SUMMARY

• Over (8+) years of experience as a Sr. Business Analyst/ DataAnalyst in all phases of Software Development Life Cycle with solid understanding of Excellent communication and problem solving skills. Full life cycle (SDLC) Data Warehousing, Data Integration, Business Intelligence.
• Good understanding of health care industry, Claims Management process, Medicaid and Medicare Services and insurance sector
• Using Facets for various health insurance areas such as enrollment, member, Products and other FACETS related modules
• Experience in testing Facets applications and EDI transactions
• Experience working on 4010 and 5010 HIPAA implementation guides relate to Claim Testing and Medical Billing.
• Knowledge of the EDI transaction sets such as 837, 834, 835, 270, 271, 276, 277, 999
• Understanding of HIPAA Standards and Compliance issues, HIPAA Privacy policy, opt in/opt out policy.
• Extensive experience with Object oriented Analysis and Design using Rational Unified Process (RUP), Waterfall methodology and Agile Modeling
• Well versed with project management techniques/tools in managing complex onsite/offshore delivery models.
• Requirements gathering in compliance with HIPAA 4010 and 5010 standard.
• Proven ability to analyze complex problems, identify risks and develop effective solutions to improve productivity, reduce cost and track progress through all phases of SDLC
• Expert in analyzing, elicitation and management of requirements. Highly experienced in creating Business Requirement Document (BRD) and Functional Requirement Specifications (FRS) document.
• Hands on experience in all major facets of Project management - project planning, execution, milestone monitoring, resource utilization and driving a team with multi vendors and customer.
• Executed SQL queries and documented them as part of validating the Business Object reports and for testing purposes
• Designed High level design, for New process, integrating with legacy and Facets
• Facilitating one on one interviews, Joint Requirement Planning (JRP) and Joint Application development (JAD) sessions
• Experience in creating SQL queries to facilitate UAT and perform data validation.
• Experience in methodologies like Agile, Waterfall Model and Data Modeling; Creating Process mapping, Use Cases, Sequence diagrams, Activity diagrams
• Solid understanding of Membership, Claims Processing, Billing, Benefit/Eligibility, Authorization/Referrals, COB, and have experience in HIPAA standards and corresponding EDI transactions.
• Facets support systems were used to enable inbound/outbound HIPAA EDI transaction in support of HIPAA 834, 835, 837 270/271 transactions.
• Proficient in conducting System Testing, Functionality Testing, Regression Testing, User Acceptance Testing (UAT) and training of users
• Experience in testing Business Intelligence reports generated by various BI Tools like Cognos and Business Objects.
• Expertise in Claims, Subscriber/Member, Plan/Product, Claims, Provider, Commissions and Billing Modules ofFacets.

TECHNICAL SKILLS

Process/Modeling Tools: Agile Methodology, CPT and ICD-9 Coding, FACETS, AMISYS, MS Visio

Testing Tools: Rational Requisite Pro, Business intelligence

Operating Systems: Windows 7/2000/XP/, UNIX

Reporting Tools: Quality Center, Rational ClearQuest

Languages: SQL VB, SQL, PL/SQL, Test Scripting Language, C++, Java, SOAP UI, XML

Methodologies: Agile, JAD, Waterfall, RUP, MS Word 7.0, MS Excel, MS PowerPoint 5.0, MS Access, IBM

RDBMS: SQL, Oracle, and MS Access

Utilities/Application: MS Project, MS Visual, MS Office 03/07 (MS-Word, MS-PowerPoint, MS-Excel, MS-Access, MS-Outlook)

PROFESSIONAL EXPERIENCE

Confidential, Schenectady, NY

Sr. DataAnalyst

Responsibilities:

• Worked with SSIS to load individual table and work with SSRS to generate reports.
• Worked With HIPAA compliant ANSI X12 837 formats for both professional claims and institutional claims.
• Experience in calling a Web Service, through SSIS Package
• UsedFACETSAnalytics for fast and easy retrieval, display and grouping of information for performing queries and generating reports.
• Worked with FACETS, Facets are extended enterprise of Trizetto's solution to assist payer organizations in staying ahead of trends in the employer benefits market
• Involved in extensiveDATAvalidation by writing several complex SQL queries and Involved in back-end testing and worked withdataquality issues.
• Construction and test of incrementaldatamovement code (extract, cleanse, validate, transform, and load)
• Performed extensive task which include DataQuality Analysis,Datalineage andDataStandardizationdatastructures,database design,data warehouses, business intelligence/analytic tools, SQL, ETL tools, anddataintegration methods
• DevelopedDatastage parallel jobs using stages Transformer, Modify, Look-Up, Join, Merge, Aggregator, Remove Duplicate, Column Generator, Change Capture, Change Apply, Dataset, Sequential File stage etc.
• Extensively usedDatastageEnterprise Edition (Parallel Extender) to develop various jobs to extract, cleanse and load thedataand also involved in migration from DS to versions.
• UsedDatastageDirector to schedule, monitor, cleanup resources and run job with several invocation ids.
• Used SharePoint web application platform for content management, document management file management, business intelligence and process integration.
• Scheduled reports for daily, weekly, monthly reports for executives, Businessanalystand customer representatives for various categories and regions based on business needs using SQL Server Reporting services (SSRS).
• Worked with Waterfall methodology during the beginning of the project then transitioned to Agile methodology
• Worked on design and development inDatastage VTO develop ETL code including:
• Handled Source to TargetDataMapping, Technical Specs documentation, and ETL documentations such as EarlyDataInventory DesignedSSIS Packages to transferdatabetween servers, loaddatainto database on SQL Server 2005 environment and deploy the data.
• Support for creation and documentation of the ETL Detailed Design.
• Perform Metadata analysis of the Grants data dictionary from various grants systems;
• Modified existing program logic to improve overall system performance.
• Created Sequence jobs to control the flow of jobs and their dependencies
• UsedDatawarehousing forDataProfiling to examine thedataavailable in an existing database.
• Designed and developed matrix and tabular reports with drill down, drill through and drop down menu option using SSRS.
• Working with the application and BusinessAnalystteam to develop requirements
• Translating process/technical solutions for business during defect analysis
• Used TOAD, PL/SQL developer tools for faster application design and developments
• transformation, and wherein you declare a variable with its URL link
• Participate in the scrum meeting and also represented the teamduring the meeting
• Working through the phases of SDLC using the Agile methodology
• Worked closely with Development team on ETL process,datainfrastructure,datamodeling, business intelligence reporting and dashboards
• Responsible forDatamapping testing by writing complex SQL Queries using WINSQL
• Reviewed ETL and Business Objects defects and proposed fix for defects as per the scheduled timeframe
• Configured SSIS packages to incorporate slowly changing dimensions for tracking historical data.
• Expert in TSQL, creating and using Stored Procedures, Views, User Defined Functions, implementing Business Intelligence solutions using SQL Server.
• Dealt with the EDI transaction 835 claims payments and remittance advice, which deals the payment from payer to provider.

Environment: IBM Information infosphere Informatica, SSIS, SSRS, COGNOS, Windows XP Toad for Oracle Version, SQL Developer

Confidential, Avon, CT

Lead Business Analyst

Roles & Responsibilities

• Worked with the statisticians and underwriting team to analyze and validate run-time decision models.
• Gathered and analyzed requirement for HIPAA 5010 and ICD 10 changes.
• Analyzed and documented the changes in the compliance rules for adverse action redesign.
• Worked on different EDI scenarios for batch processing.
• Ensure day-to-day EDI transmission, Reject tracking and Reconciliation.
• Run EDI Reconciliation reports daily and document in MS Excel.
• Involved in up-gradation of HIPAA X12 4010 transaction to HIPAA X12 5010 and ICD 9-CM (Clinical modification) to ICD-10-CM/PCS (Clinical modification/procedure coding system) simultaneously.
• Gathered and analyzed requirements for HETS
• Maintained and monitored project progress and status through MS Project.
• Extensive use of Use cases, written business flows, and work flow diagrams for effective plans.
• Integrated Requisite Pro to provide all teams visibility and maintains tractability among requirements, use cases and change requests.
• Managed all the requirements, making requirements available to all team members.
• Created requirements analysis and design phase artifacts using Requisite Pro and MS Visio.
• Defined Business Process align with Company goals and existing HIPAA regulation in Amisys
• Worked extensively with the users and with different levels of management to identify requirements, use cases and to develop functional specifications.
• Created Use cases, Activity, Sequence and Collaboration diagrams.
• Interacted with various cross-functional teams for building business use-cases.
• Conducted Asset Management, Risk Analysis of the Requirements and Traceability focus areas of the various projects and worked with the project team to help them identify the high-risk areas.
• Traces and manage all the requirements with Metadata to ensure the delivery of deliverables on time.
• Data mapping, logical data modeling, used SQL queries to filter data within the Oracle and Sybase.
• Installed and configured Cognos BI and worked with Cognos BI modeling, Report Studio.
• Responsible for co-coordinating business meetings and generating monthly status reports etc.
• Used the Agile methodology to build the different phases of Software development life cycle.
• Design specifications and Test Case usages for the HIPAA 837i, 270/271, 276/277, 835, 824, 275 and others.
• Involved in assembling, organizing and analyzing patient information, including medical history, symptoms, examination results, test results and prior treatments for EHR software development.

