PROFESSIONAL SUMMARY:

• A Sr. Professional with over 14 years of experience working as a Director/Program Manager/Sr Project Manager, Team Lead.
• Sr. Business Analyst within the Health/ Healthcare, Finance,ecommerce,Insurance and Biopharmaceutical industries. Responsible for business requirements gathering, business, process flows and process modeling.
• Responsible for Creation of Business Requirements Documents, USE Case Specifications, Functional Specifications, Systems Design Specification (SDS),
• Business Continuity Plan (BCP), Workflows and Unified Modeling Language (UML) Diagrams, Sequence Diagrams, Activity Diagrams, State Diagrams,
• Class Diagrams, communication Diagrams and Business Intelligence Tools. Worked extensively with Architects in designing Data Models and Relational Databases.
• Extensive experience working with Business Process Engineering, the Software Development Life Cycle (SDLC), Rational Unified Process (RUP) methodology and Waterfall methodologies.
• Proficient in using system - modeling tools such as Rational Rose, RequisitePro and MS Visio.

TECHNICAL SKILLS:

Software/Hardware: HTML, DHTML, Visual Basic, JavaScript, UML, Microsoft Word, Adobe AcrobatMicrosoft Excel, Photoshop, Microsoft FrontPage, Dream Weaver, Microsoft PowerPoint, Microsoft AccessRational Rose, Microsoft Project 2000, Crystal Report, SQL, Oracle, Visual Source Safe, Visual Studio .NETMicrosoft Access, Visio, SDLC, OOP, UML, Load runner Win Runner and Test Director.

PROFESSIONAL EXPERIENCE:

Confidential, NYC

Sr. Healthcare Consultant/Director/Sr PM

Responsibilities:

• Responsible to provide weekly status/Dashboards to senior executives
• Responsible for Preparation and Fulfillment of Staff up of document creation team
• Responsible for Creation and preparation of Medicare Readiness Plan and Medicare Bid Plan
• Prepared and designed member communications strategy and generated internally and to the vendors to establish a review cycle for ALL member communications
• Review of all communications/templates prior to their mailing by the Fulfillment vendor
• Established processes for publishing of online videos for Medicare/Medicaid members
• Responsible for creation of online video tutorials for user community
• Obtained and finalized from vendors a master list of all interfaces and process outputs (Master Process Outputs) and established a review process for each MA Readiness period.
• Developed high-level requirements for each interface document specifying which members are included and the inclusion criteria, frequency, submission time, etc.
• Developed a site where the Vendors’ Configuration, CMS bid, Product Matrix, FDR Configuration, etc. documents are available to the CHOICE personnel.
• Responsible for Preparation and implementation of Medicare Readiness for upcoming year(s)
• Responsible for Medicare Initiatives implementation, Guiding the team for MA Bid submission 2017
• Creation of Sharepoint sites for storing and monitoring timely uploads/submissions to CMS
• Monitored and facilitated Mock Audits as part of preparedness for CMS Audit
• Worked closely with Vendors to identify the documents to be completed in order to stay in compliance of CMS Regulations
• Accountability to identify all internal documentation to deliver the solution defined in the Benefit Grid and Configuration questionnaire
• Created end to end testing plan

Environment: Microsoft Word, Adobe Acrobat, Microsoft Excel, Microsoft Visio, Dream Weaver, Microsoft PowerPoint, Microsoft Access

Confidential, NYC

Sr. Healthcare Consultant/Sr PM

Responsibilities:

• Project management responsibility to ensure a structured approach to overcome current limitations
• Provide a detailed vision of the product that MPI will develop and capture measurable objectives for the project’s success
• Transition and Train the team from Clearquest to Service now
• Capture and implement Business rules related to Flexible claim routing
• Provide methodology pertaining to requirements to Simplify claim entry and adjustment
• Support the ITPMA to Improve Client Services
• Consolidate business requirements of claim-entry applications across repricing platforms
• Manage PMO Team to Rewrite Business rules and requirements for Advice sheets templates
• Leading the transition effort from Waterfall to Agile Methodology
• Hands on Experience working in an Agile environment
• Guiding the team in developing User Stories and reviewing in JIRA Board
• Facilitation and leading the User Stories grooming sessions

