PROFESSIONAL SUMMARY:

• 5+ years of experience in Business Requirements Modeling, Business Process Analysis, and Business Process Reengineering, providing solutions to business processes in diverse domains of Insurance, Healthcare, and IT.
• Certified SCRUM Master with experience working in agile SCRUM environment with diverse cross functional teams.
• Experience working with managed care plans, Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Point of Service (POS) plans, Coordination of Benefits (COB), Explanation of Benefits (EOB).
• Experience in configuration of claims processing applications, claim adjudication process, claims management process, real time claims adjudication, Electronic Medical Records / Electronic Health Records (EMR/EHR) and Medicaid Management Information System (MMIS), and Medicaid Information Technology System (MITS).
• Good knowledge of COBRA insurance, claim submission process for CMS - 1500 (HCFA-1500) and UB-04 claim forms.
• Have knowledge of HL7 Messaging protocols, HIPAA transaction and code set standards, electronic data interchange (EDI) standards like X12 837, 270, 271, 276, 277, 278, 835, 275 and knowledge of claims encounters process.
• Worked on HIPAA 4010 and ICD 9 systems. Possess implementation knowledge of HIPAA 5010 and ICD -10 initiatives.
• Experience with health care systems: FACETS, Medicare Part A, B, C, D, Medicaid systems, and validating General Equivalency Mappings (GEMs), Technical Report Type 3 (TR3) Implementation Guide, and Companion Guide.
• Experience in SDLC, Agile, Waterfall, Rational Unified Process, and SCRUM software development methodologies.
• Proficient at coordinating with stakeholders, vendors, Subject Matter Experts (SMEs), Project Manager (PM) and end users and elicitation of requirements through Joint Application Design (JAD) sessions, Brain storming sessions, interviews, Surveys and questionnaires, prototyping, benchmarking, Requirements workshops, focus groups, document analysis, Joint Application Requirement (JAR) sessions and Rapid Application Development (RAD).
• Experienced in creating workflow analysis and design, Process re-engineering, process remodeling, Object Modeling Technique (OMT), Object Oriented Analysis (OOA), Unified Modeling Language (UML) diagrams like activity diagrams, sequence diagrams and use case diagrams through MS Visio, What-IF scenario analysis (WISA), To- Be Scenario Analysis, Gap Analysis, User Interface (UI) design, User Experience design (UX), prototypes and wireframes.
• Proficient in creating and managing Use Cases, Test cases, Test plans, Test summary reports, and Test scripts.
• Knowledge about different types of testing like Black Box Testing, White Box Testing, System Integration Testing, Alpha Testing, Beta Testing, Stress Testing, Static Testing, Dynamic Testing, Load Testing, and Regression Testing.
• Skilled at performing User Acceptance Testing (UAT), handling Change Request, and Configuration management.
• Strong knowledge of creating conceptual data models, ER diagrams, data mapping, data profiling, data verification, data integrity, ETL process, data normalization, data dictionary, SQL queries for data analysis and data validation.
• Have good understanding of Service Oriented Architecture (SOA), client-side validation, server-side validation, HTML, CSS, DOM, SAX, XML, XSD, JSON, WSDL, SOAP, REST, web services, API functional testing, and Data Binding.
• Experience in facilitating SCRUM ceremonies like product backlog grooming sessions, sprint planning, daily stand-up, sprint review, and sprint retrospective; Coordinated with Product owner on project planning to enhance the ROI.
• Experience in working with self-organizing and cross functional teams, and well-versed with estimation techniques like Planning Poker, T-shirt sizing and Relative Mass valuation and prioritizing methods like MoSCoW, Kano, business value based and walking skeleton. Calculated sprint velocity and capacity; Handled Requirements Churn.
• Experience in Release planning, Acceptance criteria, definition of done, definition of ready, Potentially Shippable Product Increment (PSPI), minimum viable product (MVP), and good understanding of test driven development.

