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girish@careits.

com
732-997-7678
Professional summary:
Over 7 years experience as a Business Analyst, proficient in developing business processes and system solutions
particularly for HealthCare domain and Finance domain.
Strong Knowledge of SDLC methodology and project life cycle and well versed with industry standards and software
methodology such as Waterfall, Agile, RUP and CMM standards.
Interacted with the Stakeholders, End Users to understand and gather stakeholder requirements and create the
Business Requirements Document (BRD) and Functional Requirement Document (FRD) and communicating it
to the entire team involved. Good knowledge of Business Process Modeling and Business Re-Engineering.
Excellent exposure to SQL, Web services, Object Oriented design, Windows Applications, XML,SSIS, and SSRS
Strong Knowledge of UML, RUP, Rational Suite including Rational Rose, RequisitePro etc.
In-depth knowledge of gap analysis framework to identify AS-IS processes of claims transactions of 4010/4010A
standard and TO-BE processes (ICD-10-CM and ICD-10-PCS compliance requirements) of 5010 standard.
Expertise in EDI and HIPAA Testing Privacy with multiple transactions exposure such as 837 for submitting claims,
835 for payments, 834 for benefit enrollment, 820 for premium payments to insurance products, 270, 271 for health
care benefits and eligibility, 276, 277 for claims status and 278 for transmitting health care service information.
Proficient in medical terminology and coding outpatient and inpatients diagnosis and procedures using ICD-9, ICD10 and CPT codes. In depth knowledge of Medicare/Medicaid Claims/Electronic Medical Record (EMR)
processes.
Strong Subject Matter Expertise (SME) in Credit Card Industry, Retail/ Commercial/Investment Banking, Risk
Analysis, Asset Management- risks and returns.
Facilitated JAD session and requirements review meetings with all functional groups and participated in industry
events.
Documentation of the Test Plans, Test Cases, Test Scripts, Test Procedures based on the Design Document and
User Requirement Document for the Unit, Integration, Performance and User Acceptance Testing (UAT).
Trace and inform business requirement changes through the lifecycle of the project using Rational RequisitePro
while maintaining customer needs and maintain a Requirements Traceability Matrix (RTM) to keep the
stakeholders informed of the progress of the project.
Excellent exposure to SQL and database querying including FACETS.
Excellent communication and presentation skills. Experience working with business users as well as senior
management.
Technical skills:
Methodologies
Testing Tools
Change Management Tools
Business Modeling Tools
Version Control Systems
Project Management
Programming Languages
Databases
Requirement Analysts
Operating Systems
Other Tools

RUP, SDLC, Agile, SCRUM Methodology


Rational Enterprise Suite, Test Director, WinRunner, LoadRunner, QTP
Rational Clear Quest, Test Director.
UML, Rational Rose, MS Visio
Rational Clear Case.
MS Office Suite, MS Project, Clarity
SQL, PL\SQL, Visual Basic, Java, JavaScript, HTML, dBase, Cobol, Fortran.
Oracle 8/8i, MS SQL Server 7.x/2000, MS-Access, SSRS
Rational RequisitePro, Quality Center
MS-DOS, Linux, Unix, Windows (2000, NT, XP, VISTA)
SPSS, Test Director, SSRS, Winrunner, Hyperion, Mainframe.

Professional experience:
Express Scripts Inc. (Pharmacy Benefit Management Company), Franklin Lakes, NJ
Role: Business Analyst

Apr 2013 - Till Date

Description: ESI has established connections with Medical Partners and Vendors, including National Health Plans, Blues
Plans, Behavioral Health Companies and TPAs.This number of vendor connections is expected to grow by the end of
2014 due to the addition of CDH and HCR Partners/Vendors.
The CDH Vendor Operations Management is responsible for managing and maintaining the relationship with the CDH
Third Party Partners and manage the setup, connection and testing with the partners users. Having this dedicated Test
Region, will allow the team to continue to install and certify the accuracy of clients plan design, files and protocols.
Responsibilities:

Expert in Requirement Elicitation, Gathering, Analysis, Documentation from Subject Matter Experts.

