Shefali Arora

Email: ac1ze7@r.postjobfree.com

Phone: 617-***-****

PROFESSIONAL SUMMARY:

* ***** ** ********** ** business analysis, requirements gathering, business requirements modeling and development of Web Based, and Client/Server applications across diverse verticals of Healthcare and IT domains.

Experience using various Business Analysis methodologies like Business Process Modeling (BPM), Unified Modeling Language (UML), with Software Development methodologies like System Development Life Cycle (SDLC), Rationale Unified Process (RUP), Waterfall, Iterative, and Agile.

Experience with the Business Analyst Body of Knowledge (BABoK), management requirements, application/data security policies and practices, program and business goals and the systems development process.

Extensive experience in the Healthcare domain, with clients including McKesson Corp, Cigna International, Blue Cross Blue Shield (BCBSNC), Blue Cross Blue Shield (BCBSM), and Hewlett Packard Enterprises.

Experience in Payer side systems including Enrollment, Benefits, Billing and Claims Adjudication. Managed Care Payer requirements, Provider data management and Claims Processing and Procedures.

Experience with BCBSA Mandate 18.0 and 18.5 Provider Taxonomy Code Implementation.

Experience with National Provider Identifier (NPI), and commercial insurances in HIPAA ANSI X12 formats including 270/271, 276/277, 834, 835, and 837 (P, D, I), Medicare and Medicare Advantage claims.

Worked on Web-portal development, User interface (UI/UX), Customer Relationship Management (CRM), data mapping, learning Management Systems (LMS) and systems and Enterprise wide Integration initiatives using Enterprise resource planning software (ERP).

Extensive project work in the technical realm – building API’S, Interoperability, HL7 - FHIR model, implementing security protocols like SAML 2.0, OAuth and Active Directory Federation Services (ADFS).

Strong experience in data validation and manipulation in SQL Server databases using SQL queries for integration between various systems like mapping and converting of Provider data to FHIR format.

Experience in conducting Joint Application Development (JAD) sessions with Subject Matter Expert (SMEs) stakeholders, Product Owners, Vendors, Technology partners, End users, Architects and design group development and QA team for project meetings, walkthroughs and customer interviews for requirement elicitation, planning and review.

Solid understanding of Rational Unified Process (RUP) using Visio, Rational Rose, Requisite Pro and Unified Modeling Language (UML).

Proficient at gathering and converting Business Requirements into Functional Requirement documents (FRD).

Excel at PowerPoint presentations, WebEx recordings for feature reviews and Product demo’s to stakeholders across the board and facilitating the Marketing, sales, support and documentation teams in the transference of knowledge to the end user/Client.

Effective communication with management, customers and business owners to provide updates as appropriate on a timely basis regarding progress on assigned tasks, projects and issues, via written or oral reports.

Proficient with using software systems and tools like JIRA, TFS, Rational tool, NASCO, BFM, BFAST, Power MHS, Trizetto Facets, Quality Center, Test Mart, V-Claims, GEMS, TIBCO Bus, and Postman.

Proficient in all testing methods, performed GUI testing, Functional testing, Regression testing, End-to-End testing, UAT and Database testing. Identified, logged and resolved defects.

Worked as SME on various projects leading internal business groups on process improvement projects designed to improve business results.

Display excellent organizational skills with the ability to handle multiple projects and timelines with minimal supervision.

PROFESSIONAL EXPERIENCE

Blue Cross NC – Durham (March 2017 to Current)

Role: Enterprise Business Analyst

As an Enterprise BA at Blue Cross NC, my role is to support Enterprise Initiative projects as part of the requirements team and apply relevant tools and techniques to assess impact based on changes to the enabling technologies that support business processes. I am responsible for handling multiple projects in the domains of Healthcare, IT and Finance. My prime activities as BA involve working with a diverse group of business stakeholders to elicit Business, stakeholder and functional requirements with key deliverables being the Finding and Analysis document (F&A) and the Functional Requirement Document (FRD).

