SUMMARY:

• Business Analyst with 9 years experience within healthcare and Social Services ACA (Affordable Care Act), SNAP, (Medicaid, Medicare Claims) insurance and pharmaceutical industries, MMIS
• Experienced documenting Business Requirements Document (BRD), developing UAT Plan, maintaining Traceability Matrix and assisting in post implementation activities.
• Extensive experience in working in SDLC for various methodologies, including RUP, Agile and other internal methodologies.
• Expert in translating business requirements and user expectations into detailed Functional Requirements Specifications (FRS) by employing Unified Modeling Language (UML).
• Highly experienced in performing Feasibility Studies, Impact analysis, GAP analysis and Risk Analysis.
• Expertise in creating Use Cases, Use Case Diagrams, Class Diagrams and Sequence Flows using MS Visio and UML concepts.
• Skilled at Insurance Administration systems, including Actuarial, Policy Application, Eligibility, Enrollment, Underwriting, Claims, Billing and Payments.
• Experienced working on HIPAA X - 12 EDI Insurance/Health Series (INS) such as 270/271, 274, 276/277, 278, 820, 834, 835, 837 and version 5010 of this transactions.
• Experienced working with healthcare claims, ICD-9/10 diagnosis codes, CPT, Claims, Provider, Enrollment, finance, benefits and Vendor Management Business areas.
• Experienced working models on MITA, HIX, HL7 and EHR, FISS (Part A), MCS (Part B), DME (ViPS).
• Strong experience in Extraction, Transformation and Loading (ETL) data from various sources into Data Warehouses and Data Marts using Informatica Power Center (Repository Manager, Designer, Workflow Manager, Workflow Monitor, Metadata Manger), Power Exchange, Power Connect as ETL tool on Oracle, DB2 and SQL Server Databases.
• Deep understanding of database management systems, data warehousing concepts, BI technologies and data mining.
• Skilled in data warehouse design using Star Schema rollout for fact and dimension tables.
• Expert in application development with full lifecycle implementation of large data warehouses, including project Scope, Requirements Gathering, Star Schema Design, Snowflake Schema, data modeling and ODS.
• Experience in writing SQL queries and reviewing/analyzing store procedures in SQL and PL/SQL.
• Expertise in creating dimensional models and creating ETL specifications.
• Defect Management/Bug Fixing - fully involved in the process of defect identification and resolution using tools like Test Director, ClearQuest and Quality Center.
• Experienced conducting User Acceptance Testing (UAT) and documentation of Test Cases.
• Organized professional with excellent oral and written communication skills, excellent presentation, interpersonal skills, problem solving skills, fast learner and also adept quickly new technology with ability to take new roles in minimum time and little training.

TECHNICAL SKILLS:

• Curam 6.0.4, Curam 6.0.5 and Curam 6.2
• MMIS, HIPAA ANSI X 12 4010-5010, ANSI X12, HCPCS Codes, CPT and ICD-9 coding, ICD-10, 21 CFR 312/820, FISS, MCS, ViPS
• Agile Methodology, SDLC, RUP, CMMI, Six Sigma, ARGUS Clinical Data Management System
• Cognos, Informatica, Crystal Reports, Mumps, SAS, SAS/SQL, .NET, INKSCAPE, ERwin, COBOL
• Rational Rose, Rational RequisitePro, Rational Quality Center, DOORS, HP ALM
• MS Project, MS Visio, MS SQL Server 2005/2008, MS Access, MS Office, MS Windows 7/98/XP

PROFESSIONAL EXPERIENCE:

Confidential, Arkansas

Sr.Business Analyst

Responsibilities:

• Conducted JAD sessions with the state clients to gather requirements and specific policies per Arkansas state.
• Developed Design documents per Fit Gap analysis.
• Developed ruled documents to provide correct eligibility and determination of benefits.
• Developed Application Intake functional documents for Online and Case Worker portals.
• Worked with Confidential vendor and for designing solution for data migration from Legacy system to Curam.
• Developed design documents in the Functional Areas, Change in Circumstances, Application Processing, SNAP rules, DSNAP rules.
• Developed technical design documents for various interfaces like TEA, eDRS, SSN Enumeration.
• Developed design document for Unified HCR and CGISS module intake script, along with associated task and evidence brokering rules as required.
• Preformed data analysis, prepared ER diagram to demonstrate relationship between various entities within the system.
• Worked with team Data Architect and Prepared the transformational rules for the Data Conversion as well as transformational rules.
• Worked with the SOA team to leverage the business requirements and the correct working of Web Services as well as technical feasibilities around these functionalities

Tools: /Technologies: HP ALM, WINSCP, PUTTY, DB2, TOAD Oracle, Cognos 10.1, MS Office. MS Visio.

Confidential, MISSOURI

Sr.Business Analyst

• Agile Methodology was used for implementation with different modules divided in different sprints for implementations.
• Developed Functional Design documents for Application Intake on the Citizen’s Portal and Case Worker portal.
• Conducted JAD sessions with business to gather the requirements and translate into Functional Design and Technical Design Document.
• Developed design document specification and provided essential solution for various batches to resolve ongoing production issues.
• Performed Unit testing for the Complete Change in Circumstances design and accordingly interacted with the testing team to help them understand the functionality.
• Developed and Designed various WSDL and Batch Processes to implement functionalities like SSI title 16, TMH notices, presumptive eligibility, Annual Renewals.
• Performed Database testing using by executing SQL queries, along with analyzing the database using dbeavor tool to validate the correct population of the expected data.
• Developed data mapping documents for IVR implementation, by analyzing the CURAM Code Table and the legacy system FAMIS.
• Performed SOAP UI testing using SOAP UI tool to verify the Federal Web Service as well as the Local Web Service Call.
• Analyzed log files using WINSCP tool to analyze the log files and the underlying issues in the functionality.
• Managed Functional design documents and Requirement Traceability Matrix on sharepoint.

Tools: /Technologies: JIRA, WINSCP, PUTTY, DB2, TOAD Oracle, Cognos 10.1, MS Office. MS Visio.

Confidential, Columbia

Sr. Business Analyst

• Developed Functional Design Documents for various modules such as Application Intake, Notices, Case Management, Plan Management, External upload and SHOP.
• Worked with Business Stakeholders from DCHBX for developing the exchange related documents.
• Worked with the Business Stakeholders from DHCF for developing design documents for the Medicaid eligibility expansion/New MAGI Rules.
• Worked with OCM team to help understand the working of the product as well as provided training to the Case Workers Team Leaders and Team to help them understand the new implementations in the application.
• Maintained requirements traceability matrix using HP ALM and design documents in Sharepoint.
• Performed UAT testing and provided clarifications to the testing team for various defects.
• Analyzed and tracked defects in HP ALM as well as interacted with IBM CURAM team to help them understand the product limitations as well as product defects based on the CMS mandates.
• Conducted meetings on a regular basis with Accenture to help meet the goals of IV and V team.
• Later phase in the project worked as the QA manager for IPS prioritizing defects and providing new desgn as required by the development team for implementation.
• Worked on the Renewals/Recertification for Beneficiaries present in the Legacy system in DC (ACEDS) to DC Health Link new system.
• Preformed data analysis, prepared ER diagram to demonstrate relationship between various entities within the system.
• Worked with team Data Architect and Prepared the transformational rules for the Data Conversion as well as transformational rules.
• Worked with the SOA team to leverage the business requirements and the correct working of Web Services as well as technical feasibilities around these functionalities.

