SUMMARY

• Over 8 years of experience as Business Analyst/UAT tester wif emphasis on domain logic, identifying implementation requirements and resolving solutions to business processes based on complex software projects, that includes system development module, business process improvement, tactical planning and policy improvement.
• Expertise in Software Development Life Cycle (SDLC) including Waterfall, Agile (Scrum), and RUP methodology.
• Proficient in creating and renovating Business Requirement Documents (BRD), Functional Specification Documents (FSD), and converting business requirement into Software Requirement Specifications (SRS) using MS Word and Rational Requisite Pro.
• Excellent analytical and problem solving skills in designing, developing, and implementing business innovative business processes using new approaches and technology.
• Experienced in GAP Analysis, Cost Benefit Analysis, organizing, facilitating and coordinating many Joint Application developments (JAD), Joint Requirement Planning sessions (JRP), and Rapid Application Development (RAD) sessions, weekly meetings, conference calls and other regular project meetings.
• Worked closely wif stakeholders and SMEs to fulfill teh project goals and objectives as well as able to manage multiple initiatives, projects and deadlines on time.
• Experience working wif TEMPEffective Enterprise Data Management (EDM).
• Goal - oriented professional wif excellent interpersonal skills wif verbal and written communication, presentation skills and flexibility in adapting wide range of work environments by inculcating new relevant skills wif ease in a time sensitive frame.
• Experienced in creating Data Flow Diagrams (DFD), Use Cases, Class Diagram, Activity Diagrams, Sequence Diagram, and UML Modeling methodology using tools such as Rational Rose and MS Visio.
• Familiarity wif White-Box and Black-Box testing techniques such as Load Testing, Regression Testing, Unit Testing, System Testing, Quality Center and Performance Testing.
• Developed test scenarios and implemented test plans for system testing and user acceptance testing (UAT).
• Involved closely wif teh Developer and Testing team during defect resolution phase.
• Excellent understanding of HIPAA standards (4010 and 5010), HIPAA code sets ICD-9, ICD 10 and HL7.
• Experience in Process Documentation, Analysis and Implementation in 835, 837IPD, 834, 270/271, 276/277, 999/TA1 (X12 Standards) processes of Medical Claims Industry from teh Provider/ Payer side.
• Captured allHIPAA-relatedEDI datain teh repository usingFACETS and supported integrated EDI batch processing and real-time EDI usingFACETS.
• Proficient understanding of Medicare Part A, Part B, Part C and Part D products and procedures managed care concepts (Medicaid and Medicare) and experienced in determining teh membership eligibility, billing experience wifin life and disability in health plans.
• Extensive knowledge of Medicaid Management Information Systems (MMIS)/ Replacement Medicaid Management Information System (RMMIS), Medical Information Technology Architecture (MITA).
• Comprised wif Health Insurance Exchange, products develop and successfully release of private HIX and public HIX under Obama Care (PPACA).
• Experience developing, maintaining test plans, detailed test cases, executing tests cases, validating test results, and logging defects, and tracking defects.
• Familiar wif RDBMS tools like oracle (TOAD), DB2, IBM Mainframe and MS SQL Server wif very Strong SQL skills (writing queries and verifying data). Solid understanding of databases, data ware house, OLTP, OLAP, Data Modeling, Business Intelligent tools like Business Objects.

TECHNICAL SKILLS

Business Skills: Business Process Analysis and Design, Requirement Gathering Use Case Modeling JAD/JRP Sessions Gap Analysis, Impact Analysis.

Methodology: RUP, Agile, Scrum and Waterfall, SDLC, UML, OOAD, JAD, GUI, UAT, RTM.

Business Modeling and Change Management Tools: UML, MS Visio, Rational Rose, Smart Draw, SharePoint, Documentum, Requisite Pro, Clear Quest, ALM.

Language/Standards: JAVA, SQL, PL/ SQL, HTML and XML, HTTP, HIPAA 4010/5010, ICD9/10, ANSI X12, CPT, CMS form.

Applications: MS office suite, Adobe suite, IBM Lotus Notes, Lotus Symphony, IBM Same time, Domino Designer, IBM Blue Pages, communicator, Kick start, Network installation manager, IBM smart cloud meetings.

Testing Tools: HP Quality Center, Win Runner, Load Runner, JIRA, Quick Test Pro, RMT.

Health Care: ANSI X12, HIPAA, EDI, Enrollment/Claims/Benefits/Remittance, FACETS.

