Professional Summary:

• Over 8+ years of professional experience in Business Analysis, Business Modeling, Requirements Gathering, Technical Documentation
• Experience in creating Business Requirement Documents (BRD), Use Case Specifications, Process Flow Diagrams, Functional Specifications, Requirements Traceability Matrix(RTM) across the project Deliverables
• Experience with claims process and adjudication in the Medicare, Medicaid, Private Insurance Sectors and property and casualty insurance sector.
• Excellent in writing business and system specifications, designing and developing use case and test case scenarios, Sequence Diagrams, Collaboration Diagrams, Activity Diagrams, developing test plans, analyzing root-cause analysis of software failure, conducting user acceptance testing as well as training and implementing new processes and procedures
• Extensive experience on Software Development Life Cycle(SDLC) in Waterfall, Agile, and RUP
• Experience with claims process and adjudication in the Medicare, Medicaid and Private Insurance Sectors
• Experience in technical writing skills and writing BRD, FRD.
• Excellent knowledge of various data design models- Entity Relationship(ER), Multi-Dimensional/ Star Schema and Snow Flake Schema models.
• Helped in creating a Data Dictionary having the business definition of Data Mapping to map the Logical Data elements in use cases to Physical data elements (record source)
• Expertise in gathering requirements for implementing complex business rules using different Transformations, Mappings and Mapplets.
• Expert in querying and analyzing the data in SQL and their relationships.
• Expertise in implementing Rational Unified Process (RUP) using Rational Suite
• Possesses experience in framing business process and acting as a liaison between the Business Management, development and testing teams
• Experience in conducting Joint Application Development (JAD) sessions, Feasibility Studies, Risk & Impact Analysis
• Ability to implement Change Management and Defect Management techniques
• Proficient at coordinating the testing team in developing test plan and test cases by giving the view of functional requirements
• Excellent knowledge of MS Office especially MS Excel, Visio, Power Point, Word etc.
• Successful as a team player to work in conjunction with other testers, developers and other team members in validation and testing complex scenarios and projects and in the maintenance of Quality Standards in Projects especially with Test Director

Skills:

Operating System : Windows 2003/2000/NT, Linux, UNIX
Languages : C, Java, VB, HTML, UNIX shell scripting, .Net Framework
Database : MS-Access, Oracle10g/9i/8i, SQL Server 2008/2005/2003, IBM
DB2
Microsoft Office Suite : MS Word, MS Excel, MS PowerPoint, MS Project
Web protocols : HTTP, TCP/IP, FTP
Modeling tools : MS-Visio, Rational Rose, Adobe Fireworks, Visual Studio.
Methodologies : SDLC, OOAD, RUP, UML, JAD, HIPAA, Agile Methodology,
CPT, and ICD-9 and ICD-10 Coding,
Requirement and Test : RSA (Rational software Architect), Rational Case, Req-pro.
Tools : Win Runner, Test Director, Load Runner, Quick Test pro, QC,
Cognos 8.4, Informatica IDE 8.6

Confidential,NJ Aug’ 11 – Till date
Business System Analyst

Horizon BCBSNJ is incorporated under New Jersey statute as a not-for-profit, health Service Corporation. Horizon BCBSNJ sells health insurance in New Jersey. I was involved in working with Enterprise Data warehousing team, involved in working as BSA in multiple projects like Rendering Referring and Attending physicians, State Health Benefits Program, LATRON Dental Migration and High Cost Injectable.
Referring Rendering and Attending Physicians:
The Rendering, Referring and Attending Physician project is to capture a unique ID number, National Provider ID (NPI) for individual providers submitted on a claim.
State Health Benefits Program:
The SHBP/SEHBP claims are processed on NASCO and the enrollment in the NMS. The SHBP changes their current product offerings. The ADR is which we use to deliver external group reports and extracts to the Division of pension and benefits, AON Hewitt, local employers and their brokers.
High Cost Injectable:
Horizon BCBSNJ has partnered with ICORE (a Magellan Healthcare Company) to render pre-service and post-service Medical Necessity Determination (MND) and process prior authorization and retro reviews requests for Providers utilizing high cost Injectable such as Remicade, IVIG, Oncology drugs, etc.
Responsibilities:

• Gathered Requirements from various Business Areas like Claims, Provider Relations, Enrollment, Finance and Benefits Administration for their updates to the Claims, Insurance.
• Developed BRD, FRD, use cases, test scenarios, test cases for testing the functional
• Conducted JAD sessions with business and technical team to understand expectations and priorities.
• Interacted with NASCO and QBLUE teams for analyzing the claims data and gathering the requirements to write the technical requirements document and analyze the quality of data which flows into EDW team.
• Experienced in Data Analysis- Mapping and Staging in SQL Server Environment.
• Performed Gap Analysis & Assessment
• Worked on data profiling of the data using Informatica IDE tool to check the quality of data.
• Worked with Claims, Insurance, enrollment, eligibility verification for members and providers, benefits setup worked with the technology team to resolve application configuration issues.
• Worked on insurance on medical professional liability.
• Developed strategic partnerships with the Business Users to develop solid knowledge base of the business line, including the business plan, products and process
• Facilitated weekly meetings with the review teams to continuously improve the Quality Assurance (QA) process for the application development
• Worked with the client to identify payer issues that affect claim submission and payment.
• Experience in writing Select queries, joins to retrieve and analyze the data.
• Reviewed the companion guides and made appropriate suggestions to the technology team.
• Worked with the client to identify daily business needs (Electronic claims, Paper claim requirements).

