SUMMARY

• More than fourteen years of experience in information technology as a senior business/system analyst/lead with experience in business/system analysis, design and development of applications, testing, group enrollment and implementation with PEGA 6.1 and TIBCO.
• Ten years of healthcare experience with healthcare mandate implementations including enrollment/eligibility & ICD9 to ICD10, Medicare, Medicaid, PBM and affordable care Act 2010, Obama care and PBM using FACETS 4.7/5.0/NetworX Pricing.
• Seven years of BCBSIL (HCSC) and BCBSMD (CareFirst) experience as facets 5.0/IBM 3270 TSO expert in claims processing, enrollment, membership, benefits management and billing/payments and I have also performed well in testing lead/manager/business architect roles on healthcare migration or reform projects with Pega/Tibco/Facets/NetworX Pricing.
• Specific industry experience includes health care, retail and financial services.
• Worked with all facets of the software development life cycle including design, analysis, and development and testing the Web - based and n-tier client/server applications.
• Comfortable with internet technologies such as HTML, DHTML, CSS, XML, XSL, XSLT and JavaScript and comfortable working with Mainframe/NASCO COBOL, JCL, CICS and DB2.
• Extract Transform and Load(ETL) and BI tools have been used in the projects on loading the data and maintained the data for reporting with Cognos and Star Schema to maintain the data.
• Familiar with relational database design and other database management oriented concepts such as writing Stored Procedures, PL/SQL, database Triggers, Views and RFP development.
• Used case tools such as rational rose and ITIL to maintain process.
• Translated business requirements into UML diagrams/Visio diagrams and detailed designs.
• Highly self-motivated with excellent analytical and problem solving skills.
• Extensive knowledge on workflow analysis with the help of UML, and Use Case diagrams, Data Flow Diagrams, Component Diagrams, Sequence Diagrams and Activity Diagrams with the ability to translate them to the system requirement specifications and technical specification.
• Thorough knowledge of the industry standard SDLC practices such as Agile, Scrum Rational Unified Process (RUP), Rapid Application Development (RAD), Joint Application Development (JAD), and Waterfall and various SDLC phases including requirements, analysis, design, development, testing and implementation of the software applications

TECHNICAL SKILLS

Operating Systems: Windows (all), HP-UNIX, Linux, MVS/ESA, OS/390, IBM 3270 TSO

Programming Languages: Java, COBOL, C, C++, VB

Mainframes: JCL, CICS, VSAM, IMS-DC, Clear QuestUnit Testing JUnit

RDBMS: SQL Server 2005, ORACLE 11i, My SQL, DB2

Healthcare Tools: FACETS 5.1, Hiperstation, EDIFECS 7.0 & 8.3, NASCO-NPS

Automation testing tools: Mercury QTP, Load runner, Win runner, Members Edge, PEGA 6.1 Rational Robot,HP Test director, Quality Center, Clear Quest

Business Analysis Tools: Relativity Application Analyzer, Profiler, Clarity, MS Visio, RUP, RFP Business Rule Manager, Req Pro/Web, Visual Studio 2010, UML, HPXR

Special Software: MS Visio, MS Excel, MS Word, MS PowerPoint, ETL, Cognos MS Access, MS Share point, Lotus Notes - Citrix client, SharePoint 2010

Methodologies: Agile, Scrum, V-Model and Waterfall Model, ITIL, NetworX Pricing Knowledge on HIPAA- EDI transactions of 270/271, 834, 820, 276/, 835, 278, 837 I/P/D, Medicaid/MMIS, ACT/Obama CareHIPAA ANSI X 12 4010/5010 , ICD 9 to 10, PBM, PII or PHI and SPI

PROFESSIONAL EXPERIENCE

Facets/PEGA Sr. Business/System Analyst

Confidential, Owings, MD

Responsibilities:

• Responsible for the process management, requirement gathering with PRD, development estimation, execution, implementation and group assessment plans for groups with NASCO, FACETS5.0, Care first Connect portal, PCF and STEPWISE-OPTUM.
• Performed the TDM role for April 24th release and coordinated the production deployments PEGA BE.
• Used SDLC Waterfall Methodology from Carefirst and Agile Scrum methodology from CFC vendor side to implement the CFC and NASCO projects using PEGA 6.1.
• Coordinated daily DRB calls on defects with the QA teams and the development teams.
• Requirements gathered and implemented, the jurisdiction check based on the position of the PDPD ID (product ID), sent error message accordingly and then implemented in the PEGA Broker Express system.
• Performed UI enhancements with Broker Express system for FES, SFDC and VIP requirements etc.
• Microsoft SharePoint 2010 was used to manage the project related deliverables to the clients and maintained internally for the audit of PII or PHI and SPI data.
• Participated in the business meetings including sales for new business/benefit changes or product changes (Blue Choice HMO to PPO, HMO OA, HMO OA HAS and PPO to HMO) and drafted BRD which was provided to the development teams for development work and UAT tested.
• Coordinated all of the deliverables to SIT A, SIT B and the production regions including conducting with Smoke testing with PEGA Broker Express, TIBCO, Facets and CFC systems.
• Coordinated the UAT testing with the business and sales team. Validated requirements Vs system functionality and coordinated with the QA teams for any testing activities.
• Used SOAP UI for rate pushes for testing and validated the broker express system when OPTUM was not available.
• Successfully coordinated migrations of the group enrollments from facets to NASCO and Care First connect portals with the small mid groups.
• Interacted with group contacts/broker on requirement gathering and requirement verification on the GUI/Mainframe based screens and implementations.
• Coordinated the end to end testing with 2-50 and mid-market group files from the CFC portal and verified that all of the enrollment data from the groups were accurate.
• Managed all Confidential /Blue choice plans including dental/vision/CVS Caremark drugs data and conducted testing and audits to maintain 100% accurate with systems.
• Analyzed the system/business requirements with facets/NASCO for migrations of the groups.
• Coordinated with the systems, regression and UAT testing teams, creating test plans for the CFC team.
• SQL server and various SQL queries used to validate the enrollment values in the backend DB.
• Worked on developing and testing functionality for the subgroups modules like PBM (pharmacy benefit), FACETS5.0, Medicare and MMIS etc.

Environment: Pega 6.1, Tibco, Care first Connect Java portal, FACETS 4.7/5.0, NASCO, NPS, HP ALM, SQL Server, Web Share point, ALM Quality Center, EDI, Ultra Edit, MS Visio, EDI 834, RFP Tumbleweed, BAM, Agile, JIRA, RUP, HPXR, IBM 3270 TSO, SFDC, OPTUM, SOAP UI and GUI

Confidential, King of Prussia, PA

Responsibilities:

• Provided process management, estimation and coordination of the projects with the offshore teams.
• Interacted with the group contacts/broker on requirement gathering and requirement verifications on the UI enrollment and benefits for the enrollment Liferay portal implementations.
• Led end-to-end testing with the Liferay portal and verified that all of the enrollment data from the group was accurate.
• Performed audits based on enrollment/benefits changes with group and update systems to match enrollment data.
• Prepared the BRD and TRD and functional documents.
• Created the current and future state diagrams using UML and MS Visio.
• Maintained the Liferay system for open enrollments and yearly group renewals.
• Planned for ID cards processing for all open, passive enrollment and yearly renewal members including new enrollments with Liferay portal.
• Developed new Websites using new company logo TRION instead of Confidential and the McLennan Agency and created many public forum/social communities to improve the enrollments.
• Coordinated system, regression and the UAT testing teams and created test plans for the Liferay portal.
• Worked with the SQL server and SQL queries to validate the enrollment values in the backend database.
• Established and tested functionality for sub-groups modules such as PBM (pharmacy benefit), Facets, Medicare and MMIS.
• Created risk assessment plans for group implementation with Liferay and NPV portals.
• Jira was used for tracking the tasks and creating sub tasks and assigned the time for the offshore teams.
• Created phone and iPads/tabs compatible Trion portals/Websites and conducted testing for the same to improve the enrollments from the duration of October to December.
• Agile and Scrum Methodology was used to execute the Liferay portal implementation.

