SUMMARY

• Business Analyst with 8 + years’ Total experience in IT /Telecom/ Healthcare. Expert in Business analysis, Requirements Elicitation, Business Modeling, and Use Case development using UML methodology & UAT and apply LOGIC and focus on End - Game of Project Life cycle.
• Effective COMMUNICATOR and Good LISTENER with strong technical DOCUMENTATION SKILLS and ANALYTICAL BENT OF MIND Possessing strong WILLINGNESS TO LEARN NEW SYSTEMS.
• TEAM-ORIENTED Professional with extensive Experience and exposure in IT & HEALTHCARE settings/environment and a good Deal puncher with customer focused Negotiating abilities.
• Expert in Gathering system requirements, defining business processes, UML modeling using ENTERPRISE ARCHITECT 9.2, SMART DRAW, Blueprint and Version One.
• Strong understanding of Software Development Life Cycle (SDLC), including good knowledge of RUP methodology. Reproduce, Expertise in SOA, investigate and debug software issues. Knowledge of both Agile and Waterfall Software development methodology. ENTERPRISE WEB DEVELOPMENT Experience (Large.com).Accu Process, SaaS (Ajax), Informatica Cloud. Extensive knowledge of Datawarehouse.
• Extensive experience in interacting with Stakeholders, gathering Requirements and creating Business Requirement Documents (BRD), User Requirement Specifications, Functional Requirement Documents (FRD), System Requirement Specification (SRS), Test Plan, analyzing and Creating Use Cases, Use Case Diagrams, Activity diagrams, System Workflow Diagrams and Knows How to break the Ice.
• Experience in applying Rational Unified Process (RUP) methodology using Modeling and requirement documentation tools such as MS Office, MS VISIO, and MS Project.
• Conducting JAD Sessions and communicating with Stakeholders, Development team, SMEs, System Analyst, Business Analyst and Project Manager, strong Leadership skills.
• Provide business analysis services to capture and drive requirements development for end user reporting using Microsoft Business intelligence Reporting
• Excellent skills in Business Analysis, OO analysis, requirement analysis, Business modeling and Use Case development using UML Methodology.
• Experience in customizing the portal sites on Share point 2007 and 2010, Rational RequisitePro, Team Foundation Server.
• 5 + Yrs experience in conducting GAP Analysis & SWOT analysis and SSRS Expertise.
• Solid in-depth knowledge of the Salesforce.com schema, API calls and debugging techniques.
• Strong Experience in Claims Processing and Claims in Medicaid and Medicare Good knowledge on different modules within healthcare (Membership, billing, enrollment, claims, capitation, providers).Expertise in all X12 EDI transactions. Knowledge in HL7, CPOE and ADT .Solid experience in health care claim engines, claims processing.
• Strong knowledge in reporting tools like Excel/Crystal Report/BI, and ETL tools like Informatica, Abnitio, Business Objects(SAP),Cognos(IBM)Strong in Business Objects,Marketing analytics, Pricing analysis, Executive Support, PowerPoint Skills Ability to showcase the big picture and gain Client signoffs.
• Strong knowledge of SFDC toolkit (Visual force, Apex, S-controls, Triggers, Apex Data Loader, etc.)
• Apply LOGIC and Critical Analysis while interacting with end users, Stakeholders and develop report specifications, create technical requirements, and develop a full set of development requirements.
• Contracted with the Medicare Centers and Medicaid Services (CMS) to provide quick, easy, and affordable access to the health care service of their choice. Created wireframes, mockup screens using MS Visio, Rational Rose during elicitation of requirement.
• Extensive experience / Analysis in FACETS (Trizetto’s ), 3M ICD-10 Code Translation Tool/Configuration Design & Build Workflow Implementation/Configuration Design & Build, Workflow Implementation. MMS batch processing application in Facets and surrounding interfaces.
• EDI, HL7, NCPDP, revenue cycle and claims processing operations. developing the GEMs and ICD-10 Reimbursement Mappings under contracts with the Centers for Disease Control and CMS.
• Knowledge about the claims engines like McKesson’ ClaimsXten.
• Knowledge of extensions used to augment a core FACETS instance in MS SQL Server.
• Self-motivated Team leader, DETAIL ORIENTED and ability to think OUTSIDE THE BOX and thirst for learning new systems and adapt with changing corporate environments and increase the Bottom line of the Company.
• “Cradle to grave” experience with large Payer system implementations analyze, interpret and configure business requirements based upon client’s design documents.

TECHNICAL SKILLS

Languages: SQL, HTML, XML .Net, ASP.Net, ASP (Active Server Pages)

Operating Systems: Windows NT/95/98/2000/XP./Linux

Software: MS Office (Word, Excel, PowerPoint), Adobe Acrobat, Rational Rose, Microsoft Visio, Microsoft Project, Front Page 2000, Visual Studio,, Blue Print, Quality Center, I-Rise, VERSION ONE, RequisitePro, EDI Mappings using TIBCO’s Foresight In stream® Translator.

