Summary

• 6 years of experience as a Business Analyst working on multiple levels of SDLC.
• Good at analyzing the Business Requirement Documents, Functional Specifications and Technical Specifications.
• Good knowledge on Waterfall and Agile methodologies of software development life cycle.
• Assisted Quality Analyst in preparing Test Plans and Test Cases.
• Competent in using testing tools like Quality Center, Quick Test Professional, WinRunner and LoadRunner.
• Experience with health care Systems: MMIS, QNXT, FACETS, Medicare Part A, B, C, D, Medicaid systems.
• Experience with FACETS upgrades.
• In-depth knowledge on different modules of FACETS Member, Provider and Claim , QNXT.
• Good knowledge about EDI transactions 270, 271, 810, 850, 834, 835, 837 , HIPAA gateway, ICD9 and ICD10, HIPAA 4010 and 5010.
• Experience with NCPDP, HCPCS NDC and DRG Codes.
• Good backend skills on SQL Server, Oracle, and MS Access databases.
• Proficient in Testing methodologies, Test Matrices and Trace matrix.
• Worked on Business Intelligence tools like Cognos, Business Objects.
• Conducting User Acceptance Test UAT and verifying performance, reliability and Fault tolerance issues.

Technical Skills

Change Management tools: Requisite Pro, ClearCase

Modeling tool: Rational Rose, MS Visio

Utilities: MS Office, MS Project, MS FrontPage

Methodologies: RUP, Agile, and Waterfall

Database: MS Access, MS SQL Server 2000, Oracle 9i/10g, Teradata

Testing tools: WinRunner, Quick Test Professional, LoadRunner, Quality Center, Rational Suite

Operating System: Windows98/XP/ NT/ 2000/vista/7, DOS, UNIX

Data Modeling: E-R Diagrams, Data Flow Diagrams, Data Dictionary, Data mapping

Reporting Tools: Cognos, Microsoft Reporting Services, Crystal Reports, SharePoint and Business Object

Professional Experience

Confidential

Position: System Analyst

Roles and Responsibilities

• Responsible for end user training UAT and testing of related business processes and for implementing the same.
• Experience in facilitating the test process by using bug-tracking tool ALM.
• Extensively worked on all phases of Data Warehousing project like Data Cleansing, Data modeling for data staging Data Mart, ETL, Indexing, Quality Assurance, Data updating plan, and Data presentation to business users.
• Maintained documents and collaborated with the team by extensive use of SharePoint.
• Helped in reviewing and editing of the test scripts.
• Experience in writing Use cases and Functional Requirement Document.
• Planned Test Plans and Test Cases for User Acceptance testing UAT with the assistance of QA teams
• Developed Flowchart and process diagram using Microsoft Visio.
• Often communicated with developers to solve technical issues.

Environment: SQL, DataStage 8.5, Toad, ALM Quality Center , UAT, MS Excel, SharePoint.

Confidential

Position: Business Analyst

Roles Responsibilities

• Ensuring that X12 transactions can be carried out as per the EDI standards during any of the system changes as well as system upgrades.
• Worked on EDI transactions 820, 837, 835, 270, and 271.
• Utilized Agile Methodology to configure and develop process, standards and procedure
• In Agile environment elicited, analyzed, documented and communicated requirements for implementation and build out of automated billing process
• Worked in a true Agile/ Scrum/ XP environment, experiencing using Agile Automation Frameworks.
• Gathered requirements and prepared functional documents for FACETS 4.7.
• Analyzed on FACETS 4.7 and FACETS 5.0 versions.
• Provided business analysis support for the execution of an upgrade of FACETS 4.7 to 5.0.
• Designed High level design, for New process, integrating with legacy and FACETS
• Defined Functional Test Cases, documented, Executed test script in FACETS system.
• Responsible for architecting integrated HIPAA, Medicare solutions, FACETS.
• Configured patient codes, healthcare codes and test codes in FACETS.
• Worked with Claims, Enrollment, Eligibility verification for Members and Providers, Benefits setup, and backend payment cycle in FACETS.
• Analyzed and tested various Common Eligibility Outbound Interface Process and other Inbound/Outbound FACETS interfaces.
• Involved in implementation of HIPAA EDI Transactions 835,837 .
• Involved in Forward Mapping from ICD 9 to ICD 10 and backward mapping from ICD 10 to ICD 9.
• Packages designed to support HIPAA requirements for claims such as CPT or HCPCS coding codes, ICD-9, ICD-10 coding.
• Worked extensively on Gap Analysis of ICD 9 and ICD 10.
• Participated in ICD 9 to ICD 10 codes mapping sessions as well as status meetings and provided comments and suggestions on challenges.
• Performed GAP Analysis for HIPAA 4010 and 5010 transactions.
• Used EDI tools to verify mapping to X12 format.
• Analyzed HIPAA 5010 impact on external Data Warehouse and data warehouse extract process and mapping of MMIS database and data warehouse.
• Analyzed System Impact including MMIS Tables, Windows, Reports and Interfaces to external entities.
• Constantly communicated with CMS regarding the Medicaid Claim adjudication through MMIS.
• Work with Compliance and Regulatory operations to follow and monitor different IT process bound by CMS Regulations.
• Review requirements and understand technical recommendations and constraints, and develop comprehensive and accurate functional specifications Data Mapping, and process flows.
• Performed the requirement analysis, impact analysis and documented the requirements using Rational Requisite Pro.
• Created Mapping Documents, Report Mock-ups and modified existing report mock-ups and finalized for development.

