PROFESSIONAL SUMMARY:

• Extensive knowledge, expertise and involvement in various phases of Software Development Life Cycle (SDLC) in Waterfall, Agile - Scrum, Scrum-Waterfall Hybrid, SAFE, Agile-Extreme Programming methodologies.
• HealthCare domain experience in projects involving the customization, design, development, implementation, and testing of automated systems to support the Automated Claims Processing 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. Good understanding of Professional Billing/CPT codes and Institutional Billing/HCPCS Codes, Diagnosis Codes, Taxonomy Codes etc. Well versed in the compliances and regulations like CMS HIPAA, HL7, FDA etc.
• Worked on project to convert EDI X12 Healthcare HIPAA 4010 transactions into HIPAA 5010 Complaint transactions.
• Excellent Knowledge in Electronic Medical Record (EMR)/Electronic Health Records (EHR) modules and process flow and knowledge of Affordable Care Act, Medicare and Medicaid program, Claims Processing and Adjudication.
• Strong knowledge of Managed Care Plans like HMO (Health Maintenance Organizations), PPO (Prefer Provider Organization), POS (Point of Service), Medicare (A, B, C, D), Medicaid and Claim Processing concepts like Bundling, Unbundling, Pricing Edits, Business Edits etc. Well versed in Claim Submission Terminology.
• Proven experience in conducting GAP Analysis, Risk Analysis, Impact Analysis, Root Cause Analysis.
• Gathered SMART (Specific, Measurable, Attainable, Realistic and Timely) requirements and transforming them into Business Requirements documents (BRD), Use-Case Specifications and System Requirements Specifications
• Proficient in working with diverse users and stakeholders to elicit, analyze, communicate, gather and document requirements using techniques such as Interviews, JAD Sessions/Requirement Workshops, Brainstorming sessions, Observations (Job Shadowing), existing system Document Analysis, Prototyping, Questionnaires, Focus Groups etc.
• 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.
• Cooperated with the Project Manager to create Project Charter, Work Breakdown Structures and Project Plans and acted as a bridge between the business and IT, translating customer needs into a vision of a fully functional product.
• Experienced in collaborating with Product Owner to write User Stories, Acceptance Criteria, Definition of Done (DOD), Definition of Ready, M inimum viable product (MVP) . Also assisted PO in gathering the stakeholder feedback.
• Participated in all the Scrum Ceremonies like Sprit Planning, Daily Scrum Meeting, Review Meeting, Retrospective.
• Facilitating Change Management and Impact Analysis at various stages of the project Life Cycle by streamlining communication among the project stakeholders and interacting with Change Control Board. Also experienced in documenting, managing, facilitating the Requirement Changes in the Scrum environments using tools like Rally, JIRA.
• Well acquainted with Business Process Management and Unified Modeling Language (UML) diagrams including Use Cases, Activity Charts, Sequence Diagrams, Data Flow Diagrams, and ER Diagrams using the tools like MS Visio.
• Proficient in drafting Wireframes, Prototypes, and Mockups using tools like Balsamiq, Pega UI Designer, InVision.
• Extensive experience in breaking-down of epics into User Stories (INVEST criteria), then estimating using techniques like Poker Planning, Bucket Sizing and prioritizing user stories using various techniques like MoSCoW and Kano Model.
• Good Knowledge of Data Warehousing concepts like Data Mapping, Data profiling, Data Mining. Extensively involved in creating Entity Relationship diagrams (ER Diagrams). Performed Conceptual and Logical Data Modeling.
• Extensively involved in ETL methodology for supporting data extraction, transformations and loading, in corporate-wide-ETL Solutions using Data Stage and Informatica. Also well versed in reporting and BI tools like Tableau, Power BI
• Performed SQL Queries to run complex operations like joins to verify the authenticity of the data and exposer to various database platforms such as Oracle and Microsoft SQL Server.
• Knowledge of XML, JSON, and loosely coupled services like REST, SOAP, Service Oriented Architecture, Microservices.
• Experienced in documenting and testing the RestFul and SOAP APIs using tools like Postman, SOAP UI and Swagger.
• Extensively involved with QA team to develop the Test Plan, Test Scenarios, Test Cases etc. and worked with tools like HP ALM, Selenium, Cucumber etc.
• Experience supervising Black-box Testing, Functionality Testing, System Testing, Integration Testing, Regression Testing, User Acceptance Testing (UAT), Load/Stress Testing, and Performance Testing.
• Expert in Tracking and managing the requirements using Requirement Traceability Matrix (RTM) that links and controls numerous artifact's produced by several teams across the deliverables of the Project.
• A proactive and dedicated team player, with proven track record in producing high quality work under tight deadlines and multi-tasking to meet business goals. Experience in scheduling meetings, negotiating and co-ordination with Developers, Application Architects, Subject Matter Experts, business users and senior executives.

