SUMMARY

• Over 8 years of diverse experience as a Business System Analyst/Lead in developing and implementing innovative business processes for clients.
• Experience working as Track Lead to execute plans in a time bound manner meeting high quality of standards.
• Proficient in all phases of SDLC including Requirement gathering, analyzing, designing, detailing, and tracking requirements.
• Worked in production support team as functional specialist / BA Oversight - managing and delivering fixes for post-production defects and enhancements.
• Worked as Process Improvement analyst with operational and production support team to align multiple IT areas, business areas, systems business processes, tools and vendors to minimize process redundancies, enhance performance & efficiency and improve cost effectiveness.
• Worked as IT Analyst/ Liaison in the Pre-Project management and resource planning area.
• In-depth knowledge and experience in full SDLC with Agile, Waterfall and RUP methodologies.
• Functional experience in health Care Industry with vast knowledge of Value Based Program, Wellness and Care Management, Revenue Manage and Risk assessment, Episode Based Payment / Bundle Payment, Provider Systems and third party Vendor management.
• Excellent knowledge of Medicare and Medicaid.
• Hands-on experience with Entity Relationship Diagram Modeling, Data Modeling, and Data Normalization.
• Strong experience and understanding of health care industry, claims management process, Knowledge of Medicaid and Medicare Services.
• Experience in using methodologies such as Unified Modelling Language (UML), Object Oriented Analysis and Design (OOAD) and Agile Project Management (APM).
• Experience working with development, enhancement and modification of JAVA based application like evaluator (Member and activity evaluation)
• Designed Graphical User Interface using Adobe Photoshop. Knowledge of DB2, SQL queries using MS Access and Oracle.
• Extensive experience on MMIS Medicaid Systems. Exposed to using ICD9/ICD10 coding standards in Medicare and Medicaid domains of the healthcare systems and industry for inpatients, outpatients, Reimbursement methodology. Familiar with COBOL technologies and DB2.
• Experienced with Medicaid Information Technology Architecture (MITA) and implementing its Business rules to the state agencies.
• With help of SQL developers, Performed Data mapping, logical data modelling, created class diagrams, entity relation (ER) diagrams. Reverse-engineer several databases, such as research, business, clinical in order to extract metadata to leverage it for extract transform and load (ETL) design and reporting.
• Expertise in Claims, Subscriber/Member, Plan/Product, Claims, Provider, Commissions and Billing Modules of Facets.
• Involved in Facets Output generation, Interface development and Facets Migration Projects.
• Expertise in designing tools/UI and creating the companion guides for users.
• Experience in training users from multiple teams for newly developed tools.
• Executed advanced level SQL queries to verify data integrity of the databases.
• Expertise in process improvement, GAP analysis and solution implementation.
• Expertise in impact analysis on the key application systems (Membership, Provider information, Claims system, Invoicing, Billing, General Ledger, Incentive Management, Gain Share, HEDIS, HHS communication, Reporting, Payment, Clinical Data Repository) and business process of health insurance companies.
• Expertise in creating prototypes and mock-ups for user interface designs.
• Specialized in creating UML Diagrams such as Use Case, Business process models, Activity and data flow diagrams using MS-Visio, Rational Rose and consistently translate business requirement into IT solutions.
• Exceptional ability to maintain and build client relationships with business owners to identify, prioritize and document business requirements.
• Extensive knowledge of reporting tools for underlying database tables and resolve data issues.
• Expertise in RDBMS concepts and running SQL queries.
• Excellent knowledge and expertise of SharePoint.

