SUMMARY:

• 8+ years of experience in Business Analyst with solid understanding of Business Requirements Gathering, experience in elicitation of high level and low level requirements. Quality Assurance, Verification and Validation of applications such as EDIFECS Transaction Management, Facets.
• Solid understanding of Business Requirements Gathering, Experience in elicitation of high level and low level requirements.
• Excellent working knowledge of System Development Life Cycle (SDLC)
• Experienced in writing and reviewing Business Requirements Document (BRD), Functional Requirement Document (FRD), and participated in the preparation of System Requirement Document (SRD).
• Assisted in decision analysis when dealing with complex, difficult and uncertain situations.
• Expertise in managing requirements, by facilitating a formal requirements presentation, review and approval sessions.
• Skilled in conducting Joint Application Design (JAD) and Rapid Application Development (RAD) sessions, brainstorming sessions, requirement reviews, system walkthroughs and customer interviews for various business processes
• Solid experience in recording meeting minutes.
• Proven track record in producing high quality work under tight deadlines and in multi - tasking to meet business goals.
• Supervised testing efforts for Functionality, Usability, Reliability, Performance and Regression testing. Also, reviewed Test Cases with queries in SQL.
• Interviewing Subject Matter Experts (SME), asking detailed questions and meticulously recording the requirements in a format that can be reviewed and understood by business and technical stakeholders.
• Possess strong analytical and problem solving skills with the ability to adapt to a new environment and meet stringent deadlines.
• Experience in conducting GAP analysis, User Acceptance Testing (UAT), SWOT analysis, Cost benefit analysis and ROI analysis.
• Responsible to Track, Document, Capture, Manage and Communicate the Requirements using Requirement Traceability Matrix (RTM) which helped in controlling numerous artifacts produced by the teams across the deliverables for a project.
• Experienced in gathering and documenting test scenarios and ability to train users to translate technical requirements to a business and have experience in conducting User Acceptance Testing (UAT).
• Proficient in Excel Vlookup and MS word.
• Ability to excel and succeed in diverse environment and projects with strong determination, dedication, and inclination towards customer satisfaction.
• Creative, fast learner, highly motivated team player, and capable to work independently.
• Experience in both Waterfall and Agile Methodologies.
• High interpersonal skills and ability to work individually and as a group member.
• Experience working within a LARGE enterprise environment

TECHNICAL SKILLS:

• Cobol
• JCL
• CICS
• Java
• J2EE
• XML
• UML
• Visual Basic
• Perl and C/C++
• QTP
• Robot
• Track Record
• Rational Quality Manager
• Rational Functional Tester
• ClearQuest
• Rational Test Manager
• Compuware QA Director
• Compuware QARun
• Track Record
• PVCS
• WebSphere
• Weblogic
• IIS
• DB2
• SQL Server
• Oracle 8.x
• 7.x
• MS-Access
• Microsoft Office 97
• Microsoft Office 2000
• LIMS
• Lotus Notes
• MS Front Page
• Documentum
• Windows NT/2000/XP
• OS/2
• UNIX
• MVS and MS-DOS

PROFESSIONAL EXPERIENCE:

Confidential, Indiana

Facets Business Analyst

Responsibilities:

• Conducted Joint Requirements Planning (JRP) Sessions as a Facilitator to gather requirements from the group.
• Facilitated the weekly meetings with the Developers
• Facilitated user interviews and workshops to gather requirements.
• Participated in creating User manuals. Documenting all user and system requirement along with the workflow process.
• Created all the documents like Business Requirement Documents (BRD), Functional Requirement Documents (FRD) in MS Word and Excel.
• Involved in GAP Analysis and Technical Feasibility study with the technical leads and other SMEs.
• Created various UML models like Use Case diagrams, Activity Diagrams and State Diagrams in MS Visio.
• Created process flow diagrams in MS Visio.
• Worked with other team members for requirement analysis and clarifications and recommending changes for the gaps identified.
• Involved in the End To End testing for HIP 2.0 Medicaid Project with the State of Indiana in migrating from HIP 1.0 to 2.0 with the full understanding of the 834 Enrollment Medicaid transactions.
• Involved in migration of Central Region Facets to GBD Facets for HIP 2.0 Medicaid Project..
• Manually creating mock up test data 834 as a part of testing.(Add, change and Term record 834s)
• Involved in End to End testing with Confidential ’s Vendors - Xerox, Ventanex, ORCC for payments processing.
• Involved in submitting the Medicaid member’s payment and non-payments to the state on a regular basis and tracking the responses of records.
• Developed Test Plans, Test Cases and Test Scripts for various applications Cosmo and Facets to validate 834 Enrollment Transactions from State of IN.
• Followed the HIPAA implementation guides for preparing the EDI files.
• Documented various key elements of HIPAA compliance and made sure that they are understood by the development teams. Test cases written for the project were HIPAA complaint.
• Managed the team of consultants responsible for developing on-demand Medicaid Management System reports.
• Prepared Need Analysis Documents of the requirements gathered through JAD sessions and individual elicitation sessions with different IT Group Department Managers and refined the requirements. Conducted user interviews, facilitated Joint Requirement Planning (JRP) to reduce the Scope Creep and document analysis in requirements elicitation.
• Extensively worked on version control, library services, work flow, lifecycle management, security and audit trails using Document.
• Authored progress and completion reports, which were then submitted to project management on a weekly basis. Worked closely with management to keep track of the status of project and draft strategies for the near future. Used MS Project to manage schedules, deadlines, and resources for the project.
• Involved in both Manual and Automated test scripts representing various
• Tested and validated the various Medicaid Enrollment transaction naming Conditional, Potential Plus, Fast Track, Hospital Presumptive Eligible and Fully Eligible.
• Involved in the Indiana Medicaid Migration to GBD Facets (Government Based Division Facets Application) from Regular Central region Facets.
• Involved in the Detailed Business Requirements for Migration to GBD Project for determining the testing effort needed for the project.
• Will be involved in the overall End to End testing and validation of Migration to GBD.
• Perform analysis of Business requirements for HIPAA regulations and policies by coordinating with various Enrollment Business team.
• Working closely with customer service team, operations team, and finance team to resolve the Medicaid member related issues.

Confidential, Louisiana, LA

Business Analyst/EDI Analyst

Responsibilities:

• Worked with cross-functional business teams to define and document functional specifications (use cases and interaction behavior) for integrating existing data (health care providers, doctors, policy holders etc.) customizations to the out of the box software for the claims processing component.
• Collaborated with the business, user interface designers and information architects to define these functional specifications.
• Was responsible for driving decisions during the project to assist in next step conclusions, change control procedures and managed day-to-day interaction between various internal support groups to successfully implement process improvements.
• Collaborated with IT Project Managers and Development Managers to scope the work for different customization projects and estimate the effort required to do requirements, analysis and testing.
• Gathered business requirements through interviews, surveys and observing from account managers and managed changes to those requirements.
• Worked very closely with the development teams to help them understand the functional specifications and work through issues during development.
• Developed Test Plans, Test Cases and Test Scripts for various applications (HIPAA support console, Trading Partner Management (TPM) Web portal, Portico, EDI Visibility) by following Waterfall Model (SDLC)
• As a part of EDI visibility project we created test data and tested the 837 from E2E.
• EDI visibility helps the give the status of a 837 claim in Edifecs Events (NPI, EDITS, To CDE, XC Sent) in EDIFECS TM.
• Tested all the Claim statuses in Edifecs as a part of visibility.
• Involved in System, Regression, Functional and Integration Environment testing
• Worked with ANSI X12 EDI Transactions (270, 271, 276, 277, 278, 834, 837I, 837P, 837D, 835)
• Regression tested all the EDI transactions after deploying Hotfixes in Edifecs Transaction Manager in all Test environments (Test, Stage, UAT) and Production
• Created Claims for Medical / Hospital and Dental Claims Processing
• Perform analysis of Business requirements for HIPAA regulations and policies by coordinating with various Business teams
• Review requirements, and confer with management and users about format, distribution, and purpose, to identify problems and suggest improvements
• Coordinate End-to-End testing with HIPAA transactions
• Tested 4 Trizetto Facets Releases each quarter for more than an year
• Tested Routing of Claims, Claims Adjudication and Claims Processing in Facets
• Collaborate with HIPAA transactions team for developing test scenarios for validation
• Verified the Trading Partner software application according to the requirement specification (SRS)
• Design, evaluate, recommend, and approve changes of Project during SDLC life cycle
• Involved in testing various Edifecs Interfaces, Inbound and Outbound transactions
• Tested Routing of Claims, Claims Adjudication and Claims Processing
• Tested the Web applications and Web Portals linked to EDI HIPAA transactions
• Tested the Facets (Membership, Claims and Provider)
• Tested the various actions on claims like Pending Denying, Resolving Exception, Splitting claims etc
• Used Mercury Quality Center for managing the defect flow
• Worked in Quality Center Upgrade to ALM 11.0 testing
• Tested Various Edits on the claim by editing data on the claim and routing it to XC’s
• Prepared 837I, 837D, 837P, 835 and 270 EDI transactions by referring to the TR3 documents
• Provide analytical support and assist team members in resolving problems related to the process
• Work on multiple tasks simultaneously and independently establishing work plans and timelines
• Analyze data gathered and develop solutions or alternative methods of implementation

