Summary

7 years of Business Analysis experience with in-depth knowledge of business processes in health care, banking and financial industries. A thorough understanding of the Software Development Life Cycle (SDLC) including but not limited to the various concepts such as Requirement Gathering. Possess a detailed-oriented nature with excellent communication, interpersonal, problem solving skills, and recognized for being a valued team player.

• Proficient in Requirement Management, including gathering, analyzing, detailing and tracking requirements.
• Extensive experience in IBM Rational Team Unifying Platform containing tools such as IBM Rational Unified Process (RUP), RequisitePro, ClearCase, ClearQuest and Rose.
• Experienced in documenting requirement using Unified Modeling Language (Use Case and Activity Diagrams) also building business Process Flow, Context Diagrams, Sequence Diagram using tools such as Visio and Rose.
• Experience in writing requirements and specification like Business Requirements Document (BRD), Use Case Realization Document, Functional Requirements Specifications (FRS), Systems Design Specification (SDS), Systems Requirements Specification (SRS), Data Dictionary, Business Continuity Plan (BCP), Requirements Traceability Matrix (RTM), Defect Traceability Matrix (DTM), throwaway prototypes, Knowledge Transfer manuals, User Guides, Release Notes, Training Material.
• Experience in building project plans, delivery schedules and project budgets.
• Experience and strong understanding of ICD, Claims Processing, Dual Processing of claims, Claim Adjudication, Memberships and other standards.
• Developed use case diagrams, class diagrams, sequence diagrams, state diagrams and activity diagrams using UML to make users and developers understand the system.
• Expertise in performing GAP Analysis, Impact Analysis and Risk Assessment in several projects.
• Strong experience in the creation of Test Plan and Test Cases from the Requirements document. Documentation of the Test Plans, Test Cases, Test Scripts, Test Procedures based on the Design Document and User Requirement Document for the Unit, Integration, Regression, Functional, Performance, and User Acceptance Testing (UAT) using Synergy, Rational’s Test Manager and Mercury’s Test Director.
• Experience in Defect management.
• Excellent communication skills and adept at facilitating walkthrough and training sessions.

TECHNICAL EXPERTISE
Operating Systems : Windows, DOS and UNIX
Languages : C/C++, Java, SQL, UML, Visual Basic, XML
Databases : RDBMS, MS Access, MS SQL Server, MySQL, Oracle8i
Methodologies : SDLC, Rational Unified Process, Waterfall Methodology, Agile
Quality Standards : CMMI, ISO 9001, HIPAA
Web Development : HTML, Front Page, Image Composer, Macromedia Dream weaver and Flash
Tools : MS Project, MS Visio, MS Office (Word, Excel, PowerPoint) MS Access, MS Query, Open office, Rational Rose, Rational ClearCase, ClearQuest and RequisitePro, Rational Enterprise Suite, TestDirector7.6, WinRunner, LoadRunner

PROFESSIONAL EXPERIENCE

Confidential, Eden Prairie, MN Apr 2009 – Till Now
Position: Business Analyst

Confidential is the nation’s leading PBM with different prescription drug benefit programs that are designed to drive down the cost of pharmacy health care for private and public employers, health plans, labor unions and government agencies of all sizes, and for individuals served by the Med D Prescription Drug Program.
In Confidential, I worked for Confidential Part D Finance team which comprised of Premium Billing, Insurance Accounting, Accounts Receivable as well as Medco Finance IT team. I worked as a Business Analyst in the Transition to TMG Health project to implement Trizetto’s Facets application to perform all the financial operations activities.

Technologies: Windows, Rational Unified Process (RUP), CMMI, Six Sigma, UML, MS Office Tools – MS Word, MS Excel, MS Access, MS Visio, MS PowerPoint, Brio Query, Requisite Pro, Clear Quest.