Confidential

Business Analyst

• Developed systems edit logic for Institutional (Part A), Professional (Part B), and Durable Medical Equipment (DME) Encounter claims to ensure accurate editing of Encounter claims.
• Conducted JAD sessions to develop new EDPS system edits for the proper processing of Medicare Advantage Encounter claims and ensured accurate data is captured for reporting to CMS.
• Researched and corrected defects identified during the testing of new and existing system edits.
• Maintained reference documents for the various EDPS edits.
• Ensured project resources and documentation meets the clients expectations accurately as well as maintaining RTM in SharePoint.
• Involved in system release deployment to mitigate any potential problems during production implementation prior to the release being sent to the users.
• Maintained a functional knowledge of changes introduced into the FFS plan.
• Developed test cases for the functionality developed and implemented in the system.
• Assisted with the process of changes to the EDPS processing of claims based upon added functionality requests from CMS.
• Developed presentations for the functionality of integrated claims processing in the FFS environment.
• Reviewed and analyzed the ICD-10 codes per CMS Mandated change requested and assisted in implementing edits and pricing related to ICD-10 codes. Proficient in General Equivalence Mapping for ICD-9 to ICD-10 diagnosis code.
• Worked with NGS and CDS SME for clarification and concerns of technical processing in comparison to CMS mandates.
• Worked on Informatica Power Center tools- Designer, Repository Manager, Workflow Manager, and Workflow Monitor.
• Designed and customized data models for Data warehouse supporting data from multiple sources on real time
• Involved in building the ETL architecture and Source to Target mapping to load data into Data warehouse.
• Created mapping documents to outline data flow from sources to targets.
• Performed data modeling by creating logical and physical models of the database system using ERwin.
• Developed data transformation, data manipulation documents as well as worked on informatica for integration into a central model and depicting data flow across systems.
• Used Star Schema methodologies in building and designing logical data model into Dimensional Models.
• Documented and maintained RTM for various internal enhancements and implementations.
• Reviewed Functional Design and system’s design documents; developed functional specs for eligibility/Enrollment module/track.
• Worked on SaaS enterprise guide for implementing functionalities related to Client Communication, Notifications, Appeals.
• Prepared documents for new functionalities being embedded in system, as part of change request.
• Implemented Business rules/logic for Eligibility application.
• Developed Functional Design Documents/ handled Change Request for SHOP (Plan selection, etc)
• Interacted with DOH (Department of Health NY) requirements team to develop functional documents in sync with the State requirements.
• Developed process flow diagrams for solutions for system implementation.
• Participated in Peer Review process and thereby provided essential changes required in Functional Design Document.
• Reviewed and performed data mapping for the system generated 834 transactions.
• Interacted with development team to understand system’s performance and associated enhancements needed, per state’s requirements.

Tools: /Technologies: FISS, MCS, VMS, Agile, Mercury Quality Center, TOAD Oracle, Cognos 10.1, MS Office. MS Visio.

Confidential, Port Washington, NY

Sr. Business Analyst

• Agile methodology was used throughout the project, with daily status report, queries and updates on the Scrum master.
• Conducted JAD sessions, meetings, teleconferences to gather business requirements from various stakeholders and SMEs.
• Performed GAP analysis by the performing the system analysis between the scheduling systems and documented the gap items.
• Prepared the Business Requirement Specifications, System Requirement Specification, Interface documents, Architecture Specification and documented environment setup for various environments (Development, QA, UAT, Implementation, Testing and Production).
• Worked extensively with developing business rules engine enabling the business rules such as referral, prior authorization, eligibility, claims processing and billing essential for EDI transaction.
• Using Informatica PowerCenter Designer analyzed the source data to Extract & Transform from various source system(oracle 10g,DB2,SQL server and flat files) by incorporating business rules using different objects and functions that the tool supports.
• Using Informatica PowerCenter created mappings and mapplets to transform the data according to the business rules.
• Used various transformations like Source Qualifier, Joiner, Lookup, sql router, Filter, Expression and Update Strategy.
• Worked extensively with the XML files for analyzing and handling various billing formats from various agencies which included standard 837P along with ICD-9 and HCPCS codes.
• Developed Use Cases for unit testing, prepared spreadsheet for testing criteria, including regression, positive and negative testing, process flow testing and screenshot for test results to complete expected and actual results.
• Prepared various diagrams and Swim Lane diagrams using MS Visio and INKSCAPE tools.
• Prepared documents for the wireframe and prepared a data dictionary for the same.
• Prepared various SOA for diagrams for various systems in Sandata.
• Prepared architecture document for system. Documented environment setup for system.
• Managed testing for various functionalities using JIRA and Quality Center tools.