BI Tools: Cognos 8.4/8.3/8.2/ 8.1 and Microstrategy, OBIE, Business Objects (Designer, Dashboard), Informatica, Crystal Report.

Database/RDBMS: Oracle 10g/9i/8i/DB2, TOAD, MS SQL Server, Teradata, Sybase.

Operating System: UNIX, Windows XP/ NT/2000/ 95, MS-DOS.

Microsoft Office tools: MS Office (Package), MS Project, MS Front Page, Visio, Excel, Word, Outlook, PowerPoint.

PROFESSIONAL EXPERIENCE

Confidential, Phoenix, AZ

Lead Business System Analyst

Responsibilities:

• Responsible in providing Business Requirement Document (BRD) and Functional Requirement Document (FRD) using Requisite Pro.
• Analyzed inpatient and/or outpatient medical records using International Classification of Diseases, Ninth Revision (ICD-9/10) and Update ICD-9 and CPT code changes.
• Maintained reimbursement summaries from third parties and compare wif clinic fees, Updated reimbursement regulations, Notified Business Manager of significant changes, conduct periodic medical record audits to ensure documentation is consistent wif billing.
• Well-defined and produced inclusive, accurate conversions of ICD-9 codes into equivalent ICD-10 codes wif teh option to adjust system application for ICD-10 specificity.
• Assisted wif teh User Interface (UI)prototypes to capture and validate requirements and spike solutions to teh occurring problem.
• Performed performance tuning of Informatica Mappings in a relational database, sessions for Informatica 8.x workflows, transformations and cache optimization for loading, creating teh batches and optimizing batches to load in teh production environment.
• Locate and validate teh data in teh transactions of 837 and report teh file that is in error. Also, excellent understanding of loops, segments, elements and structure.
• Experience working wif TEMPEffective Enterprise Data Management (EDM) wif capabilities of profiling, cleansing and monitoring to improve data quality; metadata (data about data) to ensure consistent definitions and usage; data governance to provide ongoing oversight and enforcement of standards and procedures; retention and security to support accessible and secure data; and master data management.
• Tested claim billing processes as well as other healthcare processes such as enrollment, eligibility, andclaims-to-remittance adjudication processes.
• Worked wif providers and Medicare/Medicaid entities to validatehealthcare processes, including end-to-end claims processing, payment processes and eligibility where special focus on procedure and diagnosis coding.
• Created technical documentation,reviews, analysis, and evaluations ofbusiness systemsfor end user needs, including Companion Guides,business process reengineering,GAP analysisandmedical forms processing andworkflows.
• Worked onClaims and Remittanceprojects, including syntax and business rulesfor HIPAA4010and 5010validation for loops, segments, elements, qualifiers and code sets.
• Created EDI Export and Import processes and worked wif EDI Trading Partners, Payers/Vendors.
• Used SDLC (System Development Life Cycle) methodologies using Agile and RUP.
• Created Testcases, testplan and Companion Guide from stage to production.
• Performed UAT testing for ICD10 and legacy testing for HIPAA 4010 and 5010 projects for HIPAA requirements and compliance mandates.
• Performed Unit testing documentation developed using Excel and created Artifacts and listing for UAT validation,and writing and validating Use Case Documents.
• Experience developing, maintaining test plans, detailed test cases, executing tests cases, validating test results, logging defects, tracking defects and also automated testing wif experience in using Quick Test Pro in quality center.
• Complete knowledge in Medicaid and Commercial entities which include claims, enrolment testing, as well as NPI and medical coding and ICD-9 EDI testing.
• Captured allHIPAA-relatedEDI datain teh repository usingFACETS and supported integrated EDI batch processing and real-time EDI usingFACETS.

Environment: Share Point 2010, MS Visio 2010, Rational Rose, GAP Analysis, UML, Use Case Analysis, SQL Server, Microsoft Office Suite, Quality Center, JSP, Java Script, XML, HTML, Agile, and Scrum Master, test Director, Rational Unified Process (RUP), MS Access, and DB2.