Environment: AMISYS, FACETS, Requisite Pro MS SQL, Windows XP, UML, Business Objects, MS Visio, MS Project, MS Excel

Confidential

SR.Business System Analyst

Roles & Responsibilities

• Coordinate with Project Managers, ETL Developer, Business Objects team, QA Testers and work on defects
• Gather and analyze requirements for development write code in ETL Informatica tool
• Analysis of the defects related to the reports and various EDI transactions within the HP system
• Create and maintain the Business Requirement Documents for the defects (Defect Resolution Document)Act as a liaison between the ETL developers, QA tester and SME
• UsedFACETSAnalytics for fast and easy retrieval, display and grouping of information for performing queries and generating reports.
• Working with the application and Business Analyst team to develop requirements
• Translating process/technical solutions for business during defect analysis
• Help in preparing the training material of the providers and insurance companies using the software supporting ICD 10.
• Worked with Business Owners ofIDX, the claims adjudication system,and documented updates and enhancements to the application.
• Utilized survey assessment results of ICD-10 to create listing constraints, processes, projects and systems, applications and vendor software to be impacted by the ICD-10 Conversion Project.
• Conducted theUser Acceptance Testingprocedures.
• Worked With HIPAA compliant ANSI X12 837 formats for both professional claims and institutional claims.
• Considered HIPAA rules while data validation and testing
• Analyzed the mainframe reports for member/eligibility/claims and mapped the fields withFACETSbatch jobs and reports.
• Study the business process and gather the client requirements. Base line the Business Intelligence tools.
• Participate in the scrum meeting and also represented the team during the meeting
• Working through the phases of SDLC using the Agile methodology
• Reviewed ETL and Business Objects defects and proposed fix for defects as per the scheduled timeframe
• Performed adjustments (Void, VR) for all lines of business.
• Authored progress and completion reports which were then submitted to project management on a weekly basis in MS project.
• Worked on different modules ofFacetssuch as Members/subscriber, commissions, provider, billing, plan and Case management.
• Worked on defect related to EDI 837, 835, 277 and 999 transactions
• Worked on new requirements (Change Request) and modifications on various reports that were determined as critical by the Client.
• Met the high expectation from the Client to deliver on tight deadlines
• Worked with Waterfall methodology during the beginning of the project then transitioned to Agile methodology
• Validating member’s benefits against the benefits matrix.
• Involved in the transition of the reporting team, provided necessary Knowledge Transfer sessions to the Cognizant Solution Team for the takeover
• Validating member’s accumulator track right member’s benefits and making sure that Claims gets paid according to the SEPY’s rule.

Environment:Informatica, Toad for Oracle Version 11.5, SQL Developer, Agile, Waterfall, Oracle 11g, MS Office tools, Facets, HP Quality Center, Windows 7, SharePoint, MS Visio.

Confidential, Tampa, Florida FL

Business Analyst

Roles & Responsibilities:

• Involved in gathering requirements as per the consensus meetings between Humana and providers.
• Ensuring all the PLC and PM deliverables are developed in compliance with company policies.
• Created domain models and made them an integral part of multiple FRDs that I created for various aspects of the project.
• Participated in creating Facets data model.
• Worked on the EDI 834-file load to Facets through MMS (Membership maintenance sub-system)
• Developed Use Case diagrams and process flow diagrams using Rational Rose and MS Visio.
• Actively prioritized and managed requirements throughout SDLC with all key stakeholders
• Supported QA in the definition and execution of integration and system testing.
• Created Test Plan, Test cases and test scripts for implementation of test cases in Quality Center
• Negotiated and managed multiple priorities, project plans, time frames and trade-offs while ensuring the clinical and administrative staff understood the final results of the projects, sharing detailed vision of cost-benefit analysis.
• Worked on solving the errors of EDI 834 load to Facets through MMS.
• Provide input to estimates for project management and change management activities through analysis of requirements effort, resources, and technology.
• Worked on EDI 834, 835,837 as per HIPPA guidelines.
• Performed the detail comparison between 4010A and 5010 especially in regard to EDI 837.
• Used the Rational Unified process methodology for the application development and created Use cases, activity diagrams and drafted UML diagrams using the Rational Rose.
• Worked on cross-functional team to deliver software systems as per the customer expectations.
• Updated the requirements and prepared comprehensive Business Requirements Document (BRD) that provided the appropriate scope for the users and management to make appropriate decisions.
• Developed associated project documentation, schedule, design specifications, test plan, test scenarios/scripts, performed gap analysis, and test tracking reporting/monitoring for all phases of testing including B2B user acceptance testing.
• Created Data Flow Diagrams (DFDs) and ER diagrams for domain modeling.
• Played a key role in planning UAT and implementation of system enhancements and data migration and conversions.

Environment: Microsoft Visio, Windows XP, Facets, MS Office, Rational Requisite, Rational Rose, Quality Center, SQL.

Confidential, VA

Business Analyst

Roles & Responsibilities:

• Involved in HIPAA/EDI Medical Claims, Design and Documentation
• Monitor and Analyzed activity report and transaction monitoring.
• Creating document and diagrams for membership enrollment according to HIPAA 834 compliance standard for membership enrollment.
• Created various database objects like views, tables, and procedures to extract data and support the end user reportingdata ware houserequirements.
• Conduct meeting with the development team to discuss any requirement changes.
• Checked inbound/outbound HIPPA regulated EDI transactions facets
• Conducting business validations, covering the following deliverables FACETS Providers, Facets Claims and Facets Membership and Operational reports
• Wrote standard and complex SQL queries using MS SQL Server and also in Mainframe for data validation process.
• Prepared BRDs (Business Requirement Documents) supporting documents containing the essential business elements, detailed definitions, and descriptions of the relationships between the actors to analyze and document business data requirements fromData ware house.
• Performed GAP analysis of business rules, business and system process
• Worked on solving the errors of EDI 834 load to Facets through MMIS.
• The project involves creation of custom tables, developing custom forms to load data into the custom tables and creation of a XML report to compare sales values against the data in oracle. The custom tables are populated from a third partydata ware houseon a regular basis.
• Worked with QA in defect reporting using Quality Center
• Designed Activity, Sequence and process flow diagrams using MS Visio to simplify and elaborate certain selection and filter condition.
• Documented requirement using Use Case analysis
• Involve in testing the applications to carry out data validation

Environment: Rational Requisite Pro, MS Visio, SDLC, UML, Rational Clear Quest, Rational Clear Case, Rational Tools Suite, AGILE methodology, Windows, XML, HTML, Facets.

Confidential, Hartford CT

Business Analyst

Roles & Responsibilities:

• Acted as a liaison between the Corporate Finance Clients and Technology department of Prudential Financials.
• Involved in Requirements Gathering and business analysis through online portal to provide visibility to corporate customers on their Equity and investment positions, FX, integration with market data and analyzed the traders fixed income business requirements.
• Responsible to pull a team of analysts from all of our extended financial departments to guide and direct the overall EQFD strategy for forecasting and budgeting, Risk Management and Fixed Income and derivatives.
• Wrote Functional Specifications that included UML Diagrams and Use Case using Visio
• Identified the gaps between annuity product specifications within the business requirement documents
• Involved in preparing Business Documents through extensive interaction with SME’s
• Responsible for documenting and developing business rules for our metrics based on the business needs, financial requirements and processes used to track our work.
• Conducted JAD/RAD Sessions/weekly meeting/walkthroughs to monitor the project progress.
• Created, Verified and managed the BCP/DR documents, such as BCP and DR plans, First Responders list, and IT call list.
• Made presentations to senior management to outline our project process and phases whose end result will help them to reduce their cost significantly

Environment: RUP, UML, Rational Requisite Pro, MS Project, MS Office,