SUMMARY

• Over 6 years of Information Technology as Business Analyst with a focus in Healthcare including MMIS, Medicaid, Medicare, FACETS, HIPAA, EDI, and other supporting applications for insurance providers & service providers.
• Highly motivated team player with excellent communication, presentation and interpersonal skills, always willing to work in challenging and cross - platform environment.
• Experienced as a Business Analyst in using the iterative software development life cycle principles of Rational Unified Process to manage, develop and test distributed client/server, internet and intranet applications on heterogeneous environments.
• Highly proficient in working with users to gather requirements, analyze them and subsequently use the Rational project and design tools to model the requirements.
• In-depth knowledge of creating use cases, functional design specifications, activity diagrams, logical, component and deployment views to extract business process flow.
• Used Query Analyzer, Execution Plan to optimize SQL Queries.
• Strong understanding of project life cycle and SDLC methodologies including RUP, RAD, Waterfall and Agile.
• Interviewed SMEs and Stakeholders to get a better understanding of client business processes and gather business requirements.
• Experience in using strong communication skill in eliciting and analyzing requirements
• Expertise in broad range of technologies, including business process tools such as Microsoft Project, Primavera, Promodel, MS Excel, MS Access, MS Visio, technical assessment tools, Data Warehousing concepts and web design and development.
• Conducted JAD sessions, created Use Cases, work flows, screen shots and Power Point presentations for the Web Applications
• Familiar with HIPAA EDI transactions such as 835, 837 (P, D, I) 276, 277, 278 etc
• Expertise in the EPIC Medical software application (EMR, HER) as it relates to hospital workflows and setting up the infrastructure for a software implementation in a clinic environment.
• In depth knowledge of SDLC and implementation of the Rational Unified Process (RUP) in all four phases of a project: Inception, Elaboration, Construction and Transition.
• Utilized a fusion of industry knowledge and technical programming to provide executive management the development and implementation of interactive busines 1 s tools, and strategic analysis, vital for use in mission-critical decision-making
• Conducting requirement gathering sessions, feasibility studies and Impact Analysis and organizing the software requirements in a structured way using Rational RequisitePro to track development.
• Interacting regularly with the development team, creative services, database designer, system administrator and the higher management to meet the deadlines of Project milestones.
• Worked in close co-ordination with the testing team in developing test plan and test cases from functional and business requirements.
• Performed UAT and exposure to User Certification Testing (UCT) and Operational Readiness Testing (ORT)
• Expertise in understanding and supporting the client with Project Planning, Project Definition, Requirements Definition, Analysis, Design, Testing, System documentation and user training.
• Used Rational ClearQuest for tracking and prioritizing defects and for enhancements after base lining the requirements.
• Used Rational ClearCase for Version Control of requirement documents.
• Well versed in writing queries/Scripts for Data Analysis and QA reporting and testing.
• Experience in Change Management Process (Identify, Analyze, Evaluate, Plan, Implement, Review and Close).
• Expertise in Procurement and Management Services
• Experience in implementing Microsoft Office SharePoint 2007.

TECHNICAL SKILLS

Programming Languages: C, C++, HTML, XML, SQL.

Data Base: MS Access, Oracle (SQL Series), DB2

Reporting Tools: Crystal Reports 8.0

Operating Systems: MS-DOS, Windows95/98/NT/2000/XP, Apple McIntosh, Linux

Software: MS Office Suite(Word, Excel, Access, PowerPoint & Outlook), MS Visio, Rational Rose, Rational Requisite Pro, Adobe Acrobat, MS Office FrontPage, Lotus Notes

Performance Testing Tools: Virtual User Generator, Load Runner

Processes/Technologies: Rational Unified Process (RUP), Waterfall, UML & Microsoft Office SharePoint 2007

Automation Tools: Requisite Pro, Win runner, QTP, Test Director, Quality Center

PROFESSIONAL EXPERIENCE

Confidential, NE

Senior EDI Analyst

Responsibilities:

• Created Use Case, Sequence and Activity Diagrams using MS Visio.
• Conducted weekly meetings for deciding the Policies and Procedures to be followed while constructing new sites.
• Performed the requirement analysis, impact analysis and documented the requirements using Rational Requisite Pro.
• Was responsible for data mapping of HL7 messages into relational database.
• Tested the ANSI X12 Version 4010 / EDI transactions (HIPAA) like 270, 271, 276, 277 P, 837I, 837D, 835 remittances)
• Diagrammed cross-functional business processes in accordance with FederalMITAregulations and system functionality.
• Documented the server farm requirements and requirements related to security within Share Point and using Windows Active Directory.
• Analyzed System Impact includingMMISTables, Windows, Reports and Interfaces to external entities.
• Analyzed HIPAA 5010 impact on external Data Warehouse and data warehouse extract process and mapping ofMMISdatabase and data warehouse.
• Developed plan for data feeds and data mappings with the use of HL7 for integration between various systems, to follow ICD 9/ICD 10 Code set and ANSI X12 5010 formats.
• Hands on experience in MITA, Medicaid, Medicare, Claims, HIPAA compliance,ICD and CPT standards
• Performed Gap Analysis to check the compatibility of the existing system infrastructure with the new business requirements.
• Participated in creating theUser Interface Mockupsfor the monitoring system usingMS Visio
• Built business requirements into the Medicare Advantage (MA) requirements database and created the Project Requirements Document for the three functional areas
• Experienced in evaluation, customization, and implementation of various Commercial Off the Shelf packages (COTS)
• Managed the team of consultants responsible for developing on-demand Medicaid Management System reports.
• Gathered requirements and prepared Use Cases (General System Design documents and Detailed System Design document) by interviewing tax agents, users and clients.
• Involved in Eliciting requirements for new line of business
• Followed a systematic approach to eliciting, organizing, and documenting requirements of the system.
• Experienced in managing requirements from project inception through release. Skilled in eliciting user demands and translating them to data, functional, quality and usability requirements
• AnalyzedMMISsystem impact for Windows and Interfaces.
• Involved in eliciting requirements via SME interviews, document analysis, requirements workshops, surveys, business process descriptions, use scenarios, and workflow analysis.
• Interacted with Informatica developers for designing and developing complex web intelligence, Business intelligence, Client and ad hoc reports for corporate data.
• Led SAE data reports, DSMB specification, data reconciliation between safety DB and clinical operations EDC system
• Use Cases and other Process Flow Models were designed using Visio and Rational Rose
• Authored various Use Cases and Activity diagrams, Sequence diagrams using Rational Requisite Pro and used UML methodology to define the Data Flow Diagrams (DFD).
• Worked with Data Analyst inData Mappingof report elements to SQL database.
• Designed the online screens and reports for the Medicaid Online Electronic Claims Submission System.
• Analyzed, designed, and coded several online subsystems for the Medicaid System.
• Followed a systematic approach to eliciting, organizing, and documenting requirements of the system.
• Managed the completeRequirement Gatheringprocess, which involved eliciting, analyzing, and translating user requests into documented requirements.
• Working knowledge of MediCare, MediCaid and Commercial Insurance benefits eligibility (834s), contracts set up, billing, claim (837s) processing includes remits (835s) and denials.
• Reviewed the Joint Requirement Documents (JRD) with the cross functional team to analyze the High Level Requirements.
• Good knowledge of Health Insurance Plans (Medicare Part A, B, C and D), managed care concepts (Medicaid and Medicare) and experienced in determining the membership eligibility, billing experience within life and disability in health plans with thorough understanding of CPT coding,CMS-1500claim forms and reimbursement forms.
• Designed, authored, reviewed and revised Clinical Data Management Plans and Drug Safety Technical Reports are FDA 21 CFR Part 11 compliant
• Assisted in requirements gathering by interviewing store managers and supervisors
• Used MS Visio for Process modeling and Business Process flow diagrams.
• Modeled AS IS and TO BE processes using MS Visio
• Knowledge of health care services regulatory environment including HIPAA 4010/5010 formats, ICD9 and ICD10, HL7, MITA, MMIS and EDI.
• Performed Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data
• Worked in an AGILE delivery model involving multiple scrum teams and daily stand-up meetings
• Implemented and tested the application withAgile Methodology for overall software test strategy and approach, project schedules, issue management, estimations and risk assessment.
• Participated in meetings to discuss the alignment between the two different software development processes used by Amex (waterfall model) and NAN (agile method).
• Effective with the creation of artifacts and management of various roles specified by Rational Unified Process (RUP), Agile Methodology, RAD, Workflow Processes and Waterfall cycle method
• Retail Management & Data Warehouse ª Data Mining & Risk Management ª Quality Assurance
• Analyzed trading partner specifications and created EDI mapping guidelines
• Designed and developed project document templates based on SDLC methodology
• Performed Unit Testing and User Acceptance testing and documented detailed results.

