SUMMARY

• Over 8+ years of experience in the IT industry specializing in Business Systems Analyst and Scrum Master
• Experience in health information and health care services regulatory environment including HIPAA, Medicaid/Medicare, CCHIT, EDI and XML
• Experience with various modules like membership management, premium billing, enrollment, claims processing & adjudication, benefits administration within Healthcare industry
• Experience with claims process & adjudication in Medicare, Medicaid & Private insurance sectors
• Experience with Medicare, Medicaid & commercial insurances in HIPAA ANSI X12 4010, 5010 formats including 270/271, 834, 835, 837, 997, ICD 9, ICD 10, NDC, DRG, CPT, NCPDP codes & NSF formats for interfaces & images to third party vendor applications
• Possess a strong analytical, project management and negotiation skills in addition to in - depth knowledge and experience with Software Management.
• Excellent knowledge of MS SQL Server and Oracle and with Data modelling techniques.
• Experience in data migration Masterworks via FTP to an Amazon cloud (AWS).
• Extremely skilled as Scrum Master in facilitating scrum process and events (Backlog grooming, Sprint Planning, Daily Scrum, Sprint Review and Sprint Retrospective) to optimize team productivity and handling team dynamics.
• Experience working with IT&S team members to complete validation of first bi-directional HL7 LIS interface.
• Experience in 835 files validations for HIX at Claim level, Line level, Service level and Transaction level.
• Created companion guides for EDI transactions for both 4010 and 5010 versions and created crosswalks and experience in using EDIFECS Spec builder.
• Experienced with various Business Analysis SDLC Methodologies, such as RAD, RUP, JAD, and Spiral Methodologies.
• Created test and tested Web based and consumer applications, using manual and automation tools like HP ALM and QTP
• Hands on experience in converting the Mainframe M204 & IDMS data to SQL Server.
• Expertise in Project Planning, Project Design, gathering requirements, creating Functional Specifications, and Data Flow Diagrams.
• Experience in conducting/facilitating Focus Groups Sessions, Stakeholder Interviews, Joint Application Development (JAD) and Joint Requirement Planning (JRP) Sessions for effective requirement gathering.
• Experience in creating documents such as Feasibility Reports, Systems Request, and Risk Assessments.
• Experience in development methodologies like RUP, SDLC, AGILE, SCRUM and Waterfall
• Establish documentation for agile methodology for implementation with a very water-fall-centric development team.
• Excellent knowledge of HIPAA standards, EDI (Electronic data interchange) Transaction syntax like ANSI X12, Implementation and Knowledge of HIPAA code sets, ICD-9, ICD-10 coding and HL7.
• Consolidated CDA (CCDA) - MU Stage 2, Transitions of Care, CCDA R1.1 and R2
• CCDA Interoperability support - all documents; Continuity of Care Document - HITSP C32 v2.1 - 2.5
• Experience in assisting Project Managers in creating Cost/Benefit Analysis Reports.
• Involved in maintaining Requirements Traceability Matrix.
• Experience in writing SQL queries to generate reports.
• Excellent Documentation skills to ensure proper communication channels between Business sponsors and technical teams during the entire software development process.

TECHNICAL SKILLS

Tools: Experience: Test Director, JIRA, Rational Clear Quest, ALM/ Quality Center, MS VISIO, SQL Developer, Toad, Agile

Testing Software: QTP, Test Director

Cloud Infrastructure/ Computing: Amazon Web Services (AWS), EC2, SAN / Network troubleshooting, AWS Red Shift, AWS DynamoDB, AWS Kinesis -Fire Hose

Bug Reporting Tools: Test Director

Operating Systems: Windows, DOS

Programming Languages: SQL, UML, JAVA, .Net, RUP, Agile

PROFESSIONAL EXPERIENCE

Confidential, Bloomington MN

Sr. Business Systems Analyst

Responsibilities:

• Created Business Requirements Document, System Requirement documentation, Business Requirements Document, Functional Requirements and System Requirements documents on Worked on Functional and Technical Requirement Document, Requirement Traceability Matrix on Family Membership Project, Delivery Management, IMAX-Konnex Data reconciliation on the IMAX.
• Utilized the Mainframe systems (TSO/ISPF, SDSF, FTP, EVT, IMS, JCL, COBOL, CICS, AS400) for generation of Gmax/Imax flat files, running the JCL jobs, transferring, Edit and validating the Data sets, reports
• Analyzed plan requirements and then contributed further defining the plan requirements with their Project Manager. Observed the compliance of the requirements with federal and state government regulations Medicaid, Medicare, and accreditation body requirements
• Facilitated sprint planning as Scrum master for multiple Scrum teams
• Support Data warehouse infrastructure and develop and troubleshoot SSIS ETL packages while ensuring data integrity and data quality. Develop initial stages of SSAS tabular models and Python Statistics for healthcare analysis.
• Developed and managed the formal Software Development Life Cycle (SDLC) Methodology which includes Configuration Management, Requirements Management, UML Analysis and Design under Agile (SAFe) methodology.
• Managing all EDI-related activities for the business that include 837 Institutional and Professional claims that comes from all Insurance Carriers, Medicare and Medicaid
• Works with GPO's: Innovatix, MHA, HPSI, Navigator, MedAssets.
• Elicit complex requirements across multiple systems and business lines using effective meeting facilitation, process visualization, data mapping, JAD sessions, and rapport building skills.
• Have worked on HIPAA 5010 validations, 820, 834, 835, 837 transactions and EDI validations
• HIPAA and HIPAA2 naturally became the inclusive elements in the package to address the X12 4010A1 as well as 5010 transaction solutions. Analysed results and EDI ANSI X12 file mapping and reported on standard analysis spread sheet. \ Developed & executed several Optimized queries in SQL on this data.
• Designed, test, and customized EMR templates, documents and crystal reports
• Ensured current EDI 278 business validation rules applicable to ICD-9 codes
• Developed a Visio chart to outline all electronic file types (EDI), direct connect and third party, to include remit files. Assisted with 5010 testing files.
• Working knowledge in ICD 9/ANSI Health codes/HL7/ADT in the claims environment for inpatients and outpatients; reviewed the implementation of the changes made in the systems as per the formats and compliance for EDI usage.
• Performing data mining, data analysis and data discovery efforts.
• Led end-to-end project management, from concept development to post-launch analysis.
• Researched EDI claims and claims adjustments data to determine root causes of data errors
• Developed and executed SQL queries on claim records to validate reporting data
• Established new data governance, stewardship and change management processes for the product/service information group to manage information related to the new product hierarchy and other enterprise master data references for product information.
• Designed and documented Test Cases according to the application requirements using HPQC/ ALM
• Coordinated and attended meetings to review these specifications with the Quality Assurance Manager, Business Systems Analysts, RUP Engineers, Project Manager & others on the team
• Reviewed Test Cases for EDI transactions and executed them in HPQC/ ALM testing environment
• Participated in the bug review meetings, Updated requirement document as per business user feedback and change in functionality of the application
• Used Agile and Rational methodology in the project development for Rational Test Suite for various phases of RUP.
• Designed and implemented SQL queries for QA testing
• Performed Unit Testing and User Acceptance testing and documented detailed results.
• Trained providers, administrators, and staff on implementation and use of NextGen's EHR and EPM
• Worked effectively with physicians, nurses, and engineers to solve problems related to EMR, EPM, and ICS to make software more user-friendly to staff and doctors

Environment: Windows, J2EE, Asp.Net, Agile, Rational Clear Quest, Sql, UML, Rational Clear Case, Microsoft office, Word, Excel, Power point

Confidential, Round Lake, IL

Business Systems Analyst

Responsibilities:

• 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. Done research to understand some facts behind the AMS icon requirement.
• Enforced Kanban principles as a Scrum master that resulted in reduction of Cycle time by 20% thus increasing team's throughput.
• Involved in testing the conversion of the application into web application using XML web services.
• Conducted data driven testing using QTP to conduct backend testing.
• Utilize the SAFe agile methodology for backlog/sprint planning/development, QA testing, and business readiness
• Interacted with business heads to finalize the Business Requirements for the application.
• Extensively used relational and dimensional data modelling for creating Logical and Physical Design of Database and ER Diagrams using data modelling tools like ERWIN.
• Experience with logical and physical data modelling and database design using Erwin. Created Sessions and Workflows of the source to Target loading.
• Worked with the Data Governance Council to identify accountable parties to provide remedy for information defects based on my recommendations.
• Created project plans in accordance with project management framework standards and procedures. Identified ongoing issues and gaps within project plans, to eliminate implementation issues.
• Defined dashboards/DART views in Actimize RCM application.
• Serve as the liaison between the Supply Chain IT&S department and the user community.
• Development of all Healthcare HIPPA- EDI related transactions - 820, 834, 837,835 - 271/272, 278, etc.
• Managed various tests, stored test information, reviewed and analyzed test results.
• Conducted presentations of the Q/A test results with analysis to the stakeholders and users and documented modifications and requirement.
• Worked on proper configuration management, change controls and best practices/ guidelines for design were maintained by AWS systems during development and deployment of Big Data models using Framework Manager and Transformer.
• Provided database and data warehouse support for enterprise applications (across SQL Server and Oracle platforms).
• Advised on changes for the system design, methods, procedures, workflows and policies that effected the Medicare/Medicaid claims processing in compliance to government procedures such as HIPAA and EDI formats as well as ANSI.
• Facilitated JAD sessions for Requirement Validation with HPA to gather requirements for the new MMIS.
• Raised and Tack the defects in HP ALM, with appropriate snap shots, and log the defects.
• Conducted HIPAA related EDI development for 837, EDPS, 835 and other EDI processes using Pervasive EDI translator.
• Provided recommendations to clients to meet their requirements, while ensuring that technical solutions were sound and acceptable to HMS
• Performed extensive data modeling to differentiate between the OLTP and data warehouse data models.
• Proficient in Unit Test Plans (UTP), Integrated Test Plans (ITP) Extensive experience in User Acceptance Testing (UAT).
• Imported data from various patient accounting systems via delimited text files, XML, HL7
• Coordinated various kinds of User Acceptance Testing (UAT) including regression testing, system testing, integration testing, functional testing, alpha & beta testing.
• Worked with SQL Server and developed and ran SQL queries for data selection, cleansing and data mapping.
• Loading the data into Oracle Database to verify data integration by using SQL plus.
• Creating and testing 834 transactions for 5010 and 4010 and mapped the changes according to ICD 9 and ICD 10.
• Used the Agile methodology to build the different phases of Software development life cycle. (SDLC)
• Used Test director to link the description and documentation of project requirements.
• Provided detailed traceability views that display relationships and show requirements by using Test director.
• Configured the Data mapping between Oracle and SQL Server.
• Coordinated and developed QA activities with team members to support the Scrum methodology.
• Maintained proper communication with the developers ensuring that the modifications and requirements were address and monitor these revisions.
• Involved in compatibility testing with other software programs, hardware, Operating systems and network environments.
• Performed (UAT) once QA Manager approved the application and it was migrated to the User Acceptance Testing Environment.

Environment: PL/SQL, Windows Server, HIPAA, X12 EDI, HP ALM, AWS, Agile Methodology, MS Office, .Net, Rational Clear Quest, Rational Clear Case, Microsoft office, Word, Excel, Power point

Confidential, Portland, OR

Business Analyst/ Data Analyst

Responsibilities:

• Performed Requirements Gathering and Analysis, interviewed the SME (Subject Matter Experts), and ensured that contributors and all key stakeholders were motivated to complete assigned tasks.
• Worked directly with software engineers to ensure clear communications on requirements and defect reports.
• Analyzed, designed and tested EDI 278 Health Care Services Review Information transaction set files.

  Reviewed ANSI X12 EDI standards, documented functional requirements and worked with the developer to write the code to generate a 278-transaction file. Tested successfully, passing EDI edits.

