SUMMARY:

• Experienced professional with strong knowledge of the medical and insurance fields, including but not limited to customer service, claims processing, medical transcription and practice management.
• Nearly 7 years of experience leading projects across multiple verticals. I have cultivated expertise in Agile Leadership and Project Management.
• Worked in all phases of project life cycle and in different SDLC methodologies such as Waterfall and Agile.
• HealthCare management experience in projects involving the customization, design, development, implementation, and testing of automated systems to support the Medical Management Information System (MMIS) as well as day - to-day business operations.
• Experience with HIPAA EDI Transactions 837, 835, 820, 276, 277, 278 code sets testing in Health Insurance.
• Experience with EDI HIPAA Project to convert EDI X12 Healthcare HIPAA 4010 transactions into HIPAA 5010 Complaint transactions.
• Experience in analyzing requirements, 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.
• Experience in conducting GAP analysis, User Acceptance Testing (UAT), SWOT analysis, Cost benefit analysis and ROI analysis and working with different software methodologies like Agile, Waterfall.
• Supporting all the documents with UML Diagrams such as Use Case Diagrams, Class Diagrams, Activity Diagrams, Data Flow Diagrams, Sequence Diagrams, Process Flows (Business and System) using UML modeling tools such as MS Visio and Rational Rose.
• Experience in data warehouses and data marts for business intelligence reporting and data mining along with developing and documenting process flows for business processes.
• Organized many Joint Application Development (JAD) sessions and Joint Requirement Planning sessions (JRP), walkthrough, Interviews, Workshops and Rapid Application Development (RAD) sessions with end-user/clients/stake holders and the IT group.
• Teaming with all stakeholders to build 'as-is' and 'to-be' business process flow documentation using Microsoft Visio, as well as conduct gap/deficiency identification and analysis, including cross functional members.
• Knowledge of healthcare standard Health Level Seven (HL7).
• Lead fit/gap sessions to map requirements to standard Business Application Suite features and functions and experience on SQL queries to check the integrity of data and Facilitating Project Discovery, Sprint Backlog and Sprint Planning meetings
• Extensive experience in designing of Workflow Alerts and Actions, Workflow Approval, Profiles, Role based hierarchy, Sharing Rules, Validation Rules, Case Management, Custom Reports, Report Folders, Report Extractions to various formats, Dashboards, and Email generation according to application requirements.
• Knowledge of Oracle, SharePoint, Visio, IBM Rational Clear Case, Requisite Pro., UML/XML models.
• In depth knowledge in the analysis, design, and re-engineering of system applications and business processes, using structured system analysis methodologies, placement of business controls, diagramming data and process mapping, applying Unified Modeling Language (UML), and implementation of performance measures.
• Experience in system conversions (Mapping) such as HIPAA, ICD-9 codes to ICD-10 & PCS codes and claims processing.
• Strong knowledge of Word, Excel, VLOOKUP, Pivot table generation, Pivot Reporting and Flow Charts Monitored project execution/ change control/ release management.
• Experienced in Preparation of Test plans, Test Strategy Document, Test cases, developing and maintaining Test scripts, Analyzing bugs, Test Summary Report etc.
• Extensively used ETL methodology for supporting data extraction, transformations and loading processing, in corporate-wide-ETL Solutions using Data Stage, Informatica, and Oracle Data Integrator.
• Very Good experience in using HP-Quality Center and testing
• Sound proficiency in analyzing and creating, Use Case Diagrams, Sequence Diagram, Activity Diagram, Data Flow Diagrams, Business Flow Diagrams, Wire Frames and Mock-ups using MS Visio and Rational Rose to communicate business and functional requirements to clients and developers.
• Managed platform deliverables including Study & DBTR estimates, Master Test Plans, Detailed Test Plan, Quality Assurance reports, Static Testing reports, RAID logs and Daily Status Reports.
• Experienced in preparing test data and validating data using SQL Queries.
• Experience in Data mapping, Data mining, Data warehouse concepts, OLAP and OLTP Technologies.
• Experience in Rational Rose, Clear Case, Requisite Pro, Clear Quest and MS Visio.

