M. Mike Singh

818-***-****

ql1i4z@r.postjobfree.com

Over 12 years of Information Technology experience with good understanding of Business Process Flow and Business Analysis pertaining to Healthcare, Insurance and Manufacturing domain. Area of expertise includes extensive knowledge of medicine protocols and procedures, medical terminology, strategic planning, requirement analysis, and staff development along with a vast experience in all the stages of Software Development Life Cycle (SDLC). Possess excellent verbal and written communication skills and the ability to interact professionally with a diverse group, executives, managers, and subject matter experts.

Technical Expertise

• Result- oriented professional with significant and progressive experience in business process engineering and software development life cycle, including analysis, design, development, testing and implementation of software applications.

• Extensive experience as a liaison between Stakeholders and developers in developing automated solutions for their company.

• Collaborated with project stakeholders and SMEs to understand the requirements and specifications for new applications along with re-engineering the existing applications.

• Gathered Business Requirements, and wrote Business Requirements Document (BRD), System Requirements Specifications (SRS), Requirements Specification Document (RSD) and System Design Specification (SDS), functional specifications by working with the client, IT staff and project managers. Created Requirements Traceability Matrix (RTM) in order to keep the stakeholders updated on the progress of the project. Constantly work with Tech writers for all the documents.

• Elicit requirements using interviews, document analysis, requirements workshops, surveys, site visits, business process descriptions, use cases, scenarios, business analysis, and task and workflow analysis.

• Experienced in the Software Development Life Cycle (SDLC) methodologies; defining and understanding the scope of the project, creating application road maps, gathering business requirements, developing business process models performing effective communications and expectation setting including understanding of business functional requirements matching to technical systems setups and configuration, and finding the perfect solution for the client. Strong knowledge of Quality Assurance Life Cycle.

• Defined scope and boundaries as part of concept development. Prepare and present Project Proposals.

• Worked in coordination with database development/testing and data warehouse (ETL) teams to establish data cleansing rules, in defining data triggered logic and events, modeling the data in ERD diagrams, specifying the primary and secondary key relationships, identifying the relationship between the database tables, normalizing data and supporting complex database and warehousing systems.

• Sound knowledge in reviewing test input data and test procedures, documented detailed test plans, test scenario, defined test cases, executed detailed test scripts, analyzed bugs, interacted with team members in fixing bugs, conducted User Acceptance Testing (UAT) and assisted in post–production support.

• In-depth knowledge of standard methodologies like Software Development Life Cycle (SDLC), Agile, Waterfall, Scrum and Rational Unified Process’s (RUP) iterative software development life cycle process; Capability Maturity Models (CMM); risk engineering; data modeling and mapping and design using UML, Rational Rose, and Visio.

• Responsible for facilitating Joint Application Development (JAD), Rapid Application Development (RAD), and Joint Requirement Planning (JRP) sessions. Gather, synthesize and prioritize requirements using interviews, document analysis, requirement workshops, site visits and surveys.

• Performed GAP analysis, SWOT analysis, Risk analysis, and Cost/Benefit analysis.

• Proficient in creating Use Cases, Class Diagram, Sequence Diagrams, Collaboration Diagrams, and Activity Diagrams.

• Hands on experience with IBM Rational Software integration tools like Requisite Pro, Rational Rose, ClearCase, ClearQuest. Used Rational Rose and Requisite Pro for requirement management and analysis.

• Good understanding of HIPAA EDI 4010, 5010 with ICD-10, HMO, PPO, ICD-9. Experience in HEDIS Reporting Software and VIPS as per NCQA standards.

• In-depth knowledge of Medicare/Medicaid Claims processes and benefits.

• Conducted User Acceptance Testing (UAT), Functional Testing, Integration/system testing.

• Experience in writing queries for data analysis and QA report testing

• Excellent communication, analytical (SPSS), interpersonal, and presentation skills; expert at managing multiple projects simultaneously.

• Worked with the Development team to develop maps for following transaction sets:

270 - Eligibility Inquiry transaction-Inbound.

271 - Eligibility Response-Outbound.

277 - Health care claim status notification.

278 - Referral certification and authorization

837 - Health Care Claims (Professional. Institutional and Dental)

835 - Remittance Advice

Education

PhD: SUNY Buffalo, NY, USA.

MBA: Punjab University, India.

Undergraduate degree in Engg.

PMP Certification: In Progress.

Methodologies RUP, Agile, Waterfall, UML

Tools WinRunner, LoadRunner, Quick Test Pro, Rational Robot, Quality

Centre.