Environment: Database: MS Access, ORACLE, MS Office Applications:MS Word, MS Project, Excel, PowerPoint, Axosoft, Agile Bench, Agile and Pivotal Target

Confidential, NJ

Director/Sr. Project Manager

Responsibilities:

• Responsible for setting up of Business Analysis Centers of Excellence and BPO Centers at offshore locations to increase the visibility and competency of the business analysts.
• Responsible for End to end implementation of Customer Service Project - 360
• Successfully implemented the Learning and Development phase to the project team
• and provided the team with tactical project assistance and ensure best practices
• Excellent knowledge in SDLC in various Project Management methodologies
• Ensure that the analysts are properly trained with the methodologies of the clients
• Responsible for creating a training environment for the business analysts, so they play a lead role in identifying, defining, and documenting business and stakeholder requirements for IT and other projects.
• Guide the team to on strategy to identify High-quality requirements which are key factors in successful projects.
• Documentation of Requirements generally communicated to different stakeholders and creation of repository
• Training includes various documents including but not limited to a variety of artifacts, such as use cases, context diagrams, storyboards, data dictionaries, data models, business process models, business rule catalogs, decision tables, among many others.
• Providing Guidance as to how those artifacts should be communicated to clients utilizing visualization tools.
• Establishing and Training the team of Business Analysts on adopting a clear communication strategy to all stakeholders

Confidential, Newark, NJ

Sr Project Manager

Responsibilities:

• Provided leadership to the team of Business Analysts and Project Coordinator and assisted the management in implementing Project plan
• Responsible for providing Executive Management with weekly Audits Statistics reports and biweekly Project status reports. Coordinated with site supervisors to ensure Audit Analysis is implemented and meet performance targets.
• Responsible for resolving issues with up to 160 offshore team members and third party vendors.
• Worked with crisis management and resolving issues within turnaround timelines for SLA’s. Responsible for verification of offshore resources’ invoices and coordination with finance to ensure timely payment.
• Coordination of over 160 members to ensure efficient project implementation as per project scope as well as facilitated Biweekly Core Team Status Meetings and provide updates to Executive Management.
• Facilitated Stakeholders Meeting, ERM Review meetings as per EPMO Requirements to implement Risk management strategies.
• Ensure adherence of timelines in posting KPIO Reports, Status Reports, RYG Reports, Risks and Project Time management in Planview.

Environment: PIBA, PIBA Tech,Planview, Load, Sales &Contract, Member Portal, Provider Portal, NASCO, Static Accum Manager (SAM), SQL Server MS Access,MS Word, MS Project, Excel, and PowerPoint

Confidential

Team Lead/Program Test Manager

Responsibilities:

• Managed and led a team of 9 resources to achieve the desired deliverables.
• Provided leadership to the team of Business Analysts and QA’S and assisted the management in developing Project plans, Test Plans and Test conditions to conduct Systems testing.
• Responsible for administration of multiple teams and reporting to the Managing Director.
• Facilitated JAD sessions for multiple testing teams for gathering and documenting new requirements for the project.
• Responsible for the testing and successful implementation of the Landacorp maxMC Project.
• Monitored Vendors, UAT and QA Team’s deliverables. Designed the project plans and worked with the Assistant and Managing Directors with various project management tasks.
• Interviewed and assisted with staffing the project with consultants.
• Designed and developed the Functional Specification Documents and Business Process Flow documents and prepare Use Cases for different modules: Appeals, Disease Management, Adverse Determination, Complex Case Management and Surveys.
• Designed UML diagrams for business process Flows and Use Case diagrams using MS Visio.
• Worked on SOX Compliances for GHI Error resolution of the failed cases (Pre-Authorizations).
• Extensively used member populations from different LOB’s (Line of Business) - Medicare, Medicaid, HMO, PPO, EPO, and POS for testing and validation process.
• Responsible for Medical and Behavioral Health (Psychiatric, Alcoholism, Drug Addiction and Substance Abuse) test scenarios for QA and UAT Testing cycles.
• Designed Test plans/Scenarios/Cases for Medical and Behavioral Health with different combinations of Place of Service and Type of Service with corresponding ICD and CPT codes for different phases of QA and UAT testing cycles.
• Extensively involved in testing different scenarios on Medical cases by creating Referral or Prior Approvals for: Inpatient services, outpatient services, office services, Home Care, DME and Transportation and the ER Notifications using the HIP Legacy system: PEPs and Heads down and MEDecision’s - WinUCS.
• Tested scenarios for Behavioral Health Cases by creating referral or prior approval for: Inpatient services, outpatient services, office services and the ER Notifications using the HIP Legacy system: PEPs and Heads down and WINUCS.
• Extensively tested a new medical management system - maxMC for the Care Management and its subsidiary departments. Tested different scenarios on Medical and Behavioral Health cases by creating Pre-Authorizations for: Inpatient services, outpatient services, office services, Home Care, DME and Transportation using new medical management system: maxMC and the mainframe system: QCARE.
• Extensively involved in testing the CERME (Care Enhance Review Manager Enterprise) Assessments in maxMC.
• Extensively involved in designing test scenarios, testing and validations of the JCS and ECP rules in maxMC system.
• Extensively involved in testing the Claims Processing System: QCARE (Mainframe system).
• Extensively involved in testing the entire data flow or mapping validations across the systems: Web Portal (PEP / HD) to maxMC and maxMC to QCARE and back fills during different phases of QA and UAT testing cycles.
• Designed and created multiple databases for the Care Management Department Projects in order to maintain the tested and validated data scenarios. Designed and created a CMS project using MS Access Database, in order to track the status of existing and upcoming projects by the management of CMS department.