Confidential, MD

Facets Business Analyst/QA Tester

Responsibilities:

• Active involvement in the project from the very beginning phase right from gathering business requirements from business users till the pilot phase and analyze the dependencies, issues, risks upfront to implement SHIFT LEFT methodology.
• Responsible for providing detailed estimates for several projects for each release.
• Using Facets to compare and test the claims Facilitated requirement gathering sessions with the business team to collect the business, security and service level requirements and documented them.
• Responsible for resource loading based on the detailed estimates provided.
• Participate in scoping of the projects and effort estimation. Create Project definition and scope documents
• Conduct inception, conceptual meetings and JAD sessions to gather requirements and project details from the business users.
• Create Functional Requirements, UML diagrams, Page Specification document, UAT test plan, UAT use cases, and UAT documents as needed for projects.
• Involved in System, Regression, Functional and Integration Environment testing.
• Worked with ANSI X12 EDI Transactions (270, 271, 276, 277, 278, 834, 837I, 837P, 837D, 835).
• Compared and Validated the Reports between Facets 4.61 and 4.81.
• Created Claims for Medical / Hospital and Dental Claims Processing.
• Participated in testing the various Interfaces (Inbound and Outbound) of Facets.
• Tested Routing of Claims, Claims Adjudication and Claims Processing in Facets.
• Tested and Processed the claims in NPS (NASCO Processing System)
• Tested the Web applications and Web Portals
• Tested the XML files and SOAP (web services).
• Validated the user profiles and single sign on for web application portals.
• Tested the various actions on claims like Pending Denying, Resolving Exception, Splitting claims etc.
• Used Mercury Quality Center for managing the defect flow.
• Worked with SQL queries and UNIX shell scripts.
• Tested Various Edits on the claim by editing data on the claim and routing it to FEPOC.

Technologies: Quality Center 11.0, Parasoft SOATest 6.1, FACETS 4.61/4.81, NASCO, XML SPY, XML Schema, SOAP, Oracle, Unix, Tibco, JMS, MS-Office, Windows NT/XP, MQ Series v6.o

Confidential, Boston, MA

Sr. Business Analyst

Responsibilities:

• Created and maintained Business Use cases and System Use cases, Use Case diagrams, Flow Diagrams, Business Flow Diagrams, Activity diagrams, Sequence diagrams throughout the SLC using MS Visio.
• Supporting developers with unit testing and troubleshoot where the issues emerging.
• Performed Gap Analysis to compare all elements of existing "as is" with desired "to be" processes. Reengineered the user interface of the application.
• Thoroughly studied the existing application features and functions and then assessed and analyzed the scope and impact on business needs.
• Extracted, discussed, and refined User and Business Process Requirements from SME’s from Business User Groups. Also, co-authored User and Functional Requirements Documents by interacting with development team.
• Developed business process models in Agile to document existing and future business processes.
• Created and maintained Business Use cases and System Use cases, Use Case diagrams, Flow Diagrams, Business Flow Diagrams, Activity diagrams, Sequence diagrams throughout the SLC using MS Visio.
• Tested the EDI 270, 271, 837, 997, 276, 277 interfaces.
• Verified the claims in HIPAA support Console through Payment for all claims above that make it to adjudication.
• Tested the Members, Claims and Providers in mainframes.
• Validated the data on Mainframes (QMF) and worked with JCL jobs on Mainframes.
• Involved in Pilot testing
• Tested the web-based enrollment application.
• Tested the Web services (SOAP request and SOAP response).
• Tested the stand-alone web services by giving WSDL (XML) request and getting response in XML.
• Coordinating between QA Managers, Developers and Team Members.
• Used Mercury Quality Center for managing the defect flow.
• Worked with SQL queries and UNIX shell scripts.
• Used Quality Center for managing the defect flow.

