SUMMARY

• Proficiency in BusinessProcess Engineering and Software Development Life Cycle including analysis, design, testing and implementation of software applications in Healthcare.
• Expertise in S.D.L.C methodologies which includes significant experience in Waterfall, Hybrid and Agile methodology.
• Liaison aligning technology solutions with business missions, strategies and goals.
• Exceptional communication and presentation skills with experience in teh development, implementation, integration and utilizing quantitative and qualitative analytical skills
• Highly proficient in working with diverse users and stakeholders to elicit, analyze, communicate and gather requirements using techniques such as Brainstorming sessions, workshops like JAD, observations and existing systems documentation /procedures.
• Proficiency in gathering SMART (Specific, Measurable, Attainable, Realistic, Timely)Functional, Non - Functional, Business and System Requirements and transforming them into functional/Non-functional specifications.
• Create Business Requirement Document (BRD), Functional Requirement Document (FRD), Requirement Traceability Matrix (RTM), Scope Statement and other project related documents using Microsoft Excel (2017), Microsoft Word (2016), Google docs.
• Conduct walkthrough of deliverables, component validation, solution evaluate, requirement &solution approval and critical requirement prioritization for upcoming releases.
• Experience in performing GAP Analysis, SWOT Analysis, Impact Analysis on various projects as per teh requirements.
• Working experience as Software Quality Assurance. Expertise in writing Requirement Traceability Matrix, identifying different Testing Techniques, identifying and tracking defects and conducted Manual and automated testing.
• Proficient in developing use cases, process workflows, activity & sequence diagrams using tools like MS VISIO.
• Developed and maintained Test plans, Test Script, Log Sheets, reviewed and documented defects using HPQuality Centre.
• Understanding of Data validation and warehouse concept.
• Knowledge in theETL(Extract, Transform and Load) of data into a data ware house/date mart and assisted mapping
• Extensive knowledge in Claim Adjudication and healthcare reforms like teh Patient Protection and Affordable Care Act (PPACA) and COBRA.
• Validated 837 (Healthcare Claims), 835 (Healthcare Claims payment / Remittance), 270/271 (Eligibility request/Response).
• Comprehensive knowledge in Conversion of HIPAA X12 4010 codes to X12 5010 codes and ICD 9 codes to ICD 10 codes and used GEMS for mapping them.
• Performed a baseline assessment and related interfaces, existing service level agreements, policies, and operational business procedures for readiness to comply with ICD-10 requirements.
• Knowledgeable in area of teh various types of health insurance programs such as: Medicaid, Medicare (Part A, B, C and D), PPO (Preferred provider organization), HMO (Health maintenance organization), and POS (Point of Service).

TECHNICAL SKILLS

Methodologies: Waterfall, Agile - Scrum, Scrum Waterfall Hybrid

Project Management: Rally, JIRA, Confluence, HP ALM

Languages: HTML, SQL, XML, JSON

Database/ETL: TOAD, Oracle DB, MS Access, Informatica, SQL Server

Data Warehousing: Data Modelling, Data Marts, OLTP, OLAP

Business Modelling Tools: MS Visio, Balsamiq, Lucid Chart, Mockup Screens

Reporting/BI: Tableau, IBM Cognos, Microsoft Power BI

Defect Tracking/Testing Tools: HP QC, JIRA, HPALM, Test Manager, Bugzilla

Operating Systems: Windows, Mac OS

Miscellaneous: Microsoft Office, GoToMeeting, Google+

PROFESSIONAL EXPERIENCE

Confidential, Minneapolis, MN

Sr. Business Analyst/Scrum Master

Responsibilities:

• Analyzed teh Business case for teh project to understand teh customer needs. Involved in business process reengineering (BPR) by conducting Process modelling, SWOT analysis, Document analysis, and GAP analysis to analyze As-Is business process and teh To-Be system and assisted in fixing teh scope of teh project.
• Created Business Requirement document (BRD) to in corporate high-level business requirements, and Software Requirements Specification (SRS) for functional, non-functional, Data, and GUI requirements.
• Responsible for identifying data sources from internal systems, external systems, silos on legacy systems.
• Created Mock-Ups and Wireframes of User Interface components for client verification using Balsamiq.
• Developed Use Cases, Activity Diagrams and Sequence Diagrams and other UML diagrams for a clear understanding of teh project vision by using MS VISIO and Lucid charts.
• Prepared Business process models; used Visio to create process flow diagrams for mapping teh logical aspects.
• Prepared Requirement Traceability Matrix and interacted with QA team to ensure quality of software.
• Captured and defined teh vision and scope of teh project with teh SME and documented them as teh scope document, teh Functional Requirement document and Business Specification Requirement Document.
• Conducted thorough analysis of teh Business Requirements and created design specification to accomplish and achieve business needs related to Healthcare EDI X12 transactions such as 835 and 837.
• Experienced with Informatica, Power center for ETL in order to map teh code sets according to teh implementation, teh companion guides and used GEMs for mapping teh data.
• Assisted Data Analyst in all stages of development processes including extraction, transformation and loading(ETL) data from various sources like IBM web sphere application server, Sterling file gateway, Sybase facets performance analytics.
• PerformedUser Acceptance Testing (UAT) with business users and stakeholders, gathered requirements through interviews, workshops, and existing system documentation.
• Helped reporting and representing teh claims post processing by using Tableau and also teh Splunk Enterprise Software.
• Assisted in analyzing, gathering teh machine generated data for insights into operational intelligence.
• Involved with teh Subject Matter Experts and assisted in teh mapping process of teh ICD9-ICD10 code sets through Informatica and Facets.
• Assisted writing SQL queries, to manage and extract information from a database by using MySQL.
• Conducted and led face-to- face and conference meetings with teh team and teh business to review business
• Requirements related to automating Healthcare claims processing system.
• Provided insights into issues in teh automated claim review process and assisted in teh easy correlation and real-time monitoring of events across all layers and components of teh claim processing chain through data analytics

Environment: Agile (scrum), MS Excel, MS Word (2016), MS Visio (2016), Lucid Chart, Balsamiq, MS Project (2016), HPQC, JIRA v6.4, Tableau v9.0, Splunk Enterprise Software, MySQL(2014), Oracle, Informatica, XML, REST API, SOAP API

Confidential, Virginia Beach, VA

Sr. Business System Analyst

Responsibilities:

• Assisted Project Manager in drafting teh Project plan; defining scope, establishing work breakdown structure, defining critical path analysis and project milestones using Microsoft Project.
• Involved in GAP and Feasibility analysis for teh design and architecture of teh new application.
• Involved in Requirement Scoping and analyzing high priority requirement for implementation; Created BRD, functional Requirement documentation(FRD), System Requirement Specification document (SRS) and use case documents using MS Word.
• Created Mock-Up Screens and Wireframes using UI compenents and used Balsamiq and MS VISIO.
• Interacted with teh business users in understanding teh current application and process.
• Used rational Requisite Pro to manage teh requirement and keep teh Requirement Traceability Matrix.
• Prepared logical data model in teh form of Business Context diagram to include various entities and attributes in order to facilitate teh design of Data model in teh form of ER Diagrams.
• Used my previous knowledge of SOA to decide teh orchestration of various internal and external Web serviceusing REST and SOAP API and teh web methods to save teh cost and time of teh project.
• Worked with Cross Functional Teams and interacted with all levels of management for requirements, resources, and project status and delivering custom applications in phases.
• Involved in HIPPA assessment and HIPAA X12 EDI transaction (835, 837,270/271) mapping and identified changes dat needed to be done to comply with HIPAA regulations.
• Worked with HIPPA compliant ANSI X12 837 formats for all teh types of claims.
• Gathered teh business requirements for Medicare Part D and managed teh requirements using Rational Requisite Pro.
• Was responsible for testing teh HIPAA Transactions and Code Sets 837 transactions.
• Executed SQL queries to test teh database for records dat detect and submit functional acknowledgement and remittance advice in teh claims application.
• Prepared test cases, test script and coordinated with teh QA team for testing and Interacted with teh developers to report and track bugs using Test Manager.
• Documented and analyzeddefects reporting and tracked using HP Quality Center and updated teh status to QA Lead for functionality testing.
• Involved in GUI Design sessions with Usability Team; Browser compatibility and navigation were tested manually.
• Developed and managed Test Plan, Test Cases, Traceability Matrix and executed them in teh test lab using Quality Center(QC).
• Tested teh final application for usability testing to verify whether all user requirements were catered to, by teh application.
• Managed teh Change Request and analyzed teh Impact of teh Change request on teh application in regards to Project Plan, Scope, and Schedule.