TECHNICAL SKILLS:

Documentation: BRD, FSD, UIS, SRS, RSD, UML, Activity & Sequence diagrams, Business Process Flow

Requirement Elicitation: JAD, JRP, stand-up meetings, workshops

Analysis: As-is, To-be, GAP, Traceability and Impact Testing Unit, Regression, Functionality, Integration UAT, Win Runner, Load Runner, Test Director, Quick Test Pro, PR Tracker

Programming Languages: C, JAVA, Oracle

HIPAA: 5010, 4030, 4010, 3060

EDI Transaction Sets: 270, 271, 276, 277, 278, 820, 834, 835, 837, 997

Business Modelling Tools: MS Visio, MS PowerPoint, MS Project, MS Word, MS Excel, MS SharePoint

Methodologies: RUP, Agile, Waterfall, SDLC

Defect tracking: Mercury Quality center, HP Quality center/ ALM and Bugzilla

Database: XML, HTML, SQL, PL/SQL, CRM

PROFESSIONAL EXPERIENCE:

Confidential, San jose,CA

Senior Business Analyst

Responsibilities:

• Understood Current state and future state of the project, performed “As-Is” and “To-Be” processes/GAP analysis.
• End to End project management and business analysis for several modules from inception to delivery.
• Involved in the acquisition process of new infrastructure, establishment of a new service model, and implementation of a new service management system (ServiceNow)
• Worked with internal and external customers to gather the business requirements and transform them into user stories on ServiceNow Agile Development module
• Used ITIL practices to implement ServiceNow applications in phase by phase approach, created SLAs and participated in running SLAs and responsible for closing successfully in ServiceNow
• Developed Service catalog which includes creating new catalog items, designing workflows and execution plans
• Processed Medicaid claims and worked on X12 format of EDI 837 and EDI 835 for Medicaid claims.
• Validated the following: 837 (Health Care Claims or Encounters), 835 (Health Care Claims payment/ Remittance), 270/271 (Eligibility request/Response), 834 (Enrolment/Dis-enrolment to a health plan).
• Involved in EDI automated first-pass claims adjudication, requiring thorough understanding of claims processing, both front and backend operations.
• Collaborated with ServiceNow Team to align the functionality and ease of use of the ServiceNow Service Catalog by undergoing a re-design into the workflow, functionality, and overall usability of the Catalog of services. Results: Intelligent routing, Built-in request approvals, Catalog item KPIs and reporting gauges, Workflow phases that allow for customers to easily view the "stage" of their requests and when it will be fulfilled, and Separate models more specific requests as well as general information requests.
• Actively participated in activities such as CMDB administration, system upgrade and patching, regression testing and releasing of new applications
• Worked on creating Users, roles, groups and load the data to service-now objects using import sets on daily, weekly, monthly on request basis.
• Responsible for creating homepages, including basic reporting and dash board presentation.
• Worked on creating survey questions in ServiceNow using Survey designer.
• Provided training on service-now process, operations, answer questions, resolve issues and capability to all required teams.
• Manage the user story backlog by ensuring that the backlog items are appropriately groomed, prioritized and estimated and that the teamfully understand what needs to be delivered.
• Conducted interviews, meetings and JAD sessions during the process of Requirement Gathering.
• Planned and documented procedures for data processing and prepared data flow diagrams for the application.
• Analyzed and translated business requirements into system specifications utilizing UML and RUP methodology.
• Conducted weekly meetings for deciding the Policies and Procedures to be followed while constructing reporting portals.
• Performed the requirement analysis, impact analysis and documented the requirements.
• Tracking and maintaining release schedule to estimate efforts and aligning stakeholder& expectations with the availability of time and resources for development of features and functionalities promised to business-users.
• Provided thought leadership at bank-sponsored events, industry forums and regional and national treasury conferences.
• Adhered to team Agile development practices, including BDD story writing and Continuous Integration.
• Facilitated daily Scrum Stand-Ups, sprint planning, sprint review, sprint demo.

