Asha Patel 832 252 9394

SUMMARY: Proficient Business Systems Analyst with 7 years of experience in the field of Business analysis, risk analysis and software validation for various Healthcare and finance companies. In depth knowledge in using Business Process Modeling Tools to visually display the business process and indicate where a possible solution could be implemented. Expert in Healthcare domain specific regulations including Medicare, Medicaid, HL7, HIPAA, ICD 9-10, and X12 [EDI transactions 834, 835, 837, 270,271,277,278 etc...]. Proactive team player with a positive outlook combined with strong leadership qualities, communication and organization skills. Possess detailed knowledge of designing, developing and implementing business processes using state of the art approaches, technology and training. EXPERTISE:

Extensive experience working on agile modeling and SDLC methodology. Extensive experience in Business Process Modeling using various tools such as MS Visio, Rational Rose, PEGA and Optimal Trace to create Data Flow Diagrams (DFD), Use cases, Activity, Sequence diagrams. Excellent skills in Business Analysis, Data Analysis, Requirement Analysis, Business Modeling and Use Case development using UML methodology and BPMN An accomplished associate between management and development team for requirements and QA. Experienced working on Edifecs Healthcare Tools like SpecBuilder, XEngine, XEServer, Transaction Management, Edifecs Application Manager. Excellent Report analysis skills using Cognos and SSRS. Experienced in requirements gathering sessions, feasibility studies and Impact Analysis. Experience working on EDI transactions and following norms of HIPAA. Experienced with health information technologies such as ICD9, ICD10 and CCD verification. Skilled in Rational tools including Rational Analyst Studio, Rational Rose, and Requisite pro. Involved in all phases of Software development life cycle including requirements and specifications. Used rational clear quest for tracking and prioritizing defects and for enhancement after base lining the requirements. Worked in close coordination with the testing team in developing test plan and test cases from functional and business requirements. Sound knowledge in Gap analysis and business refinement process. Highly motivated team player with excellent communication, presentation and interpersonal skills, always willing to work in challenging and cross platform environments.

Education Master of Information System, VA. TECHNICAL/PROFESSIONAL SKILLS: Business Modeling Tools Requirement/Change Management Tools Operating Systems Databases Project Management Tools Application And Utility Rational Rose, Enterprise suite, MS Visio HP Quality Center, Requisite Pro, Rational Clear case, Clear quest MS Windows 98/ 2000/XP/ Vista/7/HP-UNIX ORACLE, SQL,DBMS, TCP, KWS MS Project, MS Word, MS Power point, MS Excel Arena 7.1, 5.1, Endnote

CAT Technologies Inc. for Blue Cross Blue Shield Association, Chicago - IL, USA Sep. 2010 Present Business Systems Analyst Description: The Blue Cross and Blue Shield Association is a national federation of 39 independent, communitybased, and locally operated Blue Cross and Blue Shield companies. The 39 local member companies of the Blue Cross and Blue Shield Association provide healthcare coverage for nearly 100 million people nationwide. As a Systems Analyst I played a critical role in two releases at the same time working on web-based enhancements to streamline HIPAA 837I, 837P,835, 276 and 277 transactions involved EDI X12 on HIPAA 5010 Guidelines and Claims Administration (An additional utility to enhance Blue. As per HIPAA mandate BCBSA has to be compliant with HIPAA 5010 so that BCBSA licensed 39 Plans can efficiently use Blue Application for Inter Plan Claims. Responsibilities:

Created and maintained Project plan throughout the SDLC using MS Project and RPM Managed Project Scope, Project Schedule, Project Timelines and Resource Allocation throughout the Project Lifecycle.

