Summary:

• Senior Business Analyst with extensive experience in business process analysis/modeling, business requirements gathering, database design and development of Web Based, and Client/Server applications. Expertise in Finance, insurance, Business Process Engineering, Systems/ Solutions Engineering, Strategic Planning, and Systems Analysis. Strong oral and exceptional written business communication skills.
• Over Six years of professional experience as a Business Analyst
• Extensive experience in heath care 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.
• 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.
• Provide leadership and guidance in configuration of Core Facets and Networks V5.01
• Solid understanding of Business Process definition, Risk Analysis and SDLC methodologies.
• Excellent in Developing and evaluating business process Models.
• Design and review of various documents including the Software Requirement Specifications SRS , Business requirements document BRD , Use Case Specifications, Functional Specifications FSD , Systems Design Specification SDS , Requirement Traceability Matrix RTM and testing documents
• Familiar with HIPAA EDI transactions such as 835, 837 P, D, I 276, 277, 278 etc
• Proven success as a business analyst through the years, providing a well-balanced understanding of business relationships, business requirements, and technical solutions.
• Professional experience in business analysis, operations management and development, design, documentation and testing.
• Excellent Analytical, methodical, and resourceful approach to problem solving, identifying and documenting root causes and corrective actions to meet short and long term business and system requirements.
• Effective in executing multiple tasks and assignments ahead of schedule. Created and maintained effective budgets.
• Advised management on improvement strategies, Competitive Profitability Analysis.
• Excellent in Business proposal Risk Assessment. Highly effective management and organizational skills with ability to prioritize.
• Exposure to Client/Server, Web Application developmental tools and Software development and design.
• Demonstrated ability to identify root causes of problems, consider both the long and short-term impact of proposed solutions and develop workable solutions. Ability to manage Multiple project tasks with changing priorities and tight deadlines. Ability to work well in a team. Open to Team related tasks, team meetings, team interaction and conference calls.
• Demonstrated ability to work well with a wide variety of people at various levels, foster cooperation and collaboration among individuals in the work unit, help team resolve conflicts constructively and ability and willingness to communicate when help is needed. A Self starter with a positive attitude, willingness to learn new concepts and acceptance of challenges.

Technical Skills:

Software/Hardware: OOAD OOA/OOD , RUP, UML, SDLC, Waterfall, QA, WAP,CVS,TEAMMATE, MS Access, SQL Server, MySQL, PL/SQL, Oracle DBA,DB2. Windows 98/2000/XP, basic UNIX, HTML, basic DHTML, basic XML, MS Office Suite-Excel Macros, Project, Visio, Adobe Photoshop, Flash, Rational- Rational Rose, Rational XDE, DOORS, Cobol, RequisitePro , CaliberRM, Crystal Reports, various NIKU products, C, C , Sharepoint, Docushare, BASIC, Intermediate level-Visual Basic

Employment History:

Business Analyst

GHI contracted with the Medicare Centers and Medicaid Services CMS to provide quick, easy, and affordable access to the health care service of their choice. Market Prominence is the only system that provides management with the ability to tailor each step of the regulatory process based on the health plan's interactions with each of its beneficiaries. Project involves integrating Market Prominence and the Claims processing System with the data warehouse to support the reporting requirements. My duties were included designing the model of ODS to automate and maintain the ETL process

Responsibilities

• Gathered analyzed, documented business and technical requirements from both formal and informal sessions and validate the needs of the business stakeholders.
• Performed Cost benefit, ROI and ROM studies
• Working knowledge of setup configuration for various platform components for coding of benefits, pricing, and provider platform components within Facets for production loads.
• Conducted user interviews and documented business and functional requirements.
• Performed Requirement Analysis and developed UML Use Cases, Activity Diagrams using Rational Rose to understand the requirements.
• Process and data flow models for STD Short Term Disability , LTD Long Term and FMLA claims processes as well as interfaces to Human Resources.
• Performed workflow analysis toward automated disability claims process. Detailed comparison of two competing proposals, including HR interfaces. Facilitated requirements definition for new system.
• Completed the documentation of Claims Scenario's for the source system
• Analyzed the existing claims process and specific business rule logic will be applied in the ACP model.
• Involved in creating business processes and modeling diagrams using Rational Unified Process RUP .
• Created use case scenarios and documented work flow and business process.
• Documented requirements associated change requests with requirements and connected requirements with Use cases.
• Work and triage Facets configuration issues and route work back for correct processing.
• Document step by step Facets configuration steps for Quality Assurance team.
• Analyze and trouble shoot all issues surrounding Provider Agreements, Network Rows, Supplemental Mappings, and all facets of claim and system issues.
• Understood the requirements of the Sales and Marketing team
• Incorporated Rational Unified Process RUP to create Requirement Document Specifications using Visible Analyst.
• Performed extensive data modelling to differentiate between the OLTP and Data Warehouse data models
• Identified/documented data sources and transformation rules required populating and maintaining data warehouse content.
• Responsible for creating test scenarios, scripting test cases using testing tool and defect management for Policy Management Systems, Payables/Receivables and Claims processing.
• 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
• Worked directly with users of the Multi-Channel Desktop to gather and document their business requirements. Followed up with the users to test the implementation, achieved sign-off and continued to move the system toward go-live.
• Worked hands on with the Multi-Channel Desktop to test it to ensure it meets the business requirements.

Environment: Windows XP Professional, Oracle9i, MS Access 2000, MS Excel, RUP, Oracle, UML, Rational Rose, Requisite Pro, Clear Case 2002, Rational Clear Quest 2002, MS Office suite, MS Visio 2003.

