- Experienced technology professional with teh ability to identify and document business requirements with over 7 years of experience in Healthcare Domain.
- Skilled in software development life cycle, including analysis, design, development, testing and implementation of software applications.
Databases: My Sql, Access, Oracle Financials and Access; Data Query tools such as PL/SQL, Share Point 2010, SDLC, NET
Microsoft Office Suite: 2003, 2007 and 2010 (Word, Excel, PowerPoint, Visio, Access, Outlook)
- Evaluates current procedures and practices for accomplishing department objectives and implement improved procedures and practices in accordance with HIPAA.
- Assists in evaluating and designing data collection, data staging, data movement, analytics delivery, data quality and archiving strategies
- Provides 24x7 post - implementation supports, responds to problem quickly and provide both short and long term resolutions
- Serves as teh subject matter expert on teh technical aspects of teh application which supports population health product suite
- Supports implementation of teh care management system, including organizing ongoing user feedback and user acceptance testing.
- Analyzes business domain and developing workflows in conjunction with technical requirements for proposed solutions
- Documents and systematically identify functional specifications used for software design and development.
- Prepares and maintains all project-related requirements such as; Functional Requirements Document, Software Requirements Traceability Matrix, Use Case Diagrams, XML, UML etc.
- Manages project activity assigned within scope, quality and timeframe allocated with PM supervision.
- Identifies and keeps track of risks, issues, dependencies and assumptions in compliance with project standards.
- Exercised control throughout all teh phases of teh Project life cycleInitiate
- Involved in creating project Charter and SOW/Proposal for implementation of teh project.
- Developed vision document involving general vision of teh core project's requirements, key features, and main constraints.
- Documented an initial project glossary and an initial business case, which included business context, success criteria (revenue projection, market recognition, and so on), financial forecast and an initial risk assessment.
- Analyzed TRICARE Dental Program Coverage for modification and enhancement of various HWSI Services for Eligibility, Claim, and Billing etc.Plan
- Developed understanding of various transactions involved in transition from HIPAA 4010 to HIPAA 5010 like Eligibility, Benefit, Claim submission transactions.
- Initiated discussions with Clients Business/IT team for Functional query resolution.
- Analyzed and validated requirement for HIPAA 5010 and gatheird requirement for ICD10.
- Analyzed and documented differences between teh AS-IS and TO-BE processes.
- Worked on EDI 270/271 (Claim Eligibility Inquiry) /276/277 (Claim Status Check) /837 Claim Submission /835 (Claim Remittance).
- Developed mapping documents for ICD 9 to ICD 10 application.
- Performed UAT, Regression testing on EDI 835 and 837 X12 format.
- Analyzed all ICD10 codes and validated teh outcomes.
- Analyzed Business requirement document, developed functional requirement document (FRD) and got it approved by teh client.
- Created help documentation in accordance to teh client's documentation guidelines.
- Provided functional assistance to project team by preparing functional documents, conducting sessions to provide information on various channels like MetDental, MyBenefit, MetLocator, MetCare, IVR and teh web services they are using. Also shared teh information these channels receive from UCS (Claims) system and UIS (Eligibility) system. Suggested TRICARE changes required in teh existing MetLife channels and teh significance of HIPAA changes etc.
- Facilitated sessions on Group Insurance, Dental Insurance, HIPAA, Eligibility, Benefit and Claims transactions in HIPAA.Execute
- Created and maintained Issues Log and ensured timely resolution of all items.
- Supported User Acceptance testing (UAT) and collaborated with teh QA team to develop test plans, test scenarios, test cases and test data to be used in testing, based on business requirements and application noledge.
- Reviewed Integration Test Plan for integration between modules.
- Interacted with teh developers to report and correct bugs.
- Efficiently interacted with designers and software developers to understand application functionality and navigational flow and keep them updated about business user’s specifications.
- Assisted Project team in test case preparation for testing MetDental (Provider Application) functionalities by sharing functional noledge on dental insurance and making them understand different business scenarios that need to be tested.
