SUMMARY

• Accomplished business and technology professional with 8 + years experience working within top global and national Healthcare companies.
• Leading small projects / supporting large technology projects and implementations, trouble - shooting client issues, relational database management systems, data ware houses, ETL tools, project management support, integration tools, systems analysis, healthcare business processes, software development life cycle, Highly proficient in creating complex UML diagrams from business and systems specifications.
• Adept with industry standard methodologies like SCRUM, Rational Unified Process (RUP), Agile Methodology and waterfall traditional method.
• Sound knowledge of concepts like Gap Analysis, Risk Analysis, Impact Analysis.
• Excellent Business writing skills in writing Business requirements document, USE Case Specifications, Functional Specifications, Systems Design Specification (SDS), Systems Requirements Specification (SRS)
• Thorough exposure of conducting JAD sessions and interviews with Subject Matter Experts (SME) and data stewards to understand the business process, business rules, and data requirements.
• Worked in complete project life cycle of Analysis, Design, Implementation, Integration Testing, Functional and Regression testing.
• Extensively working experience on SharePoint/TeamSite and Asp.Net environment.
• Involved in User Acceptance Testing and training of end users.
• Experience in Maintaining Reference Data Management System and Master Data Management System with Service Oriented Architecture (SOA).
• Exposure to HIPAA Compliance requirements and HL 7 standards.
• Experience of creating applications that are 21CFR Part 11 compliant.
• Experienced with Confidential claim processing system.
• Experience with Medicare, Medicaid, and commercial insurances in HIPAA ANSI X12 formats including 270/271, 276/277, 810, 820, 834, 835, 837, 997.
• Deep understanding of X-12 Implementation Guide for Healthcare Domain and SOX compliance auditing.
• Experience in Rational Rose, Clear Case, Requisite Pro, Clear Quest and MS Visio.
• Good communication and customer service skills, Responsible, self-motivated and organized, Excellent written and verbal skills.
• Ability to prepare RTM (Requirements Traceability Matrix) & do requirements analysis
• Proficient in using UML for Business Process Modeling, Use Cases, Activity Diagrams, Sequence Diagrams, Data Flow Diagrams, Collaboration Diagrams, Class Diagrams and document them using Microsoft Visio.
• Used MS Office extensively (Word, Excel, MS Access Visio, Power Point, Outlook, Project) for calculations, graphs, analysis, presentation and documentation throughout the projects.

TECHNICAL SKILLS

Environment: Languages C, C++, C#.NET, Asp.Net, Java, J2EE, COBOL

Operating Systems: Mainframe, Windows 9x, 2000, XP & NT, Linux, UNIX

Scripting Languages: SQL, PL/SQL

Tools: & Technologies Microsoft Visio, SharePoint Site, Microsoft Exchange Messaging, SQL Server, SQL Navigator, TOAD, Erwin, Rational Rose and UML Design, MS Front page. Quality Center, BEA Aqualogic, TeamSite Interwoven

Database Server: MS SQL Server, Windows, Sun Solaris, Weblogic app server

Database: Oracle, DB2, Mainframe, MS Access, SQL Server

Methodologies: Rational Unified Process (RUP), Agile and Scrum.

Reporting Tools: Crystal Reports, Business objects

Source Control Software: Rational Clear Case, Clear Quest, Perforce, Documentum, SharePoint

PROFESSIONAL EXPERIENCE

Confidential, Chicago, IL

Business Analyst

Responsibilities:

• Reported Business Growth and projections to Senior Management.
• Compiled Vision and Scope documents to better define the rationale for the project.
• Updated the Functional Requirement Specifications (FRS) based on User Requirement Specification (URS).
• Gathered and articulated business requirements from users and SME interviews and maintained the document repository on Requisite Pro.
• Worked on Confidential Processing System, household claim processing system.
• Used Confidential ’s Data Analysis and report tool (DART) and XML messaging service.
• Base-lined the requirements in DOORS.
• Schedule meetings with technical personnel to determine technical parameters for EDI and other related processes, including communication, security, and privacy.
• Worked on multiple 837s and multiple Eligibility (270/271) and healthcare claim status (276/277).
• Understood Functional/Technical (Data Model) flow of 4010 HIPAA Transactions and identify the new 5010 segments/element changes required with minimum changes to system.
• Used guidelines and artifacts of RUP to strategize the implementation of Rational Unified Process effort in different iterations and phases of software development life cycle (SDLC).
• Redefined use case, process flow, and activity diagrams using MS Visio for a clear understanding of the requirements.
• Played a pivotal role in conducting Functional testing, Regression testing, and User Acceptance Testing (UAT).
• Reviewed test plan based on Requirement Traceability Matrix (RTM) and defect tracking using Clear Quest.
• Collaborated with developers and quality assurance analyst to track defects and used Rational Clear Case to maintain consistency in the builds.
• Suggested possible schema for the XML structure for automation of data processing and generation and acceptance of feeds over the web.
• Designed and validated schema for XML structure.
• Researched on XML Diff and Validation tools and recommended to the management.
• Analyzed System and Functional Specification documents for the Web Portal System
• Worked with SOA meta- model, SOA governance and SOA reference architecture and maintained SOA standards.

