Project Customer Service

Vijay Kumar K Principal Business Analyst

®

CBAP®, PAHM H EALTHCARE SPECIALTY

O

ver seven years experience in healthcare as a Business

Analyst with significant experience in requirements

● BA Planning and Monitoring gathering, Vijay is proficient in CMMI process and an

● Requirements Management expert in gathering functional requirements, preparation of

and Communication

user acceptance, and system test case scenarios. He has led BA

● Elicitation

teams in projects following Agile SCRUM and Waterfall

● Enterprise Analysis

methodologies and has extensive experience as a business

● Requirements Analysis

writer, designing use cases, preparing BRDs and FRDs, as well

● Solution Assessment and

Validation as training manuals. Vijay is an award-wining analyst with great

● SCRUM Master talent in communication, team leadership, and solid

● Data Modeling

presentation skills.

● Gap Analysis

Solid Healthcare Domain Experience

ACOs; Medicare Part D; Medicaid; Pharmacy; Medical Management;

Broker Sales Compensation; Consumer Segment: Individual, Group

POSITIONS

TECHNOLOGIES

Lead Business Analyst & ScrumMaster • 10/13 - Present

Version Controls: Clear Case,

Aetna Inc.

Visual SourceSafe, SharePoint

Lead Business Analyst • 1/13 - 10/13

IBM Rational Tools: Requirements

Composer, Requisite Pro, Clear Aetna Inc.

Quest, Clear Case, Team Concert Business System Analyst • 4/12 - 1/13

Software: Microsoft Word, Excel, Northwestern Mutual Life Insurance

Live meeting, Access, Visio, Business Analyst • 8/07- 4/12

File-Aid, Cisco WebEx

Aetna Inc.

Languages: COBOL, JCL, SQL, XML

Tech Specialist • 5/06 - 8/07

Databases: IBM DB2, Oracle

Aetna Inc.

ERP: PeopleSoft

Systems: Windows Vista, XP, 2000,

Mainframe

Other: Business Objects, nVision,

Plan View, Cognos

ScrumMaster™ • team leadership • healthcare payer expertise • strong requirements analysis

use case narratives • process modeling • Affordable Care Act (ACA)

2 011

• Certified Business Analysis

Professional (CBAP®) by

Exceptional Bachelors in Electrical and

International Institute of

Business Analysis Electronics Engineering, 2006

Performance

• Professional Academy for

Healthcare Management

GPA 4.0 / 4.0 from Acharya

Award

(PAHM®) offered by America’s

Nagarjuna University,

Health Insurance Plans (AHIP)

Guntur, INDIA

• IBM Certified Database

B usiness Analyst

Associate- DB2 Universal

Database V8.1 Family- DB2

Universal Database

PROFESSIONAL EXPERIENCE

CLIENT: Aetna, Inc.

PROJECT DETAILS: Accountable Care Organization Foundational

The project is aimed at developing and maintaining a new application Individual Attribution book of

record to store the association of an individual to an organization and maintain the history of the

transactions appropriately. This project involves designing a database to maintain the person to

organization association data; a front user interface for business users to access the data stored in the

database. This is part of Aetna’s Accountable Care Services department’s vision of the narrow network

strategy to form value-based network contracts with provider organizations in order to compensate the

providers for being responsible for the overall healthcare delivery and the quality of services to a specified

population of members.

SUMMARY:

Worked as a ScrumMaster and Lead Business Analyst for this project dealing not only with gathering and

maintaining requirements but also guiding the team towards successful implementation of the application

functionalities in various releases.

RESPONSIBILITIES:

• Analysis of the existing business process and helping the product owners in determining the epics

according to the proposed business process

• Working with the product owner to create and maintain product backlog

• Planning the timelines for each of the sprints after categorizing the priority of the epics

• Facilitating productivity by removing impediments that obstructed the team’s pursuit of its sprint goals

• Ownership of requirements and also turning the requirements into working software

• Tracking and reporting the progress of the sprints and ensuring that the timelines are achieved

comfortably

• Conducting meetings for planning, daily scrum status, scrum pre-planning, backlog grooming,

review/demo and retrospective discussions

• Ensuring the application of standard processes in each and every stage of the sprints by enforcing the

rules of the agile process

• Documentation of the User stories, Use Case framework.

• Preparation of Business Process Flow Diagrams, User Interface Screen Flow Diagrams, User Interface

Mock Ups, Use Case Diagrams, Application Overview presentations

• Documentation of Deployment Communication Material and end user reference materials

• Ensuring that the scrum team works in a productive manner to deliver the goals of the sprints

MY DELIVERABLES:

Business Process Flow Diagram; Data Requirements Specifications; User Interface Specifications; User

Stories; Gap Analysis; Deployment Communication Materials; End User Application Documentation;

Product Backlog; Issue Tracker; Risk Analysis; Prototypes; Storyboarding; User Interface Screen Flow

Diagram; Business Rule Definitions; Requirements Traceability Matrix.

