Summary of Qualifications:

• Seven years of experience in Software Development Life Cycle SDLC which involves requirement gathering, requirement analysis, design, development, implementation maintenance of Projects
• Over 7 years of extensive experience as Business Analyst with solid understanding of Business Requirement Gathering, Business Process Flow and Business Process Modeling.
• Exposure to Healthcare, Insurance and Finance business domains.
• Over 7 years of experience in Use case design.
• Over 7 Years of experience in RUP environment
• About 6 years of experience in Generating Test scripts for UAT.
• Experience with designing and verifying databases on Oracle and SQL Server RDBMS using Entity-Relationship Diagrams ERD .
• Worked on HIPAA compliance and experience in designing the healthcare transactions to be HIPAA 5010 compliant
• Extensive experience on MMIS Medicaid Systems, HealthCare Industry including supporting efforts including response to RFP, Requirements Analysis Documentation, General System Design and Detailed System Design Documentation, conducting JAD and JAR sessions of project life cycle.
• Experience in development methodologies like RUP, SDLC, AGILE, SCRUM and Waterfall.
• Extensive knowledge of Object Oriented Analysis and Design OOAD using Unified Modeling Language UML , Rational Unified Process RUP , Waterfall model, Rational Rose, Requisite Pro, Rational Clear Case and MS Visio.
• Experienced in interacting with business users and executives to identify their needs, gathering requirements and authoring Business Requirement Documents BRD , Use Case Diagrams, Activity Diagrams and Sequence Diagrams using UML modeling.
• Experienced in facilitating and conducting Joint Application Development JAD , Rapid Application Development RAD and Joint Requirement Planning JRP sessions, interviews, workshops and requirement elicitation sessions with end-users, clients, stakeholders and development team.
• Experienced in Business Analysis, SWOT Analysis, Gap Analysis, Cost-Benefit Analysis, Risk Analysis, Disaster Recovery Planning, Return On Investment ROI Analysis, Testing and Project Planning.
• 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.
• Experienced in developing reporting application using ETL Informatica and Cognos Business Intelligence Suite with multiple data sources like Oracle, MS SQL and DB2 database.
• Proficient in RDBMS concepts and also in database testing using PL/SQL tools such as TOAD.
• Experienced in working with various departmental teams, developing interactive relationships with business and IT colleagues, having a thorough understanding of the constraints, needs, and perspectives of both the business users and the technical team.
• Experienced in training and mentoring team members with product knowledge and business processes.
• Strong work ethic, taking ownership of all duties and responsibilities and meeting management objectives.
• Strong business acumen, analytical, problem solving, interpersonal and presentation skills.
• Excellent written and oral communication skills to keep executive staff and team members apprised of goals, project status, and resolving issues and conflicts.

Technical Competencies:

Business Skills: Business Process Analysis Design, Requirement Gathering, Use Case Modeling, JAD/JRP Sessions, Gap Analysis and Impact Analysis.

Methodology: RUP, Agile, OOAD and Waterfall.

Standard and Codes: HIPAA 4010A1/5010, ICD-10, ICD-9, ANSI X12, HL7, CPT and CMS form.

Languages: C, C , SQL, PL/SQL, HTML and XML.

Visual Modeling Tools: Rational Rose, Requisite Pro, Clear Quest, Clear Case and MS Visio.

Testing Tools: HP Quality Center, Win Runner, Load Runner and TOAD

Data Modeling Tools: Erwin, Informatica 7.1.1/6.5

BI Tools: Cognos 8.4/8.3/8.2/8.1Cognos ReportNet 1.1, Cognos Enterprise 7.1 Series, Business Objects, Crystal Reports, SSRS 2005, SSAS 2005.

Database: Oracle 8i/9i/10g, DB2, MS SQL Server.

Web Servers: Microsoft Internet Information Server IIS 4.0/3.0, SunOne Server 5.2.

Operating Systems: UNIX, Windows 95/2000/NT/XP, and MS-DOS.

Office tools: MS Office 2003 Word, Excel, Power Point, Outlook , MS Visio, MS Project, and MS FrontPage.

Professional Experience:

Confidential

Role: System Analyst

Responsibilities:

