Business Analyst

PRIYA AJGAONKAR

Email Id- *****.************@*****.***

Contact No- 778-***-****

CAREER SUMMARY:

Over 6 years of experience in gathering business requirements, defining business process flow, system analysis, business process modeling and analysis

Specialized in Healthcare, Insurance and Document management

Strong Experience in Claims Processing and Claims Scrubbing in,Medicaid and Medicare

Expertise in ICD-9 to ICD-10 Conversion

Worked on various Web & Desktop Reporting tools and Database applications such as HEDIS, CCP, DM Scorecard, ICM Dashboard, Client Letter Maintenance

Knowledge on medical necessities, software validation and healthcare compliance auditing

Expertise in Enrollment, Claims, Subscriber/Member, Plan/Product,Utilization Management, Case Management, Disease Management, Inpatient & Outpatient Services

Experience in developing work requests for Contract & Compliance department

Involved in Output generation, Interface development and Migration Projects

Hands on experience gathering requirements, interviewing senior level company officials, SME’s to gather requirements for documenting project functional specification

Experience and understanding of software development process including Software development life cycle (SDLC), RUP’s Iterative System Development Life Cycle process, implementing the Rational Unified Process (RUP) in all four phases of a project Inception, Elaboration, Construction and Transition

Experience in capturing data requirements, data profiling, data analysis & data mapping for Vendor feeds and Databases.

Experience in writing the Technical Specification Documents and worked on application’s input / output data definitions

Experience in creating and maintaining the Requirements definition documents that included Business requirements and Functional requirements

Skills in developing Use Case diagrams, Sequence diagrams, State Chart diagrams, and Class diagrams.

Prepared unit test cases and performed unit testing

Possess very good organizational skills, with the ability to multi-task and deal with shifting priorities

Proven ability to manage mulitple competing high priority projects in a fast paced environment

Adept at reducing development costs and providing traceability of projects

Proven experience in establishing, developing and maintaining strong customer relationships

Proven leadership qualities, capable of managing multiple projects simultaneously

TECHNICAL SKILLS:

OPERATING SYSTEM: Windows 2003 Server, Windows XP/2000, UNIX

TESTING TOOLS: Quick Test Professional, Rational Team Test, Rational Clear Quest, Test,Director

REPORTING TOOLS: Cognos 10

FRONT - END TOOLS: Adobe Photoshop, MS Office, MS Project, Lotus Notes

DATABASE: MS SQL Server

PROFESSIONAL EXPERIENCE:

Carefirst- Blue Cross Blue Sheild, Washington DC,USA September 2013- February 2016

Business System Analyst & Enrollment Analyst

Carefirst has developed New Enrollment code strings creating system “Client Letter” for centralizing the all-Healthcare related Enrollments and Agreements all over the states(VA,MD,DC). This project is a large IT project replacing the Enrollment system and comparing it with Facets database. Responsible for all aspects of testing, creating and managing the code strings in the “Client Letter”. Primary responsibility is to ensure that the system functions as designed, meets the requirements of the business community and conforms to all applicable Federal and state laws. As a Business System Analyst I was involved in various Projects also

Responsibilities:

Project 1: New Enrollment code strings creating system “Client Letter”

Utilized Rational Unified Process (RUP) to configure and develop process, standards and procedures

Create the Code String Requests for BSBS Standard Codes, 200+ Non Standard Codes in the Client Letter

As per the Work Requests from C&C via Lotus Notes, created the following documents and Imported it in the code frame in Client letter - EOC, DOCS, Eligibility Schedule, SOB, Dom Partner, Disclosures and Agreements

As per the Contract Requests from C&C, created the whole Enrollment for the specific Group ID/ Member ID

Facilitating Provider Enrollment, Setting up Provider profile & Trading Partner Agreement

Wrote FRDs for the defects and enhancements and approve it for the developers

Working on Technical design documentation (TDD) of the enrollment processing system

Performing task estimations, SOP’s and documentation of procedures to operate “Client Letter”

Design, prepare and implement test cases for system testing as well as for User Acceptance testing

