SUMMARY:

• Results - oriented business analyst offering 6+ years of professional experience in Healthcare, investments and corporate finance domain, having concrete understanding of key finance and IT concepts.
• Excellent communication, presentation and project management skills.
• Professional experience with expertise as Data analyst/ Business Analyst in understanding and transforming into business process requirements into Functional Requirements and specifications and documenting change requests through Business Requirement Documents.
• Experience with full HIPAA compliance lifecycle from gap analysis, mapping, implementation and testing for processing of Medicaid Claims.
• Experience with health care services regulatory environment in compliance with HIPAA, ICD, MITA, MMIS and EDI.
• Extensive knowledge in Medicaid & Medicare.
• Experience in FACETS front end and data model, Facets Keywords and HIPAA EDI transactions
• Combined views and reports into interactive dashboards in Tableau Desktop that were presented to Business Users, Program Managers.
• Profound understanding of insurance policies like HMO and PPO and proven experience with Medicare, Medicaid, & commercial insurances in HIPPA 4010 EDI transaction codes such as 270/271(inquire/response health care benefits),276/277(Claim status), 834(Benefit enrollment), 835(Payment/remittance advice), 837(Health care claim).
• Knowledge of Data Warehousing concepts and Extract, Transform and Load (ETL) processes.
• Extensively used SQL scripts/queries for data verification and validation
• Reduced data redundancy and visualized the data to form an analysis reports
• Experience in Healthcare Application Facets in different modules like Claims, Membership, and Provider.
• Experience in HEDIS process for new Medicaid integrated care plan
• Conduct several JAD sessions with stake holders, such as which Business Partners, Division Heads of various units to extrapolate requirements, business rules, business processes, approval workflows, field level details and produce Business Requirement Document, Functional Requirement Document
• Expertise in creating Unified Modeling Language (UML) diagrams such as Use Case Diagrams, Activity Diagrams as well as Data Flow Diagrams, Entity Relationship Diagrams, and Flow Charts using MS Visio and Rational Rose.
• Good knowledge and experience in Business Process Modeling and Reengineering ("As-Is" & "To-Be" modeling / mapping of business processes.) using Microsoft Visio
• Excellent knowledge of industry standard methodologies like Software Development Life Cycle (SDLC),Agile (SCRUM), Iterative Software Development Life Cycle Process, CMM (Capability Maturity Models) and PMO (Project Management Office)
• Deep understanding of different business management strategies as Business Process Automation (BPA), Business Process Improvement (BPI) and Business Process Re- engineering (BPR).
• Provided real-time access to information related to authorization and referrals, care planning activities, claims, PCP selection, encounter data, HEDIS Alerts for missed services and provider profiling scorecards.
• Good analytical and communication skills and ability to work independently with minimal supervision and also a great team player.
• Excellent business analysis experience in the manufacturing, investment and capital market (securities) domains.
• Worked with development team to help implement RESTful interface and APIs for vendor facing project in WebFOCUS newer version post upgrade.
• Experience in performing Gap Analysis, SWOT Analysis, Risk Analysis and Impact Analysis
• Proficient in developing interface and process specifications such as business required documents (BRDs), Functional Requirement Documents (FRDs)
• Experience and understanding of different SDLC methodologies like Agile, RUP.
• Experience in managing Requirement Traceability Matrix (RTM) for tracking and managing changes based on project's evolving needs.
• Used Query Analyzer, Execution Plan to optimize SQL Queries.
• Experience in writing Shell Scripting to transfer the files.
• Strong Knowledge of Best practices in the Industry for Data Modelling, ETL and Reporting
• Analyze and interpret the collected raw data into models, stories, and concepts.
• Experience in conducting various testing phases in the project life cycle.
• Collaborated with QA teams for creating and reviewing Test Plans and Test Cases.
• Experience creating and managing defects in the Quality Center.
• Experience in advanced statistical analysis software (SAS, SPSS, Stata, etc.).

TECHNICAL SKILLS:

Languages: SQL, SAS v8.x/9.x, SAS/BASE, SAS/SQL, VBA.

Databases: MS SQL Server (2000, 2005, 2010), Oracle 8i, 9i, 10g, MS Access, Oracle 11g (PL), DB2

Operating Systems: Windows vista, Macintosh, UNIX.

Microsoft Tools: MS Office, MS Outlook, MS Project and MS Visio.

Visual Modeling Tools: Rational Rose, MS Visio, Snagit9, Smart Draw and UML.