Confidential, Lansing, MI

Business Analyst

Responsibilities:

• Worked on the procurement module of ServiceNow where the primary responsibilities are to understand the procurement compliance processes for purchase requests, approvals and orders, audit compliance, general ledger coding and then gathering the requirements, BPMN.
• Also worked on the implementation of Incident Management, Problem Management, Change Management, Event Management, CMDB, Reporting, Service Catalog in ServiceNow.
• Involved in Order Management and Inventory Modules.
• Enhancement related to pl/sql and sql for Oracle Clinicals (oracle product used by client for clinical trials)
• Business / Functional Analysis of the Clinical Data Management Applications (EDM, RDC (TAO-Trial Access Online), SMT, I-Review, PRS, IBISecg, DLS, PC Imaging, EmBARC) . The tools help to support the IT part of the Life Sciences (like Clinical Trail and Discovery)
• Led and collaborated with internal/external Subject Matter Experts and business leads to analyze and document Pharmacovigilance business, functional, data, regulatory, and nonfunctional system requirements ensuring timely delivery and quality within budget.
• Testing the New functionality related to OM, Purchasing, Advance Pricing, Inventory.
• Worked on Price Lists, Qualifiers, Modifiers, Pricing Attributes in Advanced Pricing.
• Responsible for requirement gathering, business process flow, business process modeling and business analysis.
• Facilitated JAD sessions with management, users and other stakeholders to define the project and to reduce the time frame required to complete deliverables.
• Created minutes of meetings and published to all stakeholders highlighting discussion points and pending action points.
• Performed as-is analysis, to-be analysis, data Analysis, Gap analysis, competitive analysis, comparative analysis, process flows and business flows.
• Used Jira for writing Epic, user stories with acceptance criteria or user stories with use cases, used Confluence for upload documents.
• Prepared BRD (Business Requirements Document), FRD (Functional Requirements Document) and N-FRD (Non-Functional Requirements Document).
• Effectively managed the hardware and software assets through their lifecycle using the procurement module.
• Managed procurements of complex IT products and services via RFPs, IFBs, RFQs, and single/sole source methods.
• Understand user requirements and translate them to functional requirements/specification and assist end user with Epic request submissions obtaining team approval.
• Worked on backlog grooming items and presented what items can be picked up in next sprint to the squad/scrum master.
• Participated in sprint planning with PM/Dev/QA to conclude the User Story points and the effort estimates.
• Strict adherence to principles of Good Clinical Practice, Good Laboratory Practice and Good Manufacturing Practice and ISO standards. Extensive knowledge of SDLC, clinical research; knowledge and familiarity with 21CFR11 and EDC systems.
• Conducts coverage analysis of clinical research trial procedures to delineate standard of care and research procedures; reaches out to research site to assist in determining charge direction.
• Assists in feasibility review process by gathering information from Recruitment Core, Pharmacy and Finance Core for budgeting purposes.
• Good knowledge on payroll management related queries which include pay check creation, on-cycle and Off-cycle processing, contribution and refund payment to employees, provided data by the clients
• Knowledge on Transforming data of Legacy platforms of ADP to Strategic Platforms -Vantage)
• Created, analyzed and validated different clinical studies data.
• Performed monitoring and analysis systems related events and operations in clinical system.
• Created documentation which allowed dated DB2 tables to be converted into DB2 tables within an upgraded dynamic environment.
• Worked with technical team in delivering the cloud based solutions involving web services, Apache Tomcat, iPad & iPhone Integration (SQLLite, Objective-C, REST API), Oracle E-business and Oracle CRM OnDemand
• Implemented multiple ITSM modules: Incident, Change, Service Request, Asset, configuration, knowledge, problem, release, capacity, availability, and service level management.
• Created reading material for better analysis and explanation of system flows.
• Accurately forecast clinical trial timelines using advanced modeling and simulation techniques .
• Develops process for participation in the reporting and improvement of QCDR measures to fulfill PQRS reporting requirements.
• Reviewed statistical data on HEDIS measures and manages special projects that are related to disease prevention, and quality improvement.
• Collaborate with Clinical and IT staff to support HEDIS business requirements and maintain consistency and integrity of data collection and storage.
• Gathering user requirements and conducting in depth analysis of the same
• Used SQL query to analyze the Pfizer source systems and existing data warehouse data. Prepared data mapping documents to build the new data mart and Tableau reporting.
• Tracking Project Status, milestones and team collaboration in Jive.
• Resolving the complex requirements into simpler fragments and conveying it to the technical team for faster and efficient development.
• Coordinated with Data Analyst, ETL and UI interface Developers and did tasks in construct phase.
• Used ETL to map data and assemble data repository and created data marts.
• Generated and designed reports for HEDIS specifications to analyze complex data through internal databases.
• Reviewed Stored Procedures for reports and wrote test queries against the source system (SQL Server) to match the results with the actual report against the Data mart (Oracle).
• Conducts coverage analysis of clinical research trial procedures to delineate standard of care and research procedures; reaches out to research site to assist in determining charge direction.
• Created dynamic reporting using MS Excel formulas, macros and Visual Basic for Applications (VBA).
• Created Batch files to execute the multi transaction data feed files into CTMS.
• Clinical Data Exchange Bulk Migration: EIM Imports/Updates and SQL's Procedures to load the Historical data in between Staging/Legacy and CTMS systems.
• Participating in testing process and coordinating with QA team in each test cycle.
• Create and run analytical reports as needed using tools such as Reporting Workbench, Epic Cubes, BI Portal and other reporting tools.
• Assist in the co-ordination and management of various activities associated with clinical trial planning and initiation including clinical trial budget and agreement review, third-party vendors identification, and site/study feasibility assessment; among other responsibilities.
• Involved in Project co-ordination, Onshore/Offshore Co-ordination, optimal service delivery and Knowledge management.
• Performed UAT and participated in writing test plans, and developed different testing strategies like black box testing and load testing.
• Staff Augmentation and mentor new team members.

