Pratik Shyam

Sr. Business Analyst

Phone: 862-***-**** E-Mail: ac7eh4@r.postjobfree.com

Professional Summary

Over 8+ years IT experience specializing in comprehensive Business Analysis, Data Modeling, and extensive industry domain knowledge in Healthcare, Retail Pharmacy Insurance, and Finance.

• Highly efficient in Requirement Gathering, Modeling, Designing, Testing, Validation, Workflows, and Data Management.

• Extensive experience in Waterfall and Agile (Scrum) methodologies, enterprise environments, architectural and solution design, implementation, and complex customizations.

• Worked in all phases of Software Development Life Cycle (SDLC) including UAT Testing, Production and Deployment.

• Liaison to several cross-functional teams and in-depth understanding of the AS-IS and TO-BE business processes and experience in converting these requirements into technical specifications for preparing test plans.

• Efficient in reformulating strategies through Process Re-engineering, Change Management, Release Management and Process Improvements.

• Lead planning meetings, eliciting requirements from stakeholders through Joint Application Development (JAD) sessions and Rapid Application Development (RAD) sessions, focus groups, and interviews for developing BRD, FRD, FSD and SOW.

• Created Product Backlog, Sprint Backlog, Burndown chart, and managed User Stories.

• Expertise in conducting in-depth Problem Analysis, GAP Analysis, SWOT Analysis, Root Cause Analysis and Impact Analysis. Assisted in conducting Cost Benefit analysis and ROI analysis.

• Implemented data modeling techniques including data visualization, data warehousing and data mapping.

• Conducted overall business management and data management by using Microsoft Excel and database tools including SQL, MySQL, and MS Access.

• Prepared graphical depictions of project processes using Sequence diagrams, activity diagrams, Entity Relationship Diagram (ERD), Use Case diagrams, Wireframes, Mockups, including the business workflow.

• Implemented Manual and Automation testing techniques by the creation of Test666 Scenarios, Test Plans, Test Cases, and facilitating Test Inspections.

• Detailed knowledge on different modules within healthcare (Membership, billing, Enrollment, Claims, Capitation, Providers).

• Good understanding about the Electronic Data Interchange (EDI) standard used in various business processes.

• Strong Knowledge and understanding of ICD-9-CM and ICD -10-CM coding and claims processing

• Experience with HIPAA compliance, and Involved in up-gradation of HIPAA 4010 transaction to HIPAA 5010 in health care with strong understanding of Medicaid and Medicare rules and claim adjudication.

• Knowledge in generating Reports, Analytic Snapshots and Dashboards, Enabling Email Services, and constructing Page Layouts.

• Excellent interpersonal skills, effective writing and oral communication skills.

• Ability to work both independently and as part of a team to meet objectives. Possess ability to motivate a team towards successful completion of project milestones.

Certifications

• Certified Business Analysis Professional (CBAP) Certified.

• Scrum Master Accredited Certification (SMAC) Certified from International Scrum Institute.

Technical Expertise

Domains Healthcare, Finance, Retail

Requirement Management HP ALM, Blueprints, Doors, ERP

Document Creation/Management MS Office Suite – Word, Excel, Outlook, Publisher, PowerPoint, OneNote,

MS Project, Adobe Acrobat, Lotus Notes

Content Management MS – SharePoint

Database Management MS-Access, SQL, MySQL, Oracle, Erwin, Guidewire, Informatica, ETL

Business Modeling Enterprise Architect, Balsamiq, MS-Visio, Rational Rose, Pencil

Business Intelligence Cognos, Business Objects, Crystal Reports

Testing Selenium

Bug Tracking/ Quality Control JIRA, Rally, HP Quality Center

CRM Salesforce, Pega

Languages UML, HTML, CSS, XML, JavaScript, APEX, Visualforce

Operating Systems Windows, Mac OS, Unix and Linux

Other Tools PeopleSoft, and Insurity

Methodologies Agile-Scrum, Waterfall

Work Experience

Client: McKesson Specialty Health, AZ August ‘15 - Present

Role: Sr. Business Analyst/ Systems Analyst

Project: Patient Assistant Services

Project Description:

McKesson Specialty health provides services of patient’s coverage information to patients and providers for reimbursement of specialty drugs. The first phase of the project involved data migration of the Java based application to a Salesforce platform. The second phase of the project involved reporting of data to third party vendors and clients. The application helped determining patient eligibility for reimbursement of the specialty drugs and for the patients to get the claims processed.

