SUMMARY:

• Experience with heavy client relationship focus to ensure full awareness of client business workflow, strategy, issues, requirement, and tools.
• Over Eight years of cross-platform experience in healthcare domain, healthcare applications, reforms and interacting with both technical and business issues for developing applications.
• Extensive experience in Rational Unified Process RUP and Software Development Life Cycle.
• Experienced in business requirement elicitation and gathering techniques such as brainstorming sessions, and focus groups conducting Joint Application Discussions JAD , project meetings and coordinating various technical and managerial teams at all levels including clients, business users and Subject Matter Experts SME .
• Experienced in documenting with the help of writing Use Cases, creating process flows, Report specification documents, UML modeling, including Use Case Design, Sequence, and State and Activity diagrams.
• Conducted GAP analysis and documented system and process inconsistencies.
• Other experiences include methodology development, process re-engineering, facilitated sessions, proposal development, functional testing and software metrics.
• Requirements management using tools like Rational Requisite Pro and Microsoft Project
• Creating use case models in Microsoft Visio.
• Effective communicator with excellent skills in making business presentation Documentation, writing Business Reports and Technical Specifications. Liaising/interacting with clients and all stakeholders. Knowledge of System, Functional, Regression and User Acceptance Testing
• Worked on bridging technology and business goals to provide productive solutions.
• Developed Test cases and Traceability Matrix's.
• Multi-platform exposure and experience in interacting and addressing both technical and business issues for developing applications, business intelligence, and managing expectations.
• Well-experienced in the user requirements gathering, design, development, support, project management, Rational Unified Process RUP , Object-Oriented Analysis and Design using UML based development process, Data Modeling, Data Mapping, Conceptual Designs, Risk Management, Bug Tracking, Testing, and management of custom and vendor application systems.

TECHNICAL SUMMARY:

• Business Modeling: Rational Rose, Rational Requisite Pro, Microsoft Visio, UML
• Languages: C , C, SQL, Visual Basic, HP Exstream
• Defect Tracking Tools: JIRA, Quality Center, Rational Clear Quest
• Testing Tools: Quality Center
• Methodologies: Rational Unified Process RUP , Agile Method
• Microsoft Tools: MS Word, MS Excel, MS PowerPoint, MS Project, Outlook
• Operating Systems: MS Windows 95/98/2000/XP
• Databases: MS Access, SQL Server

PROFESSIONAL EXPERIENCE:

Confidential

Consultant Sr. Business Analyst

Responsibilities:

• Determining high level solution designed for each work stream, with all gaps identified for resolution.
• Gathering requirements needs and features from the SME's.
• Identifying the flow of data from upstream core claims processing systems and analyzing all the information to streamline a better process.
• Understanding the current process in HP Exstream and segregating the requirements for current and future state.
• Documenting Use cases, Process flows, Business design documents and Process design documents.
• Coordinating with the current process resources in identifying the gaps for the future phase.
• Working with the solutions architect resource from HP to understand the HP Exstream tool and help design the workflow process.
• Testing and coordinating the release of BCBS member correspondence via HP Exstream tool with output services/print shop resources and HCSC's online web portal application.
• Testing and coordinating the correspondence publishing on HCSC's online web portal application for Members/Providers.
• Working as a manual tester. Creating test cases, scenarios and test plans.
• Executing test plans and test cases in Quality center. Overlooking the defect tracking and resolution tasks.
• Preparing documents as per SDM rules and work with the project coordinator for final review and sign-off of the documents.
• Assist in post-production activities.

Confidential

Consultant - Sr. Business Systems Analyst

Responsibilities:

• Identifying the key process changes between 4010 and 5010 transactions.
• Determining and analyzing the data changes for all 5010 transactions.
• Creating the Companion Guides for 837I, 837D and 837P Transactions.
• Facilitating and participating in client meetings for gathering requirements, writing Business requirements and General System Design document.
• Identifying and documenting the key principles for the National Provider Identifier NPI crosswalk program.
• Worked with the NPI team to make changes to the Provider database screens in mainframes in order to accommodate the new 5010 Transactions and their corresponding Trading partner information.
• Working with the Translator team for Sybase mappings and testing the load spreadsheets.
• Creating test scenarios based on the requirements and writing test scripts. Extensive regression testing on 837 claims.
• Building 837 Institutional, 837 Dental and 837 professional claims for testing.
• Extensive knowledge of creating and testing the transactions including crossover claims.
• HIPAA 5010 implementation support tasks.
• Knowledge transfer sessions and user acceptance testing for the clients. Trained users on the new healthcare applications.
• HIPAA 5010 post implementation tasks and Production support.
• Worked on supervising and supporting of trading partner testing files received from the Trading partners thus ensuring successful crossover from 4010 to 5010 claims.
• Trained new team members on the process and the business knowledge of the legacy systems.