TECHNICAL SKILLS:

Project Management: Rally, JIRA, HP ALM, MS Project, MS SharePoint.

Database and Warehousing: Oracle DB, DB2, MS Access, SQL Server, Informatica, AWS Athena

Modeling and Prototyping Tools: MS Visio, Balsamiq, Lucid Chart, Pega UI Designer, InVision

Business Intelligence and Reporting Tools: Tableau, Microsoft Power BI.

Issue Tracking Tools: JIRA, HP ALM

Testing Tools: Selenium, Cucumber, Load Runner, Postman, SOAP UI

Web Development and APIs: Java, CSS, JS, HTML, XML, REST, SOAP

PROFESSIONAL EXPERIENCE:

Confidential, Brentwood, TN

Sr. Business System Analyst

Responsibilities:

• Performed extensive GAP analysis by identifying AS-IS and TO-BE process models and process flows.
• Identified the business users who will use the new application. Summarized the primary job responsibility for each user. Also identified client business needs, problems, and desired outcomes and established a common understanding of the business problems and possible solutions.
• Responsible for eliciting, analyzing, document, business requirements, functional and non-functional specifications based on DCO sessions with business unit stakeholders and technical team members, SMEs.
• Followed Direct Capture of Objectives (DCO) process to enter business objectives, requirements and associated specifications directly into Pega (DCO Repository) so that all business and technical team members have access to the same information.
• Worked with System Architects, and other project members collaboratively and iteratively to create the content in the artifacts like Application Profile, Application Specifications, Application Requirements.
• Used Agile Workbench to directly capture user stories and used JIRA for issue tracking and generated reports to analyze the performance of the project/team.
• Assisted product owner in prioritization of Product Backlog Items (PBIs) using planning poker including the process of breaking down EPICS into user stories using INVEST criteria. Also, assisted Product Owner in define Acceptance Criteria for User Stories, DOD, DOR.
• Developed Use Cases, Sequence Diagrams and Activity Diagrams based on UML Methodology using MS Visio.
• Involved in creation of Mock-Ups and Wireframes of user interface using Pega’s UI Designer for client verification.
• Involved in designing, documenting and determined n-tier architecture for the claim processing system.
• Worked on HIPAA Standard/EDI standard transactions: 270, 271, 276, 277, 278, 834, 835, and 837 (P.I.D), 997 and 999 to identify key data objects.
• Worked on Pega Frameworks supporting healthcare industry especially with PRPC, Pega Foundation for Healthcare, Claims Workstation+, and Claims Repair.
• Involved in modelling the integrations of Pega with External Data Sources and Services with PRPC Connectors and Services. Documented the integration needs of the system and identified the integration points.
• Used Connect SQL rules to run SQL statements like joins to verify the authenticity of the data.
• Knowledge of a variety of industry-standard protocols like HTTP, SOAP, REST involved in integrating the Pega with Other Systems.
• Involved in designing an Objected Oriented Security model for different Access Groups and assigned different roles to the Users.
• Documented and Configured the Service Level Agreements requirements. Created Service Level rules to address the urgency of the Work Item/Case and used Preconfigured Escalation Activities.
• Defined the Correspondence and Notification needs of the system and identified the triggers for the correspondence. Created simple correspondence rules for the Notifications.
• Used Report Browser in PRPC to generate Standard Pega Process Reports like Analyze Performance, Analyze Quality, Case matrices, Service Level Performance etc. and Claims Processing Reports like Claims Inventory Aging, Aging Inventory by Line of Business, Aging Inventory by Workbasket, Operator Productivity etc.
• Developed Requirements Traceability Matrix (RTM) to trace the relationship between business and functional requirements to test cases.
• Assisted QA team with Test Planning, Writing the test cased and Test Scenarios, Defect Tracking and Test Results.
• Involved in system integration testing and API testing and documentation using the API testing tool, SOAP UI.
• Involved in developing, executing and managing User Acceptance Testing (UAT).

