SUMMARY

• Qualified professional with Almost 7 years of extensive experience in the field of Business Analysis, working with the technical staff to implement management and staff's business requirements into the software application in Healthcare Industry.
• Strong visual modeling and business process modeling skills using Rational Unified Process (RUP) and Agile Unified Process (AUP) with tools like Rational Rose, MS Visio, and well experienced in developing Use Case Models, Entity Relationship Diagrams (ERD), Data Flow Diagrams (DFD), Activity Diagrams, Sequence Diagrams and UML CASE tools
• Expertise in broad range of technologies, including business process tools such as Microsoft Project, MS Excel, MS Access, MS Visio, technical assessment tools, MicroStrategy Data Warehouse Data Modeling and Design.
• Experienced in interviewing business users and customers, to resolve issues for various business/technical groups and defining strategic solutions to business problems in a multiple project environment.
• Experience in developing business requirement document (BRD) and functional requirement document (FRD) through JAD sessions and user interviews.
• Experience with Object Oriented Analysis and Design (OOAD) using UML, RUP, agile, waterfall life cycle, rational suite (Rational Rose, Rational Requisite Pro, Rational ClearCase, and ClearQuest).
• Validated the business requirements and data by writing and executing SQL Queries in MS SQL Server, oracle and mainframe databases.
• Strong experience in documenting existing process, analyzing business requirements, working with requirements traceability matrix.
• Experience with government health programs like Medicare, Medicaid, FEP and commercial insurances.
• Experience configuring QNXT 3.4 and 4.6 applications for case management, flexi conversion, provider, member, member eligibility, prior authorization.
• Comprehensive experience in business analysis, gap analysis, cost/benefit analysis, testing, development of business requirements specifications, and project planning working with project managers and business sponsors.
• Used agile methodology of system development and coordinated the sprint activities.
• Worked with business users to come up with reporting requirements. Reports were developed in Cognos /Business Objects.
• Experience with Confidential Facets 4.21/4.31 and Confidential HIPAA Gateway 4.11 - supported new business requirements by extending the functionality of the core Facets system using the Facets extensibility architecture feature.
• Conducted JAD sessions, created Use Cases, work flows, screen shots and Power Point presentations for the Web Applications
• Gathered and documented Non-functional requirements.
• Knowledge of healthcare standard Health Level Seven (HL7).
• 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.
• Experience with HIPAA compliance and CFR Part II electronic exchange guidelines.
• Experience in EDI automated first-pass claim adjudication, requiring thorough understanding of claim processing, both front and backend operations.

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, /2000/XP/7/8, 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

Mainframe: COBOL, DB2, JCL, CICS, MVS

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, Plano, TX

Sr. System Analyst

Responsibilities:

• Worked in implementing various areas in QNXT for Case Management, Flexi conversion, Provider, Member, Member Eligibility and Prior Authorization.Involved in requirement gathering phase (Provider, Claim components and HIPAA)
• Utilized Rational Unified Process (RUP) to configure and develop process, standards and procedures.
• Met with report users and stakeholders to understand the problem domain, gathered customer requirements through surveys, interviews (group and one-on-one) along with JAD sessions.
• Responsible for working with the State to review and modify process flows to increase productivity and effectively utilize QNXT features not provided by the legacy systems.
• Involved in understanding the current business process, defining scope of the project along with position statement.
• Wrote BRD, FRD, use cases, test scenarios, test cases for testing the functional requirement.
• Implemented automated COB processing of Medicare claims into Facets
• Created reports using Microsoft SQL Server 2005 Reporting Services and QNXT 3.4 tables
• Mapping of ICD-10 codes to procedure and diagnostic codes in Facets.
• Created data files to be loaded to the Target QNXT system and reviewed and corrected error reports.
• Help in preparing the ICD-10 context diagram.
• Analyzed the ICD conversion information provided by the CMS and Gained understanding of ICD-9 versus new ICD-10 codes sets
• Conduct meeting with the stakeholders and assess their accurate involvement with ICD-10.
• Followed Unified Modeling Language (UML) methodology using ReqisitePro and Rational Rose to create/maintain: Use Cases, Activity Diagrams, Sequence Diagrams, and Collaboration Diagrams.
• Tested and delivered Inbound/Outbound Facets interfaces.
• Experience with Confidential Facets System implementation, Claims and Benefits configuration set-up testing, Inbound/Outbound Interfaces and Extensions, Load and extraction programs involving HIPPA 837 and proprietary format files and Reports development.
• Assisted Design Team in preparing SRS, Software Design Document (SDD), User Interface Design, Application Architecture & Database Modeling.
• Helped in project testing efforts for doing integration tests, regression tests and user acceptance tests.
• Worked on Data mapping, logical data modeling, used SQL queries to filter data within the Oracle database tables.
• Made sure that the systems complied with the rules of HIPAA and CFR Part 11.
• Documented the dimensional models of ETL system.
• Led the testing efforts of the datamarts in development, coordinated moving/setting up of processes in dev/qa/production. Worked with QA team and UAT team to go over the various test scenarios for different types of loads in the datamarts.
• Used SQL to test various reports and ETL load jobs in development, QA and production environment
• Provided input (scope, goals, risks, constraints, timelines and interfaces) to PM for project planning and control.

Environment: Java, JSP/Servlet, Oracle 9i, SQL, SQL Server, MS Office Tools, Windows XP, MS Project, RequisitePro, Rational Rose, ClearCase, MS Powerpoint, MS-SharePoint, MS-Word, MS-Excel, Business Objects 5.1/6.5, Informatica 7.1, IBM Process Modeler, Siebel CRM, Facets 4.21/4.31

Confidential, Baltimore, MD

Sr. Business System Analyst

Responsibilities:

• In-depth interaction with Primary markets, Secondary markets and mortgage backed securities and asset backed securities for requirement gathering.
• Wrote test cases for the QNXT model areas of Case Management, Flexi conversion, provider, member, Member eligibility, Prior Authorization.
• Studied the CMS regulation for reporting requirements Attended HIPAA training
• Work closely with Business Owners and Stakeholders to outline Business Requirements using rational requisite pro.
• Work with System analyst and IS teams to understand the flow of data.
• Helped the Business Users while performing the UAT testing and helping them resolve the defects in the environment
• Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data within the Oracle database
• Planned and documented procedures for data processing and prepared data flow diagrams for the application
• In-depth knowledge and solid experience in the design, development, implementation, management, and testing of EDI applications.
• Worked with ICD 9 encoding to verify the validity of incoming claims documented ICD 9 codes presently used by the system.
• Created Mapping Documents, Report Mockups and modified existing report mockups as to CMS requirements and finalized for development
• Develop and maintain sales reporting using in MS Excel queries, SQL in Teradata, and MS Access.
• Reviewed Stored Procedures for reports and wrote test queries against the source system (SQL Server) to match the results with the actual report against the Data mart (Oracle).
• Managed timely completion of multiple projects in parallel- worked in close conjunction with the Project Management Office (PMO) to define scope of the project and its deliverables
• Created context and workflow models, information and business requirement models, Use Case and Object Models during the analysis using Rational tools.
• Create standard benefit packages for Medicare Advantage and Part D plans, such as requiring that Medicare Advantage plans charge no more cost-sharing for services than what is charged under Original Medicar .
• Implemented Facets NASCO claims management system to allow for more efficient claims processing, membership enrollment and provider data maintenance.
• Worked with ICD 9 encoding to verify the validity of incoming claims documented ICD 9 codes presently used by the system.
• HIPAA EDI transactions such as 834,835, 837 (P, D, I) 276, 277, 278.
• Created requirements analysis and design phase artifacts using, Rational Software Modeler and MS Visio to create DFDs, ER diagrams, Use Case, Activity/State chart, Sequence, Collaboration and Deployment Diagrams.
• Defined Functional Test Cases, documented, Executed test script in Facets system.
• Authored progress and completion reports which were then submitted to project management on a weekly basis in MS project.
• Deploy three Electronic Data Interchange (EDI) interfaces linking nation-wide network of 250 drug wholesalers for electronic price contract awards, processing of change-back claims and tracking of wholesalerinventory using Sterling Software via GENTRAN server.
• Analyzed trading partner specifications and created EDI mapping guidelines
• Review requirements and understand technical recommendations and constraints, and develop comprehensive and accurate functional specifications; Data Mapping, and process flows.
• Used MS-Visio for flow-charting, Use- Case process model and architectural design of the application.
• 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.
• Reviewed the data model and reporting requirements for Cognos Reports with the Data warehouse/ETL and Reporting team.
• Established questionnaires and resource leveling required for implementing HIPAA 5010 and upgrading ICD-9 diagnosis codes to ICD-10 codes
• Analyzed the test results with Win runner reports
• Analyzed results and EDI ANSI X12 file mapping and reported on standard analysis spreadsheet. Reviewed EDI companion guides for all payers to ensure compliance, edit integrity and maintain up-to-date list of payer contacts. Acted as a liaison between client and payer/intermediary.
• Highly experienced Senior EDI Programmer Analyst with a record of developing and supporting successful IT applications and solutions, with an emphasis on technical, as well as non-technical, Customer Service. Skilled at utilizing EDI translation software, including mapping, debugging, trading partner relationships, and user files. Extensively uploaded test cases from MS Excel, MS Word to Test Director & Quality Center.