Environment: Agile/Scrum, Guide wire Policy Center, Claim Center, DB2, ETL Informatica, SQL Server, Microsoft Visio, HP Service Manager, procurements, Oracle EBS 11.5.10 (Oracle Inventory, Oracle Supply Chain, Advance Pricing), CRM, DML,MS Office, HTML, HEDIS/STARS, CSS, VBA, Informatica Power Center 9.1/8.6, Rational RequisitePro, Java, .NET, Business Objects, ServiceNow .

Confidential, Atlanta, GA

Healthcare Business Analyst

Responsibilities:

• Extensively involved in implementation of effective requirements practices, including gathering User Requirements, and analyzing User Requirement Document (URD), and functional specification document (FSD), use and continuous improvement of a requirement gathering processes.
• Applied RUP methodology with its various workflows, artifacts and activities to manage life cycle from inspection to transition phase.
• Acted as liaison between external clients and SMEs to generate and standardize product requirements specification documents such as URS/FRS/Use Cases.
• Employed UML methodology in creating UML Diagrams such as Use Cases, Sequence
• Diagrams, State Diagrams, Activity Diagrams and business process and workflows.
• Involved in implementing Six Sigma practices to systematically improve processes and standards and by eliminating defects
• Coordination / Support for HL7 Interface testing (ADT Messaging)
• Involved in HIPAA 5010 gap analysis of ANSI X12 4010 and ICD 10 initiatives.
• Coordinated JAD sessions with all the stakeholders to understand the impact of HIPAA 5010 on the existing system.
• Developed and updated HL7 interfaces for HIS and ancillary apps and involved in source mappings and translation tables. Supported EPIC message processing with Record Viewer functions.
• Assisted JAD sessions to identify the business flows and determine whether any current or proposed systems are impacted by the EDI X12 Transaction, Code set and Identifier aspects of HIPAA.
• Involved in GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims. Worked on EDI transactions: 270, 271, 835, and 837 to identify key data set elements for designated record set.
• Performed AS-IS and TO-BE analysis for EDIFECS Standards - HIPAA 5010 Database Setup for new version releases. Documented proposed changes and coordinated development, testing and production release environments, including end-to-end testing.
• Used edifecs to quickly perform gap analysis and automate migration between guideline versions.
• Planned, developed, scheduled and conducted systems acceptability tests of modernization and production systems; including Mainframe and web applications
• Involved in testing the HL7 Version 2.5.1 to receive messages from HL7 version 2.3.
• Gathered requirements for "Front End" and for "Core Adjudication System" by conducting meetings and brainstorming sessions with end users and Subject Matter Experts (SMEs) and documented them using Requirement Traceability Matrix and later exporting them to HP Quality Center.
• Involved in designing & determined 3-tier architecture for the claim processing system.
• Assisted team lead in developing Requirements Traceability Matrix (RTM) to trace the relationship between business and functional requirements to test cases.
• Prepared and executed different Test Cases and Test Scripts.
• Involved in conducting Functionality testing, Integration testing, Regression testing and User Acceptance testing (UAT). Provided analysis and insight to QA Team in defects and bugs tracking.
• Gathered requirements for ICD 10 transition.
• Maintained and controlled track of stakeholders' requests for enhancements and changes using Rational Clear Quest also shared knowledge on SAAS in brainstorming storming session.
• Identified and documented issues, risks, gaps and their impact to the project life cycle.
• Used JIRA for project tracking, bug tracking and reporting.