Databases: SQL Server, MS Access 2000, Rational Requisite Pro. JAVA Environment.

Processes/Technologies: Rational Unified Process (RUP), Use Cases, Workflow Integrated Methodology (IM). BETS, EPIC, Diamond/Xcelys/SOX Processes. Business Objects,Datawarehouse & SQL Skills

ERP Systems: Working Knowledge of SAP/BI/BW.

PROFESSIONAL EXPERIENCE

Confidential, Minneopolis, MN

Business Analyst /Assistant Project Manager

Responsibilities:

• Played dual role of a BA and Assistant Project Manager on a DATA INTEGRATION & CRM Tool and Software Products for this newly merged company doing multi-tasking with Multiple projects .
• Seriously engaged in designing the Project Charter and Scope and conducting GAP Analysis and JAD sessions to elicit the requirement from Business and Stakeholders thorough out the Project life cycle.
• Used SHAREPOINT to create and post the documentation pertaining to BRD’s/FRD’s, Design and develop custom objects, reports, applications, workflows, etc.
• Integrate Salesforce.com with in house and 3rd Party applications
• Worked with business process owners, stakeholders and elicit business requirements and translate them into sound technical designs and deliver solutions, Write FRD’s for the Technical team at back end handing out all the Deliverables of the project within Timelines and Budgets.
• Worked with clinical staff and Hospital Staff/ Confidential ts members to elicit feedback and requirements, suppliers, and other stakeholders to define user requirements and provide integrated solutions based upon customized computer architecture and applications. Applying expertise to improve business processes and support critical business strategies, as they seek out opportunities to educate customers in the strategic use of technology and add Value to the Product Life cycle.
• Experience in handling multiple customer implementations / upgrades and product enhancements simultaneously. Played key role in Market Analytics and pricing schedules of the Pharmacy products.
• TIBCO sofware used to use on-premise or as part of cloud computing environments..
• Created Technical Data Reports using Crystal Report tool using all Business Objects modules.
• Gathered business requirements from SME’s and drafted business requirement document (BRD) used i-Rise Software to showcase the prototype the project visualization to the end user before the UAT.
• Used AGILE Methodology while defining standards and processes for BI requirements and testing phases of Software Development Lifecycle (SDLC) Document Test Cases, Lead Quality Assurance testing, and manage User Verification process.Perform data analysis (using SQL, data profiling tools, and reporting tools) to facilitate requirements gathering, support testing, as well as to troubleshoot production issues. Identified all necessary Business and System Use Cases from requirements, created UML diagrams including Data Flow Diagrams, Activity Diagrams, Sequence Diagrams using MSVisio.
• Understood the Business Logic, User Requirements & developed Design & User Interface Specifications. Exposure to web services, MQ messaging.-
• Created new users and sandbox testing and deployment the applications into Salesforce platform.
• Worked through the RCM (Revenue cycle management) Metrics of the providers.
• Used SQL Server skills to access the database cloud computing and synchronized the Requirements.
• Involved in Inception Phase and prepared Logical Data Models that contains set of diagrams and BRDs (Business Requirement Documents) supporting documents and Planned and defined system requirements, Use Case Scenario and Use Case diagrams for web-based application based on HIPPA .
• Conducted JAD session with management, vendors, users and other stakeholders to gather Requirements using tools like VERSION ONE, CALIBER and Blueprint.
• Scheduled meetings with developers, System Analysts (SA) and testers to collaborate resource allocation and project completion using MS Project.
• Created and managed project templates, use case project templates, requirement types and traceability relationships in Requisite Pro

Confidential, Windsor, CT

Business Process Analyst

Responsibilities:

• PRODUCTION SUPPORT& TESTING and Analysis of Defects related to Transaction sets 837/ 835/277 CA utilizing HP “QUALITY CENTER” Requirements/Defects MODULE, /EDIFECS Working collaboratively with technical team to Fix the defects and find appropriate Solutions to the satisfaction of the Business/Trading partners/End users.
• Providing production support to EDI related issues originating from internal or external customer/Trading partners/Insurance payer/provider requirements in AGILE Environment.
• Involved in Crosswalk forward mapping from ICD 9t to ICD10 and backward mapping from ICD10 to ICD9 using GEM’s. Conducts
• Conducts Tested to fix the Defects, (Defects Module)using Quality Center(HP)and do Critical Analysis/Document the Data and find the solutions after conducting JAD Sessions .
• Performed GAP analysis, working with the respective SME’s to include the missing Benefit Services based on the Benefit Summaries as well as Group Contract and created Reports.
• Coordinating the upgrade of X12 Transaction Code Sets 277,837P, 835 and 834 to HIPAA compliance.
• Involved in claim adjudication process using Edifecs /SpecBuilder and Quality Center/Transaction Manager application
• Used i-Rise Software extensively to prototype the projects to end users/Business users.
• Attending daily SCRUM and JAD Sessions and guided QA and Developers regarding the defects, Technical Specification Documents and Mapping Documents and post the documentation on SharePoint site.
• Conducting JAD sessions with business units and stakeholders to define project scope, to identify the business flows and determine whether any current or proposed systems are impacted by the new development efforts.