Confidential

Consultant - Sr. Business Systems Analyst

Responsibilities:

• Extensively researched Provider data and demographics.
• Coordinated with the Trading Partners across all platforms of the various releases.
• Coordinated and facilitated the walk throughs, meeting and the sign off sessions with the Health and Human Services Commission HHSC members/group.
• Worked with the team to gather business and functional requirements and to create Business User Requirement BUR document and the Functional Specification document FD .
• Complied and utilized the MITA business process areas and groups.
• Submitted and tested Claims processing for Account receivables through Tex Med Connect PTest environment . Hands on experience with Cash financial areas such as creating Payouts, Account receivables, Cash receipt, Cash receipt dispositions, 1099 forms, Provider Remittance and status reports R S , new Explanation of benefit crosswalks.
• Knowledgeable and hands on experience working with EDI Health Care Eligibility/Benefit Inquiry 270 , EDI Health Care Eligibility/Benefit Response 271 .
• Implemented HIPAA Privacy Policies and Procedures as per the client guidelines.
• Verified the data on Cash financial vouchers and reports as per the requirements.
• Created the Joint Interface Plan JIP layouts and process flows.
• Conducted Impact surveys and documented the results.
• Worked with the developers in reviewing the detailed design documents.
• Created the Test Approach, Test Plan and the UAT package.
• Executed Product testing, Regression testing and Trading Partner testing.
• Analyzed defects and documented them. Determined the severity to troubleshot issues and isolate problems by working with the developers to resolve issues.
• Worked with the Avaya CCQ team to set up the call center protocols for Providers to access the Program.

Confidential

Consultant Functional Lead

Responsibilities:

• Defined various elements and objects used in Healthcare Medicaid Management Information Systems MMIS and COTs Product County Billing, Third Party Liability, and Miscellaneous , processing of HIPAA 837 Professional and Institutional Claims, third-party claims for outpatient services and supporting billing processes.
• Knowledgeable and hands on experience working with EDI Health Care Eligibility/Benefit Inquiry 270 , EDI Health Care Eligibility/Benefit Response 271 , EDI Health Care Claim Status Request 276 , EDI Health Care Claim Status Notification 277 ,EDI Health Care Claim Transaction set 837 and EDI Retail Pharmacy Claim Transaction
• Gathered requirements and developed business requirement document for multiple enhancements and Technology requests forms for sizing and planning the Healthcare Medicaid application for the state of New Hampshire.
• Performed Data Analysis to see the variation in the as is system and to be system.
• Conducted GAP Analysis, and created Business Rules and Error Message catalogue for the new version of MMIS. Provided training to over 20 Users on the MMIS application.
• Created Traceability Matrix using IBM Req Web to trace the Business Rules and Error Messages to the Business and Functional Requirements.
• Developed use cases, user interface documents and report specification documents for the MMIS application.
• Worked closely with the offshore technical and testing team to make sure all the requirements were met and the functionality was developed as per the Business Requirements.
• Worked with the quality team to review the test documents. Conducted UAT and documented the results. Worked with the technical team in fixing the bugs.

Confidential

Consultant Business Systems Analyst

Responsibilities:

• Conducted Gap analysis, developed questionnaires, and gathered user requirements by interviews, user meeting, JAD session, and requirement elicitation sessions.
• Analyzed and documented business requirement document BRD and system design.
• Worked with the software architects/developers to ensure that the applications confirm to customer requirements.

• Interacted with business users and performed Gap Analysis of client requirements.

• Worked extensively with MS Visio to document requirements, create the As-Is and To-Be process flow diagrams
• Developed Test cases and Traceability Matrix's.
• Conducted GAP analysis and documented system and process inconsistencies.