• Create wireframes using Axure RP Pro based on collaboration with use cases and Visio flows
• Exposed to using ICD 9/ICD 10/ANSI/HL7 coding standards in Medicare and Medicaid domains of the healthcare systems and industry for both inpatients, outpatients, Reimbursement methodology.
• Streamlined Claims (837 EDI X12) Migration project by gathering functional specifications in Edifecs
• Tracked the change requests.

Environment: MS Project, MS Visio, MS Word, MS Excel, MS PowerPoint, Mainframes, JIRA, COBOL, Rational Requisite Pro, Rational Rose, Rational Clear Case, Oracle, SQL, Toad, Java, Windows XP, HP Quality Center, UML, HIPAA

Confidential, Lansing, MI

Business Analyst

Responsibilities:

• Developed data flow, work flow, process flow and entity relationship diagrams in MS Visio, and analyzed them to create "AS IS" and "TO BE" scenarios
• Verified the functional aspect as per the business process and validated the interfaces with the other systems and data conversion from the existing systems
• Experience in EDI automated first-pass claim adjudication, requiring thorough understanding of claim processing, both front and backend operations.
• Interacted closely with QA team in different phases of testing such as System testing, Functional testing, Regression testing and Integration testing for Quality Analysis using Quality Center and resolving the issue assigned on JIRA.
• Validated 837 (Health Care Claims or Encounters), 835 (Health Care Claims payment/ Remittance), 270/271 (Eligibility request/Response) and 834 (Enrolment/ Dis-enrolment to a health plan)
• Assisted JAD sessions to identify the business flows and determine whether any current or proposed systems are impacted by the EDI X12 Transaction, Code set and Identifier aspects of HIPAA.
• Acted as a liaison between business area subject matter experts (SMEs) & developed teem throughout all the phases of SDLC, starting from inspection to transition phase of the life cycle.
• The process involved performing gap analysis, compiling the results, impact assessment and designing new screens for portal
• Run and analyze weekly and bi-weekly patients' encounter data and present to department Heads for data quality management and regulatory body (such as Joint Commissions) Standard Compliance.
• Develop business process models for projects and demonstrations at the Centers for Medicare and Medicaid (CMS) using business process model notation and enterprise architecture.
• Worked extensively with developing business rules engine enabling the business rules such as referral, prior authorization, eligibility, claims processing and billing essential.
• Utilized Agile Software Methodology using Scrum framework. Actively participated in creating the user stories and prioritizing user stories along with tracking of burn up, burn down charts to estimate sprint delivery.
• Conducted formal interviews and JAD sessions with business users and SME's
• Designed and developed use cases diagrams activity diagrams and sequence diagrams
• Also performed regression testing and created test scenarios for User Acceptance Testing(UAT)
• Performed Ad-hoc SQL queries for the information to be retrieved and asked by the members of the team
• Created Data Flow Diagrams (DFDs), ER diagrams for data modeling and web-page mock-ups using MS Visio for acceptance from end users
• Assisted in Change Management and Release Management by requesting, implementing and evaluating changes to the system using Rational Requisite Pro and recording defects using Quality Center.
• Reviewed the Joint Requirement Documents (JRD) with the cross functional team to analyse the High-Level Requirements
• Analyzed, manipulated and updated the database using SQL
• Performed test cases for multiple transactions including 837, 835, 277, 270, 271 transactions
• Created various artifacts such as BRD, Functional requirement documents(FRD), Requirements traceability matrix (RTM)