Roles Responsibilities:

• As a business analyst in Medco Finance team I Acted as primary liaison between Business area Subject Matter Experts (SMEs) team development team throughout all phases of SDLC; starting from Inception to Transition phase of Rational Unified Process (RUP) methodology of iterative software development to generate numerous Business Requirement Documents Functional requirements specification documents, Use cases, Vendor Requirement Specifications, Architectural documents, system flow and work flow diagrams.
• My responsibilities included understanding, articulating, extracting, and refining user requirements by conducting JAD sessions, facilitating meetings interview with Business Units and Technical Supports Development team, identifying the business flows and process flows, conducting detailed and comprehensive business, functional system analysis to determine High Level and Low Level artifacts deliverables and design the application that will support the business and meet the constraints of time, resources and budget taking into consideration other functional areas such as Medicare Part D Enrollment Eligibility team and Customer Service Team as well.
• Created numerous Business Requirement documents and converted those into use cases, functional system requirement specifications so that developers can understand the business process and rules according to their perspective.
• Some of the Business Functional requirement document I created includes but not limited to: defining business rules for calculations of member balances before and after sun-setting current application; True Up Process: designing Audit File, Accounting Adjustment File, Refund Write-off File; Invoice Validation process workflow; Payment History files transfers process workflow; Billing Profile for Members and Clients process workflow; defining Retro-active Adjustment Processes; CMS historical payment files.
• Created different Standard Operating Procedures (SOPs), policies and workflows.
• Analyzed and developed business and functional requirements for the Financial Client Reporting website and including Med D Banking Payment Optioan for the members Clients in the Medco Home Page.
• Performed the Data Analysis for Data staging Teradata Database design for the To-Be reporting system. Created Data Mapping specs for different source system including IBM Mainframe system, Teradata, and Data Warehouse to target system, share drive, access database and application.
• Designed and created different Reporting Metrics identifying the file, delivery method, format, and delivery schedule. Created designed the different requirement document and data modeling documents to stage all the daily and month end reports and extracts expected to be received from the new vendors into the mainframe servers and loading it to the Teradata database and to the individual share drives. Created documentation to establish connectivity for FTP process and staging process to receive the reports and extracts.
• Defined the reporting extracts Formats and Layout including Header Trailer on behalf of Medco Business users.
• Employed UML methodology to carry out the business process modeling to develop the business architecture, data flow models, and different solution options in creating Use Case diagrams and business/process flow diagrams, to assist development team to understand the requirements.
• Designed the Requirements Traceability Matrix (RTM) to trace the relationship between business and functional requirements to test cases and achievement metrics on an ongoing basis for keeping the project team informed on the progress report of the project.
• Validated technical design documents created by IT developers against functional specifications.
• Developed Test Plans and Test Execution Procedure Document based on the Business Functional Requirement Document and numerous Test Cases and Test Scenarios to cover overall aspect of quality assurance.
• Assisted End User in performing User Acceptance testing and performed testing of the end result files created by the development team to verifying whether all the User Requirements were catered to by the development effort.
• Created numerous Test Cases, Test Conditions and Test Scenarios for Premium Billing, Accounts Receivable, Insurance Accounting sub-teams to be used as testing base for assists Testing QA team to performs End to End with the transitioning vendor and ultimately to Facets application.
• Performed defect tracking and prioritizing defects after base lining the requirements by facilitating Proof of Concept sessions.
• Performed and produced change control documents as described by CMMI standard by keeping track of changes on an ongoing basis whenever there were any changes to the requirements.
• Reported on a daily and weekly basis regarding the project status updates to the manager and project manager.

Confidential, FL July 2008 – Apr 2009
Position: Business System Analyst

Confidential is the nation's leading provider of comprehensive home health services. Confidential serves patients through more than 350 direct service delivery units within approximately 250 locations in 35 states, and through CareCentrix®, which manages home healthcare services for many major managed care organizations throughout the United States and delivers them in all 50 states. Gentiva Health Plan is a community-accountable health plan that serves nearly 800,000 residents through four free or low-cost health insurance programs: Medi-Cal, Healthy Families, Confidential’s Healthy Kids.
Coordination of Benefits (COB) is a Health Care Financing Administration (HCFA) Program undertaken by Gentiva. Medicare Coordination of Benefits is the process for ensuring that payment of Medicare beneficiaries' claims is properly shared among insurers when the beneficiary is covered by private insurance in addition to Medicare. By coordinating benefits, the COBC assists Medicare in paying claims more accurately the first time, which saves costly follow up and mistaken payments.

