System Analyst Resume Profile
SUMMARY
- More than twelve years of experience in information technology as a Senior Business Analyst/Lead with experience in business analysis, design and development of applications, testing, group enrollment and implementation.
- Ten years of healthcare experience with healthcare mandate implementations including enrollment/eligibility, 4010 to 5010 ICD9 to ICD10, Medicare, Medicaid, PBM and Affordable Care Act 2010/Obama Care and PBM using FACETS 4.7/5.0/NetworX Pricing.
- 7 Years of BCBSIL HCSC BCBSMD Care first Experience as Facets 5.0 expert in claims processing, enrollment, membership, Benefits Management and billing/payments and I have also performed well in testing lead/manager/business architect roles on healthcare migration or reform projects with Pega/Tibco/Facets/NetworX Pricing.
- Specific industry experience, health care, retail financial services.
- Worked with all facets of the software development life cycle including design, analysis, and development and testing of web-based and n-tier client/server applications.
- Comfortable with internet technologies such as HTML, DHTML, CSS, XML, XSL, XSLT and JavaScript and Comfortable working with Mainframe/NASCO COBOL, JCL, CICS and DB2
- Extract, Transform and Load ETL and BI tools have been used in the projects on loading the data and maintain the data for reporting with Cognos and Star Schema to maintain data
- Familiar with relational database design and other database management oriented concepts such as writing stored procedures, PL/SQL, database triggers and views.
- Used case tools such as rational rose and ITIL to maintain process.
- Translated business requirements into UML diagrams/Visio Diagrams and detailed designs.
- Highly self-motivated with excellent analytical and problem solving skills.
- Extensive knowledge on workflow analysis with the help of UML, and Use Case diagrams, Data Flow Diagrams, Component Diagrams, Sequence Diagrams and Activity Diagrams and ability to translate them to System Requirement Specifications, Technical Specification.
- Thorough knowledge of industry standard SDLC practices such as Agile, SCRUM, Rational Unified Process RUP , Rapid Application Development RAD , Joint Application Development JAD , and Waterfall and various SDLC phases including Requirements, Analysis, Design, Development, Testing and Implementation of software applications
SKILLS
- Operating Systems Windows all , HP-UNIX, Linux, MVS/ESA, OS/390
- Programming Languages Java, COBOL, C, C , VB
- Mainframes JCL, CICS, VSAM, IMS-DC, Clear Quest,
- Unit Testing JUnit
- RDBMS SQL Server 2005, ORACLE 11i, My SQL, DB2
- Healthcare Tools Facets 5.0, Hiperstation, Play Back, EDIFECS, NASCO-NPS
- Automation testing tools Mercury QTP, Load runner, Win runner, Members Edge
- Rational Robot, HP Test director, Quality Center, Clear Quest
- Business Analysis Tools Relativity Application Analyzer, Profiler, Clarity, MS Visio, RUP
- Business Rule Manager, Req Pro/Web, Visual Studio 2010, UML, HPXR
- Special Software MS Visio, MS Excel, MS Word, MS PowerPoint, ETL, Cognos
- MS Access, MS Share point, Lotus Notes Citrix client, SharePoint 2010
- Methodologies Agile, Scrum, V-Model and Waterfall Model, ITIL, NetworX Pricing
- Knowledge on HIPAA- EDI transactions of 270/271, 834, 820, 276/277
- 275, 835, 278, 837 I/P/D, Medicaid/MMIS, ACT/Obama Care
- HIPAA ANSI X12 4010/5010, ICD 9 to 10 and PBM
EXPERIENCE
Confidential
Business/System Analysis-Testing
- Care first has the group enrollment processing system and process the group enrolment and eligibility electronically with Care first connect system to NASCO for Medical/Facets for Dental.
- Process management, estimation, execution, implementation and risk assessment plans for group implementation with NASCO, FACETS5.0, and Care first Connect portal.
- Used SDLC waterfall methodology from Care first side and Agile Scrum methodology from CFC vendor side to implement the CFC and NASCO projects.
- Microsoft SharePoint 2010, used to manage the project related deliverables to client and maintained internally for the audit purpose
- Participated NAEGS meetings with sales/LGIT team for new benefit changes or Product changes Blue Choice HMO to PPO, HMO OA, HMO OA HAS PPO to HMO and Medicare Part A to D , Medicaid-Obama Care changes relate to groups/companies.