Organized and facilitated meetings with the client and the development team with the purpose of defining the system requirements Prepared Business Use Cases, work flow diagrams and data flow diagrams using UML and BPMN Authored BRD (Business Requirement Document) and reviewed with stakeholders for approval. Gathered functional requirements and documented them as FRD for product engineering team. Performed Gap Analysis of 4010 and 5010 for step up and step down process. Kept track of SDLC issues and risks and communicated them with responsible persons on HP or Edifecs side. Responsible for managing documents in the EDM as per the company policy. Responsible for building artifacts routes for Data Migration in XEServer Edifecs claim processor. Prepared Specs in SpecBuilder, Spec Analyzer and Worked on preparing Test data files of EDI transactions for testing in XEServer. Mapping with the Target and source file of 837 and 835 Transactions in SpecBuilder. Responsible for creating Trading Partners and Partner profiles for claim transaction to take place in Transaction Management. Responsible for developing routes in XEServer for processing Inbound 837 and Outbound 835. Creating Artifacts for 276 and 277 claim processing. Responsible for preparing Remote Servers like Windows 2008, HP-Unix and deploying Edifecs Healthcare suite for clients. Worked on creating Claim processor route for Inbound, Claim Acknowledgement process, Claim Status update, Batching and Splitting of claims and generating Outbound 277CA.

Worked on Trouble shooting issues which come during 837, 835, 277,276, 270, 271 processing in XEServer and Transaction Management. Designed reports using Visual Studio and SSRS. Responsible for designing a SQL Query Based Extractor Tool for extracting Trading partners profile into CSV format (Comma separated value) from Edifecs Trading Partner Management. Prepared good and bad data files in SpecBuilder for 837,277,271 and mapping it with 4010 and 5010 guidelines. Worked in QA team for preparing Test Scenario, Test plans, and Test Cases for 837 and 835 claims in HP Quality Center.

Leon Medical Centre, Westchester, FL Sr. Business Process Analyst May 2009-Aug 2010 Leon Medical Centers purchased and integrated Trizettos Facets Extended Enterprise(TM) administrative system to help it efficiently manage the demands of the growing Medicaid market. Under this project Facets was integrated with the Leaons business intelligence tool (SAP business objects) Responsibilities:
Lead JAD Session and gathered and analyzed requirements using Compuware (Optimal Trace). Identified, researched, investigated, realized, analyzed, defined and documented current business process model and desired business process model.

Developed Use cases and Activity process flow diagrams using MS Visio for the Facets Membership Enrollment Process. Part of the SME Workgroup of Facets Electronic Data Interchange standards Business Process Flows for defining testing strategy that need to comply with the Medicaid guidelines. Worked with X12 standard SME for 834 and 837 transaction sets requirements. Developed plan for data feeds and data mappings for integration between various systems, to follow ICD 9/ICD 10 Code set and ANSI X12 5010 formats
Acted as a liaison between business staff and technical staff to articulate and communicate their needs, issues and concerns. Responsible for conducting gap analysis as is to be for ICD9 and ICD10. Prepared Data Flow Models for code sets validating in Facets and Claim Process Engine. A strong emphasis on developing and producing daily, weekly, monthly reports for different departments, especially the Regulatory Department was practiced Documented, reviewed, and verified testing procedures for compliance to Interface Quality Assurance and Development standards and policies and other required standards Coordinated database configurations changes and report definitions with MAXIMO System Administrator and Report Developer. Assisted with user testing of systems (UAT) and ensuring that appropriate documentation is in place Worked with the UAT team to validate that the developed application will meet the business requirements Identified and documented issues, risks, gaps and their impact to the project life cycle. Provided recommendations and alternatives. Analyzed the Gaps for Training purposes. Authored various SOPs and User guides.

Emblem Healthcare, NY Sr. System Analyst January 2008-April 2009

Emblem Healthcare is one of the leaders in health insurance. The project was about modifying claim adjustment process to comply with NY Medicaid prompt Pay rule. Responsibilities:

Involved in Implementation team to determine the best solutions to solve business problems and utilize the existing resources to optimize the output Assisted in the requirements and design phases to help conduct trade-off analysis among solution alternatives. Established business analysis methodology after assessing the corporate and Medicaid compliance procedures Designed the business requirement collection approach based on the project scope and SDLC Methodology. Conducted interviews with key business users to collect requirements and business process information and converted those into detailed Functional Specification Documents (FSD). Developed business process models to document existing and future business processes. Performed extensive requirement analysis including data analysis and gap analysis. Responsible for translating business requirements to functional specifications and analyzing and documenting meta-data requirements for a highly data centric application of the Facets involving Claims Adjudication, Claims Pre-pricing and Claims Logging Designed and developed detailed Use Cases and UML models like Activity Diagrams using UML and Rational Rose. Created training materials for the end users on how to use the main functionalities of the system. Involved in the meeting with Business process owners, SME (subject matter experts) and Marketing Team for Requirements gathering in Definition Stage and also in JAD Sessions. Actively carried out functionality testing on various Membership Modules. Responsible for Regression testing on Provider contract maintenance, reports and renewal screens. Performed functionality testing on membership listing reports.