Environment: Windows 2000/XP, Microsoft Office SharePoint 2007, Rational Requisite Pro, MS Office, SQL Server, Agile, MS Project, MS FrontPage 2003, MS Visio, MS Access, EDI, Documentum 2.0.,UML

Confidential, Middletown, NY

EDI Analyst

Responsibilities:

• Responsible for defining the scope and implementing business rules of the project, gathering business requirements and documentation.
• Responsible for writing Functional Requirement Specifications (FRS) and User Requirement Specification (URS).
• 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.
• ReviewedMITABusiness process documents, Functional and Technical Specification
• Wrote PL/SQL statement and stored procedures in Oracle for extracting as well as writing data.
• AnalyzedMMISsystem impact for Windows and Interfaces.
• Developed straightforward DBMS queries, knowledge of HL7 and xml interface messaging.
• Assisted in monitoring ancillary data transactions and addressed problems with HL7 messages.
• Responsible for architecting integrated HIPAA, Medicare solutions, Facets.
• Identify Member, Provider, Coverage, Medicare, and Medicaid.
• Supported the CMS Medicare Part B program by providing technical, analytical, testing, and implementation support to existing interfaces.
• Coordinated with the developers and IT architects to design the interface of the new system according to the X12 (270, 276, 278, 834, 837 (I,P,D) and 820) standards
• Worked as a SME Medicaid Management Information Systems (MMIS) including The AccreditedStandardsCommittee X12 (ASC X12) standard EDI Transactions-834 and other, ICD 9 & 10, HL7, Medicare, Medicare Advantage, MediGap, HIPAA, HIE,, EHR and all other compliances.
• Working knowledge of Medicare, Medicaid and Commercial Insurance benefits eligibility (834s), contracts set up, billing, claim (837s) processing includes remits (835s) and denials.
• Assisted the database development team in data modeling, data structure and data table layouts required for consolidation of incongruent databases,
• Performed Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data
• Designed, authored, reviewed and revised Clinical Data Management Plans and Drug Safety Technical Reports are FDA 21 CFR Part 11 compliant
• Involved in Service Oriented Architecture (SOA) of the claims processing system
• Understand the As Is system and develop the To Be system concept and also prepare the System Process Maps.
• Performed extensive requirement analysis including Data analysis and Gap analysis.
• Defined Functional Test Cases, documented, Executed test script in Facets system.
• Successfully conducted JAD sessions, which helped synchronize the different stakeholders on their objectives and helped the developers to have a clear-cut picture of the project.
• Conducted presentations of the Q/A test results with analysis to the stakeholders and users and documented modifications and requirements.
• Coordinating and Developing QA activities.
• Assisted in requirements gathering by interviewing store managers and supervisors
• Involved in Eliciting requirements for new line of business
• Followed a systematic approach to eliciting, organizing, and documenting requirements of the system.
• Designed, developed and implemented predictive models using data mining tools, analyze test results and be able to discover segments in data
• Worked with Data Analyst inData Mappingof report elements to SQL database.
• Retail Management & Data Warehouse ª Data Mining & Risk Management ª Quality Assurance
• Reduced operational risk by creating controls, documenting procedures, reviewing and reducing manual processes
• Facilitated the documenting of test cases and recorded them for the functionality testing in Test Director based on test requirements.
• Worked on SQL Queries to analyse the intended system behavior.
• Involved in eliciting requirements via SME interviews, document analysis, requirements workshops, surveys, business process descriptions, use scenarios, and workflow analysis.
• Expertise in creating Business Domain Model, interviewing SME (Subject Matter Experts) and requirement elicitation.
• Extensively used SAS for data analysis in Clinical Trials and worked closely on Clinical Operations to provide specialized programming support.
• Followed a systematic approach to eliciting, organizing, and documenting requirements of the system.
• Worked with the scrum master in getting the estimates for the projects and also user stories and defined the sprint periods using Agile/ Scrum methodology
• Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data within the Oracle database
• Worked in an AGILE delivery model involving multiple scrum teams and daily stand-up meetings
• Implemented and tested the application withAgile Methodology for overall software test strategy and approach, project schedules, issue management, estimations and risk assessment.
• Participated in meetings to discuss the alignment between the two different software development processes used by Amex (waterfall model) and NAN (agile method).
• Created Process Flow diagrams, Use Case Diagrams, Class Diagrams and Interaction Diagrams using Microsoft Visio and Rational Rose.
• Migrated Data from MS Excel to SQL Server Reporting Service Using DTS and SQL loader utilities.
• Used MS Visio for Process modeling and Business Process flow diagrams.
• Modeled AS IS and TO BE processes using MS Visio
• PerformedEnd to Endtesting for the member, provider and claims modules as per theMITAbusiness process
• Wrote Test Cases and performed User Acceptance Testing, documented the in detail defects using the Defect Tracking report.
• CreatedUse Case, SequenceandActivity DiagramsusingMS Visio.