Environment: JAD, Microsoft office, rational clear quest, quality center, rational requisite pro, UML methodology, oracle, database

Confidential

Healthcare Business Analyst

Responsibilities:

• Played an active and lead role in gathering, analyzing, and writing business requirements.
• Project was implemented in phases, enabling system to deliver as many business requirements as early as possible.
• Involved in Requirement Scoping and analysis of high priority requirements for implementation.
• Worked on Transaction-835 claims payments and remittance advice, which deals the payment from payer to provider.
• Involved in HIPAA EDI transactions such as 270, 271, 837 (P, D, I), 276, 277, 834, 820, 278, 999/TA1, and 277 CA.
• Evaluated Medicare requirements and benefits in Medicare Health Plans for member enrollment and management.
• Coordinated, implemented and provided on-going support of the Quality Performer as outlined in the Specifications Manual for Well Care Inpatient Quality Measures Centers for Medicare & Medicaid Services (CMS).
• Used HP Quality Center for writing Test plans and Test Cases.
• Worked on documenting business rules to be defined in the business rules management engine (IBM ODM).
• Participated in requirements meetings, writing requirements in CaliberRM, converting requirements from Caliber RM to HP Quality Center.
• Working knowledge of implementing software development projects using methodologies such as Waterfall, RUP, and Agile Scrum.
• Used HIPAA guidelines and regulations to keep track of Healthcare transactions like Eligibility Request/ Response, Request and Response for Claims Status, Prior Authorization, Claims Vision and Claims Payment.
• Worked closely with business team, and identified, analyzed the core requirements and key features of the ongoing project. Extracted, discussed, and refined business requirements and developed comprehensive business requirement document (BRD).
• Developed Software Requirement Specification (SRS) document using Visio and MS Office.
• Loaded the defects on to HP Quality Center and maintained a track record of the updates on the defects from the development team.
• Executed Test Cases Manually, once the application is stable and documented the successful or unsuccessful completion of each test case in HP Quality Center (QC) for End-to-End Scenario based testing.
• Worked on Agile SDLC during the project phase, performed the role of Product Owner and Team member in Scrum Meetings.
• Participated in agile process - planned iterations, created tasks, assigned tasks to quality assurance team based on the priorities and estimated capabilities of quality assurance team for every iteration.
• Involved in Testing Out-Bound Transactions (835 Health care claims Payment, 277 Claim Status Response).
• Consulted with healthcare third-party Administrator Company to develop conversion specifications for member, enrollment, and authorizations.
• Involved in Scrum development process and prepared Sprint burn down chart, product catalog and sprint backlog contain Business Requirements and supporting documents that contain the essential business elements and definitions as well as the tasks to be completed.
• Responded to billing inquiries from patients and payers.
• Analyzed and studied the technical, structural and data content changes for EDI transaction sets 834 (Enrollment and Maintenance), 837 (Professional, Institutional and Dental Claims) and 835 (Claim Payment/ Advice).

Environment: UML, SQL, Microsoft Office, HP, Agile, MS SharePoint, HTML, XML, DB2