Some of my project work includes: Fast-track project for implementing SSO for HIX and PSR, BCBSA Provider Taxonomy code Implementation as part of the NPR 19.0. Lawson migration to Cloud Suites and Clinical data Exchange (CDX 1.0).

Responsibilities:

• Working with a team of 48 stakeholders and business owners for enterprise wide system impact that included ITS Home and Host claims, Provider Source Systems, Claims Processing systems for commercial and Senior Markets. (NPM, Power MHS, Facets, Amisys, Optum, Blue E, BCBSA).

• Working with the Business Architect to analyze the Business scope Document (BSD).

• Working with the Project Manager to identify key requirement stakeholders and conduct requirement planning.

• Creating and delivering the BAM methodology as part of the Discovery kickoff.

• Conducting high-level business requirement elicitation sessions with the identified stakeholders.

• Using the in house built BRM tool to map the business and stakeholder requirements and assigning them LOE’s as part of the Finding and Analysis Document (F&A).

• Conducting the F&A review with business stakeholders to drive the LOE’s for each impacted team.

• Collaborating with the Solutions architect to conduct the architectural assessment with the As-Is To-Be flows.

• Working with the Architect and key Business stakeholders to prepare Requests for Vendor Proposals (RFP’s).

• Creating requirement plans and identifying requirement-gathering techniques for the solution-scoping phase.

• Conducting requirement gathering sessions with stakeholders.

• Documenting the Functional Requirements in the Functional Requirements Document (FRD).

• Reviewing and obtaining sign off on the FRD from the stakeholders and Business Owners.

• Building the Requirements traceability matrix in DNG in preparation for the delivery phase.

• Providing the support to testing and development teams as needed. Reviewing and approving test scenarios and test scripts.

• Creating change requests, building and linking the changed scope requirements to the original FRD and getting approvals as needed.

• Collaborating with the documentation and Training teams to provide support as needed for the transitioning and Implementation Phase.

• Providing support as needed to verify and validate the solution.

Environment: DNG, BRM, NPM, Facets, PowerMHS, Amysis.

McKesson Health Solutions – KOP, PA (April 2016 to January 2017)

Role: Sr. Business System Analyst

As part of the Product Development Team for Provider Manager 9.6. Activity packs, Contract Manager (CM), Claims Xten and Facets I facilitated the Implementation of Fast Healthcare Interoperability Resources (FHIR) to enable healthcare data exchanges between Provider Manager and various Claim Engines. Building API's to call PM data & using JMS messaging for FHIR Interop on TIBCO Bus. Development driven in a Scaled Agile environment using Lean Kanban Methodology.

SAML 2.0 / OAuth implementation for an on Premise Provider Manager system being developed for commercial Health Plan Clients. (Implemented April - June 2016).

Responsibilities:

• Collaborating with the Product owners on projects related to the Provider Manager family of software products to understand the business needs and translate these into functional requirements to ensure that the product vision and goals are met.

• Simultaneously worked on Client documentation with client teams to provide project overview and timelines.

• Key liaison between the Product Owner and the Product Development team, ensuring that the requirements are understood and that the end product developed meets the acceptance criteria.

• Assist Product Owner/Product Management in the definition of high-level business requirements (Initiatives) and the prioritization of the product backlog and planning. (Initiative Analysis and documentation).

• Lead and documents requirements definition sessions with business and technical stakeholders to better understand functional, data, user interface, and non-functional requirements.

• Grooming Features for the proposed enhancements into written user stories, use cases and acceptance criteria for development.

• Facilitating joint application development between multiple software development teams, collaborating to clarify technical requirements and considerations.

• Conduct meetings with business representatives, SMEs, analysts, technical teams, and developers for design reviews and feature reviews and seek validation for Feature development and User Stories.

• Work closely with business sponsors to define and manage the scope, requirements analysis, and implementation. of projects.

• Work with QA to create, manage, and execute test plans and scripts, testing and bug identification

Lead the team through functional, integration, and UAT processes.

