SUMMARY:

• Qualified professional with 7 years of extensive experience in the field of Business Analysis, working with the technical staff to implement management and staff's business requirements into the software application in Healthcare Industry.
• Extensive experience in the development, implementation, deployment and integration strategies within a team oriented environment, utilizing quantitative and qualitative analytical skills
• Possesses experience in Implementation of Systems/Applications and Database design in a variety of environments with expertise in Client/Server Architecture.
• Experienced in writing IEG scripts using the IEG2 editor, curam data mapping, work queue provisioning within Curam 6.0 framework.
• Security implementation to curam applications to prevent cross site scripting and sql injection hacks.
• Worked on SDLC Methodologies - Waterfall, Iterative Development for the study link project based on Curam framework.
• Experiences in using modeling tools Rational Software Modeler (RSM) and IBM Rational Modeler in various Curam projects.
• Extremely proficient in Manual testing and have knowledge on automated test tool (Quick Test Pro) and database testing tools to troubleshoot systems, integration, user acceptance, positive and negative, functional and non-functional and regression in the specific field database.
• Analyzing and documenting the data flow from source to target system as the files and data coming from different systems and we send files to different systems and on different networks such as IDS and Curam databases.
• Deep knowledge and expertise on the CBAS (Curam Based Application Suite) working with clients and other system integration partners on requirements definition/elaboration, functional design, fit/gap, CBAS configuration, and testing.
• Experience in building Business Process Models and flow, process mapping for systems and processes, Context Diagrams, Sequence Diagram, Activity Diagrams, Class Diagrams using Rational tools and Microsoft Visio for elaborating business requirements.
• Met with the Business and MMIS to ensure that all transactions pass the Curam and mapped to MMIS.
• Several years of experience in creating data flow process, process mapping for processes and systems, system specifications and system documentation for the health data systems that integrate with the hub.
• Experience in Curam implementation especially in Medicaid/MA/Obama Care/Affordable Care Act and Medicare Part A through D projects.
• Practical knowledge of various SDLC methodologies such as RUP, Waterfall and Agile with hands on experience especially in Agile.
• Good understanding of the core Curam functionality and all the associated business processes of human services such as Medical Assistance (both traditional and MAGI Medicaid), Minnesota Care (MCRE), APTC (Applied Premium Tax Credits) and QHP (Qualified Health Plan) both assisted and unassisted.
• Experience in working with various business intelligence (BI) tools like spreadsheets, digital dashboards, data wearhousing, reporting and quering software. Extensively used IEG (Intelligence Evidence Gathering) in Curam environment.
• Experience in IBM Curam Framework, Document Management, Social Security, Health Care applications and Insurance domain applications.
• Extensive testing experience in all phases and stages of testing with good working knowledge of testing disciplines, tasks, resources and scheduling.
• Professional experience in writing Test Scenarios, Test Conditions, and Test Cases for Functional and non-functional requirements.
• Designed and executed test cases for the black box testing and perform boundary value analysis, decision table analysis for business rules, and state transition verification.
• Extensive experience in using Test Management tool HP Quality Center (QC) for organizing and managing all phases of application testing process, including specifying testing requirements, planning tests, executing tests and tracking defects.
• Experienced in testing Health Care applications and ability to think through the requirements to identify the ambiguities and build test cases for effective test coverage.
• Excellent knowledge in creating Test Input Data for positive and negative testing, Test matrix creation and Defect Analysis.
• Expertise in Analyzing Business Requirements, Functional and Technical Specification and documenting Test cases and Test Scripts.
• Review and analysis of Business Requirements, Development, Functional Specifications, and Detail Design of the Application.

PROFESSIONAL EXPERIENCE:

Sr. Curam Business Analyst

Confidential, Chicago,IL

Responsibilities:

• Conducted weekly meetings for deciding the Policies and Procedures to be followed while constructing new sites.
• Performed the requirement analysis, impact analysis and documented the requirements using Rational Requisite Pro.
• Work with Curam Software V 6.0 to implement eligibility system.
• Worked on bug tracking reports on daily basis using JIRA.
• Followed a systematic approach to eliciting, organizing, and documenting requirements of the system.
• Coordinating and working with IBM Curam team on Curam requirements and then verifying the test cases/scenarios for the same.
• Reviewed the Joint Requirement Documents (JRD) with the cross functional team to analyze the High Level Requirements.
• Assisted the PM in developing Use Cases and project plans and also managed changes to the scope of the project.
• Used Query Analyzer, Execution Plan to optimize SQL Queries.
• Analyzing and documenting the data flow from source to target system as the files and data coming from different systems and we send files to different systems and on different networks such as IDS and Curam databases.
• Designed the process flow diagrams for flow of information and report creation process.
• Interacted with client and the Technical Team for requirement gathering and translation of Business Requirement to Technical specifications.
• Conducted interviews, meetings and JAD sessions during the process of Requirement Gathering.
• Planned and documented procedures for data processing and prepared data flow diagrams for the application.
• Execute test plans and test cases to verify actual results against the expected results. And making sure that the functionality meets business requirements.
• Developed Data Conversion Strategy for converting data from the existing site to the new site.
• Designed and developed project document templates based on SDLC methodology
• Designed workflows and allocated permissions within SharePoint.
• Performed requirements modeling and develop analysis diagrams, activity diagrams, sequence diagrams, state diagrams, data models, and use-case realizations using RUP tools in Agile.
• Prepared test Data sets and performed data testing using the PL/SQL scripts. Also used MS excel for data mining, data cleansing, data mapping, data dictionary and data
• Involved in Testing Various EDI transactions like 835,834,270,271,276,277,278.
• Assisted JAD sessions to identify the business flows and determine whether any current or proposed systems are impacted by the EDI X12 Transaction, Code set and Identifier aspects of HIPAA.
• Utilized Mercator as an EDI mapping tool to map the claims data that passes through the EDI gateway to the Facets claims processing application.
• Worked on EDI transactions: 270, 271, 834, 835, and 837 (P.I.D) to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
• Involved in Testing Various EDI transactions like 837, 835,834,276,278.
• Performed after Action/Post Milestone Reviews and quality reviews to ensure that developed software products met the business needs and are in compliance with RUP and CMMi 3

