SUMMARY:

• 9+ years of experience in Business Analysis, Quality Assurance, Software Development Life Cycle (SDLC), Rational Unified Process (RUP) and managing complex cross functional projects using Water fall and Agile Methodology - SCRUM.
• Effective in Facilitating Joint Application Development (JAD) sessions to gather, synthesize and prioritize requirements using interviews, document analysis, requirements workshop.
• Working experience with SAS reporting tool.
• Expertise in detailed documentation of business and system requirements.
• Experienced in security application to assign user Roles in Active Directory.
• Expertise in writing test cases and using Quality Center for test case execution and defect management.
• Team player, result-oriented, fast learner with excellent communication skills. Excellent problem solving, conflict resolution, analytical and presentation skills.
• Firm grasp on Microsoft Office Word and Excel features
• Familiarity with databases such as Oracle and SQL Server with basic querying skills.
• Earned in-depth knowledge on Implementation of Business Systems for major HealthCare, Banking and Financial clients.
• Strong experience with health insurance administration systems including actuarial, policy application, eligibility, enrollment, underwriting, claims, billing, and payments.
• Knowledge of HIPAA EDI transactions, ICD 9 and ICD 10 codes, MMIS and Medicare/Medicaid Claims processes.
• Strong experience of working with Medicare and Medicaid insurance data, Medicare parts A, B, C & D, and Insurance Claims.
• Experienced in Determining objectives, scope, policies expected to be accomplished from a security program.
• Developed and published of policies, standards, procedures, and guidelines documents.
• Excellent Business writing skills in documenting Business Requirements Document (BRD), Functional Requirement Document (FRD), Technical Specification Document (TSD's) and Use Case Specifications.
• Experienced working with SaaS enterprise solutions and large clients.
• Established questionnaires and resource leveling required for implementing HIPAA 5010 and upgrading ICD-9 diagnosis codes to ICD-10 codes.
• Fostered and maintained positive working relationships with various international and cross-functional teams.
• Strong understanding of Agile software development and the ability to work on cross-functional teams
• Experience with software testing best practices including automated testing and DevOps

TECHNICAL SKILLS:

Methodologies/LANGUAGES : SDLC, RUP, Waterfall, AGILE, UML

Regulatory Compliances: HIPPA, EDI X12, HL7, SOX, Sec 326 USA Patriot Act.

Analysis Tools : Rational RequisitePro, Rational Rose, Rational Clear case, Rational Software Architect, HP Quality Center, Unified Modeling Language

Administrative tools: Kintana - HP Project and Portfolio Management

Business/Data Modeling Tools: MS Visio, MS Project, MS Excel, MS Word, MS PowerPoint, MS SharePoint Rational Rose, Rational Req Pro Reporting Tools, Rational SODA

DATABASE: Business Objects, SQL Server, Outside View, Relational Database Management Systems

Healthcare: HIPPA, EDI, Medicaid

Defect Tracking Tools: HP Quality Center, Microsoft TFS, Rational Clear Quest, Mercury Test Director, QTP.

PROFESSIONAL EXPERIENCE:

Sr. Business Test Analyst

Confidential, Texas

Responsibilities:

• Module Lead for web portal projects around services for Long Term Care members.
• Managed Modification and Maintenance Service Requests through the stages of Initial Review, Analysis, Design, Build, Product Test, User Acceptance Testing and Deployment.
• Established project plan and timelines and did resource allocation in Kintana- HP PPM.
• Managed Project plan throughout the project life cycle from inception to successful completion.
• Conducted sessions to define project scope and identify business and system requirements.
• Responsible for writing Charter/Business User Requirements (BUR), Functional Design and Test Plan documents.
• Experienced in writing requirements to create reports using crystal reports, SAS tool, Business Objects, SSRS.
• Experienced in working with security teams in documenting security standards and documenting security processes from initial phase to implementation.
• Acted as liaison between the business users and technical teams.
• Analyzed requirements for conversion into testing scenarios and test cases.
• Performed Product Testing and User Acceptance Testing and logged the results in Quality Center.
• Experienced with application security testing, data validation, data mapping and reports testing using tools such as Microsoft SQL, Informatica, XML, BOXI and Visio.
• Created and assigned defects to developers; retested fixed defects and logged resolutions in Quality Center.
• Experience in Business and Data Analysis, Data Profiling and Metadata Management Services.
• Responsible for traceability between requirements and test cases for quality assurance.
• Responsible for version control of project artifacts using Microsoft SharePoint.
• Used front end tool Phoenix to interact with the Compass21 claims processing system.
• Used Business Objects to retrieve claims, provider and client related data from the V21 Data warehouse.
• Used TexMedConnect system for submission of claims in the product test environment.

Sr. Business/ Testing Analyst

Confidential, Austin, TX

Responsibilities:

• Conducted next generation product design and definition, including creation of Product Requirement Documents, user stories and Sprint and Release planning
• Gathered requirements for mobile application development specifically for apple products.
• Facilitating with business in merging multiple applications into Sales Force tracker application.
• Gathered requirements for Marketing Managers in a division with annual revenues over $1 billion; analyzed current market share by product category and geography which impacted sales growth and new product development
• Conducted continuous improvement efforts in building mobile applications to refine user experience and implemented efficient ways to build the user friendly application
• Supported senior executives by monitoring monthly financial performance, and evaluating the financial status of projects within the U.S. Sales Division
• Presented key findings to senior executives via impactful visuals in order to provide meaningful insights, develop opportunities and identify risks

Sr. Business Analyst

Confidential, Tampa, FL

Responsibilities:

• Modified the existing requirements to in corporate both ICD 9 and ICD10 diagnosis and procedure codes.
• Modified the Claims Adjudication Process to process the claims with pre-existing conditions using ICD-10 codes.
• Prepared "FSD" functional specification document for 5010 from 4010A.
• Expertise in ICD-9 to ICD-10 Conversion and creating a crosswalk between ICD-9 to ICD-10.
• Involved in the Suppression of EOB’s and generation of Letters for ICD-10 Non-Compliant Claims.
• Modified the Claims Adjudication Process to process the claims with pre-existing conditions using ICD-10 codes.
• Proficient Experience in Testing ASC X12 EDI for HIPAA and electronic healthcare transactions such as 274, 278, 820, 834, 835, and 837 for Version 5010.
• Modified the existing Claim Process to make sure that for HIX Member’s Co-payment per visit should not be more than allowed amount, keep track of co-pays and deductible when members switch between plans for HIX Members.
• Established questionnaires and resource leveling required for implementing HIPAA 5010 and upgrading ICD-9 diagnosis codes to ICD-10 codes.
• Experience in training the whole team to apply the Agile principles to the delivery cycle with a goal of continuous improvement
• Managing the incidents which are of critical or high priority, tracking and taking necessary actions as required.

BUSINESS Analyst

Confidential

Responsibilities:

• Experience of doing documentation on business requirements.
• Assisted Q.A. team members to develop test cases, browser requirements and functional requirements.
• Earned comprehensive knowledge of LEAN/Six Sigma in an IT Service Management- ITIL V3 Certified.
• Translated Business requirements to functional and technical language with the help of Use cases and UML diagrams for developers
• Compiled and analyzed Fortune 500 and 100 prospective customers to create Whitespace Opportunity Model.
• Conducted trend analysis on monthly incidents reported and identified the root cause of those incidents to reduce issues reported by 60%
• Collaborated with operations team to provide financial models, support, and insight in creating the strategic and financial plans
• Conducted financial reviews of the company’s monthly performance for the senior management team, CFO, and others as needed