SUMMARY:

• An astute, detail - oriented Business Analyst with 9+ years of consulting experience including Healthcare (Medicare, Medicaid and Medical), Insurance. Experienced in testing implemented systems and system changes, including liaising with QA teams to develop test cases, test plans, test scenarios, generating test data, and conducting manual testing (regression, end-to-end, functional).
• Experience in Software Development Life Cycle (SDLC) phases with a strong background in team development from requirements gathering to product release.
• Managed teams for implementation of software development methodologies including Agile, Waterfall, RUP and SCRUM.
• Responsible for creating project charter, Business Requirement Document (BRD) and Functional Specification Document (FSD).
• Proficient in creating User Acceptance Test (UAT) Plans and implementing and coordinating UAT. Experienced running scripts to check web user interface and Portals for Broken Links, Frame Properties, Table Properties, URL links, Images, Text and has prepared Test Metrics to test execution status and results.
• Demonstrated expertise with Medicare and Medicaid, including Claims, Adjudication and Billing. Extensive experience with HIPAA regulations, and EDI standards (X12).
• Skilled at conducting JAD sessions with stakeholders, project meetings, reviews and walkthroughs.
• Experience capturing requirements for Explanations of Benefits (EOB). Translating requirements to the development team.
• Experience in designing and developing project document templates based on SDLC methodologies including RUP, RAD, Waterfall, Scrum and Agile.
• Strong experience in conducting UAT and documentation of Test Cases. Expertise in designing and developing Test Plans and Test Scripts.
• Process and Coordinate Change Requests ensuring Governance, Risk Management and Compliance are met
• Excellent business writing skills in writing Preliminary Investigation Report, System Requirements document, Systems Design Specification and System Requirement Change Request.
• Thorough knowledge of Eligibility and membership Affairs. Also, knowledge of HIPAA, X12, and HL7 standards and Medicaid provider best practices.
• Hands on experience in manual testing and automation testing using HP ALM/QC, JIRA and QTP, Load runner.
• Data Analysis on change order metrics and reporting to senior/department managers and review and update change procedures and compliance.
• Good Knowledge of ICD-9 codes and CPT codes for both Mental and Medical Health.
• Excellent knowledge of HIPAA transaction codes such as 270/271 (inquire/response healthcare benefits), 470 (benefit codes), 276/277 (claim status), 834 (benefit enrolment), 835 (payment or remittance advice) and 837 (health care claim). Experience testing Curam Medicaid (MAGI) application and also attended Curam Caseworker Training.
• I have completely handled the Regression team from cycle planning, execution, coordination, status calls, cycle result reviews, failure analysis, GAP analysis, BRD & FRD updates, process diagrams creating and process improvisations in Curam and finally reporting to management
• Support, coordinate, analyse, and manage IT Change Management activities at an Enterprise level
• FACETS experience, knowledge of ICD-10- CM, ICD-10- PCS, HIPAA 4010/5010 initiatives and regulatory compliance framework.
• Knowledge in the ETL (Extract, Transform and Load) of data into a data warehouse/date mart and Business Intelligence (BI) tools like Business Objects Modules (Reporter, Supervisor, Designer, and Web Intelligence).
• Design and review of various documents including the Software Requirement Specifications (SRS), Business requirements document (BRD), Use Case Specifications, Functional Specifications (FSD), Systems Design Specification (SDS), Requirement Traceability Matrix (RTM) and testing documents
• Extensive risk management experience conducting fraud and risk investigations for financial institutions and payment processing organizations
• Highly motivated team player with excellent Interpersonal and Customer Relational Skills, Proven Communication, Organizational, Analytical, Presentation Skills, problem solving, negotiation, judgment and decision making skills.

