SUMMARY:

• Experienced professional with strong knowledge of the medical and insurance fields, including but not limited to customer service, claims processing, medical transcription and practice management.
• Having 8 years of experience leading projects across multiple verticals. I have cultivated expertise in Agile Leadership and Project Management.
• Worked in all phases of project life cycle and in different SDLC methodologies such as Waterfall and Agile.
• HealthCare management experience in projects involving the customization, design, development, implementation, and testing of automated systems to support the Medical Management Information System (MMIS) as well as day - to-day business operations.
• Experience with HIPAA EDI Transactions 837, 835, 820, 276, 277, 278 code sets testing in Health Insurance.
• Experience with EDI HIPAA Project to convert EDI X12 Healthcare HIPAA 4010 transactions into HIPAA 5010 Complaint transactions.
• Experience in analyzing requirements, design and review of various documents including the Software Requirement Specifications (SRS), Business requirements document (BRD), Use Case Specifications, Functional Specifications (FSD), Systems Design Specification (SDS), Requirement Traceability Matrix (RTM) and testing documents.
• Experience in conducting GAP analysis, User Acceptance Testing (UAT), SWOT analysis, Cost benefit analysis and ROI analysis and working with different software methodologies like Agile, Waterfall.
• Supporting all the documents with UML Diagrams such as Use Case Diagrams, Class Diagrams, Activity Diagrams, Data Flow Diagrams, Sequence Diagrams, Process Flows (Business and System) using UML modeling tools such as MS Visio and Rational Rose.
• Experience in data warehouses and data marts for business intelligence reporting and data mining along with developing and documenting process flows for business processes.
• Organized many Joint Application Development (JAD) sessions and Joint Requirement

PROFESSIONAL EXPERIENCE:

Confidential

Business Data Analyst

Responsibilities:

• Gathered requirements by coordinating and interviewing with Subject Matter Experts (SME)s and Product Owner Conducted Joint Application Development (JAD) sessions and developed Business requirements and design document based on business user concepts and specifications. Created Use Case document that contained the Use Case defining role of users receiving claims, processing claims and adjudicating claims. Also created UML diagrams to validate EDI claim process as per HIPAA compliance. Creation of new JIRA Projects and setting up the projects based on user requirements Developed various artifacts like BRD, FRD, data mapping documents etc. Worked on ICD 9, ICD 10 as per HIPAA guidelines. Application dependency mapping (ADM): which devices are communicating with one another, which TCP ports they are communicating on, and which processes are running on these devices.
• ServiceNow core system setup of Service Catalog Management (assign roles, customize the service Catalog homepage, define content to provide in the service Catalog, and define request fulfilment) & Service Level Management Process (defining service guarantees, monitoring service guarantees, measuring customer satisfaction, continual service improvements to incident management). Performed assigned projects related to the data center. Document current processes using MS - Office products, HP ServiceNow and identified gaps in current processes. Worked with Product Owner to solicit business requirements and create User Stories for development of customer facing applications using Agile methodology. Project Management working in an Agile environment Analyzing the story point prioritization of Product Backlog, Sprint Backlog to manage current and subsequent release was done using JIRA.
• Responsible for ensuring client functional/technical requests are captured, documented and communicate to the project management team for prioritization. Used MS Visio to design detailed business process flow diagrams and created UI Wireframes and Mockups using Snag its tool. Responsible for analyzing and validating Claims processing in FACETS Automated testing is done with ALM tool and selenium. Manual testing is performed for selected. Experience with Identity and Access Management (IAM) tools such as NetIQ Identity Vault, Oracle Identity Manager, and Sail Point Identity Governance etc. Support multiple research sales representatives by providing information specific to life science, including technical informa

Confidential

Senior Business Analyst /Data Analyst

Responsibilities:

• Processed Medicaid claims and worked on X12 format of EDI 837 and EDI 835 for Medicaid claims. Understood Current state and future state of the project, performed "As - Is" and "To-Be" processes/GAP analysis. End to End project management and business analysis for several modules from inception to delivery. Involved in the acquisition process of new infrastructure, establishment of a new service model, and implementation of a new service management system (ServiceNow) Worked with internal and external customers to gather the business requirements and transform them into user stories on
• ServiceNow Agile Development module Used ITIL practices to implement ServiceNow applications in phase by phase approach, created SLAs and participated in running SLAs and responsible for closing successfully in ServiceNow Developed Service catalog which includes creating new catalog items, designing workflows and execution plans. Integrated applications into the enterprise-wide Sail Point solution. Worked under the Identity Access Management. Validated the following: 837 (Health Care Claims or Encounters), 835 (Health Care Claims payment/ Remittance), 270/271 (Eligibility request/Response), 834 (Enrolment/Dis-enrolment to a health plan). Maintain an up-to-date knowledge of life science industry regulations, quality assurance practices, infrastructure qualification and computerized system validation practices and procedures Maintain knowledge and act as team super user for related systems (e.g. CTMS, R&D Select, PO creation, SharePoint) Acted as CFT lead and providing Analytical document support from the LIMS-R&D module for the creation of required data for regulatory filings through PMS - RIMS within timelines.
• To ensure Proper Documentation like Raw data, Instruments logs of the analysis carried out in compliance with cGLP through LIMS Involved in EDI automated first-pass claims adjudication, requiring thorough understanding of claims processing, both front and backend operations.
• Provide strategic direction and drive business with client to achieve revenue growth, profitability and continuing customer satisfaction in the Life Science sector. Collaborated with ServiceNow Team to align the functionality and ease of use of the ServiceNow Service Catalog by undergoing a re-design into the workflow, functionality, and overall usability of the Catalog of services. Results: Intelligent routing, Built-in request approvals, Catalog item KPIs and reporting gauges, Workflow phases that allow for customers to easily view the "stage" of their requests and when it

Confidential

Service Now Business Analyst

Responsibilities:

• Worked on the procurement module of ServiceNow where the primary responsibilities are to understand the procurement compliance processes for purchase requests, approvals and orders, audit compliance, general ledger coding and then gathering the requirements, BPMN. Also worked on the implementation of Incident Management, Problem Management, Change Management, Event Management, CMDB, Reporting, Service Catalog in ServiceNow. Involved in Order Management and Inventory Modules.
• Enhancement related to pl/sql and sql for Oracle Clinicals (oracle product used by client for clinical trials) Systems implementations, process improvement projects, identifying internal or external risks that may adversely affect business operations. ServiceNow

Confidential

Healthcare Business Analyst

Responsibilities:

• Extensively involved in implementation of effective requirements practices, including gathering User Requirements, and analyzing User Requirement Document (URD), and functional specification document (FSD), use and continuous improvement of a requirement gathering processes. Applied RUP methodology with its various workflows, artifacts and activities to manage life cycle from inspection to transition phase. Acted as liaison between external clients and SMEs to generate and standardize product requirements specification documents such as URS/FRS/Use Cases. Employed UML methodology in
• Creating UML Diagrams such as Use Cases, Sequence Diagrams, State Diagrams, Activity Diagrams and business process and workflows. Involved in implementing Six Sigma practices to systematically improve processes and standards and by eliminating defects Coordination / Support for HL7 Interface testing (ADT Messaging) Involved in HIPAA 5010 gap analysis of ANSI X12 4010 and ICD 10 initiatives. Coordinated JAD sessions with all the stakeholders to understand the impact of HIPAA 5010 on the existing system. Developed and updated HL7 interfaces for HIS and ancillary apps and involved in source mappings and translation tables. Supported EPIC message processing with Record Viewer functions. Worked on Interfaces like QAWO which interacts with AS400 & BPCS. Using this interface Specification and Jobs were downloaded into SampleManager LIMS. Preparation of Summary Report for the
• Laboratory Analysis, Data Entry in LIMS. Maintained, prepared and tracked reagents and standards including documentation in the laboratory information management system (LIMS). 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. Involved in GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims. Worked on EDI transactions: 270, 271, 835, and 837 to identify key data set elements for designated record set. Performed AS - IS and TO-BE analysis for EDIFECS Standards - HIPAA 5010 Database Setup for new