Environment: Windows XP Professional, Oracle9i, MS Access 2000, MS Excel, RUP, PL/SQL, SQL Server, Oracle, UML, Rational Rose, Requisite Pro, Agile, Clear Case 2002, Rational Clear Quest 2002, MS Office suite, MS Visio 2003.

Confidential, St. Louis, MO

Business Analyst

Responsibilities:

• Experienced in preparing detailed requirements specification documents and use case documents after close interaction with the project managers and the business, subject matter experts, analysts, architects and the development teams.
• Documentation completed include business requirement documents (BRD), functional specifications document (FSD), technical specification document, joint requirement document (JRD), high level design documents (HLD), use cases, gap analysis, test scripts, training materials.
• Experience in Configuration of Claims Adjudication systems, i.e., Amisys and QNXT.
• Responsible for architecting integrated HIPAA, Medicare solutions, Facets
• Kept a track of all QAT and UAT bugs/defects and helped the testers to resolve the issues and made a report of all the defects which were resolved and which were not using MS EXCEL.
• Wrote SQL Queries for DataMigration Module.
• Worked on SQL Server 2005 concepts SSIS (SQL Server Integration Services), SSAS (Analysis Services) and SSRS (Reporting Services).
• Designed, built and/or maintained the following custom software systems to interface with QNXT 3.4 using Microsoft .NET and SQL 2005 technologies:
• Implemented automated COB processing of Medicare claims into Facets
• Responsible for researching QNXT client issues from claims paying, configuration to installation issues.
• Analyzed existing data and used tools available to successfully forecast the pricing models.
• Designed a claim processing system for the healthcare management client system. It allowed the user to inexpensively capture information regarding patient, summary of medical history, symptoms (ICD-9, ICD-10 codes), and treatment (CPT).
• Worked with Cognos and micro strategy reporting systems to extract the data for analysis using filters based on the analysis. Generated test cases in Claims Analyzer Editor Professional to ensure unification with CPT-4 and ICD-9 codes
• Assigned tasks among development team, monitored and tracked progress of project following Agile methodology
• Facilitated JAD sessions to document the technical and functional requirements and provided overall assistance in areas such as group readiness planning and issue escalation and resolution process.
• Utilized Agile/ SCRUM to monitor, steer and develop project objectives
• Participated in Bug-Review meetings with software developers, QA engineers, managers to check for 7 claims and suggested enhancements to the existed application from business perspectives and provided solutions to existing bugs.
• Implemented business and data modeling using Ms Visio to develop the business architecture for the application and created use case diagrams, activity diagrams, state transition diagrams, sequence diagrams, data flow diagrams and collaboration diagrams using Rational Rose.
• Served as a liaison between the project and groups, always promoting a positive message about system enhancements and facilitating the transition from one application to another.
• Establish documentation for Agile methodology for implementation with a very water-fall-centric development team
• Prepared Deployment plan, Entry criteria, Exit criteria, Target user list, Go Live support plan, Deployment activities plan and other Deployment related documents.
• Actively involved in User Acceptance Testing, Go Live Support call and to keep track of the issue log following up on Go live calls in assisting the Project Manager.