• Created Process Work Flows, Functional Specifications, and responsible for preparing Software Requirement Specifications (SRS), Functional Specification Document (FSD).
• Performed Gap Analysis to identify the deficiencies of the current system and to identify the requirements for the proposed system.
• Proficient in using Agile Scrum methodologies, performed roles of Scrum Master following sprint/standup sessions and used Excel extensively to write user stories, analyzed the Iteration Burn Down charts and reviewed defects.
• Used ETL (SSIS) to develop jobs for extracting, cleaning, transforming and loading data into final database/data warehouse.
• Conduct data mining, data modelling, statistical analysis, business intelligence gathering, trending and bench marking.
• Recommended changes for system design, methods, procedures, policies and workflows affecting Medicare/Medicaid claims processing in compliance with government compliant processes like HIPAA (4010A1)/ EDI formats and accredited standards like ANSI
• 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.
• Developed plan for data feeds and data mappings for integration between various systems, including XML, to follow ICD 10 Code set and ANSI X12 5010 formats.
• Involved in HIPAA Transactions & Code Sets Standards like (820- Premium Payment for enrolled health plan members, 834 Enrollment to a health plan, 835, 837...etc.)
• Responsible for HL7 Development and File transfer support, Analyze EDI mapping guidelines and Data validation and Support EDI Production Workman's Comp and Healthcare claims
• Developed an automated change management process to assist governance teams for review and approval of information change requests.
• Researched data issues in the warehouse and worked with IT team in getting them resolved.
• Performed Defect Tracking and Change Control Procedures using Rational Clear Quest and Configuration Management and Version Control using Rational Clear Case.
• Worked with the development team to make sure that they understood the user requirements and that the system developed met those requirements.
• Recorded the Defects in HP ALM, QTP (VB scripting) and win runner with priorities and co-ordinate with Development team for fixing.
• Formulating/defining specifications for future end state, designing Enterprise Architecture, Database design and Data Modeling.
• Conduct complex documentation and user needs analysis. Interface with team and staff to develop HL7 integration. Participated in the application scrum meetings and the sessions.
• Trouble shooted file transmission problems and assisted customers with EDI and Medicaid Insurance claim related inquiries explained.
• Worked with the technical and business staff to produce Test Scripts, Configuration and Management Plan documents.
• Worked directly with developers, Project Managers and Business contacts to produce Data Flow Diagrams.
• Followed established formats and procedures, created new formats, as well as researched, created, edited technical and business data documents.
• Executed Budget/Measurement/Forecast processes, which provided accurate, timely and meaningful information to finance and line management.
• Designed and executed performance and functional test scripts.
• Worked with other Business Analyst to develop test plan and test cases for (UAT).
• Worked with the Project Manager on various Project Management activities like keeping track of Project Status, Deadlines, Environment Request, and Compliance Issues.

Environment: Windows, J2EE, Asp.Net, Rational Clear Quest, SQL, UML, Rational Clear Case, Microsoft office, Word, Excel, Power point

Confidential, Wellesley, MA

Business Analyst/ Systems Analyst

Responsibilities:

• Responsible for defining the scope and implementing business rules of the project, gathering business requirements and documentation.
• Responsible for writing Functional Requirement Specifications (FRS) and User Requirement Specification (URS).
• Analyzed Business Requirements and segregated them into high level and low-level Use Cases, Activity Diagrams / State Chart Diagrams using Rational Rose according to UML methodology thus defining the Data Process Models.
• Created HL7 compliant script for proprietary Oracle messaging system. Understand the As Is system and develop the To Be system concept and prepare the System Process Maps.
• Involved in HIPAA EDI transactions processing such as 835, 837 (P, D, I) 276, 277, 278.
• Created SAS programs that are used for data validation, statistical report generation and program validation and automated the Edit Check programs using Macros.
• Worked with NASCO teams to get current work flow for detailed business process.
• Involved in applications analysis, which involves claims processing in NASCO.
• Conducted presentations of the Q/A test results with analysis to the stakeholders and users and documented modifications and requirements.
• Performed extensive data modelling to differentiate between the OLTP and Data Warehouse data models.
• Involved in part of the data migration team to map data between the Centricity and Epic system on the scheduling interface.
• Involved in strategic planning, project management, forecasting, business assessment, process design, knowledge management, technical and continuing process improvement and analysis.
• Coordinating and Developing QA activities. Assigned tasks among development team, monitored and tracked progress of project following agile methodology.
• Created Process Flow diagrams, Use Case Diagrams, Class Diagrams and Interaction Diagrams using Microsoft Visio and Rational Rose.
• Performed Unit Testing and User Acceptance testing and documented detailed results.
• Wrote Test Cases and performed User Acceptance Testing (UAT), documented the in-detail defects using the Defect Tracking report.
• Created Use cases, activity report, logical components and deployment views to extract business process flows and workflows involved in the project. Carried out defect tracking using Clear Quest
• Maintained proper communication with the developers ensuring that the modifications and requirements were addressed and monitored these revisions.
• Involved in compatibility testing with other software programs, hardware, Operating systems and network environments.

Environment: Requisite Pro, Rational Rose, Agile, PL/SQL, HTML, MS Office, Cognos, RUP, XML, MS Visio, EDI, UML, QTP, Test Director.