SUMMARY

• Senior Systems Analyst/ Business Analyst withover 10years of experience in Healthcare, and Retail.
• Data Analytics and Business Intelligence and Reporting Domain.
• Worked on Commercial, Medicare and Medicaid line of business in Medicare/Medicaid Membership Enrollment, Claims and Utilization management, managing diverse team of technical experts in analyzing systems, processes and improvements implementations.
• Created Technical documentation with Data transformation logics as per the business needs for Data extraction and worked closely with external vendors, SFTP - ingMedicare/Medicaid HealthcareMembership EnrollmentData, Medical Claims, Pharmacy claims, Provider Data and Utilization Management Data extracts.
• Worked on BI reporting, Creating Report Books for ETL jobs from Teradata server to Hadoop tan to Tableau reports, and Business Object Reports.
• Performed Gap Analysis to understand and demo Business Stakeholders/POs AS-IS to TO-BE state of the system.
• Worked closely with System Architects, Business Project Sponsors, and Project Managers, Project Leads and Lead developers and Testers in identifying timelines, choosing appropriate Project methodology like Waterfall, Agile, Hybrid or Kanban based in team strength and resource availability.
• Created Jira workspace for resources and added them to the Jira board and created Confluence documentation page to document requirement and flow and architectural diagrams.
• Participated in Scrum of Scrum meetings for the Project status reporting and plan release timelines and to ensure the team allocated is complying with the timelines if Release train.
• Created Workflows/Flowcharts/Sequence Diagrams using MS Visio to demonstrate visual representation of various work flows to the business users and Developers and Testers.
• Reviewed Test plan documents by verifying Test Cases and Test Scenarios with the Testing team.
• Extensive usage of Jira Requirement Tracker and Confluence documentation.
• Conducted UAT walkthrough sessions with Business Stakeholders/Product owners.
• Understanding ofSOA, Web Service, HTTP, XSD, XSLTandJSON.
• Worked as Pega Analyst for Confidential EFUSE Team, an Application which will store historical and most updated Co-Ordination of Benefit information among Confidential and Other Payers.
• Proficient in developing Business Requirement Documents (BRD) and Functional Requirement Documents (FRD), Business Modeling Process (BMP) and Requirement Traceability Matrix (RTM).
• Worked on Waterfall project models, Agile Project models, Waterfall-Agile hybrid Project Models, and Agile Scrum Project models.
• Facilitating Stakeholder meeting for requirement elicitation, conducted JAD sessions, User Story Grooming sessions, Requirement Walkthrough sessions with business stakeholder/POs.
• Technical Specifics Walkthrough sessions, Report Book Walkthrough sessions, UAT walkthrough sessions for BO and Tableau reports.
• Experience with Healthcare Effectiveness Data and Information Set (HEDIS) to measure performance on important dimensions of care and service.
• Knowledge of HIPAA Regulations and Claims Processing with good knowledge of Health Insurance Plans (Medicare Part A, B, C and D), managed care concepts (Medicaid and Medicare), billing experience with thorough understanding of CPT coding, CMS-1500 claim forms and reimbursement forms.
• Created test plans, scenarios, test cases and test execution using ALM platform
• Successfully managed multiple projects concurrently.

TECHNICAL SKILLS

Operating Systems: Microsoft Windows, UNIX

Languages: SQL, HTML, XML, X12 (EDI), and UML

Databases & Tools: SQL, Access, MYSQL, Oracle 9i/10g, Teradata - Teradata SQL Assistant, Hadoop, Google Cloud Platform, AWS Redshift, SAP HANA

Quality Management: HEDIS, HP ALM-Quality Center, Rational Test Manager, QTP/UFT, Rally, MS Test Manager (MTM), Team Foundation Server (TFS).

Business Modeling Tools: Microsoft Visio, MS Excel, MS PowerPoint, Microsoft Visio

SOA Testing: POSTMAN, SOAP UI, Smart Bear READY API INTEGRATION

Reporting Tools: SAS, Tableau, BO

Project Management: Microsoft Project Professional, JIRA, Confluence

SDLC Methodologies: Agile, Waterfall, Spiral, Iterative, Kanban

Others: MS (Visio, Outlook, Word, Excel, PowerPoint, Share point, Snagit 11 editor, Balsamiq Wireframes.

