SUMMARY

• With 8+ Years Professional Experience as a Senior Business Systems Analyst in Healthcare & Insurance with project management skills.
• Very good understanding of Business Intelligence and Data Warehousing and MDM concepts with emphasis on ETL and Life Cycle Development including requirements analysis, design, development, testing and implementation.
• Experience with Health Insurance Packaged Application like Facets. Providing US Health Insurance domain
• Gathered Business Requirements from the Subject Matter Experts (SMEs) and documented the requirements in the BRD. Utilized data flow diagrams, use case diagrams and process flow diagrams to represent information provided by the Business Owners.
• Designed and Administered Teradata Scripts, Tables, Indices and Database Objects
• Functional experience in health Care Industry with vast knowledge on Medicare and Medicaid.
• Defined Functional Test Cases, documented, Executed test script in Facets system.
• Extensive experience in Data Analysis and ETL Techniques for loading high volumes of data and smooth structural flow of the data.
• Exceptional ability to maintain and build client relationships with business owners to identify, prioritize and document business requirements.
• Strong experience in conducting User Acceptance Testing (UAT) and documentation of Test Cases. Expertise in designing and developing Test Plans and Test Scripts.
• Specialize in HIPAA 5010 implementation including GAP analysis.
• Experience with TrizettoFacetsSystem implementation Version 4.81, Claims and Benefitsconfigurationset - up testing, Inbound/Outbound Interfaces and Extensions, Load and extraction programs involving HIPAA 837 and proprietary format files and Reports development.
• Well versed in project management tool (MS Project) for status reporting, planning and resource allocation.
• Extensive experience in testing and implanting Extraction, Transformation and Loading of data from multiple sources into Data warehouse using Informatica.
• Working knowledge of implementing software development projects using methodologies such as Waterfall, Rational Unified Process, Agile/Scrum.
• Extensive Experience in reviewing PRD'S, BRD'S, and scheduling Project plans.
• Strong knowledge of all phases in Software development life cycle (SDLC) and the iterative Rational Unified Process (RUP)
• Design and review of various documents including the Software Requirement specifications (SRS), Use Case Specifications, Functional Specifications (FSD), Systems Design Specification (SDS), Requirement Traceability Matrix (RTM) and testing documents

TECHNICAL SKILLS

• Rational Rose Enterprise Suite
• Rational Requisite Pro
• MS Visio
• Test Director
• Test Manager
• Rational Clear Quest
• PVCS Tracker
• MS Office
• MS Project
• MS Publisher
• Rational Robot
• Performance Studio
• Mercury Win Runner
• Load Runner
• Korn Shell Script
• C/C++
• . NET
• Java 2
• Teradata
• SQL
• PL/SQL
• VB
• Shell Script
• Html
• Crystal Reports
• Micro strategy
• Visual Basic
• Access
• Excel
• MS-SQL Server
• Oracle
• Sybase
• SQL* Plus
• UNIX (Solaris/Linux)
• MS-DOS
• Windows 95/ 98/ 00/NT/XP
• MS FrontPage
• Dream weaver

PROFESSIONAL EXPERIENCE

Confidential, Durham, NC

Sr. Business Analyst

Responsibilities:

• Created Business Requirement Document (BRD), Functional Requirement Specification (FRS) document, User Requirement Specification (URS) and Change Request (CR) document for system application development.
• Extensive experience with Medicare/Medicaid processing as well as the Claims/Billing.
• Worked on data mapping of source applications to theMDMdata model.
• Strong experience in Claims, Claims Adjudication, enrollment, eligibility verification for members and providers, benefits setup, and backend payment cycle in facets.
• Created and scheduled Sessions based on demand, run on time and run only once using Informatica Server Manager.
• Responsible for defining Functional Requirement Specifications following theAgilemethodology using HP Quality Center.
• Resolved Data Integration issues between data repositories within the organization. Work with the Master Data Management (MDM) and Integrated Data Store (IDS) teams to implement the unique ID.
• Implemented EnterpriseDataManagement Policy and Standards s into Legacy Asset Servicesdata management practices including, Accountability,Governance,DataQuality, Metadata,DataProvisioning andDataControl.
• Performed Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data.
• Inbound/Outbound Interfaces and Extensions, Load and extraction programs involving HIPPA 837 and proprietary format files and Reports development.
• Worked with Claims, enrollment, eligibility verification for members and providers, benefits setup, and backend payment cycle in facets.
• Strong experience with SQL Demonstrated working knowledge of data warehousing / business intelligence technologies
• Reviewed and documented data process implementation in Data Warehouse - source, staging and production and capturedbusinessrequirements forMDM.
• Processed Medical claims and applied edits to the claims for testing purposes.
• Analyzed and assessed complexbusinessrequirements by interpreting and translating intoFacets configurationsolutions and presented finding to clients.
• Reviewed the data model and reporting requirements for Cognos Reports with the Data warehouse/ETL and Reporting team.
• Handled change request and change management and project management using Clarity Project.
• Involved in the PRD (Project review), TRD (Technical Requirements), SDD (System design) meetings. Reviewed the documents to make sure that this Re hosted applications are supposed to meet all the functionality requirements as existing applications in Stratus.
• Documented and maintained RTM to ensure that all requirements are traceable from top to bottom and to provide a basis for test plan.
• Provided innovation tobusinessareas and contribute to improve operational processes through configurationbest practices.
• Written SQL queries using TOAD to prove the data mapping and Reports.
• Utilized corporation developed Agile SDLC methodology.
• Requirements elicitation fromBusiness. PreparedBusinessRequirements Documents (BRDs) and mapping specifications forMDMproject.
• Involved in all SDLC stages under agile process in applications including Requirements analysis, implementation, testing, deployment and maintenance.
• Conducted review sessions on regular basis with QA and development teams for preparing status, delivery report and client reporting.
• Met daily requirement of working the claims queue processing pended claims or claims with errors in theFacets systems and routing them to the appropriate area.
• Responsible for allfacetsof testing - unit, component integration, system integration and user acceptance testing; quality assurance.
• Performed system and integration testing along with testers, conducted UAT with the business.
• Supported daily team stand-ups as part ofAgileandScrummethodology. Maintained updates to the Kanbanboard in team pod daily.
• Gathered requirements for business process flow and on screen flow for wizards driven products from products SME's and Sales people and created Requirements documents to implement in Pega.
• UtilizedSCRUM,AgileandKanbantools to simplify planning and execution of activities
• Collaborated with ITBusinessPartner and other SMEs to analyze tradeoffs between requirements, usability and performance needs.
• Planned and defined system requirements to Wire Frames with Use Case, Use Case Scenario and Use Case Narrative using the UML (Unified Modeling Language) methodologies.
• Worked on data modeling and produced data mapping and data definition documentation
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, OOD using UML
• Developed strategic partnerships with the business unit to prepare a solid knowledge base of the business line, including the business plan, products, and process’ and revenue streams aimed towards problem solving.
• Assured that all Artifacts are in compliance with corporate AGILE Policies and guidelines.
• Gathered requirements and modeled the data warehouse and the underlying transactional database
• Performed requirements gathering from the business users of the system while adhering to SDLC (Software Development Life Cycle) industry best practices.
• Facilitated JAD sessions with management, development team, users and other stakeholders to refine functional requirements.
• Tested, analyzed and presented data to confirmFacetsconfigurationduring the initial implementation of the newFacetssystem. This includes pricing, capitation, benefits accumulator, and claim testing.
• Preparation of Test Plans and execution of business testing, preparation for and delivery of application. Data validation using database tools such as SQL and Access queries and following up with the development and QA team for the same.
• Provided clear and concise documentation regarding requirements management plans, Functional Requirements, supplemental Requirements, Test Plans and Test Cases.
• Assisted in development of training materials for new technology and process improvements.

