AAKASH PATEL @ 201-744-1438 Professional Summary: 7+ years of professional experience as a Business Analyst in Insurance and Healthcare Industry.

. Good working knowledge of Claims processing, HIPAA EDI Transactions for health care industries and worked with FDA regulation like 21CFR part 11 Experienced in conversion of ICD-9 codes to ICD-10 and implementing HIPPA 5010. Comfortable in working with different requirement gathering techniques like Brainstorming, JAD sessions, Reverse Engineering, Storyboarding, Document Analysis, Interview, Prototyping and Observation Strong experience in Developing and evaluating business RUP and SCRUM Business Modeling process and participating in all phases of SDLC including requirements gathering, requirement analysis, functional specifications, product management, data modeling, prototyping, user acceptance testing, client implementation and product support. Experienced in Software Requirement Specifications (SRS), Business requirements document (BRD), Use Case Specifications, Functional Specifications (FSD), Systems Design Specification (SDS), Requirement Traceability Matrix (RTM) and testing documents Strong Knowledge of UML, Rational Suite including Rational Clear Quest and Requisite Pro including Class Diagram, Object Diagram, State Diagram, Sequence Diagram, and Activity Diagram. Proficient in developing Use Case Diagram. Experience as Data Analyst in performing data requirements analysis in partnership with business users producing Data Requirements/Specifications document to implement technical solution addressing specific business needs. Experienced in Data Modeling concepts- Conceptual, Logical and Physical Models using Erwin. General understanding of Database Management System and Data Warehouse including their functional and technical architecture and the design of Data Flow Diagram Efficient in MS Project/MS Excel for planning/status reporting/writing test scenarios. Excellent presentation and communication skills combined with a proficiency in problem abstraction, business modeling, interpersonal, leadership skills, and ability to work in a cross functional team Expert in EPIC and EPIC Interface systems, EPIC medical record system. Professional experience in business analysis, operations management and development, design, documentation and testing. Effective in executing multiple tasks and assignments ahead of schedule. Created and maintained effective budgets.

Education and Certification: Masters in Business Administration majoring in Healthcare Business/Technical Skills: MS-Access, MS Office, SharePoint, ERWIN, QTP, Quality Center, Java, Quick Test Pro, XML, XML Schema, DTD, HTML, JavaScript, VBScript, Test Director, Mercury BAC, SQL Server, DB2, MS-Access, Rational Requisite Pro, Clear Quest, Test Track Pro., MS-Office, SharePoint, MS-Visio, Windows, SQL, TSQL Project Summary: Endurance Insurance, New York, NY April 2011 Present Sr. Business Analyst ENDURANCE SERVE CLIENTS FROM WALL STREET TO MAIN STREET PROVIDING HIGH QUALITY AND SERVICES, UNDERWRITING SPECIALTY RISK WITH A FOCUS ON PROPERTY, CASUALTY, AGRICULTURE, PROFESSIONAL LINES, AND HEALTHCARE. THE PROJECT AIMED TO REPLACE EXISTING LEGACY SYSTEM TO A WEB BASED APPLICATION DEVELOPED BY GUIDE WIRE. THE NEW APPLICATION WILL BE ONE STOP SHOP FOR CREATING NEW, CANCEL, REINSTATE, AND RENEW EXISTING POLICIES FOR THE COMMERCIAL LINE CUSTOMERS. BASED ON THE CUSTOMER INFORMATION, SYSTEM GENERATES THE QUOTE EVALUATING WITH THE RISK INVOLVED TO ISSUE A POLICY / QUOTE, IN INTEGRATION WITH VARIOUS OTHER INTERNAL AND EXTERNAL APPLICATIONS TO COMPLETE THE QUOTE PROCESS. Responsibilities: Gathered requirements for creating the rating inputs screen for the policy system. Established questionnaires and resource leveling required for implementing HIPAA 5010 and upgrading ICD-9 diagnosis codes to ICD-10 codes. Worked on Implementation of HIPAA 4010 and ICD 9, version for all EDI transactions. Conducted analysis of HIPAA compliance and took part in migration of HIPAA 4010. Worked with underwriters, actuary to determine the rating algorithms for TO BE system. Assigning Zone Code information per Sentry standards to the territory codes from ISO Net. Conducted requirements gathering using JAD and interview sessions Created Activity diagrams, Use Case Diagram and Domain Diagram for Policy Quote, Bind, Renew and Cancellation process. Documented requirements in form of user stories, UI documents and process flow diagrams in MS SharePoint. Actively Involved in Discussing with Upper management regarding change in requirements and creating weekly Report. Worked closely with business partners, SMEs and product owners to understand the process. Conducted Acceptance review with Product owners for the developed functionality. Participated in creating user manual and training users on the application software. Performed risk analysis of various features and managed risk registry for the project to avoid scope creep.