Databases Oracle (RDBMS), MS SQL, DB2, SQL Server, MS Access,

Sybase

Operating Systems UNIX, Win NT/Win2k/XP

Project Management/ Requirement Tools

Market Data Sources MS Visio, Rational Rose, Rational Requisite Pro, Bloomberg,

FactSet, Share Point

MS Office MS Access, Excel, PowerPoint, Visio, MS Project

Technical Skills

Professional Experience

Diversified Health Systems, Salt Lake City, UT

Client: Healthbenchmarks Inc. (Remote)

Woodland Hills, CA

Sr. Business Analyst

Jan 2009 - Present

Health Benchmarks, Inc. operates as a health services Research Company. It specializes in transforming healthcare data into actionable information. The company conducts health outcomes research and analysis to facilitate evidence-based decision-making. It offers physician clinical quality indicator and physician cost of care measurement services; health services research and analysis, patient registry network, retrospective database study services; and HBI Online, a provider performance online reporting Web tool. Worked as a business analyst on the patient registration system for patient scheduling, medical insurance checking, claims processing, and reporting tools. The company also provides consulting services, P4P program development and implementation, performance scoring methodologies, high performance networks/provider tiering methodologies, performance benchmarking, and ROI analysis services, as well as survey development, implementation, and analysis services. It serves health plans, life sciences, and federal and state governments. The purpose of this project involves population of the Enterprise Data Warehouse (EDW), which is used in critical reporting and analysis. The operational data from Mainframes is picked and transformed to store in a central repository DB2 for data warehousing needs.

Responsibilities:

• Coordinated collection of business needs. Converted high level requirements to functional requirements and documented them in functional, navigational and page Use Cases. Prepared Functional Requirements documents using the existing templates. Documented business rules and functional requirements iteratively. Imported these use cases into Requisite pro; tagged and traced them

• Developed use cases using RUP methodology for the technical team, which consisted mainly of business rules, which were inherently related to the functions described in the use case.

• Documented technical details including data source, file formats and data mapping

• Involved in writing use cases for medical, pharmacy and vision claims as part of Health Statements

• Experience with gathering claims data and display of the same; also processing of medical, pharmacy and vision claims as part of the Health Statements project

• Used Requisite Pro for requirements management to capture, prioritize and manage requirements, which helped in controlling numerous artifacts produced by the teams working on the same project by keeping track of simultaneous update, change notification and multiple versions

• Researched claim overpayments and requested funds

• Quickly established capability in EDI claim exchange format (ANSI 837 5010) and mapped entire professional and institutional claims structure from main warehouse. Working as functional lead through the project.

• Helped create a dashboard application for provider performance users: Identified key metrics and designed presentation layer. Developed a new business process to streamline performance-scoring methodologies reporting.

• Actively involved in creating test strategy, conducted manual testing and logged defects using Electronic Project Notebook and Clear Quest. Assisted testing team in understanding the business rules and system development. Created users and user groups to assist tester

• Executed SQL queries using SQL navigator to gather data elements from Enterprise Data Warehouse

• Developed a comprehensive Test Strategy to determine how the testing would be approached in terms of tools, people, procedures and support. This included test management process, integration testing, description of test effort, test reporting plan and the test case schedule

• Conducted JAD sessions for communicating with all project managers, senior management and other stakeholders.

Environment: Requisite Pro 4.0, Rational Clear Quest 6.0, Test Manager, MS Office, SharePoint.

Project: Docu-Mart (Remote)

Sr. Business Analyst

Nov 2007 - Dec 2008

CTIS (CMMI level 3 organization) do clinical trials research and management, provides informatics-based systems, solutions to and delivers accurate and relevant information to the wide spectrum of healthcare and research disciplines like NIH (National Institute of Health), NCI/CTEP, DCTD and DAIDS etc. and positively impact the data accuracy, processes and decision making capabilities of healthcare professionals.

Docu-Mart is developed and maintained by CTIS and used by CTEP (Cancer Therapy Evaluation Program) to author, review and publish the oncology protocols. Docu-Mart Project was created to develop a system of software applications (web/desktop) to assist in the authoring, review and tracking of clinical trial protocol documents. The application is planned to assist in reducing the administrative burden of protocol development so that investigators can focus on scientific integrity and reduce the time between concept approvals to protocol approval. This application has various modules like Publish, Scientific Library, Review and Commenting, Tasks and Inbox.

Responsibilities:

• Conducted JAD sessions to identify the future requirements.

• Documented the requirements for the project.

