- Over 8 years of Health Care and Information Technology experience with expertise in Business Analysis, Data Analysis and Software Testing.
- Worked on Healthcare Electronic Data Interchanges (EDI’s), 837(I/P/D) - Claims, 835 - Remittance Advices, 834 - Managed Care Organization’s Enrollment Data, 270/271 - Eligibility Inquiry/Response and 276/277 - Claim Status Inquiry/Response.
- Expertise in reading ‘Edit’ logics used to adjudicate claims, duplicate checks and adjustments.
- Expertise knowledge on HIPAA 4010 (Legacy), HIPAA 5010, ICD9 (Legacy) & ICD10, MMIS and MITA framework.
- Experienced in Agile and Waterfall environment of application development mainly working on gathering business requirements, developing System Design Document (SDD) that provides detailed system architecture design including interfaces, file layouts, reference layouts, appendices, business users and business process.
- Experienced in Business Analysis - gathering business requirements from product owners to derive functional, non-functional requirements, software requirements specifications, technical architecture, business workflows and document these in appropriate Business Analysis Artifacts (BRD, FRD, SRS, RTM).
- Experienced in Requirements Analysis - conducted Gap Analysis, Impact Analysis (analysis on identified gaps), and Feasibility Analysis (solutions to identified gaps) to validate for S.M.A.R.T requirements. Analysis report with Decision Matrix was then provided to product owner for decision making.
- Experienced in writing Use Cases, User Stories and build them into Epics. Actively participated in prioritizing Sprint Backlogs.
- Experienced in building UML diagrams using MS - Visio Pro, to illustrate business processes, building data flows, application interfaces, As-Is and To-Be systems.
- Experienced in Data Analysis - data mapping, validating file layouts (initial load layouts, weekly/monthly/quarterly incremental load records, reports) for multiple data attributes, written/modified/tested data conversion rules and built data extracts as required.
- Experienced in using code managing tool - IBM Clear Case for analyzing business logics embedded in application code.
- Experienced in Teradata SQL and performed Data Analysis by pulling data from Enterprise Data Warehouse and DB2 tables.
- Experienced in Microsoft SQL Server - created and modified stored procedures, staging tables, data migration and resolved data quality issues.
- Experienced in Quality Assurance of applications, performed Manual System Testing (Unit, Integration, Regression and UAT) using HP Quality Center and HP ALM tools.
- Experienced in writing Test Cases, building Test Scenarios, extract and build Test Data.
- Experienced in using issues tracking tools - JIRA, Microsoft Team Foundation Server (TFS), IBM Clear Quest and As-One (proprietary tool).
- Expert in MS-Office 365 suite.
SDLC Methodologies: Agile, Waterfall.
Business Process Modeling: MS Visio.
Project Management: MS Project, JIRA.
Business Analysis: JIRA, IBM Rational Rose, IBM Requisite Pro, IBM Clear Quest & Clear Case.
Database Tools: Teradata SQL, T-SQL, PL/SQL, BI Query, Tableau, MS Access.
Testing: HP Quality Center, HP ALM, Load Runner, Manual Testing.
Tools: SAP Business Objects, Cognos .
Issue Tracking: JIRA, MS Team Foundation Server, As-One.
Sr. Business Systems Analyst
Confidential, Springfield, IL
- Determine operational objectives by analyzing business functions and gathering data from project stakeholders and evaluate scope of work, project planning and budgeting.
- Provide Subject Matter Expert services with Medicaid and Medicare business and associated software applications used to process claims, Eligibility & Enrolment System, Pharmacy Benefits Management System (PBMS), New Medicare Card Replacement
- Project, Enterprise Data Warehouse and other MMIS upgrade/replacement systems.
- Elicit and analyze user and system requirements include - functional, technical and nonfunctional requirements and maintain a traceability matrix of these system functionalities.
- Perform Requirements Engineering (including Gap Analysis, Feasibility Studies, and Impact Analysis) and write Detailed System Design Documents (DSDD) which is a blue print architecture of complete functional application.
- Write use cases, user stories, test scripts, test scenarios.
- Perform code review (COBOL, .NET programming language) to identify validity of business logics using IBM Mainframes and MS-Visual Studio.