Curam Business Analyst

Confidential, Dallas, TX

Responsibilities:

• Worked on data element mapping with Curam and Connecture team for IRS reporting project.
• Conducted FIT-GAP analysis between legacy CMIPS and Curam and designed system use cases.
• Collaborated with vendors (CURAM, CONNECTURE and PWC) in order to ensure smooth transition of requirements from State toVendors.
• Run complex SQL queries to query database and responsible for testing web services using SOAPUI for the SOA implementation.
• Met with the Business to ensure that all transactions pass the Curam.
• Used Quality Center to store, schedule the test cases and report the Defects and Identify defects in aggregate tables and report data center defect in Quality Centre and coordinate with developers to resolve them based on defect severity and priority.
• Customized Curam to resolve timesheet issues and helped counties respond to provider inquiries regarding timesheet/payroll.
• Worked on Curam Upgrade to 6.0.5.6 release from IBM.
• Knowledgeable in business process analysis (use cases and/or process flows) and (gap analysis) techniques within the CURAM Application Suite.
• Performed gap analysis of current operations with IBM Curam Health Care Reform (HCR) software.
• Development of EAMS module for ADJ, DEU, UEF, VOC using Curam framework.
• Worked on analysis of common APIs for IBM Curam Agenda Player and dynamically load agenda pages based on admin configuration.
• Review and provided comments to upper management on functional and technical designs for CURAM extensions and configurations such as workflow and/or rules.
• Worked on analysis of common APIs for IBM Curam Agenda Player and dynamically load agenda pages based on admin configuration.
• Worked with various teams on the CBAS (Curam Based Application Suite) and other system integration partners on requirements definition/elaboration, functional design, fit/gap, CBAS configuration, and testing usually UAT and other testing like smoke, sanity, performance, conversion testing and regression testing.
• Responsible for defining the scope of the Renewal project and implementing business rules for the project involving both Medicaid and Medicare.
• Lead fit/gap sessions mapping requirements to standard Curam Based Application Suite features and functions.
• Provided major information on the Curam data model and explained entities and attributes in the model and the relationships between them.
• Participating in team meetings, coordinating with the stakeholders, HCEO, MNsure, developers, Policy, PMs and QAs to analyze, and understand the business requirements and help make changes in requirements.
• Played a vital role in translating BRD into functional specifications and test plans
• Established a business Analysis methodology around the SDLC, helped to develop use cases, project plans and manage scope for Health information exchange (HIE), Member Enrolments and Managed Care Organization applications.
• Responsible for assisting in the development, planning and execution of change management activities for Maryland Health Benefits Exchange Project utilizing Curam Case Management

Business Analyst

Confidential, NY

Responsibilities:

• Gathered functional and non---functional requirements in collaboration with business users, project managers, and department managers.
• Analyzed business requirements, rules, rates and data.
• Performing gap analysis to evaluate processes that need to be implemented / improved.
• Created Use Case Templates, work flows, and System Specification Documents to describe critical and alternative paths.
• Involved in the preparation of UAT Test Plans, Test Cases and Test Scenarios for Medical Claims Systems in accordance with project deadlines.
• Performed functional testing, reported and documented errors and ensured errors were solved once they were fixed.
• Compiled and maintained Test Conditions using HP Quality Center to track progress and report issues. Also reviewed logs and reports to identify the program processing errors.
• Evaluated current workflow processes to efficiently update and in corporate appropriate CMS codes.
• Used SQL Queries and visual validation to validate data.
• Maintained and assured the accuracy and consistency of new code utilization throughout the payment system.
• Identified changes that need to be made and updated data accordingly in mainframe system.
• Modified/Added CPT codes, revenue codes, reimbursement policies, and modifiers according to CMS guidelines.
• Checked and reviewed updates to ensure data was loaded correctly.
• Converted CPT codes into GHI codes and mapped ICD9 codes to ICD10 codes and vice versa.
• Made sure that reimbursement policies were loaded correctly and according to the ICD10 standards.
• Performed functional testing to identify bugs and errors of new functions and updated layout that were implemented in order to accommodate ICD10 codes.
• Analyzed rates and payments and calculated rates in order to ensure claims were paid correctly.
• Actively participated and mediated in daily performance and progress meetings in coordination with project leads and department manager.