• Extracted the business requirements from the end users keeping in mind their need to request for information about medical services offered to the customers and documented it for the developers
• Identified system integration requirements, and coordinated the collection and verification of business needs.
• Involved in the day-to-day implementation of the Rational Unified Process RUP methodology of application development with its various workflows, artifacts and activities.
• Documented Functional Requirements Specifications FRS .
• Created activity diagrams using Rational Rose to communicate the system activity flow to the developer and QA team.
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, OOAD using UML and Business Process Modeling.
• Provide implementation assessment, strategy, and mentoring services for Rational Rose, UML and RUP.
• Utilized Agile/ SCRUM and PMI methodologies to monitor steer and develop project objectives.
• Ensured that project/requirement s are properly tracked and documented as per Project Manager's needs
• Involved in project management using MS Project
• Designed and developed Project document templates based on SDLC methodology
• Identified features, Prioritized features, Identified Requirements by features and Developed Traceability Matrix using Rational Requisite Pro.
• The Addenda version of the ANSI ASC X12 834 transaction set was selected as the HIPAA-mandated format for electronic enrollment and disenrollment in a Health Plan.
• Followed the Business Rules, and ensured that HIPAA compliant Rules are followed to display minimum benefit information that the Provider is required to pass on the EDI transactions.
• Managed the privacy and security environments of healthcare data that was governed by HIPAA and other government mandates.
• Worked as a User/Customer advocate and negotiated with user as well as the technical team and management staff to resolve any outstanding requirement conflict during the whole SDLC process.
• Generated and maintained clinical data security policies and procedures.
• Responsible for attaining HIPAA EDI validation from Medicare, Medicaid and other payers of government carriers.
• Worked on following applications Business Objects, Enterprise Architect, Toad, PlanView project management , Microsoft Suite Word, Excel, PowerPoint, Visio, Access, Project
• Planview administrator Responsible for end user training, report development, process documentation, and software administration.
• Involved in Documenting and Executing business test cases.
• Assisted developers and testing team to ensure that the requirements are communicated accurately and that the system being developed is verifiable against the requirements gathered.
• Assisted QA Team in executing the test cases and collected the test and process metrics.
• Involved in claims submission and payment remittance retrievals and used ASC X12N 820 for the In- bound premium payments, ASC X12N 834 for the Inbound Enrollment and Maintenance, ASC X12 276/277 for the claims status enquiry and response and ASC X12 835 for the Healthcare Claim Payments.
• Involved in filing claims for billing using the CPT forms, CMS-1500 claims forms and First report of Injury forms.
• Involved with the coders in evaluation of CPT and ICD-9 codes to ensure that the diagnosis meets medical necessity for the specific CPT code.
• Maintained Web application using Adobe Flex 3.0.
• Assisted in developing help guide and presentations as per project specifications and timelines.

Environment: RUP Methodology, Microsoft Word, MS Visio, Microsoft Excel, Microsoft PowerPoint, Rational Requisite Pro, Rational Rose, Win Runner, Load Runner, Test Director, HIPAA Desk Tool, Adobe Flash 3.0, Oracle 10g and Windows XP.

Confidential

Business Analyst

Responsibilities:

• Conducted weekly meetings for deciding the Policies and Procedures to be followed while constructing new sites.
• Performed the requirement analysis, impact analysis and documented the requirements using Rational Requisite Pro.
• Was responsible for data mapping of HL7 messages into relational database.
• Documented the server farm requirements and requirements related to security within Share Point and using Windows Active Directory.
• Performed Gap Analysis to check the compatibility of the existing system infrastructure with the new business requirements.
• Built business requirements into the Medicare Advantage MA requirements database and created the Project Requirements Document for the three functional areas
• Worked on billing system a cash management module and enhanced the encrypting standards that are required for the application.
• Create and maintain data model/architecture standards, including master data management MDM .
• Performed Analysis on NextGens EPM/EMR application.
• Generated test cases in Claims Analyzer Editor Professional to ensure unification with CPT-4 and ICD-9 codes
• Followed a systematic approach to eliciting, organizing, and documenting requirements of the system.
• Reviewed the Joint Requirement Documents JRD with the cross functional team to analyze the High Level Requirements.
• Used Rational Clear case for version control.
• Mapped high-level to-be designs using Business Process Modeling Notation BPMN on MS Visio.
• Manage changes to requirements through change control -clear case, MQC, Documentum.
• Been a part of Architecture and modeling team and have used SOA Service Oriented Architecture
• Used Query Analyzer, Execution Plan to optimize SQL Queries.
• Responsible for creating a business process and workflow documentation using BPMN standards.
• Meticulously assessed data from various sources and generated conceptual and logical database designs using ERwin data modeling tool.
• Implemented and managed the formal SDLC implementation using the RUP/Agile Methodologies depending on the client .
• Interacted with client and the Technical Team for requirement gathering and translation of Business Requirement to Technical specifications.
• Conducted interviews, meetings and JAD sessions during the process of Requirement Gathering.
• Planned and documented procedures for data processing and prepared data flow diagrams for the application.
• Analyzed and translated business requirements into system specifications utilizing UML and RUP methodology
• Expertise with supply chain strategies/vendor manufacturing process methods to determine level of procurement and strategic sourcing strategies/plans and worked with vendors/peers to determine lead times, schedules and cycle counts, established requirements needs.
• Interacted with line of business managers and coordinated the transition into the security database to assure business compliance with SOX.
• Analyzed trading partner specifications and created EDI mapping guidelines
• Documented the Traceability Matrix for tracing the Test Cases and requirements related to them.
• Developed Data Conversion Strategy for converting data from the existing site to the new site.
• Designed and developed project document templates based on SDLC methodology
• Prepared Demo on SharePoint for various Business to get new approvals like the Therapist and Nursing divisions.
• Designed workflows and allocated permissions within SharePoint.
• Performed Unit Testing and User Acceptance testing and documented detailed results.
• Provided input scope, goals, risks, constraints, timelines and interfaces to PM for project planning and control.

