SUMMARY

• Nearly 7 years of consistent experience in the following areas: Ability to Elicit, Analyze, gather and document Business Requirements, experienced in writing Use Cases.
• Proficiency in SDLC life cycle, understands the workflow concept, ability to gather and document the 'As - Is' and 'To-Be' processes.
• Requirement gathering through interviews, workshops, JAD sessions with clients, developers and referring to existing system documentation and procedures
• Experienced in gathering and documenting test Scenarios and ability to train users to translate technical requirements and translate them to a business audience
• Worked in a software development IT shop, created quality documentations such as Requirements Documents, Design Document, Test Plan, and User Acceptance Test Plans.
• Strong data analysis skills, experienced in data warehousing.
• Hands on experience on various SQL Server Services like Integration Services (SSIS), Analysis Services (SSAS), and Reporting Services (SSRS).
• Followed the software Development Life-Cycle (SDLC) and Agile development methodology during the life of the project to include phases i.e., Pre-planning, Requirements, Design, Development, Testing, User Acceptance Testing, and Production.
• Experience in developing strategies for Extraction, Transformation, Loading (ETL) data from various sources into Data Warehouse and Data Marts.
• Strong experience with different project methodologies including Agile, Scrum Methodology, SDLC, RUP.
• Strong experience and understanding of claims management process
• Strong experience and understanding of health care industry, claims management process, Knowledge of Medicaid and Medicare Services .
• Strong knowledge and experience with claims associated with payers, claims by providers and member/subscriber claims
• Extensive hands on experience in consuming as well as developing API's for SOAP and REST based Web services to integrate third party functional modules into the core application.
• Extensive knowledge of Medical Management Information Systems (MMIS), National Provider Identification (NPI), Health Insurance Portability & Accountability Act (HIPAA) standards, Electronic Data Interchange (EDI), HIX (Health Information Exchange), EMR/EHR, Health Care Reform and Patient Protection and Affordable Care Act (PPACA).
• Strong knowledge of EDI Claims, member enrollment, and billing transactions
• Understanding of HIPAA Standards and Compliance issues, HIPAA Privacy policy, opt in/opt out policy.
• Expertise in Claims, Subscriber/Member, Plan/Product, Claims, Provider, Commissions and Billing Modules of Facets.
• Experienced in Full life cycle Manual and Automated Testing in a Web-based Applications (JAVA, .NET etc), Client/Server Applications, and mainframe applications in Multi-Tier environments
• Migrated data from different data sources (SQL Server, Flat files, Excel source files, Oracle) and loaded the data into target tables, data warehouse by performing different kinds of transformations such as conditional split, derived columns, aggregation etc., to ensure data validation, before loading based on the business need using SSIS.
• Thorough understanding of Software Development with various programming languages such as, C, C++, Java, .Net, HTML, XML, etc
• Hands on experience on various SQL Server Services like Integration Services (SSIS), Analysis Services (SSAS), and Reporting Services (SSRS).
• Involved in Facets Output generation, Interface development and Facets Migration Projects.
• Provided analytical solution to the customers for Facets Production Issues.
• Prepared unit test cases and performed unit testing.
• Requirements gathering in compliance with HIPAA 4010 and 5010 standard.
• Experience web based application development and maintaining wikis.
• Used SQL to test various reports and ETL load jobs in development, QA and production environment.
• Experience with healthcare fraud and abuse problem and solution development
• Writing Use cases and producing Behavioral diagrams (Sequence diagrams, Collaboration diagrams) and Class diagrams based on UML Methodology & creating Business process flow diagrams
• Writing & documenting Business Plan, Requirements Document, Functional Specification Document, and Test Cases
• Defining Test Cases, analyzing bugs, interaction with team members in fixing errors and User Acceptance Testing (UAT)

TECHNICAL SKILLS

Methodologies: Agile/Scrum Rational Unified Process (RUP), Waterfall

Languages: SQL, Java, Mainframe, .NET, HTML, XML, COBOL

Database Tool: QL*PLUS, TOAD, SQL DEVELOPER, Squirrel

Office Tools: Office 2002/XP/2003/ MS Word, Excel, PowerPoint

Testing Tools: HP ALM Quality Center, ALM, JIRA

Database: MS SQL Server 2000, MS SQL Server 2010, MS Access, Oracle, DB2

Other Tools: Claims Data Validator, Ultra Edit, MS Office Suite, Biz Talk, Edifices, Trello, Parature, MQ Visual Edit, WebSphere, CICS, Claim Test Pro, Facets