Management Tools: Mercury Quality Center, Test Director and Requisite Pro.

Modeling Languages: UML .

Other Tools: Share Point, Win runner and QTP.

PROFESSIONAL EXPERIENCE:

Confidential, Chicago, IL

Sr. Business System Analyst

Responsibilities:

• Strong Business analysis skills through an in depth understanding of Software Development Life Cycle (SDLC) and understanding different methodologies at all stages of Rational Unified Process(RUP), Agile, Waterfall and Business Process Re-engineering .
• Strong knowledge of modeling the system using Use Case Diagram, UML Diagrams (Activity diagram, Sequence diagram, State diagram and Class diagram) and also knowledge of Impact Analysis, Scope Definition and Change Management through MS Visio.
• Facilitated Sprint Planning, Daily Scrum Stand Up, and Sprint Retrospective meetings as a ScrumMaster.
• Responsible for Elicitation, understanding the business requirements for the project, and translating these into functional specifications and detailed test plans.
• Extensively worked with FACETS Implementation, FACETS Billing, Claim Processing and Subscriber/Member module.
• Actively assisted Client Implementation manager on all active clients including HEDIS services.
• Reviewed minutely Front end claims validation related Business Requirement Documents (BRD), Notice of Plan Changes (NOPC), Benefit Checklist, Facets Medical Plan and Facets Application Support application Groups for writing test cases/test scripts.
• Worked on Facets to efficiently execute core administrative functions, including claims processing, premium billing and customer service.
• Maintained requirements status update log.
• Conducted JAD sessions with business units and stakeholders to define project scope.
• Created workflow diagrams, UML diagrams, process models, activity diagrams, use cases, for incorporating design changes in the order creation/ management system.
• Assisted in conducting manual and automated tests for Functional Testing, Integration Testing, Regression Testing and User Acceptance Testing.
• Gathered requirements for ETL and Reportings Applications.
• Mapping Document for the ETL process
• Identify new potential clients through portfolio analysis and research
• Tested the ANSI X12 Version 5010 / EDI transactions (HIPAA) mainly on 837 Professional and Institutional Claims.
• Experience in developing test plans and test cases for the migration of HIPAA 4010 to 5010
• Proficient in processing batch jobs related to Benefit Enrollment (834) and Claims (837).
• Experience in real-time EDI transactions such as Benefit Inquiry and Response and Claim Status Request and Response (276 / 277).
• Involved in creating the Production Plan along with writing user manuals (System guides, training material for Business users and Deployment guides).
• Involved in Forward Mapping from ICD-9 to ICD-10 and Backward Mapping from ICD-10 to ICD-9 using General Equivalence Mapping (GEM).
• Experience in Managed Care Plans (HMP, PPO and POS) and Government Sponsored Programs (Medicare, Medicaid) with understanding of compliance and regulation of CMS and other State/Federal regulations.
• Worked on developing the Business requirements and use cases for FACETS batch processes.
• Knowledge of SQL Queries and identifying various test scenarios

.Environment: Windows 7, Unix, Tableau 8.0 9.0,PL/SQL, Facets, Oracle 11g, MS Visio 2013, Rational Clear Quest, Rational Rose, HIPAA, FACETS HEDIS, ETL,MS Word, MS PowerPoint, MS Excel.

Confidential, Rochester, NY

Sr. Business System Analyst

Responsibilities:

• Improved productivity by re-engineering the delivery of information and moving information online.
• Defined, reviewed and assessed customer and business requirements and Service Level Agreements.
• Responsible for integrating with Facets. Designing test scripts for testing of Claims in Development, Integration and production environment.
• Reviewed requirements gathering methodologies. Defined and document customer business functions and processes.
• Created Claims in Medical and Hospital Claims Processing application in Facets.
• Tested Member Enrollment, Eligibility, Group and Plan Year in Facet
• Validated Accumulator Benefit Period and Claim Filing Period limitation in Facets Medical Plan application group.
• Tested the changes for the front end screens in FACETS related to following modules, test the FACETS batches (membership, Billing, Provider claim processing, etc).
• Worked as Business Analyst in a Scrum Team.
• Conducting Daily Scrum Stand ups, Agile sprint review meetings and actively participate in retrospective sessions
• Analyzed specifications and Business needs to be incorporated in WebFocus reports
• Defined business needs and objectives, operational procedures and problems, and the input and output of requirements.
• Extensive requirement gathering and testing for the ETL processes
• Experience in SQL Server Analysis Services (SSAS) for data mining to identify rules and patterns in the data.
• Used Aggregate awareness function of Business Objects to route the query objects through the appropriate path while selecting from multiple contexts.
• Used HEDIS data collection for Patient-Level-Detail (PLD) file validation process documentation.
• HEDIS measure specific documents were analyzed for record sampling, calculation and overall performance check.
• Implemented business intelligence analysis and reporting by developing custom reports, interactive dashboards, and ad hoc analyses that leverage complex data sources and BI tools (Excel/VBA, Tableau, Python, SQL).
• Defined Report Level Ranking, Database Ranking and Alerts in Reports based on the specifications.
• Extensively used tools such as MS Visio, QC. ALM
• Designed Use Case Diagrams, Activity Diagrams, and Data Flow Diagrams to define the Business Process.
• Tracing requirements throughout the development process and verifying adherence using the Requirements Traceability Matrix (RTM).
• Performed the responsibilities of Scrum Team by complete involvement with the Scrum Product owner.
• Conducted Joint Application Development (JAD) sessions to allow different stakeholders to communicate with each other, resolve problems at an early stage.
• Coordinated with the test team to check the Weekly Status and Report it to the Project Manager.
• Responsible for Interacting with the Developers to explain the proposed changes and ensure understanding of the system requirements to handle these changes.
• Worked with the Quality Assurance lead to develop detailed Test Plan and Test Cases.
• Created UAT Test Plans and Test Cases.
• Created WebFOCUS reports from simple to complex business logic and partnered with vendor IBI for complex technical needs.
• Involved in Metadata testing, Data Completeness testing and Incremental ETL testing.
• Used formal requirements gathering methodologies. Developed report specifications.
• Developed business, functional, and non-functional requirements. Translate and simplify requirements. Developed requirements traceability matrix.
• Worked with Data Analyst for ETL Design review meeting to get approvals from cross-functional teams.
• Scoping, scheduling and facilitating of workshops with the business and subject matter experts (SMEs) to discover, document, analyze and optimize business processes through modeling.
• Meet with End User groups to determine changes needed in the requirements to ensure processes are correct.
• Create workflows using formal notation such as the Business Process Modeling Notation (BPMN).
• Develop graphic representations of complex business processes. Conduct/facilitate workshops for requirements analysis.
• Organized and conducted meetings within the team and resolved the issues faced by the team

  members.

Environment: PL/SQL, MS Office 2007, MS Visio, WebFOCUS, Oracle9i, ETL, DB2, MS Word, Facets MS PowerPoint, MS Excel.

Confidential, Detroit, MI

Business System Analyst

Responsibilities:

• Performed detailed Gap Analysis between current and future state business process models for three initiatives.
• Documented, defined, analyzed and translated functional and non-functional business requirements into process and activity models, system use cases and supplemental specifications that contribute to effective software development.
• Facilitated business process re-engineering or business process improvement involving broad-based information systems, utilizing tools and techniques and business process methodologies (BPMN)
• Performed data mining and data analysis activities to explore how data can identify customer patterns thus help drive new strategies.
• Authored, designed, & implemented custom quantitative financial management and custom CRM software (VBA) that contributed to significant process improvement, and a reduction in required resources.
• Used SSAS to create cubes with various measures and dimensions for financial reports generation.
• Reviewed and analyzed reports about format, distribution, and purpose, identified problems and improvements, develop solutions or alternate methods of proceeding
• Established and maintained regular communication with the client, management and team members for current and upcoming projects regarding the development and implementation for AEP 2016. Functional expert regarding Medicare A, B, C and D enrollment.
• Extensive ETL requirement gathering and testing involved for the Online and Paper Enrollment, Invoice, Billing, Refund, Membership Removal, Delinquency and Recurring ACH modules of the Opermart project.
• Integrated various systems with HEDIS and create design for HEDIS and other systems to pull data in HEDIS.
• Prepared Healthcare Effectiveness Data and Information Set (HEDIS) reporting.
• Responsible for processing data and flowcharting techniques
• Excellent knowledge and daily use of HIPAA (Health Insurance Portability and Accountability Act) transaction codes such as 270/271 (inquire/response health care benefits), 276/277 (claim status), 470 (benefit codes), 835 (payment or remittance advice), 837 (health care claim) and 834 (benefit enrollment).
• Analyzed changes of product design to determine the effect on the end product design and function and determines and prepares documentation necessary for change.
• Coordinated with customers and manufacturers to determine a process for change reporting.
• Reviewed released engineering change data and changes documenting activities to ensure adherence to configuration management procedures and policies.

