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Sr. Business Analyst Resume

Saint Charles, MD

SUMMARY:

  • Over Eight years of Experience as a Business Analyst in Health Care domain on various areas like Claims Processing, Billing, Insurance and Reimbursement, Medicaid and Medicare Services, and Pharmacy Benefits Management.
  • 7 years of experience on projects related to Health Information Exchange (HIE), Interoperability, Medicare, Medicaid, EDI transactions (inbound and outbound: 837, 820, 834 etc.,)
  • Experience in Eligibility and Benefit systems, ICD - 10, HCPCS, CPT, HIPAA 4010 and 5010, Claims Adjudication and expert in Affordable Care Act (ACA), Healthcare Reform (HCR).
  • Used advanced Microsoft Excel to create pivot tables, VLOOKUP and other excel functions
  • Experience using data visualization and analysis tools, such as Tableau, Logi, and QiikView to create insightful and attractive dashboards and data visualizations to track key business information and enable better, faster decisions.
  • Having extensive domain knowledge in MMIS, EPIC, EDI X12, HL7, HIPAA, ICD-10, System, Medicare and Medicaid, CMS Compliances/Regulations.
  • Strong institutional knowledge of Medicaid; including Medicaid Information Technology Architecture (MITA), and Medicaid Management Information Systems (MMIS).
  • Development of 820, 834, 837 Claim billing, 276 Status, 834 Enrollment, 835 Claim Payments, 829, 270-278 and many other healthcare maps.
  • Understanding of EDI business practice and the ability to understand the client's needs.
  • Strong Experience in Claims Processing and Claims Scrubbing in HMO, PPO, Medicaid and Medicare.
  • Validated 837 (Healthcare Claims), 835 (Healthcare Claims payment/ Remittance), 270/271 (Eligibility request/Response), 834 (Enrollment/Dis-enrollment to health plan) for Part B and Part A of Medicare health claims.
  • Worked on different EDI healthcare transactions like 834-Benefit Enrollment and Maintenance and 820-Payment Order/Remittance Advice.
  • Revitas Flex, Model N, iContracts or BPI Contracts software experience.
  • Extensive experience in all platforms of invos/open text EDI mapping software including trusted link, Biz Manager and Biz Mapper and 5010 Upgrade mapping for new B2B and existing B2B clients
  • Conducted internal audits and prepares audits reports to ensure compliance with Medicare, Medicaid and other institutions.
  • Knowledgeable for gap analysis in changing old MMIS and Involved in testing new MMIS.
  • Working knowledge of healthcare Technology standards such as HL7, ANSI ASC X12, IHE XDS/XDM, HITSP, CCR (continuity of Care Record), CCD (Continuity of Care Document.
  • Expertise in Membership Enrolment, Claims, Subscriber/Member, Plan/Product, Claims, Provider, Commissions and Billing Modules of Facets.
  • Proficient in conducting Business process modeling (BPM), feasibility studies, Impact Analysis, Cost/Benefit analysis, Gap Analysis and Risk analysis.
  • SQL application management, (added users, created backup and recovery plans, ran SQL scripts).
  • Thorough knowledge of ICD-9, ICD-10 codes and CPT codes for both Mental and Medical Health.
  • Experience in implementation of HIPAA 4010 and HIPAA 5010 changes in the existing claim processing integrated system.
  • Involved in Facets Output generation, Interface development and Facets Migration Projects.
  • Experience as developing, building and maintaining data warehouse.
  • Strong understanding of project life cycle and SDLC methodologies including RUP, RAD, Waterfall, Scrum and Agile.
  • Operated Visual basic on different operating systems such as Windows and UNIX.
  • Excellent experience in developing and executing Test Procedures, Test Cases, Test Scripts, Test Plans, performing Functional Testing, Compatibility Testing, Usability Testing, Stress Testing, UAT.
  • Knowledge in the ETL (Extract, Transform and Load) of data into a data ware house/data mart and Business Intelligence.

