SUMMARY

• Senior Business/Systems Analyst/ EDI Analyst with 8+ years of experience in business process analysis/modeling, business requirements gathering, database design and development of Web Based, and Client/Server applications.
• Experience as Business/Systems Analyst with expertise in Insurance, Healthcare processes, Business Process Engineering, Systems/ Solutions Engineering, Strategic Planning, and Systems Analysis.
• Experience with health care Systems: QNXT, Medicare Part A, B, C, D, Medicaid and BDS (Business Distributor System).
• Familiar with HIPAA EDI transactions such as 835, 837 (P, D, I) 276, 277, 278 etc.
• Industry experience as a Business/Data Analyst with solid understanding of Business Requirements Gathering, Data warehousing, Data Modeling, Evaluating Data Sources, Translating Requirements into Specifications, Application Design.
• Proficient in business process modeling, documentation, and testing using Rational Suite (Rational Rose, RequisitePro, SoDA, ClearQuest, Robot) as well as MS Visio and MS Project in combination with UML 2.0 diagramming techniques.
• In - depth knowledge of creating use case, activity, logical, component and deployment views with rational tools to extract business process flows and workflows thereby helping development and quality assurance teams in understanding the requirements.
• Knowledge in the ETL (Extract, Transform and Load) of data into a data ware house/date mart and Business Intelligence (BI) tools like Business Objects Modules (Reporter, Supervisor, Designer, and Web Intelligence).
• Results-oriented Joint Application Development (JAD) Facilitator and meetings coordinator with excellent interpersonal skills.
• Expertise in the EPIC Medical software application (EMR).
• Knowledgeable of HL7 Messaging protocols.
• Extensive experience in all phases of RUP and SDLC processes
• Managed content using Docushare 5 and DocushareCPX and integrated it with other products like Liberty, Xerox Advanced Multifunction Devices
• Excellent understanding of Software Quality Assurance Techniques, CMM, Six Sigma and ISO Standards and highly acquainted in working in SOX Compliance Environment.
• Analytical, methodical, and resourceful approach to problem solving, identifying and documenting root causes and corrective actions
• Performed Gap Analysis to check the compatibility of the existing system infrastructure with the new business requirements
• Expertise in broad range of technologies, including business process tools such as Microsoft Project, Primavera, MS Access, MS Visio, technical assessment tools, Data Warehousing concepts and web design and development.
• Experience in Change Management Process (Identify, Analyze, Evaluate, Plan, Implement, Review and Close).
• Strong oral and exceptional written business communication skills
• Hard working, positive thinking, self starter with a strong goal orientation
• Excellent meetings facilitator with excellent inter-personal and conflict resolving skills.
• Proven success as a business analyst through the years, providing a well-balanced understanding of business relationships, business requirements, and technical solutions.

TECHNICAL SKILLS

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

Performance Testing Tools: Virtual User Generator, Load Runner

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 - Sacramento, CA

Sr. Business Analyst

Responsibilities:

• Served as the conduit between the users and theITteam, through which requirements flow
• Reviewed, design and business requirement documents to learn the scope and purpose of the application.
• Analyzed trading partner specifications and created EDI mapping guidelines.
• Acted as a liaison between the client and the project team to relate expectations, oversee progress, and alsoresolve conflicts.
• Collaborated with system users and management to identify Business system needs evaluated solutions to business problems/bottlenecksand evaluated alternate methods to improve efficiency and control.
• Involved in adding Contracts to the Provider in QNXT and associating Providers in Portal while creating claims.
• Accumulated system requirements from stakeholder through surveys, interviews and JAD sessions.
• Experience in EDI automated first-pass claim adjudication, requiring thorough understanding of claim processing, both front and backend operations.
• Wrote clear, conciseBusiness Requirement Document(BRD) andFunctional Specifications Document(FSD) where developers can interpret and develop the application with minimum guidance.
• Worked on EDI transactions: 270, 271, 834, 835, and 837 (P.I.D) to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
• Designed field’s layout and fieldmappingstrategy fordata migrationfrom legacy systems usingETL.
• Experienced in processing the Claims EDI 835 and EDI 837 using the Rx Claims Claim Processing Systems.
• Involved in auditing and evaluating the change management process of a business and performed Impact Assessment(IA)
• PreparedFlow Diagrams(As-Is) for the existing system usingVisio. ConductedGap Analysisby brainstorming with Developers, Architects and Business users to get the ‘To Be’ process/ proposed environment.
• Tested the claims and various Interfaces in QNXT.
• Trouble Shooted file transmission problems and assisted customers in a call center environment with EDI and Medicaid Insurance claim related inquiries explained and enforced guidelines in the X12 Implementation guides (837P, 837I, 837D, 270/271).
• Prepared Requirements Traceability Matrix (RTM) and mappedtest caseswith requirements documents.
• Used Rational Clear Quest fordefect trackingandCognos Analysis Studiofor data analysis andreporting.
• Detected, reviewed andreported bugsusing Bugzilla.
• Wrote SQL queries, working with back end tools such as TOAD and performedUAT.