DELIVERABLES CONTRIBUTED TO:

Non-Functional Requirements Specification; Logical Data Model; Business Need Analysis Document;

Work Breakdown Structure; Test Data Sheet; Test Plan; Test Scripts; Test Strategy; Test Results Summary;

Information Architecture; Project Deliverables List.

CLIENT: AETNA INC.

PROJECT DETAILS: Medicaid Data Warehouse & Portal

The project is aimed at building the Medicaid data warehouse intended to augment the current Analytical

Services Database (ASDB). This provides a more complete and integrated historical picture of the various

Medicaid plans along with a powerful reporting toolset for analytical users. The new data warehouse will

provide a new, centralized data structure and business intelligence tool set that provides for standard

metric definitions, comprehensive data sources, standardized reporting functions and business focused

presentation. This project also encompasses the effort to develop a new Medicaid Web Portal for use by

providers and members. This portal includes integration with Milliman’s CareWeb QI to provide prior

authorization automation.

SUMMARY:

Worked as a Lead Business Analyst for this project, managing the business analysts, resolving issues to

track to their closure, ensuring there are no scope-related concerns from stakeholders, guide and train the

Business Analysts, and ensure the requirements gathering, elicitation, and reviews are completed per plan.

RESPONSIBILITIES

• Leading a team of nine domain Business Analysts for all business analysis activities

• Problem solving and issue resolution for scope related and business definition related topics

• Managing the requirement timelines and overcoming the challenges faced by individual domain level

Business Analysts

• Coordinating all the tasks that need to be accomplished by all the Business Analysts in the project

• Business analysis and requirement gathering

• Conducting Joint Application Development (JAD) sessions

• Preparation of RTM Requirement Traceability Matrix

• Preparation of Functional Requirement Specification document

• Analysis of existing and nature of proposed process

• Developing process flow diagrams according to the proposed process and applications impacted

• Preparation of Use Case Narratives

• Reporting status of requirements progress for Level 1 management during project planning stage

• Support design, development, and testing teams on clarifications for the requirements after

requirements phase

• Expertise in using various IBM Rational Tool: Rational Clear Case, Rational Clear Quest, Rational

Requisite Pro

• Function Point Estimation

MY DELIVERABLES:

Data Requirements Specification; Gap Analysis; User Interface Specification; Functional Requirements

Specification; Business Requirements Specification, Business Process Models; Use Case Model; Use Case

Narratives; User Interface Screen Flow Diagram; Prototypes; Deployment Communication Material; Risk

Analysis; Issue Tracker; Decision Tables; Coverage Matrix; Requirements Traceability Matrix.

DELIVERABLES CONTRIBUTED TO:

Non-Functional Requirements Specification; Logical Data Model; Source to Target Data Mapping

Documents; Business Need Analysis Document; Work Breakdown Structure; Test Data Sheet; Test Plan;

Test Scripts; Test Strategy; Test Results Summary; Information Architecture; Project Deliverables List;

Estimation Work Book.

CLIENT: AETNA INC.

PROJECT DETAILS:

Project: Medicare Part D 2012 Call Letter (CMS Guidance)

The project accommodates the 2012 Call Letter regulatory requirements branching from the healthcare

reform, for Part D sponsors. By implementing the functionality specified in this project, Aetna will be

compliant with the rules and regulations required to participate in the part D program.

The CMS (Center for Medicare and Medicaid Services) guidance has specifications regarding how Part D

sponsors should handle prescriber identifiers on Part D Claims and PDE record. The provider reported in

the PDE records should be valid.

Project: Medicare Part D Claim Recovery and Reporting (CMS Guidance)

The overall project will provide enhancements that meet the 2011 regulatory requirements for Part D

providers stemming from numerous CMS Published Documents:

MA Part D Final Rule

Operational Guidance PDE 2011

Numerous Medicare Prescription Drug Benefit Manual chapter revisions.

Implementing the functionality specified in this project will help ensure Aetna is compliant with the rules

and regulations required to participate in the Part D program. The project will address the requirements

necessary to support the ability to recover money from a Medicare Part D member when they underpay on

a Medicare Part D claim or when Aetna covered a claim after the member is terminated.

Project: Medicare Part D 10-year Data Retention/Correction (CMS Guidance)

As a Part D carrier Aetna needs the ability to store Member, Group and Claims data for 10 years per CMS

guidance and we need the ability to correct claims up to a 10 year time period.