Planning and analyzing the current

And advising on more feasible business process during JAD session.

Conducted GAP analysis and assessed the status of the organization to determine the scope of the application.

Developed test plan and test cases for User Acceptance Testing (UAT) and responsible for facilitating UAT with end
users (customers) to help prioritize development efforts and to negotiate deadlines.

Participated with information Exchange team via FTP server to establish new connections or to amend any existing
connection as a part of CDH Operation Team in order to process pharmaceutical claims.

Modeled the detailed design of the system using UML and Rational Rose, Use Case Diagrams, Sequence Diagrams,
Activity Diagrams and State Chart Diagrams.

Provided the data warehouse development methodology and created the architecture and dimensional model to
develop an effective decision support system (DSS).

Developed Windows Communication Foundation (WCF) Services to encapsulate business logic components to be
used in a distributed environment and exposed them through SOAP and XML.

Developed source to target mapping documents for multiple subject area.


Worked closely with the ETL team to coordinate data mapping during code development.
Identified, researched, investigated, analyzed, defined and documented business processes and Use Case Scenarios.
Involved in developing Test plan and Test cases based on Use cases and Functional Specifications.
Helped review and edit test scripts, certify test results and fulfilled business requirements.
Worked on the Flowchart and process diagram using Microsoft Visio.
Gathered and identified Business Requirements in DOORS and collaborated with the technical team to define
Functional Requirements.
Created test cases for FRD to perform Integration tests and verify the integrity of the accounts built on FRD.
Monitoring and reconciling inbound and outbound claims.
Reported progress against Development/Action Plan routinely to the Program Manager with recommendations for
corrective actions, where necessary.

Experience in managing Daily Standup meetings based on Agile- Scrum and enforced quality standards as related to
build-release schedule.

Communicated with Business Partners on status of issues, action plans, and timeframe for resolution throughout
development cycle.

Environment: Mainframe- rumba, Agile- Scrum, CBM, UML, SQL, Microsoft Office (Project, Publisher, Excel, Word,
PowerPoint and Visio), MS Office Suite, MS Project, Quality Center, ALM, QTP, Cognos.

HSBC Bank, New York City, NY


Jan 2012 Apr 2013
Role: Business Analyst
Description: Fixed income Performance Attribution System (FIPA) was developed specifically to support Asset
Management Groups to provide valuable advisory services to clients on Asset Projections, Executive stock option models,
Derivatives Holdings, Investment Holdings, Liquidity needs and future goals. The systems solutions advise the clients on
asset management strategies and provide clear and complete picture of the clients assets.
Responsibilities:
Worked with the business team and technology team in substantiating the System Requirement Specification
document for the project
Analyzing, interpreting and translating Client's business requirements into viable solutions
Actively involved in JAD sessions, Brain Storming Sessions with Requirements, Design and Development Teams,
Conference Call Meetings with the User Community spread across the Globe, Interviews with Subject Matter Experts
for identification and documentation of business and user requirements
Served as a liaison between the business and technical team.
Researched the various steps in the lifecycle and then constructed the system in a way that the high risk customers
would be easily identified and monitored.
Responsible for Requirement gathering and writing use cases on the extended application which supports
FACETS.
Developed use cases, workflow, screen mock-ups, report mock-ups and conversion requirements
Made presentations in MS Power Point based on analysis of data gathered from different sources
Identified systems of record / potential sources of data with the assistance of source system experts
Implemented business modeling using MS Visio to develop business architecture for the application
Designed and implemented data integration and data warehousing solution for HSBC.
Clarifying functional requirements and resolving implementation issues.
Designed web service with XML dynamic configuration to support new predictive models by just deploying the
model code and an XML configuration file for the new model or new model version.
Developed data mapping documents between Legacy, Production, and User Interface Systems during migration.
Involved in the mapping of data sources and analytics, with the goal of ensuring data quality.
Developed test plan and test cases for User Acceptance Testing (UAT) and responsible for facilitating UAT with
end users (customers) to help prioritize development efforts and to negotiate deadlines
Created SQL queries to insert, update or delete information from the SQL Server database and generate reports for
data analysis
Reviewed test strategy and test plans to ensure that test cases reflects user needs for the functional, user interface,
usability and security requirements.
Created and maintained documentation that serves as a knowledge base on application and business processes.
Environment: Windows, Agile-Scrum,SQL, MS Visio 2010, HTML, MS Project 2008, MS Office 2010, MS SQL Server
2008, MS Access 2010, MS Share Point 2010, ALM, Cognos.
AETNA, Phoenix AZ
Role: Business Analyst

