SUMMARY

• Highly accomplished IT professional with 6+ years of experience in IT industry in Business Systems Analysis, Data Analysis, Development and Client Relationship Management.
• Strong Healthcare Domain knowledge with implementation experience in EDI X12 transactions complying with HIPAA and CMS Compliances/Regulations.
• Experience with claims process and adjudication in the Medicare Part A, B and D, Medicaid and Private Insurance Sectors.
• Validated 837 (Healthcare Claims), 835 (Healthcare Claims payment / Remittance), 270/271 (Eligibility request/Response), 834 (Enrollment/Disenrollment to health plan) for Part B and Part A of Medicare health claims.
• Validated codes for billing process which included ICD - 9, ICD 10, Procedure codes (CPT, HCPCS) and various modifiers where applicable in compliance with HIPAA 5010.
• Performed a baseline assessment and related interfaces, existing service level agreements, policies, and operational business procedures for readiness to comply with ICD-10 requirements.
• Identified risks, problems, requirements and concerns in order to comply with ICD-10 changes by conducting interviews.
• Actively worked on Data analysis with respect to ICD-10 impact.
• Experience in preparing various documentations like Business Requirement Document (BRD), Functional Requirement Document (FRD) / System Requirement Specification (SRS), Data Mapping Document (DMD), Report Specification Document (RSD), Requirement Traceability Matrix (RTM) and other client specific documents.
• Experience in working with various database environments likeSQL Server 2008/2012, Oracle10g /11g, IBM Netezza andMS Access databases.
• Gathered high level requirements from the business, created user stories, and prioritize the backlog with Scrum Master.
• Excellent team player with experience in working with medium to large size project team / Strategic initiatives that includes Business stakeholders, Architects, Project Manager, ETL Developers, Quality Assurance and Reporting team.
• Awareness of all SDLC methodologies & models - Staff Augmentation, Co-development, Managed Service, Fixed Prices, Waterfall, Agile in both onsite-offshore model.
• Proficient in eliciting requirements and assisting the development/ Quality assurance team for business intelligence / data warehousing environments including technologies and processesacross data sourcing, validation, reconciliation, and reporting.
• Experience in performing GAP Analysis and Impact Analysis on various projects.
• Excellent in finding creative solutions to complex problems.
• Ability to adapt to change, balance multiple priorities and meet deadlines.
• Highly motivated, strives for excellence in delivery with strong communication skills, fosters relationships and active participant in process improvement.
• Experience in training new team members and being a mentor to support and provide directions on their day to day work.
• Exceptional analysis skills with an ability to transform the needs of the business users and stakeholders needs into Functional/Business requirements.
• Extensive collaboration with the Quality Assurance in providing inputs to create Test Strategy, Test Plans, and Test case and involved in defect tracking using HP Quality Center.
• Experience working in CMDB 7.6, BMC ITSM 7.6 Change Management and Incident management and BAO.

TECHNICAL SKILLS

Skills Category: Skills Description

Requirement Management: JIRA and Microsoft Office (Word & Excel)

Defect Tracking: HP Quality Center

Query and Programming: SQL, HTML

Databases: SQL Server 2008 & 2012, Oracle 11g, IBM Netezza and MS Access

Document Management: SharePoint

Methodologies: Waterfall and Agile

Reporting Tools: IBM Cognos and Tableau

Querying Tools: Toad, Aginity Workbench, SQL Management Studio and Oracle SQL developer

Other Tools: BMC Atrium CMDB 7.6, BMC Remedy ARS 7.6 and BMC Remedy ITSM 7.6

PROJECT WORK EXPERIENCE

Confidential, Charlotte, NC

Business Analyst / Data Analyst

Responsibilities:

• Working as a Business Systems Analyst, for team size of 3 and project team size of 10.
• Created Functional Requirement Document (FRD), Source to Target mapping document (STTM) and Requirement Traceability matrix (RTM).
• Scheduled, Facilitated and managed JAD sessions with business team members from various business teams.
• Conducted walkthroughs of SRS, STTM, RTM documents with all stakeholders.
• Performed Data Analysis in Oracle, SQL Server 2008 and also involved in creating the inventory list of impacted data element.
• Involved in Data Profiling, writing scrub rules, providing input to data modelers that include Data type and length.
• Assisted ETL development done using Data Stage and report development using Cognos.
• Participated in Agile Scrum planning meeting and provide status on daily stand up meetings.
• Participated in the review of Test Strategy and Test plan documents.
• Scheduled and facilitated various meetings during SDLC lifecycles like requirement meetings and weekly touch point meeting with Dev and QA team.
• Escalated to the PM any other matters requiring substantive or time-consuming issue resolution (i.e. resource response time, communications, project workflow etc.).
• Closely worked with Data Modelers with support and clarification on the requirements.
• Reviewed Physical data models, data dictionaries and provided feedback to Data modelling team.
• Responsible for gathering report requirements and support to Cognos development.
• Create Report specification document (RSD) and worked very closely with report development team.
• Performed User Acceptance Testing (UAT).
• Managed and controlled the project documentation using SharePoint.
• Participated in the Defect triage meeting and provided inputs.
• Provided weekly status update for Business Analysis work to Project Manager.

Environment: Agile (Scrum), MS Office, MS Visio, MS Project, JIRA, Oracle, SQL Server 2008, Data Stage, IBM Cognos, Aginity and Dimensional modelling.

Confidential, Durham, NC

Business Analyst / Data Analyst Raleigh, NC

Responsibilities:

• Elicited requirements and information from internal and externalbusinessstakeholders through the use of individual interviews, surveys, and informational review sessions. Enacted secured communication protocols as needed
• Coordinated and communicated testing activities of multiple commercial and government carriers.
• Performed claims data analysis to identify claims appropriate for various payer testing activities. Composed and created Excel workbooks utilized by ICD-10 Program Testing Team to execute specific end-to-end payer testing activities.
• Developed various summary and informational ad hoc documents in Excel, Word, PowerPoint, Publisher and Visio, often times utilizing charts and pivots for emphasis and analysis.
• Mapping client's requirements and providing them with the best IT solutions involving evaluation and definition of scope of project.
• Performed GAP analysis to derive requirements for existing systems enhancements.
• Managed and developed EDI specifications, for data feeds and mappings for integration between various systems, to follow ANSI X12 5010 formats including 270 Eligibility/Benefit Inquiry, 271 Eligibility/Benefit Information, 276 Claim Status Request, 277 Claim Status Response, 834 Benefit Enrollment, 835 Remittance Advice to meet and exceed HIPAA requirements set forth by the federal government.
• Involved in forward and backward mapping between ICD 9 and ICD 10 using general equivalence mapping (GEM).
• Worked Extensively with Inbound 837I and 837P and 835 (Out bounds) claims processing systems.
• Directed and managed the Change Management Control process for the projects by facilitating group meetings and/or one-on-one interviews/meetings with work stream owners to discuss change request impact on timelines and scope.
• Provided training and guidance to client staff and fellow consultants

Environment: SDLC- Agile/Scrum, UML, XML, MS Office, JIRA, TOAD, MS Access, MS Project, SQL Server 2008

Sterling Health Plans, WA

Business Analyst Bellingham, WA

Responsibilities

• Documented business requirements, and communicated these requirements to the development team for the design and implementation of business solutions.
• Extensive knowledge of Medicare (Part A, Part B and Part D) benefits, Coinsurance and Medicare Supplements.
• Responsible for ensuring that privacy and security environments of healthcare data remained intact.
• Effectively conduct JAD sessions and Business Requirement review sessions with teams to complete project documentation and work with the business to gain approval/sign-off.
• Document functional requirements, system design specification use cases, workflow diagram, screen and interface designs.
• Communicate Business process, business solutions and status update to IT managers and upper Business during Status meeting.
• Data cleansing, data migration, and data mapping were used to and validation of database structure in the OLAP.
• Work with the business to analyze business process and system issues and turn them into actionable system changes that benefits the business.
• Created data mapping to increase efficiency of data usage for transactional and analytical processes.
• Work on Data Analysis in terms of Data Type and Data Length of each back-end system and map to one another.
• Review and provide final approvals to SIT Test Scenarios, Test Cases.