WORK EXPERIENCE

Sr. Business Analyst

Confidential - Saint Charles, MD

Responsibilities:

  • Responsible for providing Senior GP technology leadership in the areas of team mentoring, process and procedure improvement, and providing leadership on project related activities.
  • Ensured all EDI Claims are received from Trading Partners and they are processed and loaded into its appropriate claim systems daily.
  • Extensively worked with EDI transaction 837 (Professional & Institutional) following the HIPAA compliance EDI standard format of x12.
  • Coordinated with IT to implement EDI 844, EDI 849, and PDF reconciliation documents.
  • Assisted Information Management team with Implementations and Processing of 837 Encounter and 834 Member Enrollment transactions (both inbound and outbound)
  • Responsible for implementing payers onto the Health Care Exchange (HIX) for the Affordable Care Act.
  • Strong working knowledge of the 834, 837 & 835 EDI Healthcare files and Transactions.
  • Building and maintaining relationships with a portfolio of Account Services customers through all stages of the customer lifecycle via Imax and Gmax with benefit focus.
  • Worked with the internal Project Managers and Customer Success Team for new and existing Customer implementation.
  • Provided support for existing outsourced interfaces and the transition to an in-house instance through the development of outbound/bidirectional HL7 interfaces and integration solutions.
  • Designs, develops, and implements data integrations to connect in-house and third party software systems using Microsoft BizTalk and SQL Server.
  • Compile, validate and report system-wide metrics to attest meaningful use of EHR to the Centers for Medicare and Medicaid Services.
  • 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.
  • Collaborate with federal clients (CMS, NIH, ONC) and standards development organizations such asHL7 to develop
  • Modified stored procedures and functions to support efficient data storage and manipulation as per Business Requirement Document (BRD).
  • Responsible for UAT project planning like creating testing scenario, test plans, and test scripts.
  • Gathered the Requirements for Medicare Systems as part of Patient Protection Affordable Care Act (ACA).
  • Performed Regression, UAT, Integration, User Interface, GUI, and Usability Testing and wrote test cases and test scripts, execute test scripts and analyzed outcomes.
  • Assist clients in resolving billing issues for Medicare, Medicaid, and private insurance.
  • Acted as an SME on various subject areas including state reporting, death benefits, Medicare, Bill review and RX eligibility.
  • Troubleshooting utilizing CPT4 & ICD-10 codes and Managed HL7 interfaces for PM/EHR software and Lab computers and performed requirements gathering, business process mapping and re-engineering as a part of health exchange readiness efforts for leading public health plan entering state HIX market.
  • Involved in HIPAA/EDI Medical claims analysis, design, implementation and documentation.
  • Developed various test cases for testing HIPAA 8371/P/D 834/835 and 276/277.
  • Ensured that the Pre-UAT activity is performed accurately and efficiently.
  • Wrote test plans and tested individual transactions for Medicare / Medicaid transactions (835 and 834).
  • Performed database designing and developed applications for the support of different business personnel.
  • Provided high level analysis design, programming, testing, implementation, and documentation of software in a network environment.
  • Tracked and performed daily routine necessary applications such as merging duplicates, task assignments, maintaining and upgrading security permissions, & more on salesforce.
  • Uses FACETS, knowledge of medical coding and billing, ICD-10-CM, ICD-10-PCS initiatives and regulatory compliance framework.
  • Worked with Member/Subscriber and HIPAA Privacy Facets application groups.
  • Involved in reporting projects using SQL Server Reporting Services like tabular report, matrix report, chart report, pie charts and sub-reports, drill-down and ad hoc.
  • Involved in fact finding and investigation for problem solving for assigned multiple ETL using Pervasive Data Integrator.
  • Gathered analyzed, documented business and technical requirements from both formal and informal sessions and validate the needs of the business stakeholders.