Environment: SQL Server, .NET, SSIS, SSRS,SSAS, Windows XP, QNXT, Rational Rose, Rational Requisite Pro, Clear Case, Clear Quest, UML, Rational Suite, MS Visio, MS Project, MS Office (MS Word, MS Excel, MS PowerPoint), MS Access, XML

Confidential

Sr. Business System Analyst

Responsibilities:

• Played key role in System Development Life Cycle Process consisting of: Design and Gap Analysis, Business Requirements, Systems Requirements, Test Criteria
• And Implementation to have the outputs of project dealt with the automation of correspondence directed to Insurance policy owners.
• Conducted Requirements walk- through with the Business Team to ensure that all their needs are met and gathered sign off on the requirements for SOX compliance after the requirements were base lined.
• 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 testing Membership enrollment in QNXT.
• Used knowledge of Health Care Information Systems EMR model to develop proposed workflow in MS Visio.
• Design, development, implementation and roll-out of Microstrategy Business Intelligence applications.
• Published detailed guide describing data file content and structure for business partners; created quick reference guide for HIPAA EDI ASC X12 834 transaction set for Medicaid enrollment.
• Conduct complex documentation and user needs analysis. Interface with team and staff to develop HL7 integration.
• Developed HL7 messaging for bi-directional case and disease report exchange, in text and XML formats, in accordance with HL7 specifications.
• Reduced costs of labor by implementing QNXT.
• Conducted Functional Walkthroughs, User Acceptance Testing (UAT), and supervised the development of User Manuals for customers.
• Worked on EDI 834 transaction code for benefit enrollment and also involved in HIPAA validation.
• Interfaced between Business new product builders and System platform builders.
• Worked with systems area to translate business needs into system requirements.
• Made sure the test cases and test process guarantee accountability to business and systems requirements.
• Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data within the Oracle database
• Involved in the testing phase right from the Unit testing to the User Acceptance testing.
• Used SDLC (System Development Life Cycle) methodologies like the RUP and the waterfall.
• 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.
• Use Cases and other Process Flow Models were designed using Visio and Rational Rose.
• Involved in jobs and analyzing scope of application, defining relationship within & between groups of data, Star Schema etc
• Followed the UML based methods using Rational Software Modeler/MS Visio to create: Use Cases, Activity Diagrams / State Chart Diagrams, Sequence Diagrams, and Collaboration Diagrams.
• Tuned the batch programs and online transactions to alleviate performance problems.
• Developed & executed several Optimized queries in SQL on this data.

Environment: RUP, UAT, GAD (Gap Analysis Document), QNXT, Microsoft Office 2003 Professional (Outlook, Word, Excel, Visio, Access), Microsoft SharePoint 2003.

Confidential, Grand Rapids, MI

Business System Analyst

Responsibilities:

• Documented the server farm requirements and requirements related to security within Share Point and using Windows Active Directory.
• Followed a systematic approach to eliciting, organizing, and documenting requirements of the system.
• Reviewed the Joint Requirement Documents (JRD) with the cross functional team to analyze the High Level Requirements.
• Conducted data analysis of the existing ICD 9 and SNOMED databases in the system to identify the data gaps.
• Responsible for creating the ICD 9 to SNOMED data mappings and creating the new SNOMED Master table.
• Involved in testing claims/Financial management in QNXT.
• Used Query Analyzer, Execution Plan to optimize SQL Queries.
• Meticulously assessed data from various sources and generated conceptual and logical database designs using ERwin data modeling tool.
• Interacted with client and the Technical Team for requirement gathering and translation of Business Requirement to Technical specifications.
• Conducted interviews, meetings and JAD sessions during the process of Requirement Gathering.
• Planned and documented procedures for data processing and prepared data flow diagrams for the application.
• Got involved in designing future state processes for HIPAA 5010 transaction processing EDI’s 837,835, 270, and 271.
• Analyzed HIPAA 5010 related to 837,835, 270, and 271. Transactions and performed gap analysis between the 4010 and 5010.
• Analyzed and translated business requirements into system specifications utilizing UML and RUP methodology.
• Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data within the Oracle database
• Experience in EDI automated first-pass claim adjudication, requiring thorough understanding of claim processing, both front and backend operations.
• Used Test Director, Oracle PL/SQL for testing the application.
• Prepared and documented System Requirements and workflows for the Content Management Application tool.
• 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 the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims.
• Worked on EDI transactions: 270, 271, 834, 835, and 837 (P.I.D) to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
• Performed Unit Testing and User Acceptance Testing and documented detailed defects.
• Designed and developed project document templates based on SDLC methodology.