Project: Consumer Portal States Roll Out

AARP currently resides on IPS. As part of the migration off IPS (Individual Purchase Solution) to

Consumer Portal, AARP (American Association for Retired Professionals) products must be moved from

the current platform. In addition, we need to ensure that AARP is on a competitive par with IVL products

in terms of rating methodology, underwriting practices and capabilities. Aetna has committed to move

AARP to an annual rate guarantee based on the member’s effective date. This will enable a competitive

offering; mitigate the need to do this on IPS at an additional premium load and spread out the block of

business so all renewals are not on January 1 each year.

Project: Lockheed Martin Corporation 2010 Plan

Aetna has been selected as the single source carrier for network and claims administration for Lockheed

Martin Corporation’s domestic population beginning in 2010. LMC’s goals are to deliver best in class care

management, engage the population in health plan decision that encourage use of appropriate care, use an

IT infrastructure that has real time links among all of LMC’s component health plan features, produce

data feeds to the data warehouse that link all services received by members, deliver superior claims

administration and customer service, and ensure that the philosophical direction of the selected vendors

aligns with LMC goals. Healthways has been selected as the plan integrator and care management vendor,

while other vendors such as NEAS, Free and Clear, CIGNA disability, EyeMed, Delta Dental, and LMC

worksite wellness centers will also be part of the integrated plan for 2010.

Project: ATV Disease Management

The primary purpose of this project is to enable Aetna Total Clinician View (and Medical Management

Business) to support Aetna's Disease Management program (aka AHC-DM). Previous to Nov 08, Active

Health Management (AHM) performed all AHC-DM functions for Aetna using their Active Advice

application. Therefore, this project will be devoted to migrating that work from AHM and supporting

AHC-DM in pilot mode using ATV.

Project: Agent Desktop Expanded Support

LifeCare is well known for its EAP support. Aetna has LifeCare as its vendor for handling those services.

ASD will provide the capability to transfer the call coming from members who want LifeCare activities.

This includes sending member’s demographic data on the transfer of call to LifeCare. The Transferred call

for EAP service will be handled by Case managers of LifeCare. LifeCare has to send the information

regarding the activities/case dispositions that were performed for the calls that were transferred, on a

nightly basis. Medical Management’s part is to store the data coming from LifeCare. ATV/eTUMS will

pass the special program member engagement information to ASD. Medical Management will populate

source ASD Patient Management Event Screen with eTUMs events and ATV Service Offering

Engagements exist in the Source system.

Project: AIM Consumer Portal, UW, and DI Release

Aetna Individual Market offers a variety of health plans to accommodate individuals’ different life

circumstances. People’s changing priorities determine the type of health care coverage they need. Aetna

Advantage Plans are designed to address the unique needs that arise during particular stages in life, such as

graduating from college, getting married, raising a family, becoming a sole proprietor of a business, being

between jobs or retiring early. Aetna Advantage Plans offer health, pharmacy and dental coverage.

These products are competitively-priced medical and ancillary products designed with the right amount of

choice to meet the needs of consumers in specific life-stages. Plans, such as HSA- Compatible plans, those

evolve to capitalize on recent health legislation, providing advantages and savings to the consumer.

SUMMARY:

Worked as a domain business analyst in all these projects and played a key role in analyzing the current

process and working with the architecture team towards formulating a proposed process.

Worked with the appropriate stakeholders to deliver the requirements deliverables with good quality

keeping in mind the stringent timelines and compliance related constraints on the project.

RESPONSIBILITIES:

Business Analysis and Requirement Gathering

•

Preparation of business process flow diagrams and use case model diagrams

•

Conducting Joint Application Development (JAD) Sessions

•

Preparation of RTM Requirement Traceability Matrix

•

Preparation of Functional Requirement Specification Document

•

Analysis of existing and nature of proposed process

•

Developing process flow diagrams according to the proposed process and applications impacted

•

Preparation of Use Case Specifications

•

Reporting status of requirements progress for Level 1 management during project planning stage

•

Support design, development, and testing teams on clarifications for the requirements after

•

requirements phase

Expertise in using various IBM Rational Tools: Rational Clear Case, Rational Clear Quest, Rational

•

Requisite Pro

MY DELIVERABLES:

Requirements Specification Document; Business Requirements Specification; Data Requirements

Specification; Prototypes; Issue Tracker; Use Case Narratives; Use Case Models; Business Process Models;

Risk Analysis; Gap Analysis; Data Scenarios; Decision Table; Business Rule Definitions; Data Models;

Requirements Traceability Matrix; Function Point Estimation.

DELIVERABLES CONTRIBUTED TO:

Non-Functional Requirements Specification; Logical Data Model; Business Need Analysis Document;

Work Breakdown Structure; Test Data Sheet; Test Plan; Test Scripts; Test Strategy; Test Results Summary;

Information Architecture; Project Deliverables List.

CLIENT: AETNA INC.

PROJECT DETAILS:

Strategic Re-Architecture and True Comp Upgrade Callidus

The overall goal of the project is to implement an extensible, nimble architecture that can be extended to

support evolving business needs without incurring significant cost or resource requirements.