Confidential

Business Analyst/ServiceNow

Responsibilities:

• Developed data flow, work flow, process flow and entity relationship diagrams in MS Visio, and analyzed them to create "AS IS" and "TO BE" scenarios Verified the functional aspect as per the business process and validated the interfaces with the other systems and data conversion from the existing systems Experience in EDI automated first - pass claim adjudication, requiring thorough understanding of claim processing, both front and backend operations. Interacted closely with QA team in different phases of testing such as System testing, Functional testing, Regression testing and Integration testing for Quality
• Analysis using Quality Center and resolving the issue assigned on JIRA. Validated 837 (Health Care Claims or Encounters), 835 (Health Care Claims payment/ Remittance), 270/271 (Eligibility request/Response) and 834 (Enrolment/ Dis-enrolment to a health plan). Collaborated with ServiceNow to standardize the undocumented change management process for Online Tech and Online CT groups using ServiceNow and mirroring (as much as possible) the current Corporate Change Management process. Results: Increased accuracy of change information for CI's in the ServiceNow CMDB, clear accountability for all steps in the change process, complete auditability of changes by SOX auditors, eliminate single points of failure in the approval processes, streamline processes for efficiency and consistency and improved the communication and notification of changes. Performed business process GAP analysis and identified the areas to improve the efficiency of the business process. Created business process mapping document, analyzed the as-is business processes and created a to-be process using MS Visio. ServiceNow core system setup (establish connectivity for LDAP, change the default passwords, customize the look and feel of Service.now.com, change CSS color scheme, and change default system settings) Assisted in entering and updating Issues (Epics, Stories, and Tasks) onto JIRA Agile application.
• ServiceNow administration of Incident, Problem, Change, & Configuration Management applications (UI policies, data policies, UI actions, business rules and client scripts) ServiceNow mentoring of onshore, nearshore and offshore resources to introduce key concepts and demonstrate step-by-step processes Understand the ITSM business requirements provided by Solution Architects and convert them into technical specifications. Involved in Installing and Configuring ITSM 7.6 Provided Busine

Confidential

Healthcare Business Analyst

Responsibilities:

• Played an active and lead rolein gathering, analyzing, and writing business requirements. Project was implemented in phases, enabling system to deliver as many business requirements as early as possible. Involved in Requirement Scoping and analysis of high priority requirements for implementation.

  Worked on Transaction - 835 claims payments and remittance advice, which deals the payment from payer to provider. Involved in HIPAA EDI transactions such as 270, 271, 837 (P, D, I), 276, 277, 834, 820, 278, 999/TA1, and 277 CA. Evaluated Medicare requirements and benefits in Medicare Health Plans for member enrollment and management. Coordinated, implemented and provided on-going support of the Quality Performer as outlined in the Specifications Manual for Well Care Inpatient Quality Measures Centers for Medicare & Medicaid Services (CMS). Used HP Quality Center for writing Test plans and

  Test Cases. Worked on documenting business rules to be defined in the business rules management engine (IBM ODM). Participated in requirements meetings, writing requirements in CaliberRM, converting requirements from Caliber RM to HP Quality Center. Working knowledge of implementing software development projects using methodologies such as Waterfall, RUP, and Agile Scrum. Used HIPAA guidelines and regulations to keep track of Healthcare transactions like Eligibility Request/ Response, Request and Response for Claims Status, Prior Authorization, Claims Vision and Claims Payment. Worked closely with business team, and identified, analyzed the core requirements and key features of the ongoing project. Extracted, discussed, and refined business requirements and developed comprehensive business requirement document (BRD).

  Developed Software Requirement Specification (SRS) document using Visio and MS Office. Loaded the defects on to HP Quality Center and maintained a track record of the updates on the defects from the development team. Executed Test Cases Manually, once the application is stable and documented the successful or unsuccessful completion of each test case in HP Quality Center (QC) for