• Working with offshore development teams, proficiently managing different time zones and extended hours.

• Perform functional acceptance testing of development deliverables to verify they meet the business and functional requirements.

• Perform detailed system demonstrations to SMEs in support of workflow and product alignment review efforts.

• Collaborate with Documentation and Training to ensure accurate representation of the targeted features in customer-facing documentation.

• Identify opportunities for improving quality and efficiency and helps drive process improvement initiatives.

• Responsible for managing dashboards for daily standups and tracking the product development through its lifecycle in JIRA and Confluence.

• Collaboarated with developers for the building of Restful API’s using thre JAVA language and run on JVM and tested in Postman.

Environment: JIRA, TIBCO BW, MYSQL Studio, Provider Manager 9.6. Postman.

Cigna Global Health Benefits – DE (June 2015 to April 2016)

Role: Business Analyst Senior Specialist

Primary BSA on a large cross functional project - Global Clinical - MNR, CM, UM, IGO, NGO management for UK, Belgium and NA Markets involving combinations of platforms and technology across countries. Development driven in Waterfall Framework.

CRM Reporting - Developing Custom Analytics reports from CRM based Applications. Development driven in a Scaled Agile Framework (SAFe) environment. RBAC based Masking of SSN on claim engines and other applications.

Responsibilities:

• Participated in extended on site and off site workshops where stakeholders from UK, Belgium, Spain, China and North America gathered to brainstorm and share their business needs, business plans for the MNR, CM, UM, IGO and NGO verticals (Discovery phase).

• Worked with global stakeholders to create workbooks and document extensive reports capturing the business need of different geographic domains. Also facilitated Product teams in the development of project plans for approvals during the discovery phase.

• Gathered Business requirements by driving user-group meetings and working with various global, cross-functional and virtual teams.

• Evaluated and translated functional designs diagrams, workflows and interface wire-frames of proposed system enhancements into written user stories, use cases and acceptance criteria for development.

• Analyzed current system requirements to generate business/functional requirements and produce clear and timely documentation that provided traceability from business/functional requirements through to solution development.

• Facilitated joint application development between multiple internal and external software development teams, collaborated to clarify technical requirements and considerations.

• Conducted meetings with business representatives, SMEs, analysts, technical teams, PM, and developers for requirement reviews and approvals.

• Performed detailed system demonstrations to SMEs in support of workflow and product alignment review efforts.

• Worked closely with business sponsors and vendors to define and manage the scope, requirements analysis, and implementation of projects.

• Lead and analyzed client operations and health care delivery models to determine opportunities to streamline processes and automate where appropriate (Business Process Reengineering, BPR) and assess customer utilization of the product to provide operational recommendations to improve their efficiency and adoption.

• Work with QA to create, manage, and execute test plans and scripts, testing and bug identification.

• Lead the client through functional, integration, and UAT processes.

Environment: TFS, Microsoft Dynamics CRM, Diamond.

Blue Cross Blue Shield of North Carolina (April 2014 to June 2015)

Role: Sr. Systems Applications Analyst

Worked with the Information Systems and Business Applications Team (ISBA) on various projects as follows;

Enhancements to the LMS system Blue U and member portal UI, implementing SSO to move various applications like Blue U, Plan view, Tuition Assistance from WAI to SAML 2.0

Fast Track Projects for Technical Infrastructure upgrades for Business Applications like - Metify, LCMS, ACL, Microsoft CRM, Macroview DMF, Autoaudit, and Envision.

SAS FM replacement by Dashboard Gear in a waterfall environment and Individual Commission Changes for 2015 for PMPM for fewer than 65 Health & Dental Products in a scaled Agile environment.

Responsibilities:

• Conducted Discovery Analysis, Prepared Level 0 estimates, Investment requests, Vendor support reference documents, CEF’S and Design agreements and worked with the LOE Intake Assessment team, growth council and the steering committee to obtain project approvals.