Environment: Requisite Pro, Rational Rose, Agile, HL7 Interfaces, SQL, PL/SQL, HTML, MS Office, MS Visio, EDI, UML.

Confidential, Bismarck, ND

Business EDI Analyst

Responsibilities:

• Interactions with the end users in order to generate the report required and to understand the business requirements relating to Medicaid program and Pharma.
• Involved in all phases of Software Development Life Cycle (SDLC).
• Used Informatica power center for extraction, loading and transformation of data in the data warehouse.
• Worked on the ICD 9 CM and 10 CM codes for billing purposes in pharma division.
• Obtained Data requirements, identified data sources, determined the content of data fields and created Data Mapping Documents and performed Data Extraction and Data Compilation using SQL queries.
• Worked on HIPAA X 12 transactions 4010 and 5010 Edi Transactions and test cases.
• Built and managed successful client relationships with representative, director, and deputy chief level contacts within the Centers for Medicare & Medicaid Services (CMS).
• Worked on hospital information systems and electronic medical records.
• Interacted with Informatica developers for designing and developing complex web intelligence, Business intelligence, Client and ad hoc reports for corporate data.
• Successfully designed and implemented statistical reporting processes for regular data collection and clinical data analysis. Analyzed safety and efficacy data from Phase II and III clinical trials.
• Met with physicians, nurses, billing and administrative personnel. Documented the clinical, financial and administrative business practices, procedures and workflows.
• Defined the current clinical and financial business processes and practices.
• Applied guidelines, standards and regulations such as HL7 CDA, CDISC, MedDRA, Code of Federal Regulations (CRFs) to clinical data modeling.
• Designed, authored, reviewed and revised Clinical Data Management Plans and Drug Safety Technical Reports are FDA 21 CFR Part 11 compliant
• Developed reports based on the Clinical Trial protocol
• Developed and executed SQL queries on claim records to validate reporting data
• Created and executed SQL Queries
• Worked with X12 standard SME for 834 and 837 transaction sets requirements with HL7.
• Worked with DBA and data architects on implementation of database changes.
• Documented technical services with desktop and other technologies and worked on analyze business and process flows.
• Worked with SME’s in Finance, Investment, Commercial and Personal banking to collect the Business process requirements, documented them in Business Requirement Document (BRD) and performed Business Process Re-engineering.
• Obtained Data requirements, identified data sources, determined the content of data fields and created Data Mapping Documents and performed Data Extraction and Data Compilation using SQL queries.
• Analyzed data flow requirements and developed a scalable architecture for staging and loading data and translated business rules and functionality requirements into ETL procedures.
• Analyzed business requirements and implemented technical solutions and assisted with local WAN, LAN, Server, desktop and other technologies.
• Developed test plans, test scenarios, test cases, test data to be used in testing based on business and user requirements, technical specifications.
• Interacted with DBA’s to understand the table’s schemas.
• Involved in the requirement gathering and analysis for implementing the data warehouse.
• Interpreted logical and physical data models with data modelers to determine common data definitions and establishing the referential integrity system.

Environment: Informatica PowerCenter6.2, MS SQL Server 2000, UNIX, PL/SQL, MS Pr