Environment: Windows, MS Office(MS Word, MS Excel, MS Power point, MS Visio), Agile, Waterfall,Kanban, .NET, Oracle, Trizetto Facets 4.81, Crystal reports, RUP, UML, Visual Basic, SQL, SWOT analysis, OBIEE, Cognos, Win Runner

Confidential, Dayton, OH

Business Analyst / Systems Analyst

Responsibilities:

• Responsible for the fullHIPAAcompliance lifecycle fromgap analysis, mapping, implementation and testing for Medicaid Claims.
• Responsible for integrating with Facets, Designing test scripts for testing of Claims in Development, Integration and production environment.
• Served as the liaison between business users and the technical team (i.e. Data Warehousing, BI and Reporting, Teradata, and Master Data) to analyze and document business and users needs, and provide solution.
• Extensively involved in the modeling and development of Reporting Data Warehousing System.
• Involved in TrizettoFacetsSystem implementation, Claims and Benefitsconfigurationset-up testing, Inbound/Outbound Interfaces and Extensions, Load and extraction programs involving HIPPA 837 and proprietary format files and Reports development.
• Assisted in identifying enterprise facts and dimensions for Master Data Management (MDM).
• Design details and workflow of automated EMR solutions on a monthly feature release cycle using Agile/ScrumandKanbanmethodologies.
• Worked with TrizettoFacetsSystem implementation, Claims and Benefitsconfigurationset-up testing.
• Analysis of source data to assist with source to target mapping for provider data elements for Master Data Management (MDM) during Extract Transform Load (ETL) process along side of Gaine.
• Experience with Trizetto 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.
• Completed requirements forFacetsbenefitconfigurationsneeded to support new Exchange Products and Claims Processing related to Cost Share Reductions (CSR) and Accumulators. (Affordable Care Act).
• Worked with cross functional teams to support the implementation and integration of the complete stack of the TriZetto suite of applications
• Worked closely with the Enterprise Data Warehouse team and Business Intelligence Architecture team to understand repository objects that support the business requirement and process.
• Created mapping document and helped in creation of ETL from source toMDM.
• Assured that all Artifacts are in compliance with corporate SDLC Policies and guidelines.
• Coached and developed a distributed team ofbusinessexecutives and technical professionals regardingAgileroles, routines and responsibilities resulting in a more thorough understanding of Scrum/Kanbanand a faster start up time to developing software.
• Interacted with other Business Analysts for designing and implementation of Use Cases and Test Plans.
• Used claims logging a plurality of navigation choices and the appropriate facet element item count by using facets.
• Extensive experience in Data Analysis and ETL Techniques for loading high volumes of data and smooth structural flow of the data.
• Created and maintained technicalconfigurationsolutions to theFacetssystem.
• Responsible for creating business work flows and processes and creating management reports based on the analysis.
• Followed the UML based methods using Rational rose to create use cases, activity diagram, sequence diagram, collaboration diagram that include functional and non-functional specifications to hand off to development teams
• Worked with Documentum for storing documents like RTM, RMP and keep track of the projects.
• Gathered requirements from JAD/JAR sections with developers and business clinets.
• Completed a thorough customer analysis and prepared a Request for proposal (RFP) document and got the shortlisted vendor document signed off. Finally CRM was decided upon by the stakeholders among shortlisted as final implementation customer.
• Analyzedconfigurationacross Medicaid lines ofbusiness.
• Helped in QA methodologies like regression testing, phases like SIT & UAT, and documentation like unit test plans.
• Experience in development methodologies like RUP, SDLC, AGILE, SCRUM and Waterfall
• Involved in the meeting with Business Process Owners, SME (Subject Matter Experts) and store users for Requirement gathering in Definition Stage.
• Mapped provider data from source to targetFacets4.31 data layout for the claims and benefit configuration.
• Part of team conducting logical data analysis and data modeling JAD sessions, communicated data-related standards.
• Defined charter, scope, schedule, and resources for projects productizing R&D programs, managing (and often defining and delivering) customer needs via marketing requirement documents (MRD) and Project requirement documents (PRD) with program milestones, user documentation and QA, increasing profitability while building a best practices organization.
• Supported operationsKanbanteam to manage enhancement and bug fixes in production support systems.
• IncorporatedAgilemethodology (Scrum) to create BRD, FSDs using MS Visio and MS Word.
• Introduced Agile and RUP methodologies to reflect liquid nature of front-office improving time-to-market
• Facilitated JAD sessions with SMEs and business analysts from other feeder systems for a detailed analysis and a better understanding of impact of various projects on each other.
• Prepared a handbook of standards and Documented standards for Informatica code development.
• Created Data Dictionary and ER diagrams for data mapping purposes.
• Developed business requirement specification documents as well as high-level project plan.

