SUMMARY

• Result - driven professional with 8+ years of consistent experience serving in multi-faceted roles of Scrum Master, Business Analyst and Sr. Business Systems Analyst across multiple functional and projectized organizations in various segments of Life Sciences, Healthcare and Pharmaceutical industries in the US.
• Comprehensive knowledge of ADT messages, HIPAA Transaction and Code Sets (EDI 834, 835, 837, 270, 271, 276, 277, ICD-9, ICD-10), Electronic Health Record (EHR)/Electronic Medical Record (EMR), Clinical Trial.
• Extensive experience on Membership Enrolment, Billing, Claims payment processing relating to HIPAA, ICD-10 codes and EDI transactions for transmission of the Protected Health Information (PHI).
• Thorough knowledge on various types of health insurance programs including Medicaid, Medicare (Parts A, B, C and D), Preferred Provider Org. (PPO), Health Maintenance Org. (HMO), Point-of-Service plan (POS).
• Adept at implementation of HIPAA 4010 and 5010 changes in the existing claim processing integrated system.
• Strong knowledge of Health Level 7 (HL7), Health Insurance Exchange (HIX), Healthcare Reform, Patient Protection and Affordable Care Act (PPACA) and utilizing Facets Software for medical claims processing.
• Seasoned professional worked on moderate to high complex projects such as Application Development; Data warehousing and Business Process Re-engineering (BPR), across various levels of organizations.
• Proficient in SDLC Methodologies: Waterfall, Scrum-Waterfall Hybrid, Agile - Scrum, Kanban, Scrum-ban, SAFe (Scaled Agile Framework) V 4.0, Spiral, eXtreme programming (XP), Rational Unified Process (RUP)
• Conducted numerous business analysis techniques such as GAP Analysis, Fish - Bone Diagram, SWOT, Impact Analysis, Root-cause identification, Cost-Benefit analysis, KPI, Workflow analysis, Feasibility study and Business Risk Analysis to understand the business pain points and devise solutions for the stakeholders.
• Skilled in gathering requirements from stakeholders by conducting various requirement elicitation techniques including Brainstorming, Joint Application Development (JAD), RAD, One on One Interviews, Surveys & Questionnaire, Focus Groups, Requirement Workshop, Prototyping, Observation and Document Analysis.
• Drafted quantifiable project artifacts such as Project Vision; Strategy Document; Statement of Work (SOW); RACI Matrix, RTM; Requirements Management Plan; Requirements artifacts such as BRD, FRD, FSD, SRS; Use cases; Training documents and Test plans; Prototypes, mock-ups and wireframes across various phases.
• Prepared Test Strategies, Test Plans, Test Cases, Test Scripts and maintained Defect Logs for defect tracking during the different phases of the STLC process using testing software such as HP ALM/QC and Selenium.
• Involved in various kinds of testing including User Acceptance Testing (UAT), Black Box testing, Regression testing, Smoke Test, Sanity Testing, White Box Testing, Stress Testing, System Integration testing (SIT).
• Expertise in defining and documenting the business process flows (UML) like Use case diagrams, Activity diagrams, Sequence diagrams and Data Flow Diagrams (DFD) across several phases of the projects.
• Proactively teamed with the Product Owner to help in prioritizing the release backlog and product backlog to achieve maximum business value, to vertically slicing the EPICS into user stories using the INVEST criteria and the development team for the sprint backlog using the SMART criteria enabling adherence to Agile principles
• Facilitated ceremonies of Agile Scrum Methodology like Sprint Planning, Sprint Execution and Daily Stand up Meeting, Sprint Review and the Retrospective. User story Mapping as well as sorting impediments. Handling requirements churn; evolving the Definition of Done, Acceptance Criteria
• Exceptional skills of facilitating: Prioritizing Techniques such as Moscow, Kano, Validated Learning, Business Value Based, Technology Risk Based; Estimation Techniques such as Planning Poker, T-shirt Sizing, Relative Mass Valuation and Dot Voting; and Retrospective Techniques such as ORID, Secret Box, Happiness Histogram, Silent Writing, Star Fish enforcing true Scrum practices across organizations.
• Extensively used SQL queries using joins, unions, group by, order by and aggregate functions to extract data from different data sources and to perform DDL (Data defining language) operations to create, read, update and delete (CRUD) the data in the database for data manipulation/calculations, and data analysis.