Tools: /Technologies: Agile Scrum, MS Office, TFS (Team Foundation Server), SharePoint, QuickView, Visual Studio, MS Visio, Case Complete, INKSCAPE, JIRA, Tracker, MS Project, Linux (RHEL), Drools, Groovy, JBOSS, Neo4J, .Net

Confidential, Danville, PA

Business Analyst

• Reviewed BRD for different Part D and Hospital Claims functional areas such as for Adjudication-wrap plan formulary determination, Pharmacy handling. For Marketing-Member communications, Claim determination-Grievances, PA Authorization, Appeals and Exception, COB adjudication, PDE (Prescription drug events).
• Performed GAP analysis assessed As-Is processes through user interviews, data collection and analysis, design and evaluation of To-Be process solutions.
• Claim Transactions and Billing Transactions - created flows for adequate matching of claims. Performed data mapping by matching the billing file and EDI claim file record claims received from Medicare and Medicaid agencies.
• Monitored automated enrollment data and batch files for Facets 4.21for Medical and Dental transactions; provided customer service for members and trading partners.
• Developed Business Flow diagrams, Activity/State diagrams and Sequence diagrams so development team and other stakeholders for FACETS 4.21.
• Developed Data Mapping documents for the 834 transaction sets for the EOB files to be generated Using FACETS 4.21
• Designed and developed reports for data in the data warehouse using BO.
• Analyzed data using Slice/Dice and Drill up/Drill down to analyze data to meet end user’s requirements.
• Assisted QA Manager to develop Test plan and Test Case.
• UAT - performed UAT tests using Observer Usability Testing Tool Manager Mode.
• Testing - developed Test Scripts using Test Director/QualityCenter and coordinated with developers to quickly resolve the defects associated with them.
• Participated in system testing and UAT. Worked with System Test Review team and developers to resolve system test issues and re-test.
• Helped create 'Business Glossary' to facilitate efficient understanding of business process amongst other teams.

Tool: /Technologies: Agile Scrum, MS office, MS Visio, My SQL, Rational Quality Center

Confidential, Pittsburgh, PA

Business Analyst

• Conducted meetings with Data Architects, Data Modelers and MS SQL Reporters to determine feasibility of related data.
• Extensively involved in requirements gathering and design meetings with Integrated Product Team (IPT) Business/Lead users to understand requirements for configuring/test System Workflows.
• Worked with HIE, HL7 and EHR along with assisting in hospital integration for data received from trials site.
• Used mainframe platform to retrieve data and utilized SAS/ETL to extract data from operating data system.
• Worked with FDA and ICH-GCP guidelines, including 21 CFR Part 11 and 21 CFR Part 312 required for clinical trials data.
• Successfully conducted numerous JAD sessions with various stakeholders at different phases of SDLC.
• Conducted feasibility study to identify if business system can be created within limited time, budget and resources.
• Performed GAP analysis to identify areas of improvement for business process.
• Developed, compiled and updated the RTM during all phases of software lifecycle.
• Worked in with Requirements Analyst for documenting/revising User Requirements, User Interface Requirements, Migration Requirements, Software Requirements Specification, Product Retirement Requirements and RTM.
• Worked with Technical Writer and Senior System Analyst to prepare user manuals, System Administrator, Facility Administrator and B HQ Administrator manuals.
• Created data mapping document to load data from XML files to SQL table.
• Provided training to Business Users, Test Team and Product Specialists
• Attained IPT meetings and meetings with management and lead business users from various regions.
• Involved in prototyping application and Gap analysis.
• Worked with Senior Requirements Analyst to understand User Requirements.
• Reviewed/revised Use Case document.
• Prepared UAT protocol from Use Cases encompassing basic and alternate flows.
• Prepared Test Cases and procedures for UAT.
• Tracked documents through all stages of lifecycle. Coordinated activities with authors, reviewers and approvers to promote document flow through system.
• Executed distribution workflow phase for new and revised documents.
• Authored and reviewed technical documentation for multiple CFR Part regulated business units within company.

