SUMMARY

• Business Analyst with 8 plus years’ experience in all phases of software development life cycle including requirement analysis, test planning, test design, test execution, defect tracking and status reporting.
• I have worked in Agile and Waterfall methodologies in the area of web - based and client-server applications.
• Extensive experience with Medicare/Medicaid processing as well as the Claims/Billing.
• Strong knowledge of the Software Development Life Cycle methodologies (phases and gates) like Agile and Waterfall models.
• Expertise in data migration between divergent architectures and systems. Experience includes data extract, transform, and load
• Involved in all phases of the Facets Extended Enterprise administrative system implementation to include the planning, designing, building, validation, testing, and Go-live support phases.
• Strong understanding ofFACETSandFacetsData Model working on data model and data extracts.
• Good understanding of using MicroStrategy Command Manager Script outlines to automate the administrative tasks.
• Maximize delivery of technical strategies and data migration from legacy systems to new environments using SQL 2012 and Visual Studio for the ETL process
• Extensive use of Data Analysis Expressions functions in creating Power BI dashboards, reports and Tabular Models.
• Assist with custom application development, e-Commerce, web development and training Manage all phases of testing from connectivity, interfaces and modification to existing of processes for FACETS 4.2.1, ACES andQCAREapplications
• Experienced working inFacetsonline modules such as Billing, Provider, Claims and Membership modules.
• Good working knowledge of Claims processing, Excellent knowledge of HIPAA standards, EDI (Electronic data interchange) Transaction Set EDI X12 837, 270/271, 276/277, 278, 834, 835, Implementation and Knowledge of HIPAA code sets, ICD-9, ICD-10 coding and HL7.
• Experience with HIPAA 4010 and 5010 EDI healthcare transactions and transition of ICD 9 to ICD 10 codes.
• Expert in all phases of Defect Management, including documenting, analyzing, tracking defects and quality assurance.
• Coordinated with the business areas on business process enhancements.
• Worked closely with project managers, Subject Matter Experts (SMEs), and staff to understand the requirements and specifications for new applications along with re-engineering the existing applications.
• Facilitated governance and compliance meetings to improve Quality Assurance processes.
• Strong understanding of various SDLC methodologies such as Waterfall and Agile with hands on experience in all of them.
• Experienced in writing and defining project test plans and defect management plan.
• Expert in organizing and managing all phases of the application testing process using Quality Center, Jira and Rallydev.
• Strong understanding of test plans, test cases, test scripts and defects tracking/reporting.
• Conducted User Acceptance Testing (UAT).
• Experienced in various Healthcare areas like Enrollment, Benefits, Claims, Medicare, and implementation of HIPAA key EDI (ANSI X12) transactions.
• Excellent interpersonal skills with technical and non-technical areas to gain consensus.
• Excellent knowledge of REG CC, Patriot ACT, FDIC Regulations and HIPAA acts.

TECHNICAL SKILLS

Methodologies: Agile, Waterfall

Requirement management tools: QC, Rally Dev, Jira

Project management tools: MS Project

Business Modeling: MS Visio

Defect tracking: Rallydev, Jira

Web technologies/languages: SQL, C++, Java, XML

Front-End tools: Microsoft Excel, Word, Power Point SharePoint

Database: MS SQL Server, Oracle

Operation system/platform: MS Windows 2010, 2008, 2003/XP/2000/NT

Applications: Merlin, QNXT, CCA, TrackWise

Rules and Regulation: REG CC, Patriot ACT, FDIC Regulations, HIPAA

PROFESSIONAL EXPERIENCE

Confidential, Dallas TX

Business Analyst

Responsibilities:

• Work in partnership with Project Team, functional Team Leads and functional end-users to identify and document business process improvement opportunities and complete the definition of requirements for system design, implementation & training.
• Interacted with the “End-Users” by interviewing them, by preparing appropriate questionnaire to better understand end-user needs and the business process.
• Created test cases for System Testing (Development Environment), Integration Testing (UAT) and Production (Post Implementation Review) in Agile environment.
• Responsible for gaining a good understanding of user needs and accurately representing them in a well-documented software functional specifications document.
• Worked with stakeholders to obtain deliverable sign-offs. Provided functional direction to other systems analysts and used the meta-data definition and workflow needs and how these functions map to business processes.
• Delivered comprehensive data migration capabilities facilitating assured, secure and timely delivery of confidential business information to cross function departments and partner organizations and met the dead line.
• Create flow diagrams illustrating the work flow of both ‘as is’ processes and ‘to be’ processes.
• Understand and Analyse the functionality and Impact on all the applications involved
• Documented the Use Cases and prepared the Use Case, Activity, Sequence diagrams and Logical views using MS Visio and MS Office for a clear understanding of the requirements by the development team.
• Production support for FACETS / QCARE, making sure we meet the Serves Level Agreements (SLA)
• Facilitated Joint Application Development (JAD) sessions with all IT group members for communicating & managing expectations and to discuss various means for integrations with current system using an adoption through execution strategy.
• Created and maintained data mapping document(s) in reference to the HIPAA transaction: 837.
• Involved in developing Test plan and Test cases based on Use cases and Functional Specifications Documented, reviewed, and verified testing procedures for compliance to Interface Quality Assurance and Development standards and policies.

Environment: MS Office Excel, Word, PowerPoint, MS Project, MS Visio, MS Access, UML, .Net, MS Office, MS-Project, Windows 2000, Test Director, DB2

Confidential, Addison, TX

Business Analyst

Responsibilities:

• Responsible for system integration testing of 837 claim files, 834 eligibility files and 270/271 interface files to ensure required interactions are met during the SDLC process.
• Validated Inbound and outbound 837 transactions, including but not limited to the loading and correcting any errors with the process of EDI inbound and outbound files
• Validated outbound 835 transactions.
• Performed data migration and testing of transaction data from one core system to another.
• Experience with care operational workflows, clinical data and standards, including HL7 2.x/3.0, CCD/C-CDA, LO INC, SNOMED, and ICD-10.
• Excellent in High Level Design of ETL DTS Packages& SSIS Packages for integrating data using OLE DB connection from heterogeneous sources like (Excel, CSV, Oracle, flat file, Text Format Data) by using multiple transformations provided by SSIS such as Data Conversion, Conditional Split, Bulk Insert, Merge and union all.
• Great ability to create and manage various database objects like tables, views.
• Created reports using SQL Reporting Services (SSRS) for customized and ad-hoc Queries.
• Generated several drill down and drill through reports using SSRS.
• Worked Extensively on ETL process using SSIS package.
• Worked with the development team to ensure that they understand the functional specifications by providing detailed BRDs and FRDs
• Business Process Analysis/End User Education/Business Requirements Documentation
• Validated System configuration, including enrollment, provider and benefits modules
• Creation of queries and reports to assist Health Plan Operations with the analysis of data relating to claims, members and providers.
• Execution of daily, weekly and monthly reports and processes and the creation of ad-hoc reports.
• Broad knowledge of CCHP departmental processes, procedures and data.

Environment: QNXT, RUP, Rational Rose, Requisite Pro, MS Visio, RUP, MS Project, SQL, SSIS, SSRS, Oracle, MS Access, MS Excel and MS Word.

Confidential, Lumberton, NJ

Business Analyst

Responsibilities:

• Performed JAD sessions with stakeholders and business users to gather and document requirements
• Interfaced with business users to create Business Requirements Document (BRD) and Functional Specifications Document (FSD)
• Was an integral and active team member during the sprint and scrum ceremonies
• Analyzed requirements and did Use Case analysis designing Use case diagrams, Class diagrams, and Sequence diagrams using UML approach.
• Maintained a Traceability Matrix to ensure that all Functional Requirements are addressed at the Use Case Level as well as the Test Case Level
• Worked on ‘AS-IS’ and ‘TO-BE’ models to enhance the existing system
• Defined validation to be built into application in line with the functional requirements
• Assisted in development of business rules and testing for HIPAA compliance certification of healthcare standards
• Facilitated testing walkthroughs with developers and testers
• Interacted with End User for User Acceptance Testing and further modified the application based on user requirements
• Conducted usability tests, created user flows and wireframes, researched and documented usability standards
• Participated in the Change Management Control process for the projects by facilitating group meetings and/or one-on-one interviews/meetings with work stream owners to discuss change request impact on timelines and scope

Environment: MS Office, Agile (Scrum), MS Project, UML, MS Visio, JIRA, Oracle, Quality Centre, Java

Confidential, Rochester, NY

Business Analyst

Responsibilities:

• Facilitated JAD sessions with SMEs’, Product owner, and Development managers to understand the business process, gather Business Requirements and identify enhancements for the application.
• Designed and documented the entire Architecture of Power bi Poc
• Followed AGILE methodology viz. Scrum throughout the project.
• Scheduled Automatic refresh and scheduling refresh in power bi service.
• Wrote calculated columns, Measures query's in power bi desktop to show good data analysis techniques.
• Prepared release plan and iteration plan for the project working with the stakeholders
• Re-factor Epics to Stories and maintain the prioritized Sprint backlogs
• Assisted JAD sessions to identify the business flows and determine whether any current or proposed systems are impacted by the EDI X12 Transaction, Code set and Identifier aspects of HIPAA.
• Developed plan for data feeds and data mappings for integration between various systems, including XML, to followICD 10Code set andANSI X12 5010formats.
• Worked on EDI transactions: 270, 271, 834, 835, and 837 (P.I.D) to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
• Worked on FACET to terminate or reinstate health coverage for the subscriber.
• Documented requirement for HIPAA, EDI transaction 837 and for Medicare Part A, Part B, Part C and Part D.
• Researched/Analyzed the various steps involved in claims processing life cycle and then wrote the BRD in such way that developers could construct the system to identify riskier claims.
• Conducted requirement sessions, identifying business needs, getting sign-off on requirements and capturing requirements in CaliberRM and Rally.
• Facilitated pre-planning meetings, demos and daily stand ups.
• Wrote test cases and test scripts for the User Acceptance Testing (UAT).
• Worked with design team to prepare Project plan for User Interface documents.
• Tracked daily issues and dependencies and coordinated with common team to work on the impediment list.
• Conducted GAP analysis for fixed fee projects.
• Coordinated management of projects on MS SharePoint 2007.
• Used Rally and TFS for updating the status of all the Test Cases & Test Scripts that are executed during testing process.
• Created traceability matrix to map requirements with test cases.
• Managed and assigned defects to the development team in Microsoft Team Foundation Server
• Created test plans for Test driven development (TDD)

Environment: Windows XP professional, MS Office suite, MS Excel, Google Spreadsheet, Documentum, MS Project, UNIX/Oracle Platform, XML, Oracle Application server, Oracle Pl/SQL, MS Visio, Bugzilla, Quality center, Clear quest, clear case, HP Service Manager

Confidential, Atlanta, GA

Business Analyst

Responsibilities:

• Gathering, maintain, and developing requirements to create BRD from the initiation to final phase of the project.
• Provided security for Power bi data sets in Power bi service among organizational content pack.
• Liaise with SOA to develop framework for the project development.
• Interact with stakeholders on Delta ONE experience to better understand project and provide customer with exceptional customer service
• Coordinate and schedule meetings with stakeholders
• Developing Use cases for functional specification and coordinate SOA team to capture each stage of process interaction
• Assist in business process redesign as needed.
• Maintain communication with customer and team members and promote a team environment.

Environment: Windows, MS Visio, UML, RUP, MS-IIS Web Server, UNIX, Oracle

Confidential

Claim Analyst

Responsibilities:

• Acted as the primary Intermediary between the Subject Matter Experts, business user and technical SME’s to identify the business needs, Business Rules, Business Processes & Interface Specifications for the improvement of the claims processing systems and then documented them in Business Requirement Documents (BRDs), Functional Requirement Documents (FRDs) using Power Designer.
• Used the guidelines and artifacts of the Rational Unified Process (RUP) to strategize different iterations and phases of the Software Development Life Cycle (SDLC).
• Performed GAP analysis and wrote application enhancement specifications detailing in scope/out of scope items, as-is/to-be process maps and critical test scenarios.
• Designed Use Case modeling, authored Narrative Use Cases and created UML diagrams such as Use Case Diagrams, sequence diagrams and Flow Diagrams (Business/System) using MS Visio.
• Provided structured walkthrough to the developers to understand the Use Cases and worked with quality control teams to develop Test Plans, Test Cases and test scripts based on usability and functional performance criteria.
• Led and conducted JAD sessions to identify the flows and processes involved in the content.
• Organized and Performed UI/GUI Testing, Progression, Regression testing and provided support for User Acceptance Testing (UAT) for multiple iterations involving the entire User environment setup.
• Worked with development and testing teams to accomplish timely release objectives.
• Participated in product release and deployment to end-users after successful development and testing of the product. Also participated in training the end-users and creating training documents.

Environment: Rational Rose, MS Visio, UML, RUP, MS Office 2000, VB.NET, Oracle 9i, Windows, MS Excel, MS PowerPoint, Quality Center