EXECUTIVE SUMMARY

• 10 yearsof experience performing business analysis and technical project management with expertise in business analysis, web design development, testing and deployment system solutions for Healthcare, Insurance and Information technology domains.
• Comprehensive knowledge of Software Development Life Cycle SDLC , having thorough understanding of its various methodologies like waterfall, Agile, Rup, Scrum, etc.
• Good knowledge of Project Management, IT Governance, and project portfolio management.
• Highly organized, results driven adept at recognizing inefficiencies and developing innovative cost-effective solutions. Excellent communication and interpersonal skills.
• Worked closely with project stakeholders, SME's and staff to understand the requirements and analyzing specifications for new applications along with re-engineering the existing application.
• Proficient in utilizing Project Management tools to develop SOWs, RFPs, RFQs, project plans, project schedules, resource planning and management, cost-benefit analysis, budgeting, project kickoff meetings, status meetings, and timeline management.
• Demonstrated success in managing business requirements, process and workflow analysis, development of functional specifications and documentation, development and testing of interfaces, testing of applications, deployment and implementation, training, and post implementation support.
• Excellent writing and analytical skills in preparing business requirements, system requirement, system design, functional specifications and defining project plans.
• Performed analysis on multiple areas within the NASCO Processing System NPS results of analysis where documented in detail and shared with functional workgroups for approval.
• Knowledge of NASCO Claims Processing Systems, which included eFDE, EEC, HIQK, accumulations DEDMAX, BASS, and benefit file.
• Hands on experience working with HIPAA 4010 x12 transactions such as 837, 835, 834, 278, 270 and 271.
• Sound knowledge on HIPAA 5010 version and changes involved with EDI transactions and working knowledge of creating 5010 GAP documents and companion guides.
• Excellent knowledge on ICD 10 codes, and their structural differences with ICD 9 codes.
• Experience on GEMs and Reimbursement Mapping documents and requirement management involved with ICD10 conversion.
• Adept at creating and transforming business requirements into designing business models using UML diagrams Data flow, Context, Use Case, Sequence, Activity diagrams using tools like Enterprise Architect, MS Visio and Rational Rose.
• Excellent facilitation skills in conducting walkthroughs, surveys, questionnaires, interviews, brainstorming, JAD and JAR sessions.
• Extensive experience in coordinating SIT, UAT,Regression testing and Security testing in different stages of QA process.
• Excellent track record for meeting deadlines and submitting deliverables on time.
• Well versed in different management scenarios like Change Control, Quality Assurance, Defect Tracking, System Integration and Scheduling.
• Exposure in educating internal customers on business systems and procedures, coordinating with Cross-functional teams to set priorities and schedules.

AREA Of ExPERTISE

• Health Information Systems
• Vendor Management
• Systems Testing
• Business Analysis
• Project Management
• Business Process Improvement
• Systems Integration
• IT Strategic Planning
• Budgeting and Early Indicator Reports

EXPERIENCE

Project Manager

Responsibilities:

• Responsible for Financial, Early Indicator Reports, Forecasting model for all projects under special projects team.
• High-level Requirement Documentation and Business Requirement Documentation BRD . Facilitated JAD sessions and documented business requirement. Developed business current and future state.
• BRD Re-Estimate: Worked closely with all lines of business and presented the BRD Re-Estimate to EOC
• Conducted IT Impact Assessment and completed RTM incorporating design and testing elements.
• Conducted Conceptual Design Sessions and developed IT current and future state, system architectural document SAD or technical design document TDD
• Worked on alphanumeric SSN Randomization solution and Dual subscriber solution eliminating dual subscriber issues, fraud and right DE-ID assignment process.
• Responsible for conducting weekly team meeting and maintained project financial dashboard.
• Responsible for gate/milestone closure deliverables and EOC approvals.
• Managed MSP tasks, created and managed work plans.
• Created Workspaces on SharePoint for SER.

Confidential

Sr. Business System Consultant

Responsibilities:

• Authored Use cases for the web services design and development.
• Created end-to-end Data mapping documents.
• Responsible for Story documents for Development team.
• Key playerin defining analysis strategy and provided input for work stream solutions and project challenges.
• Facilitated JAD's and gathered requirements. Responsible for BRD, Current and Future state flows.
• Mapped requirements in RTM to design and testing elements. Completed System Impact assessment.
• Completed RASIC for Gate/Milestones Deliverables. Responsible for Playbook.
• Engage in PM activities to support agile work stream Experience.
• Worked with UI design to get the designs approved by Business owners, Compliance and Legal dept.
• Co-ordinate information flow between design team and Business owners.
• Reviewed SAD/SRD and got QR approved.
• Responsible for weekly status meeting status report, project financial and dashboard.

Confidential

Responsibilities:

• Reviewed technical documentation to understand the Business logic and technical aspects system

• Analyzed the application and decided, which parts to be manually tested, and which to be tested automatically.
• Designed and implemented HIPAA 835 Payment Advice Transaction, 837 Health Care Claim Transaction.
• Experience with EFT, ERA transaction sets 835, 837, 270, 271, 276, 277 and 5010, PGP encryption and responsible for Claims processing, coordination of benefits and pricing process.
• Conducted detailed and comprehensive Business Analysis by working with end users and other stake holders to identify the system, operational requirements, and proposed enhancements.
• Working knowledge of regulatory requirements HIPAA, 21 CFR Part 11 and audits. Designed and developed Use Cases, Activity Diagrams, OOD using UML and Visio.
• 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 . Co-authored Business Requirements Specification BRS , Use Case Specifications, Systems Requirement Specification SRS and Change Request along with the Business Group and the IT project group members.
• 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.