Environment: Agile-Scrum, MS Visio, JIRA, Selenium, SOAP UI, XML, PRPC, Agile Workbench, Pega’s UI Designer, Pega 7, Pega Health Care Foundation v7.2, Claim Repair v7.2, Claims Workstation+ 7.2, My SQL.

Confidential, Phoenix, AZ

Sr. Business System Analyst

Responsibilities:

• Conducted thorough GAP Analysis to derive the functionality of the existing legacy applications being used and make viable recommendations to carry out the upgrades.
• Worked in an Agile environment with daily scrum meetings, grooming sessions, planning and sprint cycles.
• Gathered business requirements by interviewing the users, subject matter experts, asking detailed questions and carefully recording the requirements in a format that can be reviewed and understood by both business and technical teams.
• Worked closely with Product Owner and SMEs in understanding existing system functionalities and to create Project Charter document.
• Created the user stories and assisted Product Owner in defining the acceptance criteria. Assisted the PO, Scrum Master and team to break down Epics into User Stories using MoSCoW technique.
• Used JIRA for the issue tracking, bug and defect monitoring. Also used confluence for the sharing various project related documents.
• Developed Use Cases, flow diagram, sequence diagram, using UML diagrams in MS Visio.
• Designed UI screen mockups and prototypes for the proposed system, using Balsamiq, to provide a user-friendly front end for the proposed system.
• Worked on identifying data sources and involved in data cleansing and profiling to avoid data duplication and data redundancy. Performed gap analysis to consolidate data from multiple sources to fill the target data models.
• Actively involved in creating Data Mapping documents to define source to target mapping.
• Defined Conceptual and Logical Data Models, E-R Diagrams, and helped in creating data dictionaries.
• Assisted in developing the dimensional models and defining Fact Tables, Dimensions, etc. Also, helped in defining OLAP cube dimensions and performed various OLAP operations like Roll Up, Drill Down, Slicing, Dicing etc.
• Involved in extraction, transformation and loading of data using AWS Glue from identified data sources to S3 bucket and ultimately to Amazon Redshift.
• Verified the data extracted and record counts in the database with SQL Queries using AWS Athena.
• Involved in preparing testing schedule and coordinate the testing activities in HP ALM for entire Test Life Cycle.
• Involved in REST API testing and documentation using Postman.

Environment: Agile-Scrum, JIRA, Confluence, Amazon Web Services, HP ALM, AWS Athena, AWS Glue, Amazon EC2, Amazon VPC, Amazon EBS, Amazon S3, Amazon CloudSearch, Amazon CloudWatch, Amazon ElastiCache, Swagger, Postman, MS Visio, Balsamiq.

Confidential- Columbia, SC

Sr. Business Analyst

Responsibilities:

• Acted as the primary Intermediary between the Subject Matter Experts, business user to identify the business needs, Business Rules, Business Processes & Interface Specifications
• Elicited, analyzed, documented, business requirements, functional and non-functional specifications based on inputs from JAD sessions, personal interviews with business unit stakeholders and technical team, SMEs
• Assisted the PO and team with the User Story writing. Also used techniques like Poker Planning for estimation and MoSCoW technique for prioritization.
• Used Rally Software to log the User Stories, tasks, defects, bugs and monitor the project progress.
• Used SharePoint to share the relevant documents related to the project with the stakeholders.
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, using Lucid Chart and set the technical foundation for the system.
• Created Wireframes and Mockups for the proposed UI of the system using Balsamiq, to gather the User feedback.
• Identified different data sources to be integrated with the app for it to provide desired functionality.
• Involved in the integration testing, documentation and testing of SOAP APIs using SOAP UI. Also gathered the integration needs of the system and identified the integration points.
• Implemented SQL queries for the operations like Joins to facilitate QA testing and report / data validation.
• Worked with quality control teams to develop Test Plans, Test Cases and involved in the test execution activities in Selenium.
• Organized and Performed UI/GUI Testing, User Acceptance Testing (UAT) to confirm that App meets the Business needs.
• Drafted Requirements Traceability Matrix (RTM) to trace back test cases to the requirements.

Environment: Agile-Scrum, JavaScript, Selenium, My-SQL, SOAP UI, Rally, SharePoint, Lucid Charts, Balsamiq4.