Sr. Business Analyst

Confidential - Chicago, IL

Responsibilities:

  • Worked on an Agile project of converting the desktop Ecommerce Confidential website to Mobile and Tablet by using the Responsive Methodology and worked on multiple pages of website (Payment portal, Auto Refill Landing, COTS products, Refill by Rx number, Prescription History, Prescription Status, Transfer Rx, New Rx, Refill Hub, Refill Tile and Lean Checkout Store Locator & POS) and SEO Optimzation.
  • Understood the overall scope of the application and requirements, had a meeting with Architecture team to give the L0 and L1 Estimates for the effort required, focused on user interface and user experience and good understanding of APIs.
  • Implemented and understood the PBM (Pharmaceutical Benefits Management) role in the requirement gathering phase.
  • Set out the budgeting plan and based on the estimates presented weekly updates to sponsors of the project.
  • Worked in an Agile environment where involved in Grooming, Pre-Sprint, Sprint and Regression phases.
  • Worked closely with Business customers continuously to gather the business requirements/stories and having multiple sessions with them in order to verify and validate all the requirements.
  • Defined Scope of the sprints (mainly of 2 to 3 weeks), created User Stories, Widgetization, Wires and Comps (Mockups of Website which provided the user interface experience).
  • Worked as an intermediary between Business and Technical teams and gathered the requirements of Wires, Comps and Copies of Confidential .com. Involved in creating and maintaining User Stories and Tasks and prioritized them in Sprints with the help of Product Owner, Scrum Master and Scrum team, estimated them, designed Test cases and Integration test cases in JIRA.
  • Facilitated work sessions to analyze the As Is and To Be process designs.
  • Participated as a part of the team including the Product Owner to groom the Product Backlog items in removing user stories which were no longer required, prioritizing the stories, splitting user stories into task which were huge and of high priority. Created new user stories in response to newly discovered needs.
  • Used JIRA to plan and create test cases and assigned them to the testing team and gathered the results (passed/failed).
  • Conducted meetings with Scrum Master, Scrum Team and Product Owners to discuss concerns and issues in Daily Standup meetings. Identified all the key stakeholders related to the issues and filled in their name, contribution and affect in release.
  • Documented all the issues and facilitated technical teams to create Technical Solution document.
  • Conducted meetings with offshore and onshore QA and Development team to discuss the failed test cases, assigning it back to them to fix the errors following the process of Defect Management System.
  • Worked in the Integration process of integrating different webpages and performed the integration testing.
  • Worked throughout the sprint to fulfill all the tasks by assigning them to development teams, getting updates from development teams regarding any issues/dependencies and risks and helping them out in resolving those issues.
  • Participated in process by verify QA test cases and executing test cases to ensure all requirements all met before client release.
  • Worked with business teams to discuss and plan the Sprint Review Meetings.
  • Worked with Engagement Managers in reviewing the activities related to technology deliverables.
  • Wrapped up the technical documentation for integration points such as customer data, store data and pricing. Cleaning of user story backlog and updating the project timelines and scope. Organized, planned, and documented weekly production defect and enhancement deployments. Presented the development of different pages to Business user to get the approval and signoff.
  • Participated in Sprint Planning meetings, Daily Standup meetings, Retrospect Sprint meetings.

Sr Business Analyst / Model N

Confidential, NJ

Responsibilities:

  • Involved in Implementation Workshops
  • Gathered user requirements and report requirements during the workshops
  • Maintained the user requirement and Report Requirement document for business functions
  • Created current and future state VISIO workflow diagrams for the different functional areas
  • Maintained a Contract Profile Inventory spreadsheet containing key elements and details of a contract for all organizations (affiliates). This will be used as a reference guide for the users to enter the contracts in Model N during the Conference Room Pilot (CRP) sessions
  • Created and also assisted the users in creating real time contract scenarios in Model N for all organizations (affiliates) during the Conference Room Pilot (CRP) sessions
  • Documented any GAP identified in Model N application during the Conference Room Pilot (CRP) sessions
  • Used SharePoint extensively for sharing and storing documentation
  • Used HP Quality Center to plan, create and execute functional tests for each component and also to submit, track and validate defects
  • Reviewed functional documentation in order to identify requirements for the creation of test plans, test cases and test scripts
  • Conducted test case reviews to ensure scenarios accurately capture business functionality
  • Identified/worked with Business team on the creation of a detailed test plan, test scenarios, test case and test scripts needed for test execution during System testing, Franchise Interface testing, UAT and End to End (Business Stimulation) testing
  • Analyzed testing results, report defects, identify and report root causes for test failures by working with the development team
  • Assisted Application Developers and technical support staff in identifying and resolving problems
  • Provided regular status reports to project management, updating tasks and tasks estimates, as necessary
  • Lead the integration testing cycle, coordinate working with technical team and distributors selected by business, franchise resources, WebMethod and GHX team to successfully test the EDI 845, EDI 867, chargeback claims and invoice reconciliation processes
  • Responsible for validating inbound and outbound data files (XML,CSV,IDOCs) to and from the contracting system to regional (MDM, SAP) and franchise systems (DATAWAREHOUSE)
  • Assisted with training materials and provided training as needed.
  • Provided technical leadership and mentoring to business resources and team members