- Perform database administration using Teradata, SQL Assistant tool including data extraction, generating data reports depending on requirement, create data crosswalks using multiple data models, perform data conversions, validate application interface data file layouts and EDI file layouts (270/271, 276/277, 837/835, 834/820).
- Execute User Acceptance Testing (UAT) to evaluate business requirements, technical specifications and user interface.
- Build Concept of Operations for applications including Business Continuity & Contingency Plan and prepare technical documentation required for system certification by Federal Government Agency, Centers for Medicare & Medicaid Services.
- Build technical architecture using MS Visio for legacy MMIS and identify potential areas of development/automation.
- Working on Paper Claims (UB-04, CMS-1500) Automation Project - conducted feasibility studies, risk analysis, data mapping, built architecture of AS-IS process.
- Developed detailed vision and scope for project by gathering business requirements from federal government, Social Security Administration, business partners (MCO’s & Providers) and state’s departments (Human Services, Innovation & Technology, Child & Family Services).
- Wrote Functional Requirements (FRD), Business Requirements (BRD) and maintained traceability thru Requirements Traceability Matrix (RTM).
- Developed Software Development Life Cycle (SDLC) using Waterfall approach for making system changes, testing and deployment.
- Worked on developing and managing project artifacts - project charters, advance planning documents, budgeting, concept of operations, business continuity & contingency plans, Work Breakdown Structures, project schedule, resource planning, milestones, deliverables, change requests management, project reports using MS - Project and JIRA tools.
Technical Environment: Agile & Waterfall SDLC approach, COBOL, .NET, Java/J2EE, DB2, Teradata SQL, JIRA, 3M Core Grouper (V 10.5.1.1.18 ), IBM BlueZone Mainframes (V 6.2.2325), Opentext BI Query, Sandbox (v 126.96.36.199), As - One (version control proprietary tool), .
Sr. Business Analyst
Confidential, Los Angeles, CA
- Experienced in performing Business Analysis across hybrid software development life cycle (SDLC) methodologies - Waterfall and Agile (Kanban & Scrum experienced).
- In-depth working experience of Gap Analysis between As-Is and To-Be processes of software applications (data flows, business processes, reports, claims transactions - HIPAA 5010).
- Experience in extracting and reading EDI’s (270/271 - Batch Eligibility Transactions, 837/835 - Medical/Professional/Dental Claims Submission with Remit Advices, 834/820 - Managed Care Enrollment).
- Experience in creating project management and business analysis artifacts - Technical Requirements/Work Breakdown Structures (WBS), Business Requirements Documents (BRD), User Stories, Use cases, Functional Requirement Specifications, Requirements & Use Case/Test Case Traceability Matrices & Reports.
- Experienced in developing Object Oriented Detailed Design for technical system architecture including functional and business stakeholders, data flows, infrastructure (hardware) and applications (software).
- Experienced in conducting Technical Feasibility Study, Impact Analysis and Risk Analysis required for application development.
- Hands-on experience in designing and building standardized Business Intelligence reports and dashboards using BI Query and ad-hoc requests from SAP-BI users.
Technical Environment: RequisitePro, Rational Rose, XML, ClearCase MS Office, MS-Visio, Java, TOAD, Agile, Quality Center, MS Project, SOA, SQL server, UltraEdit, Mainframes, C#, Jira v6.2.3, ScrumWorksPro, JBoss Web Services, Oxygen XML Editor, Spring 3.0, BizAgi Suite
Business Analyst/Quality Analyst
Confidential, Columbus, OH
- Experienced in building Data Mapping artifacts between AS-IS and TO-BE data warehouses.
- Experienced in controlling versions of EDI 270/271, 276/277, 837/835, 834/820 depending on amendments made to proprietary data file layouts or adjudication business process.
- Worked on Enrollment Broker System, building and testing additional functionalities to existing system - mainly centralized to add/modify/cancel data related to enrollment brokers and their association with providers and state Medicaid agencies.
- Experienced in writing Use Cases and built Use Case Activity & Sequence diagrams and Logical views using MS Visio and Rational Rose for a clear understanding of the requirements by the development team.
