OBJECTIVE

• To join a team of competent, progressive and task - oriented professionals and to be a part of organizational growth and excellence by working in a challenging environment that welcomes creativity and enhancements of skills possessed.

SUMMARY

• Over 7 years of comprehensive knowledge of Business Analysis methodologies, Software Development Life Cycle (SDLC) using Rational Unified Process (RUP), Waterfall and Agile (Scrum).
• Extensive experience in SharePoint to collaborate information, sharing documents, document versioning, and in project management activities.
• Experience in QA Analysis/Testing, Conversions, Customizations, Interfaces, Implementation of business applications using Client/Server and Internet Technologies.
• Extensive knowledge of Facets Billing, Enrollment and Claims processing
• Experience in writing Business Requirements Documents (BRD) and Functional Requirements Documents (FRD).
• Expertise in Microsoft SQL Server, Oracles and Workflow Modeling.
• Proficient in SSIS, SSRS, SSAS, ETL and Informatica.
• Professional experience using advanced SQL coding, in various platforms, such as Oracles and SQL server for data mining and report generation.
• In-depth knowledge and extensive experience in Health care systems: FACETS, Medicare part A, B, C, D and Medicaid system
• Expertise in Claims, Subscriber/Member, Plan/Product, Claims, Provider, Commissions and Billing Modules of Facets
• Experience in capturing data requirements, data analysis & data mapping for Vendor feeds and Databases.
• Professional experience in the IT Industry using advanced SQL coding, over varied platforms like Teradata, Oracle.
• MySQL, DB2 and SQL server for data mining and report generation.
• Good knowledge of Data Modeling using Erwin, Visio, ETL tools, OLTP, OLAP tools, Star Schema, Snowflake
• Strong exposure todata warehouse ETL environment like Informatica
• Experience in matching requirements with Traceability Matrix.
• Experience in conducting Requirement Gathering sessions, Feasibility Studies and organizing the software requirements in a structured way.
• Good knowledge on EDI HIPAA transactions, ANSI X12 data files, Inbound and Outbound 83 Claims, transactions focused on were 270,271, 834, 835, and mainly on 837.
• Rich experience with various modules of Facets like membership management, premium billing, enrollment, claims processing & adjudication, benefits administration within Healthcare industry.
• Interviewing Subject Matter Experts (SME), asking detailed questions and carefully recording the requirements in a format that can be reviewed and understood by business and technical stakeholders.
• Experience in conducting Joint Application Development (JAD) sessions. Implementing current Project Management methodologies and learning their characteristics, weaknesses and impacts as they relate to software development.
• Capable of writing complex SQL queries FACETS support systems were used to enable inbound/outbound HIPAA EDI transaction in support of HIPAA 834, 835 /271 transactions.
• Excellent knowledge of Medicare (Part A, B, C and D) and Medicaid Health Insurance Policies and reimbursement forms.
• Skills in developing Use Case diagrams, Sequence diagrams, State Chart diagrams, and Class diagrams.
• Exposure in creating and analyzing Data flow diagrams.
• Extensive use of UML/RUP for modeling views in Microsoft Visio.
• Worked with adhering HIPAA compliance and ICD 9 to ICD 10 conversions.
• Conducted User Acceptance Testing (UAT).

TECHNICAL SKILLS

Business Tools: MS Office Suite, MS Visio, MS Project, MS Access, SharePoint

Business Skills: Requirement elicitation, Documentation, Quality assurance

Methodologies: Waterfall, Agile,JIRA

Database Tools: Oracle SQL Developer, SQL Server

Test Management Tools: Quality center, QTP

PROFESSIONAL EXPERIENCE

Confidential, Bronx,NY

Business System Analyst

Responsibilities:

• Independently studied ICD-10 requirements and studied the changes to be implemented using the General Equivalence Mapping (GEM)
• Performed forward and backward mapping between the two standards and documented the required changes.
• Conducted meetings, Joint Application Development (JAD) sessions and interviews with the business users to gather requirements.
• Involved in the processing of the claims on Facets and then sharing the test results with the business according to test acceptance criteria during their UAT phase.
• Created Business Requirement Document (BRD) for the whole project.
• Created use case diagrams, activity diagrams, and flow charts to depict the interaction between the various actors and the system.
• Analyzed HIPAA 4010 and 5010 standards for 837I/P and 835 EDI X12 transactions, related to providers, payers, subscribers and other related entities
• Assisted in Data File Definitions and Data mapping activities for the data gathered during the process of development and implementation.
• Responsible for data analysis, project plan, gap analysis, data mapping, all business analysis functions/artifacts, documentation and implementation.
• Worked on EDI 834, 835,837, 276/277, 278 as per HIPPA guidelines
• Actively involved in preparing and writing the business requirement documents, functional requirement documents and data mapping documentation.
• Validate transaction records using SQL queries.
• Worked on the database analysis part by helping the technical team in identifying the data sources required for the application and coordination with the IT team in migration of the data within the databases.
• Developed non-functional requirements and documented them to be presented to the technical team
• Helped the QA team in writing the Test Plan and conducting the quality assurance phase.
• Worked with the QA team in testing the application using HP QTP.
• Intensive use of SQL within the Teradata platform.
• Logged application bugs and was involved in all stages of the bug life cycle.
• Dealt with Project lead, stakeholder and end users regarding any issues encountered during the project.

Environment: MMIS, UAT, ORACLE, MS SQL Server,Workflow Modeling, MS office, MS Visio, Quality Center, TOAD, Facets

Confidential, Philadelphia, PA

Business System Analyst/Data Analyst

Responsibilities:

• Developed and conducted statewideHIPAA 5010 and ICD-10 awareness program for all AMFC staff in the Philadelphia Campus.
• Worked on analysis of FACETS claims processing system and gathered requirements to comply with HIPAA 5010 requirements.
• Analyzed HIPAA 4010 and HIPAA 5010 standards for 837I/P, 27x’s and 835 transactions and prepared gap analysis document for each transaction.
• Presented the process improvement solutions to the client, performed Project Management Office (PMO) activities. Worked with ETL group for understating mappings for dimensions and facts.
• Worked extensively on Business Requirements, Functional Specification, Data-Integration, Data Mapping, and Data Warehouse access using SQL and Crystal Reports, ETL process, use cases modeling (UML) using MS Office (Word, Excel, Access, Visio) and dashboards.
• Used HIPAA 4010 transactions to support the analysisof current business processes and work with management to improve and implement enterprise solutions to ensure compliance and got involved in designing future state processes forHIPAA 5010 transaction processing EDI’s 837, 835, and 834 and ICD-10 Code sets.
• Developed Database packages, procedures, functions, triggers using Sql/plsql.
• Wrote high level and low level business requirements for the project.
• Conducted meeting with the EDI team and other stakeholders team members to discuss the requirements
• Worked closely with the business team, development team and the quality assurance team to ensure that requirements are understood as intended in order to achieve the desired output.
• Performed numerous data extraction requests using SQL scripts to prepare ad hoc reports.
• Facilitated Joint Application Development (JAD) Sessions for communication and managed Net Meetings.
• Analyzed “AS IS” and “TO BE” scenarios, designed new process flows and documented the business process and various business scenarios.
• Wrote Views, PL/SQL procedures and function for processing business logic in the database
• Wrote use cases and relevant UML diagrams such as Use Cases, Activity and Sequence diagrams
• Participating in all facets of the standard project life cycle and ensured smooth transition of projects to production support of Use Cases.
• Maintained clear understanding of project goals among stakeholders by conducting walkthroughs and meetings involving various leads from BA, Development, QA and Technical Support teams.
• Involved in creating mappings for the conversion ofEDI X12 transactions code sets version and translation of ICD 9 codes into ICD 10 codes.