AREAS OF EXPERTISE

• Business Analysis
• Data Integration & Migration
• Agile (Scrum) Methodology
• Healthcare/Pharma Industry
• Requirement Eliciting
• Software Development Life Cycle
• Test Cases/Plans Preparation
• Project Management
• Data warehouse and ETL

TECHNICAL SKILLS

Project Management Tools/Methodologies: MS-Project, MS SharePoint, JIRA, RALLY, AGILE-SCRUM, WATERFALL-SCRUM, WATERFALL, SAFE, SCRUMBAN

REQUIREMENT MANAGEMENT: MS Office, JIRA, Version-One, HP ALM QC

REPORTING TOOLS: SSRS, IBM COGNOS, MS OFFICE SUITE, Tableau

ETL TOOLS: Informatica Power Centre 7.x/8.x/9.x, SSIS, IBM Data Stage.

DATABASES: MySQL, SQL Server, MS Access, Oracle.

OFFICE TOOLS: MS Word, MS Excel, MS PowerPoint, MS SharePoint, MS Visio, MS Access, MS Outlook, MS Project

TESTING TOOLS: HP ALM, HP Service Centre, HP QC, Cucumber, Selenium

ANALYTICS TOOLS: MS Excel, MS Access, Power BI, Tableau

LANGUAGES: Java, C# .NET

DEFECT TRACKING TOOLS: HP ALM, JIRA

SCRIPTING AND MARK-UP: HTML-5, CSS-3, JavaScript

PROFESSIONAL EXPERIENCE

SR. BSA/SCRUM MASTER

Confidential, Virginia beach, VA

Responsibilities:

• Understood the utilization of meaningful use of EHR in hospital, long term and ambulatory care settings to leverage the data across the analytical platforms and its integration abilities with other hospital systems.
• Worked with a growing knowledge of X12 4010 and 5010 HIPAA 837 I, P, D, 835, 834, 820, 270, 271, 276, 277, and 278, EDI, Privacy, Security, Medicare and Medicaid throughout the lifecycle of the project.
• Worked within project team to identify and interpret state Medicaid policies as applicable to define complex project’s scope & objectives, effectively gaining a sound understanding of the clinical system
• Lead multiple teams concurrently on implementation of the integrated system by providing sound Technical Project management, while effectively worked within a diverse technology environment, self-sufficiently.
• Facilitated JAD Sessions, Document Analysis, Survey/Questionnaire and Focus Groups to elicit requirements from various stakeholders including business users and Subject Matter Experts (SME’s).
• Documented the elicited business and technical requirements, translated the requirements on to proper system requirement specifications for development of Data Warehousing and Reporting Implementation roadmap
• Facilitated various Scrum ceremonies like Sprint Planning Meeting, Daily Stand-up Meeting, Sprint Review Meeting, Sprint Retrospective Meeting, Backlog Grooming, throughout the lifecycle of the project.
• Actively assisted the product owner in prioritizing the product backlog as per the maximum business value along with proactively working on grooming User Stories in planning activities using INVEST criteria.
• Documented & drove best practices throughout the system, by creating and updating UML diagrams - use case diagrams, Activity diagrams, Sequence diagrams, Data Flow Diagrams (DFD) using MS Visio.
• Extensively used RALLY to record and maintain the artifacts such as Product backlogs (user stories), Sprint backlogs(tasks), defects and issue tracking; and ensuring transparency of Impediments list across the team.
• Defined scope and implementation procedures by working closely with Project Management, QA, Developers and implementation team to build, configure and document new workflows to minimize the pain points.
• Evaluated the impact that integrated information system had on the clinical workflow; Identified workflow and process changes to develop procedures to solve problems, factoring in availability, capacity and results.
• Understood the impediments and roadblocks, escalated to accountable, solved impediments and maximized productivity by continually training Junior Business System Analyst’s by providing guidance and mentorship.

