SUMMARY

• A certified Professional Scrum Master (PSM 1), result - oriented with good communications, analysis and problem-solving skills including around 6 years’ experience in Business Analysis, Quality Assurance, Data Analysis, and client relationship management
• Ability to educe, define, document business user requirements, managing requirements and analyzing requirements, changing requirements, and translating requirements and objectives into business/technical requirements based on project scope parameters.
• Good Working Knowledge of HIPAA Regulations and Claims Processing.
• Strong experience in Requirements elicitation techniques - conducting user interviews, document analysis, JAD sessions and managing the requirements.
• Created design documents like data flow diagrams, process flow charts using MS Visio and UML.
• Excellent understanding of Data services, Data ETL using SQL query tools and applications.
• Functional Knowledge of Medicaid Management Information System (MMIS).
• Exposure to multiple EDI (Electronic Data Interchange) transactions such as Claims 837-Institutional, 837-Professional, 837-Dental, 835-Claim Payment/Remittance Advise, 834 - Enrollments, 270/271 Benefit Inquiry/Response, 276/277 Status Inquiry/Response.
• Vast experience of working in data management including data analysis, gap analysis and data mapping.
• Advanced noledge of Power BI and Tableau and has strong noledge in data visualization, developing Dashboards, Charts, Graphs, and reports.
• Excellent noledge and hands on experience in ETL validation and Data Model Validations.
• Extensive noledge of MMIS claims processing for Managed Care Organization (MCO) and Fee-For-Service (FFS) Claims.
• Strong noledge of Claims Process, Medicaid (MMIS), Medicare, Procedural and Diagnostic codes.
• Highly proficient in writing user stories, use cases and requirement documents.
• Proficient in connecting to different data sources, including MS Excel and Oracle in order to create reports from the different data sources.
• Expert in documenting and defining functional requirements, non-functional requirements, and business rules
• Excellent noledge of ETL, Data warehouse and Teradata concepts.
• Experience in performing gap analysis to check the compatibility of the existing system infrastructure with the new business requirements
• Expertise in business modeling and UML Diagrams (Use Case Diagrams, Swim Lane Diagrams, Sequence Diagram, Activity Diagrams and State Chart Diagrams) using MS Visio.
• Experience in performing data mapping, data modeling and data analysis.
• Analyze and document data management, document data dictionaries, relationships, and data mapping between different systems
• Extensive noledge about various health insurance programs such as Medicare and Medicaid and exposure to Managed Care operations and Encounter Payments.
• Very well experience working with Waterfall and Agile (Scrum) development technology.
• Proficiency in elaborating the Use cases, writing Test cases, and preparing Requirement Traceability Matrices (RTM).
• Experience in working with Databases and using SQL, SQL Server, Oracle
• Proven ability to grasp any new technology in any software and in any domain.
• Strong influence management skills, reporting and analytical/problem solving skills with attention to detail.
• Assisted Quality Assurance (QA) team in writing test plans, defining test cases, test scenario and data sets.
• Built strong relationships with clients and demonstrated commitment to delivery.
• Strong communication, business understanding, critical thinking, and analytical skills.
• Highly motivated, organized and target oriented team player who enjoys working with multi-functional team towards a common goal.

TECHNICAL SKILLS

Operating Systems: Microsoft Windows 8/7/XP

SDLC Methodologies: Agile, Scrum, Waterfall

Web Languages: HTML, XML, CSS

Databases and Tools: Microsoft SQL Server, MySQL, Oracle 9i/10/11g/12c, MS Access

Quality Management: HP Quality Center, QTP, HP ALM

Project Management: Microsoft TFS, JIRA

BI/Reporting: Tableau, Power BI

Other Tools: MS Office Suite (Word, Excel, PowerPoint, Visio) Bizagi-BPMS, Balsamiq Mockups

PROFESSIONAL EXPERIENCE

Business Analyst/Quality Analyst/Data Analyst

Confidential, Massachusetts

Responsibilities:

• Scheduling and conducting meetings with SME’s to identify requirements and documenting them in specification documents and identifying the priorities.
• Creating/Maintaining source-to-target maps, as well as their corresponding addendums, requirements documents and crosswalk spreadsheets.
• Responsible for generating requirements for portion of the eight mandated T-MSIS data files in the standardized formats required by CMS. Eligibility, Provider, Managed Care Plans, Long Term Care Claims (LTC), Other Claims (OT), In Patient (IP) and Pharmacy Claims (RX) and Third-Party Liability.
• Assisted with source to target mapping of MMIS data to the T-MSIS data as required and documented in the T-MSIS Data Dictionary developed by CMS.
• Working with software developers to convey issues and solve production issues.
• Performed ETL test scenarios by writing SQL scripts with consideration of Business scenarios.
• Did data analysis for the encounters data in the data warehouse.
• Design test templates and robust automated test scripts for Tier-1, 2 and 3 edits using SQL in data warehouse as per CMS requirements.
• Creating and reviewing System test plan and end to end test plan. Create Requirement Traceability Matrix (RTM) to ensure that all the requirements are covered by the test cases.
• Facilitate client meetings to review System test results before implementing them in Production.
• Validate the accuracy of the data in the backend with that of the user input using complex SQL queries.
• Perform functional and regression testing in each sprint and UAT for each release to Production.
• Involve in data loading from file to database through UNIX scripts.
• Identifying Test Cases to be run for Regression Testing and conducting Regression testing as and when new builds were made.
• Analyze business rules and system requirements, translate business logic into SQL mappings.
• Involve actively in the post-production activities and provide updates on timely basis.
• Involve in T-MSIS Testing and Production environment and monitor the jobs, processes running daily.
• Validate Business transformation logic is applied on target system, Business data check, record count check for active and passing transformation logic applied, Derived Field from the source data is proper, check data flow from stage to intermediate table.
• Validate data after loading from stage file or table after applying transformation.
• Validate the file name, file headers and the record count of the production files generated on monthly basis through UNIX SSH client protocol, WinSCP and use PuTTY for UNIX script execution.
• Use UNIX shell script to run the test file into UNIX Server.
• Worked with ETL Source System and Target System (ETL Mapping Document) for writing test cases and test scripts.
• Participating in sprint planning meeting to prioritize and determine level of work for various team members.
• Responsible for writing SQL queries for testing the source to target document and testing data quality for load systems.
• Defined Test Scripts, created Test cases, analyzed defects, by interacting with QA /developer teams in fixing errors and writing simple SQL queries.
• Extract and analyze state error report data using UNIX and SQL Manager and log defects for federal mandatory data specifications for file validation. Also, responsible for documenting the causes, analysis and final resolution to the issues/errors file.
• Using SQL to test source to target data warehouse transforms.
• Reviewing and certifying deliverables including test plan and test cases before submitting to Client.
• Developing test plans, creating test scenarios and conducting business application testing to verify if requirements and business needs are fully implemented.
• Involving in testing and working with data quality issues using SQL.

Environment: SQL, Oracle SQL Developer, SSH, PuTTY, Cybermation, Hybrid Agile, C Compiler, Hewlett Packard HP-UX, Sun Solaris, Microsoft Office, Microsoft SharePoint, Microsoft Team Foundation Server (TFS), ClearCase, SFTP, MFTP Platform Server, JIRA, MS Project, VMWare Workstation Pro, MMIS Replication Database, Data Warehouse, HPES T-MSIS Common Solution.

Confidential, Scottsdale, AZ

Business Analyst

Responsibilities:

• Participated in gathering Business Requirements from State, Users and Internal Offices.
• Worked in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims.
• Interacted with Claims, Payments and Enrollment teams, for analyzing and documenting related business processes.
• Maintained Requirement Traceability Matrix (RTM) to make sure that all the requirements are covered in test cases.
• Analyzed legacy systems, file and record formats, system flow charts and other information to develop a comprehensive depiction of the existing environment.
• Participated in JAD sessions to identify the business needs and determine the impact on current and proposed systems.
• Developed training material for understanding the newly developed application.
• Wrote technical documentation for root cause analysis on customer support issues.
• Worked on EDI transactions, submitting and tracking claims until adjudication and Remittance Advice.
• Worked with multiple teams to improve the overall reporting of the Claims, payments, Real-time adjudication information.
• Developed test cases based on the crosswalks and compliance guidelines for 837 Professional and Institutional claims and for 270/271 Eligibility inquiry and response.
• Assisted in designing and developing Use Cases, Activity Diagrams, Sequence Diagrams, Object Oriented Design (OOD)
• Participated in Forward Mapping and analysis of ICD 9 - ICD 10 Conversion, for CM (Diagnosis Codes) and PCS (Procedure Codes)
• Assisted to quality control teams to develop test plans and test cases.

Environment: SQL Server, MS Visio, MS Office, Clear Case, MMIS, Clear Quest, Ratio, EDMS

Confidential

Business Analyst Intern

Responsibilities:

• Acted as primary liaison between the client departments and the Information systems IT department to perform analysis, review, and estimation of client requests.
• Performed Gap Analysis to check the compatibility of the existing system infrastructure with the new business requirements.
• Accumulated system requirements from various departments through surveys and interviews.
• Involved in prioritizing the defects and writing Business Requirements to resolve them.
• Conducted JAD sessions with management, SME, vendors, users, and other stakeholders for open and pending issues. Planned and defined system requirements to Wire Frames with Use Case, Use Case Scenario and Use Case Narrative and UML (Unified Modeling Language).
• Responsible for creating test scenarios, scripting Test Cases using testing tool and defect management.
• Worked as Technical Analyst to understand the requirements and explain it to the developers’ team.
• Responsible for making UML diagrams (ERD, Flow Chart, and Activity Diagram) on Microsoft Visio.
• Responsible for making DFD diagrams and Presentation to Stake Holders.
• Scheduled weekly calls with clients and based on prepared Meeting Minutes.
• Followed a structured approach to organize requirements into logical groupings of essential business processes, business rules, and information needs, and ensured that critical requirements are not missed.
• Preparing a Business requirement document (BRD) for changes require to the application.

Environment: MS Word, MS Access, Waterfall, UML, HTML, SQL, MS Visio