TECHNICAL SKILLS

Microsoft Software: Project, Visio, Excel, Word, PowerPoint, Access, Outlook

Requirements Test Management: Rational Requisite Pro, Rational Test Manager

Testing Automations Tools: Quick Test Professional, WinRunner, Rational Robot

Defect Tracking Tools: HP Service Manager, HP Mercury Quality Center/ALM, Rational ClearQuest, SharePoint Based Inquiry Tool

Languages/Standards: SQL, HIPPA 5010, ICD9, ICD10, XML, ANSIX12

Methodologies: Rational Unified Process (RUP), Agile, Scrum, Waterfall

PROFESSIONAL EXPERIENCE

Confidential

Business System Analyst/Lead

Responsibilities:

• Planned and conducted JAD sessions with Subject Matter Experts (SME’s) to obtain domain level information, interviewing and asking detailed questions and carefully recording the requirements in a format that can be reviewed an understood by both business and technical team.
• Involved in gathering the requirements that were critical to the business process flow and using those requirements for the Business Requirements Document (BRD).
• Created Requirement Traceability Matrix (RTM) for end to end tracking of business requirements from Analysis to implementation phase.
• Created numerous documents working with Architects, Tech Leads and Developers during analysis and design phase, such as System Requirement Document (SRD), Software Architecture Document (SAD), Supplementary Specification documents.
• Assisting in implementing and executing Independent Verification and Validation (IV&V) Test Methodology conforming to the Full Development Life Cycle.
• Checking member eligibility, provider enrollment and member enrollment for Medicaid and Medicare claims.
• Medicaid Claims Resolution/Reimbursement for state healthcare plan using MMIS.
• Managing and Billing Medicare, Commercial HMO/PPO claims on a daily basis.
• Developed System Maintenance Operation Guide (SMOG) during the Post Implementation phase.
• Performed process mapping.
• Created UML Diagrams using MS Visio( Use Case Diagrams, Sequence Diagrams, Activity Diagrams, Data Flow Diagram, Process Flow Diagrams).
• Created and updated Use Cases along with being involved in UI Screen Prototyping to demonstrate the differences between the present state and the future state of the system to the development team.
• Created several plan and SOPs documents for the operational and process improvement purpose.
• Worked with user to define user acceptance test cases. Involved in UAT (User Acceptance Testing) and Implementation.
• Maintained Project Glossary for the entire project team.
• Experienced in working with business requirements, business rules, functional specification documents and other relevant documentation for UAT planning, design, decision tables, behavior modeling and execution.
• Develop templates and standards documents to guide creation of business process steps under MITA framework.
• Designed Entity Relationship Diagram (ERD) for logical data flow.
• Developed White Paper to documents post production issues and fixes.
• Administered Service Manager to manage, track and deliver fixes for post-production defects and enhancement.
• Designed and Developed SharePoint tool for business and production support team to store, coordinate, manage, and maintain documentation, and tasks via workflow.
• Worked on Data Mapping among different interfaces.
• Wrote SQL queries to extract and validate the data from the database.
• Worked closely with testing team develop test cases and manipulation of data in QA environment for testing newly developed application.
• Design, developed and produced daily and weekly reports for monitoring the performance of the system, process, etc.
• Helped create the 'Business Glossary' to facilitate efficient understanding of the business process amongst the other teams. Assisted in creation of the Functional Design Document from the Business Requirements Document which was used as the reference by the development team while preparing the design and held the responsibility of the required data setup for unit testing.
• Monitor and analyzed activity report. Created reports for Server monitoring and Transaction time.
• Maintained open and clear communication with the team on change requests.
• Implemented the full project life-cycle with all phases from requirements gatherings to development and quality assurance.
• Worked closely with leadership to monitor project pipeline for the team.
• Created report and conducted weekly sessions to report and manage projects in pre-projects phase.
• Environment: MS Visio, MS Outlook, MS access, Nintex, DB2 Mainframe, JAVA, Windows, MS Office (Word, Excel, PowerPoint, Outlook), Oracle, SQL Developer, TOAD

Confidential, Des Moines, IA

Business System Analyst

Responsibilities:

• Participated in IME-MMIS knowledge transfer in preparation for Implementation and Operation of the 5010 standards.
• Worked closely with the customer to detail and convert business requirements into system and operations requirements while working with the external partners to complete the design, development and implementation of the requirements.
• Addressed requirements as a liaison among stakeholders in order to elicit, analyze, communicate, and validate the requirements and business processes.
• Analyzed business processes and performed needs assessment to align IME-MMIS information technology solutions with their business initiatives.
• Performed independent validation and verification (IV&V) for products and upgrades delivered to the government client.
• Experience in writing SQL queries, Stored Procedures and Triggers.
• Produced Initial Medicaid Information Technology Architecture (MITA) State Self-Assessment Report to support the current Medicaid Management Information System (MMIS) Replacement Project.
• Prepared monthly and quarterly business reports for Managed Care resource management.
• Coordinated with Project Managers to resolve risk issues and ensure compliance of Security System related to the HIPAA.
• Designed and developed Use Cases, Activity Diagrams, and Sequence Diagrams using UML tools.
• Maintained Project Glossary for the entire project team, Conducted User Acceptance Testing (UAT).
• Provide support for documenting CMS requirements and ongoing support as assigned.
• Worked on Data Mapping to map Facets data to outbound eligibility extracts.
• Provide documentation support of Medicaid Information Technology Architecture (MITA) in preparation for the Confidential new claims system.
• Coordinated on phases of IV&V testing activities (test planning, requirement analysis, test case identification, test scripting, regression script identification, script execution, defect management).
• Worked extensively in the executing of SQL queries on the database to verify data integrity.
• Worked with Member/Subscriber and HIPAA Privacy Facets application groups.
• Documented requirements using Use Case (UC) analysis for the development team; also, stored the documentation in a common SharePoint Repository for version control.
• Formulated system design, methods, procedures, policies and workflows affecting Medicare/Medicaid claims processing in compliance with government compliant processes such as HIPAA/ EDI formats and accredited standards.
• Documented requirements using Use Case (UC) analysis and User Experience (UX) GUI design.
• Monitoring the performance of the system on a day-to-day basis.
• Monitored and analyzed activity report and created reports for Server monitoring and Transaction time.
• Documented requirements using Use Case (UC) analysis, and created As-Is and To-Be process flows to conduct gap analysis to improve efficiency.
• Highly experienced with the Agile Methodology and Software Development Life Cycle.
• Maintained open and clear communication with the team on change requests.
• Worked on 837 and 835 projects, including syntax and business rules for X12 HIPAA 4010 and 5010 validation for loops, segments, elements, qualifiers and code sets.
• Performed System testing, Regression testing and UAT for several claim types and test scenarios.
• Performed Integration testing for various modules of MMIS such as Claims, Billing, Member and Provider enrollment, and pricing.
• Extensively used UML to draw Business Process Flow, Use Case Diagrams and Entity Relationship Diagrams
• Thorough with inbound and outbound transactions flow and EOB / EOP.
• Compared and validated 5010 system test results with 4010 results for the same test scenarios.
• Created X12's for 4010 and 5010 standards to meet test scenarios.
• Configured, set up and managed the automated build servers for EDI Gateway.
• Worked with the system administration team, technical leads, and project managers to release builds to production through EDI Gateway.
• Hands-on experience in the design, development, implementation, and production activities associated with X12 transaction sets ( 1 7, 834, 837, and 835), and other proprietary data standards.
• Knowledge in EDIFACT, X12 and other formats compatible with EDI Gateway.

Environment: Facets, MS Visio, MS Outlook, DB2, SQL, UNIX, Quality Center, MS Visio, Use Cases

Confidential, Indianapolis, IN

Business Systems Analyst

Responsibilities:

• Conducted user interviews at both in-house and client locations, gathering and analyzing requirements using Requisite Pro and Requisite Web.
• Extensively used Agile Methodology in the process of the project management based on SDLC.
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams and Object Oriented Design (OOD) using UML.
• Gathered and documented Business Requirements, created Functional specifications and translated them into Software Requirement Specifications.
• Performed Gap analysis by identifying existing technologies, documenting the enhancements to meet the end state requirements.
• Assisted in designing Conceptual Data Model to capture system functionality and build a framework for the software development phase by using Flowchart, ER Diagram, Use Case Diagram, Data Flow Diagram, Activity Diagram, and Sequence Diagram.
• Developed test cases and test scripts and assisted Quality Assurance activities, with system integration testing and user acceptance testing (UAT), developing and maintaining quality procedures and ensuring that appropriate documentation is in place.
• Identifying and documenting business rules and creating detailed Use Cases.
• Participated in the process of internal and external auditing activities and developed timelines for project delivery, and managed projects and resources to successful completion.
• Involved in data dictionary management, extraction, transformation and loading (ETL) of data from various sources.
• Participated in ETL requirements process during data transition from source systems to target systems.
• Involved in Data Analysis & Mapping to track all data elements used in the application from the user interface through different interfaces to the target databases in which they are stored.
• Developed tables, Views, Stored Procedures and Triggers using SQL Scripting.
• Established Inner Join, Outer Join and created Indexes whenever necessary.
• Writing Complex SQL queries and optimizing SQL Queries.
• Responsible to meet the information demands of our business users by delivering timely, accurate, meaningful and standardized data and reporting.
• Participated in creating logical and physical data models, their enhancement. Based on the data models, worked with business architect, to create the software solution models.
• Helped in creating of Data-Mapping best practices document including visual processes and trained team members on Data Mapping process and tools.

Environment: Windows, RUP, MS Project, SQL, MS Office (Word, Excel, PowerPoint, Outlook), MS Visio

Confidential, Atlanta, GA

Business Analyst

Responsibilities:

• Facilitated JAD sessions to collect requirements from system users and prepared business requirement that provided appropriate scope of work for technical team to develop prototype and overall system.
• Interacted closely with the Business users along with the administration and management to gather Business Requirements and analyze the functionalities to be incorporated into the system.
• Involved in gathering, documenting and verifying business requirements.
• Followed agile scrum methodology throughout the project.
• Involved in requirement gathering phase (Provider, Claim components and HIPAA).
• Met with report users and stakeholders to understand the problem domain, gathered customer requirements through surveys, interviews (group and one-on-one) along with JAD sessions.
• Involved in understanding the current business process, defining scope of the project along with position statement.
• Conducted peer design and code reviews and extensive documentation of standards, best practices, and ETL procedures.
• Followed the Agile methodology for the entire SDLC.
• Constructed logical and physical data models and data mapping. Created Data Flow Diagrams to depict ETL processes.
• Wrote BRD, FRD, use cases, test scenarios, test cases for testing the functional requirement.
• Implemented automated COB processing of Medicare claims into Facets.
• Validated business rules and all artifacts with users, got approval and sign off.
• Experience with Trizetto Facets System implementation, Claims and Benefits configuration set-up testing, Inbound/Outbound Interfaces and Extensions, Load and extraction programs involving HIPPA 837 and proprietary format files and Reports development.
• Assisted Design Team in preparing SRS, Software Design Document (SDD), User Interface Design, and Application Architecture & Database Modeling.
• Helped in project testing efforts for doing integration tests, regression tests and user acceptance tests.
• Worked on Data mapping, logical data modeling used SQL queries to filter data within the Oracle database tables.
• Identified Use Cases and documenting through UML.
• Made sure that the systems complied with the rules of HIPAA and CFR Part 11.
• Documented the dimensional models of ETL system.
• Led the testing efforts of the Datamarts in development, coordinated moving/setting up of processes in dev/qa/production. Worked with QA team and UAT team to go over the various test scenarios for different types of loads in the Datamarts.
• Used SQL to test various reports and ETL load jobs in development, QA and production environment.

Environment: Java, MS Office Tools, Windows XP, SQL, MS Project, ClearCase, MS PowerPoint, MS-SharePoint, MS-Word, MS-Excel, Informatica 7.1, IBM Process Modeler, Facets 4.21/4.31