SUMMARY:

• Proficiency in Business Process Engineering and Software Development Life Cycle including analysis, design, testing and implementation of software applications in Healthcare.
• Expertise in S.D.L.C methodologies which includes significant experience in Waterfall, Hybrid and Agile methodology.
• Liaison aligning technology solutions with business missions, strategies and goals.
• Exceptional communication and presentation skills with experience in the development, implementation, integration and utilizing quantitative and qualitative analytical skills.
• Highly proficient in working with diverse users and stakeholders to elicit, analyze, communicate and gather requirements using techniques such as Brainstorming sessions, workshops like JAD, observations and existing systems documentation /procedures.
• Proficiency in gathering SMART (Specific, Measurable, Attainable, Realistic, Timely) Functional, Non - Functional, Business and System Requirement s and transforming them into functional/Non-functional specifications.
• Create Business Requirement Document (BRD), Functional Requirement Document (FRD), Requirement Traceability Matrix (RTM), Scope Statement and other project related documents using Microsoft Excel (2017), Microsoft Word (2016), Google docs.
• Conduct walkthrough of deliverables, component validation, solution evaluate, requirement & solution approval and critical requirement prioritization for upcoming releases.
• Experience in performing GAP Analysis, SWOT Analysis, Impact Analysis on various projects as per the requirements.
• Working experience as Software Quality Assurance. Expertise in writing Requirement Traceability Matrix, identifying different Testing Techniques, identifying and tracking defects and conducted Manual testing.
• Strong communication skills, including verbal and written ability to translate complex clinical concepts to clients and non-clinical staff.
• Proficient in developing use cases, process workflows, activity & sequence diagrams using tools like MS VISIO.
• Developed and maintained Test plans, Test Script, Log Sheets, reviewed and documented defects using HP Quality Centre.
• Understanding of Data validation and warehouse concept.
• Knowledge in the ETL (Extract, Transform and Load) of data into a data ware house/date mart and assisted mapping
• Extensive knowledge in Claim Adjudication and healthcare reforms like the Patient Protection and Affordable Care Act (PPACA) and COBRA.
• Validated 837 (Healthcare Claims), 835 (Healthcare Claims payment / Remittance), 270/271 (Eligibility request/Response).
• Comprehensive knowledge in Conversion of HIPAA X12 4010 codes to X12 5010 codes and ICD 9 codes to ICD 10 codes.
• Performed a baseline assessment and related interfaces, existing service level agreements, policies, and operational business procedures for readiness to comply with ICD-10 requirements.
• Knowledgeable in area of the various types of health insurance programs such as: Medicaid, Medicare (Part A, B, C and D), PPO (Preferred provider organization), HMO (Health maintenance organization), and POS (Point of Service).

TECHNICAL SKILLS:

Methodologies: Waterfall, Agile - Scrum, Scrum Waterfall Hybrid

Project Management: Rally, JIRA, Confluence, HP ALM

Languages: HTML, SQL, XML, JSON

Database/ETL: TOAD, Oracle DB, MS Access, Informatica, SQL Server

Data Warehousing: Data Modelling, Data Marts, OLTP, OLAP

Business Modelling Tools: MS Visio, Balsamiq, Lucid Chart, Mockup Screens

Reporting/BI: Tableau, IBM Cognos, Microsoft Power BI

Defect Tracking/Testing Tools: HP QC, JIRA, HPALM, Test Manager, Bugzilla

Operating Systems: Windows, Mac OS

Miscellaneous: MS Excel, MS Word, GoToMeeting, Google+

PROFESSIONAL EXPERIENCE:

Confidential, Minneapolis, MN

Sr. Business System Analyst

Responsibilities:

• Analyzed the Business case for the project to understand the customer needs. Involved in business process reengineering (BPR) by conducting Process modelling, SWOT analysis, Document analysis, and GAP analysis to analyze As-Is business process and the To-Be system and assisted in fixing the scope of the project.
• Created Business Requirement document (BRD) to in corporate high-level business requirements, and Software Requirements Specification (SRS) for functional, non-functional, Data, and GUI requirements.
• Responsible for identifying data sources from internal systems, external systems, silos on legacy systems.
• Created Mock-Ups and Wireframes of User Interface components for client verification using Balsamiq.
• Developed Use Cases, Activity Diagrams and Sequence Diagrams and other UML diagrams for a clear understanding of the project vision by using MS VISIO and Lucid charts.
• Experience with Scrum and different scrum meetings like backlog refinement, sprint planning meeting, daily stand up meeting, retrospective meetings.
• Exposure in assisting Scrum master for the Backlog grooming meeting and have created user stories, acceptance criteria and high level artifacts.
• Provided clinical daily/weekly reports, metrics, and recommendations, as needed, to all Business stakeholders and management teams using MS Excel.
• Have conducted various face to face conference meetings and have successfully been a liaison between the IT and the departments.
• Assist with planning and implementing quality assurance needs, acknowledged and discussed with clients the potential errors with claim processing.
• Fostered a team approach working with clients and built fantastic professional relationship with both clients and staff.
• Have knowledge on inventory management and database related facility.
• Felicitated as an excellent communicator to the clients and have proved to be a successful team player.
• Prepared Business process models; used Visio to create process flow diagrams for mapping the logical aspects.
• Prepared Requirement Traceability Matrix and interacted with QA team to ensure quality of software.
• Captured and defined the vision and scope of the project with the SME and the implementation team and documented them as the scope document, the Functional Requirement document and Business Specification Requirement Document by using MS Word.
• Conducted thorough analysis of the Business Requirements and created design specification to accomplish and achieve business needs related to Healthcare EDI X12 transactions such as 835 and 837.
• Experienced with Informatica, Power center for ETL in order to map the code sets according to the implementation, the companion guides and reported the claims statues using Tableau and Splunk Enterprise.
• Assisted Data Analyst in all stages of development processes including extraction, transformation and loading(ETL) data from various sources like IBM web sphere application server, Sterling file gateway, Sybase facets performance analytics.
• Performed User Acceptance Testing (UAT) with business users and stakeholders, gathered requirements through interviews, workshops, and existing system documentation.
• Assisted in analyzing, gathering the machine generated data for insights into operational intelligence.
• Involved with the Subject Matter Experts and assisted in the mapping process of the ICD9-ICD10 code sets through Informatica and Facets.
• Assisted writing SQL queries, to manage and extract information from a database by using MySQL.
• Provided insights into issues in the automated claim review process and assisted in the easy correlation and real-time monitoring of events across all layers and components of the claim processing chain through data analytics

Environment: Agile (scrum), MS Excel (2016), MS Word (2016), MS Visio (2016), Lucid Chart, Balsamiq, MS Project (2016), HPQC, JIRA v6.4, Tableau v9.0, Splunk Enterprise Software, MySQL (2014), Oracle, Informatica, XML, REST API, SOAP API

Confidential, Virginia Beach, VA

Sr. Business System Analyst

Responsibilities:

• Assisted Project Manager in drafting the Project plan; defining scope, establishing work breakdown structure, defining critical path analysis and project milestones using Microsoft Project.
• Involved in GAP and Feasibility analysis for the design and architecture of the new application.
• Involved in Requirement Scoping and analyzing high priority requirement for implementation; Created BRD, functional Requirement documentation(FRD), System Requirement Specification document (SRS) and use case documents using MS Word.
• Involved in creating UML diagrams like activity, sequence and class diagram using MS VISIO.
• Created Mock-Up Screens and Wireframes using UI compenents and used Balsamiq and MS VISIO.
• Interacted with the business users in understanding the current application and process.
• Prepared generic reports over the periods using MS Word and MS Excel.
• Executed research on the various incoming requrements AS-IN-WHEN and suggested with necessary changes.
• Acted as a successful liason between the IT and management and the development team.
• Facilitated communication from and among the clinical end users across the patient care departments while working collaboratively and directly with the vendors and IT Department members.
• Used my previous knowledge of SOA to decide the orchestration of various internal and external Web service using REST and SOAP API and the web methods to save the cost and time of the project.
• Worked with Cross Functional Teams and interacted with all levels of management for requirements, resources, and project status and delivering custom applications in phases.
• Involved in HIPPA assessment and HIPAA X12 EDI transaction (835, 837,270/271) mapping and identified changes that needed to be done to comply with HIPAA regulations.
• Worked with HIPPA compliant ANSI X12 837 formats for all the types of claims.
• Was responsible for testing the HIPAA Transactions and Code Sets 837 transactions.
• Executed SQL queries to test the database for records that detect and submit functional acknowledgement and remittance advice in the claims application.
• Prepared test cases, test script and coordinated with the QA team for testing and Interacted with the developers to report and track bugs using Test Manager.
• Documented and analyzed defects reporting and tracked using HP Quality Center and updated the status to QA Lead for functionality testing.
• Involved in GUI Design sessions with Usability Team; Browser compatibility and navigation were tested manually.
• Developed and managed Test Plan, Test Cases, Traceability Matrix and executed them in the test lab using Quality Center(QC).
• Tested the final application for usability testing to verify whether all user requirements were catered to, by the application.
• Managed the Change Request and analyzed the Impact of the Change request on the application in regards to Project Plan, Scope, and Schedule.

