Email: rqx2ki@r.postjobfree.com

Contact: 267-***-****

Shirish Kanthed

Summary of Experience:

• Committed and result oriented professional with over 8+ years of experience as Business Analyst in Finance and Healthcare industry.

• Worked closely with project stakeholders, SMEs, and development team to understand the requirements and specifications for new applications.

• Experienced in Software Development Life Cycle (SDLC) methodologies Traditional Waterfall Model and iterative approach to software development as per Agile methodology and Rational Unified Process (RUP).

• Solid experience in Business Requirements Gathering, Business Process Flow, and Business Analysis.

• Coordinated all the project related activities, implementing action plan to meet agreed standards and deadlines, ensuring the effective preparation delivery of all project events meetings and creating all necessary documentation.

• Skilled in conducing GAP analysis, Impact analysis, Feasibility analysis, SWOT analysis and cost benefit analysis.

• Expertise in identifying, developing and documenting Business Requirements Documents (BRD) and Functional Requirements Specifications (FRS), System Requirement Specification (SRS).

• Organized one on one discussion, workshops, JAD sessions, Project planning, presentation skills, resolving issues and conflicts.

• Extensive experience with process modeling using UML diagrams like Use Case diagrams, Activity diagrams, and Sequence diagrams.

• Proficient in creating test plans, test cases, test scenarios and test strategies to ensure quality assurance and to test all the business requirements.

• Experience in understanding database structures and write SQL queries.

• Knowledge of health care services regulatory environment including HIPAA, Medicaid/Medicare, and EDI.

• Knowledge of ICD 9 and ICD 10, and various HIPAA 4010/5010 formats.

• Creative and aggressive self-starter with ability to handle ambiguity, Able to communicate effectively with Cross Functional Teams at all levels, capable of delivering solutions under high-pressure environment.

Technical Skills

Operating System Mac OS, Windows 97/2000/XP/Vista/7

Methodologies Waterfall, RUP, and Agile (Scrum).

Languages UML, SQL, HTML, XML, JavaScripts

Business Modeling Tools: MS Visio, UML, Rational Rose

Databases MySQL, MS-Access, Oracle

Testing Suite Quality Center, WinRunner

Office Automation Microsoft Office Suite, Outlook

Management Tools MS Project, Clarity Tools, Requisite Pro, SharePoint, RallyDev

Healthcare Transaction Management Tools Edifecs (Xengine, HTM, Specbuilder)

Professional Experience:

Hewlett-Packard/ Cigna, Windsor, CT Jan’12–Current

Sr. Business Analyst

HP is the implementation partner for CIGNA to execute the HIPAA 4010A to 5010 project for all of the CIGNA’s health insurance subsidiary companies. HP seeks to accomplish all the migration tasks and production releases within the newly extended deadline. In order to compensate the need for 5010 implementation, HP works with EDIFECS, Deloitte, Oracle and IBM to upgrade and manage all of the Cigna’s broker gateways and claim engines environments that are aimed to deliver cost-effective, on-time and easy flow of EDI transaction for CIGNA which will reduce administrative cost and increase productivity.

Responsibilities

Document Trading Partner Migration Process Flow from 4010 to 5010; create process flow diagrams and presentation materials; and monitor production and release events.

Interpret Systems Architect and Logical Diagrams to business users and other stakeholders, and assist with change requirements elicitation.

Assist in writing business requirements and system specification documents.

Extensively work on EDI transaction sets 834, 835, 837I, 837P, 820 and 270/271, 276/277 and 999.

Responsible for interpreting ASC X12 Original and Errata documents such as X12 220, 221A1, 222A2, 222, 224A2 to business and technical users including the developers.

Research, track, parse and interpret EDI files 999, Transaction Acknowledgement records, and enrollment and claims files in EDIFECS data repository and UNIX server and analyze them according to the request.

Conduct operational and implementation assessment of project tasks and prepare budget estimate documents for change request using standard templates.

Work as a liaison between HP and CIGNA and responsible for all the Cross Functional Communication.

Validating the Log Files (999, x12,) for 834/820,277CA, 837IB and 835 Transactions in UNIX and HTM (Healthcare Transaction Manager).

Responsible for preparing and presenting technical reports and documents to stakeholders in client facing environments. Moderate teleconferences and JAD sessions.

Extensively use Quality Center to manage defects, change request and pre-uploaded requirements and mapping documents.

Blue Cross Blue Shield of Michigan, Detroit, MI Sep’11–Jan‘12

Sr. Business Analyst

BCBCM an independent licensee of Blue Cross Blue Shield is envisioned at transforming healthcare system that provides people with, most affordable care possible. As a leader in the healthcare community for more than 70 years, BCBSM is committed to provide healthcare access for everyone.