- Analyzed the group structure prepared by LGIT based on the benefit/product changes related to groups/Companies and prepared the process documents RUP to implement the same with CFC
- Prepared the group implementation profile functional specification and coordinated with Care first connect team for medical/dental 834 file implementations with NASCO Members edge/FACETS5.0/HPXR/NetworX Pricing
- Writing technical specifications to create the SEED file for the group implementations
- Successfully coordinated migrations of group enrollments from Facets to NASCO and Care First connect portals with Small Mid groups to large groups
- Very good experience interacting with croup contacts/broker on requirement gathering and Requirement verification on the GUI/Mainframe based screens and implementations.
- Coordinating end to end testing with large group files STEP/834 files from CFC portal and verified all the enrollment data from group are accurate.
- Coordinating the Audits based on enrollment/benefits changes with group and updating the systems to match with enrollment data with BAM, PEGA, 824 errors
- Managed open enrollments/yearly group renewals with eEnroll/eExchange/HRIT groups for all Active/Cobra/Medicare/Medicare splits members
- Involved in the ID card processing for all the open/ passive enrollment and yearly renewal members including new enrollments
- Managed all Care first BCBS/Blue choice plans including dental/vision/CVS Caremark Drugs data and conducted testing and audits to maintain 100 accurate with systems
- Analyzing the system/business requirements with Facets/NASCO for Migrations of groups
- Coordination with system, regression and UAT testing team and creating test plan for CFC Team.
- SQL server and various SQL queries used to validate the enrollment values in the backend DB
- Worked on developing and testing functionality for the subgroups module like PBM pharmacy benefit , FACETS5.0, Medicare and MMIS etc.
Environment: Care first Connect Java portal, FACETS 4.7/5.0, NASCO, NPS, Members edge, COBOL, CICS, SQL Server, JCL, Web Share point, Quality Center, EDI, Ultra Edit, MS Visio, EDI 834, Tumbleweed, BAM, Agile, JIRA, PEGA, RUP, HPXR, NetworX Pricing and COBIT Framework.
Confidential
Business/System Analyst
- On October 1, 2013 a key element of the data foundation of the United States' health care system will undergo a major transformation. We will transition from the decades-old ninth edition of the International Classification of Diseases ICD-9 set of diagnosis and inpatient procedure codes to the far more contemporary, vastly larger, and much more detailed tenth edition of those code sets or ICD-10, used by most developed countries throughout the world.
- Project management, resource, estimation, execution, implementation and risk assessment plans for ICD 10 project and used Agile Scrum methodology to implement the project
- Very good experience interacting with vendor or stake holder on requirement gathering and Requirement verification with GUI/Mainframe based screens.
- Managing project with agile-scrum methodology for successful execution with Joint Application Sessions JAD to collect and report requirements, perform data analysis/reconciliation of BRD
- Created future state diagrams using MS Visio, RUP and UML to use it for future state development
- Created the use cases based on the requirements gathered with various client/state holders and reviewed with various stake holders using JAD sessions.
- Worked on the defect fixes for the release and used visual studio for code debug/validation
- Test and execution plan has been created for the ICD10 project to execute, SIT, Regression UAT testing on the EFE system.
- Reviewed logical design documents and use cases and making sure the enhancements based on the ICD10 changes with business team
- Coordinated with performance team using load runner to make sure the performance of the claims
- Involved in smoke, unit test results reviews and validated with smoke and unit test results with Dev, Test business team
- SQL server and various SQL queries used to validate the ICD 9 ICD 10 values in backend DB
- Cycle's execution for the latest ICD 10 project and defects tracking and validating the results.
- Involved in analysis, detailed design, development, testing
- Worked on developing and testing functionality for the subgroups module like PBM pharmacy benefit , HL7, FACETS5.0, Medicaid and MMIS Etc
- Extract, Transform and Load ETL and BI tools have been used in the projects on loading the data and maintain the data for reporting and STAR Schema, Cognos also used to manage the data and testing with the data ware housing system.
Environment: Java 1.6, COBOL, CICS, SQL Server, NetworX Pricing, HPXR, EEDIFECS QTP, Quality Center, EDI, GEMS, Agile, JAD, Facets 4.51, ITIL, ETL, Cognos, BI, JIRA, Visual Studio, RUP
Confidential
Business/System Analyst
- In January 2009, the final rule was published requiring the health care industry to adopt version 5010 of the X12 standard transactions by January 1, 2012.Scope is meeting the mandate of CMS 5010 and accepting and sending HIPAA transactions in the standard formats. The transactions in scope are:
- 837 P-I-D, professional/institutional/dental claims and ITS claim submission
- 835 claim remittance and 834 enrolment submission
- 270/271 eligibility/benefit inquiry/response and 276/277 claims status inquiry/response
- Created project management, resource, estimation, execution, implementation and risk assessment plans for 5010 project
- Managed project with agile-scrum methodology for successful execution with Joint Application Sessions JAD to collect and author report requirements, perform data analysis / reconciliation
- Created future state diagrams using MS Visio, RUP and UML to use it for future state development use
- Created the use cases based on the requirements gathered with various client/state holders.
