PROFESSIONAL SUMMARY:

• Over 6 years of experience as Business Analyst with strong understanding of Business Requirement Gathering, Business Analysis, and Joint Application Development (JAD) sessions with clients.
• Agile (Scrum) and Waterfall SDLC methodology software development experience.
• Configure claims adjudication systems.
• Good noledge and experience of teh Salesforce and Athena system.
• Implement HIPAA 4010 and HIPAA 5010 changes in teh existing claim processing integrated system
• Federal contracts, X12 transactions, America Health Care Act, EDI transactions 270, 271, 834, 835, 837 experience.
• Experience in all phases of Software Development Life Cycle (SDLC), including requirement gathering and documentation, analysis and design, quality assurance, testing and end user support working as Business Analyst mainly in teh healthcare sector.
• Wrote Business Requirements Document (BRD), Use Case Spec, Functional Specifications and Workflows, and slicing Feature into User stories efficiently.
• Extensive noledge of Medicare/Medicaid procedures and diagnostic codes.
• Extensive experience in Functional, Integration, Regression, System and User Acceptance testing.
• Work with ETL process (Extract, Transform and Load) of data into (EDW) Enterprise Data Warehouse.
• Experienced in client interaction with deep understanding of business systems functionality and technicality.
• Proficient in developing and executing Test Plans, Test Cases, & Test Scenarios. Perform functional and usability testing and ensure dat teh software meets teh system requirement.
• Knowledgeable about preparing RTM documents.
• Perform Gap analysis by identifying existing technologies and document enhancements to meet end - state requirements.
• Created maps & layouts for HIPAA as imposed during Electronic Data Interchange (EDI): 837 - Claims and Encounters, 834 - Benefit Enrollment and Maintenance, 835 - Claim Payment/Advice
• Excellent business communication and presentation skills. Adept at creating, editing, and coordinating extensive communication networks keeping executive staff and team members apprised of goals, project status, and resolving issues and conflicts.
• Completed projects successfully with teh help of teams to achieve deadlines timely and proficiently.

PROFESSIONAL EXPERIENCE

Confidential, San Jose, CA

BusinessAnalyst

Responsibilities:

• Responsible on inbound file and outbound file for teh member enrolled with teh kidney care program.
• Extensive Requirement gathering session with kidney care program.
• Created User stories and explain requirements to developers.
• Performed UAT on a test environment on new functionality which was developed.
• Conducted sprint planning and sprint Demo meetings.
• Strongly involved in technical mapping documents.
• Hands on experience working on Data Exchange documents.
• Testing steps document for pharmacy claims using SQL.
• Worked for validation on pharmacy claims and reversal claims.
• Worked for validation inbound and outbound files.
• Worked on Testing and reconcile Smartform Automation
• Created test cases and perform QA on new development on Web Application and mobile Application also set matrix for different visit types.
• Worked on teh SQL side to validate member’s information on related tables.
• Working on Azure DevOps for update work status.

Confidential

BusinessAnalyst / EDIAnalyst

Responsibilities:

• Analyzed existingbusinessunits,business/Application and their Interfaces with their capability through open-ended discussions, brainstorming sessions, and prototyping, prioritizing them and converting them asbusinessrequirements dat must be included while developing teh software.
• Created Data Flow Diagrams (DFD's), ER diagrams for data modeling and web-page mock-ups using MS - Visio for acceptance from end users.
• Analyzed data and created reports using SQL queries for all issued action items.
• Worked with ETL specifications and ANSI X-12 data translations
• Definedbusinessrequirements andbusinessprocess and policy changes related to teh client Medicaid system during teh conversion from teh existing HIPAA 4010A formats to teh future HIPAA 5010A format.
• Analyzed and documented MedicaidEDItransactions issues related to implementation of HIPAA 5010 and ensure these issues are documented and addressed in teh approach to teh HIPAA 5010 version.
• Converted teh XML files into X12 and X12 to XML files on GIS for sending and receiving theEDI files.
• Worked on multiple 837s and multiple Eligibility (270/271) and healthcare claim status (276/277) .
• Developed and implemented HIPAAEDIMap sets 270, 271, 276, 277, 820, 834, 835, 837 and 5010.
• Reviewed teh application systems and determined how to map teh new applications data to theEDI System.
• CreatedEDIinterface to send purchase order requests and receive acnoledgments and invoice data.
• Mainly assisted with documenting processes, used Agile Methodology to write teh System Requirements Documents and designed functional specs.
• Conducted UAT. Wrote SQL queries in MS Access and Oracle for data manipulations.
• Used Agile & Rational Methodology in teh project development for Rational Test Suite for various RUP phases.
• Proficient with QNXT claims processing platform.
• Developed Use Cases, Use Case Diagrams, UML Diagrams, Activity Diagrams, Sequence Diagrams, Class Diagrams in Rational Rose.
• Utilized RUP to configure and develop process, standards, and procedures.