Hema

732-***-****

acu2ta@r.postjobfree.com

SUMMARY

7+ years of diverse experience in Requirements Management, Business Analysis, Business Intelligence, Data Analysis and Project Management through Healthcare/Insurance/Banking/Telecommunication clients.

Excellent skills in performance management to support strategic planning (SWOT Analysis), goal setting, strengthen accountability and enhance decision making.

Developing functional specifications for business process refinement and automation, data modeling, conducting feasibility studies and scope.

Well acquainted with Oracle database warehousing, query writing, performance optimization and object oriented analysis.

Conducted Requirement Gathering Sessions such as Joint Application Development (JAD), Rapid Application Development (RAD) interviewed Subject Matter Experts (SMEs), Stakeholders for deriving detailed functionality aspects of business process and carefully updated the requirements information in an easily understandable format.

Developed RACI Charts for clarifying roles and responsibilities in cross-functional/departmental projects and processes.

Experience working with ORACLE 10g and 12c.

Knowledge of Health Benefit Exchange system and Obama Care implementation

Profound knowledge of Medicare, Medicaid and Health Insurance

Knowledge of ICD 9 and ICD 10

Extensive knowledge of HIPAA 4010 & 5010, Electronic Data Interchange (EDI) Transactions ex. such as 270/271(inquiry/response health care benefits), 276/277(Claim status), 834(Benefit enrollment), 835 (Payment/remittance advice/ Explanation of benefits), 837(Health care claim).

Extensive knowledge of Healthcare Insurance including Medicaid. Medicaid Information Technology (MITA), Medicare (Part A, B, C, D), Procedural and Diagnostic codes, Claims Process and Medicaid Management Information Systems (MMIS)

Strong knowledge EMR/EHR, Health Care Reform and Patient Protection and Affordable Care Act (PPACA) and Facets

Excellent business writing skills essential for producing various business documents such as Business Requirements Document (BRD), Functional Requirements Document (FRD), and Non-Functional Requirements Document (NFRD), Business Process Documents, Business Flow Documents, User Training Manuals, User Interface Specifications.

Experienced in Data Analysis techniques such as Data Flow Diagram, Data Mapping, and Decision Tree Analysis.

Experience in performing ETL operations like Extraction, Transformation and Loading Informatica with Power Center.

Comprehensive knowledge of software development methodologies (SDLC) such as Waterfall, RUP and AGILE.

Strong knowledge of Business Process Modeling assessing “As Is” & “To Be” scenarios and Business Re-Engineering (Re Design) research, & implementation methodologies, diagramming data & process mapping, applying Unified Modeling Language (UML).

Applied Object Oriented Analysis and Design (OOAD) approach to analyze the functional requirements on various projects.

Well versed in performing Change Management by using Impact Analysis, Gap Analysis. Developed Requirement Traceability Matrix using MS-Excel.

Worked on various Graphical user interface &Web-Based user interface with great excellence.

Extensive experience in analyzing and creating Use Cases, Use Case Diagrams, Data Flow Diagrams, Business Flow Diagrams, Navigational Flow diagrams, Swim Lane Diagram, and Sequence Diagrams using MS –Visio.

Proficient in writing SQL queries and in creating complex SQL Queries using Joins and Sub-Queries.

Extensively worked with the On-site and Off-shore Quality Assurance Groups by assisting the QA team for developing Test Plans, Test Cases, and Test Scripts etc., conducted User Acceptance Testing (UAT) and Performance Testing.

EDUCATION:

Bachelors in Engineering

TECHNICAL SKILLS:

Business Intelligence Tools

:

Web Intelligence, Universe Designer, CMC, CCM, Import Wizard, Info View, IBM Cognos 8, Tableau.