Technologies: Quality Center 9.0, ASP.NET, VB.NET, C#, IIS, XML SPY, XML Schema, SOAP, SQL Server 2000, Oracle 9i, Mainframes (JCL, TSO/ISPF, DB2, CICS), Unix, MS-Office, Windows NT/XP

Confidential, Kansas City, MO

Business Analyst/QA Analyst

Responsibilities:

• Authored the Business Requirements Documents (BRD) containing the essential business elements, detailed definitions, and descriptions of the relationships between the actors to analyzed and document business data requirements.
• Analyzed and prioritized Business Process and User Interface (UI) requirements as system requirements that must be included while developing the Application. Created automation profile of the process.
• Planned and defined system requirements to Use Case Scenarios and Use Case Narratives using the UML methodologies and created UML based models: Use Case Diagrams, Activity Diagrams, Sequence Diagrams in MS Visio.
• Tested the Members/Provider/Claims Products in Facets.
• Developed Test Plans, Test Cases and Test Scripts for various applications (Trizetto Facets, EDI applications and Provider Web Portals) by following Agile/Scrum process.
• Developed Test Cases and Test Scripts for the Edits coming through ASK (Administrative Services of Kansas) based on requirements in Rational Quality Manager.
• Worked with ANSI X12 EDI Transactions (270, 271, 276, 277, 278, 834, 837I, 837P, 837D, 835).
• Tested all modules of the Facets Application as a part of a Facets Upgrade from Ver. .
• Performed End-to-End testing for Facets upgradation from Ver. .
• Tested Loading of Claims Data and Claims Adjudication in Facets.
• Involved in the build of an Institutional claims (837I) receipt process that can perform all relevant validation, scrubbing, and splitting without the use of ASK’s technology services.
• Performed all phases of end-to-end testing, which includes Functional, Regression, GUI, System, and Smoke testing.
• Created XML files and tested the web services (SOAP).
• Tested the 837I Edits in Edifecs SpecBuilder using HIPAA Guidelines.
• Managed the flow of raw file into Edifecs X-Engine, to TIBCO and to the Edifecs Transaction Manager for the 997’s and TA1 transactions.
• Manually created the Transactions not covered by ASK, which includes Loops, Segments, Composites and Elements on the 837I files and analyzed them using SpecBuilder.
• Involved in Responding to St. Luke’s batch institutional claims with confirmation reports, 997s, TA1s, and TRNs.
• Verified the Files split into NASCO, ITS Host, Facets and WyJo.
• Tested the EDI 270, 271, 837, 997, 276, 277 interfaces.
• Verified the claims in Facets through Payment for all claims above that make it to adjudication.
• Tested the Members, Claims and Providers in Facets.
• Validated the data on Mainframes (QMF) and worked with JCL jobs on Mainframes.
• Involved in generation and validation of Confirmation reports Using Edifecs Transaction Manager.
• Worked with SQL, PL/SQL and functions to test the database integrity (Oracle).
• Automated the reusable scripts using RFT
• Used Rational Quality Manager for managing the defect flow.
• Worked with SQL queries and UNIX shell scripts.

Technologies: Rational Quality Manager (RQM), RFT, Trizetto Facets 4.31/4.61, Spec Builder, ASP.NET, VB.NET, C#, IIS, XML, SOAP, SQL Server 2000, TIBCO, Oracle 9i, Mainframes (JCL, TSO/ISPF, DB2, CICS), Unix, MS-Office, Windows NT/XP