SUMMARY

• Over Six years of diverse progressive experience in Information Technology, with emphasis on Business Analysis and Software Development lifecycle.
• Strong knowledge of Business Process modeling (BPM), Unified Modeling language (UML), JAD sessions, and Gap Analysis.
• Excellent interpersonal, presentation skills, oral and written expression to communicate on different levels of management.
• Extensive knowledge of the IBM/Curam Income Support healthcare products
• Experience working with business users and the senior management.
• In depth knowledge of Software Development Life Cycle (SDLC), with thorough understanding of various phases such as Requirements, Analysis/Design, Development, Testing, UAT and Implementation.
• Expertise in Business Analysis, System Analysis, Data Migration, Data Analysis and Business process flows.
• Experienced in working with Trizetto Facets on Provider Life cycle, Members Enrollment and Claims modules.
• Experience with claims process and adjudication in the Medicare, Medicaid, MMIS and Private Insurance Sectors.
• Experience in configuration of claims adjudication systems, QNXT
• Good working knowledge in Enrollment, Billing, Claims, CMS regulation, Facets, HIPAA regulations, ACA regulations, 834 enrollment and 837 claims transactions for health care industries.
• Expert in using various requirements gathering techniques including White boarding, Brainstorming, JAD, Focus Analysis, Reverse Engineering, Survey, Document Analysis, Interviewing and Observations.
• Experience in writing documents including Software Requirement Specifications (SRS), Business requirements document (BRD), Use Case Specifications, Functional Specifications (FSD), Systems Design Specification (SDS), Requirement Traceability Matrix (RTM) and testing documents.
• Experienced in performing Gap Analysis to capture system gaps.
• Proficient in translating business requirements, user stories into detailed System requirements and technical requirements.
• Solid background in Software Development Life Cycle methodologies including Waterfall, RUP, and Agile Methodologies.
• Experienced in creating User Stories and product backlog using scrum methodology.
• Experienced in conducting Joint Application Development (JAD) sessions with end - users, Business system analysts, software developers and quality assurance teams.
• Proficient in using business knowledge, technical skills, and strategic analysis to design solutions and provide creative insights to critical business problems.
• Proficient in requirement analysis and creating Use Cases, Sequence Diagrams, Activity Diagrams, Class Diagrams etc.
• Strong experience in Microsoft Office Tools (Excel, Word, Access and PowerPoint)
• Experience in the use of tools like Rational Rose, Rational Requisite Pro, Rational Clear Case, and MS Visio.
• Involved in reviewing test procedures, defining test cases, reviewing and maintaining test scripts, analyzing bugs and User Acceptance Testing (UAT).

TECHNICAL SKILLS

Operating Systems: Windows 98/NT/2000/XP/7, Citrix, VSE Mainframe.

Software: MS Exchange, MS Office 97/2000/XP, MS FrontPage, Adobe (Acrobat, Photoshop), CURAM, Medicare Billing,.

Languages: C, C++, Visual Basic, SQL/PLSQL

Databases: MS-Access03/07/10, SQL Server, Oracle, DB2.

Tools: MS Visio, Rational Rose, Rational Clear Case, Rational RequisitePro.

Bug Tracking Tools: Mercury Test Director, Rational Clear Quest

Testing Tools: Test Director, Load Runner, Quality Center, HP ALM

PROFESSIONAL EXPERIENCE

Confidential, Rochester, NY

Business Analyst

Responsibilities:

• Assembled business requirement documents (BRD) and the functional specifications as per the user requirements.
• Created Business Workflow based on the requirements gathered from the client.
• Created functional specification documents based on the business requirement documents.
• Conducted weekly meetings with the clients and internal teams to formulate priorities and determine solutions both automated and manual.
• Management according to the HIPAA Compliance Standards for Claims Processing.
• Extensively worked with HIPAA 837,834,835,297 files.
• Working knowledge for FACETS batch file.
• Tested Different portals like Member portal, provider portal as a part of HIX 10/1 releases.
• Extensively worked with HIPAA Privacy FACETS application groups.
• Wrote complex SQL queries to extract and validate the data from the FACETS database
• Involved in creating documents and diagrams for Claims Processing.
• Extensive Knowledge and experience in EDI transactions, ASC X12 Transactions like 270,271,277.
• Worked on modules related to Claims, Providers, & Contracts and worked with Claims attributes, Provider attributes, enabling EOB & Remit rules associated with Provider configuration process in FACETS.
• Working Knowledge of the data model, data fields, relationships (backend) of the FACETS System. FACETS tables such as Provider, Contract, Benefit, Claim, Claim details, and Member.
• Organized JAD Sessions to resolve issues and conflicts and to arrive at quick agreements regarding the system architecture design
• Performed Functionality and Regression Testing on IBM Curam web application
• Testing execution of CURAM/ACES customized components general test types of Unit.
• Resolved issues like member duplicated in file, dealing with dependent transaction if subscriber is not found, failures in submissions in QNXT.
• Worked with the project manager for planning and organizing the project activities, and in communicating with other business center managers and stakeholders of the project.
• Analyzed and documented the limitations of the billing system.
• Interacted extensively with the client and the management teams to understand the requirements and to report the status of the testing efforts on their applications.
• Performed Gap Analysis. Followed the RUP methodology for the entire SDLC. Actively worked with developers as needed to isolate the Root Cause Analysis of defects.
• Worked with the clients on the final signing process in the User Acceptance stages. Managed scope and deadlines.
• Participated in various meetings and discussed enhancement and modification request issues.