Accomplishing this goal requires three separate architectural focal points:

1. Re-factor the existing Broker Account Entry System to remove any dependencies on the ‘True Comp’

database and provide layering between presentation, business and persistence layering.

2. Build an extensible pre-pipeline process that focuses on data aggregation and preparation, relying on

the True Comp rules engine to provide compensation processing.

3. Redesign True Comp compensation plans, utilizing the True Comp rules engine to the greatest extent

possible for processing both base compensation and bonuses

There is a need to restructure the components of the existing compensation system. Restructuring will

allow for minimal development efforts for new compensation plans, providing quick time to market. The

re-structuring at this time is essential in order to take advantage of strategic initiatives currently underway

within the enterprise.

SUMMARY:

Worked as system integration tester, being the front runner in completing related testing, and made sure

the deployed product is defect free. Identified design flaws and notified the project team of the impacts and

behavior of the system under flaws.

RESPONSIBILITIES

• Developed the various test artifacts, such as test plan, test scripts, test cases, test execution logs, test

result summary

• Execution of application oriented testing and recording the status in quality center

• Key resource with strong business knowledge in the corporate domain

• Performed complete analysis of the existing process and maintained proper repository for all the

clarifications

• Conducted knowledge transfer session for explaining the design to the whole team

• Verification of coding for meeting the design in the given technology; performed the code review

according to the coding standards

• Supported the team members for any technical challenges, as well as for the application challenges

• Well-versed in various tools used in the project such as IBM-DB2, Hummingbird Connectivity tool and

monitoring jobs through Informatica

• Team management and effective team play

MY DELIVERABLES:

Test Data Sheet; Test Plans; Test Results Summary; Test Scripts; Test Strategy; SQA Testing Strategy and

Requirements Summary; Coverage Matrix; Defect Tracker

DELIVERABLES CONTRIBUTED TO:

Estimation Workbook; Requirements Specification Document; Work Breakdown Structure; Use Case

Narrative; Report Mockup

CLIENT: NORTHWESTERN MUTUAL LIFE INSURANCE

PROJECT DETAILS: Financial Platform Strategy

The Financial Platform Strategy project was initiated to develop short term and long term plans for the

Oracle (PeopleSoft) applications that support financial and regulatory reporting processes. The driver of

this project is to address current and future technical support issues, business performance and

functionality issues, and Oracle’s long-term application alignment with Northwestern Mutual’s (NM)

architecture strategy. The project involves creating new structures and moving the data from the old

structures to the new structures. Financial platform refers to the technical infrastructure used to support

the business processes in place to facilitate NM’s financial accounting, control and reporting

responsibilities, as well as the company’s purchasing, accounts payable and travel reimbursement activities.

SUMMARY:

Worked as a business systems analyst in gathering requirements related to the proposed apart from

understanding the nature of the current system. Played a key role in ensuring that the high level design

deliverables aligned to the business needs enlisted by the business stakeholders.

RESPONSIBILITIES

• Analysis of existing system process functionality

• Analysis of the proposed business process flow and working on the proposed system process

functionality based on the architecture guidelines

• Formulation of proposed process flows, use case diagrams and documentation of use cases.

• Documentation of the functional requirements for the proposed financial reports which vary across

multiple business areas

• Worked with the design teams to develop the technical specifications according to the reporting

requirements

• Helped the architectural and database design teams in migrating the data from the old database to the

new database

• Provided valuable contribution to the design of the new people soft accounting database (by providing

suggestions on the trees and nodes to be created)

• Worked as an information system business consultant and helped to document the functional

requirements for the reports to be run from the new database

• Contributing in preparation of test strategy and test plan for the functionalities that are expected from

the new database

• Preparation of high level design documents with the help of the development team and conducted

review sessions with the business stakeholders

• Reporting the status of the functional specification and the high level design deliverables to the

necessary stakeholders

• Experience of working on nVision and Business Objects Reports

• Experience of working on reports based out of Cognos (for Business Intelligence Reporting)

MY DELIVERABLES:

Report Requirement Specifications; Data Requirements Specifications; High Level Design Documentation;

Business Process Models; Prototypes; Requirements Specifications; Deployment Communication Material;

End User Documentation; Gap Analysis; Issue Tracker; Risk Analysis; Requirements Traceability Matrix

DELIVERABLES CONTRIBUTED TO:

Non-Functional Requirements Specification; Logical Data Model; Source to Target Data Mapping

Documents; Business Need Analysis Document; Work Breakdown Structure; Test Data Sheet; Test Plan;

Test Scripts; Test Strategy; Test Results Summary; Information Architecture; Project Deliverables List;

Estimation Work Book

CONTACT:

Ultramatics 813-***-**** for more information, or to schedule an interview.

Contact this candidate