Tools: /Technologies:Scrum Methodology, MS Office, MS Visio, SharePoint, .Net, Java, MySQL

Confidential, Maryland, MD

Business Analyst

• Conducted detailed and comprehensive business analysis by working with end users and other stakeholders to identify the system, operational requirements and proposed enhancements.
• Validated business process flow for claims processing (EDI transactions) which included hospital claims (Parts A, B) and Prescription Drug claims (Part D) for Nebraska State.
• Facilitated JAD sessions with all IT group members for communicating and managing expectations and to discuss various means for integrations with current system using an adoption through execution strategy.
• Conducted Gap analysis on As-Is and To-Be business processes and technology; and identified potential pitfalls, risks and issues.
• Mitigated risks and developed contingency plans for risk management.
• Identified all necessary Business and System Use Cases from requirements, created UML diagrams, including Use Case Diagrams, Activity Diagrams and Sequence diagrams using MS Visio.
• Understood Business Logic, User Requirements and test objectives to develop Test plans, Test Cases and Use Case scenarios.
• Involved in comprehensive testing of system to ensure it satisfies functional specifications.
• Responsible for checking benefit set and adjudication of claims.
• Created High Level Test scenarios, Test Cases and Test Scripts for Data Hub requirements as described in RSD and DSD, as well as HIPAA.
• Gathered Data Hub requirements and created Test Cases and Test Scripts under Quality Center Test Plan and Test Lab modules.
• Worked with ICD-9 and CPT codes required for processing claims required in compliance with HIPAA 4010.
• Developed Test Scripts using Test Director and coordinated with developers to quickly resolve defects associated with them.
• Analyzed and evaluated UI designs, Technical Design Documents and Quality Assurance Test Conditions for the performance of the application from various dimensions.
• Documented UAT Plan for project and worked with UAT team to ensure every acceptance criteria for requirements included in UAT Task Plan.
• Data Hub testing scope included testing Data Hub requirements, documenting and testing source system records, change requests and assisting SMEs with validation of daily error files.
• Verified and validated all build or release related issues and resolved them through discussion with business analysts with users’ approval.

Tool: /Technologies: Scrum, HTML, MS Project, MS Office, UML, MS Visio, Visual SourceSafe, Rational tools, SQL, WinRunner, LoadRunner

Confidential, Parsippany, NJ

Business Analyst

• Performed Gap analysis, requirements gathering and enhancements to existing systems and processes.
• Worked with Investigator brochures, NDA periodic Reports, PSUR, and e-CTD.
• Worked with Regulatory Report Authoring and Publishing Management Systems (e.g. Dossier, Liquent Insight, etc) and Documentum in compliance with FDA guidelines.
• Worked with Documentum Query Language and Documentum wrapper.
• Prepared use case models, based on Business Requirement documentation gathered through interaction with users and stakeholders.
• Assisted in maintaining EHR and health record interchange for clinical trial image management system, as well as assisted in HL7.
• Implemented RUP, including requirements, specifications, design and analysis.
• Created and maintained RTM.
• Assisted in data modeling, mapping fields for reports along with generation of periodic reports using Cognos.
• Worked with Project Manager on various project management activities like tracking Project Status, Deadlines, Environment Requests and Compliance Issues.
• Ensured Use Cases were consistent and covered all aspects of Requirements document.
• Identified and analyzed data requirements for various site teams and ensured required data available in testing environment.
• Worked directly with Software Engineers to ensure clear communications on requirements and defect reports.
• Designed and developed scenarios, based on business requirements.
• Involved in Functional System Testing, Integration Testing, Regression Testing, and UAT before releasing application.
• Validated scripts to ensure proper execution and meeting of scenario description.
• Involved in project status, QA review and System Test meetings.

Tools: /Technologies: Rational Unified Process (RUP), MS Office, MS Visio, MS Project, Oracle, SQL, Rational RequisitePro, Rational Test Manager, WinRunner, Rational ClearQuest, Mercury testing tool, Business Objects-Data Integrator