Confidential, Jacksonville, FL

Business Analyst

Responsibilities:

• Prepared the Business requirement Document (BRD) and functional requirement document (FRD) for the enhancement of the existing services
• Analysis and Design of existing transaction sets, and modification of these transaction sets to ensure HIPAA compliance.
• Did GAP analysis between ICD 9 and ICD 10/Crosswalk.
• FACETS - Testing/ Building and maintaining code sets, benefit (or product) plans and pricing agreements for Medicare, Medicaid, HMO, PPO, POS, CDH, dental and ASO product lines
• Building and optimizing pricing configurations, including fee-for- service, DRG and DRG grouper, percent BRVS, Medicare and Medicaid schedules, capitation, facility, professional and clinical editing criteria. Facets, MMS, XPF, XC, and UMI
• Managing code sets, including ICD-9, DRG, HCPCS, CPT codes, diagnostic codes, place-of-service codes and EOB/EOP explanation codes
• Conducted JAD sessions with business units and stakeholders to define project scope, to identify the business flows and determine whether any current or proposed systems are impacted by the new development efforts in an AGILE Environment.
• Created workflow diagrams, UML diagrams, process models, activity diagrams, use cases, for incorporating design changes in the order creation/ management system
• Coordinated and TESTED the upgrade of Transaction Sets 837P, 835 and 834 to HIPAA compliance and post the Technical Docs on SHAREPOINT site and maintain the upgrades.
• Involved in claim adjudication process of facets application
• Did gap analysis for HIPAA P and 835 transactions and HIPAA P and 835 transactions. Created Reports using Abnitio /Cyrstal Report.
• Utilized Agile Methodology to configure and develop process, standards and procedures
• Involved in forward mapping from ICD 9 to ICD10 and backward mapping from ICD10 to ICD9 using GEM
• Did gap analysis and impact analysis for the facets up gradation system.
• Attended daily SCRUM and guided QA and Developer regarding the defects, Technical Specification Documents and Mapping Documents. Knowledge of Facets functionality and concepts and Facets Data Model.
• Dealt with data mapping issues between various source systems and staging area and data marts
• Handled multiple customer /Trading partner implementations and upgrades at the same time.

Confidential - Horsham, PA

Business Analyst/Sales force Admin

Responsibilities:

• Created Custom reports and custom report types involving complex integrations such as Big Machines & Right 90.
• Was responsible for gathering requirements using VERSION ONE for reports and dashboards.
• Created Dashboards and scheduled automatic refresh and email.
• Responsible for all dashboard, metrics & analytics for global operations.
• Strong experience with Big Machines environments with proven ability to perform configuration of custom fields, custom objects, workflow, validation rules, triggers, and web service enablement.
• Migrated survey data, csv, excel files to Salesforce using Data Loader, Salesforce inbuilt custom importer.
• Created custom objects, apps, roles, profiles & page layouts etc.
• Conducted UAT and updated integrations based on it and used AGILE Methodology throughout the Life product Life cycle.
• Refreshed Salesforce Sandbox periodically.
• Worked with Salesforce.com Premier technical support.
• Was involved in training users to use Salesforce.com.
• Worked with offshore team in migrating data from Oracle.
• Was involved in new integrations & upgrades.
• Analyzed the needs of 1000+ users and updated requirements.
• Identify Risks and involved management in decision making.
• Worked with management and I.T. in drafting high level requirements.
• Worked with Top Executives such as Director of Finance and Business to understand the requirement and suggested solutions based on time, funds and manpower available.
• TIBCO software used for real - time processing of applications for all the clients.

Environment: Big Machines, Right90, Visual Force,, WINDOWS, SQL, Oracle, Sales force, Crystal Reports, MS Visio, MS Office 2007, Google Apps, SAML.

