- Over 6 years of IT experience in the Analysis, Design, Development, Testing, and Implementation of business application systems for Pharmaceutical, Healthcare and Insurance sectors.
- Worked as Sr. Business Analyst in implementation teams for User Requirement Gathering and Transforming Business Requirements into Software Requirement Specification SRS using MS Office Suite, Rational Rose Suite.
- Expertize in in Waterfall, Rational Unified Process RUP , Agile methodologies SCRUM/ XP , Unified Modeling Language UML , and Use Case Specification Documents USD .
- Expert in Business Process Re-engineering/Re-modeling developing different SOPs for the each of the department, Designing Work flows, Batch processing, creating business rules, communicated the trade-off decisions on product, budget constraints, customer requirements and also performed Asset management.
- Sound Proficiency in analyzing and Creating Use Cases, Use Case Diagrams, Activity diagrams, Class diagrams, Data Flow Diagrams, Business Flow Diagrams and Sequence diagrams using MS Visio and Rational Rose.
- Thorough knowledge of regulatory working environment HIPAA principles and HIPAA ANSIX12 Standards, FDA regulations, 21CFR part 11 and International classification of disease ICD 9 and ICD10 classifications .Worked in conjunction with Claims Processing, OSHA, CLIA and HL7 teams to meet all the compliances.
- Involved in FACET configuration, Customization, reporting, analysis and enhancement. Extensively worked on EDI transaction like 837, 835,834, 820, 270, 271, 276, 277 and 278.
- In depth knowledge of HIPAA 5010 transaction processing's and ICD 10 compliance, code set mapping, General equivalence mapping, Performed gap analysis and impact analysis of HIPAA 4010 to HIPAA 5010 and Used General equivalence Mappings GEM to convert ICD 9 to ICD 10,Data Stewardship Data Governance and data ware housing.
- Strong understanding of Good laboratory practice GLP , Medicaid, Medicare, Good Clinical practices GCP and LIMS laboratory information management system
- Excellent Team Player to work in conjunction with other testers, developers, PM and other team members in Project Plan, Charter, Schedule, validation, testing complex scenarios, requirement analysis, verification and in the maintenance of Quality standards in projects.
- Proficient in holding Joint Application developments JAD and Joint Requirement Planning sessions JRP , Interviews and workshops with end-user/clients/stake holders and the development group.
- Extensive Knowledge in reviewing Test Procedures, extensively interacted with the QA Team in executing the Test Plans for UAT, RFP, Prototyping, Screen Mockups, providing Test Data, creating Test Cases, analyzing bugs, interacting with team members in fixing errors and also assisted in Post Production support.
- Extensively interacted with both user group and development team in coming up with structured charts, PRD, Work flow diagram, Data models, Class and sequence diagrams and also proficiently worked on HP quality center for bugs and requirement tracking.
- Strong business acumen, strategic thinking, communication, interpersonal and presentation skills, adept at creating, editing, and coordinating extensive communication networks to keep executive staff and team members apprised of goals, project status, and resolving issues and conflicts.
- Expert in developing user manuals, presentations and training manuals as per project specifications and timelines and actively generates process improvements supports and drives change.
MS Office Suite Excel, Word, PowerPoint, Access, Publisher, FrontPage, Outlook , MS Project, MS Share Point, MS Visio, Rational suite and Documentum, HP quality Center, Power Designer, SAP Business Object, Open Office 2.2,3.0,3.2 and C, Balsamic, HTML, SQL,.net, VB .net, COBOL, DB2, Oracle 9i, 10i/g, 11i/g SQL PLSQL Server, TOAD, Win XP, 2000, Server, FACETS, UNIX, WinRunner, Load Runner, Test Director 7.01, FDA Quality System Regulation,MDM, FDA Compliance,HL7, HER, Six Sigma, 21 CFR Part 11, Photoshop, QTP 8.0, 8.2, Integration, Unit, System, Regression, Black Box, White Box, UAT, and Crystal Reports.