TECHNOLOGY STACK:

SDLC Methodologies: Waterfall, Agile (SCRUM), Hybrid (SCRUM-Waterfall), Rational Unified Process(RUP), SAFe, Extreme Programming (XP), Kanban, DevOps

Operating Systems (OS): Windows XP/8/10/Vista, Linux, Mac OS

Modeling Tools: MS Visio, Rational Rose, Mock-up screens, Erwin, Enterprise Architect

Requirement Management Tools: JIRA, Rally, Version One, Rational Requisite Pro, Rational Requisite Composer, Rational Team Concert, Visual Studio Team Services (VSTS)

Collaboration Tools: SharePoint, Confluence

Testing Tools: HP QC, HP ALM, Selenium, Load Runner, VSTS Testing Suite

Languages: SQL, HTML, CSS, XML, JSON, Java, J2EE, JavaScript

Reporting Tools: Tableau Desktop, IBM Cognos, Power BI, Crystal Reports, Logi Analytics

Architecture: Service Oriented Architecture (SOA), 3 Tier Architecture, N-tier Architecture, Cloud Platform (SaaS), Model View Controller (MVC), .NET, ASP.NET Webforms

Data Warehousing: ER Modeling, Dimension Modelling, Data Marts, OLTP, OLAP, Data Profiling, Data Mapping, Data Mining, Data Validation, Star schema, Snowflake Schema

ETL Tools: Informatica (Power Center), SQL Server Data Tools, Cognos Data manager, Aginity Workbench, Hue - Hadoop User Experience

Databases: MySQL, IBM DB2, Oracle, Hadoop, Netezza (IBM Pure Data System)

PROFESSIONAL EXPERIENCE:

Confidential, Tallahassee, FL

Business Systems Analyst

Responsibilities:

• Facilitated requirement analysis sessions, brainstorming, focus groups, and Joint Application Development (JAD) sessions with clinical, administrative, and technical stakeholders to elicit requirements and deliver the product.
• Created various artifacts like Requirement Specification Documents, System Requirement Specifications (SRS), Use Cases, Data Mapping Documents, Process Flow Diagrams, User Manuals, UML diagrams like Activity, Sequence, and Use Case Diagrams, through collaboration with epidemiologists, informatics, and surveillance departments.
• Implemented the agile SDLC framework, refining the business process, and promoting collaboration between team members, managing team progress, ensuring completion of sprint tasks during iterative time boxed sprint cadence.
• Conducted user story writing workshops to illustrate creating user stories that satisfy INVEST criteria, assigning acceptance criteria to the user stories, and to elucidate concepts of story points, velocity, and capacity planning.
• Assisted with validating mapped data variables for implementation of Form 1628, Electronic Lab Ordering (ELO) and Electronic Lab Reporting (ELR) through CTLS application for clients and providers in various counties and areas.
• Ensured HIV/AIDS episodes, risk factors, client demographics, epidemiological metrics, and so on, for patients, are implemented through application workflows, to satisfy program requirements of various Public Health initiatives.
• Ensured technical debt management strategies are implemented by development team to deliver a PSPI which is fully tested and functional satisfying the KPIs, performance metrics for the organization, and definition of done.
• Created Entity Relationship Diagrams (ERD) through Erwin and MS Visio Reverse Engineering module, creating conceptual and logical data models, ETL specification documents, and source to target mapping documents.
• Collaborated with database analysts, and assisted with data migration, Extraction Transformation and Load (ETL) process, data standardization, data clean up, data scrubbing, data deduplication, data normalization, and so forth.
• Reviewed Stored Procedures, SSIS Packages, statistical reports and wrote SQL queries for CRUD (Create, Read, Update, Delete) operations to validate client data in various databases, to match Business Intelligence (BI) reports.
• Ensured HIPAA compliant automated workflows through enterprise applications to monitor HIV/AIDS surveillance activities, ensuring contractor and sub-contractor budget allocation features, and CAREWare program initiatives.
• Validated Medicare and Medicaid claim details, XML scripts, HL 7 messaging protocols for exchange of patient information, and assisted with statistical and predictive data analytics, for BI reporting purpose through Tableau.
• Collaborated with database analysts (DBA) analyzing data requirements for Master Data Management (MDM) to create Master Data Repository, containing lookup tables and data attributes used by multiple source systems.
• Worked with DBAs to analyze requirements for data obfuscation or masking of Personal Health Information (PHI) of clients, and assisted in the creation of an Enterprise Data Warehouse (EDW), having data from multiple sources.
• Performed Manual Testing in dev, test, and prod environments, creating artifacts like test plans, test scripts, test summary reports, test scenarios, test steps, test results, bug and defect mitigation strategies, Requirements Traceability Matrix (RTM), ensuring User Acceptance Testing(UAT) and Test-Driven Development (TDD) practices.

