PROFESSIONAL SUMMARY:

• Have extensive experience in Business Requirements Modeling, Business Process Analysis, Data Analysis, Quality Analysis and Client/Server applications for enhancing the business processes in diverse business domains.
• Extensive working experience in agile SCRUM environment with diverse teams.
• Experience in SDLC, Agile, Waterfall, Rational Unified Process, and SCRUM software development methodologies.
• Have knowledge of HL7 Messaging protocols, HIPAA transaction and code standards and electronic data interchange (EDI) standards like X12 837, 270, 271, 276, 277, 278, 835, 275 and knowledge of claims encounters process.
• Experience with health care systems: QNXT, 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.
• Extensive experience with Medicare/Medicaid processing as well as the Claims/Billing.
• 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.
• Used tools like JIRA and RALLY to create and maintain Product Burn - down chart, Sprint Burn-down/ Burn-up chart.
• Possess skills like Conflict Resolution, Sense Making, Root Cause Analysis, Risk Analysis, Communication Management, problem management, Stakeholders Management and having Servant-Leader leadership skills.
• 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).
• Skilled in gathering and converting User Requirements into High Level and low level documents (HLD/LLD) like Business Requirements (BRD), Functional Requirement Documents (FRD), Functional Requirement Specifications (FRS) System Requirement Specification (SRS),and visualizing graphical user interface (GUI) using mockup screens.
• Expertise in Gap Analysis, SWOT analysis, risk analysis, cost-benefit analysis, feasibility analysis, and impact analysis.
• Worked on UAT testing and took signoff from the Commercial line of Property & Casualty business users.
• 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.
• Managing Requirement Traceability Matrix (RTM),Service Level Agreement (SLA) and assisted Project Manager with creating Work Breakdown Structure (WBS),Project proposal and Project charter, Statement of work (SOW).
• Proficient in creating and managing Use Cases, User Stories, Test cases, Test plans, Test reports, Test scripts.
• 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.
• 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.

SKILL:

SDLC Methodologies: Waterfall, Agile (SCRUM, XP), Hybrid (SCRUM-Waterfall)

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

Modeling Tools: MS Visio, Mock up screen, Erwin, Enterprise Architect

Requirement Management Tools: JIRA, Rally

Languages: SQL, HTML, CSS, XML

Reporting Tools: Tableau Desktop, IBM Cognos, Excel

ETL Tools: Informatica (Power Center), SQL Server Data Tools, Cognos Data manager

Databases: MySQL, IBM DB2, Oracle

PROFESSIONAL EXPERIENCE:

Confidential, TX

Business Analyst / Project Manager

Responsibilities:

• Coordinated project scheduling in association with the Software Development Manager.
• Provide support to team members for new PMS and Reservation applications.
• Developed blueprint and tested the prototype. Designed base template, mockup of Graphical User Interface, and webpage lookup field mockup and report generation feature of the system.
• Wrote Use Case Specifications according to the business requirements.
• Participated in brainstorming sessions and walkthroughs with subject matter experts (SME).
• Interacted with various groups, including business owners, SMEs (subject matter experts) and marketing team, for requirements gathering in definition Stage.
• Involved in business analysis and project management, coordinating between the team members according to the business requirements.
• Identified various business processes and developed process flow diagrams for the business processes and validated the processes with SME
• Worked with the project manager for planning and organizing the project activities, and communicated with other business canter managers and stakeholders of the project.
• Developing Use Case Models, Entity Relationship Diagrams (ERD), Activity Diagrams, State Diagrams and Data Flow Diagrams (DFD)
• Organized and conducted meetings, briefings, demonstrations, conducted JAD sessions, and wrote minutes of project meeting.
• Worked as an liaison between business users, testers and application development team so that all teams understand business needs and take them into consideration
• Coordinated in day-to-day technology needs of the business unit focusing the analysis of processes.
• Gathered requirements, developed Process Model and detailed Business Policies.
• Worked with the project manager to estimate best/worst case scenarios, track progress with weekly work status, conducting informal meetings ad hoc as needed.
• Followed the RUP methodology for the entire SDLC along with Agile / scrum xp.
• Involved in project planning and coordination.
• Resolved conflicts and negotiated changes in project priorities.
• Worked on elicitation of User Stories from the High level User Requirements for the development of an additional feature module using agile / scrum xp.
• Prepared the Business Workflow using MS-Visio with input, output, and Pre and Post conditions.
• Worked with the clients on the final signing process in the User Acceptance stages.
• Prepared recommendations and designed solutions for process improvements and “best practices”.
• Contributed in improving the overall customer experience through customer entered business processes.
• Vendor software compliance, database integrity and performance evaluation. Successful implementation of online transaction processing applications and its associated modules like database testing and validation.
• Framed guidelines for installation, configuration and other essential management practices for the developed software package across diverse platforms
• Led feasibility study, built business models for target markets and conducted disruptive technology transformation.