PROFESSIONAL EXPERIENCE

Confidential, Richardson, TX

Business System Analyst

Responsibilities:

• To Update/Add any commission or Incentives to the Brokers and General Agents.
• To facilitate easy on-boarding of the new accounts and Producers/Brokers.
• Audit Monthly Credit pull from the SQL server which is fed from Cobol based Bluestar legacy Commission System and tan compare the data with Callidus Cloud backend data using Oracle SQL developer/Toad and Teradata reporting database.
• Use SecureFX to verify if there is any data discrepancy between legacy vs SAP Cloud based Callidus Cloud Commission pay-out system.
• Assist Confidential wrongly paid commission recoupment by identifying error in earlier updates.
• Work on Service ticket which is created on SAP workflow software, review documents such as Underwriter approvals, and state specific commission documentations send by Sales team in order to make error free Add/Terminate/Update contract with accounts and with Brokers.
• Worked on Broker Commissions and Incentives data in Teradata Enterprise Data warehouse from Callidus Commission payment system to investigate and report on producers who are wrongly paid or inadequately paid due to wrong commissions or calc method is used in the Callidus system.
• Work with BA Lead, Architect Lead, Scrum Masters to create stories for building AWS frame work for Workers, Listeners and Queues, creating various buckets to store medical documents in encoded PDF format and also to create XDR and X12 xml files enveloped in JSON format.
• Work with Test Lead to create a Test Strategy and get it approved from the Architects and Business.
• Work with Oracle DBA and AWS PostgreSQL DBA to plan and to strategize migration of Data Models, Schema, Triggers, Indexes, and Stored Procedures.
• Work with Mulesoft developers to create required WSDL documentation for integration of EPOR esMD system with AWS Cloud.
• Create Jira work space for the team and Create email distribution lists among the team members.
• Create Jira user stories, document the work flows in the Confluence
• Facilitate backlog refinement, to capture more detailed requirements as Acceptance Criteria and Story Description.
• Identify gaps, assumption and dependencies for each story after consulting with Architects, Migration and Integration team.
• Create XDR and XDR transactions mimicking HIH (Health Information Handlers) and sending PA and Non PA requests such as Ambulance, DMEPOS, and HHPCR to CMS Review Contractors to validate various scenarios during transaction failure.
• Work on production defect which is logged into the service now portal to validate, write requirements and to work with developers for code fix and work with test to validate in lower environments
• Worked on Data Migration Project in Google Cloud Platform (GCP) from AWS Redshift and SAP HANA platforms.
• Analysed the Data gaps, gathered the requirements from the Business Stakeholders on the consumption ready data models from Microsoft Azure Cloud, Salesforce (SFDC)/AWS/SAP HANA vs GCP and Created Consumption ready views for various reporting purposes.
• As part of Enterprise Technology Revamp Program, dis was a Data Migration Project from AWS Redshift and SAP HANA to Google Cloud Platform.
• Here when data is ingested from the source systems like SAP TPM, SAP CRM, Salesforce.com by Data ingestion team using attunity near-real time data transfer to Google Cloud Platform.
• Once the Source Identical tables are there available in prod and non-prod environments of Google Cloud Platform, we
• Meet with Business Stakeholders
• Get inputs for the new reporting requirements and perform necessary data curation,
• Design and Create Consumption ready data models/views (both fact and Dimensional models, so the Business Process Developers can use these models without accessing the physical source-identical tables in the GCP.

Confidential, Norfolk VA

Business System Analyst

Responsibilities:

• Grooming the acceptance criteria with technical requirements after analysis of various systems.
• Preparing unique test data needs for the above alerts working with SOA team and Analytical teams such as RHI, CPCC and CMOS teams.
• Worked with KAFKA team to set up Member Alerts and Speech Trigger alerts to the Member IDs provided for testing the Member Alerts and Speech Trigger functionality.
• Worked on Indiana GRS and Texas DSNP Membership, Claims, UM Data in Confidential Norfolk Pega Projects where Pega system consumed dis data which were made available from Claims systems by SOA services.
• Facilitating Stakeholder meeting for requirement elicitation, conducted JAD sessions, User Story Grooming sessions, Requirement Walkthrough sessions with business stakeholder/POs with developers and testers.
• Facilitating Acceptance Test Driven Development (ATDD) meetings to understand various scenarios and scope of the Acceptance criteria alongside PO, Developers and Testers.
• Testing API using SOAP UI or POSTMAN to validate the API Integrations built for enhanced features.
• Preparing test data for the developers’ unit testing, System Integration testing and UAT for regression testing.
• Performed Gap Analysis to understand and demo Business Stakeholders/POs AS-IS to TO-BE state of the system.
• Reviewed Test plan documents by verifying Test Cases and Test Scenarios with the Testing team.
• Extensive usage of Jira Requirement Tracker and Confluence documentation.
• Conducted UAT walkthrough sessions with Business Stakeholders/Product owners.
• Create mappings and matrixes to fulfill the business needed.
• Work with Application UI/UX team to developed realistic visuals mock ups and wireframes for the Business Stakeholder can decide on the color Confidential Specific Color patterns from the Enterprise Color Pallets and Schemes.
• Conducting individual and group sessions to clear the requirements to Dev and test teams.
• Supporting Production release.
• Maintaining documentation of completed enhancement to the COMPASS application in Confluence.
• Compass Production Support: Compass Production support team works on issue encountered by end users who are the Confidential Associates who work in the frontline call centers and service Confidential Members and Confidential Providers.
• dis Call Center Application is mainly service Government-Business-Division (GBD) Line-of-Business members like Medicare Medicaid, MMP, FEP etc. for all 14 markets where Amerigroup Confidential services for queries regarding Medicare/Medicaid Membership Enrollment, Medical Claims and Pharmacy related queries from Members, Brokers and other Confidential Co-ordination of Care partners .
• Compass Application, the Call Center Application, is a Pega Out-of-the-Box Product which configured for servicing Confidential GBD members and Providers.
• Compass Users login issue when they encounter it in Compass Production environment.
• As Production Support System Analyst, me pick them up the issue logged in by Compass end users and try to reproduce the same in Lower environments, and if reproducible assign to L3 team developers for Code Fix, and if not reproducible check on the Web Service where the data is either get or post from or to dependent systems to confirm they are working fine, respond to technical request from the users and assign to developers for closure request so certain work objects.
• Work with Application UI/UX team to developed realistic visuals mock ups and wireframes for the Business Stakeholder can decide on the color Confidential Specific Color patterns from the Enterprise Color Pallets and Schemes.
• Test GET and POST requests and response web services using the tools like SOAP UI, POSTMAN depending on the type service.
• Work with Facets Database Team when any Data Issues are found in order to rectify the same.
• Monitored, audited and reconciled the transmission and receipt of FACETS EDI data in accordance with company policies, procedures, and regulatory compliance.
• Work closely with SOA team, Custom Web Services Team to be ensure the Compass Call Center Application is working flawlessly.
• Perform Data Analysis by running SQL queries of the data source Oracle and mapping document creation.
• Convert these user stories into technical Specification and conducted JAD sessions so Pega developers can understand and start developing.
• Created for production release CNR documentation for Production demo for the end users.
• Facilitating Stakeholder meeting for requirement elicitation, conducted JAD sessions, User Story Grooming sessions, Requirement Walkthrough sessions with business stakeholder/POs with developers and testers.
• Created UML modeling diagramsfor framework API Integration like class diagrams, sequence diagrams object specifications usingUML modelingtool.
• Preparing test data for the developers’ unit testing, System Integration testing and UAT for regression testing.
• Performed Gap Analysis to understand and demo Business Stakeholders/POs AS-IS to TO-BE state of the system.
• Worked on MS Access to pull sample Medicare Healthcare Membership Enrollment and Claims and Provider data for Analysis prior to designing data consumption by reporting and Call center Pega EFUSE application.
• Reviewed Test plan documents by verifying Test Cases and Test Scenarios with the Testing team.
• Extensive usage of Jira Requirement Tracker and Confluence documentation.
• Conducted UAT walkthrough sessions with Business Stakeholders/Product owners.
