SUMMARY

• Overall 7+ years of experience as a Business/System Analyst wif Strong analytical, problem solving and multi - tasking skills, wif proven experience in applying people and process noledge to assist organizations make important and critical decisions.
• Experienced in every phase of Software Development Life Cycle (SDLC) and Software Testing Life Cycle (STLC).
• Specialized in testing Web application and Client server applications.
• Specialized in testing in both Windows and UNIX environments.
• Experienced in creating Test Plans, Test Cases based upon the business requirements.
• Worked on Agile (Scrum) and Waterfall methodologies to complete the projects.
• Expertise in Unit testing, Integration testing, Regression testing, System testing, User Acceptance testing, and Implementation testing.
• Experience of Web Services, SOAP and REST API Testing using Restful API and SoapUI.
• Expert in EDI and HIPAA testing privacy wif multiple transaction exposure such as new Member enrolment 834 inbound, claim 837 inbound or claim adjudication, response to claim835 outbound, 276 status inquiry277response, 270 eligibility/271 benefits.
• SAP experience specializing in design and configuration of SAP-SD and implementation experience.
• Validates professional, Institutional and dentist claims in FACETS, verify codes wif description and requirements verify adjudication process of claim in FACETS.
• Profound understanding of insurance policies like HMO and PPO and proven experience wif HIPAA EDI transaction codes such as EDI834(Benefit enrollment), 835(payment/remittance advice), EDI 837(Health care claim), 837P,837I, 837D.
• Experience testing of Data Warehouse/ETL Applications developed in Informatica using SQL Server, Oracle and UNIX.
• Utilized FACETS for various health insurance areas such as products, enrollment, members and other modules related to FACETS.
• Supported Data Prep for HIPAA edits by creating and dropping X12 EDI 837 files to EDIFECS.
• Medical Claims experience in Process Documentation, Analysis and Implementation in 835/837/834/270/271/277/997 (X12 Standards) processes of Medical Claims Industry.
• Expert in EDI and HIPAA testing privacy wif multiple transaction exposure such as new Member enrolment 834 inbound, claim 837 inbound or claim adjudication, response to claim835 outbound, 276 status inquiry277response, 270 eligibility/271 benefits.
• Extensive working experience in Sanity, Security, Black box, White box, Functionality, System, Integration, Front-End, GUI, Back-End, Recovery Testing, Compatibility Testing, Usability Testing, Regression, Tracking Bug Reports using Bug tracking Tools like Quality Center, Rational Clear Quest, and Test Manager.
• Tested SOAP request and response in XML format using SOAP UI.
• Experience in Back End Testing using SQL on windows platform to validate the consistency of data.
• Profound understanding of insurance policies like HMO and PPO and proven experience wif HIPAA EDI transaction codes such as EDI834(Benefit enrollment), 835(payment/remittance advice), EDI 837(Health care claim), 837P,837I, 837D.
• Extensively written many SQL scripts against Facets tables& SQL server and validated the values wif XML file.
• Proficiency in problem solving and bug tracking using tools like Quality center, HPALM.
• Knowledge on MS Office Suite, MS Visio and MS Access.
• Expertise in creating test reports, bug reports and test summery report.
• Expertise in querying and testing using Database Management Tools like MS-Access, MS- SQL server.
• Involved in developing and maintaining Test Matrix and Traceability Matrix, and performing Gap Analysis.

TECHNICAL SKILLS

Project Methodologies: Agile and Waterfall

Project Management: Jira, MS Project, TFS

Modeling Tools: MS Visio, Lucid Chart, Moqups

BI Tools: Tableau

Testing Tool: QC/ALM, QAComplete, JMeter, SoapUI

Database Tools: MS SQL Server, MS Access, Oracle DB

Programming Language: C, C++, Java, C#

Web Development Tool: HTML5, CSS, JavaScript

Platforms: Windows, Mac OS, Linux

Office Tools: MS Office, Excel, PowerPoint

PROFESSIONAL EXPERIENCE

Confidential, Downers Grove, IL

Senior Systems Analyst

Responsibilities:

• Participates in the design of software development lifecycle (SDLC) representing the role Data & System Analysis plays by placing appropriate integration points and deliverables in the corporate SDLC.
• Worked wif ETL group for understating mappings for dimensions and facts.
• Works on large scale and enterprise level Data Warehouse and Analytic projects providing status, risk, and issue identification and mitigation, as well as functional specific tasks.
• Facilitate Model Management activities when data model changes are needed.
• Provides data profiling, data mining, and forensics for all Analytic Platform projects.
• Delivers data and system analysis documentation that in corporate the business and data requirements including technical requirements.
• Manage and administer JIRA/Confluence/BitBucket add-ons, plugins, and extensions.
• Facilitated Agile adoption Retrospective for the organization wif the leadership and guided teams wif outcome resulting in enhanced performance.
• Facilitated Daily Scrum Meetings and Monthly Reviews meetings. Conducted sprint retrospective and followed up on action items for continuous improvement.
• Worked Extensively wif Inbound 837 I and 837 P, 835s(Out bounds) claims processing systems
• Support the project throughout the SDLC, including review of test cases, test plan, as well as support of the testing and development process.
• Participated in the design of the 276/277 Claims Status transaction, create EDI map(s), and added some project leadership thru-out the project by working closely wif the Business Analysts and Project Manager.
• Produce Business Requirements Document (BRD), Functional Requirements Documents (FRD), Impact Analysis Document and Requirements Traceability Matrix (RTM).
• Involved in FACETS Implementation, involved end to end testing of FACETS Billing, Claim Processing and Subscriber/Member module.
• Created mapping documents and technical analysis on Paper Claims, Medicaid Claims like UB04, and HCFA.
• Responsible for customer interface, requirements definition, general and detailed design, testing, maintenance and training programs and managed requirements using Rational Requisite Pro.
• Involved in FACETS Implementation, involved end to end testing of FACETS Billing, Claim Processing and Subscriber/Member module.
• Experience in developing, implementing and testing EDI ANSI X12, EcMap, EDIFECS Spec Builder.
• Prepared Test Cases based on business requirements and business rules for HIPPA EDI Transaction 834, 276/277, 270/271,820, 837/835.
• Performed Back-End testing manually for database integrity using SQL statements on UNIX platform.
• Used the Rational Unified process methodology for the application development and created Use cases, activity diagrams and drafted UML diagrams using MS Visio
• Tested HIPAA regulations in FACETS HIPAA privacy module.
• Created/scheduled SQL server jobs and maintenance activities of database.
• Conducted Black Box Testing on the application and validated the dataflow in the application.
• Worked on EDI transactions: 270, 271, 834, 835, and 837 (P.I.D) to identify key data set elements for designated record set. Interacted wif Claims, Payments and Enrollment hence analyzing and documenting related business processes.
• Tested HIPAA Transactions and Code Sets Standards such as 820,834, 837/835, 270/271, 276/277 transactions using Facets.
• Worked on the EDI 834-file load to Facets through MMS (Membership maintenance sub-system.
• Developed test strategies and test scenarios for all 837, 835, 834, 270/271, 276/277 transaction related reports
• Tested SOAP request and response in XML format using SOAP UI.
• Performed Back-End Testing to check database integrity by writing SQL queries.
• Extensively worked wif EDI transaction 834 (Benefits enrollment) and 837 (Health Care claim) following the HIPPA compliance EDI standard format of ANSI X12.
• Adept at writing Data Mapping Documents, Data Transformation Rules and maintaining Data Dictionary and Interface requirements documents.
• Responsible for checking of data in database by writing and executing SQL statements and initiating data acquisition user story after verifying wif lead.
• Involved in testing Web services (SOAP and REST) and XML wif tool called 'SOAP UI' for the local WSDL wif URL and created Test cases, run them, do load testing, security testing.
• Worked wif Claims, enrollment, eligibility verification for members and providers, benefits setup, and backend payment cycle in Facets.
• Worked on solving the errors of EDI 834 load to Facets through MMS. Created keyword files to has member data bulk loaded into the FACETS system through the MMS batch
• Write SQL queries to pull data from different data sources and compile various reports.
• Worked on EDI X 12 transaction set 837 I/P/D, 834,276/277 feeds to allow for change in the claim number
• Used RUP to create use cases, activity, class diagrams and workflow process diagrams
• Analyzed the FACETS Requirements and conducted gap analysis.
• Performed Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data.
• Responsible for checking of data in database by writing and executing SQL statements.
• Involved in project using SoapUI and run request wif input XML to receive a response XML for the request sent.
• Performed Test execution and wrote and executed Test scenarios/Test Scripts
• Defect Tracking and Bug Reporting was performed using Quality Center

