SUMMARY

• Qualified professional with over 6+ years of extensive experience in the field of Business/Data Analysis, working with the technical staff to implement management and staff's business requirements into the software application in Finance industry and Healthcare Industry.
• Highly motivated team player with excellent communication, presentation and interpersonal skills, always willing to work in challenging and cross - platform environment.
• Experience in B2B, B2C and Ecommerce portals web application developments.
• Experienced as a Business Analyst in using the iterative software development life cycle principles of Rational Unified Process to manage, develop and test distributed client/server, internet and intranet applications on heterogeneous environments.
• Experience with TriZetto Facets 4.21/4.31 and TriZetto HIPAA Gateway 4.11 - supported new business requirements by extending the functionality of the core Facets system using the Facets extensibility architecture feature.
• Experience with TriZettos Facets Application Groups: Claims Processing, Guided Benefit Configuration, Medical Plan, Provider, Subscriber/Member, Utilization Management.
• In my career I have proven myself to be a valuable leader in managing staff in the configuration of Facets and identifying areas for improvement and tangible administrative savings to the organization.
• Vast knowledge and experience in Health Care industry, experienced in testing different healthcare ERP solutions such as FACETS, MedPlus, EPIC and other claim processing solutions.
• Highly proficient in working with users to gather requirements, analyze them and subsequently use the Rational project and design tools to model the requirements.
• In-depth knowledge of creating use cases, functional design specifications, activity diagrams, logical, component and deployment views to extract business process flow.
• Extensive experience with the SAS programming and in data step and with various SAS Procedures in Base SAS and SAS/Stat, including thorough knowledge of SAS Macro.
• Used Query Analyzer, Execution Plan to optimize SQL Queries.
• Experience with SOX, Regulatory Compliance and Controls.
• Strong understanding of project life cycle and SDLC methodologies including RUP, RAD, Waterfall and Agile.
• Conducted JAD sessions, created Use Cases, work flows, screen shots and Power Point presentations for the Web Applications
• Gathered and documented Non-functional requirements.
• Experienced in preparing Business Process Re-engineering Models
• Familiar with HIPAA EDI transactions such as 835, 837 (P, D, I) 276, 277, 278 etc
• Extensive knowledge of IBM and Tandem Mainframe, AS400, and ASP/Client Server
• Designed changes for Mainframe Systems and Web Based System.
• In depth knowledge of SDLC and implementation of the Rational Unified Process (RUP) in all four phases of a project: Inception, Elaboration, Construction and Transition.
• Utilized a fusion of industry knowledge and technical programming to provide executive management the development and implementation of interactive busines 1 s tools, and strategic analysis, vital for use in mission-critical decision-making
• Conducting requirement gathering sessions, feasibility studies and Impact Analysis and organizing the software requirements in a structured way using Rational RequisitePro to track development.
• Interacting regularly with the development team, creative services, database designer, system administrator and the higher management to meet the deadlines of Project milestones.
• Worked in close co-ordination with the testing team in developing test plan and test cases from functional and business requirements.
• Performed UAT and exposure to User Certification Testing (UCT) and Operational Readiness Testing (ORT)
• Expertise in Procurement and Management Services
• Excellent skills in Project and Performance Management to support Strategic Planning, Goal Setting, Strengthen Accountability, Enhance Decision Making, and Improve Customer Service.
• Experience in implementing Microsoft Office SharePoint 2007.

TECHNICAL SKILLS

Skill Sets: Description

Programming Languages: C, C++, HTML, XML, SQL.

Data Base: MS Access, Oracle (SQL Series), DB2

Reporting Tools: Crystal Reports 8.0

Operating Systems: MS-DOS, Windows95/98/NT/2000/XP, Apple McIntosh, Linux

Software: MS Office Suite(Word, Excel, Access, PowerPoint & Outlook), MS Visio, Rational Rose, Rational Requisite Pro, Adobe Acrobat, MS Office FrontPage, Lotus Notes

Mainframe: COBOL, DB2, JCL, CICS, MVS

Processes/Technologies: Rational Unified Process (RUP), Waterfall, UML & Microsoft Office SharePoint 2007

Automation Tools: Requisite Pro, Win runner, QTP, Test Director, Quality Center

PROFESSIONAL EXPERIENCE

Confidential, Phoenix, AZ

Sr. Business Analyst

Responsibilities:

• Worked with Business team, Development team and externals Vendors to review BRD’s in order to define test strategies and test plan.
• I gathered process redesign requirements; coordinated and participated in development activities and supported the testing and implementation of package-based patches forFacets4.71 by the vendor.
• Lead FACETS QA team in MS CHIP, defined test scope, setup up test environment and test data.
• Experience creating mapping documents forFACETS4.71 applications for rate sheets from Web to ODS.
• Performed extensive testing in Facets Subscriber/Member, tested Groups, Eligibility, and Enrollment and validated outbound 834 Extracts to different Vendors.
• Prepared state review documents to get approval on respective tasks from states.
• Perform Extensive EDI testing on X12/, 835, 270 etc, worked with state vendor Confidential to validate inbound /outbound EDI transactions to Facets.
• Created detail test plans for Pharmacy, Dental and Vision claims which were processed by External Vendors RxSolution, Dental Benefit Provider (DBP), and Vision Service Provider (VSP ).
• Involved in core architecture design and software development for Enrollment project team for HIPAA andFacets. (HIPAA Gateway, TrizettoFacets4.71, Pervasive, EDI, 5010, ICD -10, MMS)
• Provided Facets related systems expertise (training) to system users, business partners, and other internal/external customers including trouble shooting issues, as well as, identifying and correcting inefficiencies.
• Completed CMS File Load and Mapping for ICD-10 PCS 2012 Procedure Codes onFacets4.71
• Extensively performed System and System Integration testing.
• Facilitated User Acceptance Testing by creating UAT test scripts in order to test end-user functionality and to ensure that business requirements were met.
• Extensively performed Partner Testing to make sure all the external components are receiving data from FACETS according to new MS CHIP plan configuration.
• Used Mercury Quality center for defect tracking and prioritizing defects and for enhancements after base lining the requirements.
• Coordinated defects with different stalk holder, assigned defects to different resources across UHG as well as to external vendors for regression testing.

Environment: Quality Center, Facets 4.41, UNIX, Java, XML, Oracle, Sybase, Manual Testing

Confidential, Atlanta, GA

Sr. Business Analyst

Responsibilities:

• Captured all the requirements for new feature implementation, up gradation and had a complete walkthrough on the existing application and documentation
• Gathered requirements by conducting interviews, meetings, JAD sessions for Web-portal development for members, providers, agent-brokers
• Completed CMS File Load and Mapping for the ICD-10 CM 2012 Diagnosis Codes onFacets4.71
• Clearly defined systems work scope and objectives based on business requirements
• Worked to resolve customer issues with proactive support, developed point solutions and prototypes components, created factory with best practices and reusable components
• Worked on custom in/out bound interfaces - extracts between Facets and legacy systems. These include modules like customer service, membership, billing, claims processing workflows
• PerformFacets4.71 conversions, updates, maintenance of Subscriber/Members module.
• Analyzed data sets for review data and quality control to evaluate data periodically in batches using File-Aid
• Interacted with Subject Matter Experts, software architects and developers, involved in UI design process; Designed user interfaces by using MS Visio; defined page controls and business rules for validations
• Supported roll-out of the upgraded system as gate keeper and consultant
• PerformFacets4.71 conversions, updates, maintenance of Subscriber/Members module.
• Coordinated and facilitated key upgrade activities like Facets conversion, upgrade and patch implementation
• Analyzed bi-directional EDI interface (eligibility export and claims import) with Rx vendors and prepared interface specification document
• Assisted ICD-10 Team with loading the ICD-10 CM 2012 Diagnosis Codes as well as the MDC associations to each Diagnosis Code intoFacetsfrom file download from the CMS website
• Coordinated with the design team for EDI transaction code set (X12 835, 837, 270) development and ensured compliance with standards for HIPAA
• Developed test strategies and test plans to the satisfaction of QA
• Performed User Acceptance Testing, system and data testing of enhancements including regression testing

Environment: FACETS, Quick Test Pro, Test Director, Facets, Windows XP, C++, PL/SQL, Oracle, UNIX, Manual Testing.

