SUMMARY:

• Experienced professional with strong knowledge of the Pharmaceutical, clinical trails, medical and insurance fields, including but not limited to customer service, claims processing, medical transcription and practice management.
• Around 4+ 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.
• Worked with various BI tools like Tableau, Power BI, Business Objects, and OBIEE.
• 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 EXPERIENCE:

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: 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, Fairfield, NJ

Business Analyst

Responsibilities:

• Interfaced with the IT division and business to address ongoing business needs.
• Prepared process flow documents capturing the defined SOP (Std Operating Procedures) for Application Outsourcing (AO) endeavors.
• Delivered project overview and status presentations during committee’s meetings.
• Aligned the AO processes for the team as per the business requirement.
• Lead daily scrum meeting to review execution progress and identify changes if required. Participated in Agile Development Cycle. Experienced in Agile technology with Scrum.
• Created and maintained project plan. Review the BRD, FRD, SRS, High level Design Documents, Detailed Design Documents and Requirement Matrix and prepare WBS.
• Developed and configured functionalities in Veeva CRM, Veeva Network and Data warehouse applications.
• Designed and developed custom objects, layouts, reports, CLM functions in salesforce.com and Veeva platform.
• Worked on developing new functionalities/customizations/configurations for Veeva/Salesforce CRM.
• Implement and maintain a standardized, organization-wide, quality information governance plan and program to ensure compliance with external regulatory and accreditation requirements, consistent and proper management of information across the organization to improve data quality & data integrity, and aid in identifying, investigation, and preventing violations.
• Involved in Testing Outbound Transactions
• Collaborate with SMEs from Regulatory, Clinical, Pharmacovigilance, and Quality to integrate data, including assessment of source and target properties and product dictionaries to align with Sanofi and FDA Regulations
• Scheduled daily meeting with requirement managers and development managers to review issues identified during execution. Participates in the development of contingency plans.
• Configured the standard Salesforce SFDC objects and created custom components as per the requirement.
• Created new custom objects, assigned fields, designed page layouts, custom tabs, components, custom reports.
• Extensively worked with FACETS Implementation, FACETS Billing, Claim Processing and Subscriber/Member module.
• 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)
• Extensive working experience with EDI and X12 formats in HIPAA providing Business Process Assessment, Requirements Gathering, Gap Analysis, Implementation and Testing.
• Involved in Order Management and Inventory Modules.
• Received in HP Quality Center (ALM) for Application Lifecycle Management in accordance with Pfizer validation policy following regulatory policy aimed at FDA guidelines
• Production support on OM, Advance Pricing, Inventory.
• Experience with Model N (previously known as iMany and Revitas) Flex supporting the CARS and Contract Management applications
• Prepared user acceptance criterion and testing strategy that will be utilized by QA team to validate the addressed functionality of all critical requirements. Developed and maintained Test Matrix and Traceability Matrix. Utilized Quality Center to plan and execute tests, track defects and create change alerts. Conducted User Acceptance Testing (UAT)
• Developed risk assessment document detailing Model N access and risks by functional area.
• Created documentation and quality assurance reports for Model N implementation.
• Testing the New functionality related to OM, Purchasing, Advance Pricing, Inventory.
• Collaborated with ERP to align interfaces of Production Execution System to the Global Process Model of Supply Chain Operation of Pfizer Inc
• Worked on Price Lists, Qualifiers, Modifiers, Pricing Attributes in Advanced Pricing.
• Provided technical and consultative leadership for government pricing restatement project.
• Coded all adverse event terminology, other medical information, and drug information in Pharmacovigilance database utilizing MedRA and WHO-DD dictionaries.
• Designed and deployed Custom tabs, Validation rules, for automating business logic.
• Worked in an agile environment, during all iterations of system, and software development.
• Author of AMPS (Agile Manufacturing Production System) BPML (business process master listing)
• Developer and author of BIM (Business Integrated Model) for AMPs, IPL, PPRS, PES Serialization project
• Created workflow rules and defined related tasks and email alerts.
• Managed project review meeting and make sure all identified issues are discussed and scheduled properly without having any downtime.
• Conducted daily scrum meetings to coach and mentor the self-organized, cross-functional Agile Project team on key principles of Scaled Agile (SAFe) competencies & practices including team ownership, commitment, effective user stories, agile estimation and transparency.
• Interfaced with third party suppliers and vendors for support, upgrades and implementations.
• Worked on Change Management and change control on a pharmaceutical regulatory tracking system for change submissions.
• Extensively worked in Data Requirement Analysis and Data Mapping for ETL process.
• Performed (Enterprise Data Warehouse) validation and analysis to identify the accurate data source and to track data quality to detect/correct the invalid data.
• Daily ETL involved dealing with extremely large tables. Responsibilities also included working with business users to analyze requirements and bringing in new content into the Data Warehouse.
• Worked closely with Technical Architect and Business Owners to close out on the requirements.
• Highly involved in build and design sessions, creating and modifying XML schema definitions.