Environment: Medical Management Systems, maxMC, WinUCS, Web Portal: Heads Down, PEPs

Confidential, NY

Senior Business Analyst

Responsibilities:

• Worked with clients to identify and create business process models, task definitions and service definitions for the project(s), acting as the facilitator and chief moderator
• Facilitating requirements gathering/definition/elaboration meetings and/or interviews with project stakeholders / user community
• To define functional, usability, reliability, performance and supportability requirements in partnership with users for the development and maintenance of software systems Worked in close association with IBM in implementing websphere ecommerce platform.
• Responsible for successful documentation of user guide of IBM Accelerator tool for Business users.
• Documented workflows and results of business analysis and obtaining sign-off from project stakeholders on specifications. Partnered with project stakeholders in gather all requirements to formulate business specifications and translating those into application functionality, deciding when to advocate and when to compromise to arrive at a mutually acceptable solution
• Ensured high level design including architecture requirements are accurately documented and mapped to approved requirements
• Constructed activity/process models as may be required to support business requirements. Facilitate the communication of business and technical requirements among the appropriate business and technical communities
• Promoted and developed communication between assigned business units, technical staff and vendors to integrate information systems with cross-functional and/or enterprise wide business requirements
• Analyzed application/system enhancement requests and participate in Change Management Process
• Facilitated workshops to support requirements management and change management workflow standards
• Provided process methodology expertise to working groups and project stakeholders

Environment: Microsoft office, MS Visio, UML, MS Excel, Microsoft Word, Microsoft Projects, Microsoft PowerPoint Rational Clearquest, Rational Software Modeller, Rational Rose, Adobe Acrobat, SQL, Oracle, SDLC, Java, IBM Accelerator

Confidential, Parsippany, NJ

Senior Business Analyst

Responsibilities:

• Responsible for Validations of Transactional and Structural Documents and Business rules.
• Worked extensively on prototypes for Email Layouts Error Email specs.
• Responsible for review of Outbound Preference/subscription Docs.
• Responsible to gather Business requirements and user requirements.
• Assisting the Project Manager with schedules, Project plan implementation and Identifying Resources to achieve deliverables as per schedule dates.
• Organized cross training of team members and users to become more responsive.
• Extensive experience in performing Validations to specifications.
• Worked Extensively on Core Specs of Reconciliations and Repository Mapping.
• Responsible to review status of deliverables and providing updated status reports to the PM.

