PROFESSIONAL SUMMARY:

• IT specialist with 9 years of result - driven professional experience in the Analysis, Design, Development, Testing, and Implementation of business application systems for Healthcare and Insurance sectors.
• Worked as Business Analyst and Quality Analyst in implementation teams for User Requirement Gathering and Transforming Business Requirements into Software Requirement Specification (SRS) using MS Office Suite, team foundation server
• Expertize in in Waterfall, Rational Unified Process (RUP), agile methodologies (SCRUM/ XP), Unified Modeling Language (UML) and Use Case Specification Documents (USD).
• Expert in Business Process Re-engineering/Re-modeling developing different SOPs for the each of the department, designing work flows, batch processing, creating business rules, communicated trade-off decisions on product, budget constraints, and customer requirements.
• Proficient in Manipulating, cleansing, processing, loading, extracting and validating client data using Excel, Access and SQL and also have Strong experience in Data Analysis, Data Profiling, Data Migration, Data Integration and Metadata Management Services.
• Talented with the data management policies, procedures and widespread technical tools with strong logical, assessment and interpretation skills
• Sound Proficiency in analyzing and Creating Use Cases, Use Case Diagrams, Activity diagrams, Class diagrams, Data Flow Diagrams, Business Flow Diagrams and Sequence diagrams using MS Visio and Rational Rose.
• Involved in QNXT configuration, Customization, reporting, analysis and enhancement. Extensively worked on EDI transaction like 837, 835,834, 820, 270, 271, 276, 277 and 278.
• In depth knowledge of HIPAA 5010 transaction processing’s, ICD 10 compliance, CMS compliance, Medicaid, Medicare, provider network management and provider directory.
• Excellent Team Player to work in conjunction with other testers, developers, PM and other team members for creating Project Plan, Charter, Schedule, validation, testing complex scenarios, requirement analysis, verification documents and in the maintenance of Quality standards in projects.
• Proficient in holding Joint Application developments (JAD), Joint Requirement Planning sessions (JRP), Interviews and workshops with end-user/clients/stake holders/SME’s .
• Extensive Knowledge in reviewing test procedures, extensively interacted with the QA Team in building the test plans, RFP, prototyping, screen mockups, providing test data, creating test cases, analyzing bugs, interacting with team members in fixing errors and also assisted in Post - Production support.
• Expertise in defining scope of projects based on gathered Business Requirements including documentation of constraints, assumptions, business impacts & project risks.
• Extensively interacted with both user group and development team in coming up with structured charts, PRD, work flow diagram, data models, class and sequence diagrams and also proficiently worked on HP quality center for bugs and requirement tracking.
• Strong business acumen, strategic thinking, communication, interpersonal and presentation skills, adept at creating, editing, and coordinating extensive communication networks to keep executive staff and team members apprised of goals, project status, and resolving issues and conflicts.
• Expert in developing user manuals, presentations and manuals as per project specifications and timelines and actively generates process improvements; supports and drives change.
• Process improvement champion with a history of implementing new procedures and technologies to strengthen security posture, enhance operational efficiency, and control costs.

TECHNICAL SKILLS:

Tools: MS Office Suite (Excel, Word, PowerPoint, Access, Publisher, FrontPage, Outlook), MS Project, MS Share Point, MS Visio, Rational suite and Documentum, HP quality Center, Power Designer, ERWIN4.0, Informatica, SQL management studio, visual studio, visual source safe 6.0, Win Runner, Load Runner, Red Gate, Test Director, TOAD, QTP, Notepad++, Ultra edit, Visual Studio 2008 & 2010, Visual Source safe, Microsoft Team Foundation Server, Bugzilla, Biz Talk.

Claim adjudication tools: Amisys, FACETS, QNXT 3.4/4.7/4.8/5.01/5.2, HIPAA, EDI X12, FDA Compliance,HL7, HIXDatabases: MS Access, Oracle 8i, SQL Server 2000/2005/2008/2008 R2, DB2, Teradata.

