Summary:
Professional Business Analyst with over Five years of experience in the Health Care and Retail domain. Expertise in Software Development Life Cycle (SDLC), Business Analysis and Modeling, Functional Requirements Gathering and Analysis and collaborating with Technical Teams in preparing System Design Document (SDD). Business Process Reengineering in Health Care Sector with prime focus on Membership, claims adjudication, migration, provider, eligibility and prior authorization for Medicaid and Medicare programs. Recent assignments include working with Payer Organizations (Insurance Companies) on upgradation projects (EDI ASC X12 4010 to 5010; ICD-9 to ICD-10; FACETS).
AREAS OF EXPERTISE:

• REQUIREMNT GATHERING: Document Analysis, Joint Application Design (JAD), Reverse Engineering Interview, Observation, Survey, Interface Analysis
• BUSINESS ARTCHITECTURE FRAMEWORK: SOA (Service Oriented Architecture), Zachman, POLDAT
• FEASIBILTY STUDY: GAP Analysis, Cause and Effect Diagrams, Impact Analysis, Root Cause Analysis, Prototype Development (adhoc, vertical and horizontal)
• BUSINESS AND SYSTEM MODELING: UML Diagrams: Context, Activity, Class, Use Case Sequence
• REQUIREMENT MANAGEMENT AND DOCUMENTATION: Business Requirement Documentation, Functional Requirement Documentation, Requirement Traceability Matrix, Change Request Documentation, Managing Requirement Risks
• SDLC METHODOLOGIES: Agile, Waterfall, RUP
• UML MODELLING TOOLS: MS Visio, Rational Rose
• CHANGE MANAGEMENT TOOLS: Rational Requisite Pro, Clear Case
• TESTING TOOLS: Win Runner, Test Director, Load Runner
• PROJECT MANAGEMENT TOOLS: MS Project, MS Office
• DATABASES: Oracle 11g, SQL Server 2000
• SOFWARE TESTING: Unit, Integration, Regression, System Performance, User Acceptance
• OPERATING SYSTEMS: Windows, Linux
• DATA MODELING: E-R Diagrams, Data Mapping, Data Flow Diagrams
• LANGUAGES: C, C++, Java, HTML, UML, NET
• REPORTING TOOLS: Business Objects, Crystal Reports

EDUCATION:
BACHELORS OF SCIENCE IN COMPUTER SCIENCE

PROFESSIONAL EXPERIENCES:
Confidential,Denver, CO
Duration : Nov 2010 – Present
Role : Facets Analyst
Environment : Facets4.81, Facets interfaces (IFOX), Facets extensions, Agile, Requisite Pro,
SQL Share point, MS Access, MS Visio, MS office, MS word, MS excel Clear
Case ClearQuest, Quality Center, Oracle 11g, Data Warehousing, Java
Informatica7.1 Cognos 8.4
Great-West Healthcare has been around to serve its customers for more than 50 years. It provides an extensive network of 550,000 providers and more than 4,250 hospitals. It works to provide group and individual coverage with creative solutions to the continuously evolving needs of American patients. It also offers more traditional plans that offer a choice of in-network Primary Care Physicians.
Design, develop, testing and implementation of transition from a legacy system to Trizetto’s Facets enterprise solution. Adhered to strict compliance, policies/regulations configured Facets modules such as Membership, Benefit and plan. Part of the project was to migrate all application functionality and convert data from a mainframe-based system to an open systems environment.
Responsibilities:

• Involved in configuration of FACETS Subscriber/Member application..
• Worked on FACETS Data tables and created audit reports using queries. Manually loaded data in FACETS and have good knowledge on FACETS business rules.
• Performed data mapping and data modeling and used canonical data model to map data from X12 834 transactions.
• Did theforward and backward data mappingbetween the fields in mainframe and FACETS.
• Analyzed the mainframe reports for member/eligibility/claims and mapped the fields with FACETS batch jobs and reports.
• Tested the changes for the front end screens in FACETS related to following modules, test the FACETS batches (membership).
• Re-engineering and capturing of transactions with legacy systems[Enrollment -834].
• Conducted extensive analysis on migration and conversion of Provider and Member data, Group configurations, plan codes, benefit set-ups, fee schedules, provider pricing, capitation set-ups, etc from Legacy system (Amysis) to FACETS (Client Server based system).
• Provided support to full Software Development Life Cycle, testing, training and implementation.
• Analyzed the functional details of various modules in mainframe and did theGAP analysiswith the new system.
• Developedlogical & physical modelingas per business requirements.
• Responsible for working with the State to review and modify process flows to increase productivity and effectively utilize FACETS features not provided by the legacy systems.
• Assisted QA team in Preparing Test cases.
• ConductedIntegration tests and User Acceptance Tests.
• Organized, managed and developed EDI specifications, for data feeds and mappings for integration between various systems, to follow ANSI X12 4010 – 834 format to meet HIPAA requirements set forth by the federal government.

Confidential,Duration : Aug 2009 – Oct 2010
Role : Facets Analyst
Environment : HIPAA versions 4010A1 and XML 5010, Quality Center, HTM, TOAD, XML Notepad, Medicare, Medicaid, EDI transactions and code sets, ICD 9, ICD 10

Cigna Windsor, Connecticut is a global health services company. HP is the implementation partner for CIGNA to execute theHIPAA 4010A to 5010 Migrationprojects for all of the CIGNA’s health insurance subsidiary companies. HP works with EDIFECS, Deloitte, Oracle and IBM products to upgrade and manage all of the Cigna’s broker gateways and claim engines environments that are aimed to deliver cost-effective, on time and easy flow of EDI transaction for CIGNA, in order to reduce administrative cost and increase productivity, and will lay a foundation for ICD 10 implementation.

