SUMMARY

• Passionate and value - driven professional with over 10+ years of progressive experience within various segments of IT framework such as Project Management, Business Partnerships, Client Services Management, and Business/Systems/Quality/Data Analysis
• Business strategist focused on planning and managing projects aligning business goals while driving process improvements, competitive advantage and bottom-line gains
• Gathered business requirements through JAD sessions and one-on-one interviews with the Business Stakeholders and tracked the requirements.
• Expertise in Software Development Life Cycle (SDLC), Agile SCRUM Methodology, Business Process Modeling Notation (BPMN), Object-oriented Analysis and Design, Rational Unified Process (RUP) and Rational tools used during all four phases of RUP: Inception, Elaboration, Construction, and Transition.
• Experience with HIPAA Compliance requirements and possess strong knowledge of healthcare X12 EDI (270/271, 276/277, 835, 837) transactions.
• Experience with Confidential ’s Facets Application Groups: Claims Processing, Guided Benefit Configuration, Medical Plan, Provider, Subscriber/Member, and Utilization Management.
• Ability to define timelines for prioritizing work requests using tools such as MS Project
• Expertise in modeling business processes (BPM) in enterprise level projects using industry standard case tools.
• Sound knowledge of concepts like Confidential Analysis, Risk Analysis, Impact Analysis, Data analysis.
• Excellent writing skills in writing Business requirements document, Technical requirement documents, Design documents, USE Case Specifications, Functional Specifications, Systems Design Specification (SDS), Systems Requirements Specification (SRS).
• Prepared Test Plans, High-level Scenarios, and Test Cases from Requirement and Design documents.
• Proficient in writing Test Plans, Test Scripts, Test Scenarios and Test Cases for both Manual and Automated Testing.
• Experience with testing various test cases for QNXT interfaces and tracking/explaining bugs to development teams.
• Worked on Informatics Power Center tools- Designer, Repository Manager, Workflow Manager, and Workflow Monitor.
• Worked with development teams for correcting and investigating to find the defects and deficiencies based on the testing results.
• Worked in ETL environment involving Informatics /Data Stage.
• Created the Test Specification documents for the ETL process.
• Effective in both a team or individual environment and having Strong organizational skills.
• Performed GUI testing, Integration testing, Regression testing, Ad -hoc testing, Negative testing, End to End testing, User Acceptance testing on multiple projects

TECHNICAL SKILLS

Office Tools: Microsoft Word, power point, excels.

Operating System: Windows 95/98/2000/XP/VISTA/7, UNIX

RF Tools Awareness: TEMS report analyzer, GPS, Ag, MapInfo 8.0, TEMS 12, ActixOne, Microsoft Street and Trips, Atlas Street and tips GPS tool

Process/Modeling Tool: Software Development Life Cycle (SDLC), MS Visio, Quality center, Rational Clear Quest, Informatics Power Center

Database: SQL server 2008, Oracle SQL Developer, SQL Workbench

Web Technologies: HTML, SOAP UI

Programming Languages: Java Script, SQL

PROFESSIONAL EXPERIENCE

Confidential

EDI System Analyst

Responsibilities:

• Prepared Detailed and High-level requirements, scope diagrams, functional diagrams, user cases, Confidential analysis, user stories, traceability matrix.
• Developed operational processes for increase company organization, productivity and performance
• Researched, defined and analyzed changes to both state and federal laws affecting the Medicaid Management Information System (MMIS) for Illinois and Texas.
• Served as a project management analyst on multiple initiatives involving maintenance and systems changes for EDPS implementation for CMS submission
• Completed system documentation, researched system requirements, participated in system testing and verification for EDPS implementation.
• Works closely with business users to define requirements, prioritize issues, and address production support issues.
• Followed the Agile methodology for elicitation and representation of requirements based on interaction with the business process owner, SME’s and the development team. Participated in daily scrum.
• Wrote requirements of Suggested options to updated roll of inventory cycle, based on issues generated in different way: system Vs manual, Cost Vs quantity.
• Created thebusiness process modelusingMS Visioand present it to SME’s for validation and getting thesign-offs.Document testing process flows using Visio flow-charting.
• Created an automated solution to help for selecting the appropriate claim center at time of insurance clearance in System.
• Analyzed customer needs and existing functions inHIPPA.
• EDIexperience with X12 transaction sets835, 837.
• Extensively worked on 999 and 277CA response error correction
• Worked with data analysis team to identify pending encounters and reject codes
• Coordinated with CSSC to resolve discrepancies in responses and reports received from CMS
• Provided X12 structure guidance to avoid TA1/999 rejections
• Responsible for End to End validation and processing of encounters
• Functional coordination with the EDPS team to develop rejects management dashboards for Encounter Data Management in Medicare and Medicaid
• Provided assistance with weekly data extractions and imports utilizing SQL in IBM DB2
• Coordinated the testing effort for End-to-End Testing and User Acceptance Testing
• Provided X12 error resolutions using 837 companion and implementation guides
• Customize Conduit’s EDPS solution for various Health Plans based on individual customer requirement
• Reject Analysis of CMS 999s, 277CA and MAO-002/MAO-004 level errors and reports
• Prepare business cases, initiate, manage and deliver projects; develop detailed total cost of ownership including project cost estimates
• Proactively manage changes in project scope or schedule and assess their impact on budgets, business processes or other initiatives
• Drive effective business governance of projects and post implementation oversight of applications
• Work with business colleagues to develop and support strategies for business process improvements through information systems automation

Confidential, Rensselaer, NY

BA/QA

Responsibilities:

• Created various documents such as Business Requirement Documents (BRD), Functional Requirement Documents (FRD), and Technical Requirement Specification, conducted impact assessment sessions along with the project team to identify impacted functional areas by implementing new code changes
• Accountable for receipt, distribution, tracking, and monitoring of all Medicare EDPS (Encounter Data Processing System) changes and updates as directed by the NY Medicaid
• Responsible for preparing Change request documents and getting the CRs approved by higher management
• Extensively worked on response error correction
• Worked with data analysis team to identify pending encounters and reject codes
• Responsible for End to End validation and processing of encounters
• Validated all the incoming/Outgoing data from EDI 837 on GDIT web portal
• As part of a team, provided assistance with weekly data extractions and imports utilizing SQL in IBM DB2
• Prepared documents for external agency testing guidelines
• Coordinated the testing effort for End-to-End Testing and User Acceptance Testing
• Provided X12 error resolutions using 837 companion and implementation guide
• Customize GDIT's EDPS solution for various Health Plans based on NY DOH Requirement.
• Designs and develops usability-testing scenarios, and administers more complex portions of the testing process.
• Identify / setup test data to support test cases.
• Participate in formal discussions of user stories and design meetings to optimize testing coverage.
• Cross checking of data in database by writing and executing SQL statements.
• Collaborate closely with product owner, storywriters, product designers and developers
• Write and maintain automated test scripts that perform integration systems tests for web applications.
• Support defect resolution testing initiated from production support / break-fix situations
• Responsible for definition, planning and execution of testing efforts.
• Executes testing across multiple testing phases, including SIT and UAT
• Delivers assignments within specified time frames, adheres to all established methodologies and guidelines.
• Manage daily assignments and priorities of other team members.
• Attending the regular client calls and discussing the weekly status with the project leadership team
• Perform root cause analysis of test failures, and recommend corrective actions to development team.

Confidential - Albany, NY

BA Analyst

Responsibilities:

• Responsible for working with the State to review and modify process flows to increase productivity and effectively utilize MDW features.
• Create and update the test plans and test cases for the system integration testing and User acceptance testing.
• Good knowledge with UNIX commands and shell scripts.
• Worked with the MDW (Medicaid data warehouse) web application for the testing of different report like provider, fee schedule etc.
• Worked on the OBIEE web portal to test the data is properly extracted from the database.
• Conducted application security discussions and vulnerability analysis.
• Cross checking of data in database by writing and executing SQL statements.
• Running back-end/ database queries for data verification.
• Tested Extracts and files before and after the ETL Process.
• Used SQLs to test various reports and ETL load jobs in development, QA and production.
• Experience in testing web applications developed in JavaScript, HTML.
• Coordinate with appropriate stakeholders to resolve issues identified during testing and validate product corrections and fixes.
• Responsible for doing Functional testing, Integration testing, and performance testing and security testing.
• Verify that the functionality of Medicaid Analytics and Performance Portal web application is complete, correct, and as required by the business.
• Worked on Delivery System Reform Incentive Payment (DSRIP) Program Application, to verify the functionality of automated logic to permit Performing Provider Systems (PPS) to apply for DSRIP Projects.
• Review functional and design specifications to ensure the MAPP security enhancements for Health Home Tracking System.
• Coordinated with the ETL team to come up with processes for ETL involving Oracle SQL Developer.
• Eliminate, document, and report defects in the test process as early in the systems development life cycle as possible.
• Worked on to add the new ICD version code attribute logic to support ICD-10 and ICD-9 codes.

Confidential, Baton Rouge, LA

Business Analyst

Responsibilities:

• Communicate the Confidential process Analysis with the stakeholders and feed that into the BRD, FRD and RTM for the various areas impacted by ICD-9 CM/PCS to ICD-10.
• Created artifacts such as Business Requirements Document, Requirements Models, Functional Speciation documents, UML diagrams, Confidential analysis documents.
• Conducted business analysis on claim processing such as Claim Adjudication and Claim Reimbursement
• Validated and prepared requirement document for X12 transaction 837 and 835
• Determine which claim system to interact with to display data on the UI.
• Provided production support including backup/recovery/archiving, job scheduling and monitoring, performance management, upgrades and patches (OS and application), and migrations (code and data).
• Interacted with Claim Adjudication, Claim Reimbursement, Billing, and Banking SME’s to finalize business requirements.
• Worked with Associates and understand the business rules, systems and integrate them into the requirements document and generate test cases and test data.
• Translated the requirements to the developers and guide the team when issues arise related to business requirements.

Confidential, New York City

Business Analyst/Qa Analyst

Responsibilities:

• Developed project schedules, requirements, and preliminary design for environment applications.
• Interviewed SMEs and Stakeholders to get a better understanding of client business processes and gather business requirements.
• Involved in validation of Claims Institutional & Professional through Facets.
• Facilitate various Vendor & Provider calls and take meeting minutes, Create Documents, Process Flows, Presentations.
• End to End Claims Adjudication Validation & Analysis through Confidential FACETS Claims, Billing, Member, Provider and Utilization Management Module.
• Conducted controlled brainstorming sessions with project focus groups for collecting high-level business requirements.
• Conducted several Requirement Gathering Sessions for gaining detailed requirements and finalizing Business
• Requirement Document (BRD).
• Involved in data mapping, field mapping of the data elements responsible for the BRD.
• Performed Confidential analysis of business rules, business, and system process flows.
• Worked on Prior Authorization, Claims Systems, member enrollment and eligibility and Customer Service Requests.
• Responsible for the full HIPPA compliance lifestyle from Confidential analysis, mapping, implementation and testing for claims and Encounters.
• Provided monthly encounter error reports to monitor encounter rejections and provide a fix to Confidential with CMS guidelines.
• Performed system analysis, trend analysis, data analysis and historical claim assessments.
• Developed various reconciliation reports to provide end-to-end data analysis.
• Conducted UAT for various initiatives and enhancements.