Confidential, Minneapolis, MN

Business System Analyst

Responsibilities:

• Conducted formal interviews, Live Meetings and JAD sessions with business users Subject Matter Experts (SME's) to gather the requirements.
• Prepared the Business Requirement Document (BRD) to in corporate the high-level requirements and System Requirements Specification (SRS) for functional, non-functional, data and GUI requirements.
• Performed GAP analysis to analyze AS-IS and TO-BE state of the system and assisted in developed process models and systems integration structure.
• Worked with the ICD-10 team to created organization's ICD-10 map by mapping ICD-9 to ICD-10 Diagnosis Codes.
• Conducted Fields Mapping by explaining each column name in the backend database tables.
• Designed and developed Use Cases, Activity Diagrams and Sequence Diagrams using MS Visio.
• Documented, organized and tracked the requirements using Rational Requisite Pro.
• Incorporated and implemented all the HIPAA standards, Electronic Data Interchange (EDI), transaction syntax like ANSI X12, ICD-9, ICD-10 coding.
• Gap Analysis: Analyzed the client's applications to determine the impact of the HIPAA final rule on EDI Transaction Set and Code List implementation and defined the changes to bring the affected systems into HIPAA compliance.
• Also developed Requirements Traceability Matrix (RTM) mapping UAT plan and BRD.
• Developed Functional Testing Approach for ICD-10 Remediation and included in UAT Plan.
• Worked on different EDI scenarios for batch processing and ensured day-to-day EDI transmission, Reject tracking and Reconciliation.
• Performed SQL queries to test the database for records that detect and submit functional acknowledgement and remittance advice in the claims application. Worked on ODBC compliant databases for HL7 data transfer.
• Involved in Smoke Testing of the new ICD-10 UAT region and recorded all the testing results in RTM.
• Involved in System testing, Regression testing and UAT for several claim types and test scenarios.
• Developed (UAT) User Acceptance Testing plan to guide a select group of key end-users in testing the user interface and functionality of the application

Environment: Agile Scrum-Waterfall Hybrid, MS Word, MS Excel, MS Visio, MS Project, Jira, Confluence, HPALM.

Confidential

Jr. Business System Analyst

Responsibilities:

• Implemented SDLC which included Requirements, Specifications, Design, Analysis and Testing
• Elicited requirements involving vast set of interactions with various stakeholders using JAD Sessions, Structured Interviews, Process Analysis and Business Rules Analysis and then convert these requirements into BRD
• Involved in identification of different types of Data Sources. Performed Gap analysis on the multiple sources to fill the target data model.
• Created UML diagrams like activity diagrams, sequence diagrams, Use Cases etc. using MS Visio.
• Created Conceptual models, assisted in defining ER Diagrams and relationships between the different entities.
• Created the data mapping document to map source to the target.
• Identified the different Access Groups and Users and documented different UI Portal requirements. Also Drafted the End-User forms.
• Assisted in creation the dimensional models, defined Fact tables, Dimensions and Schema.
• Involved in defining the dimensions of the OLAP cubes and performed different OLAP operations.
• Responsibilities include analyzing and testing the user interface and constantly redesigning the system to increase its user friendliness for the clients.
• Implemented SQL queries for complex operations like joins and gathered the reporting requirements for the different Access Groups.
• Identified the integration needs of the system and involved in the integration testing and API testing.
• Participated in the development and preparation of the Test Plan, Test Cases with the testing team as well as ensuring testability, reliability, usability, maintainability and performance of the application.
• Managed test cases and logged defects using HP QC.
• Planned and Conducted the User Acceptance Test to verify that system meets the Business Needs.

Environment: Waterfall, Microsoft Visio, Informatica, HP Quality Center, MS Project, SharePoint, My SQL, Tableau.

Confidential

QA/Tester

Responsibilities:

• Work closely with the Functional Team and Development Team in understanding the functionality and the design documents of the Application.
• Involved in creating test scripts, executing tests and tracking defects.
• Involved in developing test cases for smoke, integration, system and regression testing.
• Involved in the creation and design of Test Data for both Front end and Back end testing.
• Create, Review and Execute Test cases and manage/track defects in the HP QC.
• Participate in Design Phase along with the Business Stakeholders and Developers.
• Attend daily and weekly project and release meetings for status progress updates.
• Created Knowledge manuals, Checklists and other documentation.

Environment: Waterfall, MVC, HP Quality Center, Firebug, Windows. MS Word, MS Excel.