PROFESSIONAL SUMMARY:

• Eight plus years of diverse progressive experience in Information Technology, with emphasis on Business Analysis and Software Development.
• Expertise in working with Business Analysis, Risk Analysis, Business Process Models, Business Flow Diagrams and Business Requirement Documents.
• Comfortable in working with different requirement gathering techniques like Brainstorming, JAD sessions, Focus Analysis, Reverse Engineering, Survey, Document Analysis, Interview, Prototyping and Observation
• Good working knowledge in Enrollment, Billing, Claims, CMS regulation, HIPAA regulations, ACA regulations, 834 enrollment and 837 claims transactions for health care industries.
• Strong knowledge on Federal Exchange projects, implemented as part of Affordable Care Act.
• Experienced in working with Trizetto Facets on Provider Life cycle, Members Enrollment and Claims modules
• Extensive experience in developing Use Cases, creating Screen Mockups, conducting Gap Analysis and Impact Analysis, SWOT analysis, Cost Benefit Analysis, Risk Analysis.
• Experience 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
• Expertise in creating Use case diagrams, Activity Diagrams, Sequence diagram, Business work flows with complete understanding of various SDLC life cycle concepts.
• Extensive experience in modeling the AS IS and TO BE ecommerce solutions
• Extensive exposure of working in projects related to data and system integrations needed due to Merger and acquisitions.
• In depth knowledge Rational Unified Process (RUP) methodology, Use Cases, Software Development Life Cycle (SDLC) processes, Object Oriented Analysis and Design (OOA/D).
• Experience in the ETL (Extract, Transform and Load) process used to migrate data into new platforms using Informatica tool and Business Intelligence (BI) tools like Business Objects Modules (Reporter, Supervisor, Designer, and Web Intelligence).
• Hand on Experience in the back end applications of data validation process using SQL
• Experienced in performing Business Process Analysis to check the compatibility of the existing system infrastructure with the new business requirements and in translating business requirements, user expectations into detailed specifications by using various Text formats & Unified Modeling Language (UML).
• A self - starter and good at making healthy and productive working relationships in internal, external, independent, and team environments
• Result oriented, highly motivated, organized and eye for detail with excellent communication and interpersonal skills. Ability to adapt and quickly learn new technologies.

TECHNICAL SKILLS

Operating Systems: Windows 98/NT/2000/XP/7, Citrix, VSE Mainframe.

Languages: C, C++, Visual Basic, SQL/PLSQL

Databases: MS-Access03/07/10, SQL Server, Oracle, DB2.

Tools: MS Visio, Rational Rose, Rational Clear Case, Rational RequisitePro.

Bug Tracking Tools: Mercury Test Director, Rational Clear Quest

Testing Tools: Test Director, Load Runner, Quality Center

PROFESSIONAL EXPERIENCE

Confidential, Jacksonville FL

Sr. System Analyst (Lead)

Responsibilities:

• Worked on over several independent exchange projects implemented as part of ACA Act.
• Worked with vendors as a representative from Florida Blue on integration projects.
• Worked with Florida Blue's IT and Business areas closely to understand business needs and implementation approach and have coordinated with enterprise architects to ensure seamless deliveries.
• Worked on FB gateway and Data integration services (HUB AND SPOKE) to coordinate impacts, interfaces, enhancements, and other ad-hoc request.
• Worked as a lead to provide sizing for work (Scope) items.
• Worked on projects following Waterfall/Agile methodologies for exchange items and exchange related postproduction issues.
• Worked on 834 inbound and outbound files using Hub and Spoke model.
• Used detailed knowledge of the application, features and functionalities to assess the scope and impacts
• Performed Gap Analysis to check the compatibility of the existing system with the new business design using the “As is” and “To be” phase analysis.
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, and AOD’s using Visio.
• Interact with development/review BRD's to identify system Impacts and Process impacts
• Organize JAR and JAD sessions to document system requirements
• Documented Functional Requirements Specifications (FRS), Created Process flows/activity diagrams using Visio for projects following water fall methodologies
• Organized and participated in status call/meetings for project status tracking, BTIs and other issues.
• Worked with developers to debug code issue and update data transformation rules using Informatica.
• Worked with Business users to help them set up Groups in Sell-Point (Pega).
• Worked with development team for documenting rules for setting initial quotes and final quotes.
• Worked with Business users to setup SOP’s for BA setup in Sell-Point (Pega)
• Documented and tagged requirements using Rational Requisite Pro.
• Identified features, Prioritized features, Identified Requirements by features and Developed Traceability Matrix using Rational Requisite Pro.
• Involved in UAT testing, UAT Regression and Implementation phase for releases.