PROFESSIONAL EXPERIENCE

Confidential, Louisville, KY

Business Analyst

Responsibilities:

• Managed software system development and integration projects through all phases of project life cycle - analysis, design, development, testing, implementation, and post-production support.
• Interacted with stakeholders to get a better understanding of client business processes and gathered requirements.
• Designed reports using SQL Server Reporting Services (SSRS).
• Performed testing of the health benefit claims receiving and processing system to ensure that the system adheres to project standards, performance criteria, and functional specifications
• Implemented Standardized and Unified process throughout the Software Development Life Cycle (SDLC).
• Responsible for gathering the functional requirements for the health benefit claims receiving and processing system.
• Develop business requirements for new projects involving federal and state government initiatives regarding Health Insurance Exchange
• Conducted requirement gathering sessions with the purpose of creating and defining the Business Requirement Document (BRD) and the Functional Requirement Document (FRD) using Rational Requisite Pro.
• Developing Use Case Models, Entity Relationship Diagrams (ERD), Activity Diagrams, State Diagrams and Data Flow Diagrams (DFD)
• Use SQL server management studio for data analysis and SSIS tool for ETL on a daily basis.
• Involved in Requirement Scoping and analyzing high priority requirement. Conducted sign-off meetings with IT teams to lock down the requirements.
• Created high-level Use Cases from Business Requirements and created UML diagrams like Use Case and Activity diagrams using MS-Visio.

Confidential, Danville, PA

Sr. EDI Business Analyst

Responsibilities:

• Formulated and defined systems scope and objectives through research, data mining, analytics and fact-finding.
• Participated in Scrum/ Agile PI (Program Increment) planning sessions within a SAFe (Scaled Agile Framework) environment.
• GAP Analysis: Analyzed the client’s applications programs 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
• Used SQL developer tools to create data report from data warehouse
• Strong experience in Data warehouse concepts.
• Experience in API documentation.
• Created ETL documentation such as EDI X12 837(P,I), 834 and 835 Data Mapping, Transformation logic for Main Frame Layout, Updating Meta data documents for new Platform.
• Creating and validating data using SAS functions and procedures.
• Successfully used Agile/Scrum Method for gathering requirements and facilitated user stores workshop. Documented User stories and facilitated Story Point discussions to analyze the level of effort on project specifications.
• Customizing Visual Studio Team Services (VSTS) for alignment with SAFe.
• Systems Documentation included Business Requirements Document (BRD), Systems Requirement Specification (SRS) and test plans using Requisite Pro.
• Weekly and monthly sales reports generation and distribution to end users in defined timelines using Cognos Bursting on Network path
• Used and verified the EDI messages 837. Healthcare encounters claim and coordination of benefits (COB)-Claim payment and remittance advice 835 - Healthcare claim status 276/277, Eligibility for a health plan 270/271.
• Developed a Schedule and identified project milestones.
• Expert in agile software development and release management.
• Created ETL test data for all ETL mapping rules to test the functionality of the Informatica Mapping.
• Worked with FACETS Team for HIPAA Claims Validation and Verification Process (Pre-Adjudication)
• Did forward and backward data mapping between the fields in mainframe and FACETS
• Worked with FACETS edits and EDI HIPAA Claims (837/835/834) processing.
• Assisted the EDI team in the development and documentation of the test strategies for the EDI transactions which included all standard transactions, auditing and error correction processes, and the creation of the transactions.
• Developed Restfull API Automation scripts in EclipseIDE,Java,Maven,Cucumber,restassured and used TestNG framework
• Developed the T-SQL stored procedures/functions to process these data and populate them in the appropriate destination tables.
• Incremental development and testing of Enterprise Data Warehouse.
• Writing SQL queries and using concepts like Explain, Stats, CAST and volatile tables.
• Implemented business rules on data using Stored Procedures, Functions and Packages.
• Designed and implemented complex SQL queries for QA testing and data validation.
• Worked on HIPAA Transactions and Code Sets Standards according to the test scenarios such as 270/271, 276/277,837/835 transactions.