Confidential, Baltimore, MD

Lead Business Systems Analyst

Responsibilities:

• Analysed and collected business requirements identified system interfaces and created teh requirements specification documents.
• Identified Use Cases from teh requirements and created UML Diagrams including Use Cases, Activity/State Charts, Sequence diagrams, Data Flow Diagrams and ER Diagrams using Rational Rose and MS-Visio thus defining teh Business Process Model and Data Process Model.
• Performed requirement analysis by gathering both functional and non-functional requirements based on interactions wif teh users, stakeholders, document analysis, user interviews, and documented those requirements in teh BRD.
• Consistently utilized MS-Project for planning and project tracking purposes.
• Developed Test plans and mapped them to requirements wif QA team.
• Developed and updated Requirements Traceability Matrix (RTM) using Rational Rose, mapped teh developed Test Cases to teh requirements to ensure that teh requirements were fully tested and implemented according to teh specifications.
• Experience developing, maintaining test plans, detailed test cases, executing tests cases, validating test results, logging defects, tracking defects and also automated testing wif experience in using Quick Test Pro and Quality center.
• Evaluated and tested teh new and modified software application to verify that programs function according to both technical and business requirements.
• Used teh Rational Unified Process (RUP) methodology for teh project.
• Developed, executed and validated user acceptance test plans (UAT) and implementation support.
• Performed Gap Analysis to figure out what we have and what we ought to have, to be better-off.
• Developed project schedules, conducted project status meetings and managed resources during all phases of teh SDLC.
• Created and maintained teh Requirements Traceability Matrix (RTM)
• Part of Health Insurance Exchange (HIX) product team and experience in handling Private and Public Exchange solution.
• Experience wif conducting assessments and impact/gap analysis concerning State Medical Management Information System (MMIS).
• Involved in teh UAT testing of web portal of MMIS System and conducted training to users.

Environment: MS Visio, SQL, Java, Windows 2000/2003, MS Project, MS Word, MS Excel, Rational Requisite Pro, ALM, Rational Rose, and RUP, Share Point, Quality Center.

Confidential, Charlotte, NC

Business Analyst/UAT Tester

Responsibilities:

• Conducted analysis studies that serve as input to teh strategic planning, goal setting, and approach to achieving teh goals.
• Involved in gap analysis workshops to facilitate teh proper requirements strategy and defined existing business process (BPM-Business Process Modeling) and identified teh gap (Gap Analysis) between teh existing and improved business process.
• Worked closely wif Business Users to gather requirements in Requisite Pro for streamlining teh Claims Processing System. Prepared business requirements documents (BRD) and converted it to functional requirements (FRD).
• Involved in claims and record data mapping and data modeling wif technical teams.
• Facilitated teh administration of increasingly complex benefit plans and regulations.
• Provided an outstanding platform for data exchange between client and vendors.
• Explained teh solution model, analyzed functional requirements, prepared Use cases, defined user profiles, defined supplementary requirements, defined assumptions and prepared traceability matrix and validated requirements.
• Conducted Joint application development (JAD) sessions by convening project sponsors, end-user representatives, SME’s. Also, used Brain storming, Document analysis, and user task analysis for various reporting types like CLUE (Comprehensive loss underwriting exchange, Change Report, Claim Count, Claim summaries).
• Interacted wif teh SMEs and stakeholders to get a better understanding of client business processes and gather business requirements.
• Prepared and maintained Requirement Traceability Matrix (RTM) in Rational Requisite Pro.
• Assisted in locking bugs, in order to meet specific requirements and deadlines for successful execution of teh project.
• Createduse cases, process flow models, data flow diagrams and logical flow diagramsusingUMLfor various integrations.
• Prepared diagrams using Rational Rose and developed test plans, test cases to analyze and match results.
• Gatheird requirements from teh end-users and acted as a liaison between teh end-users and teh development team and QA team.
• CreatedUATtest strategies,including regressionandintegrationtesting, wrote test scripts,end-to-end testingscenarios and test plans, managed testing, defect reporting and change requests.
• Assisted Quality Assurance (QA) Analysts in creation of various tests by using Quality center, developing, maintaining test plans, detailed test cases, executing tests cases, validating test results, logging defects, tracking defects and also used automated testing wif experience in using Quick Test Pro.
• Followed teh Agile methodology during teh entire SDLC.
• Assured that all artifacts are in compliance wif corporate SDLC policies and guidelines.

Environment: Visual Basic, Oracle 11i, MS-Project, MS-Visio Windows 2000 Server, Windows 2000, Rational Tools, HP Quality Center, Dot Net Framework, Java, Agile wif XP.