• Worked on Microsoft Azure Cloud migration of EFUSE data from on-premises servers
• Used postman and soap UI to connect to Legacy system to retrieve data as per Business requirements.
• Created test cases, test suite for multiple threadedwebservicestesting using SOAP UI.
• Work with Application UI/UX team to developed realistic visuals mock ups and wireframes for the Business Stakeholder can decide on the color Confidential Specific Color patterns from the Enterprise Color Pallets and Schemes.
• Work with Product Owners and end users to gather, understand, and define business requirements for Data visualization in Salesforce CRM during migration of TIBCO to Mulesoft in Microsoft Azure Cloud environment.
• Develop user stories in Version-One and create Data flow diagrams in order to clarify requirement for the developers while supporting the design and development of Salesforce solutions for our clients.
• API Integration testing using REST and SAOP UI based on type of web services used which is consumed by Salesforce CRM.
• Database testing by Groovy Scripts in SmartBear Ready API Integration testing tool during dis migration process.
• Collaborate with developers and Testers in Functional testing of the data migration in the Salesforce CRM Frontend to ensure it meets the acceptance criteria.
• Work with Salesforce associates to identify the defects and work with developers and testers to identify checkpoint to rectify the defect.
• Facilitate and Participate in key meetings with clients including requirement sessions, system demos, user acceptance testing, and end user training
• Worked as a System Analyst in these Pega platforms both in Scrum Team which enhance the existing features and to add new features
• Worked in Compass Production Support Team analysing code related issues, SOA related issues or Data Issues from Data Source which is GBD Facets.
• 6 extracts created and send out to eternal vendor - Aspire who performs member outreach on behalf of Confidential .
• Created User story documents, Technical responses, UAT documentation, Provided complex transformation for multi-system data pulls to integrate data as per the Business needs.
• Facilitated Stakeholder meeting for requirement gathering sessions, conducted JAD sessions, User Story Grooming sessions.
• Performed Data profiling and analysis using Teradata SQL Assistant to query on various instances with in Teradata Enterprise data warehouse, staging tables, and Landing zone tables to identify the data gaps after the Business requirements are gathered.
• Requirement Walkthrough sessions with business, Technical Specifics Walkthrough sessions, UAT walkthrough sessions with Business Product owners.
• Preparing test data for the developers’ unit testing, System Integration testing and UAT for regression testing.
• Performed Gap Analysis to understand and demo Business Stakeholders/POs AS-IS to TO-BE state of the system.
• Reviewed Test plan documents by verifying Test Cases and Test Scenarios with the Testing team.
• Extensive usage of Jira Requirement Tracker and Confluence documentation.
• Conducted UAT walkthrough sessions with Business Stakeholders/Product owners.
• Elaborate usage of Healthcare Data in data extraction, reporting, SOA services, and Data analysis by profiling and mapping for Pega Call Center applications both for Commercial and Medicare & Medicaid Healthcare Enrollment, Claims and Rx.
• Created User story documents, Technical responses, UAT documentation, Provided complex transformation for multi-system data pulls to integrate data as per the Business needs.
• Facilitated Stakeholder meeting for requirement gathering sessions, User Story Grooming sessions, Requirement Walkthrough sessions with business, conducted JAD sessions, Technical Specifics Walkthrough sessions, UAT walkthrough sessions with Business Product owners.
• Analysed Claims, Membership, UM and Clinical data by performing Data profiling using Teradata SQL Assistant to query on various instances with in Teradata Enterprise data warehouse, and production, non-prod environments, Staging tables, and Landing zone tables to identify the data gaps after the Business requirements are gathered.
• Preparing test data for the developers’ unit testing, System Integration testing and UAT for regression testing.
• Performed Gap Analysis to understand and demo Business Stakeholders/POs AS-IS to TO-BE state of the system.
• Reviewed Test plan documents by verifying Test Cases and Test Scenarios with the Testing team.
• Extensive usage of Jira Requirement Tracker and Confluence documentation.
• Conducted UAT walkthrough sessions with Business Stakeholders/Product owners.
• Top 20 utilizers of Whole Person Care
• In-Patient Hospitalization Claims
• Out Patient and Emergency Claims
• Pharmacy Claims
• Member list with PCP information extracts
• Mariposa and San Benito Counties
• Membership
• Medical Claims
• Pharmacy Claims
• Medical Necessity reports (3 reports)
• Medical Necessity Provider report - Tableau and Business Objects
• Medical Necessity Reviewer (Nurse/MD) Report - Tableau and Business Objects
• Medical Necessity Summary report
• Hot Spotter Provider Report - Tableau and Business Objects
• Hot Spotter Procedure Code Report - Tableau and Business Objects
• Claims Utilization Report - Business Objects
• Claims Audit Reports - Tableau
• On - Boarding Providers Claims Utilization Report (3 reports)
• Detail Report - Business Objects
• Summary Reports - Tableau
• Provider facing Code list reports -
• Provider - Procedure Code Threshold Report