Confidential, Dayton, OH

Business System Analyst

Responsibilities:

• Analyzed the available artifacts such as BRDS, both functional and nonfunctional, Use cases, Data Flow Diagrams.
• Facilitated JAD sessions to collect requirements from system users and prepared business requirement that provided appropriate scope of work for technical team to develop prototype and overall system.
• Extensively involved in planning efforts for the Utah State Health Insurance Exchange (HIX)/ Health Benefit Exchange (HBE).
• Worked with e-billing and EDI HIPAA Claims 834 and 837 processing.
• Connected to SQL plus in UNIX and created and executed complex SQL queries.
• Wrote complex SQL queries to perform the Back End Testing of the Oracle database using SQL and UNIX shell commands.
• Played an active role in the UAT.
• Facilitated the Customer in defining the high-level Functional Requirements and needs.
• Utilized RUP to create use cases, activity, class diagrams and workflow process diagrams.
• Prepared the Prototype and mockup screens.
• Responsible for creating different sessions and workflows to load the data to Data Warehouse.
• Involved in the Data Movement between Systems validated the Business Requirements.
• Verified the correlation between the UML diagrams and developed detailed diagrams.
• Responsible for providing fiscal and economic solutions through financial modeling and cost basis analysis
• Worked in converting existing API written in PHP
• Worked with Scrum/ Agile Product Owner to set up Agile SAFe deliverables and ceremonies .
• Involved in writing extensive SQL Queries for back end testing oracle database.
• Retrieved files using SQL statements and UNIX commands.
• Experience with Claims, enrollment, eligibility verification for members and providers, benefits setup, and backend payment cycle.
• Performed User Acceptance Testing (UAT) with business users.
• Coordinated with the developers and IT architects to design the interface of the new system according to the X12 EDI (834, 837 standards)
• Created and maintained the Requirements Traceability Matrix (RTM).
• Worked with the Project Manager on various Project Management activities like keeping track of Project Status, Deadlines, Environment Request, and Compliance Issues.
• Responsible for checking member eligibility, provider enrollment, member enrollment for Medicaid and Medicare claims.
• Designed and developed the architecture of business intelligence components including data models, and enterprise reporting. Conducted UAT.
• Worked with providers and Medicare or Medicaid entities to validate EDI transaction sets or Internet portals.
• Clear understanding of Medicare (Part A, Part B and Part D) and Medicaid benefits as well as business processing.
• Involved in 835 files validations for HIX at Claim level, Line level, Service level and Transaction level.
• Validated the following: 837 (Health Care Claims or Encounters), 835 (Health Care Claims payment/ Remittance), 270/271 (Eligibility request/Response), 834 (Enrollment/Dis-enrollment to a health plan).
• Worked with project manager and other users and created work flow diagrams using MS Visio/UML.
• Worked with IP Multimedia System (IMS), which is used for communication.
• Ensured Use-Cases were consistent and covered all aspects of the Requirements document.
• Maintained the Business Impact Analysis Template (BIAT) to analyze and document the effect of proposed changes on the project schedule and costs.
• Created, maintained, prioritized Scrum/ Agile/ SAFe training content and processes, including weekly training sessions to Developer audiences.
• Performed UAT, regression testing on EDI 835 and 837 X12formats in Facets.
• Was responsible for tracking issues that are detected and updating the status of existing issues based on the daily meetings with the offshore team.

Confidential

Business System Analyst

Responsibilities:

• Creating test plans and tested the EDI transactions including 270,276,277, 835, 837I and 837P.
• Testing Authorizations for Claims.
• Updating ticketing software with results.
• Tested LIS-LEP Enhancement for HEALTH suite system
• Tested MIM (McKesson Integration Module) Claim Check integration enhancement with HEALTHsuite
• Tested NACHA files and Batch Eligibility Query (BEQ) Request and Response files for CMS
• Prepared UAT Materials, including the UAT Process, UAT Test document which would include step-by step process for UAT as well as all the tests that would cover all requirements.\
• Provided project planning, milestones, and deliverables for implementation of document management system using MS Project.
• Produced clear user manuals & training guides for User Acceptance Testing (UAT) and deployment for end-clients with step-by-step instructions and created appropriate GUI screenshots.
• Involved in analysis of requirements for Medicaid and Commercial line of businesses.
• Scheduled the meetings with domain leads to determine the mapping parameters for each field.
• Followed agile methodology to gather the Business Requirements and designed Functional specifications.
• Used Parasoft SOA test to test backend API services.
• Performed numerous data extraction requests involving SQL scripts and UNIX
• Highly involved in Gap Analysis to identify the deficiencies of the current system and to identify the requirements for the change in the proposed system.
• Involved in the requirement definition and analysis in support of Data Warehouse and ODS efforts.
• Played major role to create the Business Requirement Documentation (BRDs), using MS Word and MS Visio that provided appropriate scope of work for technical team to develop prototype and overall system.
• Identified the crosswalk table schema to persist the mapping of new system to existing system codes.
• Tested the interface between Member360/EEM 360 and HEALTHsuite enhancement
• Testing EDI inbound and Outbound Mapping
• Strong MS Project experience to manage project schedules analysis and reporting.
• Decoded XML results to validate test results
• Checking conflicts and installing the COBOL scripts into Test Environment Setting up the properties
• Used Apache POI API to register the test data from the excel sheet.
• Create and run SQL queries for database validation
• Testing the Medicaid Provider Number Status Enhancement.
• Extensively involved in UAT support for their execution and Defect Triage
• Creating several Test Cases and Test Conditions for testing various Claims, Membership, and Billing and Provider reports
• Performed complex ad hoc SQL queries from BAs in Teradata SQL Assistant.
• Extensively tested different versions of RA (Remittance Advice) and EOB (Explanation of Benefits) both paper and XML
• Migrated SSIS packages and SSRS reports.
• Created an issue log document and documented all User Acceptance Testing (UAT) issues using Quality Center.
• Wrote test script for Members benefits verification
• Wrote SQL statement for to extract providers, claims and member information for validation
• Wrote test scripts for Mercato products testing
• Monitored the progress of projects using MS Project and took appropriate action to ensure that they keep up with the schedule.

Confidential

Business System Analyst

Responsibilities:

• Assembled business requirement documents (BRD) and the functional specifications as per the user requirements.
• Created Business Workflow based on the requirements gathered from the client.
• Created functional specification documents based on the business requirement documents.
• Developed tables, Views, Stored Procedures and Triggers using SQL Scripting
• Organized JAD Sessions to resolve issues and conflicts, and to arrive at quick agreements regarding the system architecture design.
• Responsible for day-to-day project team communication and coordinated project meetings and updated everything in MS Project.
• Gathered knowledge on CPT-4, HL7, HIPAA rules and regulations
• Conduct complex documentation and user needs analysis. Interface with team and staff to develop HL7 integration
• Experience in creating reports using SSRS (SQL Server Reporting Services), Crystal Reports, SSAS (SQL Server Analytical Services) objects and OLAP including Interfaces with BIDS (Business Intelligence Development Studio).
• Performed functional testing, regression testing, API testing and database testing.
• Gathered business requirements for CMS and non-CMS projects through different stakeholder interviews and translated those into Functional Specification which was key for successful implementation of systems
• Conducted Interviews and JAD sessions with SMEs and stakeholders to understand business requirements
• Worked on ODS system for setting up Claims submissions.
• Worked closely with the Enterprise Data Warehouse team and Business Intelligence.
• Route Health records received in HL7 2.x and CCD, CCDA messages to Clinical Document repository.
• Actively participated in enhancement meetings. Involved in the meeting with Business process owners, SME (subject matter experts) and Marketing Team for Requirements gathering in definition stage.
• Created user interfaces, record keeping and backup pages using Java server pages and MS Access database.
• Configuring interfaces using HL7 v.3.0, XML Schemas etc.
• Worked with the project manager for planning and organizing the project activities, and in communicating with other business center mangers and stakeholders of the project using MS Project.
• Led the Business Process Re-engineering and Fit Analysis, Change Leadership Development, Business Transformation, and modification of Supply Chain Applications activities.
• Assisted user interface (UI) designers in conducting usability studies and developing the UI.
• Conducted individual and group joint application development (JAD) sessions with business stakeholders and technical units.
• Actively worked with developers as needed to isolate the Root Cause Analysis of defects.
• Worked with the clients on the final signing process in the User Acceptance stages.