SUMMARY

• Systems Analyst with Excellent Communication Skills & 7 years of experience
• Experienced in various methodologies & models including Waterfall, Agile SCRUM, Prototyping, Six Sigma (DMAIC), Rapid Application Development (RAD) and Rational Unified Process (RUP).
• Extensive knowledge of Medicaid Management Information Systems (MMIS), EMR & HER
• Possess thorough understanding of the manufacturing of EDI transactions set including but not limited to 834, 820, and 837. Strong knowledge and use ofX12industry transactions specifically 835, claims processing
• Hands on Experience with Health Insurance Portability and Accountability Act (HIPAA) standards, Electronic Data Interchange (EDI) and implementation of HIPAA code sets, ICD - 9, ICD-10 and HL7.
• In-depth understanding of the gap between HIPAA 4010 and HIPAA 5010
• Extensive knowledge of Pharmacy Benefit Management (PBM) working environment and Medicare Part D including processing Retail pharmacy claims, Direct claims and Mail-Order Pharmacy claims. Also, extensive knowledge of PBM’s Drug Management Lists (DML).
• Excellent knowledge of Medicare (Part A, B, C and D) and Medicaid, CPT/HCPCS coding, HCFA-1500 and CMS-1500 claim forms and reimbursement forms.
• Experience in White Box, Black Box, Unit, Functional, Integration, Back End and System Level Load and Stress Testing.
• Extensive Experience with DBMS and skilled in creating DDL and DML queries using SQL
• Extensive Data Management Skills including ERD, Data Dictionaries, Normalization, De-Normalization, Data Warehousing & Data Mining

TECHNICAL SKILLS

Business Skills: Business Process Analysis & Design, Quality Control, Gap Analysis, Unified Modeling Language (UML), Business Process Re-engineering (BPR),Change Management, IT Services Management, Total Quality Management, Testing Lifecycle, Data Modeling, Service Oriented Architecture (SOA), Risk analysis, cost-benefit analysis, Impact Analysis, JAD/JRP Sessions, Requirement Gathering, and Use Case Modeling

Methodologies & Models: Agile, RUP, CMM, CMMI, SPICE, ISO and Waterfall

Languages: C, C++, C#.NET,ASP.NET MVC,SQL, HTML, XML

Testing Tools: HP Quality Center, Win Runner

Database: DB2, MS SQL Server, Oracle, Teradata, DB2

Software: MS Office Suite (Word, Excel, Power Point, Outlook), MS SharePoint, MS Visio, MS Project, ClearQuest, ClearCase, Rational Rose, Requisite Pro, Remedy, Rally, Visual Studio, MS Team Foundation Server

PROFESSIONAL EXPERIENCE

Confidential, Atlanta, GA

Programmer Analyst

Responsibilities:

• This project involves developing and managing the Electronic Data Interchange (EDI) interfaces for exchange of patient data between the company and clients in compliance with HIPAA guidelines.
• Developing automated solutions for clients to screen the patient information sent through EDI for eligibility and enrollment.
• Importing the screened data into the in house application called PACE for operations to work on.
• Developing automated solutions to update the existing information in PACE as well as sending notes on patient’s status back to the hospitals through EDI.
• Creating data mappings and crosswalks according to the specifications of every individual request for a new interface.
• Performing dual role of a programmer as well as of an analyst in order to analyze different interfaces and implementing coding skills using Agile methodology.
• Oversee the timely processing of all daily/weekly Electronic Data Interchange (EDI) transaction processing, and troubleshooting as needed.
• Coordinate the setup of new EDI interfaces as per the requirements under C# .NET environment.
• Performed interface testing under dev and UAT environments.
• Daily production support, monitoring and resolution of the EDI environment which includes monitoring of system alerts and providing support to the current EDI interfaces.
• Understand the current interfaces and also work on some of conversions from VB.Net to C#.
• Working on SQL Server to write and execute SQL queries and stored procedures for data extracting, and mapping purposes.
• Setting up FTP sites and connections for clients using Core FTP client and Mirth engine set up for HL7.
• Working on the enhancements of EDI.
• Develop systems documentation.

Environment: C# .NET, Team Foundation Server, ASP.NET MVC, MS SQL Server, Visual Cron, MS Visio, MS Project, MS Word, MS Excel, MS PowerPoint.

Confidential, Parsippany, NJ

Systems Analyst

Responsibilities:

• Gathered Business Requirements, created Functional Requirements Document (FRD) and analyzed data/workflows, defined the scope, financial projections and cost/benefit analysis; progressed from Problem Statement to well-documented designs. Prepared user guidelines for easy access of the application.
• Conducted JADsessions with business users and Subject Matter Experts (SME’s) to understand the as-Is system and gather requirements for the To-Be system.
• Worked with Source system Subject Matter Experts (SMEs) to ensure that the extracts are properly mapped.
• Involved in Rational Unified Process (RUP) andanalyzed User Business Requirement Document (BRD), Technical Requirement Specification and Functional Requirement Specification (FRS) usingRequisite Pro, Rational Rose and MS Visio.
• Conducted project related presentations and provided reports to the higher management.
• Involved profoundly in the GAP Analysis of the transition fromHIPAA (EDI ANSI X12 835 and 837) focusing on how current transactions and system was going to be effected by the new 5010 compliance.
• Clarified QA team issues and reviewed test plans and test scripts developed by development team and QA team to make sure all requirements have been covered in scripts and tested properly.
• Worked onICD conversion from 9 to 10with respect to the claims related toMedicare (Part A, Part B, Part C, Part D).
• Completed a review ofexisting documentation for orders, referrals and reports and compared it to the clinical detailsneeded forICD-10.
• Assisted in writing test case scenarios for unit testing, integration testing and compliance testing.
• Designed and Documented Use Cases,Activity Diagrams, Sequence DiagramsandEnd to End ScenariosusingUML.
• Created Inbound/Outbound EDI business processes and process to move outbound acknowledgements, Enveloping processes etc.
• AnalyzedHIPAA5010 related to 837,835, 834. Transactions and performed gap analysis between the 4010 and 5010.
• Tracked and maintained Stakeholder requested enhancements and changes using Requirement Traceability Matrix (RTM).
• Created SQL Scripts including Stored Procedures, Triggers and various other DDL & DML commands.
• Assisted with user testing of systems and maintained quality procedures and ensured appropriate documentation is in place.

Environment: MS SQL Server, Windows XP, Rational Rose, Rational Requisite Pro, UML, Rational Suite, MS Visio, MS Project, MS Word, MS Excel, MS PowerPoint.

Confidential, Detroit, MI

Systems Analyst

Responsibilities:

• Performed GAP analysis of business rules, system process flows and requirements for all client functional teams.
• Completed data mapping as per HL7 standards.
• Reviewed vendor specs, application results and developed interface for HL7 messages.
• Identified implementation risks and designed change and communication strategy to address those risks.
• Involved in three tier testing of web, XML and HL7 messages with client applications
• Supported requirements with process flows and Visio diagrams.
• Performed Bug fixing with other developers.
• Developed detailed wireframes and mockups of the proposed GUI with general and ad-hoc reporting.
• Prepared User Acceptance Testing and Integration Testing. Test Cases for testing the interface between applications.
• Clarified QA team issues and reviewed test plans and test scripts developed by development team and QA team to make sure all requirements have been covered in scripts and tested properly.
• Generated SQL scripts for Development and testing purposes.

Environment: Agile, Scrum, Windows XP, Rational Rose, Rational Requisite Pro, Clear Case, Clear Quest, UML, Rational Suite, MS Visio, MS Project, MS Office (MS Word, MS Excel, MS PowerPoint), MS Access, XML, HL7 Standards.

Confidential, Bloomfield, CT

Systems Analyst

Responsibilities:

• Gathered Business Requirements, created Functional Requirements Document (FRD) and analyzed data/workflows, Performed SWOT and Gap analysis for the new functionality requirements.
• Created User Business Requirement Document (BRD), Technical Requirement Specification and Functional Requirement Specification (FRS) usingRequisite Pro, Rational Rose and MS Visio and Team Foundation Server.
• Performed data analysis including creating data dictionaries, normalization and writing SQL queries
• Developed Use Cases,Activity Diagrams, Sequence Diagrams
• Supported Project Manager in project related presentations and providing reports to the higher management.
• Worked withHIPAArules and regulations to draft business rules and claim processes.
• Responsible for developing business crosswalks for EDI (ANSI X12) transactions.
• Implemented theHIPAAprivacy and security regulations to enhance the capabilities of the systems to process new products.
• Supported QA team in creating Test Plans and Scenarios based on use cases.
• Employed Rational Clear Quest for effective Change Management and bug tracking during the testing lifecycle

Environment: MS SQL Server 2005, MS Team Foundation Server, Windows XP, Rational Rose, Rational Requisite Pro, UML, Rational Suite, Clear Quest, MS Visio, MS Project, MS Office, MS Access, XML.

Confidential

Systems Developer

Responsibilities:

• Played a key role in the planning, testing, and implementing system enhancements and conversions.
• Provided key project inputs by working with users in defining the project and system requirements.
• Reviewed business process, performed process analysis and gathered functional requirements.
• Worked on Pharmaceutical data processing for improving database for storing user files.
• Analyzed business needs, created and developed new functionality to meet real time data integration that facilitated decision.
• Worked on functions such as Change Control and Request, and managed complaints to ensure customer satisfaction.
• Experience of managing multiple stakeholders across the organization, and in QA integration of systems.
• Involved in detailing project mission, data process flow diagrams, and timelines.
• ImplementedASP.NET MVCpattern mechanism to display product catalogs and categories.
• Worked with SQL queries for data manipulations.
• Assisted in building a business analysis process model using Rational Rose, Requisite Pro and Visio.
• Designed and developed Use Cases, Activity Diagrams and Sequence Diagrams.
• Assisted in process modeling; conducted and participated in JAD sessions with system users; helped with design walkthroughs with stakeholders for base lining architecture.
• Developed strategic partnerships with the business unit to develop a solid knowledge base of the business line, including the business plan, products and processes.
• Research operational procedures and methods and recommended procedures for improvement - with an emphasis on automation and efficiency.
• Assisted Test Lead, Testers understanding business process and help them successful completion of Unit Testing, Integration Testing

Environment: Oracle 9i, XML, Microsoft Dynamics CRM, Rational Rose, Requisite Pro, QTP, MS Visio, RUP, MS Project, SQL, MS Access, MS Excel and MS Word.