Operating Systems: Windows 98/2000/ME/NT/XP/7, Mac OS.

Methodologies: Waterfall, UML, RUP (Rational Unified Process), RAD (Rapid application development), Agile, Business and Data Modeling.

Languages: C, C++, SQL, Java, SAS, HTML, VB Script, JCL (mainframe)

Reporting tools: Micro strategy, Cognos, Business Objects, Crystal Reports

PROFESSIONAL EXPERIENCE:

Confidential, Yonkers, NY

Senior Business Analyst/Quality Analyst/Data Analyst/EDI Analyst

Hardware/ Software: SQL server management studio, visual source safe, SSIS, SSMS, HP Quality Center 11.0, Biz Talk, MS Office Suite, Agile, SQL,UML, SSRS,SSIS, MS Access, HIPAA 4010/5010, XML, SAP Business Objects, VB, .net, Visual Studio, SQL Server Reporting Services, Paper claims processing, Notepad++, Ultra edit, EDI, Microsoft Team Foundation Server, Bugzilla.

Responsibilities:

• Interacted with the “End-Users” and stake holders by interviewing them, by preparing appropriate questionnaire to better understand end-user needs and the business process for QNXT 5.01/5.2 upgrade requirements.
• Extensively involved in claim scrubber process and claim loading process analysis and requirements changes.
• Worked on member, provider and affiliation matching logic for 837 claim files submitted by different submitters.
• Creating the test cases, test plans and test scenario for claim scrubber, loader and matching logic testing. Successfully logged defect, analyzed them, reporting them to the developers and resolved them using TFS.
• Worked on Deny, Pend, Incomplete, PNE, MNE, CMO letter for claims for different health plans, also successfully tested migrated SQL 2008 code for claim letter consolidation process
• Worked on 835,999 and Flat files validation by comparing output test files with the existing production files by using data analysis tools like ultra-edit, Red Gate and Excel.
• Worked on check print application to generate checks for different providers and submitters for the adjudicated claims.
• Involved in user acceptance testing and supported user for claim testing by dropping the claims files, moving to different server, BizTalk validation and running scrubber and loader jobs.
• Tested CCMS and Echo interface for QNXT upgrade impact, also performed parallel testing of all requirement of QNXT 3.0 and 5.01/5.2 QA environments.
• Documented requirement changes and tested EDI loader, PCPXwalk, scrubber, Member ID flips and member move eligibility applications

Confiential

• Documented designs for interface using modeling tools. (E.g. prototypes, Visio, data modeling tools) and created flow chart for Echo-CIS Interface process.
• Involved in creating business requirement and change request for current systems. Constantly held meeting with business users and stake holder to understand their requirements and document them.
• Created test cases and test plan for Echo-CIS Interface process and also executed all test cases using manual and automated tools
• Used Defect tracking system like HP QC and Bugzilla to log, analyze, track and solve the bugs produced during testing and UAT cycles.
• Created test matrix for positive, negative, regression and parallel testing and also tested all test data to make sure that system is working functionally and as a whole system.
• Tested SQL server jobs, triggers, parameters and stored procedures involved in Interface file generation process.
• Tested connection between MIT and tandem DB (Care Cast) to make sure successful incoming and outgoing file transfers between two systems.

Confidential

• Identified all necessary Business and System requirements, created UML diagrams including Use Case Diagrams, Activity Diagrams, and Sequence Diagrams using Microsoft Visio.
• Developed mapping document for real time eligibility member to load them in to eligibility loader and tested them.
• Designed quality regulations and evaluations based on monitoring of data flow.
• Developed and upgraded EDI maps for transactions using the X12 standard. Maps created were for both inbound and outbound trading partner relationships.
• Tested new sets of inbound 834 file, converted text format to system accepted standard and helped business user to clarify the whole eligibility process.
• Assessed QA performance - Retrieved and analyzed QA information to identify root causes of performance gaps and other QA problems.

Confidential

• Worked on Provider rooster files and provider directory files for EPIC data
• Worked on Echo - Epic provider feed files which are used to send current provider details/Status to EPIC module.
• Worked on requirement gathering, Integration testing and EPIC testing for 278 (Prior Authorization) Transaction.