Environment: Waterfall- SCRUM hybrid methodology, MS Visio, Enterprise architect, Informatica 8.5, Share Point, MS Outlook 2013, MS Project, MS office Suite 2013 (Word, Excel, Power point), MySQL, SSIS, SSRS, Javascript, jQuery, JAVA, J2EE, Tableau 7.0, Selenium, Logi Analytics, .NET Framework, Model-View-Controller (MVC), ASP.NET Web Forms, Visual Studio Team Services (VSTS), JIRA, Balsamiq, GitHub, Melissa Data, Microsoft SQL Server Database, Oracle.

Confidential, Hartford, CT

Business Systems Analyst

Responsibilities:

• Gathered functional and non-functional requirements and involved in development and documentation of Business Requirement Document (BRD), and Software Requirements Specification (SRS) using various elicitation techniques.
• Assisted in creating implementation guides for various EDI X12 transactions such as 834, 835,837,270, 271 and 274.
• Prepared Business Process Models (BPM) and UML diagrams like workflow diagrams, activity diagrams, sequence diagrams, use case diagrams, by using MS Visio, for visual representation to explain various steps involved in business.
• Developed elaborate use cases to explain interaction between user and system context, and system to system context, demonstrating dependencies between various applications in the plan, member, provider & claims domains.
• Involved in creating and executing test cases, test plans and test scripts for EDI 837 Claims (I & P) Transactions.
• Performed Data mapping to validate and customize Claims daily load into FACETS for processing the transactions.
• Performed Data profiling through careful range and pattern analysis and checked for data integrity by looking for various data anomalies and doing data normalization and data verification using Informatica Data Quality Center.
• Built Data Dictionary for various designers, developers, users, and administration with information on contents, data-type, and data element in various tables, columns and rows, and data modelling through star and snowflake schema.
• Participated in Validating ETL process by creating various simple and complex SQL queries.
• Responsible for the development and implementation of HIPAA EDI Data Mapping artifacts for various claims related transactions like 270, 271, 274, 276, 277, 820, 834, 835, and 837.
• Performed User Acceptance Testing for the ANSI X12 Version 5010 / EDI transactions (HIPAA) for Claims Status and Adjudication process involving 270, 271, 276, 277, 834, 837P, 837I, 837D, 835 remittances and NCPDP Claims.
• Validated HL7 messaging protocols for bi-directional case and disease report exchange, in HTML and XML formats, in accordance with HL7 specifications for electronic communication of patient health information.
• Developed XSD Schemas and wrote XML test files for backwards compatibility testing.
• Created test cases for the premium calculations and Claims limits and deductibles (Claims calculations).
• Wrote SQL queries to match the results with the actual BI report for various analytics purposes.
• For User Acceptance Testing (UAT) created ad hoc BI reports using Tableau version 7.0

Environment: Waterfall- SCRUM hybrid methodology, Enterprise architect, Rational Requirements Composer (RRC), Rational Team Concert (RTC), Clear Quest, Clear Case, MS Visio 2010, Informatica 8.5, Altova map force, COBOL, Share Point, MS outlook 2013, MS office Suite 2013 (Word, Excel, Power point), MySQL, Javascript, jQuery, JAVA, J2EE, Tableau 7.0.