Environment: RUP, Siebel, PEGA (Sell-Point), Sales Force, Diamond, JAVA services, SAS, Mainframes, RBMS, MS Office 2010, MS Visio, QC, Rational Requisite Pro.

Confidential, Michigan

Facets Analyst/Data Analyst

Responsibilities:

• Gathering requirements from business users based on new market rules and Desk level procedures.
• Worked with Architects to Create Data flow model for Government owned Facilities, and for new oncoming ROSTERS.
• Created business requirements document (BRD) & functional requirements document (FRD) to map the business rules as documented.
• Built databases in Microsoft Access07 as per new market guideline based on business rules and Desk level procedures, to asses Data Cleansing.
• Created Test data and test cases in MS Excel to test numerous scenarios, for setting up Providers in FACETS.
• Worked with Facets Architects to get in-depth knowledge on Providers life cycle and how can Members and Claims get affected with Providers Network setups.
• Did Reconciliation of Data on Providers back-end table to gauge the quality and enhance quality of existing entities.
• Worked with Facilities to get the correct count on number of Members/ Eligibility and Demographic information to set Groups/Subgroups/Subscribers/Members accurately in facets
• Reconciled the Relation tables to ensure the dependencies does match with Health products selected.
• Built Automated system to Add, Terminate and update existing data based on incoming weekly ACT files from existing Rosters.
• Created Audit Adhoc update system to capture any changes that were skipped.
• Worked with Operational and Implementation team to build a system where loading Providers and Eligibility checks can be made successfully which overcomes efforts of keying records through GUI.
• Did Post load Check through GUI to make sure provided updates/Demographic information is loaded accurately.
• Manually created records through GUI to create Network rows for existing TIN/NPI combinations.
• Reported Vendors about the data issues and Data Quality when required.
• Created a Mapping document to map Codes provided by Vendor/Roster/Government owned Facilities to match the codes that are acceptable in Facets.
• Created Pivot tables to show the oncoming new Adds vs Terms from new vendors.
• Worked with Operational team and End users to ensure the quality of data to help them get agreements from new providers.
• Worked with Users to make sure Claims get Adjudicated correctly for the new providers added into the Network.
• Set Flags for Government run Facilities to process claims with different rules.

Environment: Facets 4.71, RUP, MS Office suite, MS-Access 07, VBA, MS Excel, SQL Server 08, VB script, Quality center 9.0.

Confidential, Charlotte, NC

Business Analyst

Responsibilities:

• Performed requirement gathering & analysis by actively soliciting, analyzing and negotiating customer requirements and prepared the requirements specification document for the application using MS Word.
• Involved in mentoring specific projects in application of the new SDLC based on the Agile Unified Process, especially from the project management, requirements and architecture perspectives.
• Gathered Functional and Data Requirements, analyzed workflows and created Use Cases, Requirement Specifications, Report Specifications, Data Requirements, Data Mappings and Data Flow Diagrams.
• Extensively used MS SharePoint a content management platform, for managing content across the organization within a shared repository.
• Assists Web Developers with development and maintenance of web sites and applications using ASP.NET, SQL, HTML, CSS, JavaScript, AJAX, Flash, and ActionScript.
• Created various mockups to indicate the changes to the current receipts as a result of the enhancements.
• Created RUP activity diagrams and sequence diagrams to analyze the requirements and recommend solutions.
• Prepared scenarios, Use Cases & UML State Diagram for scenarios using Rational Rose.
• Prepare presentation slides in MS Project, which was extensively used in different JAD sessions and to track progress.
• Worked closely with reporting teams to help them design universe using BO and rules conversion in Informatica.
• Assisted the technical team in translating application functionality into application architecture.
• Participated in the bug review meetings, updated requirement document as per business user feedback and changes in the functionality of the application.
• Clarified QA team issues and reviewed test plans and test scripts developed by QA team to make sure that all requirements will be covered in scripts and tested properly.
• Organized meetings to discuss outstanding issues with QA and developers.
• Wrote test scripts for User Acceptance Testing (UAT).