Business Modeling Tools

:

SmartDraw, Snagit9, MS-Visio, Snipping Tool

SDLC Methodologies

:

Waterfall, Agile, RUP and OOAD

Requirement Management Tools and Change Management Tools

:

Rational Rose, Power Designer, IBM Rational Requisite Pro, JIRA, Confluence, Rational Clear Quest, Rational Clear Case, Silk Central Test Manager, Team Track, Rally

ETL Tools

:

Informatica Power Center 9.1, Repository Manager, Designer, Workflow Manager, Workflow Monitor, Informatica Developer, Informatica Analyst, SQL *Plus, Toad

CRM Tools

:

Salesforce, Pipedrive

Languages

:

PL/SQL, JAVA, Shell Scripting

Networking Tools

:

MS Share Point/ Network share drives

Databases

:

MS Access 97/2000/2003, SQL Server, Oracle, DB2

Testing Tools Knowledge

:

Mercury QC, Load Runner, Test Harness

MS Office Suite

:

Word, Excel, Access, PowerPoint, Project, Outlook

Operating Systems

:

MSDOS, Windows 95/98/NT/2000/XP, Unix, Linux, Solaris

EXPERIENCE:

CVS Health, RI Aug 2014 – Till Date

Business System Analyst

CVS Pharmacy is the second largest pharmacy chain in the United States, with more than 7,600 stores and is the second largest US pharmacy based on total prescription revenue. It also provides healthcare services through its more than 1000 Minute Clinic as well as their Diabetes Care Centers.

Description:

Project was related to development, enhancement, maintenance and scheduling of jobs which extract data from various data sources, processing of data and migrating it to a different server to be used by Business Objects for generation of reports.

Responsibilities:

Conducted meetings with the clients for Gathering Requirements and evaluation/analysis of their data.

Converted the business requirements into IT specifications.

Documented technical requirements and project templates based on Agile methodology.

Developed and documented technical and functional requirements that translate Business Requirements associated with new and changing business capabilities into a technical solution.

Managed a team of developers, determine feasibility of requirements and developed project documentation for signoff.

Identified production problems and resolves systems problems and performance test issues on Oracle and Informatica.

Strong knowledge of HIPAA 4010A rules to store the transactions. Monitored all the HIPAA transactions through the gateway.

Tested the system and applications for compliance with the HIPAA, HL7 and EDI

Verified the privacy issues and compliance with the HIPAA Security and Privacy Act.

Involved in the development and enhancement of jobs related to Data Warehousing.

Coordinated daily, weekly and monthly meetings with developers and project leads to keep track of development tasks in the onsite offshore model.

Worked with the front end team while storing the patient’s information into the database using Facets software.

Worked with Facets software for maintaining data about the enrolment, billing and health care claims management and to store, send, receive HIPPA transactions and facilitate the administration of HIPAA privacy rights.

Interacted with the SME’s to gather information about the health care enrolment, billing and health care claims processing and checked if they are processed correctly or not.

Experience of working with EDI transactions such as 837, 270, 271, 276 and 835 transactions.

Mentored business analysts in methodology for defining ICD-10 mapping processes and documenting business requirements.

Subject Matter Expert and part of the technical team in ICD-10 transition project.

Worked closely with Operations, Data Centre and UNIX DBA teams.

Worked with MS Visio to create detail workflow diagrams.

Involved in detailed analysis of the various mdb files, reference tables for data validation and data accuracy.

Created mappings from the Informatica Power center for the staging by loading the data from mdb files and reference tables to stage tables.

Analysis and Creation of various tasks, sessions, and workflows to extract data from CVS files, Oracle sources and load to Oracle.

Worked in onsite-offshore model and lead offshore team.

Build and demonstrate interpersonal relationships with business partners, project managers and IT functions.

Performed Data Analysis using Excel and created ad-hoc Reports as per the business request.

Environment: Unix, Oracle 12C, Data Warehousing, Informatica Power center 9.1, Business Objects, MS Visio, MS Word, MS Excel, Oracle, SQL Developer, Healthcare and Pharmaceutical.

Sr. Business Analyst

Blue Cross & Blue Shield of North Carolina, NC Oct 2012- Jul 2014

Business Analyst

ICD-10 Project is a federal mandate to replace the current ICD-9 Diagnosis codes with the ICD-10 Diagnosis code set.

Description:

The main deliverable of this project was to develop an integrated solution to provide quality healthcare, optimized process flows, increased patient flows, and exceptional and consistent patient experience across all services. The project focus was on HIPAA Claims Processing (HIPAA 837 & 835 transactions) and ICD 10 readiness. The project involved analyzing and assessing impacts and risks related to the ICD-10 migration based ICD-9 to ICD-10 GEM analysis.