Confidential

Business Analyst

Responsibilities:

• Collaborated with business analysis team members in understanding existing business processes and requirement management process.
• Followed a structured approach to organize requirements into logical groupings of essential business processes, business rules, and information needs, and insured that critical requirements were not missed.
• Compiled requirements sitting in different documents and prepared a single requirement documents for reference.
• Identified stakeholders of the project prepared interview questionnaire for requirement elicitation on Benefits, PA submission, and Referral areas and interviewed SME's and documented requirements.
• Facilitated JADs for requirement walkthrough, identification of non-functional requirements from system users and updated business requirements using Rational Requisite Pro that provided appropriate scope of work for technical team to develop prototype and overall system.
• Validated existing workflows written for Member Eligibility Verification, PA submission and security access in the portal.
• Followed UML based methods and created Use Cases for Claims Submission and Adjudication Referral Submission, and PA services.
• Created Activity Diagrams followed by State diagrams to illustrate standard claims adjudication and their statuses.
• Verified claims edits posted in the web as per the standard CIGNA approved edits and reported the issues that occurred.
• Participated in high-level 5010 update assessment session and documented the meeting outcome.
• Created high-level 5010 update related implementation plan, and presented to the manager.
• Analyzed 5010 implementation guide as per 5010 and developed high level gap documents.
• Worked as an Interface between the users and the different teams involved in the application development for the better understanding of the business and IT processes.
• Verified test scenarios written for ICD 9 extreme testing for ensuring system compliance with ICD 9 code set rules and participated in testing.
• Worked extensively with the QA team for designing Test Plan, Test Cases for the User Acceptance testing on ANSI X12 837, 835, 278, 270 and 271 files and analyzed TA1, 997, and BRR.
• Mapped the test scenarios to business requirements as part of creating traceability matrix.
• Verified the Business Scenarios on new builds to allow extended testing by the QA team.
• Developed test plan, test cases in Quality Center, after the requirements are signed off.
• Created project status report in terms of component testing, defects logged, defects resolved, pending scenarios, passed test cases and presented to the management during status update meetings.
• Provided UAT support as a liaison to business and test team by helping them understand the requirements.

Confidential

Business Process Engineer

• Defined and modeled the current state of business.
• Identified the scope and vision of the FMHP project.
• Performed Impact analysis for the potential impacts of FMHP on various business verticals, systems and clients.
• Organized JAR sessions to understand needs and requirements of different business departments, for them to incorporate FMHP.
• Worked closely with the state of NY to understand the rules and impacts of FMHP.
• Enterprise level business modeling using Meta storm Provision to elucidate current state, system interactions, business rules, Impacts, requirements, workflows and associations.
• Designed use cases and activity diagrams for the processes highlighted specifically by the business.
• Explored and identified a multitude of activities and areas where business transformation needs to be done. For Example Claims Processing, Utilization Management, Sales and Marketing, membership and Billing etc.
• Worked with configuration to update benefit grids and summaries to ensure parity.
• Updated activities and workflows to incorporate FMHP as an integral part of product development.
• Designed and analyzed requirements using Meta storm Provision and Req Pro. Performed enterprise level associations to connect the requirements to different business activities and technical systems.
• Analyzed I Facets input systems/requirements, configuration and functional design changes, created design models and test plans, test cases and executed test cases/scripts.
• Conducted Business Process re engineering to create the desired state models for the Underwriting and Fiduciary.
• Outlined and implemented change management protocols for the end users- strategy, planning and implementation.
• Worked with the design team to communicate design fits and gaps that had to be affected for this project.

TECHNOLOGY SKILLS

• Project Management: Project planning Process improvement Mapping and managing budget, Forecasting model and financials, Early Indicator Reports. Resources and timeline PMBOK
• Operating Systems: Windows 95/98/XP/NT/2000, Server 2003, Server 2008, MS Dos
• Methodologies: SDLC Rational Unified Process, AGILE, Waterfall , Six Sigma, UML Modeling, CMMI
• Business Modeling Tools: MS Visio, MS Project, Rational Rose, UML, MS Share Point
• Databases/Query Tools/Web: MS Access, Microsoft Internet Information Server, HTML, Dream Weaver, and MS Front Page.
• Languages: C, C , JAVA Script
• Graphics/ Utilities: MS FrontPage, Access, Outlook, Office XP
• Platform/Hardware: Windows, Macintosh HP/Dell/Cisco hardware, miscellaneous PC hardware, IDE hard drives, SCSI devices, Direct Attached Storage.
• Software: Microsoft Office Suite Word, Excel, Office, Outlook, PowerPoint, Access and Visio, Visual studio, Publisher , TSM, VERITAS backup, Symantec, Trend Antivirus, Altiris, VMware, NetIQ.
• Languages: Adept in Windows Server 2003 and 2008, C , Netbeans IDE 6.9.1 Java EE, .NET , Adobe Dreamweaver CS4, CS5, ITIL e learning, XML, .NET, HTML.
• Networking: TCP/IP, DHCP, DNS, WINS, FTP, Telnet, DSL/Cable, hubs, routers, SMTP, POP3, NAT, VPN, VLAN, LAN/WAN