 Involved in creating test plans, test strategy and executing test cases for rating used for premium calculation and Quality Center. Participated in creating UAT test strategy, planning and UAT testing Responsible in managing and maintaining the defect tracking process. Analyzed user requirements, attended change request meeting to document changes and implemented procedures to test changes. Involved in the weekly status meeting to discuss the upcoming releases and changes in the hardware requirements and other major issues. Tools & Technologies: HTML, Toad, Oracle, Rational Suite, Agile, Scrum works, Quality Center and Share Point. Beacon Healthcare Solution, Severna Park, MD April 2010- March 2011 Business Analyst Beacon Healthcare Solutions (BHS) is the premiere-based CMS content provider in the Healthcare industry. The BHS Business rules are used to transform the raw Medicare database into useful, easy to use data sets which are then made available to our customers for additional customization or simply to research an issue. The project was on Healthcare system specifically designed to incorporate with clinical, material management and medical billing applications needs of the users. The system was also easy to integrate with most patient accounting and clinical healthcare software solutions. Supported Medicare and Medicaid through the internal software system within the company were also responsible for the successful implementation Medicaid Management Information System. Responsibilities Gathered analyzed, documented business and technical requirements from both formal and informal sessions and validate the needs of the business stakeholders. Gathered requirements and modeled the data warehouse and the underlying transactional database Conducted user interviews and documented business and functional requirements. Analyzed the existing claims process and specific business rule logic will be applied in the ACP model. Involved in creating business processes and modeling diagrams using Rational Unified Process (RUP). Involved in project management using MS Project. Worked with Claims, enrollment, eligibility verification for members and providers, benefits setup, and backend payment cycle in facets. Used Scrum Work Pro and Microsoft Office software to perform required job function. Conducted JAD sessions to resolve critical issues Designed new Business Intelligence (BI) system using Oracle Discoverer 10g to provide reporting under Oracle Applications. Involved in designing the end user webbased interface, which involved OLAP reporting system implemented in Business Objects to provide business intelligence capability to Asset Managers. Playing a lead role in identifying and documenting as-is business processes and practices. Creating user case diagrams and process diagrams based on business requirements Suggested process change and re-engineering as needed based on requirements gathered. Analyzed and documented performance/security/User Interface Branding requirements for the application.

 Created and handled sales reports, activity reports, forecasting, referral summaries and

other miscellaneous ad hoc reporting. Worked in all the different processes of Claims processing from Claim Online editing/processing/ Adjudication/Payments systems. Incorporated Rational Unified Process (RUP) to create Requirement Document Specifications using Visible Analyst. Prepared UAT Materials UAT Test Cases to include various steps involved for UAT and to have proper coverage of requirements. Reviewed test scripts and made sure that the Test scripts covered all scenarios of the requirements. Identified/documented data sources and transformation rules required populating and maintaining data warehouse content. Used Rational Clear case for version control Designed and developed Project document templates based on SDLC methodology Served as conduit for managing system requirements between the business and the software development team. Queried database using SQL for backend testing. Used Rational clear quest for defect management .Tools & Technologies: J2EE, MS Project, MS Office Suite, MS Visio, UML, SQL, FIXML and MS SQL Matria Healthcare, Atlanta, GA June 2009 March 2010 Sr. Systems Analyst Matria Healthcare Company (MHC) is an innovative leader in the health and well-being industry serving approximately 55 million Americans, these healthcare solutions make it easy to deliver Electronic Medical Records (EMR) at the point of care. The project called Teraface aimed at creating web-front end patient management system- Healthcare system implementation including enterprise Electronic Medical Records (EMR) software. Responsibilities: Worked effectively with physicians, nurses, and engineers to solve problems related to EMR, EPM, and ICS to make software more user-friendly to staff and doctors. Met with users and stakeholders to understand the problem domain, gathered customer requirements through interviews (group and one-on-one) along with JAD sessions. Performed requirements gathering process in iterative approach using RUP methodology. Formulated logical statements of business requirements researched and evaluated alternative solutions and recommend the most efficient solution for system design. Review requirements and understand technical recommendations and constraints, and develop comprehensive and accurate functional specifications; Data Mapping, and process flows. Involved in preparing flow diagrams for the decision in MS-Visio. Work with Compliance and Regulatory operations to follow and monitor different IT process bound by CMS Regulations. Prepared test Data sets using Prototyping and performed data testing using the PL/SQL scripts. Also used MS excel for data mining, data cleansing, data mapping, and data dictionary and data analysis. Used Rational Rose for creating the Use Cases Diagrams, Activity Diagrams, Class Diagrams, and Sequence Diagrams etc. Identified gaps and performed gap analysis