Environment: .NET, MS SQL Server 2005, WebSphere, Windows XP, RUP, UML, Visual Basic, Rational Rose, Rational Requisite Pro, Rational Clear Case, UML

Confidential, Sioux Falls, SD

Business Analyst

Responsibilities:

• Drove the requirement-gathering phase (Provider, Claim components and HIPAA).
• Created and tested Scripts for the premium calculations and Claims limits and deductibles (Claims calculations).
• Developed Base line scripts for testing the future releases of the application
• Applying the SQL scripts to the test database and execution of the scripts on the database
• Work with business representatives to understand data marts requirements and priorities and ensure that IT work is appropriately aligned
• Studied Oracle 11i data elements and provide a mapping from the existing legacy system.
• Responsible for creating business work flows and processes and creating management reports based on the analysis.
• Conducted joint discussion sessions with business users, stakeholders to understand the requirements in more detail.
• Clarified QA team issues and reviewed test plans and test scripts developed by development team and QA team to make sure all requirements have been covered in scripts and tested properly.
• Maintained Test Matrix with the test results obtained.
• Work experience in maintaining datamarts dealing with ETL (extraction, transformation, and load) using Oracle and Informatica.
• Dealt with data mapping issues between various source systems and staging area and data-marts.
• Worked with Business users to come up with Reporting Requirements. Reports were developed in Cognos.
• Used the Rational Unified Process (RUP) to build the different phases of Software development life cycle.
• Data mapping, logical data modeling, used SQL queries to filter data within the Oracle database tables.
• Interaction with the business user and the IT team for understanding the requirements.
• Came up with test cases for various reports on the data marts and identified that the test case documents are updated timely.
• Defects and bug testing by using Rational ClearQuest, Configuration management and Version control with ClearCase.
• Review of high-level design document and low level design of classes and sequence diagrams.

Environment: JSP/Servlets, JDBC, Teamsite Interwoven, BEA Aqualogic, WebSphere, UNIX, MS-Project, Visio, Rational Rose, clear case, Requisite Pro, Oracle

Confidential, Philadelphia, PA

Business Analyst

Responsibilities:

• Responsible for defining the scope of the project, gathering business requirements, doing gap analysis and documentation.
• Understood and articulated business requirements from user interviews and then converted requirements into technical specifications.
• Interviewing area experts, asking detailed questions and carefully recording the requirements in a format that can be reviewed and understood by both business and technical people.
• Adhered to HIPAA for health insurance & Medicare claims, responsibility included from functional requirement specification to testing the claims for HIPAA-compliant format and also to ensure all NCPDP formatting standards.
• Reviewed and implemented the change requests from CMS (Center for Medicare Services).
• Analyzed Healthcare transaction flow for HIPAA Healthcare Transactions like 834, 835, 270, 271, 276, 277, and 278.
• Involved with all the departments like Claims, Actuarial and Pricing for developing company Data Warehouse.
• Requirements specification for Indemnity Healthcare plans and Indemnity Payer.
• Interacted with development team for communicating the requirements & use cases.
• Interacted with Offshore Development teams & testing teams by guiding then in design questions & test deliverables.
• Responsible for writing Functional Requirement Specifications (FRS) and User Requirement Specification (URS) for the Web based application.
• Used Rational Rose extensively to create Use Cases, Activity Diagrams, Sequence Diagrams, State chart diagrams and Collaboration diagrams.
• Prepared a prototype, had JAD sessions with users explaining data flow and sequence of events.
• Followed FDA and HIPPA guidelines in collecting, reporting data, organization with graphical representation.
• Familiar with 21CFR parts 210, 211 and 11.
• Experienced with technical writing, SOPs, documentation and reporting of data.

Environment: MS Office, MS Visio, UML, MS Project 2000, Oracle, UNIX, Windows

Confidential, Cypress, CA

Business Analyst

Responsibilities:

• Gathered business requirements through JAD sessions and one-on-one interviews with the Business Stakeholders and tracked the requirements using CALIBER.
• Authored Functional Requirements document and Screen design specifications.
• Design and implement software components such as reports, forms and database packages using PL/SQL, ORACLE 9i and 10g on Unix/Solaris platform.
• Recommending and specifying changes to existing technologies to improve content flow and eliminate redundancy
• Performed analysis and design using a systems development methodology. Worked with all levels of client staff in solution definition.
• Conducted technical review sessions and facilitated other project meetings as required.
• Developed business requirements document with the project team. Extracted, discussed and refined business requirements from the users.
• Developed functional requirements documents by interacting with the IT personnel and the Business users.
• Worked on Web based Knowledge management system Live Link.
• Experience in Live Link Notifications and Workflow management.
• Experience in Live Link Work flow functionality and Database connectivity.
• Worked with the business team to collect the business requirements, security and service level requirements and documented them using Requisite-Pro.
• Participated in the logical and physical design sessions and developed design documents.
• Designed new process flows for the existing system as well as for the enhanced system.
• Conducted and lead status report meetings with the business and the IT team on a weekly basis.
• Co-authored Data design, Architecture design and Staging requirements for the Data warehouse environment.
• Exposure to HIPAA Compliance requirements and HL 7 standards.
• Worked on EDI Transactions Validation such as 270/271, 276/277, 835/836, NCPDP 5.1/D.0.
• Member number and RX number expansion for D.0 5010 HIPPA
• Used IVR to help customers receive anonymous calls about their test results or content update.
• Performed Document Management and version control using Share Point.
• Documented test cases during requirements gathering, analysis and design phases.
• Manage Scope and change throughout the life cycle of the product.
• Responsible for addressing, diagnosing and resolving issues that arise on a day to day basis for the team.
• Also responsible for documenting the causes, analysis and final resolution to the issues/errors.
• Identified areas of risk exposure and loss techniques adopted.
• Translated customer/client needs into new features and new services.

Environment: SCRUM, Share Point, HIPAA, NCPDP, Caliber, Feature Driven Development (FDD), MS Project, MS Visio, MS Word, MS Excel, MS SQL Server, ASP. NET, Windows XP, Microsoft Reporting Services