Responsibilities:

• Gathered, analyzed and prioritized business requirements and system requirements that must be included while developing the software.

• Elicitation techniques used included interviews, surveys, prototyping, and developing mockups of the GUI.

• Prepared Logical Data Models that contained set of diagrams, Business Requirement Documents, and supporting documents containing the essential business elements, detailed definitions, and descriptions of the end user requirements.

• Conducted JAD sessions with data management team, SMEs, vendors, users and other stakeholders for open and pending issues.

• Collected, stored, reviewed and modified requirements in MS Word.

• Authored progress and completion reports which were then submitted to project management on a weekly basis.

• Planned and defined system requirements through Use Case Diagrams, Use Case Scenarios, and Use Case Narrative using the UML (Unified Modeling Language) methodologies.

• Created Activity Diagrams, and Sequence Diagrams in MS Visio.

• Created State Chart Diagrams, Sequence Diagrams, and Collaboration Diagrams thus defining the Data Process Model and Business Process Model.

• Worked on creation of wireframes during the Elaboration Phase.

• Managed third party applications integrated into the Salesforce Org.

• Created test cases and test scripts to check the functionality of application (UAT).

• Performed manual front-end testing to check all functionalities of different phases.

• Suggested measures and recommendations to improve the current application performance. Designed organizational tools and forms to facilitate accurate data collection and recordkeeping.

• Involved in exploratory testing on the website.

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

Environment: MS Office, JIRA, SharePoint, Agile-SCRUM, MS-Visio, SQL, Salesforce, infomatica

Client: Express Scripts, NJ January ‘14 – July ‘15

Role: Sr. Business Analyst

Project: Retail Pharmacy Claims

Project Description:

The project involved the enhancement of the regular claims process for purchase. The project’s goal was to improve the entire claim adjudication process from receiving the prescription to processing the payment process and updating accounts receivable. It also eliminated the complex, inefficient and labors-intensive aspects of payment processing; including customizable workflow, compliance, document preparation management, and customer relationship management.

Responsibilities:

• Performed and assisted the Business Intelligence department with internal audits for insurance claims

• Documented system requirements to meet business and end user needs.

• Associating Business Processes to data, job profiles and corporate applications.

• Involved in Capturing and Designing, Executing and Monitoring Business Process Management Activities.

• Identified requirements by conducting JAD sessions with SMEs and Business Owners.

• Interacted with Business Owners, Delivery Managers, Application Developers, Testers and other IT staff to ensure successful teamwork and high-quality solutions in the development and delivery of new applications.

• Evaluated the information gathered from multiple sources, decomposed high level information into details to gain understanding of end-to-end solution.

• Coordinated and facilitated requirements analysis and walk through meetings.

• Employed systems analysis methodologies to obtain analyses and document IT system/application requirements including user security requirements.

• Utilized standard templates to accurately and concisely write requirement specifications.

• Produced the visual models for the application to create State Chart, Use Cases, Use Case Diagrams, Sequence Diagrams, and Activity Diagrams.

• Coordinated business and IT signoff on requirements documentation. Created and maintained project schedule using MS Project showing all the deliverables target dates.

• Worked as primary IT contact for team members developing and executing test plan.

• Communicated business risks and project cross-impacts to Project Manager and BSA Manager - Support.

• Working on the Business problems cited by the Account management team and provide Data backed recommendations/insights

• Provided additional adjudication processing assistance to team members with complex reimbursement and client-related questions.

• Involved in managing Test Requirement Management and Business Rules Management.

Environment: MS Office Suite – Word, Excel MS project, Microsoft Visio, Microsoft Share Point, Cognos, UML, JAD, GAP, PL/SQL, Agile Scrum

Client: First Union National Bank, Linden, NJ October ’12 – January’14

Role: Associate Business Analyst

Project: Transfer and Payment Service Up-gradation

Project Description:

The objective was with Union Bank’s Retail Banking transfer service customer can securely send money to friends, family or coworkers using an email address or mobile phone number. Customer can transfer money without using the recipient Bank account number. This service also allows customers to transfer money from Union Bank account to any other bank account.

Responsibilities:

• Worked as a Business Analyst for multiple module wise development teams. The project followed full project life cycle as per the SDLC specifications using MS Project.

• Categorized and prioritized requirements from end users and communicate with project manager to design the business requirements

• Worked with project manager and high-level management team to identify Project Scope, develop work plans and schedules.

• Generated functional requirements by collectively gathering requirements from all teams.