Business Analyst

Confidential, Chicago, IL

Responsibilities:

  • Responsible to insure that EDI Process is HIPAA (Health Insurance portability and Accountability) compliant and worked on ANSI X12 standards
  • Participated in CA-MMIS (California - Medicaid Management Information System) knowledge transfer in preparation for Implementation and Operation of the ICD 10 enhancement.
  • Serving as a lead for requirements team and subject matter expertise (SME) with healthcare systems.
  • Worked closely with the customer to detail and convert business requirements into system and operations requirements while working with external partners to complete the design, development and implementation of the requirements.
  • Addressed requirements work as a liaison among stakeholders in order to elicit, analyze, communicate, and validate requirements and business processes.
  • Leaded the development of Business Requirements Documentation (BRD) for analysis related to the ICD 10 mandate.
  • Used the Agile-Scrum Methodologies for the Software Development Life Cycle (SDLC)
  • Participated in CA-MMIS (California - Medicaid Management Information System) knowledge transfer in preparation for Implementation and Operation of the enhancement.
  • Configured and updated hospital, ancillary and professional agreements in Facets using NetworX pricer.
  • Performed extensive testing of all configuration and updates.
  • Instrumental in ensuring conversion from old system to Facets did not disrupt claim payments.
  • Followed Workgroup for Facets Electronic Data Interchange standards for testing that need to comply with the HIPAA guidelines.
  • Involved in FACETS Implementation, FACETS billing, enrollment, and Claim Processing and Subscriber/Membership module.
  • Followed Workgroup for Facets Electronic Data Interchange standards for testing that need to comply with the HIPAA guidelines.
  • Worked on Member Management, Eligibility, Claims and Billing modules within FACETS.
  • Design, build and test Facets configuration in support of business requirements
  • Configure Facets modules based on the design approach
  • Involved in Facets Configuration to make sure all information will be sent without any error
  • Involved in Trizetto Facets System Administration, Claims and Benefits configuration set-up testing, Inbound/Outbound Interfaces and Extensions, Load and extraction programs involving HIPPA 837 and proprietary format files and Reports development
  • Evaluated and performed testing within Facets for Rejected QA Scenarios.
  • Designed and developed web pages to explain the requirement for technical team using XML.
  • Involved in project planning, coordination and QA methodology in the implementation of the Facets in the EDI transaction of the claims module.
  • Create test data as required by tests in Facets
  • Develop Business Requirements for all 5010 EDI transactions: 270, 271, 278, 834, 835, 837i/o, and 837d
  • Involved in Claim Processing from End to End and major work was involved with 837 P/I Claims Processing systems and 834 benefit enrollment
  • Provide analyst support during all phases of the Software Development Life Cycle including development and testing (unit/system) phases
  • Worked on SQL queries and PL/SQL stored procedures for QA testing and data validation of Metric Reports.

Environment: Windows 7, SQL Server, MS Visio, HIX, QNXT, MS Office, Agile, Clear Case, Clear Quest, Rational Quality Manager, CHDP Systems, CMIS, CRM, Oracle, .NET, XML.

