SUMMARY

• Experience in all phases of the Software Development Life Cycle (SDLC).
• Organized Joint Application Development (JAD), workshops and interview sessions.
• Expertise in Documentation and Review of Software and Business/Technical Requirement Documents.
• Through knowledge of various phases of Edifecs Spec builder - Analyzer and Mapper.
• Conducted JAD Sessions to develop an architectural solution that the application meets the business requirements, resolve open issues, and change requests.
• Good Knowledge of Test Plan, Test Scripts and Test Cases for Functional, System, Integration, UAT, and Regression Testing based on the Design Document for the Functional, Security, and Performance Testing.
• Excellent written and verbal communication.
• Consistently demonstrated ability to achieve tight deadlines.
• Managed complex business initiatives to balance requirements for functionality, efficiency and quality.
• Excellent knowledge of Health Insurance Portability and Accountability Act (HIPAA) transaction, code set rules such as EDI 837,270,271,276,277,834,835, NCPDP and ICD9-ICD10.
• Experienced with Rational tools like ReqPro, ClearQuest, ClearCase, Rational soda, Rational Rose.
• Experienced working in Obama care, Medicare and Medicaid projects.
• Exceptional Documentation Skills for writing Use Cases and Functional Requirement Documents.
• 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.
• Strong experience with MS Visio for creating visual representation of Software/Data Architecture, Use Case diagrams (especially in an Agile environment), Sequence diagrams, Class diagrams, Business Process Flows and basic flowcharts.
• Extensive experience in configuring data mapping of files using EdifacsSpecbuilder.

TECHNICAL SKILLS

Languages: C, C++, Java, SQL, HTML, XML, C#, VB, ASP, .Net

Databases: Oracle, MS SQL server, MS Access

Tools: MS Office Word, Excel, Access, Power point, Project, Visio, Front Office, Rational Rose, SoDA, Software Modeler, Team Test, Doors, PROLOG, ClearCase, ClearQuest, WinRunner, LoadRunner, WebSphere, Business Modeler, HP Quality Centre, Ultra Edit, TOAD and Test Director,Medicaid Management Information System (MMIS)

Industry Standards: HIPAA 5010, ICD 10, PPACA (Patient Protection and Affordable Care Act)

PROFESSIONAL EXPERIENCE

Senior System Analyst

Confidential, Madison, WI

Responsibilities:

• Worked with client to gather Business/Technical Requirements, Approval of CR (Change request), Design and Implementations for State MMIS.
• Responsible for designing future state processes forICD 9-10 Crosswalk Table and drafted High Level Business Requirements for ICD 9-10 conversion mapping.
• Worked extensively on the Procedure and Diagnosis Pricing and worked on the Reimbursement processing.
• Gained extensive experience in designing/modifying the CICS screens for various areas such as Enrollment, Billing, Provider Record and Reimbursement Status in MMIS.
• Analyzed HIPAA 5010 related to 837 (I/P), 835, 834, 270,271 transactions and performed gap analysis between HIPAA 4010 and 5010.
• Wrote clear, concise detailed System Requirements Specification(SRS) documents and user documentation in accordance to guidelines and standards of a level where developers can interpret, design and develop the application with minimum guidance
• Experience in implementation of ICD-9-CM codes and ICD-10-CM codes changes in the current claim processing modules in MMIS.
• Worked on HP Quality Center 10.0 which include Defects Management, Test Plan and Dashboard.
• Talking to the client based on requirements of that particular defect, uploading document required, checking history, status notes, setting up resources to handle and fix it.
• Worked on Rational Requisite Pro application to handle various requirements including Functional requirements, High-level requirements, Non-functional requirements, Scope statement and User requirements.
• Provided online support to users for various applications such as IPCS (Internet Professional Claims Submission).

ENVIRONMENT: HP Quality Center 10.0, Caliber RM, SAP, MS Office, Windows XP, Windows Vista, MS Visio, HP SharePoint, MS Project, MS Visio, SQL, SOA Infra, XML, Specbuilder, MMIS.