Environment: MS Project/Office, MS Visio, Waterfall, Web FOCUS, WPF/.NET framework, Windows o/s. MS Word, MS PowerPoint, MS Excel.

Confidential

Benefits/ Business Analyst

Responsibilities:

• Gathered user and business requirements through interviews, surveys, prototyping, and UI (User Interface).
• Stored and modified requirements in MS Word.
• Interacted with Business Owners, Users, and Stakeholders to identify Business System Needs, evaluated solutions for business problems, and prepared Business Requirements Document (BRD) and later translated them in to Functional Requirements Document (FRD)
• Represented the business requirements in various alternative views such as analysis models, process flow diagrams and user stories.
• Used UML to produce AS IS and TO BE models.
• Worked close with System Analysts to create the functional document for the development for the new databases.
• Analyzed and prioritized user and business requirements as system requirements that must be included while developing the software.
• Prepared Logical Data Models that contained set of diagrams, Business Requirement Documents, and supporting documents containing the essential business elements, detailed definitions, and descriptions of the relationships between the actors.
• Planned and defined system requirements to Use Case, Use Case Scenario, and Use Case Narrative using the UML (Unified Modeling Language) methodologies.
• Created Use Case Diagrams, Activity Diagrams, and Sequence Diagrams in MS Visio.
• Worked on Wire frames during the Elaboration Phase.
• Conducted JAD sessions with management, SME, vendors, users and other stakeholders for open and pending issues.
• Produced project estimates for short and long-term versions of data integration solutions.
• Owned detailed design, construction, testing and implementation of data integration program, processes, and cycles
• Created and managed project templates, Use Case project templates, requirement types, and traceability relationships in Requisite Pro.
• Authored progress and completion reports which were then submitted to project management on a weekly basis.
• Created test cases and test scripts to check the functionality of application (UAT)
• Performed manual front-end testing to check all functionalities of different modules.
• Suggested measures and recommendations to improve the current application performance.

Environment: MS Project/Office, MS Visio, Waterfall, WPF/.NET framework, Windows o/s. MS Word, MS PowerPoint, MS Excel.

Confidential

Business Analyst

Responsibilities:

• Gathered Business Requirements, interacted with the Users, Designers and Developers, Project Manager and SMEs to get a better understanding of the Business Processes
• Conducted JAD Sessions periodically with various stakeholders at various phases of the Software Development Life Cycle (SDLC) to discuss open issues and resolve them
• Organized requirements into high level use cases and low level Use Cases Specifications and modeled them into UC, Activity and Sequence Diagrams using Rational Rose
• Used the Unified Change Management (UCM) tool, Rational Clear Quest, to maintain and track the Stakeholders requested enhancements and changes.
• Creation of the functional solution documents, getting them verified with the peers and the client team
• Working with a tight deadline and rigid work schedule to match the hours of operations in India due to the time difference
• Prepared process flow-using Visio to better understand the existing business process and worked with the team to find solutions
• Wrote test plans and estimated time frames for functional IT, UAT test phases and Conducted QA meetings for team to walk-through on test plan.
• Followed a structured approach to organize requirements into logical groupings of essential business processes, business rules, and information needs, and ensured that critical requirements are not missed.
• Followed the UML based methods using Rational Rose to create: Use Cases, Activity Diagrams, Sequence Diagrams, and Collaboration Diagrams; created the AS-IS and TO-BE process flows.
• Facilitated User Acceptance Testing (UAT) and collaborated with the IT team and system administrators to develop the test plans, test scenarios, test cases, test data to be used in testing based on business requirements, technical specifications and/or product knowledge
• Defined the test scenarios and created the test cases. Mapped them to the requirement traceability matrix. Executed Test Cases & involved in Regression Testing
• Expertise in Problem solving and Bug Tracking Reports using Bug tracking Tools
• Creation of the Defect Tracking report and sharing it with the Client business team, Infosys functional and technical team and managers
• Updated project tasks, identified project milestones and other deliverables and communicated this with the project manager and other team members to ensure the project was on time and on schedule

Environment: MS Office, Rational Rose, UCM, Rational clear quest, Windows o/s. MS Word, MS PowerPoint, MS Excel.