Confidential, Englewood, CO

Business Intelligence Analyst

Responsibilities:

• Have worked to interpret NCPDP standards and HIPPA regulations.
• Supervise and work well wif others in diverse work groups and write reports, business correspondence, and technical documentation.
• Proficiently worked wif MS SQL Server, Oracle Database 10g and 11i, web services and XML data.
• Designed technical and functional specifications for new projects.
• Developed business intelligence dashboards and assisted in its integration on multiple data platform.
• Analysed system and implemented various improvements to systems and performed necessary test patch and upgraded system.
• Provided technical support to business intelligence platform, diagnosed and resolved problems on same.
• Developed and executed various business intelligence training programs.
• Performed troubleshoot on all intelligence jobs on multiple sources and provided End-user Training and documentation for customer reporting services.
• Assisted in developing business intelligence strategies in coordination wif data architect.

Environment: MS Visio, SQL, Java, Windows 2000/2003, MS Project, MS Word, MS Excel, Rational Requisite Pro, ALM, Rational Rose, and RUP, Share Point, Quality Center, Cognos 8.4/8.3/8.2/ 8.1 and Microstrategy, OBIE, Business Objects (Designer, Dashboard), Informatica, Crystal Report.

Confidential, Franklin Lakes, NJ

Sr. Business System Analyst/ UAT Tester

Responsibilities:

• Involved in gathering, analyzing and documenting business requirement and data specification.
• Monitor Medicare Part D PBM contract including, but not limited to, rebate amounts, claim pricing and benefits, formulary coverage/tier application and contractual performance measures. Performance measures include validation of claim adjudication accuracy from both a pricing and benefit perspective.
• Worked wif teh compliance and audit team to make sure we were following correct HIPAA guidelines/protocols throughout teh project lifecycle.
• Included in selection committee for teh selection of a code mapping tool.
• Created and reviewed business requirements, functional specifications, project schedules and documentations.
• Created use case models, analysis models, implementation models, authorized use cases, use case diagram, behavior diagrams (sequence diagrams, activity diagram) based on UML methodology using Rational Software Modeler and MS Visio.
• Conducted Joint Application Development (JAD) and interview sessions to elicit requirements from teh users and subject matter experts.
• Prepared and maintained requirements using Rational Requisite Pro and traceability matrix (RTM) throughout teh project lifecycle
• Documented teh UAT plan for teh project and worked wif teh UAT Team to ensure every acceptance criteria for teh requirements has been included in teh UAT task plan.
• Involved in designing and developing Data Models and Data Marts that support teh Business Intelligence Data Warehouse.
• Performed Gap Analysis to identify teh gap between teh optimized allocation and integration of teh inputs, and teh current level of allocations.
• Created diagrams using Rational Rose and developed test plans, test cases to analyze and match results.
• Reproduced, verified and validated issues documented in a defect tracking system and wrote tractability matrices based on use cases and business requirements (BRDs).
• Extensive experience wif Business Process Management (BPM) system.
• Involved in UAT sessions to test and validate teh system wif stakeholders.
• Analyzed teh test results from QA teams using Performance Studio Analysis to create various scenarios.
• Prepared schedule work flow, following agile methodology in SDLC.

Environment: UML, Windows XP, Business Objects, Informatics, MS Project 2000, MS Word, MS Excel, MS Visio, SharePoint, Agile, and waterfall.

Confidential, San Francisco, CA

Business Analyst/Web Analyst/UAT Tester

Responsibilities:

• Gatheringand updatingrequirements for new web interfaces, handling defects and security audits using RequisitePro.
• Coordinated work plan between project manager and client wif Microsoft Project, implemented and managed migrationprocess and developer fixes, retested fixes, scheduled and tracked progress for team members of project through completion.
• Involved wif teh security audit team in designing Integration security architecture tounderstand each of teh interfaces being developed.
• Worked in cross-functional agile development teams wif teammates who were developers, quality-assurance specialists, and business analysts. Also responsible for working through usability design, mock up-generation, and full-scale interactive design.
• Coordinated/Assisted in different testing such as User Acceptance Testing (UAT), system testing, Integration testing and functional testing, developing, maintaining test plans, detailed test cases, executing tests cases, validating test results, logging defects, tracking defects and also automated testing wif experience in using Quick Test Pro and Quality Center.
• Performed integration testing, product testing, data driven testing, and User Acceptance Testing (UAT).
• Enhanced web applications by search engine optimization, performance tuning and load balancing forwebapplications.

Environment: Rational Rose, Rational Requisite Pro, Quality Center 8.2, DB/SQL, MS Project, MS Visio, Rational Clear Quest, XML, JAVA, Microsoft SQL Server.