Analyst

Responsibilities:

• Lead business analyst for multiple projects and systems across the Library analyzing requirements and specifications to determine the feasibility of proposed projects and solutions, to include risk assessment of current production systems, project estimation using agile methodology, writing communication and technical documentation.
• Product Owner on projects and manage and ensure that all required meetings are running under the Scrum/ Agile process.
• Gathered business requirements by driving user-group meetings and working with various global, cross-functional and virtual teams
• Prepare the document for Claims Editing & Resubmission and verify the backend process to resubmit the claim by transferring correct X12 files.
• Responsible for business system analysis of customizing the BPS Risk Management product with involvement through the whole SDLC
• Teamed up with both internal and external software development groups to provide functional requirements specifications in form of use cases, business process flows, and prototypes and management reporting requirements
• Validated the following: 837 (Health Care Claims or Encounters), 835 (Health Care Claims payment/ Remittance), 270/271 (Eligibility request/Response), 834 (Enrolment/Dis-enrolment to a health plan).
• Worked on analytics with th insurance system and its modules for business users.
• Requirements Elicitation, Analysis, Communication, and Validation according to Six Sigma Standards created Functional Specification Document (FSD).
• Extracted data from disparate sources by SAS/ACCESS and Created SAS procedures that are used for data validation, statistical report generation and program validation and automated the Edit Check programs using Macros.
• Lead JAD Sessions for gathering of Business requiremenets
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, OOD using UML
• Responsible for data mapping of HL7 messages into relational database
• Working with EDI programmers, came up with many complicated business and technical solutions to customers’ requirements.
• Converted various SQL statements into stored procedures thereby reducing the Number of database accesses.
• Coached and developed a distributed team of business executives and technical professionals regarding Agile roles, routines and responsibilities resulting in a more thorough understanding of Scrum and a faster start up time to developing software.
• Working with functional teams in an agile environment, analyze factors and components of systems and processes to manage interrelationships and facilitate change. Detects inefficiencies or conflicts in systems and processes and helps to identify effective improvements. Facilitates communications between customers, SME's and Technical staff. Participate in various testing functions (i.e. string and acceptance tests) to verify that results are correct.
• Maintained data quality by Data Analysis, Data Profiling(row/column level, statistics, pattern, etc.), Data Validation, reviewing logs and repository tables and making sure there are no duplicates, bad data, rejections, empty data in null columns, etc.
• Gathered data and ran queries using Teradata and worked on data movement and migration.
• Produced requested reports and ran analytics using SAS.
• Parsing high-level design specification to simple ETL coding and mapping standards.
• Provided management support to the off-shore End to End Integration / Regression Test Team.

Environment: Rational Enterprise Suite (Rose, RequisitePro, ClearCase, ClearQuest), Microsoft Office Products (Word, Excel, PowerPoint), IBM WebSphere, XML, Java, J2EE, JSP, VoAVPN, Oracle, MS Visio, DB2,UAT, Sybase, SQL Server Reports, WinRunner, LoadRunner, Quick TestPro

Confidential

Business System Analyst

Responsibilities:

• Performed the role of facilitator to conduct JAD session for requirement gathering.
• Interacted with business people and stake holders to analyze and create business requirement documents.
• Initiated communication with the users and development team.
• Worked on GUI, User Traceability Matrix, Use Test Scenarios and Process Flow Diagrams.
• Attended weekly meetings for lessons learned and shared new discoveries about adjudicated claims getting loaded into AIMS through Claims Highway.
• Attended meetings for AIMS vendor on boarding to monitor accumulator trading among all vendors.
• Performed on GAP analysis document.
• Coordinated with the development team and the testing team about the technicality defects that were logged into the HP ALM Quality Centre.

Environment: Microsoft Office Suite, MS Visio, Windows XP, DreamWeaver, SQL, PLSQL, XML, VB, ASP, Crystal Reports, Adobe Photoshop, Mercury TestDirector, UAT,WinRunner, LoadRunner

Confidential

Business Analyst

Responsibilities:

• Gathered business requirements by driving user-group meetings and working with various global, cross-functional and virtual teams
• Identify Member, Provider, Coverage, Analyzed, designed, and coded several online subsystems for the Healthcare System.
• Mapping Documents and performed Data Extraction and Data Compilation using SQL queries.
• Requirements Elicitation, Analysis, Communication, and Validation according to Six Sigma Standards.
• Assignment was to develop applications under Agile Scrum master.
• Extensive knowledge of implementing software development projects using Agile/Scrum
• Expert in business process engineering and software development life cycle, including analysis, design, development, testing and implementation of software applications under Agile and complete SDLC.
• Translated customer feedback into workable Acceptance Criteria for Agile/Scrum user stories
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, OOD using UML
• Involved in all phases of software development life cycle in RUP framework.
• Used Rational Rose to model the process using UML to create behavioral and structural diagrams.
• Assisted front-end development teams in integrating Crystal Reports in the .NET application using SDK. Developed business process models in RUP to document existing and future business processes.
• Provided management support to the off-shore End to End Integration/Regression Test Team

Environment: Microsoft Office Suite, MS Visio, Java, UAT, DreamWeaver, Windows, JavaScript, XML, HTML, Oracle, SQL Server, Mercury TestDirector, Mercury LoadRunner