Confidential, Malden, MA

Business Analyst/EDI Analyst

Responsibilities:

• Involved in various requirements gathering workshop sessions to capture and elicit the requirement to prepare URS and FRS documents for various reports and obtain sign off on final documents.
• SAP experience specializing in design and configuration of SAP-SD and implementation experience.
• Experience in working on Agile methodology. Attended story grooming meetings, daily SCRM meetings for the sprints planned.
• Design & manage JIRA/Confluence queries, dashboards for metrics reporting for various teams.
• Actively participated in various business process flow sessions to capture detailed swimlane diagrams using MS Visio, which depicted the overall business process.
• Performed GAP analysis to assess the space between As-Is state and To-Be state of a the system.
• Experience in testing applications developed in waterfall, Agile Methodology.
• Participate in design sessions, report on project progress and identify potential risks and issues.
• Responsible for analysis of discrepancies in the eligibility reconciliation process for multiple stakeholders and continuous process improvement of the reconciliation process.
• Facilitates the agile scrum process as a Scrum Master & accountable for removing impediments to the ability of the team to deliver product goals & deliverables.
• Provide content to and for collaboration wif training staff on training stakeholders on the transactions and the reconciliation process.
• Wrote SQL queries to conduct the back end testing of the database and to validate data.
• Working as a mentor to newly hired analysts and provide training on the transactions and on the reconciliation processes.
• Responsible for troubleshooting and resolving errors in 834 and 820 transactions for health insurance exchanges and performing root cause analysis.
• Participation in all phases of testing
• Perform testing and thoroughly document issues
• Work wif the technical and development team to resolve identified issues in a timely manner
• Review documented training material for accuracy and assist in end user training and support

Confidential, Los Angeles, CA

Systems Analyst

Responsibilities:

• Involved in gathering the requirements that were critical to the business process flow and using those requirements for the Business Requirements Document (BRD).
• Conducted JAD sessions wif Subject Matter Experts (SME’s) to obtain domain level information, interviewing and asking detailed questions and carefully recording the requirements in a format that can be reviewed an understood by both business and technical team.
• Gathered business requirements for the Claims Business Area and updating EDI Transactions like EDI 837, 835, 276 and 277.
• Assigning defects detected by the Test Team to the relevant developers and escalating issues when and where required.
• Prepared ETL technical Mapping Documents along wif test cases for each Mapping for future developments to maintain Software Development Life Cycle (SDLC).
• Analyzing business requirements and understanding web analytics for building a web warehouse wif data collected via Google Analytics.
• Managed the ETL and Business Intelligence vendor selection life-cycle from business requirements to contract negotiations.
• Responsible for overall data warehouse and Business Intelligence architecture, design strategy, process and organization.
• Created User Interface for displaying various information related to providers and claims (Billing, Payments and Invoicing) using FACETS.
• Used Agile-testing methodology for achieving deadlines in UAT.
• Developing and automating ETL processes to extract and upload daily data from Google Analytics API into the web warehouse using Talend Integration Suite.
• Created 837 I & 837 P claims using macro enabled claim spreadsheets.
• Created data flow diagrams, data mapping from Source to stage and Stage to Target mapping documents indicating the source tables, columns, data types, transformations required and business rules to be applied.
• Processed EDI 837P, 837I, 834 and 837D transactions, verified 837 transactions were converted correctly to XML file format and verified the claims data loaded to Facets for further processing.
• Worked on analysis of FACETS claims processing system and gathered requirements to comply wif HIPAA.
• Implemented Normalization Techniques and build the tables as per the requirements given by the business users.
• Developed and maintained stored procedures, implemented changes to database design including tables and views and Documented Source to Target mappings as per the business rules.
• Conduct JAD sessions to gather and document requirements that enhance a wide range of functionalities including claims processing, eligibility and enrollment, provider networks, and electronic data interchange for our Facets core application.
• Gathered business requirements, working closely wif business users, project leaders and developers.
• Facilitated claims processing while passing 837 claims for a compliance check and running through load processing.
• Analyzed the business requirements and designed Conceptual and Logical Data models.
• Worked wif ANSI X12 HIPAA EDI Transactions 270, 271, 276, 277, 837, 835 and 997
• Created and maintained data mapping document(s) in reference to the HIPAA transactions: 270/271, 276/277, 837, and 835.
• Performed GAP analysis to analyze the difference between the system capabilities and business requirements.
• Tested web services by generating XML SOAP requests and validated the corresponding XML SOAP responses.
• Conduct Design reviews wif the business analysts and the developers to create a proof of concept for the reports.
• Performed detailed data analysis to analyze the duration of claim processes and created the cubes wif Star Schemas using facts and dimensions through SQL Server Analysis Services (SSAS).
• Performed testing of the health benefit claims receiving and processing system to ensure that the system adheres to project standards, performance criteria, and functional specifications
• Implemented Error Handling during ETL load in SSIS packages to identify dimensions and facts that were not properly populated.
• Analyzed the system thoroughly and Created System Document of a complex system wifout any input/document which halped us to get the project from competitors.
• Participated in client discussions to gather scope information and perform analysis of scope information to provide inputs for project documents.

Confidential, Boston, MA

SQA/Business Analyst

Responsibilities:

• Conduct day-to-day software quality assurance assignments of out-sourced software development activities for clinical trial operations
• Responsible for developing detailed validation plans to cover the testing strategy, intended use of application, validation and functional risks, and the planned validation activities.
• Designing the functional specification and technical design document for the module (Integrations) in Enovia PLM.
• Responsible for creating test cases and scripts to adequately verify that the software is performing as intended.
• Worked on Data Migration from Oracle to PLM to keep systems in sync.
• Responsible for creating Requirements Traceability Matrixes to ensure that all requirements has been adequately tested.
• Requirements gathering, writing story documents in Agile methodology. Manage solution scope, changes to requirements, and requirements conflicts.
• Responsible for developing detailed validation reports covering the results of the validation activities and any issues identified.
• Ensure that issues are documented and resolved in the issue tracking system (JIRA) in a timely manner.
• Responsible for versioning of different documents, and routing them for approval through controlled document repository system.
• Extensive working noledge of JIRA, issue-tracking system.
• Performed ad-hoc testing to validate minor improvement tickets.
• Support the development of detailed User Requirement Specifications, and Functional and Design Specifications as applicable.
• Provided the as-is functionality of legacy application in Agile PLM as per their business requirement.
• Responsible for ensuring that software applications are develop and deployed wif the ability to comply wif 21 CFR Part 11, Electronic Records; Electronic Signature and Annex 11: Computerised Systems, EudraLex, The Rules Governing Medicinal Products in the European Union Volume 4, GMP Medicinal Products for Human and Veterinary Use
• Coordinates procedural or system changes wif the Head of QA who TEMPhas oversight of dis function for Regulatory compliance, to improve the TEMPeffectiveness of the quality assurance system.
• Responsible to gathering and documenting User Requirement Specifications (URS) and Functional Requirement Specifications (FRS).
• Collaborated on various requirements gathering workshop sessions to capture and elicit the requirement to prepare URS and FRS documents for various reports and obtain sign off on final documents.
• Collaborated on various business process flow sessions to capture detailed swimlane diagrams using MS Visio which depicted the overall business process.

Environment: Quality Center (ALM), Agile, Jira, EDI, Facets, SOAP UI, HP ALM, Share Point, SQL Server, MS Office, Windows, SOA.