PROFESIONAL SUMMARY:

• An assertive professional with 7+ years of practical experience as a BA and as a Software developer. Extensive experience in Wire framing and making Mockups.
• I have worked on projects with ETL and MDM (Informatica). Experiencedin buildingData Integrationand Workflow solutions and Extract, Transform,and Load (ETL) solutions for data warehousing usingSQLServer Integration Services (SSIS).
• Designed and wrote SSIS ETL systems for data from many disparate sources, structured and semi - structured, using transformations such as lookup, merge, derived column, data conversion and aggregates extensively.
• I have a good understanding of a diverse range of Business Solutions and their applications who possesses good presentation, client Interaction, requirement gathering and analysis. Objective is to work in an environment where I can assist to design, implement and support high quality Software Development Projects. Work with end clients to define needs and to develop clear business solutions, to gather and analyze quality data to assist management in making informed, high quality decisions
• I use extensively Balsamiq for wireframes, and either Photoshop / Illustrator or HTML + CSS (depending on complexity) for mockups Knowledge of the SDLC models such as Waterfall, Agile.
• Writing & documenting Business Plan, Business Requirements Document and Functional Specification Document
• Expertise in translating user requirements into System Specifications.
• Experience in testing the HIPAA EDI transactions 834,820,837/835, 276/277, 273, 270/271 according to the requirement test scenarios
• Experience in Use Case design and analysis, Use Case specifications, Scenarios, Business processes, Class diagrams, and Activity Diagrams and technical documentation, using Unified Modeling Language (UML), MS Office Suite, and Rational Suite.
• Ability to gather and document Business Requirements, experienced in writing Use Cases. Proficiency in SDLC, understand the workflow concept, ability to gather and document the 'As-Is' and 'To-Be' processes.
• Proficient in maintaining Test Matrix and Traceability Matrix and performing GAP analysis.
• Good knowledge of SQL queries.
• Tested EDI transaction 834 and 820. Performed extensive manual testing of each module.
• Experienced inthe implementation ofHealth CareReforms
• Medical Claims experience in Process Documentation, Analysis and Implementation in 835/837/834/270/271/277/997(X12 Standards) processes of Medical Claims Industry from the Provider/Payer side.
• Knowledge of HIPAA standards, EDI, Implementation and Knowledge of ICD-9, and ICD-10
• Functional experience in health Care Industry with vast knowledge on Medicare and Medicaid.
• Expertise in creating the companion guides on various EDI transactions.
• Specialize in HIPAA 5010 implementation including GAP analysis
• Experience in preparing documentation which is in compliance with21 CFR Part 11,MedicarePart D requirements, HIPAAANSI X12 Transaction sets,and in accordance with NCPDP (National Council for Prescription Drug Programs) Standards.
• Trained and mentored new associates on Reconciliation process through approved and documented processes.
• Performance testing expertise in developing Performance Test plans, Test Strategy, Load Modeling, Performance Metrics and Performance Analysis
• Experience with various modules like membership management, premium billing, enrollment, claims processing & adjudication, benefits administration within Healthcare industry
• Tested the Professional, Institutional Claims processing and adjudication and validate data with facets.
• Good knowledge of Health Insurance Plans and Expertise in determining the membership eligibility, billing experience within life and disability in health plans.
• Worked with EMR/HER, extensively worked with FACETS, and experience with Medicare.
• Conducted User Acceptance Testing (UAT).
• Performed GAP analysis for EDI transactions such as 837,834,820 to support state specified X12 5010 file formats.
• Strong knowledge and working experience of industry standards such as HIPAA, Six Sigma, and SOX, ICD-9, ICD-10 coding, EDI (Electronic data interchange), transaction syntax like ANSI X12.
• Strong understanding of Account Receivable, Premium Billing and Premium Transactions.
• Experience with MS VISIO, TFS and SharePoint.
• Expertise in Bug reporting tools such as Quality Center (ALM) and SharePoint.
• Strong Knowledge on MS Office suite, MS Visio, MS Project, and MS Access
• Strong experience in developingparameterized, drill down, chart, matrix, Ad-Hoc and sub reports using SSRS 2005/2008R2/2012 using data from a variety of sources
• Some understanding for GL and other finance reports.
• Good working knowledge of major Operating Systems such as Windows and UNIX.
• Successful as a team player to work in conjunction with other DBA’s, testers, developers and other team members in validation and testing complex scenarios and projects and in the maintenance of Quality Standards in projects.
• Expertise in Analysis of Problem Severity, Defect tracking and reporting system.
• Highly motivated, organized and results and detail oriented with good interpersonal, communication and presentation skills. Proven capability of adapting to new and fast changing technologies.

