PROFESSIONAL SUMMARY:

• 6+ years of experience in Business Analyst in various industries.
• Heavily experienced with requirement analysis, creating traceability matrix, test planning, creating test data and implementation of test suite (test plan, test scripts and test cases).
• Expertise in writing the BRD, FRD and Technical documents.
• Expertise in tracking tools such as Quality Center
• Strong Knowledge of Agile and waterfall methodology of SDLC
• Experienced working with 5010 transactions changes analysis, design and migration strategy.
• Have good knowledge of HIPPA 4010 /5010 versions.
• Profound understanding of insurance policies like HMO and PPO and proven experience with HIPPA 4010 EDI transaction codes such as 270/271(inquire/response health care benefits),276/277(Claim status), 834(Benefit enrollment), 835(Payment/remittance advice), 837(Health care claim).
• Maintained Requirement Traceability Matrix and Test summery report.
• Performed Gap Analysis.
• Strong Knowledge on MS Office suite, MS Visio, MS Project, and MS Access.
• Analyzed test results to ensure existing functionality and recommend corrective action where necessary. Participated in UAT and wrote Test Cases for UAT.
• Experience in implementing HIPAA Gateway EDI Transactions. Experience in HIPAA transactions EDI 837 (Institutional/Professional), 835(Payment Remittance Advice), 270 (Eligibility Request) / 271 (Eligibility Response), 276 (Claims Status Inquiry Request) / 277 (Claims Status Inquiry Response), 834(Benefit Enrollment and Maintenance Transaction), 278 (Prior Authorization), 997 (Transaction Acknowledgement), ICD10, CPT and NDC Codes.
• Expertise working in Healthcare industry with Insurance, Loans, Claim Processing, Medicaid and Medicare modules as well as Interface Testing and Data Conversion.
• Good working knowledge of major Operating Systems such as Windows and UNIX
• Good knowledge in Medicaid/Medicare claim processing
• Strong experience in gathering Medicaid and Medicare plan requirements from the client
• Extensive knowledge of all aspects of the Software Development Life Cycle
• Good knowledge on different modules within healthcare (Membership, billing, enrollment, Claims, providers).
• Excellent communication and writing skills with the ability to adapt to new and dynamic environments
• Good team player and can work alone with minimal or no supervision
• Experience with Medicare, Medicaid, & commercial insurances in HIPAA ANSI X12 4010, 5010 formats including 270,271, 276, 277, 835, 837, 997, NPI, ICD 9,ICD 10, for interfaces & images to clearinghouses/ trading partners applications.
• Ability to multi - task, prioritize and work with time constraints while paying attention to details

TECHNICAL SKILLS:

Testing Tools: Quick Test Professional (QTP), Load Runner, Win Runner.

Bug Reporting Tools: Test Director, Quality Center.

Databases: Oracle, MS Access, MS SQL Server

Operating Systems: UNIX, Windows

Scripting Languages: VB Script and C

Others: MS Office Suite- Word, Excel, MS Visio, MS Project, NASCO, FACETS

PROFESSIONAL EXPERIENCE:

Confidential, Boston, MA

Business System Analyst

Responsibilities:

• Gathered the requirements and created Business Requirements documents, Functional Design Documents and Technical Specification documents
• Created Test Cases and Test data after analyzing the BRD.
• Involved in Gap Analysis and came up with business requirements.
• Good Understanding of the EDI (Electronic data interchange), Implementation and Knowledge of HIPAA code sets.
• Involved in Up-gradation of HIPAA X12 4010 transactions to HIPAA X12 5010.
• Worked on HIPAA Transactions and Code Sets Standards according to the test scenarios such as 270/271, 276/277,837/834/835 transactions.
• Involved in the documentation of HIPAA 5010 changes to EDI 837, 834, 835, 276, 277 Transactions.
• Verified and tested Exchange Inbound EDI enrollment file through mainframe process where mainframe change different values for Exchange assign ID's for subscriber, member and exchange reference ID.
• Created the interface document between database and the application
• Participated in requirement walkthroughs and creation of test plan
• Checked the data flow through the frontend to backend and used SQL Queries to extract the data from the database.
• ICD 9- ICD 10 Conversion Analysis - Worked in the analysis of the ICD 9 - ICD10 codes.
• Analyzed the diagnosis codes, procedure codes to the related tables in development environment to verify the changes related to ICD9 - ICD10 changes.
• Verified the fields length & character which was impacted by ICD9 - ICD10 changes.
• Involved in writing the training documents for business users.
• Wrote the documents like roll-up, back-up plan.
• Involved in the processing of the claims on the NASCO and then sharing the test results with the business according to test acceptance criteria during their UAT phase.
• Gathered Data Hub requirements and responsible for creating test cases and test scripts under Quality Center Test Plan and Test Lab modules in Quality Center
• Worked on legacy conversion data base systems on claims processing.
• Maintained Traceability matrix and Test Matrix
• Reviewed EDI 837 claims and flagged HIPPA non­compliant claims received from the Payer side
• Investigating software bugs and reporting to the developers using Quality Center Defect Module
• Analyzed system requirements and developed detailed test plan for testing
• Involved in the validation of variety of claims detail (i.e. subscriber, provider, procedure codes, diagnosis code etc.) on the NASCO.
• Identified and remediated system testing defects related to test claims as noted above.
• Addressed the outstanding issues to business users.
• Tracked and reported defects using Quality Center.
• Helped business users to perform the User Acceptance Testing (UAT).
• Coordinated with third party vendors to exchanges the inbound/outbound files.
• Generated defect reports using Quality Center for the developers.