Confidential

• Responsible for ICD 10 requirement gathering and testing of claims, claim letters, Encounter, Remit, Eligibility and Echo applications.

• Worked on claim, eligibility, remit, ref/authorization migration, CCMS letters applications for MLTC Medicaid program.
• Coordinated with NYSOH (NY State of Health) to create diamond care claim files (Medicaid claims) mapping documents as per requirement from state for new insurance plan.

• Thoroughly involved in creating 837 I and P encounters file, handling file edits and rejection files from the state and SFTP connection/ for file transfers
• Involved in all phases of MLTC project from requirement gathering to QA execution and Production support.
• Involved in building and testing the application that handle all kind of rejection files (RJ, 999, 277CA and TA1) from NYSOH.
• Involved in requirement gathering and testing of SSRS reports of State rejection files, encounter files and encounter edits.

• Created mapping document, documented the changes and tested the Health First and Emblem encounters P and I files
• Involved in testing and requirement changes of linked and unlinked chart review institutional and professional claim files to Emblem for review.
• Worked on Defining preprocessing validation checks for Emblem Encounters to minimize the validation errors in Emblem system.

Confidential, Danville, PA

Senior Business Analyst /EDI analyst / Quality Analyst

Responsibilities:

• Identified all necessary business and system use cases from requirements, created UML diagrams including use case diagrams, Activity Diagrams, and Sequence Diagrams using Microsoft Visio.
• Developed and upgraded EDI maps for transactions (835, 837 (I &P), 834, NCPDP, 277) using the X12 standard.
• Tested new developments of X12 837 claims, 835 payment files and ensured timely and quality delivery of Revenue Cycle product releases.
• Responsible to understand EDI transaction (Inbound / Outbound) requirement coming to the MCO and going out to State of PA.
• Created functional specs documents and business requirements for EDI transaction for the development of accurate transaction platform.
• Set and verified standards of quality and testing procedures - Reviewed and modified quality assurance programs and tested performance according to user’s specific requests and data inputs.
• Worked with the state of PA Medicaid team in the submission/ Locating FTP/ Checking Frequency/ Error reports of the Daily, Weekly, Monthly 834 Enrollment files.
• Performed end to end testing of the Application and reports using HP Quality Center.
• Executed smoke, integration and system testing and used Mercury Quality Center for organizing requirements, test cases and defects.
• Created SQL queries and scripts to prepare data or validate data from databases to application.

• Documented designs using modeling tools (E.g. prototypes, Visio, data modeling tools) and captured key design assumptions and risks.
• Highly involved in the discovery phase JAD sessions of the project for understanding the user needs to implement third party product.
• Created overview document for data conversion, data mapping, detailed instructions, specification, pre-requisites, sample files, loader formats and business test cases
• Actively involved for requirement gathering and creating specs for Single Sign on (SSO) using SAML 2.0 and information exchange between payers and providers.
• Created and delivered provider data test files for continuous testing.
• Delivered fully functional real time 270/271, 276/277 services end points with continuous testing and improving the products.
• Defined and delivered 278 Authorization transaction and 835 with supplemental Explanation codes file for batch processing and tested them to make free from errors.
• Involved in the Phase 1 and Phase 2 testing of 270/ 271, 276/277 Real time and 278, 835 batch transactions with making sure cosmetic changes and logging defect according to it.
• Continuously held meeting with PNM ( Provider Network Management) for discussing defects for data on provider rooster files and their loading process and closing them after approval or Any product Variance that need to be reviewed
• Involved in GAP analysis of 276/277 and 270/271 transaction to Identify GAP of the Specs between NaviNet and Client’s System.