Environment:Microsoft office, MS Visio, UML,MS Excel, Microsoft Word, Microsoft PowerPoint Rational Clearquest, Rational Software Modeller, Rational Rose, Adobe Acrobat, SQL, Oracle, SDLC, Java, Toad

Confidential, Owings Mills, MD

Senior Business Analyst/Lead Designer

Responsibilities:

• Worked with a team of Business Analysts, Architects and Developers. Worked Extensively on Project Plan of EWRPN Project, Responsibilities including Identifying the need of resources, participated in selection process and setting tasks.
• Worked on Requirements Gathering, Business process flow, and business analysis. Coauthored PRD’S, Architecture Plans involving Business flows, Database models. Assisted project managers with the development of project schedules. Develop requirements and preliminary design for client applications. Perform analysis and design projects using a systems development methodology. Work with all levels of client staff in solution definition.
• Responsible for Review of Use Cases, Activity Diagrams, and Sequence Diagrams.

Environment: Microsoft office, MS Visio, UML,MS Excel, Microsoft Word, Microsoft PowerPoint Rational Clearquest, Rational Software Modeller, Rational Rose, Adobe Acrobat, SQL, Oracle, SDLC., Mainframes

Confidential, Edison, NJ

Sr. Business Analyst

Responsibilities:

• Worked with the business community to define business requirements and analyze the possible technical solutions.
• Requirement gathering, Business Process flow, Business Process Modeling and Business Analysis.
• Worked extensively with SME in understanding and documenting their requirements
• Co-authored business requirements document with project teams. Extract, discuss, and refine business requirements from business users and team members.
• Designed and developed project document templates based on SDLC methodology.
• Collaborated with the QA team to develop the test plan, test conditions and test cases to be used in testing based on business requirements, technical specifications and/or product knowledge.
• Studied and assessed the clients systems and business processes.
• Addressed all aspects of the claim processing lifecycle, starting from identifying a claim right up to closure.
• Established a business Analysis methodology around the Rational Unified Process.
• Researched the various steps in the lifecycle and then constructed the system in such a way that the riskier claims could be easily identified and monitored.
• Streamlined clerical work processes and mapped to the automated system.
• Assisted in building a business analysis process model using Rational Rose and Visio.
• Performed requirement analysis, went through all the use cases and workflows.
• Designed and developed Use Cases, Activity Diagrams, and Sequence Diagrams using UML.

Environment: HTML, DHTML, Visual Basic, UML, Microsoft Word, Adobe Acrobat, Microsoft Excel, Photoshop, Microsoft FrontPage, Dream Weaver, Microsoft PowerPoint, Microsoft Access, Rational Rose, Microsoft Project 2000, Crystal Report, SQL, Oracle

Confidential, Edison, NJ

Sr Business Analyst

Responsibilities:

• Participated in all the phases of Rational Unified Process with specific focus as it pertains to the software testing and used the guidelines, templates and Rational tools in all the phases.
• Integrated with Business analyst & end users for Business functions. Analyzed business requirements and detail design of the software. .
• Used Rational Requisite Pro for managing the requirements.
• Documented Test Plans and Test Cases using Rational Test Manager.
• Tested Reports functionality and result applying Business rules with estimated Results, which are developed on the GUI.
• Participated in production support for the problems originating in the Post production Phase

Environment: UML, Microsoft Word, Adobe Acrobat, Microsoft Excel, Photoshop, Microsoft FrontPage, Dream Weaver, Microsoft PowerPoint, Microsoft Access, Rational Rose.

Confidential

Sr. Business Analyst

Responsibilities:

• Facilitated and managed meeting sessions with committee of SMEs from various business areas including Loan Monitoring, Asset Management, and Marketing.
• Excellent Knowledge of Customer Segmentation, Portfolio Analysis/Mgmt, and Operating Expenses.
• Conducted interviews with key business users to collect requirement and business process information.
• Performed extensive requirement analysis including data analysis and gap analysis.
• Participated in various stages of data and requirement analysis for project needs.
• Identified internal and external system requirements, design and configuration set-up, also created User Documentation and conducted training classes.
• Developed business requirement specification documents as well as high-level project plan.
• Designed and developed all Use Cases and UML models using Rational suite

Environment: HTML, DHTML, Visual Basic, UML, Microsoft Word, Adobe Acrobat, Microsoft Excel, Photoshop, Microsoft FrontPage, Dream Weaver, Microsoft PowerPoint, Microsoft Access, Rational Rose, SQL, Oracle, Visual Source Safe