PROFESSIONAL SUMMARY:

• 7 years of varied experience in Business Analysis across various domains including Health care, Medical Billing and Claims Management
• Experienced in interacting with business users to identify their needs, gather requirements
• Document FRD and Statement of Work SOW .
• and author Business Requirement Documents BRD , Functional Requirement
• Knowledge of project management concepts including Work breakdown structure WBS , Milestones, Triple constraints, Gantt chart, Change control board CCB and Risk mitigation.
• Excellent presentation skills designed to senior management including for training and analysis with prior proven sales and marketing experience.
• Good working knowledge of ICD9 to ICD10 conversion and HIPAA transaction requirements. Experience with Medicare, Medicaid, and commercial insurances in HIPAA ANSI X12 formats including 270/271, 276/277, 834, 835, 837, 997, and NSF formats for interfaces and images to third part vendor applications
• Performing Impact analysis for readiness of ICD-10 conversion
• Adopted best practices in ERP Enterprise Resource Planning while integrating different departments, databases, platforms to optimize and customize to improve accuracy and efficiency.
• Experience in SAP SD/LE and CRM implementation.
• Interface with clients from Operations, Marketing, Sales, Technologies, and Outside Vendors and act as their customer interface point .
• Highly motivated team player with excellent Interpersonal and Customer Relational Skills, Proven Communication, Organizational, Analytical, Presentation Skills, and Leadership Qualities
• Expert in Tracking and Managing the Requirements using Requirement Traceability Matrix RTM that controls numerous artefacts produced by the teams across the deliverables for a project and Data Mapping.
• Design and development of Use Cases, Activity Diagrams and Sequence Diagrams using UML
• Expereince in creating Wireframes and Mock ups as part of documentation
• Expertise in documenting Business requirement document BRD , Functional and Non-functional requirements in a Traceability matrix RTM , Use case Specifications and the complete System requirement specifications SRS
• Well versed in Requirement Gathering through techniques such as JAD sessions, Interviews, Document analysis and Reviews
• Adept with different methodologies which include Agile, Waterfall and Rational Unified Process RUP
• Familiarity with HL7structured, message-oriented protocol framework for computer communication between healthcare application systems.
• Involved in meetings for Test Planning, Test Preparation, Test Execution and Issue Resolution and Report Generation to ensure that all aspects of a Project are in Compliance with the Business Requirements
• Knowledge of Big Data, Hadoop and Map Reduce with Pig Latin, Hive and Squoop.
• Reviewed Test plans to make sure all the requirements have been covered and corresponding test cases have been created
• Involved in training of end users
• Documented Training Manuals for new product releases
• Involved with long term projects from the requirements gathering phase to the implementation phase

TECHNICAL SKILLS:

UML, SDLC, Waterfall, QA, MS Access, MS Excel, SQL Server, MySQL, PL/SQL, Oracle DBA, Windows 98/2000/XP, HTML, basic DHTML, basic XML, MS Office Suite-Excel Macros, Power Point, Project, Sharepoint, Visio, Adobe Photoshop, Lotus Notes, Pig Latin, Hive and Sqoop.

PROFESSIONAL EXPERIENCE:

Confidential

Business Analyst II

Responsibilities:

• Involved with various vendors in contract negotiations including working closely with the finance team in finalizing per member per month PMPM payment system with the vendors.
• Experienced in drafting customized encounter data , reverse encounter data and accumulators.
• Responsible for interpreting the new CMS mandated EOB template for HMO and PPO and co- rdinating the effort to get approval from OIR.
• Conducted multiple Ops readiness meetings with various lines of business to align with ACA and the new market place Health Exchange
• Involved in developing the new child only paediatric QHP compliant dental benefit plans and adult dental insurance products for the IU65 segment on and off exchange.
• Worked closely with alliance and other external business partners including HPS, United Concordia and RRD in streamlining the process.
• Involved in the integration of stand-alone qualified child only and adult dental products into the existing sales channels.
• For the newly federally funded Navigator integration with health centres Prestige Health recently acquired by FB , involved in the revised process workflow to generate new revenue for Florida Blue, also involved in the finalization of all collaterals.
• Involved in designing testing strategy on Big Data for pre-hadoop processing, during map reduce process and validation of extracted data moved into EDW.
• Successfully generated a custom project plan to support Ancillary Business Unit with the senior project managers including a revised BRS template to suit the new medical landscape.

Environment: Microsoft Word, Project, Excel, PowerPoint, Visio, Requisite Pro, Requisite Web, SharePoint.