Environment: Java portal, JIRA, NPV, Plan Source, SQL Server, JCL, Web Sharepoint, SOAP UI, Quality Center, Ultra Edit, MS Visio, EDI 834, BRD, TRD, Agile and Scrum, PEGA

Sr. Business/System Analyst

Confidential, Owings Mills, MD

Responsibilities:

• Processed management, RFP development, estimation, execution, implementation and risk assessment plans for groups with NASCO, FACETS5.0, and the Care first Connect portal.
• Used SDLC Waterfall Methodology from Care first side and Agile Scrum Methodology from the CFC vendor to implement the CFC and NASCO projects.
• Microsoft SharePoint 2010 used to manage the project related deliverables to the clients and maintained internally for the audit of PII or PHI and SPI data.
• Participated in the NAEGS meetings with the sales/LGIT team for the new benefit changes or product changes (Blue Choice HMO to PPO, HMO OA, HMO OA HAS & PPO to HMO) and Medicare (Part A to D), Medicaid-Obama Care changes relate to groups/companies PII or PHI and SPI data.
• Analyzed the group structure prepared by LGIT based on the benefit/product changes related to groups/companies and prepared the process documents (RUP) to implement the same with CFC.
• Prepared the group implementation profile (functional specification) and coordinated with the Care First Connect team for medical/dental 834 file implementations with NASCO members edge/FACETS5.0/HPXR and NetworX pricing.
• Wrote technical specifications to create the SEED file for the group implementations.
• Successfully coordinated migrations of group enrollments from facets to NASCO and Care First connect portals with the small mid groups to the large groups.
• Excellent experience interacting with the group contacts/broker on requirements gathering and requirement verifications on the GUI/Mainframe based screens and implementations.
• Coordinated the end to end testing with the large group file STEP/834 files from the CFC portal and verified that all of the enrollment data from the group was accurate.
• Coordinated the audits based on enrollment/benefits changes with group and updated the systems to match with enrollment data with BAM, PEGA and 824 errors.
• Managed open enrollments/yearly group renewals with eEnroll/eExchange/HRIT groups for all Active, Cobra, Medicare and Medicare splits members.
• Involved in the ID card processing for all the open, passive enrollment and yearly renewal members including new enrollments PII or PHI and SPI data.
• Managed all Confidential /Blue choice plans including dental/vision/CVS Caremark drugs data and conducted testing and audits to maintain 100% accuracy with the systems.
• Analyzed the system/business requirements with facets and NASCO to migrate the groups.
• Coordinated with the system, regression and UAT testing teams and created the test plans for the CFC team.
• SQL server and various SQL queries used to validate the enrollment values in the backend DB.
• Worked on developing and testing functionality for the subgroups modules like PBM (pharmacy benefit), FACETS5.0, Medicare and MMIS etc.

Environment: Care first Connect Java portal, FACETS 4.7/5.0, NASCO, NPS, Members edge, COBOL, CICS, SQL Server, JCL, Web Share point, Quality Center, EDI, Ultra Edit, MS Visio, EDI 834, RFP Tumbleweed, BAM, Agile, JIRA, PEGA, RUP, HPXR, IBM 3270 TSO and PEGA.

Lead

Confidential, Chicago, IL

Responsibilities:

• Project management, RFP development, resource, estimation, execution, implementation and risk assessment plans for ICD 10 project and used Agile Scrum Methodology to implement the project.
• Interacted with the vendors or stake holders on requirement gathering and requirement verification with GUI/Mainframe based screens.
• Managed the projects with Agile-Scrum Methodology for successful execution with Joint Application Sessions (JAD) to collect and report requirements, performed data analysis and reconciliation of BRD.
• Created future state diagrams using MS Visio, RUP and UML to use it for future state development.
• Created the use cases based on the requirements gathered with the various clients/state holders and reviewed with various stake holders using JAD sessions.
• Worked on the defect fixes for the release and used Visual Studio for code debugging and validations.
• Tested and executed the plans that were created for the ICD10 project to execute, SIT, Regression and UAT testing on the EFE system.
• Reviewed logical design documents and use cases to make sure the enhancements based on the ICD10 changes with the business teams.
• Coordinated with the performance teams using load runner to make ensure the performance of the claims.
• Involved in Smoke, unit test results reviews and validated with Smoke and unit test results with Dev, test and the business teams.
• SQL server and various SQL queries used to validate the ICD 9 & ICD 10 values in backend DB.
• Cycle’s execution for the latest ICD 10 project and defects tracking and validating the results.
• Involved in analysis, detailed design, development and testing.
• Worked on developing and testing the functionality for the subgroups modules like, PBM (pharmacy benefit), HL7, FACETS5.0, Medicaid and MMIS etc.
• Extracted, Transform and Load(ETL) and BI tools were used in the projects on loading the data and maintained the data for reporting and STAR Schema, Cognos was also used to manage the data and testing the data ware housing system.