Responsibilities:

Participated in the initial Impact Analysis (ICD-10) for all the critical functions, i.e. Membership & Enrollment, Claims Processing, Utilization Management, Medical Policy, Reporting, Vendor Management, etc.

Worked with the internal team to build out a high level roadmap and time line to achieve compliance

Exposure to Medical Billing and Medical Workflows and ETL Testing

Performed impact analysis on 5010 upgrades and ICD-10 conversions

Participated in ICD 9 to ICD 10 codes conversion requirement gathering sessions and created high level business requirements documents (BRD’s)

Exposure to all the 75 measures under HEDIS

Prepared product backlog working with product owner and other SME (Subject Matter Experts)

Facilitated daily stand ups and managed task board with user stories, Data Flow Diagrams, Process Diagrams.

Managed to work and coordinate with internal and external business and technology partners.

Prepared and tracked burn down charts and velocity charts for timely delivery of projects

Utilized corporation developed Agile SDLC methodology and Microsoft Office software to perform required job functions

Experience in designing and defining User Interface Requirements (UIR) and visual patterns by creating wire frames, screen mockups and story boards

Prepared 5010 GAP documents involved with 837 and 835 transactions in collaboration with other team members

Defined ICD-9 to ICD-10 mapping process using GEM (General Equivalency Mapping) crosswalk file

Exposure to Enterprise Application Integration technology

Created custom mapping between ICD-9 and ICD-10 codes

Extracted data from several databases to create a master list of the ICD-9 codes

Ran reports using Excel and Business Objects to compare and verify data

Conducted Business Requirements walkthrough with the business owners as well as the Technical Stake holders

Change Control Process (CCP) – Led the Change Control Process for changes submitted for the BRD once the document was submitted to IT department

Documented the UAT Plan for the project and worked with the UAT Team to ensure every acceptance criterion for the requirements has been included in the UAT task plan

Maintained the Traceability Matrix table to uniquely trace the identified business requirements to general design to testing as proof that requirements requested have been developed into a solution and that it has been tested and tracked

Environment: Agile, MS Visio, Word, Excel, PowerPoint, SQL, SharePoint 2010, MS Project.

Humana Inc. KY. Sep 2011 - Oct 2012

Business Analyst

Humana is a Fortune 100 company that markets and administers health insurance. With a customer base of over 11.5million in the United States, the company is the largest (by revenues) Fortune 100 Company headquartered in the Commonwealth of Kentucky.

Description:

The system streamlined patient registration, patient scheduling, medical insurance checking, claims processing, and reporting. The purpose of this project involves population of the Enterprise Data Warehouse (EDW) which is used in critical reporting and analysis. The data is pulled together from multiple, disparate systems. I was also involved in certain modifications to the claims processing system.

Responsibilities:

Played key role in System Development Life Cycle Process consisting of: Design and Gap Analysis, Business Requirements, Systems Requirements, Test Criteria, and Implementation to have the outputs of project dealt with the automation of correspondence directed to Insurance policy owners.

Involved in requirement gathering and Database Design and implementation of star-schema, dimensional data warehouse using Erwin.

Extensively used Informatica client tools. The objective is to extract data stored in Oracle database, flat files to load finally into a single data warehouse repository, which is in Oracle.

Used knowledge of Health Care Information Systems EMR model to develop proposed Workflow in MS Visio.

Responsible for integrating with Facets. Designing Test Scripts for testing of Claims in Development, Integration and production environment.

Gathered user/business requirements by meeting with business users and generated business models and use case analysis. Considered HIPAA rules while data validation and testing.

Exposure to HIPAA Compliance requirements and HL 7 standards

Conduct complex documentation and user needs analysis. Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, OOAD using UML and Business Process Modeling.

Excellent in Developing and evaluating Business Process Models.

Conducted Functional Walkthroughs, User Acceptance Testing (UAT), and supervised the development of User Manuals for customers.

Gathered requirements and modeled the data warehouse and the underlying transactional database

Perform Gap Analysis of the processes to identify and validate requirements.

Identified/documented data sources and transformation rules required populating and maintaining data warehouse content.