Environment: SQL database, Linux, Agile SDLC, SQL, TFS, Quality Center, MS Visio, MS Project, SharePoint, Jira, MS Access

Confidential, Norfolk, VA

Business Data / System Analyst

Responsibilities:

• Worked on implementation of new markets with defining and managing the scope of new systems requirement.
• Responsible for the development and maintaining EDI Data Mapping documents 277, 835, 837.
• Responsibilities include developing and documenting requirements, ensuring all compliance standards are met, coordinating testing, evaluating and identifying possible application system issues
• Create, maintain, and organize backlog of features, epics, stories, and tasks in JIRA.
• Validated Inbound and outbound 837 transactions, including loading and correcting any errors with the process of EDI outbound files.
• Execution of W eekly and M onthly reports and processes and the creation of ad-hoc reports.
• Validated and Created queries for the analysis of data relating to claims, members and providers.
• Involved in Source Data Analysis, analysis and design mappings for data extraction.
• Responsible for maintaining HIPPA validation for 837 outbound files for various markets (Washington DC, Washinghton State, Kentucky, Virginia Confidential, Virginia CCC+)
• Helped in the implementation process while tailoring test plans to client use cases and configurations.
• Lead validation work sessions with the client.
• Demonstrated strong competency across the product suite and in providing best practice configuration recommendations or adjustments.
• Have worked in coordination Data Integration, Standardization, and Configuration teams to resolve issues with client products/results.
• Performed User Acceptance Testing for the ANSI X12 Version 5010 / EDI transactions (HIPAA) for Claims Status and Eligibility (277, 837P, 837I, 837D, 835 remittances and NCPDP Claims).
• Remediated errors receieved from state for different markets for claims with missing segment elements.
• Performed Data mapping to validate and customize Claims daily load into FACETS for processing the transactions.
• Conducted Requirements Clarification Sessions with concerned project members to clarify requirements.
• Good interpersonal skills, committed, result oriented and hard working.

Environment: Facets, Jira, MS Sharepoint, MS Visio, SQL, Oracle, MS Access, MS Excel, MS Word, MS Powerpoint, Notepad++, UltraEdit, DBeaver .

Confidential, Baton Rouge, LA

Business Analyst / QA Analyst

Responsibilities:

• Implemented SDLC which included Waterfall-SCRUM hybrid agile methodology with requirements, specifications phase and development phase in iterative time boxed sprint cycles, incorporating a rigorous definition of done.
• Gathered functional and non-functional requirements and involved in development and documentation of Business Requirement Document (BRD), and Software Requirements Specification (SRS) using agile methodology.
• Developed implementation guides for Partners EDI X12 transactions such as 834, 835,837,270, 271 and 274.
• Assisted the Project Manager in defining the project plan, project charter, scope, vision, and timelines. Handled requests for proposals (RFP), making presentations to customers, and negotiating project timelines and deliverables.
• Performed Gap Analysis by identifying current technology, policies, procedures, documenting the enhancements for the requirements, and analyzing new HIPAA 5010 compliance and developed an action plan for the migration process.
• 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.
• Responsible for the development and implementation of HIPAA EDI Data Mapping artifacts 270, 271, 274, 276, 277, 820, 834, 835, 837 and 5010.
• Performed User Acceptance Testing for the ANSI X12 Version 5010 / EDI transactions (HIPAA) for Claims Status and Eligibility (270, 271, 276, 277, 834, 837P, 837I, 837D, 835 remittances and NCPDP Claims).
• Developed HL7 messaging for bi-directional case and disease report exchange, in HTML and XML formats, in accordance with HL7 specifications.
• Developed XSD Schemas and wrote XML test files for backwards compatibility testing.
• Developed and executed detailed Use Case to describe the functionality of the system including claims transactions.
• 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.
• Build 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 modeling through star and snowflake schema.
• Responsible for developing Traceability Matrix, worked on developing test plans, writing test cases, generated test scripts Involved in developing the test strategy.
• Extensively used Rational Clear Case for test planning and test management.
• Developed QA Test plans for Functional, Regression and User Acceptance Testing (UAT).
• Regression Testing is performed and the additional scripts are generated for each version.
• Develop Data Driven tests to handle the scenarios requiring multiples sets of data and parameterize the scripts to input varying data from MS EXCEL.
• Generated Data Driven scripts that access the backend database, Performed Both Positive and Negative Testing.
• Performed the tests and documented the results and bugs by using Rational Clear Quest.
• UsedQuality Center to invoke the scripts and initially performed the baseline testing and organized all the scripts systematically and generated reports.
• Develop SQL Queries for checking the Data Transaction and Database Integrity.
• Verified the loaded data in oracle and compared the extracted data from Legacy system
• Performed queries in the database using 'SQL' to check successful transaction using TOAD
• Checked the logs were written for each process that runs.
• Developed SQL Queries to perform Database testing.
• Participated in Validating ETL process by creating various simple and complex SQL queries.
• 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 User Acceptance Testing (UAT) created ad hoc BI reports using Tableau

Environment: Waterfall- SCRUM hybrid methodology, Version one, MS Visio, Informatica, Altova map force, Enterprise Architect, MySQL, Tableau, Excel.