The project is to become compliant with Michigan health insurance claims tax on paid claims for Michigan residents. The project is planned to leverage this new process to help administer the HCR market share. This act will require health plans / third party administrators to pay a 1% tax on paid claims for MI residents to the MI Dept of Treasury on a quarterly basis effective date January 1, 2012.

Responsibilities

Gathering information, analyzing and providing it to the processing team for development.

Worked with Business Users to better understand their needs and present solutions using SDLC approach.

Successfully conducted JAD sessions to gain clarity and finalize business requirements.

Documentation of the updates and enhancements in the process using RUP methodology.

Facilitated meetings with the review teams to continuously improve the QA process for the application development.

Distribution of minutes of the meeting to the team member.

Training and coaching team members about the process and the updates if any.

Involved in forming strategy for increasing call conversions.

Analyzed requirements and created Use Cases defined business rules and created UML diagrams (activity diagrams, data flow diagrams, sequence diagrams etc) using MS Visio

Developed flow charts using MS Visio for MetaVance when they receive notification of new CDH business.

Good understanding of changes from ICD 9 to ICD 10.

Worked on crosswalking changes from ICD 9 to ICD 10 one to one or multiple-choice codes.

Created forms that need to be sent out to Benefitfocus for payment history issue in eBilling.

Extensively worked and published documents on SharePoint.

Managed change request for MetaVance (ASC, Premium and Mixed billing) and updated the scope with the new changes.

Worked with Benefitfocus staff to ensure requirements will be incorporated into system design and testing.

Worked with cross functional teams to implement regulatory requirements for claims processing, addressed privacy and security issues in compliance with HIPAA regulations concerning protected health information (PHI).

Utilized technical writing skills to create effective documentation and training materials.

Medco Health Solutions, Blue Bell, PA Aug ’09 – Aug ‘11

Business Analyst

Medco is a leading pharmacy benefit manager (PBM), with the nation's largest mail order pharmacy operations. Through advanced pharmacy, Medco improves the health and lowers the total cost of care for clients and their members.

The project with Medco involved working in the claims interface group to develop and implement EDI applications as per HIPAA 5010 implementations under the coordination of benefits agreement, developing and modifying EDI transaction sets (834/835,837,270/271, 276/277, & 997) for partners (BCBS, WellCare Health Inc, etc).

Responsibilities

Interfaced with, and interviewed, cross-functional stakeholders to generate requirements.

Extensively worked on EDI 834 transaction set and Experience in 835, 270/271, 276/277, & 997 processes of medical claims/underwriting for support and point of reference for the vendor in business issues.

Leveraged Agile methodology for development process.

Coordinated with product managers to create Product Backlog. Helped create MRF’s (Minimally Releasable Features), and MMF’s (Minimally Marketable Features).

Empowered development team by helping them understand requirements through release planning. Part of iteration meeting to ensure requirements and user stories were well understood and in compliance with business requirements.

Collaborated with development team through iteration and attended every SCRUM meeting to represent product team. Served as product champion to assist team.

Enabled product-centric testing and facilitated QA team’s understanding of acceptance criteria and test scenarios. Coordinated with UX designer to create storyboards related to user stories.

Developed Activity Diagrams, Use Case Diagrams, and Workflow Diagrams using Microsoft Visio. Accountable for extensive UAT testing.

Maintained documents on Confluence to facilitate seamless interaction with multiple teams with different document repositories.

Interfaced between users and diverse teams involved in application development to enhance understanding of business and IT processes.

Assisted in updating ICD 9 code sets to ICD 10 form as per HIPPA guidelines.

Assisted in understanding the changes needs to be implemented from ICD 9 to ICD 10.

Worked with team to stay abreast with new process and render it more effective.

Facilitated transition to Agile and despite reduction in documentation, succeeded in creating alternate strategies to ensure development was completed as required.

Utilized technical writing skills to create effective documentation and training materials.

Great-West Life & Annuity Insurance, Greenwood Village, CO Jan ‘08- July ‘09

Business Analyst

Great-West Life & Annuity Insurance Company serves full range of managed healthcare, life and disability insurance, and retirement savings products and services.

This project involved development of a system that gives full information regarding benefits, plans offered by the company, educate people about diseases, prevention, Users can enroll and can avail the benefits offered.

Responsibilities

Met with client groups to determine user requirements and goals. Utilized Rational Unified Process (RUP) to configure and develop process, standards, and procedures.

Analyzed business requirements and segregated them into high-level and low-level Use Cases.