Implemented data access, storage and validation routines on the database server using Procedural Language/Structured Query Language (PL/SQL).

Involved in the testing phase right from the Unit testing to the User Acceptance testing.

Used SDLC (System Development Life Cycle) methodologies like the RUP and the Waterfall.

Use Cases and other Process Flow Models were designed using Visio and Rational Rose. Developed & executed several Optimized queries in SQL on this data.

Followed the UML based methods using Rational Software Modeler/MS Visio to create: Use Cases, Activity Diagrams/State Chart Diagrams, Sequence Diagrams, Collaboration Diagrams.

Environment: RUP, UAT, GAD (Gap Analysis Document), Microsoft Office 2003 Professional (Outlook, Word, Excel, Visio, Access), ERWIN, SQL, PL/SQL.

Bank of Baroda, India Jun 2010 - Aug 2011

Oracle DBA/Analyst

Description:

Bank of Baroda is a Government of India undertaking, having a record of uninterrupted profits since inception. At present, it has more than 5300 branches, and also offers a global link with 105 branches / offices / subsidiaries spread out in 25 countries across the world. Project was related to create and manage the existing databases of Bank.

Responsibilities:

Gathered Requirements and modeled the data warehouse and the underlying transactional database.

Perform Gap Analysis of the processes to identify and validate requirements.

Identified/documented data sources and transformation rules required populating and maintaining data warehouse content.

Conducted meetings and interview sessions for Change Management in current Production Databases.

Implemented data access, storage and validation routines on the database server using Procedural Language/Structured Query Language (PL/SQL).

Monitor system activities and logs.

Managed multiple Cross-Functional projects using formal project management techniques and tools, including project resources, project plans, status updates, communication plans, and risk assessments for assigned projects.

Database Start-up and Shutdown.

User administration – Creating/ managing roles, privileges, security, backup and restoration activities.

Installation/ reinstallation/ maintenance of Oracle databases.

Backup solutions involving RMAN.

Performed Performance tuning on SQL queries.

Created Database/ Table Space Management.

AWR and ASH Report Generation.

Running SQL Scripts, Creation and Manipulation of database tables.

Re-organization of tables to improve performance.

Import and Export of database and objects as per the requirements.

Excellent in Developing and evaluating business process Models.

Environment: Oracle DB, RUP, UAT, SQL, SQL*PLUS, Microsoft Office Outlook,MS Word, Excel,GAD (Gap Analysis Document), Oracle 10g.

Reliance Communications, India Jul 2009 – May 2010

JR. Business Analyst

Reliance Communications Ltd. (RCOM) is an Indian Internet Access and Telecommunications Company headquartered in Navi Mumbai, India.

Description:

Converting Non-Usage customers to Usage Customers special schemes were introduced for customers who were not using the Reliance Network for making calls and SMS. The segments were identified using Hyperion and DSS. The initiative led to average conversion rate of 10% for all segments targeted.

Responsibilities:

Requirements gathering & Analysis to develop functional specifications in all projects.

Implementation of High Level, Detailed System Design and Use Case Analysis using UML.

Preparation of Strategic Documents to set the short-term goals after discussion with all roles involved.

Conceptualization and implementation of product ideas to sustain and increase the usage and revenue of subscriber base and graduate them to next higher level of usage.

Conducted Meetings with users for understanding the Gaps in current system.

Responsible for developing Product Development Plan, Iteration Plan, Quality Assurance Plan, Risk List as described by the RUP Rational Unified Process methodology.

Performed a current situation analysis, future state vision analysis, and migration strategy for situation at hand.

Conducted and participated in status meeting to collect data from business users.

Used data mining application to generate models and refined rules based on the data analysis.

Segmenting and analyzing the base on projected need-basis and designing special products to cater to the needs of those segments.

Augmenting the basic offering with VAS services to make the proposition more appealing and meaningful to customers.

Worked on different configuration technologies- Blackberry, Nokia and Ericsson IN.

Environment: HTML, SharePoint, MS Excel, JAVA, MS PowerPoint, MS-Visio, MS Project, MS Word, IBM Blue Works, SQL, TOAD, Crystal report.

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