Did impact analysis for changing requirements and coordinated with business users for prioritizing the testing/release of the changes

Data analysis, create data mapping and data interface documents and kept the documents updated with changes in requirements and functional specifications

Test User Interface inconsistency and application functionality

Created BPR charts for AS IS and TO BE processes of different business functionalities

Participating in JAD sessions, finalizing BRD and creating high-level designs for the technical and configuration team

Import the “New Hire Rule 9” information from the Facets to the Client Letter

Project 2: Managing data of Facets for Enrollment, Membership and Billing areas

Manage the collaboration with users, analyze and redesign Billing and Enrollment processes

Intensively involved in the Data Mapping meetings and process, used Crosswalk file prepared by Enrollment system (Facets) and updated the Files (Design Documents) to send required field values to the downstream system for their payment to providers

Performed Facets Data Analysis and data mapping between Facets Data elements and Client Letter system

Worked on Membership information related to Payment methods and Associated Bill date for the selected payment method required financial system

Provided Technical inputs from Facets perspective in the BRD completion process for satisfying the Client Letter requirements

Extensively involved in Facets billing module mainly in Back – End system process for membership’s enrollment

Involved in the Data Migration meeting and process to provide feedback from Facets side based on its technical functionality

Project 3: Carefirst Document Writer (CDW) Project – CDW is a new database for the contracts where user can find any contract from the history. This database is connected with the FACETS and Client Letter

Investigated and analyzed feasibility of low to moderately complex enhancements, automations and processes.

Analyze, define and interpreted business needs and issues by gathering, analyzing, documenting and validating the Business area(s) and user(s) technical (functional/non-functional) requirements

Participated in the creation of complex PRD (Project Requirements Document) which includes defining Business, User, functional and non-functional requirements needed for approval by Business and for use by Design, Development and Testing teams

Participated in requirements analysis and verification sessions for complex projects and may lead requirements analysis and verification sessions for less complex projects

Participated in the tracking and management of open issues and assists in planning for resolution for complex projects

Leaded testing efforts by defining, developing and implementing practices and procedures for complete end user test plans

Created the RTM gap analysis reports for complex enhancements, automations and implementations

Enviorment : SQL 2000, MS Office, Lotus Notes, Quaility Center, MS Project, Clear Quest, Rational Rose, Requisite Pro TeamTrack

Blue Cross Blue Shield Association, Washington, DC,USA July 2012- August 2013

FEP Analyst/ Business Analyst

BCBSA is one of the nation’s leading diversified healthcare benefits companies. I am working as a Business Analyst in FEP Clinical Data Integration team(CDI) and primary duty is to work as a liaison between FEP CDI team and BCBS Plans, Other business group and Vendors. The work involves translating the business requirements into technical terminologies and vice versa that include defining scope, resources, issues management, requirement reviews, status reporting. As a Analyst I was involved in various Projects

Project 1: Transformation from legacy system (MCSource) to new system (IDEA) – It includes the implementation of new Datawarehouse with the front end reporting tool- Cognos 10 for FEP user groups and Plans

Responsibilities:

Participated in the logical and physical design sessions and developed design documents

Conducted and lead status report meetings with the SME and the IT team on a daily basis

Manage Scope and change throughout the life cycle of IDEA

Responsible for supporting multiple, strategic, complex, services and associated deliverables related to data analysis activities in support of FEP objectives

Performing Impact analysis for readiness of ICD-10 conversion

Identified all necessary Business and System Use Cases from requirements, created UML diagrams including Use Case Diagrams, Activity Diagrams, and Sequence Diagrams using Microsoft Visio.