Confidential, Windsor, CT

Business Analyst/ Quality Analyst/ Data analyst

Hardware/ Software: HP Quality Center, MS Office Suite, Lombardi, MS Visio, MS Project, Oracle DeveloperSharePoint, Agile /Scrum, SQL, UML, UNIX, Oracle, MS SQL Server, MS Access, HIPAA versions 4010A1 and XML 5010, Informatica (ETL), SAP Business Objects, TOAD, XML Notepad, Medicare, Medicaid, FACETS, EDI Transactions

Responsibilities:

• Responsible for gaining a good understanding of user needs and accurately representing those in a well-documented software functional specifications document and creating test cases based on that.
• Gathered Business Requirements, interacted with the users, designers and developers, project manager and QA team to get a better understanding of the business processes
• Interacted with the “End-Users” by interviewing them, by preparing appropriate questionnaire to better understand end-user needs and the business process.
• Involved in historical data fix and data recovery/replay operations for reporting cleanup of HIPAA Compliant EDI transactions 270/271, 276/277, 837, and 835
• Developed detailed design specifications including service models and message schemas and detailed source-to-target data mapping and data transformation rules
• Supported PL/SQL development for contingency and internal audit reports and also maintained data in warehouse and data marts.
• Reviewed design documents and business requirements to learn the function and scope of the application, to understand release changes and to create a Test Strategy for every release.
• Planning and creating test scenarios and test objectives to ensure that the system modification will meet the specified business requirements.
• Developed component level scripts in Quality Center per established standards and maintain daily status.
• Followed a structured approach to organize requirements into logical groupings such as requirements for Customer, Client, Group, Member and Reporting that critical requirements are not missed.
• Performed GAP analysis of 5010 EDI transaction using implementation guide to identify the changes in the segments and data elements and also created and maintained data mapping documents for them.
• Created Data mapping documents, test cases for System Testing (Development Environment), Integration Testing (UAT) and Production (Post Implementation Review) in Agile/Scrum environment.
• Supported the testing team with defect management, requirement analysis and SQL development for back-end and regression testing.
• Directly involved in process improvement plans and implementing business change and health information exchange between trading partners and payers.
• Lead UAT testing activities done by the business users and securing Sign off on the patches released to UAT.

Confidential, Rockville, MD

Business Analyst/Quality Analyst

Hardware/Software: SQL 2008, .net, HIPAA, HL7,HTML, SQL, TOAD, Java, MS Share Point, Bugzilla, WS FTP, Power Designer, MS Visio, Windows XP/2000, XML,BWL, MS Project, MS Office Suite (Word, Excel, Access, PowerPoint, and Outlook).

Responsibilities:

• Understood and articulated business requirements from user interviews and then convert requirements into technical specifications and test cases.
• Worked with Business Users in articulating the Rx Claim life cycle process into CRx. Identified the GAP between Walgreen and Catalyst Rx system Like HX PBS fields to make changes that are compatible to use in CRx.
• Understood metadata, SQL server 2008 and database structure for migration of data structure to CRx claim and Medicare Part D prescription drug coverage
• Creating business process and requirement gathering for Medicaid, Medicare Part D Explanation of Benefit (EOB) letters processing. Data mapping from pharmacy vendor files.
• Worked for Batch processing, ID card Generation, Pricing, Enrollment, Billing and eligibility checking for Part D subscribers and dependents.
• Worked on Power designer for metadata management and requirement documentation so to better communicate requirements between stake holders.
• Efficiently responded to client inquiries and resolved discrepancies. Identified, prioritized, tested and proved essential business functions to assure compliance with FDA and internal auditing.
• Developed SOPs for archival and retrieval procedures from RX claim to CRx claim (Catalyst Rx Library) and also deployed documents and reports on server using MS Share Point.
• Scheduled meetings with technical personnel to determine technical parameters for EDI and other related process including security and privacy.
• Created and maintained templates such as: Test Plans, Requirements Traceability Matrix, Test Scripts, Testing Issues, Project Sign-off and Test Reports.
• Run bi-weekly business requirements sessions with the QA resources to ensure requirements accurate understanding and to ensure test cases are easy to understand and execute
• Communicated quality and testing goals effectively to project managers, project participants and testing staff.