Environment: Rational Suite (Rose, Requisite Pro), Rational Unified Process (RUP), Windows NT/XP/2000, Blue Martini, UML, UNIX, MS-Project, MS-Office Suite, MS Visio, Mercury, JavaScript, Win Runner, Test Director

Confidential, Ewing, NJ

Business Systems Analyst

Responsibilities:

• Gathered Business Requirements, analyzed data/workflows, defined the scope, and performed GAP analysis.
• Met with client groups to determine User Requirements and Goals, thus converting User Requirements into Business Requirements and User and Functional Requirement Specification.
• Involved in designing and developing Data-Flow diagrams, E-R diagrams, and logical and physical database design.
• Facilitated collection of Functional Requirements from system users, and prepared Business and Technical Requirement Specification documents.
• Helped manage risk analysis and mitigation plans, status reports, and client presentations; prepared business process models, defined milestone deliverables, and established critical success factors.
• Gathered requirements during inception phase, documented and delivered functional specification documents, and assisted architecture analysis and design using UML and Rational tools.
• Analyzed business and technical requirements, thus creating the Business Use Case (BUC) and Application Use Case (AUC) documents. Written Business Use Cases, Business Rules, logical analysis and change management of requirements.
• Project lead (technical and functional) for stream: Correspondence. This covers various types of letters/mails/forms and checks that are dispatched from NJM premises to its policyholders and claimants.
• Facilitated Joint Application Requirement (JAR) sessions to identify business rules and requirements with Business Teams.
• Worked extensively with SMEs and performed Gap analysis to arrive at the gaps between current and future systems and the modules to be impacted.
• Translated business functionality and opportunities into clear, precise and easy-to-read functional specifications, technical specifications with data mapping and application process flow and facilitated Joint Application Development (JAD) sessions with programmers.
• Involved in creation of Data Dictionary describing data model of claim center database for WC Claims Integration and Reporting. Used Erwin to design conceptual, logical data model enforcing the data integrity and preventing use of redundant data within and between systems.
• Wrote SQL Queries to create tables, stored procedures, triggers and performed data analysis, data mapping, data reporting using Microsoft SQL Server Management Studio.
• Formulated integration test plans, test cases, test scripts and executed integration testing with assistance in UAT.

Environment:Agile (Scrum), Rational Requisite Pro, SQL Server 2005, MS SQL Server Management Studio 9.0, Quality Center, VBA, SAS, MS Office (MS Excel, MS Access, MS Word, MS Power Point), MS Visio.

Confidential, Murrysville, PA

Business Analyst

Responsibilities:

• Analyzed User Requirement Document, Business Requirement Document (BRD), Technical Requirement Specification and Functional Requirement Specification (FRS).
• Involved in the analysis of the existing credit card processing system.
• Extracted the Business Requirements from the end users keeping in mind their need for the application and prepared Business Requirement Documents (BRD) using Rational RequisitePro.
• Reviewed the data model and reporting requirements for Cognos Reports with the Data warehouse/ETL and Reporting team.
• Defined the test criteria, project schedules and base lined the Test Plan with the help of project meetings and walkthroughs.
• Performed Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data
• Created and managed Project Templates, Use Case Project Templates, Requirement Types and Traceability Relationships in RequisitePro.
• Involved in creating automated Test Scripts representing various Transactions, Documenting the Load Testing Process and Methodology. Created meaningful reports for analysis and integrated the Performance Testing in the SDLC.
• Developed the Test plans for quality assurance based on functional requirements.
• Assisted in the requirements to the source systems, the DW and applicable data marts.
• Worked on data modelling and produced data mapping and data definition documentation
• Developed and managed Project Plans and Schedules. Managed resolution of Project issues and conflicts.
• Conducted Functional Walkthroughs, User Acceptance Testing (UAT), and supervised the development of User Manuals for customers.

Environment: RUP, UML, SDLC, MS Office, MS Project, MS Visio, DOORS, Project Management.

Confidential

Business Analyst

Responsibilities:

• Created Business procedure documents to load subscriber/members into Facets from UI
• Wrote SQL Queries to create tables, stored procedures, triggers and performed data analysis, data mapping, data reporting using Microsoft SQL Server Management Studio
• Translated business functionality and opportunities into clear, precise and easy-to-read functional specifications, technical specifications with data mapping and application process flow and facilitated Joint Application Development (JAD) sessions with programmers.