- Experience in all phases of software development life cycle (SDLC), Optimized waterfall, Agile, Scrum including Requirement gathering and documentation, Use Case Documentation, Business Case Study/Analysis and user stories.
- Experience in developing and writing functional business requirement, Scope documents, Gap and Risk analysis documents,
- Expertise in generating various reports to assist with validating Reconciliation reports for claims and also Daily Outstanding Reports
- Experience in working on multi - channel cross-platform web applications, supporting implementation of new and existing products, ensuring requirements delivery on budget, time and quality for the agreed upon scope.
- Experience in Software Quality Assurance with excellent understanding of Software Testing Life Cycle (STLC), Change Control management, Defect Tracking, and reporting.
- Experience in conducting JAD sessions for project definition involving analyzing requirements, creating user interface (UI) prototypes.
- Excellent knowledge of Health Insurance Portability and Accountability Act (HIPAA) transaction and code set rules such as EDI 837,834,835.
- Extensive knowledge, and experience on Medicaid, and Medicare Part A, Part B, Part C, and Part D, and Medicare advantage plans.
- Experience in implementation of HIPAA 4010 and HIPAA 5010 changes in the existing claim processing integrated system.
- Good understanding of ICD 9, ICD 10, HCPCS, and CPT.
- Highly experienced with requirements gathering, planning, organizing, and Change Management.
- Experience with Rational Tools including Rational Requisite Pro, Rational Rose.
- Extensive exposure to SDLC Methodologies like Rational Unified Process (RUP) Agile, Waterfall, Spiral.
- Experienced in GAP Analysis, Traceability Matrices, SWOT and Cost Benefit Analysis.
- Experience with User Acceptance Testing (UAT), Unit Testing, application testing, integration testing, Black box testing.
- Designed and implemented basic SQL queries for QA testing and report / data validation.
- Experience with PL/SQL and MS Access database and MS office.
- Developed Process flows, use case diagrams, class diagrams, sequence diagrams, collaboration diagrams, state diagrams and activity diagrams using UML to make users and developers understand the system.
- Practical understanding of the Data modeling (Dimensional & Relational) concepts like Star-Schema Modeling, Snowflake Schema Modeling, Fact and Dimension tables.
- Experience in extracting, transforming and loading (ETL) data from spreadsheets, database tables and other sources using Datastage.
- Understanding the Business Architecture and Business Processes of technology network like insurance, banking, finance, and investment industry.
Process/Model Tools: MS Word, Excel, PowerPoint, Visio, Toad, Agile Methodology, Scrum, Rational Unified Process (RUP), Rational Rose, Rational RequisitePro, Rational Clear Case, UML, Use Case Diagrams, Sequence Diagrams, Excel VBA, Activity Diagrams, MS Office, Google Analytics.
Reporting Tools: Crystal Reports, OBIE.
Test Tools: ALM (Application Lifecycle Management), Bugzilla, Jira
Operating System: Unix, Windows NT/2000, Windows XP, IBM Mainframe
Languages and tools: C programming, IBM mainframes, DataStage.
Databases: Oracle, SQL Server 2000, 2005, 9g, 10g, My SQL.
- Engage business stakeholders to gather software requirements/business rules, and ensure alignment with development teams.
- Translate Business needs into functional requirements, use cases, user stories, workflow/process diagrams.
- Identify system and data requirements for the project and engage appropriate stakeholders to ensure those needs are met.
- Support all levels of testing including functional, regression, user acceptance, system integration and performance to verify the client’s needs are met.
- Identify risks related to requirements implementation and ensure project management is kept up to date on assigned tasks, issues, risks and key decisions.
- Facilitate meetings to discuss complex situations with business stakeholders and external vendors and explore potential solutions.
- Monitor and report defects, review open issues with stakeholders to set priority and ensure speedy resolution.
- Prepare presentations for business, give demo to sales and marketing team for assigned products.
- Participate actively in focus groups and process improvement meetings.
SDO Tech Business Analyst
- Responsible for making and maintaining necessary changes for claims finalization tasks using Confidential -chip (core enrollment and adjudication system).
- Responsible for cost containment for investigating the eligibility of Institutional inpatient hospital stays and specific Institutional outpatient diagnostic procedures
- Develop business analysis using requirements such as scope, processes, and risks assessment.
- Worked on Healthcare experience management rules cleanup and DCDD updates.
- Establish requirements with using ALM to ensure it is written for the business needs.
- Gathered requirements from Business Partners, Business Managers, Stakeholders, and SME’s.
- Conducted Joint Application Development (JAD) sessions with stakeholders.
- Involved in walkthroughs and meetings with development team to discuss related issues.
- Maintained Requirement Traceability Matrix (RTM).
- Involved in the creation and maintenance of the Workflow plans and artifacts.
- Modified existing workflow to accommodate change request from the client.
- Updated Impact and Trace Matrix.
- Participated in functional and technical reviews.
- Worked with QA team to design test strategy and test cases for User Acceptance Testing (UAT).
- Resolve and process different types of claim audits.
Environment: BlueChip, CLAIMS GUI, PREMIER, Agile, Waterfall, ALM, ARIS, JIRA, SharePoint, Super Scrubber, Splunk, UML, Use Case Analysis, MS Visio, MS Project, MS Office, One Note, BAM.