Rockville Bank, Vernon, CT Business Analyst Mortgage March 2005- December 2007 Rockville Bank offers business banking and retail banking in Connecticut State, with 21 branches. They moved from an older Altos system to LA PRO. The project was about using LA Pro as an enhancement of banking processes, LA Pro is the best-of-breed loan servicing software for Mortgage Service Package. It is powerful, flexible, scalable, and easy to use and easily integrates with other systems. LA Pro is used by organizations of all sizes including banks, investor-lenders, credit unions, CUSOs, development authorities, finance companies, government agencies and non-profit organizations. It can be used for business loans, mortgages, SBA loans, commercial loans, development loans, and participations Multiple business channels such as retail correspondent, and wholesale lending, Internet origination, government, conventional and subprime loans. More can be accommodate in LA PRO mortgage processing. It is an object-oriented, open- architecture, enterprise-wide system that allows for multiple database connectivity. Responsibilities: Responsible for defining the scope of the project, gathering business requirements, doing gap analysis and document them textually or using models. Organized and facilitated meetings with the management and the development team, conducting requirements gathering sessions with the purpose of defining the functional business and system requirements utilizing Use cases in UML diagrams and textual descriptions, documenting requirements in a requirements database to track development. Developed Business flow diagrams, Activity diagrams and Sequence diagrams so that the development team and the stake holders can understand the business process. Organized requirements of Project Manager with just in time concept, performance of various

duties relating to Mortgage Loan Servicing. Developed job descriptions, Identified staffing needs with general directions, assigned tasks and responsibilities and mentoring staffs. Assisted release manager with release management work. Coordinated and lead project updated meetings, documented project status and issues related to project. Wrote clear, concise detailed business requirement documents, System requirements specification (SRS) documents and in accordance to guidelines and standards of a level where developers can interpret, design and develop the application with minimum guidance. Provided support services as they pertained to daily workflow and reported on critical issues and service levels to management to ensure resources were effectively utilized. Formulated recommendations and identified areas requiring code modification to ensure accurate and user-friendly applications. Assisted end users with the implementation of new technology for Mortgage Process Management.

Prudential Securities Incorporated, FL Business Analyst E-Commerce January 2004-February 2005 Prudential Securities was the nations first full-service brokerage firm to offer customers online access to their account information and bill payment over the internet. The Project was Prudential Online service that links customers personal computers to Prudential Securities and provides access to their account information 24 hours a day, seven days a week. Clients enrolled in Prudential Online can use the cuttingedge technology to better manage and plan their financial goals. Once enrolled, they can access their account information, including balances, security values, transactions, account activity, and portfolio allocation. This information is updated twice daily. They also have access to eight daily market commentaries, delayed quotes, charts, research, investment ideas, and more. Prudential Online also enables customers to send electronic fund transfers between financial institutions as well as email to their Prudential Financial professional. Responsibilities: Involved in defining scope of project, gathering business requirements, documenting them and performing gap analysis. Wrote Functional Requirements Specifications for data collectors and converted requirements into Technical Specifications. Prepared requirements documents using Rational Requisite Pro. Played major role in deployment, documenting and implementation throughout the development lifecycle. Used Rational Rose to create Use-cases, activity diagrams and sequence diagrams. Managed project completion and ensure business needs were met. Traced and communicated project tasks progress against deadlines, and provided measurable results to management. Provided business support for mock implementation and performance testing verification. Reported the defects in ClearQuest and collected Test Matrices weekly from defects database to keep track of defects.