Confidential

Sr:Business Analyst

Responsibilities:

• Gathering business requirements from the Business team and generating system workflows
• Involved in creating the targeted questionnaire for SMEs and Business users for elaborating requirements
• Primarily involved in the Reports and Letters work stream including Case Management, Disease Management, Quality Improvement, Billing, UM and Appeal.
• Participated in JAD sessions / conducted interviews for analysing business requirements and reviewing them with business and technical teams
• Responsible to get soft approval from the business and management team in the Analysis and Design phase and work closely with the development team during Construction phase.
• Participated regularly in walkthroughs and review meetings with PM, QA Lead and development teams
• Enhanced the job properties for performance tuning including data mapping.
• Assisted the PM in setting up realistic expectations and in evaluating the impact of change requests and risks and conducted project related presentations
• Conducted meetings to document Change Requests for new requirements
• Coordinated with system architects and developers to convert business requirements into system requirements.
• Attended demo sessions to understand existing system functionalities
• Prepared the cost estimate for the business analysis involvement of the project
• Prepared the BRD and conducted reviews with the stake holders
• Writing change requests follow up with the respective teams on the impact and action

Confidential

Business Analyst/Subject Matter Expert

Responsibilities:

• Interacted closely with the Business users along with the administration and management to gather business requirements and analyze the functionalities to be incorporated into the system
• Worked on HIPAA 5010 transaction requirements and analysed and tested HIPAA ANSI X12 formats including 270/271, 276/277, 834, 835, 837, 997, and NSF formats for interfaces and images to third part vendor applications
• Validated sending and receiving HL7 messages.
• Analysed business requirements as part of the overall HL7 interface planning process which included HL7 interface analysis business requirements analysis, application analysis , HL7 interface requirements, HL7 interface specification, and HL7 interface testing.
• Prepared the project status reports and represented the BA team in the PMO meetings
• Participated in UAT along with the development testing teams
• Gathered requirements from collection, claims, Billing, and insurance appeal departments
• Interacting with National Pricing Staff Underwriting, Actuarial Sales/AM on daily basis with regards to how the NPS application functions, troubleshooting incidents/issues for Users and completing defect and enhancement requests on daily basis
• Working with the business and various technology departments, and acting as a liaison between the underwriters and application developers to provide production support for the National Pricing Solution web based application
• Performing system administrator duties i.e adding/removing users to system Participating in UAT and working
• This project also provides the Base component of the MMIS, which receives and processes prior authorizations, referrals, claims, and remittance advices for medical and dental services.
• The project also manages provider enrollment for all Medicaid providers along with the Medicaid Member. This includes the files and data conversion and migration of all application functionality from the legacy MMIS system to the client-server application Health PAS system .
• Maintaining and modifying training documents
• Extracting data from databases and preparing reports for auditing/SOX compliance purposes
• Traveling throughout regional offices to provide support and training to end users
• as an SME Subject Matter Expert in Claims processing management, mentored trained entry levels

Environment: Microsoft Word, Project, Excel, PowerPoint, Visio, Oracle 10g/11g

Confidential

Business Analyst

Responsibilities:

• Interacted with the Business Leads and Users to understand the existing Business processes.
• Implemented One Full Life cycle of CRM Internet Sales. Created business blueprint document for the Internet sales and configured the internet sales according to the company requirements.
• Configured the Master data which includes Business Partners, Internet users for both B2B and B2C scenarios, Product Catalog, Transaction types and Item categories.
• Created a Web shop for Business Partners and Consumers. Created users for B2B scenario via User Management. Maintained the control parameters for each Web shop.
• Created Product Catalogs including creating Document types, Catalog variants, Catalog areas, Country groups, Template for Folders, Defining Types, assigning Products to product catalogs, XML export of product catalog, External Catalog Integration with XCM and OCI.
• Product Proposals : Created and assigned Attribute sets and Target groups for Cross/Up-Down selling/Best seller, Maintaining Top n products, Personalized and Web shop specific catalogs
• Coordinated with R/3 consultants in setting up of Order fulfillment Availability check, Delivery, Post goods issue and Billing processes for the Orders generated from Web shop through CRM.
• Configured Internet Pricing and Configurator IPC , which combines the functions of the Sales Pricing Engine SPE and Sales Configuration Engine SCE with a standardized web interface. IPC SPE setup for customer specific pricing information. Variant configuration design with IPC - SCE server to replicate SAP R/3 Variant configuration in CRM.
• Configured the Solution Search which includes FAQ's and handled the complaints and returns.
• Provided end-user support on Internet sales.
• Created and maintained Marketing plans, Campaign type and Campaign elements.
• Planned, Prepared and executed Marketing Campaigns through multiple Interaction channels.
• Configured and customized the External List management, Campaign Automation, Marketing Calendar and Personalized Email Forms.
• Implemented lead management scenario, creating General lead setting and Questionnaires for Lead Generation, Dispatching, Processing and Qualification.
• Configured Inbound/Outbound lead management including creation of target groups for lead generation and transferring qualifying leads into sales.
• Business Partner Segmentation using Segment Builder. Worked with Segment Builder to identify target groups in the Campaign Management process.
• Analyzed the results of Marketing plans and Campaigns through SAP SEM and SAP BW to allow in-place analysis of the campaign data.

Environment: Microsoft Word, Project, Excel, PowerPoint, Visio, Windows NT 4.0,UNIX, Oracle 8i, PL/SQL, DOS and UNIX Sequential Files, MS Access, XML File, RUP, MS Visio, MS Project, MS Office Suite Word, Excel, Access, Power Point, Outlook ,

Confidential

Sales Manager

• Independently established extensive sales and distribution network to support Degussa's construction chemical business in Oman and markets across the Gulf Co-operation Council GCC countries
• Trained field staff in product usage, provided key input in product pricing
• Led a team of sales engineers, implemented key solutions yielding optimized pricing and increased sales performance.
• Awarded Employee of the Year 2004-05
• Business User and SME for SAP SD/LE/CRM implementation.