Environment: Windows XP, Business Objects, MS Excel, Word, Visio, power point, Rational Rose, Requisite Pro, RUP, UML, SQL, Oracle, EDI, ANSI X12/HIPPA, FACETS 4.7/5.1.

Confidential

Position: Business Analyst/Quality Analyst

Roles and Responsibilities

• Prepare test plan, test cases and test procedures in accordance with the Business Requirements.
• Used MS Visio for flow-charting, process model and architectural design of the application.
• Involved in writing SQL queries to check for the data validation.
• Used WinRunner for GUI tests and tested GUI Standards of this application.
• Participated in creation of web based test automation management tool designed to store test data, run automated tests and report results using the QTP automation object model.
• Involved in testing the efficiency of healthcare delivery by using HIPAA.
• Involved in writhing high-level end-to-end business scenarios.
• Rational Test Manager used for managing the manual testing, tracking and status report.
• Clearly understood coding standards for all transactions involving Electronic Data Interchange 270/271,837/835 between the clients with their users which includes the use of unique health identifiers for the insurers before proceeding to address health insurance claims processing life cycle.
• Performed GAP analysis of 4010 and 5010 EDI transaction using implementation guide.
• Analyzed HIPAA 4010 and 5010 standards for 837P EDI X12 transactions, related to providers, payers, and subscribers.
• Experience working in Claims, and Member/Subscriber module of FACETS.
• Involved in Impact Analysis, Gap Analysis, and Data Mapping on FACETS upgrade.
• Extensively involved in FACETS Batch Processing such as Eligibility Batch, Enrollment Batch, ID card generation Batch.
• Worked closely with the SME in Claims Logging, Claims Pre-pricing and Claims Processing application of the Claims module.
• Experience with ETL extraction, transformation, and load using Oracle.

Environment: SQL Server, MS Visio, Oracle, DB2 Mainframe, RUP, ClearQuest, ClearCase, Rational Suite, QTP, ETL, FACETS 4.7/4.8.

Confidential

Position: Business Analyst

Roles and Responsibilities

• Proficient in the role of Scrum Master, facilitating/organizing daily scrum sessions, Sprint Planning meeting and sprint review meeting and preparing/analyzing burn down charts.
• Analyzed existing Business units, Business process, System/ Application and there Interfaces with their capability through open-ended discussions, brainstorming sessions, and prototyping, prioritizing them and converting them as system requirements that must be included while developing the software.
• Assisted project manager throughout all SDLC phases to ensure timely delivery of specified business solutions.
• Collected Business Requirements converted to Functional Requirements in Facets Platform.
• Involved in making the Medicare patient profiles being compliant with the HIPAA regulations. Management of patient profile transfer PPT reports created by data team by verifying the associated data.
• Analyzed HIPPA EDI transactions in X12 responses and of 837, 835, 277 and looked for defects.
• Developed Requirements Tractability Matrix RTM using MS excel to trace each software design requirement to test case.
• Interacted with the Test Team and reviewed Test Plans and Test Cases.
• Experience with the EHR system.
• Worked on McKesson upgrades on Member/Provider/Clinical management data interfaces.

Environment: MS Visio, SQL Developer, Rational Requisite Pro, RUP, EHR, McKesson.

Confidential

Position: Business Analyst

Roles and Responsibilities

• Used MS Visio to create Use Cases and Sequence Diagrams.
• Dealing with EDI transactions like 270, 271, 834, 837 and 835.
• Processed EDI test files and verified system is able to validate certified and non-certified trading partners.
• Worked on the database and adjudication process of the NPI conversion.
• Performed GAP Analysis for the NPI conversion.
• Facilitated Joint Application Development JAD Sessions with the Management.
• Participated in Business Modeling by understanding the needs of the business, and also documenting Business Use Cases as well as System Use Cases.
• Initiated Test Plans, developed and executed test cases and scenarios, worked with users to develop specific acceptance criteria and prepare test exhibits.
• Conducted User Acceptance Testing UAT sessions with business users and prepared document for enhancements and bug fixes.
• Used HP Quality Center to report any bugs found and communicate to the developers and product support team.

Environment: MS Visio, Windows XP, HIPAA, Quality center, Rational Unified Process RUP , SCRUM, Clear Case, UML, UAT.

Confidential

Position: Senior Business Analyst

Roles and Responsibilities

• Claim validation and Pend/Denied Claims Analysis for the health plans Medicaid programs.
• Effectively communicated user acceptance test results between users and development team and provided recommendations for Application Change Requests ACR .
• Extensively tested claim data using SQL from different prospective. Dealt with following table from QA and BA prospective: Claim, Claim Line CDHP, Max Revision, Claim Paid, Provider, Pharmacy, Member, Product, Enrollment, and Pharmacy MED D.
• Clearly understood coding standards required for all Medicare Part D users transactions involving electronic data interchange as provided by department of health and human services and incorporated at every stage of the project wherever found necessary.
• Worked with Pharmacy Claims from PBMs Pharmacy benefit management companies for Medicare Part D.
• Worked with CMS on PDE events reconciliation for Pharmacy claims/payments.

Environment: Agile, Windows XP, HP Quality Center, Rational Requisite Pro, WinRunner, Load Runner.