Confidential, Arizona

Business Systems Analyst

Responsibilities:

• Responsible in the new design and development of Medical Service Plan
• Reviewed, examined, calculated and authorized insurance claims investigated by insurance adjusters
• Ensure claims are valid and settlements are made according to company practices and procedures. Examined reports and similar insurance claims or precedents to determine extent of insurance coverage
• Performed feasibility, adaptability study and risk analysis to identify the business critical areas from the user perspective and update the metrics on SHAREPOINT site.
• Responsible for creating and reviewing business requirements, functional specifications, project schedules, technical documentation and test plans
• Gathered user/business requirements by meeting with business users and generated business models and use case analysis
• Interfaced with internal clients and technical vendors on new feature requirements and conducted a thorough analysis of the system features to assist project team with implementation of new features.
• Conducted individual and group (JAD) sessions with business and technical units. Gathered requirements by interacting with the stakeholders by interviewing them, by preparing questionnaires and getting feedback which helped in developing application as per HIPPA Rules
• Responsible for defining the scope of the project, gathering business requirements, doing gap analysis and documenting them textually or within models
• Exposure to HIPAA Compliance requirements and HL 7 standards. Considered HIPAA rules while data validation and testing
• Involved in creating functional specification documents for the design, development and implementation of the project
• Created SSRS report in Report Designer using the Report Wizard
• Designed/Implemented the testing environment for MS SQL Reporting Services (SSRS)
• Designed/Implemented the performance testing environment for SQL Reporting Services using the SQL Tracer
• Experience with DATA Marts, Data Interfaces, Data Systems, SSRS and SSAS
• Developed SSRS reports, SSAS, OLAP cubes, dashboards or scorecards based on business requirements
• Involved in upgrade of existing MS Access reporting system to reports deployed on a SSRS 2000 reporting system. Custom tables within a Dynamics SQL database were developed to ascertain custom reporting needs
• Analyzed and documented Business requirements and detail design of the software for full understanding of the business
• Contracted with the Medicare Centers and Medicaid Services (CMS) to provide quick, easy, and affordable access to the health care service of their choice

Environment: ASP.Net, C#, SQL Server 2005, EDMS, CMC, GPC, PDM, PMO, Windows, VBA, UML, MS Access, SQL, PL/SQL, MS Visio, HTML, XML.

Confidential, NYC

Business Analyst

Responsibilities:

• Analysis for making system compliant with HIPAA. Involved in making the Medicare Confidential t profiles being compliant with the HIPAA regulations. Management of Confidential t profile transfer (PPT) reports created by data team by verifying the associated data
• Involved in analysis, design, and implementation of the following systems
• Control Management Reporting and Security Systems: generation of daily, weekly, and monthly reports of hospital Confidential ts’ activity
• Accounting Systems: Financial Statement generation and analysis according to government standards and protocols
• Coordinated and conducted system requirements walkthroughs/sessions (JRDs/JADs) with business Owner/stakeholders/SMEs as well as design/development teams
• Worked with business area SMEs/analysts to develop and finalize test plans/scripts/use cases.
• Analysis of key business requirements and assisted in the development of Business Requirement (BRS), Functional Requirement (FRS), and System Requirement Specification (SRS)
• Working knowledge of EpicRx /Epic Lab/Epic Care In Confidential t/Health Information Management and Chart Tracking
• Conducted detailed and comprehensive Business Analysis by working with end users and other stake holders to identify the system, operational requirements, and proposed enhancements
• Facilitated Joint Application Development (JAD) sessions with all IT group members for communicating & managing expectations and to discuss various means for integrations with current system using an adoption through execution strategy
• Gathered business requirements from business users such as Insurance Policy Managers, credit card Managers and drafted business requirement specification (BRS)
• Identified all necessary Business and System Use Cases from requirements, created UML diagrams including Use Case Diagrams, Activity Diagrams, and Sequence Diagrams using Microsoft Visio.
• Understood the Business Logic, User Requirements and test-objectives to develop Test plans, Test cases, Use Case Scenarios
• Assisted in developing test scenarios, test scripts and test data to support unit and system integration testing
• Involved in comprehensive testing of the system to check it satisfies functional specifications.
• Facilitated JAD sessions to identify business rules and requirements and then documented them in a format that can be reviewed and understood by both business and technical people
• Followed Rational Unified Process methodology for creating artifacts.
• Provided primary liaison between Business/Operations/Vendors and development

Environment: Rational Unified Process, FACETS, MS Project, MS Visio, MS Word, MS Excel, QTP, Oracle 9i, SQL, PL/SQL, Windows NT/2000.

Confidential, Chicago, IL

Business Analyst

Responsibilities:

• Assisted project managers with the development of project schedules and manage scope using MS Project and Excel.
• Responsible for creating UML modeling plans, Use cases, process flows, Wire Frames and business requirements documentation using Define IT, Visio, Caliber RM and Star Team
• Participated in Kaizen sessions to capture AS-IS and TO-BE business process flows, Integrate process flow diagrams to show one end-to-end business model and process mapping exercise including swim lanes

Environment: SQL Server, Agile Unified Process (RUP), Caliber RM, MS Project, MS Visio, MS Word, MS Excel, Test Director, Microsoft Reporting Services, Windows NT/2000.