Confidential, NYC, NY

Business Systems Analyst

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 expert, 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.
• Facilitated breaking down EPICs into User stories and estimation of User Stories using estimation techniques like Planning Poker in Backlog grooming sessions, assisting the team to clarify ambiguity in estimating the user stories.
• Efficiently handled team and organizational impediments thereby fostering an environment for efficient team work.
• 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.
• Maintained SCRUM Task Board and did issue tracking through prioritizing and managing the defects using JIRA.
• 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.
• Conducted Impact Analysis and Gap Analysis to derive and document requirements for Web based Claim Processing System (CPS) and identified AS-IS and TO-BE business processes based on which created business process models.
• Identified gaps between current policies and procedures and new HIPAA 5010 compliance, to check the compatibility of the existing system capabilities with the new requirements and developed an action plan for the migration process.
• Implemented Test Driven Development (TDD) to ensure quality of application is maintained through SDLC.
• 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 the 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 HL7specifications 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.
• The process included importing claims into Facets that had been adjudicated and setting them in a "PAY" status so that a payment cycle could be run to create checks on Facets.
• 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 (Excel, Word, Power point).

Confidential, Lincoln, NE

Business Systems Analyst

Responsibilities:

• Worked as a liaison between the business client and development team for the implementation of transition in compliance with HIPAA standards.
• Involved in the HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Health Insurance Claims. Worked on HIPAA Standard/EDI standard transactions: 270, 271, 276, 277, 278, 834, 835, and 837 (P.I.D) to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
• Worked on document approval and submission system on COTS application for pharmaceutical regulatory submission system.
• Identified the business functions and processes, and prepared system scope and objectives based on user needs and industry regulations.
• Defined terms, conducted stakeholder analysis, elicited business needs, conducted business process modeling, and facilitated JAD sessions. Elicited, documented requirements and use cases. Analyzed, validated & prioritized requirements; traced requirements to related project documentation (process models, designs, test scenarios & scripts).
• Documented the Requirements and circulated them to Business & Technical teams for Signoffs.
• Coordinated with the developer and testers for transition of EDI X12 4010 series to 5010 series. Maintained traceability through updates to the Requirement Traceability Matrix (RTM) using Requisite Pro.
• Identified testing scenarios and defined Test Cases for detailed functional testing.
• Developed a Schedule and identified project milestones.
• Analyzed business scenarios to track possible business outcomes for the functions which could be incorporated into more detailed test scripts.
• Reported project progress to the team, senior management and all stakeholders periodically.
• Identified risk and project impact and performed risk assessment and mitigation.

Environment: SQL, MS Word, Excel, Access, Oracle, DB2, Lotus Notes, File Viewer, Web Client, Clear Quest, Requisite Pro, GEM, MS Visio, SharePoint.

Confidential, Los Angeles, CA

Business Analyst

Responsibilities:

• Coordinated IT projects and ensures company resources are utilized appropriately.
• Compiled project status reports, coordinates project schedules, manages project meetings, and identifies and resolves technical problems.
• Identified and analyzes systems requirements and defines project scope, requirements, and deliverables.
• Coordinated project activities and ensures all project phases are documented appropriately
• Conducted Requirements Clarification Sessions with concerned project members to clarify requirements.
• Worked on Policy Submissions, Policy Changes, Policy Renewals, Rewrites and Reinstatements Functionalities
• Scheduled and conducted JAD (Joint Application Development) sessions for analyzing and documenting requirements.
• Used the guidelines and artifacts of the Rational Unified Process (RUP) to strategize the Implementation of Rational Unified Process effort in different iterations and phases of the Software Development Life Cycle.
• Carried out AS-IS and TO-BE Analysis to showcase the improvements in business processes.
• Worked as an interface between the users and the different teams involved in the application development for better understanding of the business and IT processes.
• Followed the UML based Methods using Rational Rose to create Activity Diagrams, Sequence Diagrams, and Collaboration Diagrams.
• Used Requisite pro to input all the data elements, Use cases, and UI specifications.
• Prepared Business Process Models that includes modeling of all the activities of the business from the conceptual to procedural view.
• Aided management in standardizing web applications by preparing GUI standards and recommending alternative strategic solutions incorporated in a phased and iterative manner.
• Involved in project status meetings, QA review meeting, and Defect Status Meeting.
• Prepared Test Strategy and Test plan documents.
• Worked for multiple Sprints in Agile Methodology.
• Written Test conditions based on Requirements.
• Created positive and negative Functional Integration test cases by analyzing requirements and test conditions.
• Worked on Test Data Setup, created data as per test case requirements.
• Interacted with Business Partners in Reviews and User Acceptance Testing.
• Created and Reporting Bugs, involved in every phase of Bug Life Cycle.
• Escalation of Critical problems / issues during Testing and reporting them in JIRA.
• Prepared Final Test reports containing test steps and snapshots of execution

Environment: UML, RUP, Microsoft Office Suite, Microsoft Visio, Unix, Documentum, Windows NT/XP, Oracle, SQL, SQL Server, Sybase, VBScript, C#,DOORS, C++, NET, ASP.NET, COBOL, JCL, Business Objects.