Confidential, NYC, NY

Business Systems Analyst / SCRUM Master

Responsibilities:

• Implemented SDLC, agile (SCRUM) methodology for the developing life cycle and followed the standards process in the application and elicited requirements from Business users and stakeholders by interacting with them and asking them detailed questions, and through JAD sessions, Focus Groups, Brainstorming, Prototyping and carefully recording and documenting the requirements in a format easily understood and reviewed by both business and technical people.
• As a SCRUM Master, I facilitated SCRUM ceremonies like Backlog Grooming sessions, Sprint planning meeting, Daily Stand-Up Meeting, Sprint Review, and Sprint Retrospective meetings, acting as a service leader to guide the team.
• Proficient in writing and prioritizing User Stories using INVEST in Product Backlog along with the Product Owner as per business and Technical needs using prioritizing techniques like business value based and technical value based.
• Used JIRA for issue tracking, User Story management and requirement traceability and created, managed, tracked and analyzed sprint Burn Down Chart and Product Burn Down chart to estimate sprint velocity, Development team’s capacity and release planning respectively, to improve and maximize value while focusing to achieve the Sprint Goal.
• Ensured that the team is following coding standards and is adhering to Definition of done to avoid/reduce technical debt and focused on resolving and shielding the team from impediments to keep them working in a group flow.
• Developed Mockup screens and wireframes using UI components such as Radio Buttons, Down lists, Check Boxes, and Data Entry Fields for web based custom dashboard of the CPS application for Business Users and Stakeholders.
• Worked with Front end and UI developers and Created HTML and CSS files using HTML5 and CSS3 for web based custom dashboard, and ensured that client-side validation and server-side validation were implemented.
• Created XSD schemas and verified XML files based on XSD schemas. Assisted testers with validating XML requests.
• Developed HL7 messaging for patient EMR in text and XML formats, in accordance with HL7 specifications and performed functional (API) testing and worked with QA team in reviewing and executing test plans and test cases.
• Created Data mapping documents between various data elements, XML files, flat files, excel files, HIPAA EDI files X12 837, 270, 271, 276, 277, 278, 835, 275, and 5010 and web services, to perform verification and validation.
• Defined Data Maps to validate and customize Claims daily load into FACETS for processing the transactions.
• Reviewed Stored Procedures for reports and wrote test SQL queries for Joins, Unions, Group By functions against the source system (SQL Server) to match the results with the actual report against the Data mart (Oracle 10g).

Environment: SCRUM Methodology, JIRA 5.0, JAVA, Eclipse 4.3, MS Visio 2013, UML, Apache, AWS, AMI, Amazon EC2, HP ALM v11, Oracle 10g, Tableau 9.0, Altova XML spy, SOAP UI PRO, MS outlook 2013, MS office Suite 2013 (Excel, Word, Power point).

Confidential, Louisville, KY

Business Analyst

Responsibilities:

• Lead remediation of encounters through periodic workgroup meetings between business, development, and market office. Created BRD and FRD.
• Involved in Forward Mapping from ICD 9 to ICD 10 and backward mapping from ICD 10 to ICD 9.
• Perform Gap Analysis to upgrade HIPAA 4010 to 5010; prepared solution document and project plan.
• Worked on the EDI 834 file load to Facet. Participated in creating Data models.
• Supported requirements management using HP ALM and Quality Assurance by using HP QC. Participated in UAT and manual testing.
• Identified various attributes for fact and dimension tables in constellation, star, and snowflake schemas.

Environment: Waterfall methodology, MS project 2010, HP ALM V11, HP QC, Oracle 10g, IBM Cognos, MS outlook 2010, Erwin, SQL, General Equivalence Mapping, MS Visio, MS Office Suite 2010 (Excel, Word, PowerPoint), MS Outlook 2010.