Business Analyst/ EDI analyst / Quality Analyst
Roles and Responsibilities :
- Conducted detailed and comprehensive Business Analysis by working with end users and other stake holders to identify the system, operational requirements, and proposed enhancements
- 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
- Identified all necessary Business and System Use Cases from requirements, created UML diagrams including Use Case Diagrams, Activity Diagrams, and Sequence Diagrams using Microsoft Visio.
- Developed maps for following transaction sets: 835, 837 I P , 834, , NCPDP, 277
- Developed and upgraded EDI maps for transactions using the X12 standard. Maps created were for both inbound and outbound trading partner relationships.
- Tested new developments of X12 837 claims, 835 payment files and ensured timely and quality delivery of Revenue Cycle product releases.
- Gathered requirement and helped QA in developing test cases and test plans to continue smooth transaction between State and MCO.
- Responsible to understand EDI transaction Inbound / Outbound requirement coming to the MCO and going out to State of PA.
- Created Functional Specs documents for EDI transaction for the development of accurate transaction platform
- Responsible for EX code mapping for the 835 Transaction
- Worked with the state of PA Medicaid team in the submission/ Locating FTP/ Checking Frequency/ Error reports of the Daily, Weekly, Monthly 834 Enrollment files.
Provider Service Center Portal Replacement NaviNet
- Gather and analyze requirements from multiple sources and also Validated requirements to ensure they meet stakeholders' needs
- Document designs using modeling tools. E.g. prototypes, Visio, data modeling tools . And Captured key design assumptions and risks.
- Highly involved in the Discover phase JAD sessions of the project for understanding the user needs to implement third party product.
- Created overview document for data conversion, data mapping documents, detailed instructions, specification documents, pre-requisites, sample files, loader formats and business test cases
- Actively involved for requirement gathering and creating specs for Single Sign On SSO using SAML 2.0
- Created and delivered provider data test files for continuous testing.
- Deliver fully functional real time 270/271, 276/277 Wen Services End Points
- Defines and delivered 278 Authorization transaction and 835 with supplemental Explanation codes file for batch processing
- Defining test cases, creating test scripts, analyzing bugs, interacting with QA / dev teams in fixing errors and User Acceptance Testing UAT
- Involved in the Phase 1 and Phase 2 testing of 270/ 271, 276/277 Real time and 278, 835 Batch transaction with Making sure cosmetic changes and logging defect according to it.
- Continuously having meeting with PNM Provider Network Management for discussing defects and closing them after approval or Any product Variance that need to be reviewed
- Involved in GAP analysis of 276/277 and 270/271 transaction to Identify GAP of the Specs between NaviNet and Client's System.
Business Analyst/ System Analyst/ EDI analyst
Hardware/ Software : HP Quality Center, MS Office Suite, MS Visio, MS Project, Oracle Developer, Sharepoint,
Agile /Scrum, SQL, UML , UNIX, Oracle, MS SQL Server, MS Access, HIPAA versions 4010A1 and XML 5010, Informatica ETL , SAP Business Objects, TOAD, XML Notepad, Medicare, Medicaid, EDI transactions
- Responsible for gaining a good understanding of user needs and accurately representing them in a well-documented software functional specifications document
- Gathered Business Requirements, interacted with the users, designers and developers, project manager and QA team to get a better understanding of the Business Processes
- Documented the Business Requirements Document BRD and the Functional Specification Document FSD
- Interacted with the End-Users by interviewing them, by preparing appropriate questionnaire to better understand end-user needs and the business process
- Liaison between Business Stakeholders, Reporting ETL SAP Business Objects and 820, 834, 835, 837, 277 and 999 Transaction Tower Leads.
- Involved in historical data fix and data recovery/replay operations for reporting clean up of HIPAA Compliant EDI transactions 270/271, 276/277, 837, and 835
- Supported PL/SQL development for Contingency and Internal Audit Reports.
- Conducted walkthroughs and code reviews with developers, project managers and stakeholders and users to comprehend business workflow of applications
- Experience documenting Impact and Risk Analysis of Change Requests/Enhancements also worked on data warehouse and data marts..