- Managed all teh requirements effectively and made them available to all team members and presented teh testing defects and resolution in teh project review meetings.Close
- Involved in training of users and maintainers and executed roll-out of teh product to teh marketing, distribution, and sales teams
Environment Rational Rose, Rational Clear Case, MS Visio, MS Project 2010, UML, HTML, Quality Center, SQL Server, MS Office (Word, Excel, PowerPoint), Load Runner, OO Modeling.
- Led and conducted JAD sessions for requirements gathering, analysis and design of teh system.
- Provided hands on agile project management approach & planning, apply strategy and scrum framework in various projects/phases, set team's objectives and goals.
- As Scrum Master facilitated all aspects of teh scrum framework, including sprint planning sessions, backlog grooming sessions, daily scrums, product demos, sprint reviews and sprint retrospectives.
- Support and consult product owner in developing, maintaining and grooming product backlog.
- As Scrum Master maintained teh capacity plan, iteration board, sprint backlog, velocity charts and burn down charts.
- Identified and removed impediments to teh success of teh sprint by working with every single team member.
- Helped in defining Change Management Process for Release Management Team.
- Mapped process flows; assessed as-is processes through user interviews, data collection and analysis, design and evaluation of to-be process solutions.
- Prepared Business Object / Business Process Models that included modeling of all teh activities of business from conceptual to procedural level.
- Consulted with healthcare insurance company to develop conversion specifications for other insurance Coordination of Benefits (including Medicare).
- Validated teh following: 837 (Health Care Claims or Encounters), 835 (Health Care Claims payment/ Remittance), 270/271 (Eligibility request/Response), 834 (Enrollment/Dis-enrollment to a health plan)
- Responsible for creating Customized Transaction set using ECMAP tool
- Identified gaps in teh business process.
- Worked in HL7 transactional environment
- Analyze business requirements and segregated them into Use Case Diagrams, Activity Diagrams, Sequence Diagrams, and OOD using Borland Together according to UML methodology thus defining teh Data Process Models.
- Responsible for writing and reviewing Functional Specs (Use cases and userstories)
- Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, OOD using UML
- Documented Requirements for Management Reporting with Crystal Reports.
- Performed Functional and GUI Testing to ensure that teh user acceptance criteria are met.
- Co-coordinated teh UAT with teh SME’s to make sure that all teh Business Requirements are addressed in teh application.
- Used SQL for data mapping and querying.
Environment: Windows 2000/XP, Toad, Agile, Rally, MS Access, MS Visio, SQL Server, HP Quality Center, Crystal Reports, UML, MS Office, HL7, ECMAP.
Confidential, Sunnyvale, California
- Involved in collecting teh requirements for teh integration of GEPACS with EPIC andIdentify teh FACORG(dual operation) impacted application which cannot be integrated and ensured teh images and results imported to teh EPIC
- Coordinated with Business users from Dual operation team, Server operations, NetworkEngineering team, User management, Security management, VPN operations forsuccessful integration.
- Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams and UML.
- Conducted user interviews, gathering requirements, analyzed teh requirements.
- Participated in teh analysis, design, testing and implementation of plan items, system enhancements, bug fixes and release coordination.
- Performed GAP Analysis while mapping teh functional requirementsand in UAT.
- Was part of performance analysis on existing initial and concurrent based review, peer to peer review, and peer to admin review and transferred teh requirement to Facets for adjudication process.
- Coordinated with Testers and designed EPIC interface test plans by applying MOSCOW rules
- Collected requirements and collaborated with DWH teams to generate reports through HP quality center.
- Coordinated with radiology system vendors for contracts. (SLA and Business uses for OLA) Annual maintenance contracts and purchase orders for jobs outside of contracts.
- Coordinated with teh business owners and Vendors for service delivery and issues related to configuration on new modalities (Fluoroscopy), CT SCAN, GE PACS and for other radiology systems.
Environment: GE PACS,GEPACS web, IDX databases, EPIC - HL-7 RIS,EXIT, MIM VISTA, Terarecon, NMIS, RADWORKS, Nighthawks systems, Power scribe, Vocera, Misys and PACTS, SQL server, SharePoint, EMR, EPIC clarity .
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