 Created Mapping Documents, Report Mockups and modified existing report mockups and finalized for development. Involved in Testing by using SQL and work with QA together to develop test Scenarios and test cases. Tools & Technologies: Windows XP, Business Objects, Rational Unified Process (RUP), MS Excel, Word, Visio, Java/J2EE, UML, power point, SQL, Oracle, DB2. Cigna Healthcare, Bloomfield, CT July 2008 May 2009 Business Analyst CIGNA Corporation and its subsidiaries serve millions of people worldwide. It is known as a health and related benefits company. Application was an Electronics Claims Processing (ECP) system designed to accept the electronic claims coming from the various providers (doctors and hospitals) and process them. The project was also to make the service providers acquired by CIGNA, HIPAA compliant and to integrate all of them into one system. The project also involved migration from Diamond software to Facets 4.31 including configurations, claims auto adjudication scope and definitions, financial transactions ID cards, Membership, Enrollment. EDI 835, 837I, 837P, 276/277, 278 and proprietary conversions utilizing Facets extensions and development of new scripts and extensions to meet proprietary origination formats and reformat them into HIPAA standardized formats Responsibilities: Performed SWOT and Gap analysis for the new functionality requirements for the pharmacy processing system Worked with HIPAA rules and regulations to draft business rules and claim processes. Interacted with the client and the Technical Team for requirement gathering and translation of Business Requirements to Technical specifications. Facilitated numerous JAD (Joint Application Development) sessions utilized for the creation of design documents and system specifications for applications. Identified and documented the dependencies between the business processes. Worked on MS Project to manage schedules, deadlines and resources and collaborate on the project. Involved in preparing project plans and identifying major milestones for each stage as per the SDLC model (RUP Methodology). Analyzed and optimized the process, prepared Business Requirement Document (BRD) and then converted the business requirements into Functional Requirements Specification and Technical Specification Conducted Requirement Validation through requirement reviews and use of prototyping and planned how requirements should be verified by establishing Acceptance tests. Developed business requirement specification documents as well as high-level project plan. Create and maintain Use Cases, visual models, including activity diagrams, logical Business process models, and sequence diagrams using UML. Documented Requirement Traceability Matrix in Requisite Pro for traceability of requirements.

Scheduled meetings with developers, system analyst's (SA) and testers to identify resource allocation and project completion using MS Project. Tools & Technologies: Rational Rose, Visio, MS Office, MS Visio, UML, MS Project, Visual Studio .NET, Oracle, SQL Server 2000

Northwest Community Healthcare, Arlington Heights, Chicago, IL Nov 2006-June 2008 Business Analyst NCH provides quality, compassionate healthcare services to the people of northwest community of Chicago. NCH wants to be recognized as a leader in creating 21st century hospital through the innovative use of a caring culture, clinical expertise and advanced technologies. The project was aimed to integrate the finance application and claim reimbursement systems of home facility with parent system. The system was designed to reduce the administrative overheads, resource reductions as part of their budget initiative measures, maintain accuracy on the accounts maintained for each plans and claims through unique claim editing process. Responsibilities: Gathered a business requirement through user interviews, JAD sessions and analyzed the requirements which include health and business compliance regulations. Successfully performed complex analysis and broke down to a simple requirements to be able to capture in the system Rational unified process methodology was used as part of project development. Documented Functional Requirements for business level components, user interface, and system security. Designed Use cases, verbose as part of functional document specification. Developed and evaluated Use Cases, Activity Diagrams, Sequence Diagrams and UML. Performed risk analysis for each business and health compliance outcomes. Coordinated with the Project team on MS Share point to reduce redundancy across two systems. Coordinated with radiology system vendors for contracts. (SLA and Business uses for OLA) Annual maintenance contracts and purchase orders for jobs outside of contracts. Was part of performance analysis on existing initial and concurrent based review, peer to peer review, and peer to admin review and transferred the requirement to Facets for adjudication process. Participated in the analysis, design, testing and implementation of plan items, system enhancements, bug fixes and release coordination. Performed GAP Analysis while mapping the functional requirements and in UAT. Performed Analysis on Facets requirements and part of facets development team for Gap identification and full filling the requirements to be captured for claims purposes EPIC clarity, EPIC radiant, EPIC sun quest were web portals designed for physicians and providers to updated EMR records and store it in web server. Tools & Technologies: Rational Rose Enterprise, MS shares point, EPIC, MS Office, MS Visio, RUP, UML, SQL, Oracle INTAS Pharmaceutical, Gujarat, India Business Analyst July 2004- Oct 2006

Intas is a leading, vertically integrated global pharmaceutical formulation development, manufacturing and marketing company headquartered in India. Our team was involved in gathering requirements, analyzing these requirements and transforms the data's in to Siebel for data analysis, reports generation and evaluation of existing drugs in the market for the business Users. Responsibilities: Defined the scope of the project based on the gathered business requirements including documentation of constraints, assumptions, business impacts, project risks and scope exclusions. Successfully defined functional business requirements, analyzed client requirements, and generated workflow processes. Responsible for coordinating JAD sessions with business users to analyze, gather and define the key performance indicators, document and present the requirements specifications Prepared Business Requirement Document (BRD) and then converted business requirements into Functional Requirements Specification (FRS). Analyzed to identify which system would utilize the least development time. Assisted in project management activities like planning, development, task allocation, project execution. Provided full project life cycle flowcharting, analysis and documentation. Interacted with business users and performed Gap Analysis of Client requirements. Worked extensively with MS- Visio to document requirements, create the AS-IS and TOBE process flow diagrams. Interacted extensively with offshore development team to make sure that the developed system matches the client requirements. Involved in creating UI and preparing layout for the system. Tools & Technologies: Rational Rose Enterprise, MS shares point, MS Visio, Mercury testing tool, Business objectsdata integrator, SQL server SQL server, Oracle, EPIC clarity System, EPIC sun quest.