Confidential, Nashville, TN

Business Analyst

Responsibilities:

• BusinessAnalysis and Modeling, Functional Requirements Gathering and Analysis and collaborating with Technical Teams in preparing System Design Document (SDD) .
• Recent assignments include working with Payer Organizations (Insurance Companies) on upgradation projects (EDI ASC X12 ; ICD-9 to ICD 10;FACETS
• Responsible for writing Functional Requirement Specifications (FRS) and User Requirement Specification (URS).
• Analyzed Business Requirements and segregated them into high level and low level Use Cases, Activity Diagrams / State Chart Diagrams using Rational Rose according to UML methodology thus defining the Data Process Models.
• Led the development of a training program to train users on a custom web application and a Cognos ad-hoc reporting environment.
• Responsible for architecting integrated HIPAA, Medicare solutions, Facets.
• Identify Member, Provider, Coverage, Medicare, and Medicaid.
• Involved in Service Oriented Architecture (SOA) of the claims processing system
• Understand the As Is system and develop the To Be system concept and also prepare the System Process Maps.
• Gained in-depth knowledge and experience in pricing, inventory, procurement, time & attendance, barcode, EFT, credit cards, and handheld wireless technology in mainframe, client/server and web based environments.
• Used SoftTest software with pseudo code to ensure test cases covered all branches of project's code impacting the system. (The system is an IBM mainframe based system that contains the master set of customer information used to bill customers.)
• Defined Functional Test Cases, documented, Executed test script in Facets system.
• Successfully conducted JAD sessions, which helped synchronize the different stakeholders on their objectives and helped the developers to have a clear-cut picture of the project.
• Conducted presentations of the Q/A test results with analysis to the stakeholders and users and documented modifications and requirements.
• Coordinating and Developing QA activities.
• Designed and implemented basic SQL queries for testing and report/data validation
• Assigned tasks among development team, monitored and tracked progress of project following Agile methodology.
• Created Process Flow diagrams, Use Case Diagrams, Class Diagrams and Interaction Diagrams using Microsoft Visio and Rational Rose.
• Wrote Test Cases and performed User Acceptance Testing, documented the in detail defects using the Defect Tracking report.
• Used Test Case distribution and development reports to track the progress of test case planning, implementation and execution results.
• Assisted ICD-10 Team with loading ICD-10 PCS 2012 Procedure Codes toFacets4.71
• Wrote PL/SQL statement and stored procedures in Oracle for extracting as well as writing data.
• Created Use cases, activity report, logical components and deployment views to extract business process flows and workflows involved in the project. Carried out defect tracking using Clear Quest
• Maintained proper communication with the developers ensuring that the modifications and requirements were addressed and also monitored these revisions.
• Involved in compatibility testing with other software programs, hardware, Operating systems and network environments.

Environment: Requisite Pro, Rational Rose, Agile, PL/SQL, HTML, MS Office, MS Visio, EDI, UML, Manual Tester V6.1, Rational Clear Quest, Facets 4.31, UNIX, Java, XML, Oracle, SQL Server, Sybase, SQL advantage, SQL*Plus, SQL Navigator, Mainframe, Manual Testing

Confidential, Washington DC

Business Analyst

Responsibilities:

• Gathered analyzed, documented business and technical requirements from both formal and informal sessions and validate the needs of the business stakeholders.
• Performed Cost benefit, ROI and ROM studies
• Conducted user interviews and documented business and functional requirements.
• Performed Requirement Analysis and developed Use Cases, Activity Diagrams using Rational Rose
• Developed UML Use Cases using Rational Rose and developed a detailed project plan with emphasis on deliverables.
• 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.
• Worked with Cognos and micro strategy reporting systems to extract the data for analysis using filters based on the analysis.
• Wrote detailed specifications for various reports generated using Cognos
• Upgraded HMO Medicare EDI and reporting.
• Maintained on-going technical assistance and provided help desk support to customer’s mainframe systems software that included problem determination and resolution.
• Completed the documentation of Claims Scenario’s for the source system
• Analyzed the existing claims process and specific business rule logic will be applied in the ACP model.
• Documented Medicare claims processing.
• Designed High level design, for New process, integrating with legacy and Facets
• Involved in creating business processes and modeling diagrams using Rational Unified Process (RUP).
• Exposed to Agile methodology.
• Involved in Service Oriented Architecture (SOA) of the claims processing system
• Created use case scenarios and documented work flow and business process using Rational Rose
• Involved in project management using MS Project
• Collaborated with External Auditors and documented SOX compliance requirements
• Documented requirements, associated change requests with requirements and connected requirements with Use cases.
• Wrote test cases and test scripts for the User Acceptance Testing
• Incorporated Rational Unified Process (RUP) to create Requirement Document Specifications using Visible Analyst.
• Performed extensive data modelling to differentiate between the OLTP and Data Warehouse data models
• Identified/documented data sources and transformation rules required populating and maintaining data warehouse content.
• 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
• Responsible for creating test scenarios, scripting test cases using testing tool and defect management for Policy Management Systems, Payables/Receivables and Claims processing.
• 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.
• Queried database using SQL for backend testing
• Used Rational clear quest for defect management

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