• Worked with Solution architects to review high-level design documentation, worked with business owners and partners to determine project requirements, and created workflows, design documents and functional and technical specs for various projects.

• Created process flows in Visio to facilitate Knowledge transfer and provide production support.

• Analyzed end-to-end business and technical flows, including impacts to operations.

• Planning and implementing Technical Upgrades of Business Applications and Technical Infrastructure.

• Served as point of contact for business testing activities to meet business requirements for hardware and software upgrades, security changes, and architectural enhancements as needed.

• Reviewed, edited, and prioritized business requirements, specifications, processes and recommendations.

• Lead in the development of functional design specifications, GUI and screen interface, designs (internal applications), and VUI designs for customer engagements.

• Conducted gap analysis for business/functional requirements, Joint Application Design (JAD) facilitation, Expertise in the Rational Unified Process (RUP) and User interface design.

• Supported the Product Owner and Development Teams to meet project goals. Providing all support to the team in Scrum and Agile.

• Facilitating Scrum ceremonies including sprint planning, daily standups, and sprint reviews.

• Helping the team maintain their burn-down chart. Removing obstacles that inhibit the team’s ability to deliver upon expectations.

• Documenting Use cases and User Stories at various levels of functionalities and walking the product owner through more technical user stories to ensure success metrics and acceptance criteria are clearly identified and measured.

• Supported the Product Owner in managing the product backlog.

• Created plans for necessary requirements and resources in order to achieve success with partner engagements.

• Conducted code reviews with end users through WebEx, Documented Process maps and guidelines for successful transference of knowledge and supported end users in successful change implementation post release.

Environment: Trizetto Facets, Rational Requirements Composer (RRC)

Blue Cross Blue Shield of Michigan (April 2012 to April 2014)

Role: System Analyst Adv.

Worked on the Auto and hospital benefits team. Responsible for business analysis in relation to Auto and Hospital benefit plans, Hospital Blue provider database and Internal Processing system changes.

Responsibilities:

• Gathered and analyzed business requirements through SBP'S and SER’S and communicated with the business teams to clarify and implement the change requests for health benefits for Auto and hospitals.

• Analyzed and documented Functional requirements for new benefit plans, benchmark health plans, base ACA Bronze plans, Traditional Care Network (TCN) health plans, Medicare advantage, Individual and group coverage plans, Customized benefits for full time and part time employees etc.

• Documented change requests and small enhancement requests for COBs, dedmax categories, Out of pocket maximums, coinsurance and deductible changes, updates in diagnosis and procedures, changes in benefits to existing plans, updates to term dates, contracts and provider databases.

• Interacted with business managers and other stakeholders to determine project scope thus defining key changes to benefit plans, coding scripts, the internal systems and its impact.

• Responsible for creating Customer Service requests (CSR’S) and communicating with Design & Review, Q&A and Coding teams to review and implement changes.

• Documented and analyzed Test scripts, Test plans, Project plans, Test Grids, Checklists, and work flows.

• Implemented code changes and click changes in BFM (Benefit File manager) to ensure benefit is applied in the system as per client requested Implementation date.

• Rendered Design Testing, Acceptance Testing, Code Testing and Defect testing to ensure the benefits are processing correctly on NASCO (NPS System).

• Updated Dedmax categories in NASCO to update Cost share for various Auto and Hospital pans.

• Created scripts for Coding new Sub particulars and logic in BFAST (An internal BCBSM tool).

• Conducted extensive analysis on Claims edits, Claim stop codes, and defects.

• Managed identification and execution of recoveries, restores, and statistical adjustments working with both IT and the customer.

• Collaborated with project team, project leads, and project managers and fostered harmonious work relationships with them for review of Plans.

• Conducted system testing and overall testing of Auto and Hospital benefits changes for all major auto companies and Hospitals in the BCBSM Network.

• Conducting Work Product Reviews (WPR), peer reviews and Team reviews on various testing projects.