Confidential, Grand Rapids, MI

Business Analyst/ Quality Analyst

Hardware/Software : FACETS (4.41), Facets interfaces (IKA SYSTEMS and IFOX), Facets extensions, Agile, Requisite Pro, Oracle, SQL, Toad 9.7, MS Access, MS VISIO, MS office, MS word, MS excel, BWL,Oracle CRM, HL7, HIE, Data warehouse and data marts, Share Point, Java, Business Object reports, HP Quality Center.

Responsibilities:

• Utilized Agile Methodology to configure and develop process, standards and procedures.
• Created workflow diagrams, UML diagrams, process models, activity diagrams, use cases, swim lanes, for incorporating design changes in the order creation/ management system
• Prepared the Business requirement Document (BRD) and system requirement document (SRD), Defect Resolution Document (DRD) for the enhancement of the existing services.
• Act as a liaison between business and IT team. Worked on the Facets (4.4.1) interfaces with IKA systems and developed business requirements for historical load, PCP lookup file, Broker lookup file, Subscriber ID file, Letter inbound and outbound file, Plan information for employer groups file, Siebel interface file and EDI 834-file from IKA systems.
• Worked on the EDI 834-file load to Facets through MMS ( maintenance sub-system), solving the errors of EDI 834 load to Facets through MMS.
• Worked with Facets Claims transactions, data model and structure as well as EDI Claims (HIPAA 837 I and P) standards
• Performed data analysis, checked data quality, created data mapping and data interface documents and kept the documents updated with changes in requirements and functional specification.
• Worked on a client/server system designed to capture information from Centers for Medicare and Medicaid Services enrollment forms
• Successfully Ran SQL queries to analyze the requirements and for testing the files and reports. Performed gap analysis and impact analysis for the new Medicare PPO product.
• Developed business requirements for online pricing tool for Medigap product and online web form for capturing application information.
• Performed EDI duties such as FTP of files to and from our Clearinghouse and secured information exchange with different third parties and providers.
• Attended daily SCRUM and guided QA and Developer regarding the defects, Technical Specification Documents and Mapping Documents.
• Worked closely with business users and IT team in War room to solve the issues in time also provided Production support and post-production support/explained the changes to the business users/did one on one sessions/one to many sessions to make the business uses aware of the system changes.
• Mentored and drove the UAT team function and ensure all the Clients online business / technology test requirements are met

Confidential

Business Analyst/ Presales and Marketing

Hardware/Software: Rational Rose, Rational DOORS, Rational Requisite Pro, MS Visio, RUP, UML, Windows, Unix, Java/J2EE, XML, HTML, VB .net, Manual and Automated testing Win Runner, Load Runner, EHR, HL7, Quick Test Pro.

Responsibilities:

• Worked as Business System Analyst in implementing Soarian MedSuite at New Medical Center, Dubai.
• Responsible for planning, organizing, writing and editing operational, maintenance, test procedure manuals, or materials also working on ISO 13485 Design Control.
• Worked with business owners, technical team, QA and PMO to scope and prioritize development releases and developed documents in compliance with CRM, CMMI/CMM.
• Analyzed the business requirements and the site specifications and developed detailed testing strategy for the entire application and developed various test cases.
• Documented detailed business requirements for automated journal entries, automated management, automated financial reporting and automated process notifications to relevant departments.
• Analyzed system and functional specification documents for the web portal system and created a Test Strategy to be implemented across multiple projects across the web integrated system.
• Worked with application development team to identify bottlenecks that could hinder progress of development and web based interface.
• Worked with systems analysts and programmers to create and edit application and systems documentation, user manuals, courses, and procedures
• Implemented a modified RUP process for managing requirements and played a key role in helping the company adopt Rational Unified Process
• Used UML notations for Object Oriented Design and documentation also created UI design and tested according to requirements.
• Generated test scripts by inserting standard check points, synchronization points, regular expressions, database checkpoints, bitmap checkpoints, output value parameters and parameterization.
• Worked with the development team in investigating and correcting software bugs and deficiencies based on testing results