Environment: Hybrid-Agile, EHR, Rally, Microsoft Excel, Microsoft Word, Microsoft PowerPoint, Tableau, Alteryx, Hadoop, Mule ESB, Kafka, Red Hat Enterprise Linux Server, MS Windows Server (Exchange Server, Sharepoint Server, MS SQL Server), VMWare ESXi Hypervisor, HTML5, CSS3, Javascript, Angular JS, Ajax, Informatica RulePoint

SR. BSA/SCRUM MASTER

Confidential, Buffalo, NY

Responsibilities:

• Modelled the 'as-is' process flow and the 'to-be' process flow and analysed the gap and developed the action steps to fill the gaps, devising processes & procedures to solve the problems, effectively satisfying the gap.
• Involved in Project Leadership by acting as a liaison between theBusinessneeds (businessusers and sponsor) and the Technical team (development and testing staff), defining complex project scopes, objectives and establishing/documenting best practices throughout the project, considering resource availability and time.
• Facilitated various Scrum ceremonies including Sprint Planning, Daily Stand-up, Sprint Review, Sprint Retrospective, Backlog Refinement; Created an environment conducive to team self-organization.
• Provided technical project management by conducting Impact analysis when there is any change in the requirements and updated crucial project artifacts including the Business Requirements Document (BRD) andSystemsRequirements Specification (SRS) to baseline them; handling multiple projects simultaneously.
• Developed Requirements Traceability Matrix (RTM) to record the requirements and their corresponding test cases throughout each stage of the requirements gathering process in the Hybrid Agile environment.
• Identified critical path to create schedules in different scenarios (best, neutral and worst) including phases, milestones, resource tasks, and workflow, dependencies, logs & status reports throughout the project.
• Developed the User Interface (UI) prototypes and mock-ups of the necessary screens to capture and validate requirements and spike solutions for the problems faced in developing the requirements, in diverse technology.
• Created 837(P, I, D) claims, and maintained data mapping documents in reference to HIPAA transactions primarily 837(P, I, D), 835, 270/271, 276/277 and 278, ensuring proper translation and compliance.
• Analyse EDI -X12 data elements captured by the existingsystemto validate it against the data elements required for the newIndependent Co-ordination of Benefits (COB) system, including Medicare Part-D benefits.
• Involved in designing and creating database, helped DBA team with creating database views & SQL tuning.
• Analysed the mainframe reports for member/eligibility/claims and mapped the fields with FACETS batch jobs and reports, in the corresponding modules of Facets related to Providers/Networks/Agreements.
• Participated in developing test plan, test scripts, and test scenarios and designed user documentation.
• Generated the most crucial Sprint Burn Down chart which helped Product Owner and the Dev Team; simultaneously coaching and mentoring newly hired Business Analysts/Business Systems Analysts
• Continuously shielded the Scrum Development Team from external interference & distractions.

Environment: Hybrid-Agile, MS Access, MS Excel, MS Word, Facets, MS Visio, MS SharePoint, SQL Server, Informatica, Jira, HP QC, HTML, XML, Javascript, AJAX, Angular JS, Tableau.

BUSINESS SYSTEMS ANALYST

Confidential, ALBANY, NY

Responsibilities:

• Assisted Document Analysis sessions to document the requirements, translate to appropriate system requirement specifications, identify the business flows and determine whether any systems are impacted by the EDI Transaction Code set and Identifier aspects keeping in control of existing HIPAA restrictions.
• Proactively participated in the project leadership for the development of Medicare Systems as part of Patient Protection Affordable Care Act (ACA); established & implemented best practices for the system
• Identified the Test Cases corresponding to the requirements, to ensure that all the requirements are tested.
• Actively provided technical project management, while leading State Children’s Health Insurance Program(SCHIP), CMS requests to identify Medicare eligibility; handled multiple projects concurrently while providing concrete guidance to Junior BSA’s across the handled teams.
• Built an Information Security Risk Assessment (ISRA) to enable the secure exchange of health insurance data as part of the Confidential ’s Health Information Exchange (HIX) system for the Affordable Care Act (ACA).
• Responsible for implementing payers onto the Health Care Exchange (HIX) for the Affordable Care Act; modified existing procedures to solve complex problems factoring in HIX’s capacity and system availability.
• Compiled, validated and reported system-wide metrics to attest meaningful use of Electronic Health Record (EHR) in accordance with the Centre for Medicare and Medicaid Services (CMS) regulations.
• Responsible for support and enhancement requests for a SQL data warehouse and transactional database.
• Responsible for UAT project planning including creating testing scenario, test plans, and test scripts.