• Clearly defined systems work scope and objectives based on business requirements.

• Analyzed data sets for review and quality control to evaluate data periodically in batches using ad hoc and Personix.

• Created CSR’S, ISTAT reports and CCSRD’S in PDM.

• Benchmarked claims using benchmarking tools and QM through HIPPA compliance.

• Used internal tools like Personix and change manager to generate reports, Closeout communications, communication alerts and Vouchers and EOB’S.

• Used V-Claims and Test Mart to generate claims for testing.

Environment: NASCO, PDM, Test Mart, V-claims, Ad hoc Tool, Personix, Change Manager, Cross walk mapping tools, hospital blues database, BFM and BFAST.

Hewlett Packard Enterprises Inc., CT (June 2011 to April 2012)

Sr. Business System Analyst

Worked for the 5010 HIPAA compliance project for their healthcare client Cigna.

Responsibilities:

• Participated in the daily standup with the client CIGNA to discuss and review the 5010 HIPPA rules and changes being implemented for enrollment, eligibility and claim status and Response.

• Attended detailed Business Requirement review sessions with Client on 276/277 Transactions and the 277 family (277 CA, 277U).

• Involved with business user and stakeholders for discussing Action Items, mapping documents, Architecture requirements, Joint reviews and Project plan schedules.

• Prepared mapping documents, Caliber reports, change requests, release master and project plan schedules.

• Conducted stakeholder meetings for elicitation of business requirements and converted them to Functional requirement Documents (FRD) for 276/277 4010 to 5010 changes and System Integration testing for Facets core modules with external systems.

• Attended Internal Testing Approach sessions with the Business Teams for data requirements, design requirements, testing activities and testing environments.

• Worked on Design deliverable modules for finalization of Data Models (Pre-requisites to mapping completion).

• Conducted planning meetings for IS (Integrated Specs), EA (Enterprise Arch), Functional Test Plans, Detailed Design Specs. Business Rules, Design Traceability, and Mappings and X12 Crosswalk.

• Involved In developing Test Plan and Test Requirements in Quality center.

• Developed Functional Test Scripts from requirements to test the X12 276/277/277CA/277U Batch and Real Time Transactions.

• Developed Testing Scenarios for Transactions to pass through TPG, and new claim status flow Orchestration – through the rules solution for 276 using IBOR, HBOR, New Alliance, NPI.

• Developed Scenarios for the Functional testing of processing Batch Transactions and LOB’s for Split claim prior to Member Validation and Call to CIGNA.

• Designed Test Scripts for System Testing across HP-CIGNA integrated LOB’S.

• Designed detailed Test Scripts for Batch and Interactive 276/277 and developed mock Data migration CCSR’S and Trading Partner Migration reports generated by different HP LOB’s.

• Performed Functional, User Interface, End-to-End, Cross Browser, Application, System, Integration, Regression, UAT and Back End Testing.

• Used Quality Center Version 10.00 to track and report System Defects. Participated in defect reviews with developers, managers and business and presented Defect reports in Meetings.

Environment: TriZetto Facets 4.31/4.51, SOAP UI, SQL Server 2000, QTP 9.0, Quality Center 10.0

TECHNICAL SKILLS:

Languages: UML, HTML, XML, JSON, JAVA.

Databases: SQL and MS Access

Testing Tools: Quality Center 10.0, NASCO (NPS) systems, Power MHS, Facets Trizetto, GEMS, Postman.

Requirement Gathering Tools: DNG, Quality Center, TFS, JIRA, BRM.

Business Modeling Tools: MS Office, Excel, SharePoint, Balsamiq, and Visio

ERP Applications: Blue Connect, Microsoft Dynamics CRM, Office 365, Lawson, Envoy.

EDUCATION:

• MBA from University of Massachusetts Boston – 2010

CERTIFICATIONS:

Scrum Master Accredited Certification: scrum-institute.org, License 961*********** April 2016

NASCO Claim Processing Engine (Mainframe) April 2012

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