• Used SQL queries to identify the lookup data and various fields in the system.

• Worked with the SMEs to identify the key business requirements.

• Provided valuable suggestions during Critical Design Meetings to make application more user friendly for better clinical trials.

• Developed Requirement Traceability Matrix.

• Coordinated with the users while they performed UAT (User Acceptance Test). Assisted them with anything they wanted to know about the system while testing.

• Worked closely with the GUI design team to model the screens, which met user defined requirements.

• Wrote and executed SQL queries in order to check if the system is pulling and displaying the correct data on the UI screen after checking all the necessary validations, business and system rules.

• Helped creating simple user training documents and user guides. Conducted in-class training sessions for the business users.

• Created Organizational chart and other detailed documents in-order to identify the various user groups with different levels of permission for access security reasons.

• Worked with reporting team to help them gather requirements, report design and lay-out details etc. from the business users for development of new reports.

• Participated in Critical Application Review meetings in order to ensure that changes requested by the client were incorporated into the product.

• Met with project team weekly to monitor the deadlines of the release and given status updates on the ongoing requirements.

• Created Test Scenario, Test Cases and Test Data to conduct Testing.

• As part of CMMI process regularly updated SharePoint Portal Server.

• HIPPA and HL7 compliance.

• Used IBM Rational ClearCase as Repository tool.

• Used IBM Rational ClearQuest as Version Control/Change Management Tools.

Environment: MS Office, Windows XP/2003, IBM Rational RequisitePro, IBM Rational ClearQuest, IBM Rational ClearCase, Documentum, SharePoint Portal Server 2003, PL/SQL.

Magellan Health Services, Glen Allen, VA (Remote)

Sr. Business Analyst

Sep ‘05 - Oct ’07

A specialty health care management company specializing in managing behavioral health care, diagnostic imaging, specialty pharmaceutical services and providing pharmacy benefits administration. Magellan provides innovative solutions in collaboration with health plans, corporations and government agencies and their members nationwide.

Responsibilities:

• Understand and articulate business requirements from user interviews and then convert requirements into technical specifications.

• Interacted with users to finalize the Business Requirements for the application. Conducted joint requirements planning sessions as a facilitator to gather requirements.

• Efficiently responded to client inquiries and resolved discrepancies. Identified, prioritized, tested and proved essential business functions to assure compliance with vendor and internal auditing.

• Responsible for the completion of projects within specified time and budget dealing with financials, project work flow, change management and dealing with outside vendor relationships.

• Effectively conducted JAD/JRP sessions, meetings and conferences with end users for Gathering Requirements for FRD (Functional Requirements Document)

• Planned the project time-line and scheduled various project deliverable dates according to the various phases of the project; Used Rational Unified Process as the development methodology.

• Used SQL queries for data validation, Involved in UAT, executing test cases, evaluating test results and preparing test summary reports.

• Identified gaps between legacy system and new Data warehouse that comprises main business dimensions and are used as data source of the reporting system.

• Tactfully delegated work to Business Analysts for the Business Analysis Document,

• Implemented HIPAA compliant transaction formats.

• Prepared the project schedule using MS-Project and worked with plan reporting to receive and review to the reports.

• Organized meetings with the development and QA teams to elicit use cases and document them.

• Created Use Cases and Use Case Diagrams to define the Functional requirements of the application using MS Visio. Used MDM for Data storage and normalization.

• Generated Unified Modeling Language (UML) diagrams such as Activity, State Transition, Sequence Diagrams and Workflow Diagram to demonstrate critical processes using MS Visio.

Environment: MS Office 2007, MS Visio 2007, .NET, JAVA, C++, Work Bench, MS SQL Server, DB2, Windows NT, OS/390,Oracle9i.

United Health Group, Phoenix, AZ (Remote)

Business Analyst

Dec 2003 – Aug 2005

United Health Group is one of the leaders across most major segments of the US health care system. I was part of the Medical Management quality applications & operations team at United Health Group. Responsible for the creation, maintenance and reporting all HEDIS (healthcare effectiveness data and information set) measures for NCQA accreditation. Management of few departmental projects including programming for HEDIS measures for NCQA accreditation through FOCUS and SQL programming. Ensure completion of all programming projects for all programmers in department.

Responsibilities:

• Conducted the AS-IS and TO-BE analysis of the business process using GAP analysis.

• Gathered requirements and prepared Charter, Business Requirement Documents (BRD), System Requirement Specification (SRS) by interviewing Business Users/SME’s

• Lead as well participated in JAD sessions and interacted with various functional leads and analysts.