TECHNICAL SKILLS:

Business Analysis: Requirement Analysis, Axure, detail design, Business Rules, data flow diagrams, data definition table, data modeling, system integration, UML with Rational Software Modeler and team building, Software Development Life Cycle Methodologies including Waterfall Model, Agile, CRM, Change Management

Programming Languages: C, C++, SQL

Testing Tools: Quick TestPro (QTP), HPALM, MS Project, MS Visio, MS Office Suite

Development Methodologies: RUP, AGILE/SCRUM, Waterfall, ESDM, STV, UML, SDLC

Bug Tracking Tools: Mercury Test Director, Rational Clear Quest, HPALM

Reporting Tools: Crystal Reports, SQL Server Reports (SSRS)

PROFESSIONAL EXPERIENCE:

Confidential, Rochester, NY

Sr. Business Analyst/ Facets Administrator

Responsibilities:

• Worked as Facets Administrator and done lot of Provider Data Gap Analysis
• Played the key role as a lead in managing the team and was responsible for all the deliverables to the Customer.
• Involved in Project estimation for Extraction and Analytics Project.
• Responsible for analyzing technical specifications, creating plans and strategy for Data Extraction and Analytics project.
• Coordinate meetings and facilitate communication between IT and business on testing
• Performed gap analysis as pertains enrollment, membership management, Commissions, Finance and claims processing; relating for instance to Provider IDs use on plan communications; remittance advice statements; explanation of payments (EOP); and Member ID cards; and healthcare providers use of the assigned Provider ID number(s) for use in claims submission and plan inquiries.
• Used ETL tools such as Informatica, Data Stage and Ab Initio for performing ETL testing on Extraction, Transformation and Loading data from source files such as flat files, oracle and SAP
• Tested HIPAA Gateway Application Interface for all inbound and outbound messages (Healthcare Eligibility 270 and 271, Healthcare Claim Status request 276 and 277, Healthcare Claim 837 and 835 ERN)
• Participated in all phases of the Facets Extended Enterprise(TM) administrative system implementation including the planning, designing/building/validation (DBV), testing, and Go-live support phases
• Using the Curam software to improve care coordination, preventing gaps in care for people. Developed standard Business Process Models detailing the Curam Eligibility Enrollment solution process and presented the models to the State.
• Various aspects of the project’s needs such as the logging, tracking, and resolution of issues, current state workflow assessments, facilitating/presenting DBV sessions, and assist with integration testing
• Clarified to Claims personnel the new payments and EOPs for same claim processing cycle: Unlike currently where payments for all claims received within a given cycle are lumped into a single check, there would be two separate EOPs and checks in the same cycle since the new and old systems would be used to process different types of claims, based on dates of service and product
• Conducted User Acceptance Testing and user training pertaining to old and new Provider ID appearing on documents providers and some system generated letters)

Environment: Facets Extended Enterprise(TM), Oracle, MS Office Suite, Windows XP, S SQL, VB.NET, HTML

Confidential, CT

Sr. Business Analyst/ UAT Coordinator

Responsibilities:

• Responsible for Analyzing the Requirement Specifications, creating Functional and technical Requirement documents.
• Identifying the Test data from the Source systems satisfying all the test scenarios for the System Testing.
• Responsible for preparing the Weekly Status Report (WSR) for the Project and Regular Project progress to the client.
• Work with the test executive management in evolving methodologies and procedures in retaining skilled testing personnel.
• Work closely with Business Team on requirement gathering and Test Planning.
• Look beyond the current scope to define/identify potential risks and comes up with a suitable mitigation plan.
• Integrate working with the test executive team, the project management deliverables for the test component of the project activity.
• Acted as a liaison between clients and development departments and distinguished requests from needs.
• Transferred information from management into needed data.
• Found out defects which existed in the system, analyzed how the defects were originated, and cooperated with another department to fix them.
• Set up meetings with other departments, SMEs, or clients to solve problems and gathered requirements from meeting. Review and understand the ETL processes, functionality & identify test requirements and coverage
• Coordinate with infrastructure and application teams to support the integration of projects approved and reviewed by stakeholders, senior management, and technical advisors.
• Translated business requirements into technical details.
• Used SAP Business Objects to complete report generation based on corresponding issues of defects.
• Worked closely with project lead, technical team and business analysts to investigate data and logic within the database and reporting application.
• Prepared BRD’s and test cases for each defect before defects moved to testing.
• Coordinated with project manager on regular status updates and assists the overall project management initiative.
• Worked extensively with MS office suite for preparing status reports
• Prepare and monitor testing scope and requirement changes, assess the impact of requirement changes on test deliverables.
• Prepare test estimates and sizing of the test object.
• Plan, organize, direct and execute the test process and manage test releases.
• Prepare test execution metrics and use the metrics to derive “best practices” and suggest / recommend improvements to test processes and methodologies.
• Implement and evolve appropriate test measurements and metrics to be applied against test release and to be applied against the QA team.