Confidential

Business Analyst

Confidential and Dental Insurance Claims and Eligibility efforts. The core data is in MMIS Legacy system and can handle the processing of different Claims within POS in MVS Site D and AIX Box. The MMIS can handle the HIPAA transactions such as 835, 837 P, D, I 276, 277, 278. The Inbound and Outbound is run through JCL in batch mode.

Responsibilities

• Worked with the account managers, managements, and report requestors to gather requirements, get report requests.
• Wrote Business Requirements, analyzed them and tested them.
• Owned the entire reporting process. Interacted with the ETL team, developer s , management, and account holders to get the requirements, document them, design templates, and write specifications .
• Designed report templates based on the requests by account managers.
• Designed Functional Specification Documents for the reports.
• Conducted meetings with insurance brokers
• Performed peer review testing for configuration builds, and provided data mapping from one legacy system to another. Facets 4.41, 4.51, Diamonds 9.5, and Amisys .
• Configured agreements in FACETS and converted agreements from Core Facets into Network pricer.
• Analyzed trading partner specifications and created EDI mapping guidelines.
• Extensive use of Excel to create Functional Specification Documents Templates.
• Designed the process flow diagrams for flow of information and report creation process.
• Analyzed Business Requirements and segregated them into high level and low level Use Cases, Activity Diagrams / State Chart Diagrams using Rational Rose according to UML methodology thus defining the Data Process Models.
• Conducted RAD sessions for the report users, requestors, and the developers.
• Prepared Need Analysis Documents of the requirements gathered through JAD sessions.
• Documented all the changes in the initial templates and was responsible for Release Management.
• Reviewed Requirements deliverables for delivery timeline.
• Used MS Visio to create Flow diagrams and Use Case Diagrams.
• Hands-on experience with claims adjudication tools: MMIS and Facets.
• Updated provider tables, diagnosis tables, fee schedules, and service ids contained in Facets back end tables.
• Worked with government products for Medicare and Medicaid products for MsChip, TennCare on Facets web-based, and client server applications, as well as commercial MCO's.
• Handled troubleshooting on Core Facets claims and worked with IA Internal Audit for best practices.
• Created presentations explaining the entire report development process, while drawing a comparison between the legacy the new report.
• Worked on Report Re-engineering Project and made enhancements to the system flow.
• Modified System flow diagrams using SDLC.
• Tracked the defects in legacy reports as per account managers and end users. Compared the results and tracked the differences in excel
• Reviewed Stored Procedures for reports and wrote test queries against the source system SQL Server to match the results with the actual report against the Data mart Oracle .
• Worked with ETL team during the upload process.
• Helped with Data Mapping between the data mart and the Source Systems.

Environment: SQL Server 2000, Windows, HL7 v2.X,Crystal Reports, Oracle, Mantis Defect Tracking, UML, MS Office, MS Visio

Confidential

Business Analyst

Confidential is an innovative leader in the health and well-being industry serving approximately 55 million Americans. MHC has a system called Enterprise Customer Information Claim System CICS that provides to check the contract information, deductible pay of the contract and allows creating claims and viewing or deleting the claims. Providers can be hospitals or health care centers, doctor's office or an insurance agent who can sell the MHC's insurance. This system also allows members to log into their account and check their contract information, deductible, company information and provider's information

Responsibilities:

• Adjudication of Short Term and Long Term Disability Claims.
• Identification and Investigation of insurance fraud.
• Initiated independent medical exams and rehabilitation programs.
• Work closely with Business Owners and Stakeholders to outline Business Requirements using rational requisite pro.
• Analyzed and translated business requirements into system specifications utilizing UML and RUP methodology.
• Work with System analyst and IS teams to understand the flow of data.
• Reviewed and analyzed data from various sources.
• Identified gaps and performed gap analysis with respect to CMS requirements
• Created Mapping Documents, Report Mockups and modified existing report mockups as to CMS requirements and finalized for development
• Provide technical expertise as an early engagement to different modules and enhancements to access impacts and define scope.
• Formulated logical statements of business requirements researched and evaluated alternative solutions and recommend the most efficient solution for system design.
• Review requirements and understand technical recommendations and constraints, and develop comprehensive and accurate functional specifications Data Mapping, and process flows.
• Work with Compliance and Regulatory operations to follow and monitor different IT process bound by CMS Regulations.

Environment: Windows XP, Business Objects, MS Excel, Word, Visio, power point, SQL, DB2, SAS database

Confidential

Business/Systems Analyst

This project involved creating the medical claims processing system for Aetna. It consisted of different modules like provider enrollment, member enrollment, programs and coverage. This project also involved the maintenance of claims workstation that automatically handles the entire claims life cycle.

Responsibilities:

• Gathered user requirements and directed developers for practical deliverables.
• Worked with the full SDLC, elicit, analyze and define requirements.
• Conducted JAD sessions with the clients to identify the requirements.
• Worked with the software architects / developers to ensure that the applications conform to customer requirements.
• Used Rational Unified Process RUP for streamlining the team's development activities.
• Followed the UML based methods using Rational Rose to create: Use Cases, Activity Diagrams/State Chart Diagrams, Sequence Diagrams, and Collaboration Diagrams.
• Worked extensively with insurance brokers
• Participated Testing and Evaluation of projects at established integration points to assess progress and identify key functionality issues.
• Tracked UAT issues/bugs and prepared reports.
• Performed job of contact point for all stakeholders business, legal, compliance, development .
• Documented monthly status reports for enhancement and modification requests for the development team to assist them in efficient tracking and monitoring of open issues of the project

Environment: UNIX, MS Power Point, MS Excel, Rational Rose, System Analysis, Load Runner, Crystal reports, SQL.