• Created and maintained Business Requirements document and System Requirements document. In addition, was responsible for getting appropriate sign-offs and approvals.

• Assisted in GAP analysis and business process reengineering; identified and documented improving area to meet the end state requirements.

• Developed BRDs and FSDs and designed Use Cases using Microsoft Visio.

• Worked with QA testing team to design test methods to verify the application's functions of generating consumer loan, home equity, refinance, and performing commercial loan activities.

• Reviewed and modeled existing loan processing workflow; identified improved opportunities

• Assisted in UAT.

Environment: MS Office – Word, Excel, Access and PowerPoint. UML, Axure, Waterfall Methodology

Client: State Division of Medicaid, CA September ’11 – September ’12

Role: Business Analyst

Project Description:

Medicaid’s Medicaid Management Information System (MMIS) must comply with Health Insurance Portability and Accountability Act (HIPAA) and ICD 10 requirements. Purpose of the project was to analyze GAP between current HIPAA 4010 / ICD 9 and compliance HIPAA 5010 / ICD 10 for state Medicaid Management Information System.

Responsibilities:

• Aided in the collection of User Requirements and Business Requirements to create the Business Requirement Documentation (BRDs), using MS Word and MS Visio that provided appropriate scope of work for technical team to develop prototype and overall system.

• Conducted and facilitated Joint Application Development (JAD) sessions to reduce time spent in moving information between stakeholders and team members.

• Conducted HIPAA 834 data mapping and interpretation, as well as the conversion of this type of data from state partner receipt, via the MMS application.

• Managing and manipulating the pharmacy data (PBM) and putting down requirements around it.

• Conducted AS-IS and TO-BE analysis and assisted in developed process models and systems integration structure.

• Identified critical areas of business risk and modified business processes to reduce risk by using the Risk-Management Process.

• Involved in the analysis of HIPAA compliance and EDI transaction sets and actively participated in the designing of the EDI transactions using the new HIPAA 5010 version also including the use of ICD-10 codes, conversion of ICD9 codes to ICD 10 codes.

• Migrated documents from shared drives to SharePoint environment

• Wrote test cases and test plans for the related and assigned scripts according to the test strategies defined in the project and testing team guidelines in Quality center.

• Recommended corrective actions, if necessary, along with the progress against Development/Action Plan routinely to the Project Manager.

• Tracked and maintained Stakeholder requested enhancements and changes using Requirement Traceability Matrix (RTM).

• Knowledge of the complete EDI format used in electronic documentation, which was part of the knowledge transfer program to the vendors as per the requirements.

• Worked with Source System Subject Matter Expert (SME) to ensure that the extracts are properly mapped. Used SQL for data mapping and querying.

• As part of the data mapping procedures, assisted in writing requirement document for ETL - Data Extraction, Data Analysis and Loading process of collected data.

• Guiding stakeholder teams in delivering a new online learning platform that will serve employees.

Environment: MS Office, Quality Center, SQL Server, MS Visio, SharePoint, Waterfall Methodology

Client: Citi Bank, Mumbai July ’10 – September ’11

Role: Jr. Business Analyst

Project Description:

The project was to upgrade the Corporate Banking System of Citi Bank in Mumbai Branch for architecture alignment and technical obsolescence reasons. The new system would reduce operational risks and eliminate current inefficiencies on the user side and would enhance the overall customer experience.

Responsibilities:

• As a Business Analyst defined current business processes and defined future business process models.

• Worked directly with key senior acquisition and portfolio management managers in obtaining business requirements translating them to functional and technical specs for IT developers to produce required reports as well as enhance existing applications to meet business needs for servicing originated loans.

• Worked with the PM and technical lead to quickly evaluate options and propose then pursue the most efficient cost-effective solution.

• After performing GAP analysis worked intimately with end-users, IT staff and business sponsors from inception to warranty period.

• Worked on interface conversion from disparate legacy applications to the new solutions

• Provide SharePoint best practices and advice regarding site set-up, site security, maintenance, and future needs.

• Preparing PowerPoint presentations and Excel spreadsheets for business meetings.

• Provided end-user training, support and guidance on product / functional feature

• Utilized Agile methodology ensuring each sprint timeline was met as well as pursuing backup options when proof of concepts and milestones passed critical deadlines

• Developed test plans and scenarios, regression testing, comparing actual with expected results.

• Iterative UATs, development and user acceptance sprints

Environment: BPR, HP ALM, SharePoint, Windows, HTML, Excel, Outlook, My SQL, Waterfall Methodology

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