- Involved in detail system/business analysis, detailed design with Development team for UAT testing
- Created detailed test and execution plan for the 5010 Regression UAT testing on the EFE system and mapped the system requirements UAT cases in Quality center.
- Created detailed test schedule for regression and UAT of 5010 project for 2012 implementation
- Analyzed the 5010 business requirements and created the impact analysis document to create the error free test cases and scenarios for the EFE system.
- Worked on the defect fixes for the release and used visual studio for code debug/validation
- Validating the results of the Junit tests and suggested Dev team for code changes required by business
- Analyzed the 837 I, P, dental and ITS claim changes in the 5010 implementation in Facets 4.51.
- Very good experience interacting with vendor or stake holder on requirement gathering and Requirement verification on the GUI/Mainframe based screens and used ITIL.
- Created automation process with QTP execute the test cases for 5010 project
- Managed five members team and verified the test cases n test scenarios created for 5010 project
- Coordinated with performance team using load runner to make sure the performance of the claims
- Created test and execution plan for the 4010 / 5010 regression comparison to make sure the new changes in the 5010 project.
- SQL Server and various SQL queries used to validate the ICD 9 and ICD 10 values in database
- Created SDLC PMLC documents for 5010 projects
- Coordinated reviews/ re reviews with Dev, test and business team and implemented the 5010 project
Environment: Java 1.6, COBOL, CICS, SQL Server, NetworX Pricing, HTML, EEDIFECS QTP, Quality Center, EDI, GEMS, Agile, FACETS 4.51, JAD, ITIL, Jira, Selenium, Junit, ETL, BI and HPXR
Confidential
Enrollment Compliance Team
- Confidential has the group enrollment processing system and process the group enrolment and eligibility electronically for FEPOC with connecting the following systems NASCO for Medical/Facets for Dental.
- Analyzed the current CareFirst BCBS system with all the EDI transactions 834, 835, 270/271, 276/277 and 278 and gathered the requirements from the system as well as end clients
- Analyzed the current FEPOC Enrollment processing and EDI transactions in to make sure the PHI compliance and other related data issues.
- Analyzed software development life cycle / project management life cycle processes in the Care first/BCBS-FEPOC with HIPAA regulations and making sure the accurate process to avoid the HIPAA PHI breaches with new 5010 project.
- Analyzed the enrolment system with membership data and created the business/use cases to enhance the process in the modernization project without PHI issues
- Validated the test results for the new implementations for the 270/271 276/277 as part of 5010 changes and Medicaid and MMIS for PHI issues and conducted audits on Enrollment data
- Gathered information on the transactions of 270/271 health care eligibility benefit enquiry and response and 276/277 health care claim status enquiry and response current state information to implement the 5010 changes in the segments and loops without any PHI issues
- Analyzed the enrolment system with membership data and creating the business/use cases to enhance the process in the modernization project
- Verified and Translated the business/user requirements into functional requirements to design the future state system at CareFirst FEPOC without any compliance
- Coordinated with testing managers for the test plan and test cases creations for the 5010 implementation project using Quality center and verified the test data also for PHI issues
Environment: Java 1.6, COBOL, CICS, SQL Server, Web Services, XML, HTML, Quality Center, EDI, GEMS, Agile, Facets 4.71, ETL, BI, STAR, ITIL, Visual Studio 2010, COBIT, HPXR
Confidential
- Confidential is a non-investor-owned mutual insurance company that operates through its Blue Cross and Blue Shield divisions in Illinois, New Mexico, Oklahoma, and Texas, and several subsidiaries to offer a variety of health and life insurance products and related services to employers and individuals. It is an independent licensee of the Blue Cross and Blue Shield Association.
- Created project management, resource, estimation, execution, implementation and risk assessment plans for BRM project
- Managed project with agile-scrum methodology for successful execution with Joint Application Sessions JAD to collect and author report requirements, perform data analysis / reconciliation
- Six sigma green belt as well as reverse engineering techniques used for gathering the requirements and redefine the future state model using latest tools
- Created future state diagrams using MS Visio, RUP and UML to use it for future state development use
- Created the use cases based on the requirements gathered with various client/state holders.