Environment: Windows 2000/XP, Microsoft Office SharePoint 2007,Agile, QNXT, Facets 4.21/4.31, MS Office, SQL Server, MS Project, MS FrontPage 2003, MS Access, EDI, Kintana, RF Tool, Scrum, Mercury Test Directory 8.0 SP1, BI Toolset, Phoenix Production 7.6, CutePdf, Microsoft Excel, Microsoft Word, Microsoft Power Point, Visio.

Confidential, Montvale, NJ

System Analyst

Responsibilities:

• Gathered requirements from the user and prepared functional specifications along with data flow diagrams for the Member configuration, Enrolling subscribers and members, Configuring different sections of members like Eligibility, Address, Medicare, Claims data etc...Assisted in developing strategic direction and oversight of defining clinical semantic and technical requirements for analytics and BI application across various clinical systems.
• Built Product variation matrix for all “Blue exchange, Blue Choice & Blue preferred” products like HMO, Opt Out, Opt Out Plus,Advantage,PPO, HSA/HRA and then later entered into facets 4.3.1
• Played major role in development of variation matrices based on the template provided by the SME’s for all plans and products
• Develop implementation guidelines and principles for practice-based clinical applications, including various practice management and EMR systems.
• Aided management in standardizing web applications by preparing GUI standards and recommending alternatives for in corporation in a phased, iterative manner.
• Developed custom reports and deployed them on server using SQL Server Reporting Services (SSRS).
• Queried database using SQL for backend testing
• Successfully handled the testing of health care products like Epic Systems and HER (Electronic Health Record).
• 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.
• Understand the As Is system and develop the To Be system concept and also prepare the System Process Maps.
• HIPAA EDI transactions such as 835, 837 (P, D, I) 276, 277, 278.
• 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.
• Involved in User Acceptance Testing (UAT) and Test Execution.
• Involved in decision making of converting manual test cases into automated test scripts and analyzing their life time and time required to update the scripts.
• Used Castor to create objects from XML documents. Involved in Logical & Physical Data Modeling. Database Schema design and modification of Triggers, Scripts, and Stored Procedures in Sybase Database Servers.
• Assisted front-end development teams in integrating Crystal Reports in the .NET application using SDK.
• Reported and analyzed all application defects, user issues and resolution status to the higher manager using Mercury Quality Center...
• Implemented data access, storage and validation routines on the database server using Procedural Language/Structured Query Language (PL/SQL).
• Responsible to import the data from Crystal reports by using Business Objects Live office into Microsoft Excel and Word.
• Used Lotus Notes for project delivery and internal communication
• Created use cases, activity diagrams and process diagrams using Microsoft Visio.
• Validate test plans/scripts and perform final reviews of test results.
• Supported in creating test cases to check the functionality of the enhanced application.

Environment: Rational Rose, Clear Quest, Microsoft Project, Crystal reports, SharePoint, Mercury, Lotus Notes, Erwin, Microsoft Visio, Microsoft Office suite, Facets 4.31, SQL, Business Objects, ETL, Oracle, Windows NT, Mainframes, COBOL.