• Was responsible for reviewing and documentation of CMS GEM (General Equivalency Mapping) crosswalk/mapping.

• Participated in risk sessions to address the risks and project impacts to bring to light the possible workaround.

• Conducted workflow analysis to bring out the identified gaps and documented those.

• Traced Requirements using Requirement Traceability Matrix.

• Analyzed Business Requirements and created Use Cases, Use Case Diagrams, class diagrams, wire-frame diagrams, screen-mock up, Navigation Flow, Business Flow Diagrams for applications and created Activity Diagrams / Sequence Diagrams using MS Visio and Enterprise Architect created conceptual model, behavior diagrams.

• Responsible for providing all business events, rules, and process information for workflow, external interfaces.

• Followed Best Practices during the life cycle of the project. Assisted Technical team in documenting Technical Design Documents by clarifying the technical team's queries pertaining to functional specification.

• Extensively interacted with the QA Team in executing the Test Plans, Test scripts, Providing Test Data, Creating Test cases, and followed bug handling procedures on detection of bugs.

• Scheduled meetings with technical personnel to determine technical parameters for EDI and other related processes, including communication, security and privacy.

• Performed User Acceptance Testing, developed Test logs and opened/closed as and when the issue was fixed and quality checked with the assumed company data with all the possible Test Scenarios.

• Designed and developed all Use Cases and UML models using Rational.

• Defined project milestones, schedules, and monitored progress using MS – Project and updated plans as required.

• Identify data populations for Member Outreach projects

• Produce monthly and quarterly reports on health care product data

• Gather user requirements and lead the design of a system to meet those requirements

• Responsible for leading multiple projects and ensuring they are completed on time and functional

• Gather user requirements and lead the design of a system to meet those requirements

• Responsible for HEDIS reporting for three product lines and 180,000 members, Medicaid, SCHIP (Healthy Families) and a local health initiative.

• Analyze database for errors.

• Currently using Med Measures and Med Capture for HEDIS reporting software

• Post HEDIS analysis reviewing HEDIS processes that can be improved as well as developing interventions for measures with areas for improvement

• HEDIS reporting from mainframe data systems. Design, program and generate HEDIS data from VIPS mainframe environments. This data is used internally as a data quality check for current HEDIS rates.

• CAHPS reporting and statistical analysis. Performing statistical data analysis on CAHPS indicators testing for significant improvements and identifying.

• CAHPS reporting and statistical analysis. Performing statistical data analysis on CAHPS indicators testing for significant improvements and identifying opportunities for improvement. This is then presented graphically and reported to the Quality improvement department for barrier analysis.

ENVIRONMENT: Rational Unified Process (RUP), MS Office Suite, MS Project, MS Visio, Rational RequisitePro, Rational ClearQuest, UML

Health Services IT, University at Buffalo,

Business Analyst

Jan 2000 - Nov 2003

Health Services IT at SUNY, Buffalo has a system called Enterprise Customer Information Claim System (ECICS) that helps providers (Hospitals, Healthcare Centers, Doctor’s office or an Insurance Agent) to check the contract information, deductible/co-pay of the contract and allows creating claims and viewing or deleting the claims. This system also allows members to log into their account and check their contract information, deductible, co-pay information and provider’s information. The project was to enhance the system functionality and provide the members to get the detailed report of the transactions, print the reports and to see the information of their dependents. Claim paid and rejected details were made available.

Responsibilities:

• Worked with business representatives to understand requirements and priorities and ensure that IT work is appropriately aligned.

• Created and managed Use Cases and requirements.

• Facilitated Joint Application Development (JAD) Sessions and weekly client and team meetings.

• Interacted with the Subject Matter Experts (SME) and stakeholders to get a better understanding of client business processes and gather business requirements.

• Worked as the primary liaison between the business user and the developers throughout the project cycle.

• Performed Gap Analysis to identify the deficiencies of the current system and to identify the requirements for the change in the proposed system.

• Assessed project status and tracked defects for quality control.

• Documented RTM (Requirement Traceability Matrix) for traceability of requirements.

• Handled Change request.

• Handled business requirements for Medicare Part A, Part B, Part C and Part D

• HL7/HIPAA compliance.

• Familiar with HIPAA EDI Transactions (837, 835, 834, 820, 997, 278, 277, 276, 270, 271).

• Used HP Mercury Quality Center for Requirements and defects management.

Environment: .Net, C#, SQL, UNIX ES7000, HTML, XML, Windows 2000, Crystal Reports, BizTalk.

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