• Analyzed data with discrepancies through Error files and Log files further data processing and cleansing.
• Implemented the HIPAA EDI solution for the Healthcare clients and in-depth knowledge of health care including Medicare/Medicaid, HIPAA, EDI transactions.
• Involved in testing HIPAA EDI Transactions with transactions focused on 837/997,835,270/271,276/277,834.
• Worked extensively with TriZetto Facets and Informatica HIPAA Validator on HIPAA 5010standards for Electronic Data Interchange (EDI) Transactions 834 ( Enrollment), 835 (Enrollment of Benefits), 270 (Benefits Inquiry), 271 (Benefits Responses), 837 (Claims Processing)
• Familiar with FDA regulations such as, Title 21 CFR Part 11, Annex 11, 21 CFR Part 210, 21 CFR Part 211 and 21 CFR Part 820
• Comprehensive knowledge related to 21 CFR Part 11: Electronic records, Electronic signatures and Audit trials.
• Worked with Edifecs Spec builder to create test files, analyzed all EDI test files with 5010 implementation guides and gap analysis of EDI transactions.
• Report on potential issues, standard processes and productivity to those who require information, including EMR Data Integrity Analyst and leadership and other staff.
• Developed user stories in EPC (Event Process Chain)
• Track and follow-up on all Medicare, Medicaid, and government programs, commercial and contracted payer issues; concentration on root cause analysis and resolution.
• Maintaining knowledge of Medicare and Medicaid rules and regulations pertaining to the Facets configuration and evaluating the impact of proposed changes in rules and regulations.
• Utilized payer and clearinghouse web-portals for claim status and/or eligibility inquires; followed- up with insurance carriers on problem payments and adjustments; Identified and documented new payer denial trends and notified supervisor for escalated follow up.
• Interpret, analyze and implement contracts, government guidelines to ensure payer set-up is accurate.
• Work closely with IT, and organization management to develop and enforce data integrity policies, resolve issues, educate staff responsible for scheduling, registering or otherwise have patient identification editing capabilities within systems; provide initial and remedial as necessary.
• Identify updates and/or changes to payer requirements prior to implementation and work with applicable Revenue Operations teams to ensure those changes are accurately reflected in all systems.
• Analyzed the data model of the existing data warehouse to fetch data from that system.
• Worked on Guidewire Policy Center & Billing Center enhancement, CR's & Production issues, PC integration with third party apps from inception to implementation.
• Integrated the Claims and Policy data models in the data warehouse.
• Good understanding of Relational Database Design, Data Warehouse/OLAP concepts and methodologies
• Worked on configuration capability (Screen/UI, application settings or parameters, and Business Rules) using Guidewire Policy center.
• Worked on Estimates, Business impact analysis, and Risk analysis on all the phases of Guidewire Policy Center Integration and Change control process.
• Responsible for writing in process data specifications for vendor partner's data mapping into QNXT these data maps included vendors regarding behavior health, dental, chiropractic, eligibility, senior plans, and 834/837 HIPAA transactions.
• Researches and verifies data to substantiate request validity. Maintains data file in terms of data integrity.
• Updates information going to source systems to ensure data integrity.
• Wrote and implemented interface and extract documentation Responsible for data mapping of existing data tables from IDX into SQL to support QNXT.
• Developed and maintained post-implementation claims reports using Microsoft
• Claims Processing (QNXT, SQL Server (SMSS)
• Thoroughly understand health plan's environment and how QNXT 5.5 software can be used to increase efficiencies, cost effectiveness and quality care.
• Used ARIS tool for Manufacturing Execution System (MES) and Production Management for Shop-floor production of pharmaceutical products
• Provided IT asset management of QNXT by overseeing financial, contractual and inventory functions to support life cycle management and strategic decision making for the claims processing environment.
• Reviewed the test cases provided by the QA team, and provided feedback.
• Worked on document approval and submission system on COTS application for pharmaceutical regulatory submission system.
• Responsible for ensuring that all documentation and procedures comply with the FDA 21 CFR Part 11 Regulations.
• Involved in preparing 21 CFR Part 11 Risk Assessment and Overall Risk Assessment document.
• Participated in all phases of the Facets Extended Enterprise administrative system implementation to include the planning, designing, building, validation, testing, and Go-live support phases
• Designed, implemented and validated 21 CFR Part 11 compliance strategies for LabWare LIMS.
• Knowledgeable of the Final Rule emphases on importance of protecting public health and safety while strengthening transparency and accountability in the Program for all users
• On boarded and mentored new employees on Pharmacovigilance tools and business processes
• Reviewed vendor contracts and monitor all deliverable are delivered on time to avoid further discrepancies.
• Communicates policies, procedures and regulatory changes with other hospital departments and medical staff to maintain the data integrity of the medical record and utilizes skills to diffuse difficult situations resulting in positive outcomes.
• Maintaining the Salesforce Applications and Veeva Instances for various operations.
• Led and managed the User Acceptance Testing (UAT) for the implementation of Facets Extended Enterprise administrative system with emphasis on ensuring that the HIPAA regulation are met across all the modules
• Negotiate the use of resources in management and distribute along areas where execution is lacking. Evaluated logistic issues with the potential to impact development and architecture costs.