Responsibilities:

• Gathered requirements and prepared business requirement documents (BRD).
• Responsible for translating BRD into functional specifications and test plans. Closely coordinated with both business users and developers for arriving at a mutually acceptable solution.
• Conducted JAD sessions to define the project and to reduce the time frame required to complete deliverables.
• Used Rational Rose/MS Office Suite for creating use cases, workflows and sequence diagrams according to UML methodology thus defining the Data Process Models.
• Defined Use cases from requirements and helped convert them into software specifications.
• Involved in HIPAA/EDI Medical Claims Analysis, Design, Implementation and Documentation.
• Involved in preparing the Test Scenarios for Health Care Claim Payment/Advice.
• Written multiple Use Cases for multiple transactions include 837I, 837P, 835, 276, 277, 270, 271(both inbound and outbound) transactions.
• Maintained Requirement Traceability Matrix (RTM).
• Use Case development and UML modeling using modeling tools like Rational Rose/MS Visio.
• Presented the nursing outcomes to C-Level executives in Gentiva Nursing and Data Management group using Crystal Reports XI.
• Expertise in building applications using SQL and Oracle 10g.
• Analyzed business needs, created and developed new functionality to meet real time data integration that facilitated decision-making.
• Created product documentation, printed user manual and training materials.
• Developed queries using SQL to automate the weekly and monthly “Meds Update Reports” and FCO reports.
• Coordinated Regression Testing and created test scenarios for User Acceptance Testing (UAT).
• Maintained documents for change request and implemented procedures for testing changes.

Environments: Rational Rose, Rational ClearCase, RUP, MS Visio, MS Project 2000, UML, HTML, TestDirector7.6, SQL Server, MS Office (Word, Excel, PowerPoint), Load Runner, OO Modeling.

Confidential, Portland, OR Jan 2007 – July 2008
Position: Business Analyst

Project Description: In Confidential BCBS I was working on Medicare Revenue Realization project. The objective of the Medicare Revenue Realization (MRR) project was to develop and modify integrated application, processes and implement tools that facilitate the identification of payment discrepancies and reconciliation of Medicare revenue. The MRR project contributed to Regence’s objectives by maximizing the revenue through a cost effective process to capture and submit complete diagnosis information for Medicare members.
The MRR project was divided into

• Track# 1: was initiated to build and modify the application to Edit and Scrub the Medicare Part D-Prescription Drug Event (PDE) data coming into the process from different sources before Regence can send it to Centers for Medicare Medicaid Services (CMS) for reconciliation so that the error rate can be reduced.
• Track# 2: was initiated to incorporate the CMS mandated change of adding few new fields into the Medicare Part D – Prescription Drug Event Claim Data and all the system it passes through within Regence.

Technologies: Windows 2000, Rational Unified Process (RUP), CMMI, UML, MS Office Tools – MS Word, MS Excel, MS Visio, MS PowerPoint, VB Script, MS Access dB, Oracle, SQL Navigator.

Roles Responsibilities:

• Engaged in different phases of SDLC of the project executing RUP methodology of iterative software development from Inception to Transition phase.
• 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.
• Created different documentations based on CMMI standard model.
• Conducted detailed and comprehensive business analysis by constantly working with the Business Users, Solution Engineers, Developers and Testers, Management, Deployment and Support Staff in order to determine High Level and Low Level artifacts deliverables to be produced and design the application that will support the business and meet the constraints of time, resources and budget.
• Acted as liaison between development team, testing team and Business SMEs to generate and standardize Functional requirements specification documents, Use cases, Vendor Specification documents and Architectural documents. Converted Business requirements into Functional requirements so that designers and developers can understand.
• Also performed the Data Analysis and Data Mapping for different source system including Mainframe system, Data Warehouse and Database to target system, database and application for the Medicare Part D - Prescription Drug claims.
• Employed UML methodology in creating Use Case diagrams, business/process flow diagrams, and Activity/State diagram to assist development and engineering in understanding the requirements.
• Involved in Gap analysis of processes As-Is and To-Be Processes within the organization for implementation of RUP methodologies.
• Assisted development team with design and testing efforts and assisted them on resolving the reported bugs and various technical issues.
• Developed customized SQL reports and queries for management decision-making and operational management.
• Assisted in preparing and executing Test Cases, and reviewed Test Execution Procedure Document (EPD) document prepared based on the Business Requirement Specifications (URS), Functional Requirement Specifications (FRS) to cover overall quality assurance.
• Participated in the team meetings to discuss the issues arising out of testing. Reported weekly and monthly project status updates to project manager and senior management.