Environment: SQL, Oracle, Quality Center, Use Cases, HTML, MS Office, Visio

Confidential, Jacksonville, FL

Systems Analyst

Responsibilities:

• Gathered functional system requirements from process owners and developed functional specifications for application enhancements.
• Worked with development / technical team members to ensure that the enhancements would meet the defined business requirements.
• Conferred with Business Users to Gather Requirements for the design and development teams.
• Involved in exporting data from the database to flat files.
• Facilitated Joint Application Development (JAD) sessions, as well as conducted interviews with appropriate business/technical stakeholders.
• Validated EDI transaction sets as HIPAA 4010; 837, 835, 270/271
• Analyzed Business Requirements to produce System Requirements for the technical team
• Identified and documented UML Use Cases with Use Case diagrams.
• Worked with business users to define Business, Process, and Data Models to understand the overall business.
• Wrote high level and low level system requirements for the project.
• Conducted meeting with the EDI team and other stakeholders team members to discuss the requirements
• Worked closely with the business team, development team and the quality assurance team to ensure that requirements are understood as intended in order to achieve the desired output.
• Facilitated Joint Application Development (JAD) Sessions for communication and managed Net Meetings.
• Analyzed “AS IS” and “TO BE” scenarios, designed new process flows and documented the business process and various business scenarios.
• Tested HIPAA EDI Transactions and Code Sets Standards such as 837/835 and 834 transactions.
• Wrote use cases and relevant UML diagrams such as Use Cases, Activity and Sequence diagrams
• Participating in all facets of the standard project life cycle and ensured smooth transition of projects to production support
• Maintained clear understanding of project goals by conducting walkthroughs and meetings involving various leads from BA, Development, QA and Technical Support teams, Process Modeling.
• Worked with developers to test the iterations of the system under development (SUD) to ensure it met the user’s needs.
• Interacted and assisted the entire team on the testing tools and processes.
• Wrote and executed Test cases for the application when in UAT Environment.
• Involved in evaluation of the user request for new or modified program to determine feasibility, cost and compatibility with current system, and computer capabilities.

Environment: MS Office, Visio, Process Modeling, RequisitePro, Quality Center, QDQ (Quality Development tool)

Confidential, St. Louis, MO

Business System Analyst

Responsibilities:

• Involved in various meetings with business user and SME to define Business
• Worked as the communication line in between the technical groups and the business group
• Strong visual modeling and business process modeling skills in Rational Unified Process (RUP) and Agile Modeling with tools like MS Visio
• Worked with team leaders and supervisors to ensure project and organizational deadlines are met
• Coordinated updates with client's staff and implement efficiencies in documentation maintenance.
• Conducted JAD sessions to complete the prerequisite for the Business Requirement
• Created Use Case, Sequence, Activity and Entity-Relation Diagrams to illustrate for testing effort of Process Modeling.
• Responsible for doing the gap analysis for the interfacing system.
• Extensively worked with HIPAA Privacy Facets application groups.
• Documented the Business Requirements Document (BRD) and the Functional Specification Document (FSD).
• For testing purposes, manipulated members’ information in the QA environment through Facets front-end application
• Used SQL queries for Data Validation and Verification
• Resolved/tracked production issues with Reports in Cognos and Mainframe.
• Facilitated requirements gathering activities, including meeting with users to discuss System Task Requests (STRs), Enhancements, and Project Assessment Quotations (PAQs) requirements.
• Wrote use cases and relevant UML diagrams such as Use Cases, Activity and Sequence diagrams
• Conducted requirement feasibility analysis with the developers to ensure the project was in scope with the timeline defined in the project plan
• Created test plan, test data and conducted manual testing to validate functionality and performed regression testing
• Documented issues and resolutions, and wrote specific requirements for system changes.

Environment: Microsoft Outlook, Share Point, Microsoft Office, Microsoft Visio, Facets and Windows XP Professional