Derived Functional Requirement Specifications (FRS) based on User Requirement Specification URS. Understand and articulate business requirements from user interviews and then convert requirements into technical specifications.

Interviewing Subject Matter experts, asking detailed questions and carefully recording the requirements in a format that can be reviewed and understood by both business people and technical people.

Resolved or escalated business process issues, item management issues or technical issues.

Worked with Management to create and communicate mission-critical information to user community through emails.

Followed the UML methods to create Use Cases.

Conducted technical/non-technical presentations to the management and training workshops for the clients.

Monitored the development and testing process to ensure that final product meets all the desired functionality requirements.

Thorough documentation of the entire process along with all its activities.

Bio Reference Laboratories, Elmwood Park, NJ July ‘06 – Jan ‘08

Business Analyst

The project involved a strategic initiative to replace its legacy “Vertex” information processing system with new systems. The Vertex system is the central information-processing component responsible for on-boarding of specimens and test requests and the routing of information to instruments and to the BioReference reporting system. Vertex functionality will be replaced with a combination of systems and data services designed to provide efficiency and flexibility.

Responsibilities

Worked with the Business users, tech Lead and 3rd party vendors in gathering their requirements.

Designed and Conducted interviews with individual regional financial managers to understand the high-level requirements.

Participated in JAD sessions for requirement gathering, analysis, and design.

Developed Use Cases, Use Case Diagram and Activity Diagram.

Designed and developed all Use Cases and UML models using MS-Visio.

Comprehensively performed requirement gathering for enterprise reporting system-using Requisite Pro – RUP.

Conducted workflow, process diagram, data analysis and gap analysis to derive requirements for existing systems enhancements.

Helped testing team documenting system requirements & testing system development.

Set up definitions and processes for test phases including Product test, system test following quality procedures & user acceptance test (UAT).

Functioned as the liaison between the business line, operations, and technical areas throughout the project cycle.

Prepared weekly & monthly status reports, documented process flows, policies & procedures & developed training materials and executed training.

Providian Financial, Oakland, San Francisco, CA June ‘05 – June ‘06

Business Analyst

Providian Financials, one of the largest bankcard providers in the nation, offers broad range of lending, deposit and membership based products. Providian offers online services such as 24-hour online account access to credit card accounts, instant online account opening for deposit accounts, instant decision credit cards for Aria visa card, Providian (Visa and Master) credit cards and loan comparisons through GetSmart.com

Project OLA (On line Access): 24-hour online access to Aria and Providian credit cards, where customers can login and view the account information (Current and Previous Account history) and can make online payments and change their Contact information (Such as Contact Address, Phone Number and Email Address if available), and can contact customer service representatives for questions.

Responsibilities

Assisted the senior business analyst in defining the scope, and defining business rules of the project. Also assisted in gathering business requirements, doing gap analysis and documents them textually or within models.

Responsible for writing Functional Requirement Specifications (FRS) and User Requirement Specification (URS).

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

Followed a structured approach to organize requirements into logical groupings of essential business processes, business rules, information needs and insured that critical requirements are not missed

Developed prototype of new information processing application.

Involved in maintaining and managing different versions of Documents using Rational Clear Case.

Interacted with the testing team to review test cases and test scripts.

Matria Healthcare, Marietta, GA Jan ’04 – June ’05

Business Analyst

Matria Healthcare provides health enhancement, disease management and high-risk pregnancy management programs and services through its Health Enhancement and Women's and Children's Health divisions.

Matria Healthcare has a system called Customer Information Claim System (CICS) for providers to check the contract information, deductible/co pay of the contract and allows creating claims and viewing or deleting the claims. Providers can be hospitals or health care centers, doctor’s office or an insurance agent who can sell the MHC’s insurance.

Responsibilities

Analyzed, documented, and managed all business processes, requirements and changes to requirements throughout the software development lifecycle using Requisite Pro.

Followed the Business Rules, HIPAA compliant Rules to display minimum benefit information.

Responsible for attaining HIPAA EDI validation from Medicare, Medicaid and other payers of government carriers.

Experience in analyzing medical claims data and interfacing SAS with MS Office applications such as Access/Excel.

Conducted user interviews, attended JAD (Joint Application Development) sessions, and documented analysis in requirement gathering.

Deep understanding of ICD 9 code sets.

Assisted in providing updated information for ICD 9 codes.

Developed UML Use Case model for the application using Rational Rose and assigned to prepare the detailed work flow diagram based on the proposed enhancement for the system.

Extensively interacted with both user group and development team in coming up with structured charts, class and sequence diagrams.

Responsible for status check at regular timeframe.

Education

MBA Global Marketing & Finance

Johnson & Wales University, Rhode Island

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