Environment: Windows 2000/XP, Microsoft Office SharePoint 2007, MS Office,XML, SQL Server, Agile, MS Project, MS FrontPage 2003, MS Access, EDI, Documentum 2.0., Rational Clear Quest, Rational Clear Case, Rational Requisite Pro, Rational Rose, UML,RUP, Microsoft Excel, Microsoft Word, Microsoft Power Point, Visio.

Confidential

Role: Business Analyst

Responsibilities:

Inception phase:

• Performed Gap Analysis to check the compatibility of the existing system infrastructure with the new business requirements
• Responsible for attaining HIPAA EDI validation from Medicare, Medicaid and other payers of government carriers. Developed Requirements Traceability Matrix RTM using Rational Rose to trace each software requirement to test case.
• Accumulated system requirements from various departments through surveys and interviews.
• Utilized corporation developed Agile SDLC methodology. Used Scrum Work Pro and Microsoft Office software to perform required job functions.
• Conducted JAD sessions with NASCO project team and came up with the best solution to setup Accumulation Rules in the system.
• Provide business support for benefit accumulator and Claims processing system NASCO.
• Conducted JAD sessions with management, SME, vendors, users and other stakeholders for open and pending issues.
• Incorporated Rational Unified Process RUP to create Business Requirement Document Specifications using MS Visio and MS Word.

Elaboration phase:

• Planned and defined system requirements to Wire Frames with Use Case, Use Case Scenario and Use Case Narrative using the UML Unified Modeling Language methodologies.
• Created Use Case Diagrams, Activity Diagrams, Sequence Diagrams and ER Diagrams in MS Visio.
• Assisted in the development, design and implementation of new relational or multi-dimensional databases, including the analysis of user needs.
• Responsible for meetings with users and stakeholders to identify problems, resolve issues and improve the process to ensure a stable and accurate solution.

Construction phase:

• Advised on capturing the additional data requests from the ODS Performed business process mapping for new requirements.
• Worked with the data modelers, D B A's and QA teams to resolve issues
• Facilitated user acceptance testing and test strategies with Information Systems Group.
• Performed manual front-end testing to check all functionalities of different modules.
• Uploaded Benefits data into NASCO Claims System
• Suggested measures and recommendations to improve the current application performance with the aid of SCR' s Small Change Requests

Transition phase:

• Developed strategies with Quality Assurance group to implement Test Cases in Mercury Test Director for stress testing and UAT User Acceptance Testing
• Assisted the SA to document all custom and system modification were satisfactorily solved.
• Created and managed project templates, use case project templates, requirement types and traceability relationships in Requisite Pro.

Environment: Data stage, Microsoft Windows Server system, Win Runner, NASCO Test Director, Visual studio, ASP. Net, Web services MS-Project, MS-Visio, and Windows 2000.

Confidential

Role: Business Analyst

Responsibilities:

• Worked with business users to define Product Feature Requests, Business Requirement Specifications and Change Requests.
• Comprehensive understanding of MMIS subsystem files, screens and integrated workflow processing.
• Performed requirements modeling and develop analysis diagrams, activity diagrams, sequence diagrams, state diagrams, data models, and use-case realizations using RUP tools in Agile.
• Analyzed and translated business requirements into system specifications utilizing UML and RUP methodology
• Perform risk and gap analyses on multiple MMIS subsystems created test plans, traceability matrixes and heavy conversion of electronic media claims data into text and various other formats to ensure OMMISS that all possible efficiencies within the Department of Health and Human Services were realized
• 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
• Modeled business process flow using UML Activity diagram, Class diagram and Sequence diagrams in Rational Rose.
• Wrote functional requirements and non-functional requirements based upon the approved business requirements by following UML processes and standard procedures for developing use cases, use case diagrams, and other supporting documentation.
• Used Requisite Pro for analyzing and managing the Requirement Management efforts.
• Established traceability matrix using Rational Requisite Pro to trace completeness of requirements in different SDLC stages.
• Involved in creating business processes and modeling diagrams using Rational Unified Process RUP .
• Supervised the development carried out by third party contract development staff.
• Created and executed SQL queries in SQL analyzer to view and update data in tables.
• Developed data access queries using SQL Loader to run in production on a regular basis and assisted end users with development of complex ad hoc queries and analysis.
• Reviewed Development Plans, Quality Assurance Test Plans and User Documentation to ensure correct interpretation of original specifications.
• Involved in documenting and executing Business Test Cases and once the Unit testing was performed and results are reviewed, the Functional and System Integration Testing was executed in Model Office followed the Defect Documentation Standards , by which the team was able to systemically test and validate the system through any combination of data or cycles deemed appropriate for the Implementation and Automated User Acceptance Testing.
• Assisted in defining and documenting Test Cases and Test Scenarios for User Acceptance Testing.
• 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 P.I.D to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes

Environment: Microsoft Word, Microsoft Visio, Microsoft Project, Microsoft Excel, Rational Rose, Rational Requisite Pro, WinRuner, LoadRunner, Test Director, TOAD, Oracle 9i, SQL, PL/SQL, .NET and Windows XP.