TECHNICAL SKILLS:

Methodologies: Agile, Waterfall, UML, RAD, Scrum

Modeling Tools: MS Visio

Database: Oracle, SQL Server

Management Tools: Quality Center (ALM), SharePoint, TFS

Operating Systems: Windows XP/Vista/7/8, UNIX

Business Applications: MS Project, MS Visio, Microsoft Office Suite, MS

PROFESSIONAL EXPERIENCE:

Confidential, Sacramento, CA

Business Analyst

Responsibilities:

• Extensive experience in Wire framing and making Mockups
• Throughout the project, I made extensively middle-to-high fidelity, static, design representations.
• Very often I even made mockup, visual design draft
• I made mock ups to represent the structure of information, that visualizes the content and demonstrates the basic functionalities in a static way
• Through wire framing and mockups, I encouraged my teammates to actually review the visual side of the project
• I used Axure to make flow diagrams and skeletons and structure throughout my time here.
• Environment: DPI (Telecom Billing), Payment Gateway, CDG CABS billing
• Technologies worked with: Unix, JCL, NDM, Shell Scripting, OS/390, EMI record format
• Identifying the existing and new feeds to be tested and supplying the test data to QA teams.
• Responsibilities as Implementation Specialist:
• Requirements’ gathering for the Billing data feeds viz. Usage, BDT and MPB
• Working with business and technical contacts of 3rd party some service bureaus to finalize the billing and provisioning interface requirements.
• Undertook onboarding tasks such as setting connectivity, Trouble Administration, assigning filenaming conventions.
• Co-ordinating the method of transfer and conducting JAD sessions with technical teams of other telecom carriers to discuss solution details and finalize technical details.
• Identifying the existing carriers affected, develop contingency plans to if new data fails to be merged in the existing feeds.
• Maintaining the environments needed for conversion data, testing and development. Co-ordinate environment allocation requests across various teams
• Ensuring the conversion data is loaded properly into source system and all the master data needed are available prior to conversion.

Confidential, Baltimore, MD

EDI Analyst

Responsibilities:

• I used Axure to make Wire framing and mock ups here almost to the extent of prototyping
• Analyzed and collected business requirements identified system interfaces and created the requirements specification documents.
• Organizing sessions with QA team to make them understand the requirements.
• Conducting test case reviews.
• Worked withEdifecs Specbuilderto create test files, analyzed all EDI test files with 5010 implementation guides and gap analysis of EDI transactions.
• Analyzed all medical ANSI X12 specifications for processing electronic claims
• Transactions focused on were270,271, 834, 835,and837.
• Experience with EDI files in X12 format.
• Validate EDI Claim Process according to HIPAA compliance.
• Involved in HIPAA assessments and HIPAA X12EDItransactions mapping and identified the requirements and involved in finalizing the system requirements.
• Performed analysis on HIPAA-EDI Transactions (270, 271, 275, 276, 278, 820, 834, 835 and 837).
• Involved in HIPAA gateway transactions 997/999 and converting HIPAA 4010 messages into HIPAA 5010.
• Identified Use Cases from the requirements and created UML Diagrams including Use Cases, Activity/State Charts, Sequence diagrams, Data Flow Diagrams and ER Diagrams using Rational Rose and MS-Visio thus defining the Business Process Model and Data Process Model.
• Performed requirement analysis by gathering both functional and non-functional requirements based on interactions with the users, stakeholders, document analysis, user interviews, and documented those requirements in the BRD.
• Consistently utilized MS-Project for planning and project tracking purposes.
• Developed Test plans and mapped them to requirements with QA team.
• Developed and updated Requirements Traceability Matrix (RTM) using Rational Rose, mapped the developed Test Cases to the requirements to ensure that the requirements were fully tested and implemented according to the specifications.
• Experience developing, maintaining test plans, detailed test cases, executing tests cases, validating test results, logging defects, tracking defects and also automated testing with experience in using Quick Test Pro and Quality center.
• Evaluated and tested the new and modified software application to verify that programs function according to both technical and business requirements.
• Used the Rational Unified Process (RUP) methodology for the project.
• Developed, executed and validated user acceptance test plans (UAT) and implementation support.
• Performed Gap Analysis to figure out what we have and what we ought to have, to be better-off.
• Developed project schedules, conducted project status meetings and managed resources during all phases of the SDLC.
• Performed information flow from external applications into QRM while ensuring data integrity
• Created and maintained the Requirements Traceability Matrix (RTM)
• Knowledge of invoice generation and payment process, both automatic and manual.
• Extensive knowledge of health exchange, Medicare and Medicaid.
• Performed unit testing with the developer.
• Used HP QC and JIRA as the defect management tool and also requirement gathering tool.
• Part of Health Insurance Exchange (HIX) product team and experience in handling Private and Public Exchange solution.
• Experiences working in ANSI x12 270-271 EDI Transaction.
• Supported QA team in performing testing.
• Experience with conducting assessments and impact/gap analysis concerning State Medical Management Information System (MMIS).
• Involved in the UAT testing of web portal of MMIS System and conducted training to users.
• Created reports using Cascading parameters and Drill-Through Reports, Sub reports, Parameterized Reports, Report Models and ad hoc reports.
• Worked with Payment processing and financial reports.
• Worked with Payment processing and financial reports.
• Experience in training resources for the product.
• Validated results for internal testing
• Performed Integration and regression testing along with testers.
• Assisted with Test Cases and developed strategies with Quality Assurance group to implement them.
• Efficiently responded to client inquiries and resolved discrepancies.
• Collaborated with Quality Assurance Analysts to track defects.
• Also supported client for the UAT.
• Created user manuals and Supported Business Objects' end-user in areas including software (Designer, Reporting, Web Intelligence, and Publisher) and running ad hoc/core reports.
• PerformedGap Analysisto identify the deficiencies of the current system and to identify the requirements for the proposed system.
• Assisted manager with the development of project schedules, project planning.

Environment: MS Visio, SQL, Java, Windows 2000/2003, MS Project, MS Word, MS Excel, Rational Requisite Pro, ALM, Rational Rose, and RUP, Share Point, Quality Center.

Confidential, Phoenix, AZ

Sr. Business System Analyst

Responsibilities:

• Responsible in providing Business Requirement Document (BRD) and Functional Requirement Document (FRD) using Requisite Pro.
• Analyzed inpatient and/or outpatient medical records using International Classification of Diseases, Ninth Revision (ICD-9/10) and Update ICD-9 and CPT code changes.
• Processed claims in Facets and verified 835X12's are generated and sent to Provider.
• Involved in testing the EDI transactions 834, 837, 835. 270/271 & 276/277 conversion to Facets.
• Created EDI Export and Import processes and worked with EDI Trading Partners, Payers/Vendors
• Experiences working in ANSI x12 837-835 EDI Transaction.
• Maintained reimbursement summaries from third parties and compare with clinic fees, Updated reimbursement regulations, Notified Business Manager of significant changes, conduct periodic medical record audits to ensure documentation is consistent with billing.
• Well-defined and produced inclusive, accurate conversions of ICD-9 codes into equivalent ICD-10 codes with the option to adjust system application for ICD-10 specificity.
• Analyzed baseline data and integrate checks and balances into the loading process to validate the data in Relational Database.
• Assisted with the User Interface (UI)prototypes to capture and validate requirements and spike solutions to the occurring problem.
• Experienced inX12transactions835/837/834/820/271of medical claims/underwriting for support and point of reference for the vendor in business issues.
• Locate and validate the data in the transactions of 837 and report the file that is in error. Also, excellent understanding of loops, segments, elements and structure.
• Performed information flow from external applications into QRM while ensuring data integrity.
• Experience working with Effective Enterprise Data Management (EDM) with capabilities of profiling, cleansing and monitoring to improve data quality; metadata (data about data) to ensure consistent definitions and usage; data governance to provide ongoing oversight and enforcement of standards and procedures; retention and security to support accessible and secure data; and master data management.
• Tested claim billing processes as well as other healthcare processes such as enrollment, eligibility, andclaims-to-remittance adjudication processes.
• Worked with providers and Medicare/Medicaid entities to validatehealthcare processes, including end-to-end claims processing, payment processes and eligibility where special focus on procedure and diagnosis coding.
• Created technical documentation,reviews, analysis, and evaluations ofbusiness systemsfor end user needs, including Companion Guides,business process reengineering,GAP analysisandmedical forms processing andworkflows.
• Worked onClaims and Remittanceprojects, including syntax and business rulesfor HIPAA4010and 5010validation for loops, segments, elements, qualifiers and code sets.
• Used SDLC (System Development Life Cycle) methodologies using Agile and RUP.
• Created Testcases, testplan and Companion Guide from stage to production.
• Performed UAT testing for ICD10 and legacy testing for HIPAA 4010 and 5010 projects for HIPAA requirements and compliance mandates.
• Performed Unit testing documentation developed using Excel and created Artifacts and listing for UAT validation,and writing and validating Use Case Documents.
• Tested and validated the database tables using SQL queries during Data Validation and Data Integration. Used SQL to analyze Ad-Hoc reports for data mapping and requirement validation.
• Involved in the UAT testing of web portal of MMIS System and conducted training to users.
• Experience developing, maintaining test plans, detailed test cases, executing tests cases, validating test results, logging defects, tracking defects and also automated testing with experience in using Quick Test Pro in quality center.
• Complete knowledge in Medicaid and Commercial entities which include claims, enrolment testing, as well as NPI and medical coding and ICD-9 EDI testing.
• Captured allHIPAA-relatedEDI datain the repository usingFACETS and supported integrated EDI batch processing and real-time EDI usingFACETS.

Environment:Share Point 2010, MS Visio 2010, Rational Rose, GAP Analysis, UML, Use Case Analysis, SQL Server, Microsoft Office Suite, Quality Center, JSP, Java Script, XML, HTML, Agile, and Scrum Master, test Director, Rational Unified Process (RUP), MS Access, and DB2.

Confidential, Pittsburg, PA

Business Analyst

Responsibilities:

• Responsible for requirements analysis, design and developing technical requirements.
• Reviewed the Business requirement, Functional Design Documents and Technical Specification documents
• Logged of defects in Quality Center to maintain Test requirements and to communicate the bugs with the Developers.
• Performed Backend testing by writing SQL validation queries in Oracle Toad against the database.
• Facilitated Joint Application Development (JAD) Sessions for communicating and managing expectations.
• Performed Data analysis from the data warehouse along with business intelligence solutions delivery team.
• Identified processes for developing and documenting detailed business requirements. Data was collected from end-users, and analysts. Created Use-Cases and Requirements documents to document business needs.
• Requirements were gathered through interactions and meetings and periodic walkthroughs with SMEs, client, and other potential users of the application.
• Worked on HIPAA-EDI Code sets are in X12 also known as ANSI ASC X12.
• Tested EDI transaction 834 and 820. Performed extensive manual testing of each module
• Maintained requirement traceability matrix on daily basis and participating in status meeting.
• Conducted Use-Case reviews and identified gaps, leading to improvements/enhancements.
• Maintained documents and the effect of proposed changes on the project schedule and costs.
• Managed and tracked Defects using Quality Center.
• Worked on EDI transactions: 270, 271, 834, 835, and 837 (P.I.D) to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes
• Worked directly with software engineers to ensure clear communications on requirements and defect reports.
• Designed and developed scenarios based on business requirements.
• Worked with providers and Medicare or Medicaid entities to validate ANSI EDI transaction sets or Internet portals.
• Interacting with other teams through walkthroughs, teleconferences, meetings, etc. to resolve various issues.
• Facilitated analysis and user needs (use case surveys) with project teams and authored Use Case document (UCD), Functional Specifications and Requirements Traceability Matrix (RTM) with project teams.
• Served as a liaison between business users and IT team and Implemented business process analysis, business process modeling and business process re-engineering techniques.
• Assisted manager with the development of project schedules, project planning.
• Experience in training resources for the product.
• Performed Gap Analysis (“AS IS” - “TO BE”) to derive requirements for existing system enhancements.
• Wrote UAT Test Plan, organized and conducted User Acceptance Testing with clients and worked as a part of support team.

Environment: SQL Server 2000, Oracle, MS Project, Quality Center, Agile, MS Office, MS Visio, Toad.

Confidential, Woodland Hills, CA

QA Analyst

Responsibilities:

• Performed stakeholder analysis to identify key players for project success
• Identified and involved all key stakeholders, contributors, business, operations and technical resources that must participate in the project
• Played an active and lead role in gathering, analyzing, and writing business requirements.
• Followed the Agile Development methodology throughout the SDLC.
• Collected and documented business processes as well as business rules. Provided key input in working with users in defining project and system requirements.
• Translated the business needs into functional requirements and communicated with the business users on a non-technical level
• Analyzed and worked with HIPAA specific EDI transactions for claims, member enrollment, billing transactions. Worked specifically on EDI Health Care Claim Transaction set (837)
• Established, documented, and maintained EDI procedures. Tasks include identifying errors and taking corrective action, reconciling EDI transactions through coordinating information with internal and external customers, and working closely with internal departments and external vendors to maintain EDI integrity
• Worked on modules related to Claims, Providers, & Contracts and worked with Claims attributes, Provider attributes, enabling EOB & Remit rules associated with Provider configuration process
• Created the System Specifications Document, use cases and Use case diagrams.
• Created and maintained the Requirements Traceability Matrix (RTM).
• Interacted with other teams through walkthroughs, teleconferences, meetings, etc. to resolve various issues.
• Conducted JAD sessions when needed.
• Worked with billing and claim processing modules.
• Ensured Use-Cases were consistent and covered all aspects of the Requirements document.
• Designed and developed scenarios based on business requirements.
• Worked on Unix Platform and experienced in back end testing by executing SQL Queries.
• Checked the data flow through the front end to backend and used SQL Queries to extract the data from the database.
• Carried out User Acceptance Testing (UAT).
• Conducted reviews with all the stakeholders to ensure that the data warehouse meets requirements and Service Level Agreements (SLA).
• Performed Integration and regression testing along with testers.
• Assisted with Test Cases and developed strategies with Quality Assurance group to implement them.
• Collaborated with Quality Assurance Analysts to track defects.
• Consolidated the status reports of the team for the Project manager.

Environment: MS Visio, Sybase, SQL Server, Facets, Networ X, MS Excel, MS Word, MS PowerPoint and UML.