Environment: MS Access, MS Excel, MS Word, MS Visio, Lucid Chart, Test Manager, MS Project, Rational requisite Pro, HTML, XML, Oracle, Tableau, JIRA, HPQC, MySQL

Confidential, Tallahassee, Florida

Business Analyst

Responsibilities:

• Knowledge of EDI and HIPAA Transactions 837/835, 834, 276/277, 270/271.
• Conducted gap analysis in changing old MMIS and involved in testing new MMIS. Also, accountable for Medicaid Claims Resolution/Reimbursement for each state health plan using MMIS.
• Conducted Impact analysis of the current functionality with the to-be business processes to provide recommendations and finalize business requirements. Modified System flow diagrams using MS Visio.
• Working with Business users to create UML, Use cases and activity diagram using Balsimiq and MS Visio.
• Facilitated Joint Application Development (JAD) sessions to focus on defining the Health Claims Processing process.
• Conducted user interviews, gathered requirements, analyzed them and used JIRA and Tableau to display and manage requirements for the whole team.
• Worked as primary liaison between business partners and clients.
• Developed clinical records of the department and provided documentation of proposed workflow for conversion of ICD9 - ICD10 by using MS Excel.
• Facilitated and assisted client meetings and discussed potential risks and liabilities.
• Collaborating with other SME’s to scope the proposed project, make time and quantify business benefits and preparing the business case using MS Word.
• Assisted in developing the systems implementation documents, project management plan with milestones and steps till implementation and maintenance phase in the SDLC.
• Designed and reviewed various documents including the Business requirements document (BRD), Use Case Specifications, Functional Specifications (FSD), Requirement Traceability Matrix (RTM). Translated business requirements and assisted IT with the development of technical specifications.
• Implemented new agile processes planned and coordinated sprints with project management in a Waterfall/ hybrid environment.
• Validating Technical data mapping of ICD 9 to ICD 10 conversions for Clinical modification and Procedure codes.
• Created Test Plans, Test cases and assisted in running them manually by using HPQC.
• Performed User Acceptance Test (UAT) for 5010 and ICD 10 codes. Assisting leading through UAT procedure and also conducted training sessions for the end users along with the necessary documentation.
• Documented and analyzed defects using Quality Center and tracked them to completion by communicating with the team.
• Data cleansing, data migration, and data mapping were used to and validation of database structure in the OLAP.
• Created issue logs, work request template, change request template and problem request template for the users.
• Analyzed data and investigated service related issues to identify root cause of problem(s).

Environment: SDLC- Agile/Scrum, UML, XML, MS Word, MS Excel, JIRA, TOAD, MS Access, MS Project, SQL Server 2008, HPQC, Balsamiq, MS VISIO.

Confidential, Bellingham, WA

Business Analyst

Responsibilities:

• Responsible for ensuring that privacy and security environments of healthcare data remained intact.
• Work with the business to analyze business process and system issues and turn them into actionable system changes that benefits the business.
• Effectively conducted JAD sessions and Business Requirement review sessions with teams to complete project documentation and work with the business to gain approval/sign-off.
• Documented functional requirements, system design specification use cases, workflow diagram, screen and interface designs.
• Documented business requirements, and communicated these requirements to the development team for the design and implementation of business solutions.
• Communicated Business process, business solutions and updated status to IT managers and upper Business during Status meeting.
• Created data mapping to increase efficiency of data usage for transactional and analytical processes.
• Assisted in writing Test Cases, Test plans using MS Word.

Environment: Agile (Scrum), SharePoint 2010, SQL Server 2008, MS VISIO, Business Objects, MS Excel

Confidential

Jr. Pharmacovigilance Analyst

Responsibilities:

• Gathered ADRF forms, coordinated and assisted the In-House Translation team to convert them into the language our company used for MQC.
• Performed quality check of source documents/literature abstracts/articles in non-English language (language of expertise of linguist) to English for ICSRs, as applicable and filled forms as requested/ instructed by the client.
• Ensured consistency in translation terminology, in particular for frequently translated medical terms, throughout the team.
• Performed quality checking of aggregate reports or sections of aggregate reports from English to target language (language of expertise of linguist), as applicable
• Proof-reading, quality checking and editing the translated documents to ensure high quality of translation
• Experienced in MedDRA coding in accordance with “MedDRA Term Selection: Points to Consider”.

Environment: MS Word, MS Excel, My Memory, Linguee, MS Project, MedDRA application center

Confidential

Resident Dentist

Responsibilities:

• Root canals treatment followed by crown preparations
• Aesthetic restorations and treatment
• Surgical & non-surgical procedures
• Assisting surgical procedures
• Outpatient and Inpatient clinical experience
• Administrative duties like collecting, analyzing and compiling patient data, handling office work, accounts for the Dental Department
• Accounting and handling finances in the department
• Patient safety and protocol
• Knowledge on Inventory management clinic level.

Environment: MS Word, MS Excel