Environment: Agile (Scrum), SharePoint 2010, SQL Server 2008, MS VISIO, Business Objects, Service Now, UML and HPQC.

Confidential, Seattle, WA

Business System Analyst Seattle, WA

Responsibilities:

• Involved in Requirement Scoping and analyzing high priority requirement for implementation.
• Created 'Business Glossary' to facilitate efficient understanding of business process amongst other teams.
• Conducted JAD sessions during the various stages of upgrading the matching system and discuss the current system preference.
• Ensured that Business, Data Governance and Integration team leads are deeply involved in critical design issues and decisions.
• Developed Requirements Tractability Matrix (RTM) using MS excel to trace each software design requirement to test case.
• Developed SQL queries to help reverse engineering and mapping for various system applications.
• Worked closely with ETL and BI teams during project implementation and actively suggest ways and means to share and optimize work.
• Claim Transactions and Billing Transactions - created flows for adequate matching of claims. Performed data mapping by matching the billing file and EDI claim file record claims received from Medicare and Medicaid agencies.
• Validated 837 (Healthcare Claims), 835 (Healthcare Claims payment/ Remittance), 270/271 (Eligibility request/Response), 834 (Enrollment/Dis-enrollment to health plan) for health claims.
• Created high-level Use Cases from Business Requirements and created UML diagrams like use case diagram and activity diagram using MS Visio and UML 2.0 for various stakeholders.
• Validated codes for billing process which included ICD codes and various modifiers where applicable in compliance with HIPAA 4010 and HIPAA 5010.
• Well versed with HIPAA, Facets, CHIP claim adjustments, claim processing from point of entry to finalizing, claim review, identifying claims processing problems, their source and providing corresponding solutions.
• Assisted QA Leads to develop Test plan and Test Case.
• Developed UAT Test Plan and performed UAT tests along with the Business Users.
• Developed Test Scripts using Test Director/Quality Center and coordinated with developers to quickly resolve the defects associated with them.

Environment: Agile (Scrum), BizTalk2010, SharePoint 2010, MS VISIO, Cognos, Service Now, UML, HPQC

Confidential

Developer / Systems Analyst

Responsibilities:

• Analysis on the existing CMDB functionalities.
• Preparation of Impact Analysis with effort estimation.
• Involved in System design and providing solutions for integrating the different data source with CMDB
• Hands on experience in CMDB coding which includes creating data exchange, data mappings and reconciliation, creation of dataset.
• Analyzing the Common Data Model and deciding on Data mappings for Atrium Integration Engine
• Analyzing the data and fetching it to CMDB as per the business requirement
• Worked on Data Exchange, CI Class Mappings, Relationship Class Mappings, AR System Form mapping and Reconciliation
• Preparing project documents with quality compliance.
• Complete ownership for all deliverables for the Change Request (CR)/defect assigned with.
• Adhere to estimated effort & dates as communicated by the project manager.
• Accountable for defect free delivery on detailed design, code & ST cases/results.
• Identify dependencies/risks that can impair deliverable dates, highlight/escalate them as needed.
• Participate and contribute to activities like defect analysis & improvements.
• Suggest improvements / resolution for repeating issues
• Involved in Code deployment in Pre-Prod and Production servers.
• Involved in developing Requirement document, Impact Analysis, Remedy Development and LLD and HLD preparation.
• Worked on ITSM modules namely Incident Management, Change Management, and SRM and have knowledge on Task Management, Problem management.