SUMMARY

• Around 8 years of Total IT experience which includes more than 4 years of experience in Health care IT domain
• Around 5 years of Facets implementation experience along with more than 4 years of experience in Business and Systems Analysis
• SDLC: 7+ years of IT experience in Gathering Business Requirements, System Analysis, Design, Acceptance testing of implementation for Health Plans applications.
• 4+ years of Facets implementation experience in preparing Business Requirement Documents/Project Requirement Documents, Use Cases, User Stories, Functional/Technical specifications documents, designing the solutions for business problems, preparing test plans & functional test cases. Designing reports and interfaces for various business areas of health plans like; Claims, Provider Networks Management, Membership, Utilization Management etc.
• Experienced with Facets Data Model, Data Dictionary, Table Structures, Database Object Naming Conventions, Referential Integrity, Batch System Architecture and Design patterns.
• Experience in working with Facets core batch jobs, Designing custom XCOM/XSQL/Embedded extensions and interface development involving modules like members/providers/claims areas
• Experience in working for Facets Migration/Regulatory /New Business Implementation projects.
• Data Analysis:
• Strong experience on Data Design/Analysis, Business Analysis, User Requirement Gathering, User Requirement Analysis, Gap Analysis, Data Transformations, Data Relationships, Source Systems Analysis and Reporting Analysis
• Experience in designing applications using 3 Tier, service - oriented Architecture
• Databases:
• 7 years of experience using Sybase, MS SQL Server, Oracle, MS Access, PL/SQL, SQL*Plus and SQL Developer.
• Experience in designing all database objects, including tables, clusters, indexes, views, sequences, packages and procedures. Assists with impact analysis of any changes made to the database objects
• Project Management:
• Experienced in taking applications from conceptual stage to final installation and successful delivery to the end user.
• Effectively collaborated with business, architect, testing and project management teams to design timely solutions for several client/server applications along with interfaces.
• Experienced with coordinating cross-functional teams. Excellent analytical, problem solving, and communication skills with ability to interact with individuals at all levels.
• Experience in Agile Project Methodologies (Scrum).
• Healthcare:
• Experience in providing excellent technical solutions for business requirements related to Members/Providers/Claims and Finance Areas using common reusable languages/tools and frameworks.

TECHNICAL SKILLS

Databases: Oracle 9i/8i, MS SQL Server 2005/2008, Sybase, MS Access

Programming GUI: SQL, PL/SQL, SQL Plus, HTML

Environment: Win NT. Windows server 2003, windows XP

Tools: /Applications: MS Access, MS Excel, MS Visio

Project Server: Share point 2003

Ticket Management: Test Director 8.0, HP Service Desk 4.5

Healthcare applications: Facets, Amisys

Microsoft Technologies: C#.NET, XML

PROFESSIONAL EXPERIENCE

Confidential, Virginia Beach, VA

Business/Functional Analyst

Responsibilities:

• Worked as Business Systems analyst (Solution Analyst) for Membership migration to Facets
• MEDISYS is one of the Confidential membership source system. Reviewed current membership processes on Medisys and designed a flat file to get the membership data from Medisys
• Gathered Requirements from business users and designed a process to load Membership file from Medisys in GBD (Government Business Division) Facets.
• Documented/Reviewed business rules with Subject Matter experts and documented them in design document/requirement portals.
• Business rules are documented in Design to handle Medicare events for updating Facets SBSB, SBAD, SBCS, SBSG, MEME, MEEL, MEPR, MEMD, AOR data, SBRT tables. Created mapping documents to map the data between Medisys and Facets MMS keyword.
• Designed end to end process for creating custom batch jobs for MMS file generation.
• As a Phase II of Medisys migration, handled real time transactions from Medisys to Facets.
• Gathered requirements to develop an application called HORNET Q to process Real time transactions.
• Worked closely with Trizetto team to understand how facets Web services will work.
• Designed process to send and Receive Messages through web services from Medisys to GBD Facets.
• Gathered requirements to create multiple interfaces to recieve different real time transactions.
• Created new approach to assign PCP’s for these new migration membership based on Provider multiple addresses.
• Gathered requirements to build new Extension screens to display AOR and Demographic information.

Environment: Facets 5.01.SQL server, Oracle, Facets web services

Confidential, Virginia Beach, VA

Business/Functional Analyst

Responsibilities:

• Worked as Business Systems analyst (Solution Analyst) on Legacy platform migrations to Facets
• Worked with Business Vision Documents to create Project Requirement Documents, Traceability documents and Acceptance test case documents
• Coordinated with health plans to understand the demands on reporting demands and documented in BRDs and PRDs worked with design/development
• Designed the functional specifications for interfaces for different business areas like; Claims, Membership, Providers, Member Benefits, Provider Networks Management.
• Collaborated with Health Plan, Data analytics and business users for requirements gathering, analysis and integration design for extracting data from the heterogeneous source systems like MS SQL Server, Oracle, flat files, XML files and loading into Facets and vice versa.
• Worked with Legacy application users, Health plans to gather provider directory requirements and implement state wise provider directory requirements. Created Design patterns to use for multiple state provider directory requirements using Directory Sort.
• Gathered requirements and designed multiple custom interfaces to migrate the provider data from Amisys to Facets. Created processes to load daily updates from Facets to Auxiliary database (internal system). Designed processes to send state provider extracts from Auxiliary database to states for Network advocacy and encounter purpose.
• Worked with various vendors like Nationwide, Dataquest, Logisticare to get provider data in a standard layout and load them in the system for encounter reporting and state submissions and contract management.
• Worked on State Provider File load into Facets Systems and support Medicaid id extraction programs. Extracted Medicaid ids are used in claims edits and State File submissions.
• Gathered Requirements and designed Member ID cards, Member handbooks requirements, Rate Cell population, Emergency contact information load from state. Worked with Health Plan Business, Enterprise Architects, Dev, QA, PMO to come up with Requirement document, solution summary document.
• Worked on Claim audit requirements with SAM which is an online tool to find the error in processed claims like detecting overpayments and underpayments before reaching the provider.
• Tracked Defects, Attended daily Defect Review calls, Project Management Status calls to provide/gather status.
• Performed several Impact Evaluation demonstrations, POC (Proof of Concept) exercises to create options for business issues.
• Trained new team members and business users with System architecture/Development processes.

Environment: Facets 4.71, Amisys, Oracle, C#.Net.

Confidential, Virginia beach,VA

Systems Analyst

Responsibilities:

• Worked as Systems Analyst for Macess Exp Implementation
• Requirementanalysisanddesigndocumentpreparation.DesigndocumentflowsandfunctionaldiagramsusingVisio.
• Documented existing Content Management and operational processes in the system and requirements are documented. Previously used Macess IMAX Tool was analyzed and existing processes were documented.
• Created Functional specifications and worked with Macess configuration people to decide the file layouts and required extracts. File Layouts, File mapping, File Frequency, Batch job configuration has been decided.
• Identify the gaps and pain points in the current processes and applications. Documenting the high level business requirements and proposed solutions for the current pain points.
• Implemented Member Folder Build solution to send a full membership XML file from Facets to Macess FTP site. On a daily change file the member changes will be sent. Member terminations, plan changes are sent.
• Implemented Provider Folder Build solution to send a full Provider XML file from Facets to Macess FTP site. On a daily change file the provider changes (Practitioners, Groups and Facilities) will be sent.
• Implemented Claims Edoc extract where the Submitted claims data needed to be made available for submitted data inquiries. A user friendly format will provide ease of use and help consolidate applications needed to view claims data based on Claims Edoc solution.
• Implemented Claims Doc Flow extract where pended claims extract are sent from Facets to Macess EXP system. Pended claims are assigned to claims operations team to resolve the claim issue and pay them.
• Implemented Mis File Extract where the extract sent from Macess to Facets. Based on Mis file claims data respective provider and member details need to be sent back to Macess from next business day.

Environment: Facets 4.71, SQL server, Macess EXP.

Confidential, Plymouth, MN

Programmer Analyst

Responsibilities:

• Designed solutions to send provider data to Enterprise systems automatically based on save operation. After provider data is updated in Facets, Post save exit point is used to find the updated Facets data and a feed is extract put in FTP place to send the updates
• Designed Menu based extensions to support credentialing process to store Provider unavailability, Facility Program, Provider Audit details
• Designed Interfaces to Populate out of Network fee schedules (UCR) for providers on daily basis for newly inserted providers to reduce data entry effort and claims payment.
• Successfully gathered requirements and Designed XCOM extension in provider application to display state Medicaid ids and state submitted provider data for reference purpose.
• Participated with business in screen/interface designs and functionality for review & sign off. Participated in Software Engineering Life Cycle from Requirements Analysis through Testing and maintenance.
• Worked with Faces Core batch jobs like MMS, XPF, XC, CLMU and CKMM for support activities. Analyzed step logs to resolve business issues.
• Worked on root cause analysis and provided recommendation for support activities. Assist with Integration and End to End testing teams to sign off the requirements
• Understand Migration responsibilities and Triage the issues and bring it to closure
• Defect Triaging for ongoing business requirements
• Identify/Submit User requirements and design robust solutions
• Analyze the new requirements and propose solutions for Data migration and setup in Facets
• Worked with QA team to resolve issues in System testing, integration testing and UAT phases.
• Perform business analysis, requirements analysis and data mapping
• Implemented change controls for some extension/interface requirements

Environment: Facets 4.71, SQL SERVER, XCOM, VS 2008

Confidential

Business IT Lead

Responsibilities:

• Information Technology lead for Confidential Med Online Portal
• Travelled all over Asia to work with Physicians to educate on Confidential Med Usage and given presentations
• Mapped Physician and customer comments as requirements and presented to IT Development team
• Closely worked with Development team, QA and Production teams to design/develop CIPLAMED.
• Designed physician login and administration modules to access Confidential Med portal
• Captured Requirements on Personalization and Community Building features.
• Created Acceptance test cases to provide sign off on Confidential Med for production deployment
• CIPA Med has Product Index module to display all Confidential innovations, captured requirements for the same.
• Assisted in Unit and System Test Case preparation.
• Closely worked with Dev teams to perform unit and integration testing, testing of online portal.
• Involved in entire software development lifecycle.
• Worked on User demos for the portal and trained business users on using the portal.
• Confidential Med Community allows for Physician collaboration, Peers view URLs allows to rate articles, comment and sharing.

Environment: C#.NET, ASP.NET, SQL SERVER 2005, AJAX, Windows 2003.