Environment: Java 1.6, COBOL, CICS, SQL, NetworX Pricing, HPXR, EDIFECS 7.0 & 8.3 QTP, Quality Center, EDI, GEMS, Agile, JAD, Facets 4.51, ITIL, ETL, Cognos, BI, JIRA, Visual Studio, RUP

Lead/Manager

Confidential, Chicago, IL

Responsibilities:

• 837, P-I-D, professional/institutional/dental claims and ITS claim submission.
• 835 claim remittance and 834 and enrolment submission.
• 270/271, eligibility/benefit inquiry/response and 276/277 and claims status inquiry/response.
• Created project management, resource, estimation, execution, implementation and risk assessment plans for 5010 project.
• Managed the project with Agile-Scrum Methodology for successful execution with Joint Application Sessions (JAD) to collect and author report requirements, perform data analysis and reconciliation.
• Created future state diagrams using MS Visio, RUP and UML to use it for future state development use.
• Created the use cases based on the requirements gathered with various clients and state holders.
• Involved in detail system/business analysis, detailed design with the development teams for UAT testing.
• Created detailed tests and execution plans for the 5010 regression and UAT testing on the EFE system and mapped the system requirements UAT cases in the quality center.
• Created detailed test schedules for regression and UAT of 5010 projects for the 2012 implementation.
• Analyzed the 5010 business requirements and created the impact analysis document to create the error free test cases and scenarios for the EFE system.
• Worked on the defect fixes for the release and used visual studio for codes, debugging and validation.
• Validated the results of the Junit tests and suggested Dev team for codes changes required by the business.
• Analyzed the 837 I, P, dental and ITS claim changes in the 5010 implementation in facets 4.51.
• Very good experience interacting with the vendor or stake holders on requirement gathering and requirement verification on the GUI/Mainframe based screens and used ITIL.
• Created an automation process with QTP, executed the test cases for 5010 project
• Managed a five member team and verified the test cases and test scenarios created for the 5010 project.
• Coordinated with the performance teams using Load Runner to ensure the performance of the claims.
• Created test and execution plans for the 4010, 5010 regression comparison to make sure of the new changes in the 5010 project.
• SQL server and various SQL queries used to validate the ICD 9 and ICD 10 values in the database.
• Created SDLC and PMLC documents for the 5010 projects.
• Coordinated reviews and re- reviews with the dev, test, business teams and implemented the 5010 project.

Environment: Java 1.6, COBOL, CICS, SQL Server, NetworX Pricing, HTML, EDIFECS 7.0 & 8.3 QTP, Quality Center, EDI, GEMS, Agile, FACETS 4.51, JAD, ITIL, Jira, Selenium, Junit, ETL, BI

Business/System Analyst

Confidential, Washington, DC

Responsibilities:

• Analyzed the current CareFirst - Confidential system with all of the EDI transactions (834, 835, 270/271, 276/277 and 278) and gathered the requirements from the system as well as end the clients.
• Analyzed the current FEPOC enrollment process and EDI transactions to ensure the PHI compliance and other related data issues.
• Analyzed software development life cycle, project management life cycle processes in the Care First/ Confidential -FEPOC with HIPAA regulations and made sure accurate the process was accurate to avoid the HIPAA PHI breaches with the new 5010 project.
• Analyzed the enrollment system with the membership data and created the business/use cases to enhance the process in the modernization project without PHI issues.
• Verified and translated the business/user requirements into functional requirements to design the future state system at CareFirst FEPOC without any compliance.
• Analyzed the enrollment system with membership data and created the business/use cases to enhance the process in the modernization project.
• Gathered information on the transactions of 270/271 (health care eligibility benefit enquiry and response) and 276/277 (health care claim status enquiry and response) current state information to implement the 5010 changes in the segments and loops without any PHI issues.
• Validated the test results for the new implementations for the 270/271 and 276/277 as part of the 5010 changes and Medicaid and MMIS for PHI issues and conducted audits on enrollment data.
• Coordinated with the testing managers for the test plan and test cases created for the 5010 implementation project using quality center and verified the test data and the PHI issues.

Environment: Java 1.6, COBOL, CICS, SQL Server, Web Services, XML, HTML, Quality Center, EDI, GEMS, Agile, Facets 4.71, ETL, BI, STAR, ITIL, Visual Studio 2010, COBIT, EDIFECS 7.0, PEGA

Sr. Business/System Analyst

Confidential, Chicago, IL

Responsibilities:

• Created project management, RFP development, resource, estimation, execution, implementation and risk assessment plans for BRM project.
• Managed project with Agile-Scrum Methodology for successful execution with Joint Application Sessions (JAD) to collect and author report requirements, performed data analysis and reconciliation.
• Six Sigma Green Belts as well as reverse engineering techniques used for gathering the requirements and redefined the future state models using the latest tools.
• Created future state diagrams using MS Visio, RUP and UML to use it for future state development use.
• Created the use cases based on the requirements gathered with the various clients and state holders.
• Validated business rules and extracted the legacy functionality with HIPAA Edi transactions for DC, Claim Lock, GCPS and DME and RX-pharmacy claims.
• Defined the current, future state business processing models using UML, MS office for the Medicare A-D claims including DME/Illinois public aid claims and Medicaid claims.
• Implemented a new approach of business rules gathering from the legacy system to CCSP and saved two million dollar’s worth of time.
• Defined the business, user and functional requirements using the appropriate documentation techniques to describe the statements of the goals, objectives, or needs of a particular stakeholder or group of stakeholders using the low and medium complexity.
• Translated the high-level business requirements into functional specifications for the IT organization and managed the changes to such specifications.
• Extracted claims from mainframe using JCLs and tested with BIS compare tools and verified the results of legacy and Java PRAP (Pre adjudication) system and raised the defects using QC.
• Tested and verified the results of BIS (Batch Input System) compare tools, with claims and service lines information for the IL, TX, NM and OK claims.

Environment: Java 1.6, COBOL, CICS, SQL Server, XML, HTML, EDIFECS 7.0, Quality Center, EDI, Agile, Req Pro, JCL, DB2, VB, Fileaid, OS/390, ETL, STAR, ITIL, HPXR, Six Sigma

QA/BA Lead/ Functional, UAT Testing

Confidential, Hartford, CT

Responsibilities:

• Coordinated extensive testing for the TOPS applications using QTP, Hiperstation and Playback for all of the releases.
• Microsoft SharePoint 2007 is used to manage the project related deliverables to the client and to maintain internally for the audit purposes.
• Prepared the estimation for development and testing for all the releases.
• Created automated test scripts using QTP for various new changes in the enhancements.
• Executed regression cycles using QTP for the online claims and verified the results using QTP.
• Deployment plans and executed strategy for all of the new releases and related new changes and coordinated with the offshore team.
• Coordinated with the businesses on the latest functional requirements to test scripts conversions and the outcomes of the latest scripts.
• Executed claims details in the VSAM/DB2 tables using regression cycles for the entire claim processing systems including PBM.
• Analyzed the TOPS claim systems and raised the defects using test director.

Environment: Java 1.6, COBOL, CICS, SQL Server, Web Services, QTP, Quality Center, EDI, Agile, Req Pro, JCL, DB2, VB, File aid, OS/390, VSAM, HYPERSTATION, SharePoint 2010, ETL, ITIL