Confidential - Solon, Ohio

Business Analyst Consultant

Responsibilities:

• Facilitating Stakeholder meeting for requirement elicitation, conducted JAD sessions, User Story Grooming sessions, Requirement Walkthrough sessions with business stakeholder/POs with developers and testers.
• Capturing requirements and defining Customer Service Action Queue and Pending Queue, its access, display, attributes and navigation.
• Written logic for Client Preferences and Cadence (Frequency to communicate with the facility or prescriber), number retries and time gap between each attempts.
• Created Workflows/Flowcharts/Sequence Diagrams using MS Visio to demonstrate visual representation of various work flows to the business users and Developers and Testers.
• Preparing test data for the developers’ and conducted JAD sessions, performed smoke testing, assisted in System Integration testing, regression testing and UAT testing.
• Performed Gap Analysis to understand and demo Business Stakeholders/POs AS-IS to TO-BE state of the system.
• Reviewed Test plan documents by verifying Test Cases and Test Scenarios with the Testing team.
• Extensive usage of Jira Requirement Tracker and Confluence documentation.
• Conducted UAT walkthrough sessions with Business Stakeholders/Product owners.
• Installed and configured different network platforms residing on hardware equipment such as network equipment, cabling, modems, routers, and switches. PCs, POS hardware.
• Created mock-ups with Snagit 11 editor to simulate the displays of the Queues, Outbound Communication Request detail screen, and Simulate Delivery Manifest print preview.
• Extensively user MS Excel to create numerous Matrixes to map Client preferences and Cadence Logic.
• Contributed to Business Requirement Document for Improve Customer Service Project.
• Played pivotal role by contributing with functional Requirements and Use Cases and drafting the Solution Requirement Package (Functional Requirement Document) to fulfill needs of the Business.
• Facilitated Daily status meetings, Requirement Gathering meetings and follow up meeting with the Business to close out all the action items in a timely manner.
• Presented MS PowerPoint slides to the Business to clarify the requirements whenever needed.
• Worked closely with Solution Architect to understand the technological limitations and refined the requirements taking account of IT team’s inputs.

Environment: UNIX, Windows, .Net, SQL Server Management Studio,POS, MS Excel, MS Word, MS Visio, MS SQL, MS Power Point.

Confidential

Business System Analyst

Responsibilities:

• Facilitating Stakeholder meeting for requirement elicitation, conducted JAD sessions, User Story Grooming sessions, Requirement Walkthrough sessions with business stakeholder/POs with developers and testers.
• Created System Specification document to locate and specify the data from sources like DB2 Galaxy Data warehouse, specify the actual tables and columns from Facets claims data need to be pulled in order for the programmers to Code for Denominator and Numerator Data.
• Performed JAD sessions and smoke testing with developers to ensure the solution matches with the detail oriented requirements.
• Worked on MS Access to pull sample Claims membership and Provider data for Data profiling and Analysis for reporting in Confidential projects.
• Worked on MS Word, Excel and PowerPoint to document, map, and create presentation to the Business and IT team.
• Preparing test data for the developers’ unit testing, System Integration testing and UAT for regression testing.
• Performed Gap Analysis to understand and demo Business Stakeholders/POs AS-IS to TO-BE state of the system.
• Reviewed Test plan documents by verifying Test Cases and Test Scenarios with the Testing team.
• Extensive usage of Jira Requirement Tracker and Confluence documentation.
• Conducted UAT walkthrough sessions with Business Stakeholders/Product owners.
• Created Programing ER diagram for BCS, FPC Measures.
• Created test data for 837I, 837D, 837P to have Segments/loops information with different combination of Submitter, Receiver, Billing Provider, Pay-To-Provider, Subscriber, Payer, Patient, Claim Information, Physicians, Referring Provider, Service Line Info, Adjudication Information.
• Reviewed, Analysed, and accommodated the transmission and receipt of EDI data transmission as per organization policy, systems, and administrative consistence.
• Created Report book for BI Reporting for NY State Medicaid programs for Provider gold carding and ADHOC and Multi-Dimensional and periodical reports.
• Lead the project as HEDIS Subject Matter Expert (SME) and liaised between client and payer/intermediary.
• Worked closely with Programmers to Verify SAS Codes for the Facets Claims Data pull for Denominator-Numerator Values.
• Reporting Data bases like H-Pro and C-Mart and Claims Data ware houses like DB2 Galaxy contains periodically loaded Claims data from the Facets claims adjudication tool
• Responded to billing inquiries from patients and payers.
• Created Crosswalk on Medical/Pharmacy/Revenue Code Changes from HEDIS specification.
• Written Proc Freq., Proc content, Proc SQL statements for the Validation and Verification of thee Facets Claims data.