Mar 2011 Jan 2012

Description: AETNA is one of the nations leader in health care, dental, pharmacy, group life and disability insurance and
employee benefit. Aetna offers a broad range of traditional and consumer-directed health insurance products and related
services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management
capabilities and health care management services for Medicaid plans. I was assigned the Project ANSI X12 837which
involved the conversion of 4010 A - ANSI 5010 X 12 for 837 transaction, in order to compliant with 5010 which is a
government mandate that has to done by January 1, 2012. This Project involved the impact analysis on the claims
adjudication system, front end system, and the companys internal claims processing system.
Responsibilities:
Conducted Gap Analysis for 4010 -5010, 837I and 837 P.
Conducted JAD sessions to discuss the impact analysis and interviewed Users (SME's) to gather the requirements,
Facilitated collection of User Requirements and Business Requirements to create the Business Requirement
Documentation, using MS Word and MS Visio that provided appropriate scope of work for technical team to develop
prototype and overall system.
Manage Requirement using Requirement Traceability Matrix (RTM).
Experienced in X 12 transactions 835/837/270/271 of medical claims/underwriting for support and point of
reference for the vendor in business issues
In depth knowledge of Medicare/Medicaid Claims processes from Admin/Provider/Payer side which were later
part of the training program to vendors
Involved in Risk-Management Process, whereby identified critical areas of business risk and modified the
business process to reduce the same.
Knowledge of the complete EDI format used in electronic documentation which was a 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.
Wrote test cases and test plans as per the test strategies defined in the project for the related and assigned scripts
along with the testing team guidelines in Quality center.
Participated in Joint Requirement Planning (JRP) sessions with Stakeholders, Subject Matter Experts (SMEs),
and Joint Application Development (JAD) sessions with IT group.
Schedule periodic review sessions with department team members to assess progress and propose tactics in
development.
Documented, reviewed, and verified testing procedures for compliance to Interface Quality Assurance and
Developed standards and policies.
Environment: MS Office, Quality Center, SQL Server, Facets 4.21, MS Project, Server, MS Visio, Unix, J2ee, Java,
XML, Mainframes and Rational ClearQuest, Rational Requisite Pro, ClearCase, Windows XP, QTP
UNITED HEALTH CARE, NJ
Jan 2009 Feb 2011
Role: Business Analyst
Description: United Health Care is a leading health care provider in the United States. The project is about creating a web
portal to which the customers of United Health Care customers login to check their health coverage, claims, benefits,
information of hospitals, doctors etc.
Responsibilities:
Conducted and Managed JAD sessions with SMEs and Business departments, for planning and Requirements
Gathering.
Responsible for Requirement gathering and writing use cases on the extended application which supports
FACETS.
Performed Use-Case analysis using UML to capture the dynamic aspect of the application.
Mentored several of the team members on best practices of HIPAA documentation requirements when Process
Flow diagrams and Uses Cases.
Conducted GAP analysis and assessed the status of the organization to determine the scope of the application.