- Followed a structured approach to organize requirements into logical groupings such as requirements for Customer, Client, Group, Member and Reporting that critical requirements are not missed.
- Performed GAP analysis of 5010 EDI transaction using implementation guide to identify the changes in the segments and data elements
- Responsible for gaining approval of reference data design and domain and domain value code sets, gaining approval of ETL Transformation rules and calculations.
- Created Data mapping documents, test cases for System Testing Development Environment , Integration Testing UAT and Production Post Implementation Review in Agile/Scrum environment.
- Supported the testing team with Defect Management, Requirement Analysis and SQL development for back-end and regression testing.
- Created and maintained data mapping document s in reference to the HIPAA transactions: 270/271, 276/277, 837, and 835
- Directly involved in process improvement plans and implementing business change
FACETS 4.41 , Facets interfaces IKA SYSTEMS and IFOX , Facets extensions, Agile, Requisite Pro, Oracle, SQL, Toad 9.7, MS Access, MS VISIO, MS office, MS word, MS excel, Oracle CRM, HL7, HIE, Data warehouses and data marts, Share Point, Java, Business Object reports, HP Quality Center.
- Utilized Agile Methodology to configure and develop process, standards and procedures.
- Conducted JAD sessions with business units and stakeholders to define project scope, to identify the business flows and determine whether any current or proposed systems are impacted by the new development efforts.
- Created workflow diagrams, UML diagrams, process models, activity diagrams, use cases, swim lanes, for incorporating design changes in the order creation/ management system
- Prepared the Business requirement Document BRD and system requirement document SRD for the enhancement of the existing services.
- Act as a liaison between business and IT team. Worked on the Facets 4.4.1 interfaces with IKA systems and developed business requirements for Membership historical load, PCP lookup file, Broker lookup file, Subscriber ID file, Letter inbound and outbound file, Plan information for employer groups file, Siebel interface file and EDI 834-file from IKA systems.
- Worked on the EDI 834-file load to Facets through MMS Membership maintenance sub-system ,solving the errors of EDI 834 load to Facets through MMS.
- Involved in different reports of Business objects and RPX reports like Class-plan verification report, Medicare broker license validation report, and Medicare letters report to enrollment, LIS changes report to sales and enrollment.
- Performed data analysis, checked data quality, created data mapping and data interface documents and kept the documents updated with changes in requirements and functional specification.
- Responsible for developing the business requirements and use cases for Facets batch processes automating the billing entity and commission process.
- Worked on different modules of Facets such as Members/subscriber, commissions, provider, billing, plan and Case management.
- Extensively worked in customization and configuration of Claims Processing applications in FACETS 4.71.Involved in reconfiguration of FACETS in functional areas, including Membership, Claims, Provider, Enrollment and Service Modules.
- Extensively worked in customization and configuration of Claims Processing applications in FACETS 4.71. Involved in reconfiguration of FACETS in functional areas, including Membership, Claims, Provider, Enrollment and Service Modules.
- Worked on a client/server system designed to capture information from Centers for Medicare and Medicaid Services enrollment forms
- Successfully Ran SQL queries to analyze the requirements and for testing the files and reports. Performed gap analysis and impact analysis for the new Medicare PPO product.
- Developed business requirements for online pricing tool for Medigap product and online web form for capturing application information.
- Performed gap analysis and impact analysis of HIPAA 4010 to HIPAA 5010 and Used General equivalence Mappings GEM to convert ICD 9 to ICD 10.
- Developed test cases and performed UAT testing for all the files and reports also performed Facets regression testing.
- Developed test cases for IKA gateway and co-ordinate the testing of gateway with testers.
- Worked on HP Quality Center to document, change, and track requirements and Medicaid softwares and also involved in UI testing of developed applications.
- Performed EDI duties such as FTP of files to and from our Clearinghouse.
- Attended daily SCRUM and guided QA and Developer regarding the defects, Technical Specification Documents and Mapping Documents.
- Worked closely with business users and IT team in War room to solve the issues in time also provided Production support and post-production support/explained the changes to the business users/did one on one sessions/one to many sessions to make the business uses aware of the system changes.