Confidential, Little Rock, Arkansas

Business Systems Analyst

Responsibilities:

• Created use case documents based on the business requirements document.
• Interacted and arranged meetings with Business and End users to gather business requirements for configuration of Benefits with various other systems.
• Identified, documented and analyzed business needs, contributed in the design of solutions, and assisted in the implementation of solutions.
• Designing of Informatica power center jobs that will provide data from CURAM to the MEC Common Table as well as external systems like the MMIS database and the OK Medicaid Card Printing Center. Data sent to MMIS database and the OK Medicaid Card Printing Center via data files.
• Elicited MMIS/HIPAA business requirements from relevant State and Government agencies, healthcare providers and other stakeholders during the evolution of Billing, Encounters.
• Supported MMIS/HIPAA Claims, Payments and Fraud Detection Applications.
• Worked on EDI transaction 835 to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
• Created Use Cases for different modules of MMIS.
• Designed ETL process to load the data provided by CMS - Center for Medicare and Medicaid Service; to the systems operated by Arkansas Department of Health Service.
• Gathered requirements and developed detailed documentation related to systems requirements and conceptual solutions.
• Created test data for testing in Facets development client.
• Worked on defining requirements and analyzing the business process to create a business process model.
• Experience with Trizetto QNXT System implementation, Claims and Benefits configuration set-up testing, Interfaces and Extensions, Load and extraction programs involving HIPAA 834 and proprietary format files and Reports development.
• Worked with SME close to understand Claim Adjudication Process setup in Facets.
• Wrote standard and complex SQL queries to perform data validation to ensure test results matched back to expected results based on the user needs.
• Worked closely with theETLdata warehouse and BI teams while developing data marts, data models and while reporting and data mapping & validation and wrote SQL queries, prepared dashboards and performeddata analysis.

Confidential, Fargo, ND

Business Analyst

Responsibilities:

• Extensive and thorough Gap Analysis for HIPAA and HIPAA Companion Guides and also for HIPAA and HIPAA Companion Guides.
• Exhaustive study and analysis of the various trading partners’ (Medicaid and Commercial) companion guides to identify the specific changes required for that particular client.
• Study other enrollment processing systems and perform impact analysis with an objective to establish the impact and scope of the changes needed for the systems.
• Conduct review sessions with business owners to establish business rules and identify data requirements for the changes within the transaction set Schedule meetings with technical personnel to determine technical parameters for EDI and other related processes, including communication, security, and privacy.
• Create transaction sets requirements, usually with Microsoft Excel, for transactions such as: HIPAA 270/271, 276/277, 278/278, 820, 834, 271U, 835, 837-(I,P, &D), 835 Remittances and others.
• Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data within the Oracle database
• Extensive backend data validations with SQL queries to ensure proper data load to existing and the newly added tables, comparison of 4010 set of data against 5010 set of data using SQL output.
• Worked on developing a program that can add/delete and retrieve information from mysql database using a html form as front end interface.
• Worked on 834 and 5010 files as input and converts them into flat file layout
• Perform Extensive analysis, prepare comprehensive design for the new translator as per the requirements of the state and commercial clients. Data mapping to ensure that the data in 5010 is understood by the translator and make it 5010 compatible
• Migrated Data from MS Excel to SQL Server Reporting Service Using DTS and SQL loader utilities.

Environment: JAVA, Citrix, SeeBeyond, Toad, JIRA 3.1, MySQL 5.0MS Office (MS Excel, MS Access, MS Word, MS Power Point), MS Outlook, MS Visio, MS SQL Server 2007, .Net, JavaScript, SharePoint library, SharePoint Defect Tracking Tool.

Confidential, Plano, TX

Business Analyst

Responsibilities:

• Interaction with operational staff at all levels in gathering business requirements relating to application design.
• Analyzed and designed workflow mapping and modeling for the claim system, claim adjudication and claim payment.
• Performed gap analysis of claims and enrollment business process for changes from SSN identifier to USI (Unique Subscriber Identifier) affecting for HIPAA EDI X12 transactions 837, U277, 276/277, 270/271, 278,835 and 820.
• Created high quality functional requirement specifications and supporting documents for business.
• Preparing detailed requirements for the dashboard features and regional sales and national sales in Rational Requisite Pro.
• I have been reassigned to help with the MITS MMRS/CURAM interface project for the new Medicaid system
• Recording the use cases in documents using a modular approach using
• Extensively used Rational Requisite Pro for preparing system requirement document (SRD).
• Prepared test Data sets and performed data testing using the PL/SQL scripts. Also used MS excel for data mining, data cleansing, data mapping, and data dictionary and data analysis.
• Designed and developed different use cases, activity diagrams, sequence diagrams, Object Oriented model (class/object diagrams) using MS Visio and UML
• Created and managed project templates, use case templates, requirement types and traceability relationships in Requisite Pro.
• Extensively used Rational Requisite Pro for preparing system requirement document (SRD).
• Used IBM’s Rational Clear quest tool for defect tracking
• Organized Joint Application developments (JAD), Joint Application Requirements sessions (JAR), Interviews and Requirement Elicitation sessions.
• Prepared scenarios, Use Cases & UML State Diagram for scenarios using Rational Rose.

Environment: Windows 2000/XP, JAVA/J2EE, Rational Requisite Pro, MS Office, SQL Server, Agile, WebSphere, MS Project, MS Access, UML.