- Performed Testing & Reporting on IND & SHOP: EDI 834/820/Audit/ Reconciliation work for Federal Centers for Medicare and Medicaid Services (CMS).
- Experienced in writing Technical System Architecture Documentation for Claims Processing Subsystem and Enrollment Broker System. Maintained version controls on 270/271, 276/277, 837/835. Reviewed and updated the system documentation as required.
- Conducted Functional Requirements reviews and walkthroughs with project stakeholders.
- Facilitated Test Planning Sessions with Quality Assurance Team to develop Test Plan, Test Cases and required Test Data.
- 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.
- Developed User Acceptance Testing (UAT) plan to guide a select group of key end-users in testing the user interface and functionality of the application.
- Performed System Unit testing, Regression testing and UAT on Enrollment Broker System and ad-hoc testing as required in other subsystems.
- Logged, monitored, retested & managed complex data defects using HP QC/ALM and produced defect status reports including defect density, defect age etc.
- Experienced with functionalities of HP Quality Center to create test plans, document and track test requirements, test cases & generate reports as required.
- Working knowledge and implementation experience of Quality Assurance, Testing Principles, and Configuration and Change Management Disciplines.
Confidential, Grand Rapids, MI
- Document and analyze the required information and data. Understanding the technical designs as well as the specifications to design and deliver system solutions with the needs of stakeholders. Participate in requirement review and design meetings.
- Understand business process management and business requirements for translating them to Functional, Technical and Non-Functional requirements.
- Facilitate Joint Application Development (JAD) and Workshop/Brainstorming sessions to elicit business requirements and map it to functional specifications.
- Developed detailed use-cases, activity diagrams, sequence diagrams etc for Enterprise Data warehouse(EDW) Upgrade & other project
- Develop Test Strategies, Test Plans and Test Cases based on the technical requirement document. Identify/Develop Test Data Sources.
- Created SSIS Packages using SSIS Designer for exporting heterogeneous data from OLE DB Source (Oracle), DB2 and MS Excel to SQL Server 2008.
- Worked extensively on DTS Package Designs for import/export of raw data (flat, .CSV, XML, .DAT files) to MS SQL Server 2008.
- Developed ETL packages with different data sources (SQL Server, Flat Files, Excel source files, XML files etc) and created multiple stored procedures to load target tables with transformation rules as appropriate (Control flow transformations such as FTP, Loop Container, Execute Package, Data Reader Task, XML Task and Data Flow Transformations such as Lookup, Conditional Split, Derived Column, Audit, Merge, Merge Join and Sort) using SQL Server Integration Services (SSIS).
- Developing stored procedures, triggers, views, and adding/changing tables for data load and transformation, and data extraction.
- Developed custom reports, Ad-hoc Reports by using SQL Server Reporting Services (SSRS).
- Experienced with capabilities of Tableau functionalities such as Data extracts, Data Blending, Forecasting, Dashboard Actions and Table Calculations.
- Created Reconciliation Data Sources to check data consistency between ECC, BI and Tableau systems and prepared test documentation.
- Facilitated requirements elicitation sessions with business users on eliciting required business rules and logics for predictive data modeling.
- Experienced in Reverse Engineering on RDBMS, including MS Access and Teradata for data analysis.
- Generated Data Definition Language (DDL) scripts using Erwin and supported DBA in implementing developed data models.
- Analyzed data for Online Transactional Processing (OLTP) and Online Analytical Processing (OLAP) systems and generated reports using SAP Business Objects reporting tool.
- Experienced in Sybase Power Designer tool used in designing RDBMS data models.
- Experienced in Data Quality Assurance - includes data extracts, data cleansing and prepared ad-hoc analytical reports using Teradata SQL.
- Analyzed OLTP source systems and Operational Data Store and research the tables/entities required for the project.
- Developed DB Stored Procedures and Data ETL Functions, ensuring low data quality issues on warehouse data.
- Written Shell scripts to balance the data between source and target tables after each ETL load.
- Tested load performance on databases in OLTP and OLAP models.
- Experienced in SQL Developer, PL/SQL developer, Teradata SQL Assistant.