Understood and articulated business requirements by having sessions with SMEs, understanding the AS IS
system and conducted GAP analysis.
Interacted with stakeholders and gathered requirements as per the business needs
Conducted Claims and HIPAA Compliance Training to run the test cases
Experience in managing Daily Standup meetings and enforced quality standards as related to build-release
schedule.
Communicated with Business Partners on status of issues, action plans, and timeframe for resolution throughout
development cycle.
Involved in developing Test plan and Test cases based on Use cases and Functional Specifications
Helped review and edit test scripts, certify test results and fulfilled business requirements.
Worked on the Flowchart and process diagram using Microsoft Visio.
Created test cases for FRD to perform Integration tests and verify the integrity of the accounts built on FRD.
Assisted the technical team in understanding and developing the appropriate functionality of system.
Identify business issues and define the required solution to ensure delivery.
Involved in preparing Data flow diagrams for the decision logic using Visio tool.
Reviewed detailed test cases with in-depth description of each test scenario of the system according to HIPAA
guidelines.
Played a key role in planning, testing, and implementing system enhancements and conversions.
Environment: RequisitePro, Test Director, UML, Microsoft Office (Project, Publisher, Excel, Word, PowerPoint and
Visio),Rational Requisite Pro, Rational Clear Case, Rational Clear Quest, MS Office Suite, MS Project.
Allergan, Irvine, CA
Nov 2007 Dec 2008
Role: Business Analyst
Description: Allergan, Inc. is a multi-specialty health care company focused on discovering, developing and
commercializing innovative pharmaceuticals, biologics and medical devices that enable people to live life to its greatest
potential.
The project dealt with Clinical Data Entry (CDE) application. The CDE subsystem provides a front-end interface and for
entering data directly into the Clinical Trial System repository. The tool interprets the trail metadata and dynamically
builds data entry screens into which clinical data is entered.
Responsibilities:
Acted as a liaison between business staff and technical staff to articulate needs, issues and concerns as per GxP
and IRB department requirements
Conducted user interviews, gathered requirements, and analyzed the requirements using Rational Rose &
Requisite Pro RUP in Clinical Phases I, II, III
Worked with the client architecture team in defining tools, processes and technologies to be leveraged on the data
warehouse
Maintained a good working relationship with departments such as, Research, Clinical Trial, and Regulatory
departments and often communicated with them and provided technical support throughout the product development
Identified and documented issues, risks, gaps and their impact to the project life cycle. Provided recommendations
and alternatives.
Monitored the project cost control and identified and advised on scheduling shortfalls.
Reported progress against Development/Action Plan routinely to the Program Manager with recommendations for
corrective actions, where necessary.
Facilitated collection of User Requirements and Business Requirements to create the Business Requirement
Documentation, using MS Word and MS Visio that provided appropriate scope of work for technical team to develop
prototype and overall system.
Maintained and submitted periodic/monthly status reports to the Program Manager to serve as the teams
assessment of the project and its schedule

Conducted Joint Requirement Planning (JRP) sessions with Stakeholders, Subject Matter Experts (SMEs), and
Joint Application Development (JAD) sessions with IT group. Identified the key changes, and participated in
Stakeholder Management to communicate effectively with them.
Environment: MS Office, MS Project, MS Visio, SQL, Oracle, Test Director, Rational Unified Process (RUP), Rational
Suite (RequisitePro, ClearQuest,ClearPro),Business Objects, Windows XP.
Laxmi Bank, Kathmandu, Nepal (Remote)
Oct 2006 Sep 2007
Role: Business Analyst
Description: Laxmi Bank is a major banking company providing retail and corporate banking services. The requirement
was to develop a system for the credit cards division to monitor credit card business. Three-tier web based architecture
was developed considering the increasing business volume of the credit card division and user-friendliness.
Responsibilities:
Analyzed clients systems and business processes.
Addressed all aspects of credit card business
Established a Business Analysis methodology around the Rational Unified Process.
Streamlined clerical work processes and mapped then into the new system.
Developed project plans and managed project scope.
Assisted in building a Business Analysis Process Model using Rational Rose and Visio.
Performed extensive Requirement analysis and developed use cases and workflows.
Developed requirement reports for day to day servicing needs using Rational SODA.
Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, and OOD
Played a key role in the planning, User Accepted testing, and Implementation of system enhancements and
conversions.
Provided key input in working with users in defining project and system requirements.
Environment: MS-Project, MS-Visio, UML, Windows 2000, SQL, HTML Editor, MS Office Suite, Waterfall SDLC, MS
Access , Visio, Microsoft Office, Rational Rose, Web Sphere, Oracle, SQL Server , Microsoft Outlook.
Educational Qualification:
Master of Business Administration, Finance, Mississippi College, USA.
Diploma in Information Technology, National Institute of Information Technology, Nepal.

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