Environment: Informatica 9.1.0,SQL Server 2005,Win SQL, Congos 10.2 Windows, Unix, MS Office Suite, MS Visio, UML, SQL, MS SharePoint, Agile/Scrum, Toad.

Confidential, Broomfield, CO

Sr. Business Analyst/ QA Analyst

Responsibilities:

• Prepared the Functional Specification Document (FSD) and Software Requirement Specifications (SRS) as per SEI CMM standards.
• Gather business requirements through interviews, JAD sessions and observations and created the business requirements documentation for building UI for viewing data through Guidewire Policy Centre.
• Conduct quality assurance tests of the several Cognos software applications into practice and make note of the application failing quality tests.
• Interacted with business heads to finalize the product backlog for the Guidewire application.
• Mined data for the application team and design team to assist with creation of the application
• Utilized SQL server for select statements needed to access data from different schemas containing data stored.
• Customizing and generating multiple TFS reports to serve company needs.
• Worked on improvement of Claims Reimbursement User Interface for a better experience and incorporate changes as per HIPAA guidelines using the gap analysis.
• Explained HIPAA guidelines and workers compensation, claim to the Dev team.
• Worked on the documentation of the screens in Billing Center.
• Wrote SQL scripts for creating performance evaluation reports.
• Used Guidewire for maintaining billing and claims of policy holders and identified gaps in the existing systems by performing GAP Analysis on the As-is business process maps.
• Developed test cases and test plans on the basis of requirements and also did manual testing of the functionality of the application to ensure that the application is able to handle a lot of data.
• Used UML to create use case diagrams, sequence diagrams and activity diagrams.
• Performed Backend testing by using PL/SQL queries to test the integrity of the application.
• Developed flowchart and process diagram using MS Visio.
• Conducted interviews with clients to analyze their data and gather requirements.
• Clarified QA team issues and reviewed test plans and test scripts developed by development team and QA team to make sure all requirements have been covered in scripts and tested properly.
• Was in regular contact with Business partners on the status of issues, action plans and timeframe for resolution throughout the development cycle.
• Identified bugs during the test phase and reported them using HP Quality Center.
• Maintained Traceability Matrix throughout the project.
• Used the Rational Unified Process (RUP) to build the different phases of Software Development Life Cycle (SDLC).

Environment: Windows, Unix, MS Office Suite, MS Visio, UML, SQL, MS SharePoint, JIRA, Agile/Scrum, Informatica, Cognos, Toad, J2EE, WebSphere.

Confidential, CA

Business Analyst

Responsibilities:

• Met with users to generate and review business use cases. Assessed the status of the organization to determine the scope of the validation process.
• Prepared requirements document for Commercial Auto, Inland Marine, Crime, Worker’s Compensation, Umbrella, Business Owners Policy, Commercial Output Policy, and Commercial Property Package.
• Also, responsible for managing communication and expectations of system vendor, the former parent company IT and business departments, and Allied Worlds various business units (underwriting, claims, reinsurance, actuary, accounting, and IT)
• Created the configuration document for custom setup for various user groups such as HR, marketing, R&D & sales, research analyst & investigators.
• Tested HIPAA Gateway Application Interface for all inbound and outbound messages (Healthcare Eligibility 270 and 271, Healthcare Claim Status request 276 and 277, Healthcare Claim 837 and 835)
• Worked with the compliance group to make sure that the electronic data was CFR part 11 compliant.
• Gathered requirements by using interviews, requirement workshops and brainstorming sessions.
• Reviewed the requirements for calibration, maintenance and cleaning developed as draft procedures and finally wrote Standard Operational Procedures (SOPs)
• Acted as a liaison between business staff and technical staff to articulate needs, issues and concerns as per GLP in Lab Ware LIMS & Pre-Clinical Phases (electronic laboratory notebook) & data migration issues.
• Designed and developed project document templates based on SDLC methodology
• Documented all aspects of the computer system validation lifecycle, in accordance with FDA regulation which includes validation plan and protocol, Installation Qualification (IQ), Operational Qualification (OQ) and specification performance
• Proficient with Test Management tools such as ALM/Quality Center, Site Admin, Test Director and Test Brix (In house Test Management Tool) and Defect Management tool Jira
• Worked in Healthcare HIPAA ICD 9-CM to ICD 10-CM rule set migration.
• Responsible for analyzing the current system and followed the development of a J2EE based application through various iterations of all phases of the Rational Unified Process (RUP).
• Mentored and Knowledge transfer on how to create and implement test assets in RQM - Test Plan, Test Case, Test Scripts, Test Execution Records, Test suites, how to execute test and report on the test result using RQM Reports.
• Prepared Logical/Business Process and Data Models that contained set of diagrams and supporting documents containing the essential business elements from conceptual to procedural level.
• Validate test plans/scripts and perform final reviews of test results.
• Used use case diagram during analysis to capture requirements. Conducted acceptance tests to verify that the validation effort was complete
• Developed UAT Test Plan, Test Strategy, Test Cases, Test Criteria or Test Condition, Test Scripts and performed User Acceptance Testing along with the Business Users.
• Developed strategies with Quality Assurance group to implement Test Cases in Mercury Test Director for stress testing and UAT (User Acceptance Testing).

Environment: Rational Rose, UML, Java, RUP, Windows XP, Rational RequisitePro, Microsoft Office tools, MS Project, SQL

Confidential

Business Analyst

Responsibilities:

• Elicited and gathered user and business requirements through open ended discussions, brainstorming and prototyping.
• Utilized Rational Unified Process (RUP) to configure and develop process, standards and procedures.
• Performed GAP analysis to compare the existing system with the proposed system and documented new requirements and features.
• Developed Business Requirement Document and Use Cases Specification/Document for various Use Cases.
• Responsible for converting the business requirements into functional and non-Functional requirements.
• Conducted JAD sessions for communicating with the all Project directors and stakeholders and created process Workflows, Functional Specifications and project initiation artifacts.
• Scheduled meetings with developers, System Analysts and testers to collaborate resource allocation and project completion.
• Created and managed project templates, use case templates, requirement types and tractability matrix in Requisite Pro.
• Analyze Risks, documented Risk Logs and created Requirement Traceability Matrix (RTM) as a roadmap for the 'TO BE' system.
• Identified Use Cases from the requirements. Created Use Cases Diagrams, Activity Diagrams/State Chart Diagrams, and Sequence Diagrams, based on UML Methodology using Rational Rose and MS Visio.
• Monitor version control and defect tracking activities using Rational Clear Case and Rational Clear Quest.
• Created Mock-up forms in HTML for better visualization and understanding of the software solution.
• Assisted quality assurance team in testing different releases and in designing test plans and test cases. Performed User Acceptance Testing (UAT).

Environment: Mainframe, Oracle 9i, SQL, Microsoft Office suite, Rational Clear Quest, Rational Requisite Pro, DOORS, Test Director, MS Visio, Rational Unified Process (RUP), UML.