Environment: Mainframes, COBOL, JCL, Db2, Visual Basic, Oracle, Teradata, Kanban, Agile / Scrum, UNIX, .NET, Rose, MS office, Cognos, MS Word, MS Excel, MS Visio, OBIEE, SAS, Load Runner, Win Runner

Confidential, Albany, NY

Business Analyst

Responsibilities:

• Gathered, analyzed, documented business and technical requirements from both formal and informal sessions and validate the needs of the business stakeholders.
• Processed durablemedicalequipmentlab, x-ray, outpatient surgery, speech, occupational therapy and chemotherapy claims.
• Worked on HIPAA Transactions and Code Sets Standards according to the test scenarios such as 837 health care claim transactions.
• Served in a variety of key roles for State Government MMIS implementations and State government related projects / sub-projects.
• Used Master Data Management (MDM) technology, tools to create and maintain consistent and accurate lists of Master Data
• Researched the existing client processes and guided the team in aligning with the HIPAA rules and regulations for the systems for all the EDI transaction sets.
• Designed workflows and allocated permissions within SharePoint.
• Conducted user interviews and documented business and functional requirements.
• Worked in the ETL Procedures and processes. Reconciled disparate master data from distributed systems and synchronized this reliable data with analytical and operational systems using master data management (MDM) solution Siperian MDM Hub.
• Performed Requirement Analysis and developed Use Cases, Activity Diagrams using Rational Rose
• Defined, developed specs for federal reporting specific to Medicare Advantage
• Performed Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data
• Designed High level design, for New process, integrating with legacy and Facets.
• Assisted in developingtestplans,testcases and performed User Acceptance Testing.
• Performed testing for Medicare, Medicaid and X-Over claims for Medicaid Management Information System (MMIS).
• Involved in creating business processes and modeling diagrams using Rational Unified Process (RUP).
• Maintained benchmark controls to policies, company standards and contracts, performed vendor sourcing, pricing and contract negotiation, performed procurement, ensured compliance with service/joint interest contracts.
• Used Rational Clear case for version control
• Involved with all the phases of Software Development Life Cycle (SDLC) methodologies throughout the project life cycle.
• Served as conduit for managing system requirements between the business and the software development team.

Environment: Windows XP Professional, Oracle9i, MS Sharepoint, MS Access 2000, EDI, MS Excel, RUP, Oracle, UML, Rational Rose, Requisite Pro, Clear Case 2002, Rational Clear Quest 2002, MS Office suite, MS Visio 2003.

Confidential, Indianapolis, IN

Business Analyst

Responsibilities:

• Organize requirements into high level Use Cases and low level Use Case Specifications and modeled them into UC, Activity and Sequence Diagrams using Rational Rose and MS Visio.
• Worked using Dashboard Reporting Tool for easy extraction of information.
• Performed usability analysis and testing including user interface design throughout the development life cycle, provided Client meetings. Performed Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data
• Implemented the full project lifecycle phases including requirements gatherings, development and quality assurance develop functional test plans, execute and review results of test plans to ensure the system meets user community requirements.
• Generated and managed dashboards for project progress documentation design and organize the process flow for project reporting information management.
• Performed Defect Tracking and Change Control Procedures using Quality Center.
• Created product documentation, including online help, user manual and training materials
• Developed strategies with Quality Assurance group to implement Test Cases in Mercury Test Director for stress testing and UAT (User Acceptance Testing
• Designed and implemented basic SQL queries for reports and data validation.

Environment: Windows 2000/XP, RUP, UML, Visio, Doors, Rational Suite (Rational Requisite Pro, Test Director, Clear Quest, Rational Clear Case, Rational Soda) MS-Office 2003, SQL Server, UAT.