Involved in comprehensive testing of the system to check it satisfies functional specifications

Created Gantt chart and PERT chart and used them to develop project schedule, allocate resources and make cost estimates using MS Project

Identified the deliverables at the end of the inception and elaboration phase of the Rational Unified Process (RUP) life cycle in terms of business modeling and requirements analysis

Created and maintained the Requirement Traceability Matrix (RTM) between the requirements and other products such as design documents and test plans

Provided analytical solution to the Plans by creating Reports using Cognos Report Studio

Involved in managing the effort of implementing government regulated mandates (HIPAA 5010 and ICD-10 codes) across IDEA

Worked with the business owner and business sponsor (MD of CDI team) on the final signing process in the User Acceptance stages

Provided training to Plans and other business group through weekly Webinar presentations

Carried out a thorough target organization assessment and risk analysis

Project 2-Worked on 2 different Interactive Web & Desktop Reporting Applications

a.Care Coordination Portal (CCP) - It’s an interactive database repository for care managers, nurses, case managers, etc.

b. Healthcare Effectiveness Data and Information Set (HEDIS) – It’s a reporting analytic environment

Responsibilities

Coordinated and conducted system requirements walkthroughs/sessions (JRDs/JADs) with SMEs as well as design/development teams

Analysis of key business requirements and in the development of Business Requirement (BRS). Applied change requests, versions, and addendums

Developed use cases, workflow, screen mock-ups and conversion requirements

Developed prototype of new information processing application. Helped collect functional requirements, measures calculations and prepared business requirement documents using Rational Requisite Pro

Understood the Business Logic, User Requirements and test-objectives to develop BDM model, Test plans, Test cases, Use Case Scenarios

Assisted in developing test scenarios, test scripts and test data to support unit and system integration testing

Developed development revision document, data exchange document, requirement traceability matrix document and operational deployment tasks document

Developed User Guide for Plans and other business groups

Conducted training sessions with Plans and other business groups

Helped manage risk analysis and mitigation plans, status reports and client presentations

Aided management in standardizing HEDIS applications by preparing GUI standards and recommending alternatives for incorporation in phased, iterative manner

FEP Data Insight – Created presentation for BOM with accurate data

Created Benefit Cost Reports and ETG Reports for internal business groups on monthly basis

Worked on another reporting application- Blue Health Intelligence

Environment: Windows XP, MS Visio, COGNOS 10, Clear Quest, Rational Rose, RequisitePro TeamTrack, Quality Center, MS Project, MS Access, MS Excel 2010, MS Powerpoint 2010

Cityweb,India July 2009 – Nov 2010 Business analyst

Cityweb is one of the leading company who deals with the Web Portals as well as in E-commerce websites.As a Business Analyst I was involved in various Web Projects

Responsibilities:

Communicated and interacted on a regular basis with the project manager and development team during different stages of the project

Prepared Business Requirement Document and convert it into functional specifications.

Designed Data Flow Diagrams (DFD's) and we page mock ups using MS

Managed schedules and collaborated with different teams working on the project

Prepared project progress reports and status reports and submitted to the management on an ongoing basis

Researched best industry practices and implemented best practices via template and process improvement

Defined and documented the vision and scope of the project.

Interacted with the development and testing teams to improve overall quality of the application

Prepared project progress reports and status reports and submitted to the management on an ongoing basis

Environment: Windows XP, MS Visio, MS Project, MS Access, MS Excel 2010, MS Powerpoint 2010, MS Access My SQL

ADCC R&C,India July 2008 – June 2009 Business Developer & Planner

ADCC is one of the good company who deals with the Website Devleopment as well as in Maintenaince.As a Business Developer and Planner I was involved in various Website Development Projects.

Responsibilities:

Mapped new corporate clients, studying and understanding their requirements accordingly offering useful solutions

Sent the excellent proposals to the prospective clients at International Market through ‘Elance’

Worked with business users to gather expectations of the new system

Worked as an interface between the users and the different teams involved with applications development to enhance understanding of the business and IT process

Interacted frequently with the Project Manager and made suggestions about areas that required attention

Worked under the general supervision of senior staff with some latitude for the exercise of independent judgement

Involved in cross-functional teams, developing new ways to boost efficiency and delivering results in a fast changing environment to achieve company goals

Worked with the clients on the final signing process in the User Acceptance stages

Environment: Windows XP, MS Visio, Rational Rose, Defect Tracking System, Quality Center, MS Office, SQL

EDUCATION:

Master in Information Systems, Stratford University of Virginia, USA

Master in Business Administration (IT & Systems), India

B.Tech in Electronics, India

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