Confidential, New York, NY May 2006 – Jan 2007
Position: Business Analyst

Project Description: Confidential is a company providing customers with benefits, expertise and service that improves the health, well-being and productivity. As a BA, I was involved in developing fully automated, real-time claims processing system for complete, on-line mediation of medical, dental, vision, and disability claims and encounters as per HIPAA guidelines. System allowed the efficient and timely management of all relevant data clinical, financial, and administrative throughout the organization enabling the sharing of information between subsystems.

Technologies: Windows NT/2000, MS SQL Server, Rational Unified Process (RUP), CMM, UML, Rational Rose RequisitePro, Mercury Quality Center TestDirector, Clear Quest, MS Office Tools, MS Outlook, Java.

Roles Responsibilities:

• Extensively involved in implementation of effective requirements practices, including gathering User Requirements, and analyzing User Requirement Document (URD), and functional specification document (FSD), use and continuous improvement of a requirement gathering processes.
• Applied RUP methodology with its various workflows, artifacts and activities to manage life cycle from Inception to Transition phase.
• Acted as liaison between external clients and SMEs to generate and standardize product requirements specification documents such as URS/FRS/UseCases.
• Employed UML methodology in creating UML Diagrams such as Use Cases, Sequence Diagrams, State Diagrams, Activity Diagrams and business process and workflows.
• Was engaged in applying CMM standards which provided guidance for improving organization’s processes and the ability to manage the development, acquisition, and maintenance of products or services Cigna was providing to its clients.
• Assisted JAD sessions to identify the business flows and determine whether any current or proposed systems are impacted by the EDI X12 Transaction, Code set and Identifier aspects of HIPAA. Involved in GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims. Worked on EDI transactions: 270, 271, 835, and 837 (P.I.D) to identify key data set elements for designated record set.
• Involved in designing determined 3-tier architecture for the claim processing system. Assisted team lead in developing Requirements Traceability Matrix (RTM) to trace the relationship between business and functional requirements to test cases. Prepared and executed different Test Cases and Test Scripts.

• Involved in conducting Functionality testing, Integration testing, Regression testing and User Acceptance testing (UAT). Provided analysis and insight to QA Team in defects and bugs tracking.

Confidential, Cleveland,OH June 2005 – May 2006
Position: Business Analysis

Project Description: Confidential provide a variety of product and services such as individual health and small employer group health insurance, dental insurance, disability insurance and life insurance. I worked on Healthcare system specifically designed to incorporate with clinical, material management and medical billing applications needs of the users. The system was also easy to integrate with most patient accounting and clinical healthcare software solutions.

Technologies: Windows NT/2000, MS SQL Server, Rational Unified Process (RUP), UML, Rational Rose, Mercury Test Director, MS Office Tools, Lotus Notes, Java.

Roles Responsibilities:

• Engaged in different phases of SDLC of the project executing RUP methodology of iterative software development from Inception to Transition phase. Performed the role of a liaison between Business Units and Technical Solution Developers.
• Understand and articulate Business Requirements from SME interviews and workshops and translate requirements into Business Requirement Specifications (BRS). Involved in conducting JAD with SMEs, Developers, Project Managers and Quality Analysts to discuss business requirements, test planning, resource utilization, and defect tracking sessions as a facilitator to gather requirements from the business area.
• Implemented Unified Modeling Language (UML) methodologies for process modeling and developing use cases. Developed Use Cases, Sequence diagram, State diagram, and Activity diagram.
• Involved in implementing Six Sigma practices to systematically improve processes and standards and by eliminating defects.
• Analyzed EDI ANSI X12 file mapping and reported in analysis spreadsheet. Performed validation of 837 (P, I, D) 835 format files according to the EDIFECS engine. Management of Patient Profile Transfer (PPT) reports created by data team by verifying the associated data.
• Involved in creating Test Plans and created Test Cases from the BRD, FRD and design document to cover overall quality assurance. Conducted Functionality testing, Integration testing, Regression testing, UAT, and ETE testing. Generated weekly and monthly reports and submitted to the Team Leads and Manager for reporting status report and analyzing purpose.

Environment: OO Modeling, Rational RequisitePro, Rational Rose, RUP, UML, Load, MS-Project, MS Visio, Java, MS Office, Windows XP.