Senior System Analyst

Confidential, Richmond, VA

Responsibilities:

• Responsible for gathering and documenting Legislative, Business, Functional requirements for all the provisions and their impact on the existing products and systems.
• Responsible for integrating with Facets. Designing test scripts for testing of Claims in Development, Integration and production environment.
• Participated in the CORE (Committee on Operating Rules for Information Exchange) compliance process for the company.
• Responsible for creating test scenarios, scripting test cases using testing tool and defect management for Policy Management Systems, Payables/Receivables and Claims processing.
• Worked on the PPACA for various mandates such as Grandfather Rule, Rescissions, D-26, Pre Ex-19, Preventive Care, Operating Rules, and Early Retirees Fund etc.
• Wrote test cases and test scripts for the User Acceptance Testing.
• Performed Requirement Analysis and developed Use Cases and Activity Diagrams.
• Traced High Level Requirements (HLR) to Detailed Level Requirements (DLR) using MKS Integrity.
• Conducted meetings with SME's to understand current business process and performed Gap Analysis to meet future business needs.
• Created and managed project templates, use case project templates, requirement types and traceability relationships in MKS Integrity.
• Developed Systems Specifications document to define the impact of the new requirements on the existing system.
• Developed and managed creation of product documentation to communicate features, benefits, positioning and impacts to different audiences and ensured that documentation deliverables from various groups are produced as needed.
• Created Business Requirement Document (BRD), Functional Requirement Specification (FRS) document, User Requirement Specification (URS) and Change Request (CR) document for system application development.

ENVIRONMENT: - MS Project, SQL, Rational Unified Process (RUP), Rational Requisite Pro, Rational Rose, Clear Quest, Microsoft Visio, Windows XP/Vista/Windows 7, Mercury Test-Director, MS Visio, Business Objects.

Senior System Analyst

Confidential, San Diego, CA

Responsibilities:

• Aided Valuable Information’s in the collection of User Requirements and Business Requirements to create the Business Requirement Documentation (BRDs), using MS Word and MS Visio that provided appropriate scope of work for technical team to develop prototype and overall system.
• Conducted AS-IS and TO-BE analysis and assisted in developed process models and systems integration structure.
• Conducted and facilitated Joint Application Development (JAD) sessions to reduce time spent in moving information between stakeholders and team members.
• Wrote test cases and test plans for the related and assigned scripts according to the test strategies defined in the project and testing team guidelines in Rational Quality Manager.
• Identified critical areas of business risk and modified business processes to reduce risk by using the Risk-Management Process.
• Knowledge of the complete EDI format used in electronic documentation which was part of the knowledge transfer program to the vendors as per the requirements.
• Worked with Source system Subject Matter Expert (SME) to ensure that the extracts are properly mapped. Used SQL for data mapping and querying.
• As part of the data mapping procedures, assisted in writing requirement document for ETL - Data Extraction, Data Analysis and Loading process of collected data.
• Involved in various types of Audits and the Financials involved through different stages.
• Gained Compliance audit experience due to exposure to the legal/audit consulting groups.

ENVIRONMENT: MS Office, Rational Quality Manager, SQL Server, MS Project, Server, MS Visio, Unix, J2ee, Java, XML, Mainframes and Rational ClearQuest, ClearCase, Windows XP

Systems Analyst

Confidential, Bellevue, WA

Responsibilities:

• Worked with a cross functional and diverse team of business users and developers to enable accurate communication of requirements and ensure consensus.
• Attended the training sessions provided by SFHP to make sure that I have an understanding of all the modules in QNXT for example: Members, Providers, Claims, Utilization Management, Finance, Underwriting etc.
• Had meetings with business users and managers to understand the process what is required/to understand the AS IS process and providing them with the best solutions
• Conducted JAD sessions with management, SMEs, developers and users for open and pending issues.
• Was involved in the documenting the BRDs for letters to be sent out to members. Had meetings with developers and managers to make sure that letters are coming out of QNXT using SSRS. Users were able to generate letters from reporting services or letters were sent directly to folders using subscription.
• Was involved in QA the reports/letters before user testing and was communicating with developers if correction needed.
• Facilitated User Acceptance Testing (UAT) with the stakeholders and the business users, and the errors discovered were fixed and then verified via regression testing.