Environment: Salesforce.com / Veeva, SFDC, ARIS Business Architect suite, HP Quality Center (ALM), ARIS Business Designer and Publisher, Mercury Quality Centre, Peregrine, VMobile, Exploria, HP Quality Center, Model N Flex (previously known as iMany, Revitas), QTP 8.2,9.0, VB Script, Java, J2EE, Oracle, Visual Basic, MS-Office, Windows XP/2000/NT, Chrome, Quick book, EDI, HIPPA, .Net, TSD, SQL, CMMI, Oracle 9i, Oracle Seibel, Oracle OBIEE, Six Sigma, UAT.

Confidential, South Easton, MA

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.
• Work with various GxP groups in their day-to-day activities and streamline their workflows.
• Enhancement related to pl/sql and sql for Oracle Clinicals (oracle product used by client for clinical trials)
• Assisted in increasing data integrity by performing data normalization and data verification.
• 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.
• Calculated, analyzed, validated and reported all mandated product and pricing data for all federal and state government pricing programs on a monthly, quarterly and annual basis.
• Managed the successful completion of GXP Computerized System Validation SDLC Document and Change Control Review/Approval projects for designated IT systems project documentation, for Global Quality in GXP areas of Development, Pharmacovigilance, and Commercial operations.
• 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.
• Extensive validating experience in FDA regulated environment and research laboratories with good understanding of GxP (cGMP, GDP, GCP, GLP) standards under the compliance of 21 CFR Part 11
• Analyzed the data model of the existing data warehouse to fetch data from that system.
• Updates information going to source systems to ensure data integrity.
• Perform periodic review of GxP qualified and validated computer systems.
• Created tools and templates to support GxP Compliance and Inspection Readiness
• 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.
• 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 (SQL Lite, 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.
• Experience in Guidewire Claim enters, Policy center and Billing enter, claim center Integrations and Configuration User Stories.
• Provided detailed walkthroughs to all stakeholders Strategic Team, Business Users, development and testing teams and ensured functional adherence for Guidewire Policy centre implementation.
• Worked on various Guidewire integration concepts like Messaging, Batch Processes, Plugins, and Web Services and worked with Technical and Business leads during Guidewire Policy Centre implementation.
• 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.
• Development and testing of Tableau Dashboards.
• Created action filters, parameters and calculated sets for preparing dashboards and worksheets in Tableau.
• Actively involved in the creation of users, groups, projects, workbooks and the appropriate permission sets for Tableau server logins.
• 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.
• Used MS Excel, Word, Access, and Power Point to process data, create reports in Tableau and analyze metrics, implement verification procedures, and fulfill client requests for information.
• Prepared use cases in Tableau and look and feel documents and got reviewed with end client.
• Handled tableau admin activities like granting access to users, managing extracts and installations.
• 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.
• Continuously evaluates the integrity of data in the health record to efficiently complete requests and identify and correct inconsistencies. Determines the correct action to be taken to ensure the integrity of the data.
• 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, Guidewire 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 Requisite Pro, Java, .NET, Business Objects, Service Now.

Confidential, Grand Rapids, MI

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.
• Claims Implementation Project - design, specification, implementation, and of QNXT 3.0 along with McKesson's Integration Wizard and Claim Check application.
• Extensively worked on Facets, the claim processing tool used in the project.
• Business rules configuration - implementation of business rules processing for software integration into QNXT.
• 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.
• Created detailed use cases, use case diagrams, and activity diagrams using MS Visio.

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 Rational Unified Process (RUP), Waterfall, EDI X12 (834, 835, 270, 271, 276, 277, 278, 837), UNIX, Axure RP, Application Lifecycle Management (HP ALM), Microsoft SQL, Microsoft Access, TriZetto Facets.