Environment: QNXT, Windows 2000/XP, Microsoft Office SharePoint 2007, Rational Requisite Pro, MS Office, SQL Server, Oracle, PL/SQL, Agile, MS Project, MS FrontPage 2003, MS Access, EDI, Documentum 2.0.,UML.

Confidential, Washington DC

Business/Systems Analyst

Responsibilities:

• Interviewed Business Users to gather Requirements and analyzed the feasibility of their needs by coordinating with the project manager and technical lead.
• Collects requirements from department managers and users for enhancements. Acts as liason between clients and development. Facilitates sessions to bring business requirements and functionality into SAP system development and enhancement.
• Prepared Business Requirement Documents (BRD’s) after the collection of Functional Requirements from System Users that provided appropriate scope of work for technical team to develop prototype and overall system.
• Used IBM WebSphere Business Modeler to fully visualize, comprehend, and document the business processes. To model and optimize the business-critical processes. Define and refine process models through the company's best practices.
• Interacted with users for verifying User Requirements, managing Change Control Process, updating existing Documentation
• Created reports from SAP modules using Business Objects / Crystal Reports based upon business requirements.
• Identified/documented data sources and transformation rules required to populate and maintain data warehouse content.
• Was responsible for indexing of the tables in that data warehouse.
• Reverse Engineered the existing ODS in to Erwin.
• Involved in data migration design so that the data can be exchanged from other systems in standard ACORD XMLife standards.
• Worked on data modeling and produced data mapping and data definition documentation
• Configured the Data mapping between Oracle and SQL Server 2005.
• Tested Performance & Accuracy related queries under SQL Server
• Created relationships in Requirement Traceability Matrix linking Business Requirements to Functional requirements and Functional Requirements to Systems Requirements.
• Conducted Joint Application Development (JAD) sessions with IT groups. Identified the Key Changes, and participated in Stakeholder Management to communicate effectively with them
• Used Data warehousing for Data Profiling to examine the data available in an existing database.
• Prepared graphical depictions of Use Cases, Use Case Diagrams, State Diagrams, Activity Diagrams, Sequence Diagrams, Component Based Diagrams, and Collateral Diagrams and creation of technical design (UI screen) using Microsoft Visio.
• Worked on Documentum for Version Controlling, to maintain up to date changes in the Documents.
• Assisted to develop the Test Plan, Test Cases and Test Scenarios to be used in testing based on Business Requirements, technical specifications and/or product knowledge.
• Conducted User Acceptance Testing, gathered and documented User Manuals and Business Rules

Environment: Microsoft Office Suite, Microsoft Visio, Documentum, Windows NT/XP, Oracle, SQL, SQL Server, Sybase, EVPN, IBM Websphere Business Process Modeller, ACORD, XML,Business Objects, TestDirector, LoadRunner

Confidential, Chicago, IL

Business Analyst

Responsibilities:

• Served as a liaison between mortgage specialists and the project team.
• Responsible for gathering user requirements and specifications for designing a mortgage based loan system using and documenting the same.
• Extensively involved in maintaining requirements traceability and communicating any changes to these requirements to different business groups and programmers.
• Worked on HL7 and xml interface messaging.
• Led and conducted JAD sessions for requirements gathering, analysis and design of the system.
• Created context and workflow models, information and business rule models, Use Case and Object Models during the analysis using Rational tools.
• Provide implementation assessment, strategy, and mentoring services for Rational Rose, UML and RUP.
• Designed the system, prepared UML and sequence diagrams using Rational Rose.
• Responsible for writing detailed descriptions of user needs, program functions, and steps required for developing or modifying software programs using Rational Rose (UML).
• Prepared Functional Specification Documentation (FSD) and communicated these to the stakeholders.
• Actively interacted with different business groups to perform Gap analysis to identify the deficiencies in the system by comparing the actual objectives with the system objectives desired.
• Conducted Business Requirements, Functional and Technical meetings with Business groups.
• Used MS Visio for Process modelling and Business Process flow diagrams.
• Extensively involved in regression testing during various phases of the application.
• Used Aggregator stages to sum the key performance indicators used in decision support systems.
• Troubleshot the designed jobs using the DataStage Debugger.
• Tuned DataStage transformations and jobs to enhance their performance.
• Wrote PL/SQL statement and stored procedures in Oracle for extracting as well as writing data.

Environment: Rational Enterprise Suite (Rose, RequisitePro, ClearCase, ClearQuest) UAT, RUP, WinRunner, Load Runner, MSOffice2000.