SQL 2008, ASP, HIPAA, HL7,HTML, COBOL, SQL, TOAD, Java,MS Share Point, Bugzill, WS FTP, Power Designer, MS Visio, Windows XP/2000, XML, MS Project, MS Office Suite Word, Excel, Access, PowerPoint, and Outlook .
- Understood and articulated business requirements from user interviews and then convert requirements into technical specifications.
- worked with the Project Manager and the business partner to ensure effective communication for solutions development, project requirements, project status, and provide timely escalation of issues to ensure project objectives are met.
- Worked with Business Users in articulating the Rx Claim life cycle process into CRx. Identified the GAP between Walgreen and Catalyst Rx system Like HX PBS fields to make changes that are compatible to use in CRx
- Strong understanding of metadata, SQL server 2008 and database structure for migration of data structure to CRx claim. And Medicare Part D prescription drug coverage
- Creating business process and requirement gathering for Medicaid, Medicare Part D Explanation of Benefit EOB letters processing. Data mapping from pharmacy vendor files.
- Worked for Batch processing, ID card Generation, Pricing, Enrollment, Billing and eligibility checking for Part D subscribers and dependents.
- Held team meeting with the SMEs to understand the Verifications and Validation process before the close out of a protocol or study. Proposed BPR in the few clinical trial process areas to address both system and business needs.
- Worked on Power designer for metadata management and requirement documentation so to better communicate requirements between stake holders.
- Efficiently responded to client inquiries and resolved discrepancies. Identified, prioritized, tested and proved essential business functions to assure compliance with FDA and internal auditing.
- Developed SOPs for archival and retrieval procedures from RX claim to CRx claim Catalyst Rx Library and also deployed documents and reports on server using MS Share Point.
- Scheduled meetings with technical personnel to determine technical parameters for EDI and other related process including security and privacy.
- Involved in deployments of reports and document on server using MS Share Point and CRM tools like MS 360.
- Assisted project manager in preparing and developing the Project scope definition, Project Management Plan, Project Traceability Matrix and Resource Allocation Plan.
- Developed Use Cases, Use Cases diagrams, Class diagrams, Activity diagrams, Sequence diagrams using tools. Experience in conducting Joint Application Development JAD and Rapid Application Development RAD sessions.
- Organized project performance on time and budget as per the project plan and conducted status and review meeting to assess project progress.
- Performed System and Integration Testing along with testers. Conducted UAT with the business users and tracked/managed maintenance request MR and change request CR .
- Interacted with the client and the management teams to understand the requirements and report the status of the testing efforts on their applications
- Worked on Enrollment modules of software for new subscriber or dependent enrolment, Batch processing and ID card generation.
- Worked on HP quality center for tracking requirements and managing requirement and also for testing and tracking bugs.
- Developed user manuals, presentations and training manuals as per project specifications and timelines according to changes in new HX PBS.
RUP, Rational Requisite Pro, Rational XDE, FACETS, HL7, Rational Rose, Balsamic, MS Share Point , Rational Clear Quest, BPMN 2.0,Base Clear case, Java, crystal reports 6.0, Oracle, DB2, VB .net , Bugzilla, MS Project, MS Office Suite, HP Quality Center.
- Involved in all phases of software development life cycle in RUP framework and worked in the RUP environment for the elicitation, representation of requirements and in change management.
- Performed requirement analysis by gathering both functional and non-functional requirements based on interactions with the process owners stake holders and document analysis, represented them in requirements traceability matrix RTM using Requisite Pro. Performed user interviews, JAD sessions.
- Assessed the flaws in the existing as-is system and made clear recommendations of Business process improvements and BPR, incorporated them in the future to-be system design.
- Participates in development sessions and design reviews in order to ensure design meets user requirements
- Familiar with FDA regulation like 21 CFR part 11, HIPPA, HL7, SOX and Diagnosis Codes for ICD 9 and MDM, HIPAA Gateway.
- Extensively worked on claims processing and with HIPAA in different EDI healthcare transactions 837, 835,834, 820, 270, 271, 276, 277 and 278 ,FTP/SFTP, file transfer success/failure monitoring and Biz talk Server.