Environment: UNIX, Windows, DB2, SQL Server Management Studio, SAS enterprise Guide, MS excel, MS Word, MS Visio, MS SQL, MS Power Point, Tableau, Facets.

Confidential, Cleveland, OH

Systems Analyst / Business Analyst

Responsibilities:

• Facilitating Stakeholder meeting for requirement elicitation, conducted JAD sessions, User Story Grooming sessions, Requirement Walkthrough sessions with business stakeholder/POs with developers and testers.
• Worked on creating data requirements on Medicare/Medicaid Healthcare Membership Enrollment, Claims data for HEDIS adhoc, geomap and recurring reports
• Extensively interacted with the stakeholders, SMEs and the IT Department in finalizing the requirements according to the CMS Compliances/Regulations and HIPAA Regulations.
• Successfully created a Business Requirement Document (BRD) and Functional Requirement Specifications (FRD) in a timely manner.
• Reviewed Test plan documents by verifying Test Cases and Test Scenarios with the Testing team.
• Preparing test data for the developers’ unit testing, System Integration testing and UAT for regression testing.
• Performed Gap Analysis to understand and demo Business Stakeholders/POs AS-IS to TO-BE state of the system.
• Performed JAD sessions and smoke testing with developers to ensure the solution matches with the detail oriented requirements.
• Reviewed Test plan documents by verifying Test Cases and Test Scenarios with the Testing team.
• Extensive usage of Jira Requirement Tracker and Confluence documentation.
• Conducted UAT walkthrough sessions with Business Stakeholders/Product owners.
• Analysed Business Requirements and segregated them into high level and low level Use Cases, Activity Diagrams/State Chart Diagrams (UML).
• Analysed X12 (EDI 834 Membership Enrollment, 835 remittance advice, 837 claims submission) files from Facets system and XML.
• Supported implementation of pilot systems with FHIR standards by working on user interfaces, and back-end services to create prototypes and drive demonstrations.
• Worked with Healthcare Effectiveness Data and Information Set (HEDIS) to measure performance on important dimensions of care and service.
• Created Data Stage jobs to extract, transform and load (ETL) Facets Claims data into data warehouses from various sources like relational databases, application systems, temp tables, flat files etc.
• Created Process Flow diagrams, Use case diagrams (UML) using MS-Visio
• Prepared Screenshots, Mock-ups and web layouts for the application
• Prepared Test Strategy, Test Plan, test report and Gap Report
• Performed UAT based on Requirements Document and prepared the Test Cases using Quality Center.

Environment: HEDIS, HP ALM-Quality Center, Facets, MS Project, MS excel, MS Word, MS Visio, MS SQL, Agile, MS Power Point.

Confidential, Wyoming, MI

Clinical Business Analyst / Systems Analyst

Responsibilities:

• Facilitating Stakeholder meeting for requirement elicitation, conducted JAD sessions, User Story Grooming sessions, Clinical Requirement Walkthrough sessions with business stakeholder/POs with developers and testers.
• Successfully developed Business Requirement Documents (BRD) and Functional Requirement Documents (FRD)
• Worked on Healthcare clinical data sharing standards such as HL7, FHIR, 837/835.
• Conducted and participated in JAD Sessions periodically with various Subject Matter Experts at various phases of the Software Development Life Cycle to discuss open issues and resolve them.
• Performed JAD sessions and smoke testing with developers to ensure the solution matches with the detail oriented requirements.
• Preparing Clinical test data for the developers’ unit testing, System Integration testing and UAT for regression testing.
• Performed Gap Analysis to understand and demo Business Stakeholders/POs AS-IS to TO-BE state of the system.
• Reviewed Test plan documents by verifying Test Cases and Test Scenarios with the Testing team.
• Extensive usage of Jira Requirement Tracker and Confluence documentation.
• Conducted UAT walkthrough sessions with Business Stakeholders/Product owners.
• Created documents like the Business Glossary to facilitate the other teams in understanding client business.
• Prepare required regulatory reports which show the progress on the collection reporting and analysis of the HEDIS.
• Successfully worked with Healthcare Effectiveness Data and Information Set (HEDIS) to measure performance on important dimensions of care and service.
• Review detailed claims data in order to verify HEDIS rates as necessary.

Environment: HEDIS, Agile, Rational Requisite Pro, Rational Rose, Rational Clear Quest, QNXT, RUP, UML, MS-Project, MS Office, UNIX, MS SQL Server.

Confidential

Clinical Business Analyst/Systems Analyst

Responsibilities:

• Facilitating Stakeholder meeting for requirement elicitation, conducted JAD sessions, User Story Grooming sessions, Clinical Requirement Walkthrough sessions with business stakeholder/POs with developers and testers.
• Worked on Enterprise Resource Management (ERP) systems to configure in order to integrate various enterprise Data repositories.
• Followed the UML based methods to create Use case Activity Diagrams/ State Chart Diagrams, Sequence Diagrams, Collaboration Diagrams.
• Worked on HL7 system integration, converted CSVflat files into HL7 messages and modified and translated segmentsofHL7 messages.
• Responsible for the definition and the scope of the business requirements for the application developed
• Responsible for the documentation of the various modules of Salesforce Application which helps Patients and Physicians to collaborate, serve as a document repository, dat were involved in the business process
• Gathering of Clinical business requirement and converting them into Functional Requirement Specification and User Requirement Specification.
• Performed JAD sessions and smoke testing with developers to ensure the solution matches with the detail oriented requirements.
• Preparing Clinical test data for the developers’ unit testing, System Integration testing and UAT for regression testing.
• Performed Gap Analysis to understand and demo Business Stakeholders/POs AS-IS to TO-BE state of the system.
• Reviewed Test plan documents by verifying Test Cases and Test Scenarios with the Testing team.
• Extensive usage of Jira Requirement Tracker and Confluence documentation.
• Conducted UAT walkthrough sessions with Business Stakeholders/Product owners.
• Interacted with the Business Users to convert requirements document into Business System Design documents and Technical Specification for the Development Team
• Involved in creating queries, stored procedures and views in SQL
• Conducted regular ERP System Specs walk-through with the developers and testers.

Environment: Salesforce Agile, Rational Requisite Pro, Rational Rose, Rational Clear Quest, RUP, UML, MS-Project, MS Office, UNIX, MS SQL server.

Confidential, Thousand Oaks, CA

Business Analyst/Systems Analyst

Responsibilities:

• Facilitating Stakeholder meeting for requirement elicitation, conducted JAD sessions, User Story Grooming sessions, Requirement Walkthrough sessions with business stakeholder/POs with developers and testers.
• Reviewed EDI, 834 Membership Enrollment data file, 835 remittance advice, 837 claims for all Medicare and Medicaid line of business and flagged HIPPA noncompliant claims received from the Payer side.
• Performed manual back-end testing using PL/SQL to connect to an Oracle 9i database on a UNIX server
• Successfully worked with Healthcare Effectiveness Data and Information Set (HEDIS) to measure performance on important dimensions of care and service.
• Preparing test data for the developers’ unit testing, System Integration testing and UAT for regression testing.
• Performed Gap Analysis to understand and demo Business Stakeholders/POs AS-IS to TO-BE state of the system.
• Performed JAD sessions and smoke testing with developers to ensure the solution matches with the detail oriented requirements.
• Reviewed Test plan documents by verifying Test Cases and Test Scenarios with the Testing team.
• Extensive usage of Jira Requirement Tracker and Confluence documentation.
• Conducted UAT walkthrough sessions with Business Stakeholders/Product owners.
• Tracked and reported defects using Quality Center.
• Performed backend smoke testing using Database Checkpoints in QTP.