Environment: MS Access, MS Excel, MS Word, MS Visio, Lucid Chart, Test Manager, MS Project, Rational requisite Pro, HTML, XML, Oracle, Tableau, JIRA, HPQC, MySQL

Confidential, Tallahassee, Florida

Sr. Business Analyst

Responsibilities:

• Knowledge of EDI and HIPAA Transactions 837/835, 834, 276/277, 270/271.
• Conducted gap analysis in changing old MMIS and involved in testing new MMIS. Also, accountable for Medicaid Claims Resolution/Reimbursement for each state health plan using MMIS.
• Conducted Impact analysisof teh current functionality with teh to-bebusinessprocesses to provide recommendations and finalizebusinessrequirements. Modified System flow diagrams using MS Visio.
• Working with Business users to create UML, Use cases and activity diagram using Balsimiqand MS Visio.
• Facilitated Joint Application Development (JAD)sessions to focus on defining teh Health Claims Processing process.
• Conducted user interviews, gathered requirements, analyzed them and used JIRA and Tableau to display and manage requirements for teh whole team.
• Worked as primary liaison betweenbusinesspartners and clients
• Collaborating with other SME’s to scope teh proposed project, make time and quantifybusiness benefits and preparing thebusinesscase using MS Word.
• Assisted in developing teh systems implementation documents, project management plan with milestones and steps till implementation and maintenance phase in teh SDLC.
• Designed and reviewed various documents including theBusinessrequirements document (BRD), Use CaseSpecifications, Functional Specifications (FSD), Requirement Traceability Matrix (RTM).Translatedbusinessrequirements and assisted IT with teh development of technical specifications.
• Implemented new agile processes planned and coordinated sprints with project management in a Waterfall/ hybrid environment.
• Validating Technicaldata mapping of ICD 9 to ICD 10 conversions for Clinical modification and Procedure codes.
• Created Test Plans, Test cases and assisted in running them manually by using HPQC.
• Performed User Acceptance Test (UAT) for 5010 and ICD 10 codes. Assisting leading through UAT procedure and also conducted training sessions for teh end users along with teh necessary documentation.
• Documented andanalyzed defects using Quality Center and tracked them to completion by communicating with teh team.
• Data cleansing, data migration, and data mapping were used to and validation of database structure in teh OLAP.
• Created issue logs, work request template, change request template and problem request template for teh users.
• Analyzed data and investigated service related issues to identify root cause of problem(s).

Environment: SDLC- Agile/Scrum, UML, XML, MS Word, MS Excel, JIRA, TOAD, MS Access, MS Project, SQL Server 2008, HPQC, Balsamiq, MS VISIO.

Confidential, Bellingham, WA

Business Analyst

Responsibilities:

• Extensive knowledge of Medicare (Part A, Part B and Part D) benefits, Co-pay, Coinsurance and Medicaid Supplements.
• Responsible for ensuring dat privacy and security environments of healthcare data remained intact.
• Work with teh business to analyze business process and system issues and turn them into actionable system changes dat benefits teh business.
• Effectively conducted JAD sessions and Business Requirement review sessions with teams to complete project documentation and work with teh business to gain approval/sign-off.
• Documented functional requirements, system design specification use cases, workflow diagram, screen and interface designs.
• Documented business requirements, and communicated these requirements to teh development team for teh design and implementation of business solutions.
• Communicated Business process, business solutions and updated status to IT managers and upper Business during Status meeting.
• Created data mapping to increase efficiency of data usage for transactional and analytical processes.
• Assisted in writing Test Cases, Test plans using MS Word.

Environment: Agile (Scrum), SharePoint 2010, SQL Server 2008, MS VISIO, Business Objects

Confidential

Jr. Pharmacovigilance Analyst

Responsibilities:

• Gathered ADRF forms, coordinated and assisted teh In-House Translation team to convert them into teh language our company used for MQC.
• Performed quality check of source documents/literature abstracts/articles in non-English language (language of expertise of linguist) to English for ICSRs, as applicable and filled forms as requested/ instructed by teh client.
• Ensured consistency in translation terminology, in particular for frequently translated medical terms, throughout teh team.
• Performed quality checking of aggregate reports or sections of aggregate reports from English to target language (language of expertise of linguist), as applicable
• Proof-reading, quality checking and editing teh translated documents to ensure high quality of translation
• Experienced in MedDRA coding in accordance with “MedDRA Term Selection: Points to Consider”.

Environment: MS Word, MS Excel, My Memory, Linguee, MS Project, MedDRA application center

Confidential 

Resident Dentist

Responsibilities:

• Root canals treatment followed by crown preparations
• Aesthetic restorations and treatment
• Surgical & non-surgical procedures
• Assisting surgical procedures
• Outpatient and Inpatient clinical experience
• Administrative duties like collecting, analyzing and compiling patient data, handling office work, accounts for teh Dental Department
• Accounting and handling finances in teh department
• Patient safety and protocol

Environment: MS Word, MS Excel