Environment: Quality Center, HIPPA, EDI 5010, QTP, Windows, Db2, SQL, PL/SQL, Oracle 9i

Confidential, Hartford, Connecticut

Business Analyst

Responsibilities:

• Responsible for decomposition of the requirements based on the functional specifications, design, development, coding, testing, debugging and documentation of applications to satisfy requirements.
• Conducted the JAD session to clarify the requirements.
• Validated the member information of different groups against FACETS during the batch enrollment.
• Analyzed details of business rules for multiple scenarios.
• Interacted with development and testing team to resolve issues.
• Prepared Test plan and Test cases based on the functional specifications.
• Involved in writing UAT test cases for end users.
• Set claim processing data for different Facets Module.
• Verified HIPAA regulations in Facets HIPAA privacy module
• Executed SQL queries for searching, creating and updating test data
• Created and executed test scripts for approved Change Requests, logged their test results and related documentations in Quality Center.
• Identified, analyzed, and documented defects, errors, and inconsistencies in the application using Mercury Quality Center.
• Reported defects according to Defect Life Cycle.
• Responsible for defect tracking and bug reporting using Quality Center; interacted with developers and Business Analysts to discuss and resolve defects
• Created and Maintained Test Matrix and Traceability Matrix and performed GAP Analysis.
• Coordinated with the developers on Defects Status on a regular basis.
• UAT testing for HIPAA 4010 and 5010 projects including legacy testing and HIPAA requirements and compliance mandates.
• Analyzed all the bugs in the QC reported by the users during the UAT.
• Performed feedback concerning completeness and accuracy of UAT.
• Involved in documenting the defects found during UAT.
• Participate in various meeting and discussed Enhancement and Modification request.

Environment: Oracle, Windows, IIS, Quality Center, QTP, DB2, Load Runner

Confidential, Buffalo, New York

Business Syatem Analyst

Responsibilities:

• Analyzed the system requirement specifications and developed appropriate BRD, FRD, test cases.
• Worked on claim processing module which involved Receipt and Verification of Claim Forms (837) and Claims Adjudication, Health Claim Payment/Advice (835) as per HIPAA guidelines.
• Interacted with business users to understand the requirements.
• Came up with best practices documentation.
• Designed and documented test plan, test strategies, test cases in Test Manager by evaluating the requirement document in RequisitePro and performed hands-on testing for complex test conditions, scenarios and scripts so HIPAA transactions in EDI formats are verified.
• Validated and analyzed EDI outbound and inbound Transactions.
• Executed test cases for the existing market’s various lines of business. (The test cases covered: Authorization of claims, Accumulator, Benefits, Claim Payment and Pricing, as well as member and provider data updates)
• Validated the application against the expected results by inserting Database, Bitmap and GUI checkpoints.
• Performed data-driven testing to read test input data from an Excel File so as to test the application with different positive and negative data.
• Performed QA Acceptance testing for test workflows with business users and performed data encryption testing as per HIPAA guidelines to ensure the privacy, security and confidentiality.
• Extensively used QC for defect reporting and tracking and prioritizing defects and enhancement requests after base lining the requirements.
• Attended change request meetings to document changes and implemented procedures to test changes.
• Involved in continual improvement of automation test scripts to provide improved QA of testing processes and to reduce whole testing cycle time.

Environment: Quality Center, JavaScript, Oracle, MS Office, XML, HTML, QTP

Confidential, Southfield, MI

Business Analyst

Responsibilities:

• Developed BRD, FRD, TSD and test plan.
• Good Understanding of the EDI, implementation and knowledge of HIPAA code sets.
• Worked on HIPAA Transactions and Code Sets Standards according to the test scenarios such as 270/271, transactions.
• Documented and tested the interface between database and the application
• Validated the member information of different groups against FACETS during the batch enrollment.
• Set up the subscriber/member Group, Sub Group, Plan, Product etc. using GUI application and help of batch process.
• Entering Claims and Customer Service Tasks into the FACETS.
• Participated in requirement walkthroughs and creation of test plan
• Involved in preparing the Test Scenarios for Health Care Claim Payment/Advice
• Involved in writing extensive SQL Queries for back end testing oracle database.
• Enhanced Test Scripts using various utilities provided in Quick Test Pro like check points
• Created and maintained SQL Queries for back-end testing
• Investigating software bugs and reporting to the developers using Quality Center Defect Module
• Analyzed system requirements and developed detailed test plan for testing
• Tracked and reported defects using Quality Center.
• Generated defect reports using Quality Center for the developers.

Environment: Win Runner, Quality Center, Windows 2000, Oracle/Unix. MS Office Suite, EDI, SQL

Confidential, Framingham, MA

Business Analyst

Responsibilities:

• Actively participated in review meeting including Functional Spec, Test Plan and Test Case.
• Created and published Test cases based on available requirements and functional spec.
• Wrote test cases using Microsoft Excel and performed extensive manual testing.
• Worked with business users to get sign off in the requirements.
• Created Business and process documents.
• Created the Use Cases on the requirements and came up with different diagrams for technical team.
• Reviewed vendor solution designs and assists in coordinating testing between vendor and client for product enhancements.
• Reproduced and researched problems for their consistency
• Performed Backend Testing by developing, modifying, and executing SQL queries for data validation and data verification on database
• Involved in Functional (positive, negative, null value, boundary value), Integration and Regression Testing.
• Used Quality Center to log defects and monitored the defects for successful resolution.
• Prepared and Documented the test scripts for functional and regression testing
• Wrote SQL statements and SQL queries to check the contents of the application tables
• Participated in weekly meetings to discuss the progress and bugs identified the testing.

Environment: J2EE, DB2, Websphere Commerce, HTML, XML, JavaScript, CSS, Excel, QTP, Quality Center.