Environment: ETL, MS-Excel, Visio, Word, PowerPoint, SQL, Windows XP, IBM DB2, Cognos 8.4, Informatica IDE.

Confidential,FL Oct’10 – Jul’ 11
Business Analyst

PMSI is one of the nation’s largest full-service providers of technology-enabled, clinically driven services for Pharmacy, Medical Services and Equipment, and Settlement Solutions and is devoted exclusively to the workers’ compensation and liability markets. Claims management system (Vital Point) – Implementation of the claims management system was part of PMSI initiative to upgrade and integrate its overall IT infrastructure. With better claims processing PMSI was able to achieve higher operational efficiency and considerably shorter revenue cycle time. Vital Pointis a web based real time application which manages claims related to Pharmacy and Medical Services & Equipment. It is used to review eligibility and utilization information, authorize pending transactions and view claims data.
Responsibilities:

• Gathered Requirements from various Business Areas like Claims, Provider Relations, Enrollment, Finance and Benefits Administration for their updates to the Claims, Insurance.
• Developed BRD, FRD, use cases, test scenarios, test cases for testing the functional and non-functional using RequisitePro and Rational Rose to create/maintain: Use Cases, Activity Diagrams, Sequence Diagrams, and Collaboration Diagrams.
• Interviewed stakeholders to produce a business problem statement, establish scope and goals.
• Created PowerPoint project presentations for briefing the stakeholders.
• Helped the PM in making the Work breakdown Structure.
• Conducted JAD sessions with business and technical team to understand expectations and priorities.
• Experienced in Data Analysis- Mapping and Staging in SQL Server Environment.
• Performed Gap Analysis & Assessment
• Worked with Claims, Insurance, enrollment, eligibility verification for members and providers, benefits setup, fee worked with the technology team to resolve application configuration issues.
• Worked on insurance on medical professional liability.
• Worked with the client to identify payer issues that affect claim submission and payment.
• Reviewed the companion guides and made appropriate suggestions to the technology team.
• Worked with the client to identify daily business needs (reporting needs, paper claim requirements).
• Validated the test scenarios and test results, documented defects in Test Director.
  Worked with users to accomplish User Acceptance Testing (UAT).

Environment: ETL, MS-Excel, Visio, Word, PowerPoint, SQL, Windows XP, SQL Server 2008, .Net, UI design
Confidential,NY Jan’09 - September’ 10
Business Analyst
File Tracker
Pfizer Inc. is the world\'s largest research-based pharmaceutical company. I was involved into Self-service team. The Novell File Tracker site will track all Novell services and the dates associated with the migration activities. It will also function as a reporting mechanism to track and scope the migration efforts. In order for sites to either close or undergo an HP support transition activity, the Novell services currently in use must be identified and decommissioned.

• Served as a liaison between the business units and technical staff (ISD).
  Initiated and conducted interviews with business units to complete business specifications, documenting the Business Requirements Document (BRD).
• Create activity diagrams based on user interactions, participated in problem solving, decision-making and the specifications walk through with the users.
  Analyzed, defined, documented and communicated systems requirements.
• Validated the test scenarios and test results, documented defects in Test Director.
  Worked with users to accomplish User Acceptance Testing (UAT).
• Responsible for conducting data shifting, analyzing, compiling, and validating patients medical data by using basic skills in statistics and relational database management.
• Perform the tasks of gathering and compiling patients’ electronic medical data or experimental study data to analyze, interpret, summarize and report research findings.

Environment:Test Director, MS-Excel, Visio, Word, PowerPoint, Outlook Express, Rational Rose, Clear Case, SQL, Windows XP

Business Service Catalog
the world\'s largest research-based pharmaceutical company. I was involved into Self-service team. The Business Service Catalog (BSC) is designed to define and categorize our service offerings. The goal is to enhance the ability to identify services that will support your business requirements and to enhance your understanding of what the service provides. Each service provides you with a description of the service, business benefits, features included, options for the service, Service Level Agreements, cost and how to get additional information on the service.

• Analyzes trends to recommend process and/or operational improvements
• Prepares detail and summary level reports including written interpretation of analytic results
• Serve as a liaison with financial managers and other technical members
• To assess and document current capabilities and develop requirements as necessary for new projects/initiatives
• Participated in new database design in order to get updated information of data mart
• Created Use Case Scenarios and maintained the Use Cases (Business Use Cases, System Use Cases) and modeled Use Case Diagrams, Activity Diagrams,BusinessFlow Diagrams, and revised functional specifications
• Gathered requirement for Informatica mappings, enabling the extract, transporting and loading of the data into target tables.
• Created and validated Use Cases for the reports requested by the Business users.
• Involved in requirement gathering for slowly changing dimensions.
• Created Auditor reports and tracked user access of reports and Universes.
• Validated use cases for dimensional modeling and the bottom-up approach.
• Gathered requirements for basic test strategy to support test development and execution of source-to-target mappings.
• Evaluates financial impact of implemented initiatives
• Developed requirements for Informatica mappings for data loads and data cleansing.
• Validated the requirements for all Mappings, Sessions and Workflows for Data accuracy.
• Gather requirements of existing industry competitors and financial ratios

Environment:
Rational Rose, MS Word, MS Excel, MS Visio, MS Project, SQL Server 2005, Test Director, Quality Center.

Education:

• Bachelors in Computer Science and Engineering.