SUMMARY

• Senior Systems Analyst/ Business Analyst wifover 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 wif Data transformation logics as per teh business needs for Data extraction and worked closely wif 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 then to Tableau reports, and Business Object Reports.
• Performed Gap Analysis to understand and demo Business Stakeholders/POs AS-IS to TO-BE state of teh system.
• Worked closely wif 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 teh Jira board and created Confluence documentation page to document requirement and flow and architectural diagrams.
• Participated in Scrum of Scrum meetings for teh Project status reporting and plan release timelines and to ensure teh team allocated is complying wif teh timelines if Release train.
• Created Workflows/Flowcharts/Sequence Diagrams using MS Visio to demonstrate visual representation of various work flows to teh business users and Developers and Testers.
• Reviewed Test plan documents by verifying Test Cases and Test Scenarios wif teh Testing team.
• Extensive usage of Jira Requirement Tracker and Confluence documentation.
• Conducted UAT walkthrough sessions wif 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 wif business stakeholder/POs.
• Technical Specifics Walkthrough sessions, Report Book Walkthrough sessions, UAT walkthrough sessions for BO and Tableau reports.
• Experience wif Healthcare Effectiveness Data and Information Set (HEDIS) to measure performance on important dimensions of care and service.
• Knowledge of HIPAA Regulations and Claims Processing wif good knowledge of Health Insurance Plans (Medicare Part A, B, C and D), managed care concepts (Medicaid and Medicare), billing experience wif 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 teh Brokers and General Agents.
• To facilitate easy on-boarding of teh new accounts and Producers/Brokers.
• Audit Monthly Credit pull from teh SQL server which is fed from Cobol based Bluestar legacy Commission System and then compare teh data wif 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 wif accounts and wif 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 teh Callidus system.
• Work wif 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 wif Test Lead to create a Test Strategy and get it approved from teh Architects and Business.
• Work wif Oracle DBA and AWS PostgreSQL DBA to plan and to strategize migration of Data Models, Schema, Triggers, Indexes, and Stored Procedures.
• Work wif Mulesoft developers to create required WSDL documentation for integration of EPOR esMD system wif AWS Cloud.
• Create Jira work space for teh team and Create email distribution lists among teh team members.
• Create Jira user stories, document teh work flows in teh 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 wif 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 teh service now portal to validate, write requirements and to work wif developers for code fix and work wif test to validate in lower environments
• Worked on Data Migration Project in Google Cloud Platform (GCP) from AWS Redshift and SAP HANA platforms.
• Analysed teh Data gaps, gathered teh requirements from teh Business Stakeholders on teh 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, this was a Data Migration Project from AWS Redshift and SAP HANA to Google Cloud Platform.
• Here when data is ingested from teh 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 teh Source Identical tables are there available in prod and non-prod environments of Google Cloud Platform, we
• Meet wif Business Stakeholders
• Get inputs for teh new reporting requirements and perform necessary data curation,
• Design and Create Consumption ready data models/views (both fact and Dimensional models, so teh Business Process Developers can use these models wifout accessing teh physical source-identical tables in teh GCP.

Confidential, Norfolk VA

Business System Analyst

Responsibilities:

• Grooming teh acceptance criteria wif technical requirements after analysis of various systems.
• Preparing unique test data needs for teh above alerts working wif SOA team and Analytical teams such as RHI, CPCC and CMOS teams.
• Worked wif KAFKA team to set up Member Alerts and Speech Trigger alerts to teh Member IDs provided for testing teh 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 this 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 wif business stakeholder/POs wif developers and testers.
• Facilitating Acceptance Test Driven Development (ATDD) meetings to understand various scenarios and scope of teh Acceptance criteria alongside PO, Developers and Testers.
• Testing API using SOAP UI or POSTMAN to validate teh API Integrations built for enhanced features.
• Preparing test data for teh 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 teh system.
• Reviewed Test plan documents by verifying Test Cases and Test Scenarios wif teh Testing team.
• Extensive usage of Jira Requirement Tracker and Confluence documentation.
• Conducted UAT walkthrough sessions wif Business Stakeholders/Product owners.
• Create mappings and matrixes to fulfill teh business needed.
• Work wif Application UI/UX team to developed realistic visuals mock ups and wireframes for teh Business Stakeholder can decide on teh color Confidential Specific Color patterns from teh Enterprise Color Pallets and Schemes.
• Conducting individual and group sessions to clear teh requirements to Dev and test teams.
• Supporting Production release.
• Maintaining documentation of completed enhancement to teh COMPASS application in Confluence.
• Compass Production Support: Compass Production support team works on issue encountered by end users who are teh Confidential Associates who work in teh frontline call centers and service Confidential Members and Confidential Providers.
• This 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, teh Call Center Application, is a Pega Out-of-teh-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, I pick them up teh issue logged in by Compass end users and try to reproduce teh same in Lower environments, and if reproducible assign to L3 team developers for Code Fix, and if not reproducible check on teh Web Service where teh data is either get or post from or to dependent systems to confirm they are working fine, respond to technical request from teh users and assign to developers for closure request so certain work objects.
• Work wif Application UI/UX team to developed realistic visuals mock ups and wireframes for teh Business Stakeholder can decide on teh color Confidential Specific Color patterns from teh Enterprise Color Pallets and Schemes.
• Test GET and POST requests and response web services using teh tools like SOAP UI, POSTMAN depending on teh type service.
• Work wif Facets Database Team when any Data Issues are found in order to rectify teh same.
• Monitored, audited and reconciled teh transmission and receipt of FACETS EDI data in accordance wif company policies, procedures, and regulatory compliance.
• Work closely wif SOA team, Custom Web Services Team to be ensure teh Compass Call Center Application is working flawlessly.
• Perform Data Analysis by running SQL queries of teh 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 teh end users.
• Facilitating Stakeholder meeting for requirement elicitation, conducted JAD sessions, User Story Grooming sessions, Requirement Walkthrough sessions wif business stakeholder/POs wif developers and testers.
• Created UML modeling diagramsfor framework API Integration like class diagrams, sequence diagrams object specifications usingUML modelingtool.
• Preparing test data for teh 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 teh 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 wif teh Testing team.
• Extensive usage of Jira Requirement Tracker and Confluence documentation.
• Conducted UAT walkthrough sessions wif 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 wif Application UI/UX team to developed realistic visuals mock ups and wireframes for teh Business Stakeholder can decide on teh color Confidential Specific Color patterns from teh Enterprise Color Pallets and Schemes.
• Work wif 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 teh developers while supporting teh 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 this migration process.
• Collaborate wif developers and Testers in Functional testing of teh data migration in teh Salesforce CRM Frontend to ensure it meets teh acceptance criteria.
• Work wif Salesforce associates to identify teh defects and work wif developers and testers to identify checkpoint to rectify teh defect.
• Facilitate and Participate in key meetings wif 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 teh 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 teh 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 wif in Teradata Enterprise data warehouse, staging tables, and Landing zone tables to identify teh data gaps after teh Business requirements are gathered.
• Requirement Walkthrough sessions wif business, Technical Specifics Walkthrough sessions, UAT walkthrough sessions wif Business Product owners.
• Preparing test data for teh 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 teh system.
• Reviewed Test plan documents by verifying Test Cases and Test Scenarios wif teh Testing team.
• Extensive usage of Jira Requirement Tracker and Confluence documentation.
• Conducted UAT walkthrough sessions wif 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 teh Business needs.
• Facilitated Stakeholder meeting for requirement gathering sessions, User Story Grooming sessions, Requirement Walkthrough sessions wif business, conducted JAD sessions, Technical Specifics Walkthrough sessions, UAT walkthrough sessions wif Business Product owners.
• Analysed Claims, Membership, UM and Clinical data by performing Data profiling using Teradata SQL Assistant to query on various instances wif in Teradata Enterprise data warehouse, and production, non-prod environments, Staging tables, and Landing zone tables to identify teh data gaps after teh Business requirements are gathered.
• Preparing test data for teh 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 teh system.
• Reviewed Test plan documents by verifying Test Cases and Test Scenarios wif teh Testing team.
• Extensive usage of Jira Requirement Tracker and Confluence documentation.
• Conducted UAT walkthrough sessions wif Business Stakeholders/Product owners.
• Top 20 utilizers of Whole Person Care
• In-Patient Hospitalization Claims
• Out Patient and Emergency Claims
• Pharmacy Claims
• Member list wif 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 wif business stakeholder/POs wif 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 wif teh 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 teh business users and Developers and Testers.
• Preparing test data for teh 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 teh system.