- Validated business rules and extracting the legacy functionality with HIPAA Edi transactions for DC, Claim Lock, GCPS and DME, RX-Pharmacy Claims
- Defined the current, future state business processing models using UML, MS office for the Medicare A-D claims including DME/Illinois public aid claims/Medicaid claims
- Implemented new approach of business rules gathering from legacy system to CCSP and saved time as well as 2 million dollars' worth of time
- Defined the business, user, and functional requirements using appropriate documentation techniques to describe statements of the goals, objectives, or needs of a particular stakeholder or group of stakeholders using the low and medium complexity
- Translated the high-level business requirements into functional specifications for the IT organization and manage changes to such specifications
- Extracted claims from mainframe using JCLs and tested with BIS compare tool and verified the results of legacy and Java PRAP Pre Adjudication system and raised the defects using QC
- Tested and verified the results of Bis Batch Input System compare tool, with claims and service lines information for the IL, TX, NM and OK claims
Environment: Java 1.6, COBOL, CICS, SQL Server, Web Services, XML, HTML, EEDIFECS, Quality Center, EDI, Agile, Req Pro, JCL, DB2, VB, Fileaid, OS/390, ETL, STAR, ITIL, HPXR, Six Sigma
Confidential
- Provides health and well-being products serving more than 70 million Americans.
- UHG-TOPS Online Claim Processing System the second complex mainframe claims processing system in the world. The testing team is divided in three sub teams. System integration testing, FE Batch Regression Testing, TOPS Online Regression Testing.
- Coordinated the extensive testing for TOPS applications using QTP, Hiperstation and Playback for all the releases
- Microsoft SharePoint 2007, used to manage the project related deliverables to client and maintained internally for the audit purpose
- Prepared the estimation for development testing for all the releases
- Created automated test scripts using QTP for various new changes in the enhancements
- Executed regression cycles using QTP for the online claims and verified the results using QTP
- Deployment plans and execution strategy for all the new releases and related new changes and coordination with offshore team.
- Coordination with business on the latest functional requirements to test scripts conversions and outcomes of the latest scripts
- Executed claims details in the VSAM/DB2 tables using regression cycles for all the claim processing systems including PBM
- Analyzing the TOPS claim systems and raising the defects using Test Director
Environment: Java 1.6, COBOL, CICS, SQL Server, Web Services, QTP, Quality Center, EDI, Agile, Req Pro, JCL, DB2, VB, File aid, OS/390, VSAM, HYPERSTATION, SharePoint 2010 , ETL, ITIL
Confidential
- Best buy involved in retail business in all over Confidential
- Best buy is organization has been monitoring the utilization of key identifiers that are used in the systems. The location number is the identifier that is most at risk. Best buy planned to expand 25 new stores end of fiscal year 2004, in that case BBY will run out of location numbers and Later the expansion of UPC number to be used as GTIN was also added in scope, This was in view of the announcement made by the Uniform Code Council of America. BBY is in remediation of LOC and UPC in all databases, systems, files and programs.
- Impact Analysis done for the following Programs, Files, DB2 Tables, Jcls, Proclibs, Reports
- Prepare the detailed plan for the development for the new enhancements
- Co-ordinate design and construction of the programs affected by the change request.
- Conducted unit testing , system testing, regression testing
- Results validation Defects tracking using Test director
- Coordinated with End users for the user acceptance testing
- Test document and results tracking Impact analysis of the best buy retail applications
- Results validation defects tracking using test director and test cases for the new enhancements
Environment: COBOL, CICS, SQL Server, Web Services, XML, HTML, Test Director, Req Pro, JCL, DB2, VB, File aid, OS/390, VSAM
Confidential
- Micro Warehouse is involved in selling computer related products. They use a special application called MACS Mail ordering And Cataloging System which take cares of accepting a new order, processing the order, and show the inventory for a particular product of MACS.
- Development of new features and services based on the change requests CRs by Micro Warehouse
- Prepares the detailed test plan for the development of the change requests
- Co-ordinated design and construction of the programs affected by the change request
- Prepared for delivery to on-site team
- Results validation defects tracking using test director
- Writing the SQL queries and validating the warehouse data and MACS system
Environment: COBOL, CICS, SQL Server, Web Services, XML, HTML, Test Director, Req Pro, JCL, DB2, VB, File aid, OS/390, VSAM