SUMMARY:

• A Masters Graduate in Information Technology, Certified Scrum Master and a System Analyst with 7 years of experience in Business Analysis, Business Processes, Process re - engineering focusing on the analysis and design of workflows and processes within an organization, and Process Developer with strong business domain knowledge in Healthcare, Claims Adjudication , Pharmacy and Management.
• Good working knowledge about HIPAA compliance .
• Good experience of Health Insurance Plans (Medicare Part A, B, C and D), managed care concepts (Medicaid and Medicare) and experienced in determining the membership eligibility, billing experience within life and disability in health plans with thorough understanding of CMS-1500, UB-04 claim forms and reimbursement forms.
• Hands on experience of creating Business Requirement Documents (BRD) , Functional Design Specification, Business Processes, Use Stories, User Manuals & SWOT analysis
• Tested the changes for the front-end screens in FACETS modules, FACETS batches (membership, Billing, Provider, etc.).
• Experience in working with Electronic Medical Records (EMR) and Electronic Health Records (EHR).
• Responsible for expediting the claim processing
• Experience with claims processing , membership, Billing, Finance, eligibility verification care management .
• Experience in EDI and HIPAA Testing Privacy with multiple transactions exposure such as 837 for submitting claims, RA 835 for payments, 834 for benefit enrollment, 270 & 271 for healthcare benefits and eligibility, 276 & 277 for claims status and response.
• Conducted requirement gathering sessions(JAD) , feasibility studies and impact analysis and organizing the Technical requirements in a structured way to track development.
• Extensive knowledge & experience using SAP for business operation and material management, inventory management & customer relation.
• Extensive knowledge of six sigma.
• Extensive success in translating business requirements and user expectations into detailed specifications employing Unified Modeling Language (UML).
• Experience with handling functional testing teams and documenting Test Plans, Test Scenario and Test Cases.
• Strong understanding of Functional, Integration, System, and Regression testing.
• Validating and checking requirements in conjunction with the stakeholders.
• Strong analytical, excellent interpersonal and communications skills, quick- learner, detail-oriented, committed, technically competent and result-oriented with ability to meet deadlines.

TECHNICAL SKILLS:

Project Methodologies: Waterfall, Agile/ Scrum

Business Modelling Tools: Rational Rose, MS Visio, MS Project

Requirement Management: Rational RequisitePro, Quality Center, IBM rational Suite, Blueprint

Tools: Requirements center

Defect Tracking Tools: Rational ClearQuest, Quality Center, Test Director, JIRA

Operating System: Windows 7, NT/XP 2000

Databases Oracle: DB2, MS SQL Server

Scripting Languages: Unix/Linux, Bash Shell Scripting

Business Applications: Microsoft Office Suite, File Management, Custom Indexing Application, VLOOKUP PowerPoint 2010, SharePoint 2010

Healthcare Applications: Facets, Web-SDL, Affinity, RCMS, Allwin, PARS, NPS, Premium Billing/ASO Billing, Membership Enrollment, Claims Processing, Data mapping, Concepts of Data warehousingOther Applications: SharePoint, MS Office.

PROFESSIONAL EXPERIENCE:

Confidential

Business System Analyst

RESPONSIBILITIES:

• Gathered stakeholder and business requirements through open-ended discussions.
• Brainstorming sessions, structured walkthroughs, and prototyping.
• Facilitated JAD sessions with management, development team, users and other stakeholders to refine functional requirements.
• Documented the user requirements, analyzed and prioritized them and converted them as system requirements.
• Created and prioritized user stories, sorted user stories into releases and set schedules for the iterations.
• Worked on workflow of the project concentrating on current and future workflow descriptions and created Use Case Diagrams using MS Visio.
• Organized daily scrum meetings to aid and track product development.
• Involved in performing Gap Analysis in the upgrade of the existing claims processing system and highlighting related issues.
• Coordinated with multiple teams and integration architects in performing Root Cause Analysis for issues regarding speed and stability.
• Performed business and system level analysis, and provided System Use Cases and Functional Requirement Documents for deliverables
• Responsible for conducting analysis and need assessments to find the present manual records and transformed them to Electronic Health Records.
• Performed business and system level analysis, and provided System Use Cases and Functional Requirement Documents for deliverables
• Developed strategies with Quality Assurance group to implement Test Cases in Test Manager for User Acceptance Testing.
• Thoroughly reviewing the Requirement documents with the Product BA, Technical Team and Providing feedback for Testability to make testing easier for the Team
• Involved in performing the SIT (System Integration Testing) and UAT (User Acceptance Testing) of new system.

Confidential

Process Developer and system Engineer

RESPONSIBILITIES:

• Worked with Danville IL GENPACT for a month on an OJT for and the Client is Confidential .
• Worked towards SLA, with Client Satisfaction
• Facilitate monthly and or weekly meetings with insurance provider representatives to insure escalated issues are handled and resolved in a timely manner
• Successfully engaged in multiple large initiatives simultaneously.
• Analyzed system performance and initiated process improvement measures for mainframe and Web-based applications
• Designed and developed project document templates based on SDLC methodology.
• Planned and documented procedures for data processing and prepared data flow diagrams for the application.
• Involved in performing Gap Analysis in the upgrade of the existing claims processing system and highlighting related issues.
• Worked on workflow of the project concentrating on current and future workflow descriptions and created Use Case Diagrams using MS Visio.
• Prepared custom reports and performed SQL query, data analysis and verification on MS
• Access.
• Designed and implemented basic SQL queries for QA testing and report / data validation.
• Responsible for requirements gathering , analysis, detailed process flow design , user acceptance testing, and rollout of new & modified feature functionality deployed on the mobile and web applications.
• Interacted with line of business managers and coordinated the transition into the security database to ensure business compliance with HIPAA .
• Have trained the team in the process and these trainees are certified in a Sprint.
• Expert in Training Inexperienced Staff and upgrading their Skills as per the Business Requirement. Proven ability to drive the Team towards targets and execute them successfully.

Confidential

Revenue cycle analyst and SME

RESPONSIBILITIES:

• Prepared BRD, worked with Waterfall Methodology,
• Good understanding with AGILE,
• SDLC, STLC, SRS
• Ability to Drive Change and Decisions with excellent reasoning judgment
• Providing documentations to training staff to train stakeholders on the RCM modules transactions and the reconciliation process.
• Participate in production monitoring including monitoring of daily loads of transactional data to the data warehouse and other scheduled master data loads.
• Coordinated and worked hand in hand with the designers, engineers and architects to solve any problems during design, development or implementation of data warehouse projects.
• Used MS Access, MS Excel (Pivot tables), and SQL for data analysis and data validation.
• Worked in Facets online modules such as Billing, Provider, Claims and Membership modules.
• Gather requirements by conducting meetings and brainstorming sessions with end users and SME and document them using RequisitePro - the documentation tool offered by Rational.
• Completed a BRD and SRD to further identify project requirements.
• Understand the As Is system and develop the To Be system concept also prepare the System Process Maps.
• Wrote Test Cases and performed User Acceptance Testing, documented the in-detail defects using the Defect Tracking report.
• Hands-on experience with JIRA software
• Worked under HIPAA Guidelines
• Preparing Test Plan, Use Case and Test Case