Environment: Waterfall, Microsoft Office SharePoint, MS Office, SQL Server, MS Project, Oracle, MS Access, EDI, JIRA, Tableau, CutePDF, Microsoft Excel, Microsoft Word, Microsoft Power Point, Visio, Rational Rose, Rational Requisite Pro, Rational Clear case, UAT testing, UML, Balsamiq,, XML

EDI BUSINESS /SYSTEMS ANALYST

Confidential, Minneapolis, MN

Responsibilities:

• Proactively involved in the full HIPAA compliance lifecycle beginning with GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims, to devise procedures to solve problems.
• Facilitated JAD sessions, Document Analysis to elicit requirements from the concerned stakeholders.
• Created EDI documents for EDI maps to generate requirement documents and Project Charter, and logical design documents for the appropriate EDI transactions and code setsfor the transactional information
• Responsible for creating sample mappings for the conversion of EDI X12 transactions code sets version & translation of ICD 9 codes into ICD 10 codes, sticking to compliances, at phases of the project.
• Created and implemented Maps for HIPAA standard 837I/P, 834, 835, 820, 270, 271, 999 along with Examining and correcting any errors or exceptions, while proactively participating in project leadership.
• Worked with Facets Applications Facets Trizetto Eligibility/Enrolment transactions, Managed Care and MMIS Health Insurance Claims Processing system to execute enhancement of the healthcare application
• Utilized PL/SQL (stored procedures, functions, packages and triggers) and SQL (queries) programming and tuned the queries to high precision, to develop business logicsatisfying the requirements of the stakeholders

Environment: Hybrid-Agile, Java, MS Office, DB2, UAT testing, Linux, HTML, MS Project, BI, Facets, XML, SFDC, MS excel, Power MHC, MS Word, MS Visio, MS .NET, XML, XSLT, MS SQL, MS FrontPage, MS Power Point.

BUSINESS SYSTEMS ANALYST

Confidential

Responsibilities:

• Provided full life cycle support for company's Facets enhancement to Facets Workflow and Network Management Suite with Pricing Modeler and Network Modeler application--including Business Requirement gathering, Functional Design, Technical Design, and Production Support documentation for outgoing interfaces
• Managed Requirement churn during the project by performing Impact Analysis by checking the feasibility in maintaining the Triple Constraint and discussing them in Daily Scrum Stand-up ceremony.
• Allocated task and tracked issues using JIRA. Also, managed user stories and the RTM during project duration.
• Designed data models and conducted normalization and de-normalization of data to fit OLTP and OLAP frameworks, slicing and dicing of data marts for analytical decision-making support across the teams.
• Participated in Facets Table data modeling; planning, designing, implementation of the data warehouse and conducted testing by developing moderate to complex SQL queries involving joins and unions.

Environment: Waterfall, Windows, Microsoft Office SharePoint, ETL, QNXT, Facets, MS Office, SQL Server, MS Project, Oracle, T-SQL, MS Access, EDI, RF Tool, Scrum, Mercury Test Directory, Mercury QC, BI Toolset, CutePDF, Microsoft Excel, Microsoft Word, Microsoft Power Point, Visio.

JR.BUISNESS SYSTEMS ANALYST

Confidential

Responsibilities:

• Setup and lead requirement gathering meetings with stakeholders, document and share Minutes of Meeting.
• Built swim lanes using Microsoft Visio for as-is and to-be process flows depicting the Gap Analysis results.
• Worked with System Architect for documenting CAB/RRB approvals of design and solution of the project.
• Proactively worked on Federated Systems’ (CMDB) and Total Maintenance Solution (TMS).
• Built mock-up screens to effectively convey the look and feel of GUI screens for the end users to developers.
• Assisted the technical project management team, while working on upgradation of ITSM systems.

Environment: Waterfall, Office 360 (Visio, Word, Excel and Powerpoint), ServiceNow, Sharepoint, SQL

SQL DEVELOPER

Confidential

Responsibilities:

• Interacted with users and stakeholders to Identify business needs, evaluated solutions for business problems.
• Performed intermediate queries using SQL, including Inner/Outer/Left Joins and Union/Intersect.
• Pulled data from existing customer databases using views built in SQL Server, Excel and csv flat files.
• Converted various T-SQL statements into stored procedures thereby reducing the number of database accesses.
• Efficiently addressed onshore-offshore challenges in understanding and developing the new validation module.
• Performed various calculations using complex expressions in the reports and created report models.

Environment: Waterfall, MS SQL Server 2008, Windows Server 2008, SSIS, Visual Studio, T SQL, PL/SQL