- Worked on Batch processing, member, subscriber enrollment module of 834 , ID card generation processes and Created business process flow to capture the required data in future, define business rules to determine Medicare Part C and Part D Member Coordination of Benefit letters as required by CMS, Medicare Secondary Payer for members with Workers Compensation,
- Involved in FACET configuration, Customization, reporting, analysis and enhancement and also worked on membership, claim module, Batch Processing, Pricing Module.
- Reconfigured and customized FACETS applications for groups, sub-groups, types of plan, pricing and provider to expedite benefit enrollment process and to ease claim processing.
- Extensively worked on EDI 834 on FACETS to customize and configure membership benefit enrollment data files according to the need of the proposed system.
- Responsible for reviewing and modifying process flows to increase productivity and effectively utilize FACETS features not provided by the legacy systems.
- Implemented system changes to the Washington Medicaid Management Information System WMMIS .
- Performing business analysis for a web-based Management Information System MIS designed to support critical reporting functions for customers of the Centers for Medicare and Medicaid Services.
- Wrote user requirements specification URS and Functional requirements specification FRS Documents as per the Business requirements and process flow.
- Helped to identifying potential problems quickly, before they occur and interacted with customers providing product information, product use information, and technical assistance on web sites that are accessible 24 hours a day, 7 days a week.
- Developed UML Use Cases for the application using Rational Rose and prepared the detailed Work flow diagram based on the proposed enhancement for the system and also developed Process DFD and Data ER models for the as-is and to-be systems.
- Actively involved in the UML based Class, Communication, structured charts, Class and sequence diagrams activity Diagrams for certain modules of the application in collaboration with Design Team.
- Involved in Deployment of Crystal Reports and production support. Significantly involved in created reports using BI tools like Business Objects.
- Experience with HP Quality Center to document, change, and track requirements and also for testing of applications.
- Developed modules in the HR department for the user education and training about the new web based system.
Business System Analyst/ Presales and Marketing
Rational Rose. Rational DOORS, Rational Requisite Pro, MS Visio, RUP, UML, Windows, Unix, Java/J2EE, XML, HTML, VB .net, Manual and Automated testing Win Runner, Load Runner, EHR, HL7, Quick Test Pro.
- Worked as Business System Analyst in implementing Soarian MedSuite at New Medical Center, Dubai.
- Prioritized project efforts, developed project plans, process flows, Use Cases and SRS using Agile.
- Responsible for planning, organizing, writing and editing operational, maintenance, test procedure manuals, or training materials also working on ISO 13485 Design Control.
- Direct experience working with Computed Tomography scanners, for example as a system engineer, service technician, designer or clinical specialist.
- Worked with business owners, technical team, QA and PMO to scope and prioritize development releases and developed documents in compliance with CRM, CMMI/CMM.
- Analyzed the Business requirements and the site specifications and developed detailed Testing Strategy for the entire application and developed various test cases.
- Documented detailed Business Requirements for Automated Journal Entries, Automated Management, Automated Financial Reporting and Automated Process Notifications to relevant departments.
- Analyzed System and Functional Specification documents for the Web Portal System and created a Test Strategy to be implemented across multiple projects across the web integrated system.
- Worked with application development team to identify bottlenecks that could hinder progress of development and Web based interface.
- Helped designer to layout and design of the material. Works with systems analysts and programmers to create and edit application and systems documentation, user manuals, training courses, and procedures
- Implemented a modified RUP process for managing requirements and played a key role in helping the company adopt Rational Unified Process
- Used UML notations for Object Oriented Design and Documentation also made UI designed and tested according to requirements.
- Assisted in performing functional and GUI testing by preparing automated scripts using WinRunner.
- Developed RUP Analysis Model that included entity classes, use case diagram, sequence diagrams that provided a view of the requirements
- Tested security privileges of the application for individual users as well as group access for EHR software also performed system and end to end testing.
- Interacted with the client and the management teams to understand the requirements and report the status of the testing efforts on their applications