Sr. Business Analyst

Confidential,Waukegan, IL

Responsibilities:

  • 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.
  • Responsible for creating working document to document provider agreement information.
  • Responsible for gathering and documenting Participating Specialist, Ancillary & Hospital providers.
  • Responsible for gathering providers agreements.
  • Responsible for verifying current provider agreement information.
  • Responsible for creating Specialist, Ancillary & Hospital agreements in Facets.
  • Responsible for documenting testing scenarios.
  • Responsible for resolving failed claim test.
  • Responsible for documenting progress and ensuring all provider agreements were created.
  • Key resource for Facets questions.
  • Provide analyst support during all phases of the Software Development Life Cycle including development and testing (unit/system) phases
  • Maintain test data files and monitor system configuration to ensure data integrity; review data loaded and processed to identify gaps and data anomalies
  • I was responsible to analysis of the proposed system and prepare the gap analysis document and functional design documents.
  • Extensively involved and performed Feasibility Analysis for the proposal of the new systemaroundagilemethodology
  • Benefit and contract Administration
  • Modified configuration errors in order for adjustments and processing
  • Develop, coordinate and support Information Technology Division on all operational requirements of FACETS claims processing system and production management.
  • Performed Quality Assurance of new or existing contracts and configuration to ensure appropriate or correct payment was made via unit testing.
  • Created and modified queries utilizing Facets data tables
  • Involved in developing database objects using FACETS database in both SQL Server and Sybase environments.
  • Develop, design & implement department plan to operationalize new FACETS integrated processing system, to include but not limited to, workflow, management oversight and performance analysis.
  • Worked closely with stakeholders and SME’s for requirements gathering.
  • Created EDI Export and Import processes and work with EDI Trading Partners,Payersor Vendors
  • Identified end to end requirements for all systems and business units that may be impacted by the project.
  • Conduct design meetings with data architects to review and update internal data models for clinical data warehouse
  • Conducted client requirement gathering sessions to leverage web service APIs
  • Developed requirements integrating Use Case diagrams and designed the testing process flows.
  • Followed the RUP methodology for the entire SDLC.
  • Conducted walkthrough and lead work sessions.
  • Documented and tracked all product defects with use of SQL (reporting).
  • Developed tables, Views, Stored Procedures and Triggers using SQL Scripting
  • Writing Complex SQL queries and optimizing SQL Queries
  • Using MS-Visio analyzed business requirements and process through Use Cases, Class, Sequence, and Activity diagrams, and adapted UML standards to define modularized Data Process Models.
  • Ensured Use-Cases were consistent and covered all aspects of the Requirements document.
  • Developed a Business Acceptance testing strategy and plan.
  • Created test files and analyzed test results using MS-Excel.
  • Involved in project status meetings, QA review meeting, and System Test meeting.
  • Coordinated and facilitated the execution of User Acceptance testing.
  • Conducted Business Process (As Is/To Be) sessions with various department directors and staff to ensure the Testing Plan and Test Approach would meet the identified Business Requirements, and the Training Program covered all identified new and changed processes.
  • Gathered requirements for impacted system and business areas for ICD-10 and their needs to embrace the changes

Environment: Trizetto, Facets, SQL, HIX, QNXT, UML, JAD/RAD, ECMS, MS Visio, J2EE, Cognos, MS Project, MS Office (MS Word, MS Excel, MS PowerPoint, MS Visio), Oracle, Rational RequisitePro, Web Based Application (IIS)

EDI Business Analyst

Confidential, San Jose, CA

Responsibilities:

  • Perform gap analysis between HIPAA 4010 834 and HIPAA 5010 834 Companion Guides
  • Perform gap analysis between HIPAA 4010 820 and HIPAA 5010 820 Companion Guides.
  • Perform impact analysis of other enrollment processing systems to determine potential scope/impacts.
  • Performed thorough analysis of the companion guides from each trading partners both Medicaid and Commercial clients and identified the changes that specific clients need.
  • Review with business owners to identify data requirements and business rules based on the changes within the 5010 834 transaction set
  • Map the data according to the client requirement.
  • Provide dual usage processing capabilities to support both the 4010 and 5010 versions of the 834 transaction set to accommodate those clients who choose to remain on the 4010 version and for those clients who convert to the 5010.
  • Monitor state communications to determine if states will be moving from proprietary formats to 5010.
  • Prepare Requirement Traceability Matrix, Functional Specification, System Change Documents, Technical Specification Documents, as-is and To-be flows for the entire conversion process.
  • Work with the commercial business owners as well as the state representatives in process of gathering the requirements.
  • Build a brand new translator for accepting the 834 and 820 X12 5010 files and converting into the flat file layout.
  • Mapping the new data in 5010 to the translator to make it 5010 compatible.
  • After performing the thorough analysis, design the new translator based on the specific requirement from the commercial and state clients.
  • Tested the new translator to verify and validate if the input data is being translated correctly to the correct positions in the Flat file.
  • Maintained the dual usage functionality in order to receive the 4010 formatted files for the clients who are not ready to switch to 5010 and 5010 formatted files that are willing to switch to 5010.
  • Prepared the common as well as the translator specific test plan for testing the new 5010 process flow.
  • Performed System Testing for the X12 formatted data that gets translated to the flat file through translator.
  • Set-up the trading partners for receiving either 997 (Functional Acknowledgement) or 999 (Implementation Acknowledgement) and not both.

Environment: Windows, Citrix, MS Office, MS Visio, .Net, SharePoint library, SharePoint Defect Tracking Tool.

Sr. Business Analyst

Confidential, Grand Rapids, MI

Responsibilities:

  • Gather requirements and document the proposed processes to the existing system. Modules included: Claims Processing Files and HIPAA Guidelines adherence across the company.
  • Enhanced applications associated with Claim Numbers so that duplicate Claim Numbers could be allowed in the system. Updated the Electronic Claims, Patient Screen and Sales Administration processes.
  • Claim Transactions and Billing Transactions - Created flows for adequate matching of Claims. Matched Billing File and EDI Claim File records upon receipt.
  • Duplicate Claim Number Project - Enhanced three different applications - EDI Feeds and Patient Screen App to allow duplicate claim numbers to exist in the database.
  • Drug Card Project - Worked in a project involving Miami Systems to create Drug Cards.
  • Created Test File to be sent to the Drug Card Vendors for approval. Worked on a Paid without prejudice project for various States.
  • User Acceptance Testing (UAT) - Performed UAT tests using the MORAE Usability Testing Tool using the Observer and the Manager Mode.
  • Testing - Developed Test Scripts using Test Director/Quality Center and coordinated with developers to quickly resolve the defects associated with them.
  • Conducted JRP sessions and JAD sessions with the management, users and other stakeholders for open and pending issues to develop specifications.
  • Analyzed and evaluated User Interface Designs, Technical Design Documents and Quality Assurance Test Conditions the performance of the application from various dimensions.
  • Helped create the 'Business Glossary' to facilitate efficient understanding of the business process amongst the other teams.

Environment: MS Visio, Word, Excel, PowerPoint, CMMI, Rational Rose, Requisite Pro, Clear Case, Clear Quest, SQL, J2EE technology, Java, Perl.

Business Analyst

Confidential, Mountain View, CA

Responsibilities:

  • Studied existing business application and processes, current source system, collected end user requirements and suggested the improvised business process model.
  • Analyzed the "As is" and "To be" system documents to show the current and proposed functionalities of the system using MS VISIO.
  • Gap Analysis of client requirements, generated workflow process, flow charts and relevant artifacts.
  • Involved in defining and documenting the vision and scope of the warehousing project.
  • Worked with ACES and QNXT claims data for claims subject area, Enrollment and billing data for member/Subscriber, and Product subject areas.
  • Involved in the development of Business and Technical Requirements Document (BTRD) and Business System Design (BSD) document for the project.
  • Involved in identifying and studying the ACES and QNXT system data for the attribute mapping purpose
  • Conducted interviews with management team.
  • Conducted and participated in the JAD session with the SME's and project team members.
  • Worked as a liaison between the business and technical side to convey the business needs to the system architects.
  • Participated in weekly status meetings to present status and incorporate any digressions from the original scope.
  • Designed Use Cases using UML and managed the entire functional requirements life cycle using SDLC.
  • Created and managed project templates, Use Case project templates, requirement types and traceability relationships in Requisite Pro.
  • Involved in cross-functional teams, developing new ways to boost efficiency and delivering results in a fast changing environment to achieve company goals.
  • Participated in the walkthroughs and meetings specifically for Claims and Membership modules.
  • Coordinate with Development and Business team to develop high level Business and Technical documents.
  • Worked with the clients on the verification process for the requirement phase documents.
  • Implemented Standardized process throughout the Software Development Life Cycle (SDLC)

Environment: Windows XP, UNIX, QNXT, Rational Requisite Pro, MS Office, MS Visio, UML

Business Analyst

Confidential, Grand Rapids, MI

Responsibilities:

  • Conducted JAD sessions with business users, SME and stakeholders located remotely and in different time zones to elicit requirements.
  • Created Process Flow diagrams, Use Case Diagrams, Class Diagrams and Interaction Diagrams using Microsoft Visio and Rational Rose.
  • Created Business Requirement Document (BRD) and functional requirement documents (FRD) based on the requirements of the project.
  • Built strong knowledge of health insurance industry understanding the subscriber, member, sponsors, provider (I/P), Service Centers, CMS, coordination of benefits (COB), Medicaid and Medicare Programs (Part A, B, C and D)
  • Built strong knowledge of health insurance claims processing systems (HIPAA Gateway, FACETS, NASCO etc.), EDI transactions, customer relation management (CRM), ANSI X12 codes, CMS rules and regulations, and Mandates and Guidelines of HIPAA compliance.
  • Created Use cases and tied them to the BRD for traceability.
  • Maintained and archived all project related documents in SharePoint for accessibility.
  • Loaded requirements in HP Quality Center for System testing.
  • Assigned tasks among development team; monitored and tracked progress of project following the Agile methodology.
  • Ensured that all the test cases are updated in the Quality Center along with Master test plan.
  • Created test plan, Walk through, integration approach and strategy document, test cases, scenarios, conditions and scripts, generated system test scripts for Customer Relationship Management (CRM) and Medicaid Transportation Program (MTP)
  • Assisted in various types of testing, such as functional, regression, user acceptance (UAT), negative and installation testing.
  • Analyzed business and functional requirements to design Product test and UAT Test Cases for MTP and MS Dynamics CRM projects.
  • Extensively worked with development teams investigating and correcting software bugs and deficiencies based on the testing results.
  • Wrote SQL statement and stored procedures in Oracle for extracting as well as writing data.
  • Designed and developed test cases for putting the application on manual testing.
  • Created System test scripts for different test scenarios covering all aspects of project functionality.
  • Defects were tracked, reviewed, analyzed and compared using Quality Center.

Environment: MS Visio, HP Quality Center, SharePoint, MS Dynamic CRM, MS Word, Excel, PowerPoint, Rational Rose, Rational Requisite Pro, Oracle, SQL, Sybase, Agile.

TECHNICAL SKILLS

Standards & Methodologies: HIPAA, CMM, Six Sigma, SDLC, RUP, Waterfall, Iterative, Incremental, Agile-Scrum Methodology, CPT and ICD-9 Coding, ANSI X12

Project Management: Microsoft Project and Microsoft Office

Modeling Tools: Rational Rose, Microsoft Visio

Change Management Tools: Rational Requisite Pro, Clear Quest, Clear Case, SharePoint

Testing Tools: Rational Enterprise Suite, Quality Center, Win Runner, Load Runner

RDBMS and Databases: Oracle, MS SQL Server, MS-Access, Sybase

Operating Systems: Windows (98/2000/XP/7/8), Familiar with UNIX and LINUX

Statistical Tools: SAS

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