Profile: A MBA professional with experience as Business and System Analyst

in the Healthcare and Insurance Industry

Professional Summary

> Excellent skills in client relationship management, interaction with

business partners, subject matter experts, portfolio architects and

technology partners.

> Ability to gather and document Business Requirements, experience in

writing Use Cases. Proficient in understanding SDLC life cycle,

understand workflow concept, ability to gather and document 'As-Is and To-

Be' process.

> Proficient in authoring Business Requirement Documents (BRD) into System

Requirement Specifications (SRS) and identifying interface and business

process specifications.

> Competent in analyzing and creating Use Case Narratives, Use Case

Diagrams, Activity diagrams, Class diagrams, Data Flow/Navigational flow

diagram using UML Tools like MS Visio.

> Experience with SQL queries to extract reports as required by the

business using MS SQL server.

> Well versed in Data integration and Data Mapping to define data

requirements.

> Adapt in conducting UAT User Acceptance Testing and familiar with UAT

tools.

> In-depth knowledge of Rational Unified Process (RUP); risk engineering;

data modeling and data mapping, data warehousing; and design using UML,

Rational Rose, and Visio.

> Performed Functional (System & System Integrated Testing) and Regression

Testing.

> Able to adopt change management and process management process.

> Proficient in preparing Requirement Traceability Matrix (RTM) and GAP

analysis with proof of concept.

> Experience with Wireframes and Mockups to facilitate the Design and

development team.

> Well versed in database modeling using Toad SQL.

> Extensive experience in ETL process consisting of Data extracting,

transforming, sourcing, mapping and loading to the data warehouse.

> Prepared custom reports and performed SQL query, data analysis and

verification.

> Extensive experience in Dimensional Data Modeling using star schema, fact

and Dimension tables and Physical and logical data modeling.

> Comprehensive knowledge of working in Scrum and Agile methodology.

> Experience preparing ad hoc reports using crystal reports.

> Highly motivated, organized and result and detail oriented with excellent

interpersonal, communication and presentation skills.

> Proficient in soliciting client requirements through interviews,

workshops, existing system documentation and organizing JAD sessions

> Writing and Reading data objects i.e. stored procedures, tables, and

views, etc. in SQL Server

EDUCATION

Degree : Master Of Business Administration

Specialization: Human Resource and Marketing

Technical Skills

MMMM MS -Visio, confluence, JIRA, QTP, Soap UI, LR, QC, TFS, RUP,UML,

GIT-STASH, MS-VSS, MS-office

DENTAQUEST (Boston,MA)

April 2014

to present

This project was about to implement the automated adjudication system,

which deals with different phase of claim process such as intake phase,

adjudication phase and reporting phase. Implementation of ACAS to generate

automated claim submission, processing and creating a report and claim

payment with remittance advice.

Roles & Responsibilities:

. Gathered Business Requirements, interacted with the Users, Designers,

Developers, Project Manager, and SMEs to get a better understanding of

the Business Processes, and analyzed and optimized the process

. Actively involved in the entire Software Development Life Cycle (SDLC)

Process.

. Created reports containing all the information regarding the

publishers, distributors and retailers using crystal reports.

. Address all the aspect of the claim processing life cycle starting

from identifying a claim right up to the closure under HIPPA privacy

and security rules.

. Validate EDI Claim Process according to HIPAA compliance

. Facilitated demonstration of a major ACH software systems and

performed evaluations with a group of expertsto select a package that

best suits the need of the business.

. Worked on HIPAA Transactions 270,271, 276,277, 834, 835, and 997

. Experience working with HIPAA transactions such as 835-claim payment/

Advice.

. Developed Traceability Matrix for maintaining/updating current and new

system requirements using MS Excel.

. Researched/Analyzed the various steps in the claims processing

lifecycle and then wrote the Business Requirement Document and

Functional Requirement Document in such a way that the developers

could construct the system to identify and monitor the riskier claims.

. Experience working with Electronic Claims clearing houses like Web MD

and Automated Clearing Houses (ACH) for electronic payment, remittance

data processing and services under HIPPA compliance.

. Created the user requirement specifications and helped convert them to

functional requirements, and assisted the developers withsystem

requirement specifications.

. Responsible for ensuring data integrity and coordinating efforts with

testing and implementation Responsible for the development and

execution of test plans.

. Conducted User Acceptance Testing (UAT) sessions with business users

and prepared document for enhancements and bug fixes

. Conducted User Acceptance Testing (UAT) sessions with business users

and prepared document for enhancements and bug fixes

Apollo Healthcare (Atlanta, GA)

April 2011 to

March 2014

Apollo serves millions of people worldwide. It is known as a health and

elated benefits company. This project involves enhancements to the

Electronics

Claims Processing (ECP) system designed to accept the electronic claims

coming from the various providers (doctors and hospitals) and process them.

The project was also to make the service providers, HIPAA compliant and to

integrate all of them into one system.

Roles & Responsibilities:

. Identified and documented the dependencies between the business

processes.

. Worked with HIPPA rules and regulations to draft business rules and

claim processes.

. Developed logical system architectures and requirement documents and

documented algorithms, system interfaces and program flows.

. Transmission of EDI files in ANSI 837.

. Performed SWOT and Gap analysis to evaluate business systems and to

develop implementations to align system to overall business strategy.

. Interacted with the client and the Technical Team for requirement

gathering and translation of Business Requirements to Technical

specifications.

. Conducted JAD sessions.

. Documented the Use Cases and prepared the Use Case, Activity, Sequence

diagrams and Logical views using MS Visio, MS Office and Rational Rose

for a clear understanding of the requirements by the development team.

. Worked with the project manager in coordinating team activities and

review meetings.

. Generated weekly reports for the Senior management and collaborated

between the team lead and development teams for clarification of

issues.

. Responsible for overall project development cycle with RUP approach.

. Well versed with HIPAA, claim adjustments, claim processing from point

of entry to finalizing, claim review, identifying claims processing

problems, their source and providing alternative solutions using best

practice model and principles.

. Prepared test plans based on Business Requirements Document (BRD) for

Quality Centre.

. Implemented the HIPAA privacy and security regulations to enhance the

capabilities of the systems to process new products

Environment:

Rational Unified Process (RUP), UML,, Rational Test Manager, Windows, MS

Office, SQL.

ICICI Lombard (Delhi,India)

AUG 2008 TO

MAR 2011

Electronic Health Record is designed to create a paperless office with

features designed for Physicians and consultants. Quick and easy access to

patient records through secure web access makes it possible to provide

better care for patients. This web-based application has Medicare and

Medicaid claims features. Records are electronically stored in database

Roles & Responsibilities:

. Analyzed, documented and managed all project requirements and changes

to requirements throughout the software development life cycle through

Rational Doors.

. Prepared and created Test Cases/Test Data according to Business

Requirements.

. Created Statement of Work (SOW) document for various capabilities in

the initial requirements gathering phase.

. Strong Documentation experience that required converting business

needs to technical documents.

. Documented and reviewed high level and detailed requirements in

Business Requirement Document (BRD).

. Created Use Cases and Use Case Description/narratives based on the

requirements list and BRD.

. Created activity diagrams in UML using Rational Rose and also involved

in creating the Business Process Models.

. Coordinated activities involved in QA and User Acceptance Testing.

Environment: Rational Doors, RUP, Test Foundation Server, UML, Rational

Rose, MS Office.

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