Responsibilities:

• Responsible for gaining a good understanding of user needs and accurately representing them in a well-documented software functional specifications document
• Gathered Business Requirements, interacted with the users, designers and developers, project manager and QA team to get a better understanding of the Business Processes
• Interacted with the “End-Users” by interviewing them, by preparing appropriate questionnaire to better understand end-user needs and the business process
• Involved in historical data fix and data recovery/replay operations for reporting clean up of HIPAA Compliant EDI transactions 270/271, 276/277, 837, and 835
• Analyzing defects, go to HTM, pull X12, ACCR, CCF and ECHCF compare them and find the problem that is causing to replay the claims.
• Gather the artifacts and communicated with developers and upload required artifacts in HTM prod Environment to ease developers to replay.
• Upload the analysis documents in QUALITY CENTER (QC), and keep posted the R&D comments regarding the defect status.
• Compare every segment of X12 in Inbound and Out Bound claims regarding 837, 277, 835, in HTM, and suggest developers for appropriate solutions.
• Create and maintain data mapping document(s) in reference to the HIPAA transaction: 837, 277,835
• Generate a report regarding the claims that fell to maintain the HIPAA validation standard in HP gateway and distributed to
• Conducted walkthroughs and code reviews with developers, project managers and stakeholders and users to comprehend business workflow of applications
• Followed a structured approach to organize requirements into logical groupings such as requirements for Customer, Client, Group, Member and Reporting that critical requirements are not missed.
• Performed GAP analysis of 5010 EDI transaction using implementation guide to identify the changes in the segments and data elements
• Created test cases for System Testing (Development Environment), Integration Testing (UAT) and Production (Post Implementation Review) in Agile/Scrum environment.
• Get the Facets Claim IDs from X12 in HTM, HP environment and verify them in TIBCO layer and Facets Claim Adjudication system.

Confidential,Arizona
Duration : Jan 2008 - Aug 2009
Role : Systems Analyst
Environment : Oracle 10g, Facets 4.61, MS Office Tools, MS Visio, Lotus Note, Share Point,
Serena Dimension CM,UML, TOAD 9.7

QCSI (MyHealthBank), headquartered in Phoenix, Arizona, with offices in Portland, is the leading provider of healthcare payer enterprise application solutions for the Next Healthcare Economy. As part of this project, an online application was built for business user to track the reconciliation process of each plan sponsor, in accordance with the new retiree drug subsidy program, to approve, stop, and to redo the process from any process step of the reconciliation process. This also allowed the business user to view and maintain some of the key tables in the database.

Responsibilities:

• Primary responsibilities involved documentingfunctional specification, detail design and implementation.
• Gathered requirementfrom the business side. ConductedJAD sessionswith stakeholders to analyze needs, requirement and resources.
• Designed and prepared detail document and functional specification.
• Validate the result usingPL SQLin Oracle SQL Developer and TOAD.
• Prepared release notes for each job. Came up with methods toreduce risks of releasing new upgradeto the system in production by doing a controlled of new features (upgrades).
• Involved in testing different interfaces and web application for FACETS.
• Actively involved in developing web-based system framework to process new business applications electronically.
• Played a key role in the planning, testing, and implementation ofsystem enhancements and conversions.
• Prepared test scenario and test cases.Reviewed and updatedtest cases, test scenarioand conductedunit testingin development and production.
• Measured the success/failure/demand for new or existing features.
• Designed and developed Use Cases, Activity Diagrams, and Sequence Diagrams.
• Monitored client expectations and skillfully negotiated with them.
• Conducted discussion sessions to make sure that systems built are incomplaint to HIPAA.
• Assisted informational needs in mapping of Test Cases.
• UsedMS Projectto maintain the project schedule and track its status.
• Worked Extensively on HIPAA EDI transaction 834.
• Configured and maintained of Facets and other application software products, such as Claim check, Facets
• Supported the business and the technical team in the product development and delivery process with successfully managing cross- departmental relationships.
• Coordinated with other QA and user acceptance testing for testing purpose.
• Used SQL to test various reports and ETL load jobs in development, QA and production.
• FollowedRUPmethodology.
• Dealt with 834 import members lookup processes and resolving issues with member attributes, enabling multiple rules associated with member lookup process in FACETS.

Confidential,Mooresville, NC
Duration: Oct 2006- Nov 2007
Role: Business Analyst

Lowe\'s has been helping our customers improve the places they call home for more than 60 years. Founded in 1946, Lowe’s has grown from a small hardware store to the second-largest home improvement retailer worldwide. Lowe’s stores stock 40,000 products in 16 product categories ranging from appliances to tools, to paint, lumber and nursery products. Lowe’s has hundreds of thousands of products available by Special Order – offering everything customers need to build, maintain, beautify and enjoy their homes. Lowe\'s operates more than 1,745 stores in the United States, Canada and Mexico. To increase sales by simplifying and enhancing the selling process and tools, through the deployment of the Sterling Commerce application to support multi-channel selling, and provide a platform for flexible selling and enhanced functionality.

Responsibilities:

• Attended meetings with managers to understand various process plans, business process, and functionality in detail.
• Prepared User Requirements Specification Document.
• Identified major deliverables and collected businessrequirements for the project.
• Assisted the development team ininterface developmentand performingunit testing.
• Effectively worked with QA teams to review test requirements and documentation.
• Maintained weekly project status reports, issues and documents.
• Drafted project chart which included project goals, business case, opportunity statement,and highlevel timeline and team assignments for the projects.
• Identified resource requirements i.e. business analysts, software developers, testers etc
• Involved in Change Control Management and Configuration Management.
• Assisted the team in developing Test Scripts, Test Plans and Test Cases from business, technical and functional requirement.