• Reviewed Test plan documents by verifying Test Cases and Test Scenarios wif teh Testing team.
• Extensive usage of Jira Requirement Tracker and Confluence documentation.
• Conducted UAT walkthrough sessions wif 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 wif Snagit 11 editor to simulate teh displays of teh 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 wif functional Requirements and Use Cases and drafting teh Solution Requirement Package (Functional Requirement Document) to fulfill needs of teh Business.
• Facilitated Daily status meetings, Requirement Gathering meetings and follow up meeting wif teh Business to close out all teh action items in a timely manner.
• Presented MS PowerPoint slides to teh Business to clarify teh requirements whenever needed.
• Worked closely wif Solution Architect to understand teh technological limitations and refined teh 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 wif business stakeholder/POs wif developers and testers.
• Created System Specification document to locate and specify teh data from sources like DB2 Galaxy Data warehouse, specify teh actual tables and columns from Facets claims data need to be pulled in order for teh programmers to Code for Denominator and Numerator Data.
• Performed JAD sessions and smoke testing wif developers to ensure teh solution matches wif teh 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 teh Business and IT team.
• Preparing test data for teh 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 teh system.
• Reviewed Test plan documents by verifying Test Cases and Test Scenarios wif teh Testing team.
• Extensive usage of Jira Requirement Tracker and Confluence documentation.
• Conducted UAT walkthrough sessions wif Business Stakeholders/Product owners.
• Created Programing ER diagram for BCS, FPC Measures.
• Created test data for 837I, 837D, 837P to has Segments/loops information wif 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 teh 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 glod carding and ADHOC and Multi-Dimensional and periodical reports.
• Lead teh project as HEDIS Subject Matter Expert (SME) and liaised between client and payer/intermediary.
• Worked closely wif Programmers to Verify SAS Codes for teh 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 teh 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 teh 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 wif business stakeholder/POs wif 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 wif teh stakeholders, SMEs and teh IT Department in finalizing teh requirements according to teh 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 wif teh Testing team.
• Preparing test data for teh 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 teh system.
• Performed JAD sessions and smoke testing wif developers to ensure teh solution matches wif teh detail oriented requirements.
• Reviewed Test plan documents by verifying Test Cases and Test Scenarios wif teh Testing team.
• Extensive usage of Jira Requirement Tracker and Confluence documentation.
• Conducted UAT walkthrough sessions wif 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 wif FHIR standards by working on user interfaces, and back-end services to create prototypes and drive demonstrations.
• Worked wif 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 teh application
• Prepared Test Strategy, Test Plan, test report and Gap Report
• Performed UAT based on Requirements Document and prepared teh 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 wif business stakeholder/POs wif 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 wif various Subject Matter Experts at various phases of teh Software Development Life Cycle to discuss open issues and resolve them.
• Performed JAD sessions and smoke testing wif developers to ensure teh solution matches wif teh detail oriented requirements.
• Preparing Clinical test data for teh 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 teh system.
• Reviewed Test plan documents by verifying Test Cases and Test Scenarios wif teh Testing team.
• Extensive usage of Jira Requirement Tracker and Confluence documentation.
• Conducted UAT walkthrough sessions wif Business Stakeholders/Product owners.
• Created documents like teh Business Glossary to facilitate teh other teams in understanding client business.
• Prepare required regulatory reports which show teh progress on teh collection reporting and analysis of teh HEDIS.
• Successfully worked wif 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 wif business stakeholder/POs wif developers and testers.
• Worked on Enterprise Resource Management (ERP) systems to configure in order to integrate various enterprise Data repositories.
• Followed teh 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 teh definition and teh scope of teh business requirements for teh application developed
• Responsible for teh documentation of teh various modules of Salesforce Application which halps Patients and Physicians to collaborate, serve as a document repository, that were involved in teh business process
• Gathering of Clinical business requirement and converting them into Functional Requirement Specification and User Requirement Specification.
• Performed JAD sessions and smoke testing wif developers to ensure teh solution matches wif teh detail oriented requirements.
• Preparing Clinical test data for teh 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 teh system.
• Reviewed Test plan documents by verifying Test Cases and Test Scenarios wif teh Testing team.
• Extensive usage of Jira Requirement Tracker and Confluence documentation.
• Conducted UAT walkthrough sessions wif Business Stakeholders/Product owners.
• Interacted wif teh Business Users to convert requirements document into Business System Design documents and Technical Specification for teh Development Team
• Involved in creating queries, stored procedures and views in SQL
• Conducted regular ERP System Specs walk-through wif teh 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 wif business stakeholder/POs wif 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 teh Payer side.
• Performed manual back-end testing using PL/SQL to connect to an Oracle 9i database on a UNIX server
• Successfully worked wif Healthcare Effectiveness Data and Information Set (HEDIS) to measure performance on important dimensions of care and service.
• Preparing test data for teh 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 teh system.
• Performed JAD sessions and smoke testing wif developers to ensure teh solution matches wif teh detail oriented requirements.
• Reviewed Test plan documents by verifying Test Cases and Test Scenarios wif teh Testing team.
• Extensive usage of Jira Requirement Tracker and Confluence documentation.
• Conducted UAT walkthrough sessions wif Business Stakeholders/Product owners.
• Tracked and reported defects using Quality Center.
• Performed backend smoke testing using Database Checkpoints in QTP.